Having Sight Does Not Mean Having Vision

A year ago, one of my patients underwent stereotactic brain surgery to remove a tumor that had been causing dizziness and vertigo. After the procedure, there were no issues with speech, swallowing or cognition, but my patient had significant visual field issues. Double vision, visual field cuts, feeling like ‘being wrapped in cellophane’ were common complaints during the last 12 months. Over time, these issues have gotten better, but are not fully resolved yet. Unfortunately, the vision deficits have caused significant limitations in the ability to drive, use a computer, and return to work. It made me wonder what options are available for the visually impaired in our state.

Stigmatized and Left for Dead, Who Should Make the Call?

Over the past couple of weeks I have become more aware of opinions that could be unfortunate barriers to HB 271 being passed by the Senate.  While participating in an EMS continuing education presentation, the question was put forward as to who might not be in favor of having naloxone (Narcan) more readily available for addicts, their friends, family members and others to administer emergently to anyone whose life is threatened from an opioid overdose.  Surprisingly, there was more than one hand raised.  The supporting commentaries shared a similar concern, that it will only aid and abet abusing illicit drugs.  Others, who are not EMS providers or healthcare professionals, have also recently expressed their biases to not support easier access to Narcan, regardless of its lifesaving potential.  There have been deeper dives and hard looks at the risks and benefits for bystander Narcan to be more readily available.

Have I got your attention?

We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too. - President John F. Kennedy, Sept. 12, 1962

Stop the Madness

Columbine.  Santana High.  Rocori.  Red Lake.  Chardon.  Sandy Hook.  Reynolds High.  Arapahoe.  Marysville-Pilchuck.  Kids killing kids in school.  15 years.  More than 75 deaths.  More than 100 wounded.  Communities all over this country wondering if they are next.  Americans are 20 times more likely to die via a shooting than any other developed country in the world, and children between the ages 5 of 14 are 17 times more likely to suffer this fate.

Give The People What They Want?

On February 27, 2014, the Draft Patient Registry Rules for the Therapeutic Use of Cannabis Program (He-C 401) were posted by the N.H. Department of Health and Human Services for public comment and were posted in the Rulemaking Register.

Stop the Pain - Killers

So much time is spent on the astonishment of the opiate epidemic in the United States.  Where did it start?  How did it get to be so bad?  Who is the most responsible party?  Most importantly, who has the greatest likelihood of making the most timely impact in reducing the overprescribing, abuse and unnecessary deaths from opioids?  After all is said and done, there needs to be greater federal and state mandates to stop the incessant marketing and prescribing of opioids as first line analgesics for chronic pain.  It is clear that current practices and usage are directly correlated with killing the thousands of people using them as painkillers, as well as facilitating recreational use and abuse. That, too, stems from overprescribing, overabundance and greater availability to secondary markets.  Refer to the blog two weeks ago, noting predictable prescribing practices by zip code.

Generically Expen$ive

It can be a self-rationalizing moment to reconcile prices at the pumps when filling up these days.  If you are not driving an economy car, it can break the bank.  No need to even go near the social conscientious swirl of how big your carbon footprint is, essentially a personal decision of indiscretion.  If you do a bit of research, a graduate degree in economics is not requisite to understand how prices from the wellhead to the pump are influenced by supply and demand through embargos and OPEC controls.  However, it is not as easily understood regarding the rapid rise in costs for several generic medications over the past few years.  For many this can lead to a personal healthcare and financial crisis that is not based upon personal indiscretions, while the drug companies’ explanations just don’t make sense.

Forget Me Not

This past Mother’s Day, my father’s wife told my brother and me that our dad was forgetting her name as well as having some other short-term memory difficulties.  He is in his early 80s and for years has tried to put up a good front, telling anyone who asked that the weather was great and life was copasetic.  However, the truth was that he has been slowing down his activity over the past few years, decreasing his interactions with other people and never telling his doctors what was really going on.  The concern, of course, is whether this is an early Alzheimer’s presentation or just an older man being stubborn and perhaps in denial.  As we assessed all the clinical information from a thousand miles away, it made sense to review the current research and treatment options for Alzheimer’s disease.

For Subcutaneous Use Only

If you were asked to name the best-selling medication in the United States last year, what would your guess be?  Not the most prescribed drug, but the medication with the most revenue, mind you.  I know what you are thinking — it must be a cardiac drug, due to the prevalence of heart disease.  Lipitor?  Close, but that would be the lifetime sales king ($141 billion).  Maybe a diabetic drug?  There are obese people with diabetes everywhere.  No, wait, an opioid — that has been in the news all over the place in the last year.  Well, the answer is not exactly clear cut, depending on what source you quote.  However, it does appear that between July 2013 and June 2014 the best-selling medication in this country was aripiprazole (Abilify), with sales of $7.2 billion, and the most prescribed medication was levothyroxine (Synthroid), with 22.6 million prescriptions written.

First Step in Our Journey to Better Healthcare System in NH.

Elections bring out strong emotions in all of us.  There are winners and losers and we often feel very strongly about the candidates we supported.  Following the election, we are exhausted from the campaign.  We are left wondering what, if anything, are we to do next and how can we move our agenda forward.  The answer is rarely clear, however, regardless of how we feel about the results of the election, doing nothing is not an option.

The work of the NHMS is critically important to advancing our profession and the public's health. While we may not know how our agenda will be received by our elected officials, we must reach out in good faith to them because they are the ones with whom we will work with over the next few years. 

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