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Contributing Physicians - Dr. Joseph Kahn & Dr. Richard Allen Willams
CJF Board Members

Dr. Richard Allen Williams Dr. Joseph Kahn


GET COVERED IN THE HEALTH INSURANCE MARKETPLACE

Please click here to view information about the ACA and assistance with signing up. This is updated information that musicians and others can use. I have also written an Update on Obamacare that I am sending you to post on the CJF website. In order for a person to get insurance coverage by March 1, 2014, the new date for signing up is Feb. 15, 2014, so we should post this information fast.

Richard Allen Williams, MD, FACC, FAHA


THE WEST NILE FEVER STORY

West Nile Fever is due to a virus infection in people, birds, and mosquitoes. The disease is spread by mosquitoes who acquire the virus from infected birds and then bite humans. The number of cases in people have increased to more than 4000 in the U.S. and there have been close to 170 deaths this year. For the past 4-5 years there has been an increasing number of cases every year.

70% of the cases this year have been reported in California, Illinois, South Dakota, Texas, Oklahoma, Mississippi, Michigan, and Louisiana. This estimate is probably very low since many of the cases have mild symptoms and are never reported to a physician. There is no treatment for the disease and no vaccine to protect against it The best way to avoid getting West Nile infection is to wear insect repellent when outdoors, wear long sleeved shirts, and support local programs to eradicate mosquitoes.

80% of the people infected with the virus develop no, or few symptoms, while 20% develop mild to severe symptoms such as headache, joint pain, fever, skin rash, and swollen lymph glands. Most people with mild infection recover in 6-8 days, however those who develop severe symptoms frequently have inflammation of the brain or spinal cord (meningitis) and may die; therefore anyone with symptoms should be seen by a physician. People with immune deficiencies, or those over 50 years of age with medical conditions such as cancer, diabetes, hyprtension, kidney disease, or organ transplants, are at greater risk for serious illness.

In addition to wearing long sleeves, log pants, and insect repellant, do not have standing water outside in open containers, install or repair windows and door screens, and use air conditioning when possible.


IMPACT OF THE NEW HEALTH REFORM LAW ON YOU

Richard Allen Williams, M.D., F.A.C.C.
Professor of Medicine
UCLA School of Medicine
President/CEO
The Minority Health Institute, Inc.
Los Angeles, California

On March 23, 2010, President Barack Obama signed H.R. 3590, the healthcare reform bill, into law and created the Patient Protection and Affordable Care Act (PPACA). The purpose of this article is to help the public understand various provisions of the new law regarding its benefits and its limitations. This comprehensive overview is a public service provided by the Minority Health Institute and is not intended to cover every single detail. More specific details may be obtained from the sources cited below. Here are the main provisions:

  1. It is now mandatory for you to have health insurance. If you are not covered, you will be penalized. Penalties will not begin for a few more years. This is the Individual Mandate, and it applies to every man, woman and child who is a citizen of the United States regardless of race, ethnicity, gender, or disability status.

  2. You can choose your own private insurance company and plan. This includes keeping what you already have, if you choose to. There is no “Public Option”.

  3. Subsidies will be available for those who cannot afford to pay for coverage on their own. A high-risk pool is being organized by the Department of Health and Human Services (DHHS) for such individuals and is promised to be up and running within 90 days.

  4. Your Medicare coverage will not be decreased. In fact, certain benefits will be increased, such as closure (by 2020) of the “doughnut hole” which requires increased payment for prescription drugs after a certain deductible is reached. For example, right now seniors pay 25% of drug costs up to $2,830. After that level has been reached, seniors pay 100% of the costs (this is the “doughnut hole”), until they reach $4,550 (the catastrophic cap), when the payments of drug costs are decreased to 5%. The new law will completely eliminate this costly gap. Prescription drug coverage and preventive benefits will be increased. The financial burden on Medicare beneficiaries will be decreased by slowing the rate of Medicare spending. Waste and fraud in the system are targeted for elimination, which is expected to save billions. A rebate plan is being set up for Medicare beneficiaries who pay too much for their drugs.

  5. Preventive care procedures will be free with no cost-sharing involved. This includes vaccinations for flu and other disorders, screenings for high blood pressure, etc. So far, mammograms and screenings for cervical cancer are not included in these free services.

  6. Low-income persons may enroll into Medicaid, and eligibility will now be determined based on income rather than demographic status. An individual who makes less than $14,404 or a family of four with income less than $29,327 (upper limits of the Federal Poverty Level or FPL) would qualify for Medicaid by 2014.

  7. You cannot be refused insurance coverage by any company due to pre-existing conditions.

  8. The lifetime cap on insurance payments is eliminated, so you will no longer be threatened with the possibility of bankruptcy due to high medical bills.

  9. You cannot be dropped retroactively by any insurance company due to frequent need for care or high costs (rescission). Medical underwriting for out-of-program care will be limited. Insurance companies will be strongly regulated and will not be able to raise your premiums arbitrarily. (Recall the recent situation with Wellpoint, the nation’s largest insurer with 33 million lives, which threatened a 39% increase in rates to its clients in California.)

  10. If you are an employer and your company has fifty or more employees, you must offer them an insurance benefits plan. Coverage will be on a cost-sharing basis. Employers will receive tax credits for enrolling employees in their plans. If you are an employee and your company does not pay at least 60% of the cost or if the cost exceeds 9.5% of your income, you are eligible to apply for a government subsidy.

  11. Health insurance exchanges will be established BY 2014 which will allow small businesses and individuals without employer coverage to afford better coverage. This is especially important for individuals who exceed the Federal Poverty Level.

  12. Children may remain on their parents’ coverage up to the age of 26 years. This is not limited to children in college.

  13. It is estimated that the Patient Protection and Affordable Care Act signed into law by President Barack Obama on March 23, 2010 will save thousands of lives by broadening access to medical care.

  14. The health reform program is expected to cost $940 billion over the next decade and to decrease the Federal deficit during the next twenty years by more than $1trillion, according to estimates from the non-partisan Congressional Budget Office (CBO). It is also estimated that it will save about $100 billion in the next 10 years. This is a bargain of major proportions.

  15. The major provisions of the law will not go into effect until 2014, when the mandates, penalties, subsidies, etc. will be fully exercised. However, more than 150 new policies have already gone into effect with the signing of the Act into law. This includes most of the regulations on insurance companies mentioned above.

More information on healthcare reform can be obtained online at www.healthreform.gov, www.whitehouse.gov, www.aarp.org, and www.kff.com. Dr. Williams can also be contacted through the Minority Health Institute at mhinst@aol.com.


FACTS ABOUT FIBROMYALGIA

Fibromyalgia is a disorder that is being diagnosed much more frequently in the past 10 yrs. than it had been before. It is more prevalent in females than it is in males. The cause is unknown but it may be genetic as it tends to run in families. It is believed that people with fibromyalgia have a lower threshold for pain because of increased sensitivity in the brain to pain signals, which is due to an increase in the level of certain neurotransmitters in the brain that signal pain.

It is characterized by widespread pain on both side s of the body involving the neck, shoulders, back, buttocks, elbows, and knees. In addition morning stiffness, fatigue, headache, depression, insomnia, and memory impairment may be present. There are no laboratory tests to diagnose fibromyalgia, but on examination there are at least 11 trigger points on the body. Trigger points
are areas that are sensitive to pressure and elicit more pain than would be expected from the amount of pressure applied. There is no known cure for fibromyalgia, but symptoms can be improved with gradual exercise, rest, and medication for pain such as Advil, Aleeve, and Ultram. Cymbalta, Lyrica, Neurontin, and Savella are additional medications that may help to alleviate the symptoms. Some patients have had relief with accupuncture, massage, or Yoga.

Other ailments that frequently accompany fibromyalgia are migraine, irritable bowel syndrome, temporomandibular joint syndrome, and bipolar disorder. Fibromyalgia is not life threatening but can cause much discomfort and impair an individual’s ability to work. It may last for many years.


WHAT BLACK MEN NEED TO KNOW
ABOUT HEART DISEASE

Black men are an endangered species. As long ago as the eighteenth century, when the demographer Hoffman surveyed the health of the slave population of the United States and predicted that blacks would be extinct by the year 2000 because of their poor physical status, there has been grave concern about whether African American men were going to survive. This concern was so great that slave owners and others dealing in the traffic of slavery felt it necessary to insure the lives of their most precious commodity. It is to the perpetual discredit of some of our most prominent insurance companies and banking institutions that they funded these slaveholders and insured their human property against loss; this meant that slave holders did not have to worry about keeping their charges in good health, because if they died, their masters would be compensated. Read more...


FACTS ABOUT GOUT

Gout is becoming much more prevalent than it used to be because we are living longer (it occurs more frequently as we age ),we are more obese, and our diet puts us at risk for Gout.

Kidney disease is the most common cause of Gout, but genetics may also be important.

Overproduction or decreased excretion of uric acid leads to an accumulation in the blood and results in uric acid crystals precipitating and getting deposited in the joints, skin, and kidneys causing arthritis, tophi (nodules under the skin),kidney stones, and kidney disease. Gouty arthritis is characterized by sudden acute attacks of pain in one or more joints interspersed with pain free intervals, often the joint at the base of the great toe is involved ,and it becomes swollen, hot, red, and exquisitely tender. Kidney stones are made up of uric acid crystals.

Treatment is with allopurinol or febuxostol, which inhibit the formation of uric acid, or probenecid to increase the excretion of uric acid. The flares(acute attacks)are treated with ibuprofen, Indocin, colchicine, or cortisone to relieve the pain, after which allopurinol is started to lower the blood level of uric acid and which should be maintained at 6 mg or less. If the uric acid level is
elevated, but there are no symptoms present, there is no need for treatment. Flares can occur due to the use of thiazide diuretics, alcohol,, red meat, organ meat( liver, sweetbreads, hearts,or brain), small fish(sardines,herring, anchovies), shellfish (shrimp, lobster, crab), mushrooms, asparagus, cauliflower, spinach, sweets, or fatty foods.

There is no cure but the complications of Gout can be controlled by the above measures.


Newer medications for the treatment of Diabetes
Byetta, Januvia, & Victoza

Byetta & Victoza are given by daily injections that stimulate the secretion of insulin in response to food ( this lowers the blood sugar). They also Inhibit the secretion of glucagon (which normally raises the blood sugar), they act on the stomach delaying the passage of food and they decrease the appetite which encourages weight loss.

All of these actions tend to lower cholesterol, lower blood pressure, and lower blood sugar. These effects are similar to those produced by a substance called GLP-1 that is produced by the intestine.

Januvia prolongs the activity of GLP-1 in the body making the GLP-1 more effective. Januvia comes in tablet form so that the diabetic patient does not have to give himself an injection as he/she would with Byetta or Victoza.

These medications rarely have side effects, and do not cause hypoglycemia.They are usually used with other antidiabetic medications and can result in much better control of diabetes. Importantly they decrease the risk of atherosclerosis (hardening of the arteries) ,which is the number one cause of death in diabetics.

DISCLAIMER

The above content should not be considered a substitute for medical advice from your physician. You should talk to your medical professionals for diagnosis and treatment. None of the information represents or warrants that any particular drug or treatment is safe, appropriate, or effective for you.