Monday, November 25, 2013

Lemon of a Law

If PPACA, aka The Unaffordable Insurance Act, were a car, folks could recoup under the lemon law. We now know that if you like your plan, despite the president's "fix," you probably can't keep it. Some states like NY have already said it's too late to roll back that clock. Other states might be willing to go along but it depends on state regulators.

We also learn that if you like your doctor, you may not be able to keep your doctor. You may not be able to use your local hospital either, for that matter. Insurers have been both cutting their networks and decreasing their share of the payments to the doctors and hospitals for their services. Some prestigious NYC hospitals, like Langone Medical Center, have declined to participate in many of the new plans. Many doctors are also declining to participate or find (att some difficulty, I might add) that they've simply been dropped from the networks.

Without going into the Epic FAIL that is, many who are able to get to shop for insurance are experiencing firsthand the meaning of sticker shock. I guess that promise that folks would save about $2500 on their insurance costs was an "incorrect promise" also.

I ask you, when did we elect Joe Isuzu?

Tuesday, November 19, 2013

Mourning Time

Early this morning, my sister - in - law lost her courageous battle against an aggressive cancer. It had snuck up on her like the biblical thief in the night, making its presence known only when it had secured too strong a foothold to be removed. For about six months or so, chemotherapy was able to give her a few more days in the sun, a few more happy days with family and friends. But in the end, the disease broke through and she finally succumbed. Just as the comet was visible in the eastern sky, her soul left this mortal plane. She left for family and friends, a legacy of music and dancing, lilting laughter, a radiant smile, and great beauty of body, mind and soul. Dearest Awilda, you never really left for you always remain a part of us.

One woman leaves behind a legacy that will never be lost for she touched so many.

The Strength of One Woman

© Glorimar Fontanez

She played a different role in all our
lives, a mother, a sister, and a
grandmother, no matter what the love
we have for her is one, ask anyone
they'll tell you the same, she brought
us joy when we had pain , the strength
and love of one women held all of us
together even more now then ever, she
isn't physically here but we still
feel her near in every step we take
and every move we make, what she's
giving to us no one can ever replace.

Source: The Strength Of One Woman, Dying Poem 

Monday, November 18, 2013

A Killer In The Community

What would you say if you knew an infectious disease which kills more people annually than AIDS, spreads by both skin to skin and airborne routes, and is resistant to all commonly used antibiotics was loose within the community? You'd doubtless want to know what public health authorities were doing about this. Well, Methicillin Resistant Staphylococcus Aureus or MRSA causes such infections and has gone from a predominantly hospital - acquired to a community - acquired infection as well. Despite the recent stories from the NFL about players infected with MRSA, the disease gets far too little attention, especially when compared with the brouhaha over Obamacare or the latest exploits of Miley Cyrus. The real scary news is that tracking by public health authorities is not universal. This seems absurd.

How did this condition get out of hand? It did so over many years, as we got complacent over the ease with which infectious diseases were handled by antibiotics. To be sure, there were outbreaks of occasionally resistant bugs but by and large, this was not a widespread problem. So we tended to reach for the Z-Pak or Amoxicillin for almost any respiratory illness, abandon old-fashioned topical antiseptics like iodine for neosporin ointment for cuts and scrapes, secure in the knowledge that our antibiotics would be successful. Unfortunately, bacteria are nothing if not resourceful and developed resistance over many generations as the susceptible strains fell by the wayside, leaving only the hardier strains intact. Moreover, antibiotic overuse, not only for illness but also in animal feed, played havoc with the body's normal flora, upsetting a balance which formed another line of defense.

While new promising treatments are on the horizon and work continues apace on vaccines, there are many who need help today and many more others potentially in harms way. What can we do? First, don't ask your doctor to prescribe an antibiotic for a cold. First, it won't work and second, this is what got us here in the first place. And don't think your physician a bad doctor because he or she won't reach for that prescription pad. Your doctor's trying to help you. In the long run, you'll thank him.

If you get a cut, wash it out with soap and water, one of our best antiseptic combinations. Grandma's iodine from the medicine cabinet would be a far better antiseptic than that new tube of neosporin.

If you belong to a gym, ask the manager about their cleaning regimens. Ideally, equipment and mats should be wiped down between uses to lessen the likelihood of skin to skin contact between patrons. It might pay to bring your own lysol wipes too, as well as your own clean towel, etc.

Finally, if ever there were a condition in need of a celebrity spokesperson, it's MRSA. This disease has been under the radar for far too long. We had and have countless celebrities raising AIDS awareness, but MRSA now kills more than AIDS. We need a MRSA spokesperson, a MRSA global fund, a MRSA telethon. Bill and Melinda Gates, please call your office.

Monday, November 4, 2013

Transvaginal Ultrasound - The Rest of the Story

Recently, an incredibly useful diagnostic tool for women's health has become embroiled in the firestorm of abortion politics. I'm speaking of transvaginal ultrasound and I'm here to try to set the record straight. Transvaginal sonography, or TVS, has been around for longer than you think, having come a long way from the first use by the Japanese in 1971. The technique was popularized in the late 1980's as a logical extention of women's healthcare. Rather than have a woman fill her bladder to point of significantt pain and disttress, a small, high frequency transducer is simply placed close to the organs of interest, resulting in images usually far more detailed than those obtained from the transabdominal route.

During this introductory phase of TVS, I was a practicing gynecologist and it seemed a natural extension of my pelvic examination. I was initially using a small standard pediatric transducer which was easily introduced, but switched over to the standard long-handled probe when I got the chance. As a shameless plug, I'd like to say I was, at least in my neck of the woods, a pioneer in this regard. I found quickly that I could evaluate potential difficulties in early pregnancy for those women who thought they were miscarrying and usually reassuring them that things were OK. I could also confirm the location of an early pregnancy, often a week earlier than transabdominally. This came in handy in those cases of suspected tubal pregnancy, which previously wasn't diagnosed until the woman presented to the emergency room in significant distress.

TVS also was able to characterize ovarian cysts, with endometriomas and dermoids usually exhibiting such a distinctive appearance that a definitive diagnosis became possible. Now, when coupled with sensitive color and power doppler, vascular signatures can be determined, facilitating the diagnosis of ovarian cancer, often at an earlier stage than before.

Today, TVS has many uses in both obstetrics and gynecology. Monitoring cervical length in patients at risk for preterm delivery is routine. TVS is often useful in evaluating fetuses for certain abnormalities such as anencephaly. In women undergoing IVF, monitoring of follicles and obtaining eggs via the transvaginal route is standard of care. TVS, especially with 3D probes, facilitates the monitoring of the location of possibly malpositioned IUD's. Three dimensional multiplanar transvaginal sonography produces images of the uterus which can rival an MRI, allowing cost-effective diagnosis of uterine malformations and location of fibroids and polyps. Instillation of saline into the uterus in patients with abnormal bleeding is now a standard technique for triaging therapy for these women.

So, once the political smoke is allowed to clear, we're left with one impression. Transvaginal ultrasound is an impressive advance in women's healthcare. It's truly frustrating that this diagnostic modality has become such a political football. I truly hope that the dust settles sooner rather than later.

If you have any questions, feel free to leave a comment or tweet me @sonodoc99 on Twitter.