LifeSpan Elements

What Big Teeth You Have!

2008-06-25T07:32:00.000-07:00

Insurance might have first have been conceived when Babylonian traders made loans to the caravan trade that were reimbursed with interest after their safe arrival to market; Hammurabi’s Code gave legal weight to the practice in about 2100 B.C. Greek and Phoenician cultures used a similar system for their sea-going trade. Funeral expenses were assumed by the Romans, who even extended death benefits to survivors. Medieval trade guilds in Europe protected their members from shipwreck and arranged ransom payments to pirates when needed.

The first known insurance contract was drawn up in Genoa in 1347, and ushered in an era when marine insurance was offered by all of the maritime nations of the world.

In 1693, Edmond Halley, famed astronomer, created the first mortality table, based on statistics and compound interest, making it possible for insurers to rate the value of a human life.

Health Insurance is a relatively new idea in the United States. Before the innovations of the 20^th Century, medicine was virtually powerless against the forces of nature. Insurance companies couldn’t calculate health risks and so couldn’t formulate premiums. A house burning down or the loss of a life were concrete enough to determine a payout, but chronic disease and/or an ongoing complaint were too ephemeral for computation. Sickness Insurance was available, but it covered lost pay during the course of an illness, not the myriad costs of being unwell. Lives were shorter and most healthcare was delivered in the home by a general practitioner because there was very little available in the few hospitals to be found that wasn’t available in most people’s kitchens. Hospitals were originally conceived as places to serve the poor; it was cleaner and safer to stay home.

Several advancements conspired to change American’s relationship with the world of medicine. In 1904, the American Medical Association formed the Council on Medical Education with a view to standardizing requirements for gaining a license to practice medicine. So stringent were these new measures that between1910 and 1922, 307 medical schools closed down because they weren’t producing qualified doctors (JAMA, 8/12/1922). The resulting decline in licensed physicians at a time when the country’s population was exploding (due, in large part, to unprecedented immigration and a baby boom) gave doctors the highest average income of any profession. In 1900, there were 1.7 doctors per 1000 population, a number that remained virtually unchanged until 1970!

In 1913, the American College of Surgeons was founded, and they instituted new standards for the accreditation of hospitals. In 1918, only 13% of 692 large hospitals were accredited. By 1932, 93% of 1600 hospitals made the grade.

A new-found respect for the “Science of Medicine,” opened during this era, with the progress and development of vaccines and technologies, bolstered by the improved credibility of the physicians and institutions that dispensed care. Gone forever were the days when you were born and died in the same bed at home, and gone, too, are the days when the average person spent $290 per capita (1929) on healthcare. Now we spend an average of $5556 per capita (2004, Kaiser Family Foundation Health Stats).

In 1929, the great granddaddy of health insurance was created to offer pre-paid hospitalization policies. The guidelines of this venerable institution were designed by the American Hospital Association in order to manage price competition between hospitals, and evolved, over time into Blue Cross. Simultaneously, the American Medical Association, with accusations of Socialist National Health Programs on their lips, countered with their own primitive version of Blue Shield. This allowed them to continue to “price discriminate,” or charge their patients based upon what they imagined they could pay. Established as non-profit organizations, Blue Cross and Blue Shield continue to enjoy this designation today, despite an excess of revenue over expenses. The American population flocked to join the Blues and commercial insurance companies, witnessing their wildfire success, began to offer their own health plans. In the 1950s, these commercial plans could boast more members than the Blues.

During World War II, the Stabilization Act limited wage increases to defray competition over the sparse workforce, so employers offered insurance plans as an enticement. Legislation also allowed payroll tax exemptions to both the insured employee and their employer. By 1958, 75% of Americans had some form of private health insurance.

According to the New York Times, Harry Truman attempted to create a national health insurance system in 1945, and 75% of Americans thought it was a good idea. Unfortunately, special interests such as the American Medical Association and southern politicians defeated the plan because of their fear of loss of revenue and the specter of integrated hospitals, respectively.

In 1965, the government passed Medicare and Medicaid with funding from income taxes, payroll taxes, trust fund interest, and, of course, enrollee premiums. Medicare Part A is a compulsory hospital insurance program with automatic enrollment at age 65. Part B is supplemental medical insurance for physician services, made palatable to them by allowing them reimbursement at their regular rates. Medicaid provides medical resources for the indigent; originally available only to those Americans in receipt of public assistance, Medicaid pays out based on each state’s per capita income. Families that make too much money for Medicaid might qualify for State Children’s Health Insurance. In the early 80’s, the government reworked Medicare so that doctors were reimbursed according to a set fee schedule based upon a diagnosis.

Our legacy is an astronomically expensive, unwieldy and largely incomprehensible crazy-quilt that covers our elderly and provides tax shelters for the rich.

Health insurance might be thought of as a gigantic casino. We are welcome to pull up a chair at the blackjack table and plunk our money down on the chance that we might draw 21 and beat the house. Of course, despite the jingle jangle of loose change that you hear all around you, the chances of this are slim. The insurance company gambles on the notion that they can collect more in premiums than they’ll have to pay out in benefits. More often than not, they’re right.

Health insurance reform is up against some of the most powerful industries in Washington, DC. The website www.publicintegrity.org reports that of the 1,291 lobbyists listed as representing pharmaceutical corporations and their trade groups in 2004, 52% were former federal officials; these people have the ear of the FDA, the House, Senate and the Department of Health and Human Services. This is the same group that shepherded the Medicare Modernization Act of 2003 through Congress, creating Medicaid Part D to cover prescriptions at taxpayer expense. Their investments in Washington are enormous, although not when compared to their profits. As a result, they call the shots that allow astronomical pricing, that prevent people from going to the doctor when they need to, and that cause people to skimp on and even skip medications.

According to www.Health-Insurance.org, health care and insurance dominated the Washington lobby, generating an average of $2.79 billion in 2007, more than any other Washington lobby and exceeding all previous records for total lobby dollars spent. Under these circumstances, it is hard to envision a time when the politicians who are supposed to have our best interests at heart don’t put the lobby ahead of the people.

It would seem that, in the institution of Medicare, we already have a federal health insurance plan, but until those of us under the age of 65 are covered, it doesn’t do as much good as it could. “If reform fails again, we’ll be on the way to a radically unequal society, in which all but the most affluent Americans face the constant risk of financial ruin and even premature death because they can’t pay their medical bills.” (New York Times, 6/13/2005).

In the long run, a vast population of uninsured Americans will be – and indeed, already is - more expensive than solid, preventive care. Until our health insurance is more concerned with our health than their profits, each of us faces a yawning abyss of insecurity. In the more than four thousand years since Hammurabi recognized the prudence of caravan insurance, it would seem that we have not evolved beyond the notion that a basket of spices or a camel saddle is worth more than a human life. It’s time for Americans to rise up and take the bite out of health insurance. As a group, we’re bigger than they are, and it is completely within our grasp to tame the beast.

Pharmaceutical Waterloo

2008-05-06T08:39:00.000-07:00

Caveat Emptor is a Latin axiom meaning, “Buyer Beware,” and is sound advice for anyone taking medication of any kind.

Today, heart disease is the number one cause of death in the United States, but in 1900, influenza, pneumonia, tuberculosis and diarrhea were the leading causes, followed by heart disease – perhaps because rampant infectious diseases carried many people off before they were old enough to contract it. Reputable physicians conducted their war against disease with the paltry compounds available to them at the time, such as mercury for syphilis, quinine for malaria, and a variety of herbal remedies.

Fast forward to the new millennium: more than 3-1/2 Billion prescriptions are written in a single year (according to The National Center for Health Statistics, an average of more than 10 per person!) and out of those, 1.5 Million Americans are harmed by their prescriptions. 200,000 people actually go so far as to die because of them. When one stops to consider that an average of 42,682 Americans die in auto accidents each year, this is a staggering number. We’re paying more for the privilege, too. A 2005 study conducted for Senator Gutneckt’s (R-Minn.) office shows that a 30-day supply of 10 popular prescriptions costing $455.57 in Frankfurt, Germany, costs $1,040.04 in Rochester, Minnesota. US News & World Report estimates that Americans pay somewhere in the neighborhood of 60% more for pharmaceuticals than any other industrialized country in the world.

The top ten pharmaceutical companies make more in profits than the rest of the Fortune 500 combined. Considering that they spend 2.5 times as much on marketing and administration as they do on research and development discredits the picture that they paint of themselves as a righteous industry largely subsisting on crumbs while their research and development departments gorge on the rest of the feast.

The pharmaceutical companies are privately held, multi-national corporations, and, as such, are in the business of making money, mostly by shaking down the American public. Other industrialized countries subsidize their citizens’ healthcare, so insist that drug prices are kept in check, while the consumers of this country are bilked for higher prices than anywhere else on earth and kept in a state of fear. Why should it be that a company with manufacturing plants in more than 50 countries across the globe should declare drugs coming out of Canada dangerous and beyond the scope of regulation? Shouldn’t one, then, be wary of any drug manufactured outside of the United States and imported over international borders?

In fact, approximately 86% of all drugs sold in the U.S. are manufactured outside of our borders. Among the most popular, Prevacid, is produced in Japan, Lipitor and Viagra are produced in Ireland and Nexium is made in both Sweden and France.

Consider:

The Center for Drug Safety says that 26.5% of all patients experience an allergic reaction from prescribed medication.

Newstarget.com headline on 2/20/2006 website: “Statistics prove prescription drugs are 16,400% more deadly than terrorists.”

An average RX costs $68.26.

An average name brand RX costs $111.02.

An average generic brand RX costs $32.23.

A study conducted by Brigham & Women’s Hospital in Boston July of 2005 found that 4.2 million hospital visits were for the treatment of an adverse drug event (15 visits per 1,000 Americans).
The pharmaceutical industry has the largest lobby in Washington, D.C., the industry employs more lobbyists than there are Congress members.
The pharmaceutical industry’s principal output is minor variations or combinations of old drugs—“me-too” drugs. These drugs cash in on already established, lucrative markets. For example, Pfizer’s Lipitor, is the fourth of six cholesterol-lowering drugs of the same type.
According to Families USA, older adults account for approximately 40% of every dollar spent on prescription drugs and consume 34% of all prescriptions dispensed.
The Federal Interagency Forum on Aging Related Statistics says that Medicare enrollees with 3 or 4 chronic conditions filled an average of 44 prescriptions a year, while those with 5 or more filled 60.

The bottom line as far as the solicitous hearts of the LifeSpan team are concerned is the fact that approximately 40% of all people who enter a nursing home do so because they are unable to take their medications safely at home. 50% of prescriptions are not taken correctly and so contribute to or create problems for the taker. Contraindications, or the prescribing of incompatible drugs, are a growing risk as we get older and see more than one doctor. Unsavory interactions are even reported with the combination of vitamins/herbs/minerals and prescriptions. There is too much for the average person to know about all of the things that can go wrong, to keep straight the voluminous information necessary to safely wrangle prescriptions, and to get the best medicinal bang for the buck. Unlike you, we are medical people and we know one thing beyond a shadow of a doubt:

You are safer and your long-term prognosis is better when you stay in your own home, so an educated and judicious approach to pharmaceuticals might just save your life.

While there are legitimate wonder drugs, one would be wise to be skeptical of an industry that prescribes the lion’s share of its cures for indigestion, erectile dysfunction, high cholesterol and other important problems that are just as easily cured - for free and without medication of any kind - with simple changes in diet and behavior. A LifeSpan Care Manager knows that the old adage about an ounce of prevention being worth a pound of cure is true.

Guinness Is Good For You, Too!

2008-03-03T10:58:00.000-08:00

Research into the connection between beer and wine and health started with the detection of the French Paradox, a phenomenon characterized by the fact that although they smoke more, exercise less and dine on a comparatively high fat diet, the French rate of heart disease is about 1/3 that of America; red wine was named as the reason for the dichotomy.

When this information was aired on an episode of 60 Minutes in 1991, American wineries lobbied for the right to call their products health food and general consumption of red wine increased by 44%. Perhaps an extreme reaction, but the French Paradox did lead to a whirlwind of research that concluded that one or two glasses of red wine or dark beer each day is advantageous. Each of these beverages is loaded with flavonoids which have beneficial effects such as a reducing the tension of the blood vessel walls, raising good HDL cholesterol, lowering bad LDL cholesterol, inhibiting the production and development of tumors, inhibiting the formation of blood clots, and controlling a high white blood cell count. Free radicals and anti-inflammatories protect against heart attack, and new evidence seems to find dark beer and wine efficacious in fighting heart failure, stroke, osteoporosis, prostate cancer, tooth decay, upper respiratory tract disease and even dementia.

In Ireland, where Guinness is King, an extensive body of lore exists about the miracle curative of the beer. There is no way to confirm that Guinness was ever served to blood donors, post-operative patients, nursing mothers or race horses, but in the 1930s, the SH Benson Advertising Agency came out with the ‘Good for You’ campaign, based upon market research that revealed that people felt good after drinking a pint. In a marketing move that would never be allowed today, Guinness advised, “Seven glasses, 7 days of the week and 7 beneficial reasons to drink it (for strength, nerves, digestion, exhaustion, sleeplessness, its tonic effects and the blood).”

Like Coors Light, Guinness is 4.2% alcohol (compared with Budweiser’s 5%) with 210 calories and 17 Carbs, while red wine is 10% - 16% alcohol but only 102 calories for a five ounce glass and only 2.41 Carbs.

In his book The Wine and Food Lover’s Diet, Dr. Phillip Tirman, a specialist in sports medicine, says, “…statistics show that moderate wine consumption is associated with lower risk of stroke, heart disease, and diabetes, among other ailments. One explanation is that wine appears to increase the ratio of “good” HDL cholesterol to artery-clogging “bad” LDL cholesterol. The antioxidants found in red wine, in particular, reduce the oxidative stress on cells, which in turn appears to reduce the risk of certain cancers.”

This Saint Paddy’s Day, when Irish eyes turn to you and smile and say, “Sláinte,” or “To Your Health,” there may, in fact, be no small “In Vino Veritas,” or “Truth in wine.”

“Love Is Good For You,”

2008-02-01T09:21:00.000-08:00

trumpets an article written by the staff of the venerable Mayo Clinic (2/6/2006, www.mayoclinic.com), and here’s why:

Stress kills. Your cardiovascular, hormonal and immune systems are negatively impacted by stress, making you vulnerable to disease. A happy partnership is an extremely effective stress management tool because you have more hands on deck, more solutions, more money, and a sense of responsibility to your partner that affects your behavior for the better.

A decades-long study still underway at Ohio State University examines how our personal relationships bring to bear on our health. Positive interaction between partners caused lower levels of the stress hormone cortisol, which in turn allowed the compounds and cells responsible for repairing injured tissues to expedite their healing process.

Professor Linda Waite of the University of Chicago, in an address to the Population Association of America, explained that the health benefits of marriage are so strong that a married man with heart disease can be expected to live, on average, 1400 days longer (nearly four years!) than an unmarried man with a healthy heart. This longer life expectancy is even greater for a married man who has cancer or is 20 pounds overweight compared to his healthy, but unmarried, counterpart. (Linda J. Waite, “Does Marriage Matter?” Presidential Address to the American Population Association of America, April 8, 1995; Linda Waite, “Does Marriage Matter?” Demography 32 (1995): 483-507).

Although new studies prove that good relationships are critical to our health, the current medical model, one that requires doctors to process patients as though they were Model Ts on Henry Ford’s assembly line, does not address the isolation and loneliness of an immense part of the national population. LifeSpan advocates for our clients like they were family, and we are pleased to report that the effect of our counsel has garnered some remarkable results.

Ice Cream for Breakfast . . . and other diet tips

2008-01-06T09:21:00.000-08:00

Since the ancient Greeks, thinking persons have touted the idea of MODERATION IN ALL THINGS - Hesiod, Euripides, Plato, Cicero, Chaucer, Moliere, Lord Byron, Montaigne, Ben Franklin, Oscar Wilde, Mark Twain, and even Henry Kissinger have weighed in on the merits of self-restraint and we are inclined to agree. One should absolutely have ice cream for breakfast, but not every day.

Good health is a question of the general condition of the body and mind with reference to soundness and vigor. We digress from here to a very clinical punch list of measurements delineating the various bodily systems, but in truth, and aside from chronic sickness (which, for the sake of discussion, is precluded from this particular diatribe), it all comes down to how content you feel in your own skin. Does your body keep up with your ideal of life? Are you comfortable in your clothes? Does your immune system ward off most of the bugs that you encounter? Are you happy? A preponderance of negative answers to these questions means that you are not enjoying good health.

For weight loss, the bottom line is that you need to ingest fewer calories than you burn, while not losing muscle tissue that would lower your caloric requirements. (This is why many diets only work for a short time. Starvation diets without exercise deplete muscle tissue as well as fat tissue. This effectively lowers the caloric requirement of the body, as you burn more calories when your muscle mass is larger).

One of the tricks of the trade for ensuring this outcome is to write down everything you eat, and keep track of how many calories you’re taking in. Then simply walk, run, cycle, ski, skate, or dance off those calories. Staying active is the main point, and you don’t even need to join a gym to do so. It helps to have a partner (or a support group, a la Weight Watchers) who will assist you to stay on track.

Our favorite recommendation when it comes to using a weight loss product is Hydroxyproline. This is an amino acid (not a drug, but a food product) that is derived from gelatin or collagen. It is marketed via a multi-level marketing scheme as Calorad (tagline: “Lose weight while you sleep”) and Hydroxycut in drug stores. Used as directed, it assists in lowering cholesterol and blood sugar, prevents the progression of arthritis, and assists most users to lose weight.

Taken on an empty stomach just before sleep at night (one tablespoon in 7-8 oz. of water), this food product uses adipose (fat) tissue to produce connective tissue. Connective tissue covers every muscle fiber and nerve strand. It comes together to form tendons and ligaments, and provides structure to every organ in the body. Connective (or soft) tissue injuries require lengthy healing time because as we age, our body’s ability to manufacture this tissue erodes, and because soft tissue is poorly vascularized (that is why it is white, not red like muscle tissue). Those who want to build muscle tissue can take this supplement in the morning as well, before exercising. It will tend to cut the appetite when taken in the morning, and may speed the weight-loss effort if it is taken in lieu of breakfast.

Like all amino acid supplements, some loose stool may result if large portions are taken. Otherwise, the only other side effect for most people is that they sleep more soundly. Further supplementing with Vitamin C assists this product to work better. Interestingly, the use of statin drugs robs the body of naturally occurring hydroxyproline.

There’s No Place Like Home for the Holidays

2007-12-04T11:03:00.000-08:00

The Holidays are inextricably tied up with the idea of Home. For many families, a beloved friend, spouse, parent, child, or family member are unable to stay at home because of health considerations. Loss of autonomy is an anguish-causing consideration for the individual and their family. Add to that the danger inherent in a hospital or medical facility, peace of mind is lost, and this loss is more acutely felt during this season.

I remember being horror struck, as a child, upon learning that elderly Eskimos who could no longer contribute to their community were pushed out to sea on an ice floe, but in many ways, the healthcare model of our times resembles this ancient practice: we are abandoning our elderly into a sea of confusion and misinformation.

According to the CDC, life expectancy increased dramatically during the past century, from 47 years for Americans born in 1900, to 77 years for those born in 2001. The reasons people live longer include a better understanding of cleanliness and hygiene, pharmaceutical advances such as vaccinations and antibiotics, and unprecedented progress in medical knowledge. The reasons people die have evolved from infectious diseases which strike suddenly and kill quickly such as Cholera, TB, and acute illnesses such as foot and mouth disease, to chronic diseases and degenerative illness which cause lingering pain, disorientation and despair. In order of the number of victims, the leading chronic diseases suffered by Americans 65 and older are:

Heart Disease
Other (falls & injuries, obesity, etc.)
Cancer
Stroke
Respiratory Disease
Influenza & Pneumoni
Diabetes
Alzheimer’s Disease

Infirmity is not an unavoidable byproduct of aging. Most of the chronic diseases from which we suffer in this brave new world are preventable. Still, the Merck Institute of Aging and Health notes that the average 75-year-old suffers from no less than three chronic conditions and uses an average of five prescription drugs. We believe that the added years should reflect a quality of life at least equal to the quantity of time inferred.

A consultation with a professional health advocate can secure, for you and your family, the knowledge you need to save time, money and unnecessary pain and distress while negotiating the troubled waters of the modern healthcare system. You are entitled to the peace of mind that comes with knowing that you’ve done the best you can do for yourself and your loved ones.

Save Your Own Life.

2007-11-01T11:42:00.000-07:00

An old joke goes something like this: Doctors go to school to learn how to write illegibly, and Pharmacists go to school to learn how to read what Doctors write.

Long acknowledged with a wink and a nod, the illegible penmanship of Doctors kills more than 7000 Americans every year and injures more than 1.5 million (National Institute of Medicine, 2006); many of these incidents are attributable to incomprehensible or incomplete medical records and prescriptions.

Your medical record serves as the doctor’s memory, representing your body’s history and geography, “The definition of an adequate medical record is one which enables reconstruction of the events without reference to memory and contains only the information which clinician B will require when taking over the care of a patient from clinician A.” (Dr. Gerard Panting, Communications and Policy Director Medical Protection Society, O:\Lectures\2004\A&E Conference\Article.doc)

Imagine yourself vacationing far from home and becoming sick enough to need medical attention. Without medical records, the caregivers attending to you have no way of knowing that the medication prescribed will interact badly – perhaps even fatally - with the medication you’re already taking. With access to all of your medical data, clearly and concisely presented, the outcome of this encounter would be entirely different.

Imagine yourself on the eve of a lifesaving medical procedure, when a Hurricane Katrina caliber disaster takes place, sweeping all of your medical records away, and leaving the hospital staff without the essential information necessary to proceed with the surgery. Portable medical records stored in more than one location would dramatically alter the end of this story.

Finally, imagine that you suffer from later-stage diabetes, and so in addition to your primary care physician, you regularly consult with an endocrinologist, a nephrologist, an ophthalmologist, a podiatrist, a vascular surgeon and a neurologist. That’s a huge paper trail, disseminated between seven different offices, and an overwhelming administrative task to organize and coordinate. A LifeSpan GuardianKey™ USB flash drive with each of these physician’s notes, histories, observations, records, prescriptions and prognoses would be both safer and more cost effective, ensuring fewer medical and medication errors, hospitalizations, and duplications of tests and procedures.

In 1928, the American College of Surgeons established the Association of Record Librarians of North America (ARLNA) to, “elevate the standards of clinical records in hospitals and other medical institutions.” In 1938, to keep up with increasingly data-driven decision-making in healthcare settings, the organization created standards and regulations that made their members medical record experts. Today, ARLNA has been re-christened the American Health Information Management Association (AHIMA) and they are on the cutting edge of the new age implementation of electronic medical records, as well as to the creation of a national health information network.

Broadly, AHIMA describes your medical record as a:

Basis for planning your care and treatment
Means by which your doctors, nurses and others caring for you can talk to one another about your needs
Legal document describing the care you received
Means by which you or your insurance company can verify that services billed were actually received

In a State of the Union Address in 2005, President Bush called for national standards that would enable medical information to be digitized, stored and shared electronically. “Within ten years, every American must have a personal electronic medical record,” he said. A new position has even been created within the Department of Health and Human Services to coordinate government Health-Information Technology initiatives. “The 21^st century healthcare system is using a 19^thcentury paperwork system. Modern technology has not caught up with a major aspect of healthcare, and we’ve got to change that,” the President said.

2015 might as well be 3015 if you or a loved one are unwell. Be an early innovator and save your own life.

Honor thy Father and Thy Mother.

2007-10-01T12:45:00.000-07:00

Here is a true story that demonstrates how LifeSpan works and how LifeSpan WORKS for you:

I was called in to see a patient who was getting discharged from Jefferson Hospital. She had had her second cardiac catheterization, and her daughter (we’ll call her Sophia) called LifeSpan because she just did not know what to do. There were no findings on the “cath” study, no recommendations for surgery or any other treatment. The fact is that this 69 year-old Italian immigrant complained frequently of chest pain, had spasms and shortness of breath, sweating, and profound weakness. Since her husband had died of a heart attack several years prior, she lived with her daughter Sophia’s family, a husband and three young children, in the suburbs of Marlton, New Jersey. She was at home alone during the day while the rest of the family were at work and in school. She busied herself cooking and cleaning for the family, but had nowhere to go since she did not drive, her command of English was not very good, and she had never worked outside of the home.

When I interviewed her and reviewed her chart, a long history of the same symptoms and a failure of different attempts at controlling the symptoms were evident. While I was speaking with the mother and daughter, the mother was rocking back and forth in the bed, saying, “Mio Dio!” and mumbling in Italian. I asked for a quick translation, which was, “My life has no meaning; I am so lonely.” I said to Sophia, “she’s depressed, and what you’re seeing are anxiety attacks.” “Oh no.” she said, “Mother denies any depression. Our family doctor put her on Xanax and Lexapro, but it didn’t do any good. He wanted to send her to a psychiatrist, but she wouldn’t go.”

Still, I said, she reminds me of my mother in law, and I think she’s depressed. I had one of our Care Managers see her to follow up at their home. This particular nurse is also an immigrant Italian, from the state of Abruzzi. She nailed it right away: Depression. Sophia again protested. “Our family doctor said she’s not!” The LifeSpan Care Manager recommended that the family try a new doctor, “he speaks Italian, and in a dialect that your mother will recognize.” Right away, this nurse later reported to me, a look of horror at the realization of all the hassle she and her mother had gone through, the lost opportunity, wasted time and worry, crossed over her face. It would have saved years of distress if Sophia’s mother had just had the right doctor, someone informed about the cultural aspects of her complaints—she was lonely, isolated in the suburbs with nowhere to go, and no outlet for her distress. She only had doctors who wanted to give her pills and try to perform heart surgery. Sophia was relieved to find someone who would listen enough to make sense out of her mother’s complaints, and help sort out the issues that were distracting her from her own children, her husband and her job responsibilities. She regretted the years of wasted time, effort and money spent on treatments that were off base.

Dealing with the problem in a way that the people involved could understand, LifeSpan made it possible for the family to cope in a constructive way.

LifeSpan Nurses do not diagnose disease and cannot promise a cure for complicated and seemingly intractable disease and debility. What we do promise is a fresh look at the problem by highly experienced clinicians who will listen to the patient and family and offer new ways of analyzing the issues. We refer to expert doctors and therapists who have the appropriate training to address the problem and to improve the quality of life of the client and family.

Pain = No Gain

2007-09-06T06:26:00.000-07:00

Google lists more than 208 million results for the word, “Pain.” Pain is your body’s way of telling you that something is wrong, and usually, once you’ve addressed the reasons for it, pain goes away. “Acute Pain” is normally caused by bodily injury: a burn, broken bone or appendicitis, while, “Chronic Pain” goes on for days, months or years, and can be ascribed to causes such as arthritis, cancer, inflammatory bowel disease, or – worst case scenario - for reasons unknown and/or unidentified.

Chronic pain invites a host of other problems in its wake: sleeplessness, loss of energy and appetite, weight loss, and depression are only some of the contingencies that accompany chronic pain. Suffice it to say, chronic pain takes the stuffing out of you, bringing your defenses down, and making you vulnerable in ways that do not benefit long-term recovery or immediate comfort.

A more recent body of evidence leads some pain experts to believe that parts of the body “remember’ pain in inappropriate and destructive ways, much like an early psychological trauma can cause an individual to have a bizarre phobia as an adult to something that is generally considered innocuous.

“Contrary to the old saw, pain kills. A body in pain produces high levels of hormones that cause stress to the heart and lungs. Pain can cause blood pressure to spike, leading to heart attacks and strokes. Pain can also consume so much of the body’s energy that the immune system degrades. Severe chronic pain sometimes leads to suicide. There are, of course, many ways to treat pain: some pain sufferers respond well to surgery, physical therapy, ultrasound, acupuncture, trigger-point injections, meditation or over-the-counter painkillers… But for many people in severe chronic pain, an opioid … is the only thing that allows them to get out of bed.” (New York Times, June 17, 2007).

How pain is handled is of the utmost importance. Pharmacalogical pain relievers, called, Analgesics, come in three categories: Opiods, such as morphine, Non-Opiods, such as aspirin, and Adjuvant Analgesics, such as anti-depressants, anti-convulsants and oral and topical local anesthetics. Each of these solutions come with a wealth of side effects, not the least of which is addiction. In the quest to relieve pain, care must be taken to ensure that the “cure” isn’t worse than the illness. (For example, Arsenic and Mercury have been used since time immemorial to treat any number of diseases, and even today, people line up to have Botulism injected into their faces to defy aging).

One consideration when taking pain medication is that with any nervous system depressant (and that is what we are talking about here) there is going to be a rebound effect. If you have two beers, you will suppress your nervous system and feel disinhibited. Four hours later, you will feel edgy, irritable, and if you have had the alcohol prior to bed time, you will be aroused from sleep wondering why. There is a body of evidence linking chronic headaches to (mostly) women who habitually took acetaminophen (Tylenol) for their headaches. Each time the rebound would become worse, the self-administered dose would rise, the rebound pain would worsen, and etc. This cycle of pain, suppression, rebound, more pain, more drugs, and on and on can become very destructive. The nervous system remembers patterns that can get out of control. When LifeSpan Nurses are asked to sort out chronic pain issues, one of the first things we do is ask the client to fill out a “pain diary.” This assists us in recognizing the patterns in which the pain arises, its intensity, its location, and how it is relieved so that we can begin to understand the patterns better and thus bring more appropriate interventions (interventions that are more likely to work) to bear.

If a disease is terminal, living with pain might not be the best choice, and any repercussions from medications are mute. If the prognosis is good, a less extreme course of action with fewer long-term consequences might be a better option. On the sliding scale of pain management opportunities, knowing all the facts is essential, but in a well-meaning but sometimes misguided effort to show compassion, doctors do not always pass along the whole truth to their patients, making a truly informed decision virtually impossible. LifeSpan’s Registered Nurse Care Managers provide total disclosure to our patients, allowing them to authoritatively review all of the options and weigh the significance of each contingency.

The management of chronic pain should be a multidisciplinary effort. Unfortunately, some pain experts are strictly anesthesiologists, and since they are unlikely to offer much more that a series of drug delivery interventions, they can muddy the waters further. Alternative interventions can be very effective in getting pain to a manageable level. These interventions include:

Cold packs. This is especially good for recent (within 24 hours) muscular injuries, soft tissue injuries, such as sprain, strain injuries to the neck and back. While a hot shower may alleviate the pain for a chronic back pain, it swells the soft tissue and increases the impingement on the nerve that is causing the symptoms. Cold packs can also be helpful for chronic arthritis pain. The pack should not be in place for more than 20 minutes, otherwise the local circulation is disrupted, and the cold packs are counter-productive.
Gentle massage works for short periods of time for some kinds of pain. When you fell and hurt your knee as a child, and your mother rubbed it, it really did make the pain go away because by rubbing it, she was substituting low frequency stimulation that essentially blocked the high frequency nerve stimulation to the brain that makes the brain perceive pain.
This “Gate Control Theory” of pain promulgated by Ronald Melzack in the 1960s is the basis for a useful tool called a Transcutanious Electronic Nerve Stimulator (TENS). These are small battery-powered boxes that send a low frequency electric current through the skin via electrodes attached to the skin, usually on either side of the source of the pain. The stimulation is set at a frequency that is lower than the pain frequency (~ 7 cycles/second vs. ~14 cycles per second). These devices work by blocking the pain sensation rather than taking it away. They are used with chronic pain, often with encouraging results at first, but with diminishing effectiveness later on if the source pathology of the pain is not resolved.
Chamomile extract is very effective for tooth pain, teething babies, insect bites and other local irritations.
Lidocaine patches are sometimes prescribed for those with chronic, mostly arthritis pain. They consist of numbing medication that is suffused onto a patch that is placed over the painful area for up to 12 hours at a time. The patch must be taken off of the skin area, because it can cause a decrease in the circulation of the skin under the patch.
Magnets have been shown to be effective in reducing pain for 85% of those with chronic pain, and no one seems to know why. It is known that the magnets do increase local circulation, and this is a good thing. The Nikken Company of Japan sells a whole range of magnet products via multi-level marketing, and there are products sold in some drug stores and home medical supply stores that have magnets in wraps, shoe sole inserts, necklaces, etc. Hint: before spending money on this method, apply a refrigerator magnet, and see if it has any positive effect.
Frequency Specific Microcurrent (FSM) offers new hope for people with chronic pain and sports injuries. Please see Kristine Allcroft's article in our September, 2007 newsletter.

You will know that the treatment you’ve signed up for is the right one only if it works.

My Advice to You: Live Well.

2007-07-30T14:30:00.000-07:00

You would be hard pressed to think of a single person whose life hasn’t been touched by cancer. The American Cancer Society estimates that there will be 1,444,920 new cancer cases in 2007, 559,650 of which will result in death. The most commonly diagnosed cancer is non-melanoma skin cancer, followed closely by lung and breast cancers.

Cancer, Old English, from Latin "a crab," later, "malignant tumor." Greek physician Galen, among others, noted similarity of crabs to some tumors with swollen veins. From Greek karkinos, which, like the Modern English word, has three meanings: crab, tumor, and the zodiac constellation (1391), from Proto-Indo-European base *qarq- "to be hard" (like the shell of a crab); cf. Sanskrit. karkatah "crab," karkarah "hard;" and probably cognate with Proto-Indo-European base *qar-tu- "hard, strong," source of English hard. Meaning "person born under the zodiac sign of Cancer" is from 1894. Cancer stick "cigarette" is from 1959.” (Online Etymology Dictionary)

Ancient medicine took an immense leap forward when Galen, influenced by Hippocrates and his theory of the “humors,” began to see illness as an organic physical process and not as a supernatural or religious one. They thought that a balance of the four humors made for good health, and that a deficiency or excess caused illness. Galen declared cancer incurable. Until incredibly recently, surgery was primitive and often worse than the disease. Not until anesthesia became available in 1846 did major advances take place in cancer surgery, followed 50 years later by the invention of the X-Ray, and in 1956, chemotherapy was successfully employed to treat a cancerous tumor. Since then, there has been an explosion of therapies and advances in cancer research and treatment. According to the American Cancer Society, “Scientists have learned more about cancer in the last decade of the 20th century than has been learned in all the centuries preceding.”

In simple terms, “the human immune system often fights off stray cancer cells just as it does bacteria and viruses. However, when cancer cells establish themselves in the body with their own blood supply and begin replicating out of control, cancer becomes a threatening neoplasm, or tumor. It takes a minimum of one billion cancer cells for a neoplasm to be detectable by conventional radiology and physical examinations. Cancer, which represents more than 100 separate diseases, destroys tissues and organs through invasive growth in a particular part of the body and by metastasizing to distant tissues and organs through the bloodstream or lymph system. Heredity, lifestyle habits (such as smoking), and a person's exposure to certain viruses, toxic chemicals, and excessive radiation can trigger genetic changes that affect cell growth. The altered genes, or oncogenes, direct cells to multiply abnormally, thereby taking on the aggressive and destructive characteristics of cancer. Treatments such as surgery, chemotherapy, and radiation are effective with many cancers, but they also end up killing healthy cells. Gene therapy attempts to correct the faulty DNA that causes the uncontrolled growth of cancer cells. Researchers are investigating other treatments, such as immunotherapy (the stimulation of the body's natural defenses), vectorization (aiming chemicals specifically at cancer cells), and nanotechnology (targeting cancer cells with minute objects the size of atoms).” (The American Heritage Science Dictionary)

American soldiers who fought in World War I were issued cigarette rations, creating a generation of smokers that became a generation of lung cancer victims. By the early 1930s, medical scholars first recognized a link between smoking and cancer. This led to a new focus on the disease, which had largely been viewed in light of the knowledge assembled by Galen almost 2000 years before. On August 5, 1937, Congress passed an act creating the National Cancer Institute to “reduce the worldwide burden of cancer through innovative research and the development of ever better interventions to prevent and treat cancer.” (www.cancer.gov )

Interestingly, cancer deaths in the United States have modestly declined - for the first time since 1930, when the U.S. began to compile cancer statistics. In 2003, 369 fewer people died from cancer than in 2002.

It would seem that everything from household mold to HPVs to barbecued chicken has been identified as causing cancer – the media hypes a new trigger every day. The good news is that a sensible and balanced approach to life can cut the risk of cancer dramatically. Moreover, advances in medical technologies are enabling improved screening for early detection. Early detection and appropriate treatment fosters dramatically improved survival rates.

New treatment technologies hold amazing promise. Example: invasive radiologists can choke off a tumor in the liver by a technique called “chemo-ablation.” This involves threading a catheter via a blood vessel into the area proximate to the tumor, then instilling chemicals (various ones from hypertonic salt water to various drugs used in chemotherapy) that choke off blood circulation to the tumor. The tumor dies; the body slowly takes away the dead tissue. The patient doesn’t even have to be cut open.

Also, radiation treatments are much improved. While radiation burns and gross destruction of non-involved (surrounding) tissue were once common, the combination of computerized tomography and precise delivery of radiation doses now result in better tumor shrinkage with fewer side effects. These techniques involve coming to the hospital/facility daily for about 20 minutes per day for about 40 days, but the overall outcome is better with fewer side effects than alternative radiation therapies. Caveat: make sure the treatment facility has the latest technology, and the radiation oncologist is up to speed on the specific type of cancer to be treated.

Recent findings of chemotherapy treatments include the fact that many chemo drugs can impair heart function over time. Also, many patients get “chemo fog” described as an inability to think straight. This is an actual cognitive impairment that diminishes a person’s ability to remember, communicate and solve routine problems. They have a diminished affect, and are often depressed. The fatigue that accompanies treatment compounds this problem.

Once diagnosed, essential decisions need to be made. Depending upon the type and stage of the cancer in question, is a cure the best goal or should quality of life be the goal? Do the potential benefits of the treatment proposed outweigh the potential harm? What are the best hospitals and doctors for each particular kind of cancer? What other questions should I be asking?

An observed characteristic of cancer doctors, or Oncologists, is that (sorry guys) they are not always totally forthcoming to the patient and family with regard to prognosis, treatment choices, expected side effects, and expected quality of life during treatment. Treatments take time, many doctor visits, fatigue and loss of appetite while undergoing chemotherapy and radiation usually preclude being able to work or attend school. Doctors don’t like to give bad news, so they parcel it out in small doses, using code words and euphemisms that cloud the issues at hand, often obstructing truly informed consent.

Doctors who are not affiliated with major medial centers tend to stick with treatments that they know about, not ones which may be emerging and that are shown to be more effective. The patient and family may elect to seek out treatments that are undergoing “clinical trials”. These treatments are by definition experimental, so there is no guarantee that they will be the most effective in every circumstance. However, there are several advantages to being involved in clinical trials, such as:

They are held at tertiary care medical centers (university hospitals) and conducted by the smartest guys on the block. The treatment protocols are reviewed by experts in the specialized area of that particular cancer.
The therapy itself represents the latest thinking regarding treatment of the specific type of cancer involved.
The patient gets more thorough attention, because there is precise data collection process and a comprehensive team that is working together on the project.

Second opinions regarding proposed treatments can be helpful in sorting out what questions to ask and getting answers that make sense. Often, internet searches by those who have little medical background are not that helpful. Cancer is such a complex disease (in fact, each type of cancer has its own profile, pathology, and set of treatment modalities), and there are so many new treatment approaches coming into play, it is difficult even for a professional to know what to do.

A LifeSpan Care Manager may not know everything, but we know the right questions, and where to go for the answers. This helps design a plan of care and a support system for the patient and the family. The right treatment plan and a support system to cope with the extended therapies and unforeseen circumstances can assist optimizing the outcome.

Walk Softly and Carry a Big Stick.

2007-07-05T13:22:00.000-07:00

“Freedom from effort in the present merely means that there has been effort stored up in the past.” Theodore Roosevelt

Consider these scenarios:

1. You’re 63 years old. Your spouse is recovering from a stroke, but his care is more than you can manage alone. You’ve dutifully paid your taxes, own your own home, put several children through college, and socked away enough money to ensure what you had hoped would be a comfortable and exhilarating retirement. You did everything right, but now face a major crisis: How do you get the best for your spouse without sacrificing the lifestyle you’ve spent a lifetime building?

2. You are a single 47-year old parent, working full-time, with kids in daycare. Your last surviving parent is suffering with Alzheimer’s disease 150 miles away. Can you balance the needs of everyone who’s counting on you or will you be expected to choose between the people who raised you and the people you’re raising?

3. A football injury put your son in the hospital and now he suffers from chronic pain. You took a sabbatical from work to care for him on a daily basis, but now, months later, risk losing your position and with it, your health insurance. Family comes first, but can you cope, financially, without the insurance?

Will the government provide assistance for you?

Can your kids support you?

Will your community maintain you?

The United States Census Bureau estimates that by the year 2060, as many as 24 million people will need long-term care services and that the average cost of a year in a nursing home is $51,000 (these are obviously NOT New Jersey Prices which are much higher).

There is a lot of misinformation floating around about Long Term Care, what it is and how it is paid for. The National Endowment for Financial Education (NEFE) defines long-term care as, “family-provided assistance, self-insurance through savings or investment, or a private insurance policy purchased either individually or, to a lesser extent, through an employer. Sometimes it is a combination of all of these options. What it isn't is a Federal government program.”

NEFE goes on to say that, "It is not a senior issue. It is a multi-generation, individual, family, public policy, and workplace issue. By 2010—less than a decade from now—almost half of the U.S. workforce, many of them people in their 40s and 50s, will be involved in caring for an elderly parent, with an associated cost of between $1,100 and $2,500 per employee from reduced productivity, lost work time, extra time off, and stress-related illnesses. The value of long-term care planning goes beyond individuals: We need to re-frame long-term care as everybody's issue.”

By 2030, when the last of the 77 million baby boomers reach 65, the costs associated with caring for our elderly will almost certainly overwhelm an already ravaged system.

In January of 2000, The National Academy of Elder Law Attorneys said that the average American man can expect to spend almost $57,000 on long-term care; the average woman, approximately $125,000. Their solution? “Long-term care in America should be an integrated system of medical and personal services in a continuum of care.”

In a nutshell, Government programs such as Medicare, Medicaid and the Veterans Administration will cover the cost of long-term care only under certain conditions. Medicare will cover rehabilitation from a hospital stay or limited care at home while there is a skilled (medical) need. The Veterans Administration will cover the cost of nursing home care indefinitely if the veteran is at least 70% service-connected disabled. The VA will also cover other forms of home-based or community-based care if there is a medical need.

Medicaid will cover both medical and non-medical related long-term care, but in order to qualify for Medicaid a person has to have less than $2,000 in assets and income that is insufficient to pay the cost of care. In other words a person must be impoverished. Otherwise Medicaid will not pay.

About 84% of all long-term care is not covered by government programs. This is primarily family-provided home care to help with activities of daily living, or help with maintaining a home, providing meals and support, or care services providing supervision or companionship or providing transportation and shopping services. Care not covered by the government is also care provided from family out-of-pocket payments in nursing homes and assisted living facilities. Families are also hiring more and more aide services to help with care at home. (From www.longtermcarelink.net ).

When choosing a facility, we generally recommend looking at the following factors:

1. Is the facility close enough for the family to visit?

2. If the loved one needs to go to the hospital, what hospital is the closest to the facility? If it is not one in which the family has confidence, this will be a problem later on.

3. What physician will be directing the medical care of the loved one? Will he/she be visiting the facility often (2-3 times per week)? Are they trained in geriatric medicine? The statistics show that care by a nurse practitioner associated with a gerontologist results in superior care and fewer hospitalizations.

4. Spend some time in the lobby of the facility, and see how people in the facility interact with each other and with the residents. This can be more telling than fresh flowers or a piano placed in the lobby.

5. We recommend a facility that has the entire continuum of care, or a Continuing Care Retirement community (CCRC) if possible. If a facility has the Assisted Living component (along with a special wing for those who have dementia), offers sub acute (SA) and skilled care (SNF) all on the same campus, the options for the resident and the family are greater if the loved one has a medical setback or loses function over time. This way, if there is a hospitalization, the resident comes back to the same facility, and can advance up or down the continuum of care based upon their care needs while still being known to the staff. This way, there is less disorientation and fewer treatment delays because of lost medical records.

6. We also recommend Continuing Care Retirement Communities, or those with a range of care options, because if the resident pays a n entrance fee to the facility, then loses function later after his/her assets are depleted, there may be no good options for placement because the re are not enough assets for another entrance fee. At that point, the loved one could only be placed in a facility that has an open Medicaid bed. This limits the choices, options and the quality of care.

Your team at LifeSpan Care Management, LLC can help you to figure out the best route to take when planning for long-term care; in essence, to “Walk Softly and Carry a Big Stick.” Contact us to begin the process, and to put you in touch with our legal and financial specialists.

What Have We Become?

2007-07-03T06:05:00.000-07:00

SiCKO is a very disturbing movie. Michael Moore juxtaposes the health insurance haves and have-nots in the

United States

, and finds that both have problems.

The have-nots don’t seek care because they don’t have the money (one of the film’s first images is of a man who is suturing his own knee wound, already draining, surely to become infected later); and the haves seek care but it do not get reimbursed for a variety of reasons (a pre-existing vaginal infection, not medically necessary, etc.). One couple showcased lost their house and employment due to their respective illnesses and had to move into their daughter’s home.

Moore also focuses on three volunteers of 911 who have chronic debilitating medical conditions. Reggie Cervantes moved from New Jersey because she lost her job and home due to ground zero exposure that left her with two children and severe pulmonary disease. Moore walks into a Havana pharmacy with her and they ask for a refill for her inhaler. The cost in Havana: 5 cents. The cost in the US: $120. Cervantes breaks out in tears, and the audience could not help but feel for her.

For me, the trigger was the John Graham’s x-ray. He was a volunteer EMT from Paramus New Jersey that also developed debilitating lung disease. When the x-ray film was put on the light board by the doctor in the Havana hospital, the image made me catch my breath. The darkened and shriveled lung fields, the whited-out scars where the bronchia should be took me to back to the middle of the night in an ER, an ICU, looking at a patient, looking at his sick lung film, fighting fatigue and wondering what could be done.

What can be done? Moore asks “what have we become?” as he displays the history of how we got where we are, and what other nations provide for their citizens. The interview of the old British Labour Party politician was also disturbing. “Democracy is a system of government that gives the people what they want and need. If you don’t have that, then you don’t have a democracy.’ Right now, Americans don’t have much of either, not what we want, nor what we need. It’s enough to make you sick.

A Biographical Anecdote by Diane Gager, COO

2007-05-31T05:27:00.000-07:00

Michael Newell: Renaissance Man

When he picked his son up from the Northeast Police Detective Division on Harbison Avenue in Philadelphia, Michael Newell told his namesake that his own father, a Philadelphia cop, had died at Byberry, and that he had done the right thing.

Established in 1907 and closed in 1990, the Philadelphia State Hospital at Byberry has become the stuff of urban legends, with websites describing teenagers chased by criminally insane, spittle-flecked former patients brandishing machetes and the ghosts of abused patients lurking in crumbling hallways. The reality of Byberry is an American tragedy; a facility that was founded as a place of care and healing degenerating into a Snake Pit, a Bedlam, a Madhouse, replete with filth and neglect and, of course, the specter of questionable medical treatments of yore: the lobotomy, electro-shock therapy and the like.

In a description of Byberry as he found it in 1948, author Albert Deutsch observes, "As I passed through some of Byberry's wards, I was reminded of the pictures of the Nazi concentration camps. I entered a building swarming with naked humans herded like cattle and treated with less concern, pervaded by a fetid odor so heavy, so nauseating, that the stench seemed to have almost a physical existence of its own." (The Shame of the States).

By 1967, state legislators charged that, “a cloak of secrecy has hidden deplorable sanitary conditions as well as a lack of proper care and security” at Byberry, where 5000 patients were being cared for by attendants who found themselves in charge of a staggering 150 patients per shift (Bucks County Courier Times, 12/26/1967).By the time Michael Newell III ran afoul of the law in 1971, he was a psychology student at LaSalle University working as a psychiatric aide-trainee at Byberry. Witness to appalling neglect and bureaucratic inertia, and unable to generate interest in improving conditions from within, Newell, at the tender age of 23, decided to bring attention to the plight of his vulnerable charges by engaging in a civilly disobedient manner.

The Vietnam War was raging, Lt. Calley had just been convicted of war crimes against civilians of My Lai, John Lennon’s sublime anthem Imagine had just been released, a gallon of gas cost 40¢, and the 26^th Amendment had just lowered the voting age from 21 to 18. It was in this atmosphere that Mike Newell decided to “stick it to the man,” by handing out leaflets protesting the atrocious conditions at the hospital in the lobby of the auditorium in which the Superintendent of the facility was to deliver a “State of the Units” address to staff and press.A janitor, a fire marshall and a security guard assaulted the young man, dragging him to a security van, throwing him inside, and sitting on him until the police arrived. Without a warrant, he was arrested and taken into custody and interrogated for two hours before they recognized that he had done nothing illegal, at which time his father was summoned to take him home. The next day he was fired from his position with Byberry.

It was a “Eureka” moment for Newell, a registered nurse and published author who founded LifeSpan Care Management, a company whose mission is to counsel and advocate, to intervene on behalf of those who cannot speak for themselves. Honoring his obligation to the mute victims of a healthcare system gone mad, Newell and his nurse employees advise clients on every aspect of their care, from reviewing their medical records to attending doctor appointments.

A client recently sent a letter saying, “You were a life saver in my time of crisis. I am appreciative of your support on my behalf. I’ve been fortunate to have had LifeSpan services. Your skills, experiences, availability as well as approachability are admirable.” -Mary Bergman

The Philadelphia State Hospital at Byberry is in the process of being torn down now, but Mike Newell and his colleagues at LifeSpan Care Management are helping people find the information, connections, resources and perhaps most importantly, advice that they need to negotiate the medical maze. “It’s like having a nurse in the family,” says Newell. “We organize and put the medical records on a USB flash drive, so they’re up-to-date and accessible at all times. We get to know the patient and their family so we know what their proclivities and wishes are, their fears and aversions. Then everyone involved can go about their business, knowing that a trusted ‘family member’ with a medical degree is standing sentry.”

Imagine.

2007-04-30T06:45:00.000-07:00

Healthcare Babylon

In 1700 BC, when Hammurabi was King of Mesopotamia, ten to fourteen shekels was a middle class man's entire annual income. Rent for a year would cost about 5 shekels. A surgeon would be paid 3 shekels to set a broken bone, or about 21% of a man's annual income.

Medications were considered part of the treatment and were covered in the fee. Hemp, opium, honey, milk, oils, animal fats, bouillon, medicinal plants, minerals, and whatever other substances might be considered medicinal were filtered, ground and strained to make poultices, powders, ointments, lotions, pills and prescriptions (Spiegel and Springer, 1997).

According to the Economic Policy Institute, the average annual income for an American household in 2004 was $54,061, while the average rent paid per year came to $17,299.52.

In January of this year, California Governor Arnold Schwarznegger broke his leg in a skiing accident, and the CFO at the hospital in which he had his bone set estimates that the bill was $55,000, or 102% of an average American family's annual income. Healthcare has become a dirty word in the contemporary vernacular, with prices spiraling out of control and quality, or a lack thereof, found only in the derogatory headlines of the media.

The pharmaceutical drug industry is a stupendously powerful and wealthy international commercial enterprise. The pharmaceutical companies are privately held, multi-national corporations, and, as such, are in the business of making money, mostly on the shoulders of the American public. Other industrialized countries subsidize their citizens' healthcare, so insist that drug prices are kept in check, while the patients of this country are bilked for higher prices than anywhere else on earth and kept in a state of fear.

Why should it be that a company with manufacturing plants in more than 50 countries across the globe should declare drugs coming out of Canada dangerous and beyond the scope of regulation? Shouldn't one, then, be wary of any drug manufactured outside of the United States and imported over international borders? In fact, approximately 86% of all drugs sold in the U.S. are manufactured outside of our borders. Among the most popular, Prevacid, is produced in Japan, Lipitor and Viagra are produced in Ireland and Nexium comes from Sweden and France.

Consider:

· In the year 2000, American doctors wrote a total of 2.8 billion prescription drugs, an average of 10 per person. (The National Center for Health Statistics)

A recent study by the CDC found that the average American spent $1,100 per person on prescription drugs in 2002. · The Center for Drug Safety says that 26.5% of all patients experience an allergic reaction from prescribed medication.
Poisoning from prescription drugs has risen to become the second-largest cause of unintentional deaths in the U.S. according to the federal Centers for Disease Control and Prevention.
Newstarget.com headline on 2/20/2006 website: "Statistics prove prescription drugs are 16,400% more deadly than terrorists." While there are legitimate miracle drugs, one would be wise to be skeptical of an industry that prescribes the lion's share of its cures for indigestion, erectile dysfunction, high cholesterol and other important problems that are just as easily cured - for free and without medication of any kind - with simple changes in diet and behavior.

A LifeSpan Care Manager knows that the old adage about an ounce of prevention being worth a pound of cure is true.

Walter Reed Hospital: Just the Tip of the Iceberg?

2007-03-19T04:54:00.000-07:00

If even our venerated Iraqi War wounded can't get the treatment they deserve at America's
foremost Army Medical Center, the average patient adrift in the maze of the healthcare
system doesn't stand a chance.

Wounded, heavily medicated, brain-damaged, and crippled soldiers were left to their own
devices in a filthy, vermin-infested facility, prompting national outrage and
what the Boston Globe has described as, "the suspicion that Walter Reed is not
the exception but the rule, the most galling symbol of a badly broken system." (3/11/2007).

The tragedy at Walter Reed has further convinced me of the importance of our
mission of advocacy and counseling, protecting our clients and their families
from the devastating effects of illness and disability as they wend their way through the
monolith of healthcare in America.

A groundbreaking 1999 report by the Institute of Medicine found that up to 98,000 Americans
die every year from preventable medical errors made in hospitals alone. There are
more deaths in hospitals each year from preventable medical mistakes than there are
from vehicle accidents, breast cancer, and AIDS.

Using Hospital Quality Alliance data from 3,558 hospitals, the researchers studied 10
quality indicators, tests or treatments that have been shown to reduce death or improve
health, for three important medical conditions: acute myocardial infarction,
congestive heart failure and pneumonia. They assessed how well hospitals performed and
found that for six of the ten indicators, patients failed to receive needed care about
10 to 20 percent of the time. For the other four indicators, performance was much worse.

In other categories the researchers found that academic hospitals had higher
performance scores than non-academic hospitals for acute myocardial infarction and
congestive heart failure, but lower scores for pneumonia. Not-for-profit hospitals
consistently had significantly higher scores than for-profit hospitals. The results showed
hospitals in the Northeast and Midwest outperformed hospitals in the West and South.

In the company of a LifeSpan Care Manager, two heads are, indeed, better than one. We
know where to go and what to do when you get there. As a result, these kinds of risks are
dramatically reduced.

LifeSpan Registered Nurse Care Managers come from the hospital trenches and understand
what our patients are up against. We are singularly equipped to shepherd clients safely through the hospital experience, completely avoiding it whenever possible.