calvinjgarci

Wednesday, February 6, 2013

Implantable Contact Lenses Certification

Dr. Grochmal recently attended a conference to expand his services to increase his refractive surgery options for his patients in Baltimore. Implantable contact lenses (ICL’s) are a great alternative for patients who are not qualified for LASIK or are borderline. Often times, the glasses’ prescription is outside the range for safe and effective LASIK; or the cornea is too thin for LASIK. ICL’s will correct for high hyperopia as well as high myopia without altering the cornea’s natural refractive powers. Please contact Grochmal Eye Center to learn more.

Source: http://www.grochmaleye.com/continuing-medical-education-cme/implantable-contact-lenses-certification/

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Economy class syndrome and blood clots in travelers

Source: http://adventuredoc.net/2012/02/17/economy-class-syndrome-and-blood-clots-in-travelers/

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Understanding LASIK | Your Top 5 Questions Answered

At first glance, LASIK can seem like a confusing or complicated subject. As a result, many patients don’t explore their LASIK options, for fear of being misinformed or not understanding the procedure completely. Because we want all our patients to find out what laser vision correction can do for them, we thought we would take a moment to “de-mystify” LASIK and answer some of the most common questions we’re hearing. It’s time to set the record straight!

Here is our list of the Top 5 Patient Questions About LASIK:

What is LASIK in a nutshell? The goal of a LASIK procedure is simple: to improve vision and reduce a patient’s dependence on corrective lenses. The procedure uses special light energy to reshape the cornea, effectively combating the affects of nearsightedness, farsightedness and astigmatism.
Are all LASIK procedures the same? There are several types of LASIK procedures available today – each with their own unique benefits. Our practice is proud to offer what many are considering the gold standard in modern laser vision correction: iLASIK™. Using 3D eye mapping to create a fully-customized treatment plan, iLASIK is completely bladeless and relies on cutting-edge “cool laser” technology to safely reshape the cornea.
Is LASIK painful? While tolerance can sometimes vary, LASIK is generally regarded as a “relatively painless” procedure. Very often, the only sensation patients report is a slight pressure. Furthermore, we work to ensure patient comfort by administering numbing eye drops before the procedure.
Are most patients happy with their results? While each patient is different and can expect unique results, LASIK tends to be a highly successful procedure. In fact, “LASIK vision correction has the highest patient satisfaction rate of any elective surgery,” reports The Eye Surgery Education Council, “95.4%, according to a 10-year survey of scientific studies from around the world.”
How can I find out if LASIK is right for me? In general, LASIK patients tend to be in good health, free of eye conditions such as cataracts, over the age of 21. But, since there are other factors to consider in determining a good candidate for LASIK, we encourage anyone interested to schedule a consultation and find out what laser vision correction can do for them.

Considering LASIK? Learn More Today

To learn more about Laser Eye Surgery, contact us today. Together, we can find the best treatment options for you. Our offices are located in Winchester, serving Virginia, West Virginia and Maryland. Book your appointment at (540) 722-6200.

Source: http://www.seeclear.com/blog/uncategorized/understanding-lasik-your-top-5-questions-answered

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Tuesday, February 5, 2013

Treatment for Failed Back Surgery Syndrome Video

When pain persists after back surgery, the true cause of the patient's pain needs to be re-evaluated. It may be the case that the surgery was performed to address an issue that was not the true pain generator. It may also be damage from the surgical procedure itself that is causing pain. In a spinal fusion surgery, the mechanical changes to the spine may cause new pain to develop. All these things are considered to evaluate the cause of the post-surgical pain.

Video presented by Zinovy Meyler, DO

[TOC]

Video Transcript

Failed back surgery syndrome is a term that is used to describe pain that starts or persists after spine surgery. The important thing to remember is that spine, in itself, serves a certain purpose; it solves a number of problems, but, as with any other tool, it has its own limitations. So, sequelae of the surgery can cause pain, but also at the same time, surgery cannot address all the pain generators. So in looking at it like this, we can actually turn our attention away from the aspect of the surgery and now refocus on the patient and look at the pain generators in that patient in the context of their life and in the context of their overall function. By looking at it like that, we can actually start treating the pain generators and really get to the source of the majority of the pain that's generated after the surgery.

So what we need to look at is the physiologic changes after the surgery. Those are:

Depending on the surgery, the mechanics of the spine will change. Now, if it's fusion surgery, then what happens is that two segments, for instance, that are being fused are no longer moving on their own. They are now moving in unison, which in effect creates a single segment. Because that single segment is no longer taking up the work of two segments, separately, it is now functioning as a single segment, which means - and this is for simplicity sake - we can say five segments doing 100% of work and that's 20% per segment, now we eliminate two or three segments, per se, and now 33% falls on each segment. Now you can imagine that with additional force going through that segment, there's going to be motion, more wear-and-tear, and more potential pain caused by that segment. And that's usually referred to as "adjacent segment disease." And that’s one of the post-surgical effects.
Another effect is the actual tissue damage that can happen after surgery. So, myofascial pains can happen after a separation of tissue. When that tissue comes back together, the connective tissue may cause fibrosis - and that can trap nerves - or in itself become tight and painful. That can be treated in a separate way.
Going back into the increased motion at separate segments, we have to remember that the motion actually happens across facet joints. Those joints are hinge-like joints - they are small joints - and those joints are just like any other joint in our body, which means it can get inflamed just like any other joint and that usually happens through overuse. Treating those joints usually resolves the pain that is associated with those joints and in that way, we can restore the function that was lost through the inflammation and alleviate the pain.
There are many other pain generators that need to be looked at and can certainly be treated with appropriate diagnosis and treatment.

Treatment of pain persisting after surgery should be approached in a systematic way. Diagnosing each pain generator and eliminating the pain generators can serve to restore function and eliminate pain and in order to do that, we can employ a number of different tools that are available to us. And those include a wide array of the tools. Now it can be manipulations, it could be physical therapy, at times injections, or at times if we need to things like spinal cord stimulation or implantable pumps that can supply a steady state of medication can be used to control the pain. By using all the tools that are available to us, we can really improve the patient's quality of life by doing two very important things: decreasing the pain and restoring function. That way, they can reintegrate back into life and not be limited by pain or by mobility.

Thumbnail:

Treatment for Failed Back Surgery Syndrome Video

Author Node Id:

Zinovy Meyler, DO

Source: http://www.spine-health.com/video/treatment-failed-back-surgery-syndrome-video

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Dry Eyes in the Winter Months

The cold dry air that is common in the winter months can have adverse effects on the moisture in your eyes. But what many people may not realize is that your eyes can become just as dry while trying to keep warm inside. The heat produced in our homes is a very common cause of not only dry skin, but dry eyes as well. By taking a few simple precautions — both inside and outside — you can ensure that dry and itchy eyes are avoided. In most cases, dry eyes are caused by the quick evaporation of moisture from our tear ducts. In dry weather, hot or cold, this can occur quickly and cause itching and dryness that is very uncomfortable.

Take Steps to Keep your Eyes Moist

• Artificial Tears – Using artificial tears as directed can help keep your eyes moist when your tear ducts may not be able to keep up with the dryness of the air.

• Sunglasses – Wearing sunglasses when out in the cold weather can shield them from direct contact with the cold dry air particularly when it is windy.

• Humidifiers – When indoors, use a humidifier to make the environment less dry. Indoor heat can dry the air, making your natural moisture dry up faster than usual.

• Cut down on coffee – Qe already drink more warm liquids during the winter months in order to warm up, but coffee is a mild diuretic that can cause dryness in your eyes and skin. Monitoring your coffee consumption may aid in keeping your eyes more moist.

By making sure that your eyes are moist at all times, you can experience less discomfort while both inside and outside during the winter.

Do you have more questions?

If you feel you’re experiencing Chronic Dry Eye, and would like more information on treatment, we encourage you to contact us today. Dry eye is a common condition especially in the colder seasons, and we can work together to find the best treatment options for you. Our offices are located in Winchester, serving Virginia, West Virginia and Maryland. We can be reached at (540) 722-6200. Call today to make an appointment.

Source: http://www.seeclear.com/blog/dry-eye-carerestasis/dry-eyes-in-the-winter-months

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Are You Turned On?

Are you turned on?…electrically speaking, that is…and I’m not refering to Timothy Leary’s, “Turn On, Tune In, Drop Out.”

The other day we talked about how we are electrical beings and that from time to time we need to “ground” ourselves and release some of the static electricity that is built up in our bodies. I had a couple of people tell me that this is done all the time throughout most of Europe. I also had a few people who wanted to see learn more about how our bodies operate on an electrical current.

If you’re one of our readers who would like a visual of the body producing electricity in action then this video is for you.

What you are viewing is a group of four people holding hands and two of the people are holding “hands” with a Ring Around The Rosie Doll. On each of the dolls hands is a small metal button. When both of these buttons are touched with bare skin the doll begins to sing. You will notice in the video that there are a couple of times that the participants let go of the hand of one of their partners…once they do this the doll stops singing. Once they hold hands again the doll starts to sing. The doll sings because of the electricity being produced by each participant.

Remember, you are an electrical being…do something good for yourself to recharge your batteries…a nice walk around the block in the evening air is always a simple (and free) thing that you can do to bring in more good energy and release the bad.

Yours In Health!

G.E. Moon II

Source: http://www.abundanthealthcenter.com/blog/are-you-turned-on

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Monday, February 4, 2013

Top 5 Myths of Glaucoma

Most people have heard of glaucoma, but few know the whole story. In short, glaucoma is an eye condition where the optic nerve becomes damaged, usually as a result of increased pressure in the eye. This damaging of the optic nerve ultimately causes a gradual but serious loss of vision. Untreated, the disease often results in complete blindness.

Now that you have a basic understanding of glaucoma, let’s clear up a few of the most common myths surrounding this serious condition.

Here are the top 5 myths of glaucoma:

1. Myth: Glaucoma is rare.
Fact: On the contrary, it has been estimated that over 2 million Americans are suffering from glaucoma. Even more disturbing is the fact that glaucoma remains a leading cause of blindness in the US.

2. Myth: Only patients with a family history can develop glaucoma.
Fact: Although certain factors like age and heredity can increase your chances of developing glaucoma, the condition can affect anyone, anywhere and at any age.

3. Myth: Glaucoma cannot be treated.
Fact: While there is currently no cure, there are a host of Glaucoma Treatments aimed at minimizing the risk of permanent vision loss. These treatments include medications, eye drops and surgery.

4. Myth: Only patients with glaucoma symptoms should get checked out.
Fact: The majority of glaucoma patients do not experience any symptoms before the optic nerve actually becomes damaged. For this reason, regular glaucoma screenings are vitally important.

5. Myth: Glaucoma screenings are painful.
Fact: Glaucoma screenings test different things—visual field, pressure in the eye, etc. Each of these tests are not only quick, but non-painful.

Get Checked! Schedule a Glaucoma Screening Today

To schedule a glaucoma screening or to learn about any of the ophthalmology services we offer, we encourage you to contact us today. Our offices are located in Winchester, serving Virginia, West Virginia and Maryland. Book your appointment at (540) 722-6200. We look forward to seeing you.

Source: http://www.seeclear.com/blog/glaucoma/top-5-myths-of-glaucoma

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Treatment for Failed Back Surgery Syndrome Video

Video presented by Zinovy Meyler, DO

[TOC]

Video Transcript

So what we need to look at is the physiologic changes after the surgery. Those are:

Depending on the surgery, the mechanics of the spine will change. Now, if it's fusion surgery, then what happens is that two segments, for instance, that are being fused are no longer moving on their own. They are now moving in unison, which in effect creates a single segment. Because that single segment is no longer taking up the work of two segments, separately, it is now functioning as a single segment, which means - and this is for simplicity sake - we can say five segments doing 100% of work and that's 20% per segment, now we eliminate two or three segments, per se, and now 33% falls on each segment. Now you can imagine that with additional force going through that segment, there's going to be motion, more wear-and-tear, and more potential pain caused by that segment. And that's usually referred to as "adjacent segment disease." And that’s one of the post-surgical effects.
Another effect is the actual tissue damage that can happen after surgery. So, myofascial pains can happen after a separation of tissue. When that tissue comes back together, the connective tissue may cause fibrosis - and that can trap nerves - or in itself become tight and painful. That can be treated in a separate way.
Going back into the increased motion at separate segments, we have to remember that the motion actually happens across facet joints. Those joints are hinge-like joints - they are small joints - and those joints are just like any other joint in our body, which means it can get inflamed just like any other joint and that usually happens through overuse. Treating those joints usually resolves the pain that is associated with those joints and in that way, we can restore the function that was lost through the inflammation and alleviate the pain.
There are many other pain generators that need to be looked at and can certainly be treated with appropriate diagnosis and treatment.

Thumbnail:

Author Node Id:

Zinovy Meyler, D.O.

Source: http://www.spine-health.com/video/treatment-failed-back-surgery-syndrome-video

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Top 5 Patient Benefits of iLASIK™

Since its inception, laser vision correction has been changing the lives of our patients, enhancing vision and reducing or eliminating our patients’ dependence on eyeglasses and contact lenses. Now, our practice is proud to offer what many consider to be the most advanced LASIK system available: iLASIK™. Not sure what this cutting-edge procedure is all about?

Here is our list of the Top 5 Patient Benefits of iLASIK:

Fully-customized procedure. iLASIK is not a one-size-fits-all procedure. Rather, using cutting-edge 3D eye mapping, iLASIK creates a one-of-a-kind image that is used to guide your LASIK procedure. This unique “roadmap” means a fully-customized procedure in keeping with your unique anatomy and medical needs.
Completely bladeless. Where some LASIK systems rely on metal blades, iLASIK creates a corneal flap using a precise laser. This completely blade-free system is an ideal alternative for those hesitant about “going under the knife.” What’s more, this method often results in better and faster healing following the procedure.
Cool laser technology. A second laser – the one used to make the actual vision correction – can be understood as a “cool laser.” Using pain-free, ultraviolet light, iLASIK works to reshape the cornea and achieve better vision. What’s more, vision correction takes only seconds per eye.
Iris registration. Cutting-edge iris registration technology ensures that iLASIK’s laser remains aligned, even if you move your eye. This offers not only a more precise procedure, but very often a quicker procedure as well.
Most patients achieve 20/20 vision or better. Of course, the most important benefit of iLASIK is its remarkable results. And, while each patient’s results will vary, most iLASIK patients achieve 20/20 vision or better following the procedure.

iLASIK in Winchester

To learn more about iLASIK, contact us today and schedule a consultation. Our offices are located in Winchester, serving Virginia, West Virginia and Maryland, and you can reach us directly at (540) 722-6200. We look forward to meeting you.

Source: http://www.seeclear.com/blog/lasik/top-5-patient-benefits-of-ilasik%e2%84%a2

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A nurse practitioner-directed intervention improves the quality of life of patients with metastatic cancer

Gerardo Colon-Otero, M.D., with the Department of Hematology/Oncology at Mayo Clinic in Florida, discusses results of a randomized pilot study that show that an intervention that explains the benefits of hospice and addresses advanced directives early in the course of treatment leads to measurable improvement in the patient’s emotional and mental quality of life (QoL).

The study was published in the Journal of Palliative Medicine online ahead of print on May 4, 2012.

ABSTRACT
Background
There is a paucity of randomized studies evaluating the value of palliative interventions on a prospective basis in newly diagnosed oncology patients. We sought to prospectively evaluate quality of life (QoL) outcomes in advanced cancer patients who received discussion-based palliative care interventions from an advanced registered nurse practitioner (ARNP) integrated into the oncology team, and compare these outcomes with a control population.

Methods
Patients with metastatic cancer were randomized to standard care or an ARNP-directed intervention that included discussions of the benefits of hospice, discussions on living wills and advanced directives (Five Wishes document) along with an assessment of QoL. Relevant endpoints included change from baseline QoL and improvement in hospice knowledge.

Results
From Nov. 13, 2008, through July 28, 2009, 26 patients were accrued at the Mayo Clinic in Jacksonville, Fla. The study closed early due to published data demonstrating the benefits of early palliative care interventions in the management of metastatic cancer patients. Statistically significant improvements from baseline were noted in emotional and mental QoL assessments in the intervention group that were not seen in the control group. Patients found it useful to have the living will and Five Wishes documents offered as part of the ARNP intervention.

Conclusions
An ARNP-directed intervention that explains the benefits of hospice and addresses advanced directives early in the course of metastatic cancer patients’ treatment is well-received by the patients and their relatives and leads to measurable improvement in the patient’s emotional and mental QoL.

Authors
Gerardo Colon-Otero, M.D., Stephen H. Dyar, Jr., M.D., Mary M. Lesperance, A.R.N.P., Robert P. Shannon, M.D., Jeff A. Sloan, Ph.D.

Clinical trials at Mayo Clinic
Metastatic cancer, to bone

Source: http://physicianupdate.mayoclinic.org/2012/05/23/a-nurse-practitioner-directed-intervention-improves-the-quality-of-life-of-patients-with-metastatic-cancer/

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Mayo Clinic study finds that cardiac rehab reduces mortality by 45 percent

Randal J. Thomas, M.D., director of Mayo Clinic’s Cardiovascular Health Clinic, and colleagues found that patients who participate in cardiac rehabilitation after having heart interventions such as angioplasty, stents and clot-busting drugs have a 45 percent lower mortality rate.

The research team studied data from more than 2,300 patients between 1994 and 2008, and recently published the results in Circulation.

Only about 40 percent of patients in the study participated in cardiac rehabilitation. These findings are particularly important for interventional cardiologists, Dr. Thomas says, because encouraging patients to pursue cardiac rehab after their procedure can potentially save more lives than previously thought.

Authors: Kashish Goel, M.B.B.S.; Ryan J. Lennon, M.S.; R. Thomas Tilbury, M.D.; Ray W. Squires, PhD; Randal J. Thomas, M.D., M.S.

Source: http://physicianupdate.mayoclinic.org/2012/04/03/mayo-clinic-study-finds-that-cardiac-rehab-reduces-mortality-by-45-percent/

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Sunday, February 3, 2013

Aero-Medical Retrieval Education

Source: http://adventuredoc.net/2012/05/25/aero-medical-retrieval-education/

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Power to the people: Patient in command

Source: http://bernardlown.wordpress.com/2012/11/03/power-to-the-people-patient-in-command/

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Assess Your Risk: Should You Be Thinking About Glaucoma?

When it comes to protecting our eye health, we all know the most obvious signs and symptoms to watch out for – blurriness, halos and other changes in vision. With glaucoma, however, the condition often doesn’t present any symptoms in its early stages. Often referred to as a “silent thief of sight,” it’s for this reason that patients need to understand potential risk factors for the condition and schedule regular glaucoma screenings. A common and serious condition, we are challenging our patients to consider one important question: Should You Be Thinking About Glaucoma?

Here is our list of the Top 5 Risk Factors for Developing Glaucoma:

Age. Age is one of the most common risk factors for developing glaucoma. In fact, according to the Glaucoma Research Foundation, “You are six times more likely to get glaucoma if you are over 60 years old.”
Family History. Pointing to a genetic link, those with a family history of glaucoma tend to have a much higher chance for developing the condition. It’s important for patients to understand their family’s medical history and share it with their healthcare provider.
Certain Medical Conditions. Certain medical conditions have been marked as potential risk factors for glaucoma. In fact, according to the Mayo Clinic, “Several conditions may increase your risk of developing glaucoma, including diabetes, heart diseases, high blood pressure and hypothyroidism.”
Ethnicity. Some ethnic groups tend to be more vulnerable to developing glaucoma. Typically, these include African Americans and Hispanic populations.
Taking Certain Medications. Certain medications have been marked as potential contributing factors to glaucoma, particularly steroids. According to the GRF, “A 1997 study reported in the Journal of American Medical Association demonstrated a 40% increase in the incidence of ocular hypertension and open-angle glaucoma in adults who require approximately 14 to 35 puffs of steroid inhaler to control asthma.”

Schedule a Glaucoma Screening Today

Whether or not you are in one of these “high risk” categories, understand that glaucoma does not discriminate and everyone is ultimately at risk. This is why we are encouraging all our patients to contact us today and schedule a glaucoma screening. Our offices are located in Winchester, serving Virginia, West Virginia and Maryland, and you can reach us directly at (540) 722-6200.

Source: http://www.seeclear.com/blog/glaucoma/assess-your-risk-should-you-be-thinking-about-glaucoma

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Careers As Advanced Health Care Practitioner In Demand

According to data collected by the American Medical Group Association’s and Cejka Search 2011 Physician Retention Survey, careers in the advanced health care field are growing rapidly. As such, employment in medical groups for nurse practitioners (“NPs”) and physician assistants (“PAs”) has increased significantly in the past five years. According to the data, 75% of the responses to the survey indicated more NPs and PAs will be hired in the next five years.

Growth in these advanced health care professions is due largely to economics, according to an article in U.S. News and World Report. NPs, for example, can provide patients with many primary health care services at a fraction of the cost of an internist. In addition, FiercePracticeManagement reports that due to physician shortages and the demand to create a medical “team” to care for patients (accountable care organizations, “ACO”), medical groups are employing the NP and PA at increasingly high rates. This gives NPs and PAs the advantage of choosing where to work, thus creating a high turnover rate for these positions. In addition, recruiting and retaining these professionals are challenges to medical groups.

Meiselman, Denlea, Packman, Carton & Eberz P.C. offers legal advice to physicians on medical issues. If you need legal assistance or guidance on a matter regarding your practice, please call our office.

Source: http://www.pagingdrblog.com/2012/04/17/careers-as-advanced-health-care-practitioner-in-demand/

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Source: http://adventuredoc.net/2013/01/03/healthcare-provider-interaction/

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Types of Spinal Injections Video

There are a few different types of spinal injections, categorized by what is being injected and where the injection takes place. This video explains epidural steroid injections, selective nerve root blocks, facet joint injections, radiofrequency neurotomies, and sacroiliac joint injections, along with why and how each type of injection is used.

Video presented by Zinovy Meyler, DO

[TOC]

Video Transcript

In discussing common spinal injections, it's important to remember what we’re trying to achieve and then choose the appropriate tool for the job. So, to discuss the injections, we'll break them up into small categories.

Epidural steroid injections can be done in mainly two ways. First of all, what we're trying to achieve is to place the steroid into the epidural space. Epidural space in itself denotes space that is intimately located above the dura. Dura is the outermost layer covering the spinal cord and the nerves that exit the spinal cord. Most of the inflammation occurs in that area and that is the area that we can place the medications most safely. This can be approached in two ways. One is what’s called "interlaminar" - that means between these lamina. That can be approached from what's called paramedian - or just off the mid-line - approaching this way. Another approach is called the transforaminal - what that means is "across the foramen." Foramen being this opening through which the nerve exits. The approach is taken by going into space where the nerve usually doesn't appear and this is done under the guidance of x-ray or fluoroscopy.

Another type of injection is called selective nerve root block. Selective nerve root block is selectively choosing a specific nerve in order to determine whether that nerve is causing the pain. And in order to that, we approach under the guidance of fluoroscopy, to target a specific nerve then place a small amount of (usually) contrast to outline that we are really concentrating on this nerve root, then place a very small amount of anesthetic. Now, the small amount is important because we don't want that that anesthetic to spread anywhere else and affect our outcome. If the pain is relieved with this injection, then we know that was the cause of the pain or a pain generator.

Another injection is a facet joint injection. This can be approached in two ways. One is the injection into the joint itself and in order to do that we use fluoroscopy for guidance and we approach the joint itself, going into the joint, and then place the medication into the joint. And the reason to do that is (1) to determine if injecting anesthetic and corticosteroid will relieve the pain - and that is the diagnostic part of this - and (2) the corticosteroid reduces the inflammation.

Another way to approach facet mediated pain is by blocking the nerve that actually transmits that pain. And the reason we can do that is because, anatomically, it is consistently found in the same place. It is found traveling along this path. And what we can do, once again under fluoroscopic guidance, we approach the anatomical location of this branch placing a small amount of medication, blocking the transmission of that nerve temporarily. And that, once again, diagnostically tells us: if we block this nerve, does this relieve the pain? Now, it’s not as simple as that because there are two nerves that usually supply each facet joint, so in order to really effectively block one joint, we have to block two nerves and that way we know that joint is blocked and then we see if it truly alleviates the pain or not.

That leads me into another type of an injection, which truly is not an injection, but more of an intervention to treat facet joint pain - that is the medial branch rhizotomy. And in order to do that, what we do is we place a probe - that is just like a needle - along the path of this medial branch and then we use radiofrequency to concentrate at the tip of that probe to heat it up and then lyse the little nerve that travels along the path, effectively eliminating the transmission of the pain. The effect of this doesn't happen right away; it takes several weeks to take effect, but it provides a longer-term relief for people suffering from facet mediated pain.

Another type of a spinal injection is used to treat and diagnose sacroiliac joint pain. So, once again under fluoroscopic guidance in order to ensure the safety as well as the precision, we go into the sacroiliac joint placing a small amount of contrast to outline where the medication is going to spread, then we use a small amount of anesthetic with corticosteroid. The anesthetic serves as the diagnostic portion - if the pain is eliminated, then we know that was the pain generator and we've effectively diagnosed sacroiliac joint pain. Then, corticosteroid reduces the inflammation that usually is the cause of the pain and that is the therapeutic portion of this.

There are many other interventions that we can use for the spine, but these are the more common ones.

Thumbnail:

Author Node Id:

Zinovy Meyler, D.O.

Source: http://www.spine-health.com/video/types-spinal-injections-video

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Saturday, February 2, 2013

Implantable Contact Lenses Certification

Source: http://www.grochmaleye.com/continuing-medical-education-cme/implantable-contact-lenses-certification/

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Doctor as scientist, healer, magician, business entrepreneur, small shopkeeper, or assembly line worker — which is it? (Essay 30)

Source: http://bernardlown.wordpress.com/2012/06/26/doctor-as-scien/

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Reflections on World AIDS Day with Michael Horberg, MD

World AIDS Day is Dec. 1; this year’s theme is ‘Working Together for an AIDS-Free Generation’

Michael Horberg, MD, is Kaiser Permanente’s national director for HIV/AIDS. Appointed to Obama’s Presidential Advisory Council on HIV/AIDS in 2010, Dr. Horberg hopes to make Kaiser Permanente’s best practices a part of national policy. Practicing at Michael Reese and Northwestern Memorial hospitals in the Chicago area for 10 years before coming to California, he has spent most of his medical career in the fight against the disease. He also is chair of the board of directors of the HIV Medicine Association, an organization of 5,000 HIV clinicians in the U.S. and abroad. We caught up with him recently about his work in this field.

CTH Blog:
You’ve been committed to the fight against AIDS/HIV for three decades. What has this journey been like for you?

Michael Horberg, MD:
Professionally, the journey has been extraordinarily rewarding. It has led to a career in advanced HIV care, research and advocacy, with leadership in the HIV Medicine Association, as well as previously the Gay and Lesbian Medical Association. I know I’m a better doctor because of my work in HIV — the continuing education, learning new research and new medications/treatments daily, and the phenomenal collaborations with my Kaiser Permanente colleagues.

On a personal level, the last three decades have also been quite a journey. In the early 1980s, when the first patients infected by the HIV virus were being treated, I was in my third year of medical school. I knew I was gay, but I wasn’t ready for anyone else to know that. It was the fear of rejection, the fear of being ostracized, even in the medical community, of not being able to attract any patients. Ironically, the onset of the AIDS crisis is what finally helped to liberate me. As patients with HIV symptoms, including some of my close friends, began coming to me in private practice, I realized stepping out of the closet would help them get the care they needed and allow me to be a more powerful advocate for specialized care. Furthermore, being able to help my gay and lesbian brothers and sisters fulfilled my desire to meld technical skill with compassion. Especially early in the crisis when there was a limit for what we could do for patients, really caring, really showing love was critical.

CTH Blog:
What continues to motivate you in the fight against HIV/AIDS?

MH:
It’s been more than three decades since AIDS was first reported and the statistics of the epidemic still continue to haunt me. Every day, more than 150 people in the United States become infected with HIV. That adds up to between 50,000 and 56,000 people a year – just in the United States. And racial and ethnic minorities in gay and bisexual men are disproportionately impacted by this epidemic. About half of the nation’s HIV population is African-American – yet African-Americans have a 15 percent greater chance of dying from HIV than white Americans. This is a disease of disparities.

Until we no longer have an epidemic, I will continue to be motivated.

CTH Blog:
At the International AIDS Conference Washington D.C this summer, of which Kaiser Permanente was a key sponsor, there was a lot of discussion about an AIDS-free generation. Do you think that’s possible?

MH:
Yes, there is great hope. It can be achievable, but it requires resources, increased research, and increased access to quality HIV care for all living with HIV. I am proud to support the concept of an AIDS-free generation and working towards that goal. As a leader in HIV treatment, what we are doing at Kaiser Permanente and the tools and research we can share with the world, it’s entirely possible.

CTH Blog:
How has Kaiser Permanente been a leader in HIV treatment?

MH:
Kaiser Permanente has an outstanding record of successful HIV clinical care outcomes. Our care teams have treated more than 60,000 people and have reduced disparities among its current HIV population of approximately 20,000 people by working to meet or exceed the objectives of the U.S. National HIV/AIDS Strategy. We also have an outstanding record of successful HIV clinical care outcomes. Such as:

HIV mortality rates that are half the national average
94 percent median treatment adherence among KP patients that are regularly in care and on antiretroviral therapy
No disparities among Kaiser Permanente’s African-American and Latino HIV-positive patients for both mortality and medication rates, compared to a 15 percent higher rate in the U.S. for mortality and medication
89 percent of Kaiser Permanente’s HIV-positive patients are in HIV-specific care within 90 days, compared to 50 percent in the U.S. within one year
69 percent of Kaiser Permanente’s HIV-positive patients have maximal viral control compared to 19-35 percent nationally

CTH Blog:
And how does this knowledge help other health care providers?

MH:
We started by challenging them. Earlier this year, the organization challenged all health care providers nationwide to follow its lead and improve the health equity for people living with HIV by sharing a toolkit of clinical best practices, tools, mentoring, training and health IT expertise (kp.org/hivchallenge).

We also reach out to our communities through grants. This year, Kaiser Permanente announced several grants for community organizations to continue their work on HIV/AIDS care and prevention.

In May 2012, Kaiser Permanente committed $2 million to award to eight community health organizations focusing on eliminating racial and ethnic disparities in health care and health outcomes, specifically related to HIV disease. The first four recipients will be announced later this year. Furthermore, we’ve also had significant grants in our Northern California, Southern California and Colorado regions. The organizations awarded grants were chosen specifically for having innovative approaches to preventing new HIV infections; identifying HIV positive patients sooner and connecting them with high quality HIV care; and reducing disparities among minority populations — particularly gay, African-American, youth and Latino — disproportionately impacted by HIV disease.

CTH Blog:
And we reach out to students and youth across the country as well, correct?

MH:
Yes! For more than two decades, Kaiser Permanente has been reaching out to millions of youth about HIV prevention through our Educational Theatre Program. In the early 1980s when many organizations were uneasy about talking about sexual behavior and prevention of HIV to adolescents, Kaiser Permanente wasn’t. In 1989, Kaiser Permanente’s Northern California ETP created the live production “Secrets,” aimed at educating young people about the growing epidemic. Since 1989, it’s been shown to 1.5 million youth in Northern California alone. Almost all of our theater programs, which serve communities where Kaiser Permanente is present in eight states and the District of Columbia, have adopted a production dealing with HIV prevention in one way or another. We continuously work with educators, community groups and Kaiser Permanente physicians, to update our productions to meet the needs of our communities.

CTH Blog:
World AIDS Day is just around the corner. What do you hope people reflect on Dec. 1?

MH:
I hope on World AIDS Day people reinvigorate themselves to meeting the challenge of fighting HIV. But I also hope they take the opportunity to show love — for themselves, and for those impacted by HIV. This isn’t the end, but at least we can envision the end realistically now.

Source: http://centerfortotalhealth.org/2012/reflections-on-world-aids-day-with-michael-horberg-md/

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US Media: Unending Frustration (Part III) (Essay 24)

Source: http://bernardlown.wordpress.com/2011/08/22/us-media-unending-frustration-part-iii-essay-24/

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US Media: Unending Frustration (Part III) (Essay 24)

Source: http://bernardlown.wordpress.com/2011/08/22/us-media-unending-frustration-part-iii-essay-24/

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Friday, February 1, 2013

New York State Governor Investigates Out-Of-Network Costs

New York State Governor Andrew Cuomo recently announced the continuation of an investigation into out-of-network medical costs. In 2011, the state received more than 2,000 complaints from consumers who unexpectedly received bills from out-of-network specialists and providers after taking measures to choose in-network providers and receive prior insurer approval. Consumers often are not told in advance which specialists are out-of-network, how much they charge, and how much of their fee will be covered by health insurance. The resulting bills contribute to financial strain on consumers, many of whom are unable to pay the amount charged and some of whom are forced into bankruptcy.

To aid consumers in obtaining information on out-of-network care, costs, and coverage, the New York State Department of Financial Services is calling for more transparency, better consumer protection, and system-wide reform. This follows efforts by the Obama administration to require health insurers to provide such easy-to-understand information to consumers. If you are concerned about the potential impact of reforms and new rules, please feel free to contact us to discuss your options and assist you in making decisions regarding your practice.

Source: http://www.pagingdrblog.com/2012/03/15/new-york-state-governor-investigates-out-of-network-costs/

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How and When to Get a Second Opinion before Spine Surgery

It is often said that no one should have spine surgery unless they receive a second opinion from another surgeon. On the surface, this advice would sound like good old common sense, as two opinions are better than one. However, there is a trap in this line of thinking. When a patient sees a physician for a second opinion, this next opinion has a tendency to always sound smarter than the first opinion. This is a well-recognized phenomenon, but in reality the second opinion may not be the best one.

Source: http://www.spine-health.com/blog/how-and-when-get-second-opinion-spine-surgery

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Activist Shares her Story to Increase HIV/AIDS Awareness

At birth, Hydeia Broadbent was abandoned at the University Medical Center of Southern Nevada in Las Vegas, where Patricia and Loren Broadbent adopted her as an infant. Although her HIV condition was congenital, she was not diagnosed as HIV-positive with advancement to AIDS until age 3. The prognosis was that she would not live past the age of 5. Now more than 20 years later, Broadbent spends her time spreading the message of HIV/AIDS awareness and prevention by promoting abstinence, safe-sex practices (for people who choose to have sex), and the initiative “Knowing Your HIV/AIDS Status.”

Broadbent was a keynote speaker at Kaiser Permanente’s 2011 National Diversity Conference, speaking to several hundred Kaiser Permanente physicians and employees celebrating and learning about diversity and inclusion. We caught up with Broadbent recently to see what messages she had to share in honor of World AIDS Day.

CTH Blog:
When did you start speaking publicly about HIV/AIDS?

Hydeia Broadbent:
I started speaking out at the age of 6. Back then my focus was talking about compassion for individuals living with HIV/AIDS to make sure they were treated fairly. In the late 1980s a lot of people lost their jobs or they were kicked out of their homes. Some kids couldn’t even go to school, so I really started speaking about compassion and understanding.

Now, my primary goal is to provide a clear understanding of how to avoid at-risk behaviors through self-examination and informed decision-making. With all that we know about the virus, it is clear to me that contracting HIV/AIDS today is a choice and we can’t allow anyone the power to make that choice for us.

CTH Blog:
What has your message been to clinical staff and caregivers?

HB:
Growing up I spent a lot of time in the hospital. For those who work with someone who is infected with HIV/AIDS, you guys are very important to our lives. We spend a lot of time with our doctors and our nurses and our case workers.

I know how important it is for communication between a doctor and patient. Patients want to be informed about the medicines and procedures that they go through. And it also goes back to compassion because a lot of times when people have chronic illnesses they may be facing them alone. Sometimes they don’t have the support of their families or friends. Service with a smile really does go along way.

CTH Blog:
There was a time last year when you were without insurance?

HB:
Yes, and that was very scary. I know how expensive these out-of- pocket costs can be. A lot of people wanted to help me, but I wanted to make sure we help others – it’s not just about Hydeia. I feel like I speak for a lot of people who don’t have a name or a face or a voice, but they are out there, and they deserve the compassion of their fellow brothers and sisters. Everything I go through serves a purpose. I want to inspire people, not to just care about me, but others who are living with HIV/AIDS.

CTH Blog:
At Kaiser Permanente’s 2011 National Diversity Conference, you mentioned you received care at a Kaiser Permanente facility?

HB:
I live in Las Vegas, but once I got sick when I was in Los Angeles and ended up at a Kaiser Permanente facility, so I know the care and the service that Kaiser Permanente provide, and it’s excellent.

CTH Blog:
What are you working on now?

HB:
On Nov. 26, a project I’ve been helping work on, “Forgotten but Not Gone: Kids, HIV & AIDS,” aired on Nickelodeon. The inspiration came to me after seeing a story about a 13-year-old boy in Pennsylvania who had applied to a private boarding school, but was refused because he is HIV-positive. The show is a powerful piece featuring many stories of youth who have been living with HIV, and it addresses stereotypes.

I’ve been doing a lot of work around youth lately, such as public service announcements that they can relate to. A lot of young people don’t like to be lectured to, so you have to make sure it’s more of a discussion and you’re not just preaching. And also when it comes to HIV, you have to install a sense of fear. We have kind of glamorized it because we wanted people with HIV to be accepted, but we forgot to talk about the reality of what this disease is, and it still kills people. There are medications, but not everyone can afford these medications, so we need to make sure we are speaking to the reality that these medications cost a lot of money.

CTH Blog:
World AIDS Day is around the corner. What do you hope people think about on Dec. 1?

HB:
I grew up in a time when there was no hope. I’ve seen countless friends die — my own doctor had passed away. We are definitely in a new time when there are advancements to medications and people aren’t dying at alarming rates from AIDS as they once did. But the fight is far from over. You have to go home and talk to your kids. You have to talk to them about HIV. You have to talk to them about sex. You have to talk to your nieces your nephews. We have come to a place where we are complacent about HIV/AIDS because people are healthier they are living longer and it’s kind of on everyone’s back burner. If you aren’t talking to your kids about these things, someone else probably is.

I’d also like people to stop and think: Do you know your own HIV status?

Below is an excerpt from Broadbent’s keynote at Kaiser Permanente’s 2011 National Diversity Conference.

Source: http://centerfortotalhealth.org/2012/activist-shares-her-story-to-increase-hivaids-awareness/

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Private Practice Or Hospital Employment?

According to data released by Medscape Medical News, physician employment by hospitals has increased since 2000. This increase is partly due to the protection that working for a large entity affords a physician. Many physicians feel that they can truly focus upon their specialized field by working in a hospital environment, as opposed to opening a private practice.

Working for a hospital relieves the physician of trying to keep up with complex private health care insurance and government regulations, investing in medical equipment and technology, marketing and HR issues. While owning a private practice gives a physician more independence and the physician is not constrained by the hospital’s policies or procedures, the private-practice physician must be concerned with all the business issues, which could be undertaken by a hospital employer.

It seems the current trend is leaning toward more physicians choosing to work for a hospital, with the private-practice physician becoming rare. But, as Uwe Reinhardt, Ph.D., a healthcare economist at Princeton University, told Medscape, “Don’t forget, there are cycles. Some years from now, there will be a whole new trend. Physicians working in hospitals will see what is profitable and what is not, and will jump out and establish practices in the profitable things.”

Source: http://www.pagingdrblog.com/2012/04/12/private-practice-or-hospital-employment/

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Simplifying LASIK Basics – Part 3: Safety and Results

Is LASIK just a passing thought? Or, are you ready to jump in with both feet, so to speak? Either way, two of the first things to consider are safety and what types of results you can expect. Continued advancements make LASIK safer and more effective than ever before. Still, LASIK is surgery, and you owe it to yourself to choose a reputable doctor and practice, who, in turn, owe you a full disclosure – standard procedure at Eye Consultants of Texas. As the third in our Simplifying LASIK Basics series, here are a few highlights about what you should know.

How Safe Is LASIK? Any surgery comes with risks, and amazing advancements have proven LASIK to be one of the safest surgical procedures today. At Eye Consultants of Texas, we won’t perform LASIK if we determine a patient is at high risk, which, according to the American Academy of Ophthalmology (AAO), is low. Generally speaking, AAO suggests that 2% or less of all patients have complications or side effects; from discomfort or difficult vision (that usually disappears over time), to more extreme cases where it can last longer. A thorough, necessary examination can reveal potential risks, and determine if you’re a candidate for LASIK at all. If it turns out that you are not a candidate, there are other vision correction options you and your doctor can discuss.

What Types Of Results Can You Expect? If you’re a LASIK candidate, it must be medically verified that you can achieve a level of visual improvement that makes the surgery worth it in the first place. Everyone expects to see 20/20 without corrective eye wear, and a majority of patients achieve this. There are also cases where the result may be less than 20/20. This can depend on how severe your eyesight is prior to surgery, which you can discuss with your doctor. Our LASIK patients generally tell us that they can see better without glasses or contacts than with them before they had the procedure. Once again, your doctor should only perform LASIK if he or she honestly feels you really need it.

How Quickly Does Your Vision Improve? Most of our LASIK patients are amazed at how well they can see right after surgery. Vision should continually (and gradually) improve over the next few days, and continue to improve after that. The thing to remember: your eyes will need time to adjust and heal. There may be some mild “scratchiness” and discomfort right after surgery. This should go away, and prescribed medication will help with discomfort and healing. Necessary follow-up visits carefully monitor your progress, to ensure proper healing and that there are no complications.

Can You Ditch Glasses And Contacts Altogether? LASIK isn’t permanent, and, in some instances, glasses may be needed for reading or seeing up close. The natural aging of the eyes can also have an effect. So why have it in the first place? Most people who have LASIK can see a noticeable improvement in their vision for many years, with far less dependency on corrective eye wear for simple day-to-day tasks. Which can be life-changing if you’ve had to rely on glasses or contacts for most (or all) of your life! Here are a few things patients tell us, quoted from our Patient Experiences page on our website:

“No more fumbling for my glasses and bumping into furniture just to get to the bathroom in the morning. This has been the coolest part…Eye Consultants of Texas did a fantastic job and I could not be happier with the results.”

“If I would have known how easy my life would be after LASIK, I would have had the surgery a long time ago! I had four pairs of glasses for different purposes; I probably spent $1,000 a year on eye care. Dr. Labor and his team were very patient with me and listened to all of my concerns.”

Until our next Simplifying LASIK Basics blog, if you’d like to know more about LASIK at Eye Consultants of Texas, please call our office in Grapevine at 877-516-4364, conveniently located to Dallas/Fort Worth.

This blog is a broad overview of LASIK surgery for general informational purposes only. In no way is it intended as actual medical advice. Safety and results are assessed as they apply to each specific patient. Always seek a medical or eye care professional for advisement based on your individual health and specific eye care needs.

Source: http://www.eyectexas.com/blog/lasik-safety-and-results/

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