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HIV: PRACTICAL MATTERS-FINANCING MEDICAL CARE: PRIVATE, THIRD-PARTY PAYERS FOR FINANCING HEALTH CARE-GROUP PLANS

by admin - July 28th, 2011

All private, third-party payers—Health Maintenance Organizations (HMOs), Blue Cross/Blue Shield, and commercial insurance companies—offer two kinds of plans for financing medical care: group plans and individual plans. Group plans are offered by the third-party payer to an employer, and then by the employer to the employees. Individual plans are offered by the third-party payer directly to the individual.     Group plans-Blue Cross/Blue Shield, HMOs, and a large number of commercial insurance companies all sell group plans to employers.     Commercial insurance companies are often national businesses that offer similar group plans to all employers throughout the country. Blue Cross/Blue Shield is a group of 77 not-for-profit, regional insurers who offer different group plans in each of their different regions. HMOs, whose rules for group plans are different from those of commercial companies and Blue Cross/Blue Shield.     Group plans held by companies with large numbers of employees usually do not require you to have a medical examination or to submit your medical records. Anyone with HIV infection currently working for a large company with a group plan will be covered by that plan. Smaller companies, however, are more likely to have group plans that require the employers to answer health questions about their employees.     If you are hired for a new job in a large company, the group insurance will often have a rule about preexisting conditions. To rule out people who take out insurance only when they become sick, insurance companies sometimes enforce a waiting period—usually a matter of months—between the time of application and the time coverage begins. If you are hired for a new job and you have been diagnosed with HIV infection, the insurance company will usually wait for the period set by the preexisting conditions rule before covering you. This rule applies to all preexisting conditions.     Blue Cross/Blue Shield, which has a group plan offered by many employers, does not usually transfer from one employer to another. Each employer negotiates its own individual contract with the local Blue Cross/Blue Shield company. If you transfer from one employer to another, preexisting condition rules will now apply under the second employer’s policy.     The insurer (whether a commercial insurance company or Blue Cross/Blue Shield) always sets limits on what the group plan covers. One of the limits is that group plans generally cover only some fraction of your medical expenses. They often cover around 80 percent of hospital expenses and about 60 percent of physicians’ expenses. In addition, most of the Blue Cross/Blue Shield group plans also cover home health care, the majority also cover hospice care, and about 30 percent also cover prescription drugs.     That part of the medical bill left over after the insurer has paid its fraction is called your co-pay. Co-pay is done two ways, by co-insurance and by deductibles. Co-insurance is usually stated as a percentage of an annual bill: you are usually responsible for 20 percent of eligible medical expenses each year. After that, the company pays all eligible medical expenses. Deductibles are usually stated as an amount of money that you must pay before the insurance company can be billed: you must pay, for instance, the first $25 of any bill.     A second limit on what groups plans cover is that they will pay only for what they consider to be the customary charge for a service. For example, an office visit may be billed at $50, the customary charge (based on area charges by physicians for comparable services) may be $40, the coverage may be 80 percent of the customary charge, or $32, so your co-pay for this bill will be $18.     A third limit is not so much a limit as an incentive: some plans from Blue Cross/Blue Shield provide you financial incentives to choose specific “participating physicians” or Preferred Provider Organizations (PPOs). In other words, certain physicians or groups of physicians agree to lower their fees, thereby also reducing the cost to you. In general, however, the group plans offered by both commercial insurance companies and Blue Cross/Blue Shield allow you considerable freedom of choice: you can choose your own physician and hospital.     A fourth limit: most group plans limit—or cap—total lifetime payments at $1 million or $2 million.     Most insurers periodically renew their policies with employers. Most policies are conditionally renewable, meaning that insurers can refuse an employer’s request to renew the policy only if the insurer refuses to renew all similar policies in that state. This means that an employer cannot be refused a renewed policy because some employees have HIV infection. They may, however, increase the rates charged for coverage of the same services.     In spite of the limits, being enrolled in a group plan through your place of employment is obviously desirable. Because group plans spread coverage over many people, many of whom make few insurance claims, insurers can afford to cover you without requiring that you give evidence of insurability.     HMOs also offer group plans. HMOs provide comprehensive services for a fixed, prepaid fee. In other words, when you join a group plan offered by an HMO, you pay a flat, fixed fee for all your health care bills, regardless of how much health care you actually get. The good news about HMOs is that they finance nearly all medical care. In particular, Kaiser, the largest HMO in the United States, provides a comprehensive program of services for people with HIV infection.     The bad news about HMOs is that, unlike commercial insurance companies and Blue Cross/Blue Shield, HMOs allow little choice in physicians or hospitals. Because competition among HMOs for employer contracts is fierce, costs must be kept low. Consequently, the HMO must carefully regulate hospital admissions, expensive drugs, and expensive procedures and must preapprove any consultation or procedure done outside the resources of the HMO. If your physician refers you to a specialist outside your HMO, for instance, the HMO may rigorously review the referral and often deny payment. As a result, many participants lack confidence in the quality of the health care providers and are disappointed in the range of services the HMO provides. Do not be persuaded by HMOs’ advertisements that emphasize the services offered; in practice, many HMOs choose saving money over offering services.     You can find out the details of group plans by reading the policy or by talking to the claims and benefits office of the insurer that offers the policy. For details about group plans offered by HMOs, often the best source of information are the other people who use the HMO, especially those whose health care needs are complicated.*203\191\2*

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: DIABETES

by admin - July 13th, 2011

People who have diabetes have at least double the risk for development of some types of heart disease compared with the risk in the general population. Unfortunately the symptoms of-heart disease in many people with diabetes are less apparent than they are in those without diabetes. In the absence of these warning symptoms, diabetic people may be unaware that they have coronary artery disease. Therefore, aggressive efforts to both prevent and diagnose coronary artery disease are all the more important for people who have diabetes.Diabetes increases the risk for development of coronary artery disease in any of its forms ( angina, heart attack, or sudden death) and for vascular disease in other parts of the body. People with diabetes are also more likely to have silent (or painless) myocardial ischemia or heart attacks, so significant damage to the heart can occur before treatment is initiated.   *265\252\8*

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: WHO SMOKES—AND WHY?

by admin - July 3rd, 2011

The percentage of people in the United States who smoke has gradually declined during the past 2 decades. The probable reasons are an increasing awareness of health concerns, non-smokers becoming more outspoken and unaccepting of smokers, and more restrictions on  smoking in  public places. Nevertheless, nearly a third of men and a fourth of all women smoked in 1988. If current trends continue, by the turn of the century the prevalence of smoking in this country will be about 20 percent, but by then more women than men will be smoking. Although that is an improvement in the overall number of people smoking, it still will represent a large percentage of the population and a very large number of people.Why do people expose themselves to this risk? For many established smokers, the answer is that they have developed a repetitive behavior that is triggered by many cues—stress, meals, conversations on the telephone. Smokers also develop a physical need for the constituents of tobacco, especially nicotine, to function comfortably and to avoid withdrawal. This behavior pattern and addiction can be overcome.Despite all that is known about the dangers of smoking, an estimated 3,000 children begin smoking every day. More children are likely to die ultimately from cigarettes than from drugs or alcohol. Of course, future health problems seem remote or nonexistent to young people.When young people start smoking, underlying motives are likely to include a combination of factors such as peer group acceptance, rebelliousness against authority, and a perception that smoking imparts an image of jaunty individuality. Smoking has been considered by some to be an outward expression of exercising one’s rights. All of these attitudes have been capitalized on by advertising, but they are progressively changing. Increasingly, smoking is being perceived by young people and adults as an annoying, dangerous habit.*232\252\8*

HIV: WHAT TO DO WHEN-LUNG PROBLEMS

by admin - June 30th, 2011

Most infections of the lung, or pneumonias, regardless of their cause, have the same symptoms: cough, shortness of breath, and fever. In some lung infections, the cough is productive—that is, the cough produces sputum; in other lung infections, the cough is dry. Cough and shortness of breath may be accompanied by chest pain. The person with HIV infection should watch out for these symptoms and should seek prompt medical attention for them. They can be symptoms of complications that almost invariably respond to antibiotics if given early enough.     Cough and shortness of breath are relatively common symptoms of other medical conditions as well. Causes of these symptoms include asthma, bronchitis, and chronic lung diseases like those brought on by long-term smoking. When these symptoms occur in someone who has not previously had lung problems, when they are more severe than usual, or when they are accompanied by fever, the cause could be pneumonia. People with HIV infection get different kinds of pneumonias, but the most important are Pneumocystis pneumonia, tuberculosis, and certain common bacterial pneumonias.     The standard diagnostic tests for these symptoms include a blood count, a chest x-ray, and culture of the sputum. Additional diagnostic tests will largely depend on the specific symptoms and on the results of the first set of tests.
*105\191\2*

LABORATORY TESTS FOR KNEE PROBLEMS: COMPUTERIZED AXIAL TOMOGRAPHIC SCANNING (CAT SCAN)

by admin - June 19th, 2011

A CAT scan is a tubelike X ray that attempts to define the three-dimensional aspects of the bone. At one time, these machines were loud, clumsy, and uncomfortable, with the patient slowly moving through a long tube. With the new technologies, these machines are quieter and more comfortable, with the patient simply lying on the examining table as the scanner passes over him.A regular X ray provides a two-dimensional view of bone; a CAT scan can view slices of bone section by section. By piecing together these sections, the surgeon can get a three-dimensional view of the problem. A CAT scan is useful as a surgical tool in cases of bone cancer because it enables the surgeon to see the extent of the tumor embedded within the bone. Tibial plateau or distal femoral fractures are often scanned to better assess the three-dimensional nature of these injuries.*15\185\2*

WHAT’S HAPPENING TO OUR BABY GIRLS? (GREATER RISK)

by admin - June 6th, 2011

The fetus is then placed at even greater risk. According to Sandra Steingraber, biologist and author of Having Faith: An Ecologist’s Journey to Motherhood, “More profoundly, chemicals don’t even have to cross the placenta to cause harm. Some lodge in the placenta and create injury there. I For example, nicotine damages the placenta’s amino acid trans port system, which is used to ferry proteins from the mother’s blood into the baby’s. This helps explain why the babies of smoking mothers weight on an average of seven ounces less at birth. (Nicotine also passes through the placenta and into the body of the fetus.) Similarly, the industrial pollutants called PCBs alter the placenta’s blood vessels in way that reduces their flow, and the heavy metal, nickel, a component of car exhaust, interferes with the placenta’s ability to make and release hormones. In short, the placenta not only fails to keep the fetus out of harm’s way, it cannot even prevent itself from being damaged. Like any other living tissue, it is fragile.”*4/165/1*

I CAN HANDLE ANY CRISIS— I’M A MOTHER: ANOTHER CALL FROM THE MORTUARY

by admin - May 13th, 2011

It took over a week to get Tim’s body shipped down from the Yukon, and as we were preparing to have a memorial service, I received a phone call from the very same mortuary that had called five years before to the very day. The man’s voice said, “Mrs. Johnson, I’ve never had to do this before, that is, call the same family twice, but you’ll have to come up here and identify Tim’s body since he was killed in a foreign country.”As I put down the phone, I remembered that Tim had been killed in the Yukon. Where was the Yukon, anyway? I had heard about Sergeant Preston and his sled dogs in the Yukon, but where actually was it? I looked at a map and saw that the Yukon is one of the territories that belongs to Canada and that, indeed, it was part of a foreign country.I had made this trip to the mortuary five years before and thought then it would be a once-in-a-lifetime ordeal. Now I was driving there again on a hot day in August to identify another boy in another box. As I stood there in the same viewing room, jumbled thoughts raced through my mind: This is the same dumb carpeting they had five years ago, and the same dumb wallpaper, and I am standing here next to this same little man in the dark suit, looking at ANOTHER boy in a box. I can’t BELIEVE this is happening all over again!It all seemed the same and so familiar, as if it had happened to me in another life, or in a dream! I wondered if my whole life would involve coming to this same mortuary every five years to look at boys in boxes. When you have been hit by a truck while sitting in the front seat of a Volkswagen, there isn’t a whole lot left. You look at what they show you in the plain pine box, and then you sign another little paper saying this boy is your son, Tim. But in no way does he look like the son you have had for twenty-three years.Walking out of the mortuary that day, I could smell the fresh-cut grass and hear the crows cawing in the trees nearby. Suddenly I looked up and in the blue sky was an image of Tim’s smiling face. All around him it was bright gold and white, and he was saying to me, “Don’t cry, Mom, because I’m not there. I am rejoicing around the throne of God.”It was as if God had wrapped me in his special comfort blanket of love that day. I’ve never had anything like that happen to me before or since, but I think God knew I needed that special sparkle just then to remind me that He still loves me, that I am His child, and that He never leaves us in the midst of our pain.We had the memorial service for the boys, and many of Tim’s classmates from the Police Academy came and responded to the gospel message. Ron’s parents had also accepted the Lord earlier that week. Later, articles about Tim and Ron appeared in several Christian magazines. The heading of a story in Christian Life said, “THEIR DEATH WAS ONLY A BEGINNING.”We began to see that, although they never made it home to share personally, Tim had been right: God was using their story all over the world to bring others to Him.
Barb, You’re a Pro at ThisA local pastor visited us a few days after Tim’s memorial service. He knew about our previous loss with Steve and came to bring some words of comfort. His opening remark when I greeted him at the door was: “I’m not a bit worried about you, Barb, because you’re a pro at this!”A pro at what? A pro at losing another child? He probably meant that my inner strength would come from the Lord and I would get through it, but what he said came out uncaring and unhelpful, so lacking in understanding.In some ways, losing Tim was more difficult than losing Steve. We had some time to prepare ourselves for Steve’s passing. We knew for many months he was in a danger zone and the shadow of death was always on all of us. When it happened, it was a terrific shock, but still somewhat of a relief because the terrible apprehension was over.In many ways, Steve’s death was like having a loved one die after a long time of suffering with something like cancer or AIDS. Then you have some measure of time to prepare for it, and you have already dumped part of your cup of grief during those months. By the time of the actual death, it is like a lifting from the time of suffering, and you can begin to have closure.But in Tim’s case, there was no warning of impending disaster, no signal of distress. It was only his bright, happy voice saying he would be home in five days and then, WHACK! It was all over! One moment we were anticipating his arrival with excitement, and the next we learned he was in the presence of God. It had happened so quickly that there had been no preparation, not even a thought that his life would be snuffed out.We had many wonderful Christian friends who came to visit us and tried to be comforting. They said things like, “Isn’t it wonderful that Tim is with the Lord?” Well, yes, it was wonderful, but I wanted him HOME WITH US!Or, they would say, “How good it is that you have two other children left,” and I would nod, that, yes, that was good, but I wanted TIM! I would agree on the surface with people who were quoting Scriptures to me and wanting to make themselves feel better by having me zip up my anger and distress quickly. Inside, however, I wanted to escape from all of them and their nice little platitudes. I wanted to open—to lance— the big abscess inside me. I knew the verses they were quoting and I believed them, but the raw edges of my heart were still bleeding too much. I needed to grieve.To escape some of my “Ivory soap” Christian friends, I would drive alone at night to a dump a few miles away. I would park there and just sob, and sometimes even scream, to let out my pain. I would tell God how angry I was with these people for telling me how glad I should be that Tim was in heaven. I also told God how angry I was at Him for taking one so special and precious to me. This was my way of venting emotions that HAD to be released. God doesn’t say to grieve not; instead, His Word says, “… that you may not grieve as others do who have no hope” (1 Thes. 4:13, rsv).Looking back, I can see how Romans 8:28 and other verses that were quoted to me are all true. God is faithful, but the timing of these reminders was all wrong. Nice little plastic spiritual phrases don’t help people unlock their grief. It is better to just put your arm around a grieving person and say, “I love you—God loves you.” Beyond that, it might be best to just shove a sock in your mouth and keep quiet. Don’t try to reason with people in grief to persuade them to accept their loss. When a believer dies, it IS wonderful to know that person is with God, but at the moment when those who are left behind are bruised and bleeding, the simple truth is this:WHEN GRIEF IS THE FRESHEST, WORDS SHOULD BE THE FEWEST.For a couple of weeks, I went to the dump nightly to rid myself of my grief. In recent years, the dump has been closed at night because so many people were getting mugged, but I believe God protected me when I was making my trips. By going there to grieve, I was able to come back to face my Christian friends who were spouting little spiritual platitudes that didn’t work for me.How to Dump Your Cup of GriefRecently I met a lady who sells clothing in a department store. She told me that she had experienced the loss of a child and she couldn’t work or wait on people because the tears kept coming all the time. She was a Christian and yet she hadn’t been able to stop grieving. I shared with her a little plan that could help her “accelerate” her emotions:”Get some sad music tapes, the saddest you can find,” I told her. “Make sure everyone is out of the house, then go to the bedroom, unplug the phone, turn on the sad music, flop on the bed and just SOB. Set a timer for thirty minutes and during that time cry and pound the pillow. Let out your feelings— VENTILATE. If you’re angry at God, that’s OK. He won’t say, ‘Off to hell with YOU.’ He still loves you. But get those deep hurts out through the avenue of tears. Do that every day for thirty days and every day set your timer for one minute less. By the time thirty days have passed, you will have DUMPED a lot of your cup of grief.”Not long after I talked to her, the lady called me and said she had been taking my advice for only a week, and already she felt a lot better. She was to the point to where she could get through a whole day without the tears coming continually.If you are experiencing difficulty in breaking open that deep abscess you have inside, perhaps this simple plan may help shorten your time of grief. There is no set amount of time to grieve that is considered proper or spiritual. But whatever time you need, “accelerating your emotions” may help you drain some of that pain and begin the road to recovery. The important thing is to have a closure time on your pain. Keep Psalm 84:5-7 ever in mind:Happy are those who are strong in the Lord, who want above all else to follow your steps. When they walk through the Valley of Weeping, it will become a place of springs where pools of blessing and refreshment collect after rains! They will grow constantly in strength and each of them is invited to meet with the Lord . . .” (tlb).After Tim’s memorial service in August, what helped me through the next few months was my continuing to try to help other people who had lost children. Now our ministry expanded beyond parents of Vietnam casualties, and we started talking with mothers and fathers who had lost their children in auto accidents or in other ways. I began speaking to parents’ groups, telling them that the pain of losing two sons is incredible, but God’s comfort blanket of love is still sufficient. I even got to the place where I could say that I was grateful for two deposits in heaven. We had been through dark times, and we had survived! What I didn’t know was that total blackness was yet ahead of us.*11\316\2*

FUNGAL INFECTIONS: ONYCHOMYCOSIS

by admin - May 3rd, 2011

Onychomycosis is a fungal infection of the nail bed, matrix, or plate. It accounts for one third of fungal skin infections and one half of all nail dystrophies. Infection is more common in toenails than fingernails and is usually associated with tinea pedis. Infection can be caused by dermatophytes and other molds as well as by yeasts.Infection usually starts at the distal, free edge of the nail. The edge of the nail is discolored white-yellow-brown and an accumulation of subungual white hyperkeratosis lifts the nail from the bed. The nail surface itself can become rough, furrowed, and brittle, especially in Candida infections. If all nails are affected, the dystrophy is likely noninfectious (i.e., psoriasis, lichen planus, trauma). If diagnosis is in doubt, fungal infection can be confirmed by potassium hydroxide preparation or culture.Treatment of onychomycosis can be very challenging. Topical treatment even with newer agents such as ciclopirox (Penlac), rarely achieves cure. Systemic regimens can be effective, but relapses, drug interactions, and hepatic or hematpoietic toxicity are common. Terbinifine (Lamisil) 250 mg daily for 6 (fingernails) to 12 (toenails) weeks is very effective, but complete blood cell count and liver enzyme tests must be monitored. Itraconazole (Sporanox) is also effective in a 6- to 12-week regimen of 200 mg daily. Liver enzyme tests should be monitored with itraconazole as well, but not when using pulse therapy. Pulse therapy is itraconazole 200 mg daily for 1 week during each of 2 to 4 months. There is also an effective pulse therapy regimen using fluconazole (Diflucan), but this is not approved by the Food and Drug Administration. Fluconazole 150 to 450 mg once weekly is given for 3 to 12 months. Liver enzymes need not be monitored when prescribing fluconazole.The true relapse rate of onychomycosis is difficult to measure. If culture was not initially performed, it should be done for relapses before another treatment is considered. Controlling moisture and tinea pedis may help prevent relapses.*116/348/5*

SKIN CARE: USE OF EXTERNAL AGENTS

by admin - April 27th, 2011

The use of external agents for the treatment of skin complaints has gone on from time immemorial. There are very few substances that have not been employed in this way, and the old herbal books are full of such recipes. All kinds of leaves were used in this manner; fruits were pulped up and applied, and the same was done with various vegetables. It is true to say that there is not a fruit or vegetable that was not supposed to have some special healing virtue, which, when used on the ailments of the skin, would exercise some miraculous curative power. Fresh blood, manure, cobwebs, among many other things, have been employed in such treatment.Many of the ointments and external applications which are used today have their origin in these primitive notions of the skin and its diseases. The conception that lay at the back of these methods was that healing power existed in things outside the body and that unless they were applied there was no other way of healing. The fact that the body was a self-regulating and self-healing organism was a concept that was not appreciated until more careful study and observation had been made of the various diseases – when, indeed, our minds were freed from the notion that some evil force lay behind all disease.With our long history of belief that disease can be cured by the use of external agents it is not easy for us to free our minds of such a concept, and that is the reason why so many people still cling so tenaciously to the thought that ointments and the like axe necessary in the treatment of skin diseases. They find it very hard to believe, in spite of the advance of scientific knowledge, that the treatment of disease may be placed on a rational basis. Because of their misplaced faith in external cures they lose sight of the fact that without its own inherent healing power and immunity the body would be unable to adapt itself to the forces that constantly assail it, and if we had to be responsible for the innumerable minor cuts and abrasions we should be spending all our time trying to heal them. The same fact applies to skin complaints. The body has within itself the power to heal them; what we have to do is to build up the general health of the system so- that the healing may be carried out.
*25/154/5*

MENOPAUSAL SYMPTOMS: VITAMINS & SUPPLEMENTS, HERBS AND MORE

by admin - April 10th, 2011

Vitamins and supplements (daily)E – up to 1,200 IU (stimulates production of estrogen)B6 – up to 100 mg.Brewer’s yeast – 3 to 4 tbsp.A – 50,000 unitsВ1 – 50 mg.Calcium lactate – 3 tabletsPABA – up to 100 mg. (natural substitute for estrogen)B-complex, natural, high potencyPantothenic acid – up to 100 mg. (can help delay menopause)Bone meal – 3 tabletsKelp – 3 tablets or 1 tsp. of granulesBetaine Hydrochloride – 1 tablet after each mealWhey powder – 2 tsp.С – up to 3,000 mg.Cod liver oil – 2 tsp. or 4 capsulesCold-pressed vegetable oils, such as sesame or olive oil
Juices Freshly made juices of fruits and vegetables, in season.
Herbs Honduras sarsaparilla, licorice (Aletris Farinosa), unicorn roots (Helonias Dioica), elder. All these herbs contain the natural female sex hormone, estrogen, which to some degree can help compensate for diminished hormone supply due to menopause.
Specifics Vitamins E, С, А, В, and B6, brewer’s yeast, PABA, pantothenic acid, mineral supplement, licorice, unicorn roots, elder.
Notes:Lately, it has become popular to take estrogen (female sex hormone) to prevent or postpone menopausal symptoms. Although hormone therapy is apparently quite successful and will, in many cases, help the patient to feel and act younger, the majority of biological doctors do not recommend it, mainly because of its possible carcinogenic effect. If, however, estrogen therapy is undertaken, it should never be administered at the same time as vitamin E therapy, which is recommended in this section – ingestion of estrogen and vitamin E should be separated by several hours. Also, generous amounts of vitamins B6, C, PABA, folic acid, pantothenic acid and Bi2 will render estrogenic hormones more effective.
*2/103/5*

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