Friday, April 30, 2010

The Elderly and Medications: At What Cost Health?

Recently, my elderly mother moved from the Northeastern to the Southeastern United States in order to live closer to my sister. A widow for several years, she is on what would be classified as a fixed income, and her medical insurance premiums and prescription drug plans eat up a great deal of her monthly budget.

When it comes to some of the more pedestrian prescription medications, co-pays can range from just several dollars to perhaps $20 or $30 per month. But heaven forbid that an American elder needs a medication that is not quite so generic in nature, and the monthly payments for such drugs can skyrocket through the roof, wreaking havoc with even the most well-planned budget.

We have all heard stories of senior citizens having to decide between groceries and medications, or turning off their heat in order to pay their health insurance premiums. These stories are not uncommon, and although many of these elders may be under the media radar, we all know that there are still millions of Americans struggling to retain their health insurance, obtain health insurance, or simply get by without any coverage whatsoever.

While the debate about the new health care reform legislation rages on, we must remember that many seniors like my mother are regularly raiding their hard-earned piggy banks in order to pony up enough money to purchase costly (and admittedly life-saving) medications. While the need for pharmaceutical companies to earn money and support new research is understandable, vulnerable Americans like my mother cannot continue to be placed economically between a rock and a hard place and simply offered a pillow of pity as compensation.

I agree that reform is contentious and painful, but so is making a choice between food and prescriptions. When a senior citizen skips a meal in order to fill a prescription or pay an insurance premium, it is once again illustrated that something is wrong with this picture. And when yet another uninsured child misses her annual physical and vaccinations, this flies in the face of the Surgeon General's message of the crucial importance of preventive medicine to the over all health of the nation and its citizens.

I don't have the answer to fixing this enormous challenge that our nation faces, but I can hear in my mother's voice over the phone that this simply has to change. The United States ranks behind many other industrialized nations when it comes to important markers of public health (like infant mortality, for example), and the fact that so many Americans continue to languish without health insurance would be laughable if it wasn't so tragically sad.

Every generation strives to leave a hopeful economic and social legacy for its offspring, and my mother's generation, who lived through the Great Depression, is no slacker in this regard. But when we see octogenarians eschewing good nutrition in order to pay for their basic health needs, we must realize that we are forgetting the sacrifices that our elders made for us in decades past. Change will come, but what cost we pay in the interim certainly remains to be seen.

Change of Shift is Here Again!

The newest edition of Change of Shift, the premier nurse blog carnival, is now ready for your reading pleasure by clicking here. Enjoy, and one of these days I'll actually get around to contributing regularly again, myself!

Sunday, April 25, 2010

The Misguided State of Arizona

The new immigration law enacted in the state of Arizona earlier this week is an egregious act of backwards thinking that sets the tone for draconian measures that will negatively impact millions of Americans and non-Americans for years to come.

This law, which commands that Arizona law enforcement officers demand to see the papers of any "suspicious" person who might, by some chance, be in the country illegally, will cause many individuals to be searched and questioned for no good reason other than the color of their skin. In an article by Robert Creamer on "The Huffington Post", the author correctly likens this new law to the legal climate in Alabama in the early 1960's.

Beyond requiring officers to question any individual who might be deemed as potentially illegal, the law also allows private citizens to file suit against any officer who they feel is not fully enforcing the new law, thus deputizing citizens to join in a witch hunt that will hurt families, children, communities, and the very economy of the state of Arizona.

Many law enforcement officials also believe that families with undocumented members will now choose to not report crimes for fear of being targeted by police under the new law.

In terms of health care, one of my main concerns is that injured or sick individuals in need of medical attention will choose to forgo medical care for fear of racial profiling. Most hospitals and medical institutions will treat needy individuals with or without proof of citizenship, and this new law will now send chills down the spines of sick or injured persons in need of urgent medical attention, and the human cost of such untreated illness is simply gruesome to consider.

No one can fully foresee the true human, moral and economic cost of this legally misguided and immoral act by a governor who is certainly sewing the seeds of his political demise.

Thursday, April 22, 2010


Today, while walking in the outskirts of Silver City, New Mexico, I was charged by a trio of dogs, one of whom managed to bite me on the inner thigh as I tried to turn and walk away from their barking ferocity. Normally a dog lover ( I have a dog myself), I am rarely frightened by dogs and generally have a way with them, but this triumverate were none too friendly, and I limped back to our campground as I called my wife on her cell phone and asked her to boil some water and ready the First Aid kit. (My wife and I have been traveling in an RV for six months, chronicling our adventures on our travel blog.)

Here's a photo of my wound.....

Interestingly, the Silver City Animal Control Officer was reluctant to come to see me at the campground, although he indeed paid a visit to the dogs' owner, who accused me of trespassing, a conclusion which I summarily rejected as false. Trespassing or not, a loose dog without a collar, identification or civilized manners had charged me and managed to sink a few teeth into my tender flesh, and the only thing truly on my mind was rabies.

According to the CDC (and most other authorities on the matter), if a person is bitten by an animal whose rabies vaccination status cannot be determined, that individual should receive a series of five rabies vaccinations (Post-Exposure Prophylaxis, or PEP) beginning on the day of the bite (also referred to as "Day Zero"), followed by vaccines on days 3, 7, 14 and 28. Rabies immune globulin (RIG) should also be administered as a second vaccine on Day 0, with up to half of the RIG vaccination injected into the tissue surrounding the site. Rabies is a serious illness with serious consequences, including contractions, high fever, confusion, agitation, coma and death.

As one can imagine, aside from administering First Aid to the site, and flushing it with hot soapy water and hydrogen peroxide, identifying whether or not a rabies vaccine series was necessary was first and foremost in my mind. Luckily for me, once we involved the local Sheriff's department in the case, we were informed within two hours of the incident that the canine in question was indeed up-to-date on his vaccinations, a conclusion that was obviously a happy one for us travelers.

Needless to say, dear Readers, rabies is a serious illness and must be taken seriously. If you or someone you know is bitten by an animal of unknown origin or vaccination status, prompt First Aid and rabies Post-Exposure Prophylaxis is paramount. Act quickly, seek medical attention, and be sure to follow all recommendations for treatment of such an injury, and you will be happier and healthier for it!

Tuesday, April 06, 2010

Sugar Coated

This afternoon, my wife and I were shopping at Whole Foods in downtown Albuquerque to stock up on supplies for the next leg of our travels. What struck me today was that added sugar has now crept into every aspect of the health food industry, and I am aghast at the ways in which extra sugar is now a ubiquitous ingredient no matter where one may look.

Back in the day, it seemed that the only form of added sugar that we needed to watch out for was high fructose corn syrup, that most processed of sugars that seemed to be added to everything under the sun. Now, with increasingly savvy consumers more aware of such sweeteners, companies have apparently decided that "evaporated cane juice" and other more "natural" sugars are the way to go.

Based on my readings, it seems that the "evaporated cane juice" now apparently used to sweeten the majority of products on health food store shelves (including ketchup, mustard, cereals, crackers, soy milk, etc) are just as guilty of contributing to obesity and other health problems as those containing good old-fashioned sugar, although some may debate me on this notion.

While health food stores try to dress up their processed foods as being "whole foods" by using organic milled cane sugar or evaporated cane juice as sweeteners, they are still simply adding millions of empty (and nutritionally useless) calories into the bloodstreams of ignorant (and not-so-ignorant) consumers, contributing to the overall rise in obesity, diabetes and related conditions. According to some nutritionists, sugar cane does indeed have some nutritional value, but mostly if you just went out into the field and chewed on it, benefiting from the fiber and other nutrients therein.

Searching through the health food store aisles, I am often hard-pressed to find products that are sweetened with fruit juice, barley malt, brown rice syrup or other natural sweeteners that have a lower glycemic index and some intrinsic nutritional value. Increasingly, I read labels ad nauseum, rejecting product after product when I see "evaporated cane juice" or some other unnecessary sweetener in the list of ingredients. Sigh.

I am frustrated with how the health food industry has sweetened the pot, as it were, adding natural-sounding sweeteners to a plethora of products, making shopping more difficult and maintaining a low-sugar diet a challenge. Sugar in some form or another finds its way into most everything these days, and when one looks more closely, it becomes increasingly difficult to avoid it, no matter how hard one may try.

Thursday, April 01, 2010

Hate and Healthcare

With physical intimidation, racial epithets and other threats being aimed at lawmakers who voted for health care reform, a newly appalling era of American politics seems to have dawned.

As members of The Tea Party call Representative Barney Frank a "faggot" and scream the "N-word" at Representative John Lewis, a true Civil Rights-era hero, the level of debate in the country has certainly taken a decidedly downward turn.

The controversial vote on health care reform has indeed made many enemies, and it is widely agreed that there is no way that this legislation will please everyone. While some on the left feel that the "reform" is nothing but a capitalist grab at health care dollars, many on the right opine equally strongly that "socialism" is now simply lapping at the shores of the country against the will of the majority of voters.

Never having purported to be terribly politically astute, I have admittedly had a difficult time sorting through the fact and fiction about the legislation in question, and my personal jury is currently out. While I am glad that Congress took bold action, I have concerns about provisions that may line the pockets of some insurance companies, other provisions that could hurt small businesses, and the glaring lack of a single-payer option similar to that of other industrialized nations.

Misgivings about the legislation aside, there is no room in such a debate for hateful speech, legislators being spit on, bricks being thrown through windows, physical intimidation, and other tactics which underscore the divisiveness of the issue with a complete lack of intellectual prowess or forethought. As we learned during the Civil Rights era, change is painful, and those who resist change can sometimes resort to actions and words that are hurtful, divisive and sorely regrettable.

Racial slurs and homophobic language have no place in this debate, nor do threats of death and injury. Heckling is one thing, but the foul language and violent actions of those protesting health care reform have no place in our society.

No one knows how the health care debate will unfold, and neither can we predict how the political fortunes of its authors and supporters will be changed. What is crystal clear to me at this time in history is that there are still elements within the United States who are willing to use intimidation and hateful speech to make their discontent known. Such angry action and speech is a waste of breath and energy, and will most likely only backfire on those who use it. Shame on those who stoop so low, and shame on those who sit back quietly without protest as such ugliness spills into our streets.

An April Fools Change of Shift

Dr. Dean over at The Millionaire Nurse Blog has just published an April Fools Day edition of Change of Shift, everyone's favorite bi-weekly nursing blog carnival. And lo and behold, I even managed to submit an article this time! Pay a visit if you can!