I am aware that many of us are glad that 2008 is over for different reasons.   Many are tied to financial downturns.

Some are political.   Some reasons have to do with job loss and job security.   In the Land of PIDD, many of us are glad due to health reasons.

I AM ONE OF THOSE PEOPLE.

I felt so good in 2007, that I just assumed it was going to last forever.   Nothing lasts forever, and since I turned 60 this year, I should have learned that lesson by now.

Last January started out great.   I was in South Carolina on biz, and then visited my Mom and sister.   But, alas, I flew home to a very sick husband who was happy to share.   His germs that is.

Within one week, I had the same nasty virus that he and much of the country had.  I was sick for 3 weeks and thought it was the end of it.   I was off to Phoenix on biz, and while there, ended up with pneumonia, collapsed lung, pleurisy and bronchitis.

And, it came back 2 more times – finally ending in May.

AH- SUMMER.   It was great.  I felt healthy, energetic, happy and sunny.  I played, I exercised, and enjoyed life and once again, thought it would never end (WILL I EVER LEARN)??

I had my 6 month check-up at retinal clinic only to learn I had major retinal damage.   NO EXPLANATION WHY.   I went to Chicago to see an expert and ended up getting tested for cancer and autoimmunity (AGAIN). 

Tests for cancer came back the Monday before Christmas negative.  

AHHHH- BIG OLE SIGH OF RELIEF.  

Tuesday before New Year, on dental visit, learned I had very suspicious looking sore on lip that might be CANCER (AGAIN).

I had a lip biopsy on Friday and now look a bit like Count Dracula (forget the picture of me on the blog- this does not resemble how I look today)!   Dr sliced some of my lip away- and I was forced to drink milkshakes for dinner.  SOME JOY in this event at least – except that it’s only 7 degrees outside.

And, now the WAIT for results.

The thing is- I’ve added several new autoimmune disorders this year- I think the number is either 8 or 10- and this could be one more if it’s not cancer.

So much for starting the New Year with a clean slate.

I wrote down all of the lousy things that personally touched my life is 08 and mentally THREW THEM IN THE FIRE as the ball dropped on New Year’s Eve.   But, with that exercise, a new, better, improved 09 was to come up out of the flames.

We shall see.

I just may have to start my New Year after the Dr calls to tell me that I do NOT have cancer.   If he calls with any other news- all bets are off.

Here’s to a great year for my PIDD peers- hope you have good health- great doctors, a supportive network, no insurance hassles, and a smile on your face.

ATLANTA, Georgia (CNN) – This week while you’re traveling, if you happen to spot a man applying hand sanitizer as he gets off an escalator, there’s a good chance it’s Dr. Mark Gendreau, a senior staff physician at the Lahey Clinic in Burlington, Massachusetts.

Travel season can be a germ fest. Make sure to keep your hands clean.

Gendreau studies germiness while traveling, and he knows just how infectious travel can be.

“The risk of contracting a contagious illness is heightened when we travel within any enclosed space, especially during the winter months, when most of the respiratory viruses thrive,” Gendreau said.

Studies show that germs can travel easily on an airplane, where people are packed together like sardines.

For example, a woman on a 1994 flight from Chicago to Honolulu transmitted drug-resistant tuberculosis to at least six of her fellow passengers, according to a New England Journal of Medicine study.

In 2003, 22 people came down with SARS, or severe acute respiratory syndrome, from a single fellow passenger who had SARS but didn’t have any symptoms, according to another New England journal study.

But the airplane isn’t the only place along your travel route where germs thrive. Here are five ways to avoid germs while traveling.

1. Sit toward the front of the airplane

“Pick a seat near the front, since ventilation systems on most commercial aircraft provide better air flow in the front of the aircraft,” Gendreau advised. If you can afford it, sit in first class, where people aren’t so squished together.

Don’t Miss

• Bathroom hot spots: How to use a public restroom safely
• In Depth: Empowered Patient

2. Don’t drink coffee or tea on an airplane

Monitoring by the Environmental Protection Agency shows that water in airplanes’ water tanks isn’t always clean — and coffee and tea are usually made from that water, not from bottled water, according to Victoria Day, a spokeswoman for the Air Transport Association.

The EPA advises anyone with a suppressed immune system or anyone who’s “concerned” about bacteria to refrain from drinking coffee or tea on an airplane.

“While boiling water for one minute will remove pathogens from drinking water, the water used to prepare coffee and tea aboard a plane is not generally brought to a sufficiently high temperature to guarantee that pathogens are killed,” according to the EPA’s Web site.

According to the EPA, out of 7,812 water samples taken from 2,316 aircraft, 2.8 percent were positive for coliform bacteria. Although that sounds like a small number, this means 222 samples contained coliform bacteria.

3. Sanitize your hands after leaving an airplane bathroom

A toilet on an airplane “is among the germiest that you will encounter almost anywhere,” said Charles Gerba, an environmental microbiologist at the University of Arizona who’s also known as “Dr. Germ.”

“You have 50 people per toilet, unless you are flying a discount airline; then it is 75,” Gerba said. “We always find E. coli on surfaces in airplane restrooms.”

You should wash your hands after using the restroom, but because the water itself might have harmful bacteria (see No. 2 above) and because the door handle on your way out has been touched by all those who went before you, Gendreau also advises sanitizing your hands when you return to your seat.

4. Wash or sanitize your hands after getting off an escalator

Gendreau says tests show that escalators in airports are full of germs.

Health Library

• MayoClinic.com: Health Library

To confirm these tests, here’s a fun activity while you wait for your flight this Thanksgiving: Look at your watch, and count how many people get an escalator in a five-minute time period. Multiply that by 12, and you have how many people are on that escalator every hour.

High-volume handrails are why Gendreau sanitizes his hands as soon as he can after he exits an escalator.

5. Wash or sanitize your hands after using an ATM

Gendreau says ATMs, especially in busy places like airports, are full of germs. As with escalators, he sanitizes ASAP after using one.

Gendreau says that keeping healthy while traveling can be summed up in six words: “hand hygiene, hand hygiene, hand hygiene.”

Keeping your hands clean is crucial, he says, when you’re spending the day touching surfaces that have been touched by hundreds or thousands of people before you.

Time for more vitamin D

September brings the end of summer in the northern hemisphere and, for many of us, that means less time in the sun. The sun’s rays provide ultraviolet B (UVB) energy, and the skin uses it to start making vitamin D. (The skin actually produces a precursor that is converted into the active form of the vitamin by the liver and kidneys.) Vitamin D is best known for its vital role in bone health. Without this "sunshine vitamin," the body can’t absorb the calcium it ingests, so it steals calcium from bones, increasing the risk of osteoporosis and fractures. Vitamin D also helps maintain normal blood levels of phosphorus, another bone-building mineral.

Vitamin D would be essential if it did nothing else. But researchers have discovered that it’s active in many tissues and cells besides bone and controls an enormous number of genes, including some associated with cancers, autoimmune disease, and infection. Hardly a month goes by without news about the risks of vitamin D deficiency or about a potential role for the vitamin in warding off diseases, including breast cancer, multiple sclerosis, and even schizophrenia. In June 2008, a study published in the Archives of Internal Medicine found that low blood levels of vitamin D were associated with a doubled risk of death overall and from cardiovascular causes in women and men (average age 62) referred to a cardiac center for coronary angiography. At a scientific meeting in May 2008, Canadian researchers reported that vitamin D deficiency was linked to poorer outcomes in women with breast cancer. And a large study of aging in the Netherlands published in the May 2008 issue of Archives of General Psychiatry found a relationship between vitamin D deficiency and depression in women and men ages 65 to 95.

The picture of vitamin D’s health benefits beyond bones has been drawn mainly from epidemiologic and observational investigations. The findings of such studies can suggest correlations between disease risk and certain factors - sun exposure or blood levels of vitamin D, for example - but they don’t prove cause and effect. Promising findings from observational studies don’t always pan out when put to the test in clinical trials. However, in one of the few randomized trials testing the effect of vitamin D supplements on cancer outcomes, postmenopausal women who took 1,100 international units (IU) of vitamin D plus 1,400 to 1,500 milligrams of calcium per day reduced their risk of developing non-skin cancers by 77% after four years, compared with a placebo and the same dose of calcium. The 1,100 IU dose - nearly three times the 400 IU per day recommended in federal and other expert guidelines - was correlated with a 35% higher blood level of vitamin D, on average. In the only other randomized trial of vitamin D and cancer - part of the Women’s Health Initiative - researchers found no effect on colorectal cancer. Critics say that the dose, 400 IU per day, was too small to make a difference.

More trials are needed to elucidate vitamin D’s benefits and risks at different doses and in different populations. In fact, a large-scale randomized trial that would include 20,000 U.S. women and men has been proposed by Harvard researchers and will be considered for funding by the National Institutes of Health. In the meantime, the evidence is so compelling that some experts already recommend at least 800 to 1,000 IU of vitamin D per day for adults.

Latitude and vitamin D production in the skin

Except during the summer months, the skin makes little if any vitamin D from the sun at latitudes above 37 degrees north (in the United States, the shaded region in the map) or below 37 degrees south of the equator. People who live in these areas are at relatively greater risk for vitamin D deficiency.

In search of vitamin D

Under the right circumstances, 10 to 15 minutes of sun on the arms and legs a few times a week can generate nearly all the vitamin D we need. Unfortunately, the "right circumstances" are elusive: the season, the time of day, where you live, cloud cover, and even pollution affect the amount of UVB that reaches your skin. What’s more, your skin’s production of vitamin D is influenced by age (people ages 65 and over generate only one-fourth as much as people in their 20s do), skin color (African Americans have, on average, about half as much vitamin D in their blood as white Americans), and sunscreen use (though experts don’t all agree on the extent to which sunscreen interferes with sun-related vitamin D production).

Lack of sun exposure would be less of a problem if diet provided adequate vitamin D. But there aren’t many vitamin D-rich foods (see chart, below), and you need to eat a lot of them to get 800 to 1,000 IU per day. People who have trouble absorbing dietary fat - such as those with Crohn’s disease or celiac disease - can’t get enough vitamin D from diet no matter how much they eat (vitamin D requires some dietary fat in the gut for absorption). And people with liver and kidney disease are often deficient in vitamin D, because these organs are required to make the active form of the vitamin, whether it comes from the sun or from food.

Selected food sources of vitamin D

Food

Vitamin D (IU*)

Salmon, 3.5 ounces

360

Mackerel, 3.5 ounces

345

Tuna, canned, 3.5 ounces

200

Orange juice, fortified, 8 ounces

100

Milk, fortified, 8 ounces

98

Breakfast cereals, fortified, 1 serving

40-100

*IU = international units

Source: Office of Dietary Supplements, National Institutes of Health

For these and other reasons, a surprising number of Americans - more than 50% of women and men ages 65 and older in North America - are vitamin D-deficient, according to a consensus workshop held in 2006. Growing awareness of vitamin D’s benefits coupled with the risk of vitamin D deficiency has led some experts to recommend a blood test that assesses the amount of vitamin D in the body. The test measures the concentration of 25-hydroxyvitamin D₃, or 25(OH)D, the precursor produced by the skin and converted in the body to vitamin D. If you’re over age 70, have darker skin, or live at a northern latitude, you might want to ask your clinician about the test. People who have malabsorption problems or take medications that interfere with vitamin D activity (for example, glucocorticoids) should consider it as well. However, some experts think testing is unnecessary as long as you get 800 to 1,000 IU of vitamin D a day.

Although there’s no agreement on an optimal level of 25(OH)D, deficiency is generally defined as a blood level less than 20 nanograms per milliliter, or 20 ng/mL (see chart). Levels that low have been linked to poor bone density, falls, fractures, cancer, immune dysfunction, cardiovascular disease, and hypertension. Many experts recommend a level of at least 32 and suggest that 800 to 1,000 IU of vitamin D per day is required to maintain that level.

Vitamin D status by blood levels of 25(OH)D*

Vitamin D status

25(OH)D in nanograms per milliliter (ng/mL)

Deficient

Less than 20 ng/mL

Insufficient

20 to 29 ng/mL

Sufficient

30 ng/mL or more

Potentially harmful

More than 150 ng/mL

*25-hydroxyvitamin D₃ (vitamin D precursor)

Source: Holick MF. "Vitamin D Deficiency," New England Journal of Medicine (July 19, 2007), Vol. 357, No. 3, pp. 266-80.

How to reach 1,000 IU

Unless you live in the South and spend a fair amount of time outdoors, or you like eating lots of fatty fish and vitamin D-fortified foods, supplements are the best way to make sure you’re getting 800 to 1,000 IU per day. (Higher doses may be prescribed if you’ve been diagnosed with vitamin D deficiency.) Most multivitamins contain only 400 IU. But don’t just take two, because getting double doses of other vitamins and minerals can be unsafe (for example, too much vitamin A as retinol can cause hair loss and diarrhea and is associated with hip and other bone fractures, possibly due to an adverse interaction with vitamin D). Many calcium pills contain about 200 IU of vitamin D, so one multivitamin and two or three calcium pills should suffice. Or you can take a vitamin D pill to round out your daily needs. Until we know more, make sure your intake from supplemental sources doesn’t exceed 2,000 IU per day, the current upper limit set by the National Academy of Sciences.

What ? Submit a drawing, sketch or painting about your Subcutaneous Immune Globulin (SCIG) Infusion. The winning entries will have their artwork featured in our SCIG Infusion Log.

Who Can participate? Any child or youth up to 17 years of age who has an immune deficiency OR has a brother, sister, parent, or grandparent with an immune disorder.

What to Draw, Color or Paint? The artwork should have something to do with the entrant’s family or their experiences with SCIG therapy. The entries can be no larger than 8.5 x 11 inches but may be smaller.

Prizes: All entrants will receive a $10 gift card to Toys R Us or Barnes & Noble.

The winners will have their artwork printed in our SCIG Infusion Log.

Entries: Complete the entry form and send it to:

BioRx

SCIG Infusion Log Contest

10828Kenwood Rd.

Cincinnati, Ohio 45242

Entries must be received by December 1, 2008 to be eligible

Kids and parent! A parent MUST sign the entry form on the next page, acknowledging that they have read the entry form and that we may be allowed to use your child’s art. Any entries that are not accompanied with a signed entry form cannot be used.

Name : _________________________________________________________________________ ____

Address: _____________________________________________________________________________

City, State, Zip Code: ___________________________________________________________________

Age, as of December 1: ________

Phone Numbers: ______________________________________________________________________

Email: _______________________________________________________________________________

(We need a way to contact you if you or your child is a winner!)

Contestant is: ___ living with SQ Immune Globulin Infusion

___ the sibling or step-sibling of someone living with SQ Immune Globulin Infusion

___ has a parent or step-parent living with SQ Immune Globulin Infusion

I would like the following gift card as my prize for entering::

___ Toys R Us

___ Barnes & Noble Booksellers

If your child’s art is selected to appear in the calendar, his/her first name and last name initial, age, as well as city and state will appear with the art; i.e. “Billy S. (Age 9), Plano, TX”.

Parent or Guardian’s Signature (Mandatory): ________________________________________________

Parent or Guardian’s name PRINTED ______________________________________ Date ____________

Rules: (copy from Calendar Entry Form) 9 pt.

With kids back to school and the colder weather fast approaching, we are heading into that
wonderful time of year…. Cold and Flu Season. For individuals with Primary Immune Deficiency this can
be an especially stressful time of year. With all the germs that are out there it is hard to know the best
way to protect you and your family.

Wash Your Hands:
The Centers for Disease Control and Prevention (CDC) advise that proper hand washing is the most
important thing you can do to keep from getting sick. Below is their hand washing protocol.
Washing Your Hands the Right Way:

1. Wet your hands with clean running water and apply soap. Use warm water if it is available.
2. Rub hands together to make a lather and scrub all surfaces.
3. Continue rubbing hands for 15?20 seconds. Need a timer? Imagine singing “Happy Birthday”
twice through to a friend.
4. Rinse well under running water.
5. Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the
faucet, as many germs live on faucets.
Alcohol Based Hand Sanitizers:
The CDC states that when soap and water are not available, alcohol?based disposable hand wipes or gel
sanitizers may be used.
• The active ingredient in most alcohol?based hand sanitizers is ethyl alcohol. Alcohol is a natural
antiseptic that has been used in the medical field for over 100 years because it kills most germs
in seconds, without water, and evaporates quickly, leaving no residue on the skin. It physically
destroys most germs.
• Alcohol?based hand sanitizers kill harmful bacterial, such as streptococcus, salmonella,
staphylococcus, E. coli and shigella.
• The level of alcohol in any hand sanitizer must be greater than 60% to be effective. Between
60% and 95% is ideal.
• These products have not been proven to kill viruses or Clostridium difficile otherwise known as
C?diff.
• If hands are visibly soiled, hand sanitizers will not work, making soap and water a better option.
Bottom Line:
Washing with soap and water is better, but the ease and availability of hand sanitizer makes it a good
first step in the fight against germs.
BioRx wishes you a Happy Fall Season and hope that these tips help keep you healthy!
(Information gathered from www.CDC.gov; www.itsasnap.org; and N Engl J Med 2006; 354:1199?1203, Mar 16, 2006)
Our goal is to provide cost?effective care, positive clinical outcomes, and improve quality of life for our Primary Immune
Deficient community.

Presidential Candidates Present Their Healthcare Reform Plans in NEJM

Neil Osterweil

September 26, 2008 — With the nation’s attention riveted on Wall Street, government bailouts, and housing foreclosures, another issue of prime concern to Americans in this election year has been shoved out of the spotlight: Sen. Barack Obama’s and Sen. John McCain’s positions on healthcare reform.

The New England Journal of Medicine invited both the Democratic and Republican candidates for president of the United States to outline their plans for healthcare reform, with commentary on each provided by observers from the opposite end of the political spectrum. Outlines of the candidates’ plans and the critiques were published online September 24 and will appear in the October 9 (plan outlines) and October 16 (critiques) print issues of the journal.

There isn’t much that the candidates agree on in other areas of public policy. But in side-by-side columns with color-coded headings — blue for Sen. Obama and red for Sen. McCain — the senators lay out their strategies for providing universal access to affordable, high-quality care.

However, their strategies outline fundamental philosophical differences, with Sen. Obama embracing a more public solution and Sen. McCain endorsing a more market-based approach.

The Obama Plan

Sen. Obama, who favors a mix of public and private participation, outlines 3 broad healthcare reform goals:

• Equal access to high-quality, affordable health care for all Americans.
• Elimination of wasteful spending, including “layers of bureaucracy that serve no purpose, duplicative tests and procedures that are performed because the right information is not readily available, and doctors providing unnecessary care for fear of being sued.”
• Emphasis on disease prevention and health maintenance.

According to Sen. Obama, patients who like their insurance will be able to retain it with no changes, except for lower costs. Uninsured or underinsured patients would be offered a choice of affordable plans, and he calls for establishment of a national health-insurance exchange for small businesses or people without employment-based insurance; the plans would offer policies at rates similar to those offered through large companies, although Sen. Obama does not specify how this would be achieved.

“To promote competition among insurers, we will also give patients a new public-plan option, providing the same coverage that is offered to members of Congress and their families,” the Democratic candidate writes.

Sen. Obama’s plan also calls for:

• Mandatory acceptance of enrollees by insurers without regard to medical history.
• Tax credits for families to increase affordability.
• Expansion of Medicaid and the State Children’s Health Insurance Program (S-CHIP) to cover all children without private coverage.

Sen. Obama says that the expanded programs will be paid through elimination of waste and through repeal of the Bush administration tax cuts for Americans with the highest incomes. He notes that he opposes taxes on employer-based health insurance.

Reimbursement, Medical Liability Changes

“We also need to change the way we reimburse for patient care,” Sen. Obama writes. “We should start paying adequately for care coordination, case management, and innovative care-delivery models, such as team-based care and electronic communication. Doctors should be paid fairly by private insurers and by Medicare. Payment reform should improve patient outcomes and should lower overall costs by removing incentives for unnecessary care and rewarding the right care, provided at the right time, for the right reasons”

Sen. Obama states that his administration will offer incentives for physicians in training to enter primary care, and he emphasizes renewed support for biomedical research. He also proposes to reduce malpractice insurance burden through information systems, decision support technology, and patient-safety initiatives aimed at reducing medical errors.

“I will also support legislation dictating that if you practice care in line with your medical societies’ recommendations, you cannot be sued,” he writes.

“Too Audacious to Be Believed”

In an editorial critical of the Obama plan, Joseph R. Antos, PhD, a scholar in healthcare and retirement policy at the American Enterprise Institute, a conservative think-tank in Washington, DC, says that the Obama plan is “too audacious to be believed.”

“The Obama plan offers a host of policy proposals that, in the main, address the symptoms but not the underlying disease that afflicts the health care system,” Dr. Antos writes. “We surely could use some symptomatic relief. However, failing to address the perverse incentives that drive health care spending

inexorably upward, making insurance unaffordable for millions and shaping (or misshaping) the practice of medicine, will leave us worse off than we are today.”

The “perverse incentives” Dr. Antos refers to include a “play or pay” option, similar to that currently in place in Massachusetts, under which employers that do not provide health insurance coverage pay a per-worker surcharge that is used to finance a publicly funded healthcare system.

“A play-or-pay policy probably would not be effective in expanding employer-sponsored insurance,” Dr. Antos writes. “Employers who already offer generous health benefits would not have to change their compensation structure. Other employers would choose to ‘pay’ rather than ‘play’ unless the new tax were more expensive than the cost of paying the mandated amount for insurance, which is politically implausible.”

Dr. Antos also claims that the non–group insurance plans offered to uninsured families under Sen. Obama’s plan must of necessity either offer a wide range of benefits and be costly or offer more narrow but less costly basic plans with high out-of-pocket costs.

“A generous plan requires premiums that would be unaffordable to many of the uninsured unless there was also a generous subsidy from taxpayers,” he writes. “A more basic plan would have more affordable premiums, but beneficiaries would face higher out-of-pocket costs if they became seriously ill. Lower premiums and skimpier benefits are not what the Democratic political base thinks it has been offered.”

The author is also critical of the Democrat’s proposed health insurance exchange, saying that it would limit the market-based competition, and adds that Sen. Obama’s plan to regulate health insurers more closely “substantially increases the risk of government failure and regulatory gridlock.”

The McCain Plan

Sen. McCain favors a market-driven, privately funded approach to healthcare, although he too emphasizes basic tenets of reform, including:

• Access to high-quality care
• Choice of insurance coverage
• Affordability
• Portability

“But the road to reform does not lead through Washington and a hugely expensive, bureaucratic, government-controlled system,” he writes.

Sen. McCain calls for moving Medicare toward a system that favors coordinated care and “higher quality care” for seniors, but does not specify how this would be accomplished.

The Arizona senator supports a greater emphasis on health maintenance, screening, prevention, and early intervention.

“We need to create a next generation of efforts to prevent chronic disease, early intervention programs, new treatment models, and public health infrastructure,” he writes. “We need to use technology to share information on ‘best practices’ in health care so that every physician is up to date. We need to adopt new treatment programs and financial incentives to promote healthy habits among Americans with the most common conditions, such as diabetes and obesity, in order to improve their quality of life and reduce the cost of their treatment.”

Tax Credits, Tort Reform

Sen. McCain’s plan calls for dropping the exclusion of the value of health insurance from an employee’s taxable compensation, and replacing it with a refundable tax credit of $2500 for individuals or up to $5000 for families.

“For the first time the credit will provide help to people who are shut out of the job-based insurance system; they will be able to choose an insurer or other health care arrangement, and the credit will be sent straight to the plan they pick in order to help pay their premiums,” he writes. “An essential benefit of this reform is that it will help to change the whole dynamic of the current health care system by putting individuals and families back in charge and forcing insurance companies to respond with better service at lower cost.”

Sen. McCain favors a state-based rather than national plan for ensuring access to care for people with preexisting medical conditions and “additional help for low-income individuals.”

Sen. McCain points to his record of advocacy for medical liability reform legislation, emphasizing that it must be a central component of healthcare reform. He does not offer specifics on what tort reform under a McCain administration would look like.

“Health care reform is too important an issue for one person or one party to tackle alone, and I have a record of working across party lines to tackle big challenges and change the way Washington works. By starting with putting doctors and patients back at the center of health care decisions, we can reform the U.S. system in a way that protects the quality of care while making it affordable and accessible to all,” he writes.

“The McCain Plan for Health Insecurity”

In his critique of the McCain healthcare reform plan, David Blumenthal, MD, MPP, director of the Institute for Health Policy at Massachusetts General Hospital in Boston, and an unpaid advisor to the Obama campaign, writes that “the McCain proposal violates the bedrock principle that major health policy reforms should first do no harm. It would risk the viability of employer-sponsored insurance and the welfare of chronically ill Americans in pell-mell pursuit of a radical vision of consumer-driven health care.”

Sen. McCain’s plan, he says, would increase patient out-of-pocket costs and reduce the role of insurance in healthcare. He notes that three fifths of Americans currently rely on employer-sponsored healthcare, and that Sen. McCain’s plan would “increase reliance on unregulated individual insurance markets (which are notoriously inefficient), and leave the number of uninsured Americans virtually unchanged.”

Dr. Blumenthal charges that by ending the exemption from federal income tax for employer-sponsored insurance, employers would likely drop the plans.

“Over the years, multiple studies have shown that as the tax benefit to employees of receiving employer-sponsored insurance declines, employers are less likely to offer it,” he writes. “On the basis of these studies, economists project that 10 million to 28 million of the 160 million Americans with employer-sponsored insurance will lose it as a result.”

The plan is also likely to encourage other employers to reduce benefits, thereby increasing employee costs, and would drive the newly uninsured into the more costly non–group insurance market, where administrative costs make up 30% to 50% of premiums compared with 12% to 15% of costs in employer-sponsored large group plans.

Dr. Blumenthal is also skeptical about Sen. McCain’s proposal for establishment of association health plans (AHPs) that would allow groups of consumers to buy health insurance for their members.

“By joining such plans, individuals will presumably enjoy the protections that large groups, including employer pools, offer their members. However, the required AHPs don’t exist now. If they did, they would be tempted to cherry-pick healthy members just as insurance companies do. Voluntary associations

of the sick and healthy do not naturally occur, and there is a good reason why,” Dr. Blumenthal writes.

The author also states that deregulation of private insurance markets, as called for by the McCain plan, would eliminate some state mandates that insurance companies provide policies for all who wish to buy them, thereby allowing the companies to “cherry pick” the healthier subscribers while denying coverage to higher insurance risks.

Although Sen. McCain calls for establishment of state-run high-risk insurance pools, such pools, established in 35 states, enroll fewer than 200,000 people, Dr. Blumenthal noted.

“The reason is that states are unwilling or unable to subsidize adequately the extremely high premiums that pools charge the chronically ill,” he writes. “McCain has talked vaguely of providing additional federal funds (in the range of $7 billion to $10 billion) to help states out, but he has not detailed this part of his plan. In any case, it raises a more fundamental question: What are the long-range consequences of segregating the sickest Americans into a predominantly state-run high-risk insurance system, especially in regions that have been notoriously ungenerous toward vulnerable populations?”

The full text of the plans and critiques are available online at www.nejm.org. Also on the site is a video of a presidential campaign healthcare forum presented at the Harvard School of Public Health in Boston in September.

I received this e-mail today from WebMD- and thought I would share it with you since there are some areas we all need to be clear on before we vote on November 4th.

WebMD Collaborates with Commission for Town Hall Debate Questions
In the Presidential Debate schedule, the Town Hall Debate is the place
where you can ask the presidential candidates questions. For the first
time in U.S. election history, questions posted on the Internet will
be included in this presidential debate.
WebMD is proud to announce that we’ve been selected to collaborate
with the Commission on Presidential Debates to gather your
health care questions for the second of three important
presidential debates.
Don’t miss your opportunity to pose a question to our future
president!
Submit your health care question to the candidates today!
Watch the debate on Oct. 7 at 9 p.m. ET/ 6 p.m. PT. and vote on Nov. 4th
Related WebMD Reading & Resources:
. Where do the candidates stand on health issues?
. See what other WebMD users want to ask the candidates.
. Opinion & Thought Leaders: Voices on Election ‘08
. Basic health insurance information everyone should know.
More Important Health News & Features:
. Candid Candidates: the personal side of the candidates.
. Do you need to plan ahead for retirement health care?
. Are you an ‘undecided voter’? You may not be, actually!
. What Is Medicare Part D?
. Add the Election Widget to Your Desktop or Homepage
. U.S. Health Care Not So Healthy

FEEL FREE TO POST ANY COMMENTS HERE AS WELL.

Carol

Today is a milestone for me.  I turned 60 years old.   When I was diagnosed with PIDD, I NEVER thought I would see this day.   I did NOT believe then, that I could live this long.   I was miserable.  I had no energy.   I felt so crummy, I seldom got out of bed.  I was afraid.   I had never heard of this disease.

What would the future hold for me?   Life was very scary in the years that preceded, and followed my diagnosis.  When I got my diagnosis of PIDD, I was still recovering from Valley Fever (coccidiodiomycosis) which had given me fungal pneumonia for nearly 1 year.  I was also beginning to experience some autoimmune disorders.  At the very same time, my Dr had the nerve to find a suspicious lump in my breast, and sent me for a biopsy.  I was beginning to wonder how much one person can deal with at once. 

I soon learned that you can deal with plenty at once.   My attitude these days……. just throw it at me- I’m ready for anything.

Whenever I was waiting for the results of my breast biopsy, I evolved into another person.   Suddenly I had no fears, I knew who I was, and I was prepared for whatever was coming in my life.   It’s funny how you can make peace whenever you need to.   And that peace has never left me.  That is partially how I deal with PIDD now.  

I was also blessed with an incredibly optimistic attitude.   And, great genes from my Mom.   Of course, the genes my Dad gave me most likely included the PIDD gene.   I won’t get angry with him over that.   He was my hero.   So, I take the bad PIDD gene, and mix it with the optimistic gene, and I get me.

The person who turned 60 today.   I am blessed by a loving, very patient, very caring husband, 2 fantastically talented and handsome sons (Yes, I know, I know) and 3 beautiful and brainy granddaughters (I know, I know).   My Mom is alive and kicking major butt!!  My sister and I are twins who happen to be nearly 3 years apart and love each other very much.  I have wonderful friends who not only care about me, but also make me a better person, so  life is really good - even when it’s not so good.

                      My sister, Dee, my Mom and Me

I was very fortunate in that I found a treatment for my PIDD which not only allowed me my independence, but also turned my health around.   I started taking Vivaglobin when it was FDA approved about 2 1/2 years ago- and it has changed my life.   I have the energy, the good health, and the flexibility to have ME back- and not to have to spend most of my time in bed feeling crummy.

This is not to say that I don’t have my share of problems, because I do- 

But I  have learned to deal with them so much better.

Since I have my support group, my life saving medicine, and my positive attitude to help me get through the day with a little luck- I’ll live to say:

I turned 70 today.

But for now, I’m VERY VERY HAPPY to have turned 60 today.

Carol

Credit - Paula Wagler

Probiotics are added to foods such as yogurt. Some yogurts may be more effective than others.

Our digestive tract harbors trillions of microorganisms that for the most part, happily coexist within us.

This party is going on in the colon, and most of the guests are bacteria. Our microorganisms (a.k.a. “microflora” or “microbiota,”) have been described as being as unique to us as a fingerprint, which makes studying the impact of these tiny life forms on humans an enormous undertaking.

Probiotics are live microorganisms in food or supplements that, when eaten, may promote health. However, there are many hurdles to overcome.

How do intestinal microorganisms help us?

Although not fully understood, they are thought to behave in the following ways.

No Trespassing: Private Property! Microorganisms can set up a blockade-type barrier in the digestive tract to help prevent disease-causing germs from entering the bloodstream. Like animals staking their claim, they compete for nutrients and binding sites, preventing other microorganisms from “sticking” to the surfaces of the digestive tract.

Theoretically, the more “good bugs” we have, the more likely they are to win the war for territory.

Some friendly bacteria may break down potential cancer-causing agents. They also can produce substances which kill harmful microbes and create an acid-like environment that some germs are unable to grow in.

They may reduce inflammation and allergens.

Some products of their metabolism can give us energy for brain, muscle, heart and intestinal tissues.

They can make vitamin K and some B vitamins.

What conditions allow the bad bacteria to outnumber the good ones?

When disease-causing germs find a niche, they can modify our normal balance of “friendly bugs,” giving the bad boys an edge and nudging out the good guys (think food poisoning).

Taking antibiotics can wipe out the good, the bad and the ugly bacteria. Taking probiotics can help to reestablish the good bacteria in your digestive tract. But be sure to take calcium-rich dairy foods a couple of hours before or after taking antibiotics, because the calcium can bind with them.

Are all bacteria created equally?

Not all bacteria are considered to be “probiotic.”

These microorganisms are only beneficial to us if they are still around in large quantities when they reach their expiration date. You should select products that are labeled to contain live numbers of microbes “through the end of shelf life.”

Probiotics must be capable of surviving the journey through the acid juices of the stomach and the bile in the small intestines. If they arrive unscathed, they must be able to “go forth and multiply” rather than meeting an untimely death. Many of the starter cultures in yogurt are not considered to be probiotic, because they have expired before they’ve reached the colon.

Because probiotics are regarded as supplements, they do not have to be proven to be effective before they are added to foods. However, disease claims must be backed by scientific data.

Which health conditions do they treat?

Probably the best known use for probiotics is to help people digest the naturally occurring sugar in milk—lactose.

There is also good support for specific strains that treat diarrhea in infants and children, and reduce infants’ risks for developing eczema.

Probiotics also have been reported to improve immune function in older individuals.

Although much of the probiotic research is in the early stages, it is showing some promising results in treating allergies, irritable bowel syndrome, GI inflammation, genitourinary infections, and H. pylori, the microorganism which is often responsible for causing ulcers.

If you think about a shark and your pet guppy, they hardly behave in the same way, even though they are in the same species. The same can be said for various strains of probiotics within the same species, and how they affect different health conditions.

Check with your doctor, pharmacist or dietitian for information about which strains may help with specific health conditions.

Are there any risks involved in taking probiotics?

Two of the most commonly used bacteria are bifidobacterium and lactobacillus, which have a “generally recognized as safe” (GRAS) status in the U.S. They have been safely used for hundreds of years.

People who take probiotics may initially experience gas and bloating, which may or may not subside with continued use.

Parents of premature infants, individuals with weakened immune systems or chronic diseases, and pregnant or nursing mothers should check with their doctor before supplementing their diets with probiotics.

Most of us have heard about germs becoming more resistant to antibiotics, and researchers want to know if this unwelcome characteristic could be passed on from lesser-known probiotics to our own microflora.

Where can I find probiotics?

They are added to many dairy-based foods like yogurt and kefir. You can find them in some types of cereal and granola bars, in juices, and in supplemental forms. Flavorful chewables are making an appearance in stores as well.

Some yogurt manufacturers have incorporated specific strains that will survive as far south as the colon. But these friendly bugs haven’t taken a liking to our accommodations, so they must be ingested for two weeks to be effective. However, a consumer group reports that the scientific evidence for these benefits is weak.

No matter what its bacterial effectiveness, the beauty of yogurt is that it packs a powerful nutritional punch—it’s a great source of calcium, protein, potassium, B vitamins, and sometimes vitamin D, all at a reasonable price. You can’t really lose by eating yogurt—if you try it for two weeks and it doesn’t improve your digestion, you have still benefited by consuming a nutrient-rich food.it

You can find out which supplements pass inspection from Consumer Labs, or check the label for certification from the U.S. Pharmacopeia.

Prebiotics, which are not digested, are much easier to please when it comes to supporting our friendly bacteria. But that’s another story.

Living with a chronic illness such as PIDD is stressful to say the least.   You find yourself coping with physicians, insurance companies, family members, friends, co-workers and the boss as well as the diagnosis, unanswered questions, and very possibly depression.

The best thing to do, in my opinion, is to take a three-pronged approach to the problem:  first - surround yourself with a strong support group comprised of family, friends, acquaintances and healthcare personnel.  Nothing can replace the loving support of family and friends and the caring of acquaintances.

It is important to have a strong healthcare team (with you as the head) to direct your care and to answer questions and attend to your concerns as they arise.

While many marriages are at first tested by the additional stress that a chronic illness brings, many people find that their marriages are strengthened as the partners work together to accommodate the needs of the ill member.

The second prong is the financial aspect and dealing with the insurance companies and healthcare suppliers.   A chronic illness can be very expensive.   Even with good insurance, there are co-pays until you meet your maximum out-of-pocket expense.  This is in addition to the policy costs.  Most healthcare suppliers are reasonable and will work out a payment plan for co-pays due them; some will even reduce what is due when they realize that the patient is in a financial bind.

One thing that is very important:  If you find yourself on Medicare, get secondary insurance coverage.

The third prong is mental health:  chronic illness and depression go hand-in-hand.  Most healthcare professionals agree that depression is chemically based - something in your body has caused the chemical balance in the brain to become off balance.   There has been discussion as to whether it is the disease process or if it is a result of the body trying to heal itself.  Nevertheless, it is there and a chronically ill person needs to treat depression before it gets out of hand.

There are a number of excellent pharmaceuticals on the market today that can reverse depression.   The trick is getting the right drug for you.   Either your primary care physician can prescribe an antidepressant for you, or better yet, consult a psychiatrist whose expertise is medication management to work with you to find a medication that will be effective for you.

Another thing to remember is to take excellent care of your general health, eat properly, get some exercise (stretching, walking, tai chi or whatever is best for you) and get plenty of rest.   This advice doesn’t just apply to persons with PIDDs, but to anyone with a chronic illness.

WISHING YOU GOOD HEALTH.

Guest author:

Leslie B Mink, B.A., Psychology, M.S., Counseling; Diagnosed with CVID- July, 1997,

IDF PEER CONTACT VOLUNTEER, and FEELING GREAT!