In the News

Do Enhanced Medicare Programs Make Sense?

Dr. E, guest blogger

Medicare advantage I have an elderly relative in a nursing home.  She has Medicare, of course, and secondary health insurance provided by the state she lives in, a state with excellent health care coverage.

I recently got a phonecall from a social worker at the nursing home.  She told me that they had a few openings for residents to join, at no cost, an Enhanced Medicare Program available to nursing home residents and wondered if I'd like to sign my relative up.  "What are the pros and cons?" I asked.

The social worker seemed stunned.  Since she presents the option as a gift your relative has been chosen to receive, she is used to most people saying "thank you" and signing right up.    She was hard pressed to answer my question as well as others I asked.  She finally gave me the local and national information phone numbers for the Enhanced Medicare Program she was promoting.

What I learned from making those calls is that Enhanced Medicare Programs for nursing home residents are run by several different private insurance companies, who have persuaded the Federal government, with questionable and self-serving studies, that these programs reduce patient hospitalizations and thus reduce Medicare costs.  From what I've learned and seen, however, nothing could be further from the truth.  That insurance lobby in Washington must be way more powerful than we've been told!

 I was told that the way these enhanced plans work for nursing home residents is that Medicare pays a significant monthly fee to these companies.  In return, the only added benefit for my relative is that an outside nurse practitioner would visit my relative just once a month.  We do not know how long the nurse's visit is or what the qualifications of the nurse practitioner are.  And, I wondered, do the nursing homes get a fee for every resident they sign up?  The social worker seemed more like a saleswoman for the program than an informed patient advocate. 

But here is the main question:  since licensed nursing homes have nurses round the clock and aides who see residents 24/7, and since these nursing homes also have doctors who make periodic visits and are available for phone consultations 24/7, and since Medicare and secondary insurance pay for everything else, how can this brief, just once a month visit, which costs Medicare a great deal of money, end up saving Medicare anything?  

I did my part to reduce questionable Medicare costs incurred by insurance companies in this country: I declined enrollment in the plan for my relative. 

The bottom line is that there's no substitute for your being totally involved with your relative's health and care in a nursing home.  Call the relative daily, if possible; stay in  constant communication with the nursing home staff/doctors; and and make unannounced visits as often as possible.

I'm Dr. E., Ph.D.   For more information, click on the following resources: 

Medicare Meets Mephistopheles

Healthcare Fraud:Auditing and Detection Guide 

Medicare and Medicaid Fraud and Abuse,2009 ed. 

The Political Life of Medicare  

Reforming Medicare:Options,Tradeoffs and Opportunities

Amy Bishop:Should She Get Away With Murder?

Dr. Amy Bishop In 1986, when Amy Bishop was 20-years-old, she shot her brother after she had a fight  with her father as he was leaving their Massachhusetts home.  Her mother, the only witness, said her son's death was an accident.  Amy went on to marry, earn a Ph.D. at Harvard, have children and work.

People remember her as being quite a menace in their quiet Massachusetts neighborhood.  It is said that she tried to get her child's teacher fired and also successfully barred an ice cream truck from coming to her street because, she said, her children were lactose intolerant.  In 1993, she and her husband were suspects in an attempted pipe bombing of a doctor she had worked for at Boston Children's Hospital.  And in 2002, she punched a woman in a House of Pancakes and then fled with her family.  The manager wrote  down her license plate, though, so she was brought to court and convicted of assault.

Astonishingly and unfortunately, the administration at  the University of Alabama did not have any of this information when they hired Amy Bishop, but they denied her tenure recently.  Her research and publications did not meet high enough standards for tenure, and students criticized her for  being disorganized, not making eye contact, simply reading from a textbook and too often expressing her extreme political views with unsettling passion. Several weeks ago, during a department meeting at the university, Amy Bishop pulled out a loaded gun and killed three colleagues and wounded others.

It appears she was psychotic, most likely suffering from paranoid schizophrenia.  Having this mental illness, however, should not necessarily exonerate her from being convicted of murder and serving her sentence.  She planned the attack; she got a gun; she trained with it at a local shooting range; she brought the loaded gun with her to the department meeting; and she calmly got up and started systematically shooting her colleagues in their heads.

Having gotten away with so much all her life, she might have started to believe that she was invincible and that when all the facts were presented, she would be exonerated.  She may think that her powers of persuasion are so great and her genius so valuable, that she will go free.  She most likely convinced herself that she had been wronged and that the people she killed deserved it.  She probably believes that somehow, once again, she won't have to pay for the consequences of her actions.

What is certain, however, is that Amy Bishop should not get away with assault and murder this time. She knew what she was doing and knew right from wrong when she fired her loaded gun and killed and injured her innocent colleagues.

I'm  Dr. Blokar.  For more information, click on the following resources: 

Schizophrenia for Dummies

Surviving Schizophrenia:A Manual for Families,Patients,and Providers 

The Complete Family Guide to Schizophrenia:Helping Your Loved Ones Getting the Most Out of Life 

When Someone You Love Has a Mental Illness 

Schizophrenia,Causes,Symptoms,Signs,Diagnosis and Treatments  

Tiger Woods and So-Called Sexual Addiction

Tiger Woods People of power and privilege, both men and women,  historically have engaged in extramarital affairs.  Having money and time on their hands, they indulge in all of life's pleasures, including extramarital sex.  A big difference today, however, is that journalists and the internet make it certain that eventually they will be caught.

"I thought I could get away with whatever I wanted to.  I felt that I had worked hard my entire life and deserved to enjoy all the temptations around me.  I felt I was entitled.  Thanks to money and fame, I didn't have to go far to find them," Woods said in his recent press conference.

Talented Tiger Woods, through hard work and discipline, rose to the pinnacle of success in the world of golf, and fame and riches followed.  In his private life, married to a beautiful woman and the father of two adorable children, he seemed centered, modest, and generous, funding important programs to benefit underprivileged children.  

But once the sordid truth about Tiger's multiple extramarital affairs were exposed, he needed cover, so he signed himself into a kind of "sanitarium" where people rich enough to engage in excessive sexual activity also can afford the treatment.   When he made his first public statements a few days ago, I was glad he never used the phrase "sexual addiction," because personally I do not see excessive sex, excessive eating, excessive gambling, excessive exercising or excessive working as "addictions."  One can use sex, like all of these activities, to deal with anxiety, loneliness and feelings of emptiness, and all of these activities help people avoid addressing their deeper and more painful issues.   In my opinion these are neurotic compulsive behaviors that can be successfully addressed in insight oriented therapies. 

It is possible that Tiger Woods's issues are more banal.  Prior to being caught, he was disciplined in keeping his game topnotch and keeping in top physical shape.  He was very focused and able to maintain his image.  Perhaps he is just another rich and famous man with strong narcissistic traits and an extraordinary sexual appetite and simply wanted to satisfy it while it lasted.

Based on some of his public statements a few days ago, however, and his plan to go back into therapy at the treatment center where he had been, he may indeed suffer from neurotic compulsive behaviors that can be treated with insight oriented analysis. 

"My real apology to [Elin] will not come in the form of words; it will come from my behavior over time," Woods said.  Only time will tell his wife and the rest of us whether Tiger Woods can keep his resolve to never engage in extramarital behavior again.

I'm Dr. Blokar.  For more information, click on the following resources:  

Healing the Hurt Behind Addictions and Compulsive Behaviors 

No Stones:Women Redeemed From Sexual Addiction  

Deceived:Facing Sexual Betrayal, Lies, and Secrets 

The Psychophysiology of Sex 

Addicted?:Recognizing Destructive Behaviors Before It's Too Late 

Facing the Shadow:Starting Sexual and Relationship Recovery  


Problems With Mixing Medications

This should not be taken Some foods and liquids, like grapefruits and alcohol, for example, should not be taken with certain medications, even non-prescription medications, because they may interfere with the drug's effectiveness, and some seemingly harmless over-the-counter medications and even herbal supplements can cause problems when taken together with certain prescription drugs.

Recently, for example, it was reported in a newspaper in England that women taking Tamoxifen (a drug given in order to stop the recurrence and spread of some breast cancers) together with certain antidepressants were more likely to die from breast cancer than those women not taking Tamoxifen with certain antidepressants.  These antidepressants, according to the research, seem to interfere with the metabolism of the Tamoxifen.

Another example is a thyroid medication used to treat low thyroid function that should not be taken with calcium tablets because the calcium interferes with the body's ability to absorb the thyroid medication which makes the thyroid drug less effective.  Since, in this case, the consequences do not create severe health problems, there are no red flags that would make the doctor or pharmacist warn you about mixing calcium and this thyroid medication.  Mixing may result in your having to take a higher dose of the thyroid medication, though, to get the desired result.

Calcium, as a matter of fact, is one of those seemingly harmless, over-the-counter supplements that can interfere with the absorption of many medications, so I recommend taking calcium supplements many hours apart from other medications.

Not all research is good research, so not every study requires us to panic or change our routines.  Always tell your doctor, therefore, about all the prescription, over-the-counter drugs and herbal supplements you are taking and ask about which can be taken together.  And ask your pharmacist the same question.   In the end, you must take responsibility for being informed  so you can make the right decisions for yourself. 

I'm Dr. Blokar.  For more information, click on the following resources:

Medication Errors

You:The Smart Patient:An Insider's Handbook for Getting the Best Treatment 

Taking Your Medicine:A Guide to Medication Regimens and Compliance for Patients and Caregivers 

Preventing Medication Errors and Improving Drug Therapy Outcomes:A Management Systems Approach  

Post-Traumatic Stress Disorder(PTSD)

PTSD There are now many precise diagnostic tests available to many medical fields but not to psychiatry.  Many doctors have access to all sorts of new technologies that allow them to make precise diagnoses that can eliminate unnecessary surgery or, if surgery is necessary, these tools enable the doctor to be far more precise and have even allowed some surgeries to be done on an outpatient basis.

Psychiatric diagnoses, however, depend on the observational abilities of the examiner and, therefore, there is the possibility for error.  Even a skilled examiner brings his/her own blind spots and prejudices into the process.

There have been small breakthroughs in psychiatric diagnostic tools, but most laboratory test are too imprecise and cannot be used widely.   A new promising test using data collected with magneto encephalography (MEG), however, is able to pinpoint the existence of Post-Traumatic Stress Disorder(PTSD). 

PTSD is characterized by the re-experiencing of an extremely traumatic event.  One may be haunted in dreams or may experience so-called disassociated states during which the patient behaves as though experiencing the traumatic event at the moment. 

 As a result of PTSD, the patient tries to avoid any stimuli and situation associated with a trauma.  One develops an overall numbing of one's general emotional responsiveness which often results in social withdrawal and markedly diminshed interest in previously enjoyed activities.  This is often accompanied by a feeling of detachment and estrangement from others including the inability to have loving feelings.

In spite of detachment and a seeming lack of interest, there can be a heightened excitability -- exaggerated startle repsonses, being on guard and hyper-vigilant about possible danger, difficulty concentrating, outbursts of anger and frequent difficulties with sleep. 

These symptoms of PTSD may lead to severe incapacitation in every area of one's life including learning, loving, working and socializing. Often the patient feels hopeless about his/her prospects for the future or even his/her longevity.

Although skilled clinicians are able to diagnose and treat PTSD, it involves lengthy evaluations which do not always result in an accurate outcome.  With the new and welcome MEG test, when in doubt we will be able to diagnose PTSD faster and then patients can be quickly triaged and directed into the most effective treatments.

I'm Dr. Blokar.  For more information, click on the following resources:

The Post-Traumatic Stress Disorder Sourcebook:A Guide to Healing,Recovery,and Growth

Conquering Post-Traumatic Stress Disorder:The Newest Techniques for Overcoming Symptoms,Regaining Hope,and Getting Your Life Back  

Post-Traumatic Stress Disorder for Dummies 

Healing From Post-Traumatic Stress 

I Can Still Hear Their Cries,Even in My Sleep:A Journey Into PTSD  

My Opinion of the Proposed Health Care Reform

Health care I, and many other doctors I know, breathed a sigh of relief when Speaker Pelosi announced that the Health Care bill passed in the Senate would not be approved by the House.  At least for now, the Health Care bill seems dead, in spite of  President Obama's remarks to the contrary after the recent election of a Republican Senator in Massachusetts.

As an immigrant physician who chose America based on the knowledge and perceptions I acquired while visiting the United States, I shivered at the thought that an enormous bureaucracy would make decisions that should be made between a doctor and a patient.  In addition, having some experience with state bureaucracy in a former communist country of my origin, I know how stifling and inefficient such a bureaucracy can be.

It was not uncommon for people to circumvent the bureaucracy by offering bribes in return for quality medical care, while physicians were forced to accept these bribes in order to support their families because the state paid them so poorly.

In my opinion, when bureaucrats run the system, individual talent and initiative suffer.  Everything is reduced to its lowest common denominator and all share equally in poor care.  Yet somehow highly positioned bureaucrats, politicians and the privileged always find ways to exploit the system while the average person is left with no recourse but to accept the state's largess.

I'm Dr. Blokar.  For more information, click on the following resources:

The Healing of America:A Global Quest for Better, Cheaper, and Fairer Health Care

Health Care Will Not Reform Itself:A User's Guide to Refocusing and Reforming American Health Care 

Cured! The Insider's Handbook for Health Care Reform 

The Truth About Health Care:Why Reform Is Not Working in America 

A Second Opinion:Rescuing America's Health Care  

Casey Johnson and Juvenile Diabetes

Casey johnson dies Casey Johnson, heir to the Johnson & Johnson fortune, died recently at the age of 30.  Now, snippets of her life that we are hearing about and seeing reveal that like many other children of the rich and famous, her life was a shipwreck.  Someone should do a study on why people who have so much going for them, so much of what all the rest of us want, either get into trouble and end up having to throw it all away, or die young without ever really enjoying what they had.

Casey Johnson, though, had something else besides wealth and privilege.  As a very young girl she was diagnosed with juvenile diabetes, an incurable disease that takes constant management.  Imagine her having to go through daily finger prickings in order to monitor her blood sugar level.  And imagine having to think about everything you eat in order to keep your blood sugar numbers at an acceptable level.  And think about having to restrict physical activity because overexertion can reduce one's blood sugar numbers to dangerously low levels.  And, of course, there are the daily injections of insulin to control symptoms.

Some of those symptoms, like fainting or becoming incoherent, can result in emergency trips to the hospital, often being witnessed by peers which can be embarrassing.  The growing up process unfolds in a field full of potential land mines.  Puberty is a particularly disruptive and challenging time for kids with diabetes.  The struggle between childhood and emerging adulthood, when the young person wants to assert him/herself, break away from family and shift one's loyalty to one's peers, can be particularly difficult because the chronic illness requires ongoing adult supervision.  In addition, being different and sick can be embarrassing.  Many young diabetics rebel against their illness by challenging it with careless abandon, resulting in more hospitalizations and more embarrassment. 

No doubt, Casey Johnson's diabetes, as well as her wealth and name, shaped her personality.  And there is some sad irony, and maybe subliminal anger in Casey, that the company that gave her such wealth by creating medications to treat so many illnesses never created one that could cure her diabetes. 

But at age 30, when asked what her biggest regret was, Casey Johnson did not say "having diabetes."  She said it was not doing the reality television show with her friend  Paris Hilton. 

I'm Dr. Blokar.  For more information, click on the following resources:

Type 1 Diabetes for Dummies

The Everything Parent's Guide to Children with Juvenile Diabetes

Type 1 Diabetes:A Guide for Children, Adolescents,Young Adults--and Their Caregivers, Third Edition 

Taking Diabetes to School 

487 Really Cool Tips for Kids with Diabetes  

Where Is the Confident and Courageous America I Love?

The american flag Coming from a totalitarian state with practically everything controlled by the government (your job, your apartment, your retirement age and your mobility), I had an image of America as a place in the sun. 

As a young medical doctor, I first came to the USA while working on a ship that besides carrying cargo also carried 13 American tourists.  During my three week trip I discovered that America was also unexpectedly and exceptionally generous.  I met people  who looked very young for their age, who engaged in their second, even third, careers, and I, too, wanted to live and thrive in a country where you can be young at 50 and where your prospects seem endless.  That was 32 years ago. 

What I see now, though, worries me. The 1993 bombing of the World Trade Center, in spite of subsequent bombings of US targets abroad, was not taken seriously enough.  September 11, 2001, however, changed everything.  It finally focused the public's attention on the dangers of terrorism...for a while. 

 Many of my friends and patients express doubt about our government's ability to protect us from man-made disasters.  They're resigned to whatever fate awaits us, hopeless especially after the attempted downing of an international Detroit-bound Northwest Delta plane on Christmas Day.  The symbolism was not lost on those who wish us harm, and many lament the shortness of our collective memories.

The government appears to be complacent at times, if not unintentionally complicit.  The fear of making value judgements or offending particular groups appears to paralyze the authorities constrained by the straightjacket of political correctness.

If psychodynamic concepts are applied to a nation, then America is behaving like an abused, despised child who concluded that it must be deserving of the hate it encounters.  Once you incorporate the hatred of those who are attacking you, you stop fighting the attackers.  Instead, you exaggerate your imperfections in order to justify their behavior towards you.

Where is the bold and courageous America I once knew with people who are generous, but not in denial, and who are confident in the future?

I'm Dr. Blokar.  I wish all of you a very Happy New Year, and may God bless America.

Abuse of Prescription and Over the Counter Drugs and Alcohol

Brittany murphy In the entertainment industry there have been many performers who have died after accidentally or intentionally overdosing on prescription medications.  Most recently, 32-year-old actress Brittany Murphy died, and while we don't yet have the autopsy report, we did hear that lots of prescription medications were found in her bedroom.

But what about people who are not part of the Hollywood, show business rat race?  It is estimated that more than 50% of young women take prescription drugs, with mood-enhancing stimulants and anti-anxiety drugs being the most used.  Since stimulants often make people feel "wired," stimulants are often followed by sleeping pills and anti-anxiety drugs, creating a dangerous, vicious cycle.

Many people claim that they must take these medications in order to perform well, but steady use of them can lead to serious mood disturbances, causing a person to become irritable, angry and almost manic.  It may even trigger a psychotic manic episode during which all kinds of irrational and violent acts may be committed.

If one adds over the counter medications to some prescription medications, the combination can actually be deadly.  Taking cold medications containing Pseudoephedrine  along with a hefty dose of a stimulant can cause a serious, sometimes fatal, increase in blood pressure and heart rate.  Similarly, liberal use of pain killers which are opioid derivatives, taken with commonly used antihistamines or alcohol, can lead to a dangerous reduction in heart rate and breathing and can be fatal.

People, besides using drugs unwisely, often also drink too heavily.  Alcohol is a potent central nervous system suppressant, and reckless or violent acts are often committed because of alcohol's disinhibiting effect.  Depression, a lasting mood disorder, is a less known but serious consequence of alcohol abuse.

While young people's bodies can usually take lots of abuse and recuperate, every once in awhile the combination or quantity can be deadly.  We will soon know if this is what led to Brittany Murphy's untimely death.

I'm Dr. Blokar.  For more information, click on the following resources:

Overcoming Prescription Drug Addiction:A Guide to Coping and Understanding

High Society:How Substance Abuse Ravages America and What to Do About It 

Generation RX:Kids on Pills-A Parent's Guide 

Performance Enhancing Medications and Drugs of Abuse 

The Chemical Carousel:What Science Tells Us About Beating Addictions 

Prescription Drugs(Drug Abuse & Society:Cost to a Nation) 

Connecticut Cocktail 

Adolescent Substance Abuse:Research and Clinical Advances 

Drug and Alcohol Abuse:A Clinical Guide to Diagnosis and Treatment 

Prescription Drug Abuse(What's the Deal?) 

Prescription Drug Addiction:The Hidden Epidemic  

Can a House Be Too Insulated?

Radon Recently President Obama encouraged people to insulate their homes under the "Cash for Caulkers" program.  He said making your home more energy efficient by insulating is "sexy."  But is it healthful? There are some who believe that old homes are much healthier because they are not well-insulated and are built with natural materials which are porous, so they allow air to enter and leave freely.  

It is estimated that one out of every 15 homes has too high a level of radon gas (a naturally occurring gas without taste or smell) especially in confined, low lying areas.  Radon, which comes into a home from the surrounding ground and rock, may be responsible every year for 20,000 deaths from lung cancer, and children may be more sensitive and vulnerable to the damaging effects of radon.   Radon easily penetrates many common building materials and most insulation, and while low ventilation does not cause radon gas, it does enable a greater concentration of radon gas once it's in the home.   Increasing the amount of fresh air that gets into a home can dilute radon and other contaminants. 

If it is true that some people get sick from breathing the air in airplanes, it may be because they are in such close contact with others and without fresh air and good ventilation, and some argue that's what a too well-insulated house may be like.  But, do your research, become well-informed and then decide whether going in and out of your home and the opening and closing of doors lets in enough fresh air to make it "sexy" for you to insulate your home and save energy and money.

I'm Dr. Blokar.  For more information, click on the following resources:

Harmonious Environment:Beautify,Detoxify and Energize Your Life,Your Home and Your Planet

Building Today's Green Home:Practical,Cost-Effective and Ec0-Responsible Home Building 

Green From the Ground Up:Sustainable,Healthy,and Energy-Efficient Home Construction 

Home Enlightenment:Create a Nurturing,Healthy and Toxin-Free Home 

Health and the Modern Home 

The Healthy Home:An Attic-To-Basement Guide to Toxic-Free Living 

The Mom's Guide to Growing Your Family Green:Saving the Earth Begins at Home