Health Care and Medical Malpractice

Just about every day in the US, someone sues a medical practitioner for something that the patient feels went wrong during a procedure, operation, or some health care treatment. Litigation against doctors, hospitals, and other health care providers is one of the most often sought forms to receive some type of financial compensation for injury suffered due to negligence or other form of medical malpractice. Surgeons and doctors are constantly worried that one of their patients will sue them for something deemed careless or intentionally incorrect during a medical procedure. But to win the case, the burden of proof lies with the plaintiff.

According to the Newsome Melton law firm, despite the abundance of excellent medical care, doctors are human and they occasionally make mistakes. A patient can be harmed due to negligence or mistreatment by a medical provider. If injury can be proven, then a case of medical malpractice should be argued. To be considered malpractice, it must be proven that harm was caused when the medical provider acted outside acceptable terms of standard care. A case can be brought against the practicing physician, the hospital in which the treatment occurred, and any state or federal agencies responsible for supervision of the hospital. A doctor could be at fault for misdiagnosing a patient or skipping a customary step during treatment. Any errors that occurred in the training of hospital employees resulting in neglect or sanitation problems are also grounds for a lawsuit.

Medical malpractice happens when a health care or medical provider is negligent when treating a medical condition, according to ExpertLaw.com. Malpractice can occur from an action taken by the medical practitioner, or by the failure to take a medically appropriate action. Some examples of medical malpractice include:

• Failure to diagnose, or misdiagnosis of a disease or medical condition;
• Failure to provide appropriate treatment for a medical condition;
• Unreasonable delay in treating a diagnosed medical condition;

A health care provider may also be legally liable if the patient does not give "informed consent" to a medical procedure that results in harm to the patient, even if the medical treatment is properly performed. Much more detail can be found at this website: http://www.expertlaw.com/library/malpractice/malpractice.html#3 .

According to MedicalMalpracticeHelp.com, it is impossible for a victim to know if their claim is worth presenting in court without first consulting an attorney. The most proficient advice will come from a lawyer that is experienced in handling medical malpractice cases. Many firms are willing to work on a contingency basis. This means that the law firm will only get paid if the victim is offered a pre-trial settlement or an award in court. Since it is unrealistic to assume that the ruling will favor the plaintiff, a lawyer will not argue a case that lacks substantial proof of injury.

Damage caps, liability reform, and time limitations can all affect the outcome of a medical malpractice claim. Each of these factors is dictated by the state’s government. It is best to seek council with a lawyer that has previous experience in the victim’s general location. Limits on the maximum amount awarded for malpractice claims vary from state to state. A few select states do not have any damage caps, while other states have very low boundaries in place, according to Newsome Melton.

Additionally, according to the law firm, liability reform is an aspect of law that not only changes from state to state, but is also constantly evolving. Terms of liability can be amended several times a year and are difficult to keep up with for those outside the legal profession. Many states mandate their own restrictions that define when a medical malpractice suit can be filed. Two years is the average time limit for most claims. Due to strict time limitations and complicated guidelines, a victim should schedule a legal consultation as soon as possible if malpractice is suspected.

Medical malpractice lawsuits have existed in the United States for more than 150 years, though today, most medical errors are never pursued in court, and a large majority of claims never result in any kind of payment to patients. And even though the direct and indirect costs of such suits account for only 2.4 percent of total health care costs, that’s still $55 billion yearly. To say nothing of the even more important social costs, an issue addressed by The Journal of the American College of Surgeons.

As reported in the NY Times, researchers surveyed more than 7,000 surgeons and found that nearly one in four were in the midst of litigation. Surgeons involved in a recent lawsuit were more likely to suffer from depression and burnout, including feelings of emotional exhaustion and detachment, a low sense of accomplishment and even thoughts of suicide. Other studies estimate that, depending on the specialty, anywhere from 75 percent to 99 percent of practicing doctors will over the course of a lifetime be threatened with a lawsuit.

According to the NY Times, doctors who have been sued may end up practicing defensive medicine, ordering unnecessary tests and medications or refusing to treat patients with more complex illnesses altogether as a safeguard against future litigation. Those same doctors can also become burned out, which can lead to even more errors, and more malpractice claims. And, one way to disrupt the negative cycle is to improve communication between patients and doctors, so that patients are aware of the risks that can occur despite a doctor’s best efforts. Another important step is instituting programs that continue those conversations even after an error occurs. But change will require looking at malpractice reform in a new way, one that gives weight not just to the economic costs but to the ways reform might affect how patients and doctors interact.

It is a good idea for a victim to speak with several law firms specializing in medical malpractice cases, according to Newsome Melton. The victim can then assess which group will provide the best legal assistance. A worthwhile attorney will offer a free consultation to determine the strength of a potential client’s case. Before the suit can proceed, the plaintiff will need to obtain a certificate of merit. This is acquired when another health care professional reviews the relevant medical documents and records of the victim. If proof of medical malpractice is found, the health care professional will serve as an expert witness in trial. The testimony will state that the acting physician deviated from normal medical standards, resulting in damage to the victim. The plaintiff’s attorney will file the certificate of merit, confirming that they have consulted with a licensed physician and obtained evidentiary support.

Medical malpractice issues are pretty complex from a legal standpoint. Who should be held responsible for errors in medical treatment? How can concepts like "informed consent" affect a case? What about damage caps in med mal cases? According to Medical Malpractice.com, medical malpractice suits require a substantial amount of investigation before being able to proceed with a case. For much more detail about that information and for individual state laws about medical malpractice, visit this site: http://www.medicalmalpractice.com/topics/state-state-medical-malpractice-laws .

If you feel that you have been a victim of medical malpractice, seek professional legal advice about your situation or case before proceeding with litigation. There may be a valid opportunity to seek damages, or there may be no real option that would allow a lawsuit to be filed. Opinions from your friends or relatives are not considered legal advice, unless one of them happens to be an attorney. And a law firm that specializes in these types of cases would be best for consulting and further action, but only after reviewing the merits of your file.

As a patient, it’s always best to seek a second opinion for major medical or health care decisions, but when you undergo surgery or other complicated medical procedures, always know that there can be risk, and sometimes substantial risk that the outcome may not be successful. That’s why it pays to have good counsel and great doctors.

Until next time.

Health Care and Disability

Disability claims often happen on the job, and typically can fall into short term or long term based on the severity of the injury. When you suffer from a situation that results in requiring you to leave work for an extended period of time, the most common period initially is within the first 90 days of when the injury occurs. Most companies recognize that if your disability lasts longer than three months, the disability period is considered long term and falls into that category for coverage if you are insured.

According to the US Social Security Administration, disability is something most people do not like to think about. But the chances that you will become disabled probably are greater than you realize. Studies show that a 20-year-old worker has a 3 in 10 chance of becoming disabled before reaching full retirement age. A huge amount of information about collecting disability payments based on qualifications for Social Security can be found at this website:  http://www.ssa.gov/pubs/10029.html#a0=0.

According to State Farm, But what would happen if you become disabled or ill and could not work How would you...

•Pay your bills?
•Make your monthly rent or mortgage loan payments?
•Buy your groceries?
•Make your car payments?
•Provide for your children's education?
•Save for retirement?

Most people don't realize the risk of becoming disabled, permanently or temporarily, at some point in their lives. But the reality is that at age 40, your chances of becoming disabled for 90 days or more prior to age 65 is 43%. (Source: 2004 Field Guide, National Underwriter). When evaluating the chances of disability, you should carefully consider sources of available funds:

1.) Employer coverage--How long would the business continue to pay you? How much would they pay you? When would your employer have to hire a replacement? Could the business afford to pay both?

2.) Using savings--If you saved 10% of your income each year, one year of total disability could wipe out 10 years of savings. Can you afford that?

3.) Obtaining a loan--Without an income, who will lend you money?

4.) Working Spouse or Partner--Can your spouse or partner earn enough and be a companion, parent, private nurse, and employee - all at the same time?

5.) Selling investments--Will a sale under forced conditions bring a true value? What will their value be at the time you are disabled?

6.) Collecting Social Security--You cannot collect benefits until the end of the fifth full calendar month of total disability and only if it is expected to last 12 months or more. What will you do if your disability doesn't meet those requirements? Even if it does, can you wait six months for payment?

7.) Counting on friends, family or charity--Would these sources have funds for you to use? Do you want to depend on them?

Many different disability insurance products are available to help protect you and your family against severe financial hardship that may accompany a disability. Much more options can be found at this site: http://www.statefarm.com/insurance/disability/disability.asp.

If you were to become disabled tomorrow and couldn't work for two or three months, would you have enough savings to cover your living expenses during that time? If not, you may want to consider short-term disability insurance, according to Insure.com. Plus, 1 in 7 people can expect to be disabled for five years or more before retirement. Statistics like that should make short-term disability insurance a vital piece of your overall financial plan.

What is short-term disability insurance? Short-term disability insurance pays a percentage of your salary if you become temporarily disabled, meaning that you are not able to work for a short period of time due to sickness or injury (excluding on-the-job injuries, which are covered by workers compensation insurance). A typical short-term disability insurance policy provides you with 40 to 65 percent of your pre-disability base salary, according to the Life and Health Insurance Foundation for Education. The National Association of Insurance Commissioners estimates that these benefits generally last between three and six months. Most short-term disability insurance policies have a "cap," meaning you receive a maximum benefit amount per month. Short-term disability insurance policies also have a limit on the amount of time you can receive benefits — up to two years, according to the Insurance Information Institute (III).

Short-term disability insurance, which is most often purchased as part of a group at work, can be paid by either the employer or the employee. Group short-term disability insurance policies are "guaranteed issue," meaning you do not have to take a medical exam to buy coverage, according to Insure.com. You can start receiving money from your short-term disability insurance policy with a waiting period of 0 to 14 days after becoming sick or disabled, according to the III. The actual time for coverage to kick in depends on whether you suffer an illness or injury. If you suffer an injury, your benefits will be paid immediately. If you suffer an illness, it may take longer because of the need to show that the illness is grave enough to be disabling.

For example, if you severely injure yourself by falling off a ladder at your house, your benefits would kick in immediately. However, if you suffer from a serious illness and can't go to work, your insurance may not kick in until eight days after you became ill. Your employer may have additional restrictions as to when your short-term disability insurance policy kicks in. For example, your employer may require you to use all of your sick days before you begin receiving payments from your short-term disability insurance policy. You also may receive retroactive benefits if you have a condition that worsens over time. Let's say you have a cold and you took three sick days at work. If your cold evolves into pneumonia, hospitalizing you for three weeks and preventing you from performing your job duties, you could receive disability pay retroactive to your first sick day. A huge amount of information on this topic can be found at this website: http://www.insure.com/articles/disabilityinsurance/short-term-disability.html.

According to this website: http://employeebenefits.about.com/od/ancillaryinsurance/a/STDBascis.htm, if you are an employer, you can create a policy dictating that employees use sick days before going on short term disability for an extended illness. You can also require documentation from a doctor to prove an illness or injury. Different short term disability plans dictate different terms for qualifications. The main terms are listed below:

•Employees need to work for the employer for a certain amount of time before coverage kicks in.
•Employees need to work full-time, usually 30 hours or more a week.

The following are part of what a short term disability plan benefits package may include:

•Percentage of weekly salary paid out (typically between 50% - 70% of weekly salary).
•Duration of short term disability benefits (typically between 10 to 26 weeks).
•Maximum amount of time covered under this disability program.

It’s also important to know the rules of the states where you have employees. While short term disability is not a requirement in most places, some states such as Hawaii, New Jersey, New York and Rhode Island mandate that short term disability benefits are provided for up to 26 weeks. You may also want as an employer a long term disability program in place once an employee’s short term disability ends. If an employee is still out of work due to illness or injury, a long term disability can help even further.

According to Smart Money, a typical group plan offered by an employer will replace up to 60% of your salary. Supplemental plans and individual policies will often cover up to 70% or 80%. (No plan will cover all of your salary for fear you will have little or no incentive to get back to work.) Benefits typically last for a set number of years (say five years) or until you reach retirement age. (Benefits typically stop around retirement age since once you retire, you would no longer be dependent on the income you generated by working, anyway.) If you pay the premium out-of-pocket meaning your employer doesn't cover the tab benefits are tax free.

Long term disability policies vary greatly. While some are iron-clad and pay benefits when you need them, others have more holes than a pasta strainer. Folks trying to save some money with a leaner plan may find it ultimately worthless. Typically, the cheaper plans have very strict definitions of disability, making it difficult to claim benefits over many years. Unless you're self employed, the first thing you should do is figure out if your employer provides long-term disability insurance in the first place. About half of mid- to large-sized firms offer benefits that last for at least five years, according to America's Health Insurance Plans.

As mentioned above, the typical group plan covers up to 60% of one's income. (This is offset by any other benefits you may receive from social security or worker's comp.) But the amount may actually be far less than that. That's because most group plans have a benefit cap of, say, $5,000 a month or $60,000 a year. Another surprise for many is that bonuses don't usually make it into the equation. A group plan will only insure your regular salary. Another shortcoming: Most group policies limit the amount of time it will pay benefits if you can't perform your job duties to just two years. After that, you'll need to prove you can't hold down job. Not only does this keep costs down for your employer, but the idea is that you can get new job training during those initial two years that you receive benefits

Long-term disability insurance kicks in once your short-term disability benefits run out. Unfortunately, there are no state laws that require employers to provide long-term disability, but it's estimated that half of all midsized to large firms do provide at least some insurance, according to Smart Money. If you do decide to buy an individual long-term disability plan or to supplement your employer-based insurance, be sure to find out how much short-term disability coverage you have. There's no reason to pay a premium for a long-term disability policy with a short elimination period of, say, 60 days when you have short-term coverage for six months.

If you are self-employed or not covered by your employer, it clearly makes sense to consider purchasing an individual plan. But even if you are covered at work you may want to consider supplementing what you've got: After all, you probably can't afford to live on just 60% of your salary. An individual plan will allow you to insure another 10% to 20% of your income. And in some cases, you may even be able to get individual coverage for a six-figure salary and a bonus something you'll never get with a group plan, according to Smart Money. Much more detail about disability insurance can be found at this site: http://www.smartmoney.com/plan/insurance/do-you-need-disability-insurance-17318/.

To factor how much you should consider paying for disability insurance, AARP has an online calculator to help you at this site: http://www.aarp.org/money/insurance/disability_insurance_calculator/. Here is a list of items you need to consider when calculating what amount of coverage you should purchase:

1.) Monthly net income--This calculation is done on an individual basis. Do not include your spouse's income.

2.) Current monthly living expenses--Remember to include your home or rent payments, food, clothing, gas, phone and other monthly expenses.

3.) Your monthly expenses while you are disabled--This amount is usually a little less than your original monthly expenses. The default value for this field is calculated as 70% of your current monthly expenses. You should keep in mind, however, that many expenses such as your mortgage, rent, utilities and food will most likely remain the same as before you were disabled.

4.) The number of months you expect a disability will prevent you from working--A common mistake is to underestimate the time it takes to get back to work.

5.) Your current monthly disability coverage--Make sure to include any disability coverage supplied by your employer.

6.) Length of coverage--Number of months that your current monthly coverage will last.

7.) What you expect for the average long-term or annual inflation rate--A common measure of inflation in the U.S. is the Consumer Price Index (CPI). From 1925 through 2011 the CPI has a long-term average of 3.0% annually. Over the last 31 years highest CPI recorded was 13.5% in 1980. If you are disabled for a short period of time, inflation is usually not a very important factor. However, you may need to consider the effect of inflation if you remain disabled for more than a few years.

If you are fortunate to live your entire life without suffering from a disabling event, you are fortunate as the odds can be stacked against you, especially if you work at a job that has significant stress or potential injury from the type or work you do for a living--for example warehouse, mill, or dock work, coal mining, policeman, fireman, or first responder, and many more high risk occupations. Be very careful at all times where you work, and always follow safety precautions. However, it is inevitable that many people get injured or sick and need extra financial assistance during extended leave from work. When you calculate what you need if you cannot work due to these types of situations, make sure that you protect yourself financially as much as possible. Even though you may never need it, the peace of mind from having extra coverage is worth the few dollars each month.

Until next time.

Health Care and Mono

They call it the kissing disease, but actually mononucleosis is an illness that can be contracted by exposure to someone who is carrying the bug in their system without having any direct personal contact. Mononucleosis, or mono, is often spread by saliva and close contact, according to the National Institutes for Health (NIH). It occurs most often in those age 15 to 17. However, the infection may develop at any age. Mono is usually linked to the Epstein-Barr virus (EBV), but can also be caused by other organisms such as cytomegalovirus (CMV).

According to WebMD, "mono," is a common viral illness that can leave you feeling tired and weak for weeks or months. Mono goes away on its own, but lots of rest and good self-care can help you feel better. It is most often seen in adolescents and young adults. Children can get the virus, but it often goes unnoticed because their symptoms are mild. Older adults usually do not get mono, because they have immunity to the virus.

Mono can be spread through contact with saliva, mucus from the nose and throat, and sometimes tears. If you have mono, you can avoid passing the virus to others by not kissing anyone and by not sharing things like drinking glasses, eating utensils, or toothbrushes. As soon as you get over mono, your symptoms will go away for good, but you will always carry the virus that caused it. The virus may become active from time to time without causing any symptoms. When the virus is active, it can be spread to others.

According to the NIH, mono may begin slowly with fatigue, a general ill feeling, headache, and sore throat. The sore throat slowly gets worse. Your tonsils become swollen and develop a whitish-yellow covering. The lymph nodes in the neck are frequently swollen and painful. A pink, measles-like rash can occur and is more likely if you take the medicines ampicillin or amoxicillin for a throat infection. (Antibiotics should NOT be given without a positive Strep test.) Symptoms of mononucleosis include:

• Drowsiness
• Fever
• General discomfort, uneasiness, or ill feeling
• Loss of appetite
• Muscle aches or stiffness
• Rash
• Sore throat
• Swollen lymph nodes, especially in the neck and armpit
• Swollen spleen

Less frequently occurring symptoms include:

• Chest pain
• Cough
• Fatigue
• Headache
• Hives
• Jaundice (yellow color to the skin)
• Neck stiffness
• Nosebleed
• Rapid heart rate
• Sensitivity to light
• Shortness of breath

Much more detail about mono and how to deal with it can be found at this website: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001617/ .

Symptoms usually start 4 to 6 weeks after you are exposed to the virus, according to WebMD. Mono can cause the spleen to swell. Severe pain in the upper left part of your belly may mean that your spleen has burst. This is an emergency. Your doctor will ask you questions about your symptoms and examine you. You may also need blood tests to check for signs of mono (monospot test) and the Epstein-Barr virus. Blood tests can also help rule out other causes of your symptoms. Usually only self-care is needed for mono:

• Get plenty of rest. You may need bed rest, which could keep you away from school or work for a little while.
• Gargle with salt water or use throat lozenges to soothe your sore throat.
• Take acetaminophen (such as Tylenol) or ibuprofen (such as Advil) to reduce fever and relieve a sore throat and headaches.
• Avoid contact sports and heavy lifting. Your spleen may be enlarged, and impact or straining could cause it to burst.

In severe cases, medicines called corticosteroids may be used to reduce swelling of the throat, tonsils, or spleen. More material on Mono can be found at this site: http://www.webmd.com/a-to-z-guides/infectious-mononucleosis-topic-overview .

According to MedicineNet.com, research has shown that, depending on the method used to detect the virus, anywhere from 20%-80% of people who have had mononucleosis and have recovered will continue to secrete the EBV (Epstein-Barr virus) in their saliva for years due to periodic "reactivations" of the viral infection. Since healthy people without symptoms also secrete the virus during reactivation episodes throughout their lifetime, isolation of people infected with EBV is not necessary.

It is currently believed that these healthy people, who nevertheless secrete EBV particles, are the primary reservoir for transmission of EBV among humans. Patients can continue to have virus particles present in their saliva for as long as 18 months after the initial infection. When symptoms persist for more than six months, the condition is frequently called "chronic" EBV infection. However, laboratory tests generally cannot confirm continued active EBV infection in people with "chronic" EBV infection.

There can be rare complications due to contracting mono, which is typically not seen in healthy people, according to MedicineNet. Fortunately, the more severe complications of mono are quite rare, and mono is very rarely fatal in healthy people. The rare severe complications include destruction of red blood cells (hemolytic anemia) and inflammation of the sac surrounding the heart (pericarditis), the heart muscle itself (myocarditis), and the brain (encephalitis). Mono tends to be more aggressive in patients with abnormal immune systems, such as people with AIDS or those who are taking medications that suppress immune function.

The EBV has been associated with some types of cancers, most commonly lymphomas. This occurs most frequently in people whose immune systems have been compromised due to disease or immune suppressive drugs. EBV infection has also been found to be associated with two types of cancer found in other cultures -- nasopharyngeal carcinoma (cancer of the pharynx and nose) in southern China and Burkitt's lymphoma of the jaw among children in equatorial Africa. Further, numerous studies have also found that EBV infection is associated with the development of at least one subtype of Hodgkin's disease. However, since the vast majority of people have been infected with EBV and never develop these types of tumors, EBV infection cannot be the sole cause of these cancers. The overwhelming majority of people who have had mono recover completely without any serious complications. Much more detail can be found at this website: http://www.medicinenet.com/infectious_mononucleosis/article.htm .

According to the Mayo Clinic, mononucleosis can be a prolonged condition, keeping you at home for weeks as you recover. But be patient with your body as it fights the infection. For young people, having mononucleosis will mean some missed activities — classes, team practices and parties. Without doubt, you'll need to take it easy for a while. Students need to let their schools know they are recovering from mononucleosis and may need special considerations to keep up with their work. If you have mononucleosis, you don't necessarily need to be quarantined. Many people are already immune to the Epstein-Barr virus because of exposure as children. But plan on staying home from school and other activities until you're feeling better. Seek the help of friends and family as you recover from mononucleosis. College students should also contact the campus student health center staff for assistance or treatment, if necessary. More info can be found at this website: http://www.mayoclinic.com/health/mononucleosis/DS00352 .

If you suspect that you or a family member may be coming down with mononucleosis, consult a physician or health care provider as soon as possible. Containing the contagious disease as early as you can helps to prevent the spread of mono to others. Be careful not to over exert yourself, and follow the advice of your doctor. Although not fatal in most cases, there are some lingering issues that can cause more problems if you don’t treat it as prescribed.

Until next time.

Health Care and Menopause

Menopause is a universal and irreversible part of the overall aging process involving a woman's reproductive system, after which she no longer menstruates, according to MedScape. The menopausal transition (MT) is characterized by hormonal changes and clinical symptoms that occur over a period leading up to and immediately post menopause. This period is frequently termed the climacteric, and/or perimenopause, but mostly recently is coined the menopausal transition.

Menopause is the permanent end of menstruation and fertility, defined as occurring 12 months after your last menstrual period, according to the Mayo Clinic. Menopause is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and — at least indirectly — trigger feelings of sadness and loss. Even though menopause is not a disease, women shouldn't hesitate to seek treatment for severe symptoms. Many effective treatments are available, from lifestyle adjustments to hormone therapy.

Technically, women don't actually "hit" menopause until it's been one year since their final menstrual period, according to the Mayo Clinic. In the United States, that happens at about age 51, on average. But in the months or years leading up to that point, women might experience these signs and symptoms:

• Irregular periods
• Decreased fertility
• Vaginal dryness
• Hot flashes
• Sleep disturbances
• Mood swings
• Increased abdominal fat
• Thinning hair
• Loss of breast fullness

The Mayo Clinic has lots of additional information about menopause, located at this site: http://www.mayoclinic.com/health/menopause/DS00119.

According to the North American Menopause Society (NAMS), physical signs of menopause begin many years before the final menstrual period. Perimenopause (literally meaning “around menopause”), can last 6 years or more, and by definition, ends 1 year after the final menstrual period. Perimenopausal changes are brought on by changing levels of ovarian hormones such as estrogen. During this transition time, estrogen levels gradually decline, but they do so in an erratic fashion. Sometimes they can even be higher than during the reproductive years. During perimenopause, a woman may be able to conceive, although fertility is very low. If pregnancy is not desired, contraception is necessary until menopause is reached.

When a woman suspects she is experiencing perimenopause, it is an excellent time to have a complete medical examination by a qualified health professional. According to NAMS, the diagnosis of perimenopause can usually be made by reviewing a woman’s medical history, her menstrual history, and her signs and symptoms. In most cases, testing hormonal blood levels is not recommended because in menstruating women hormone levels are changing all the time. However, in younger women (below 40) menstrual irregularity is infrequently a sign of menopause, so hormone testing may be a useful tool to test whether menopause has occurred.Testing blood hormone levels can also be helpful in assessing a woman’s fertility and potential for pregnancy. Results can help women make decisions about beginning or adjusting medications and help them understand their personal biological clock. For some women, it may make sense to test for other causes of symptoms that can mimic perimenopause, such as thyroid disease.

What about testing for follicle-stimulating hormone (FSH)? Sometimes, elevated FSH levels are used to confirm menopause. FSH is a hormone produced by the pituitary gland that triggers the ovaries to secrete estrogen. As the ovaries’ production of estrogen declines around menopause, the pituitary gland releases more FSH into the blood to try to stimulate estrogen production. So, when a woman’s FSH blood level is consistently elevated, and she is no longer having menstrual periods, it is generally accepted that she has reached menopause. However, a single FSH level can be misleading in perimenopause because estrogen production doesn’t fall at a steady rate from day to day. Instead, both estrogen and FSH levels fluctuate from fairly high to fairly low during perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid. Some healthcare practitioners recommend testing a woman’s saliva for estrogen levels, but there is no conclusive evidence that this test provides useful information around menopause. Much more information can be found at their website: http://www.menopause.org/.

What are the complications and effects of menopause on chronic medical conditions? According to MedicineNet.com, one of them is the increased risk of osteoporosis. Osteoporosis is the deterioration of the quantity and quality of bone that causes an increased risk of fracture. The density of the bone (bone mineral density) normally begins to decrease in women during the fourth decade of life. However, that normal decline in bone density is accelerated during the menopausal transition. As a consequence, both age and the hormonal changes due to the menopause transition act together to cause osteoporosis. The process leading to osteoporosis can operate silently for decades. Women may not be aware of their osteoporosis until suffering a painful fracture. The symptoms are then related to the location and severity of the fractures.

The second health risk is cardiovascular disease, according to MedicineNet. Prior to menopause, women have a decreased risk of heart disease and stroke when compared with men. Around the time of menopause, however, a women's risk of cardiovascular disease increases. Heart disease is the leading cause of death in both men and women in the U.S. Coronary heart disease rates in postmenopausal women are two to three times higher than in women of the same age who have not reached menopause. This increased risk for cardiovascular disease may be related to declining estrogen levels, but in light of other factors, postmenopausal women are not advised to take hormone therapy simply as a preventive measure to decrease their risk of heart attack or stroke. A significant amount of material on this health care topic concerning menopause can be found at this site: http://www.medicinenet.com/menopause/article.htm .

According to the National Institute on Aging (NIA), as a woman, staying healthy after menopause may mean making some changes in the way you live:

• Don't smoke. If you do use any type of tobacco, stop—it's never too late to benefit from quitting smoking.
• Eat a healthy diet, low in fat, high in fiber, with plenty of fruits, vegetables, and whole-grain foods, as well as all the important vitamins and minerals.
• Make sure you get enough calcium and vitamin D—in your diet or with vitamin/mineral supplements.
• Learn what your healthy weight is, and try to stay there.
• Do weight-bearing exercise, such as walking, jogging, or dancing, at least 3 days each week for healthy bones. But try to be physically active in other ways for your general health.

Here are some other things to remember, according to the NIA:

• Take medicine if your doctor prescribes it for you, especially if it is for health problems you cannot see or feel—for example, high blood pressure, high cholesterol, or osteoporosis.
• Use a water-based vaginal lubricant (not petroleum jelly) or a vaginal estrogen cream or tablet to help with vaginal discomfort.
• Get regular pelvic and breast exams, Pap tests, and mammograms. You should also be checked for colon and rectal cancer and for skin cancer. Contact your doctor right away if you notice a lump in your breast or a mole that has changed.

Menopause is not a disease that has to be treated, according to the NIA. But you might need help if symptoms like hot flashes bother you. Here are some ideas that have helped some women:

• Try to keep track of when hot flashes happen—a diary can help. You might be able to use this information to find out what triggers your flashes and then avoid those triggers.
• When a hot flash starts, try to go somewhere cool.
• If night sweats wake you, sleep in a cool room or with a fan on.
• Dress in layers that you can take off if you get too warm.
• Use sheets and clothing that let your skin "breathe."
• Have a cold drink (water or juice) when a flash is starting.

You could also talk to your doctor about whether there are any medicines to manage hot flashes. A few drugs that are approved for other uses, for example, certain anti-depressants, seem to be helpful to some women. Much more info can be located at this website: http://www.nia.nih.gov/health/publication/menopause .

Menopause can be treated, and it makes sense to see a primary care doctor if the symptoms appear to be troublesome. The condition can get worse in some women. Find out about available information and resources to deal with this health care issue. What you learn can help you through the emotional and physical trauma.

Until next time.

Health Care and Herpes

One of the most communicable diseases in the world is herpes, and it is very contagious to both men and women. Herpes is considered a virus. Most commonly, one strain of is transmitted through sexual contact and is classified as an STD—sexually transmitted disease. The other is typically known as a fever blister or cold sore, usually found on the face, mouth, and lips.

According to WebMD, herpes simplex viruses -- more commonly known as herpes -- are categorized into two types: herpes type 1 (HSV-1, or oral herpes) and herpes type 2 (HSV-2, or genital herpes). Most commonly, herpes type 1 causes sores around the mouth and lips (sometimes called fever blisters or cold sores). HSV-1 can cause genital herpes, but most cases of genital herpes are caused by herpes type 2. In HSV-2, the infected person may have sores around the genitals or rectum. Although HSV-2 sores may occur in other locations, these sores usually are found below the waist.

Although genital herpes used to almost always be caused by HSV-2 infection, HSV-1 is accounting for an increasing number of cases of genital herpes in developed countries, according to Avert.org. Only around 10-25 percent of people infected with HSV-2 are aware they have genital herpes. This is because genital herpes will often produce mild symptoms or no symptoms at all (asymptomatic infection). As a result, many cases of genital herpes go undiagnosed and frequently people unknowingly pass the virus on to their sexual partners. Genital herpes is passed on through skin contact with a person infected with the virus, most frequently during sexual intercourse. The virus affects the areas where it enters the body. This can occur during:

• vaginal sex
• anal sex
• oral sex (HSV-1 or HSV-2)
• kissing (HSV-1 only)

Herpes is most infectious during the period when itchy sores start to appear on the skin during an outbreak. But even if an outbreak causes no visible symptoms or breaks in the skin, there is still a risk of the virus being passed on to another person through skin contact. If symptoms do occur, they will usually appear 2 to 7 days after exposure and last 2 to 4 weeks. Both men and women may have one or more symptoms, including:

• Itching or tingling sensations in the genital or anal area;
• small fluid-filled blisters that burst leaving small painful sores;
• pain when passing urine over the open sores (especially in women);
• headaches;
• backache;
• flu-like symptoms, including swollen glands or fever.

Subsequent outbreaks are usually milder and last for a shorter period of time, usually 3 to 5 days. The sores are fewer, smaller, less painful and heal more quickly, and there are no flu-like symptoms. Subsequent outbreaks, or primary outbreaks in people who have had the virus for some time but have previously been asymptomatic, usually occur during periods of stress or illness when the immune system is functioning less efficiently than normal, according to Avert.

Genital herpes, according to the Centers for Disease Control (CDC), is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.

Results of a nationally representative study show that genital herpes infection is common in the United States. Nationwide, 16.2%, or about one out of six, people 14 to 49 years of age have genital HSV-2 infection. Over the past decade, the percentage of Americans with genital herpes infection in the U.S. has remained stable. Genital HSV-2 infection is more common in women (approximately one out of five women 14 to 49 years of age) than in men (about one out of nine men 14 to 49 years of age). Transmission from an infected male to his female partner is more likely than from an infected female to her male partner. A significant amount of information about this topic can be found at this site: http://www.cdc.gov/std/herpes/stdfact-herpes.htm

Herpes infections, no matter where they occur first, have a tendency to recur in more or less the same place. Such recurrences may happen often (for example, several times per year) or only occasionally (for example, once or twice a year), according to MedicineNet.com. After infection, the virus enters the nerve cells and travels up the nerve until it comes to a place called a ganglion. There, it lays quietly in a stage that is referred to as "dormant" or "latent." At times, the virus can become active and start replicating again and travel down the nerve to the skin, causing sores and blisters. The exact mechanism behind this is not clear, but it is known that some conditions seem to be associated with recurrences, including

• a fever, a cold, or the flu;
• ultraviolet radiation (exposure to the sun);
• stress;
• changes in the immune system;
• trauma to the involved area;
• sometimes there is no apparent cause of the recurrence.

Infections caused by HSV are contagious. The virus is spread from person to person by kissing, by close contact with herpetic lesions, or even from contact with apparently normal skin that is shedding the virus. Infected saliva is a common means of virus transmission. People are most contagious when they have active blister-like sores. Once the blisters have dried and crusted over (within a few days), the risk of contagion is significantly lessened. However, a person infected with HSV can pass it on to another person regardless of the presence or absence of symptoms and visible sores or blisters. This is because the virus is sometimes shed in saliva even when sores are not present. Despite popular myth, it is almost impossible to catch herpes (cold sores) from surfaces, towels, or washcloths. Much more detailed info can be found at this site: http://www.medicinenet.com/herpes_simplex_infections_non-genital/article.htm  .

There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners, according to the CDC. The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Genital ulcer diseases, as per the CDC, can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Correct and consistent use of latex condoms can reduce the risk of genital herpes. Persons with herpes should abstain from sexual activity with uninfected partners when lesions or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV. A positive HSV-2 blood test most likely indicates a genital herpes infection.

According to Merck, during recurrences, antiviral drugs, such as acyclovir, valacyclovir, or famciclovir, may relieve discomfort slightly and help symptoms resolve a day or two sooner. Treatment is most effective if started early, usually within a few hours after symptoms start—preferably at the first sign of tingling or discomfort, before blisters appear. For people who have frequent, painful attacks, the number of outbreaks can be reduced by continuous therapy (suppression) with antiviral drugs. Antiviral drugs are available by prescription only.

Penciclovir cream, applied every 2 hours during waking hours, can shorten the healing time and duration of symptoms of a cold sore by about a day. Nonprescription creams containing docosanol (applied 5 times a day) may provide some relief. Acyclovir, valacyclovir, or famciclovir taken by mouth for a few days may be the most effective treatment. Severe HSV infections, including herpes encephalitis and infections in newborns, are treated with acyclovir given intravenously. If the virus becomes resistant to acyclovir, foscarnet can be given. People with herpes simplex keratitis are usually given trifluridine eye drops. An ophthalmologist should supervise treatment.

For people who have minimal discomfort, the only treatment needed for recurring herpes of the lips or genitals is to keep the infected area clean by gentle washing with soap and water. Applying ice may be soothing and reduce swelling. Applying prescription or nonprescription topical anesthetics, such as tetracaine cream or benzocaine ointment, may help relieve pain. If the mouth contains many sores, the mouth can be rinsed with lidocaine, which should not be swallowed. Topical anesthetics should be used only about once every few hours. If used more often, these drugs can have harmful side effects. Pain relievers may be taken for pain, according to Merck.

Herpes is a medical condition that can be painful and embarrassing. Learning to understand it, treat it, and live with it is something everyone can do who suffers from this health care issue. If you feel that you have symptoms, see your primary care physician for diagnosis. The common sense rules of personal interaction with someone who may have herpes should apply. Be careful, and be smart.

Until next time.

Health Care and Psoriasis

Have you ever had a patch of extra flaky skin flare up on your elbows, knees, or other areas of your body, and you wonder what in the world is going on? The symptoms can be embarrassing, irritating, and often very unsightly. You may be suffering from a common skin disease known as psoriasis.

According to SkinCarePhysicians.com, Psoriasis (sore-EYE-ah-sis) is a medical condition that occurs when skin cells grow too quickly. Faulty signals in the immune system cause new skin cells to form in days rather than weeks. The body does not shed these excess skin cells, so the cells pile up on the surface of the skin and lesions form.

The lesions vary in appearance with the type of psoriasis. There are five types of psoriasis: Plaque, guttate, pustular, inverse, and erythrodermic. About 80% of people living with psoriasis have plaque (plak) psoriasis, also called “psoriasis vulgaris.” Plaque psoriasis causes patches of thick, scaly skin that may be white, silvery, or red. Called plaques (plax), these patches can develop anywhere on the skin. The most common areas to find plaques are the elbows, knees, lower back, and scalp.

Psoriasis also can affect the nails. About 50% of people who develop psoriasis see changes in their fingernails and/or toenails. If the nails begin to pull away from the nail bed or develop pitting, ridges, or a yellowish-orange color, this could be a sign of psoriatic arthritis. Without treatment, psoriatic arthritis can progress and become debilitating. It is important to see a dermatologist if nail changes begin or joint pain develops. Early treatment can prevent joint deterioration.

Psoriasis is very common. Anyone can get it, but it most commonly begins between ages 15 and 35, according to the National Institutes for Health (NIH). The following may trigger an attack of psoriasis or make the condition more difficult to treat:

• Bacteria or viral infections, including strep throat and upper respiratory infections
• Dry air or dry skin
• Injury to the skin, including cuts, burns, and insect bites
• Some medicines, including antimalaria drugs, beta-blockers, and lithium
• Stress
• Too little sunlight
• Too much sunlight (sunburn)
• Too much alcohol

Psoriasis can appear suddenly or slowly. Many times, it goes away and then comes back again and again. Symptoms include:

• Irritated, red, flaky patches of skin
• Most often seen on the elbows, knees, and middle of the body
• Red patches may appear anywhere on the body, including the scalp

The skin may be:

• Itchy
• Dry and covered with silver, flaky skin (scales)
• Pink-red in color (like the color of salmon)
• Raised and thick

Other symptoms may include:

• Genital lesions in males
• Joint pain or aching
• Nail changes, including thick nails, yellow-brown nails, dents in the nail, and nail lifts off from the skin underneath
• Severe dandruff on the scalp

Much more detail can be found at this site: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001470/ .

Treating your psoriasis is critical to good disease management and overall health, according to the National Psoriasis Foundation. Work with your doctor to find a treatment—or treatments—that reduce or eliminate your symptoms. What works for one person with psoriasis might not work for another. So it's important to know the different treatment options and keep trying until you find the right regimen for you. People with psoriasis on less than three percent of their body are considered to have a mild case. Those with three to 10 percent of the body affected by psoriasis are considered a moderate case. More than 10 percent is considered severe. (The surface area of the hand equals about one percent of the skin.) Significant details about this dermatologic condition and treatment can be found at this site: http://www.psoriasis.org/i-have-psoriasis .

In the United States, nearly 7.5 million people have psoriasis and about 150,000 new cases are diagnosed each year, according to SkinCarePhysicians.com. Studies indicate that psoriasis develops about equally in males and females. Research also shows that Caucasians develop psoriasis more frequently than other races. A study conducted in the United States found the prevalence was 2.5% in Caucasians and 1.3% in African Americans. A family history of psoriasis seems to increase the risk of developing psoriasis. It is important to know that a family history of psoriasis does not guarantee that someone will develop psoriasis.

For some people, psoriasis is a nuisance. Others find that psoriasis affects every aspect of their daily life. The unpredictable nature of psoriasis may be the reason. Psoriasis is a chronic (lifelong) medical condition. Some people have frequent flare-ups that occur weekly or monthly. Others have occasional flare-ups. When psoriasis flares, it can cause severe itching and pain. Sometimes the skin cracks and bleeds. When trying to sleep, cracking and bleeding skin can wake a person frequently and cause sleep deprivation. A lack of sleep can make it difficult to focus at school or work. Sometimes a flare-up requires a visit to a dermatologist for additional treatment. Time must be taken from school or work to visit the doctor and get treatment.

These cycles of flare-ups and remissions often lead to feelings of sadness, despair, guilt and anger as well as low self-esteem. Depression is higher in people who have psoriasis than in the general population. Feelings of embarrassment also are common. As psoriasis is a life-long condition, it is important to take an active role in managing it. Learning more about psoriasis, seeing a dermatologist to discuss treatment options, and developing a healthy lifestyle can help people live life to the fullest.

Thanks to ongoing research, there are many treatments for psoriasis. It is important to work with a dermatologist to find treatment that works for you and fits your lifestyle. Every treatment has benefits, drawbacks, and possible side effects, according to the American Academy of Dermatology (AAD). Before you see a dermatologist for treatment, it helps to know about the treatment options. This knowledge will help you work with your dermatologist to create a treatment plan that is right for you.

For helpful tips on managing psoriasis, visit this site: http://www.aad.org/skin-conditions/dermatology-a-to-z/psoriasis/tips/psoriasis-tips-for-managing .

Until next time.

Health Care and Health Risk Assessments

When employers are concerned about having a healthy workforce, they offer various incentives in their benefits offerings to employees that can be preventive in nature and increase the potential for healthier living and overall improved health behavior. These wellness measures can be a great Return on Investment, and employees are able to get a reality check concerning their current health status. Using Health Risk Assessments are a great way to capture information about your health status, and show where improvements can be made and also provide feedback for any indicators of chronic health conditions or disease.

A health risk assessment (HRA) is a health questionnaire, used to provide individuals with an evaluation of their health risks and quality of life. Commonly a HRA incorporates three key elements – an extended questionnaire, a risk calculation or score, and some form of feedback i.e. face-to-face with a health advisor or an automatic online report. The Centers for Disease Control and Prevention define a HRA as: “a systematic approach to collecting information from individuals that identifies risk factors, provides individualised feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease.” There are a range of different HRAs available, however most capture information relating to:

--Demographic characteristics – age, sex.
--Lifestyle – exercise, smoking, alcohol intake, diet.
--Personal and family medical history (in the US, due to the current interpretation of the Genetic Information Non-discrimination Act, questions regarding family medical history are not permitted if there is any incentive attached to taking a HRA).
--Physiological data – weight, height, blood pressure, cholesterol.
--Attitudes and willingness to change behavior in order to improve health.

The main objectives of a HRA are to:
--Assess health status.
--Estimate the level of health risk.
--Inform and provide feedback to participants to motivate behavior change to reduce health risks.

Once an individual completes a HRA, they usually receive a report, detailing their health rating or score, often broken down into specific sub scores and areas such as stress, nutrition and fitness. The report can also provide recommendations on how individuals can reduce their health risks by changing their lifestye, according to the American Journal of Public Health. In addition to individual feedback, HRAs are also used to provide aggregated data reporting for employers and organizations. These reports include demographic data of participants, highlight health risk areas and often include cost projections and savings in terms of increased healthcare, absence and productivity. Organization-level reports can then be used to provide a first step by which organizations can target and monitor appropriate health interventions within their workforce

According to the Mayo Clinic, motivating and sustaining health behavior change is the key to improving population health and productivity and controlling health care costs. A health risk appraisal can lead to health risk reduction. Health behavior research has shown that helping people identify threats to their health facilitates the process of healthy change.
 
Extensive research, according to the Journal of Occupational and Environmental Medicine, has shown that HRAs can be used effectively to:

--Identify health risk factors.
--Predict health-related costs.
--Measure absenteeism and presenteeism.
--Evaluate the efficacy and return on investment of health promotion strategies.

There is also recent evidence to suggest that taking a HRA alone can have a positive effect on health behavior change and health status. However, it is generally accepted that HRAs are most effective at promoting behavior change when they form part of an integrated, multi-component health promotion program. Applied in this way, the HRA is used primarily as a tool to identify health risks within a population and then target health interventions and behavior change programs to address these areas.

Often, an HRA will show certain health care issues that require more attention by your primary care physician. After completing a health risk assessment, the report that is generated usually makes certain recommendations. Among them, elevated markers indicating more follow up are encouraged with your doctor. The limitations of a HRA are largely related to its usage and it is important to recognize that a HRA highlights health risks but does not diagnose disease and should not replace consultation with a medical or health practitioner.When consulting with your physician or health care provider, be sure to:

• Listen carefully to what your health professional says. Make sure you understand what you are told about any diagnosis or treatment.

• Ask questions. If you don't understand something your health professional says, ask for it to be repeated in a different way.

• Be honest. If your values, beliefs, fears, or concerns may interfere with a treatment that is suggested, talk with your health professional about it. Other treatment options may be available.

• Take an advocate. Have a family member or friend with you during your appointment, if possible. That person can take notes, ask questions to clarify information, and help you remember what your health professional says.

• Ask for instructions. Before leaving your health professional's office, make sure you know what you are supposed to do to care for yourself. Ask for written information or instructions.

Health Risk Assessments are designed to show you where you are, and they can identify particular medical, and behavioral problems, that need more attention to help improve your health and lifestyle.  The Wellness Councils of America (WELCOA) outlines 10 key benefits of conducting personal health risk assessments. Health risk assessments:

--Provide employees with a snapshot of their current health status.
--Enable individuals to monitor their health status over time.
--Provide employees with concrete information thus preparing them for lifestyle change.
--Help individuals get involved with health coaching.
--Provide important information concerning employees' readiness to change.
--Help employers measure and monitor population health status.
--Provide employers with important information that can help them build results-oriented health promotion programs.
--Can provide employers with important information on productivity.
--Allow employers to evaluate changes in health behavior and health risks over time.
--Engage both employers and employees in the health management process.

One of the best companies in the HRA market is Trotter Wellness, based in Wisconsin, and the company provides services to companies of all sizes, governments, resellers and individuals throughout the world. Having served thousands of clients and hundreds of thousands of members they have developed systems achieving member participation and satisfaction as well as client renewal rates well into the 90th percentile. These results have been achieved through the Trotter Wellness® system having the highest quality and most cost effective programs and services that resulted from the careful integration and coordination of scientifically crafted or selected components that are delivered using proprietary platforms and protocols. These systems drive high participation and satisfaction with a measureable return on investment for the participant and the client buyer. Trotter Wellness has built a national reputation for having the highest level of client service and satisfaction through their exceptional logistics, communications, health risk assessments, web tools, coaching, results reporting and active one on one relationship management.
 
Health Risk Assessments complement an overall wellness plan; and for any organization or employer, and for individuals, an HRA is an essential tool to provide a path for improved health and lifestyle choices. If your company is considering implementing a wellness initiative, or as an individual you are concerned about your health risks, get a tool in place through an HRA that can give you the peace of mind about your current health. Take the time to find out where you are, so you can figure out where you need to be and get there.
 
Until next time.