F.A.S.T. Are you at Risk for a Stroke

I have had many illnesses, including heart disease and a mild stroke.  I went through open heart surgery and several angioplasties for heart disease.

On a scale of dread, heart disease was about a 2 on a scale of 1 to 5.  The idea of a stroke was a 6 in my mind, and when it happened quite suddenly, while I was asleep i had an  acute anxiety attack.

When I awoke I realized there was something amiss in my non-dominant right hand, it was numb. In the past I would at times awaken and have one of  my hands tingling or numb which I attributed to a cervical disk problem.(one of my cervical disks bulges,and I have had a surgery on my lower back for a ruptured intervertebral disk)  However this did not go away even with stretching my neck. Try as I might my right arm and hand refused to obey my commands.

I am fortunate. The symptoms and signs diminished quickly over a period of two weeks.  I was left with some residual balance and gait disorder, for which I have learned to compensate.

The best way to treat a stroke is to not have one. I ignored a serious and common factor for stroke risk.  Snoring and sleep apnea, both of which are successfully treated. It is  listed as a risk factor, but is overshadowed by cholesterol issues, hypertension, and diabetes.  I ignored my spouses warnings about my snoring and periods of sleep apnea. Sleep apnea occurs when there is total airway obstruction from snoring.  Patients are unaware of these episodes but whoever sleeps with or near them will hear a gasp and see the victim roll over or moan.

Sleep apnea or severe snoring should be characterized as an urgent medical problem. There are tests to easily diagnose the problems, and even an at home testing device, which screens for sleep apnea. A formal sleep apnea test in a sleep lab is still necessary. It's a small price to pay, sleeping away from home for a night, however it is a small price as compared to paralysis

I share this as an admonition for this month' preventive measure as well as weight reduction, a healthy diet, and exercise.

AUT researchers have developed an app to calculate stroke risk factors. Available on both iOS & Android platforms, the Stroke Riskometer App was selected by leading doctors as a top health app for 2014 from 100,000+ apps available. It is available on iTunes and Google Play Store.It is endorsed by the WSO (World Stroke Organization

Remember !

Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven? Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward? Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." I s the sentence repeated correctly? Time to call 9-1-1 – If someone shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get the person to the hospital immediately. Check the time so you'll know when the first symptoms appeared. This is critical for medical personnel to know if blood thinners will be effective in treating the stroke.

Online Doctor Consultation & Virtual Doctor Visit Reviews

Online Doctor Consultation & Virtual Doctor Visit Reviews

The Mess That is MACRA | THCB

The Mess That is MACRA | THCB

The Stoessel Report

Unfortunately for John Stoessel he was diagnosed with lung cancer this month. I pray for his speedy recovery. In the process of being discharged from hospital he complained the customer service was terrible..  His complaint was not extraordinary.  Mr. Stoessel of FOX news is known for ihis acerbic commentary about current events.

Mr. Stoessel did not specify how or if his medical care suffered.  This event by a visible 'celebrity' will undoubtedly ring bells and remove stars (*****) from the hospital's HEDIS ranking and Medicare's STAR system of measuring quality assurance. I pity the hospital CEO or the VP of medical affairs. For certain the Board of Trustees will forgo their usual free lunch to allow this item to be placed on the next agenda.

I would like to add that his physicians probably have the same complaints about provider services. Such things as having to wait for an operating room, or the constant demands for paper work, signing orders, inadequate parking,and having to wear an identification card and/or a security card. and of course being frowned upon for dissing nurses administrators.  This says nothing about the disappearance of free meals every day and steaks on Friday.  When I was a sprig of a physician back in mid 20th century I expected a full buffet spread with a chef to serve me in the doctor's dining room. This of course ocurred in Orange County California where normalcy included two Mercedes in the garage (there were no Tesla's at the time) and a beach house.  At the time hospitals were popping up in the bean fields.  Doctors would chose their hospital rounds at a time when meals were being served.

Today all of those perks are gone. The small one story hospitals are gone or have morphed into multistory hotels without customer service.  There are even chains of hospitals managed or owned by nationwide companies.

John, I would like to thank you for your objective measure of hospital quality.  I do pray for your prompt recover, thanks to modern medicine. The cost of things now just does not allow for 'customer service.' That went out the window due to cutbacks long before the Affordable Care Act.

As a very visible 'celebrity' I salute your expose. I hope you will join those of us who campaign daily for patient and provider advocacy.  I wholeheartedly encourage you to continue your commentary about patient experience's.

And please don't forget us poor providers.Perhaps we should invite you to a medical staff meeting. Perhaps I can assist you there. Do you have an agent ?

A fan,

Gary M.Levin M.D.

Don Quixote and the Health Professional’s Endless Quest | THCB

Recently The Health Care Blog featured a post by Richard Gunderman M.D.

Don Quixote on his mount, Rocinate, with Sancho Panza

Are we as physicians destined to also flail at windmills?  In the modern era we face similar obstacles

"April 22 marks the 400th anniversary of the death of the greatest novelist who ever lived, Miguel de Cervantes. Though the day will pace unnoticed by most physicians, it is in fact one many should note. Why? Because both his life and work can serve as vital sources of inspiration and resilience for health professionals everywhere."

Cervantes faced numerous disappointments and setbacks in life – poverty, imprisonment, slavery, serious injury, and repeated rejection. Not unlike many contemporary health professionals, he had many reasons to become discouraged and give up. Yet he found the will to carry on. Where did he find such inspiration and resilience? I believe that he found them above all in his work – not the reactions of critics or the royalties he collected, but his deep belief in his life’s mission.

Though the novel is filled with battles of various kinds, Don Quixote reminds contemporary health professionals that the real battle takes place within.

"In giants we must kill pride and ignorance. But our greatest foes, and those we must chiefly combat, are within. Envy we must overcome by generosity and nobleness of spirit; anger, by a reposed and quiet mind; riot and drowsiness, by vigilance and temperance; lasciviousness, by our inviolable fidelity to the mistresses of our thoughts; and sloth, by our indefatigable peregrinations through the universe. . . . This, Sancho, is the road to lasting fame and good and honorable renown."

Richard Gunderman makes me realize it is time  to re-read Miguel de Cervantes.

Don Quixote and the Health Professional’s Endless Quest | THCB

Social Media Marketing Leads to Reduce Stigma associated with Mental Illness

Social Media has already played a role in improving treatment of mental illness. The result is improved economic benefit to California's economy.

A statewide social marketing campaign to reduce the stigma associated with mental illness has brought economic benefit to California’s economy, a new study says.

How? By boosting the employability, productivity and incomes of people afflicted by psychiatric conditions, according to the study, published Thursday by the RAND Corporation, a Santa Monica-based policy think tank. 

The study showed that people in need of mental health treatment who were exposed to the anti-stigma message of the social marketing campaign were more likely to seek help. Those who get treatment have a significantly higher chance of finding good-paying jobs, thus contributing more tax dollars to state coffers, it said.

“This is an important finding,” said Alejandra Acuña, an assistant professor of social work at California State University, Northridge. “Social marketing campaigns have been used with great results to change behavior and address public health concerns like nutrition and HIV testing.”

Reducing stigma, especially in the minds of people who suffer from mental illness, was a key priority. Central to the effort was a multi-faceted social media campaign that delivered stigma-reducing messages in a variety of forms, including documentaries, public services announcements, online public forums and multimedia advertisements.

An important part of the media campaign was a documentary that recounts the stories of California residents who have suffered from mental illness and recovered. It was broadcast numerous times on public television stations, showed to community groups and other audiences and is posted on the CalMHSA-funded website, EachMindMatters.org.

“The goal is to change the conversation [about mental health] in our society by increasing knowledge and changing attitudes,” said Wayne Clark, executive director of CalMHSA. “The better mental health people have, the more productive citizens they will be.”

Scott Ashwood, lead author of the RAND study, said an estimated 121,000 people per year seek mental health treatment after being exposed to a social marketing campaign’s anti-stigma, anti-discrimination message.  

Discrimination against people with mental health illnesses continues to be a serious social problem, experts say, though many of them think society is headed in the right direction.

And stigma in the eyes of others isn’t the only problem.

“Part of it has to with a person’s own self-perception,” said Tom Loats, director of behavioral health at St. Joseph Hospital in Orange, Calif. “People believe they have to pull themselves up by their own bootstraps. That’s silly. You can’t do that for diabetes or heart disease.”

“If they recognize and accept their illness, they will seek treatment and function better,” Delacruz said. But they have to jump through the stigma barrier, she said, that’s where these social media campaign efforts can help.

State Economy Gains By Reducing the Stigma of Mental Illness, Study Says

Republican experts trash Trump's healthcare 'plan'

Donald Trump's objectively awful healthcare "plan" continues to baffle and "exasperate" Republican policy types who are going to have be responsible for defending it—and him—should he get the nomination. None of them seem to have any problem now, however, unloading about just how much of a mess it is.

“If you repeal the Affordable Care Act, you’ve got to have a serious way to expand coverage to replace what you have taken away,” said Gail R. Wilensky, who was the administrator of Medicare and Medicaid under President George Bush from 1990 to 1992. “There’s nothing I see in Trump’s plan that would do anything more than cover a couple million people.”

Robert Laszewski, a former insurance executive and frequent critic of the health law, called Mr. Trump’s health care proposals “a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.” […]

James C. Capretta, a senior fellow at the Ethics and Public Policy Center, a conservative nonprofit group, said Mr. Trump underestimated how difficult it would be to uproot a law that was now embedded in the nation’s health care system. […] "I just don’t see that in Trump’s vague plans to repeal the law and replace it with something beautiful and great.” […]

Grace-Marie Turner, the president of the Galen Institute, a champion of free-market health policy, said Mr. Trump’s proposals were sketchy and inadequate.   All of which Trump's chief policy adviser, Sam Clovis, dismisses in a manner that's totally emblematic of the entire campaign. When it comes to policy, there just isn't any beyond a bunch of catch phrases and emphatic bluster from Trump.

Clovis says that his candidate is running against the political establishment, so these criticisms just don't matter because he's not relying on "traditional establishment Republican people" like them. Instead he has a half-dozen or so advisers who are "very prominent people," but who "are not ready to have their support of the Trump campaign known." 

Yeah, I bet they're not anxious to be known.

Republican experts trash Trump's healthcare 'plan'