Healthline Connects

Medical Doctors and Genocide - Dr. Karadzic Captured

2008-07-23T11:41:00.000-07:00

First Do No Harm - it's the time honored Hippocratic Oath of all medical doctors. But there is more:

I consider for the benefit of my patients and will abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked

nor suggest such counsel. I will not perform any illegal operation. Into whatever house I may enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief and corruption.

Dr. Radovan Karadzic, a US trained psychiatrist who 13 years ago was indicted by an international war crimes tribunal for involvement in the massacre of 8,000 Bosnian men and boys at Srebrinika was captured this week in Belgrade. He had been president of the Bosnian Serb administration from 1992-1995 during the Bosnian war. Karadzic went into hiding in 1998 with a $5 million US bounty on his head. He created a new identity for himself as human quantum energy expert and alternative medicine guru Dr. Dragan Dabic in Belgrade. His website, Psy Help Energy, promising the David Wellbeing Program, is still live, with an email address. He wrote for Healthy Life magazine. Karadzic will be transferred to the UN war crimes tribunal in The Hague, the Netherlands to face 11 counts of genocide, war crimes, crimes against humanities and other atrocities for his activities between 1992-1996.

Psychiatrist...warlord...alternative medicine healer...how does one man make these transitions in a lifetime? Born in 1945, his father fought against the Nazis and Tito. Karadzic moved to Sarajevo in 1960 and studied to be a psychiatrist, married and wrote poetry. He was active in the Green party and helped found the Serbian Democratic Party (SDS) in 1990. By 1992 he declared himself head of state of the newly formed Serbian Republic of Bosnia and Hercegovina. He joined forces with Serbian leaders Slobodan Milosevic and Ratko Mladic. A two year war of "ethnic cleansing" against civilians ensued leaving many dead and many more homeless or displaced.

Karadzic isn't the first psychiatrist or medical doctor to go to the dark side. The question is why? What drives them to forego their oaths and murder rather than heal?

Thank you Srebrinka Genocide Blog for use of photo Mass Grave: Children Shot in Head

Murder on My Mind

2008-07-21T10:07:00.000-07:00

No matter how great the strides we make in health care and science, the news of homicides is relentless. At least 5 homicides of males were reported in the Bay Area this weekend. Murder is the 10th leading cause of death of men in the US. But the US isn't even close to the top 10 countries in homicide rates worldwide. It is difficult to get accurate numbers and it depends on the reporting methods and sources, but as of this writing, Columbia appears to hold the dubious distinction for being the country with the highest homicide rate (although other sources claim El Salvador).

The list of the top 25 on Wikipedia reads like a Travel Zoo Top 20 - many of the same destinations we flock to as tourists are listed. Mexico, Jamaica, Trinidad and Tobago, Belize, Brazil, Panama, South Africa. The US comes in at number 40. Washington, DC is one of the most dangerous cities in the US. Honolulu and San Francisco are considered safe cities. Even though Finland as a country has a low homicide rate, the murder rate in Helsinki is high. Louisiana is the most dangerous state and Puerto Rico has a high murder rate, too. Maine has the lowest homicide rate of the 50 US states.

Most murders are due to men arguing with men, usually about money or property. Most murders (in the US) are white on white males under age 25 years, under the influence of alcohol. Homicide and violence are global public health problems. The World Health Organization defines violence as: The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm,
maldevelopment or deprivation. Over half a million people are murdered every year. A public health problem demands a comprehensive public health prevention program.

Thank you AJC1 for use of photo Chalk Outline.

Happy 90th Birthday Nelson Mandela!

2008-07-18T09:30:00.000-07:00

July 18,2008 is the 90th birthday of Nobel Peace Prize winner and South Africa's first black president, Nelson Mandela. He spent 30 years in prison for his fight against apartheid and is now a world statesman, fighting for the rights of the poor and oppressed. Today he campaigns for funding for HIV/AIDS victims and is speaking out for redistribution of wealth.

President Mandela reminds us that the poor don't live as long as the wealthy and wealthy nations have obligations to poor nations. Communicable diseases like measles, HIV, respiratory illness, malaria, TB and diarrhea account for half of the global disease burden, shouldered by the poor. Child mortality in poor countries is primarily due to malnutrition and preventable diseases.

Thank you commonswikipedia for use of image Nelson Mandela 1989.

Congress Overrides Bush Veto of Medicare Bill (HR 6331)

2008-07-16T10:18:00.000-07:00

Both the Senate and House of Representatives passed HR 6331 which President Bush vetoed on July 15, 2008 but the House voted to override him. Interestingly, neither presidential candidate for the Democratic or Republican party this issue. HR 6331 now becomes law. What's at stake? Cuts to Medicare payments (10.6%) to providers as a way to fund private Medicare Advantage (MA) Plans. Doctors threatened to stop seeing Medicare patients if the cuts were made law.

HR 6331 is a victory for those with mental illness, and may represent the beginning of a shift in policy changes. Parity for mental illness with physical illness shifts cost sharing from 50% to 20%. Part D will now offer broad coverage of antidepressants, antipsychotics, and anticonvulsants and the ban on coverage of benzodiazepines, used for treatment of mania and anxiety disorders. There are also changes to the Low Income Subsidy (LIS) eligibility requirements which lowers premiums, drug cost sharing and eliminates the nasty donut hole coverage gap for beneficiaries.

What's all the fuss about? Most (80%) of the 44 million elderly and disabled opt for Medicare's traditional fee-for-service payment plan. The other twenty percent (about 10 million people) are enrolled in a Medicare Advantage Plan which include HMOs, PPOs, MSAs and even private fee-for-service PFFS plans. The Medicare Advantage Plans offer Medicare Part A, B and sometimes D through coordinated network services. MA payments are higher than traditional Medicare payments, which raises questions about equity of distribution of benefits for the Medicare population. Apparently the government has subsidized these plans with billions of dollars to finance low premiums and extra benefits for the privileged few who enroll - who are generally in good health. Now $14 billion will be cut from these programs over the next five years and the majority of Medicare beneficiaries will continue to receive care.

Thank you eliz.avery for use of hilarious image My Doctor Often Walks Me to the Door and Waves Goodbye
...in my dreams.

Medicare in the News - Payments to Dead Doctors & other Issues

2008-07-14T08:12:00.000-07:00

The Washington Post reported that Medicare has paid millions of dollars for durable medical equipment (DME) prescribed by doctors who were dead at the time of billing. The government established the Medicare Fraud Task Force to try to prevent such abuses, but fraud continues to costs us billions of dollars each year. No wonder health care is so expensive. Senator Norm Coleman - R (MN) said, "...scam artists have treated Medicare like an ATM machine...".

Durable medical equipment (DME) is medically necessary, prescribed by a doctor and is not useful to a person in the absence of an illness or injury, and is appropriate for use in the home.
Look in the phone book or the internet to see all of the suppliers - there is a huge potential for quick profit and unscrupulous suppliers have no problem obtaining beneficiaries’ Medicare health insurance claim numbers. Most DME providers only need a business license and supplier number. Then they need to fill out claim forms verifying medical necessity to Medicare.

• The DME supplier is required to fill out Certificates of Medical Necessity (CMNs) describing products and equipment to be used by the patient. There is a medical information section on the form which must be completed by a physician. This is where fraudulent suppliers can forge the information of deceased physicians.
• When medical necessity has been documented by the beneficiary’s doctor, the Durable Medical Equipment Regional Carrier (DMERC) may purchase or make monthly payments to suppliers for rented DME. Once the equipment is no longer needed the supplier is not entitled to payments and beneficiaries notify the supplier to pick up unused equipment.

Unscrupulous suppliers may obtain Medicare claim numbers fraudulently as a path to pursuing Medicare dollars:

Beneficiaries are paid for their Medicare number or goods and services are exchanged for the number
The elderly are preyed on. Be wary of phone calls offering health surveys or health screenings.

"What is your Medicare number?" - guard and protect this number just as you do your social security number

Lists of Medicare beneficiaries are obtained from long term care facilities

Recruiters or “cappers” offer money to beneficiaries to visit a clinic for medical screening tests. The beneficiary receives a cursory examination and prescription for DME equipment that is not medically necessary. Medicare is billed for supplies the claimant does not receive and the claimants receive other household goods at a profit for the DME provider. Numerous cases of power wheelchair fraud have made headlines. Medicare is billed for a power wheelchair and a less expensive scooter is provided to the claimant. Medicare and Medicaid beneficiaries are actively solicited (we have all seen the TV commercials) for motorized scooters. Federal health care programs and private insurers are billed for motorized wheelchairs, which cost about twice as much as scooters that were provided.

Discharge planners used to be a nurse or social worker employed by hospitals and medical care centers to help patients transition smoothly from the hospital facility to the home or long term care facility. Today, some erstwhile "discharge planners" in medical centers are actually employees of DME suppliers. Conflict of interest, anyone? Unneeded equipment and supplies are ordered. Federal and private insurers pay the bill. I have personally witnessed this little trick: The beneficiary calls the provider to pick up rental equipment that is no longer needed. The provider doesn't pick it up for months because they can continue to bill for it until they do. Or they can send the wrong equipment and bill for the wrong and right equipment because it was contaminated just by virtue of the fact that it was delivered.

To Report Suspected Medicare or Medicaid Fraud
Call Toll-free 1-866-726-2916

It is illegal and fraudulent to:

• misuse a Medicare claim number to receive medical care, supplies, or equipment
• To bill federal programs for services not provided

to bill for a more expensive or Medicare covered item when a less expensive, non-covered item was provided (upcoding)
Submit duplicate claims for the same service
provide kickbacks (payments) to doctors for patient referrals
obtain Medicare numbers through false pretenses (telemarketing, health screenings, medical surveys, or offers of goods and services)

These are but some examples of the flagrant abuses of Medicare. Type in "medicare fraud" in our Search Box to learn more.

Thank you taurusaficionado for use of photo Scooter Lady.

Step Up For 9.4 Million Uninsured Children in the US

2008-07-11T08:54:00.000-07:00

The Children's Defense Fund (CDF) wants us all to step up on behalf of the almost 10 million uninsured children in our nation.

Step up and join these children and CDF's Healthy Child Campaign today by sending an email to your Members of Congress telling them to ensure that every child has access to affordable and comprehensive health coverage.

One in eight children in America is uninsured and another is born uninsured every 41 seconds. Millions of kids have health insurance, but can’t get the care they need because the services they require aren't covered or require high co-payments. According to CDF : " Although improving the federal health programs currently in place—Medicaid and the State Children's Health Insurance Program (SCHIP)—is a step in the right direction, it's not enough. Increased funding and incremental expansions would still leave many children without the comprehensive, affordable coverage they urgently need.

This crisis threatens the health and prosperity of our nation. Consider this:

When children lose health coverage, state and local costs rise due to more frequent use of emergency rooms and longer hospital stays, while children suffer needlessly.
Uninsured children are almost nine times as likely to have a medical need that goes unmet as a child with health coverage.
Uninsured children are more likely than insured children to perform poorly in school; in contrast, enrolling children in health coverage has been associated with greatly improved school performance.
Children are the least expensive to cover and a smart investment in our future.

We can solve this problem if we all do our part. And there is a solution: The All Healthy Children Act would provide affordable, comprehensive, and seamless health coverage for all children and pregnant women in America—something every child needs today!

Thousands of children across America are stepping up and taking action today to help solve this crisis. Show your support today by sending an email to your Members of Congress asking them to do their part by passing the All Healthy Children Act that would ensure every child has access to health coverage."

Please speak out and step up on behalf of our children today.

Thank you Tanitta for use of photo Happy Children.

Evolence Approved for Facial Wrinkles

2008-07-09T08:50:00.000-07:00

OrthoNeutrogena's Evolence, a dermal filler, was approved by the FDA for correction of deep facial wrinkles, including nasolabial folds. Evolence is collagen structure developed from pigs, injected by a trained physician. Results can be seen after one treatment and last for 6 months.

Collagen breaks down with age. Evolence is a 3-dimensional collagen matrix that builds up the structures beneath the skin. A skilled physician can use Evolence to restore structure and volume to depleted areas. Results can be seen immediately. The only reported side effects are mild swelling, redness and pain at the injection site.

Thank you University of Bath for use of image Collagen.

Nobel Laureate Sir John Sulston Decries Profits over Patients

2008-07-07T10:11:00.000-07:00

British scientist Sir John Sulston won the 2002 Nobel Prize in Medicine for his work in genetics. He has long advocated that knowledge derived from the Human Genome Project be kept free and open for use by scientists. He opposes privatization of scientific information and patenting genes and genetic information.

Speaking at the inauguration of the Institute of Science, Ethics and Innovation (iSEI) at the University of Manchester, Sulston called for an international biomedical treaty to develop policies about the use of intellectual property and patents. Sulston asks us to consider, Who Owns Science? The mission of iSEI is to examine the social and ethical consequences of advances in technology and science, and how they can be managed in a way that improves the lives of people. Some of the ethical questions iSEI will be exploring are:

genetic manipulation of species to create hybrids
genetic selection of human embryos
disparity in funding in research of healthcare issues in the developing world vs. the developed world
ethics of healthcare delivery models (from the US based distribution of services by wealth to free access to care)
climate change
global trade

Sulston hopes to ensure that global justice and a better future for humanity are ensured along with strides in technology and science.

New for Clinicians - Helping Patients with Obesity

2008-07-02T13:17:00.000-07:00

According to the World Health Organization (WHO), 1 billion people are overweight and more than 300 million of those people are obese. The cause of the obesity epidemic is decreased physical activity with an increase in consumption of energy rich foods high in saturated fats and simple sugars. Obesity puts the worlds population at increased risk for chronic diseases such as type 2 diabetes, heart disease, cancers and stroke. A BMI greater than 25 is overweight and over 30 is considered obese.

Clinicians are struggling to help patients who are overweight and obese. The Handbook of Obesity, Third Edition has just been published by Informa Healthcare. Edited by Drs. George Bray and Claude Bouchard, the Handbook provides in-depth information about aspects of treating and preventing obesity. Both doctors are professors at the Pennington Biomedical Research Center in Baton Rouge, Louisiana.

Seventeen of the book's forty chapters are dedicated to medical management of obesity. Reviewers are calling it a "...must have resource for endocrinologists, cardiologists, internal medicine clinicians and others working in the field..."

Thank you Malingering for use of photo Cupholder/Beer Belly.

Thank You Dr. Rich for a Very Patriotic Grand Rounds!

2008-07-01T11:26:00.000-07:00

DrRich is a cool guy who writes books and blogs about our crazy health care system. (Are you listening, presidential candidates?) He hosted Grand Rounds for the 4th of July and put together a very patriotic round-up to honor the 232nd birthday of dear old US of A at The Covert Rationing Blog (Healthcare Rationing: Where even Angels Fear to Tread). I am honored that he included my post, Record Numbers of Suicides in US Troops, in this venerable company under the heading Service and Sacrifice. Thank You Dr. Rich and Thank You to our troops who continue to serve and serve again. Our thoughts our with you...

Violence Against Pregnant Women - How Do We Protect the Vulnerable?

2008-06-30T09:26:00.000-07:00

Another pregnant soldier is dead. The story of Spc. Megan Lynn Touma grabs the headlines, but what most of us fail to realize is that murder is the leading cause of death in pregnant women. We think that only women who are already victims of domestic violence are going to be subjected to continued abuse when pregnant. While it's true that violence can escalate against women who are already battered once they are pregnant, sometimes abuse begins while a woman is pregnant.

Violence against pregnant women can be mental, physical or sexual. It seems hard to believe, but a new baby can be perceived as a threat to a jealous man who does not want his partner's time and attention monopolized. An insecure man may feel threatened by the attention others, including health care providers, are giving to the pregnant woman.

Women are at their most vulnerable when pregnant and violence against women is an exertion of power over them. Women and their unborn children are in need of special vigilance and protection from families, communities and societies. Pregnancy may threaten a man's sense of being the primary person in a family.
Men feel stress and frustration over the pregnancy, especially if it is unintended or unwanted. That frustration may be directed at the pregnant woman and unborn baby. The risk of violence is even higher for pregnant teens.

Violence against pregnant women puts two lives at risk. The belly, breasts and genitals are often targets of abuse. The problem is not limited to the US. Gender-based violence is rampant especially with the refugee population at an all time high. Women and girls are vulnerable targets and pregnant Sudanese women have not been spared rape and gang rape as a means or brutal control and subjugation. The Global Health Council cites reports from China, Egypt, Ethiopia, Mexico, India, Nicaragua, Pakistan, Saudi Arabia and South Africa. Calling the problem a "global health crisis", they report the prevalence of abuse during pregnancy is 3.4 percent to 11.0 percent in industrialized countries and between 3.8 percent and 31.7 percent in developing countries.

Thank you Bradley Wind for use of image Pregnant Woman.

Safe Surgery Saves Lives - Endorse WHO's Checklist

2008-06-27T10:14:00.000-07:00

The World Health Organization (WHO) estimates that 234 million major surgical procedures are performed around the world each year. The WHO Surgical Safety Checklist was created to help operating teams reduce poor incidence of poor surgical outcomes. By following a few critical steps, health care professionals can minimize the most common and avoidable risks endangering the lives and well-being of surgical patients.

200 surgery, anesthesia, nursing, and patient societies endorsed the introduction of safety checklists in surgery and three countries, United Kingdom, Jordan and Ireland, pledged to introduce this in all their hospitals.

The checklist includes:

All masked members of the surgical team identify themselves, their roles and ask simple questions like "Does everyone agree this is Patient X and we are doing Procedure Y?"
Mark the correct site for surgery on the patient's body
check for drug allergies
count all sponges, needles and instruments going into and out of the body
give an antibiotic 60 minutes prior to making an incision

Other things patients in hospitals can do to insure their own safety:

insist everyone who interacts with you identify themselves and wash their hands and stethoscopes or any other equipment before contacting you
If someone is wearing a tie, do not allow it to have contact with your person. Insist that is be tucked into their lab coat.

With the emergence of superbugs in hospitals, it pays to be defensive.

Pycnogenol® Helps Relieve Menstrual Pain

2008-06-25T08:58:00.000-07:00

If you are one of the thousands of females who suffer every month with dysmenorrhea (painful menses), you may want to try Pycnogenol, a pine bark extract. Numerous studies show that Pycnogenol decreases pain and the need for pain medication in females who experience menstrual pain. In one study, it also reduced the pain of endometriosis by 33 %.

Dysmenorrhea is the leading cause of short term school absence in teenage girls. Pycnogenol is pine bark extract developed by French researchers. It is high in antioxidants, which play a role in reducing inflammation and repairing and protecting the cells of the body. No dangerous side effects have been observed with its use. Pyconogenol is high in vitamins A, C, E and the mineral selenium.

Read more from Natural Standards Drug Notebook to learn more about Pyconogenol and interactions with other medications.

Merci ecototo's photostream for use of photo Pin maritime biscornu.

Sun Protection - it's not Just for Girls

2008-06-23T08:17:00.000-07:00

Melanoma, the most virulent form of skin cancer, takes over 8,000 American lives each year. Middle-aged and older men are the most likely victims of skin cancer and teen age boys the least likely to use sunscreen. Baseball players are particularly at risk because they spend so much time in the sun.

The American Academy of Dermatology, Major League Baseball and Major League Baseball Players team up every year to Strike Out Skin Cancer.

Here are 5 Tips for Sun Protection from the American Academy of Dermatology:

Use a topical sunscreen with an SPF of 30 or higher
Cover up with long sleeved shirts, hats and sunglasses
Check your skin every year around your birthday for signs of skin cancer
Avoid being out in the sun between 10 AM and 4 PM
Be extra careful near water, sand and snow due to reflective intensity

Make sure children are protected and that teenage boys know the dangers of sun exposure.

Thank you Ben & Sam's photostream for use of photo Direct Sun at Shea Stadium

Want to Lose Weight? Eat a Big Breakfast

2008-06-20T13:54:00.000-07:00

We keep hearing that breakfast is the most important meal of the day. Dr. Daniela Jakubowicz, a clinical professor at Virginia Commonwealth University and an endocrinologist at the Hospital de Clinicas Caracas in Venezuela reported to the Endocrine Society this week that starting the day with a big, carbohydrate rich breakfast prevents food cravings and induces weight loss.

Dr. Jakubowicz explained that the brain is primed to look for food for energy upon awakening and if it doesn't find it right away, the body starts breaking down muscle. She recommends eating half of your daily caloric requirements in the morning - and obese, sedentary women who did so lost nearly 40 lbs. in eight months!

Ready to rev up your breakfast to lose weight? Healthline offers these tips:

Thank you Texas to Mexico photostream for use of photo Breakfast in Santiago!

Tim Russert: Death due to Sudden Coronary Thrombosis, Age 58

2008-06-16T11:47:00.000-07:00

Everyone was shocked and saddened to learn of Tim Russert's untimely demise on Friday, June 13, 2008. NBC's Washington Bureau Chief and moderator of the popular Meet the Press died of a sudden coronary thrombosis. Russert's doctors reported the left descending coronary artery was blocked with cholesterol plaque and ruptured. His doctors report that he had asymptomatic coronary artery disease, well controlled with diet, medication and exercise and that his cholesterol levels and blood pressure were under control.

Heart disease remains the number 1 killer of men and women in the USA. Perhaps we might want to take heed of the Japanese metabo program, reported in the New York Times June 13, 2008. A national law went into effect two months ago, requiring that companies and local governments measure the waists of all people between the ages of 40 and 74 years. Males are required to have a waist measurement of 33.5 inches and women 35.5 inches. The US equivalent (accounting for different body types) would be 40 inches for men and 34.6 inches for women. In Japan, offenders will be monitored and provided education.

It is really sad to lose such a talented man and dedicated father and husband at such a young age. Baby boomers - it's time to measure your waistline and talk to your doctor about the condition of your coronary arteries. Maybe it's time for a cardiac cath test to see if the blood supply to your heart is what it should be. Our condolences to Mr. Russert's family and friends at NBC and around the world.

Healthline Wunderkind Go the Distance

2008-06-12T09:27:00.000-07:00

Healthline employees and executives don't just talk the talk - they walk the walk and swim, bike and run. On Sunday, June 8, 2008 Louisa Pickering (Manager, Communications), Lawrence Chang (Manager, Application Development), and Bill McGee, (Senior Vice President, Marketing Services) successfully completed the Escape from Alactraz Triathalon.

Lawrence, Louisa and Bill joined 2000 outstanding athletes to swim 1.5 miles through frigid waters from Alcatraz Island to San Francisco, a grueling 18-mile bike race, and a demanding 8-mile run through the rugged trails of Golden Gate Recreation Area. No one ever escaped from Alcatraz in its 29 year history as a maximum security prison, but every year 15,000 spectators enjoy watching the world's best triathletes complete this arduous course.

Healthline is proud to count Lawrence, Louisa and Bill among this crowd of elite athletes, setting an example for all of us.

Record Number of Suicides in US Troops

2008-06-09T14:53:00.000-07:00

The US Army has reported a 13% increase in the number of suicide in US troops in 2007. We may think the wars in Iraq and Afghanistan are over or winding down, but in fact, 2007 was the deadliest year on record for our service men and women.

115 soldiers committed suicide in 2007, and most of them did so within 3 months of deployment to Iraq or Afghanistan. The majority were under age 25 years old and married. The US Army is responding by training primary care providers to diagnose and treat combat related illnesses, including post-traumatic stress disorder (PTSD) and mild traumatic brain injury (TBI), two diagnoses that are seen in unprecedented numbers in our troops.

The Army emphasizes "staying connected" as an antidote to the mental health problems plaguing our soldiers.

Thank you alisonheryer for use of photo US Troops Wait Out Iraqi Scud Attack

Headache Awareness: Menstrual Migraines

2008-05-28T10:05:00.000-07:00

Migraine headaches are not life threatening but can be so disabling you sometimes feel you are dwelling in a twilight state between life and death. The pain is so crippling you can not participate in your every day life. My first experience with migraine headaches was in high school. An intelligent and talented friend of mine, William, lost days of school at a time due to migraine headache pain. He described how light and noise bothered him - he had to hide the telephone under a pillow while confining himself to a dark room until the pain subsided. I winced at his description of suffering, never dreaming I too would fall prey to this malady - my weak spot. Prepubescent boys and girls experience migraines with the same prevalence. Women, however, are 3 times more likely than men to have migraine headaches.

Menstrually related migraine (MRM) are more severe, last longer and are less responsive to pain medication than other migraine headaches. MRM occur 2 days before to within 3 days of the start of menses in at least 2 out of 3 menstrual cycles as well as other times during a woman's cycle. Menstrual migraine (MM) occur 2 days before to within 3 days of the start of menses in at least 2 out of 3 menstrual cycles and at no other time of the month. 8% of all women have MRM, but 50% of women who report headaches have MRM (me too). The theory is that falling estrogen levels in the late luteal phase of a woman's cycle trigger migraines.

Treatment of MRM and MM is two pronged - treat the migraine itself once it starts and short-term prevention taken perimenstrually. The April 2008 issue of Neurology published the following recommendations as a result of evidence-based research:

Perimenstrual short term prevention:

transcutaneous estrogen 1.5 mg

frovatriptan 2.5 mg twice daily,

naratriptan 1 mg twice daily

Treatment of acute MRM/MM:

sumatriptan 50 and 100 mg
mefenamic acid 500 mg
rizatriptan 10 mg

All recommendations, of course, depend on your clinical situation, but if you suffer from menstrual migraines and are not getting adequate relief, be sure to discuss these findings with your doctor.

Thank you AxisGrid for use of photo Last Night.

Thank You Dr. Emer For Grand Rounds 4.36

2008-05-27T11:05:00.000-07:00

Dr. Emer writes the fascinating blog, Parallel Universes from the Philippines. He hosted Grand Rounds, a compilation of the best writing in the medical blogosphere for the week, for the 5th time this week. Thanks for including my post, Rice Wars, in such great company.

NIH Back to Sleep Campaign Successful in Reducing SIDS Deaths

2008-05-23T10:59:00.000-07:00

The rate of SIDS has decreased 50% since the NIH started the Back to Sleep campaign 13 years ago. Other tips for promoting safe sleep for babies:

avoid soft bedding (extra blankets and quilts)
don't let babies sleep with adults (roll over deaths)
no stuffed animals in babies bed

The peak age of danger for babies is age 2-3 months. The American Academy of Pediatrics (AAP) advises putting babies bassinet or crib in a room with adults until they are older than 10 months of age. Pacifiers at bed time also have a protective effect in preventing SIDS. Keep your baby safe - back to sleep!

Ted Kennedy Diagnosed with a Glioma (Malignant BrainTumor)

2008-05-21T14:50:00.000-07:00

I was only twelve at the time, but I’ve always remembered Senator Ted Kennedy’s concession speech from the 1980 Democratic Convention in NYC. He had entered the hall trailing incumbent Jimmy Carter’s number of pledged delegate votes by a whopping 40%, and had he been successful in his attempt to allow pledged delegates to change their votes at the last minute, those memorable words could have morphed into an acceptance speech for the party’s nomination. What struck me then, and has always stayed with me, was the odds were irrelevant. Meaningless. Incidental. My guess is that’s how he’ll face his next great fight.

Sighs of relief were common as many of us heard that a stroke was not the cause of a seizure he experienced over the weekend. But then news broke with that terrifying combination of words…”diagnosed” and “brain tumor.”

What’s the Diagnosis?
Doctors located a tumor in Senator Kennedy’s left parietal lobe. A biopsy reveled that the tumor was a malignant glioma.

What is a Malignant Glioma?
Of the close to 20,000 brain tumors diagnosed every year, malignant glioma is the most common type and frequently occurs in older Americans. They can be located in the cerebrum as is the case with Senator Kennedy and most adults, or in the cerebellum, much more common in children.

What are the Typical Symptoms?
In Senator Kennedy’s case, a seizure led to the diagnosis. Other common symptoms include headaches, difficulty with speech, walking or other motor functions, numbness or vomiting.

What are the Treatment Options?
Depending on the size of the tumor, surgery could be the first option, albeit a risky one. If the tumor’s size or location eliminates surgical options, as appears to be the case with Senator Kennedy, chemotherapy and/or radiation therapy may be utilized.

What’s the Prognosis?
Malignant gliomas are extremely aggressive tumors and the outlook is typically grim. For the most severe grade gliomas (a “4” on a 1 to 4 scale) the average survival time is less than 12 months. Very few diagnosed with any giloma survive more than three years.

It’s always hard to come up with the right words at times like this, so I’ll borrow from Senator Kennedy’s own inspirational speech from 1980 which ended with some seemingly relevant words…
“For me, a few hours ago, this campaign came to an end. For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”

By Jerry Gulley
Director of Content, Healthline.com

Thank You David E. Williams for Grand Rounds 4.34

2008-05-13T13:10:00.000-07:00

Our good friend David E. Williams of Health Business Blog hosted Grand Rounds this week. He gathered up some fabulous tales from the medical blogosphere and included my post about HBO's Hear and Now: The Joy of Communication. David writes one of my favorite blogs - he is a strategy consultant to pharma, biotech and other healthcare services industries. Expand your brain with Grand Rounds.

Medical Records Vulnerable Targets

2008-05-12T09:29:00.000-07:00

Last month I wrote about wide spread data theft from medical centers. Security authorities have been busy offering reassurances that data wasn't compromised and other "reassurances" that some how wasn't very reassuring. US Today reports that identity thieves have been busy preying on medical records, finding them a rich treasure trove of social security numbers and credit information. Sophisticated crime rings use insiders - people who work in medical centers - to help gain access to data and commit ignoble crimes like submitting false claims to Medicare. California and Arkansas are the only states which require a patient be notified when medical records are accessed illegally.

A study commissioned by Kroll Fraud Solutions risk consultants finds that medical centers have focused on medical privacy and compliance while neglecting patient identity theft and other data breaches. HIPPAA compliance measures do nothing to prevent fraud or protect against hackers - they do a great job at preventing patients from getting access to their own records. Medical centers are not required to report or disclose security breaches. It is not even clear that any agency is monitoring this problem but it is clear that health IT experts are ignorant about the costs ($200 per record and $6.3 per incident).

Meanwhile, while the rush is on to implement electronic medical records (EMR) your data may be sold to pharma and other advertisers who underwrite the implementation of EMR. Doctors have been resisting this data mining in which patient information is aggregated and cleansed of identifying features. They are concerned about their prescribing habits being sold back to pharma. Hey, shouldn't we get a discount if our data is sold?

Thank you gayan job for use of image Yathura.

HBO's Hear & Now: The Joy of Communication

2008-05-09T11:49:00.000-07:00

HBO premiered the documentary film Hear and Now last night. It is a love story of a fascinating, quirky, intelligent, loving couple who happen to be deaf and the parents of three hearing children. One of the children, award winning filmmaker Irene Taylor Brodsky decided to document her parents journey through cochlear implant surgery.

Paul and Sally Taylor have been deaf all their lives - they are well adapted, happy people - successful, good parents. They are about to retire. Still, what are they missing out on, not being able to hear? Paul Taylor is one of the inventors of the TTY - the telecommunications system that revolutionized communications for the hearing impaired. Brodsky captures the vulnerability of the deaf - of anyone with disabilities. She captures the rejection the Taylors felt as teens trying to fit in to an uncaring world. She captures the youthful hope the Taylors feel at 65, wanting to try new things - have a conversation, go to a concert, listen to music. One thing they remind us is that communication is a joy we take for granted.

Their surgeon proclaims that cochlear implants are the #1 medical advance of the 21st century - because hearing is the only sense that can be restored. The filmmaker/daughter makes it obvious that just the thought of being able to hear for the first time is emotionally overwhelming for the 65 year old Sally, but the surgeon seems to have as much difficulty processing her emotional reactions as she seems to have processing sound.

The surgery is successful - both Paul and Sally can hear sounds. Language acquisition and understanding the spoken word is a different matter. I admit to being an emotional person but I was crying like a baby watching this deeply personal story. The technology is still new and maybe counseling and language classes are imperative adjunctive therapies to help recipients adapt to the world of sound.

Hear and Now airs frequently on HBO in English and in Spanish through June 22. Be sure to watch it exclusively on HBO.