Sample Articles: April-June 2006

Solving the Medicare Part D Puzzle

Ann Marie Grande, MS, RD Benefits Assistance Program Manager
Area Agency on Aging, Region One

Just like a puzzle, the new Medicare Prescription Drug Coverage, also called "Part D", has many pieces to consider. The amount of information and number of drug plans may be overwhelming for the Medicare beneficiary. Help in solving this puzzle is available through the Benefits Assistance Program (BAP), part of a national network of State Health Insurance Assistance Programs (SHIP). The BAP is a program of the Area Agency on Aging, Region One that can provide information, education and assistance to people on Medicare. In particular, BAP counselors can assist individuals on a one-to-one basis in choosing the Medicare Prescription Drug Plan that meets their specific needs.

The following "Quick Facts About Medicare's New Prescription Drug Coverage" will answer most of your questions about this new Medicare benefit.

What is the new coverage? Beginning January 1, 2006, individuals enrolled in Medicare will be able to get prescription drug coverage through Medicare. Private insurance companies will provide this coverage through stand-alone Medicare Prescription Drug Plans (drug coverage only) or Medicare Advantage Prescription Drug Plans (drug coverage + medical benefits). The deadline for enrollment is May 15, 2006.

How much will it cost? Your total cost includes your drug plan premium, deductible, co-payments or co-insurance for each prescription and any drug costs during the coverage gap (time period in which you may pay 100% of drug costs). In most cases, you should look for plans that have the lowest TOTAL cost each year for your prescriptions.

The basic coverage looks like this:
• monthly premium of about $28 (average for AZ)
• annual deductible between $0 and $250
• 0% to 25% co-insurance (or co-pays) for the next $2,000 of drugs
• 100% of medication cost between $2,250 and $5,100 worth of drugs   (coverage gap period)
• Catastrophic Coverage: after your out-of-pocket drug expenses total   $3,600 (not including your monthly premium), you pay either a co-pay of   $2/generic or $5/brand or 5% coinsurance for each prescription   (whichever is greater).

How do I choose a drug plan? You will need to pick a plan that covers the medications you take. Each drug plan may have a different list of drugs covered by that plan. It is very important that you check the plan’s drug formulary before choosing a plan. Also, you must choose a plan that is accepted at the pharmacy where you wish to purchase your medications - not all plans are accepted at all pharmacies. You should consider your annual drug costs. If your drug costs are low, you may want to consider a plan with a low premium. If your drug costs are high (above $2,250), you may want to consider a plan that provides coverage during the coverage gap period.

What if I forget to choose a plan by May? Your next opportunity to enroll in a Medicare Prescription Drug Plan will be the next open enrollment period starting November 15, 2006 with coverage starting January 1, 2007. You will also be assessed a premium penalty of 1% per month for every month you waited to enroll after May of 2006 unless you have creditable coverage through another drug plan.

What if I already have prescription drug coverage? In some cases you may be able to keep your current prescription plan and not join a Medicare drug plan. If you have other drug coverage through employment, retirement or a supplemental insurance policy, you should have received notification from your insurance company letting you know if your current coverage is "creditable", as good as or better than the new Medicare drug coverage. Be sure to know this information before signing up for a Medicare plan - you may not be able to have both.

How will I sort through all the plans? There are many plans to choose from in Arizona. Information on specific plans is available in the Medicare & You 2006 book, on-line at www.medicare.gov, by calling the Benefits Assistance Program at 602-264-2255 or the 24-hour Senior HELP LINE at 602-264-4357.

How do I join a Medicare Prescription Drug Plan? You've done all your homework, decided on the plan that is best for you and now you want to join the plan.

You can join by:
• Enrolling on-line at the drug plan's website
• Enrolling at www.medicare.gov using the link to the Prescription Drug   Plan Finder
• Calling the drug plan - either enroll over the phone or ask them to mail   you an application
• Calling the Benefits Assistance Program at 602-264-2255
-------------------------------------------------------------

Erectile Dysfunction’s Heart Risks May Be Offset By Healthy Lifestyle

American Heart Association
Arthur L. Burnett, M.D., and Elizabeth A. Platz, Sc.D., M.P.H

Eighteen million American men — nearly one in five, age 20 and older — have erectile dysfunction (ED) and are at greater risk of heart disease, researchers said at the American Heart Association’s 46th Annual Conference on Cardiovascular Disease Epidemiology and Prevention.

“ We found a link between cardiovascular risk factors and ED – which may motivate men to make healthy lifestyle changes,” said Elizabeth Selvin, Ph.D., M.P.H., lead author of the study and a research fellow at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD.

“ Lifestyle changes, especially increasing exercise level, may prevent ED,” she said. “The associations between ED and diabetes and other known cardiovascular risk factors should serve as powerful motivators for male patients for whom diet and lifestyle changes are needed to improve their cardiovascular risk profile.”

She said the data suggest physical activity and other measures that prevent cardiovascular disease and diabetes also may prevent or decrease ED. Furthermore, the high prevalence of diabetes and high blood pressure in men with ED suggests that physicians should screen patients reporting ED for these risk factors.

Researchers reviewed data from 2,216 adult male participants in the 2001-02 National Health and Nutrition Examination Survey (NHANES) — data representative of the non-institutionalized U.S. adult male population.

When asked about their “ability to get and keep an erection adequate for satisfactory intercourse,” men responded with “always,” “usually,” “sometimes” or “never.” In this study, ED was defined as “sometimes able” or “never able” to get and keep an erection. Men who reported being “always or almost always able” or “usually able” to get and keep an erection were categorized as not having ED.

The overall prevalence of ED in the general U.S. male population age 20 years and older was 18.4 percent. Applying this value to the 2000 U.S. Census population age 20 and older, suggests 18 million men in the country have ED, Selvin said.

She said the self-reported data is reliable. “Self-report is the way ED is evaluated and diagnosed in a clinical setting. Furthermore, widespread awareness of the issue during the time of the survey (1999-2000) may have resulted in more accurate reporting of the condition, compared with previous surveys.”

Among other significant findings:
• The prevalence of ED differed markedly by age, ranging from 5 percent in   men age 20 to 40 and up to 70 percent in men age 70 and older.
• One or more cardiovascular risk factors, including high blood pressure,   diabetes and physical inactivity, are also risk factors for ED.
• ED affects more than half of all men with diabetes (aged 20 and over).
• Men with diabetes were 3 times more likely to have ED compared with   men without diabetes, even after accounting for other risk factors.
• Physical inactivity and sedentary behaviors such as TV watching, were   strongly associated with ED.

“ The availability of effective drugs has revolutionized the management of erectile dysfunction, but the burden of the condition in the general adult male population was previously unknown. Our study assessed the prevalence of ED in the general U.S. adult male population, the prevalence of cardiovascular disease risk factors among men with ED, and the associations between cardiovascular risk factors and ED, including physical activity,” she said.

“With the advent of ED treatment, physicians should be aggressive in screening for and managing their middle-aged and older patients with this important quality-of-life issue,” Selvin said.

For additional information on this article or heart disease, visit www.americanheart.org or call 602-414-5353, 800-AHA-USA1.
-------------------------------------------------------------

Eye Health - Your Responsibility!!

Daniel T. McGehee, OD

Two-thirds of the world's blind are women - a staggering statistic if you are a woman, and very scary even if you are not. However, more than half of diagnosed vision impairment may be preventable (that's where the responsibility part comes in), correctable, or treatable. Scheduling, and keeping, an eye examination every year is the most logical first step to addressing your risk of potential vision loss.

Smoking certainly has been a known health risk for many years. Even in the days when the Marlboro Man graced billboards across the country, people were realizing the link between smoking and health maladies. Unfortunately, few realized how dramatic the long-term complications could be from this habit. We now understand more fully how smoking can affect the onset and severity of ocular problems, such as cataracts and macular degeneration.

Since April is Women's Eye Health Month, health care professionals will place an extra emphasis on education about, and prevention of, ocular disease in our nation’s predominant gender. The fact that the average life expectancy of females significantly exceeds males, contributes strongly to the greater incidence of age-related ocular problems in women, robbing them of their most precious sense. As we continue to live longer, this incidence is bound to increase even more, especially for women.

With the advancements in cataract surgical technology, just short of miraculous when you consider what it was like just 15 years ago, the vast majority of people with this aging change will not have to live with the decreased vision associated with the cataract progression. Cataract surgeries are now performed in an outpatient setting in about 15 minutes, without the need for stitching or patching of the eye. In the absence of additional ocular problems, this procedure usually restores vision to the pre-cataract acuity. Routine eye care allows your eye doctor to detect and monitor the progression of your cataract and educate you about your visual options.

Macular degeneration, second on the list of serious age-related, vision robbing, ocular problems, is also on the rise due to our increased longevity. This primarily age-related change to the central retina could take on a very destructive disease-like process in its most aggressive forms, and lead to significant (sometimes severe) central loss of vision. You do not have any control over your risk associated with aging or family history, but decreasing your risk by the cessation of smoking, maintaining a healthy diet, and protecting your eyes from excessive exposure, is a responsibility we should all take seriously.

Dry Eye Syndrome is another common denominator of the aging process that is unavoidable for many of us, especially women. But, how can you be diagnosed with "dry eye" when your eyes are watering all the time? Keep in mind that the problem is really related to lubrication, not wetness. The tear film that coats the surface of the eye is a delicate combination of water, oil, and mucous. As we age, our oil glands are less productive - just look at your skin!! This results in a decrease in natural ocular lubrication, creating a relative "dry eye." The Catch-22 is that the eye responds to this insufficiency by increasing water production and flushing the eye off. Have you ever tasted your tears - they're salty, right? So now you have a dry eye that is washing itself with salt water, and you live in the desert. Even an effective rain dance will not solve your problems for long, due to the pollen and particulates in our desert air. Ocular lubrication is your best defense, but you need to be proactive to keep the tear film efficient. Refresh, Genteal, Theratears, and Systane are just a few of the lubricant eye drops available over the counter at every pharmacy in town. Consult with your eye doctor for his/her recommendation on which may work best for you

In addition to the information you receive from your optometrist or ophthalmologist, Prevent Blindness America www.preventableblindness.org can be a valuable resource in your education about ocular problems. Founded in 1908, PBA is a volunteer organization devoted to eliminating preventable blindness through public education about eye health and safety. Be proactive with your health and diet, lubricate and protect your eyes, make (and keep) your yearly eye examinations, and enjoy our beautiful sunshine.

For questions on this article or any eye conditions, please contact the doctors at Swagel Wootton Hiatt Eye Center (480) 641-3937.
-------------------------------------------------------------

LIVE WITHOUT LIMITS
New Technology Helps Patients With Swallowing

Barbara Feth, PT,MBA HEALTHSOUTH

Imagine a life without eating. Imagine attending a wedding, but not eating the cake. Imagine smelling just-baked cookies and not being able to taste them. Imagine never being able to bite into a ripe juicy apple. Imagine a life without ice cream, or hot dogs, or popcorn, or salad, or meat…imagine what life would be like if you were unable to swallow.

Difficulty with swallowing is called dysphagia. Dysphagia affects 15 million Americans, and nearly 75% of persons who have had a stroke. Many other people with neurological disorders such as multiple sclerosis and ALS also have dysphagia. Dysphagia can also result from medical procedures, neck surgery and radiation.

The danger of dysphagia is a bacterial form of pneumonia caused by foods entering the lungs. Because of the life-threatening consequences, many people with severe dysphagia must take all their food through a feeding tube, while others are put on a modified consistency diet. Diet modifications may involve pureeing all solid foods and/or thickening all thin liquids. People may have absolute restrictions on certain items like meat, nuts, chips or popcorn. They may also be instructed in safety strategies such as maintaining certain postures during eating, having to “double-swallow” after each bite, or turning their neck to avoid food being trapped on the “weak” side.

Speech Therapists are experts in evaluating and treating swallowing difficulties, but until recently their attempts in improving swallowing were rarely successful.

Fortunately for dysphagia sufferers, there is a new therapy that is effective in helping many people regain the ability to safely swallow food. VitalStim therapy uses electric stimulation to help retrain swallowing muscles. Special electrodes are taped to the neck, right over the swallowing muscles, and electric stimulation causes the muscles to contract. Once the stimulation is begun, Speech Therapists work with patients on exercises to strength the swallow, and gradually re-introduce eating as the swallowing improves.

Nikki Parmelly, a Speech Therapist who regularly uses VitalStim, is enthusiastic about the results she has seen. “Most patients have some improvement when using VitalStim,” she told me, “and some of the improvement is astounding.” She told me of patients who had been on feeding tubes for years, but were able to regain the ability to swallow following a course of swallowing therapy using VitalStim. “Some patients have even gone from feeding tube dependency to a completely unrestricted diet.”

Who can benefit from VitalStim? Most patients with dysphagia are candidates for VitalStim therapy. There are a few cases where electric stimulation is not recommended; it cannot be used on patients who have significant muscle spasms of the swallowing muscles, and sometimes the nerves, muscles, and other structures are so damaged by injury or disease that it is not possible to regain the ability to swallow. “But we never know who will be successful and who will not,” said Parmelly, “So in most cases of dysphagia, we will try VitalStim.”

To find out more about VitalStim, information in this article, and other advances in rehabilitation that can assist people who have disability from stroke, spinal cord injury, accidents, surgery, or illness, please call HEALTHSOUTH Scottsdale Rehabilitation Hospital at 480-551-5471.