The future of medical science is bright and shining in 2018, with multiple areas promising to bare fruit. Between the use of technology in the day-to-day of patient care and treatment to the latest genetic techniques, there are a myriad of improvements that will have large practical impact.
Organ Transplantation: Using the latest genetic manipulation techniques with Crspr Cas-9 technology, a line of genetically altered pigs is being bred that have organs that will be used for kidney, heart, and liver transplant. This is likely to take place in the next several years. https://www.syntheticgenomics.com/
New Pharmaceuticals: The home-run king, Gilead pharmaceuticals, has brought us virus treatments for influenza (Tamiflu), a Hepatitis C cure (Solvaldi and Harvoni), and multiple medications to HIV/AIDS. Now they are exploring genetic treatment strategies for cancer and could potentially bottle lightning a second time. http://www.gilead.com/
Cancer Moonshots: MD Anderson has a track record of major achievements in basic science and treatment. Dr. James Allison is leading their 'moonshot' program to focus the body's immune system on cancer treatment and cure. https://faculty.mdanderson.org/profiles/james_allison.html
Heart Monitoring: New and improved heart monitoring allows better and more accurate diagnosis of heart arrhythmias and at a reduced cost. This technology that is much more sophisticated and current monitoring systems, is likely to find itself into the Apple watch.
Yes, there are areas where results are lacking. Alzheimer's disease is a notable exception that has not yielding much in the way of practical treatments, but the basic science quest continues and there is no question that success will be achieved, although it may be a few more years until we hear of it.
As the Most Interesting Man in the World says.....
Introducing Genetic Testing By Myriad, Available In Our Office Soon. . . . .
The Myriad Hereditary Cancer test is a 28-gene panel that identifies an elevated risk for eight hereditary cancers:
Genetic screening is now a practical tool that we can use to help in the management of your health and the health of your family. It is recommended by the USPTF (United States Preventive Services Task Force.) This has implications for you, but also for your family, and I think it is worthwhile to consider.
We are at the beginning stages of applying this science in the clinical setting, so it is of limited scope of application. I want to help determine if it can be applied to your particular family history. This questionnaire is meant to do just that.
Determine if you are at risk for cancers that run in the family
Determine if genetic testing, at it's current state of development, is applicable to your situation
Have the testing done to determine the best monitoring strategy, as well as helping guide you and your family in future testing and monitoring.
You will notice that this questionnaire has a specific focus on certain cancers, as that is the state of practical application of current genetic testing.
We are using a 24-gene panel from Myriad labs, the inventors of the BRCA test, which was the first large-scale genetic test validated for breast cancer family history.
For now, only a select group of patients can benefit. In the future, genetic testing will become commonplace and perhaps done routinely for everyone.
Answer the following questions and we will determine if you can benefit from this testing right now.
As for the cost, insurance coverage, and privacy issues related to such testing, this will be answered prior to running the test, so feel free to provide this information to initially see if you can benefit.
The process: Complete this questionnaire
Submit a specimen of saliva (spit test).....this will be the material that is genetically tested.
Myriad labs will contact you to review cost, insurance, and privacy issues before any testing is performed.
Once completed, you will receive a detailed report and we can review it together to determine the best strategy for monitoring your health on an ongoing basis, as well as having specific advice for monitoring of your family members.
In the future, should additional testing become available that is valid to do, your current information will be used in such an analysis.
** Click HERE for more information and to take the Myriad Genetic test to see if you are at risk.
If you think you are at risk and would like more information, please contact our office to schedule an appointment with Dr Lakin.
Ways To Avoid Colds And Flu
This Winter. . . . . . . . .
Winter is the season for colds and flu. According to Dr William Bird, medical consultant of the Meteorological Office's Health Forecast Unit, December is when infections tend to become prevalent. Here, we look at some ways you can minimise your risk of catching colds and flu.
Keep warm
Granny was right - keeping warm can help you avoid coughs, colds and flu. Dr Bird says: 'After our exceptionally mild autumn, people won't be used to dressing warmly for wintry weather. So if there's a sudden icy snap, we will be more likely to feel the cold and start to shiver.
'Shivering depresses the immune system and this makes us more likely to catch colds. Also, lower levels of sunlight and altered levels of hormones such as melatonin and serotonin negatively affect how the immune system performs.' We lose up to 30per cent of our body heat through our heads - so wear a hat.
Wash your hands
Although most infections are mainly carried in the air and transmitted by the "aerosol" effect when someone sneezes, germs can be transmitted by physical contact and enter the body when infected hands touch vulnerable parts like our eyes, mouths and noses.
These areas offer easy access to invading germs despite being equipped with defence mechanisms such as mucous and hairs. Washing hands often - and drying them on disposable paper towels (or laundering hand towels regularly) - can significantly reduce the chances of catching a virus, especially the rotavirus, which tends to infect children and causes vomiting and diarrhea.
Watch the weather
Low cloud, dull and misty conditions tend to bring an increase in germs, says Dr Bird. 'Viruses survive longer when the weather is moist. They can hang in the air attached to water droplets more easily, and when it's cloudy and dull there are fewer breezes to blow the germs away.
'This is the time when you're more likely to catch something - although you may not notice you've done so until ten to 12 days later, the incubation period for many colds and coughs.'
Avoid huddling and heating
Because people are much closer together physically during winter, this makes it easier for infections to pass between people. Crowded trains and Tubes with little ventilation, department stores bustling with shoppers, and people gathering for parties all make catching a cold more likely.
'Central heating reduces our defences and affects the respiratory system by drying out the protective mucous in our nasal passages,' says Dr Bird. 'The dry, stuffy air of central heating can also lead to sore throats and aggravate chest complaints like asthma.' A humidifier can help.
Drink plenty
Doctors recommend we drink about eight glasses of water a day to stay healthy. Rehydration expert Dr Susan Shirreffs says: 'Water helps the kidneys function properly and flushes out the toxins that accumulate in our bodies.'
If you have a cold, being dehydrated makes your mucus drier and thicker and less able to cope against invading bacteria and viruses. If you've already caught a cold, drinking plenty of fluids will help flush out the infection.
Sleep soundly
Lack of sleep makes us more prone to infection, says Dr Bird. 'But it's not a matter of simply sleeping for longer, as some people - especially those who are positively motivated - can have fewer than seven hours' sleep every night and not suffer at all.
'Moods also affect our ability to fight off infections, and if you feel stressed you are more likely to become ill compared to when you're feeling buoyant, happy and relaxed,' he says.
Keep on moving
Dr Bird says: 'Don't underestimate the importance of regular activity, especially in winter. Apart from keeping our circulation going, regular moderate exercise increases the number of natural killer (NK) cells in our bodies.'
These lymphocytes in the bloodstream and the mucosal layer of the nose and airways travel around our bodies scavenging foreign invaders such as bacteria and viruses.
'When you exercise, NK levels go up and stay elevated for about 36 hours afterwards,' says Dr Bird. 'However, if you exercise too much, this will actually lower levels of NK cells.'
Medicare currently uses a Social Security based ID number to identify people with Medicare and administer the program. On April 1, 2018 Medicare will begin the process of discontinuing Social Security numbers for identification and will begin sending new Medicare cards to Medicare recipients with new ID numbers.
Your new Medicare ID number will replace the Social Security number that is currently on all Medicare ID cards. Your new Medicare number will be specific to you and should be protected as personally identifiable information but must be provided to your medical doctors so your medical claims can be billed. The ID number on your new Medicare card will be different than your current ID number, randomly generated, and have uppercase letters that are "non-intelligent," which means they don't have any hidden or special meaning.
Moving to new Medicare numbers and issuing new Medicare cards requires a lot of change to the current system and it is a change that will be nationwide and gradual beginning no earlier than April 1, 2018 and running through December 31, 2019. This means your new Medicare card can arrive anytime within this time frame. Release of the new ID cards will be timed and controlled by Medicare. Your old Medicare cards should not be discarded but can be filed safely away.
Your new Medicare card will not change your Medicare benefits and patients with Medicare should start giving the new Medicare cards to their health care providers as soon as they arrive. It is important to know the transition period for Medicare providers also begins on April 1, 2018 and will run through December 31, 2019. This means Medicare providers have until January 1, 2020 to begin exclusively billing with the new Medicare ID numbers. Some Medicare providers will begin using the new ID numbers as soon as April 1, 2018, others will be closer to the December 31, 2019 deadline. This decision is made on a case by case basis and is perfectly acceptable under the terms of the Medicare program. A provider may require you provide your "old" Medicare card in order to submit your claim, as long services were provided prior to the December 31, 2019 deadline this is also acceptable.
If you have questions, please contact Veronica, our Billing Supervisor.
Dr. Lakin and staff are very excited to announce we have upgraded our secure patient portal!
We changed vendors, and our new secure portal,
MyHealthRecord.com, is easier to use and easier for us to respond to your requests.
At your convenience
View your health record from any Internet-enabled device
Exchange secure messages with Dr. Lakin or our staff
Request and manage appointments
Anytime access
Lab orders
Test results
Upcoming appointments
New Document and articles from Dr Lakin
To access our new patient portal, MyHealthRecord.com, you are required to complete a short questionnaire. This is a very simple process.... quick and easy. If you need assistance, we are always here to help.
Call us for your invitation email! It will give you all the information you need to use our secure portal, MyHealthRecord.com, for your medical care!
PyeongChang 2018's vision for the 2018 Games is to offer the Olympic Movement and the world of winter sports New Horizons - a legacy of new growth and new potential never seen before.
Its Winter Games plan is one of the most compact in Olympic history, it offers a unique stage on which the world's best athletes can achieve superior performances.
With PyeongChang's strategic position in Asia, and its access to a young and fast growing youth market, the 2018 Olympic Winter Games will no doubt expose new generations of potential athletes to the power of winter sport.
When the alarm goes off, what do you do? (Besides
hit snooze, that is!) Pop out of bed and get going?
Guess what: you're doing it wrong.
When you bolt upright from lying prone for several (several) hours, says physical therapist
Erika Mundinger, you run the risk of hurting yourself before your feet are even on the floor. No joke - we've all probably heard someone say they hurt their back literally just by getting out of bed in the morning, or first thing, when they get in the shower, say. Going to bed stiff, or sleeping funny, combined with the rapid transition up getting up could be all it takes to strain something.
Mundinger, who works with patients at TRIA Orthopaedic Center in Bloomington, Minnesota, also says that there's a lot more going on when we wake up than just getting upright. "You're changing blood pressure, breathing rate, brain waves," she explains. These changes are all part of the
recovery and repair our bodies do while sleeping. Then if we have to fly out of bed, she says, we don't get the slow acceleration we need.
Good news: that transition means a few extra minutes in bed. With a few simple stretches before leaving our sanctuary we can ease all of our systems into waking up - in addition to getting blood flowing and the spine warmed up.
We should be
taking cues from our pets - they instinctively know what to do. Every morning I watch my dogs stretch leisurely before hopping off the bed.
So what are the best stretches to do first thing in the morning? Choose any or all of these movements Mundinger recommends, skipping any that don't feel good.
With three to five of the stretches you're getting good general movement and it takes only five minutes, she says - and as tempting as that snooze button is, it's much
better for you than a five minute snooze. Focus on slow movements with each of these, and don't hold the positions too long, she notes, which could be too much strain first thing.
Bruxism is an oral condition in which you grind or clench your teeth. It may occur unconsciously when you are awake (awake bruxism) or during sleep (sleep bruxism).
Sleep bruxism is considered a sleep-related movement disorder. Individuals who clench or grind their teeth (brux) during sleep are more likely to have other sleep disorders, such as sleep apnea (pauses in breathing) or snoring.
Depending on the degree of bruxism, this habit may or may not require treatment. However, in some individuals, bruxism is sufficiently frequent and severe so as to lead to jaw disorders (Temporomandibular Joint (TMJ) Disorder-TJD), headaches, damaged teeth and other, significant problems.
Some of the SYMPTOMS of bruxism may include:
Teeth grinding or clenching, which if during sleep, can be loud enough to awaken you or your sleep partner
Teeth that appear flattened, have wear facets, or are fractured, chipped, or loose
Worn tooth enamel, exposing deeper layers of the teeth
Increased tooth pain or sensitivity
Fatigued or tight-feeling jaw muscles, or even a "locked" jaw that won't open or close completely
Jaw, neck or face pain or soreness
Pain that simulates an earache, although the problem is not with the ear
Dull headaches initiating in the temple area - Teeth grinding has been attributed to the TMJ disorders resulting in 15% of headaches among Americans.
Intraoral cheek abrasions from chewing the inside of the cheek
Disrupted sleep due to the oral activity or pain
CAUSES
The cause of bruxism is not completely understood, but it has been correlated to a combination of physical, psychological and genetic factors.
Awake bruxism may be due to emotional factors such as stress, anxiety, anger, frustration or tension. However, it may also be a habit that developed during deep concentration or as a response in attempts to cope with certain situations, especially stress.
In addition, it can develop as a result of a malocclusion (abnormal bite), missing teeth, or teeth that are not in proper alignment (crooked).
Sleep bruxism may be a sleep-related chewing activity associated with sleep-cycles while asleep.
RISK FACTORS
There are several factors that can increase your risk of bruxism:
Stress - Job related stress has been shown to be the most significant factor. However, any increased anxiety, stress or anger and frustration can lead to teeth grinding. As physical signs of mental and emotional health, bruxing should not be ignored since it could be an indication that treatment intervention to address the cause of the underlying stress is needed.
Age - Bruxism can be common in young children; however, as they grow there are relatively rapid changes in their teeth and jaws. usually without damaging results and bruxing typically resolves by adolescence. However, there is strong evidence of increased incidence among adults and, significantly, in older adults.
Personality Type - Having a personality type that is aggressive, competitive or hyperactive can increase the risk of bruxism.
Medications and other substances - While bruxism may be an uncommon side effect of some psychiatric medications, such as certain antidepressants, drinking caffeinated beverages, smoking tobacco, or alcohol has been demonstrated to increase the risk of bruxism, according to a study reported in the November 2016 Journal of the American Dental Association. In fact, some alcohol and tobacco users can be twice as likely to grind their teeth.
Family members with bruxism - Sleep bruxism tends to have a genetic basis with various members of a family developing bruxism or with a history of it.
Related to other disorders - Bruxism can be associated with some mental health and medical disorders, such as Parkinson's disease, dementia, gastroesophageal reflux disorder (GERD), epilepsy, night terrors, sleep-related disorder such as sleep apnea, and attention-deficit/hyperactivity disorder (ADHD).
TREATMENT
Symptomatic bruxism patients are advised to see a dentist to discuss intraoral solutions and treatment which may include using a night mouth guard or splint. Bruxing affects the health and function of the oral cavity and associated components. Protecting the temporomandibular joint and the teeth needs to be addressed and treated with the professional experience and knowledge of the entire chewing complex.
Mouth guards, which must be very carefully adjusted/equilibrated so that the occlusion (bite) is accurate, worn at night, can help protect teeth and stress management techniques may help address the underlying causes of bruxing. The patient's occlusion must be monitored and equilibrated routinely to remove any sharp, "pin-point" contacts or wear facets on teeth which may develop since these can result in producing damaging, magnified force on opposing teeth.
Extraoral treatment considerations may include meditation, counseling or exercise to assist in reducing some of bruxing's contributing factors such as stress and/or anxiety.
Recently, the results of two studies were published. The Journal of the American Dental Association reported a study's evaluation of using locally administered botulinum toxin (Botox or BTX) to treat bruxism. The study results suggested that BTX administered by a skilled practitioner is a safe and effective treatment for people with severe bruxism, particularly those with associated movement disorders. Additionally, the findings of another study, published in the Journal of Neurology, indicated that an injection of Botox may help those with bruxism to alleviate many of the harmful and damaging effects of this condition. The researchers reported that Botox injections into the major chewing muscles (in the cheek) can block the signals that cause these muscles to contract, thereby relieving the resulting grinding, clenching, and the associated compromising effects.
In most instances, while bruxism may not always cause serious complications, even moderate-to-severe bruxism may certainly lead to damage to the teeth, fillings/crowns, or TMJ function, tension-type headaches, or severe facial pain, jaw pain, or ear pain.
Awareness of potentially damaging oral habits and seeking advice and treatment are in every patient's best interest.
My wife Lynda and I have been married 50 years now, and sometimes staying together means doing our own thing such as we did this summer.
I went to Paris and Avignon where I studied French 35 years ago to visit my host family while Lynda went to Bisbee, AZ to paint. And it was 40 years ago that Lynda and I first visited Paris together. I was a math teacher who married a teacher of French and in our home she became my first of many French teachers.
Not only was I entertained by my host family but by two other families in Avignon whom we had entertained in the Valley three years ago. I guess I was lucky to only put on two pounds with all those special meals. And speaking of special meals, on the internet three months ago I found a Canadian woman who prepares dinner for 12 in her home once a week for French and others wishing to sample non-French food and practice their English. Since I was the first to inquire I got to choose the entire menu from the choices she gave me. It was a delicious and fun evening!
As a 77 year old senior I take precautions when traveling such as taking my cane for those nocturnal trips to the bathroom and several standard antibiotics for infectious ailments that can ruin a trip for a few days. Also since I traveled alone I made sure the hotel night manager checked on me in the morning at 7:15 and I informed the desk staff about my plans for evening activity and return. I even became email pals with the night manager who promised to give me a "special price" if I return.
Over the years Paris has become my "second city" after Phoenix/Scottsdale and I know it like the back of my hand after twenty trips there staying in hotels or in recent years an apartment as long as two months at a time.
If you would like information about traveling in France.... you can email Tom HERE!
When you were little, your parents probably made sure you had an annual checkup with your doctor. But as you've grown older, you may have gotten out of this habit.
Health professionals stress that these regular exams are important to help identify risk factors and problems before they become serious. If diseases are caught early, treatments are usually much more effective. Ultimately, having a regular doctor's visit will help you live a long and
healthy life.
It is also very important for you to play an active role to get the most out of your doctor's visit. Before your exam, review and update your family health history, be prepared to ask if you're due for any general screenings or vaccinations, and come up with a list of questions if you have particular health concerns.
During your actual doctor's visit, don't be shy about getting your questions answered. Also, if the doctor gives you advice about specific health issues, don't hesitate to take notes. Time is often limited during these exams, but by coming prepared you're sure to get the most out of your checkup.
Dr Lakin's Recommended Adult Immunizations Information. . . . .
Taking preventive measures is what smart people do to live longer.
Science has proven the overall benefits of these immunizations and you should give them strong consideration.
Hepatitis A
Bottom Line:
I completely recommend this vaccine. It is safe and effective and you don't want to get this infection that is 100% preventable. Get this vaccination.
Hepatitis B
Bottom Line:
If you are sexually active with various partners, it is a good idea. If your travel repeatedly to developing parts of the world, also a good idea.
Pneumonia shots: Pneumovax 23 and Prevnar 13
Bottom Line For Pneumovax 23:
Over 65 I wholeheartedly recommend this. Although not a perfect vaccine, it is better than 'nothing' against a common but often ignored health issue.
Bottom Line For Prevnar 13:
A new pneumonia shot, but data is strong and favorable, and it's a good idea to get this shot. Not perfect, but appears to be stronger than the more traditional Pneumovax.
Shingles Shot (Shingrix)
Bottom Line:
Good idea to get this vaccine, especially if you did not get the previous version (ZOSTAVAX). After age 65 it is highly recommended. After we see the results in a few years, this immunization will end Shingles in the US.
Tetanus Shot: Td or TdaP
Bottom Line:
I recommend this get updated at the time of an injury, if it is due. Also recommend if you have small children or are a new grandparent that you get the TdaP version. I don't recommend you seek a booster if it's 'due'. Tetanus is exceedingly rare and old immunizations remains generally effective.
**Now for more detailed immunization information, I have listed....
Who, What, Where, Why, and Whens', as well as the Cost, Reactions, & any Negatives for each immunization.
HEPATITIS A SHOT:
Who:
Anybody who eats out at restaurants (sushi/raw seafood especially) or who travels to Mexico or other undeveloped countries (this is pretty much everyone) Age range: any age, but over 75....perhaps less important
What:Two shot series:
First shot now (works quickly...in a few weeks)
Second shot in 6-12 months (if you forget...OK to get later than that)
Where:
We carry the shot or you can get it at your pharmacy
Why:
You don't want this completely preventable disease. It will make you sick for 1-2 months and you will be out of work for a few weeks at a minimum.
You can give this to other people in your household. It is highly contagious.
There are outbreaks in restaurants and communities. You don't want to have to 'rush' to get the immunization if you were exposed accidently. It could be too late to prevent infection.
People who have Hepatitis A can give it to you before they are even aware they are ill.
When:
Any age is fine. It lasts a lifetime, so getting it when you are younger is a good thing.
Cost: $90/each
Reactions:
Very little in way of negatives. Sore arm is mild and systemic reactions are very rare.
Negatives:
None
HEPATITIS B SHOT
Who:
Although everyone is at risk for this infection, no matter the age, if you are older and have not had the shot, you probably don't need to get it
Children get it as a matter of course among routine immunizations.
If you are very sexually active, you should have this shot as the infection is transmitted through blood exposure and sexual contact.
What: Three shot series
1st shot now
2nd shot in 1 months
3rd shot 6 months from now
Where:
We carry the shot or you can get it at your pharmacy.
Why:
Hepatitis B can cause can cause both acute and chronic liver infection. The acute infection will make you sick for 1-2 month and you will miss work for a few weeks at minimum.
If you travel to Asia quite a bit, this is worthwhile, or to Mexico or other developing areas
If you are sexually active and less than perfect with precautionary measures.
When:
Any age is fine, but if you are over 50 and not having casual sexual activity, you probably don't need this
It is suggested at the time of foreign travel, but I don't routinely recommend this unless you are travelling to developing areas and having casual sexual contact in those local countries.
Cost & Coverage:
Generally covered by insurance: $80.00
Reactions:
Very little in way of negatives. Sore arm is mild and systemic reactions are very rare.
Negatives:
Not everyone responds to this vaccination; in other words...you get the series of shots but still are not protected
PNEUMONIA SHOTS:
There are 2 pneumonia shots: Pneumovax 23 and Prevnar 13.
Pneumovax is older but not quite as effective. It has a long track record of safety.
Prevnar 13 is newer and more effective, but there is less experience with this to date.
It's recommended that you get both, 1 year apart, in any order.
PNEUMOVAX 23:
Who:
Definitely if you are over 65 you should consider this If you have a chronic health condition that compromises your immune system (diabetes, COPD, Congestive Heart Failure, Kidney Disease, Reduced Immunity from other diseases) you should definitely get this. You can get this after the age of 50 if you want.
What:
1 shot
Boosters can be given in 10 years after the first shot if your immune system is very weak (this includes missing a spleen)
Where:
Our office or at your pharmacy
Why:
It reduces the potential of serious bacterial pneumonia (the most common type called pneumococcal pneumonia)
If you are a healthy person then pneumonia is in the 'top 5' of serious health threats after age 65.
Cost:
Covered by most insurances and Medicare, $45
Reactions:
Sore arm is possible, but not common. No other major reactions generally.
Negatives:
Not completely preventive. You can still get pneumonia, but this shot makes it less likely that you will be very ill from such and infection
PREVNAR 13
Who:
Definitely if you are over 65 you should consider this If you have a chronic health condition that compromises your immune system (diabetes, COPD, Congestive Heart Failure, Kidney Disease, Reduced Immunity from other diseases) you should definitely get this. You can get this after the age of 50 if you want.
What:
1 shot
No booster ever. One shot and done.
Where:
Currently only available in your pharmacy
Why:
It reduces the potential of serious bacterial pneumonia (only the most common type called pneumococcal pneumonia)
If you are a healthy person then pneumonia is the 'top 5' of health threats after age 65.
Cost:
Covered by most insurances and Medicare, Part D.
Reactions:
Sore arm is possible, but not common. No other major reactions generally.
SHINGLES SHOT: New...SHINGRIX. Old shot ZOSTAVAX...no longer recommended
Who:
Anyone over the age of 50. Definitely important the older you get as shingles risk increases with age. There is no age limit, so even in your 80's this is a good vaccine.
Anyone who has already had the previous shingles shot (Zostavax)
Anyone with compromised immune system (it is a 'dead' virus and cannot cause infection like the Zostavax could)
What:
Two shot series
1 shot now and the 2nd shot in 2-6 months (You can get it later if you miss the 2nd shot)
Where:
At our office or at your pharmacy
Why:
Shingles is reactivated chicken pox that comes from your own body. It is a painful condition that can last weeks to years.
You have a 33% chance of having shingles in your lifetime and 50% chance of getting shingles once you are in your 80's
When:
After the age of 50 and more importantly after 60
Risk for shingles increases with age.
Cost:
$200 per shot (total $400 dollars)
Medicare covers under Part D
Private Insurance coverage is unknown and varies.
Reactions:
1 in 10 chance of feeling like you have the flu after you take the shot. It may make you feel tired/achy for 1-2 days ...so be prepared
Negatives:
It is a new immunization and well-studied, but has not been used broadly in the population, so the exact nature of how people react to the shot is not certain at this time. In the studies done to date, the shot is very tolerable and without major side effects (over 10,000 people studied)
TETANUS SHOT: Td or TdaP
Who:
Anyone who has not had their shot in the past 10 years or who has an injury and sustains a deep cut.
What:
Single shot to act as a booster
Option: Td (Tetanus / diphtheria)...covers both infections. Is generally covered by insurances
TdaP (Tetanus/diphtheria/pertussis (whooping cough).....covers all three infections. An update of the Pertussis portion of this vaccine is a good idea and prevents an illness that adults carry and children, especially babies, can get. You only need the
When:
Boost every 10 years, but many people go longer.
If you are more than 5 years since your last injection and were just sustained a deep cut or were bitten by an animal.
Where:
Our office or your pharmacy/ER/Urgent Care
Why:
Tetanus is extremely rare in the modern civilized world, but only due to massive efforts at immunization.
Tetanus is deadly. You should try to stay up to date on this immunization, or at least reasonably close to the schedule listed above.
When injured it is a good 'excuse' to get it updated
Cost:
Td (Tetanus diphtheria) is covered by insurance
TdaP (Tetanus diphtheria pertussis (whooping cough) is generally not covered by insurance
Negatives:
You will definitely have a sore arm for a day or two from the injection. Otherwise, no major issues.
Let's talk about these at your yearly physical and keep you up-to-date and healthy!
Previously, I discussed the importance of formulary versus non-formulary medications in insurance drug plans. To review: if a drug is not in your plan's formulary, or favored list of medications, expect an unpleasant coverage denial that's usually revealed to you at your local pharmacy.
However, besides formulary and non-formulary, be mindful of another acceptance roadblock as well. Inside your plan's formulary, all medications are classified in a hierarchy of tiers; a typical formulary has four or five tiers. Drug tiers can indicate what you'll pay for a prescription. Rule of thumb: the lower the tier the lower the drug price and the more likelihood of coverage. The higher the tier, so too will be your cost, co-pay or co-insurance and/or it's less likely to be approved. Tier rejections can also trigger a call or fax to your doctor's office to initiate a pre-certification or prior-authorization (PA) before payment.
The four/five tiers: (See infographic)
Tier 1: Preferred generic. These are comprised of less-costly, commonly prescribed drugs.
Tier 2: Expensive generics or brand names. Costlier and subject to higher co-pays.
Tier 3: Brand drugs without a generic version. Expect co-insurance or cost-sharing.
Tier 4/5: Specialty or newly approved drugs. To treat complex conditions. Most expensive.
Most plans steer you eagerly to the first two tiers. They start to show resistance with drugs in the third tier and will apply the brakes in the fourth. The fifth tier is rarer and not encountered by most patients; it's usually the realm of cancer, MS and RA drugs. Regardless of tier, your plan believes that they provide all therapeutic choices their members need. Seldom is there a clinical need for a non-formulary drug or a higher classified drug if a lower one will work just as well. It's all a matter of dollars and sense.
So know this: you may be denied a drug due to its tier placement. To counter the denial, your plan may require statement/data/labs proving medical necessity, proof of try/fail, or a bad reaction to one (or more) of their formulary choice(s). Your insurance argues that these denials, in fact, are necessary and beneficial and keep drug and plan costs down for you and for all members in the long run.
If however, you want to play hardball and insist on a certain medication, generic or brand, expect it to require a PA, an often times rigorous and time-consuming exercise with no guarantee of success. And despite what a pharmacy or plan rep may tell you, it is NOT as sweet and simple as a phone call to your doctor's office. One call does not do it all! The notion of a simple "override" is seldom so. Your doctor may be a knowledgeable and skilled practitioner but cannot wave a magic wand to bypass tiers or overrule your plan's rules or rulings.
Finally, if your non-formulary or high-tier medication is approved, expect to pay more for the 'privilege' of having it waived for you. You may encounter sticker-stock when you are told the cost or co-pay by your pharmacist. It may drive you back to asking for cheaper, lower-tier choices after all. Where tier pressure fails, money matters may prevail.
Mashpee, Massachusetts, Cape Cod, Falmouth -------- sandy beaches, ocean breezes, gentle waves which become thunderous in the occasional storm and other fond childhood memories -----encouraged reading this acclaimed and epic history of our noble companion... the horse".
Wendy Williams, writer, equestrienne, scientist, researcher and historian has taken the reader on an informative and insightful ride through history.
Beautifully written, encouraging, with a fulfilled promise to inform, enthrall and entertain.
NOTE: Arizona has its wild horses whose presence is a reminder of their well-deserved and rightful place in our world - a place which appears more tenuous now with a demanding need for additional grazelands for farmers' animals.
Hopefully, a well informed decision providing an equitable solution would not only be desirable but also a possibility.
Hopefully, again, the people involved directly AND indirectly will weigh the consequences and result in a decision which will give us the best of both worlds.....our beloved wild horses and an evergrowing but considerate growth in the farming industry.
Foods You Should Always Store In The Fridge. . . . . And What To Leave In The Pantry.
To store in the fridge or not? That's the question most of us ask about several common kitchen items, or leftovers. Don't feel foolish if you frequently wind up stumped - so do the rest of us!
Here's a helpful guide about where your most frequently questioned foods should be stored:
1. Unopened salami or pepperoni: Room temperature
Whether part of a gift basket, or purchased for a cocktail party, all unopened salamis and related versions can be stored at room temperature. Once you've opened them, store them in the fridge, as they're susceptible to bacteria and mold from the cut end, even if most of it remains wrapped.
2. Leftover can of frosting: Refrigerator
An open can of frosting needs to go in your fridge. Unopened, it's fine in your pantry, but once you've used it, it's prone to spoilage and bacterial contamination.
3. Peanut butter (processed commercial brands): Room temperature
Traditional peanut butters like Jif or Skippy are processed for a long shelf life, even after opening. And any additives used to stabilize the products are FDA approved, and have used safely for decades.
Sometimes referred to as "natural" peanut butter, this version of peanut butter is only ground peanuts, and nothing else. It's best to refrigerate because the oils can become rancid and spoiled when left at room temperature for weeks.
To soften, remove from the fridge 30 - 60 minutes prior to using.
5. Coconut oil: Refrigerator
All oil can become rancid when stored at room temperature for too long. This is particularly true for oils used less often, including coconut, sesame and walnut oils. To ensure freshness, store in the fridge. Coconut oil is already a solid fat at room temperature. Sesame and walnut oils become solid in the refrigerator, but return to a liquid at room temperature without a change in taste or texture.
6. Coffee beans: Room temperature
If you're looking for optimal taste and aroma from your morning joe, keep the beans at room temperature. Coffee beans can pick up moisture from the fridge, and compromise flavor (but it doesn't alter the caffeine content).
For storage longer than a few weeks, wrap tightly in plastic wrap and freezer bags, and store in the freezer for up to six months.
7. Soy sauce: Room temperature
Soy sauce is a fermented product of soybeans, and once opened can safely remain at room temperature.
8. Hot sauce: Room temperature
Hot sauces are generally a mixture of vinegar, hot peppers and seasonings. Because vinegar is a mild acid, these sauces can be stored at room temp without spoilage. If you choose to store it in the fridge, warm to room temperature for optimal flavor before using.
9. Leftover pie: Refrigerator
Because the crusts and sometimes the fillings contain butter, cream, and eggs, store leftover pie in the fridge to avoid spoilage.
10. Mixed nuts: Refrigerator
Nuts contain heart healthy oils that can become rancid when stored too long at room temperature, especially in a warm kitchen. Store your leftover nuts in a sealed bag in the refrigerator. For longer term storage, wrap carefully and store in the freezer for several months.
11. Balsamic vinegar: Room temperature
All vinegars - plain and specialty types like balsamic or tarragon - are stable at room temperature. Vinegar is a mild acid which deters bacterial growth.
12. Butter: Refrigerator
As a dairy product, butter must be stored in the fridge to prevent spoilage. While "butter crocks" can be a good idea for short term storage of several hours, for longer storage without spoilage, keep it in the fridge.
Keeping you on your correct medication is as important to us as it is to you. With your help, we can be more efficient and be sure you are getting your refill requests on time and to your correct pharmacy.
Tips: 1. If you need a refill, be sure to call your pharmacy FIRST, not our office. They will know if you have more refills, and if not, they will call/fax/electronically message us with your request. Then we will contact you if there is a question or concern.
2. Remember to call your pharmacy in plenty of time so you do not run out of your medications. Sometimes we need up to 48 hours to complete a request and we do not want this to be a hardship for you.
3. Register and use our SECURE PATIENT PORTAL for refill requests. We monitor this continually and again will contact you if there is a problem.
4. Remember we do not refill pain or routine medications on Fridays or weekends and all pain medications must be picked up at our office. We cannot mail or any medications outside our office. Please plan ahead and make arrangements!
We are always here to help you and appreciate the opportunity to care for your healthcare needs!
A Winter Favorite: Chicken Chili with Sweet Potatoes
Tons of spice, corn and bell pepper give this healthy one-pot chicken chili recipe Southwestern flair. Serve with your favorite hot sauce, tortilla chips and a cold beer.
Ingredients
2 tablespoons extra-virgin olive oil
Great Value Extra Virgin Olive Oil 17 oz
1 large onion, chopped
3 cloves garlic, minced
2 cups cubed sweet potato ( ½-inch)
1 medium green bell pepper, chopped
2 tablespoons chili powder
2 teaspoons ground cumin
1 teaspoon dried oregano
1 15-ounce can low-sodium cannellini beans, rinsed
2 cups low-sodium chicken broth or homemade chicken stock
1 cup frozen corn
2 cups cubed cooked chicken ( ½-inch; about 10 ounces)
¾ teaspoon salt
¼ teaspoon ground pepper
Sour cream, avocado and/or cilantro for garnish
Preparation
Active
Ready In
Heat oil in a large pot over medium-high heat. Add onion, garlic, sweet potato and bell pepper; cook, stirring occasionally, until the vegetables are slightly softened, 5 to 6 minutes. Stir in chili powder, cumin and oregano and cook, stirring, until fragrant, 1 minute.
Add beans and broth (or stock) and bring to a boil. Reduce heat, partially cover and simmer gently for 15 minutes.
Increase heat to medium-high and stir in corn; cook 1 minute. Add chicken and cook until heated through, 1 to 2 minutes more. Remove from heat. Stir in salt and pepper. Serve topped with sour cream, avocado and/or cilantro, if desired.
Nutrition information
Serving size: about 1½ cups
Per serving: 324 calories;10 g fat(2 g sat); 8 g fiber; 35 g carbohydrates; 26 g protein; 29 mcg folate; 48 mg cholesterol; 5 g sugars; 0 g added sugars; 8,680 IU vitamin A; 24 mg vitamin C; 86 mg calcium; 3 mg iron; 570 mg sodium; 793 mg potassium
Nutrition Bonus: Vitamin A (174% daily value), Vitamin C (40% dv)
PyeongChang 2018's vision for the 2018 Games is to offer the Olympic Movement and the world of winter sports New Horizons - a legacy of new growth and new potential never seen before. 
When the alarm goes off, what do you do? (Besides
Not only was I entertained by my host family but by two other families in Avignon whom we had entertained in the Valley three years ago. I guess I was lucky to only put on two pounds with all those special meals. And speaking of special meals, on the internet three months ago I found a Canadian woman who prepares dinner for 12 in her home once a week for French and others wishing to sample non-French food and practice their English. Since I was the first to 
inquire I got to choose the entire menu from the choices she gave me. It was a delicious and fun evening!
As a 77 year old senior I take precautions when traveling such as taking my cane for those nocturnal trips to the bathroom and several standard antibiotics for infectious ailments that can ruin a trip for a few days. Also since I traveled alone I made sure the hotel night manager checked on me in the morning at 7:15 and I informed the desk staff about my plans for evening activity and return. I even became email pals with the night manager who promised to give me a "special price" if I return.
OR 
For more Super Bowl Fun:
Annual Physicals 101:
Most plans steer you eagerly to the first two tiers. They start to show resistance with drugs in the third tier and will apply the brakes in the fourth. The fifth tier is rarer and not encountered by most patients; it's usually the realm of cancer, MS and RA drugs. Regardless of tier, your plan believes that they provide all therapeutic choices their members need. Seldom is there a clinical need for a non-formulary drug or a higher classified drug if a lower one will work just as well. It's all a matter of dollars and sense.
To store in the fridge or not? That's the question most of us ask about several common kitchen items, or leftovers. Don't feel foolish if you frequently wind up stumped - so do the rest of us!
Keeping you on your correct medication is as important to us as it is to you. With your help, we can be more efficient and be sure you are getting your refill requests on time and to your correct pharmacy.
