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Medicare’s Perspective Payment System Is Not The Primary Cause Of Early Hospital Readmission

Studies show that 10% of Medicare beneficiary’s early hospital readmissions were preventable. “There were 301,017 readmissions that were clinically related” (Norbert I. Goldfield, 2008) to a previous admission which was classified as be preventable or unnecessary. Statistics show that hospitals that have been effective in creating discharge plans experience lower readmission rates. Although the need for case management services has increased over the last decade, the concept is not new.  “Casework originated in the late 1800s under the ideologies of the coordination of human services, conservation of public funds, and care of poor and sick people.” (Hall, Carswell, Walsh, Huber & Jampoler, 2002) However, agencies lost momentum in the early 1900′s only to reemerge during the great depression.   “Traditional social work intervention [] focused on [] disadvantaged people who were struggling with basic survival needs”(Hall, Carswell, Walsh, Huber & Jampoler, 2002)

Currently, one in five patients discharged home from an acute care hospital cost Medicare over 17 billion dollars annually.  In 2008, “(19.6%) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days.” (Jencks, Williams, & Coleman, 2009)  There is a direct relationship between the rise in readmission rates and a patient’s socioeconomic status.  Individuals who live alone, have less than a 12th grade education, low income, chronic or mental ill or have no support system are less likely to comply with their discharge plan.  According to the 2008 US Census Report, national educational attainment of the individuals who were non-institutionalized and over 64 years old 3.9 million have 12 or fewer years of education.  (U.S. Census Bureau, 2008)

As the baby-boom generation moves into retirement the need for case management is on the rise.  Policy makers are hurrying to establish new health reform.  President Obama has pledged to have a Bill before Congress by the end of March 2010 to address the needs of aging Americans, who are disadvantaged, chronically or mentally ill.  Approximately, one in three Americans will experience some form of mental disorder at some point in their lives, and according to one estimate, one in every 6.4 adults is currently suffering from some form of mental illness.  (Boyle & Callahan, 1993) One of the areas of great concern is the impact early hospital readmissions of elderly patients have on the healthcare budget.  “The costs of caring for these patients and whose illness is episodic and curable have reached $136.1 billion per-year.” (Boyle & Callahan, 1993)  The first step to reducing this cost is to reevaluate the cause.

It is suggested that this increase is due to the number of Medicare beneficiaries receiving inadequate home healthcare. Could it be, because there are too many programs and variations to choose from?  On average each Medicare beneficiary “have at least 41 plan choices (excluding special need plans available to only qualifying subgroups) not including an extensive array of Medicare stand-alone prescription drug plans.” (Gold, 2009)

According to Medicare Provider Analysis and Review (MEDPAR) file for 2009, under the current Medicare policy, home health services consist of skilled nursing, physical therapy, occupational therapy, speech therapy, aid service, and medical social work.  (p. 201)

Conclusion:  Home health agencies have reduced the amount of services to their patients while receiving the same reimbursement.  Under the Medicare fee-for-service market basket policy, agencies only have to meet minimum requirements. They have adjusted their services to increase maximum input while providing substandard output. Moving from the current policy to an average rate for services would increase the services receive to clients, while reducing fraud. The increase of reimbursement for social services would provide needed care to individuals, whose socioeconomic status falls below the national average, thus reducing readmissions rates. Additionally, the government needs to reduce the number of special need plans (SNP) beneficiaries have to choose from; therefore, reducing entitlement confusion. These plans should mandate extra previsions for identifying and addressing the socioeconomic limitations of the more than nine million Medicare and Medicaid recipients.  Finally, case managers, nurses, and doctors need to advise all their patients of the benefits available and how to assess such services.

Method

Through meta-analysis, statistical data from secondary sources was used to gather information. Medicare recipients completed questionnaires consisting of 45 questions on a scale of 1 to 5 with 1 equaling does not apply and 5 equaling does apply. Within seven days of enrollment structured interviews were conducted at the recipient’s home.   Multidimensional variables were used to determine if there was a direct correlation between the number of Medicare Advantage plans, number of beneficiaries enrolled in a plan, and early hospital readmission rates.

There are currently 8,645,970 individuals 65 years old or older enrolled in Medicare Advantage. However, only 957,553 elderly or 10.5 percent is enrolled in a special need plan. (U.S. Census Bureau, 2008)  ORDI show  beneficiary demographics as follows: of the eligible recipients enrolled a SNP 98% were over 65 years old, 74% were male and 26% female, 70% white, 6% African American, and 14% other races.  Medicare eligibility status was 97.3% eligible due to age, 1.5% disabled, and 1.2% other.  Most of the participants lived in urban communities 57.1%, rural 42.9, and 66% lived in the community.  Individuals who lived in the rural communities rated as having a higher risk score. (p. 91)

Measurement Tools

In a research report published in 2007 by The Center for Medicare and Medicaid Services Office of the Research, Development, and Information (ORDI), committee members stated that if Congress continue to disregard the current way home healthcare for chronically ill is conduct, it will break this nation.  This information came from CMS enrollment records, claims received HCC and HMO payment file, fiscal years 2003 and 2004, starting on September 1, 2003 through August 31, 2005, 10,400 freestanding home health agencies were compared to the services offered and delivered. Of those agencies, 8,562 reported 59% of their clients being readmitted or going to the emergency room within 30 days of discharge from an acute hospital facility. Only 1 in 24 were enrolled in a special need program.

According to Jencks, Williams and Coleman (2009), of the Medicare beneficiaries who were readmitted in an acute care hospital within 30 days of discharge, 70% had an existing medical condition (p. 1) which would have been covered under Medicare Advantage if the recipient was enrolled.

Schmitz, Merrill, Schore, Shapiro, & Verdier (2007) conducted a survey of 800 organizations “to collect uniform information about their structure and operation.” (p. 38)   An eight hundred questionnaire survey was mailed 193 facilities who met ORDIs criteria. The participating companies were “ask about their population, relationships with providers, member screening and assessment, services offered, relationship with Medicaid, and pharmacy benefits. Of the surveys mailed (n=193), 11 were ineligible, 145 surveys were completed with a total response rate of 80%.  “Currently a little over half of the dual-eligible and institutional SNPs had more than 1000 members, which provided care for heart failure or other cardiovascular disease.” (p. 38)

CMS has identified the follow medical conditions as being eligible for the chronic condition classification.  Each illness must be:

• Medically complex

• Substantially disabling or life-threatening

• High risk of hospitalization or have other adverse outcome

• Needs specialized delivery system across care domains

• Has nationally recognized protocols or guidelines

The chronic conditions that meet CMS guidelines and are identified as being the primary cause of early hospital readmissions include: COPD 15.4%, Diabetes without complications 19.1%, CHF 21.7%, vascular disease 13.3%, specified heart arrhythmias 15.5%, major depression, bipolar, and paranoid disorders at 6.3%, renal failure 4.9%, angina pectoris 4.2%, cancers 3.7%, and ischemic or unspecified stroke 4.0%.

There are 12 insurance companies that over 75% of all Medicare beneficiaries.   There were 2,735 plans offered in Medicare Advantage in 2009. (The Henry J. Kaiser Family Foundation, 2009)

Implications

Failure to develop a program that would automatically cover all Medicare beneficiaries would be catastrophic for this nation.  Currently, the cost of each Medicare patient who is readmitted after the first 24 hours of discharge from an acute care hospital but within 30 days cost the government an average of $7,248 for each patient.  If you take the average cost for each readmission in 2008 and multiply them, it cost 17.4 billion dollars.   At this current rate, the country will be bankrupt by 2020.

The Prospective Payment System which is currently being used by CMS is inadequate and is over paying claims for service by some 6 billion dollars annually.   The way the current system is designed, it allows home health care to bill for and services only that pay the largest reimbursement.  Because of this some of the main causes of patients being readmitted is over looked.   Arbaje’s study conducted in 2008 measurements [on] early readmission [of patients'] postdischarge environment (PDE) factors, and socioeconomic (SES) factors to determine their needs once they are discharged from the hospital. PDE factors consisted of having a usual source of care, requiring assistance to see the usual source of care, marital status, living alone, lacking self-management skills, having an unmet functional need, having no helpers with activities of daily living, number of living children, and number of levels in the home. SES factors consisted of education, income, and Medicaid enrollment. (p. 495)  As shown in this model Arbaje illustrates emigrating factors that directly related to a person’s chance of being readmitted. (See figure 1.)

Most home health agencies overlook the importance of having social work involvement in the lives of their clients.  To increase their profits, client socioeconomic needs go un-assessed or are minimized.  They often fail to recognize “the scientific evidence concerning the effectiveness of case management services [and how] it has grown over recent years.” (Björkman, 2000)  There are a number of assessment tools currently being used by home health agencies, but there is no consistency. Social workers work with identifying client strengths. The strengths’ perspective assumes that everyone has the capacity to draw from a variety of resources, skills, abilities, motivations, desires, and talents”. (Hall, Carswell, Walsh, Huber & Jampoler, 2002) By home health agencies limiting patients’ access to a social worker, patients never obtain the confidence they need to heal and live productive lives.  Patients become more dependent on the system, thus returning to the hospital at the first sign of trouble. If this trend is not corrected the growth of hospital readmissions will continue.

Programs

There are several programs in place that may accommodate Medicare and Medicaid beneficiaries.  Let’s take a look at three.

The first program is The Providing Assistance to Caregivers in Transition (PACT) program.  This program is a case management program comprised of social workers and nurses. They develop case plans for patients who were discharged home from a facility.  It is also covered by Medicare, but not Medicaid.  However, the drawback of this program is that it is limited to only 10 visits per 60 day period and to those patients who came from a nursing home or hospital. It would be more effective is it “considers a broader mix of nursing homes, working directly with the nursing home’s admission Minimum Data Set coordinator in the patient selection, or working with Medicare or Medicaid HMO plans.” (Newcomer, 2006)

The second program which is available to patients is the special need plan offered by Medicare.  This program assists patients who have a chronic illness and is unable to handle their own affairs.  Patients can receive an unlimited amount of visits from a nurse or social worker.  However, this is an evidence base plan and is limited to those patients who will be able to develop an independent lifestyle. Unfortunately, the reimbursement under this plan is limited and few home healthcare agencies utilize it.

Then there is the intensive case management program. This plan assists “high-risk adults with chronic mental health conditions”. (Patterson, 1998) Patients are assisted with their medications and daily living.  This plan is also covered under the Medicare reimbursement policy; however, it is limited to patients with severe medical problems.  It is used by most home health agencies and is paid at a higher rate by both Medicare and Medicaid.

Recommendations

There are a number of possible solutions in handling the confusion and reduce readmission rates.  First, a reduction of the number of Medicare plans available under Medicare Advantage program should be made.  Second, there need to be nation minimum standards for all plans.  Third, all plans must carry dual enrollment programs (offering both Medicare and Medicaid). Fourth, every Medicare and Medicaid patient who is being discharged home is to be assessed by a social worker at home within 3 days of discharge.  Fifth, all assessments should be nationally universal; every state would use the same format.  Finally, patient socioeconomic information should be on a computer system and outcomes should also be posted.

A reduction of the number of Medicare plans offered under the Medicare Advantage program should be executed. There are currently some 2700 different programs available.  Each program offers a varying amount of services with just as many combinations. Additionally, some of the plans are hard to understand, while others are confusing. Some people will find that one of their illnesses is covered, while another is not.      The current plans, say a person is diagnosed with diabetes and depression; they may be under a plan that covers diabetes, but not depression or vice versa.

Each plan should have minimum standards that would cover the 12 chronically illnesses currently approved by Medicare or Medicaid as high risk.  There would be no all-inclusive plans.  Every service and treatment would be itemized with a time frame for outcomes.  Only those agencies that maintain a positive outcome base over 80% would be able to stay in the Medicare or Medicaid program.

Due to the high number of individuals who is low income all plans should be required to carry dual enrollment programs (offering both Medicare and Medicaid). Additionally, a large number of white patients live alone and because of assets do not qualify for Medicaid; therefore, the minimum standards should not be based on assets.  If the person qualified for both Medicare and Medicaid than they would have met the standards for those programs and additionally limits should not be imposed.

Conclusion

Without healthcare reform is necessary for this country to survive and reducing Medicare and Medicaid is the place which needs the biggest overhaul.  Currently costing this nation billion of dollars annually preventive health is the answer.  The only way to do this is by reducing the number insurance of plans, setting national minimum standards, increasing recipient enrollments in special need plans, and effective discharge plans these rates could be reduced. More choice does not always mean better choice.

With President Obama on the skirts of signing a new healthcare reform bill, case management needs to be an intricate part of the recovery plan.  Only through the reduction of ineffective care, government mandates and tougher penalties for   insurance companies who defraud the government will change come and patients receive the treatment they need.

References

Arbaje, A., Wolff, J., Yu, Q., Powe, N., Anderson, G., & Boult, C.. (2008). Postdischarge Environmental and Socioeconomic Factors and the Likelihood of Early Hospital Readmission Among Community-Dwelling Medicare Beneficiaries. The Gerontologist, 48(4), 495-504

Björkman, T., & L. Hansson. (2000). What do case managers do? An investigation of case manager interventions and their relationship to client outcome. Social Psychiatry and Psychiatric Epidemiology, 35(1), 43-50.  Retrieved February 14, 2010, from ProQuest Medical Library. (Document ID: 972364221). Hall, J. A., Carswell, C., Walsh, E., Huber, D. L., & Jampoler, J. S. (2002). Iowa Case Management: Innovative Social Casework. Social Work, 47(2), 132+. Retrieved March 6, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=5000759600

Hall, J. A., Carswell, C., Walsh, E., Huber, D. L., & Jampoler, J. S. (2002). Iowa Case Management: Innovative Social Casework. Social Work, 47(2), 132+. Retrieved March 6, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=5000759600

Jencks, S., Williams, M., & Coleman, E.. (2009). Rehospitalizations among Patients in the Medicare Fee-for-Service Program. The New England Journal of Medicine, 360(14), 1418-28.  Retrieved February 28, 2010, from ProQuest Medical Library. (Document ID: 1672517131).

Medicare Provider Analysis and Review (MEDPAR) 2009 Retrieved February 14, 2010 http://www.cms.hhs.gov/MedicareFeeforSvcPartsAB/03_MEDPAR.asp

Robert Newcomer, Taewoon Kang, & Carrie Graham. (2006). Outcomes in a Nursing Home Transition Case-Management Program Targeting New Admissions. The Gerontologist, 46(3), 385-90.  Retrieved February 14, 2010, from ProQuest Medical Library. (Document ID: 1049777191).

Patterson, David, A., & Myung-Shin Lee. (1998). Intensive case management and rehospitalization: A survival analysis. Research on Social Work Practice, 8(2), 152-171.  Retrieved February 14, 2010, from ProQuest Psychology Journals. (Document ID: 26923286).

Schaedle, Richard W., Irwin Epstein Publication title: Mental Health Services Research. New York: Jun 2000. Vol. 2, Iss.  2;  pg. 95 Source type: Periodical ISSN: 15223434 ProQuest document ID: 386427651

Schmidt-Posner, Jackie, & Jeanette M Jerrell. (1998). Qualitative analysis of three case management programs. Community Mental Health Journal, 34(4), 381-92.  Retrieved February 14, 2010, from ABI/INFORM Global. (Document ID: 32416774).

Schmitz, R., Merrill, A., Schore, J., Shapiro, R., Verdier, J. (2009). Centers for Medicare & Medicaid Services ― Evaluation of Medicare Advantage Special Needs Plans Summary Report, Contract No.: 500-00.0033(13) MPR Reference No.: 6216-711 September 30, 2008 [http://www.cms.hhs.gov/reports/downloads/Schmitz_2008.pdf]

The Henry J. Kaiser Family Foundation. (2009). Strategies for Simplifyiong the Medicare Advantage Market. Washington, DC: Mathematica Policy Research, Inc. .

U.S. Census Bureau. (2008, Januay 1). Educational Attainment of the Population 18 Years and Over, by Age, Sex, Race, and Hispanic Origin: 2008. Washington, DC, Unite States.

Hall, J. A., Carswell, C., Walsh, E., Huber, D. L., & Jampoler, J. S. (2002). Iowa Case Management: Innovative Social Casework. Social Work, 47(2), 132+. Retrieved March 6, 2010, from Questia database: http://www.questia.com/PM.qst?a=o&d=5000759600

Jencks, S., Williams, M., & Coleman, E.. (2009). Rehospitalizations among Patients in the Medicare Fee-for-Service Program. The New England Journal of Medicine, 360(14), 1418-28.  Retrieved February 28, 2010, from ProQuest Medical Library. (Document ID: 1672517131).

Robert Newcomer, Taewoon Kang, & Carrie Graham. (2006). Outcomes in a Nursing Home Transition Case-Management Program Targeting New Admissions. The Gerontologist, 46(3), 385-90.  Retrieved February 14, 2010, from ProQuest Medical Library. (Document ID: 1049777191).

Patterson, David, A., & Myung-Shin Lee. (1998). Intensive case management and rehospitalization: A survival analysis. Research on Social Work Practice, 8(2), 152-171.  Retrieved February 14, 2010, from ProQuest Psychology Journals. (Document ID: 26923286).

Schaedle, Richard W., Irwin Epstein Publication title: Mental Health Services Research. New York: Jun 2000. Vol. 2, Iss.  2;  pg. 95 Source type: Periodical ISSN: 15223434 ProQuest document ID: 386427651

Schmidt-Posner, Jackie, & Jeanette M Jerrell. (1998). Qualitative analysis of three case management programs. Community Mental Health Journal, 34(4), 381-92.  Retrieved February 14, 2010, from ABI/INFORM Global. (Document ID: 32416774).

Schmitz, R., Merrill, A., Schore, J., Shapiro, R., Verdier, J. (2009). Centers for Medicare & Medicaid Services ― Evaluation of Medicare Advantage Special Needs Plans Summary Report, Contract No.: 500-00.0033(13) MPR Reference No.: 6216-711 September 30, 2008 [http://www.cms.hhs.gov/reports/downloads/Schmitz_2008.pdf]

The Henry J. Kaiser Family Foundation. (2009). Strategies for Simplifyiong the Medicare Advantage Market. Washington, DC: Mathematica Policy Research, Inc. .

U.S. Census Bureau. (2008, Januay 1). Educational Attainment of the Population 18 Years and Over, by Age, Sex, Race, and Hispanic Origin: 2008. Washington, DC, Unite States. http://www.census.gov/aboutus/budget.html

About the Author

My name is Lori Pritchard. I am a Life Coach, who blends my education, training, experience, humor, and common sense together to create a life coaching experience that is measurable. I received my Bachelor Degree of Social Work from the University of South Florida and am currently completing my Master of Healthcare Administration at Capella. University.http://lplifecoaching.com Life Coach Radio:
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lyublyua and Russkiy muzika! first, or Tatu Taty is the most famous band in Russia. Then, Sergey Lazarev and Vlad Topalov, etc. Nich'ya Furthermore, the song stars tATu is half Russian and half in English. Rap sing in English and Russian, and English etc., Tatu-stars: Sergey Lazarev http://www.youtube.com/watch?v=WPEndJTPaeQ because you quit: Vlad Topalov http://www.youtube.com/watch?v=355P0UMPEKw: http://www.youtube.com / watch? v = EUNl9WXqEXw Nich'ya: http://www.youtube.com/watch?v=LbbtcWYcZfU http://www.youtube.com/watch?v=vn1uJeX0lqE and enjoy!

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¿Cuáles son los síntomas de isquemia miocárdica?

Cuando se llega al corazón, hay tantos problemas de salud que pueden afectar a esta parte sensible del cuerpo. Uno de estos médicos condiciones es la isquemia miocárdica. Algunas personas también llaman a este como la angina de pecho. Esto ocurre cuando el corazón ya no recibe la sangre rica en oxígeno. Aunque este es un estado temporal, esto todavía puede llevar a problemas graves o incluso puede ser fatal también. Por lo tanto, si usted está viviendo un estilo de vida no tan saludable, es posible que desee tomar nota de estos síntomas antes de la isquemia miocárdica ocurre que la situación empeore.

A continuación se presentan algunos de los síntomas que pueden indicar que usted tiene la isquemia miocárdica:

1. Usted sentirá que su pecho es pesada o apretada, aunque no hay sensación de dolor.

2. Justo debajo de su esternón, experimentará un ardor o dolor opresivo que generalmente se extiende hasta el brazo, la mandíbula, o incluso su garganta.

3. Usted puede pensar que le van a hacer la indigestión pero esto ya puede ser un indicio de la isquemia miocárdica.

Hay muchos factores que pueden desencadenar los síntomas de isquemia miocárdica. Algunas de estas actividades que pueden llevar a angina de pecho entre ellas las siguientes:

· Ejercer demasiado en las actividades físicas en particular cuando el hacer ejercicios.

· Emociones intensas negativas como la ira, el estrés, y la frustración.

· La exposición a temperaturas extremas.

· De fumar

· Las comidas pesadas y la indigestión

Pero una isquemia miocárdica no es sólo una condición de corazón sencillo. Cualquiera de dichos síntomas y factores desencadenantes pueden ser un signo de cualquiera de estos tipos. No es la estable, inestable, y la isquemia miocárdica variante. Entre los tres tipos, la angina estable es considerado como el más común. Si esto se convierte en regular, a la larga puede predecir cuando va a sentir los síntomas. Sería cuestión de un par de minutos de descanso o un medicamento para librarse del dolor. La isquemia del miocardio inestable por el contrario es más peligrosa en comparación con el otro tipo. De hecho, podría ser una señal de que la persona tendría un ataque al corazón en cualquier momento pronto. Mientras tanto, el tipo de variante es una enfermedad rara. El dolor es más severa en comparación con los otros dos y puede ocurrir mientras la persona está en reposo. Cuando es atacado por la isquemia miocárdica durante la variante de la medianoche o en la madrugada, sólo se requeriría una dosis de la medicina para que la persona se sentirá aliviado.

About the Author

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ive recently been having some discomfort in my chest. it feels as if moderate pressure is being applied on my heart. its not so much as painful but more annoying. i felt it for a short while on wednesday after doing some bench presses (my heart wasnt beating rapidly) but soon faded away. the next day, sometime between 4-5 pm, i felt the pressure again, yet this time it didnt fade away. i feel the pressure after i exercise, lay down, get up, or when i twist my torso. im wondering what factors couldve contributed to the discomfort. im also wondering if i could possibly be suffering from stable angina, and if i am, is it a medical emergency or can a few changes in my lifestyle to remedy my chest discomfort?

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The Main Symptoms Of Disease

When people consult the doctor they do so because they have had feelings and sensations that are disturbing and uncomfortable. Perhaps they have had reactions in various portions of the body which are quite different from the usual. For instance, symptoms may include pain, weakness, shortness of breath, cough, or itching. One may notice a sudden increase of weight, or loss of weight. The hands and feet may seem to be cold and numb. Indigestion may occur, with dizziness or vomiting or diarrhea. Because of jaundice the skin may develop a yellow appearance. All these are included in the signs and symptoms of disease; they are a warning that an investigation of the cause is needed.

People who are emotionally disturbed are likely to feel pain sooner and more intensely than are people in general. With the reaction to pain may come other changes, brought about through functioning of the sympathetic nervous system. These include rapid beating of the heart, sweating, rise in the blood pressure and disturbances of digestion.

Pain

Pain is described as burning, sticking or pricking, sharp, dull, throbbing or knifing. Different parts of the body feel pain in different ways. The skin reacts easily. Muscles may not feel puncture by a needle, but ache when they are in spasm or suffer cramp. Compact bone may be cut without pain but porous bone may be painful when injured. The brain tissue may not be sensitive, but the blood vessels have nerve connections and anything that pulls or stretches the blood vessels in the brain will give a pain in the head. Pain from the intestines may be due to injury of the intestinal wall, stretching of the muscles in the wall or pulling on the tissues that hold the intestines in place.

Headache

When you have a headache the doctor will want to know about the location of the pain, its quality, its intensity, the time when it comes on, and the way it is influenced by moving, reading, noise, and other factors. Usually a headache is a dull, aching pain, that arises from the structures within the skull. Sometimes a headache may be associated with a disturbance in the sinuses, or the eyes, or in the bones in the upper part of the spine.

Sensitivity to pain in the head varies in different people and in the same person at different times. The worst headaches are those associated  with inflammations or infections of the meninges, which are the tissues  that cover the brain. When a sudden, sharp pain affects the head the sensation may be due to a branch of the facial nerve. Usually headaches last longer, for minutes or even hours. When the headache is described as “throbbing” the effect comes from transmission of the pulse in the blood vessels.

A headache may be associated with exposure to cold. Other headaches may develop in healthy people during periods of great fatigue or emotional stress. Such headaches occur towards the end of the day; they begin as a dull ache in the forehead and spread towards the temples or towards the back. These headaches disappear when the person concerned has some good rest or sleep. Fear and worry seem to make headaches worse. Some headaches come from tenseness of the facial muscles, which in turn may be caused by pain or anxiety or strain.

Psychological disorders or mental disturbances may also be reflected in pains which are referred to the head. Such people complain of pressure on the head, of a tight-fitting band which squeezes the head, or of a pain that presses on the very top of the head.

Pain In The Chest

Pain in the chest may come from the ribs and the tissues related to the ribs; from organs in the abdomen; from the heart or from other organs in the chest. The muscle of the heart has to have oxygen, and when this essential is not provided the muscle responds with pain. Angina pectoris is a pain of this type which is usually continuous and which is provoked by walking, or an emotional strain, or any other factor that increases the work of the heart. The pain tends to be relieved when the burden is removed. Interference with the flow of blood carrying oxygen through the coronary arteries into the heart will bring on an attack of pain. The pain of angina pectoris and that of coronary thrombosis are about the same. Usually that of coronary thrombosis is more severe and lasts longer. Occasionally, however, thrombosis may occur with little or less severe pain.

Other pains in the chest may come from disturbances of the large blood vessels, from the nerves that reach the linings of the chest cavity, and from growths or abscesses behind the breast bone.

Heartburn probably arises from constriction at the bottom of the esophagus or swallowing tube, because material has been regurgitated from the stomach into this tube.

Pain In The Back

Strangely, one of the most difficult of all the diagnoses that a doctor  has to make concerns the cause of a pain in the back. Excluding the pain that comes with breaking the bones of the spine or twisting the spine completely out of line, a number of different conditions may be ( responsible for different kinds of pains in the back. Infections may attack the tissues of the back as they do other parts of the body. Rheumatoid arthritis may select the many joints of the  backbone as a place in which to locate. The little cartilages or discs that act as cushions between the bones may be crushed or slip out of place. The ligaments which attach to the bones of the spine may be  pulled  to the point where they are painful with every movement.

Careful study by an experienced physician reveals the cause of pain in the back and indicates the type of treatment to be followed. This may vary from changing the shoes and wearing a specially designed brace or corset, to instructions for reducing weight, improving the posture or even a surgical operation.

A recent postural instruction says:

• When standing or walking, toe straight ahead and take most of your weight on the heels.
• Sit with the buttocks tucked under so that the hollow in the low back is eradicated.
• When possible elevate the knees higher than the hips while sitting.
• Sleep on your back with your knees propped up or on your side with one or both knees drawn up.
• Bed should be firm.
• Never bend backwards.
• Avoid standing as much as possible.
• Learn to live 24 hours a day without a hollow in the lower part of your back.
• Avoid sleeping on the abdomen.

Painful Arms And Legs

Bums, frostbite, and cutting of the arms and legs may be painful. Similarly arthritis, abscesses in the bones and soft tissues, tumors and damage to the nerves may result in severe pain.

From the limbs of the body the nerves pass along until they connect with the roots in the spinal cord. Pressure, irritation or damage to these nerves at any point along their course may result in pain that is felt in the limb itself.

Pain may also be transmitted to the limbs from impulses arising elsewhere in the body. For instance, pain from the hip may be transmitted to the knee. Pain from the deep muscles of the back or from the small bones of the spinal column may be felt in the legs. Pain from angina pectoris or coronary thrombosis of the heart may be felt along the inner sides of the arms.

Various disturbances of the blood supply to the limbs may result in pain. This applies particularly to blocking of the circulation so that the tissues do not receive a proper amount of oxygen. As the blood supply becomes blocked there is a feeling of numbness and finally difficulty of movement. You say “My leg has gone to sleep.” Blocking the blood to the arm causes the fingers to get quite numb in about twelve minutes, and then they are painful when touched. As the blood returns a sensation of tingling is felt, which is due to renewed activity of the nerves of the arm. If an arm or leg is moved while the circulation is blocked severe pain may be felt. This may be called a cramp, although actually the muscles are not in spasm but flaccid.

After a limb has been amputated pain may be felt as if it were in the limb. This is called “phantom limb” pain. In diagnosing the causes of pain in the extremities the character and location of the pain are most significant.

About the Author

David Crawford is the CEO and owner of a Male Enhancement company known as Male Enhancement Group which is dedicated to researching and comparing male enhancement products in order to determine which male enhancement product is safer and more effective than other products on the market. Copyright 2009 David Crawford of http://www.maleenhancementgroup.com/. This article may be freely distributed if this resource box stays attached.

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Stress – Types, Causes and Cures (part Three)

How the body reacts to prolong stress is described by Dr Hans Selye in terms of the General Adaptation Syndrome. Selye divides the stress response into three phases: Alarm Response, Adaptation and Exhaustion. The Alarm Response is the fight or flight response that prepares the body for immediate action. If the source of stress persists, then the body prepares for long term protection through the secretion of further hormones that increase blood sugar levels to sustain energy and raise blood pressure. This Adaptation phase, resulting from exposure to prolonged periods of stress, is common and not necessarily harmful but without periods of relaxation and rest to counter-balance the stress response, sufferers become prone to fatigue, concentration lapses, irritability and lethargy as the effort to sustain arousal slides into negative stress. Under persistent, chronic stress, sufferers enter the Exhaustion phase: mental, physical and emotional resources suffer heavily and the body experiences ‘adrenal exhaustion’, where blood sugar levels decrease as the adrenals become depleted, leading to decreased stress tolerance, progressive mental and physical exhaustion, illness and collapse.

Exposure to excessive stress results in hormonal imbalances, which can produce a variety of symptoms:-

Physical symptoms – changes in sleep patterns, missed heartbeats, fatigue, palpitations, changes in digestion, breathlessness, loss of sexual drive, headaches, infections, indigestion, tingling of hands and feet, aches and pains in various parts of the body, dizziness, sweating and trembling.

Mental symptoms – lack of concentration, panic attacks, memory lapses, difficulty in making decisions, disorientation and confusion.

Emotional symptoms – deterioration in personal hygiene and appearance, bouts of depression, impatience and irritability, fits of rage and tearfulness.

Behavioural symptoms – appetite changes, eating disorders, increased intake of alcohol and other drugs, nail biting, fidgeting, restlessness, hypochondria and increased smoking.

The term ‘cardiovascular’ refers to the heart and the body’s system of blood vessels. Cardiovascular disease is probably the most serious health problem that can be linked to stress – it is the most common cause of death in the UK and the USA. The primary causes of heart disease include smoking and high fat diets but stress is a significant contributory factor.

Adrenal hormones act to increase blood pressure; temporary rises in blood pressure present no threat to health but a frequent or perpetual state of high blood pressure can have a serious effect on health in the long term. High blood pressure is linked with the development of arteriosclerosis or hardening of the arteries. Arteriosclerosis is the result of the development of blood plaque in the arteries, which progressively narrows the pathway through which the blood flows. Eventually an artery can become blocked, leading to angina, stroke and heart failure.

Infections, viruses, harmful bacteria and cancer are stopped from harming the body by the immune system. Excessive stress can damage the immune system by affecting the thymus gland, which manufactures white blood cells for regulating immunity and also produces various immune related hormones. The stress reaction diverts resources to the main parts of the body that need to deal with stress, mainly the brain, heart and muscles. The immune system and other systems are deprived of resources. The thymus gland may shrink because of the hormones that are produced by the adrenal glands. This will also degrade the work done by the white blood cells, which will cause damage to the body’s ability to fight infection. Reduced resistance to common infections, such as flu, colds and herpes is a result of high stress. Because certain types of white blood cells produced by the thymus are active in preventing the development of cancer cells in the body, any damage to the thymus may effect the bod’s ability to resist cancer.

Asthma is a respiratory disorder marked by the temporary constriction of the bronchi, the airways branching from the trachea to the lungs. Attacks are usually brought on by allergic reactions to antigens, such as grass and tree pollen, mould spores, fungi and certain foods but also may be caused by chemical irritants in the atmosphere or by infections of the respiratory tract. Susceptibility to an asthma attack is based on hyperactivity of the bronchial muscles, which constrict on exposure to one or any of these agents. Chronic stress reduces the efficiency of the adrenal glands, reducing the output of anti inflammatory and anti allergic adrenal hormones, which may make an asthma attack more likely.

Diabetes is caused by the inability of the body to metabolise sugar correctly, leading to excessively high levels of sugar in the blood. Sugar metabolism is the responsibility of the hormone insulin, which is secreted by the pancreas. The majority of diabetics are able to produce insulin but a number of factors limit its efficiency; this is known as ‘insulin sensitivity’.

Blood sugar levels are significantly impacted by the release of adrenal hormones under stress. Adrenaline causes sugar in the liver to be put into the blood stream and cortisol acts to reduce the metabolism of glucose by cells. Large amounts of cortisol act to decrease insulin sensitivity. High blood sugar levels are not dangerous in normally healthy individuals but chronic stress, combined with other factors such as obesity, act to increase the likelihood of developing diabetes.

Ulcers are frequently associated with stress, although no conclusive link has yet been demonstrated. Normally the lining of the stomach is covered with a layer of mucus to protect it from the digestive acids and enzymes used in the breaking down of food. Over time, chronic stress can stimulate the overproduction of gastric juices, which break down the protective mucus and act upon the walls of the digestive tract, resulting in ulceration. Ulcers usually occur singly in round or oval lesions; the erosions are usually shallow but can penetrate the entire wall, leading to haemorrhage and possibly death.

Many problems with the digestive tract, such as constipation, diarrhoea and irritable bowel syndrome are linked to stress. The brain will send messages to the nerves in the digestive tract in the form of hormones. These messages will tell the intestinal muscles to expand or contract. Hormonal imbalances can cause alterations in intestinal function, such as spasms, constipation and diarrhoea. Chronic stress tends to shut down the digestive system altogether, exacerbating intestinal problems.

Stress increases levels of toxicity in the body and contributes to hormonal imbalances, both of which have an effect on the skin. The visible effects of stress on the skin include:- acne, spots, skin diseases, eczema, excessive pallor and psoriasis.

Headaches are one of our most common afflictions and are normally caused not by disease but by fatigue, emotional disorders or allergies. Intermittent tension headaches are caused by worry, anxiety, overwork or inadequate ventilation. The most common type, a chronic tension headache, is often caused by depression. Brain tissue itself is insensitive to pain, as is the bony covering of the brain (cranium). The stimulation of the nerves of the cranium, upper neck and the membranous linings of the brain will cause headache pain. This stimulation can be produced by inflammation, by the dilation of blood vessels of the head or by muscle spasms in the neck and head. Headaches brought on by muscle spasms are classified as tension headaches: those caused by the dilation of blood vessels are called vascular headaches.

Migraine is the most common cause of vascular headache. Many things seem capable of triggering migraine attacks, including stress, fatigue, drugs and foods that contain substances that affect the blood vessels. Chronic headache may be physical symptoms of depression or other kinds of severe emotional problems.

Stress has a debilitating effect on the nerves in general and certain premenstrual symptoms may be aggravated by stress. Many sufferers of PMS have abnormal levels of the adrenal hormone aldosterone, which may account for some of the problems of excessive fluid retention and weight gain, breast tenderness and abdominal bloating. Further release of aldosterone caused by stress will exacerbate these problems.

Chronic stress can produce severe depression because of its debilitating psychological effects. The physiological changes produced by stress can also contribute to depression. Adrenaline and noradrenaline are not only adrenal hormones but chemical messengers in the brain. Deficiencies of noradrenaline have been linked to depression in certain individuals and so adrenal exhaustion through chronic long term stress may be a contributory factor in depressive illness.

About the Author

Andrew Tomkinson is a successful author of many articles on health related subjects. He also recommends fitness, health and nutrition products and services to improve your lifestyle and well being. Do you want to be healthier, have a better quality of life and take full advantage of the opportunities open to you? GO HERE-
http://www,fitnesshealthnutrition.org

What are the causes of Angina? How do you cure it?

When blood flow to an area of the heart is decreased, it impairs the delivery of oxygen and vital nutrients to the heart muscle cells. When this happens, the heart muscle must use alternative, less efficient forms of fuel so that it can perform its function of pumping blood to the body. The byproduct of using this less efficient fuel is a compound called lactic acid that builds up in the muscle and causes pain.

How Is Angina Treated?

The treatment you receive depends on the severity of the underlying problem, namely the amount of damage to the heart. For most people with mild angina, a combination of medications and lifestyle changes can control the symptoms. Lifestyle changes include: eating a heart-healthy diet, lowering cholesterol, getting regular exercise, quitting smoking and controlling diabetes and high blood pressure.

Some medications used to treat angina work by either increasing the amount of oxygen delivered to the heart muscle or reducing the heart’s need for oxygen. These medicines include:

* Beta-blockers
* Nitrates
* Calcium channel blockers
* ” Angiotensin-converting enzyme inhibitors (ACE inhibitors)

Others work to prevent the formation of blood clots, which can further block blood flow to the heart muscle. These medicines include:

* Antiplatelet medications
* Blood thinners
* Anticoagulants

For people with more serious or worsening angina, your doctor may recommend treatment to open blocked arteries. These include:

* Angioplasty
* Stenting
* Coronary artery bypass grafting (CABG) surgery
* Transmyocardial revascularization (TMR)
* External counterpulsation (EECP)

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You’re young so don’t worry too much, but yes, this is something you should have thoroughly checked out by a physician. There are other reasons, and more likely reasons, for the symptoms you suggest though, all of which can be dealt with medically…easily and inexpensively too.

Good luck.

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Coronary Angiography in India: a Cost Effective Solution

Coronary angiography in India is one of the cost effective solutions for the international patients who wish to have their Coronary angiography at affordable cost. Hospitals of Coronary angiography in India are providing special affordable packages to abroad patients for Coronary angiography in India. India is one of the world’s leading destinations for medical tourism. The country has the best super specialty hospitals that offer the best in terms of cardiology and treatment of heart ailments. The Hospitals in India , , has state of the art cardiac care facilities, and offers excellent preventive and intervention care that is at par with the best in the world. Coronary angiography is offered by most super specialty hospitals in India. This is an effective method for taking x Rays of the veins and arteries, or the more inaccessible chambers of the heart. In this procedure, a catheter tube is inserted into the heart or arteries close to it, and a fluorescent dye is injected into the bloodstream, which is picked up by x ray machines. The x ray photograph thus obtained is known as an angiogram.

Cornory Angiography:

Coronary angiography is an X-Ray procedure to show up the arteries that supply blood to the heart muscle (the coronary arteries). If these are narrowed or blocked they can result in angina or heart attack (myocardial infarction), and coronary angiography enables us to better work out how to treat the patient.

The procedure involves putting a tube into the heart via an artery in the arm or leg, and injecting a liquid into the coronary arteries which shows them up when viewed with X-Rays.

Who is an ideal candidate for Coronary angiography?

Your doctor may recommend that you undergo coronary angiography if:

• You have symptoms of coronary artery disease, such as chest pain (angina)
• You have unexplained pain in your chest, jaw, neck or arm, and other testing has been inconclusive
• You have new or increasing chest pain (unstable angina)
• You don’t have symptoms, but other tests have suggested you may have heart abnormalities
• You’re going to have surgery unrelated to your heart, but you’re at high risk of having a heart problem during that surgery
• You’re planning to have heart valve surgery
• You have congenital heart disease
• You have congestive heart failure
• You have certain other heart or blood vessel problems or certain traumatic chest injuries

Because of its risks, angiography often is done only after certain other heart tests have been performed, such as an electrocardiogram, an echocardiogram or a stress test.

The cost of coronary angiography in India is very affordable as compare to other western countries. Many international patients are turning to India for affordable Coronary angiography, with the help of medical tourism in India these patients are getting best medical services at very low cost. Hospitals of coronary angiography in India are located at Delhi, Mumbai, Chennai and Hyderabad; Indian hospitals combine the latest innovations in medical electronics with unmatched expertise in leading cardiologists and cardo-thoracic surgeons of India. Medical centers in India have the distinction of providing comprehensive cardiac care spanning from basic facilities in preventive cardiology to the most sophisticated curative technology. The technology is contemporary and world class and the volumes handled match global benchmarks. They also specialize in offering surgery to high risk patients with the introduction of innovative techniques like minimally invasive and robotic surgery. For more details visit on http://www.forerunnershealthcare.com and enquiry@forerunnershealthcare.com

About the Author

I am Doctor and international health consultant

How dangerous is high blood pressure, heart rate, chest pains, and shortness of breath?

I received an electrical shock of 440 volts at 15 amps from arm to arm. since the incident, I’ve had constant problems with chest pain, high blood pressure, and heart rate. I also get really short of breath after going up 4 flights of stairs.

No matter the cause, it is imperative that you get a specialist (cardiologist) to immediately work you up and give you a second opinion. Tricuspid valves normally have trace regurgitation. Mitral valve problems are present in a large minority of the population and don’t usually pose a problem – but they can sometimes. PACs – the arrythmia – seem in this instance to be an indication that your heart is working way too hard and it is out of sync. While PACs are not typically dangerous, the combination of symptoms in this case do appear problematic. An electrical shock has the potential to affect hear rythmn on a short-term/temporary basis but your constellation of symptoms seems to indicate that the arrythmia is a symptom related to the shock and the subsequent issues with heart function. The high heart rate could also explain the PACs. When the heart beats more than 100 beats per minute, it is considered abnormally fast and possibly dangerous. Without a doubt, sustained heart rates between 140-200 are dangerous (even for people who have a problem with tachycardia, sustained rates especially combined with such a slow rebound are not within acceptable limits, ever!). It seems like the heart is beating too fast in an effort to compensate and the PACs occur because the heart is beating too fast.

-electrical shocks/currents can stop and or damage the heart muscle. You may have had an ischemic attack or other damage that was missed by military MDs

- it appears that your heart is not pumping properly. You may be in congestive heart failure. Your heart rate and blood pressure, in and of themselves, are so dangerously high that you should not have been released until they were stable AND within safe limits. The numbers you describe are not at all safe, not even for a short period of time. Most people would be hospitalized and admitted to an ER with the symptoms, HR and BP you describe.

You are having a medical emergency and cannot delay. Go to the Emergency Room and don’t go to a military hospital either. Go to a private hospital for an evaluation. The military typically does cover you (if you have an emergency, and you do) to go to any hospital ER. Go, don’t delay. Irreversible damage can happen if you wait. Go get help asap, as in right now. Seriously, no physician should have allowed you to go untreated and undiagnosed considering the info you just gave me. If you haven’t already had a MI (heart attack), you are very likely to have one with such a high pulse rate and blood pressure. The angina indicates yor heart isn’t getting oxygenated blood, which actually causes the heart muscle to die from lack of oxygen. This is a vicious cycle-the heart isn’t pumping well so it compensates by increasing pressure and rate. Increased blood pressure and heart rate strain the heart and body. Strain causes further weakening of the heart muscle,a chronic state of hypoxia(low oxygen), and a high likelihood for blood clot formation or other infarction. These further complicate the heart’s ability to circulate oxygenated blood and the lack of oxygenated blood means that the heart is working extra hard but isn’t receiving good blood/oxygen supply needed to sustain itself. And this is the cycle.

Furthermore, there’s a chance you have damaged your lungs. If so, this could compromise your heart’s ability to receive oxygen and the vicious cycle described above happens and is further complicated by lung problems.

This problem won’t spontanouesly resolve or get better on its own. Delays mean damage, which is probably irreversible or very difficult to reverse. Get medical attention and don’t delay. There’s help and you can be ok provided you get things sorted out asap!

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