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Keeping Track of Doctors Bills : By Dr. De Leon

” I am not telling you is going to be easy, I am telling you is going to be worth it!”

As many of you may already know, November is caregivers’ month; thus, I will talk about an issue that affects caregivers and patients alike.

The care giver has many responsibilities and roles in making sure that their loved ones needs are met. Among one of the biggest responsibilities a care partner or giver may have is being responsible for the financial stability of the Patient fully or in part. But, even when the patient is able to care for him or herself financially he or she may still need an advocate to help decipher the ever complex and confusing world of doctor and hospital bills.

This becomes more pressing as the disease advances and dementia begins to set in. Those of you who have a chronic illness or care for someone with a progressive debilitating  illness like Parkinson’s know that as the disease advances the need for services ( PT, OT, Pain doctors etc.) increases exponentially. Subsequently, the amount of bills you receive also increases at an alarming rate. The rate can suddenly shift to ‘a warp speed’ if your loved one ends up having procedures or being hospitalized; especially if the hospitals stay is lengthy.

In which case, you can find yourself being inundated in bills and paper work. This can drive a person mad trying to make heads and tails especially when the person you are caring for needs 24 hour care or pretty constant supervision in all other aspects of care from grooming to ensuring they take their medications properly.

Here are a few tips that I have learned to help simplify life. These can be used whether you are a patient or a caregiver.

First, set a side a special box or place where you will place all the mail relating to this subject/away from all other mail so it can be easily accessed.

Second, make sure that you know what your insurance covers in and out of the hospital before you have tests, procedures; become hospitalized; so there are no surprises. If you have Medicare go to Medicare.gov. Otherwise get a copy of benefits/coverage from your insurers.

Third, designate an area and a time when you will dedicate exclusively to this. once a month is good if not so many bills but if having ongoing procedures, hospitalizations, and doctors evaluations, you will most likely start receiving bills weekly if not daily therefore be best to tackle once a week to avoid getting yourself overwhelmed.

Next…

1) Make a proper binder to place all the (EOB’s- extended office bills) and label yearly. Also if hospitalization extends several months put color dividers to delineate various months. The same can be done if patient had doctor’s appointment or procedures extending various months.

2) Do not pay a single bill until you receive an explanation of benefits from your insurance/ compare it with doctor’s bill and pay only after they have paid their part. If you have secondary insurance have to wait till both insurances have paid. Which usually means you should not have to pay anything unless at beginning of insurance cycle when you have to meet your deductibles. (the beginning for your calendar  year may vary slightly but usually around the last quarter of the year or first quarter of the new year). For Medicare the deductibles are due at the beginning of every year.

3) If you detect a problem- call your insurance company customer- service first and make sure you get names and dates of whom you speak to and if checks issued get amounts, to whom, dates issued and check numbers.

4) Once a certain bill is paid – make sure you check off ( and remove from your pile /box and file into binder in section labeled paid) so you don’t pay again or have to deal with it again because sometimes may get duplicate! Look at it carefully for services and dates!!! Use a red pen or marker to check off

5) If the problem is at doctor’s office or hospital, make sure you speak with billing person directly.

6) Always take good notes.

 7) Usually insurances give discounts so pay close attention and if doctors office or hospital tries to bill you for difference when you have received a discount, send them copy of EOB. If no discount listed in your invoice call your insurance to make sure whether one should be applied.

8) Always make sure that bills are sent to correct insurance with right policy number and that everyone has correct spelling of patients name to avoid claim errors.

 9) At times claims are kicked back due to coding errors, so always inquire if there were any problems with codes causing it to be denied which you could address with your doctors or hospital billing office.

If you remember these simple tips: you can avoid going mad when bills come in daily. Happy trailing’s!!

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Dr. M. De Leon is a movement disorder specialist on sabbatical, PPAC member and research advocate for PDF (Parkinson’s Disease Foundation); Texas State Assistant Director for PAN (Parkinson’s Action Network). You can learn more about her work at http://www.facebook.com/defeatparkinsons101 you can also learn more about Parkinson’s disease at www.pdf.org or at www.wemove.org; http://www.aan.org, http://www.defeatparkinsons.blogspot.com All materials here forth are property of Defeatparkinsons. without express written consent, these materials only may be used for viewers personal & non-commercial uses which do not harm the reputation of Defeatparkinsons organization or Dr. M. De Leon provided you do not remove any copyrights. To request permission to reproduce release of any part or whole of content, please contact me at defeatparkinsons101@yahoo.com contributor http://www.assisted-living-directory.com Contributor http://www.lavozbrazoriacounty.com

 

 

Beauty Exploration: Sweet Tooth.

defeatparkinsons:

chocolate releases dopamine naturally so go ahead an indulge particularly if a little stressed…but make sure you make it dark chocolate!!

Originally posted on Beaus and Bows:

The Body Shop Deluxe Edition Chocolate Body Butter; Chocomania Shower Gel; Ritual Chocolate.Hey there bow friends,

There’s something about cooler weather that makes me want to make everything a little more indulgent.  You all know how much I love The Body Shop body butters.  They’re nourishing with fantastic scents that never seem artificial.  The mini sizes, like the body wash, are perfect for travel and the chocolate scent happens to be my favorite out of all The Body Shop products.

Speaking of chocolate, I’ve been thinking about Colorado a lot.  I’ve been thinking about Colorado chocolate a lot.  I picked up Ritual Chocolate the last time we were there and it’s honestly some of the richest and dreamiest chocolate I’ve had in a long time.  This coffee one was really popular with my caffeine junkie mom.  All the bold flavor of coffee enveloped in some purely awesome chocolate.

Can you tell how into chocolate I am right now?  It’s a little…

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pic of a woman

Treatment for Pain in Parkinson’s patients: by Dr. De Leon

 

According to my research, laughter is the best medicine, giggling is good for mild infections, chuckling works for minor cuts and bruises, and snickering only makes things worse.

 

Recently I wrote about how 85% of PD patients suffer from pain in my last blog titled “Revisiting Pain in PD: the 50 Shades of Pain Experienced by Parkinson’s Patients” in which I explained that PD patients may experience 5 types of pain syndromes:

All can occur in one person at any given time and sometimes may have more than one type of pain concomitantly!

  1. Central pain (rare; CAN be INITIAL PD symptom presentation)-dull ache all over!!
  2. Musculoskeletal pain- throbbing
  3. Nerve root pain- electrical
  4. Dystonia- cramping
  5. Akathisia- urge to keep moving.

For this reason it is extremely important to be able to properly recognize the various different syndromes of pain in Parkinson’s patients and the best way to do this is getting a detail history- that’s where YOU COME IN!!!

As I mentioned previously untreated pain can lead to devastating consequences in all aspects of life. Know that all types can exist in the same patient throughout the disease course. Thus, identifying quality, location, triggering mechanisms can be extremely useful for your physician to provide the best treatment possible. Keeping a diary helps both you and your physician(s) to get started in the right direction. Once the source of pain is identified proper treatment can be initiated. Many times the pain can be managed successfully by your MDS/ neurologist. However, there may be times that other specialist might need to get involved. Subsequently, treating pain in Parkinson’s patients takes a multidisciplinary team or approach in which you must partner with your

1) MDS/neurologists- he or she MUST always be the quarterback or gate keeper to ensure best outcome!!! They not only know you best but first can determine if pain is related to PD either central (primary pain –i.e. Symptom of PD like tremors or stiffness etc.); or pain due to medication “Too Much” causing akathisias- or severe inner restlessness or “too little” causing dystonias or musculoskeletal pain at large joint due to rigidity, contractures and lack of flexibility and mobility.

2) PT/ OT- they will help you do stretching exercises, Range of motion exercises to prevent contracture and increase flexibility and mobility.

3) Pain specialists- this I would defer as last resort once exhausted all other venues of treatment to obtain narcotics or opiods because even a small dose CAN & WILL make PD symptoms worse in terms of cognition, constipation, sedation, depression, memory, prone to cause hallucinations, increase risk of falls, and may also directly interact with the PD medications negatively. However, they have a place if for instance you have nerve root pain and tried medications and not sure if want to do surgery or not a surgical candidate, nerve block may just do the trick and since its effect is localized will not interfere with other PD medications.

4) PCP/primary care doctor- some times because Parkinson’s is usually not the only disease most of us have, other medical illnesses like diabetes, arthritis, and gout could be the cause of your pain. Hence, it will be up to your primary doctor to do the appropriate laboratory to check for these underlying causes. In the case of cramps, these can be due to electrolyte abnormalities, medication withdrawal (dopamine agonists), or be a harbinger that you are developing neuropathies. So both neurologists and PCP have to be aware of these!!!

5) Psychiatrist/psychologists- because depression colors our perception and pain can makes depressed starting a vicious cycle sometimes we need a little help breaking this cycle to be able to rid the pain and the depression! There for psychotherapy may be beneficial.

6) Neurosurgeon – if there is a herniated disc- with clear dermatome distribution with WEAKNESS and pain unresponsive to other treatment modalities! ( MUST HAVE WEAKNESS otherwise having surgery for pain is a 50/50 shot of getting better and if you don’t get better you might get worst!! If no WEAKNESS involved suggest Botox injections or/and DBS electrical stimulation for pain –have been shown to have great response in my personal experience in my years of practice. A baclofen pump also works well for those that have a lot of pain due to spasticity. (ALL of these procedures MUST be done by someone with LOTS of experience for OPTIMAL results!!!) All of these latter procedures can be done by various specialists depending where you live so trust your neurologists, ask lots of questions always and go with someone with lots of experience!

According to 2 recent studies, there seems to be a consensus that PD patients should delay or avoid back surgery or fusion because of higher risk for “failed back syndrome.” The reason for this is believed to be natural PD symptomatology like poor posture and brittle bones ( although these studies were very small less than 30 patients each, I think that the message is valid but requires further study).

As someone who has undergone two similar back surgeries performed by the same physician one few years prior to my PD diagnosis and one as recent as last year as well as having treated countless patients with back pain including many of whom had PD; I tell you that the recovery is much different and harder with PD. It took me several months to recuperate and get strength back the second time around. My patients and I required increased dosages of dopa in order to overcome weakness!

While the procedure had been exactly same and actually much longer surgery the first time I was back to work within a week! Not a lot of data is available on the subject, but the rare article does allude to the fact that there is an increase in likelihood of compression of nerve roots as well as bulging and herniated discs simply by way of mechanical extrusion from asymmetrical stiffness, bad posturing and abnormal ambulation. I believe this is true for me and most of us with PD that suddenly end up with herniated discs without history of trauma, injury nor hard labor.  (I had a pristine back and neck and  literally had a spontaneous herniated disc doing routine activities without trauma as was the case for my first disc injury – lifting a patient)!!!

Thus, before you submit to surgery make sure it is ABSOLUTELY necessary and have exhausted all other resources!

7) Orthopedist – if there are fractures causing pain, or joint dislocations, or carpal tunnel.

First thing to rule out is pain due to Parkinson’s disease central pain. Or due to wearing off either one requires PD medication adjustment. The main stay of treatment of all syndromes after identifying cause is medication. The types of medications we use for pain include muscle relaxants (have to watch for a couple of them which may interfere with the PD meds and vice versa). Antiinflamatories, also work well. The ones I like best in this class are topical e.g. ketorolac -Toradol ( Flector patch, or your pharmacist can make a compound of topical toradol and topical anesthetics e.g. patches (lidoderm 5% patches, or lidocaine topical lidocaine intment).

Other treatments include antidepressants, anti anxiety, anticonvulsants, while opioids should be taken as last resort. What I have found is that especially with acute pain that is radicular in nature or due to fracture it is best to treat with strong medications as soon as pain comes on to prevent from becoming chronic and/or central then can go back to other treatments above. Usually something like a hydocodone will do if you treat as soon as pain starts. Worse disservice you can do to yourself is waiting until the pain is unbearable before you seek medical attention. This will make your pain much more difficult to control. YOU DON’T have to be STOIC!

Besides medications along with a team approach, other alternative therapeutic modalities reported to be effective anecdotally are:

Massage therapy & Acupuncture – again first discuss with your MDS make sure this is appropriate and find someone that is reputable in the community. Down side is that these services are usually not covered by insurance and thus are an out of pocket expense!

Next time you have pain, you will know exactly what to do and rather than suffering or enduring you can take charge and confront head on.

 

References:

http://www.pdf.org  topics on pain

Surgical outcome of lumbar fusion surgery in patients with Parkinson disease. J spinal Disord Tech. 2012-PubMed-NCBI

Spinal Surgery inpatients with Parkinson’s disease: experience with the challenges posed by sagittal imbalance and the Parkinson’s spine. Eur Spine J. Oct. 2010; 19(10);1785-1794.

Parkinson’s Disease Sufferers-  spinal -foundation.org

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Dr. M. De Leon is a movement disorder specialist on sabbatical, PPAC member and research advocate for PDF (Parkinson’s Disease Foundation); Texas State Assistant Director for PAN (Parkinson’s Action Network). You can learn more about her work at http://www.facebook.com/defeatparkinsons101 you can also learn more about Parkinson’s disease at www.pdf.org or at www.wemove.org; http://www.aan.org, http://www.defeatparkinsons.blogspot.com All materials here forth are property of Defeatparkinsons. without express written consent, these materials only may be used for viewers personal & non-commercial uses which do not harm the reputation of Defeatparkinsons organization or Dr. M. De Leon provided you do not remove any copyrights. To request permission to reproduce release of any part or whole of content, please contact me at defeatparkinsons101@yahoo.com contributor http://www.assisted-living-directory.com Contributor http://www.lavozbrazoriacounty.com

pain%20scale

Revisiting Pain in PD ….the 50 shades of Pain Experienced by Parkinson’s patients: By Dr. De Leon

Whenever you get Pain in your life, think about the full form of PAIN! -Positive Attitude In Negative Situations!”-unknown

Lately, I have been reading a lot about the frustration experienced by so many of us that have Parkinson’s disease due to the fact that pain syndromes in Parkinson’s is still very poorly understood by most of us even those of us who are ” experts” in the field.  The reason is not only because pain is such a complex syndrome produced by different sources even in the same patient which is susceptible to change as the disease progresses but because it is such a subjective thing –difficult to describe. Unless you hit the right description words, unfortunately, your doctor may not clue in to where the problem lies;

Hence, I am writing this to help you focus your physician’s attention in the right direction to accurately diagnose your pain syndromes. Ironically, as much pain as we seem to be in most of the etiologies have treatable solutions.

The most difficult to treat is ‘central pain’ but even this if caught early can be treated successfully without having to resort to use of narcotics. It is extremely important to address pain whatever the cause at the earliest sign of it because this can be a huge source of disability interfering with an individual’s day-to-day activities and overall quality of life. Pain can permeate and affect all areas of one’s social, emotional, and physical life. This can lead to not only overall healthcare costs but undue stress from multiple testing and general malaise that can lead to severe depression and hopelessness which turns into a catch 22 since scientists have shown depression itself can make the pain syndromes worst. This involves 30- 40% of PD patients. How a person view pain and reacts to it is extremely important and will color the behavior around it. For instance if you tend to focus on the pain it will worsen rather than if you try to minimize or think positively that it can and will go away!

About a decade ago if someone had asked me if pain was part of the  initial Parkinson’s presentation, I would have answered with a resounding NO! Dopamine cells are not involved in pain modulation, yet here I am as many of you! Years of seeing and treating patients had taught me this but in an instant my own illness taught me otherwise!

However,  there are several different pain sources in Parkinson’s, in fact about 85% of PD patients complain of pain usually as the disease advances.

But, in rare instances some people like myself (probably less than 10% although not found an exact number) have pain as an initial complaint or PD symptom!! This can be the FIRST symptom of disease. In my personal experience, this appears to be more common in YOPD. This type of pain associated intrinsically with PD ( like tremors, loss of smell, bradykenesia, etc.) is known as a “central pain” originating in the brain. This particular pain is typically described as a generalized -all over the body dull aching deep pain.

Other Common pain types in Parkinson’s disease patients are:

Musculoskeletal pain- usually due to poor posture (stooped forward), areas affected usually are large joint areas -hips, neck, back, shoulders, wrists. (throbbing, aching, sharp). Tender to touch, hurts to move but usually gets better after it starts moving.

Nerve root pain- usually related to neck and back pain, carpal tunnel. There appears to be an increase rate of back and neck herniated discs due to PD (presumably due to rigidity of axial muscles causing discs to bulge out) just like the same stiffness and rigidity can result in a dislocated shoulder. This is usually a sharp shooting, electrical –shock- like, burning, tingling, touch sensitivity (feels different to touch can be very painful or numb) and numbness. Usually triggered by particular position and relieved when resting most of the time).

Dystonia- one of which is “wearing off” dystonia. –twisting, cramping, or posturing of affected body part.

Restleness (akathisia)- extreme inner restlessness, unable to sit still, have to keep moving or pacing

In order to help your doctor determine cause of pain keep a diary.

Tell him/ her where the pain is?

What does pain feel like?

Does it go anywhere (radiate)?

When does it start?

Is it in the am or pm?

Is it related to medication intake? Or time they wear off?

Any activity brings on the pain?

How long it lasts? Is it continuous?

What makes it better? (Specifically if Parkinson’s medications make it better).

Remember the key to a good outcome in treating your pain before you go bonkers is being able to communicate your problem with your physician with as much detail as possible and keeping good notes. Pain in Parkinson’s like in any other disease sometimes is caused by the disease itself, at other times the medications and sometimes by completely unrelated factors just because we have Parkinson’s it does not exclude us from other illnesses which can cause pain (e.g. Diabetes, thyroid disease, fractures, arthritis, gout). With this in mind, you will be on your way to not only identifying correct source of pain but also getting appropriate treatment (which I will discuss in my next blog).

References: Wertheimer, Jeffrey. Understanding Pain In Parkinson’s. http://www.pdf.org newsletter winter 2012

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Dr. M. De Leon is a movement disorder specialist on sabbatical, PPAC member and research advocate for PDF (Parkinson’s Disease Foundation); Texas State Assistant Director for PAN (Parkinson’s Action Network). You can learn more about her work at http://www.facebook.com/defeatparkinsons101 you can also learn more about Parkinson’s disease at www.pdf.org or at www.wemove.org; http://www.aan.org, http://www.defeatparkinsons.blogspot.com All materials here forth are property of Defeatparkinsons. without express written consent, these materials only may be used for viewers personal & non-commercial uses which do not harm the reputation of Defeatparkinsons organization or Dr. M. De Leon provided you do not remove any copyrights. To request permission to reproduce release of any part or whole of content, please contact me at defeatparkinsons101@yahoo.com contributor http://www.assisted-living-directory.com Contributor http://www.lavozbrazoriacounty.com