LeBlanc: Finding a happy medium when managing dementia

Caregivers of dementia patients also easily can be called “managers.” Believe me, there are countless matters that need management. But even with all the doom and gloom, I have found a bright spot! I have met and befriended several people, diagnosed for years with different types of dementia, who are doing extremely well. Are they suffering from cognitive impairment and other multiple symptoms? Yes, but they manage it very well. Through getting to know these folks I have found a common thread that connects them: They are strong advocates for dementia awareness, actively working to spread not only consciousness but also common sense ways to handle this mind-robbing disease.

Now let me clarify this. I don’t believe it’s simply their activism in this worthy cause that helps them to handle their symptoms better than most; I’m convinced it’s the socializing that benefits them. Unlike most dementia patients they get out of their homes and practice public speaking. While educating others about what it’s really like to have dementia by running support groups and not living in a shell, they are, themselves, profiting.

I’ve learned from experience that it’s crucial to have loved ones with dementia maintain a run-of-the-mill lifestyle. This serves to keep their anxiety and confusion at bay. However, maybe we could find a happy medium with which to keep them socially active and maintain somewhat of a routine. Just because they have dementia doesn’t mean they still can’t lead a life of quality.

A good friend told me when he first was diagnosed with dementia he thought his life was over. Conversely, after he realized it was more of moving into a new phase of life, he persuaded himself to learn how to adapt to his symptoms. That was nine years ago. He still is teaching others about dementia nearly every day. Does he have bad days and horrible moments? Of course, but he has learned to pace himself.

Sadly, it is way too common for these folks and their caregivers to start noticing their social network of friends beginning to disappear, one by one. While caring for my dad, within a year my phone virtually stopped ringing. It is essential to put forth an effort to sustain a social world. It may not be a familiar one as now it will likely include people who are sharing the same dilemmas.

It’s important to realize this: I’m not suggesting trying to change the lives of patients when they’re already in the latter stages of the disease. Instead, they need to remain social from the early stages and as far into the disease as possible. Just the fact that they know they still have friends and outside support may be the best medicine they can find.

This is the concept of the Memory Caf├ęs that are popping up all across the country. These groups are designed for those with dementia to have an hour or so of a social gathering with others who are in the same boat. Whether the word “disease” does or doesn’t pop up during these meetings is fine.

The need for social contact is part of being human, regardless of a person has dementia.

For a decade Gary Joseph LeBlanc was the primary caregiver of his father after his father was diagnosed with Alzheimer’s disease. He can be reached at us41books@bellsouth.net. His newly released book “Managing Alzheimer’s and Dementia Behaviors,” and his other books “While I Still Can” and the expanded edition of “Staying Afloat in a Sea of Forgetfullness,” can be found at www.commonsensecaregiving.com.

Spring Hill doctors received highest Medicare reimbursements

TAMPA – Two Tampa clinical labs received the highest Medicare payments in the state for 2012, according to long-awaited data on the government insurance program for older people, and three doctors from the same Spring Hill practice received the highest individual reimbursements in the Tampa Bay area.

The data is consistent with top users nationwide in that laboratories for Quest Diagnostics Clinical Laboratories Inc. and the Laboratory Corporation of America handle a high volume of tests for long lists of doctors and institutes in their regions. And oncology, the specialty of the Spring Hill doctors, is traditionally the most highly reimbursed field because of the high cost of cancer-fighting drugs, which they must buy up-front.

Quest Diagnostics was reimbursed $87.6 million in 2012, according to Centers for Medicare and Medicaid Services figures assembled into a database by the Wall Street Journal. That was the seventh-highest reimbursement level in the nation. LabCorp received $56.0 million.

A spokeswoman for Quest, the industry leader with $7.1 billion in worldwide revenues, said the company is very active in Florida. “That lab would be performing testing services for the state and potentially for patients outside the state as well,” said Wendy Bost.

The three local physicians are affiliated with Florida Cancer Specialists & Research Institute, a Fort Myers-based practice with 80 locations, including Spring Hill.

Vikas Malhotra received $8.4 million from Medicare; Mary M. Li received $6.1 million; and Huayang Tang received $5.8 million.

Experts cautioned about jumping to conclusions about high payouts, which do not imply fraud or improper billing.

“Most of our expenses, the number one, number two, number three, and number four expenses, are drugs,” said Bill Harwin, founder of Florida Cancer Specialists. “Drugs are extremely expensive. The cost of drugs is set by the pharmaceutical companies and is under no control of the oncologist.”

Harwin said institutes such as his serve as a “pass-through” for cancer drugs. New cancer treatments generally cost more than $100,000 a year.

Malhotra, who has been practicing in the area for 13 years, said other factors contributed to the high reimbursement rate.

The Spring Hill area has always been a high-need area for oncology practitioners, he said, keeping the specialists extremely busy. And before the 2012 billing period, at least three high-profile doctors retired or moved, with their case loads added to existing doctors’. Others, such as nurse practitioners, also bill on the doctors’ accounts.

Malhotra estimated that drug costs represent “the high-90-percent range” in a typical Medicare reimbursement.

“There is no impropriety,” he said. “Like every physician, we are audited by Medicare, and we have never had to pay a dime back to Medicare. Transparency is a good thing, but people need to know how to interpret the data.”

The release of the Medicare billing data was a victory for employers, insurers, consumer groups and news organizations such as the Wall Street Journal, which has been fighting to overturn a 1979 injunction prohibiting the release of the information. The newspaper began publishing articles highlighting fraud and abuse in the Medicare system in 2010, and in 2011, its parent company intervened in a lawsuit that eventually overturned the injunction.

The Obama administration this week released an accounting of $77 billion in Medicare payouts to more than 880,000 health care providers for 2012.

The American Medical Association and doctors’ groups objected to the release of the claims data.

“We believe that the broad data dump … has significant shortcomings regarding the accuracy and value of the medical services rendered by physicians,” AMA president Ardis Dee Hoven told the Associated Press.

“Releasing the data without context will likely lead to inaccuracies, misinterpretations, false conclusions and other unintended consequences.”

On Wednesday, the AP and other news organizations reported that two Florida doctors topped the list for individual reimbursements in 2012.

Ophthalmologist Salomon Melgen of West Palm Beach received more than $26 million to treat fewer than 900 patients. Cardiologist Asad Qamar of Ocala received $22.9 million.

The Centers for Medicare and Medicaid Services said the data would allow consumers to conduct a wide range of analyses that compare 6,000 different types of services and procedures, as well as payments received by individual health care providers.

The information also allows comparisons by physician, specialty, location, the types of medical service and procedures delivered, Medicare payment, and submitted charges.

“Data transparency is a key aspect of transformation of the health care delivery system,” said Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services. “While there’s more work ahead, this data release will help beneficiaries and consumers better understand how care is delivered through the Medicare program.”

The data can also be used to weed out fraud, making it easier to spot unusual reimbursements.


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LeBlanc: When a dementia patient is hospitalized

Without any doubt or hesitation we now can declare that maintaining a daily routine for dementia patients is vital. But when something happens and a hospital visit is required, their world will be turned upside down and, if you are the caregiver, so will yours.

Anxiety levels and confusion will be off the charts. Unfortunately this is when bad things begin to happen, sometimes setting off a chain of events that can be difficult to stop.

The moment you accompany them into the emergency room you are entering the most critical first moments of their stay, whether long or short. First and foremost don’t let the staff separate you. They will try to keep you busy in the lobby filling out the paperwork while they whisk off the patient to triage.

Do not let this happen! Be confident and in control because the staff will begin asking them vital questions that will set the course for much of their treatment to come. The fact that these patients are cognitively impaired might not even be noticed by the triage nurse. You need to be there to field those questions; all answers must be verified by you!

I understand that the hospitals are taking these patients at face value. They see them as adults – which, of course, they are. However caregivers need to stand in the gap and be certain it is understood that yes, they are adults, but with cognitive issues. Not everyone knows that a major symptom of dementia is poor decision-making. Once the staff “gets it,” it will make a world of difference when it comes to the approach that is used, especially under these higher levels of confusion.

It’s one thing to ask them where they were born and have them answer with the wrong city, and even a state where they never have been. But when they are being asked if they’re allergic to any medications or when is the last time they had any surgeries, the incorrect answers can lead to serious complications.

Get ready. This can be an exercise in frustration. Sometimes it won’t matter how many times you stomp your foot on the floor and tell the hospital’s medical staff that the patient has dementia.

One of the first things I teach when training hospital staff members about dementia care is that all information must be verified. We are lacking dementia training in our hospitals here in the United States, and in many other countries. I’ve been working hard for years to change this. I am happy to say that I am beginning to see progress.

With the incidence of dementia patients entering our hospitals surging, these facilities need to be educated on how properly to address their behaviors and on better ways to communicate with them. This continues to be one of my biggest goals, but until we get there you, the caregiver, must be the voice and advocate for your loved ones during these admissions. If you have power of attorney, have the official papers with you, and keep them with you during the entire stay.

Make sure you tell everyone the patient has dementia and everything needs to go through you. And I mean everyone!

We, their caregivers, are the only ones who can make sure their hospital stay is safe and calm. We are an essential cog in the wheel of tranquility for our loved ones, the hospital staff and ourselves.

For a decade Gary Joseph LeBlanc was the primary caregiver of his father after his father was diagnosed with Alzheimer’s disease. He can be reached at us41books@bellsouth.net. His newly released book “Managing Alzheimer’s and Dementia Behaviors,” and his other books “While I Still Can” and the expanded edition of “Staying Afloat in a Sea of Forgetfullness,” can be found at www.commonsensecaregiving.com.

Twins with severe PDD pose special challenge

EDITOR’S NOTE: This is the first in a series of four stories focusing on autism that will be featured in Hernando Today’s Health & Fitness section during the month of April, which is Autism Awareness Month.

April 2 was World Autism Awareness Day, and people wore blue in support of research into a neurological disorder that recent studies show affects as many as one in 60 children.

In Hernando County, authorities estimate more than 650 families deal with the daily obstacles of raising children who are diagnosed with autism.

Monique and Matt Legault, of Spring Hill, are raising 4-year-old twins Beaumont and Isabel, both of whom are autistic.

Having two children diagnosed with autism isn’t rare. A mother with one autistic child is at a greater risk – especially if the child is male – of having a second. But twins – particularly fraternal twins – aren’t so common.

Beaumont and Isabel – Beau and Belle – were diagnosed with severe PDD (pervasive development disorder). They are considered low-functioning, are nonverbal and have classic autism traits. The pair pose a unique sampling of life under the autism umbrella.

Monique displayed an undying reserve of enthusiasm as she discussed the special quirks of her children that make her life both a blessing and a challenge. Like many new parents, Monique suspected something wasn’t right with her twins. But having no other children to whom she could compare them, she prayed her observations were unfounded.

Neither spoke, she said, and both had some stereotypical behaviors of autism.

Now enrolled in a special-needs preschool classroom at Westside Elementary School, Beau and Belle thrive on some days and regress on others. Monique constantly strives to secure her footing when nothing in life, especially with autism, ever is constant.

Her children have sensory issues, aversions to certain food tastes and textures, sleep issues and lagging impulse control and are developmentally delayed in cognitive reasoning and physical milestones. They receive a plethora of services, from physical, occupational and speech therapies outside the home to nutritional food therapies that help offset their dislike of certain tastes and textures.

She discussed an inability to focus continuously on her children’s needs while simultaneously possessing an ability to intercept many potential disasters by staying on task most of the time.

Her home isn’t so much child-proofed as it is Beau and Bel proofed, Monique said. Alarms and safety locks on all doors prevent the twins from wandering. Furniture is scarce to prevent climbing accidents, and breakables are well out of reach of their curious hands.

As she described life with her children, Monique laughed at the memories, knowing only a person in a similar situation truly could relate. “It’s just our life,” she said.

Trying to advocate for children in a world that is ill-equipped to handle any hiccup from traditional methods can be difficult. At the very least, it requires a lot of time and energy devoted to finding information about what will help her two children reach their full potentials.

“Twins are tough,” said Monique’s husband, Matt. “A non-verbal child with autism is very tough. Add those together and it sounds like a recipe for a life of hard times and maybe at first it felt like it would be. But then why do we smile so much?”

? ? ?

Crystal Rhine-Corder, also of Spring Hill, displays another side to the autism puzzle. Her 9-year old son, Jacob, is typical in appearance, vocabulary and physicality to most of his same-aged peers. Yet his delays, particularly in cognitive processing, are obvious after a few minutes.

Jacob is categorized as high functioning, which means he basically meets the milestones of neuro-typical children of the same age. But Jacob also has some autistic characteristics. They often are misunderstood as behavioral issues from a lack of discipline.

“Just because someone looks typical, that doesn’t mean they are,” Crystal said. “I have a fully functioning autistic child and people look at him like he’s typical so they talk it up as bad behavior.”

Crystal suspected something was unusual about Jacob when he was 18 months old. He was a head-banger, was quick to anger and suffered from sensory issues like food textures. “The seat belt was always an issue with it being too loose or too tight,” she said. He had other sensory issues, particularly aversions to clothing textures.

But Jacob reached all of his developmental milestones, some even earlier than expected.

Jacob was diagnosed at age 3 with developmental delays and oppositional defiance disorder as he entered preschool. Later he was diagnosed as having ADHD.

Still, Crystal was convinced there was more to his behavior. She pushed until he finally was diagnosed with high-functioning autism at All Children’s Hospital.

Jacob is in a full-time ESE classroom at Spring Hill Elementary where he performs well. He also receives outside therapy in language, as well as occupational and behavioral therapies.

Crystal has become the main advocate for her son, learning as much as she can about his autism and how to ensure he receives everything he needs to reach his goals. With two other children – Emma, 6, and Taylor, 2 – her life is busy. Yet she focuses on the positives.

She celebrates her experiences as a mom raising an autistic child. “I have become an educator and advocator,” she said, pausing briefly as her voice cracked a bit. “I’ve met people I probably would have never met, formed friendships that I would have never formed.”

For Jacob, Crystal believes he also was given a gift. “Even though my son is socially awkward, the friendships that he has made with other special-needs kids, it’s like they know. They aren’t weird or nerdy. They get it. They just know.”

LeBlanc: Notable increase in Lewy Body Dementia

According to Dennis Dickson of the Mayo Clinic in Jacksonville, the number of cases of Lewy Body Dementia (LBD) diagnosed by the Florida Brain Bank has taken a sharp increase, even surpassing that of vascular dementia. Lewy Body is now the second most common, after Alzheimer’s disease.

Recently I had the opportunity to be on a dementia expert panel at a symposium held at Florida Gulf Coast University. While there, I heard Dr. Dickson give an outstanding presentation on LBD. Among the many excellent components of his speech was a true standout moment. He warned that suffering from Rem Sleep Behavior Disorder (RBD) is something to be on the alert for. It can be a warning sign that LBD is about to knock on the door.

People with LBD are known for acting out their dreams, sometimes violently. This is known as “night terrors.” Experts have noticed that this behavior may present itself a decade or more before any other symptoms appear.

Normally, when a person enters REM sleep, his or her body will remain still, with the exception of rapid eye movement. This is not the case with LBD. The results of this disorder will be kicking, punching, screaming and waking up in a cold sweat, blankets tossed on the floor. If you notice these signs in your sleep partner and later on they start showing signs of dementia, their doctor should be notified of their past sleep behavior. This may help diagnose them with the correct type of dementia.

Another interesting fact that has been discovered is that with Alzheimer’s disease, the hippocampus of the right temporal lobe almost always shrinks. With LBD this is not the case. This may lead to a way to distinguish between the two diseases.

As far as which of the sexes is most often afflicted with LBD, it appears that men are most susceptible by 60 percent – 95 percent of whom are Caucasian.

I am very pleased to see that the National Institute of Health has published a free 40-page booklet on LBD. It’s informative and I highly recommend that you, the reader, order one for yourself to learn more about this type of dementia.

You can order your free copy by calling The National Institute on Aging at (800) 438-4380.

Battling the obesity epidemic

Americans have battled obesity for years, buying into fad diets, quick-fix pills and kick-start weight loss programs. Yet, collectively we have a higher rate of obesity than many countries.

According to Florida’s Department of Health, Hernando County has an adult obesity rate of about 29 percent. That number is up from 25 percent in 2010 and higher than the current state average of 26 percent.

For that reason, the Florida Department of Health Hernando is teaming with the Hernando County Library system and the YMCA of the Suncoast to launch a program focusing on nutritional health and fitness. The goal is to help people make better choices to improve their health, thereby helping to eliminate many standard illness and diseases associated with obesity.

The Hernando County Community Health Improvement Plan Partnership (CHIPP) is sponsoring the program, called My Healthy Weight Outreach Project, a free, one-on-one nutrition education program offered to local residents. A grant from the Florida Department of Health will cover the costs.

The goal of the program is to “empower local residents to make healthier food and exercise choices, which in turn will reduce the prevalence of unhealthy body weights in our community and the diseases that can result from it.”

My Healthy Weight Outreach Project will run for five months and include 45-minute, one-on-one appointments for participants. The appointments will be scheduled on Wednesdays from April 9 through Sept. 10. They will rotate among three library locations and the Hernando County Family YMCA to broaden access for residents.

Appointments will be scheduled on a first-come, first-served basis.

My Healthy Weight will kick off with a presentation at the Spring Hill branch of the Hernando County Library System on April 2. At that meeting, basic information will be discussed, including tips on good nutrition, which will be used by licensed nutritionists during the one-on-one sessions. Appointments for sessions can be made at that time.

Adult obesity is defined as a body mass index (or BMI) of more than 30.

While vanity is an issue with obesity, it is the health aspects that have the medical industry concerned. Consider that obesity is the biggest contributor to preventable chronic disease, increasing the risk of Type 2 Diabetes, heart disease, stroke, hypertension, cancer, Alzheimer’s disease, dementia, osteoarthritis and other maladies.

Moreover, obesity can affect social and emotional health as well, leading to depression, isolation and low self-esteem.

And there is increasing evidence that personal finances are influenced as health-related costs increase and productivity decreases due to job absences.

Also, new research suggests adult obesity might play a role in military preparedness with greater instances of young adults failing to meet the physical requirements.

Obesity is a predictor of many adverse health conditions. Some analysts have projected that obesity has nearly the same association with chronic health conditions as 20 years of aging and “greatly exceeds the associations of smoking and drinking,” according to an article written by Susan Moyers, director of training and consulting for the Florida Food Institute and a part-time teacher at the University of Tampa.

The article continues: “We know that a consistent course of counseling and contact is important to weight loss success.” And a minimum of 12 sessions was essential in realizing BMI reduction and maintenance.

“Although obesity is a significant concern,” said Ann-Gayl Ellis, “this project is not just about obesity. It is about a healthy weight, achieved through healthy eating and adequate physical activity. We are hopeful to meet with people of all shapes and sizes.”

Through the program, participants will receive nutritional education by licensed dieticians and qualified nutrition educators.

“The intent is to give general nutrition education and provide tips on such topics as reducing cholesterol and sodium, finding nonmeat protein sources, etc.,” Ellis said.

For more information about Hernando County Community Health Improvement Plan Partnership (CHIPP) and My Healthy Weight Outreach Project, visit the Florida Department of Health website at www.floridahealth.gov/chd hernando


Former Hernando High cheerleader inspires hope as cancer survivor

Cheri Carlson, a 1984 Hernando High School graduate and past operating room nurse at Bayfront Health Brooksville, is also a colon cancer survivor.

The 47-year-old former Leopards cheerleader still has the youthful looks and enthusiasm she displayed three decades ago. Her energy level is a bit diminished, though, she said, due partly to the side effects of the drug she takes to help remain cancer free.

One would be hard pressed, though, to find any physical indication suggesting Carlson beat a stage 4 colon cancer diagnosis eight years ago.

“I had been anemic for years, after each of my two pregnancies,” Carlson said. No other cause for her listlessness, exhaustion and depleted energy was considered because each time her blood was screened, the results were negative for other health problems. She was told anemia is common in women, particularly of child-bearing age.

But Carlson is a nurse, trained to look at things differently. Each time the results were the same, she was left wondering.

The answer came after yet another routine annual examination turned up nothing new. But this time Carlson saw a nurse practitioner, instead of her regular doctor, who questioned why more tests weren’t ordered.

“She asked me if anyone had ever looked into anything other than testing my blood,” Carlson said, and the two agreed she should see a hemotologist. After trying to bring her iron levels up with no affect, Carlson was sent for a colonoscopy. “Just as a baseline,” she said.

The scope discovered a tumor blocking nearly 100 percent of her upper colon. A biopsy determined it was malignant.

Carlson had no symptoms indicating a problem other than lack of energy. Although there was a history of colon cancer in her family, she wasn’t scheduled to begin routine screenings until age 50. She was 40 at the time of her diagnosis.

Surgeons at Moffitt Cancer Center believed the tumor had been inside Carlson’s colon for two years, suggesting it was slow-growing. As a precaution, they also removed her ovaries. A second surgery removed spots on her liver and a final surgery removed parts of a lung.

After the three surgeries and chemotherapy, Carldon’s prognosis is good. The cancer has not spread, and she is being monitored regularly for any signs of recurrence.

Her experience has empowered her to get her story out because she believes the colonoscopy saved her life.

Colorectal cancer, referred to commonly as colon cancer, affects men and women and is considered the second leading cancer killer in the United States. According to the Mayo Clinic, regular screenings can save lives by discovering pre-cancerous polyps in the colon or rectum and removing them before they become deadly.

Risk factors for colon cancer include:

Age: most colon cancers are diagnosed in those over 50.
Race: Blacks are at a greater risk than people of other races.
Personal or family history of colorectal cancers or polyps.
Inflammatory intestinal conditions including diseases of the colon, such as ulcerative colitis and Crohn’s disease, increase the risk.
Genetic syndromes including familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, also known as Lynch syndrome.
Low fiber, high fat diet.
Radiation therapy for cancer directed at the abdomen can increase the risk of colon cancer.

Carlson had none of these with the exception of a family history of colon cancer and pre-cancerous polyps. Even then, it wasn’t recommended she begin annual screenings until age 50.

“My doctors saw normal blood work and never pushed the colonoscopy,” Carlson said. She now cautions skepticism when symptoms continue without obvious cause.

Carlson is a strong advocate for the maintenance drug Avastin, which she takes as a targeted cancer treatment. “It is the miracle drug,” she said. Carlson has become a spokesperson for Avastin, delivering hard proof that hope for survival from colon cancer — even stage 4 — is possible.

Carlson’s story inspires hope on many levels. The mother of two boys, 23-year old Ryan, a Hernando High and Florida State graduate; and 11-year old Jack, is a fighter with a new perspective on the value of life.

She never thought colon cancer would kill her. But the journey that made her a cancer survivor helped her see every moment with her family as a gift.

She and her husband, Carey, also a Hernando High alumnus, had hoped to add another child to their family. But she doesn’t dwell on what could have been.

A motivator in high school as she helped cheer Leopard teams to victories, Carlson is no less a strong motivator today. Her story might inspire another life-saving colonoscopy or contribute to medical advances.

Now in remission, Carlson’s journey is propelled by a responsibility to deliver her message of hope.

Reiniers: Health care reform – forget the politics

Long before Obamacare was a gleam in President Barack Obama’s eyes, state legislators and opinion writers – myself included – expressed concern about the complex issues of health care reform.

My argument was to focus first on health care costs and not on the lofty goals of eliminating underwriting protocols. This would only add more cost to a reformed health care system and force significant premium hikes, which would trigger subsidies paid for by insured taxpayers. Then factor in higher co-pays and deductibles, and the government would be offering an unaffordable product for the very low-income uninsured they pledged to subsidize.

Before Obamacare became law, research revealed – and I had written about – the $600 to $800 billion of costs attributed by experts to fraud and overutilization (waste). Getting that astonishing number under control should have been the first order of business. This would take years, but it would give actuaries a baseline number for legislators to figure out just how affordable the Affordable Care Act would be.

The numbers thus far have been disappointing. For example, Obamacare established The Pre-existing Condition Insurance Program in 2013 and allocated $5 billion to pay the medical costs for the uninsured with pre-existing conditions. The government quickly ran out of money and closed enrollment for the very people who need the most help and to whom promises were made (another promise broken). The average annual cost per enrollee in 2012 was $32,108. One state had a high average of $171,909. Co-pays have been increased to $6,250 a year. In other words, rationing already has begun.

This virtually was ignored by the traditional media.

There is also the exploding cost of subsidies, estimates of which range from a low of $458 billion to $1.2 trillion. The harsh reality of numbers like this is problematical for the Obama administration because it desperately wants to keep the total cost of Obamacare below $1 trillion. (Americans have been getting used to that number in recent years – a mere bagatelle.) Keep an eye out for unannounced administrative fixes.

Perhaps now it should be more obvious that step one for the administration should have been to tackle the astonishing $600 to $800 billion cost of waste and fraud.

Big government never starts at the logical beginning; it always starts by handing out money, because that’s how its politicians stay in power.

The second step should have been what every big business does: run a pilot program to see if the plan is feasible and, if so, work out the bugs. (That wasn’t in the cards because the administration was, and still is, targeting an end goal of European single-payer health care.)

Massachusetts was an ideal pilot (Romneycare), because it already had a track record. With a GDP of $414 billion, Massachusetts ranks higher than Denmark, and slightly less than Norway. It has a median income of $65,850, and state and local taxes rank it sixth highest nationally. It is America’s version of a European social democracy in that its citizens are willing to pay for aggressive social programs. It was a credible pilot then and is now.

Massachusetts has had Romneycare since 2006 – an “Act Providing Access to Affordable Quality Accountable Health Care,” and, lo and behold, six years later the legislature passed an “Act Improving the Quality of Health Care and Reducing Costs” . So Massachusetts also forgot to put first things first – the operative words being “reduce costs.”

Why the new law? Because after a year’s study and analysis, the recently created Health Policy Commission determined that between an astonishing 21 percent and 39 percent of all health care spending was wasteful – eight years after the law became effective. It’s another work in progress, as is Obamacare. The Legislature has charged the commission with the responsibility of both monitoring and enforcing health care utilization and costs and tying in costs to the growth in the state’s economy. Rationing is inevitable as the heavy hand of government bureaucracy regulates away all these annoying wasteful health care practices.

We can be sure that every state, every health care professional and HHS’s Kathleen Sebelius will be watching Massachusetts closely.

As luck would have it, the latest Health Policy Commission report says “Spending in Massachusetts is the highest of any state in the U.S. crowding out other priorities for consumers, business and government.” Really? Why haven’t we heard about this?

On top of this, a recent headline of The Boston Business Journal reads: “With Obamacare changes, state girds for more Medicaid fraud.”

And this was the model that Obamacare patterned itself after. It proves the necessity of having first established a pilot to see if a scheme is even feasible.

If government is the answer, arbitrary rationing is a must. That said, consider these facts about Britain’s National Health Service (in business since 1948) and a model single-payer system:

In a recent survey, 71 percent of British GP’s believed rationing of health care has increased significantly since 2013. The government is seeking a third year of pay freeze for NHS workers. Waiting times are at a five-year high. Long-term care facilities are being shut down. The list goes on.

The Brits have admirably controlled costs, but there have been continuing crisis points over the decades. The money simply isn’t there to support the NHS. We’ve been there with Medicare and Social Security, so now Obamacare will fill out the trifecta of unaffordable government programs. This is a reality check, not a political statement.

It’s a tragedy that our country’s health care has become a testy partisan political issue. Professionals need to drive the solution – if there is one – not politicians.

John Reiniers is a retired attorney and regular columnist who lives in Spring Hill. Email him at jbreiniers@yahoo.com.

Chair yoga helps elderly hold the pose

In a quiet studio room with light hardwood floors and bright, calming graphics canvassing the back wall, a group of eight students seem to fall effortlessly into a dramatic pose. Their breathing is deep yet controlled and they hold until they are instructed to release.
Chair yoga helps elderly hold the pose
Linda Murray, Kathy Cuthbert and Scott A. Jones fall into synchronized moves during a mid-morning Chair Yoga Class. KIM DAME

The room is dotted with simple dining-room-style chairs, one for each of the eight participants. They use the chairs for support, gripping the back with one hand and stretching the other over their heads and then down to their feet. They breathe, deeply, and release.

Yoga instructor Diana Reed speaks in softly, just audible above the soothing music playing in the background. With a gentle grace, Reed leads her chair yoga class into each pose, reminding them to breathe and focus on their bodies.

Chair yoga at Gaya Jyoti Yoga provides another option for students who might find a traditional class a bit strenuous, particularly if they have any issues like a bad should or hip. Yet Reed said the benefits to the body are as dramatic as any other yoga class.

After all, the art of yoga is much more than physical. According to an article published on the website nursingdegree.net, yoga is an all body experience. The article cites 75 unique benefits to practicing yoga, all of which touch on the mental and physical aspects. They include memory, recall, decision making, cardiovascular health, metabolism, respiratory health, and others.

And Reed would agree, stressing that yoga is not an activity but a lifestyle. Her toned frame and physical health can attest to the importance of incorporating yoga in a healthy lifestyle. Many of her students stand firmly by their decision to make yoga a priority.

As the group winds down its session, each falls into a state of semi-consciousness. Reed gently glides between their bodies, tapping a bowl that sends vibrations into the air above them. She instructs each to wait until they feel the vibrations. “Relax and allow the vibrations to fill you.”

Chair yoga is only one of the options offered at Gaya Jyoti.

Ellee Simons, a seasonal resident of Spring Hill, usually takes a level one class yoga but opted for chair yoga on a whim.

“This was really good for me,” she said after completing her first chair class. Simons has arthritis in one hip and a bad shoulder. “It was a lot better for my hip,” she said.

Like many, Simons thought chair yoga would be too gentle for optimum benefit. But she was pleasantly impressed with the experience.

Reed has been teaching yoga classes for more than 10 years, opening Gaya Jyoti Yoga, which means House of Lights, eight years ago in Spring Hill. The studio began in a modest single room on Commercial Way before expanding into the studio at Eastside Center on Spring Hill Drive in 2009. Two large rooms hold classes four times a day, seven days a week.

In addition to chair yoga, Gaya Jyoti Yoga schedules beginning yoga, hot yoga, hot power yoga, kid’s yoga, mysore (self practice), therapeutic yoga, warm 60, and yoga for bone strength (Osteoporosis Prevention).

Yoga has been a way of life for Reed, responsible she said for redirecting her path. It has lead to major life changes for her, including following a vegan diet.

“You naturally want to live a better lifestyle when you embrace a Yoga life,” Reed said.

Anyone can begin to add the positive all-body affects from yoga, Reed said. Gaya Jyoti offers many options at different skill levels and pace.

“We start with the physical body because that’s what everyone can connect to,” Reed said. “Then, we start quieting your mind down. And then there’s the last part where you’re lying on the floor trying to do nothing. It’s often referred to as the hardest part. Most people have such a hard time lying there and being still.”

Catherine Jones started taking yoga after losing a significant amount of weight. She found the classes help tighten her muscles, strengthen her core, and tone her entire body.

“There is not a bad teacher here,” said Jones, who has been a client of Gaya Jyoti’s for about four months. “They each bring their own energy and light.”

Harriet Maria Weiner, a five-year student of Gaya Jyoti Yoga, can attest to the dramatic changes she has experienced since making yoga a priority in her life.

“It makes your body feel so good,” she said. “You’re completely different when you go home. I can get up and go to the floor. I can bend down to the floor. I couldn’t do that before.”

Email Hernando Today Correspondent Kim Dame at damewrites@yahoo.com.

Oak Hill Hospital announces new Critical Care-ICU program

SPRING HILL – Oak Hill Hospital last week launched its Critical Care Intensivist Program.

On Monday, a team of critical and intensive care professionals began providing around-the-clock services in the 36-bed intensive care unit in the hospital’s North Tower, hospital officials said.
Oak Hill Hospital
Oak Hill Hospital announced it will launch its Critical Care Intensivist Program this week. FILE

An “intensivist” acts as a team leader, working with primary care physicians, specialists, therapists and staff to ensure patients receive optimal care, the hospital stated.

Intensivists are also board certified physicians, trained to treat a range of complex medical conditions for critically ill patients. They have advanced skills for performing specialized lifesaving bedside procedures, according to the hospital.

Hospital officials said an intensivist will be on-site 24/7 to work with associates, physicians, patients and their families.

“This ability to immediately react to changing circumstances has been shown to bring about dramatic improvement in patient outcomes and satisfaction,” the hospital stated in a news release.

Oak Hill Hospital’s on-staff intensivists all have completed fellowship training in critical care medicine, the hospital said.

The hospital lists four medical doctors in the critical care program: John T. Malcynski, Ariosto E. Rosado, Adrian A. Salmon and Omid H. Zad.

The hospital states the benefits associated with the presence of an intensivist include: decreased mortality, improved outcomes, reduced ICU length of stay, fewer clinical and procedural complications, reduced cost per case, fewer adverse events, improved patient, family, private physician and staff satisfaction, focus on patient safety, improved morbidity, and decrease in ventilator days and associated complications.

Other benefits include a decrease in hospital acquired infection and appropriate placement of patients in the correct level of care, according to the hospital.

There are also benefits to physicians, according to the hospital, which includes the assurance that an intensivist level of care for critically ill patients is available around the clock, an ability to entrust medical care to intensive care specialists for surgical patients, prompt communication to the physician regarding the patient status and the course of treatment at the time of the patient’s change in status, and an opportunity to visit patient and family to provide updates, as well as social support.

Oak Hill Hospital has been providing care to the Nature Coast since 1984, according to the hospital, and it is the largest medical facility in Hernando and Citrus counties with 262 acute care beds.

It is also one of the area’s largest private employers, and offers Hernando County’s only comprehensive cardiovascular program, including open heart surgery.

The hospital’s healthcare delivery team includes about 300 physicians, 950 associates and more 350 volunteers, according to the hospital.

Oak Hill Hospital is at 11375 Cortez Boulevard in Spring Hill, almost two miles east of U.S. 19 on State Road 50.