House plan for healthcare reform

From what I can see, this looks like a horrible plan for health care reform. I do not understand what our congressmen could be thinking in creating this. All I can figure is they are creating a bill for self serving political gain and really don't care about "fixing" our health care system.

What I see so far is a killer though. Never mind the majority of the problems with a bill that will tax small employers who cannot provide health benefits to their employees killing jobs in a time when unemployment is going through the roof. Never mind a plan that punishes healthy young individuals who chose to go without a health care plan because they never go to a doctor and chose to save their money.

This plan will in effect make it where we all have insurance but nobody has a doctor. It is already difficult to nearly impossible in many areas to find a doctor that accepts government run health care plans like Medicare, Medicaid and Tricare. What this plan does is dramatically increase the number of patients on that plan while cutting the amount that doctors will get paid to see those patients. Nobody will be able to find a doctor.

I already have to limit the number of patients I can see on the government plans. Medicaid for example pays me less for an office visit than I pay in overhead for the same visit. I wind up paying the government to treat these patients. I cannot see more without going out of business.

There is now a shortage of primary care doctors in the United States. This is a plan that will ensure that this problem becomes infinitely worse. You can feel happy that 97% of Americans will have health care insurance. Just ignore the fact that none of them can actually find health care providers.

Obama's plan to fund Obamacare

One of our President's most common and repeated proposals is to fund Obamacare by taxing "the rich". He wants to end tax deductions for charity contributions for those "rich" people.

Mr. President, How much medical care for our needy and unfortunate citizens is directly paid for by those donations? How does choking off the source of revenue for great institutions from learning and teaching hospitals to community hospitals to great institutions like the Shriners' Hospitals benefit the medical care of our citizens?

Rethink your folly Mr. President and stop this lunacy of taxing charity. Find another way to fund your schemes or scale them back to manageable levels.

Cell Phone Elbow

The following article interested me because I'm starting to see this pretty frequently. It's like when computers became more common and more used in the 90s we started seeing a lot of carpal tunnel. Now that everyone has got their ear glued to a cell phone all day we're seeing cubital tunnel syndrome.

Solution, get off the phone. If you can't do that get one of those blue tooth things and walk around looking like a Borg all day.

http://www.cnn.com/2009/HEALTH/06/02/cell.phone.elbow/index.html

health care reform

I have a ton of thoughts on this subject, but not enough time to really get into it in depth. So I am going to touch on little details as they strike my fancy.

I read Ted Kennedy's thoughts on Health Care Reform today. This is very worrisome for me. I agree we need to work on the system, but our current administrations plans to rush and bully reform through Congress without adequate research or planning. This makes me very concerned about the future of health care in this country.

Teddy's 2nd point in his plan to reduce cost was to reduce waste in government spending. First he wants to educate doctors in how to treat patients correctly. This does not mean better medical care, people! This is simply government speak for cost shaving and cost containment. This means if your treatment for your disease is too expensive, even if it is your best chance for help, you will be denied coverage. Remember the outcry when HMOs tried this in the 90's? Of course not. Nobody learns from the past. Well, look at what happened then, and think of that travesty occurring as the result of Federal law. Now how much do you support this plan?

Teddy says the government will no longer pay for medical mistakes. Sounds great. Doc screws up, why should he get paid? But the problem is the definition of medical mistakes. The government currently has plans to refuse payments for any patient readmitted to the hospital within a month of going home from the hospital. If they get readmitted, there must have been something messed up, right?

WRONG. I readmitted 2 patients this week. They both were over 75 with chronic medical problems and new problems had popped up. They were fine when they went home, but belonged in the hospital within a few days of going home.

Now imagine a system where the government is already putting great pressure on doctors to discharge patients from the hospital as soon as possible. Add to that a plan where the government refuses to pay if they have to go back into the hospital. Add to that our current system where the local hospitals are losing money from lack of payment for government insured patients.

If your grandmother under this system has multiple medical problems and has been in the hospital recently, do you think the hospital administrators are going to allow her to be readmitted within a month for any problem, even if she needs it? How many of the most sick people in this country are going to be denied medical care because of this plan to cut costs.

I am scared when our government relies on bean counters and attorneys to formulate health care plans. Don't trust them. Don't support them. Speak out to your Representative and hope they actually care about representing you.

Swine Flu

Today the CDC confirmed what I posted last week. The Swine flu is spreading at a vigorous rate, typical of a flu epidemic. The reported cases are only the tip of the iceberg. It is likely in every state and moving around the world especially to the southern hemisphere where they are entering their normal flu season.

It is a typical flu in all respects and those that need to take precautions are those who need to take precautions in cold and flu season every year. But the general public does not need to be overly fearful at this time.

quick post

Just a bit of advice. If you're afraid of Hini flu, don't wear a mask. They just make you look silly. They don't work unless you have a respirator and even they may not do anything. Instead, just use hand sanitizer, stay 6 feet from sick people and wash your hands.

Not much change. The increase in cases continues at the same rate. 2254 cases in the US today. 100 or so in the hospital. One real US death. And this is just the tip of the iceberg, folks. These are CDC confirmed cases only. they are still catching up from last week and at this rate of increase in cases they are falling farther and farther behind. The Flu is out and we are in a national epidemic whether or not the WHO is willing to acknowledge it is a pandemic yet.

And IT'S NOT THAT BAD> This bug is on the level of any other flu. It is not 1918 killer flu. It is last winters pain in the butt flu. It is the fever and aches and stay home from work flu. If however you have chronic lung disease or immune deficiencies or other such chronic illness, you should take precautions just as you would in normal cold and flu season. Elderly patients and infants should be protected as well. Otherwise, take reasonable infectious disease precautions, and go about your daily lives.

I will update on the flu only periodically from now on unless things change.

The one thing about illness is it creates work for me. This is my usual slow time of the year and I'm seeing as many if not more patients than I usually do in the real cold and flu season.

I am working myself to death with this outbreak and cannot find time to get a good update with research. What I can say with certainty is there are 400 confirmed US cases now and 700 probable cases. There are many many more under investigation. The rate of spread seems to have slowed a little but it is still spreading at a fairly rapid rate. Yet there is only ONE death.

A 33 year-old American in a border town with chronic diseases apparently and who was pregnant died of the disease. This is horribly tragic. But from an epidemiological perspective does not increase the perceived threat level from this virus. I cannot imagine the grief her family must feel. I am glad the baby survived. But this is the kind of person the flu kills every year. It is tragic but expected.

I have also seen the Swine flu fatigue set in. I hear constant jokes and criticism of the handling of this disease. I am reminded of living in hurricane country before Katrina with all the cavalier attitudes people had after surviving storms that did not pay off as they had threatened. I fear for this country's ability to handle a killer flu if one arises.

My advice, relax. This virus is still just as likely to keep spreading as it is to fizzle out, but it is not currently dangerous. If you are in a high risk group (young children, elderly, pregnant, chronic disease) or if you are around people in high risk categories, continue to protect yourself. But stay wary. Don't completely let down your guard. This virus can still mutate as flu does. It is still a novel virus and we are not immune to it. And it can become a severe one.

Hiney flu fears

People have been stockpiling tamiflu and relenza, the 2 drugs that treat Swine Flu. Pharmacies that fill one tamiflu script every week are now filling 25 a day. The problem is there is a growing shortage of these meds and nobody is sick yet. People have them sitting on their shelves to protect every member of their family. Now if we have outbreaks especially in poorer communities with out easy medical access and funds, there will be no medicine to treat them. This can worsen an epidemic as disease spreads much more quickly in this type environment. Those privileged people who have bought up the meds also can cause additional harm by taking it unnecessarily and breeding resistance.

Why does this matter? Hiney flu is going out with a whimper not a bang. But the flu is a squirrelly bug. It may have shifted to something harmless as a kitten, but can mutate into a tiger and hit the world again next winter. This time we may have nothing to treat it.

Who's to blame. I hold my colleagues largely responsible. Those who are unable to or refuse to say "no" to unreasonable requests by their patients. It is a sad commentary on our professional ethics.

Hiney Flu

Interesting news today, much of it is very encouraging. First Mexico is backing down on its claims of over a hundred dead. They now only claim 12 confirmed cases. They will not comment on how many suspected cases. The initial reports of this virus effecting young adults primarily is no longer being reported. This was the most alarming factor of the news to me and now seems much more remote and less threatening.

Second, genetic analysis of the virus has been reported and apparently although it is very similar to the 1918 Spanish flu, it lacks many markers for genes that seem to signify increased virulence in flu viruses. To put this more plainly, it doesn’t look like a killer. It looks far weaker than initially reported and possibly even weaker than normal seasonal flu.

However, this is still a novel virus and we have no innate immunity to it. So although initial fears of its potential mortality or lethality may have been in error, fears of its morbidity or ability to cause disease are still quite valid. It is currently classified as a level 5 pandemic threat. I believe it will almost certainly become a level 6 pandemic. US cases went up more than 40% again over the last 24 hours to140 and new cases have been reported in several countries including Austria, Switzerland, and Germany.

I have seen the beast in the office. At least I suspect I have. A family in our practice tested positive for Influenza A and the state lab is testing to see if it is Swine Flu. We have not seen flu in our area for over a month now so although it could be sporadic seasonal Flu A, it is very likely the current strain of concern. These patients are not very sick, however. One child had already recovered on her own, and the 6 month old baby only had a fever and runny nose and cough. I know of several other doctors with cases like this, none of whom are very sick, but I expect the number of confirmed cases to continue to rise as these tests are completed.

Precautions are being taken to stop viral spread and even though my personal impressions are that they are probably going to wind up being overkill, I still fully support them. Schools nearby have closed for a week. Large group events are being postponed. This is the right decision. We still have an evolving picture of this virus and when you deal with people’s lives you do not gamble.

On the waste of government effort front, the effort to rename this virus continues. Although it is made up of porcine flu virus with small components of avian and human flu virus that has been found in pigs for decades, it is no longer PC to call in Swine flu. We are now to refer to it as the H1N1 Influenza A virus. I’m now going to call it the Hiney Flu for short.

And our great and powerful Vice President put his foot in his mouth again today saying to avoid travel in planes or subways. His staff, used to this by now quickly tried to temper his words to stay on message with the rest of the White House’s message. The travel industry is very upset. But I don’t think he’s all that wrong. I would avoid large crowds or unnecessary travel for the next week or so and see what happens.

Pig flu update

Our clinics are starting to get flu cases. We had 2 cases today of Influenza A. We're testing for Swine Flu, but the diagnosis is likely.

Us cases increased 50% again to 91. NO deaths. I'm sorry, I do not count a case of this disease acquired in Mexico as a US death. This poor 2 year-old's death is tragic but does not raise my concern level.

The WHO has increased the threat level to 5. I hold out little hope that we will not go to 6. I think the cat's out of the bag and we will have a flu pandemic. BUT! This flu does not appear from current observation to be any different from normal seasonal flu if you look at it's behavior outside of Mexico. I still hold out a good hope that this is just going to amount to an extra flu season in late Spring. My crystal ball (which has never been real reliable to be honest) thinks we will wind up with thousands of deaths worldwide like we do with normal flu, but not be a worldwide plague like we might fear. It could peter out and be far less. It could go the other direction.

I have added the CDC RSS feed to this blog for easy access to their updates and bulletins.

My advice, use good hygiene practices, stay home if you are sick, and avoid large crowds. I think the Hockey, and Basketball playoffs are going to suffer.

The first US casualty of the flu has been announced. This is tragic news for the family and loved ones of the 2 year -old. It is horrible when children die. This is however normal flu behavior, still. Flu deaths are much more common in those younger than 5 and older than 50. So this does not change the fact that the flu outside Mexico has not acted like the flu inside Mexico. In Mexico the deaths have been clustered in young adults. That is much more worrisome for a killer flu that kills by cytokine storm.

So stay yellow. Keep watch for a change in the mortality pattern. Do not panic.

H1NI? flu update

There are from the best I can gather only 64 confirmed US cases today. 7 however are now hospitalized severe cases. There are also 2 unconfirmed US deaths. There is no info on any other nation having severe cases as far as I can tell.

New York officials admit to likely having many hundreds of School children sick with what is likely the Mexican flu strain at this time. It also appears to have human to human transmission in the US, another key to pandemic potential.

Pandemic does not necessarily mean catastrophe. What one needs to keep in mind is that 2 out of the 3 20th century pandemics were mild. Only the 1918 one was a disaster.

So, this is not yet a pandemic although the risk level has been raised higher than usual of it becoming one. And this is not necessarily a deadly plague if it becomes one. The key to watch is the rate of spread. So far cases are increasing by 50-100% daily. This is far too quick for comfort. Second, watch for its mortality or lethality. No confirmed deaths outside of Mexico, yet. Possibly 2 in California though. We’ll need to watch this.

On the government stupidity front, our homeland security leader spent much of the day arguing over the name of the virus. Although proper nomenclature marks this as a swine flu due to its genetic composition, she worries about the negative effect on the pork industry and wants to rename it the H1N1 flu. Whatever….

Update on pig sickness

The WHO has raised the threat level of possible pandemic by one level. A level four pandemic level means that people are now spreading it between each other in one country for a sustained period of time.

The number of cases has doubled in the last 24 hours. There are now 2000 cases of severe flu in Mexico and 20 swine flu cases reported in the US. This is very concerning if this rate of spread is maintained.

The disease is still mild outside of Mexico with no deaths reported outside that country. This is encouraging in that the disease may not have any lasting power to cause severe morbidity or mortality.

The CDC needs to start making a vaccine now. They haven’t decided whether to interrupt ongoing flu vaccine manufacture. This is foolhardy. This current crop of disease may cool down as the spring and summer temperatures warm up. But this quiescence can easily reverse itself next fall and winter with a resurgence of the disease at pandemic levels. Vaccine manufacture takes months and needs to be the top priority of the pharmaceutical companies and government.

My personal advice…cancel any travel plans you might have for Mexico in the upcoming weeks. Our government may not want to restrict travel, but health conscious individuals should in my opinion restrict their own travel voluntarily.

And in today’s display of government ignorance, several countries have banned the importation of US pork. You can’t get swine flu from eating pork, people!

And at home our CDC has suggested sending your friends and family a hand-washing e-greeting card. Makes one proud to see the genius behind our government disease experts at work, doesn’t it. Here’s the link for any of you who don’t believe this is real. http://is.gd/uL0Z

Swine flu outbreak map http://www.epidemicflu.com/swine-flu-2009.php

Swine Flu update

6 confirmed cases in Canada, and in New Zeland. All cases outside of Mexico have been mild and self limited recovering on their own at home. Only one US patient was hospitalized. Why this disease killed at least 60 in Mexico is unclear at this point. So the spread of the disease is alarming, but the benign nature of the disease at this point seems encouraging.

Swine Flu update

Now 20 US cases. Only one hospitalized and no death. One new area hit is Ohio. The virus is a genetic match for the deadly Mexico strain. The CDC is now issuing instructions on the use of respirators or face masks in situations with close contact with infected individuals or in crowds in areas where swine flu cases have been detected.

From the CDC

There are everyday actions people can take to stay healthy.
Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread that way.
Try to avoid close contact with sick people.
Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them

Swine Flu update

Cases in Kansas, Cases in NYC...The WHO has declared an international emergency and has stated this has pandemic potential... The CDC says this cannot be contained.

On the positive side all of the newest cses have been mild disease and the patients have fully recovered. It is possible that the Mexican virus has mutated into a less virulent and less dangerous form.

Still be cautious. Don't change your routine, but do protect yourself. The CDC video I posted explains how.

If you get sick with fever body aches and severe GI or Respiratory symptoms see your doctor quickly. Tamiflu and Relenza seem to work against it. How much supply there is now that we are at the end of the flu season is a question I have.

swine flu info from CDC

http://www2a.cdc.gov/podcasts/player.asp?f=11226#

Swine Flu

I’m not an alarmist, but this one is scary, people.

For those of you unaware, a new strain of influenza has shown up in Mexico. It is thought to have caused as many as a thousand illnesses with around 60 deaths. The people dying of this illness are young adults. Normally the flu is most lethal in young children and the elderly. This flu bug is following the pattern of the 1918 pandemic that effected half of the worlds population and killed up to 100 million people worldwide. This was the gratest medical holocaust in History. Descriptions of the diseases severity are horrifying. You could have no symptoms and get sick and within hours be too weak to walk. People could die in 24 hours coughing up blood or bleeding out through their bowels. That flu strain was an H1N1 strain. This one is, too.

There have been US cases discovered in California and in Texas. Now there’s a possible outbreak in NYC at a prep school. The CDC says it is too late to contain the virus. The Canadian Government has taken proactive steps and issued a travel advisory. The US government has not seen fit to do so. The WHO says there all set to stop this with Tamiflu stockpiles.

As I said, I am not an alarmist. I don’t think this will amount to a pandemic plague. But I am worried enough to be cautious. Keep your hands clean at all times. Stay a minimum of 6 feet away from anyone who is coughing and appears ill. If you come down with significant respiratory illness with fever or severe diarrhea, don’t delay seeing a doctor. At this time, the CDC is not being very helpful with updates or information, but I will post what I learn as I learn it.

First entry

This is simply for me a forum to express my thoughts. I intend to expound upon my ideas related to the practice of medicine today. I'll give advice and debunk old wives's tales. I'll give opinion and speak to the politics and business of medicine. I promise that I will be frank and honest and straight forward. I do not know any other honest way to live.

So for my patients and my friends, for those who are both and for those who are neither. I dedicate this online journal to my own honest but biased and hopefully informative opinions.