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.

Do No Harm

On the evening of April 29, 2014, inside the Oklahoma State Penitentiary in McAlester, Okla., convicted murderer Clayton D. Lockett was being put to death by lethal injection.  However, his vein that was allowing intravenous access collapsed before the full extent of the chemicals being used for the execution entered his body.  Eyewitnesses have reported that Mr. Lockett was still conscious 34 minutes after the execution began, and, at that point, the procedure was aborted.  Mr. Lockett eventually died of a heart attack one hour after the chemical infusion began.  There has been much discussion during the past week that Mr. Lockett, in effect, was tortured before dying.  See the NPR blog and CNN story.

Faster May Be Better

Last week a friend of the family suffered an ischemic stroke while talking to her children.  She developed difficulty speaking, had a right facial droop and right arm weakness.  She was taken to the local acute care hospital, had imaging studies to check for bleeding in the brain and, after a few days, was discharged home.  As I was told about her situation, a media story was released concerning recommendations about acute stroke management.  It related a series of articles from the Journal of the American Medical Association, discussing early management of stroke and the impact on decreasing disability.

The Pain Puzzle

On April 22, 2014, the Food and Drug Administration’s Center for Drug Evaluation and Research held a scheduled meeting of the Anesthetic and Analgesic Drug Products Advisory Committee (AADPAC).  One of the main issues discussed and voted on concerned the proposed drug Moxduo, which is developed by QRxPharma and is a combination pain medication made up of morphine sulfate and oxycodone hydrochloride.  The proposed indication was for “the management of moderate to severe acute pain where the use of an opioid analgesic is appropriate.”  The “Combination Rule,” which is part of the FDA regulations under 21 CFR 300.50, states that:

Now Hear This...

Phyllis Frelich, the Tony Award-winning actress in 1980 for her lead role in “Children of a Lesser God,” died earlier this week at the age of 70.  As New England and America remembers the victims and survivors of the Boston Marathon bombing and embraces the awareness of disability issues that have been so significant this past year, the passing of Ms. Frelich can refocus awareness of people who are deaf or hard of hearing, and the limitations that can be exceeded if willpower and acceptance are in large supply.  Read The Washington Post story here.

18 Wheels Are Safer Than 4?

For physicians who see patients for commercial driver certifications, May 21, 2014, is going to be an important day for you.  Beginning that day, patients who need to have a commercial driver examination and license will need to be seen by a Certified Medical Examiner (CME) who is registered and certified through the National Registry of Certified Medical Examiners.  See the FMCSA regulations.

Medicaid Expansion - Now What?

On March 27, 2014, New Hampshire became the 26th state to pass legislation allowing for Medicaid expansion under the Affordable Care Act.  Gov. Maggie Hassan signed Senate Bill 413 into law in front of a bipartisan gathering of legislators and supporters at the State House, including NHMS Past President Dr. Travis Harker, NHMS EVP Scott Colby and myself.  Read the Boston.com story here.

Boston Strong

This past weekend I happened to be walking up Boylston Street in Boston at night when I passed the site of the first bombing location from last year’s Boston Marathon bombing.  The building that was damaged from that explosion was being repaired, and as I looked across the street at the Boston Central Library, I thought of the horrible events from last April 15 and wondered how the victims were doing at this time, almost one year later.  It was surreal to touch a green mailbox at that site and see many parts of the metal showing damage and indentations, perhaps from the pressure-cooker bomb that damaged and forever changed so many lives.

March Madness

As you read this, I imagine many of you will spend the remainder of today looking at the infamous NCAA March Madness brackets, filling in the teams that you hope will win each game and hoping that you win the $1 billion prize from Warren Buffet.  Some teams have been affected by injuries and may not be as capable as you remember them from earlier in the season.  One of these teams is the Kansas Jayhawks, whose 7-foot center, Joel Embiid, recently suffered a spinal stress fracture and will miss the first week of the NCAA tournament.  Read the KUSports.com article here.

The Times They Are A'Changin

On February 5, 2014, the Centers For Medicare and Medicaid Services sent out a transmittal (505) lifting the restriction on Medicare contractors, including Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs) and Zone Program Integrity Contractors (ZPICs), from taking action on claims that are "related" to but not included in claims currently under review, with an effective date of March 6, 2014.

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