Part 2 – When You Need Surgery – Be Proactive!

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As you seek treatment for your problem, you will need to advocate on behalf of yourself on several levels:

  1. Make sure you know and comply with your health insurance rules and procedures – Do you need to get tests, referrals or procedures (even if they are outpatient procedures) preauthorized or precertified?
  2. Make sure you see physicians and use facilities that are in your health insurance provider’s Preferred Network.  Otherwise, your share of payments may be larger than if you “stayed in network.”
  3. Try to move things along as quickly as possible.  The people scheduling the tests & appointments are going to try to fit you in to the schedule where space allows.  If the test can be done at more than one location, you may want to ask whether it can be done sooner at a different location.  Similarly, some doctors practice at more than one office.
  4. If the appointment gets scheduled further out than you’d like, ask to be put on a waiting list.  That’s how I was able to get my thyroid removed 3 months earlier than it was originally scheduled.  Someone canceled a week before their operation & the surgeon’s office called me to see if I would like to take their place.  I had to scramble to get a few tests done, but I was able to do it and forego three months of anxiety while waiting for the original date.  I can relax.

Another non-medical reason to try to move things along could have to do with where in your insurance policy year you are and where you stand in regard to your deductible.  If you have already met your deductible for the year, your insurer will usually be paying a greater share of your health care expenses for the balance of the year.  Therefore, it may be financially to your benefit to get your surgery within this year rather than waiting until the following year. A full explanation is beyond the scope of this blog and really depends upon individual circumstances and health insurance coverage.  Next time we’ll talk about planning ahead!

Happy New Year!!

For Your Health – Dr. Bob

Part 1 – Know When To Seek Care & Act!

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About two weeks ago on December 9, I had my thyroid removed because it had enlarged and was pressing on my windpipe.  Though I am still waiting for the final pathology report, the results of the outpatient biopsy and the surgeon’s impressions were that this is not a cancer.  I first noted symptoms at the end of September 2011 and the workup took a little over 2 months.  Over that period of time I had 12 appointments for either testing or physician consultations. I think some aspects of my experience may be useful to help people in similar circumstances understand how best to use the healthcare system.

1. Pay attention to your body.

My symptoms were quite mild actually.  I started feeling a pressure against my throat as if someone was lightly pushing against my windpipe.  It wasn’t painful.  It was just different. My voice was also a little bit hoarse.

2. Understand the potential urgency of certain symptoms

As a doctor I naturally thought of all the things it could be, going from bad to worse.  Because it could start to affect my breathing, I set up an appointment with my PCP early the next week.

As a medical student, I was taught that about 80% of the reasons a person visits a primary care physician get better on their own.  But when you are having symptoms that can affect your breathing, heart beat, consciousness, or are causing an excessive amount of pain or a loss in how your body functions, you need to see a physician sooner rather than later.  For more on this topic check out this previous post, When To Get Care.

3. Get beyond the fear of the worst

The sooner a potentially lethal condition such as a cancer is diagnosed, the better are your chances for remission and potentially cure.  Ignoring symptoms does not treat the condition.  If it is a cancer, the delay gives it a chance to grow locally and spread throughout the body.  I know that this seems to be a very cold, scientific response to a situation that can be filled with emotions.  Everyone needs to work through these issues on their own.  But at this point, where a diagnosis has yet to be made, let your good sense take the lead and get a diagnosis.

In the next post I’ll share more about my recent experience and give you some things to consider if you ever are faced with a similar situation.  Meanwhile, please add your comments and experiences!

For Your Health – Dr. Bob

Myth 4 – The BMI Causes People to Feel Bad About Themselves

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There are a couple of issues here.  First of all, I don’t think the use of the BMI has caused people to have a poor self-image.  If they do feel poorly about themselves, I believe it is the result of the many other instances of discrimination that they are subjected to every day.  This discrimination is unfair but it is there.  I truly believe everyone should feel good about their self-image no matter what it is or others may think.  If someone has a BMI that suggests they are overweight or obese, no one should view that as a criticism of their character or worth as a person, but as a risk factor that they should recognize and, if motivated, work on improving.  If they are aware of the truth about the health risk, and they choose to not address it, that does not diminish them.  It is their health decision.

Insights For Health Bottom Line: No one should define their self-worth by a number.  But you and your doctor should consider BMI, waist circumference and percentage body fat along with your family history to determine the best path to maximize your health.

I hope these last few posts gave you a clearer perspective on the value of the BMI.

For Your Health – Dr. Bob

Myth 3 – Some People Normally Have a Higher BMI & They Are Healthy

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Some people say that everyone in their family was overweight and they lived into their 80’s or 90’s.  The thinking here is that a high BMI poses no health risk for some people.  Since genetics plays a huge role in determining a lot of things including our metabolism, it’s probably true that some people are predisposed to have a higher BMI, but that doesn’t make it less of a risk factor.  Your risk for illnesses comes from an interplay of many risk factors.  So someone may have favorable risks because they are genetically predisposed to having lower blood pressure and cholesterol, but they have a family tendency of being overweight or obese.   Compared to someone with high blood pressure and high cholesterol who is also overweight, they will have a lower risk of heart disease.  However, if they lower their BMI, they will have an even lower risk.

I have a family history of high blood pressure and high cholesterol, but that doesn’t mean they are not risk factors for a heart attack or stroke for me.  I need to work on my lifestyle through making healthier food choices and exercising regularly to counteract these risk factors.  The same goes for someone who has a tendency to have a high BMI.  They have to work harder than someone whose genetics have a higher metabolism.

Insights For Health Bottom Line:  Though favorable genetics as shown in your family’s health history may lessen the impact of a high BMI, your risks will be even lower if you maintain a more normal BMI.

For Your Health – Dr. Bob

Myth 2 – The BMI Doesn’t Really Mean Anything

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Some people say all the publicity about using the BMI is part of a conspiracy by the weight loss industry, and the BMI serves no useful purpose.  This is wrong.  There are many studies that show that people who have a higher BMI are at risk for serious illnesses.  For instance, the higher the BMI,  the greater the risk of a heart attack.  Most importantly, the reverse is true.  If you decrease your BMI you decrease your risk of stroke and heart attack.   Another study in women shows that women with a BMI over 29 have a 3.3 times greater chance of a fatal or non-fatal heart attack within the next eight years than women with a BMI less than 21.  BMI values between 18.5 and 24.9 are considered normal.  These results were adjusted for age and smoking status, meaning that comparisons were made between women of the same age and smoking status so any differences in heart attack risk could not be attributed to either of those factors. 

Insights For Health Bottom Line: A high BMI increases your health risks for many serious medical conditions, but other factors can also affect those risks.  BMI is a modifiable risk factor – something you can do something about to lower your risks.

Next time we’ll consider the myth that for some people a high BMI is normal.

For Your Health – Dr. Bob