RSVP Health | Volume 3, Issue 2
Bridging Bridging The Gap The Between Gap Between Patients Patients and Providers and Providers
| Health rsvp rsvp| Health Volume 3,Volume Issue 1 3, - Spring Issue 22012 - Fall 2012
PROSTATE HEALTH FEATURE - WHAT MEN NEED TO KNOW
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HEAD’S UP CONCUSSION IN HIGH SCHOOL SPORTS Men’s Health & Wellness Issue
Pediatric Men’s Health Health & Wellness Issue Issue www.rsvphealth.com
Preventing Chronic WHAT IS ARTICLE 1 TEASER ARTICLE 2 TEASER Diseases: BIPOLAR GOES HERE Investing GOES HERE wisely in health DISORDER?
Low Testosterone ARTICLE 2 TEASER LEVELS Can Mimic GOES HERE Depression in Men
Complimentary Copy
Bodyguard
Be your own bodyguard.
When it comes to wellness, the best defense may be a healthy offense. Proper nutrition, health screenings and immunizations are some healthy ways to fight heart disease, cancer, pneumonia, influenza and other threats to your health. The good news is that many of these conditions may be prevented with appropriate and timely care. Cholesterol and blood pressure checks, diabetes and colorectal cancer tests, and depression screenings may help catch potential problems before they really flex their muscles. That’s time well spent.
Visit anthem.com for more information on staying healthy and preventing disease.
This information is intended for educational purposes only, and should not be interpreted as medical advice. Please consult your physician for advice about changes that may affect your health. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In most of Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In most of Virginia (serving Virginia excluding the city of Fairfax, the town of Vienna and the area east of State Route 123.): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”) underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”) underwrites or administers the HMO policies; and Compcare and BCBSWi collectively underwrite or administer the POS policies. Independent licensees of the Blue Cross Blue Shield Association. ® ANTHEM is a registered trademark. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
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RADIO SHOW
Credits Publisher RSVP Health Executive Editor Rodney D. Gross, Ph.D. Contributing Editors Lola L. (AuBuchon) Gross Megan O’Brien Creative Director Megan O’Brien Visual Ingenuity, LLC Contributors Advanced Ocular Therapeutics
We are LIVE on the air at 8:20 a.m. Friday mornings on KREI, 800 AM.
Anthem Kathleen W. Bilderback Centers for Disease Control and Prevention Tiffany Chan Lola L. (AuBuchon) Gross Rodney D. Gross, Ph.D. National Cancer Institute Purk & Associates Dr. Arturo Taca, Ph.D.
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or hear the shows on
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RSVPHealth.com.
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RSVP Health is provided for information and education purposes and is in no way to take the place of a health care professional’s advice. Please consult a health care professional with any health related questions. Not all information within is the opinion of RSVP Health. RSVP Health is not liable for any decisions made as a result of information received from this publication.
2 RSVP Health | www.rsvphealth.com
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From the Editor | RSVP Health
rsvp | Health “To be a complete, healthy man, one needs to listen, ask questions & accept guidance, so he can live life to the fullest.” - Dr. Rodney D. Gross As summer winds down and we prepare for fall, I thought it would be fitting to reflect on what has been an exciting, enlightening and blessed time for RSVP Health and myself. With the popularity of RSVP Health and the outstanding following we have from our readers and supporters, we are achieving astounding heights. I was contacted by a group of citizens in and around London that had viewed an RSVP Health publication, and as a result, visited our website. By spreading the information to their friends, all of sudden, I started seeing spikes on the website from London and surrounding areas in England. When first contacted, the conversations focused on “American Health Care and the Political Views of it”. I usually do not get involved with “politics”, but nowadays, it is inevitable. The discussions were about “why nothing ever gets resolved”. As the discussions went back and forth, I was asked if I would like Golden Boy to have the RSVP Health publications displayed and handed out at the 2012 London Summer Olympics. This was such an honor that I accepted and arranged for over 8,500 copies of RSVP Health (a mixture of the past few issues) be sent to my contacts. To my amazement, the number of contacts and website visits skyrocketed. Learning where the individuals were from and of their comments/questions, it was overwhelming. Since the Olympics, a staggering amount of interest has occurred with RSVP Health from around the world. For example, I have been contacted by individuals from Turin, Italy, professors from Lund University in Sweden, and professors/pre-med students from University of Oslo in Norway. This reiterates what I have always believed, “health care and wellness have no boundaries”. This issue of RSVP Health spotlights “Men’s Health and Wellness”. I am the first to admit that “we” (men) struggle when it comes to communicating and listening. This is very much the case when it
comes to our own health and wellness. We do not like to be told what to do, when to do it, etc., and that means by other men and women alike. It has been my professional experience and personal experience that when it comes to health and wellness, we (men especially) keep ourselves guarded. Even as a health and wellness professional for years, I did not adhere to the very things I managed and promoted to others. My main failing with my own overall health and wellness was not listening to my wife, Lola. She is the consistent researcher on all things health and wellness. By listening to her and paying attention to her research, my overall health and wellness continue to improve. For a man, it seems the hardest thing to admit is one’s own failures. It is ok for us to seek help, ask questions, listen and want to be as healthy as we can. Even if it means we have to eat healthy, exercise, lose weight, etc., do it not only for yourself, but also those around you. Therefore, if you look at the picture I associated with this intro, this is “one of those around me”. “Golden Boy” is my health and wellness guru! He loves taking walks every day through our trails at our home, tossing the ball endlessly, playing chase, eating healthy foods with no fillers or preservatives, swimming, drinking lots of water, getting plenty of rest, etc. I just think I laid out a healthy way of living. Well, I think it was “Golden Boy” himself and if that did not motivate me, look into those eyes in his picture and tell me that doesn’t make you want you to be the best you can be. Inside the pages of this issue, you will find the things you are accustomed to reading. You will see new health and wellness experts along with some that we have had in the past–for which I am so thankful! Reading their spotlights, articles, and informative ads, as always, makes me proud to present the RSVP Health publication to you and the world. As I said above, “health and wellness have no boundaries”, but everywhere, there are questions and concerns, thus our slogan, “Bridging the Gap Between Patient and Provider”. Rodney D. Gross, Ph.D. RSVP Health | www.rsvphealth.com 3
Your local source for individual and family health coverage. RSVP Health | www.rsvphealth.com
Health coverage made easy. • Individuals, Families and Dependents • Self-Employed / Small Businesses • Retiring Early and Seniors • Individuals without Employer Coverage
Call your local agent today
Vincent K. Blair
Authorized Independent Agent
(314) 961-7777 vince@vincentkblair.com
Buy local from Vince www.VincentKBlair.com
Vincent K. Blair is an independent authorized agent in Missouri for Anthem Blue Cross and Blue Shield. In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance RSVPand Health | www.rsvphealth.com Company4(HALIC), HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Life and Disability products underwritten by Anthem Life Insurance Company. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Table of Contents | RSVP Health
You Have More Power Than You Think
Estate Planning for Everyone
Page 6
Page 24
Prostate Health Section
Page 38 Association of Cannabis and Psychosis Confirmed
Page 62 Page 3 From the Editor
Page 28 What is Bipolar?
Page 52 Your Wellness Exam
Page11 Preventing Chronic Diseases: Investing Wisely in Health
Page 32 What is Cholesterol?
Page 54 Dry Eye in Men
Page 35 Schizophrenics More Likely to Smoke at Earlier Age
Page 57 There’s Hope
Page 13 Heads Up - Concussion in High School Sports Page 20 Low Testosterone Can Mimic Depression in Men Page 23 Tips for Safe Medicine Storage
Page 36 Healthy Heart Page 50 Tax Considerations in Selling a Medical Practice
Page 60 Holistic Health Page 64 Health and Wellness Calendar Page 68 Men: Stay Healthy at Any Age RSVP Health | www.rsvphealth.com 5
You Have More Power Than You Think! By: Dr. Rodney Gross, Ph.D.
6 RSVP Health | www.rsvphealth.com
You Have More Power Than You Think | RSVP Health
Common Terms You Need to Know Prostate-Specific Antigen (PSA) Test Alopecia Cirrhosis Inguinal Hernia
Statistics Centers for Disease Control (CDC) top Seven Health Threats for Men Comparisons to Women More Facts and Trends Become Your Own Health & Wellness Expert
Common Terms, Statistics and Trends in Men’s Health and Wellness With this segment of “You Have More Power Than You Think”, once again, I am doing it a little different than normal. As the spotlight in this edition is “Men’s Health and Wellness”, I thought I would mix it up a little and spotlight some unknown facts and trends attributed to “Men” and some definitions/conditions that you may not be aware of, but should be. Some have been requested by you, our readers. As you have become accustom, I will define some of these in my own “relevant” terms and quote those where appropriate, to help explain it thoroughly.
Prostate-Specific Antigen (PSA) Test – a blood test conducted on a man to determine the levels of “Prostate-Specific Antigen (PSA)”, a protein that is produced by the cells of the prostate gland. Alopecia – is simply, loss of hair. It can be caused by different reasons, which include damage to one’s hair shaft or the follicles. Another contributing factor for hair loss is fungal infection. Two main types of Alopecia: •
Alopecia Areata – when the hair loss is caused by one’s immune system. This condition mistakenly attacks the hair follicles and may cause hair all over the body to fall out in patches.
•
Androgenetic Alopecia – an inherited hair loss condition. Known as “Male Pattern Hair Loss”, the hair on the
The Common Terms Following are “some” of the most requested ones that all of you asked.
RSVP Health | www.rsvphealth.com 7
You Have More Power Than You Think | Dr. Rodney Gross, Ph.D.
head thins and falls out. In women, Androgenetic Alopecia is referred to as “Female Diffuse Hair Loss”. With this type of “Androgenetic Alopecia” hair loss is permanent. Cirrhosis – is a chronic disease of the liver that is characterized by scarring of the liver as a result to chronic liver damage. Identified early, mild cirrhosis can repair itself and continue to function normally. In advanced cases, the liver is unable to function properly due to more and more scarring. Inguinal Hernia – The National Institute of Health describes it as: a condition in which intra-abdominal fat or part of the small intestine, also called the small bowel, bulges through a weak area in the lower abdominal muscles. An inguinal hernia occurs in the groin—the area between the abdomen and thigh. This type of hernia is called inguinal because fat or part of the intestine slides through a weak area at the inguinal ring, the opening to the inguinal canal. An inguinal hernia appears as a bulge on one or both sides of the groin. An inguinal hernia can occur any time from infancy to adulthood and is much more common in males than females. Inguinal hernias tend to become larger with time. The two types of inguinal hernia have different causes. Indirect Inguinal Hernia – Indirect inguinal hernias are congenital hernias and are much more common in males than females because of the way males develop in the womb. In a male fetus, the spermatic cord and both testicles—starting from an intraabdominal location—normally descend through the inguinal canal into the scrotum, the sac that holds the testicles. Sometimes the entrance of the inguinal canal at the
8 RSVP Health | www.rsvphealth.com
inguinal ring does not close, as it should just after birth, leaving a weakness in the abdominal wall. Fat or part of the small intestine slides through the weakness into the inguinal canal, causing a hernia. In females, the female organs or the small intestine sliding into the groin through a weakness in the abdominal wall causes an indirect inguinal hernia. Indirect hernias are the most common type of inguinal hernia. Premature infants are especially at risk for indirect inguinal hernias because there is less time for the inguinal canal to close. Direct Inguinal Hernia – Direct inguinal hernias are caused by connective tissue degeneration of the abdominal muscles, which causes weakening of the muscles during the adult years. Direct inguinal hernias occur only in males. The hernia involves fat or the small intestine sliding through the weak muscles into the groin. A direct hernia develops gradually because of continuous stress on the muscles. One or more of the following factors can cause pressure on the abdominal muscles and may worsen the hernia: •
sudden twists, pulls, or muscle strains
•
lifting heavy objects
•
straining on the toilet because of constipation
•
weight gain
•
chronic coughing
Indirect and direct inguinal hernias usually slide back and forth spontaneously through the inguinal canal and can often be moved back into the abdomen with gentle massage.
You Have More Power Than You Think | RSVP Health
Statistics/Trends Centers for Disease Control (CDC) top Seven Health Threats to Men •
Heart Disease
•
Cancer (Lung, Skin, Prostate and Colorectal)
•
Accidents (Motor Vehicle Accidents)
•
Chronic Lower Respiratory Diseases (Chronic Lung Conditions to Include Bronchitis and Emphysema)
•
Stroke
•
Type 2 Diabetes
•
Suicide
More Facts and Trends •
90% of male lung cancer is caused by smoking.
•
Over 1 million males have used steroids for body enhancement at some point in their life.
•
Men have the highest rates of cancer and heart disease and the main cause is the use of alcohol and tobacco.
•
Men are attributed to 9 out of every 10 drunk driving arrests.
•
In nearly one-half of all accidents, suicides and homicides in men, alcohol is involved.
Comparisons to Women •
Men know less about health and take less responsibility
•
Men are less likely to see themselves as sick and admit they are sick. They also won’t admit they are more susceptible to a particular illness/ disease, when they are.
•
Men represent about 50% of the work force in the U.S. and yet, are 94% of “all” on-the-job deaths.
•
Men consume more salty and fatty foods
•
Men eat less fiber
•
Men smoke more
•
Men sleep less
•
Men have higher high blood pressure rates
•
Men use seat/safety belts less
Become Your Own Health and Wellness Expert There are abundant procedures and disorders throughout the men’s health and wellness world. If you are a male, you need to research and make yourself aware of your health and wellness. There is nothing to prove by not admitting you may be sick or susceptible to pre-determined health risks. There is nothing “manly” about denial and, most importantly, it’s not “manly” to be not around for loved ones and family. You owe it to yourself and them!
RSVP Health | www.rsvphealth.com 9
“I don’t have symptoms.” FACT: Colorectal cancer
doesn’t always cause symptoms, especially early on.
“Why Should I Get Screened?” “I’m only 53, I’m too young .” FACT: Screening is recommended for men and women beginning at age 50.
“It doesn’t run in my family.” FACT: Most colorectal
cancers occur in people with no family history.
“But that test...” FACT: There are several
kinds of screening tests for colorectal cancer.
Colorectal Cancer Screening Saves Lives Colorectal cancer is the 2nd leading cancer killer in the U.S. But it can be prevented. Screening helps find precancerous polyps so they can be removed before they turn into cancer. Screening can also find colorectal cancer early, when treatment is most effective. If you’re 50 or older—don’t wait. Talk to your doctor and get screened.
www.cdc.gov/screenforlife 1-800-CDC-INFO (1-800-232-4636) 10 RSVP Health | www.rsvphealth.com
Preventing Chronic Diseases: Investing Wisely in Health Screening to Prevent Cancer Deaths
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
The Reality
The Cost of Cancer
Cancer is the second leading cause of death in America, exceeded only by heart disease. Every year cancer claims the lives of more than a half million people. Many cancer deaths could be avoided if more people were screened for cancer.
According to the National Institutes of Health, cancer cost the U.S. an estimated $219 billion in 2007, including $130 billion for lost productivity and $89 billion in direct medical costs. Each year:
Screening for colorectal, breast, and cervical cancers can reduce illness and death through early detection of cancers and precancers. Yet many adults are not getting regular life-saving screenings as recommended. According to CDC’s National Center for Health Statistics, colorectal, breast, and cervical cancers accounted for nearly one fifth of all U.S. cancer deaths in 2001.
Cancer Facts, United States, 2004* Colorectal Deaths: 26,881 men; 26,699 women Diagnosed: 73,997 men; 71,086 women
• 3rd most common cancer and 2nd leading cause of cancer deaths (of cancers that affect both men and women) • Primary risk factor: Age; 90% of new cancer cases diagnosed in adults over 50
Breast Deaths: 40,954 women Diagnosed: 186,772 women
• 2nd leading cause of cancer death among women, exceeded only by lung cancer • Primary risk factor: Age; 77% of breast cancer diagnosed in women over 50
• Colorectal cancer treatment costs about $8.4 billion. • Breast cancer treatment costs nearly $7 billion. • Cervical cancer treatment costs about $160 million.
Cancer Screening Saves Lives Early detection could substantially reduce the billions of dollars spent on cancer treatment each year. Not only does cancer screening save lives by detecting breast, cervical, and colorectal cancers early; it also is the first step in preventing many colorectal and cervical cancers from ever developing: • Routine screening can reduce the number of people who die from colorectal cancer by at least 60%. • A mammogram performed every 1–2 years for women aged 40 years and over can reduce mortality by approximately 20%–25% during a 10-year period. • Pap tests can detect precancerous lesions so they can be treated before cervical cancer develops. Researchers in many countries found that rates of cervical cancer death dropped by 20%–60% after screening programs began. Percentage of Adults Aged 50 Years or Older who Reported Receiving a Fecal Occult Blood Test Within the Past Year and/or a Lower Endoscopy in the Preceeding 10 Years, by State, 2006
Cervical
NJ
Deaths: 3,850 women Diagnosed: 11,892 women
DC DE MA MD NH VT
* The most recent year for which statistics are available.
CT RI
≤50%
50.1%–60%
60.1%–70%
≥70.1%
Percent of respondents tested
Did not participate In the survey
Source: CDC. Behavioral Risk Factor Surveillance System, 2006.
Revised August 2008 RSVP Health | www.rsvphealth.com 11
What if your Individual health plan rewarded you for being healthy?
Deductible Credit Program
Taking care of yourself and making healthy choices is its own reward. Now your good health can pay you back with the Deductible Credit Program from Anthem Blue Cross and Blue Shield. You’re not one who leaves things to chance. You eat right and exercise. You take good care of yourself. But you also know you need solid health coverage for important preventive care…and for life’s little twists and turns. With Anthem's new Deductible Credit Program, you get rewarded when you need it most. When you don’t meet your yearly deductible, money goes into your Anthem Special Incentive Account. The account grows, and if you later meet your deductible, you get a check from us. Money straight to you for medical costs or whatever you want.
Be rewarded for your good health! If you’re self-employed, don’t get health insurance at work, making a career change or retiring early, call me today about this exciting new program!
Vincent K. Blair (314) 961-7777 vince@vincentkblair.com www.vincentkblair.com
Buy local from Vince Vincent K. Blair is an independent authorized agent in Missouri for Anthem Blue Cross and Blue Shield. In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Life and Disability products underwritten by Anthem Life Insurance Company. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
P U S D A E H You Have More Power Than You Think | RSVP Health
N O I S S U C CON
L O O H C S H IN HIG SPORTS
OACHES C R O F E D GUI
U.S. D EPARTMENT
OF H EALTH AND H UMAN S ERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION
There’s no doubt about it: sports are a great way for teens to stay healthy while learning important team-building skills. But there are risks to pushing the limits of speed, strength and endurance. And athletes who push the limits sometimes don’t recognize their own limitations—especially when they’ve had a concussion. That’s where you come in. It’s up to you, as a coach, to help recognize and make the call to pull an athlete off of the field, ice, court, or track if you think s/he might have a concussion. Playing with a concussion can lead to long-term problems. It can even be fatal. To help you properly identify and respond to a concussion, CDC, in partnership with leading experts and organizations, developed the Heads Up: Concussion in High School Sports initiative and materials. So as you’re building your concussion game plan, make sure to check these boxes: Learn concussion symptoms and danger signs Know how to respond if a concussion occurs Set up a four-step Heads Up Action Plan before the season starts Educate athletes, parents, and others RSVP Health | www.rsvphealth.com 13
CONCUSSION
IN HIGH SCHOOL SPORTS
CENTERS FOR DISEASE CONTROL AND PREVENTION
RSVP Health | www.rsvphealth.com SIGNS AND SYMPTOMS
ACTION PLAN
Athletes who experience one or more of the signs and symptoms listed below after a bump, blow, or jolt to the head or body may have a concussion. Signs Observed by Coaching Staff
Symptoms Reported by Athlete
Appears dazed or stunned
Headache or “pressure” in head
Is confused about assignment or position Forgets an instruction Is unsure of game, score, or opponent Moves clumsily Answers questions slowly Loses consciousness (even briefly) Shows mood, behavior, or personality changes Can’t recall events prior to hit or fall Can’t recall events after hit or fall
Nausea or vomiting Balance problems or dizziness
If you suspect that an athlete has a concussion, you should take the following four steps: 1. Remove the athlete from play. 2. Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion. Do not try to judge the seriousness of the injury yourself. 3. Inform the athlete’s parents or guardians about the possible concussion and give them the fact sheet on concussion. 4. Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says the athlete is symptom-free and it’s OK to return to play.
Double or blurry vision
IMPORTANT PHONE NUMBERS
Sensitivity to light
Emergency Medical Services
Sensitivity to noise
Name: Phone:
Feeling sluggish, hazy, foggy, or groggy Concentration or memory problems Confusion Just not “feeling right” or is “feeling down”
It’s better to miss one game than the whole season. For more information and to order additional materials free-of-charge, visit: www.cdc.gov/Concussion.
Health Care Professional
Name: Phone: School Staff Available During Practices
Name: Phone: School Staff Available During Games
Name: Phone:
June 2010
DID YOU KNOW? Athletes who have ever had a concussion are at increased risk for another concussion. Young children and teens are more likely to get a concussion and take longer to recover than adults.3-6 A repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems.7,8 14 RSVP Health | www.rsvphealth.com
3
P U S D HEA SION IN HIGH SCHOOL SPORTS
CONCUS What is a concussion?
A concussion is a brain injury. Concussions are caused by a bump, blow, or jolt to the head or body. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious.
What are the signs and symptoms?
You can’t see a concussion. Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days after the injury. If your teen reports one or more symptoms of concussion listed below, or if you notice the symptoms yourself, keep your teen out of play and seek medical attention right away. Signs Observed by Parents or Guardians
• Appears dazed or stunned • Is confused about assignment or position • Forgets an instruction • Is unsure of game, score, or opponent • Moves clumsily • Answers questions slowly • Loses consciousness (even briefly) • Shows mood, behavior, or personality changes • Can’t recall events prior to hit or fall • Can’t recall events after hit or fall
Symptoms Reported by Athlete
• Headache or “pressure” in head • Nausea or vomiting • Balance problems or dizziness • Double or blurry vision • Sensitivity to light or noise • Feeling sluggish, hazy, foggy, or groggy • Concentration or memory problems • Confusion • Just not “feeling right” or is “feeling down”
How can you help your teen prevent a concussion?
Every sport is different, but there are steps your teens can take to protect themselves from concussion and other injuries. • Make sure they wear the right protective equipment for their activity. It should fit properly, be well maintained, and be worn consistently and correctly.
A FACT SHEET FOR PARENTS
• Ensure that they follow their coaches' rules for safety and the rules of the sport. • Encourage them to practice good sportsmanship at all times.
What should you do if you think your teen has a concussion?
1. Keep your teen out of play. If your teen has a concussion, her/his brain needs time to heal. Don’t let your teen return to play the day of the injury and until a health care professional, experienced in evaluating for concussion, says your teen is symptom-free and it’s OK to return to play. A repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage, and even death. 2. Seek medical attention right away. A health care professional experienced in evaluating for concussion will be able to decide how serious the concussion is and when it is safe for your teen to return to sports. 3. Teach your teen that it’s not smart to play with a concussion. Rest is key after a concussion. Sometimes athletes wrongly believe that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don’t let your teen convince you that s/he’s “just fine.” 4. Tell all of your teen’s coaches and the student’s school nurse about ANY concussion. Coaches, school nurses, and other school staff should know if your teen has ever had a concussion. Your teen may need to limit activities while s/he is recovering from a concussion. Things such as studying, driving, working on a computer, playing video games, or exercising may cause concussion symptoms to reappear or get worse. Talk to your health care professional, as well as your teen’s coaches, school nurse, and teachers. If needed, they can help adjust your teen’s school activities during her/his recovery.
If you think your teen has a concussion: Don’t assess it yourself. Take him/her out of play. Seek the advice of a health care professional.
It’s better to miss one game than the whole season. For more information and to order additional materials free-of-charge, visit: www.cdc.gov/Concussion.
U.S. D EPARTMENT
OF H EALTH AND H UMAN S ERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION
June 2010
CONCUSSION A Must Read for Young Athletes
Let’s Take Brain Injuries Out of Play
concussion facts
concussion syMptoMs
• A concussion is a brain injury that affects how your brain works.
• Concussion symptoms differ with each person and with each injury, and may not be noticeable for hours or days. Common symptoms include:
• A concussion is caused by a blow to the head or body: • from contact with • being hit by a piece another player, of equipment such hitting a hard surface as a lacrosse stick, such as the ground, hockey puck, or field ice, or court, or hockey ball. • A concussion can happen even if you haven’t been knocked unconscious. • If you think you have a concussion, you should not return to play on the day of the injury and until a health care professional says you are OK to return to play.
• Headache
• Nausea or vomiting
• Confusion
• Bothered by light or noise
• Difficulty remembering or paying attention
• Double or blurry vision
• Balance problems or dizziness
• Slowed reaction time
• Feeling sluggish, hazy, foggy, or groggy
• Sleep problems • Loss of consciousness
Why shouLD i RepoRt My syMptoMs? • Unlike with some other injuries, playing or practicing with concussion symptoms is dangerous and can lead to a longer recovery and a delay in your return to play. • While your brain is still healing, you are much more likely to have another concussion. Repeat concussions can increase the time it takes for you to recover and the likelihood of long term problems. • In rare cases, repeat concussions in young athletes can result in brain swelling or permanent damage to your brain. They can even be fatal.
• Feeling irritable, more emotional, or “down” During recovery, exercising or activities that involve a lot of concentration (such as studying, working on the computer, or playing video games) may cause concussion symptoms to reappear or get worse.
*For more information about concussion and other types of traumatic brain injuries, go to
www.cdc.gov/Concussion A part of CDC’s Heads Up series
What Should I Do if I Think I Have a Concussion? Don’t hiDe it, RepoRt it. get checkeD out.
take caRe of youR bRain.
Ignoring your symptoms and trying to “tough it out” often makes symptoms worse. Tell your coach, parent, and athletic trainer if you think you or one of your teammates may have a concussion. Don’t let anyone pressure you into continuing to practice or play with a concussion. Only a health care professional can tell if you have a concussion and when it’s OK to return to play. Sports have injury timeouts and player substitutions so that you can get checked out and the team can perform at its best. The sooner you get checked out, the sooner you may be able to safely return to play. A concussion can affect your ability to do schoolwork and other activities. Most athletes with a concussion get better and return to sports, but it is important to rest and give your brain time to heal. A repeat concussion that occurs while your brain is still healing can cause long-term problems that may change your life forever.
All concussions are serious. Don’t hide it, report it. Take time to recover. It’s better to miss one game than the whole season.
Photo © Tom Zikas
16 RSVP Health | www.rsvphealth.com
HE HEADAC PRESSURE IN HEAD
All concussions are serious. If you think you have a
CONCUSSION : Don’t hide it. Report it. Take time to recover.
OMITING NAUSEA OR V BALANCE PROBLEMS OR DIZZINESS DOUBLE OR BLURRY VIS ION SENSITIVITY TO LIGHT OR NOISE FEELING S FOGGY, OR LUGGISH, HAZY, GROGGY ON OR I T A R T N CONCE PROBLEMS MEMORY CONFUSION JUST NOT “F EE OR “FEELINGLING RIGHT” DOWN”
It’s better to miss one game than the whole season. For more information and to order additional materials free-of-charge, visit: www.cdc.gov/Concussion.
U.S. D EPARTMENT
OF H EALTH AND H UMAN S ERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION
June 2010
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Low Testosterone Can Mimic Depression in Men By: Arturo Taca, Jr. M.D.
Testosterone is the primary male sex hormone and in its secretion affects neurobehavioral functions such as sexual arousal, aggression, emotions, and cognition. Postmenopausal depression and cognitive dysfunction in older women have received much attention. Many studies have established a positive impact of estrogen on mood and memory, motor coordination, alertness and cerebral blood flow. But what about depression in hormone-deficient older men–specifically low testosterone?
lifestyle factors including smoking and obesity‌were linked to declining testosterone levels
Common symptoms of regular depression include: low energy, decreased interest in sex, poor concentration, memory loss, fatigue, irritability, mood swings, changes in appetite leading to weight gain or loss. Symptoms of low testosterone in men share similar symptoms. In the 1940s, experiments showed that symptoms of depression were relieved by injecting testosterone into men with low levels of the hormone. The treatment never caught on because of painful shots and the development of antidepressant drugs. Other forms today come in testosterone patches and gels. Additionally, Australian researchers found that lifestyle factors including smoking and obesity, in addition to depression, were linked to declining testosterone levels.
A decade ago, the United States Food and Drug Administration approved a new form of gel for treating muscle loss, decreased sex drive, lack of energy, and other symptoms of low levels of testosterone. If you experience symptoms that feel like depression, get your family doctor to consider testing for other medical conditions such as low testosterone levels to make sure your treatment is the appropriate one. Other common medical conditions that can mimic symptoms of depression in both sexes include: anemia, low thyroid hormone, side effects from common drugs, sleep apnea and poor sleep hygiene. 20 RSVP Health | www.rsvphealth.com
aDDiction meDicine
INSyNergy
From left: Molly Kennedy, BA; Courtney Barnes, AA; Ed Mayuga, MBA; Taryn Zugmaier, AA; Steven Reimann, LPC, CASAC, CCGC; Ashley Halker, BA; Jordan Blankmann, AA; Eric Flanagan, RASAC; Arturo Taca, MD, ABAM. Not Pictured: Patricia Kennedy, PhD; Cheryl Ritzman, LPC; Erica Brown, BA.
What you need to knoW • A six-month, outpatient alternative to traditional 12-step, AA-based programs • Uses FDA-approved anticraving medications • Immediate detox as outpatient • Addresses psychiatric needs • Counseling included in program • Confidential with little disruption to personal life
D
11477 Olde Cabin Road, Ste. 210, Creve Coeur, Mo. 63141 314-649-STOP (7867), insynergystl.com
r. Arturo C Taca Jr., a psychiatrist who has been honored by Best Doctors, is the medical director at INSynergy Treatment Center, the premier drug and alcohol treatment program in the St. Louis area. INSynergy is an innovative program that treats drug and alcohol addictions using a modernday approach that combines medical pharmaceutical therapy with counseling. An alternative to 12-step and AA treatment, INSynergy is guided by evidencebased treatments. Detox from heroin, OxyContin, Vicodin, Percocet, Methadone, and other opiates can be safely achieved as an outpatient with new medications, such as Suboxone. The anti-craving medication Vivitrol is the first and only monthly injectable medication for alcohol dependence. It also recently received FDA approval for treatment of opiate addictions like heroin dependence.
“There is an increasing need for programs like ours as the nation’s addiction problems, especially those related to prescription drug abuse are on the rise,” says Dr. Taca. “Heroin is a middle-class drug now. According to new government data, there are more teenagers using opiate pain pills as their first recreational drug used compared to cannabis. We also saw for the first time more overdose deaths from pain pills versus deaths from car accidents.” INSynergy is the leading facility of its type within the St. Louis region that provides a highly confidential approach combining pharmaceutical therapy and counseling with minimal disruption to patients’ busy lifestyles. Services range from offering FDA-approved anti-craving medications and detox to individual, family, marriage, and group therapy sessions. Diet and nutritional counseling is also offered in the program. INSynergy also addresses the psychological and psychiatric issues that are oftentimes associated with addictive behaviors. Dr. Taca is among some 2,500 physicians in the U.S. certified by the American Board of Addiction Medicine, which sets standards for physician education, assesses physicians’ knowledge, and requires and tracks continuing education. For more information on INSynergy, please visit insynergystl.com, or call 314-649-STOP (7867) to schedule a free, no obligation, evaluation. RSVP Health | www.rsvphealth.com 21
HOW DID YOU SLEEP LAST NIGHT?
Does any of this sound familiar? If so, tell your doctor!
• • • • • • • • • • • • • •
I have trouble going to sleep at night I snore I have high blood pressure My diabetes is hard to control I do not feel refreshed in the morning My legs bother me in the evening or while I’m trying to sleep I fall asleep while I’m driving or while sitting still I wake up earlier in the morning than I would like My child is hyperactive My child sleeps less than 9 hours in a 24 hour period I have a dry mouth upon waking Someone has noticed I stop breathing I wake up gasping for air I’m tired during the day
We can help you sleep!
Skaggzzz Sleep Institute 1269 Doctor Dr., Farmington, MO (573) 760-1501 www.skaggzzz.com
If you sleep poorly, your chances of developing high blood pressure may increase, new research suggests. — USA Today
Sleep Apnea can also increase the risk of diabetes. — American Diabetes Association
Untreated sleep apnea can cause hypertension, stroke or heart failure. — Web MD
Increased awareness of the relationship between depression and OSA might significantly improve the diagnostic accuracy as well as treatment outcome for both disorders. . — Stanford University School of Medicine
Lack of sleep can cause you to gain weight: The two hormones that are key in this process are ghrelin and leptin. Ghrelin is the ‘go’ hormone that tells you when to eat, and when you are sleepdeprived, you have more ghrelin. Leptin is the hormone that tells you to stop eating, and when you are sleep deprived, you have less leptin. More Ghrelin + Less Leptin = Weight Gain.
Tips for Safe Medicine Storage Article Title | RSVP Health
Thousands of young children end up in emergency departments every year after getting into medicines while their parents or caregivers are not looking. Unfortunately, accidental ingestions don’t take a vacation.
It’s important for parents to always keep medicines and vitamins Up and Away and Out of Sight at home, and also when families are away from their homes and staying in hotels or as guests in others’ homes. When traveling, remember these five simple tips for safely storing medicines while on-the-go:
When packing for a trip, keep your medicines in their original child-resistant containers. Other containers, such as pill organizers and baggies, often lack child safety features and can be easily accessed by young children.
While staying in a hotel, secure your medicines and vitamins in a location that your children cannot see or reach, such as a high cabinet or passcode-protected hotel room safe.
As a guest in another person’s home, do not be shy about asking them where to put your medicines and vitamins so they are out of the sight and reach of children.
Remember to never leave medicine or vitamins out on a table, countertop, or bedside table where your children could reach them no matter where you are – always make sure the caps are locked and put them away every time they are used.
Program the national Poison Help number, 1-800-222-1222, along with other emergency contact numbers into your cell phone, so they are available in case of an emergency.
For more tools and information, visit UpandAway.org. RSVP Health | www.rsvphealth.com 23
In partnership with the Centers for Disease Control and Prevention (CDC)
Estate Planning for Everyone By: Kathleen W. Bilderback
Recently, a young woman called my office. Her husband had been admitted to the hospital two days earlier with a high fever. Doctors determined that he had a serious infection. By the time she reached me, he had fallen into a coma. She indicated that he didn’t have a will, or any documents indicating who should make his healthcare decisions if he could not make them himself. The young woman was the man’s second wife and they had a toddler son. The husband was the primary bread winner. Unfortunately, the husband passed away without regaining consciousness. If an individual dies without a will, the statutes of the State in which the deceased resided at death determine who receives the individual’s property. Sometimes, the property ends up passing to individuals that the deceased would not have intended. In this case, the husband had children (now adults) with his former wife. Because husband did not have a will, state law dictated that a percentage of his assets passed to the adult children from his first marriage. In addition to losing her husband, the young widow must now make drastic changes to her lifestyle and the lifestyle of her young son due to their change in financial circumstances. There are many common misconceptions about what “estate planning” involves. By definition, estate planning is a process designed to help you manage and preserve your assets while you are alive, and to conserve and control their distribution after your death. But what estate planning means to you, specifically, depends on who you are. Your age, health, wealth, lifestyle, life stage, goals, and many other factors determine your particular estate planning needs.
Documents for Lifetime Planning According to the Social Security Administration, a 20-year-old worker has a 3 in 10 chance of becoming disabled prior to reaching retirement age. Further, as life expectancy increases, a higher percentage of people are developing diseases that impair the ability to make and communicate financial and healthcare decisions. Alzheimer’s disease currently affects one in eight people age 65 and older and almost 50% of people age 85 and older. As a result, important aspects of estate planning include determine who will handle your financial affairs and medical decisions if you become physically or mentally unable to do so. Three documents address these matters: a general durable power of attorney (for financial matters), a healthcare power of attorney, and a living will (sometimes referred to as an “advance directive”). 24 RSVP Health | www.rsvphealth.com
Estate Planning for Everyone | Kathleen W. Bilderback
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Estate Planning for Everyone | Kathleen W. Bilderback
General Durable Power of Attorney Under a general durable power of attorney (GDPOA) you designate someone to act on your behalf for financial matters. The person that you appoint will be able to handle day-to-day financial tasks such as paying your bills, collecting benefits such as social security and disability benefits on your behalf, monitoring your investments, and paying your taxes. A GDPOA also allows you to appoint a temporary guardian for your minor children in the event that you become incapacitated. A GDPOA may be “springing” meaning that it only becomes effective when you become incapacitated or “immediate” meaning that it is effective immediately when you sign it. State law requires the person that you have designated to act in your best interests and imposes stiff penalties for wrongdoing.
Healthcare Power of Attorney A healthcare power of attorney (HCPOA) permits you to appoint someone to make your medical decisions if you cannot make or communicate them yourself. Although many people think of a HCPOA in the context of end-of-life decisions, that is not the only time that they come into play. If you have a car accident and are in a coma, the person that you designate will be able to discuss your condition with your doctor and hospital staff and consent to treatment on your behalf. You should discuss your healthcare desires with your designees to help ensure that they understand your wishes regarding treatment.
Living Will/Advance Directive A living will or advance directive is a document that provides instructions regarding the care that you do or do not want if you have an injury or illness and do not have a meaningful chance of recovery. It will guide your physicians and the person you have appointed under your HCPOA. A living will should be specific in addressing the types of treatment (CPR, ventilators, tube feeding) that you do or do not want. Once you have executed a living will, you should provide a copy to your physician. A study funded by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services found that between 65 and 76 percent of physicians whose patients has an advance directive were not aware that it existed!
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Consequences of Incapacity Without These Documents If you are incapacitated and do not have a GDPOA or HCPOA in place, your family members may need to file a court action so that they may be appointed your guardian and conservator. This can be expensive and time consuming. Moreover, the court rather than you will decide who serves in these very important roles. There may be ongoing court supervision creating additional time and expense.
Transfers of Property at Death There are three ways that property passes upon a person’s death: by operation of law, by contract and by will. A transfer by operation of law is a transfer that occurs automatically due to existing laws, For example, if Amy and Bob hold title to a piece of property as “joint tenants with right of survivorship”, then upon the death of Amy, the law automatically passes title to Bob, regardless of the terms of your will.
Transfers by Contract A transfer by contract occurs when an asset passes via beneficiary designation. Assets that pass by contract include qualified retirement plans such as 401(k)s, 403(b)s and IRAs, life insurance, and annuities. You simply designate one or more beneficiaries to receive these assets at your death. Your will does not affect your beneficiary designation. For example, Henry’s will states that Katherine will receive all of his property upon his death. However, he designates Anne as the beneficiary of his life insurance. Upon Henry’s death, the insurance death benefit will be paid to Anne. You should consider designating a contingent beneficiary of these assets as well, in case your primary beneficiary fails to survive you. You should revisit your beneficiary designations periodically to make sure that they are still appropriate.
Transfers by Will and the Probate Process Property that does not pass by operation of law or by contract passes by will. The main purpose of a will is to disburse property to your chosen heirs after your death. A will names the personal representative (sometimes called the “executor”) who will manage and settle your estate. In addition, if you have minor children or dependents with special needs, you can name a guardian for them in your will. If you have property which passes by will, the will must be probated.
Estate Planning for Everyone | RSVP Health Probate is defined as the action or process of proving to a court that a document offered for official recognition and registration as the last will and testament of a deceased person is genuine. Each state has its own probate process. All steps in the process must be completed before the property in the estate can be distributed to the heirs. In many states, probate is expensive and time consuming. Frequently, the law requires the personal representative to hire an attorney. State law may provide statutory compensation for both the attorney and the personal representative. Those fees can mount up quickly. For example, in Missouri, with a $300,000 estate, the statutory fee for the attorney and personal representative would be approximately $8,800 each. Add about $1,800 in costs and the $300,000 estate will have almost $20,000 in expenses and fees which is approximately 6.6% of the total estate. If you own property in multiple states, your estate may be subject to probate in more than one state. Further, the terms of a will become public record upon your death for all of your relatives, co-workers and neighbors to read and discuss.
Avoiding Probate Many people try to avoid probate by transferring as many assets as possible using joint ownership with rights of survivorship, beneficiary designations and transfer or payable-on-death designations. Payable or transfer-on-death designations can be placed on many assets such as bank or investment accounts. When the owner of the account dies, the assets automatically pass to the designee. If a beneficiary is a minor child, transferring property by transfer-on-death designation may not be a good idea. State law may require a conservator to be appointed by the court to manage the assets until the child reaches the age of 18 or 21, depending upon the state. At the designated age, the child receives the assets held by the conservator and may spend them as he or she pleases. If your beneficiaries are minors, a revocable trust may be a better choice.
Revocable Trusts A revocable trust (sometimes referred to as a “living trust”) is an arrangement under which the person creating the trust (the “settlor” or “grantor”) transfers property to a trustee, to be held for the benefit of one or more beneficiaries. The property in the trust is administered according to the terms of the trust agreement. As settlor, you control the property in the trust. Whenever you wish you can change the trust
terms, transfer property in and out of the trust, or terminate the trust altogether. Property titled in the name of the trust avoids probate. When you pass away, a successor trustee immediately assumes management of the trust, ensuring that trust assets are available to your heirs more quickly. The successor trustee can administer the assets in the trust for the benefit of your minor children or grandchildren, making distributions to or for their benefit as you specify in the trust agreement. You determine at what age the beneficiaries will receive the assets. If you have a disabled beneficiary, you can include special terms to avoid disqualifying them for government benefits. You can also include terms that protect the trust assets from the beneficiary’s creditors. In addition, for high net worth individuals, revocable trusts can create estate tax efficiency, ensuring that there will not be an estate tax at the death of the first spouse.
Conclusion It is easy procrastinate since estate planning brings up topics that are not very pleasant to consider. However, by taking control of your estate planning, you ensure that the people handling your healthcare decisions and financial affairs during your incapacity are those that you select. In addition, you ensure that your property will pass at your death to the people that you want to benefit, in the manner and at the time that you want them to receive it. It can save your heirs money and minimizes the potential for hard feelings among family members, since your intentions are clearly stated. Good planning can minimize paperwork for family members at times when family should be able to concentrate on supporting one another emotionally, rather than worrying about probate or guardianship. Kathleen W. Bilderback specializes in estate and business succession planning and is a Member at Affinity Law Group, LLC, a firm providing legal services to businesses, their owners, and their executives at all phases of the life cycle. She may be reached at kbilderback@affinitylawgrp.com or (314) 872-3333. “Disability Planner: Social Security Protection if You Become Disabled”. United States Social Security Administration. <www.socialsecurity.gov/ dibplan/index.htm>. Web. August 21 2012.
i
ii “2012 Alzheimer’s Disease Facts and Figures”. Alzheimer’s Association. Web. August 21, 2012.
Barbara L. Kass-Bartelmes BL, Hughes R. Rutherford MK. “Advance Care Planning: Preferences for care at the End of Life”. Rockville (MD): Agency for Healthcare Research and Quality; 2003. Research in Action Issue #12. AHRQ Pub. No. 03-0018.
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What is Bipolar? By: Arturo C. Taca, Jr. M.D.
Bipolar disorder has been one of the most challenging and frustrating psychiatric illnesses to diagnose and treat. Because of its different forms in which it may express itself, Bipolar can be mis-diagnosed as “regular” depression, anxiety, insomnia, personality disorder, and may also be the main factor why many people struggling with Bipolar have substance abuse issues. According to research, up to 60% of people with Bipolar will have issues with Substance Use Disorders (SUD). Diagnosing bipolar is essential to having a successful rehab experience. This is paramount because some medications that treat “regular” or major depression can actually promote mood destabilization. The group of medications called “AntiDepressants” are not indicated to treat Bipolar Disorder alone, and treatment guidelines remind us to use caution when using them along with “Mood Stabilizers”. The concern is that if a Bipolar with substance abuse issues complains of depression (which a majority do), an antidepressant may be prescribed alone. This may cause mania (increased energy with euphoria), depression, insomnia, and more anxiety. This in return may cause more self-medication and make rehab treatment difficult and unsuccessful. This cycling type of mood in itself is associated with poor outcomes. Following are some facts about Bipolar coming from the National Institute of Mental Health.
What is bipolar disorder? Bipolar disorder is a serious brain illness. It is also called manic-depressive illness. People with bipolar disorder go through unusual mood changes. Sometimes they feel very happy and “up,” and are much more active than usual. This is called mania. And sometimes people with bipolar disorder feel very sad and “down,” and are much less active. This is called depression. Bipolar disorder can also cause changes in 28 RSVP Health | www.rsvphealth.com
What is Bipolar? | RSVP Health
energy and behavior. Bipolar disorder is not the same as the normal ups and downs everyone goes through. Bipolar symptoms are more powerful than that. They can damage relationships and make it hard to go to school or keep a job. They can also be dangerous. Some people with bipolar disorder try to hurt themselves or attempt suicide.
People having a depressive episode may: •
Feel very “down” or sad
•
Feel worried and empty
•
Have trouble concentrating
What are the symptoms of bipolar disorder?
•
Forget things a lot
Bipolar mood changes are called “mood episodes.” People may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that last a week or two–sometimes longer. During an episode, the symptoms last every day for most of the day.
•
Lose interest in fun activities and become less active
•
Feel tired or “slowed down”
•
Have trouble sleeping
•
Think about death or suicide
Mood episodes are intense. The feelings are strong and happen along with extreme changes in behavior and energy levels.
What causes bipolar disorder?
People having a manic episode may:
Several factors may contribute to bipolar disorder, including:
•
Feel very “up” or “high”
•
Genes, because the illness runs in families, and
•
Feel “jumpy” or “wired”
•
Abnormal brain structure and brain function.
•
Talk really fast about a lot of different things
•
Be agitated, irritable, or “touchy”
•
Have trouble relaxing or sleeping
•
Think they can do a lot of things at once and are more active than usual
•
Do risky things, like spend a lot of money or have reckless sex
The causes of bipolar disorder aren’t always clear. Scientists are finding out more about the disorder by studying it. This research may help doctors predict whether a person will get bipolar disorder. One day, it may also help doctors prevent the illness in some people. Source: National Institute of Mental Health.
INSynergy, located at 11477 Olde Cabin Road, Suite 210, St. Louis, Mo., 63141, is the leading facility of its type within the Midwest that provides a highly confidential approach combining pharmaceutical therapy and counseling with minimal disruption to patients’ work schedules. Services range from anti-craving medications and detoxification to individual, family and group therapy sessions. INSynergy also addresses the psychological and psychiatric issues that lead to addictive behaviors such as ADHD, anxiety, bipolar disorder, and depression. Dr. Taca is a Diplomate and Board Certified by the American Board of Addiction Medicine as well as the American Board of Psychiatry and Neurology. He has been a rich resource for local and national organizations, giving lectures on the biology of addiction and the cutting edge medical treatments available currently. Before INSynergy, Dr. Taca completed his psychiatric residency training at St. Louis University where he was the Chief Resident of the Department of Psychiatry. He is currently a clinical instructor and continues to teach and supervise residents at the St. Louis University School of Medicine Department of Psychiatry and St. John’s Mercy Medical Center. RSVP Health | www.rsvphealth.com 29
Taking Care of What Matters Most, even when it’s inconvenient.
COMPREHENSIVE • COMPASSIONATE • CONVENIENT COMPLETE • COST EFFECTIVE 573-747-1510
|
508 W. Pine St., Farmington, MO
| www.midwestconvenientcare.com
Midwest Health Group Commitment to Community Midwest Health Group is proud to announce our brand new lab. It is be a Quest and Labcorp draw station and offers: - PadNet testing for peripheral artery disease and or poor circulation. - Nerve testing to help diagnose disorders of the spine and carpal tunnel syndrome - Lung testing (pulmonary function testing [PFTâ&#x20AC;&#x2122;s]) - 24 hour glucose monitoring - Saturday hours 8:00 AM - 12:00 PM (noon) - Drive up location All of these tests and services can be provided no matter where your primary physician or provider is located and the results will be forwarded to them.
Dr. Paul Moniz D.O. and Dr. Guy Roberts D.O.
Midwest Health Group and Midwest Health Group Convenient Care is proud to spotlight our nurse practitioners: Midwest Health Group Josie Savage, N.P., Christina Klinesorge-Rariden, FNP, Gina Herberlie FNP and Missy Radosevich FNP Midwest Health Group Convenient Care Angelica Lappe FNP
573-747-1510 508 W. Pine St., Farmington, MO www.midwestconvenientcare.com
Get Healthy. Stay Healthy.
What is Cholesterol? Cholesterol is a soft, waxy substance found in every cell of your body.1 It’s essential for normal body function, but your body produces all the cholesterol it needs, so cholesterol in your diet is deposited in your blood vessels. Eventually, this surplus can lead to narrowing of the arteries, stroke and heart disease.2 In fact, high blood cholesterol is a major risk factor for heart disease, the leading cause of death in the U.S. Depending on race, between 40 and 51 percent of American adults have high blood cholesterol.3
LDL vs. HDL cholesterol 4 Cholesterol is carried through the bloodstream by particles called lipoproteins, which are made up of cholesterol on the inside and protein on the outside. There are two main types of lipoproteins: Low-density lipoproteins (LDL) are the major type of lipoprotein carrying cholesterol through the body. LDL cholesterol builds up on the walls of your arteries and can lead to coronary artery disease, heart attack and stroke.
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High-density lipoproteins (HDL) carry excess cholesterol back to the liver to remove it from the body. HDL cholesterol is what’s referred to as “good cholesterol.”
Silent danger High cholesterol has no symptoms — only a blood test will tell you if you have a problem. However, there are several behavioral and genetic risk factors, including: 4 • Diet. A diet high in saturated fat and trans fatty acids or trans fats, which are primarily found in animal fat and hydrogenated vegetable oil, will raise your cholesterol level. Foods from animal sources, such as egg yolks, meat and dairy products, also add unnecessary dietary cholesterol. • Physical activity. If you don’t get regular physical activity, the resulting weight gain can raise your LDL cholesterol level. • Weight. Being overweight tends to increase LDL cholesterol levels and decrease HDL cholesterol levels. • Heredity. A genetic condition called familial hypercholesterolemia results in very high LDL cholesterol levels. • Age and gender. LDL cholesterol levels rise as people age, and men tend to have lower levels of the “good” HDL cholesterol than women. Women generally have lower LDL cholesterol levels than men until about age 55, but then their LDL levels tend to be higher.
What you can do Everyone can take steps to lower their cholesterol. First, ask your doctor to check your blood cholesterol levels. The National Cholesterol Education Program recommends that healthy adults have their cholesterol levels checked every five years.4 Have your blood tested as early as possible to establish baseline levels.2 Check the sidebar for guidelines on what these levels mean.
Regardless of what your test results show, keep your cholesterol levels healthy by eating a balanced diet, losing any excess weight, making time for regular physical activity and avoiding tobacco. If your doctor finds that you have high blood cholesterol, he or she may prescribe medications in addition to recommending lifestyle changes, including the following:2
Optimal cholesterol levels for adults 5 Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood.
Total cholesterol: less than 200 mg/dL
LDL cholesterol (“bad” cholesterol): less than 100 mg/dL
HDL cholesterol (“good” cholesterol): 60 mg/dL or higher
Triglycerides (another kind of fat found in the blood): less than 150 mg/dL
Resources Visit the American Heart Association online at americanheart.org. In the “Cholesterol” section, you’ll find tracking tools, questions to ask your doctor and information about cholesterol-lowering medicines.
Lose any extra weight. Even five or 10 pounds can make a difference in your cholesterol levels. Eat heart-healthy foods. Researchers say a fiber-rich diet can help as much as medicine to lower cholesterol for some people. Choose whole grains, lean meats, fish, skim milk, and fresh fruits and vegetables. Aim for less than 300 milligrams (mg) of cholesterol in your daily diet. Exercise regularly. As long as your doctor gives you the okay, try to work in up to an hour of exercise each day. Regular exercise can improve your cholesterol levels. Quit smoking. Quitting smoking can improve your HDL (“good”) cholesterol level.
Visit anthem.com for more ways to get healthy — and stay healthy. Sources: 1 American Heart Association, Cholesterol (2009): americanheart.org, 2 MayoClinic.com, High Blood Cholesterol (August 6, 2008), 3 American Heart Association, Cholesterol Statistics (2009): americanheart.org, 4 Centers for Disease Control and Prevention, Cholesterol (Accessed November 8, 2007): cdc.gov, 5 American Heart Association, Cholesterol Levels (2009): americanheart.org Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. MANSH0312ABS 2/10
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Schizophrenics More Likely to Smoke at Earlier Age By: Arturo C. Taca, Jr. M.D.
A new study shows that patients in the early stages of schizophrenia are considerably more likely to smoke. Old data shows that if one has schizophrenia, he/she will have a 5X risk of substance use disorder. This in particular is important because of the rate schizophrenic smoke cigarettes. Illicit drug use is common among heavy cigarette smokers in the general population, but among outpatients with schizophrenia who are heavy smokers, it is most common in the first decade of illness, according to findings from this study. The findings have important implications for the management of schizophrenia patients who are in the early stages of their disease, Kristen M. Mackowick of the National Institute on Drug Abuse and her colleagues reported in the August issue of Schizophrenia Research.
50% of smokers will die of a smoking related illness
The prevalence of cigarette smoking among those with schizophrenia is 58%-90%, compared with about 20% in the general population. Since 50% of smokers will die of a smoking related illness, it is clinically important for the schizophrenic population to address this risk because of the decreased likelihood of healthy lifestyles. Many schizophrenics will have challenges with exercise, diet, and weight control, mainly because of the illness itself and partly due to many of the medications causing obesity, sedation, and fatigue. â&#x20AC;&#x153;Clinicians should also be vigilant when treating schizophrenia patients who are in the early stages of their illness, as prodromal and first-episode patients may be more vulnerable to drug use, as we observed more past drug use than current use in our schizophrenia participants,â&#x20AC;? they concluded. This study was supported by the Intramural Research Program of the National Institutes of Health, the National Institute on Drug Abuse, and by a NIDA Residential Research Support Services contract. RSVP Health | www.rsvphealth.com 35
Get Healthy. Stay Healthy.
Healthy Heart One of every three Americans has at least one form of heart disease. How’s your heart health?1
What to look for. While serious cardiac events can occur without warning, many times people do recognize some symptoms – the key is to pay attention to your body and seek medical treatment when you feel something isn’t right. A common symptom is chest pain that’s noticeable when you’re active, excited or stressed, or after you’ve eaten a large meal or been exposed to cold temperatures. This pain is often described as weight or pressure, aching, burning or even numbness. While it’s usually felt in the chest, you may also feel it in your left shoulder, arms, neck, back or jaw. Other symptoms include shortness of breath; irregular, faster or skipped heart beats; weakness or dizziness; nausea; or perspiration. On the next page, you will see a comprehensive list of symptoms, but everyone is different – you could have a serious heart problem but experience none of the symptoms listed.1,2
The heart facts
1
MANSH0310ABS 11/11
Your heart is about the size of your fist.
It takes only 60 seconds for your blood to travel away from your heart, through your entire body and back to your heart again.
Your body contains about two gallons of blood.
Every year since 1920, heart disease has killed more Americans than any other cause.
Affordable individual health coverage is here. Protect your family without the expense you might expect. Anthem Blue Cross and Blue Shield has plans that provide protection for different needs and budgets.
For more information, just call
Vincent K. Blair (314) 961-7777 vince@vincentkblair.com www.vincentkblair.com
Vincent K. Blair is an independent authorized agent in Missouri for Anthem Blue Cross and Blue Shield. In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE速 Managed Care, Inc. (RIT), Healthy Alliance速 Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Life and Disability products underwritten by Anthem Life Insurance Company. Independent licensees of the Blue Cross and Blue Shield Association. 速ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Prostate Health By: National Cancer Institute
Prostate-Specific Antigen (PSA) Test Key Points •
The PSA test measures the blood level of PSA, a protein that is produced by the prostate gland. The higher a man’s PSA level, the more likely it is that he has prostate cancer. However, there are additional reasons for having an elevated PSA level, and some men who have prostate cancer do not have elevated PSA.
•
The PSA test has been widely used to screen men for prostate cancer. It is also used to monitor men who have been diagnosed with prostate cancer to see if their cancer has recurred (come back) after initial treatment or is responding to therapy.
•
Some advisory groups now recommend against the use of the PSA test to screen for prostate cancer because the benefits, if any, are small and the harms can be substantial. None recommend its use without a detailed discussion of the pros and cons of using the test.
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Prostate Health | RSVP Health
1. What is the PSA test? Prostate-specific antigen, or PSA, is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in a manâ&#x20AC;&#x2122;s blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per milliliter (ng/mL) of blood. The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. In 1994, the FDA approved the use of the PSA test in conjunction with a digital rectal exam (DRE) to test asymptomatic men for prostate cancer. Men who report prostate symptoms often undergo PSA testing (along with a DRE) to help doctors determine the nature of the problem. In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a manâ&#x20AC;&#x2122;s PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
only about 25% of men who have a prostate biopsy due to an elevated PSA level actually have prostate cancer
2. Is the PSA test recommended for prostate cancer screening? Until recently, many doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more has been learned about both the benefits and harms of prostate cancer screening (see Questions 5 and 6), a number of organizations have begun to caution against routine population screening. Although some organizations continue to recommend PSA screening, there is widespread agreement that any man who is considering getting tested should first be informed in detail about the potential harms and benefits. Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.
3. What is a normal PSA test result? There is no specific normal or abnormal level of PSA in the blood. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.
RSVP Health | www.rsvphealth.com 39
Prostate Health | National Cancer Institute
However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer (1). In addition, various factors can cause a man’s PSA level to fluctuate. For example, a man’s PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugs—including finasteride and dutasteride, which are used to treat BPH—lower a man’s PSA level. PSA level may also vary somewhat across testing laboratories. Another complicating factor is that studies to establish the normal range of PSA levels have been conducted primarily in populations of white men. Although expert opinions vary, there is no clear consensus regarding the optimal PSA threshold for recommending a prostate biopsy for men of any racial or ethnic group. In general, however, the higher a man’s PSA level, the more likely it is that he has prostate cancer. Moreover, continuous rise in a man’s PSA level over time may also be a sign of prostate cancer.
4. What if a screening test shows an elevated PSA level? If a man who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the man continue with PSA tests and DREs at regular intervals to watch for any changes over time. If a man’s PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound, x-rays, or cystoscopy. If prostate cancer is suspected, the doctor will recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue A microscopic photo of a slide demonstrating are collected by inserting hollow needles into the prostate and then the cellular structure of Prostate Gland withdrawing them. Most often, the needles are inserted through the Adenocarcinoma wall of the rectum (transrectal biopsy); however, the needles may also be inserted through the skin between the scrotum and the anus (transperineal biopsy). A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.
5. What are some of the limitations and potential harms of the PSA test for prostate cancer screening? Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumors that do not cause 40 RSVP Health | www.rsvphealth.com
Prostate Health | RSVP Health
symptoms. Finding a small tumor, however, may not necessarily reduce a man’s chance of dying from prostate cancer. Some tumors found through PSA testing grow so slowly that they are unlikely to threaten a man’s life. Detecting tumors that are not life threatening is called “overdiagnosis,” and treating these tumors is called “overtreatment.” Overtreatment exposes men unnecessarily to the potential complications and harmful side effects of treatments for early prostate cancer, including surgery and radiation therapy. The side effects of these treatments include urinary incontinence (inability to control urine flow), problems with bowel function, erectile dysfunction (loss of erections, or having erections that are inadequate for sexual intercourse), and infection.
In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man’s PSA level to rise.
In addition, finding cancer early may not help a man who has a fast-growing or aggressive tumor that may have spread to other parts of the body before being detected. The PSA test may give false-positive or false-negative results. A false-positive test result occurs when a man’s PSA level is elevated but no cancer is actually present. A false-positive test result may create anxiety for a man and his family and lead to additional medical procedures, such as a prostate biopsy, that can be harmful. Possible side effects of biopsies include serious infections, pain, and bleeding. Most men with an elevated PSA level turn out not to have prostate cancer; only about 25 percent of men who have a prostate biopsy due to an elevated PSA level actually have prostate cancer (2). A false-negative test result occurs when a man’s PSA level is low even though he actually has prostate cancer. False-negative test results may give a man, his family, and his doctor false assurance that he does not have cancer, when he may in fact have a cancer that requires treatment.
6. What research has been done to study prostate cancer screening? Several randomized trials of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and DRE were evaluated for their ability to decrease a man’s chances of dying from prostate cancer. The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but the same rate of deaths from the disease (3). Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment. RSVP Health | www.rsvphealth.com 41
Prostate Health | National Cancer Institute
A second large trial, the European Randomized Study of Screening for Prostate Cancer (ERSPC), compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer (4). The United States Preventive Services Task Force has analyzed the data from the PLCO, ERSPC, and other trials and estimated that, for every 1,000 men ages 55 to 69 years who are screened every 1 to 4 years for a decade (5): •
0 to 1 death from prostate cancer would be avoided.
•
100 to 120 men would have a false-positive test result that leads to a biopsy, and about one-third of the men who get a biopsy would experience at least moderately bothersome symptoms from the biopsy.
•
110 men would be diagnosed with prostate cancer. About 50 of these men would have a complication from treatment, including erectile dysfunction in 29 men, urinary incontinence in 18 men, serious cardiovascular events in 2 men, deep vein thrombosis or pulmonary embolism in 1 man, and death due to the treatment in less than 1 man.
7. How is the PSA test used in men who have been treated for prostate cancer? The PSA test is used to monitor patients who have a history of prostate cancer to see if their cancer has recurred (come back). If a man’s PSA level begins to rise after prostate cancer treatment, it may be the first sign of a recurrence. Such a “biochemical relapse” typically appears months or years before other clinical signs and symptoms of prostate cancer recurrence. However, a single elevated PSA measurement in a patient who has a history of prostate cancer does not always mean that the cancer has come back. A man who has been treated for prostate cancer should discuss an elevated PSA level with his doctor. The doctor may recommend repeating the PSA test or performing other tests to check for evidence of a recurrence. The doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.
8. What does an increase in PSA level mean for a man who has been treated for prostate cancer? If a man’s PSA level rises after prostate cancer treatment, his doctor will consider a number of factors before recommending further treatment. Additional treatment based on a single PSA test is not recommended. Instead, a rising trend in PSA level over time in combination with other findings, such as an abnormal result on imaging tests, may lead a man’s doctor to recommend further treatment.
42 RSVP Health | www.rsvphealth.com
Prostate Health | RSVP Health
9. How are researchers trying to improve the PSA test? Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. Some of the methods being studied include: •
•
Free versus total PSA. The amount of PSA in the blood that is “free” (not bound to other proteins) divided by the total amount of PSA (free plus bound). Some evidence suggests that a lower proportion of free PSA may be associated with more aggressive cancer. PSA density of the transition zone. The blood level of PSA divided by the volume of the transition zone of the prostate. The transition zone is the interior part of the prostate that surrounds the urethra. Some evidence suggests that this measure may be more accurate at detecting prostate cancer than the standard PSA test.
•
Age-specific PSA reference ranges. Because a man’s PSA level tends to increase with age, it has been suggested that the use of age-specific PSA reference ranges may increase the accuracy of PSA tests. However, age-specific reference ranges have not been generally favored because their use may delay the detection of prostate cancer in many men.
•
PSA velocity and PSA doubling time. PSA velocity is the rate of change in a man’s PSA level over time, expressed as ng/mL per year. PSA doubling time is the period of time over which a man’s PSA level doubles. Some evidence suggests that the rate of increase in a man’s PSA level may be helpful in predicting whether he has prostate cancer.
•
Pro-PSA. Pro-PSA refers to several different inactive precursors of PSA. There is some evidence that pro-PSA is more strongly associated with prostate cancer than with BPH. One recently approved test combines measurement of a form of pro-PSA called [-2]proPSA with measurements of PSA and free PSA. The resulting “prostate health index” can be used to help a man with a PSA level of between 4 and 10 ng/mL decide whether he should have a biopsy.
Selected References 1. Thompson IM, Pauler DK, Goodman PJ, et al. Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. New England Journal of Medicine 2004;350(22):2239-2246. [PubMed Abstract] 2. Barry MJ. Clinical practice. Prostate-specificantigen testing for early diagnosis of prostate cancer. New England Journal of Medicine 2001;344(18):1373-1377. [PubMed Abstract] 3. Andriole GL, Crawford ED, Grubb RL, et al. Prostate cancer screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial: mortality results after 13 years of follow-up. Journal of the National Cancer Institute 2012;104(2):125-132. [PubMed Abstract] 4. Schröder FH, Hugosson J, Roobol MJ, et al. Prostate-cancer mortality at 11 years of follow-up. New England Journal of Medicine 2012;366(11):981-990. [PubMed Abstract] 5. Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine 2012. Published online March 14 ahead of print. [PubMed Abstract]
Related Resources Interpreting Laboratory Test Results (http:// www.cancer.gov/cancertopics/factsheet/ Detection/laboratory-tests) Prostate Cancer Home Page (http://www. cancer.gov/cancertopics/types/prostate/) Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (http://dcp.cancer.gov/programsresources/groups/ed/programs/plco) Tumor Markers (http://www.cancer.gov/ cancertopics/factsheet/Detection/tumormarkers) Understanding Prostate Changes: A Health Guide for Men (http://www.cancer.gov/ cancertopics/understanding-prostate-changes) What You Need To Know About™ Prostate Cancer (http://www.cancer.gov/cancertopics/ wyntk/prostate)
RSVP Health | www.rsvphealth.com 43
Blue Cross and Blue Shield Association
Testicular Self-Exams (TSE’s) | RSVP Health
RSVP Health | www.rsvphealth.com 45
Prostate Cancer Incidence and Mortality Rate Trends
It is estimated that approximately $9.9 billion1 is spent each year in the United States on prostate cancer treatment.
Cancer Trends Progress Report (http://progressreport. cancer.gov), in 2006 dollars.
2
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
3
The estimated NCI investment is based on funding associated with a broad range of peer-reviewed scientific activities. For additional information on research planning and budgeting at the National Institutes of Health (NIH), see http://www.nih.gov/about/. For more information regarding ARRA funding at NCI, see http://www.cancer.gov/aboutnci/recovery/ recoveryfunding.
150 100 50 1988
1992
1996
2000
2004
2008
U.S. Prostate Cancer Mortality
80 60 40 20 0
1987
1991
1995
Whites Hispanics* Asians/Pacific Islanders*
1999
2003
2007
African Americans American Indians/Alaska Natives*
* Incidence and mortality data not available before 1992.
NCI Prostate Cancer Research Investment 350 300 Millions of Dollars
Source: NCI Office of Budget and Finance (http://obf. cancer.gov).
200
100
Trends in NCI Funding for Prostate Cancer Research The National Cancer Institute’s (NCI) investment2 in prostate cancer research increased from $293.2 million in fiscal year (FY) 2006 to $300.5 million in FY 2010. In addition, NCI supported $68.4 million in prostate cancer research in FY 2009 and 2010 using funding from the American Recovery and Reinvestment Act (ARRA).3
250
0
Source for incidence and mortality data: Surveillance, Epidemiology, and End Results (SEER) Program and the National Center for Health Statistics. Additional statistics and charts are available at http://seer.cancer.gov/. 1
300
$4.75B
$4.79B
$293.2M
$296.1M
$4.83B
$285.4M
$4.97B
$293.9M
$5.12B
$300.5M
250
4 3
200 150
2
100
1
50 0
5
2006
2007
2008
2009
2010
Fiscal Year Prostate Cancer Funding
Total NCI Budget
Snapshots can be found online at: http://www.cancer.gov/aboutnci/servingpeople/cancer-statistics/snapshots
0
Billions of Dollars
Prostate cancer incidence rates rose dramatically in the late 1980s, when screening with the prostate-specific antigen (PSA) test, which received initial U.S. Food and Drug Administration approval in 1986, came into wide use. Since the early 1990s, prostate cancer incidence has been declining. Mortality rates for prostate cancer have also declined since the early 1990s.
Incidence per 100,000 Men
Prostate cancer is the most common cancer, other than non-melanoma skin cancer, and the second leading cause of cancer-related death in men in the United States. AfricanAmerican men have a higher incidence and at least double the mortality rate compared with men of other racial and ethnic groups.
U.S. Prostate Cancer Incidence
350
Mortality per 100,000 Men
National Cancer Institute
A Snapshot of
Examples of NCI Activities Relevant to Prostate Cancer • The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), a large-scale clinical trial, is determining whether specific cancer screening tests reduce deaths from these cancers. For prostate cancer, the screening method involves digital rectal examination plus the PSA test. http://dcp.cancer.gov/plco • The Prostate Cancer Modeling project, conducted by the Cancer Intervention and Surveillance Modeling Network (CISNET), explores the natural history of prostate cancer, screening efficacy, screening policy, overdiagnosis, novel biomarkers, outcomes of care, and health disparities in screening and treatment. http://cisnet.cancer.gov/prostate/ • The Prostate Cancer Program, which includes staff from NCI’s Medical Oncology, Radiation Oncology, and Urologic Oncology Branches, carries out clinical training, research, and care to improve management of patients with prostate cancer. http://bethesdatrials.cancer.gov/clinical-programs/prostate_ cancer_program/default.aspx
NCI Prostate Cancer Research Portfolio Cancer Control, Survivorship, and Outcomes Research
Scientific Model Systems
10%
3%
Biology
21%
13%
Etiology (Causes of Cancer)
24% Treatment
9% 20%
Prevention
Early Detection, Diagnosis, and Prognosis
Percentage of Total Dollars by Scientific Area Fiscal Year 2010 Data source: The NCI Funded Research Portfolio. Only projects with
• The Tumor Microenvironment Network (TMEN) is assigned scientific area codes are included. A description of relevant research projects can be found on the NCI Funded Research Portfolio exploring the role of the microenvironment—the cells, Web site at http://fundedresearch.cancer.gov molecules, and blood vessels that surround and feed a tumor —in tumor initiation and progression. Network investigators are studying the interactions between prostate tumors and the prostate microenvironment. http://tmen.nci.nih.gov/ • The What You Need to Know About™ Prostate Cancer booklet provides information about prostate cancer diagnosis • NCI’s Epidemiology and Genetics Research Program supports and staging, treatment options, follow-up tests, and four Prostate Cancer Epidemiology Consortia that share data participation in research studies. Information specialists can and conduct research on genetic and environmental factors also answer questions about cancer at 1-800-4-CANCER. contributing to prostate cancer risk and outcomes. http://epi. http://www.cancer.gov/cancertopics/wyntk/prostate/ grants.cancer.gov/Consortia/tables/prostate.html • Nine prostate-cancer-specific Specialized Programs of Research Excellence (SPOREs) conduct inter-SPORE scientific studies for the clinical evaluation of biomarkers, early-phase clinical trials of anti-prostate-cancer agents, and development of inter-institutional systems to accelerate prostate cancer research. http://trp.cancer.gov/spores/prostate.htm
• The NCI Prostate Cancer Home Page provides up-to-date information on prostate cancer treatment, prevention, genetics, causes, screening, testing, and other related topics. http://www. cancer.gov/cancertopics/types/prostate
Selected Advances in Prostate Cancer Research • Using data from the SEER registry, researchers have confirmed previous study results suggesting that screening using the PSA test leads to overtreatment of many prostate cancers, including aggressive treatment in older men considered to be at low risk for disease progression. http://www.cancer.gov/ ncicancerbulletin/072710/page3
• In a phase II clinical trial, the targeted therapy cabozantinib shrank bone metastases in patients with metastatic castration-resistant prostate cancer. http://www.cancer.gov/ ncicancerbulletin/053111/page3 and http://www.asco.org/ ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&co nfID=102&abstractID=82339
• In a case-control study, researchers demonstrated that use of certain pesticides modifies the association between specific genetic variants and prostate cancer risk. http://dceg.cancer. gov/newsletter/mar2011/0311_scientifichighlights.shtml and http://www.ncbi.nlm.nih.gov/pubmed/20978189
• Researchers have determined that active surveillance with curative intent may be a reasonable option for older men with very-low-risk prostate cancer. http://www.ncbi.nlm.nih. gov/pubmed/21464416 Last updated October 2011
Prostate cancer — Know the facts Prostate cancer is the most common non-skin cancer in America. One in every six American men has it.1 Read on to see if you’re at risk. Plus, learn how it’s detected, diagnosed and treated.
What is the prostate? The prostate is a small gland in men that is part of the reproductive system. It’s about the shape and size of a walnut. The prostate rests below the bladder and in front of the rectum. It surrounds part of the urethra, the tube that carries urine from the bladder. The prostate helps make semen, which carries sperm from the testicles when a man ejaculates.
}
}
Many men with prostate cancer don’t have symptoms until their cancer gets worse. That’s why you should know your risks:
}
}
A man is more likely to be diagnosed with prostate cancer than a woman is to be diagnosed with breast cancer.1
Age – More than two out of every three prostate cancers are found in men over 65.1,2 Family history – Men with two or more relatives with prostate cancer are more than four times as likely to have it themselves. And, men whose relatives were diagnosed before age 65 run the most risk.1,2 Race – African American men get prostate cancer at a rate 56 percent higher than Caucasians. They are also more than twice as likely to die from it.1
Diet – Men who eat a diet high in animal fat may have a higher risk. Those whose diets are higher in fruits and vegetables may have a lower risk.2
Did you know?
Are you at risk for prostate cancer?
}
Weight – Obesity can lead to a delay in diagnosis, longer recovery from surgery and a higher risk of death.1
Detection and diagnosis Most men will not notice any symptoms, especially if their cancer is caught in its early stages. But, men who do notice symptoms report some of the following:1 } }
Urinating a lot, particularly at night Trouble starting or controlling urination, weak or interrupted flow, or painful urination
}
Difficulty having an erection
}
Painful ejaculation, or blood or urine in semen
}
Pain or stiffness in the lower back, hips or upper thighs
When there are no symptoms, prostate cancer can be found during a routine digital rectal exam (DRE) or prostate specific antigen (PSA) blood test. The blood test screens for raised levels of PSA, a protein made by the prostate. The American Cancer Society suggests that you get both tests every year after age 50.1 If something unusual is found, a small piece of tissue may be removed to check for cancer. This is called a biopsy. MANSH3988ABS 11/11
Treatment options When caught early, nine in ten prostate cancers can be cured.1 Treatments include:1 }
}
}
}
}
Checking the cancer for signs that it is getting worse. Since prostate cancer is a slow-growing cancer, sometimes men will not have treatment at this early stage to avoid the side effects. Radical prostatectomy. The prostate gland and some nearby tissue are removed. There is a chance of sexual and urinary problems. Radiation. Radioactive beams or metal pellets kill the cancer cells. Hormone therapy. The prostate cancer growth is slowed and testosterone levels are lowered. But, it’s only short term and there are unwanted side effects. Chemotherapy. This treatment is suggested if the cancer has spread beyond the prostate area, to other parts of the body.
Resources Call the National Cancer Institute’s Cancer Information Service at 800-4-CANCER (800-422-6237) for information on prostate cancer. Or, visit the National Cancer Institute’s website at cancer.gov and get live, online assistance through LiveHelp. For tips on speaking with your doctor about prostate cancer, visit the Prostate Cancer Foundation site at prostatecancerfoundation.org. Click any of the “Quick Links” on the left. Then, look for the “Questions to Ask Your Doctor” option on the left-hand side of the page.
Visit anthem.com for more ways to get healthy — and stay healthy
Sources 1 Prostate Cancer Foundation, An Introduction to Prostate Cancer (2011): prostatecancerfoundation.org 2 U.S. National Institutes of Health, National Cancer Institute, What You Need To Know About Prostate Cancer (2011): cancer.gov 3 Men’s Health Network, Prostate Health Guide (2011): prostatehealthguide.com Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Tax Considerations in Selling a Medical Practice By: Purk & Associates
A recent Wall Street Journal article identified and discussed a “structural shift that is sweeping through health care in the U.S.— hospitals are increasingly acquiring private physician practices.” The Journal article focused on the impact of that shift on the former patients, which was that prices for common procedures were often significantly higher—for more on that topic see the article: http://on.wsj.com/SVlood
50 RSVP Health | www.rsvphealth.com
Tax Considerations in Selling a Medical Practice | RSVP Health
The focus of this article is on the selling physician, more specifically on the tax effects of the sale. While each practice will have its unique facts and circumstances, there are some common tax features to almost all of these sales.
Capital gain vs. Ordinary income It is a (current) universal tax truth that arranging a sale to maximize the long-term capital gain element is good, for the obvious reason that the tax rate on these gains is lower. For 2012 the difference is a whopping 20%, 15% vs. 35% for individuals. For 2013 the capital gains rate is scheduled to be 20% while the top individual rate will be 39.6%. Because of the major press coverage of the tax debacle that will occur on January 1, 2013 known as “taxmageddon”, almost everyone knows about the increase in taxes that will result from the expiration of the Bush-era tax cuts. These impending tax increases, combined with the tax increases in the recently enacted health care legislation, have caused many advisors to advocate shifting income from 2013 to 2012, a reversal of the business-as-usual tax advice. For medical practices currently operating as sole proprietorships or S corporations, achieving capital gains income is relatively simple. This is accomplished by assigning the maximum value of the practice to the intangible assets such as medical records, patient lists, and general goodwill, which usually generate capital gain income. Likewise, it is tax advantageous to assign the lowest possible value to the depreciable assets of the practice, e.g. medical equipment and furniture and fixtures, as the gain on the disposition of these assets generally results in ordinary income. The situation becomes more complex if the practice is held inside a professional corporation with “C” status. If the practice is sold by the corporation, any gain is taxed at the corporate rate, there is no separate rate for capital gains. For most medical practices, the current top rate is 34%. In addition, if the corporation is then liquidated and the proceeds of the sale are distributed, the physicianshareholder is liable for individual income tax on the
excess of the net proceeds over the owner’s stock basis. This is the dreaded “double taxation” in a “C” situation. The corporation is liable for the tax on the sale, and the shareholder is taxed on the liquidation of the corporation. One strategy used to avoid the double tax on the goodwill portion is for the goodwill of the practice to be sold by the physician instead of the corporation, on the theory that the value of the goodwill is owned by the physician, not the corporation. Due to the complex tax issues involved with the sale of goodwill, it is essential to get professional tax advice when structuring these transactions.
Other considerations •
If the practice is sold on the installment basis it may be better to elect out of this treatment in order to get the lower 2012 rate on capital gain income– the ordinary income is taxed in the year of sale regardless.
•
If the practice is on the cash basis, as most are, it is important to remember that if the accounts receivable are sold all of the proceeds are ordinary income in the year of sale; if the receivables are not sold the income is reported as the receivables are collected. If it is a corporate practice, the liquidation of the corporation could affect the timing of the taxation of the receivables. Again, it may be advisable to sell the receivables in order to receive the favorable 2012 rates on ordinary income.
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If the practice is the sponsor of a tax qualified retirement program, like a 401(k) plan, it is important to consider the options for termination of the plan.
There are many opportunities to save tax dollars when structuring a practice sale. Involve an experienced advisor early in process to ensure profits are maximized and taxes are minimalized.
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Get Healthy. Stay Healthy.
Your Wellness Exam For most people, annual physicals have been replaced by periodic wellness exams based on age and general health. While it may be tempting to think of these visits as optional, they provide a unique opportunity for exchanging vital information with your doctor. A physical exam gives your doctor a basis for comparison as your physical condition changes with age – and it gives you the chance to ask questions and build a relationship with your doctor. During your checkup, you should expect both conversational probing and physical screenings for various conditions, as well as more general tests for body mass index (MBI) and to spot hearing loss or visual impairment.
Together, these screenings represent a shift in focus from early diagnosis to prevention.1 Your doctor wants to identify high-risk behaviors to help you maintain wellness and avoid more serious health problems. As part of this goal, he or she may also administer tetanus-diphtheria, influenza and pneumococcal immunizations.2 And if your family history or recent symptoms send up any red flags, your doctor may recommend additional testing.
What to expect Most doctors spend a good portion of the wellness appointment counseling patients about ways to improve their health. After taking a thorough history and asking about any specific problems, the doctor generally will discuss:2 • Your dietary habits and how to improve them • The amount of physical activity you should be getting • Any stress in your life or symptoms of depression • Tobacco, alcohol and recreational drug use • Safety precautions like seat belt use and helmet use for cyclers • Your sexual habits and any risks they pose • How to protect yourself from the sun • The need for regular eye exams • Any medications you are taking • Recommended screening tests and immunizations for your age, and risk factors for disease
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Recommended screenings follow a flexible schedule, which can change depending on your health and family history. Here are some recommendations from the U.S. Preventive Services Task Force:3,4
General Recommendations Screening
How Often?
Blood pressure
At least every two years for adults 18 and older
Cholesterol
Regular screenings beginning at age 35 for men and 45 for women – or younger if you have risk factors like diabetes, high blood pressure, family history of heart disease or you’re a smoker
Skin Exam
Self-exams at least annually; talk to your doctor about screening, particularly if you’re fairskinned or spend a lot of time outside
Diabetes
Regular tests if you have high blood pressure or high cholesterol; talk to your doctor about other risk factors
Women Screening
How Often?
Mammogram
Every one to two years for women 40 and older, with or without a breast exam
Pap test
Every one to three years if you are sexually active and between the ages of 21 and 70
Osteoporosis
Screen routinely starting at age 65, or starting at age 60 for women with risk factors (like a small frame or weight of 154 pounds or less)
Chlamydia
Routine screening for all sexually active women age 25 and younger; talk to your doctor about screenings for other sexually transmitted diseases
Making the most out of your medical exam Because doctor visits can be very short, it’s in your best interest to come prepared. Patients who are active and involved in their own health care decisions get better results – so get involved! You should expect your doctor to have reviewed your chart before your appointment, so he or she is aware of anything you’ve been treated for in the past and the medications you’re taking. It’s reasonable to expect your doctor to know who you are and to form some sort of relationship with you. Before your visit, write down important information about your family and medical history – especially any information that might have changed since your last visit. Make a list of all the medications you’re taking, along with specific dosage information. Also, write down any concerns you have about your health, or any new symptoms you’re experiencing.2 To ensure that your doctor is on time and not rushed, make an appointment as early in the day as you can, and bring a family member or friend if you’re worried you might not remember or understand the doctor’s recommendations. Another person can help you remember your concerns, or ask important questions you’re too distracted to think of. Also, a friend or family member can take notes so you remember when to expect test results and what your next steps are.
Your wellness visits are an important step toward maintaining your health, so do what it takes to make the most of them. Visit anthem.com for more ways to get healthy — and stay healthy.
Men Screening
How Often?
Colorectal cancer
Starting at age 50; talk to your doctor about the right test for you
Sexually transmitted diseases
Talk to your doctor about how often
Abdominal aortic aneurysm
Once between ages the ages of 65 to 75 if you have ever smoked
Sources: 1) Centers for Disease Control and Prevention website: cdc.gov/family/checkup/index.htm#prepare, “Regular Check-Ups are Important,” May 2008. 2) Centers for Disease Control and Prevention website: cdc.gov/family/checkuplist/index.htm, “Check-Up Checklist: Things to Do Before Your Next Check-Up,” May 2008. 3) Centers for Disease Control and Prevention website: ahrq.gov/ppip/healthymen.htm, “Screening Tests for Men: What You Need and When,” February 2007. 4) Centers for Disease Control and Prevention website: ahrq.gov/ppip/healthywom.htm, “Screening Tests for Women: What You Need and When,” February 2007. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross and Blue Shield of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
MANSH0314ABS 9/09 F0057974
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Dry Eye in Men By: Dr. Rodney Gross of RSVP Health with Drs. Mark Kahrhoff and Edward Jarka of Advanced Ocular Therapeutics
Dry eye is a common eye disease that causes pain, burning, itching and grittiness as well as blurry and unstable vision. While some sufferers have only occasional and mild symptoms, many others have severe symptoms that significantly impact quality of life. Dry eye tends to worsen with age, so many people with “mild” symptoms today may find themselves severely affected down the road. I talked again this month with Drs. Mark Kahrhoff and Edward Jarka who are the area leaders in providing an exciting treatment for dry eye and other eye-surface diseases. The treatment is called “Platelet Rich Plasma” therapy. For our men’s issue, I asked the doctors if – and how – dry eye can effect men.
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Dr. Gross: I know many women who suffer from dry eye, but can men get dry eye as well? Sure they can. While women do tend to suffer more from dry eye, reports tell us that about 4% of men in their fifties and 8% of men eighty and older suffer from dry eye. Of course, men have their own set of risk factors that make them more at risk for dry eye. Dr. Gross: What makes men at risk for dry eye? Historically at least, men have been more likely to work in somewhat harsher environments such as in construction where they are exposed to sun, wind, dust. In
Dry Eye in Men | RSVP Health
women, we often see dry eye begin somewhat abruptly after menopause, but men become more at risk with enlaDr. Grossed prostate and with the medications designed to help that problem. Men with prostate cancer have an even higher risk of dry eye due to the anti-horomone and antiandrogen treatments they undeDr. Grosso. Medications for hypertension made men nearly one-and-a-half times more likely to suffer from dry eye. Other medications such as for depression also increase the dry eye risk, as they do for women. Dr. Gross: What does the sun have to do with dry eye. Well, for one thing, sun exposure tends to make rosacea worse and a lot of men have rosacea. Rosacea affects the oil secreting glands of the skin, and we also have these glands in our eyelids. Worsening rosacea means more effect on the glands of the eyelid and, down the road, worse dry eye.
bleeding when we cut ourselves. They are also releasing a complex mixture of healing and repair agents called “growth factors.” Soon, your cut is healed and your skin looks “like new.” We concentrate these healing compounds into an eye drop using a highly specialized and sterile preparation process. Dr. Gross: As I recall, you are having real success with this treatment? Yes. We have had success in treatment men and women of all ages with a range of eye surface conditions. Patients with severe dry eye for years are now experiencing relief. These drops are not like artificial tears that just temporarily relieve symptoms. These growth factors, we believe, are healing the surface of the eye. We have patients from all over the US and from abroad who come for this therapy. It’s not a magic bullet, but it is helping folks who did not receive help from years of other therapy.
Dr. Gross: This effects men more than women? Roseacea also effects women but it does so differently than men. Men happen to have more of these oil secreting glands in the eyelids. This also, by the way, makes what we call “demidicosis” more of a problem for men. This is a mite that we all probably have in small amounts. It lives on the secretions of these oil secreting glands and, throughout its lifecycle, causes inflammation and discomfort of the eyes. We have treatments that can help this significantly. Dr. Gross: How many men would you estimate actually suffer from dry eye?
Dr. Gross: Have you had a problem with insurance not covering the treatment? Insurance does not cover it at this time. We have kept the cost as low as possible for patients but there is specialized equipment and conditions required for the preparation of the drops. The current chaDr. Grosse is $250. For most patients, we are able to provide 3 – 4 bottles of drops, enough for 2-3 months. The office visit is usually covered by a patient’s medical insurance. The office staff can answer any questions on insurance that folks may have. Many patients spend laDr. Grosse sums of money for medicines that do not help them.
The medical literature tells us that about 1.7 million men over 50 suffer from dry eye, a number that will increase to 2.8 million by 2030. These numbers may be low, however, because of men’s famous unwillingness to go to the doctor or report they are having a problem. Dr. Gross: Can PRP therapy help men as well as women? Yes. The compounds in the drop that help dry eye are the same. To remind you, we are using eye drops that are specially prepared from a person’s blood. Agents in your blood called platelets have great healing power. These are the agents we are familiar with mostly as what stops
Drs. Mark Kahrhoff and Edward Jarka 1011 Bowles Avenue, Ste. 415 Saint Louis, MO 63026 314-504-0455
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There’s Hope | RSVP Health
There’s Hope By: Tiffany Chan
Ron Nicoletti is a man of few words. He is quiet and reserved, but spend enough time with him and his lighthearted and playful spirit cannot help but spill out. In his living room, Ron sits in a chair with music streaming from the TV in the background. When the hit song “Moves Like Jagger” comes on, Ron perks up a little. With a twinkle in his eye, he asks, “Do you know who sings this song?” His wife, Mary, looks up and reads, “Maroon 5 and Christina Aguilera.” He shakes his head and says, “No, it’s Bruno Mars.” “But it says Maroon 5.” “No. Bruno Mars sings this song.” And so the conversation goes for a little while. Mary suggests that perhaps Ron is thinking of a different song that has a similar tune. “It’ll come to me,” he says. Mary quickly points out that Ron actually does know most of Mars’ songs. Whenever he hears one, he always tells her, “That’s Bruno Mars,” to which she responds, “I don’t care.” Perhaps this 62-year-old’s knowledge of pop culture is a result of his volunteer work at the Christian Brothers College High School bookstore. The fact that he has time to volunteer there is one of the many changes he and Mary, 60, have experienced since Ron was diagnosed with early-onset Alzheimer’s disease in April 2011. Alzheimer’s is a type of dementia that causes problems with memory, thinking and behavior. Today, more than 5.4 million people have Alzheimer’s, and someone develops the disease every 68 seconds. Nearly 4 percent of those 5.4 million people have early-onset Alzheimer’s, which affects people younger than age 65.
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They had seen some symptoms about two years ago. Ron was distracted at home, and he had been making some mistakes at work. One of his co-workers even called Mary and suggested they see a doctor. Then Ron’s boss called and said he could not come back to work until they figured things out.
Mary said she’s been amazed by the generosity people have shown–even people she doesn’t even know. A cashier at a restaurant who used to work with Ron said she would try to put a prize basket together for their trivia night; a volunteer at the Alzheimer’s Association knitted a scarf for her.
He was about to turn 61.
“Those are the heroes,” Mary said. “I don’t think we’re extraordinary. I think the extraordinary ones are the people who step up to help out when they don’t have to get involved, but they choose to.”
“We couldn’t believe it,” Mary said. “We did not know… it could be diagnosed so young.” The diagnosis brought a slew of emotions. Mary said she was relieved to know what was wrong but scared because she did not know what to expect. She was angry and felt cheated. After being married for 39 years, their youngest of five children had just graduated from college, and they thought they were finally going to have some time to themselves. Alzheimer’s is the sixth leading cause of death in the United States, and the only cause of death among the top ten with no way to prevent it, cure it or slow its progression. Once they got past the fear and the anger of the Alzheimer’s diagnosis, they knew they had a choice to either feel sorry for themselves or fight. “I need to fight,” Mary said. “Ron’s my best friend. I can’t imagine not having him here.” They got in contact with the Alzheimer’s Association St. Louis Chapter and joined support groups and attended a care consultation. They signed up for the 2011 Walk to End Alzheimer’s, not knowing what to expect but wanting to see what it was about. They were so touched that as soon as registration opened for the 2012 Walk, they signed up. So far, Mary has only sent out one e-mail, asking people to join their team, “Rally Round Ron,” or to donate, but that e-mail has already generated a couple thousand dollars. Their kids are also hosting what they hope will be an annual trivia night to help raise funds.
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She also said this support is one of the many blessings they have received since Ron’s diagnosis. “You have to be open to look for those blessings,” Mary said. “We’re so used to giving that it’s very hard to ask for support, but there’s been so much of it. “It’s not an accident that we’re put in this spot,” she said. “Hopefully this place will be better after we’re gone.” And so the Nicolettis are focused on Alzheimer’s research. “There’s hope,” Ron said simply. “I’m optimistic that they’re going to have a way to cure this disease.” If you would like to donate to Ron’s Walk team or start your own team, visit www.alz.org/stl or call 800.272.3900. Walk to End Alzheimer’s Information: Saturday, September 29, 2012 SIUE, Edwardsville, IL St. Charles Community College, Cottleville, MO
Holistic By: Lola L. (AuBuchon) Gross
Autumn, my favorite season of the year, is a cornucopia of healing for the body, mind, and spirit. The abundance of fresh, organic fruits and vegetables, mild weather with cooler air and sunshine, and natureâ&#x20AC;&#x2122;s beautiful tapestry of colors. Autumn is a feast for the senses! If we look at our health as a whole philosophy of body, mind and spirit, we start to notice when one of these is not healthy, it throws the rest out of balance. Each one of us is a microcosm of the world in which we live. By being more in tune with our higher self, it is easier to notice when the body, mind or spirit gets off balance.
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Harvest Let us start with the body. What we put into our bodies can affect the performance we get from it. While we will go the extra expense to put super premium petrol in our vehicles, when it comes to our own bodies we usually are hesitant to spend extra money on healthy quality food. Fall can be a great time to start investing in your body health by taking advantage of all the organic produce in season. The National Institute of Health has stated that recent evidence shows that by consuming a vegetable and fruit diet, one may lower their chances of developing chronic diseases like cancer and cardiovascular disease. Some of the produce and their health benefits are as follows:
Apples - Apples have a rich source of phytochemicals such as catechin and quercetin, which are potent antioxidants that lower cholesterol, decrease lipid oxidation, and cancer cell proliferation. Eating apples has been associated with a reduced risk of diabetes, asthma, cardiovascular diseases, and some cancers. Cranberries - Cranberries have been used as a food and medicinal by Native Americans for many years, as it is indigenous to North America. Cranberry has been known to be helpful in blocking urinary infections by binding to bacteria and keeping it from adhering to cell walls. Researchers at Rutgers University discovered a compound called proanthocyanidine that helps prevent plaque formation on teeth. Months of prolonged use of cranberry juice has also been shown to help kill H. pylori bacteria in the stomach. Current research is under way studying the anti-tumor effects of cranberry.
Pumpkin - Pumpkins are considered a “Super Fruit”. They contain high amounts of alpha and beta-carotene, which is then converted into vitamin A. Vitamin A is believed to promote eye health as well as being beneficial to the skin by fighting free radicals. Since this is a men’s health issue, I should mention pumpkin seeds. Also called pepitas, they are high in zinc, magnesium, and omega 3 fats that seem to support the health of the prostate.
Chili peppers - Chili pepper benefits are being studied extensively by health researchers. One of the main compounds is capsaicin. Research on capsaicin by the University of Nottingham has shown that capsaicin attacks the mitochondria of cancer cells. Dr. Timothy Bates, in an interview by the BBC, whom led the study, explained this effect as such: “As the compounds attack the very heart of tumor cells, we believe that we have in effect discovered a fundamental ‘Achilles heel’ for all cancers.” On a personal note, my favorites are New Mexican red and green chile peppers. When the body is fueled up on nutrition, naturally exercise comes more easily. Fall is the perfect time to embark on a routine fitness regimen. Cooler temperatures and sunshine invite us to take our exercise outdoors. One of the best and free things to do is walking. The Mayo Clinic reminds us that brisk walking can lower our blood pressure and cholesterol, reduce or manage type 2 diabetes, keeps our weight under control, and is a great mood booster. As far as the mind aspect goes, learning to reduce stress is an integral part of the mind body connection. Relax, go out in nature, look at the unique colors of the leaves and listen to the wind rustling through them. Just be, living in the now, connected to all, feeling your spirit soar in this “Holistic Harvest”.
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Association of Cannabis and Psychosis Confirmed | Arturo C. Taca Jr. M.D.
Association of Cannabis and Psychosis Confirmed By: Arturo C. Taca, Jr. M.D.
In a recent study, data showed more evidence that marijuana can cause psychotic symptoms. It has been widely recognized that some persons that smoke cannabis are at higher risk of psychotic symptoms such as paranoid thoughts, auditory hallucinations, and delusions. These symptoms mimic symptoms closely related to schizophrenia. Since the THC (the psychoactive ingredient in cannabis) amount has increased from 3-5% from the 60’s to 30% in genetically engineered plants, more psychotic behavior has been reported. The researchers in this latest study concluded that “age at onset of cannabis is directly associated with age at onset of psychosis and age at first hospitalization.” This means the earlier one smokes marijuana, the earlier the onset of psychotic symptoms Lead researcher stated, “if cannabis use precipitates the onset of psychosis, efforts should be focused on designing interventions to discourage cannabis use in vulnerable individuals,” Dr. Juan A. Galvez-Buccollini and his associates wrote (Schizophrenia Res. 2012;139:157-60). An example of a vulnerable person is someone with a firstdegree relative with psychosis, “the highest risk factor for schizophrenia,” said Dr. Lynn E. Delisi, senior investigator for the study, a psychiatrist at the Boston VA Medical Center in Brockton, Mass., and professor of psychiatry at Harvard Medical School, Boston. This study is among several recent papers suggesting an association with cannabis smoking, psychosis, and the risk of triggering schizophrenic episodes in populations having genetic risk for psychotic illnesses. 62 RSVP Health | www.rsvphealth.com
What if your Individual health plan rewarded you for being healthy?
Deductible Credit Program
Taking care of yourself and making healthy choices is its own reward. Now your good health can pay you back with the Deductible Credit Program from Anthem Blue Cross and Blue Shield. You’re not one who leaves things to chance. You eat right and exercise. You take good care of yourself. But you also know you need solid health coverage for important preventive care…and for life’s little twists and turns. With Anthem's new Deductible Credit Program, you get rewarded when you need it most. When you don’t meet your yearly deductible, money goes into your Anthem Special Incentive Account. The account grows, and if you later meet your deductible, you get a check from us. Money straight to you for medical costs or whatever you want.
Be rewarded for your good health! If you’re self-employed, don’t get health insurance at work, making a career change or retiring early, call me today about this exciting new program!
Vincent K. Blair (314) 961-7777 vince@vincentkblair.com Apply online! www.vincentkblair.com
Buy local from Vince Vincent K. Blair is an independent authorized agent in Missouri for Anthem Blue Cross and Blue Shield. In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Life and Disability products underwritten by Anthem Life Insurance Company. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
2012 Health and Wellness Calendar
September
Healthy Habits for a Healthier You
It’s hip to stretch Standing or sitting for long periods of time can make areas of your lower body sore – and that can include your hips. Your hip flexors, which are on your upper thighs, just below your hipbones, allow you to lift your knees and bend at the waist.1 Keeping your hips strong and flexible can be important when your job means having to sit at a desk or in a car, or stand on your feet day after day. The hips become very tight and congested, especially as we get older, which can lead to injury.2 Stretches can open up your hips, making them more flexible and helping prevent hip pain and injury. Note: Be sure to talk to your doctor before you start any exercise routine. 1 Mayoclinic.com, Fitness: Slide show – a guide to 10 basic stretches (2011): mayoclinic.com 2 About.com, Exercise: Stretches to prevent hip pain and injury (Accessed May 2011): video.about.com/exercise
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Itâ&#x20AC;&#x2122;s all in the wrists The wrists may be small parts of the body, but if we donâ&#x20AC;&#x2122;t treat them well, we could end up in a lot of pain. Our wrists are made up of eight small bones called carpals. Those bones support a tube, called the carpal tunnel, which runs through the wrists. The tube has tendons and a nerve inside, and is covered by a ligament that holds it in place. Making the same movements over and over can damage your wrist. Daily activities like typing, racquet sports or sewing can cause pain or injuries to the wrists, including carpal tunnel syndrome.1 People who use computers a lot, work on a factory line or who work in construction tend to do a lot of repetitive movements. Be sure to take breaks often and gently stretch your fingers, hands and wrists to help avoid any problems.2 Note: Be sure to talk to your doctor before you start any exercise routine. 1 MedlinePlus, Wrist injuries and disorders (2010): nlm.nih.gov/medlineplus/wristinjuriesanddisorders.html 2 WebMD, Finger, hand, and wrist injuries: Prevention (2008): webmd.com
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November
Ankle deep If you exercise often, you probably work out everything from your arms to your legs. But don’t stop there! One body part you may not think to work on may be your ankles. That’s not a good thing when you find out that the ankle is one of the joints of the body that’s most often injured.1 The entire weight of the body is supported by the ankle, which makes it very vulnerable to injury.1 Strong ankles are important to help prevent sprains, strains and fractures.2 Strengthening the muscles around the ankles provides extra support to the joint. And don’t forget to stretch your ankles too! Stretching your ankles helps get your blood flowing in your lower body.3 Note: Be sure to talk to your doctor before you start any exercise routine. 1 About.com, Physical therapy: Common causes of ankle pain (2009): physicaltherapy.about.com 2 About.com, Physical therapy: Ankle strengthening (2008): physicaltherapy.about.com 3 About.com, Ergonomics: The essential 2 minute stretch program (Accessed May 2010): ergonomics.about.com
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The eyes have it By now, you know about the importance of stretching and exercising your muscles from head to toe. But what about your eyes? Eyestrain, such as tired eyes or blurred vision, happens when your eyes get tired from too much use. This can happen when you drive too long, read too much or use the computer for too long. In fact, using a computer for long periods of time is one of the most common causes of eyestrain. To give your eyes a break, remember to focus them on something else if youâ&#x20AC;&#x2122;ve been looking at something for a long time. You may also need to do some exercises to help your eyes focus better.* Note: Be sure to talk to your doctor before you start any exercise routine. * MayoClinic.com, Eyestrain (2010): mayoclinic.com
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Men: Stay Healthy at Any Age | Anthem
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Men: Stay Healthy at Any Age | Anthem
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Men: Stay Healthy at Any Age | RSVP Health
RSVP Health | www.rsvphealth.com 71
?
TRUE or FALSE Colorectal cancer is the 2nd leading cancer killer. TRUE
FALSE
Colorectal cancer often starts with no symptoms. TRUE
FALSE
Both men and women get colorectal cancer. TRUE
FALSE
You can stop this cancer before it starts. TRUE
FALSE
Testing for colorectal cancer can save your life. Screening tests can find precancerous polyps so they can be removed before they turn into cancer. Screening can also find colorectal cancer early, when treatment is most effective. Talk to your doctor and Screen for Life.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention
1-800-CDC-INFO (1-800-232-4636) â&#x20AC;˘ www.cdc.gov/screenforlife