health insurance plans

In the largest reported series yet to compare transcervical extended mediastinal lymphadenectomy (TEMLA) with endoscopic and surgical primary staging and restaging of non-small cell lung cancer (NSCLC), TEMLA showed a significantly higher diagnostic yield, according to research presented at the 14th World Conference on Lung Cancer in Amsterdam, hosted by the International Assoc…
can believe what i am reading, so unfair

Ive decided to compile information from all our discussions about pain medications; available medications, effectiveness etc. etc. along with some basic medical info. There is a list of abbreviations in the Lounge for any abbreviations that you may not know. Many times threads start with very vague questions from new members who are not familiar with pain management. This is fine, there are many people here that are happy to help you and provide well thought out input. However, I have noticed a trend that many beginning threads that are vague require several posts from regular members asking for more detailed information. My goal is to provide newbies with a generic baseline to start out with so that when they post their question they are little more informed and can get faster, easier responses.A couple things to remember: Give at least a partial history of your pain condition, medications, strengths, how often you take them, and be specific in your question.One main point to remember is that everyones body has different metabolisms, processes meds differently and respond to medications differently. You can use the sticky thread Opioid Comparison by Rawoody as a guide to see the potentcies of medications and how they relate to other meds in their strength. Then dig in further to find out others experiences. Many times you can find similarities; you may find that a couple of medications you have used successfully, another member has also used successfully. It may be time to increase so you are looking for input. The person you have similarities with will possibly respond similarly as you will so they are a great person to talk to.Those looking for pill ID’s should post the shape, color, and imprints in the title. You can provide a picture if possible, but usually the regulars can ID your pill with the description alone. I have noticed that when the thread is detailed, members (specifically Goat & Kirby) are lightening fast at ID’ing your pill. Many pain management plans are composed of two main medication types,A baseline medication that is a long acting around the clock medicine (ER/CR) to keep your daily pain at bayOxyContin – Oxycodone with a biphasic controlled release mechanism, usually dosed BID or TID depending on the person, sometimes dosed QIDMS Contin – Morphine with a controlled release mechanismKadian – Morphine extra extended release capsuleAvinza – Morphine extra extended release capsule, dosed Q 12-24H depending on the personOpana ER – Oxymorphone with a controlled release mechanismRyzolt – Tramadol with a controlled release mechanism. Other names: Ultram ER.Duragesic – Fentanyl Transdermal System 72hr continuous transdermal release patch, can be rx’ed for 48hr as well. Fentanyl is the strongest narcotic.Palladone – Hydromorphone extended release capsules (not available in the US) (Members: Solo 5150)Methadone – This medication has a long half life and can be a tool in pain management or addiction managementGeneral Consensus: (”Members:” after each description refers to members who can provide more feedback & or find the drug effective in pain management.)The majority seem to find that OxyContin works the best for their baseline medication. (Members: Myself)  Duragesic, for those who can get it, is tops. However due to the higher rx’ing of OC, there are much more people taking OC than Duragesic, otherwise it may come in first. Although we may see this change as Purdue Pharma who makes OC now has sole distribution rights and the cost as astronomical. Those whose insurance will not cover it or have high co pays or the uninsured continue to change from OC. (Members: Myself, Quincy, A Mom, htmom, Str8updude) MS Contin, Kadia, Avinza seems to follow the previous two, judging by the number of members reporting its effectiveness. (Members: Goat, Woodstock) Opana comes next and is a relatively new drug and is not yet widely prescribed. This leaves feedback on it very black and white. Members either love it or hate, there are few inbetween, however more people find that it does not help their pain than those who feel it is an effective pain management tool.  (Members: Patches_NY, 3red3red) Methadone is less common than all the medications above, although some are rx’ed it and find it to be effective. Tramadol is hands down the worst pain medication there is. It is a poor excuse for a pain med and is often rx’ed as a first step or by doctors too afraid to rx narcotics. Some feel that Tramadol is useful in easing withdrawl symptoms.  An instant release medication (IR) for break thru pain flare ups to treat pain that “breaks thru” the baseline medicationOxyIR – Oxycodone in immediate release formMSIR – Morphine in immediate release formNorco – Hydrocodone/APAP, multiple dosages 10/325, Lortab 10/650, Vicodin 5/500, Vicodin HP 7.5/750, all immediate release.Percocet – Oxycodone/APAP. Multiple dosages, all immediate release.Ultram – Tramadol immediate releaseDilaudid – Hydromorphone immediate release formOpana IR – Oxymorphone in immediate release form (member: 3red3red)Actiq* – Oral Fentanyl Transmucosal Citrate x*#&er immediate release, quickest acting medicine, approved for cancer pain but also used off label for CPFentora* – Fentanyl Effervesent Buccal tablet immediate release, quickest acting medicine, approved for cancer pain but also used off label for CPDemerol – Meperidine*Note: Actiq & Fentora are not bioequivalent/interchangeable. Actiq 400mcg would not be a substitute for Fentora 400mcg.General Consensus:Results are too widely varied to go into great detail on each one, members can provide info on specific IR meds. Most members agree that Dilaudid is a poor choice as it is not absorbed very well orally. IV use of Dilaudid many report is excellent, in a hospital setting, and IM administration I have seen no feedback other my own which it is not at all effective when administered IM. Oxycodone (Oxy IR, Roxicodone) seems to be the most widely used BTP med in more tolerant patients and almost all find it effective until they are on very high dosages. Members: QuincyIn less tolerant patients hydrocodone (Vicodin, Norco, Lortab) seems to be widely used and generally very effective. Actiq and Fentora, both fentanyl BTP meds are the strongest available, although the results are mixed, some people get no relief from them and others find them excellent for BTP. Members: Myself, QuincyAgain tramadol is hands down the worst medication even with moderate pain, except for easing withdrawl symptoms.Tylenol is very tough on the liver so most try to avoid the APAP combos all together. Most on APAP combos try to keep the APAP levels down, IE taking a limited amount of Norco 10/325Opana IR, I have not seen much information on this yet. (members: 3red3red) Other common medications that apart of a regimen are:Medications that work on nerve painNeurontin – Gabapentin, relievs nerve related pain like sciatica etc.Lyrica – Pregabalin, relieves nerve pain associated with sciatica, shingles, diabetes, fibromyalgia etc. Not an A/D.TCAs – Tri Cyclic Antidepressants (Member: htmom)NSAID’s (non steroidal anti inflamatory drugs)Motrin – Ibuprofen, relieves pain, inflamation etc., multiple dosages up to 800mg. Processed by the kidneys; common misconception is that its bad for the liver.Voltarin – DiclofenacIndocin – IndomethacinNaprosyn – NaproxenRelafen – NambumetoneVioxx – RofecoxibDaypro – OxaprozinMobicMuscle relaxantsSoma – CarisoprodolRobaxin – MethcarbomalZanaflex – TizanidineFlexeril – CyclobenzaprineSkelaxin – MetaxaloneValium – Diazepam, a benzodiazapine that can help relax skelatal muscles BenzodiazepinesSeraxKlonopinXanaxValiumAtivanHalcion  Anti DepressantsPaxilLuvoxProzacWellbutrinCymbaltaZoloftDeseryl Sleep AidsAmbienLunestaDeserylVistarilBenadryl General Consensus:Both nerve pain medications are extremely effectiveMany find adding an NSAID boosts the effectiveness of their narcotic pain medMost find effectiveness in all the muscle relaxers, with Flexeril being the least effective. Different muscle relaxants can be used in different situations. Most members find Soma to be the most effective muscle relaxer. Most also agree that Soma needs to be used in conjuction with a narcotic to get the most results out of it.  Getting the most out of your insurance & prescription coverage.Many people at one time or another have had to deal with their health insurance company not wanting to cover particular medications, or they have restrictions that make getting your rx more difficult. For some of you there is a solution. Some insurances will allow a prior authorization to get approval, and some have a process known as a PER. Let me give you the rundown on this excellent bit of information.PER stands for Pharmacy Exception Request. It is a request made by the pharmacy on behalf of the doctor that is sent to the insurance pharmacy department. For example OxyContin is a formulary drug, but they only cover it for cancer patients. I use it for CP. My pharmacy faxes a paper to my doctor who says I need that medication for chronic pain signs it and sends it back. Its then sent to the insurance and they determine if they agree with the doctor and for how long the PER is good for. Since Ive been on either fentanyl or OC for so long they approve my PER on OC and its valid for 3-4 months, which means during that time I dont need a new PER and they just fill it. When the PER expires, the pharmacy takes the PER on file, sends it to the insurance and gets a new apporval. This also applies to qty limitations, I have a PER to get 120 Soma, as they only cover 90 at a time in the formulary, and applies to drugs not even in the formulary or brand names. My particular plan states that they wont disagree with my doctor, whatever he deems necessary, they will approve it, but it still has to go through the works. I hope to have this insurance forever. They approve everything, I have no co pay, and they go out of their way to help. A STAT PER can be filed if Im running low on meds and need quick approval. I am assigned a case manager that helps me with anything from PERs to making sure referrals are done in a timely manner. She also provides me with resources for my conditions and is very friendly and genuinely seems to care about my well being. Also, many insurance companies have nurses on their staff. If you ask to speak to the nurse, she can help the approval process along by contacting the insurance pharmacy department, as they do not take calls from members. You can also get a supervisor involved which will help as well. Bottom line is that sometimes you have to work at getting what you need, especially chronic pain patients. Dont take no for an answer, and exhaust all resources. Dangerous InteractionsGrapefruit causes the body to have a higher concentration of medication in the bloodstream. It can be dangerous, and there are several medications that it affects. The reason is that our small intestine has an enzyme that destroys part of the medication we take preventing full absorption. When that natural process happens less medication is used in the body than we took. Now grapefruit juice destroys that natural enzyme. The same way that lemon destroys the pepsin enzyme that helps digest meat. (making lemon on fish & seafood a complete contradiction digestively speaking, although tasty) With that enzyme blocked more of the medication is absorbed into the body, and can rise to toxic blood levels. Since many people take pills in the AM, the same time many eat or drink grapefruit for breakfast, its even worse.Here are some of the medications you have to be careful NOT to have grapefruit with:Cordarone BenzodiazepinesBuSparA/DsImmuno SuppressantsED meds, that little blue pill   ED meds are vasodialators, and opens up constricted arteries & veins, allowing better blood flow to the lower regions, but to everywhere else too. Too much flow can cause your blood pressure to drop dangerously low.Pain medications, especially methadone with its already long half lifeAllergy Meds Lovastatin……actually all the statins.  Non traditional, non pharmaceutical pain relief. Many DO’s are more open to these than MD’s. Chiropractic treatment   Physical therapy   Medications Injections: ·         Trigger point injections  ·        Epidural steroid block  Moist heat/cold to affected areas TENS unit Magnet therapy Conditioning (strengthening under supervision) Massage therapy Pain management Dietary supplements (Glucosamine, chondroitin sulfate, etc) Accupuncture  Yoga/transcendental meditation (1-13 Courtesy of BeavisMom, to see the full thread read below)This is a work in progress, and I will continue to update as I read through new & old posts. I hope some can find this post useful. Last update 11/30/09
wonder what this really means

Pictured left to right, back row: Jennifer Donovan, Nancy Belanger, Kathy Rhodes, Agatha St. Amour, Evelyn Lavoie, Louise McCarthy, Jean Bogan and Edi Sosnoskie. Front row: Kelly Botelho, Joanne Sleep, Cheryl Sullivan and Linda Monchik.

FALL RIVER, Mass. — The Auxiliary of Charlton Memorial Hospital presents “An evening of wine and roses” to benefit oncology care on Saturday, July 23, from 6 to 11 p.m. at the Fall River Historical Society, 451 Rock Street in Fall River.

“An evening of wine and roses” will feature a four-course gourmet meal with pairing wines donated by People’s Liquor Warehouse in Fall River followed by dancing and entertainment by the Mike Moran Band. The event will also include live and silent auctions. Tickets are $100 and can be purchased by contacting Agatha St. Amour at 508-679-7038 or by email at sainta@southcoast.org.

Proceeds from this event will go towards the Auxiliary’s five-year pledge to raise $1 million to benefit the Southcoast Centers for Cancer Care in the Mitchell Building at Charlton Memorial Hospital.

About the Southcoast Centers for Cancer Care

The Southcoast Centers for Cancer Care, located in Fall River and Fairhaven, feature the latest technology in radiation therapy and medical oncology services, including brachytherapy, image guided radiation therapy (IGRT), stereotactic radiotherapy, intensity modulated radiation therapy (IMRT) and video-assisted thoracoscopic surgery (VATS). The Southcoast Centers for Cancer Care offer patients a seamless continuum of care throughout Southcoast Health System — a program that supports not only patients’ medical needs but also their emotional and social needs.

Highlights of the Southcoast Centers for Cancer Care’s Fairhaven and Fall River facilities include the very latest technology in radiation therapy and medical oncology, spacious areas for chemotherapy, a dedicated Patient Navigator, advanced imaging including PET/CT, social work, nutrition, physical therapy and pharmacy services, fully electronic health records, multidisciplinary treatment planning conferences and many “green” elements.

The care delivered at the Southcoast Centers for Cancer Care is complimented by an outstanding cancer team, which includes dedicated medical and radiation oncologists and staff who have been treating cancer patients at Southcoast for decades — and new staff who include top-tier clinicians with a wealth of experience from some of the major academic cancer centers around the country.

More information is available at www.southcoast.org/cancercare/.
can believe what i am reading, so unfair

Integration with a picture archiving and communication system (PACS) improves radiologists’ use of clinical decision support tools, according to a study in the July issue of the Journal of the American College of Radiology. Decision support systems for radiologists can provide information during image interpretation that may improve diagnostic accuracy and increase radiologists’ confidence…
I like this:)

Keith A. Hovan, President & CEO of Southcoast Health System and Southcoast Hospitals Group

NEW BEDFORD, Mass. — Keith A. Hovan today assumed the role of CEO of Southcoast Health System in addition to his current roles as President of Southcoast Health System and President & CEO of Southcoast Hospitals Group upon the retirement of John B. Day as CEO of Southcoast Health System after 33 years of service to Southcoast and its legacy organizations.

In June 2010, Day announced he would retire in 2011. The decision to take measured steps to achieve this leadership transition was made to help minimize potential disruptions in operations and allow Southcoast to remain focused on its quality, strategic and growth initiatives. Hovan and Day worked together to develop an operations plan and budget that reflects Hovan’s vision and the organization’s goals and milestones.

Hovan joined Southcoast in 2008 after a nationwide search to succeed Ronald B. Goodspeed, MD, MPH, as President & CEO of Southcoast Hospitals Group. He came to Southcoast from Danbury Hospital in Danbury, Conn., where he was Executive Vice President & Chief Operating Officer. He previously was Vice President of Clinical Services at Montefiore Medical Center in The Bronx section of New York City and served in various clinical leadership positions at Bridgeport Hospital in Bridgeport, Conn.

Background information about Day and his retirement announcement, as well as Hovan’s appointment as his successor, can be found at www.southcoast.org/news/releases/2010/060310.html.
if people only knew

A team of engineers and scientists at the University of British Columbia has developed a device that can be implanted behind the eye for controlled and on-demand release of drugs to treat retinal damage caused by diabetes. Diabetic retinopathy is the leading cause of vision loss among patients with diabetes…
more to read in our archives

Pictured left to right: Mark Andrews, Wareham Town Administrator, Zelinda Makepeace Douhan, A.D. Makepeace Board of Directors, Joanna Makepeace Bennett, A.D. Makepeace Board of Directors, Christopher Makepeace, A.D. Makepeace Board of Directors, Susan Williams Gifford, State Representative, Marc Pacheco, State Senator, Warren Wood, MD, President of Southcoast Physician Services, Ray Kruger, MD, Director of Bariatric Surgery for Southcoast Hospitals Group, Keith A. Hovan, President of Southcoast Health System and President & CEO of Southcoast Hospitals Group, Michael P. Hogan, President & CEO of A.D. Makepeace, Claire Smith, Wareham Town Moderator and Walter Cruz, Chairman of the Wareham Board of Selectmen

WAREHAM, Mass. — The A.D. Makepeace Company and Southcoast Health System held a ceremonial ribbon cutting yesterday to celebrate the opening of a new medical office building at Rosebrook Business Park, 100 Rosebrook Way in Wareham.

Southcoast Health System occupies more than 65 percent of the 67,000-square-foot medical office building, conveniently consolidating a number of Southcoast physician practices and outpatient services in this spacious new complex.

“Rosebrook Business Park represents a unique opportunity to bring much-needed jobs and tax revenues to the town of Wareham and the region,” said Michael P. Hogan, President & CEO of A.D. Makepeace Company. “The top-quality design and craftsmanship of this building sets the tone for future development at Rosebrook and throughout the Makepeace holdings in Wareham, Carver, and Plymouth.”

“In just a few short weeks, this new medical center is already fulfilling its promise,” said Keith A. Hovan, President of Southcoast Health System and President & CEO of Southcoast Hospitals Group. “We have already improved access to medical specialists that patients previously had to travel for — better access to cardiac care, neurologists, ophthalmologists and even our neurosurgeons. By the end of summer, we will open a spacious new ‘state-of-the-art’ outpatient radiology and laboratory area on the first floor that will provide some of the very latest diagnostic technology available anywhere.

“We no longer need to envision a medical center that brings together some of the best community health care available. It is right here — right now,” Hovan said.

The opening of Southcoast Medical at Rosebrook brings together 15 Southcoast primary care and specialty physicians, the Southcoast Center for Weight Loss and comprehensive outpatient radiology and laboratory services, which are scheduled to open in July and will include X-ray, computerized tomography (CT), digital mammography with stereotactic biopsy equipment, ultrasound, echocardiology, nuclear medicine and bone densitometry/DEXA scanning.

“I have practiced as a primary care physician in our region for almost 24 years and I know firsthand how important it is for patients to have an ongoing partnership with a physician who knows about their lives in addition to their medical systems,” said Warren Wood, MD, President of Southcoast Physician Services. “I am very proud to say that this is the philosophy of the regional physician system we have built at Southcoast — a system that is greatly strengthened by the wonderful new medical center we celebrate today.”

“We are very excited about the Southcoast Medical at Rosebrook opening,” said Ray Kruger, MD, Director of Bariatric Surgery for Southcoast Hospitals Group, Bariatric Surgeon and a Center of Excellence Surgeon. “This significant investment signifies Southcoast’s continued commitment to the Wareham community and our patients at the Southcoast Center for Weight Loss. This major addition to the health system infrastructure solidifies our ability to provide the highest quality of care, by combining multi-specialty physician practices and advanced outpatient services into one convenient location.”

Primary care physician practices located at Southcoast Medical at Rosebrook include Randy Caplan, DO, Brian P. Fitzpatrick, MD, Thomas L. Gleason, MD, Alfredo Gonzalez, MD, John B. Howard, MD, and R. Preston Reynolds, MD.

Specialty physician practices with offices at Southcoast Medical at Rosebrook include:

Iman Ali, MD, and David Kielty, OD, MD, Total Eye Care, LLC, Ophthalmology.

Donald Colacchio, MD, Rayford Kruger, MD, Thomas T. Streeter, MD, of Wareham Surgical Associates, General and Bariatric Surgery.

Patrick Curran, MD, Southcoast Physician Services, Truesdale Cardiology.

Emmet Eby, MD, Southcoast Physician Services, Pulmonary Medicine.

Matthew Philips, MD, and Anna Somerto, MD, Southcoast Physician Services, Neurosurgery.

Southcoast Medical at Rosebrook also includes more than 100 support staff, including physician assistants, nurses and nurse practitioners, medical assistants and laboratory and radiology technologists dedicated to providing the best care for their patients.

blog updated each day, visit us again

Stanmore Implants (”Stanmore”), specialists in the design and manufacture of patient specific implants for complex orthopaedic reconstructions, announces that it has received US FDA 510k approval for its Juvenile Tumour System (”JTS”) non-invasive extendible distal femoral replacement (”JTS implant”), for use in paediatric orthopaedic oncology surgery…
and i though i was the only one to see it this way

NEW BEDFORD, Mass. — A report released this week by HealthGrades® named Southcoast Hospitals Group among the top hospitals in the nation for bariatric surgery with a 5-star rating. HealthGrades found that bariatric surgery patients have a nearly 70 percent lower risk of experiencing an in-hospital complication at a top-rated hospitals such as Southcoast Hospitals Group compared to a poorly-rated hospital.

The findings are from HealthGrades 2011 Bariatric Surgery Trends in American Hospitals report which analyzed 193,518 bariatric surgery patient records from 2007 through 2009, including 468 hospitals in 19 states where data are publically available. Local hospital ratings and study methodology are available to consumers at www.HealthGrades.com.

This makes the third consecutive year that Southcoast Hospitals Group has been 5-star rated (2009-2011). Southcoast Hospitals Group is also ranked second in Massachusetts in 2011 and is one of only three hospitals to be 5-star rated for three consecutive years.

The long-term benefits of bariatric surgery, also known as weight loss surgery, include significant and sustainable long-term weight loss, resolution of diabetes, reduction in cardiovascular disease risk, and decreased mortality. HealthGrades’ report helps patients identify long-term and short-term risks found in patients who opt for the surgery, and helps them identify the hospital programs in their area whose patient outcomes minimize the risks of such complications.

Ray Kruger, MDDirector of Bariatric Surgery for Southcoast Hospitals Group

“As one of the largest weight loss centers in New England, the Southcoast Center for Weight Loss has successfully completed more than 2,300 weight loss procedures,” said Ray Kruger, MD, Director of Bariatric Surgery for Southcoast Hospitals Group, Bariatric Surgeon and a Center of Excellence Surgeon. “At Southcoast, you’ll be in regular contact with our team of experts in nutrition and exercise as well as psychologists and social workers who run weekly support groups to help you succeed. We recognize that making a change this big takes a team and it is our priority to help you achieve your goal of long-term weight loss.”

Dr. Kruger is part of Wareham Surgical Associates, part of Southcoast Physician Services, with Donald Colacchio, MD, and Thomas Streeter, MD, which has officially moved to its new location at Southcoast Medical at Rosebrook Park, the new medical office building at 100 Rosebrook Way in Wareham.

“Given the huge gap in quality between 5-star bariatric surgery programs and 1-star programs, choosing the right provider is critical,” said Rick May, MD, HealthGrades Vice President of Accelerated Clinical Excellence. “The decision to undergo major surgery is never an easy one and a procedure is never guaranteed to be complication-free. But with the help of HealthGrades bariatric surgery program ratings, patients can optimize their chances for receiving the highest possible quality of care.”

Southcoast Hospitals has been designated a Center of Excellence by the American Society for Metabolic and Bariatric Surgery. Southcoast’s community-based weight-loss program is designed to incorporate a thorough approach to weight loss surgery utilizing a team comprised of dieticians, psychologists and surgeons to provide a safe and comprehensive surgical weight loss program. All surgeries are performed in Tobey Hospital’s surgical wing, which features the most up-to-date technology available. Minimally invasive procedures are performed in “I-Suites” which integrate computers, fiber optics and other state-of-the-art surgical tools, giving local residents access to the most advanced technology available anywhere.

Key findings of the HealthGrades 2011 Bariatric Surgery Trends in American Hospitals report include:

Patients having bariatric surgery at 5-star hospitals are 69.7 percent less likely to experience in-hospital complications than patients at 1-star programs.

Patients having a bariatric procedure at a 5-star facility spent on average, a half-day less in the hospital than patients having their procedure at a 1-star facility (1.93 days versus 2.38 days respectively).

About HealthGrades

HealthGrades is America’s most trusted, independent source of physician information and hospital quality outcomes. HealthGrades online properties are the nation’s leading destination for physician search and empower more than 200 million consumers annually to make informed health care decisions.

and i though i was the only one to see it this way

Researchers at St. Michael’s Hospital have found more evidence of the benefits of home dialysis for patients with kidney failure. Cells that help protect blood vessels work better in patients who undergo dialysis at home during the night than those who undergo standard daytime dialysis in a hospital, according to Dr. Darren Yuen, a nephrologist…
great news thought i would never see this.