Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss COVID-19 impact on long term care facilities with Nan Gammill, Executive Director of The Inn at Belden Village.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

Refill your prescriptions at medshoprx.com

Epilepsy is a broad term used to describe people who suffer multiple seizures in their life time.  Seizures are defined as sudden, uncontrolled electrical brain activity.  Depending on how the brain looks at these electrical currents a person may change behavior, display abnormal movement or even lose consciousness.

sale

The LDN Book Edited by Linda Elsegood

Sale Price:$21.00 Original Price:$27.99

As of 2015 about 3.4 million people suffer from epilepsy.1 Most people with epilepsy take one or more medications to prevent seizure activity. However, an estimated 30% of people worldwide do not respond to current FDA approved medications.2 With the rise in popularity of medical marijuana for treatment of epilepsy, scientists have begun to look at opioids again for new uses.  Ultra-low doses of naltrexone along with morphine or cannabis are being studied.

What is low and ultra-low dose naltrexone?

            Naltrexone is currently FDA approved as treatment for opioid and alcohol abuse. Available in pill or as an injection, treatment for opioid and alcohol abuse uses doses from 50mg to 380mg.  Low dose naltrexone broadly refers to dosages below the 50mg mark for opioid and alcohol abuse treatment.3 specifically 0.5mg to 10mg is the studied range when talking about low dose naltrexone. 

Ultra-low dose refers to even smaller doses ranging from 1/1000000000 of a milligram to 1/1000000 of a milligram. To picture how small ultra-low dose naltrexone is think of opioid treatment doses as a swimming pool.  Low doses are a couple of buckets.  Ultra-low doses would be drops.

There is no recommended dose of naltrexone for epilepsy or seizures in humans. The ultra-low doses have only been studied in mice as add-on to opioids and cannabis products.  These doses were administered in injection form.

How does low dose naltrexone work to prevent seizures?

            Ultra-low doses of naltrexone alone do not stop or prevent seizures.  Morphine and cannabis like products work to raise the amount of electrical activity in the brain needed to cause a seizure.  The exact way ultra-low doses of naltrexone works with opioids and cannabis in epilepsy is unknown.  Scientists think ultra-low naltrexone works either to increase the effects of the morphine and cannabis or helps to decrease tolerance.4-6

What are the studies saying about ultra-low dose naltrexone for epilepsy?

            Trials in mice using ultra-low dose naltrexone have been promising.  Data favors further study of ultra-low dose naltrexone with either opioids or cannabis like products.  However, no data yet suggests any safety for trials in humans.  Further animal study is needed to evaluate long term use.  Current trials in mice only looked at one seizure per mouse.4-6 

What are the risks of using low dose naltrexone for seizure control?

            As stated in the above section, current trial data is only for mice after one incident.  The effects of treatment long term have not been evaluated.  Seizure activity may develop again after time on the medications.  Doses tested in mice may not work in humans.

The Medicine Center Pharmacy in New Philadelphia specializes in custom compounded medications in custom dosage forms. The pharmacists are trained experts in low dose naltrexone therapy. LDN therapies can be customized across 23 different dosage forms for 15 different disease state protocols. If you would like to learn more about low dose naltrexone or would like to schedule a phone call or video conference please contact us.

Resources

1.     CDC [Internet]. Epilepsy Fast Facts. Center for disease control: Atlanta (GA); last updated 18 July 2018, accessed 18 April 2020. Available from: https://www.cdc.gov/epilepsy/about/fast-facts.htm

2.     Wahab A. Difficulties in Treatment and Management of Epilepsy and Challenges in New Drug Development. Pharmaceuticals (Basel). 2010 Jul; 3(7): 2090–2110.Published online 2010 Jul 5. Accessed April 2020.

3.     SAMHSA. Naltrexone. Substance Abuse and Mental Health Services Administration. Last updated  September 2019, accessed April 2020. Available from: https://www.samhsa.gov/medication-assisted-treatment/treatment/naltrexone

4.     Honar H, Riazi K, Homayoun H, Sadeghipour H, Rashidi N, Ebrahimkhani MR, et al. Ultra-low dose naltrexone potentiates the anticonvulsant effect of low dose morphine on clonic seizures. Neuroscience. 2004;129(3):733-42.

5.     Bahremand A, Shafaroodi H, Ghasemi M, Nasrabady SE, Gholizadeh S, and Dehpour AR. The cannabinoid anticonvulsant effect on pentylenetetrazole-induced seizure is potentiated by ultra-low dose naltrexone in mice. Epilepsy Res. 2008 Sep;81(1):44-51.

6.     Roshanpour M, Ghasemi M, Riazi K, Rafiei-Tabatabaei N, Ghahremani MH, and Dehpour AR. Tolerance to the anticonvulsant effect of morphine in mice: blockage by ultra-low dose naltrexone. Epilepsy Res. 2009 Feb;83(2-3):261-4.

Physiology of the Disease

Cancer is a condition in which cells within your body divide at an uncontrolled rate. Our body's natural defense against these cells are known as tumor suppressor genes. However, mutations can occur leading to the formation of oncogenes that promote cell growth and reproduction, or suppression of tumor suppressor genes. When this occurs, the cells divide rapidly leading to tumors or large masses and cause your bodies other healthy cells to die. These cancerous cells can then travel to other parts of your body through the bloodstream via a process known as metastasis. When this occurs, the cancer can continue to grow in these areas making it much more difficult to treat.

LDN – How it Works

At its intended doses of 50-100 mg, naltrexone is an opioid antagonist used in the treatment of addiction. However, when used at much lower doses, naltrexone is known to act as an anti-inflammatory agent. As we used LDN more and more, and involve it in animal and human studies, we have found it to be useful in many other conditions such as cancer. Although we do not know the full mechanism of action for benefit in cancer patients, here are some proposed mechanisms:

●      Intermittent dosing significantly reduced cancer cell development, in contrast to a constant blockade that accelerated tumor growth

●      May enhance natural killer cells, T-Cell, IL-2, and TH-2 activity via the mu receptor and also by binding to receptors on cancer cells themselves. These cells are the major players in our body’s natural immune system

●      LDN causes increased cell death in certain cancers and potentially increases patient response to chemotherapy agents

●      Cells that are treated with LDN up-regulate BAD and BIK1 genes that aid in cell death

●      Some cancer patients treated with intermittent LDN, experienced greater benefit by chemotherapy drugs

o   Example: Priming HCT116 with LDN before treatment with oxaliplatin significantly increased cell ki

Effectiveness

            Naltrexone’s potential for cancer prevention and treatment began mainly from the work of Penn State investigators Ian Zagon and his colleagues. They initially studied and published evidence that a dose of 0.1mg/kg in mice reduced neuroblastoma tumor incidence by 66%, slowed tumor growth by 98% and increased survival by 36% over controls.

            More recent publications include that from Liu et al in 2016 who published that cells treated with LDN followed by chemotherapy always resulted in a greater reduction in cell number and viability when compared to cells cultured with LDN after chemotherapy treatment. However, in cells treated with standard NTX, treatment with any of the cytotoxic drugs did not generally result in dramatic reductions in cell number or viability.

            Another researcher, Dr.Bernard Bihari has reported he has treated about 450 cancer patients with LDN, and he reports that over 270 patients had significant benefits from LDN. Of those patients, 86 of them had shown objective signs of decreased tumor size of at least 75%. Another 125 patients were stabilizing or on a path toward remission.

Dosing

Starting doses can be anywhere from 0.5 mg to 1.5 mg, and is increased up to 4.5 mg; which is the maximum dose for Low Dose Naltrexone. Specifically for cancer patients, the dose should be a goal daily for at least 7 days before starting an "on/off cycle"

●      An "on/off cycle" consists of 3 days on and 3 days off LDN

●      The 3 days off should fall directly before chemotherapy treatment. Although there are no known contraindications with chemotherapy, it is recommended to avoid use together until further research is completed

It has been seen in some cancer patients, that taking a CBD product on the 3 days off increases the anti-tumor effect of LDN

Side Effects

LDN is well tolerated in most patients and limited further when a patient is started on a start low and go-slow method. This means the patient should be started at a low dose and titrated up slowly. When side effects occur, they are usually mild and include:

●      Sleep disturbances

●      Mild headache

●      Mild agitation

●      Nausea/GI effects - consider switching to liquid sublingual LDN to bypass GI tract

It has been found in patients that experienced side effects, that they can be stopped by decreasing the dose by half for 2-3 days, and then continuing with titration again.

Formulations

●      Oral liquid: 1 mg/1 mL daily

●      Capsules or tablets

●      Sublingual drops

o   Drops are placed under the tongue from a dropper bottle

●      Creams: 0.5 mg/mL

o   Useful for children who you have difficulty administering the other formulations, or those who are allergic to additives in other formulations of LDN

Key Resources

Boundless. Overview of Cancer [Internet]. Lumen: Boundless Anatomy and Physiology. Available from: https://courses.lumenlearning.com/boundless-ap/chapter/overview-of-cancer/

Brown N, Panksepp J. Low-dose naltrexone for disease prevention and quality of life. Medical Hypotheses. 2009;72(3):333–7.

How Low Dose Naltrexone Works [Internet]. How does Low Dose Naltrexone Work | LDN Research Trust - Low Dose Naltrexone. Available from: https://www.ldnresearchtrust.org/how-naltrexone-works

Low Dose Naltrexone [Internet]. The Low Dose Naltrexone Homepage. Available from: http://www.ldninfo.org/

Toljan K, Vrooman B. Low-Dose Naltrexone (LDN)—Review of Therapeutic Utilization. Medical Sciences. 2018;6(4):82.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss the mental health effects of COVID-19 on our community with Dr. Margaret DeLillo-Storey, Clinical Counselor for Perry Local Schools.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

As the number of cases of COVID-19 increase, so does the associated anxiety. For the general public, the mental health effects of COVID-19 are as important to address as are the physical health effects. For one in five who already have mental health conditions - or the one in two who are at risk of developing them - we need to take personal, professional, and policy measures now to address them.

We speak with Dr. DeLillo-Story and learn how to identify and name the emotions that we are experiencing and talk about how best to help each other.

Video from our Zoom Interview

You Are Not Alone. There is Help Available.

Crisis Intervention and Recovery Center 24/7 Help 330-452-6000

Crisis Intervention (Youth Mobile - comes to home) 330-452-6000

Suicide Prevention Lifeline - 24/7 Help 800-273-8255

Opiate Hotline - 330-454-HELP (4357)

Children’s Protective Services - 330-455-5437

Text for Hope 24/7 Help - 741-741

Perry Police Department 330-478-5121 (Call 911 for 24/7 help)

Canton Police Department 330-649-5800

Podcast Available Here

Hydroxychloroquine (Plaquenil), a popular anti-malaria drug is also used as a primary treatment for Rheumatoid Arthritis and Lupus. In light of the COVID-19 crisis, we have been getting calls from patients that are concerned about maintaining drug therapy due to the nationwide shortage of hydroxychloroquine. Disease flare ups are a common concern with patients of any condition when vital medication is on the FDA shortage list or in limited supply.

What is the Medicine Center Pharmacy’s Role in Hydroxychloroquine Supply Chain?

We received a shipment of bulk powder of the active ingredient hydroxychloroquine. If a patient is having difficulty maintaining their current therapy we can consult with their provider to obtain a prescription to compound capsules or a liquid formulation if necessary. 

Compounding pharmacies use bulk chemical ingredients to formulate patient specific medications. Alternatively, hydroxychloroquine tablet are mass manufactured by large drug companies. You can have confidence in the Medicine Center Pharmacy process as we are a PCAB Accredited Non-Sterile Compounding Facility.

There are treatment options to consider outside of hydroxychloroquine.  Low Dose Naltrexone (LDN) has the potential to be a therapeutic alternative as it has been documented to be effective in many autoimmune conditions. 

Medicine Center Pharmacy accepts most insurance plans. Often insurance companies exclude compounded medications from coverage which has been a very frustrating for patients that depend on insurance for care. In many cases, the cost for a compounded medication is very affordable and often is comparable to insurance copays.

Low-Dose Naltrexone

Patients with autoimmune conditions are finding relief with Low Dose Naltrexone (LDN). The Medicine Center Pharmacy is part of national network of pharmacists that is dedicated to educating patients and providers about alternative treatment therapies and specializes in using LDN for autoimmune and pain conditions.

We have additional resources for Low Dose Naltrexone Education:

written by Jordan Hughes, PharmD Candidate Ohio Northern University

Coronaviruses are one of the largest groups of viruses that we know about in medicine, and it has an extensive range of natural hosts. Recently, newly evolved Coronaviruses have posed a massive threat to public health causing a worldwide pandemic.  The novel coronavirus that causes COVID-19 sparks an inflammatory immune response that is essential to control and eliminate the infection, however, certain immune responses can cause a decrease of gas exchange in the lungs. This causes a huge problem because oxygenation of the blood is essential for human life and is the basis for maintaining function of all major organs. So, will low dose naltrexone target certain immunological markers to ensure that the body does not injure itself during the fight against coronavirus?

Naltrexone is a pure opioid antagonist with activity and many opioid and non-opioid receptors. It is currently used for alcohol use disorders, opioid addictions and obesity. Naltrexone can be used for several different disorders depending on the dosage that is used, and the effects might differ when the doses are changed. Higher doses of naltrexone can be used for impulse control disorders and several other addictions. However, Low Dose Naltrexone (LDN), has been studied and shown promise in the treatment of many diseases such as Crohn’s disease, multiple sclerosis, and chronic fatigue syndrome. Dr. Bernard Bihari, known to some as the father of Low Dose Naltrexone, completed research that showed LDN was used to boost endorphin levels in patients by 3X. These endorphins levels can improve immune function and might be used to help at-risk patients to fight off the Novel Coronavirus infection.

To understand how medications attack and destroy the virus, we need to understand how the virus gets inside the body, how it infects the host, and how it is transmitted to others. Like many other infectious diseases, Coronavirus enters the body through direct contact with direct mucous membranes such as eyes, mouth, or nose. When the virus gets into the body, it will use the body’s own cells to replicate and spread. When the body recognizes the foreign virus, it will send in many natural defenses. These natural defenses will cause a fever, cough, inflammation, possible mucous production, and other symptoms. The virus can then spread from an infected person to others through droplets from a cough, sneeze, or contact with another person. That is why it is essential to follow social distancing guidelines, wash your hands regularly, disinfect areas high touch areas, stay home if you are sick, and wear a mask when you need to go out in public.

The next issue that we need to tackle is clarifying the process of the virus replication and the triggering of the important immune responses. To understand this process, we need look at the shape of the coronavirus.

The coronavirus uses its membrane to protect itself from attack. The spike coming from the outside of the membrane is used to connect to the body’s cells and insert replicating data into the cells to continue to make more of the virus.

The body will recognize the infection and send a variety of immune responses to attack the invader. The body has several natural defenses that are activated by Coronavirus. Some of the defenses are toll-like receptors, IL-6, transforming growth factor beta, and many other pro-inflammatory defenses in the body. These defenses will attack the virus by using complicated pathways and mechanisms. These mechanisms will trigger fever, irritation and inflammation in the lungs, and cough which are the main symptoms of the COVID-19 disease.

Toll Like Receptors (TLR) have several downstream effects when they become activated by an agonist like coronavirus. The downstream products include tumor necrosis factor alpha, IL-6, and inflammatory factor nitric oxide (NO). When low dose naltrexone blocks these TLRs, it inhibits the production of these inflammatory cytokines and acts as an immunomodulator through the suppression of innate immune cells.

Low Dose Naltrexone (LDN) has been proven to reduce several pro-inflammatory cytokines in the treatment of other diseases, but due to the recent discovery of this novel virus, we are unsure of the effectiveness of LDN on this virus. In one study where LDN was used to decrease fibromyalgia pain, the treatment group found reduced plasma levels of many inflammatory cytokines that are also released during immune response to COVID-19. These people found 18% reduction in overall symptoms, and the study suggests that that LDN plays a key role in the reduction of several key pro-inflammatory cytokines and symptoms.

The proposed mechanism by which LDN would work to effectively inhibit the coronavirus from causing severe illness is complicated and theorized. This means that the lungs would become less inflamed and have a larger amount of useful surface area in which oxygen could be passed from the lungs into the blood. When considering the mechanism of the Coronavirus, and the inhibitory effects of LDN, we are proposing the use of LDN to promote treatment and prophylaxis of this new infectious virus. Dr. Phil Boyle, an Irish physician has also proposed the immune enhancing effects of LDN for COVID-19 prophylaxis at doses of 3 mg to 4.5 mg nightly. He claims that daily LDN acts to normalize one’s immune system and could perhaps downregulate an overactive immune system in a time of infection.

When considering the possible benefits in contrast with the risks of using LDN, we should consider prior research to evaluate the likelihood of LDN causing severe adverse reactions. A meta-analysis was conducted analyzing the adverse effects of LDN compared to placebo. This study analyzed 11,194 patients and concluded that LDN does not increase the risk of serious adverse effects over placebo. These studies confirm the overall safety profile of oral LDN in the treatment of patients with varying doses and disease groups. This shows that the use of LDN in patients who are at-risk of contracting COVID-19 safe and highly advantageous.

A vaccine for the novel coronavirus is underway but could take months to years to finally hit the market. However, LDN is available now. With limited treatment options for the Novel Coronavirus and the severity of the disease, it is imperative to search for therapeutic options to improve immune health and reduce the spread of COVID-19. Low Dose Naltrexone could be used as an immune boosting agent for those who are at high risk of contracting the COVID-19 disease. Those who should be considered for this Low Dose Naltrexone therapy include the elderly, those who are immunocompromised, and those who have structural lung disease.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss how pharmacists are educated with Jordan Hughes, Pharm D candidate from Ohio Northern University. We will also discuss how your pharmacy is keeping you safe during this pandemic.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

COVID19 Resources

Ohio Department of Health

CDC COVID-19 Site

Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)

Coronavirus Symptoms vs Influenza Symptoms

Steps to Prevent Illness

Managing Coronavirus-related Stress

Refill your prescriptions at medshoprx.com

To Our Medicine Center Pharmacy Family,

For over 43 years, Medicine Center Pharmacy has been committed to servicing our patients and communities during any circumstance. That commitment still stands today, as we face the difficult challenge of responding to the coronavirus (COVID-19).
 
We will remain open, and we are committed to continuing to service all of our patients. However, there may be changes in the way that you are serviced by us in order to maintain the safest environment for you and our teammates.
 
As this situation continues to evolve, we are closely monitoring guidance from the Centers for Disease Control and Prevention and local health officials. As a result of this, we:

• Hand sanitizer pumps at all of our cash registers

• Have increased our cleaning and sanitation for all of our pharmacies and stores especially focusing on highly used items

• Have policies in place for paid sick leave for our employees, in the event that they are sick or feel sick, they can stay home, or have the option to care for sick relatives 

Our thoughts go out to those who have already been affected by this unprecedented event.
 
We recognize that these are unsettling times. Please rest assured that as circumstances continue to develop, we will send out updates.
 
Thank you for trusting us with your medication needs.

Health Screenings and Educational Seminar Updates

For the time being, we have suspended our in store Lab screenings for Lipid Panels, A1C, TSH, etc...  In addition, we have cancelled our LDN and CBD live seminar on April 7th at the Hampton Inn in New Philadelphia.  We will be conducting this seminar live either on Facebook or Zoom with details to follow soon.

Refill your prescriptions at medshoprx.com

Please support us in the Repository Best of the Best Contest

Coronavirus Resources:

This program aired on March 6th, 2020 and the information detailed in the audio of the podcast was current at that time. We have updated this post with local resources to keep you informed about the developing situation at hand.

Ohio Department of Health

CDC COVID-19 Site

Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)

Coronavirus Symptoms vs Influenza Symptoms

Steps to Prevent Illness

Managing Coronavirus-related Stress

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Colon Cancer Awareness with Dr Kirby Sweitzer, MD, President at Mercy Medical Center Angeline Barbato, RN, Cancer Nurse Navigator.

Coronavirus Resources:

This program aired on March 13th, 2020 and the information detailed in the audio of the podcast was current at that time. We have updated this post with local resources to keep you informed about the developing situation at hand.

Ohio Department of Health

CDC COVID-19 Site

Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)

Coronavirus Symptoms vs Influenza Symptoms

Steps to Prevent Illness

Managing Coronavirus-related Stress

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

Today we're going to talk about colorectal cancer. It is the third most commonly diagnosed cancer and the second leading cause of cancer in death in men and women combined in the United States. The American Cancer Society estimates that 147,000 people will be diagnosed with colorectal cancer and 53,000 could die from this disease in 2020. On average, the lifetime risk of developing colon cancer is about 1 in 23 for men and women combined; however, this varies widely according to individual risk factors. Since the mid 80s, the colorectal cancer survival rate has been increasing, due in part to awareness and screening. By finding polyps and cancer in earlier stages, it's the easiest to treat. Improved treatment options have also contributed to the rise in survival rates.

We'd like to remind our listeners that our program today is also available on our podcast, you can download that from our website or in the app store of your favorite smartphone. Just look for Health Matters with the Medicine Center pharmacy and you can listen to any of our programs anytime. If you have any questions today, you can post them up live on our Facebook feed. [00:30]

Tell us about yourself

Angeline: My name is Angeline Barbato, and I am the colorectal cancer nurse navigator at Mercy Medical Center. As a navigator I am available to our patients with either unknown or newly diagnosed cancer to provide support. [02:48]

Kirby: I'm Kirby Switzer. I’ve been in practice since 1992. I’m boarded both in general surgery and colon rectal surgery. [03:04]

Why is this month so important?

Angeline: It's very important because we can use this month to help raise awareness about colon cancer. And it gives us the opportunity to speak with our family and friends, and also the community about the importance of getting screened. So colorectal cancer is a very preventable disease with early screening. So, if we can use this month to raise awareness and hopefully encourage people to get screened, that's the whole goal and it's wonderful. [03:15]

How common is colon cancer?

Kirby: Well, it's relatively common. Unfortunately, it could be a lot less common if people get screened. And I think that's the thrust that we'd like to emphasize today is that screening, screening, screening can avoid a lot of problems down the road. [03:41]

What are the statistics?

Kirby: Well, it's about 147,000 estimated new cases in 2020. So, that's about 1 in 23 will have lifetime risk of colon cancer. So, it's relatively high risk if you compare it to other diseases. A part of it is because of how colon cancer develops; you have a high turnover of cells in the lining of the colon and the rectum, and those cells can become abnormal and then they basically come out of control and as they grow, then they'll form polyps. Polyps are a new growth lining of the colon. And then as that develops over years, it will turn into cancer. [04:09]

What are the preventive measures for colon cancer?

Angeline: So, the biggest thing we can do to prevent colorectal cancer is to promote that early screening. And other than that, there is definitely a benefit with just promoting an overall healthy lifestyle, that would include eating a diet high in fruits and vegetables, whole grains, promoting an active lifestyle, and avoiding alcohol and smoking. That's definitely good because it's overall just promoting a healthy lifestyle to prevent heart disease, diabetes, all of that as well. [05:08]

 Kirby: Well, you want to focus on green leafy vegetables more than some of the others. [05:52]

When should someone get screened?

Kirby: Well, it depends on your history. So, let's talk about the general population. If you're African American, age 45, American Cancer Society states that age 45 is when everybody should be starting to be screening. Most things in the literature and most societies still say age 50. This is a disease of older people, though, unfortunately, we're seeing more and more younger people who have this disease. [06:06]

Colonoscopy

There are multiple screening devices. So, the biggest screening is history. So, you go to your physician. You talk to them about what are your risk factors? What are your lifestyles? How much are you eating your vegetables? How much are you decreasing your fats and your red meats, which are also associated with colon cancers? And that's then you do other things. So, fecal occult blood testing, there’s a chemical picking up if there is blood in the stool. That can be influenced by a lot of other things, red meats, diet, and other things. So, the FIT test is the fecal immuno testing, which actually looks at specific immunoglobulins which is much more accurate. But none of those are as accurate or as complete as colonoscopy but they are, generally, used in screening. [07:51]

What are the symptoms of colon cancer?

Kirby: Well, early colon cancer has very little symptoms. The number one symptom of any sort of bowel problem, especially colon cancer, is change in bowel habits. Unfortunately, most people have change in bowel habits. It's not colon cancer but it's definitely a red flag that you need to have further workup. Blood in the stool is incredibly important, that's why the fecal occult blood testing has been so popular in the FIT testing, the immuno testing of the stool is also very important because it picks up that small amount of blood. So, what happens with tumor cells is you have a normal cell, it changes in some way, it becomes a kind of a rogue cell that will grow faster and not die out as quickly as normal cells. And so it continues to grow and to propagate, these cells are abnormal so they're more frail. They don't stick as well together, and because of that, there is some bleeding that can occur. So, that is the basic sequence you have polyps form from these rogue cells. And then over the period of time, you have cancers from them.

 The rule of thumb is about three to five years for a polyp to form, and that from these abnormal cells and five to 10 years for a cancer to form from those cells. And that gives us a great opportunity for screening because during that time before cancer actually occurs is the time to pick up these early growths, these neoplasms, these polyps that allow us to actually stop them developing into cancer. [14:23]

What is a polyp?

Kirby: A polyp is a new growth in the colon or the rectum that are from these abnormal cells. So, it can form a mass, it can be flat, it can be pedunculated almost looks like a little tree or bush. But they can be recognized and seen on testing. [16:07]

What can we do to help a patient get screened?

Angeline: Well, part of my job as a navigator is really to just provide them with support and if they have any concerns about the procedure itself, I can give them a pep talk and encourage them, explain the process. A lot of the time, just that pre education helps alleviate the stress. So, as a navigator, again, our job is just to really inform them, be positive, and give them that pep talk to go ahead and proceed with the screening.

Kirby: That's always a difficult situation, because you do have people that are uninsured but even a greater number that are under-insured. And so, a lot of it has to do with the insurance company. What I would say to people is that there are some funds out there to help with screening. There are some sources of help. The problem being is that if you are going to get stuck with a larger bill, you tend to say, “I don't want to have this” or “I don't need this” and you talk yourself into it. Problem is if you don't get screened then the cost and the problem is multiplied later on. [19:29]

What is colonoscopy?

Kirby: So, colonoscopy is a long lighted tube that has a video camera on one end, and you direct this tube like a snake through the twists and turns of the colon. And you can get through the colon most of the time, once in a while you can't, but almost always you can. And if the prep is excellent or are good, you can see these little growths. Polyps come in all shapes and sizes there. There are some flat ones, serrated type polyps. There's ones that form little mounds. There's ones that grow on the stalk, and that's all determined by the type of cell that has changed or has become rogue, not a normal cell. And so as any of the screen device aspects that we talked about earlier, if they are positive, then the next step is to investigate this and that is with a colonoscopy. So, it's a relatively safe procedure. There are some risks to that, but it's very minimal. So, some of the risks include, you can cause some bleeding once again, you can actually perforate or put a hole in the bowel; that happens far less than a quarter of a percent. So, it's relatively safe in that regard. There are some people that don't have sedation with this, but almost always people have some sort of sedation which makes it more comfortable. It makes you kind of forget about it, which is probably a good thing. But this tube doesn't just have a video aspect. It has channels where you can suck out things, you can irrigate clean up areas that are questionable, and you can pass small instruments through that will take bites or are biopsies. You can also pass instruments in there like a snare, almost like a lasso, and you can lasso these polyps and you can take them out. You can use it with just taking them out without any sort of cautery or if you get into some bleeding, you use some cautery on that. And those almost always can be recovered and sent off to pathology for examination. [24:47]

What is the treatment for colon cancer?

Kirby: Hopefully, with screening it's caught very, very early. So, if it’s caught early and it says “minimally invasive”, not through the bowel wall, not in the muscle of the bowel wall, then a lot of times even just removing that area locally is a cure. Most people will do a small resection, and, of course, you want to look at the lymph nodes. So, lymph nodes are very important for staging because that will tell you if it spreads. Colon cancer is one of the types of cancer that has all three types of spread the cancers do.

1. One type of spread is local invasion. So, locally they will grow through the bowel wall, form masses locally.

2. The second type of spread is into the lymph nodes. So, as the cancer grows into the normal bowel wall, the lymphatics are there as with anywhere else in our body, and they'll pick up cells and they'll go to the next filtering area, which is the next lymph node.

3. And then the third way is hematogenous spread or spread through the veins and vessels. So, the colon is drained by veins that go into the portal system or the liver. So, liver is the first area of hematogenous spread, and then the lung is the secondary hematogenous spread of the cancer.

So, when you talk about treatment, you want to say, “Where is the stage of the cancer?” first. And so when you're diagnosed with cancer, you then will go through a process of staging and that will include maybe CAT scans, depending on where it's at, maybe MRIs, you will do bloodwork to look at tumor markers and see where your baseline is or how high those tumor markers are. And then once that's established, then you do the ultimate staging, which is actually a resection. You remove that part of the colon that has the cancer; remove the lymph nodes that drain that cancer. And then, of course, from your earlier staging, if it's in the liver or long, you can biopsy those and that determines a treatment. Hopefully, it's early enough that it can be cured by removing them. We have a saying in surgery “to cut is to cure” and that's often the case but not hundred percent. [27:52]

Is there a topical remedy for the colon?

Kirby: For the colon, not as much. Now, when you talk about anal surgery, which is another whole topic. Most anal cancers, which is the opening of the anus, around the anus, are HPV or Human Papilloma Virus associated. There are topical substances that will help with that: 5-FU creams, things like that. But really inside the colon it's very hard to topically get to that. [30:21]

So, really there's no topical way to treat this. The topical way is to do the endoscopy, the colonoscopy, and to remove anything that’s there. [31:43]

If it's already widely spread then then oftentimes the next move would be chemotherapy because you're treating things outside the colon. If it's located or limited to the colon then the next step is to remove that area. [32:00]

Has there been any advancements?

Kirby: The basic principles are the same. It's been for probably 50-60 years which is remove the diseased segment. How we remove the diseased segment has changed a lot. So, in the 60s, 70s, 50s the treatment was a big open procedure, big incision, a lot of recovery time, a lot of comorbidities, problems with the surgery, hernias, infections, things like that. So, over time we've developed a process that is pretty well delineated now, on how to decrease those risks. And then also the technique. So, when I came out in 1992, laparoscopic colon resections was just being started. So, you use the small holes and you use a laparoscopic, a small camera, and then over the last few years, five years or so, then robotic surgery has really taken this place. And if you look at my career; initially, most of my colon resections that I did for patients with colon cancer, were open. And then it became mostly laparoscopic, and now it's mostly robotic. And there's some great advantages of laparoscopic robotic surgery over the open. It's much less invasive, it's much less stressful on the body. Recovery is so much quicker. And studies have shown that the outcomes are equivalent. [32:47]

Robotic surgery: What’s on the horizon?

Kirby: Well, the technology is incredible. I was just at a meeting a couple years ago in Nashville, and gentlemen presented artificial intelligence tied into the robot and talking about pelvic surgery in low anterior resections all the way down towards the anus is a tough part, and robotic surgery has helped that tremendously because the vision and everything else. But he showed a sample where the computer is using AI, determining where the fat planes were and was actually doing some of the dissection. It was incredible. So, I suspect in the next 5 to 10 years we're going to see a huge advance. [38:32]

What is a Cologuard?

Kirby: A Cologuard is a new screening test that is done basically one stool sample. And it has an aspect that looks at two different things. It looks at some parts of DNA. So, fragments of DNA that is associated with abnormal cells, and also about blood. And so the aspect of it is it's more expensive, of course, but it is also convenient. It also has less, we talked earlier about false negatives and false positives. So, it has less false positives, so there's less work up. And there's less false negatives, so you don't miss as many. But that being said, it's still a screening device. [39:51]

What’s your advice for our listeners?

Kirby: I would say pay attention to your body. If there's any symptoms, don't deny those, get them checked out. And then screening screening, screening. If we find polyps and take them out, those polyps aren't going to turn into cancer. So, screening, I think, is incredibly important.

Angeline: Yes, I definitely agree with screening and I'm just making sure that everyone knows Mercy Cancer Center is here. I’m ready to provide the best care. The nurse navigators are available, and we do have a direct line 330-430-2788 or cantonmercy.org. They can actually fill out a form online, send a question, it goes directly to me and then we can filter out from there and get them started. [42:41]

Summary

As March is Colon Cancer awareness month, this episode was mainly centered towards awareness of colon cancer. We discussed it’s symptoms, treatments, and procedures like colonoscopy and laparoscopy. We also discussed some of the technical advancements in the field. Lastly, our guests gave out some advice for our listeners.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Tips for Staying Safe and Well this Winter.

Coronavirus Resources:

This program aired on March 6th, 2020 and the information detailed in the audio of the podcast was current at that time. We have updated this post with local resources to keep you informed about the developing situation at hand.

Ohio Department of Health

CDC COVID-19 Site

Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)

Coronavirus Symptoms vs Influenza Symptoms

Steps to Prevent Illness

Managing Coronavirus-related Stress

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

**Updated: the New Closing Date for public comments is October 15th, 2020.

Protect your access to customized compounded medications for your pets.

The FDA has released a Guidance for Industry #256 that if approved as is and enforced will directly affect how your veterinarian can provide care for your favorite pet or animal. Below we have outlined some facts with the assistance of PCCA and Alliance for Pharmacy Compounding that are listed to demonstrate the far reaching scope of this prepared to submit to the FDA so that we can share what challenges this will cause for veterinarians, pharmacists, owners, and animals if this guidance document is enforced in its current form.

The policy requires compounded animal medications to be prepared from FDA-approved products with the idea that these deliver better quality active ingredients and better quality to the final compound. FDA currently regulates manufacturers of active ingredients, making the reliance on approved products an unnecessary burden. Further, no evidence is available that compounds made from approved products are of higher quality. In fact, USP has shown failures of compounds using approved products. The end-result is a more expensive compound that is not proven to have higher quality. This unnecessary stipulation will lead to fewer animals being able to receive their needed medications, or sadly, euthanized.  

The Draft Guidance fails to recognize that pharmacists generally lack access to approved animal products to be able to compound with them. Further, the Guidance does not recognize the need for compounds to be made in cases of shortages of animal drugs.  Human drug shortages are no secret in the marketplace.  Products as simple as sodium bicarbonate and cyanocobalamin were in short supply for a considerable amount of time, there is no reason to assume that this is not possible in the animal space.

The Draft Guidance attempts to enter into the practice of veterinary medicine and single out these animal health professionals as the only ones required to document their rationale for their prescription, as opposed to the prescription itself being the expression of their best choice for that individual patient based on their education, training and experience.

The Agency has previously registered its concerns with splitting tablets for the purpose of creating fractional doses; yet, somehow recommends this practice for animal patients rather than compound an appropriate dose. 

The policy on patient specific animal compounds requires that the medication be prepared in compliance with applicable “USP monographs for a compounded finished product.” These formulations are not appropriate for all species and force some animals to be exposed to ingredients that can be detrimental to their health.

USP monographs for compounded formulations do not consistently use FDA-approved products as a source of active ingredients, instead, favoring bulk pharmaceutical ingredients. This directly contradicts the FDA’s other requirement to use approved products as the source of active ingredients.   

The FDA does not have statutory authority to regulate animal compounding from bulk ingredients. Federal law discusses the application of the Agency’s extralabel use provisions to drugs with an approved application as an animal drug. Further, the scope of the Agency’s own regulations state that they apply to “the extralabel use in an animal of any approved new animal drug or approved new human drug” (emphasis added).  

The FDA has no ability to create a positive or negative list of bulk ingredients related to office use of compounded medications for animals. Further, this appears that FDA is once again attempting to apply provisions from DQSA to animal compounding. Congress has chosen for compounding from bulk ingredients to be available for human patients and it is illogical to conclude that they would prohibit or limit this for animal patients in the ways that the Draft Guidance proposes.

Animal owners, Veterinary providers, and pharmacy staff members are encouraged to submit comments to the FDA during this draft period before June 17th, 2020**. You can download a template here and customize it to share your views and make it unique.

**Updated: the New Closing Date is October 15th, 2020.

Submissions can be made on the FDA website at” https://www.regulations.gov/

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss TAVR aortic valve replacement with Dr. Ahmed Sabe, president of the Heart Hospital at Mercy Medical Center in Canton Ohio.

This is a special two part series that is detailed in the attached podcasts.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss coronavirus with Mark Adams, Health Commissioner for Henry County and former Director of Environmental Health at Canton City Health Department.

You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

It is impossible to escape the news and concerns spreading in both our community and globally about coronavirus. Locally as health care professionals who are concerned are directed toward influenza currently. Statistically, we can expect an 8% of the population to develop the flu, 1% of those with influenza to become ill enough to require hospitalization, and 0.05% of people with influence to die from the virus. If you're wondering how the coronavirus compares to influenza and what our state and local health departments are doing about coronavirus.

We'd like to remind our listeners today that our program is available on our podcast. You can search the App Store for “Health Matters with the Medicine Center Pharmacy” and listen to any of our programs anytime. You can also post up the questions you have today to our live Facebook feed. [01:33]

Mark Adams: Tell us about yourself

I was at the Canton Health Department for 25 years; leaving there as the Director of Environmental Health. And two years ago came out here to Henry County to serve as the Health Commissioner. And things are wonderful. It is a completely different change in public health going from a lot of environmental health issues that exist around sanitation and issues like that to coming out to one that deals now with sewage. The health department in a much smaller county provides a lot of the other types of health care. For example, in Henry County, we have only had a pediatrician part-time for a very small period of time: one pediatrician. So, the health departments out here in Northwest Ohio have to provide a lot of that care or be able to contract with somebody or work with other people to provide that care for the citizens to make sure that they're just as healthy here as they are in other places that have more resources. [02:38]

What is coronavirus? How did it get its name?

Well, it's named as such because of the way it looks. If you look at it, it’s this round virus that has these spiky projections and it resembles a crown. So, it was named coronavirus after the word Corona, which is in Latin.

There are seven coronaviruses that can be transmitted from human to human. To give an example, people might remember if I mention SARS, back in 2002-2003, or MERS (Middle East Respiratory); those two were also coronaviruses. [04:51]

Why did they call this the novel virus?

It's novel because it's new. So, they discovered it around the third week of December 2019. Now they have moved away from calling it coronavirus 2019 to COVID-19, which means “CO” for coronavirus, “VI” for virus, and “D” for disease, and then dash 19 because of the year it was discovered. [07:11]

Where did it come from?

In most cases, coronaviruses are easily carried by bats. They don't know exactly how that interaction took place between a bat and a snake, and how it resided in that snake but I have heard and have seen information on from both WHO and CDC and it's been reported to us that if we're going to prevent it and we're going to create a vaccine, we have to know where it started, we have to know everything we possibly can about that virus. So, that's why we try to find out exactly where it was coming from, and how that transmission went from animal-to-animal to animal-to-human. So in this case, we suspect that the market that had snakes, somehow by handling those snakes, a human was able to get it. Well, that happens that we can get something from an animal, we pay attention to that, it's a concern to us, but the main concern is when it goes from human to human because of how mobile we are. So, if you think about if we do confirm that it was transmitted from snake to human, that snake it's already in the market, it's not that mobile but we are absolutely that mobile and especially we're global. And it concerns us when it goes human to human because of how fast we can spread it. [08:03]

Are the symptoms just the same as the flu?

Absolutely, almost identical. In fact, even when it comes down to prevention, almost exactly like the flu. So they're very similar to that general malaise, fever. That's why you might see them using thermometers on the forehead to look and see if a person is already experiencing a fever, and that's where they've been stopping some people from leaving certain areas of China or before they enter certain areas. That's their quick way of doing it, and only other way of doing would be, of course, doing a confirmed lab test. [11:04]

Not really, it spreads the same way. So, if we are infected, we cough, sneeze those droplets; a person is very susceptible if they're within about six feet of a person that’s sick. So that's actually that's pretty far away when you think about what six feet is. So, the flu and coronavirus can be spread easily from human to human because of those droplets. And also, those droplets: if they land on a surface or if a person uses their hand and they cough into their hand, that virus then gets transferred to that surface. It's viable for quite some time and that person that comes in behind it, and touches that surface, whether it was a door handle, a phone, computer, keyboard, and if they touch that to their mouth in any way, they can then get sick, they can transfer that virus to themselves. So, it can either be human to human through the droplet in air or human to human through the droplets that have landed on a surface; so from surface to human. [16:17]

Coronavirus vs Influenza vs SERS vs MERS

If we look at MERS (Middle East Respiratory Syndrome), that has about a 35% fatality rate. So, that one is very extremely high. If we look at SARS, it was about a 9% mortality rate. Right now, coronavirus has actually gone down a little bit from its original to about 2%. It was at around two and a half percent. So there is a live feed so we can track this. And right now there's a total overall 64,000 cases, so a little over 64,000 and 1,300 deaths. And the recovery rate is starting to go up. So, if we just looked at the flu, last year alone in the United States killed a little over 30,000 people. So, it’s with millions of people, approximately 32 million people affected; 16 million people go into the hospital, meaning that about 16 million people stayed home with symptoms. They didn't seek out care. Hundreds of thousands of people are being admitted to the hospitals, with flu. With coronavirus it's so much less. Now, I don't say that to be able to say, “All right, let's not pay attention to it.” If anytime that we have a virus that we don't know a ton about that has the ability to go human to human, we want to know everything about it. The mortality rate is unknown in a population, so the more information we can gather about an illness and how it affects the population will provide better protocols for containment and treatment because it always has that potential to have an impact. A virus is no different than us: we change. Our genome, or every time we have children, they take on traits of both mother and father. Viruses do the same way: they change. And when they do that, they can adapt, and they look a little bit different in their next version  [19:51]. So, we want to know everything about it. That's why we want to know where it came from, what animal it started in, and how it was able to get transmitted, we can stop it there first, before a vaccine. And then after the vaccine, if we need to produce a vaccine, then we get a vaccine. [17:29]

What are the precautions?

Few precautions should be taken whether you have caught coronavirus or the flu: 

●      If you're sick, stay home. If you're a business owner and you have the ability to allow sick leave then allow it, encourage it; you don't want to infect the rest of your workforce.

●      Avoid close contact with people who are sick.

●      Avoid touching your eyes, nose, and mouth with unwashed hands. So, regardless of if you are healthy or ill, wash your hands using soap and water: 20 seconds, some people use the alphabet, there's other ways of doing it but just soap and water. A lot of people think that you can actually overdo it with alcohol. Soap and water is perfect.

●      If you do cough or sneeze do so in a tissue and discard that tissue. Don't keep it or put it in our pocket. Try not to use a handkerchief where it's multiple use, that virus just sits in there, and it just becomes this active biohazard that you're going to keep in your pocket, on your personal self. [26:18]

Do you really need a facemask?

I know that a lot of people are watching the news and they're seeing facemasks. There's no need to go in and do a rush because the same continual snapshots of people wearing facemasks end up on TV or whatever source that you're getting your news from. And then that starts saying, “Well, if I'm not seeing people without facemask, maybe I need to go get a facemask,” that is just not the case. [27:17]

What are the reliable sources of information?

Many nations are becoming educated on YouTube, and pretending to be professionals after we read something on YouTube. We're making YouTube lawyers now, we're YouTube public health people. And we've really got to get away from those types of sources. While they are some things that are fun to watch, we really need to get a reliable source.  If it's going to concern coronavirus or flu, I promise you the only place that's everyday updating where their surveillance is coming from, where they're getting information from, it's going to be cdc.gov, or the Ohio Department of Health at odh.ohio.gov, or your local health department: at Canton it’s cantonhealth.org, at Henry County residents in Napoleon it’s henrycohd.org. So, we're posting information every day on it, as most every single health department in Ohio is. We're on conference calls with the Ohio Department of Health; every day we receive an updated information packet from the Ohio Department of Health with what's currently going on, and it usually gets produced and sent out prior to midnight. So, we have very active surveillance measures that are not being covered everywhere else. Our job is to spread as much information that's true, and it's data oriented, not feeling oriented. So, I'm hoping that people can see the difference between how they feel about something and what they're actually getting data on, and go to those sources. And always double check what you're reading and say, “Can this even be real?” [34:06]

Summary

Finally, to summarize, we started with Mark giving his brief introduction and background. We then discussed coronavirus: it’s name, origin, symptoms and precautions. We compared coronavirus and some of its types with the flu. We also discussed the significance of facemasks. And lastly, we looked at some reliable sources of information to stay updated.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Atrial Fibrillation and Heart Valve Replacement. Our guest this week is Dr. Abraham, Cardiothoracic Surgeon with Aultman Medical Group Heart Core.

You can find all our Health Matters Podcasts here: iTunes Google Play Stitcher

According to the Centers for Disease Control and Prevention, approximately 2% of people younger than 65 years of age have AFib. Well, about 9% of people aged 65 and older have it. AFib is the most common irregular heartbeat that can lead to various heart-related complications such as blood clots, stroke, and heart failure.

This morning we're going to talk with Dr. Abraham about AFib, heart valve replacement, and other cardiac issues.

 We'd like to remind our listeners that you can listen to our radio show, just look for health matters in the app store of your favorite smartphone, and you can take our podcast with you anywhere you go. If you have questions today, you can post them up on our live Facebook feed and we'll address them there. [00:39]

 You can find all our Health Matters Podcasts here:  iTunes   Google Play  Stitcher

About Dr. Simon Abraham

The first thing to know is I'm not a native of Stark County. I've been in Canton and the Stark County area for a little bit over a year. I came here as a temporary or locum tenens physician in late 2018, and loved the area and loved my job at Altman so much, and I think they liked me. So, we decided to stick around and make it a permanent gig. [01:17]

 Licensed in three states: Ohio, Indiana, and Iowa. [01:47]

Medical Training

I went to medical school in Chicago, University of Chicago, and then did my surgical training at Johns Hopkins. I took a couple of years off to do research at the NIH (National Institutes of Health), which were close by, and then I went to Ann Arbor, in Michigan, for a couple of years to do cardiac surgery training, and I also had an interest in heart surgery for children. So, I spent a year at the Children's Hospital of Philadelphia, and actually a good part of my career was also doing children as well as adults. [01:51]

So, I am one, of the group of four cardiothoracic surgeons. My partner, who was here a few weeks ago, Dr. D'Agostino, focuses more on lungs and other non-cardiac issues, he also does heart surgery, and the other three surgeons, myself included, focus primarily on diseases of the heart and the blood vessels within the chest. [02:31]

Why Did You Come to Stark County?

Well, initially, I came because of the job. I had been in Toledo for a period of time and I got a call saying that they needed a temporary position, so-called locum tenens position, to come to Canton, and I had never been the Canton before and I said, “Well, you know, it's the Hall of Fame. Let's go check it out.” So, I came. I was actually staying at a hotel along 77 for the first three or four weeks that I was here, and when I got to Altman, it just seemed like a very natural fit as far as the people that I work with the cardiologists, and the overall hospital, I think the quality of care, the support that we have as physicians are excellent, and I really enjoyed the patient population here and they seem to like me, so it was kind of a natural thing. [03:36]

What Age Group of Patients do you Treat?

Currently, I treat adult patients. I'm certainly comfortable doing older children or young adults, having spent a lot of my career doing that, but most of our focus really is adult patients that would be 50 and older just given the population that is most affected by heart disease in this country. [05:30]

Where Would the Young Children be Treated for Heart Issues?

Well, in Stark County, they really have a variety of places: Children's and Akron would be, obviously, one. If people wanted to travel further, they could go to Cleveland or Columbus, which also have good children's hospitals. [06:00]

What is AFib?

So, let's talk about a normal heart rhythm to start. The heart has a very nice electrical system that coordinates the heartbeat, which starts with the upper chambers contracting first, before the lower chambers or ventricles do, and it's only a split second different but it makes a difference in terms of cardiac function and overall health. What happens is that as you get older, more and more patients have irregularities of that atrial heartbeat, and the “A” in AFib is for atrial. So, instead of having a coordinated heartbeat, the upper chambers of the heart can start beating irregularly. When you actually look at it in an open chest, a patient with AFib, it almost looks like a bag of worms; it's not a nice coordinated heartbeat, it's very irregular. Some patients can feel it immediately, others don't even know that they have it. AFib can lead to heart failure and clots forming within the upper chambers of the heart, and those, if they ever break off and leave the heart, can lead to strokes and other problems.

This is predominantly a problem that becomes more manifest as you get older. So, under 40, it's rather rare, but between 40 and 65, the incidence is a little bit over 2%, and then it starts to rise over 65, and once you're in your 80s, you get to nearly at 10% incidence. And that coordinated contraction between the upper and lower chambers really helps with cardiac output and then. obviously, increases the risk of stroke and other problems. [06:37]

Is There any Relationship Between AFib and a Murmur?

There can be. Indeed, certain valve problems predispose patients to AFib, such as a mitral valve problem which stretches the upper chambers of the heart and that stretching can lead to an increased incidence of AFib as well. [09:00]

Treatment Options for AFib

If you're first diagnosed with AFib, the immediate treatment is: One, make sure that the heart rate is controlled, and then if you see a cardiologist, for instance, they're going to try and convert you back to a normal rhythm. There are a couple of ways to do that, one would be with medication, and the other option is with electricity or electroshock; what would be called cardioversion. Now, that is not as exciting as you might see, imagine from watching TV shows, but if your doctor decides to do a cardioversion on you, you'd be brought into the hospital, you'd have some brief sedation. So, you would be out for a few seconds or minutes while they shock you, and hopefully, at the end of that session, you would go back into a normal heart rhythm. There’s certainly the possibility you could go back into AFib again, but most of the time, they're going to load you with some medications before the shock to try and keep you in a normal rhythm afterwards. [12:32]

Success Rate

Long term success rate for all treatments is probably around 60%. Now, it really depends on whether you have what's known as paroxysmal AFib, where you have brief runs or bursts of AFib; that is a little easier to treat with a higher success rate to chronic, almost permanent, AFib which is much harder to treat. And certainly, the cardioversion is, and the medicines are one spectrum, least invasive way of doing this. If, for instance, you continue to have problems with AFib, depending on your cardiologist, and your electrophysiologist or EP doctor, they may want to consider you for something known as ablation, in which they run some special tubes and wires up through your groin into your heart, and then using different types of energy, either what's known as cryoablation or radiofrequency ablation they can try and get you back into a normal rhythm. [14:05]

Are Women More Likely To Be Affected By Heart Disease Than Men?

Up to probably menopause, women are somewhat less likely to be affected than men. It seems that that is somewhat protective, especially against coronary artery disease, compared to men. But then, once women go through menopause, within 5 to 10 years after that they seem to catch up with men in terms of the incidence of atherosclerosis and coronary artery disease. [17:39]

Are You At Risk?

Coronary artery disease and heart disease is so prevalent within the United States and really, we used to say within the United States and Western world, but now, as the standard of living rises throughout the world, you're seeing a huge amount of heart disease. Even in developing countries like China and India. So, I don't know exactly what it is; it may be that you know that as we get older, some of this is just a natural progression of disease that we probably wouldn't have seen if we had been dying at 50. [18:40]

Aging and Scientific Advancements

As medicine gets better or more advanced, we're dealing more with acute problems that may have arisen early on, especially infections; those, by and large, have been taken care of and now we're dealing more with chronic problems that come with aging. So, the increasing incidence of heart disease and cancer and things like that tend to happen to people who are older, and as the population ages we're seeing more of that. [19:40]

The Watchman Procedure

So, the watchman procedure is indeed for patients with atrial fibrillation. So, as we discussed earlier in the hour, patients with atrial fibrillation are at risk for having strokes, and other embolic events; meaning having blood clots break off from inside the heart and be ejected out into the bloodstream where it can really go anywhere within the body. The area from which has the most common sight for blood clot formation is called the left atrial appendage, which is a little wind-sock type protrusion from the from the left atrium, and it's a little pocket that just sits there, it's probably like the appendix in your belly, there's probably no good reason for it to be there, but it does collect blood and when you're an angel fibrillation, that blood can become static within there and clot off.

 So, one way to deal with that, obviously is with blood thinners, if you continue to have problems, you can have what's known as a watchman procedure, which is relatively new within the last five years or so. You could come in, have it done; usually, you can go home by the next day. [23:38]

Latest Developments

Well, watchman is one. There are other interesting and new devices that have been developed over the last 10 years or so. The most prominent one is something for the aortic valve; as patients get older, some of them develop murmurs. And one of the more common murmurs that you can have is from something known as aortic stenosis. The aortic valve is the valve that opens and closes when your heart squeezes and allows blood to eject out of the left ventricle. [26:09]

Certainly, a fair number of patients as they get older, that valve can narrow, causing the heart to work harder. If you think about it, as it starts to narrow, the heart has to work harder and harder. It's kind of like weightlifting for the heart is what I tell my patients, because the heart has to squeeze even harder to get through a narrow hole. Weightlifting might be good for your biceps, but it's not good for the heart because it makes the heart thicker; it makes it stiffer, and as it gets thicker it requires more coronary blood flow. What usually happens in this day and age is that as this aortic stenosis gets worse and worse, and by the way, it never gets better, it only gets worse, you begin to have symptoms. [26:51]

What are the Symptoms of Aortic Stenosis?

You might start to have shortness of breath; you might start to have exercise intolerance or fatigue. Certainly, in older patients, often when you're talking to them, you have to kind of tease this out. One of the questions I always ask patients is, “Are you taking more naps than you used to?” And it's surprising patients who say, “I'm perfectly fine, doc. I don't have any problems,” you start to ask them, “Are you taking more naps than you did two or three years ago?” And they say, “Hey, you know, you're right. Yeah, I'm taking more naps.” So, once this aortic stenosis becomes severe, you need to do something about it. And this new technique is placement of an aortic valve without open heart surgery. [27:53]

Valve Replacement

The acronym is TAVR for Transcatheter Aortic Valve Replacement, and the studies that have been done both in the US and in Europe, suggest that TAVR is an excellent substitute for open heart surgery, certainly, for high and moderate risk patients and lower risk patients. I'm not sure that the evidence is quite clear which one is better. But certainly, for patients that previously might not have had anything done because they were 85 and frail, can now have a TAVR procedure done where their aortic valve is essentially replaced. You can come-in in the morning, have it done, and potentially leave by the next day. [28:45]

Advancements in Heart Valve Replacement

Well, one of the things we talked about was the TAVR procedure which has been really revolutionary, and treatment of aortic stenosis. The other thing, not quite as revolutionary, if you will, is the mitral valve, there's another valve in the heart; those two are the most commonly repaired ones: the aortic valve and the mitral valve. We are repairing a lot of mitral valves now instead of replacing them for the right situations and we’ve become better and better at doing that. And for certain types of mitral valve disease, we can tell our patient, “Hey, there's a 95-100% chance you can keep your valve rather than replacing it.”

 Now, if we have to replace it, there’s a couple of different scenarios, depending on the age of the patient and their lifestyle choices. People talk about pig valves and they talk about metal valves as a general. [32:42]

 If you're doing a TAVR, meaning you're putting the valve up through the groin, for the aortic valve, you don't actually take the valve out. If you're doing open surgery, you might, and often do, take the old valve out because when you look at it, it's become like a rock, really, inside it's full of calcium that needs to be debrided to put a new valve in. [34:02]

Pig Valves vs Metal Valves

What's known as pig or bioprosthetic valves, the nice thing about those are: you don't need to have any long-term blood thinners for those valves, because they're made of biologic material, so they don't tend to have clot form on them. Unlike the mechanical valves which need to be on blood thinners for a lifetime. [34:37]

But I think the important thing here is that if you're getting a bioprosthetic: a pig or a cow, you don't need to be, at least long-term, on blood thinners. Whereas, if you're getting a mechanical valve, you do need to be on blood thinners. [35:14]

What happens in those though is that the pig, and the cow valves, or bioprosthetic valves do deteriorate over time. So, the younger you are, the faster they deteriorate. [36:01]

Facts About Heart Bypass Surgery

So, I would say that 50% to 60% of our open-heart surgical volume is heart bypass or cabbage coronary artery bypass grafting because coronary artery disease is quite common. We have patients coming in either with angina or chest pain or sometimes, after a heart attack, needing to have bypasses. So, we have in our body, two major coronary artery systems: the left and the right, it’s very simple, and they can at various places get blockages. The human body has a lot of extra capacity so that in most cases a 50% blockage does not cause angina. But once you start to get to 70% and more, it can cause problems.

If you have a single blockage, or if you're extremely high risk, a stent may be the way to go. And certainly the cardiologists or cardiology colleagues are very good at putting those in and frankly, patients would prefer a stent to open surgery. But if you have multiple blockages, and/or you're diabetic, and in certain other situations, you would, in the long term, be better off with surgery and that's been pretty well shown by multiple studies.

So, what does a bypass do? Well, using different arteries or veins from within your leg, we can bypass; get blood, pass those areas of blockage to your coronary arteries so that your heart muscle, which is the important thing, is getting adequate blood supply and it improves lifestyle because it prevents chest pain, and in certain situations, has a very good effect on your lifespan mortality as well. [40:29]

Minimally Invasive Surgery

Well, we're doing more minimally invasive surgery at Altman than we used to, and I think the other exciting thing is we are getting much better at cardiac imaging as one of our cardiologists has now become a trained, and started to do both cardiac MRI and cardiac CT. And I think when you can see more, you have more accurate ability to diagnose, and some of these tests are also rather functional, meaning you can tell where the blood is going and where it's not, and all of that information really can be critical to the proper diagnosis and treatment of patients with heart disease. [42:43]

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

Health Matters is a weekly radio show sponsored by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss the role of a Hospitalist with Dr. Michael Linz, Chief of Inpatient Medicine with Mercy Medical Center in Canton, Ohio.

You can find all our Health Matters Podcasts here: iTunes Google Play Stitcher

Hospital stays can be full of surprises; one might be that the doctor who shows up in place of your personal physician. Hospitalist medicine is the fastest-growing medical specialty in the United States. Demand for this specialty was initially fueled by managed care efforts to bolster efficiency, cut costs, and improve care. Today, patients admitted to the hospital tend to be more severely ill. Hospital-based doctors can better attend such patients, respond to their problems and navigate the hospital’s increasingly complex systems.

Today we're going to talk with Dr. Michael Linz and we're going to talk about what a hospitalist is and how during a time, when a patient might feel vulnerable, they are there to manage their care and work with their personal physician.

We'd like to remind our listeners today that our program's also available on our podcast. You can just look for Health Matters with the Medicine Center Pharmacy in your favorite podcast app, and listen to any of our programs anytime. You can also post up questions on our live Facebook feed today. [00:42]

What is a Hospitalist?

Quiz Time!  Choose your answer from the possible answers below:

1. A groupie of the TV show “House”, who's obsessed with the smell of hospitals, and hangs out in the waiting room all day, talking with the ladies at the information desk, drinking day-old coffee, and eating packages of stale Graham crackers.

2. The real application of Bill Murray in Groundhog Day, waking up every morning and perpetual training in the residency program, being on call 24/7, no patient cap and no duty restriction hours.

3. Your third choice is, not actually a physician at all, but an undercover administrator hired by the hospitalist to control utilization management, kind of like Undercover Boss that infiltrates the medical staff and reports all rumors back to the CEO.

4. The last potential answer is the main cog in the fastest-growing specialty in American medical history, boasting more than 50,000 physicians in a mere 20-plus years, transforming itself, not only into an indispensable part of the hospitalist patient's care and management team, but the key driver in future health systems delivery and payment reform. [01:56]

The answer is D.

History of Hospitalist Concept

Interestingly, this is a concept that started in California in the early 1990s. It was first brought into play by the Scripps Clinic in La Jolla, but it really first became its own entity in 1996, where Paul Wachter, who is known as the father of hospitalist medicine, coined the term “hospitalist” in the New England journal article in 1996. So, it actually started in earnest and the University of San Francisco, California. So, it's only been around for 20-plus years. [03:20]

Can Smaller Hospitals Do This?

Hospitalist programs can be anywhere from 30 or 40 docs up to three, four or five physicians. A union hospital in Dover, which is a relatively small hospital and an access hospital has hospitalist program. They have programs out in Coshocton and in some of the critical access hospitals, much smaller in size than sometimes you may have just one hospitalist working as an admissions position for the day, but it can be anywhere from one to a hundred. [05:32]

What are the Pros of Hospitalist Medicine?

Well, that's the premise; it's easier said than done. The advantage of the hospitalist model is you have physicians that are hospital-based, 24 hours a day, seven days a week. So, you have immediate access to care at the bedside. You have efficiencies in moving through testing procedures, working with consultants. You have protocols that are in place for managing length of stay, and efficiencies of transfers of care. And so you have somebody who is there, basically, at all hours of the day, and we really work as an extension of the primary care physician as far as communication and interaction with them as well. [07:03]

Availability of physicians 24/7

Mercy not only has a hospitalist program, which is medicine and whatnot, they also have an OBGYN hospitalist program as well. So, OB-hospitalists that, again, are there 24/7 and help with the deliveries and whatnot. There are hospitalists in pediatrics, neurology, and also in the post-transitional care in the nursing facilities as well. So it's really a continuum of care that's being developed and integrated. [08:27]

What if you want to see your own doctor instead of a hospitalist?

Normally, your primary care physician notifies their patient population that they don't go to the hospital regularly, and that they're being cared for by hospitalists. So, we have an understood relationship with which physicians that we take care of their patients or not. And so I've really never had anybody say, “I don't want you to take care of me”. I've had instances where we'll get the primary care physician, maybe on the phone, and we have a three-way conversation. But, generally, it's been a smooth process, and I think the population understands the changes in healthcare and how medicine works. [09:15]

How do we become a Hospitalist?

The majority of the hospitalists, probably 90% of hospitalists, are graduates of an internal medicine residency program, which is a hospital-based program. So, you have to have a residency graduate training, just like you would in any other primary care specialty.

There's a growing number of programs that are actually having different tracks where you can go into the training program and move as an inpatient track, really moving as a hospitalist or an outpatient track where you're going to work in the outpatient setting. Family medicine, which traditionally has always been an outpatient practice, now also has an inpatient track as well, and I have to my physicians or family medicine grads, who did an intensive inpatient program, and so it is definitely stratifying to its own drummer. And I think eventually there will be specifically categorized programs in hospitals medicine as more of the teaching programs are overseen by academic hospitalists. [10:37]

What are the work models for a Hospitalist?

There are various work models for the hospitalist system. The most common or traditional is what's called a “seven-on seven-off model” where a physician will work seven days in a row and then have seven days off. The shifts are usually 12 hours, seven in the morning till seven in the evening, and then seven in the evening till seven in the morning, depending on what your work shift is. Other models are a “Monday through Friday model” where a physician will work Monday through Friday at various times, and then weekends are done on a rotational basis.

The seven-on seven-off model has various mutations as well, where people work part of a week, especially if they're part-time, or they have families at home and they want to work just X amount of shifts per month, there are swing shifts that come in throughout the day. So, there are all these machinations off this model, but that's the traditional model that works. [15:24]

What type of patients do you care for?

Our hospital is a team that cares for all patients that come through the door that have medical issues. So, we take care of patients who are co-managed with the intensivist and the ICU, with the cardiologists in the CCU, with cardiovascular surgeons. We admit all the normal traditional health issues to the hospital: pneumonia, congestive heart failure, infections, abdominal pain. We also work on a consultant role for the trauma program. So, a patient comes in with trauma we’ll handle their medical issues, or we'll do consultant work for orthopedic care or rehab care.

So, we really run the entire spectrum. And again, there are specialized physicians within their same disciplines. So, in internal medicine, we don't see young children, and we don't do any OB. So, the obstetricians have OB hospitalist, the pediatricians have a pediatric hospitalist. So, it's divided based on training. [17:49]

Tell us about Sound Physicians

Sound Physicians, it’s a very cool story. It was founded in 2001 by a physician by the name of Rob Bessler, who's from Ohio, grew up in Berea, did his medical education at Case Western and his residency at Cleveland Clinic. He ended up on the West Coast in Tacoma, Washington, and with eight or nine other guys started a hospitalist program was one hospital in Tacoma with nine doctors in 2001. So, fast forward, 19 years, and Sound Physicians is the largest hospital management group in the country. They are 42 states, 3,500 providers, over 350 hospitals, and all physician-run, physician-led, physician-managed, which is very comforting to myself knowing that I have a physician at the top of the chain who is making decisions based on safety and quality of health care. [20:52]

What other advantages are there of the hospitalist model?

Well, there are a number of advantages:

1. The data is pretty strong as it reduces the cost of care, predominantly, by being able to reduce length of stay, improve efficiencies, have testing done in a timely manner, getting results back, co-managing with the consultants, discussing with them, working at the bedside with the patient and families, working with the case management department, and moving people through in a timely manner; not rushing people through their hospital stay, but working efficiently.

2. The other important thing is, even though it decreases the length of stay, it does not affect; we never allow patient safety and quality of care to be superseded by time. So, that's very important.

3. The other advantage is quality of care and patient satisfaction scores are higher in the hospitalist medicine model. Again, because you're there, you can go back and see the patient two or three times a day, meet with the family, discuss things, meet with the consultant. So, it's the ability to have one on one open communication that is really, really a key.

So, our model allows us time at the bedside rather than having us have to go into the computer and have our head buried in a laptop. We actually sit down at the bedside and talk to the patients and comfort them, and actually provide them the time that they require. [25:27]

The other advantage to the program is what we call work-life balance. It's bantered about a lot but is a real entity. Young physicians coming out of training, like the idea of time-working, time-not-working ability to have time with a family to do other things. Sometimes physicians who may want to go on to further specialty training will take what's called a gap-year or two, work as a hospitalist either to solidify what they want to do long-term, work on research projects on the weeks they're off or pay off debt. [27:41]

What are the disadvantages of this model?

The main disadvantage, in my opinion, is that the model itself purposely creates a discontinuity of care. Again, not having your primary care physician take care of you, who you may be gone to for 20 years and they know you like the back of your hand, and so you're meeting somebody who you don't know, who's going to take care of you and have to figure out everything in a matter of day if they're in for an observation; a matter of hours. We have physicians that come and work a couple of days here a couple of days there. So, there's maybe one physician that you have Monday, Tuesday, and then maybe another physician Wednesday, Thursday. So, there's some disconnect there as well. There definitely is not an optimal model for communicating with the primary care physician and having their input as well. So, these are our definite disadvantages to the model itself. [28:43]

FAQs on Coronavirus

We see the trends just based on our patient population because we take care of 150 people or more a day on my service. So, we're seeing what's coming through, and so we'll see trends in different viral infections, different bacterial infections, as well as infections that set people up for secondary pneumonia. In general, the influenza virus has not had a big impact this year. We guesstimate on our service that we’ll probably see that rise in March. Now, we're seeing mostly RSV (Respiratory Syncytial Virus) which is a virus mostly seen in children, and then Rhinovirus and Enterovirus, and human metapneumovirus which sets people up then to secondary pneumonia, which is probably still pneumococcal pneumonia.

Coronavirus is not caused by drinking Mexican beer by the way, and coronavirus has been around for a while and we've had patients intermittently with coronavirus here. What's different is the virulence or nastiness of the strain that mutated in China, and it's, obviously, become epidemic and pandemic. The protection is basically no different than protecting yourself from getting the flu:

• Good handwashing technique

• Prevention of droplets that spread by covering your mouth and nose when you cough

• Again, washing your hands if you are ill

• Not going to work, not going to school, staying home and staying isolated

• Again, having an influenza vaccine is still a very important thing as well as a pneumonia vaccine, if appropriate.

We have not seen too much of the coronavirus yet, but it will come. I was speaking with one of my good friends who live in California and the folks in California are definitely on edge because of the amount of international travel and international folks that live in that part of the country. I know there's a recent question from students from Miami of Ohio.

So, the CDC is on top of things, our infection control department has a protocol already set up, I'm definitely sure that other hospitals would have the same protocol. So, I think the potential for any type of epidemic or significant exposure in Canada, Ohio is going to be fairly small. But again, any anybody who has flu-like symptoms should definitely see their primary care physician. [44:49]

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

Health Matters is a weekly radio show by the Medicine Center Pharmacy on WHBC 1480 AM in Canton, Ohio. This episode pharmacists Brad White and Paul White discuss Health Insurance mysteries and how to save money on healthcare expenses with Rick Pipes of Pipes Insurance in New Philadelphia, Ohio.

You can find all our Health Matters Podcasts here: iTunes Google Play Stitcher

A recent study showed that only 4% of Americans understand the key terms that are necessary to understand their health insurance. The four key terms identified to understand your health insurance policy are:

1. The deductible

2. The copayment

3. Coinsurance

4. Maximum out of pocket

Understanding these terms unlocks the mysteries of your health insurance and they are the key to reducing your out of pocket expenses and saving money. This morning, we're going to talk with Rick about saving, money reducing out of pocket medical expenses, and using our health insurance wisely. We'd like to remind our listeners that you can subscribe to you podcast on your smartphone. Just look for health matters with the Medicine Center pharmacy in the app store and you can take any of our programs with you anytime. If you have any questions like addressed today, you can post them up on our live Facebook feed. [00:43]

What is copayment?

On a traditional Preferred Provider Organization plan, which is a PPO, all those components exist. Most the time the people don't see their deductible, we'll talk about that in a second. They have what are called copays. Copays are literally just a flat small dollar amount that they pay for certain types of procedures; for example, you go to your general practitioner, you just pay on average $25 to $60, depending upon the type of provider that it is. They don't see their deductible, it helps with their cash flow. So they're not having that larger expense, as well with prescriptions as you well know, there's tiers of copays that exists, whether it be generic type drugs, name brand type drugs, non formulary, these range anywhere from $10 up to $300, depending upon the type of prescription. There's copays for urgent care visits, those are the non-emergency room, private facilities typically that range at about a $50 to $75 copay. And then, of course, emergency rooms if you have to go typically do have a copay as well. They're getting higher and higher because the cost of the emergency room averaging about $150 to $300 as a copay. [02:25]

What is a deductible?

Now, so when do we see our deductible? What is a deductible? Your deductible is basically for the larger expenses. Typically, we're talking outpatient services, inpatient services, diagnostic testing, perhaps even durable medical equipment. At that time you have an amount of money that you spend before the insurance starts to pay from January to January that doesn't include those copays. The range is that your deductible, ranges from $500 all the way up to larger deductibles of $5,000. And that's how much you spend before the insurance pays. [03:37]

What is coinsurance & MOOP?

After your deductible, at that point you share with the insurance company the cost, i.e., the coinsurance you're speaking of. You've probably heard of “80-20”. 80-20 means that I will pay 20% of the bills after my deductible, the insurance company will pay 80% of the bills after my deductible. This will continue on and on until you hit your annual maximum out of pocket. In our business we call it “the moop”. Sometimes employees like that term better than moop. But when you hit that the plan will pay 100% of the cost. So, if you're paying your 20% after deductible, that will go to a certain point. The highest that the government allow us to have, if you're using network doctors and hospitals, is $8,150 for one person, and double that for family, as a deductible as a maximum out of pocket, deductibles would be lower than that. [04:10]

What is Consumer Driven Health Care?

Well, it started in 2004. Basically, what happened is the republicans at that time under President George Bush thought that their answer to health care would be, “You know what? Let's make people better consumers.” If you have a $25 copay, as we mentioned, or a prescription copay of $10, you don't know that that cost of service or that cost for prescription may be $80, or maybe $150, or frankly, could be $400. We don't know. So, what they did is they created some vehicles and tools in the health care that allow the consumer to see those costs with a higher deductible and then have those copays so that they can make better decisions as consumers; thus, consumer driven health care. When you shop for a vehicle, when you shop for anything, you compare, you don't go out and buy. The expensive Porsche we just spoke about, you do some comparative shopping and that was the purpose behind consumer driven health care. [06:52]

HDP vs HSA vs HRA

I just mentioned in 2004 that is when consumer driven health care, that is when HSA’s came out and what they are, is: first of all, you have to have a High Deductible health Plan (HDP) that qualifies by the IRS to have a Health Savings Account. The deductible, the richest HSA or Health Savings Account plan you can have with the High Deductible health Plan starts at $1,400 for single and $2,800 for family, that would be the absolute richest, most of them are much higher. At that point in time on these plans, other than preventative care, because that's always covered 100%, you are not allowed to have those first dollar benefits as copays. So, everything's under your deductible. But what you do get is you get to open up this account at a bank that is specifically for Health Savings Account money, that is guided and monitored by the IRS. Now, the employer or the employee, or both can now put money into this account, completely tax free. They use this money then to pay their higher deductible, as well as the IRS let’s them to use this money for other items such as dental and vision, long term care premium, LASIK eye surgery, orthodontia, I got $9,000 in my boy’s teeth. So, all these things qualify from your account but what really makes them unique is: I tell people, this is kind of your healthcare retirement, because this money; you can put $3,550 in a single or $7,100 a family, more than your deductible at times, and then it carries year after year and the interest is tax free as well. So, hopefully I'm accumulating money so that when I retire, I can use this money towards other health care expenses at age 65 I could take it out and pay taxes but most of the time we'll just spend it down. Now, in contrast to that, so, I mentioned the High Deductible health Plan and the HSA. [08:14]

Health Reimbursement Account (HRA)

The difference between that is: that is employer money, that when you show those same types of expenses that qualify by the IRS, the employer can reimburse you for them. But if you don't use those expenses, the employer retains the money. So, it's only spent if you have those expenses where the Health Savings Account, once it's in their account, they personally own it just like they own their 401k, and you can't take it away from them. [10:09]

Having HSA and HRA both at the same time

Well, actually, you could have them both, but you have to start with the HSA and the minimum levels of deductibles, then you could have an HRA on the backside of that. [10:44]

Why care about cost when I have insurance? 

One of the things I hear all the time is these insurance companies are making all kinds of money. The reality is under the Affordable Health Care Act, they limited how much an insurance company can retain. Anywhere from 15 to 20% after claims paid, they actually have to return it, if they collect too much. So, it is not necessarily the insurance companies and I know I will get looked at unfavorably for that because people want to blame them. But the costs keep rising, and so when the costs rise, what happens to you as an employer who's offering health insurance is: a great portion of your increases relative to your claims specifically as to your group's health conditions. Average renewals are anywhere between 10% and 20%. Most employers can't afford that type of increase, especially when they can't increase their goods and services by the same amount. Therefore, they have two options:

1. They either increase what the employees are paying from their paycheck to accommodate the premium increase, or

2. They adjust their plans so that there's higher deductibles, higher maximum out of pockets and hit the employees who are using the plan.

For these reasons, I feel that the employees need to be as engaged as the employer and it is a team approach. It's not one of the others, not the employees against the employer. I've worked very hard at trying to get within the employee population and educate them with certain seminars and tools that will probably talk about today. So, that they help make good decisions, realizing they are part of how that renewals going to look and what their contributions are going to be next year. [14:42]

How can I save money on medical costs? 

Well, you need to question things, you know, it's not natural for us to ask our doctor a lot of questions. They're in a hurry, sometimes they obviously are working on their flow of patients, but we have to stop and start asking questions, including of our physician. So, find a doctor that is willing to talk to you. If they're ordering a slew of tests, ask about those tests as to the cost of those tests. For example, I heard a statistic a long time ago that a PET scan is within 5% of what maybe an MRI could show you versus maybe 85% of what an X-ray could show you, and they're not all created equally, but sometimes the X-ray may present the right solution before the MRI or before the pet and the cost difference is anywhere from $185 up to $3,000 up to $6,000. So, again, education, not questioning our doctor per se, but working with them on solutions and uncovering all of the answers that you need to listen to. [17:56]

What are the tools that can help save medical costs?

Well, right now insurance companies have been becoming pretty creative to help their constituents save on costs. So, for example, there's not a carrier out there right now that if you go to their online site, doesn't matter if it's Blue Cross Blue Shield, Medical Mutual, AultCare, any of the carriers, they have a cost comparison system. So, if I'm getting a knee surgery done, I can say, “Listen, I'm getting the knee surgery, here's my doctor,” but they can work out of several hospitals. I put those hospitals in. I put the procedure in, and they'll literally tell me what the cost of that is, at each one. Now, more importantly, they also have quality ratings. I don't necessarily want to go have a colonoscopy, but I want to go to somebody that actually has a good success rate and a good cost. So, that gives me that information as well. In addition, one of the newest things too, that insurance companies are providing is “telemedicine”. This is not in lieu of your general practitioner. I don't wish to offend any of my doctor friends, but it is in addition, it's something that they can access quickly. I mean, literally within 10 to 20 minutes a licensed physician will typically call them. They're trained in telemedicine, and if we're talking rashes, light colds, allergies, things that are minor, they can treat you telephonically over Skype, over FaceTime, and then through that they could call a prescription into the Medicine Center Pharmacy, you can fill that within a relatively quick period of time, and that person's up and running and never left their home in a short period of time. The cost of that literally is $45 to $49 if you were to build the entire cost. So, it's very affordable and they'll communicate to your general practitioner, so they have that information on your health history. [19:59]

Again, I don't want to replace the general practitioner, but at times we can't get to see them in a timely manner. So, telemedicine can help with that and it depends on the severity, but for sure on sinus infections, light colds, allergies, rashes, those things that you probably know the answer to in advance but maybe also need a prescription the remedy. [21:52]

Cost difference between Teladoc, Statcare, and emergency rooms

Definitely pricing is the first issue but, obviously, severity of the medical needs at hand, dictates where we go as well. So, we talk about Teladoc a little bit; for sure, the quickest; for sure, the most economical $45 to $49 as mentioned, but they can't do everything. They're not going to be able to take an X-ray, do stitches, take your blood pressure. [26:31]

There's packages now tied to Teladoc, within school systems they has a nurse practitioner with a station to telephonically electronically sending the information to the doc for diagnostics. So, it does exist. [27:07]

So, let's say my son's played soccer, both of them had injuries in soccer; you don't know if it’s a break, if it's a sprain, if it's that type of thing. Well, you can't do an X-ray over Teladoc. So, that is a perfect example of when an urgent care would come in handy. That's not the emergency room. It's usually a privately owned urgent care. At that time you go there's a physician on hand if the hours are appropriate, and they can do an X-ray. Cost of this is on average between $300 to $600 depending on how much the imaging is on the total visit. And again, closer to the $300, depending upon if they are doing imaging or not. But you get in, it's not as crowded. You get there quickly. It's a lower costs than going to the emergency room. [27:30]

When do I go to an  emergency room?

Oddly enough, emergencies are coded from 1-2-3-4. 1 and 2, you never need to go to emergency rooms, so those are the people that probably shouldn't be there. 3 and 4, you should. So, based on symptoms, which could be life threatening, and that's diagnostic symptoms, that's not actually what's happening, chest pains, those types of things, then you should go to the emergency room, that's what they're for and they do it well. Just realize, if it's non-emergent, you will be in that waiting room for a long time with a lot of other sick people. On average, if you're there for 4 hours, which is not that long emergency room, the costs going to be about $1,200. So, again, I wouldn't know why people would want to be there if it's not emergent, and now there's a lot of options that they can go to besides the emergency room. [28:15]

How can I save money at the pharmacy? 

I truly tell every associate and I do group meetings and have done group meetings for thousands of employees to form a relationship with their local pharmacy and specifically, I do say the Medicine Center. I encourage them to first thing go to you or somebody like you, make sure that they are giving that prescription regimen to that pharmacist and doing a few things. I've seen way overprescribing from different physicians, there's no continuity. You guys can say that this works with this. This doesn't work with this. You talk to their doctor on their behalf, make sure that they're not getting overprescribed and things are working together. Just as important the cost of those drugs as we mentioned, they may be on the newest name brand drug, they cost 10 times as much as the laboratory that's been out forever and has a low cost. You can help them with those decisions. And as important over the counter medication, they now are coming in either or which over the counter prescriptions may save their money, easier access to, on your shelves, already flu shots, which you can do in house, all these things lined itself and you work with their doctor. So, often I tell people, you want to keep the relationship with your doctor, but sometimes you need to let your pharmacist work with your doctor on your behalf to help you to keep you healthy and to help you save on costs. [32:23]

Preferred Pharmacy

I obviously have a passion for health care what I do, and part of why I have such a passion is I always want to pull back the curtain and see what the wizard’s got going on back there. And one of the biggest mysteries and non-disclosed is what we call the PBM’s, the Pharmacy Benefit Managers that are basically the conduit between the pharmacy companies and the insurance companies and yourself. So, what they do, the big boys, is that pricing on that drug may not necessarily be at a lower cost to that insurance company that they're calling a specialty, but on the back end, that overpricing of that prescription, they give out and hand out what's called “rebates”. That rebate may go to or for sure goes to the PBM, the Pharmacy Benefit Manager. Sometimes goes back to large employers, and most of time is shared with the insurance company that's telling you to go to that specialty prescription program. So, if that drug internally is more expensive, even though they're paying a lower copay, they may hit that doughnut hole that they would not hit normally in a quicker fashion, and then they have this large cost to them on a drug that they thought they're saving money. [37:09]

What Medicare plan should I pick?

Every Medicare Part-D plan has its own list of prescriptions that may or may not accommodate the patients you're working for. So, I guess my advice would be, first of all, that person work with you in conjunction with a consultant that's independent. We do have two in our office, and I say independent not working directly for the advantage plan, but they have two choices:

1. They can get a Medicare Advantage plan, or

2. Medicare supplement plan.

They have six months from the time they turn 65 to do that, without any issues, after that they have that open enrollment period that they have to go to, in order to get on board. There's a slew of options, and unfortunately, that population sometimes just get overwhelmed and does not want to make a decision that may be best. So, I say, seek trusted advisors yourself, along with somebody that understands the plan side, understands their health needs. So, they're not just looking at price, but they're looking at coverage, because coverages are not all built equally. Advantage plans are managed care, and they do have gaps and holes that may not accommodate that patient. So, you want somebody that understands that language to work in conjunction on their situation. [43:32]

The medicare supplement, when you're talking A through F, they're identical, just different carriers. But when you talk about advantage plans, managed care, they go from no premium, because they're paying part of your part B but those are really scaled back coverages, to a lot higher premium for better coverages, and those are the ones with the open enrollment on an annual basis. [45:07]

How Pipes can help?

We've been there since 1974. There's over 20 Associates working for Pipes insurance service and map investments. We do all types of insurance investment products. Of course, I do focus on the employee benefits, but that's one division. We also do commercial property and casualty insurance. We also do individual property and casualty, your home, your auto. We've talked about senior products, we have specialists in that. Individual health insurance, and again, we have another company called map investments that can help with investments, as well as life, annuity, disability, those types of things. [46:03]

We're located on West High Avenue in New Philadelphia. Our phone number is 1-888-328-8958. Our website is simple, it's pipesins.com, and if you want to email me with questions or if you have any thoughts that you'd like to talk about, it's rick@pipesins.com. [46:47]

Summary 

Since most people are insured through their employer, don't look at your employer as the enemy. Where I’ve seen success, and I've literally seen a lowering in claims year to year, is on those cultures that take time to happen. Where the employees are working with the employer. They're creating plan designs that cater to good consumerism, consumer driven health care. They're giving them tools to stay healthy. In some cases, they're even getting the medical care, but they're working together. There's benchmarks in place. They all realize they're in this problem that health care inflation is a national problem, it is not the employer problem, and what can they do as a subculture to control those costs and work together. [47:28]

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

Introduction

We've had a lot of questions about CBD in the pharmacy and as you drive around town and see signs everywhere from on telephone poles to gas stations and video stores. It's kind of make you wonder, “Okay, what's the deal with CBD?”. So, we're going to talk about CBD this morning and we're going to talk about what kind of product it really is, what you should be looking for and why it's important to find a source that's of high quality to get benefits for the body that you want. So, just as a reminder, you can subscribe to our podcast; you go to your smartphones app and you can look for our podcast Health Matters with the Medical Center Pharmacy. Please subscribe to us and we'd love to have you join us each week. [00:41

What is CBD oil?

CBD is Cannabidiol. It's a non-intoxicating cannabinoid found in cannabis. It has many potential therapeutic benefits including anti-anxiety, anti-inflammatory and anti-seizure suppression properties. It comes from a plant it called hemp, and it does not have psychoactive properties, which means CBD is not the same thing as medical marijuana. So, CBD has a profile cannabinoids in it that can help support the body's endocannabinoid system, but medical marijuana actually has high THC levels which is the psychoactive product which can get you high or hallucinogenic effects. So, they are two separate products even though they come from a very similar plant. [01:27]

Why does CBD belong in a pharmacy?

CBD currently is not recognized as a medical treatment or a drug. The FDA allows it to be sold in the US. It's basically sold as a dietary supplement but there are many therapeutic benefits which make it really belong in a pharmacy as far as I'm concerned, and the reason I feel it belongs in a pharmacy is because there are a number of different drug interactions that are possible. [03:48]

Uses of CBD

There are some studies and research that shows there's possibility that CBD could be supportive of anti-inflammatory processes and anti-anxiety effects. [04:25]

How does it work?

We have a series of receptors in our body that are part of what we call the endocannabinoid system, and when CBD stimulates these receptors, there is a potential for modulation of inflammation and pain, and also anti-anxiety properties based on how it affects your neurotransmitters; dopamine and glutamate releases. [04:45]

There's significant study that's been done on marijuana in proper for years back into the 60s and 70s, and one of the things that has been discovered are the CB1 and CB2 receptors, where both THC, and now CBD have influence on. And I'd like to give the analogy at the seminars that I've been giving in the last six months that a receptor in the body is kind of like a keyhole, and drugs or prescription drugs often affect receptors. And so in this case, CBD is a supplement or a natural product that has a key like shape that when you put it next to this lock, which is the receptor, it doesn't necessarily perfectly unlock the lock, but everybody probably has a key at home that's really worn down and you can kind of stick it in a lock it doesn't belong in and jiggle it and you sometimes can open that lock. [05:54]

Well, CBD and THC both have effects on receptors and as a result, they get a response in the body and that's where we believe that some of these anti-inflammatory and possibly anti-anxiety effects can happen. [06:52]

What is endocannabinoid system?

We have this whole system in our body, you're familiar with the respiratory system, or your digestive system, or your cardiovascular system. Well, we have what we call an endocannabinoid system, and it's this giant system of receptors in our body that can be stimulated by CBD, and also by medical marijuana or THC. [07:27]

What types of CBD are there?

There are a number of different forms. There are tinctures which are like an oil product where you'd administer it in a dropper under the tongue. There are capsules which you'd swallow orally, and there's topicals, creams, salves, lotions, ointments, and there's even inhaled smoke products which I can't get real excited about given some of the dangers we've learned about vaping lately, but there are inhaled products out there too. So, those are some of the forms and they can be used for different reasons. [09:47]

Other Keynotes

●      Brad explained full spectrum, isolate, and broad spectrum CBD. [16:05]

●      Discussion on dosages of different types of CBD. [17:54]

●      CBD for pets and it helps with anxiety in pets. [26:17]

Upcoming Seminars for LDN and CBD Oil

We've had some really exciting seminars over the last six months, and the next one is coming up on February 6th, at 6:30pm. It's at the Hampton Inn meeting room in New Philadelphia, Ohio at 1299 West High Avenue. It's right off the interstate there at 77 and West High in New Philadelphia, and we've been talking about Low-Dose Naltrexone and CBD products. So, if you want a more in-depth see discussion, we're going to talk more on that Thursday evening in February about that. But Low-Dose Naltrexone is an interesting product because it also has uses that complement CBD in a fashion where they could even be used together. Low-Dose Naltrexone actually is an immune system modulator, and it helps with autoimmune conditions through a couple different mechanisms in the body and helps modulate the immune system, and it also helps reduce inflammation. To learn more about LDN benefits join us on February 6th or check out additional resources on our site.[34:30]

Flu and Shingles Vaccine

Well, I'm looking at the CDC’s season week one ending map on their website, and their week one ended on January 4th and this is the 17th. So, the data is a little bit behind, and almost the whole country is red for high flow activity except for little Ohio and Illinois. Ohio is on the minimal side, and Illinois is on the low side. So, it's there, it won't be long for us. There's a couple ways, if you haven't gotten a flu shot yet, get it today, I mean, today, because it's going to take a week or two to build up and you're running out of time. We have flu shots available, walk into any pharmacy and we'll fix you up. On the flip side, we do have the ability to give you flu or strep tests. [40:59]

So, don't be afraid to think of the Medicine Center if you need a strep test or a flu test, and, of course, if you don't test positive, that's great, but we can maybe recommend some over the counter medications for you to help you deal with those symptoms you're suffering with. [42:47]

Shingles is probably one of the biggest questions I get from patients that come in the pharmacy. There have been enough TV ads and enough stories from family members, loved ones or friends that people have shared some pretty frustrating experiences about having Shingles and people don't want it, and I don't blame them. Numerous vaccine came out a few years ago called Shingrix and it has extremely high effectiveness and activity for duration of use, and as a result, the demand has been so high, it's been very difficult for us to keep up pace. [43:18]

Medication Compliance with Easy Dose Packs

So, it's slick because one of our most popular requests in the pharmacy is, “How can you help me figure out how to keep my medication organized?” and when you start to take two and three and four medications a day, and you got to take one in the morning, and one at noon, and one at 4pm, and one at bed time. It gets to be a lot, we're all busy, we're all trying to keep track of things. So, the neat thing about these is it's nice little strip pack and they're customized by dose. So, if you're going to go off to work, you can take off Friday's pack and it might have your morning dose, and lunch dose, and afternoon dose. You don't have to take all your bottles with you to work, it's no sweat. So, it can be really flexible. We have patients that are in assisted living facilities or senior living that use these in own residence. We have truck drivers that drive across the country and they take their seven day strip pack and take it with them. They like it because it's easy, it's labeled and it's totally functional. So, it's something that we can even deliver to your home if you live in the community. So, if you're not able to get out, our home delivery service is available. [46:30]

●      Summarization by Brad [48:35]

This episode is sponsored by Mercy Medical Center and Studio Arts and Glass.

Cardiothoracic surgery, also known as thoracic surgery, is the field of medicine involved in surgical treatment of organs inside the thorax.  The thorax is what we refer to as our chest.  Generally, this would include treatment of conditions of the heart and lungs.  This episode we will talk with Dr. D’Agostino about heart and lung surgery as well as screenings.

You can find all our Health Matters Podcasts here: iTunes Google Play Stitcher

According to the latest polling data available, 45% of Americans resolved to lose more weight and get in shape in the New Year.  For those of you in that 45% or considering weight loss we want to share information with you today about the Mercy Weight Management Open House on Monday, January 13 from 3:30 PM to 6:00PM.  This week’s podcast we will learn more about the open house and the program Mercy offers.

With Mercy Medical Center’s experienced weight-loss physicians and registered dietitians, you can choose from three medically safe options that will be customized for your health needs and goals. Each program includes weekly support, accountability, lifestyle education, exercise guidance, and maintenance programs to help you break negative eating patterns, lose weight safely and effectively, and keep it off!

This podcast has a special guest with an inspiring success story.

You can find all our Health Matters Podcasts here: iTunes Google Play Stitcher

Today we will talk again with our friends from the Great Start for Great Futures Coalition about each of our roles in helping the children of Stark County realize their potential for a Great Future. Don’t miss Part 1, Part 2, and Part 3 here.

You can find all our Health Matters Podcasts here: iTunes Google Play Stitcher

This installment Jen Griffing and Krista Allison discuss how critical it is for all of us to work together to nurture children in the 2000 days they have before they go to kindergarten.

What is Your Role at Home and in the Community?

It is important for families to understand they have what it takes to be their child’s first and most important teacher.

As a community, understanding that to build strong literacy skills we all need to begin modeling behavior that can nurture our youth. There are a number of ways that you can contribute to the success of children around you by initiating responsive interactions.

Here are 5 elements of responsive interactions:

1. Tuning-In : Tuning in is paying attention to every attempt a child makes to communicate. Eye contact is critical as is waiting and acknowledging sounds, coos and babbles as a young child’s means of communicating along with recognizing how children are moving, responding if they seem unsettled and ensuring they can rest, eat or play in a comfortable way. An ongoing lack of tuning in has been shown to cause a disruption in the developing architecture of a child’s brain. Children CRAVE these positive, responsive interactions and truthfully they are essential for ALL healthy human relationships.

2. Facial Expressions : Using your face to express yourself is another great way to build a relationship and in addition helps children learn what a word means. They will soon learn whether a word is positive or negative, what communicates an emotion or indicates a place or time of day. This all comes together later as children understand the words you are using and can take ownership of those words as their own. A great resource to illustrate how critical facial expressions are to young children is the Still Face Experiment , which you can find online.

3. Touch: Touch is another great way to communicate responsively. Pairing a light touch with talking increases learning as it stimulates multiple pathways in a growing brain to support stronger connections.

4. Gestures: Using gestures, along with words, also helps children understand the meanings of words. In the everyday this might look like, up, under, so big, bye-bye and blowing a kiss.

5. Child-directed Speech: This is the loving, sing-song, high-pitched joyful voice that children love to hear! In child directed speech, you stretch out words and repeat sounds so children start to recognize different sounds and hear the rhythm of language. It's important to note that in this case, we aren’t referring to baby talk, but rather the

What is the State of Ohio Doing?

The state of Ohio has what’s called the Third Grade Reading Guarantee (TGRG). Ohio's Third Grade Reading Guarantee is a program to identify students from kindergarten through grade 3 that are behind in reading. Schools provide help and support to make sure students are on track for reading success by the end of third grade. The point of the guarantee is to ensure a solid literacy foundation is established for each child by the end of the third grade and in many respects become an additional influence in closing the achievement gap.

While we know that there are potentially additional opportunity gaps that may exist to hinder a child’s learning progression, reading closing the reading gap is critical to a child’s life long success because children who start off behind; stay behind. Unfortunately, this trajectory can lead to dropping out of school (signs that are evidenced in the 6th or 9th grade).

What Resources are Available Locally in Stark County?

There is a strong family and community partnership element and that’s where Talk First Stark really comes in to provide support and include all of the adults who impact all of our children.

We believe that awareness + advocacy= advantage.

Awareness, which means not only being aware that we must make an early investment in our youngest citizens AND

we need to Advocate, meaning using our knowledge to act intentionally on their behalf so that they will have every advantage and opportunity afforded to them to create a positive trajectory for success. Which is back to the heart of our coalition, Great Start for Great Futures.

If you are a caregiver or community member and you are interested in learning more or having us come to your location for an awareness or advocacy training, Please visit the Stark Education Partnership’s website and look for the Early Childhood drop down icon for contact information for scheduling a Talk First Stark session.

Talk First Stark is about leveraging the power of language to ensure that all families and community members have the tools they need to nourish the growing brains of our children. We know that whatever your role is, you are a powerful partner in impacting the life of a child. It starts with you. It continues with us.

“We work collaboratively with multiple stakeholders engaging and collaborating with education, business, civic and community stakeholders to drive sustainable improvement and innovation from our youngest citizens to our college and career-minded young adults to ensure life-long success”

— -Krista Allison, Stark Education Partnership