Rss Feed
Tweeter button
Facebook button
Webonews button

Standards of ‘narrow therapeutic use’ under FDA review | To Your …

Dear Dr. Roach • You wrote recently that thyroid medication is regulated to within 5 percent of the stated amount. Are there other drugs that are similarly regulated? Are generic manufacturers held to a different standard than the manufacturers of brand-name drugs? — A.L.S., M.D.

Answer • The Food and Drug Administration continues to work on new standards for drugs that are considered “narrow therapeutic index,” meaning the dosages have to be precise, due to the fact that these drugs can be more than usually toxic at a high dose or that the consequences of too low a dose also are more dangerous than other drugs. These drugs include anti-epilepsy drugs, some other psychiatric medications, drugs to prevent rejection of transplanted organs, as well as thyroid medication and digoxin. (The Board of Pharmacy of North Carolina lists 11 drugs it considers to have a narrow therapeutic index.) I know that an internal group at the FDA has recommended implementing the same 95 to 105 percent standard for all these types of drugs, the way they have with thyroid medication.

For thyroid medication, all manufacturers, whether brand-name or generic, are required to meet the same standards.

Dear Dr. Roach • I have peripheral neuropathy due to a pinched nerve. I get some relief from it, but it still hurts and keeps me from sleeping. My doctor recommended a Tylenol PM, and it helps me sleep well for six or seven hours most nights. But some nights I wake up hurting and have trouble getting back to sleep. Then I can take two regular Tylenol and, most nights, get back to sleep after about 30 minutes. My concern is the long-term use of the Tylenol PM. — W.H.

Answer • Tylenol PM contains both acetaminophen (the pain reliever in plain Tylenol) and diphenhydramine (an antihistamine with sedating qualities). Both of these components have some potential for harm, which must be balanced against the benefit you are getting from them.

Excess amounts of acetaminophen can be dangerously toxic to the liver. This is especially important for people who consume alcohol regularly or have another kind of liver disease. Healthy adults should take no more than 4,000 mg per day .

Diphenhydramine potentially can cause a large number of problems, but most people tolerate it reasonably well. It is not my first choice for a sleep aid


Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to or request an order form of available health newsletters at 628 Virginia Drive, Orlando, Fla. 32803. Health newsletters may be ordered from

Article source:

The Correlation Between Good Health and Business Success

Healthy eating, exercise, sleep; these all keep your body healthy. When your body is healthy, you’re under less stress, and you can devote more of your energy to your responsibilities, both personal and professional. You have more motivation and energy to pursue your goals. And, of course, a healthy body is less likely to fall ill and cause all of the issues mentioned above.

Article source:

Perseverance, good health and good friends: Lexingtonian Mary Casey turns 100

Growing up in Lexington, Mary Carroll Casey walked to Parker Elementary School every day. She went home for lunch, then walked back to school.

“We swam in the golf course pool until they built the town pool,” she recalled in a recent interview with the Minuteman.

Casey remembers having snowball fights, building snow forts, and riding on a horse-drawn snowplow.

“When I was young, the town did not plow the streets,” she said.

Kids could jump off the horse-drawn plow, which didn’t have sides on it, to land in plentiful snow.

“We used to have real heavy snows,” Casey said.

The matriarch of Valley Road

Perhaps not surprisingly, her memories go back not a few decades, but several generations; Casey came into this world on Dec. 9, 1917. She turned 100 on Saturday.

“I came here when I was two years old,” she said of Lexington, “and I’ve been here ever since.”

She still lives in the house that she and her husband built 60 years ago. Family members drop by, visiting health care workers come and go and neighbors keep an eye on the matriarch of Valley Road.

Casey was born at her parents’ Brookline home, the sixth of eight children. Her parents both emigrated from County Mayo, Ireland. Casey’s father landed in Canada when he was 9, while her mother came to Massachusetts at the age of 16. Her father stayed in the Boston area after running the marathon years after moving to Canada. They met, married and started a family that eventually included six daughters and two sons. At one point, a man owed money to Casey’s father—money that he didn’t have. But he had a plot of land in Lexington, “so they sort of swapped,” Casey recalls.

Surviving the Great Depression

With that, the family settled in Lexington.

“It was sort of a two-generation town,” Casey said. “There were those that had money, and those of us who didn’t. But it became a good place to grow up.”

Casey’s family grew vegetables in a backyard garden, and her father held a variety of jobs, from florist to grocery store owner. During the grocery store years, Casey helped out.

“I loved it,” she said.

When the Depression hit, “my father even raised a pig, so we had plenty of meat,” as well as milk from the couple of cows they owned said Casey, who remembers churning milk into butter. The vegetable garden also helped.

“I remember planting potatoes, and I remember cutting them up,” Casey remembers. “Many’s the piece of potato I’ve planted.”

Through the years, “we were a very close family, all the way through,” she said; her parents’ strong bond seems to have provided a foundation for that unity.

Pulling together during war

With that mold in mind, Casey created a life in Lexington with her own husband and four children.

“Even as a child, I could tell they were in love with each other,” said Casey’s 65-year-old son, Dick, who now lives in Florida with his wife Shelley.

Casey met her husband, Joseph, through a friend and the couple married in 1942. A Gardner native, Joseph liked Lexington well enough that the couple settled here. Their son Dennis came along. Then, with World War II underway, Joseph, a Marine, shipped out the Pacific, where he remained for nearly three years.

In his absence, Casey and “all of the sisters that stayed in Lexington took care of each other’s children, while they were working different shifts,” said Casey’s niece Nancy McCue, who also lives in Florida. She bought a two-family home in East Lexington while her husband was fighting, too. The family lived there for six years before buying a house on Valley Road, where Dennis and siblings Maureen, Dick and Michael grew up.

Flipping houses, growing vegetables, raising kids

Life unfolded in a rhythm of school, kids, work, family, neighbors and friends. As an adult, Lexington was “equally as good as growing up, and we were happy to stay here,” Casey said. Joseph became a police officer, and sometimes worked one or two side jobs to keep the family flush, Dick said. Over the years, the Caseys built several homes on Valley Road, and flipped other houses in town, mostly in the 1950s and 1960s, according to Dick.

“They were the original flippers,” he joked.

Casey grew vegetables in her own garden, and enjoyed sewing when she had the time.

 “She and her husband, they had so many friends,” McCue said. “They were just very, very active, loving people.”

Retelling her life, Casey said that she put family first—and her family agrees. She remembers her husband’s antics (“He was a trickster,” she said), and her children’s, whether a slumber party pillow fight, or unexpectedly inviting the entire sixth grade class, plus teachers, for lunch on a school day.

“I had to set the table twice,” Casey said.

When her youngest children reached high school, she worked in the Massachusetts PTA office on Muzzey Street, where she could be close to them. For vacation, “my mom would load us all in the Rambler station wagon to visit relatives in Florida,” Dick recalled, driving her four kids three days each way by herself, because her husband had to work. Casey kept herself healthy, daughter-in-law Jackie Casey said, walking 5 miles at a stretch on the high school track, and eating well.

“She never smoked, she had a glass of wine,” Jackie explains. “She wasn’t fanatical about it, but she was cautious.”

Dozens gathered for celebration

On her 100th birthday, about 80 people gathered to honor Casey’s milestone birthday at St. Brigid’s Parish in Lexington. They came despite terrible winter weather, out of loyalty and love.

“Everybody is just drawn to her,” Jackie explained. “She’s got that charisma, I guess you could call it.”

Casey is the aunt everybody looked up to, McCue said—“everybody” being McCue and her 31 first cousins.

“Mary has always been our other mother, and now, of course, she’s the mother to all of us,” McCue said.

Casey’s 7 siblings, some of whom lived into their 90s, have all died. Joseph died in 1986, and Casey has even outlived her sons Dennis and Michael.

“[She’s] our last compact with our parents and their generation and their stories,” McCue added.

‘Be good..,be kind’

While it surprises Casey’s family somewhat that she’s reached the 100-year mark, it doesn’t shock them.

“She’s a very strong person, she perseveres; she’s lost two sons” said Jackie, who was married to Dennis.

She said that her mother-in-law brings to mind the old Timex slogan, “takes a licking and keeps on ticking.” The word “stubborn” surfaces from family members, too, at times, with a respectfully surrendering tone.

“I don’t know how I’m still hanging on,” Casey said.

“I don’t know what the secret would be. Just to take care of your body, respect it, and respect other people—that’s important. Everybody has their own life to lead, and you can’t change them anyway,” she added.

Beyond good self-care, Casey’s wisdom and advice after 100 years boils down to relationships.

“Be good to one another, be kind,” she said, extolling the virtues of reliable neighbors, good friends, and the near-sacred stature of family. “I don’t look back. I can remember a lot about my life, but I like my life.”

A full life

Casey spends much of her time now in a cozy-looking chair by one of her front windows. An oxygen machine sits at the ready, should she need it, along with a cache of audiobooks—not to mention the neighborhood view her chair affords. Casey doesn’t own a cell phone, an iPad, or any other such device. She’s not afraid, she said, but “I will admit that occasionally, in the evening, I get lonesome. Most of the time I’m just all right. I listen to talking books. I don’t watch much television; I hardly ever turn it on.”

Reminiscing with her son Dick a couple of days before her birthday party, Casey paused to ask him a question.

“I don’t think you lost out on anything, did you Dick,” she said.

Without hesitation, he replied: “Nope.”

Casey checked to be sure.

“At least you didn’t tell me,” she said, looking at her son.

“Nope,” he replied, looking just a bit emotional. “We always had everything we needed.”


Article source:

Bring back clean mountain air, good health

The United States Forest Service admits it has mismanaged our forests for the past 30 years. Now they are experimenting with massive daily burn projects, while concealing and refusing to discuss their serious impact on our health.

It is just an income scheme by the USFS as prescribed burning will not prevent wildfires. The general public does not realize that the USFS often no longer tries to extinguish wildfires, but are actually turning wildfires into massive prescribed burns.

The Surgeon General has determined that smoke is so hazardous to your health that it has banned indoor smoking, yet we must endure breathing the smoke created by the USFS.

Prescribed burns do not burn hot enough for the smoke to rise. Instead, the smoke spreads along the ground infiltrating our lungs, lives and homes. If you are experiencing chest pain, arthritis, inflammation, headaches, burning eyes, sinus problems and breathing difficulties, it may well be that prescribed burns are the cause.

The USFS will not even discuss how seriously they are affecting our health, but run slick ads which try to brainwash the public that prescribed burns are the only solution. To learn how prescribed burning is affecting your health and methods of safer forest management, go to Prescribed Burning Versus Human Health – YouTube.

To sign and email a moratorium request to halt prescribed burning for one year until the USFS can develop a plan that will not jeopardize human health, go to and look for the “Urgent-Stop the Burning” link in red.

Marsha Honn,


Article source:

Good Health analyses 12 lunchtime options | Daily Mail Online

For a lunch that doesn’t break the bank, a meal deal — typically a sandwich, snack and drink for around £3 — is tempting. But some are loaded with sugar, fat and as many as 900 calories.

‘An average woman won’t need more than 600 calories at lunchtime,’ says registered dietitian Helen Bond. ‘Regularly exceeding this by just 100 calories a month could lead to nearly a pound of weight gain.’

Common pitfalls include ‘healthy’ veggie options that are anything but, and ‘grab bag’ crisps that are bigger than ones you’d put in a packed lunch.

ANGELA DOWDEN shopped for lunch deals and asked Helen for her verdict. We then gave them a health rating. 


Falafel  houmous wrap PLUS Lindt Lindor chocolate treat bar PLUS Juicy Water orange and lemon 420ml — £3

Falafel houmous wrap PLUS Lindt Lindor chocolate treat bar PLUS Juicy Water orange and lemon 420ml — £3

Falafel houmous wrap PLUS Lindt Lindor chocolate treat bar PLUS Juicy Water orange and lemon 420ml — £3

Calories, 798; saturated fat, 16g; sugar, 58.4g; protein, 13g; salt, 1.6g

VERDICT: You might think this wholesome wrap — a tomato tortilla filled with falafel, houmous and chutney — and fruity water would allow you a chocolate treat. But the drink has almost as much sugar as a can of cola and the meal itself provides nearly 15 teaspoons. This combination also has 80 per cent of your daily limit of saturated fat and exceeds the 600-calorie lunch limit.

Better to swap the drink for water, and the chocolate for an 80g snack bag of apples and grapes.

Health rating: 1/10 


Shapers Moroccan Style Veggie Couscous salad PLUS Boots melon, apple and kiwi pot PLUS Diet Coke 500ml — £3.39

Shapers Moroccan Style Veggie Couscous salad PLUS Boots melon, apple and kiwi pot PLUS Diet Coke 500ml — £3.39

Shapers Moroccan Style Veggie Couscous salad PLUS Boots melon, apple and kiwi pot PLUS Diet Coke 500ml — £3.39

Calories, 204; saturated fat, 0.4g; sugar, 18.1g; protein, 6.1g; salt, 0.6g

VERDICT: The salad, packed with roasted butternut squash, aubergine and cos lettuce provides two of your five-a-day, while the fruit pot provides a third, so this is definitely a good choice — but it’s so low in energy that you could swap the fruit for an egg and spinach pot, which would add protein and another 60 calories.

If you have fruit and a handful of nuts as a snack later, this would still be a slimline day’s eating. The caffeine in the Diet Coke (around 63mg in 500ml) can give you a bit of a boost, but the acidity of soft drinks can damage teeth, so don’t have this regularly.

Health rating: 8/10 


Bacon, lettuce and tomato sandwich PLUS 150g Greek-style raspberry yoghurt PLUS Rubicon Spring black cherry raspberry drink 500ml — £3

Bacon, lettuce and tomato sandwich PLUS 150g Greek-style raspberry yoghurt PLUS Rubicon Spring black cherry raspberry drink 500ml — £3

Bacon, lettuce and tomato sandwich PLUS 150g Greek-style raspberry yoghurt PLUS Rubicon Spring black cherry raspberry drink 500ml — £3

Calories, 547; saturated fat, 7.2g; sugar, 23g; protein, 28.5g; salt, 2g

VERDICT: The malted sandwich supplies more than a fifth of your daily fibre and uses lower-fat mayonnaise, so it isn’t as bad as you’d think.

The drink is low in sugar, while yoghurt is a valuable source of calcium. The yoghurt contains the equivalent of over four teaspoons of sugar, but a third is natural sugar from milk.

However, you shouldn’t eat bacon too frequently — some research has suggested we should eliminate processed meat completely, given its high salt content and the link with bowel cancer, but eating it just once a week is a realistic limit.

Health rating: 6/10 


Ham, cheese and pickle sandwich PLUS millionaire shortbread PLUS Volvic Touch of Fruit strawberry 750ml — £3

Ham, cheese and pickle sandwich PLUS millionaire shortbread PLUS Volvic Touch of Fruit strawberry 750ml — £3

Ham, cheese and pickle sandwich PLUS millionaire shortbread PLUS Volvic Touch of Fruit strawberry 750ml — £3

Calories, 933; saturated fat, 19.2g; sugar, 71.4g; protein, 26.9g; salt, 2.5g

VERDICT: You won’t choose this thinking it’s healthy, but you may not realise quite how bad it is either. As well as more than 900 calories, there are 17 teaspoons of sugar here — most of it the added type!

Shockingly, more of the sugar comes from the flavoured water (34.5g, more than eight teaspoons) than the millionaire shortbread (26.5g, almost seven teaspoons). This combination also supplies virtually all your 20g daily limit of saturated fat and contains 40 per cent of your daily salt allowance. It’s salvageable as a treat if you swap the drink for plain water.

Health rating: 0/10 


Wild salmon and cucumber sandwich PLUS Count On Us sour cream and chive potato crisps PLUS Still Water 500ml — £3.50

Wild salmon and cucumber sandwich PLUS Count On Us sour cream and chive potato crisps PLUS Still Water 500ml — £3.50

Wild salmon and cucumber sandwich PLUS Count On Us sour cream and chive potato crisps PLUS Still Water 500ml — £3.50

Calories, 477; saturated fat, 3.4g; sugar, 4.2g; protein, 24.9g; salt, 2.1g

VERDICT: This sandwich provides healthy omega 3 fats from the salmon plus 15 per cent of your daily vitamin D needs from the fortified bread. The baked crisps are made with whole sliced potatoes, better for controlling blood sugar than other baked snacks.

This meal deal contains the highest fibre here, with 30 per cent of your daily needs. Although it’s a pity there’s no fruit or veg included: everyone should aim to have at least one piece with their lunch. Buy an apple or a banana — or an MS fruit pot (185g) — and this lunch would score a perfect ten.

Health rating: Expert’s choice


Halloumi courgetti wrap PLUS Go Go’s Protein Snack Oat Boost PLUS Sunsoul kaffir lime lemon 100 per cent natural energy drink 250ml — £3.39

Halloumi courgetti wrap PLUS Go Go’s Protein Snack Oat Boost PLUS Sunsoul kaffir lime lemon 100 per cent natural energy drink 250ml — £3.39

Calories, 720; saturated fat, 12.3g; sugar, 27g; protein, 25g; salt, 2.1g

VERDICT: The wrap (423 calories) counts as one of your five-a-day because of the courgette, grilled peppers, spinach and butternut squash, but in total the lunch is over 700 calories — a lot if you’re sitting at a desk all afternoon.

Together, the wrap and snack (a trio of roasted beans, cheese and flapjack bites) provide 60 per cent of your maximum daily saturated fat and a third of your salt: it would be better to keep the wrap but swap the snack for a 100g pot of melon, apple and kiwi.

The energy drink will provide a lift similar to a cup of coffee, but has more than four teaspoons of added sugar.

Health rating: 3/10 


Chicken salad sandwich PLUS 50g Mini Cheddars PLUS Tropicana Trop 50 400ml — £3

Chicken salad sandwich PLUS 50g Mini Cheddars PLUS Tropicana Trop 50 400ml — £3

Chicken salad sandwich PLUS 50g Mini Cheddars PLUS Tropicana Trop 50 400ml — £3 

Calories, 529; saturated fat, 3.9g; sugar, 28.9g; protein, 20g; salt, 2.2g

VERDICT: The salad of couscous, ham and pea shoots is a decent source of protein and low in saturated fat, though high in salt (1.94g). Ham is a processed meat so don’t choose it more than once a week.

Also, the greens aren’t high in fibre and won’t count as one of your five-a-day. Look for a salad with baby tomatoes or grated carrot to make it count. Malt loaf is a good option, with the dried fruit a source of fibre and iron. The drink lets this lunch down as it contains four-and-a-half teaspoons of sugar. Swapping it for water would be a healthier choice.

Health rating: 5/10 


Chicken salad sandwich PLUS 50g Mini Cheddars PLUS Tropicana Trop 50 400ml — £3

Chicken salad sandwich PLUS 50g Mini Cheddars PLUS Tropicana Trop 50 400ml — £3

Chicken salad sandwich PLUS 50g Mini Cheddars PLUS Tropicana Trop 50 400ml — £3

Calories, 742; saturated fat, 7.1g; sugar, 23g; protein, 35.3g; salt, 2.7g

VERDICT: By itself, a chicken salad sandwich is fairly nutritious, but when eaten with the 50g of snacks, this lunch is no longer healthy.

The Mini Cheddars have over 250 calories — as a rule, don’t pick a bag of crisps or savoury snacks bigger than 25g.

The high-calorie lunch also has 45 per cent of your daily limit of salt, and over a third of your daily saturated fat.

The drink is OK — it’s made with diluted orange juice and has 50 per cent less sugar than the standard version, and is a good source of vitamin C and folate, needed for a healthy immune system.

Health rating: 3/10 


Honey roast ham and egg sub roll PLUS tea with milk — £3

Honey roast ham and egg sub roll PLUS tea with milk — £3

Honey roast ham and egg sub roll PLUS tea with milk — £3

Calories, 341; saturated fat, 1.8g; sugar, 2.9g; protein, 17g; salt, 1.6g

VERDICT: The Greggs meal deal is just a sandwich and a beverage, which can be a hot drink. This cuts back the risk of overdoing the calories.

A ham and egg sub with a cup of tea and milk is straightforward but nutritious, with low levels of sugar and saturated fat. Eggs are protein-rich, so will keep you feeling full, and the ham provides iron — but don’t have this processed meat more than once a week.

A piece of fruit will make this a decent lunch. The sub is white so a better choice from Greggs would be the egg mayonnaise sandwich on malted brown for more fibre (and to skip the processed meat). 

Health rating: 7/10


Beef and horseradish sandwich PLUS Walkers ready salted 32.5g PLUS Fanta Orange 500ml — £3

Beef and horseradish sandwich PLUS Walkers ready salted 32.5g PLUS Fanta Orange 500ml — £3

Beef and horseradish sandwich PLUS Walkers ready salted 32.5g PLUS Fanta Orange 500ml — £3

Calories, 632; saturated fat, 2.4g; sugar, 28.8g; protein, 25.1g; salt, 2.2g

VERDICT: This combination obviously isn’t the healthiest, but it’s not as dreadful as you might expect, either.

The sandwich is a reasonably good choice (365 calories) — the lean beef is high in protein, low in saturated fat and provides anaemia-protective iron.

Swapping the Fanta for the ‘zero sugar’ version would cut out 21g (more than five teaspoons) of sugar and 80 calories.

Although the crisps provide some fibre as well as vitamin C, swapping them for a bag of apples and grapes would make it healthier still.

Health rating: 5/10 


On The Go tuna and cucumber sandwich PLUS On The Go carrot batons PLUS Innocent Seriously Strawberry smoothie 250ml — £3

On The Go tuna and cucumber sandwich PLUS On The Go carrot batons PLUS Innocent Seriously Strawberry smoothie 250ml — £3

On The Go tuna and cucumber sandwich PLUS On The Go carrot batons PLUS Innocent Seriously Strawberry smoothie 250ml — £3

Calories, 442; saturated fat, 0.6g; sugar, 35.6g; protein, 20.2g; salt, 1.5g

VERDICT: This meal deal is high in protein and provides more than a quarter of your daily fibre, without being high in calories, saturated fat or salt.

Together, the carrots and smoothie provide two of your five-a-day.

Smoothies are naturally high in sugar and have received bad publicity but if — like this 250ml serving — they’re not grossly oversized and contain whole crushed fruit, they can be a convenient replacement for snacking on fruit.

Just don’t have a smoothie every day.

Health rating: 9/10 


Cheese and tomato pasta PLUS Manzanilla olives PLUS San Pellegrino orange 330ml — £3

Cheese and tomato pasta PLUS Manzanilla olives PLUS San Pellegrino orange 330ml — £3

Cheese and tomato pasta PLUS Manzanilla olives PLUS San Pellegrino orange 330ml — £3

Calories, 653; saturated fat, 6g; sugar, 40.7g; protein, 14.53g, salt, 3.5g

VERDICT: Around ten per cent of the pasta pot is Cheddar cheese, which provides calcium. Pasta salads are a source of resistant starch (formed when pasta is cooked and cooled), which helps feed friendly bacteria in the gut.

However, the lunch is let down by high levels of salt and sugar — the olives are the main salt culprit. You may think fruity San Pellegrino is better than cola, but it has seven teaspoons of sugar — your daily limit. Switch the olives for pineapple chunks and the can for a low sugar option or water to make this lunch much healthier. 

Health rating: 4/10 

Article source:

Nostalgia is good for our emotional, physical and mental health

Working inside Downing Street as part of the prime minister’s team is, of course, a great privilege.

But, as I said recently in parliament, although it is a burden I would never have wanted to carry, it has been the honour of my professional life to continue work in Jo Cox’s name as co-chair of the Loneliness Commission she established before her death.

The Commission will issue its report on Friday and the government has promised a full response to our recommendations. We will be calling on ministers to take action, but loneliness is an issue none of us can shirk.

It has reached the scale of being a social epidemic and we must all play our parts in ensuring that Britain, in Jo’s words, is no longer ‘a country where thousands of people are living lonely lives forgotten by the rest of us.

I’ve learned a lot working alongside my Labour colleague and friend, Rachel Reeves, on the Commission….

Article source:

Why People with Good Health Insurance Go into Medical Debt

Personal finance experts are always telling you that you must have health insurance to avoid a financial catastrophe. And we’re not wrong: Health insurance does keep more money in your pocket and get you access to better care, compared with going uninsured. (See How Health Insurance Helps Manage Financial Risk.)

But our simple advice ignores a terrible problem: Many people who do have health insurance – good health insurance, at that – still find themselves in medical debt. In fact, “Most people who experience difficulty paying medical bills have health insurance,” the Kaiser Family Foundation (KFF) reports. And a 2014 report from the Consumer Financial Protection Bureau showed that 43 million Americans have overdue medical bills on their credit reports, with half of all overdue debt on credit reports coming from medical bills.

Defining “Good” Health Insurance

What makes a health insurance policy good? There is no universal answer.

A good health insurance policy for you might be a terrible one for your best friend or for the guy who sits in the cubicle next to you at work. You might have a chronic health condition, for example, that makes a policy with a low deductible, broad network and 90/10 coinsurance worth the high monthly premiums.

Your coworker might be a semiprofessional cyclist who hasn’t gotten so much as a cold in the past five years; the ideal policy for him asks for the lowest possible monthly premiums while providing catastrophic coverage if he should get, say, a cancer diagnosis. (See How Catastrophic Health Insurance Works and Is Catastrophic Health Insurance Right For You?)

So let’s assume you have a policy that’s good for you. How might you still end up with tons of medical debt?

Charging Medical Bills to Credit Cards

NerdWallet’s 2017 American Household Credit Card Debt Study found that over the past decade, median household income has grown by 20% while medical costs have increased by 34% – more than any other major spending category.

Indeed, almost one-third of Americans reported having trouble paying medical bills in a 2016–17 KFF survey, and NerdWallet estimates that nearly 27 million Americans could be putting medical bills on credit cards. High credit card interest rates can then cause medical debt to grow quickly and make it harder to pay off.

Skipping Checkups and Cutting Corners

With hidden, sky-high prices – not to mention busy schedules and a general aversion to doctors and hospitals – many people decide to cut corners on healthcare. They don’t take their medicine as prescribed, which means they may fail to get better or not keep a chronic condition under control. They skip annual checkups and don’t catch problems while they’re minor and inexpensive to treat. Then they end up with bigger, more expensive problems that they can’t ignore and are stuck paying huge bills. (See 20 Ways to Save on Medical Bills.)

Getting a Serious Medical Diagnosis

The bad news of a negative medical diagnosis may be just the beginning of your problems. Let’s say you’re 29 years old and have a $7,150 annual deductible, the highest allowed for 2017. You have in-network coinsurance of 80% and out-of-network coinsurance of 50%.

When you start getting hammered with bills for doctor’s visits, screenings, prescriptions and treatments, the first $7,150 of that comes straight out of your pocket.

Your annual out-of-pocket maximum (thank goodness for those) is also $7,150 for marketplace plans in 2017, thanks to the Affordable Care Act.  If you have a family plan, the out-of-pocket maximum is a less-manageable $14,300. If you have an employer plan, your limits may differ.

Your treatment will probably not fall neatly within a single calendar year. When the new year arrives, you have to pay that deductible and work your way up to the out-of-pocket maximum all over again. At that point, you may have switched to a lower-deductible plan, which will help, but it will be offset somewhat by the higher premiums you’ll pay for that plan.

Kevin Gallegos is vice president of Phoenix operations for Freedom Financial Network, a family of companies that empowers people to improve their finances. He shared the story of one of the company’s clients, a retired couple in the Dallas area who were on Medicare and had supplemental insurance when the husband was diagnosed with cancer. Neither insurance plan paid in full for the treatment he was prescribed.

“Their cost was close to $1,000 each month,” Gallegos says. “Over a couple of years, combined with other health-related expenses that were not covered, they were $30,000 in debt when he passed away. The wife has since moved to rural Nebraska, where living costs are lower and she can live in a home owned by a relative.”

Jeff Finn is a partner with Dynamic Worksite Solutions, in Katy, Texas, providing customized benefits programs for companies and brokers. He says that when it comes to cancer treatment, it’s generally experimental treatments that won’t be covered. Traditional and FDA-approved treatments will be covered, but some may come with annual limits.

Paying Hidden Costs

As discussed above, annual out-of-pocket maximums can keep your health spending down in a year when you need lots of care.

But out-of-network maximums can be significantly higher than in-network ones. Your out-of-pocket maximum for out-of-network care might be double your in-network one.

And try as you might to make sure you only receive in-network care, it’s easy to get slipped an out-of-network bill. You might have surgery at your local in-network hospital, but get a bill from an out-of-network assistant surgeon. You might visit your in-network primary care doctor but get an out-of-network bill from the lab she used for your blood work. (See 3 Big Medical Costs and How to Protect Against Them.) Or you may have a rare condition and need to see an out-of-network specialist who has expertise in treating it.

If you have trouble with huge bills you weren’t expecting, a medical-billing advocate may be able to help. Ruth Linden, the founder and president of Tree of Life Health Advocates in San Francisco, said she recently negotiated on behalf of an out-of-work client in Texas to cut a large, unpaid physical therapy bill in half and set up a manageable payment plan.

In addition, Gallegos points out that many policies limit the number of physical therapy visits per calendar year, but the doctor may recommend more than that number to get the patient back to functioning fully. However, any visits beyond the policy’s limit will come out of the patient’s pocket.

Then there’s another set of hidden costs: If you need frequent treatments for a health condition, your transportation costs will increase. Your childcare costs may increase, too, and your income may decrease if your illness interferes with work. If you’ve been caring for an aging parent, you might have to pay someone to care for mom or dad. You might need to hire a home health aide for your own care. If you’re too exhausted to cook, your food bill might go up. If you’re too exhausted to clean, you might find yourself hiring a housekeeper.

Other hidden costs that Finn pointed out are travel to specialty facilities, lodging, and lost income for a supporting spouse or partner.

Encountering Opaque Pricing

You can have good health insurance and still end up in medical debt when providers can’t or won’t give you prices before you agree to potentially expensive but necessary procedures.

Suppose you badly slice your finger in a kitchen accident. You visit the emergency room for stitches. Who knows how much the bill will be until you get it in the mail at least a month later? Good luck asking someone at the front desk to give you a cost estimate when you check in, because they don’t know what procedures you’ll need until a doctor or nurse sees you, at which point you will have at least incurred a bill for an ER visit. The  ER visit alone could cost anywhere from $533 to $3,000, according to the preliminary findings of a Vox study.

Visiting the ER may actually be a mistake in some circumstances.

“The emergency room is excellent for life-threatening emergencies,” Fox says. “But an urgent-care facility can treat most illnesses, burns, sprains and some fractures at a lower cost. For situations like flu or strep, a retail or urgent-care clinic might offer fast care at a low cost. Many of these clinics accept health insurance.”

What happens a few days after you get stitched up in the ER? Let’s say you visit a specialist about your nerve pain and numbness and learn that you need hand surgery to repair the nerve you severed. The hospital where you’ll be having the surgery can’t seem to tell you up front how much it will cost.

Finn says medical pricing is so opaque because the providers and insurance carriers have it set up that way. They have nondisclosure agreements so that neither party can reveal the provider’s billed rates or the insurance company’s discounts off those rates. Consumers also can’t get a straight answer about costs because the provider needs to know who the insurance company is and how the specific plan is designed in terms of deductibles and coinsurance. And patients are usually dealing with multiple providers for a procedure, such as a hospital or surgical facility, the surgeon, the anesthetist and others.

Sometimes pricing is opaque because doctors don’t know which services you will need before you receive care, similar to how a mechanic may not know how much it will cost to fix your car until he starts running diagnostics, says Sean McSweeney, founder and president of Apache Health, a medical-billing company serving physician practices, diagnostic testing facilities, hospitals and surgery centers nationwide. When it comes to surgery pricing, it should be easier to get pricing up front. “Most surgery groups are adept at getting pre-authorizations prior to the surgery, which include the CPT codes they are requesting be paid,” he says.

CPT codes are the five-digit billing numbers developed by the American Medical Association that are assigned to each medical service a patient receives. Insurers use these numbers to determine reimbursement rates. All healthcare practices use the same CPT codes.

To learn the cost of a procedure up front, Sean Fox, co-president of Freedom Debt Relief, a Phoenix-based company that has helped 450,000 Americans get out of debt, suggests asking for the billing manager and/or surgery coordinator. These positions have different titles at different practices, so it can take some work to get connected with the right person, he notes, adding, “It also can be very worthwhile to take the time and effort to get a second opinion on both cost and care.” 

The Bottom Line

These are just a few of the reasons why people with good health insurance can go into medical debt. Bad luck, denied claims, non-formulary prescriptions, huge cost discrepancies from one facility to another, chronic conditions and the astronomical price of COBRA premiums when you get laid off can also contribute. Even with an awareness of these problems in our current healthcare system, you may not be able to stay out of medical debt. But knowing how so many people find themselves in this situation may give you information that helps you at least reduce the extent of medical debt if it ever happens to you.

Finn says that for someone determined to stay out of debt, even the best planning won’t cover everything – especially in emergency situations. But the best things to do are be an educated consumer and take care of yourself.

“As educated consumers they will know what questions to ask and how to get the lowest cost and highest quality care possible,” Finn says. “By simply taking care of themselves, they not only reduce the amount of healthcare they will need over their lifetime, but when they do need care, the severity is likely to be reduced greatly.”

(For further reading, see When Health Insurance Doesn’t Cover Your Bills and What to Do When You Can’t Pay Your Medical Debts.)


Article source:

People say they want to live longer — if in good health

LAWRENCE — Longevity is a such a pervasive goal in public health policy and even popular media, but individually most people only want to live long lives if they will be healthy, according to a new study that includes a University of Kansas gerontologist.

“People in three cultures from around the world are reluctant to specify their desired longevity,” said David Ekerdt, KU professor of sociology and gerontology. “To me this is interesting because longevity is such a valued public health objective, but at the individual level, longer lives are a goal ‘only if’ I remain healthy.”

Ekerdt is first author of the new qualitative study published in the Journal of Aging Studies that involved interviews with 90 people ages 62 and older who lived in Germany, China and the United States.

The study is part of the larger international project “Aging as Future” supported by a grant from the Volkswagen Foundation in Germany. Ekerdt has joined with researchers from the Chinese University of Hong Kong, North Carolina State University at Raleigh, the University of Erlangen-Nuremberg in Germany and the University of Jena in Germany.

Promoting longer lives does have tremendous value, Ekerdt said, especially in reducing mortality at younger ages. However, research into how individuals consider longevity is also important because it provides insight into how people think about the aging process, he said.

The results of these interviews reinforce previous findings from this research group that revealed many older adults — in various cultures — think of life as not a smooth continuum of time but segmented into different states. The researchers refer to four “ages” or stages of life, including the third age, which is an active retirement where people leave traditional work and family roles, followed by the fourth age.

“People seem to view one part of the future as wanted and another as not wanted, typically the ‘fourth age’ which is basically the period when one might experience a disability or a potential health decline,” Ekerdt said.

For this study, the researchers interviewed 30 people in each country, and they recruited the sample with sex and age quotas to reflect a range of experience with retirement.

About one-third of respondents did not express aspirations for a longer life.

“Some felt their lives had already reached a stage of completion, and others as a form of fate acceptance,” Ekerdt said.

A larger number of respondents did mention they wanted to extend their lives. Yet less than half of that group noted a specific amount of time they desired to live.

The strongest opinion among that group was the desire to live longer only if they maintained their current or what they deemed to be acceptable levels of health.

Ekerdt said the responses indicated people likely wanted remain in the “third age” of active retirement and primarily independent living instead of the “fourth age.”

“That stage typically involves more vulnerability and decline,” he said.

One implication for public health advocates and gerontologists could be to focus not simply on longevity but stress health or quality of life as well when considering policies related to aging, the researchers recommended.

“Slogans like ‘add life to years, not just years to life,’ appear to match intentions from elders in three nations,” Ekerdt said, “because they are saying something that appears to come from deep in human culture.”


Article source:

Valley News – To Your Good Health: Anal Fissure Is Painful …

Dear Dr. Roach: My husband has been diagnosed with a rectal fissure. It has been a couple of months, and it isn’t any better. He has been treated only with a stool softener. What do you suggest? — A.T.S.

Answer: Anal fissures are painful. Although a stool softener is one part of management for people who have constipation, additional treatments also are appropriate, including a sitz bath, which is just a few inches of warm water in a basin or tub that you soak your bottom in. When I was an intern, I wondered about the origin of the term “sitz bath.” My resident, Dr. Lynn Brown, told me that it’s because you “sitz” in them, and it turns out she was right: It’s from the German “sitzen,” meaning “to sit.”

Other treatments include increased fiber and a topical painkiller (there are many over-the-counter preparations in ointment form). These treatments help heal the fissure by relieving anal spasms caused by a painful bowel movement. I’m afraid your husband hasn’t had adequate treatment, leading to a vicious cycle of pain, spasm and nonhealing.

In addition to these treatments, fissures heal more quickly with a medication to increase blood flow to the area: Nitroglycerin is available as a prescription ointment, and nifedipine can be compounded for topical use by a pharmacist, with better healing and fewer side effects than nitroglycerin (but both of these work better than no treatment). If this isn’t effective after a month, he should be re-evaluated. There are other options available before considering surgical treatment. A gastroenterologist is a good resource if his primary doctor hasn’t been successful.

One other concern is that occasionally anal fissures are a sign of Crohn’s disease, a serious inflammatory bowel disease. People with recurrent, atypical (not in the midline) or nonhealing fissures should be evaluated for Crohn’s disease.

Dear Dr. Roach: You recently wrote about exercise causing rhabdomyolysis, and I have a question about that. My 92-year-old mother-in-law fell, and wasn’t sure how long she laid there, but the doctors said she had no broken bones. However, she did develop rhabdomyolysis.

Since she does not exercise, how did she acquire this condition? The only medication she is on is one for blood pressure. — G.M.

Answer: Rhabdomyolysis is a very serious condition of muscle breakdown. The most common cause I have seen is your mother-in-law’s: pressure on muscle in someone who is unconscious or unable to move for a prolonged period (in normal sleep, the body changes position frequently, which prevents this).

However, it can happen in untrained people after heavy workouts, or even in trained athletes who do extreme workouts, especially in hot and humid conditions. Some medications rarely can cause it, such as colchicine or statin drugs. Rhabdomyolysis is treated conservatively, by removing the underlying cause, and trying to prevent damage to the kidney.

For elderly or frail people who live alone, I recommend a device that can be easily carried and pressed to get help. Some of these can recognize a fall and will send a signal automatically. Falls are common in the elderly, and these devices can help prevent some of the serious consequences of falling.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to or at 628 Virginia Dr., Orlando, FL 32803.

Article source:

More older people are doing yoga, but they are also racking up injuries

Yoga may hold a key to aging well, suggests a growing body of research into its potential benefits for body and mind — benefits that include reducing heart rate and blood pressure, relieving anxiety and depression, and easing back pain. One recent study even raised the possibility of positive changes in biological markers of aging and stress in people who do yoga.

So it’s no surprise that the number of yoga practitioners in the United States has more than doubled to 36.7 million over the last decade, with health benefits the main reason people practice, according to the Yoga in America Study conducted last year on behalf of Yoga Journal and the Yoga Alliance.

While yoga enthusiasts are often pictured as young and bendy, the reality, according to the Yoga in America study, is that 17 percent are in their 50s and 21 percent are age 60 and older.

Along with this upsurge of interest has been an upsurge in injuries, particularly among older practitioners. “Participants aged 65 years and older have a greater rate of injury from practicing yoga when compared with other age groups,” researchers wrote last year in a study of nearly 30,000 yoga-related injuries seen in U.S. hospital emergency departments from 2001 to 2014. “While there are many health benefits to practicing yoga, participants and those wishing to become participants should confer with a physician prior to engaging in physical activity and practice only under the guidance of certified instructors.”

As a yoga therapist who has been teaching in medical settings for nearly 20 years, I have found it distressingly common to hear about the negative experiences and injuries people have sustained in yoga classes. The stories my students relate suggest classes that were too difficult for them and/or were taught by an inexperienced or poorly trained instructor. Even instructors who are trained to teach able, young students typically have a limited understanding of safety considerations that are essential when working with middle-aged and older bodies and people with such health challenges as rotator cuff injuries, arthritis, glaucoma, hypertension and heart disease.

Fortunately, there is a growing recognition of the importance of safe yoga practice along with professionalization of the field. To practice yoga while reducing the risks, here are five strategies to help older adults — as well as people with health challenges — age well with yoga:

Start where you are, not where you think you should be. If you are new to yoga, try a beginner’s class — even if you’re fit and active — because yoga is not just about what you do, it’s about how you do it. Unlike Western exercise, the yogic approach is to balance effort with relaxation, which can be surprisingly difficult for many people used to our culture’s emphasis on striving, competing and being “in it to win it.” In fact, learning not to push yourself, or rush, or be ambitious to look a certain way, can be one of the most challenging (and therapeutic) parts of the practice. Give yourself time to learn how to move into a posture to a point where you feel challenged but not strained.

Recognize that styles of yoga vary widely. Yoga classes range from vigorous and athletic to relaxing and restorative — with a confusing array of trendy hybrids such as yoga with goats and kittens, and yoga offered on a paddleboard. To find a class designed for mature bodies, look for names such as “Yoga Over 50,” “Gentle Yoga” or “Senior Yoga.”

Hatha yoga is the name for any type of yoga that teaches physical postures. This means that virtually all yoga classes in the West are hatha yoga. But when a class is marketed as hatha yoga, it generally signifies a non-gimmicky approach to basic postures and breathing, which may be a good starting place. Viniyoga and Kripalu yoga are relatively gentle styles that may be appropriate for people with health concerns. Restorative yoga involves using supports (such as blankets and yoga blocks or bolsters) to prop students into passive poses that promote profound rest. Hospital-based wellness and integrative medicine centers may offer classes designed for people with specific ailments such as cancer or back pain.

Find a well-trained, experienced teacher. Ask prospective instructors about their credentials [see sidebar about yoga credentials], how long they’ve taught yoga and whether they’ve had special training and/or experience teaching older people. Ask to watch a class to see if it’s suitable, which is also a good way to assess the instructor. A good yoga teacher will act as a guide, helping students explore what works best for them as they try each posture. For people with health challenges, working one-on-one with a certified yoga therapist can be ideal.

Talk to your care provider. If you have medical issues, get guidance about specific movement precautions. For example, people with glaucoma may be advised to avoid “head-down” positions, which may increase pressure in the eye. Hot yoga may be problematic for people with heart conditions because high temperatures can increase cardiac workload. Recognize, however, that many doctors know little about yoga and may assume you’re planning to stand on your head. Tell your provider that you’d like to try gentle yoga consisting of simple movements, stretches and breathing practices.

Let go of excuses that you’re too old. You don’t have to be young or fit or flexible to try yoga. If you can breathe, you can practice yoga.

Krucoff is a yoga therapist at Duke Integrative Medicine in Durham, N.C., and co-author of “Relax Into Yoga for Seniors: A Six-Week Program for Strength, Balance, Flexibility and Pain Relief.”

Article source: