Don’t Overdo It in Pursuit of a Perfect Beach Body

By David Martin, President and CEO of VeinInnovations

What’s a better indicator that summer is coming: the first day you have to remove your jacket outside or the magazine headlines promising “The Ultimate Beach Body Workout” inside their pages? The pressure to be fit (but more importantly, thin) ramps up when the weather warms. Winter holidays centered on family and feasting contribute an extra pound or two every year. Sweater weather is a cover for weight gain, but the summer heat forces us to leave little to the imagination. Don’t jump into a crash diet or a masochistic exercise regimen in fear of the beach! Moderation is key, even when pursuing healthy activities.

A troubling tendency of those in a hurry to get fit is to push through the pain, heeding that outdated adage, “No pain, no gain.” There’s a distinct difference in using your last ounce of resolve to sprint at the end of your race and ignoring an aching joint in your knee so you don’t miss a morning run. You know your body. It’s there with you through everything from the winter nights spent on the couch to boot camp on a summer morning. Know the difference between good pain (the kind you should push through) and bad pain (your body’s way of saying it needs attention and a break.)

After a workout, good pain is indicated when there’s a general feeling of soreness throughout your body. That’s the best kind of tired. After a cool down and a shower, you’ll be ready for a good night’s sleep. If you feel pain in a specific place after a workout (be it your knees, shoulder, or back) take a break. You’ve overdone it.

Did your arm muscles start to burn while you did pushups? That heat is good pain and should dissipate soon after your finish your set. You might even be ready for another ten after your break! Did your shoulder feel pinched during your pushups? Does it hurt after you’ve stopped? Don’t attempt that next set.

Have you started taking runs around Chastain Park in the morning? You should feel tired and ready for a drink of water when you’ve finished the loop. Pushing past your fatigue to finish that last mile helps you get faster and stronger. If your knees are aching or your leg muscles feel as tight as rubber bands, you went past the point of healthy and veered into foolhardy.

I mention running in this list of good pain/bad pain because runners are trained to keep going. Mental tenacity is vital for a marathon runner. They’re aren’t many people who see mile 18 come and go and can still keep the pace until the end of mile 26. The same mental tenacity that keeps runners going until to the finish line is the same mindset that sometimes keeps them from acknowledging their body’s needs.

Remember that a small problem — like symptoms indicating the beginning of shin splints — can be treated easily when you catch it early on. Little problems won’t force you onto the sidelines, but ignoring them may!

When magazines and television and advertising send messages that we’re not good enough as we are, it’s hard not to feel pressured. Maybe it is a good goal for you to get in shape. But remember, the women and men on the magazine covers have been photoshopped. Be realistic about the goals for your body. By all means, use the warm summer weather to get outside and get exercising. Just to listen to what your body tells you so you can enjoy the whole season and not just the first three weeks!

Still feeling the pressure of the “Beach Body”? I highly recommend this article on “How to Get a Perfect Beach Body.” It should help you ignore the frantic messages of perfection at any cost!

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What Happens to the Uninsured Now That The Health Insurance Marketplaces Are Closed?

By David Martin, President and CEO of VeinInnovations

After a lot of fretting and fussing on 24-hour news channels of both political bents, the health insurance marketplaces opened, did business, and closed. More than seven million Americans purchased insurance while the marketplaces were open, despite a very rocky rollout and multiple protest campaigns. The Obama administration celebrated in public and likely breathed a sigh of relief in private. This week, I’ll cover the “death spiral” and what the uninsured will face until the marketplaces open again in November.

The “Death Spiral”

The term “death spiral” is used in several industries, from accounting to figure skating. In the insurance industry, a death spiral is responsible for the demise of a company. A death spiral is created when the pool of insured people isn’t a healthy blend of healthy and sick people. When people are sick, they use more services. Without enough healthy people paying into the system through premiums, costs rise for the insurance company. The following year, the company is forced to raise premium costs to cover the needs of the sick. When the costs rise, only the truly sick sign up. Costs continue to rise until the system falls apart.

The Obama administration focused a lot of attention on young people. Generally, they’re the healthiest and least likely to need care. What the healthy pay in premiums makes affordable care possible for us when we get sick – it’s what keeps the death spiral at bay. The administration partnered with FunnyorDie, a comedy website with lots of appeal among the young. President Obama even appeared in an episode of Between Two Ferns, a fictional talk show hosted by the painfully awkward Zach Galifianakis. The help of Galifianakis and LeBron James, who also joined in promoting the health insurance marketplaces, was credited by the administration as two of the most effective means of enrolling young people.

Still Uninsured?

If the goal is to insure everyone, some might wonder why the marketplaces close at all. If the marketplaces were available year round, there would be no incentive to buy insurance until you needed it. You’d buy insurance when you were diagnosed with cancer or broke a leg, taking from the pool of money collected through premiums without ever having paid into the system. If you want to buy insurance on the marketplace, you have to do it during the months it’s open for business. This year, there was a surge of last minute applications. (Incidentally, those were the enrollees that pushed the number of newly insured past the seven million person goal.)

The marketplaces will open again on November 15, 2014 and close on February 15, 2015. Until then, the uninsured will be responsible for all of their own health care costs and have to pay a tax penalty.

There are exceptions to the rule, of course. If you lose your job and thus your current coverage, you can use the marketplace. If you get married or divorced, have a baby or adopt a child, you’re able to enroll during the marketplace’s “off season”. The full list of exceptions is available here.

Last week, I wrote about advance directives and how to put one together in Georgia. NPR’s Planet Money covered advance directives and released an informative podcast about the difference directives can make by visiting a town where almost everyone has planned for their death. The podcast is short and well worth the listen! You can listen to the story here.

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Spare Your Loved Ones By Making Your Final Care Wishes Known

By David Martin, President and CEO of VeinInnovations

Today, I’m going to write about a subject most of us find unpleasant — death. Starting a conversation about death, especially when we’re discussing our own death or the death of a family member, is often so difficult that it doesn’t happen. Avoiding discussions about death doesn’t make it any less inevitable, but it can make the eventuality less peaceful.

If we could plan our deaths, we would all gently pass in our homes surrounded by loved ones. The reality is never as easy as we hope, and the burden of final care decisions often falls on family members or a loved one. Without a clear understanding of your wishes for end-of-life care, those decisions can become stressful and painful.

When we take time to decide for ourselves (and put our wishes in writing) we spare our family and the people who love us the unfortunate task of guessing about what we would want. Make your wishes clear and ensure that your decisions about end-of-life care are respected by setting up a living will and appointing a health care proxy. You do not need a lawyer to create a living will or appoint a health care agent, though you may wish to consult with one.

Living Will

A living will is a document that states your wishes when you are no longer able to represent yourself. A living will makes clear the types of medical treatments and-life sustaining measures you want as part of your end-of-life care. The will does not go into effect until two physicians certify that you are unable to make medical decisions in the medical condition specified in your state’s living will law. (This could include terminal illness or permanent unconsciousness). Other stipulations may exist — living will laws vary from state to state. In Georgia, living wills go into effect when we have a terminal condition or are in a persistent comatose condition or persistent vegetative state.

When creating a living will, you will determine what medical intervention you do and do not want. As technology has progressed, we have more choices and must make complex decisions about our death. Do you believe that any and all measures should be taken to keep you alive? Do you believe that when the time comes you would rather abstain from life-sustaining measures? Most religions support the use of living wills, but some are very opposed. You may want to discuss your decisions with a counselor from your religious community such as a priest, rabbi, imam or minister.

Appointing a Health Care Proxy

Just as important as a living will is appointing someone to make health care decisions for you when you are unable to do so. This person should know your wishes and have discussed them with you in-depth. They should be comfortable acting as your agent. You should be able to trust that they will make decisions in accordance with what they know you would want.

Choose a health care agent carefully. Take the time to have the uncomfortable discussion about end-of-life care. When the time comes, your loved ones will be grateful — you’ve made your decisions, which means they aren’t forced to do so for you.

Once you’ve made decisions about end-of-life care, talk to your family, doctor and friends. Let them know your wishes, especially if they may be called on by medical staff. Help them understand why you’ve chosen the care you did and why it matters to you. Don’t leave loved ones guessing!

To learn more about end-of-life care in Georgia, please refer to the following websites:

Understanding the Georgia Living Will
Georgia Advance Directives
Living Wills and Advance Directives for Medical Decisions
Advance Directives

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Spring is Here, and So Are Allergies

By David Martin, President and CEO of VeinInnovations

Temperatures are climbing as the weather begins to reflect what the calendar declared in mid-March – it’s spring! Along with azaleas come allergies, and this year experts anticipate a harsher than usual allergy season. Thank the infamous polar vortex. Winter weather has continued on longer than normal, setting the stage for a sudden, shortened spring. If trees have to make up for lost time and a shorter spring, pines, oaks, and maples eager to reproduce will release higher than average amounts of pollen.

A quick Google search for “2014 allergy season” will show headline after headline decrying this year to be the “worst ever”. Take those headlines with a grain of salt. The same headlines appear when you Google “2013 allergy season”. Still, it’s good to be prepared. The side effects of allergies to mold, pollen and grasses are certainly miserable. We’re all familiar with the sneezing, itching, and stuffed and runny nose that accompanies the burst of plant growth and reproduction each year. If you’re worried about this year and anticipate an extreme (or just annoying) bout with allergies, start taking your allergy medication now.

Allergy Tests

Many common allergies are easily diagnosed and treated by over-the-counter medication. The majority of us know when the pollen count or ragweed is the cause of mild allergic reactions. Mild allergic reactions include hives, itching, watery eyes, runny nose, nasal congestion or a rash. If you treat your symptoms with over the counter medicine and it has no effect, it may be time to contact your doctor. A variety of tests are available to help determine your specific allergies, from dust mites to pet dander.

The most common allergy tests are the scratch test and the patch test. The scratch test is administered in a doctor’s office – one of the (very) rare risks of the test is an extreme allergic reaction, so the staff will want to keep you close to appropriate emergency equipment and medications. The scratch test is simple. A numbered grid is drawn on your inner arm or upper back, then extracts of common allergens are placed on your skin. A tiny needle is used to prick the skin, scratching it into the surface of the skin. The procedure sounds painful, but it isn’t. The needles used are so small, and the prick so tiny, you barely feel it. If you are allergic to a specific allergen, a red wheal (a bump that resembles a mosquito bite) will form.

The patch test is used to determine if a particular substance is causing skin irritation. Patch tests are used to determine your reaction to things such as latex, metals, hair dye or fragrances. The test’s name is its best description. Allergens are placed on patches, then placed on your skin for about 48 hours. Irritated skin at the end of the test indicates a potential allergy.

Every family has an at home remedy favorite. For some, spicy food is the ticket to clear nasal passages. For others, it’s breathing in the steam from a bowl of hot water mixed with horseradish. Your best bet is over-the-counter medication, although spicy food can help if you’ve got the constitution for it!

Update: HB 885 (legalizing limited use of medical marijuana in Georgia) failed last month. The bill’s supporters point to a last minute addition of an unrelated autism mandate. You can read about that issue here and here.

I wrote about the bill, named Haleigh’s Hope, and the bill’s namesake, Haleigh Cox, last month. Since then, Haleigh and her mother have moved to Colorado, where Haleigh has been able to use the cannabidiol oil (CBD) she needs. According to her mother’s Facebook page, the medicine is already helping Haleigh. You can follow their story here.

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When the US Fought, Nurses Were There

By David Martin, RN, CRNFA, President and CEO of VeinInnovations

Certain wartime images become fixed in the American memory. These famous images, like the flag raising at Iwo Jima and the V-J kiss in Times Square, capture the bright moments in dark times. Surrounded by the suffering and privations of war, human compassion takes on a brighter hue. The courage and perseverance of the soldiers at Iwo Jima and the exuberance and relief evident in the kiss in Times Square have secured those images in American memory.

Shining moments during wartime deserve to be remembered and celebrated, but so too does the dangerous, sometimes deadly, work performed behind front lines. In this spirit, this article is dedicated to remembering the role of nurses in American conflict. Today, I’m writing about the American Revolution and the Civil War. Nurses played a vital role supporting military efforts in both conflicts. In these two wars, at least, the history of nursing is also (in part) a history of the role American women played in wartime. Banned from fighting, women were able to contribute through the socially acceptable role of caretaker.

I can’t hope to cover all the accomplishments and details of nursing here, but at the end of this article you’ll find links to more reading material. Please read on! Researching this topic was an enjoyable lesson in American history, especially since I am a nurse, and am also the son of a nurse.

The American Revolution

During the Revolution, the ragtag American army of farmers-turned-foot soldiers brought an entourage along with them. Women and children, now known as “camp followers,” marched in unison with the army hoping for food and safety. The women were often, but not always, wives of soldiers fighting on the front lines. (The front line was usually only a mile or so from where the troops made camp.) Though military resources were strained, even George Washington was loathe to send the followers away. Too often, soldiers would abandon the war to tend to their families.

Camp followers had to earn their keep if they expected rations. In the early days of the war, women washed clothes, cooked, carried water for the troops and worked as seamstresses. Very few were willing to work as nurses. In those days, working with the sick was often the cause of your own demise. Congress and the army preferred female nurses to male ones – with women tending to the sick, dying and injured, men were freed for service in the battlefield.

Reluctance to take up work as a nurse was common. Nursing was possibly the dirtiest job during the war. Much of what nurses did during their long hours of work was clean the hospital and patients. Chamber pots were to be promptly emptied, new patients bathed, old patients given a face and hand wash, linens changed, the hospital swept and finally cleaned with vinegar. All duties were performed, it should be added, amidst the real fear of contracting smallpox or a camp fever.

In 1777, a nurse’s wage was raised to eight dollars a month. Even with good wages, nurses were in short supply throughout the war, and women were often bribed or threatened into a nursing role. Regiments across the colonies struggled to find enough nurses to meet demand throughout the war.

The Civil War

Since the founding of our nation, Americans have struggled with the issue of slavery and how to be a truly united country. In 1861, we began the bloody fight that ended slavery and united our nation. By 1865, the South was defeated. Four million men had fought in the war. It’s estimated that 750,000 perished.

Both the Confederate and Union armies employed nurses. Dorothea Dix was appointed Superintendent of Women Nurses by the Union in 1861. Under her leadership, 3,200 women served. Requirements were stringent. Nurses had to be married, over 30, matronly in appearance, and have two letters of recommendation. Nurses were also expected to pay their own way. For their service, they were paid 40 cents and day and provided one ration.

The Union army was unprepared for the treatment of casualties, a fact the Union nurse Clara Barton recognized early in the war. In 1862, Barton successfully petitioned the military to provide supplies and personal aid on the battlefield, which she and others delivered to the front for the next two years. She was dubbed “The Angel of the Battlefield” after surprising Union surgeons with wagons of much-needed medical supplies while the battle of Antietam was still being fought. Barton’s commitment to care continued after the war was over. She went on to found the American Red Cross. Barton’s life and work is, put simply, incredible. There is not enough space to properly discuss her accomplishments here. Please follow this link to the American Red Cross to learn more.

In the Confederacy, women were also called upon to minister to the wounded. Kate Cumming, a native Scotswoman who immigrated to North America as a young child, felt called to nursing in 1862. Most nurses only served short tours. Cumming worked from 1862 until the end of the war. Her life in Civil War hospitals is chronicled in her book, A Journal of Hospital Life in the Confederate Army of Tennessee from the Battle of Shiloh to the End of the War. Her work is an important primary resource shedding light on the conditions endured by medical professionals and patients alike.

On both sides on the war, nurses faced danger, privation and exposure to disease. Though germ theory (which states that specific diseases are caused by specific microorganisms) was developed beginning in the 1850s, it was not fully accepted until the 1920s. Many lives might have been saved in the Civil War had germ theory been more widely accepted. Two-thirds of the casualties in the war were caused by disease, not mortal injury. The most infamous treatment (and also likely overused) was amputation. Soldiers under the knife faced more than the risk of bleeding - few surgeons understood the necessity of sterilization and the risk of infection.

Civil War nurses tended to the wounded where they fell. For Union nurses like Barton, that meant travelling to the front. For Confederate women, it meant tending to the wounded in their homes and on their fields. Soldiers on both sides of the war owed a debt of gratitude (and often, their lives) to the nurses that risked their own lives to care for them.

Further Reading

Thomas Jefferson: Quotations on Slavery and Emancipation

The Roles of Women in the Revolutionary War

Women’s Service with the Revolutionary Army

New Estimate Raises Civil War Death Toll

American Red Cross Founder Clara Barton

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Debunking the Myths of Heart Disease

By David Martin, President and CEO of VeinInnovations

The statistics surrounding heart disease are shocking. Heart disease is behind one of every four deaths in the United States, about 600,000 deaths a year. Our cultural image of a person having a heart attack is almost exclusively a middle-aged man clutching his arm and asking for a doctor, but in reality women are more likely to suffer a heart attack.

One in three women die of heart disease. Too often, women ignore the warning signs of a heart attack because they subscribe to the popular myths that heart disease primarily affects men and older people, and women only if they are obese or unfit. Another popular misconception is that the only real symptom of a heart attack is chest pain.

Although many assume heart disease is a man’s disease, more women die from heart disease than men. One of the reasons this assumption exists? Marketing. Think back: how many ads and PSAs have you seen promoting breast cancer awareness or a walk “For the Cure”? While breast cancer (and general cancer awareness) are overall positive influences, women should know that the most pressing risk to their health stems from heart disease. Happily, the same practice — regular, strenuous exercise — can reduce your risk of both breast cancer and heart disease!

Cultural narrative and media influence also lead most Americans to believe that a heart attack only affects older individuals. Most of us believe that a heart attack is caused by the wear and tear of life — clogged arteries caused by overeating, sedentary lifestyle and high cholesterol. While risks of a heart attack do increase with age, young women should know that they are not immune to having one. Use of birth control and smoking can increase the risk of heart disease by 20 percent. Underlying heart conditions are a risk factor many women don’t know about until they’ve already suffered a heart attack.

Obesity and a sedentary lifestyle are risk factors for many diseases and a cause of early death for many Americans. However, fit women who exercise regularly and pride themselves on twice-weekly visits to the gym should be aware that they are still at risk for heart disease and heart attack. Family history plays a large role. If your family is prone to heart disease, the American Heart Association recommends you start requesting a cholesterol check at age 20 and that your provider keep an eye on your blood pressure as well.

We imagine that the overwhelming majority of people who have heart attacks are obese or overweight. Heart disease affects everyone. Our overwhelming tendency to equate slim with healthy is damaging to everyone, regardless of body shape. Hopefully, those with faster metabolisms and slimmer figures know that if they don’t exercise and eat properly they’re no better off than people carrying a few extra pounds.

Finally, let’s discuss symptoms. On television, the symptoms depicted are chest pain and a funny, awful feeling in the left arm, but there are many more signs. One of the reasons women are more likely to die of a heart attack than men is that they fail to recognize the symptoms. Some signs of heart attack are more pronounced in women. Below is a list of heart attack symptoms common for both men and women followed by symptoms that are more common in women.

Symptoms of Heart Attack in Men and Women

  • Shortness of breath
  • Feelings of anxiety, fatigue and weakness that can’t be explained but worsen with exertion
  • Stomach pain
  • Dizziness
  • Nausea
  • Severe chest pain
  • Pressure and tightness in the chest, usually lasting for a couple minutes, sometimes coming in waves
  • Paleness and clammy sweat

Pronounced Symptoms of Heart Attack in Women

  • Pain in your back, neck, ankle, shoulder blades or stomach
  • Jaw pain
  • Lightheadedness, sweating
  • Nausea or vomiting
  • Overwhelming/unusual fatigue

Heart disease is a major killer of both men and women in the United States. The facts deserve space in the media and in our cultural narrative. Lives hang in the balance, so spread the word!

 

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Moderation the Key to Screen Time for Children

By David Martin, President and CEO of VeinInnovations

If you watch a sitcom featuring new parents, at some point the plot will involve selecting and getting into comically competitive preschools because if your child doesn’t get into the “right” preschool, how will she ever succeed?

Hyperbole employed by TV producers aside, our society values early learning. We have come to understand just how much of an impact those first few years make and a slew of on-screen products, from apps to TV shows, promise to educate our smallest children and are aggressively marketed to parents.

Sixty-one percent of Americans own a smartphone. Forty percent of families own a tablet in 2014, as compared to only 8 percent of families tablet in 2011. TV is still the king screen — 96.7 percent of Americans own a TV.

A host of apps for these smartphones purport to educate their tiny users. These tools are new and rapidly evolving, so researchers don’t have enough evidence to make a clear case for their educational utility. Parenting.com published their top ten educational picks. One pick, the Green Eggs and Ham app, is an ebook that highlights the written words as the narrator reads. Another teaches preschoolers letters, numbers and shapes with colorful fish under the sea. If parents choose to use educational apps, they should be picky. Find interactive media that requires active participation and join in while your child uses the app.

Active participation is a key difference in determining the kind of screen time for young children. The American Academy of Pediatrics once decreed that children under two should not be allowed any screen time. Last year, the organization clarified their recommendation, stipulating that children under two should not engage in passive screen time.

Passive screen time includes allowing your child to watch a show or movie or leaving a TV turned on in the background. Active screen time, however, may be of value. Skype, Google Hangouts and other video-conferencing services can be educational. The child can actively communicate with a live human. The social interaction that occurs through Skype can encourage children to learn from the parents, grandparents or friends on the other end of the screen.

Moderation is the best guideline. Keep screen time, regardless of its purported educational value, to a minimum. For older children, try to limit time in front a screen to two hours or less a day. All that being said, it’s important not to get hung up on the “rules.” Anyone with a child knows that stepping away to take a shower or make lunch while a toddler demands your attention can be difficult. If you need to turn on Dora or Doc McStuffins, relax. A little bit of screen time does not a preschool dropout make.

If parents want their children to tune out of tuning in to the TV, they need to remember that “Do as I say, not as I do,” rarely works. A 2013 study concluded that for every hour parents spend watching TV, their children watched 23 minutes. The amount of television watched by parents affected children’s screen time more than eliminating TVs from the bedroom and setting clear rules governing TV time. If parents spend their leisure time in front of the TV, then kids do, too.

Update: Several months ago, I wrote about how exercise can lower the risk of breast cancer in women. Researchers in France recently released a study that followed 4 million women from 1987 to 2013. The study affirms last year’s findings! The more active you are, the lower your cancer risk. The study I reported on found that women might be able to reduce their cancer risk by 25 percent — the French study showed a 12 percent reduction in risk. That’s still an excellent number. And the added benefits of exercise are worth the work!

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Will Nurse Practitioners Help Meet Primary Care Demand?

By David Martin, President and CEO of VeinInnovations

Imagine going to the doctor’s office. You need care and a prescription. Now imagine that you don’t need to see a doctor for the healthcare you need. Instead of a physician, a nurse attends to all your needs and you walk out the door prescription in hand. In some states concerned about the predicted doctor shortage, that scenario is already a reality. For years, experts have worried about a potential doctor shortage, citing an aging population, aging (and retiring) doctors, and, in the advent of the Affordable Care Act, a strain on the system as the ranks of the insured grow. To fill the gaps and meet the growing demand for healthcare, some states are changing their laws to provide nurses with the authority to treat patients independent of physician supervision.

In California, a patient can get one-on-one primary care and the prescription medication they need from a nurse. Although patients don’t see a doctor, a physician is still involved behind the scenes. At the Glide Health Services clinic in San Francisco, nurses treat patients all week but a doctor comes to consult on difficult cases and sign off on various forms. 30 million Americans are expected to gain insurance over the next decade and we need providers to care for them. Nurses have been, and will continue to be, a vital part of our healthcare infrastructure. Expanding the role nurses play could be especially helpful as their training time is shorter than that of physicians. Though the training period is shorter, it is rigorous. To become a nurse practitioner, candidates must first become a registered nurse, then complete a masters degree followed by up to 700 hours of supervised clinical experience. In 2012, the National Association of Governors found that nurse practitioner care is similar to physician-provided care on several process and outcome measures.

As the American healthcare system expands, we must meet demand with caring and competent providers. In 17 states and the District of Columbia, nurses are allowed to practice indepently. How independently varies widely from state to state. Advocates for expanded nurse practitioner care, like the American Nurses Association, contend that insurance companies can hamper the ability of nurses to practice by writing policies that make reimbursement difficult. Nurses are often unable to bill insurers directly for services provided to patients, making independent practice difficult or unfeasible. Physician’s groups impose their own roadblocks by opposing nurse practitioner pushes to operate independently. Many physicians argue that without the team approach of nurse care with physician oversight, patients will be put at risk. Further, the physician groups question if expanded independence will actually lead to greater access to healthcare.

Nurse practitioner groups have appealed to the White House for help, asking the Obama administration to require insurers to include their practices and services in the new plans offered to consumers through the ACA insurance marketplaces. In 2013, the administration declined to do so, but did agree to “continue assessing” the situation. In Massachusetts, the flagship state of healthcare reform, lawmakers required insurers to reimburse nurse practitioners as primary care providers. The result was not as effective as nurses hoped because insurers are still able to write restrictive reimbursement policies. Although there are now more than 6,000 nurse practitioners in Massachusetts, very few are credentialed by major insurers. As other states follow suit and expand the authority of nurses, the industry (and the administration) will follow the effects on patients and overall access to care closely.

Readers who need insurance (or know someone that does) should be advised: the Affordable Care Act marketplaces will close at the end of March. If you don’t get insurance through the marketplace before March 31, you’ll be unable to get coverage until the marketplace opens again on November 15. Remember – if you don’t have coverage, but do get sick in the intervening months, you will not qualify for coverage. You’ll be on your own for all health care costs in the interim period. (Certain milestones, such as marriage, divorce, the birth or adoption of a child or the loss of a job will qualify you for a special enrollment period while the market is closed.) Remember, too, that the tax penalty for going uninsured begins this year. You will pay either 1% of your yearly household income or a $95 fee – whichever amount is higher. Visit HealthCare.gov to get a more in-depth explanation.  

Finally, a brief update on Haleigh Cox, the eponymous inspiration behind Haleigh’s Hope Act. She and her mother are settled in Colorado Springs. Her parents hope she will soon have access to CBD treatment. If you’d like to follow her story, you can do so on her Facebook page.

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Will Medical Marijuana Become Reality in Georgia?

By David Martin, President and CEO of VeinInnovations

In recent years, no drug has been as heavily debated and discussed as marijuana. In 2013, voters in Colorado and Washington approved resolutions to legalize recreational use of marijuana. In January, recreational sales began in Colorado, and estimated tax revenue from sales has already been revised upwards.

Recreational use aside, the wider availability of marijuana benefits those who rely on the plant for medical needs. Marijuana is an effective pain reliever and safe alternative to opioids (like morphine and oxycodone) when appropriate. A growing body of evidence supporting marijuana’s legitimate medical use and benefits to patients has inspired public figures from lawmakers to well-known figures in medical journalism to advocate for medical marijuana.

It may surprise readers to learn that Georgia may become the first state in the South to legalize medical marijuana. In February, the Health and Human Services Committee unanimously approved a bill to permit medical marijuana to be grown and used in our state.

The scope of the bill is limited. The marijuana could be only be used to treat patients with cancer, glaucoma and seizure disorders. In March, the bill passed in the House, 171-4. Don’t anticipate availability just yet; the bill has to pass in the State Senate first and be signed into law by Governor Deal. If the bill gets a signature, implementation will take significant time as the state determines how to comply with federal law and regulation.

The legislation waiting on a vote in the Georgia Senate is called Haleigh’s Hope Act. Haleigh Cox is a four-year-old Georgia girl with epilepsy. She, and children like her, endure multiple seizures every day. Haleigh sometimes endures 100 seizures in a day. Although Haleigh receives excellent care, her seizures continue.

Children with Haleigh’s condition have found relief with a non-psychoactive marijuana derivative called cannabidiol (CBD). As federal law now stands, Colorado may produce CBD but cannot send the oil across state lines to patients who may benefit from its use. Haleigh’s mother, Janéa Cox, announced via the family Facebook page, titled Hope for Haleigh, that they are moving to Colorado this month in order to access the new treatment. CBD is not a guaranteed cure-all, but the family hopes Haleigh will see a significant reduction in seizures.

Pro-marijuana organizations like Georgia CARE (Campaign for Access, Reform, and Education) and the Georgia chapters of NORML (National Organization for the Reform of Marijuana Laws) have campaigned for years to liberalize marijuana laws and bring medical marijuana to Georgia. They will continue to do so even if the latest legislation passes. Critics of the bill say that it is too restrictive and that Georgia lawmakers need more time to study federal law so the state doesn’t run afoul of the national government.

As marijuana laws are liberalized across the country, we as a populace and a state should examine new evidence, and closely watch as Colorado and Washington implement their new recreational marijuana laws. As public opinion continues to shift towards liberalization, it’s unlikely they’ll be the last states to implement such laws.

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ADHD Symptoms, Diagnosis and Management

David Martin, Founder and CEO of VeinInnovations

David Martin, Founder and CEO of VeinInnovations

Jonquils and snowdrops are starting to bloom as the South begins to shake off an uncharacteristically cold winter. Warm afternoons and sunshine are enough to distract the most dedicated among us from our work. As adults, managing our attention spans to focus on the task at hand is a vital skill. We start to learn the importance of focus, as well as ways to manage our time as children.

In recent years, doctors and public health officials have watched as increasing numbers of children, especially boys, are diagnosed with attention deficit hyperactivity disorder (ADHD). In the U.S., the rates of ADHD have increased annually by 5.5 percent from 2003 to 2007. (Globally, the trend is a 3 percent annual increase.) Today, I’m sharing a brief overview of one of the most common childhood disorders.

ADHD Symptoms

The most recent version of the DSM (Diagnostic and Statistical Manual – released by the American Psychiatric Association in 2013) defines the criteria for ADHD symptoms. To be diagnosed with ADHD, a child must exhibit at least six symptoms of inattention and six symptoms of hyperactivity and impulsivity. Symptoms of inattention include:

  • Easily distracted
  • Often forgetful in daily activity
  • Trouble listening when spoken to directly
  • Reluctance or avoiding tasks like schoolwork or homework that require mental effort over a long period of time
  • Trouble organizing tasks and activities

Symptoms of hyperactivity and impulsivity include:

  • Talking excessively
  • Trouble waiting for their turn
  • Tendency to fidget, tapping fingers and toes or squirming in their seat
  • Often running or climbing in situations where it is not appropriate

ADHD Diagnosis

To properly diagnose a child with ADHD, your health care provider will need to rely on descriptions from parents, daycare providers and teachers and other individuals that spend significant time with your child. A specialist may participate, observing your child during a variety of activities.

Your doctor should rule out the possibility of an underlying cause, such as a vision, language or hearing issue that may be the true cause of a child’s inattention. Learning disabilities should also be ruled out before a diagnosis of ADHD.

As the rates of ADHD diagnosis rapidly rise, many have called attention to the possibility of over diagnosis. Studies have shown that as state and federal standards for schools rise in importance, so do the rates of ADHD diagnosis. Others have argued that drug companies are to blame for the rising rates of ADHD, “selling” the disorder to parents and doctors. There is evidence to suggest that ADHD is over diagnosed, so if you’re worried about your child, make sure to find a doctor willing to be thorough.

Managing ADHD

Once a child is diagnosed with ADHD, treatment may include prescription drugs and behavioral therapy. Parental education can also be helpful, as children with ADHD do not respond as well to traditional parenting tactics. For example, a child with ADHD requires clear, brief instructions instead of long-winded instructions.

Some parents may begin to worry about a child’s diet as the cause. Currently, there is no research that supports the idea that ADHD is caused by a diet high in sugar or a diet that includes foods with additives. But a good diet can help manage ADHD symptoms.

If your child has been diagnosed, have your doctor spend time educating you about methods of treatment and helpful ways to manage ADHD. Entire communities are dedicated to helping parents and children cope with the challenges ADHD presents – remember that children with ADHD can thrive!

Looking for more? Follow these links for in-depth resources.

The CDC ADHD Homepage Covers symptoms, treatment, data and statistics, as well as education and training.

National Institutes of Health: The History of Attention Deficit Hyperactivity Disorder This article is truly in-depth, following the history of ADHD diagnoses back to the 1790s. The history is for the truly curious!

National Institutes of Health: Attention Deficit Hyperactivity Disorder The basics of ADHD.

CHADD A nationally recognized resource, Children and Adults with Attention-Deficit/Hyperactivity Disorder is a great place to learn about managing your individual ADHD and parenting children with ADHD.

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