Medical Marijuana

#medicalmarijuana.

People who report marijuana use for medical reasons are very similar to recreational users, as determined from a recent analysis of survey data on 96,100 adults from all 50 U.S. states.

http://www.jwatch.org/na43146/2017/01/09/who-uses-marijuana-medical-purposes?query=etoc_jwpsych&jwd=000000789674&jspc=GP

Often, users already suffering from #anxiety and #mood symptoms experience further harmful effects with #marijuana that uniformly improve with stopping the #drug.

Wellness Exams

Please know “physical exams” do not include any medical issues unique to you (high blood pressure, asthma, arthritis, high cholesterol, diabetes, anxiety, depression, etc.).  Under insurance company billing rules, physical/wellness exams and treatment of your specific medical problems are two different services, even if both are performed during a single visit. Doctors are required to document and bill each separately, otherwise risk fraud charges from your insurance company.

What this means to you is that when you receive the Explanation of Benefits (EOB) from your insurance company, you may see two office visits listed. One will be zero copay (annual wellness physical), but the other will be billed as a routine office visit. Any amount not covered under the general physical/wellness exam is considered by insurance company policy as patient responsibility; the deductible or coinsurance is billed to the patient.

Our clinic finds these insurance policies to be misleading and confusing; they violate patient expectations for a “zero” copay annual physical visit that should include review of all health conditions and medication adjustments, yet to participate in network with your insurance carrier we are obligated to comply.

SUPPORT THE PRIMARY CARE ENHANCEMENT ACT

Please write your federal representative (https://www.usa.gov/elected-officials) and encourage your friends to promote the Primary Care Enhancement Act.http://media.wix.com/ugd/677d54_4383c66b92a7447296a92f17a47c194e.pdf

NATIONAL IMMUNIZATION MONTH – AUGUST

August is National Immunization Month! Be safe- be sure you and your children are immunized to help prevent potentially deadly diseases that are easily preventable!

National Immunization Awareness Month (NIAM) is an annual observance held in August to highlight the importance of vaccination for people of all ages. NIAM was established to encourage people of all ages to make sure they are up to date on the vaccines recommended for them. Vaccines play in protecting children’s and adult’s health! Please see the following for more information of vaccines recommended for different age groups:

– Birth through Age 6: http://www.cdc.gov/vaccines/hcp/conversations/prevent-diseases/provider-resources-factsheets-infants.html

– 7 through 18 years old: http://www.cdc.gov/vaccines/hcp/conversations/prevent-diseases/provider-resources-factsheets-teens.html

-College students: http://www.cdc.gov/vaccines/adults/rec-vac/index.html

-Adults: http://www.cdc.gov/vaccines/hcp/adults/for-patients/index.html

cholesterol medications for patients over 80 years old

Although cholesterol lowering medication clearly reduces heart attacks and strokes, little has been published about its’ effectiveness for patients over 80 years old.  Current use focuses on “primary prevention” (prevent the initial occurrence of a heart attack or stroke) or “secondary prevention” (prevent a recurrence of disease).

In the United States, the American College of Cardiology states the evidence is not entirely clear for patients 80+ years old, and recommends individual doctor-patient discussions. The Choosing Wisely campaign promotes the concept of avoiding lipid lowering medications in persons with a limited life expectancy (< 5 years). In Australia, the NPS recommends against cholesterol med use in patients over 80 years’ age.  They state, “the limited available evidence does not support an effect of lipid-lowering treatment in this population.”

A recent publication evaluated cholesterol medications in older individuals.  A chart review of 1,262 hospitalized patients with heart attack, unstable angina or chronic heart disease found 72% of patients were discharged on cholesterol medication and 28% were not. Subsequent evaluation found no significant difference in all-cause mortality after three years, whether medication was used or not.

What does this mean to folks over 80 years’ age, who now take cholesterol medication?  Discuss the potential risks and benefits of continued cholesterol medication with your doctor – whether for primary or secondary prevention. Please do not stop cholesterol medication without discussion with your physician. Factors to review include cost (minimal for widely available potent generics like atorvastatin), side effects (muscle aches, slight increased risk diabetes or memory loss), and benefit (possible improved quality of life via fewer heart attacks, no reduction in all-cause mortality, no clear conclusion at present).

References:

  1. Journal Of The American Geriatrics Society:  Volume 64, Issue 7 July 2016; Pages 1475–1479. http://onlinelibrary.wiley.com/doi/10.1111/jgs.14207/full
  2. http://www.nps.org.au/topics/ages-life-stages/for-individuals/older-people-and-medicines/for-health-professionals/evidence-and-guidelines/using-statins
  3. http://www.acc.org/latest-in-cardiology/articles/2015/03/10/07/46/statins-for-primary-prevention-in-older-adults
  4. http://newoldage.blogs.nytimes.com/2013/10/22/controversy-over-statins-for-older-patients/?_r=0

Alzheimer’s

As our population ages, more families are left coping with a loved one who has been diagnosed with dementia.  Recent statistics indicate that 1 in 8 adults over the age of 65 has at least some findings of dementia, and the prevalence rate balloons to HALF of people over the age of 85.  In 1983, President Ronald Reagan designated November as National Alzheimer’s Disease Awareness Month.

Dementia is an umbrella term describing a variety of diseases and conditions that develop when nerve cells in the brain lose normal function. These cell changes affect memory, behavior, personality, clear thinking and the ability safely care for oneself. Eventually these brain changes impair an individual’s ability to perform even basic bodily functions, such as personal hygiene, dressing and eating.

Given the loss of self-care, family members are needed to help. Because loved ones are often not aware of how much dementia is affecting them, discussions surrounding driving, finances and staying at home can be delicate and difficult. Care needs can progress from intermittent in-home assistance to 24/7 total care.  Dramatic changes in behavior often leave family caregivers feeling afraid or powerless.

We encourage you to talk to your doctor about dementia and care issues that your family is confronting.  Medications are available to help with depression, aggression and memory, but they will never restore a person fully to their former self. Please remember that you are not alone; numerous support organizations offer help – both in person and over the phone.

Alzheimer’s Association 24/7 help line:  1-800-272-3900

http://www.alz.org/living_with_alzheimers_4521.asp

https://www.caregiver.org/alzheimers-disease-caregiving

https://alzheimers.acl.gov/family_care.html

 

Alzheimer’s Association Greater Idaho Chapter Caregiver Support Groups: 

http://www.alz.org/idaho/in_my_community_support.asp

 

Boise

Cathedral of the Rockies

717 N. 11th Street

Boise, ID 83702

1st & 3rd Thursday, 2:00 pm – 4:00 pm

Jim Clayton

208.336.5995

 

Willow Park Assisted Living

2600 N. Milwaukee

Boise, ID 83704

2nd & 4th Thursday, 6:00 pm – 7:30 pm

Linda Arends/Joanne Franklin

208.373.1234

 

Cathedral of the Rockies #2

717 N. 11th Street

Boise, ID 83702

2nd Tuesday, 2:00 pm – 3:00 pm

Amy Leavitt

208.995.6497

 

West Boise

Overland Court Senior Living

10250 W. Smoke Ranch Dr.

Boise, ID 83709

2ndWednesday, 6:00 pm

Cheri Kantola/Pam Wilkerson

208.615.3486

 

Eagle

Paramount Assisted Living

815 N. Eagle Road

Eagle, ID 83616

2ndWednesday, 3:00 pm

Susan Ness

208.465.7121

 

Eagle Public Library

100 N. Sherman Way

Eagle, ID 83616

2nd & 4th Tuesdays, 2:00 pm

Sara Kolnes

208.860.4182

 

Meridian

Home Instead

55 W. Willowbrook Drive, Suite 101

Meridian, ID 83646

3rd Thursday, 5:00pm – 6:00pm

Mike & Geneva Powell

208.888.9962

 

Kuna

Kuna Public Library

457 Locust Ave.

Kuna, ID 83634

1st Wednesday, 3:30 pm – 4:30 pm

Lisa Underwood

208.888.7030

 

Nampa

Church of the Brethren

11030 W. Orchard Avenue

Nampa, ID 83651

2ndWednesday, 2:00 pm – 4:00 pm

Walt Miller

208.465.9064

 

Caldwell

Autumn Wind

200 W. Beech Street

Caldwell, ID 83605

2nd Tuesday, 1:30 pm

Sherry Smith

208.795.5813

Fight Back Against Govt Trying To Shut Down Independent Clinics

The Centers for Medicare & Medicaid Services (CMS) has announced new rules for how health care payments will occur. The final rules are yet to be released despite a 2017 program start date.  http://www.athenahealth.com/blog/2016/05/06/now-that-the-printers-have-cooled

A large concern is CMS is intentionally targeting small, independent clinics. The initial program rules show a heavy bias for large hospital systems. In fact, CMS paradoxically estimates that 87% of solo physicians will see a negative payment adjustment after the first year.   The rule is clearly more favorable to large groups; CMS estimated only 18.3% of groups with 100 or more eligible clinicians will be penalized. Another way to describe the situation is more than 80% of clinicians in groups of 100 or more members are projected to earn a bonus based on how CMS is writing the rules.  http://www.healthcare-informatics.com/news-item/black-book-small-physician-practices-foresee-end-their-independence-due-macra

What to do about our federal Medicare agency rigging the rules to favor large hospital monopolies? Please support your local, independent physicians. Our local ownership and accountability directly to you provides superior customer care; we daily strive to earn and keep your trust. When was the last time the CEO/Owner of a hospital system called you personally to relay results or answer questions? We do that every day – for you. Support independent doctors to keep us serving you. http://www.independentdocsid.com/why-choose-idid/

Opioid Narcotic Medications For Chronic Pain

For the past 25 years, doctors have been told to treat the underappreciated epidemic of chronic pain in our country. The main hospital certification agency and others have promoted pain rating scales as the “5th vital sign”, added onto the traditional blood pressure, temperature, heart rate and respiratory rate. Physicians and hospitals responded and we saw a surge in prescriptions for controlled opioid narcotic pain pills.

What did we discover? Opioids for acute pain (trauma, surgery, etc…) are readily justified by multiple studies. Yet, the evidence of benefit for opioids in chronic pain is very limited at best, and the risks are clear.

Recent published studies repeatedly show the scant benefits and very strong harms of opioids in chronic pain. In the past few weeks, a study in JAMA showed “Long-Acting Opioids Tied to Increased Mortality Unrelated to Overdose”.  http://goo.gl/IqL9ne Compared to patients treated with non-opioid chronic pain meds (like gabapentin or amitriptyline), those using opioids for chronic pain had a 72% increased risk for death from causes other than unintentional overdose.  http://archinte.jamanetwork.com/article.aspx?articleid=2522397 We already know unintentional (and intentional) overdose deaths are increased for those receiving chronic opioids for pain.

In Idaho in 2012, appx 90 opioid prescriptions were written for every 100 adults.http://www.cdc.gov/drugoverdose/data/prescribing.html

Maybe it would be worth the higher death rate if opioids were amazing medications for chronic pain. They are not. A meta-study combining 20 controlled trials showed opioid analgesics provide modest short-term pain relief, BUT the effect is not likely to be clinically important within guideline recommended doses. And most importantly, evidence on long-term benefits for chronic low back pain is lacking. http://jama.jamanetwork.com/article.aspx?articleid=2528212

Bottom line, chronic opioids are poor medications for chronic pain (including low back pain) and they increase the death rates for not only overdose but ALL cause mortality, including cardiovascular death (heart attacks).

CDC guidelines – http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

ASAM- http://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf

Blue Light Blocking Orange Glasses For Bipolar Mania

First randomized trial of blue light blocking glasses (orange tinted shades) for acute bipolar mania treatment showed they were highly effective as an add-on treatment for patients in a manic episode, with a significant difference seen as early as three days after the start of the intervention.

http://onlinelibrary.wiley.com/enhanced/doi/10.1111/bdi.12390https://www.lowbluelights.com/products.asp?PageIndex=9

This is exciting but early research. Since the downside is negligible compared to antipsychotic or lithium meds, this is a potential game changer, IF additional trials can confirm the findings. These glasses are already being used for 1-3 hours prior to bedtime for insomnia treatment by regulating melatonin. The current protocol included wear from 6 pm – 8 am (except while sleeping).

The mechanism underlying the effects of blue blocking glasses in mania need further investigation, but current focus is that the anti-manic effect seen during treatment is due to silencing of signalling in the ipRGC circuits directly influencing mood and cognition, rather than indirect effects via melatonin secretion, sleep or increased circadian synchrony.

Probiotics In Acute Diarrhea 1wk Is Not Recommended

The American College of Gastroenterology has released new guidelines for the evaluation and treatment of acute diarrhea and travelers’s diarrhea. http://goo.gl/bAswnG

While most of the recommendations are directed to physicians, one point stands out to patients: prebiotics or probiotics are NOT recommended, unless the diarrhea is caused by antibiotics upsetting the normal gut flora (bacteria that usually live in the intestines). Most times , one can adequately rehydrate with water, juice such as dilute apple juice, sports drinks, soups, and salty crackers.

Should you make an appt? See your physician if you have:

  • bloody diarrhea,
  • severe diarrhea disease not responding to 2-3 days of OTC treatment [such as  loperamide, bismuth, immodium, pepto bismol],
  • dehydration (no urine output > 8 hrs),
  • symptom duration >7 days.