The Pump. An insulin pump is a medical device continuously delivering insulin under the skin through a catheter. It’s usually connects somewhere in the waist area. There’s a new generation of insulin pumps, called a patch pump. Currently patch pumps are only available from OmniPod. Patch pumps adhere directly to the skin with no catheter tubing showing. It then infuses insulin directly under the skin.

Either pump delivers insulin at an hourly rate. For instance, the rate might be 1.1 units an hour. However, the pump delivers different rates at different times of day depending on the patient’s insulin infusion (or basal) rates that are programmed into the pump.

The amount of insulin delivered depends on two things. First by the amount of carbohydrate a patient eats using an insulin to carbohydrate ratio, and then by the correction factor, or the ratio of the number of milligrams per deciliter (mg/dl) a patient’s blood sugar will be lowered by one insulin unit.

If a patient eats 60 grams carbohydrate at meals and has an insulin-carbohydrate ratio of one insulin unit to 15 grams carbohydrate, the patient’s insulin injection at that meal would 4 units. However, if a patient has a correction factor of one unit to 50 points of blood sugar, the pump should give an additional injection of 2.5 units to lower his blood sugar from 245 mg/dl to a needed level of 120 mg/dl.

Pump Candidates’ Skills. To use an insulin pump a patient must be able to manage it. This involves knowledge at several levels. First, patients must understand how to insert the catheter when using the pump, or how to attach the newer patch pump to their abdomen. They must also be able to push the right buttons on the pump to deliver proper insulin doses and adjust the basal rates. Then the patient needs to be skilled in carbohydrate counting so they are able to deliver correct insulin doses at mealtimes. And they should be willing to check their blood glucose levels at least four to six times a day. This assures that they detect a pump failure and prevent hyperglycemia and diabetic ketoacidosis (DKA, in type 1 patients). Patient attention is important because no long-acting insulin is used in type 1 patients who use pumps and they need to correct high- or low-blood sugars before they are clinically observable and symptomatic.

Medical Necessity. Insulin pump therapy is almost never needed to maintain life because insulin can be easily injected under the skin. Most insurers will cover insulin pump therapy in situations where insulin pump therapy will significantly improve the level of diabetes care and control over and above multidose insulin (MDI) therapy. This includes cases where:

The glucose control in multidose insulin therapy is not optimal with glycated hemoglobin (Hba1c>) than the ADA (American Diabetes Association) recommended goal of 7%. An endocrinologist, who will be able to help the patient learn how to use and the pump and adjust basal and correction doses, prescribes the pump.

The patient has type 1 diabetes. However, in many situations patients with type 2 diabetes will benefit from the pump as well. (See Diabetes Care, Sept. 2003, pp. 2598-2603.) Presence of hypoglycemia despite adjustments in insulin doses and utilizing carbohydrate counting to help decide pre-meal insulin doses in patients who are using MDI therapy.

• Presence of hyperglycemia-especially as revealed by high morning readings (Dawn phenomenon) where increasing basal rates of insulin in the early morning hours would help to better control blood sugar levels.

Insurers require medical charts from the prescribing doctor as well as blood sugar logs from the patient to prove that there is real medical necessity.

I’ve got a leaky right eye. It doesn’t hurt, but it’s a nuisance so I made an appointment with the ophthalmologist. The receptionist told me that I’d need a driver because I’d be blinded to some nebulous degree; my Aunt Pat and Uncle Don graciously offered to taxi me and watch my 10-month old son, Jonah, while I was in with the doc.

Early one snow-squally morning, we all arrive at the giant, megaplex office. Thank God they have a children’s playroom, because Jonah has been walking since he was 8 months old and can be quite the handful if left to his own devices.

When they call my name, I hand Pat the stocked diaper bag and breathe a prayer that Jonah avoids pitching a Class-A fit. Jonah, thankfully, doesn’t see me leave the room because he’s too busy trying to stuff a germ-ridden playroom toy into his mouth. So far, so good.

First I’m led into a room containing what looks like a dentist’s chair. There the nurse sits me down and performs the standard eye chart test. (Is there any sighted person who can’t read that big-ass “E”?) Then she tells me the doctor will be right in. I sit there waiting: calm, ready to be examined, and altogether ignorant of my fate.

Shortly thereafter, the doc himself appears: Ophthalmologist Extraordinaire, maybe 30 years old, looking slightly bored. He takes an obligatory glance at my chart and then asks why I’m there.

“My right eye is leaking,” I tell him. “Actually, it’s watering right now,” I add helpfully.

He nods, turns, and writes something on the chart. I can tell right away that this doctor was not head of the Bedside Manner 101 class at the University of Ophthalmology.

After a few more questions, he repeats the eye chart test and tells me that he’s going to put numbing drops in my eyes. The word ‘numbing’ is a bright, clanging alarm bell. I don’t think my eyes have ever been numb before, and I really don’t want to participate in any activity that’s going to require loss of feeling in my ocular region.

“Are you going to do that test where there’s a loud noise and a puff of air blasts into your eye?” I ask hopefully. I’ve had that test before, and the puff of air scared me but it didn’t hurt at all.

“No.”

No explanation or alternative answer. Just no.

Quickly, as if guarding against any possibility of my escape, he guides my head into the metal torture-chamber-looking contraption. A machine comes whirring toward me and I valiantly attempt to stay calm. Hold my breath. Trust. Suddenly I can tell that something is touching my eyes, but I can’t really feel it so it’s not that bad.

I sit back in the chair and he again writes something in the folder.

Out of nowhere, slowly but with ever-increasing speed, I become Juliet after drinking her poison. I’m shaking…my vision is clouded with angry, furry, marching black clouds. My hands join my eyes in the heavy slump of the numb.

“I don’t feel so well,” I manage to whisper, whimpering like a 4 year old. “I’m very dizzy.”

I break into a sweat and begin to swoon. I ask for the garbage can and lean over it quickly, ropes of my instantly saturated hair hanging limp against its blessed coolness.

The fight begins: Puke vs. Pass Out. I can feel the darkness take me but my stomach wants to heave first. Puke and Pass Out battle, locked in combat. With a mighty effort, Puke is abruptly victorious and I vomit.

Eventually I lift my head, a string of drool stretching from the can to my trembling lip. “What’s happening?” I gasp, convinced I am dying.

Ophthalmologist Extraordinaire hands me a lukewarm, wet towel for my forehead and pauses. He mutters a Greek-sounding medical phrase and settles himself more comfortably on the stool. I am not looking at him but I can clearly envision him frowning. Sighing. Checking his watch.

He repeats the strange medical term and adds blandly, “You’ve had a very rare reaction to the stress test. Usually it happens to males, not females.”

Females? Am I a laboratory rat?

Mr. Pass Out comes knocking again. I concentrate on breathing deep and begin to feel a little better. Meanwhile, the doc has snuck up alongside of me and is adjusting my chair. Without warning I am guided backward until I am practically lying down. The black clouds regroup for another storm, so I resist this new position and try to sit up.

“I’d rather sit forward,” I protest weakly. I remember feeling faint in elementary school, the school nurse telling me to drink some water and put my head between my legs. “May I have a glass of water?” I add pitifully.

He starts, as if from a reverie, and nods. “Sure.” He returns about seven minutes later with a very full, heavy glass of almost-hot water.

Then he tells me he’s going to leave me alone for a little while to relax with my hot water cocktail and my garbage can, because he has a few more things he needs to do but wants me to rest first.

As he exits the room it occurs to me that I have no idea whether ten minutes or one hour has passed. I perk up my ears for the telltale sound of Jonah’s wail, but hear instead a blessed silence.

When the doc returns, he smiles vaguely as though nothing has happened. I survive the eye dilation drops easily enough because this time I suggest that he kindly explain to me what he is going to do before he does it.

After this, he flatly states that next on the agenda of fun-things-to-do-in-the-doctor’s-office is a procedure they like to call STICKING A NEEDLE IN YOUR EYE. “I’ll inject saline into your tear duct opening,” he explains, “and if you can’t taste the saline, I’ll know the duct is blocked.” In the distance, I hear Jonah’s distinct cry and wonder if he can somehow sense his hapless mother’s distress.

Gulping, I ask what happens if the tear duct IS blocked.

“At a later date, I’ll perform surgery and make an incision through the bone in your nose to open up the duct.”

I feel a sudden rush of empowerment.

There is no way this man is going to stick a needle in my eye, let alone perform surgery on me.

I ask if people ever just live with this leaky-eye thing. The doc shrugs. “Sure they do,” he says. Without any hesitation whatsoever I tell him that I am going to be one of those people. I have taken control of my situation, and it is good.

We end the appointment after the doc mentions that I need to come back in a year for a check-up. I nod and rise from my chair to answer Jonah’s crescendoing cry of distress.

Inside, though, I am laughing - albeit weakly - for I am certain that I will never again willingly encounter him in any kind of patient/doctor capacity.

For many of us, a visit to the dentist can be a stressful and traumatic experience.

Granted, today’s dentistry is relatively painless, but nevertheless the fear of a needle (the anesthetic injection) and a drill whizzing at nearly the speed of sound in your mouth could un-nerve even a gladiator.

There are some pre-visit preparations that you can engage in, and also some calming herbal teas to bring you closer to a quiet state.

We all worry, as Mark Twain said, “about many things that never come to be”. Here we shall tell you how to prepare, and behave at the dentist. Age, sex, and strength have nothing to do with it. The mighty elephant fears the lowly mouse.

First of all, its best to book your dentist appointment in the morning. Your nerves will be the calmest after a night’s sleep, and the stress of the day will not yet be upon you.

During the breakfast the morning of the appointment, avoid coffee, and tea. Instead, make an infusion (soaked herbs in hot water for about 20 minutes) of fresh mint leaves.

This will have the effect to lower your blood pressure, and calm the nerves. It acts almost as a tranquilizer.

Eat also sparingly, something like dry toast and some fruit. Leave your stomach half empty. Set out for the dentist, but repeat to yourself that you are in command of your nerves and not your nerves in command of you! Be resolute.

Arriving at the dentist, while waiting for your appointment, continue with your affirmation, close your eyes and try and relax your body by deep breathing; inhaling from the nose and exhaling from the mouth. Practice until you are called.

Arriving to the dentist, express your anxiety, and the steps you have taken to alleviate it. If allowed, ask the dentist if you can listen to an MP3 player (yours or the dentists), during the procedure.

Most dentists will permit this, as they know that the music will divert your attention away from the mouth and teeth, thus reducing pent-up fear. If the dentist is in agreement, fit the player’s earphones to your ears and lay back.

The dentist may need to speak a bit with you before this happens, but when the dentist begins, its best his or her attention is on your teeth and not your fears or problems.

At this point, turn your palms up on the dentist’s chair armrests. This is very important, as it will prevent also your muscles from tensing. You are forcing your body to relax, even if you mind would keep it tense. All though the procedure, remember to keep you palms facing upwards.

If you need anesthesia, keep your eyes closed. The syringe is by necessity very large, and the needle long. Your dentist will usually put a pre-anesthesia gel on your gums so the injection itself is not painful either. Its best to keep your eyes closed.

As the anesthesia starts working, concentrate on your music, and not the dentist. He or she knows what they are doing and you should be confident of them, or you should not be at that dentist.

Make sure your MP3 tracks will cover the whole of the session. Dentists don’t like to work more than two hours without a break, and for good reason. They become fatigued themselves, as well as their patient.

If you are still stressful into the procedure, ask to practice once again your breathing and relaxation technique.

Go back to the chair with resolve that you are in command of your nerves and not your nerves in command of you.

Believe it, and it will be true. This break will refresh you and the dentist as well, and know it will quickly be over.

Keep in mind a special treat for yourself at the end of the day; as a reward for conquering your fear and anxiety.

Have this in mind as the dentist is in the last phase of your appointment. You will feel relieved only at the thought only.

Hospital spread infections are on the rise. There are many reasons for this ever increasing epidemic, and it is going to be up to each one of us to protect ourselves.

Let’s face it, many hospitals are under staffed, making it harder for the nurses and doctors to perform all of their duties in a safe and practical manner.

Sure, you will always have those that do not perform their duties to the fullest making neglect another reason it is imperative that you take charge of your healthcare. You need to have some say so in how your treatments are managed, especially when mistakes could cripple or even kill you or your loved one.

The Centers For Disease Control reports that 2,000,000 patients will be affected by hospital spread infections. The sad part is that over 90,000 will die. You go to the hospital to get well not to get sick.

Awareness of the problem is the key to defending yourself. Once you are aware, then you need to act. Act by gaining knowledge on how to protect yourself or your loved ones.

You must know the basic methods for maintaining the proper care of your I.V. It all starts with proper hygiene. Proper handwashing is mandatory if we are to fight these infections. Do not, let any one at all come into your hospital room without first washing their hands. This must be done with an alcohol based cleanser or one approved by the hospital, and hands need to be washed for at least 30 seconds. This may sound like unnecessary precautions, but if it will keep you from extra days in the hospital or crippling side effects, it is worth it.

Did I mention that you must take charge? Do not go to the hospital and feel intimidated. Who pays if you get an infection that makes you miss work, keeps you away from your family, keeps you from getting on with your life? You do, your employer does, your family suffers, insurance companies will raise rates to make up for the extra expenses, which means we all pay in the long run.

Make your I.V. your lifeline not your deathline. Sterile technique must be used before and I.V. is installed and anytime it is accessed. Have your doctors and nurses write in your chart to use sterile techniques. Hang signs on your door telling all who enter to wash their hands first. These are very simple measures to insure that you get in, get out, get on with your life.

Take charge now before it is too late. Your actions may reduce pain and suffering, and most of all may save a life.

Arm yourself with the necessary weapons needed to fight infections. Discover how to help your child through the traumatic experience of getting an I.V. Learn how to take charge and have some say so in your health treatment. You have been made aware of a serious problem, how will you react? React now to avoid becoming a victim.

Fight back do not lay down. Stand your ground, do not let infections ruin your life.

Overweight and Obesity some times become life threatening. In spite of this one half of American population is overweight. Even children and teenagers are not spared.

Actually, tendency to be overweight and obese begins during childhood. These over weight children start to gain more weight during their teenage as they grow up and become unbearably overweight when they become young. Being overweight, when they reach their middle age, they become disease prone. Lot of studies has been carried out regarding the tendency to be overweight for American children.

Uncontrolled food habit and tremendous dependence on fast food along with cola drinks found to be one of the major causes for these maladies.

Doctors are regularly warning us against becoming overweight. But who cares?

However, Pharmaceutical units are nor sitting idle. They are spending millions of dollars in search for effective and sustainable medicine against overweight and obesity with minimum side effects. As a result, a number of very much effective Weight Loss Drugs have come out for rescue of the overweight persons.

Thanks to the continuous advertisements of these Diet Pills, people are becoming conscious and at present there is a craze to be slim with these Diet Pills.

Why is this craze for weight loss drugs? The other weight loss means are not that attractive generally to common persons as they include either or all of rigorous exercise, very much controlled diet and leaving all bad habits like smoking, uncontrolled drinking etc. But every one knows, that a habit once adopted is very difficult to abandon. Similarly if we are habituated to excess eating, it is difficult to avoid, as the systems in the body has adopted to it and urge for food is more for these overeating persons.

So what is the way out? If some how we were satisfied with low eating, our body weight might have reduced due to less eating! There are miracle oral drugs, which are doing the same thing and are called Appetite Suppressant.

Phentermine Diet Pills are very much popular Appetite Suppressant Diet Pills, which has proven itself to be very much effective for one’s weight loss programs.

Adipex is one of the popular brand weight loss drugs of Phentermine group Didrex and Ionamine are also Phentermine group of diet pills. Remember, all Phentermine Diet Pills are prescription drugs and a doctor should always be consulted before going for Phentermine Diet Pills. You should avoid hazardous and complicated work like driving, operating machinery etc. when you are under treatment for weight loss with any of the Phentermine Diet Pills.

Also, there are some side effects of taking Phentermine Diet Pills like dizziness, blurred vision etc.

In my opinion, if the obesity level reaches a danger level but the body is suitable in other way to adopt Phentermine Diet Pills, it can be taken as short-term use in order to get some immediate relief from the danger of overweight and / or obesity. The weight loss drug, if taken under advice of a doctor, will be really a savior when the obesity and over weight are at a danger level.

If you want a cure for cancer, heart disease, Alzheimer, or diabetes, don’t count on the academia, the National Institute of Health (NIH), or the biotech/pharmaceutical industry. With all the money they have spent on researching these diseases, they have very little to show for it.

In 1971, during the State of the Union address, President Nixon declared the war on cancer proposing “an intensive campaign to find a cure for cancer.” Since 1971, Americans spent, through taxes, donations, and private R&D, about $200 billion in inflation-adjusted dollars. This money produced 1.56 million papers on cancer. Yet, today we are no closer to a cure than we were in 1971. Why?

Consider what Dr. Almog said in his paper: Drug Industry in “depression” (Almog, D. Drug industry in “depression”. Med Sci Monit. 2005 Jan;11(1):SR1-4, I would urge you to read his paper, it’s an eye opener on relationship between academic research and commercial drug discovery): “When the basic science/biology of disease is not available, no new drugs come to market.” With the billion of dollars spent by the NIH on basic science, and the millions of papers published on the topic, the question is, “Why isn’t the basic science/biology of disease available? Individual discoveries in the biology of human disease are cornerstone in new treatments. However, in drug discovery, these basic science/biology discoveries are seemingly unrelated dots. To connect the dots you need a theory. The Blind Men and the Elephant is a famous story about six blind men encountering an elephant for the first time. Each man, seizing on the single feature of the animal, which he appeared to have touched first, and being incapable of seeing it whole, loudly maintained his limited opinion on the nature of the beast. The elephant was considered a wall, a spear, a snake, a tree, a fan or a rope, depending on whether the blind men had first grasped the creature’s side, tusk, trunk, knee, ear or tail. The story epitomizes the problem of the reductionist approach in biology. A recent book Microcompetition with Foreign DNA and the Origin of Chronic Disease, by Hanan Polansky [11], presents an alternative. The book identifies the disruption that causes atherosclerosis, cancer, obesity, osteoarthritis, type II diabetes, alopecia, type I diabetes, multiple sclerosis, asthma, lupus, thyroiditis, inflammatory bowel disease, rheumatoid arthritis, psoriasis, atopic dermatitis, graft versus host disease, and other chronic diseases, and describes the sequence of events that leads from the disruption to the molecular, cellular, and clinical effects.”

What are the implications of the NIH failure? A decline in the number of new drugs introduced by pharmaceutical companies. Consider what professor Taylor says in his paper: Fewer new drugs from the pharmaceutical industry (Taylor D. Fewer new drugs from the pharmaceutical industry. BMJ. 2003 Feb 22;326(7386):408-9): “In 2002 spending on medicines exceeded $400bn (£248bn; 377bn) worldwide. Optimists in the pharmaceutical industry believe that the global market for their products will go on expanding by around 10% a year, with the United States continuing to lead towards higher per capita outlays. Expenditure on research by the pharmaceutical industry is also increasing worldwide. It is now over $45bn a year—twice the sum recorded at the start of the 1990s—and projected to rise to $55bn by 2005-6. Concerns are growing, however, about the productivity of research being funded by the major pharmaceutical companies. … Empirical evidence indicates a crisis in productivity in pharmaceutical research. The number of medicines introduced worldwide that contain new active ingredients dropped from an average of over 60 a year in the late 1980s to 52 in 1991 and only 31 in 2001. The overall number of new active substances undergoing regulatory review is still falling.”

On the one hand, the expenditure on research is increasing. On the other, the number of new drugs is decreasing. The professionals call this situation the productivity crisis in drug discovery.

•1.5-2 Million People A Year Sustain Brain Injury From Motor Vehicle And Motorcycle Accidents, ,Falls, Sport Injuries, And Acts Of Violence
•500,000 Severe Enough To Require Hospitalization.
•50,000 Die From Complications Of Head Injury
•5.3 Million Are Living With Head Injury Related Disability
•most Common Among Males 15-24 And People Older Than 75.

These alarming statistics affects all communities. Since the advances of medical technology, health care has become more specialized and sub specialized. However, who does one see to help diagnose and treat a suspected head injury? A Family Doctor?…..A Neurologist?……A Psychologist?….A Radiologist?….What about a Neuropsychologist?…..So many to choose from, but which one would be most helpful?…..The answer is, they all offer an important piece to the puzzle. For example, Steven (a fictitious name of a patient) was 21-years-old, when he became involved in a motorcycle accident on Christmas day. An intoxicated truck driver collided with his motorcycle while making a left turn on a green light. Steven was ejected from the seat of his motorcycle and subsequently landed in the middle of the street. While he had no memory of the accident, eyewitness notified paramedics who took him to a nearby hospital. After 5 hours of being in a coma, he regained consciousness. While he did not sustain any major physical injuries, his family noticed a drastic change in his behavior and thinking. He lost his ability to read words, experienced difficulty with attention, concentration, memory, and behavior (i.e., short-temper, aggression, irritable, impulsive). According to his mother, his son had changed since the accident. She was desperate to find someone who could help him. Therefore, his mother took Steven to his family doctor who ordered some brain imaging diagnostic tests (CT and MRI scans) and referred him to a long list of specialists (e.g., neurologist, psychiatrist, and neuropsychologist) to clarify his condition. His mother wondered, about all these doctors….What did they do? How would they be able to help Steven?

WHAT IS A NEUROLOGIST?

A neurologist is a physician (MD or DO) who specializes in diseases of the brain and nervous system. Although they overlap a bit with psychiatrists because they share the same organ (brain), they tend to concentrate on physical manifestations of neurological problems, or problems related to abnormalities in structure or function of specific regions of the nervous system. They deal with brain, spinal cord, nerve roots, nerves, and muscles. Psychiatrists (also MD) deal with emotional and cognitive disorders, such as schizophrenia, depression, panic disorders, etc. A neurologist performs a neurological examination provides crucial information about the nervous system. It is a noninvasive way to find out what might be wrong. It typically includes an examination of the 12 nerves of the head and neck, reflexes, balance and coordination, muscle strength and movement, and mental status- awareness and response to the environment, appearance and general behavior, orientation, attention and memory. Neurologists also perform diagnostic tests, such as lumbar puncture, electroencephalography (EEG), and electromyography/nerve conduction velocity (EMG/NCV).

Based on the results of the neurological exam and the diagnostic tests (EEG, EMG, CT, MRI), a neurologist is likely to refer a patient with head injury to a Neuropsychologist for an understanding of which brain functions are impaired and which remain intact. A neuropsychological evaluation will reveal how the injury specifically affects thinking and behavior.

WHAT IS NEUROPSYCHOLOGY?

Neuropsychology comes from the Greek word “neuron” meaning “nerve,” the Greek word “psyche” meaning “mind,” and the Greek word “logos” meaning “the study of”. Put the words together and you have…. The scientific study of brain-behavior relationships and the clinical application of that knowledge to human problems…In simpler terms, Neuropsychology is the study of how different disorders of the brain (i.e., traumatic brain injury, concussion, aneurysm, stroke, dementia, tumor, etc) affect a person’s thinking, emotion, and behavior.

WHAT IS A NEUROPSYCHOLOGIST?

A Neuropsychologist typically holds a doctoral degree (PhD) in Clinical Psychology/Neuropsychology from an accredited university or professional graduate school, A Neuropsychologist may also have completed additional graduate level coursework in Neurosciences, such as Neurology, Neuroanatomy, Neuropathology, Neuropsychological Assessment, Neuroradiology, etc. He/she must be a licensed psychologist with specialized training and experience in the field, which include predoctoral supervised Internship in psychology and Neuropsychology, followed by 1-2 years of Postdoctoral Fellowship in Neuropsychology.

WHAT IS A NEUROPSYCHOLOGICAL EVALUATION?

A neuropsychological evaluation is a comprehensive evaluation of cognitive, behavioral, and emotional functioning performed using standardized tests and procedures. A Neuropsychologist uses a wide variety of paper/pencil and computerized tests that are very sensitive to even mild brain dysfunction. Typically the evaluation includes 60-90 minutes of clinical interview about your problems and background (childhood, education, occupation, family, medical and psychiatric history), followed by 4-6 hrs. of formal testing. The evaluation can be scheduled for a single day or divided into several days, dependant upon the fatigue level and time. In addition to time spend face to face, time is required to review records, score, interpret the tests and generate a report. This could add an additional 4-6 hours. At the completion of the report, the Neuropsychologist reviews the results of he evaluation with the patient and his/her family and makes treatment recommendations. A copy of the report is also forwarded to the referring physician and other health care providers.

WHICH MENTAL FUNCTIONS ARE GENERALLY TESTED?

A Neuropsychologist typically evaluates how the brain functions in the following areas:
1. Intellectual abilities
2. Attention/Concentration
3. Learning and Memory
4. Language
5. Problem solving, planning and organizational skills
6. Reasoning and Judgment
7. Perceptual and Motor Skills
8. Visual-spatial skills
9. Academic Skills
10. Emotion, Behavior, and Personality

HOW CAN THE RESULTS HELP THE PATIENT?

The results of a neuropsychological evaluation can help your doctor clarify weaknesses, differentiate among illnesses (Traumatic Brain Injury vs. Stroke vs. Alzheimer’s vs. Depression), establish a “baseline” before surgery or before problems are seen, plan treatment that uses strengths to compensate weaknesses. The results can also help the Social Security office determine if you qualify for Disability benefits. Following is a sample of some of the many questions that can be answered by a neuropsychological evaluation:
1. * Do I actually have brain injury?
2. What is the cause of my problems? Is it medical, emotional, neurological or stress?
3. ** All neurological, physical, and imaging (CT & MRI scans) tests are normal, why do I still
Have difficulties doing everyday things?
4. Would I be able to return to work/school, drive again, or play golf?
5. Am I getting better? How much? Is treatment helping me?

• * This is especially true following “mild” brain injury, when effects of an injury may be subtle and easily confused with other factors, such as stress, medications, or depression.
• **Just because a skull X-Ray pr CT/MRI scans of the brain are negative (normal) does not mean everything is fine. You can still experience difficulties in thinking, emotion, and behavior that affect your quality of life. Because CT/MRI measure structure, not function or behavior, a Neuropsychological Evaluation is recommended especially when problems persist.

Before pursuing a career in psychology, I worked as a CT/MRI scan technologist. It was during this time that I became interested in the brain-behavior relationships. Surely, a person with an abnormal scan behaved differently than one with a normal one? What is the relationship between brain dysfunction and behavior? Questions such as these piqued my curiosity and lead me on a career path to become a Clinical Neuropsychologist.

I obtained a B.S. degree in psychology and criminal justice, an M.A. in forensic psychology, an M.S. in Clinical Psychology, and a PhD in clinical psychology with specialty certification in neuropsychological assessment. I completed a predoctoral internship in neuropsychology at UC-Davis Medical Center and a postdoctoral residency training in neuropsychology at UC-San Francisco. Currently I am in private practice.

Crohn’s disease is an inflammatory disease that primarily affects the small and large intestine, but can be present in other parts of the digestive tract. The disease was named after an American gastroenterologist, Burrill Crohn, who was the first to describe the disease.

Crohn’s disease usually affects people in their teens or twenties, but there are cases where patients are struck with the disease later in life. The symptoms and severity of the disease vary from person to person.

At present, there are no medications that can cure Crohn’s disease. Most patients experience periods of relapse followed by periods of remission that can last months or even years. During remissions the symptoms like abdominal pain, diarrhea and rectal bleeding are lessened. The improvements in symptoms are usually brought about by prescription medications or surgery. There are cases, where without treatment, the Crohn’s goes into remission. No one knows why.

The goals of treatment are to bring about a remission, maintain it, minimize side effects from medications, and help to improve the overall quality of life of the patient. The medications for treating Crohn’s disease include anti-inflammatory agents such as the 5ASA compounds, corticosteroids, topical antibiotics and immuno-modulators.

Crohn’s Disease Medications

Crohn’s disease medications include anti-inflammatory drugs that are intended to decrease intestinal inflammation; the way arthritis medications reduce joint inflammation. The different types of anti-inflammatory medications used to treat Crohn’s disease are:

1. 5-ASA compounds such as sulfasalazine (Azulfidine) and mesalamine (Pentasa, Asacol, Dipentum, Colazal, Rowana enema, Canasa suppository) are used directly on the inflamed tissue.

Sulfasalazine is a prodrug that isn’t active in its ingested form. It is usually broken down by bacteria in the colon to create two byproducts —5aminosalicylic acid (5-ASA) and sulfapyridine. No one is sure which of these byproducts is responsible for the activity of azulfidine. The 5-ASA is known for its therapeutic benefit, though it’s not clear whether sulfapyridine offers any additional benefit.

5 aminosalicylic acid and sulfapyridine work as anti-inflammatory agents that treat the inflammation in the colon. The effectiveness is believed to be due to the local effect on the bowel, however there are also some beneficial systemic immune suppressant effects as well.

But like any medications 5-ASA is not without side effects. Some of the side effects are very frequent gastrointestinal disturbances. Nausea, vomiting, gastric distress and anorexia occur in about one out of every three patients. Likewise dizziness may also occur during but should be of little concern unless it becomes persistent.

There are also some less common side effects such as a drop in white blood cell counts or a type of anemia that happens more often in patients with arthritis. The chance of developing these side effects is about 6 out of every 10,000 patients. Some other rare, but possible side effects include fever, pale skin, sore throat, fatigue and unusual bleeding or bruising. If you experience any of these, you will likely be taken off the medication.

Additional side effects include headache, allergic reactions and photosensitivity. These side effects require medical attention since allergic reactions can cause difficulty swallowing, blistering, peeling, loosening of the skin, aching joints and muscles as well as unusual tiredness or weakness.

2. Corticosteroids act systematically without requiring direct contact with the inflamed tissue. These medications are used to decrease inflammation throughout the body. These drugs also have important, and dangerous side effects, if taken for long periods. You doctor can advise you best on this.

There are new classes of topical corticosteroids that are applied directly to the inflamed tissue. These new drugs have much fewer side effects compared to systematic corticosteroids.

3. Antibiotics such as metronidazole (Flagyl) and ciprofloxacin (Cipro). These medications decrease inflammation by unknown mechanisms.

Metronidazole is effective in killing anaerobic bacteria as well as certain parasites. Anaerobic bacteria is single a cell organism that lives in low oxygen environments, and causes disease in the abdomen, liver and pelvis. In terms of parasites, giardia lamblia and ameba are parasites that cause abdominal pain and severe diarrhea in most patients. The metronidazole blocks some of the cell functions of these parasites resulting in their demise.

Serious side effects of metronidazole are rare, but include seizures and damage to nerves that brings numbness as well as tingling in the extremities. If you have these side effects, contact your doctor at once, you’ll need to stop taking this medication.

Customers’ demands have grown in Trinidad and Tobago, thanks in large part to exposure brought about by more frequent travel, the Internet and to some extent cable television. Many local businesses don’t however realise that they too can right now satisfy sophisticated demands by using technology already available here. Take for example private clinics. I recently had the pleasure of spending some time at a local private clinic and here are some simple ways I saw that they can improve their service drastically:

The fee schedule, terms and conditions, visiting hours, what to bring from home and all the Frequently Asked Questions could have been placed on a website. This would free up phone time for the nurses who could then concentrate on nursing. Pictures of the rooms on a website would reduce the time the nurses spent giving potential patients “the tour” and showing what the shared rooms look like and what the private rooms offer.

Now here’s one that would really make a local private clinic stand out: a password-protected webcam section. If a single mother has to work during the day while her infant is in the clinic, wouldn’t it be great if she could enter a password-protected area of the website to see what’s going on with her loved one?

All of the above and more are possible right now at affordable prices. So if you know any private clinic owners, you might want to share this newsletter with them.

Now let’s look at the marvels doctors can accomplish through the Internet. You may already know that it’s happening right now in developed countries that doctors tap into each other’s expertise over the Net through teleconferencing, webinars and more. You may have even heard about “distance surgery.”

While those are great, here’s one simple way the Internet can immediately help medical doctors, dentists and veterinarians to improve their practices. Apart from adding value to their practices, the following will increase the numbers of highly satisfied patients as well as generate additional income. You know what, it could even become a long-term retirement plan for doctors. So be sure to tell your doctor about this:

Typically a patient may have a small question after a doctor’s visit that would not warrant a second visit. So how about if your doctor had a website where you could login and post your medical question anonymously. The doctor could then answer, and not only you but all patients could see the response. A sort of forum could be created for patients only and answers could be found to all sorts of doubts. Of course this would all be done in a secure online environment for which you would need a username and password and the questions can be posted anonymously by members. True, this may not work for all issues but it would definitely work for many of the trivial ones, and patients could be charged a small yearly retainer’s fee to have their questions answered on this service. So the doc even gets paid extra for the “after sales support.”

This information is designed to help you better understand HIPAA and to assist your office in becoming HIPAA compliant. The information was obtained from a variety of sources and is not intended to be legal advice. If you are having difficulty understanding any portion of the HIPAA regulations you should consult your legal counsel. First, there are no HIPAA police. No one is going to come into your office to inspect you to see if you are HIPAA compliant. A complaint must be filed in order for any action to be taken.

What is HIPAA?

HIPAA stands for The Health Insurance Portability And Accountability Act. It was enacted by the federal government in 1996 as part of a healthcare reform effort. HIPAA is intended to ensure confidentiality of all patient related health care information. It also intends to simplify the administrative processes of health care, thereby reducing the costs and administrative burdens of health care.

One thing to remember is that the HIPAA Act uses the word “reasonable” several times. You and your office staff must do whatever reasonable to protect your patient’s privacy. For instance, smaller medical offices do not have to take the same privacy measures as large hospitals do. That would not be reasonable.

Also, there are no “privacy police.” No one is going to come in and inspect your office randomly. Someone must file a complaint first. The complaints will be handled by the Office of Civil Rights. If someone puts in a complaint, then it will be investigated. The fines are very high, so you will want to be sure that your office has good privacy practices and that they are followed all of the time.

Another thing to keep in mind is that the type of your practice may determine the level of privacy that you need to acquire. For example, patient’s in an optometrist’s office may not be as concerned about people knowing they are there, as opposed to patient’s in a mental health office. There are several different components of HIPAA, each one having its own implementation date.

Section 2: The Privacy Component : implementation date: April 2002

1. You must do everything within reason to protect your patient’s privacy.

2. Patient’s files and information should be kept in a secure section of your office, a section that is not accessible by other patients.

3. Charts should not be left lying around, open where someone can read it.

4. If you are making a phone call about a patient or to a patient, you need to do it from an area where you cannot be overheard if you will be giving out personal information. For example, if you are calling their insurance company, and you will be saying the patient’s first and last name, date of birth, ID#, and/or a diagnosis, then you do not want to do it where others, perhaps in a waiting room, can hear you.

5. If patient’s charts are ever removed from the office you need to have a policy in place. For example, you should have a sign out sheet which states the patient’s name, date taken, by whom, and then signed back in when the chart is returned.

6. If charts are removed , they should be carried in a case that is marked “confidential - medical records.” If you were ever involved in an accident, or separated from the bag for any reason, either authorities or medical personel would secure the information for you. Or you would have at least done whatever reasonable to protect that information.

7. If computer screens are in a position that patients can view them, you may want to move them, or get a screen cover. A screen cover makes it so that the computer screen can only be read when directly in front of it. The above are just some things that you will need to consider when becoming HIPAA compliant. Each office will have it’s own areas that need to be reviewed. The above are many of the common areas.

Section 3: Administrative Simplification: compliance date: October 2002

This component requires the standardization of data transmissions, or EDI, and procedure/diagnosis codes.

As for the standardization of procedure/diagnosis codes, this just means that you must use CPT-4 codes for procedure codes and ICD-9 codes for diagnosis codes.

As for the standardization of EDI, that refers to your electronic billing. In order to submit your claims electronically, you must do so in a HIPAA compliant format.

Section 4: Security Component: no implementation date set yet

This component requires that health care professionals, Billing Services, and clearing houses take appropriate security measures to assure that health information pertaining to an individual remains secure and is not accessible by others.

Things to consider:

Where is your fax machine? Is it in a place where only office staff can access incoming faxes? Is it on 24 hours a day? When you are not in the office (after office hours) can anyone else access your fax machine? Whenever you fax personal information about a patient you should use a fax cover sheet with a confidentiality statement. The statement should explain that the following fax contains personal medical information and that if the fax is received by anyone other than the intended party, that the fax should be destroyed and they should notify you that it was received in error.

Do you hire a cleaning person/crew? Are they in the office when you are not? Do they have access to the patient’s personal information? You may want to ask them to sign a confidentiality statement.

Do you rent office space? If yes, does your landlord have access to your office? Do they ever enter your office without you being present? If they do, you may want to ask them to sign a confidentiality statement.

By asking people who have access to your office to sign a confidentiality statement, you are making a reasonable attempt to protect your patient’s privacy. It is not always reasonable to never allow anyone access to areas that contain private information. If those people sign an agreement and then breech that agreement, you would not be held responsible.

If you do any business by email, you will need to use an encryption service. This will ensure that if anyone were to intercept your emails, they would not be able to read them.

Section 5: Privacy Officer

All offices must designate a mandated “privacy officer.” This person would be responsible for making sure all staff are HIPAA trained and that privacy policies are typed up and followed. They would also be the person that staff members or patients could go to with any concerns or questions about HIPAA compliance. Even if you are a very small practice, you MUST have someone designated as the privacy officer. It may even be the Doctor themself.

Section 6: Release of Patient Information/Consent

You need to have the patient’s written consent in order to release any of their records/information.

(Exception: If request is due to immediate/urgent care of patient.)

You should review your current consent and authorization forms to make sure they are HIPAA compliant. HIPAA requires you to obtain consent for the use and disclosure of information from each of your patients. You may refuse to treat patients who will not sign the consent form.

Section 7: Unique Identifiers: No implementation date set yet

HIPAA will mandate the use of unique identifiers. More to come on this component. Most likely you will have one national provider number, instead of a different provider number for each insurance company.

Section 8: Policies and Procedures Required by HIPAA

1. Identify people on your staff who require access to protected health information.

2. Prevent access to protected health information by unauthorized persons.

3. Ensure that the “minimum necessary” amount of information is released for routine disclosures (only release information pertaining to what is requested, not the patient’s entire file.)

4. Verify the identity of the requestor of information.

5. Provide patients access to their records, the opportunity to request corrections, and access to and accounting of disclosures.

6. Every office must have written policies regarding privacy practices.