Later On

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Archive for the ‘Medical’ Category

Migraines through history

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Landscape with Aura, from the Migraine Action Art Collection, 1981.
Courtesy Migraine Action Art Collection (463)/Wellcome Collection.

Katherine Foxhall writes in History Today:

Migraine affects one in seven of the world’s population – approximately a billion people. The World Health Organisation calculates it to be the seventh most disabling among all global diseases, more prevalent than diabetes, epilepsy and asthma combined. Virtually everyone will live with, work with, be related to, or be friends with someone who has migraine. But how, over the centuries, have people interpreted, explained and treated this disease?

What is migraine?

The writer and broadcaster A.L. Kennedy has described migraine as ‘a ghost, it’s a gaoler, it’s a thief, a semi-perpetual dark companion’. Rudyard Kipling, on the other hand, wrote in a letter that it was ‘a lovely thing’, though it divided him in two: ‘One half of my head … throbs and hammers and sizzles and bangs and swears while the other half – calm and collected – takes notes of the agonies next door.’

There are many types of migraine. Migraine without aura is most common. Characterised by severe pain, often in one side of the head, attacks can last from a few hours to three days and often include nausea and vomiting. Before and during a migraine attack, many people experience various other symptoms, such as tiredness, emotional disturbance, poor concentration and sensitivity to light or sound. Migraine with aura involves additional neurological symptoms, most commonly a visual aura lasting between five and 30 minutes. Many people see a C-shaped zigzag pattern that spreads across the field of vision. Aura can affect any of the senses, manifesting as vertigo, tinnitus, reduced hearing, pins and needles, whistling sounds, numbness or speech disturbance. On average, migraine sufferers experience one or two attacks a month, but around two per cent of the world’s population has chronic migraine, classified by the International Headache Society as headaches that occur for 15 or more days per month (of which eight are migrainous), for three months or more.

Migraine affects women two to three times more than men, is common among children and seems to be more prevalent among people with low socio-economic status. As well as the pain and discomfort of each attack, the cumulative effect of migraine can bear on all aspects of daily life, affecting relationships with family, partners, friends and work. We know that migraine involves nerve pathways and chemicals in the brain and it seems likely that the headache pain comes from neurogenic inflammation. But much remains unknown about migraine, including its cause and the extent to which antimigraine drugs can access the brain. It is this uncertainty which makes understanding migraine’s history so important.

A migraine by any other name

For nearly 2,000 years, people have talked about a disorder called migraine. In the second century ad, the Roman physician, surgeon and philosopher Galen used hemicrania to describe a pain that affected half the head and was caused by rising vapours from bilious humours in the stomach. Through translation and use, Galen’s term spread. We find emigranea in Latin and Middle English, migran in medieval Welsh. The early modern period saw many variations on the English ‘megrim’ or ‘meagrim’. Galen’s term also provides the common root for migraine in a variety of languages, including migräne (German), migraña (Spanish), migréna (Czech and Hungarian) and, of course, the French migraine. . .

Continue reading.

Written by LeisureGuy

21 January 2020 at 9:13 am

A doctor talks about his switch from low-carb/keto diet to whole-food plant-based diet

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And as blog readers know, I also was able to discontinue all my medications (for diabetes, for high blood pressure, and for cholesterol control) 10 weeks after switching from a low-carb diet to a whole-food plant-based diet.

Written by LeisureGuy

20 January 2020 at 9:17 pm

New program aims to break taboo by teaching high school students about endometriosis

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Comprehensive sex education programs that begin in early education and include some instruction each year can help students a lot as they grow and mature. Wendy Leung reports in the Globe & Mail:

Endometriosis is a common condition that affects an estimated one in 10 females of reproductive age. But because few discuss the symptoms or regard the severe pain and nausea during menstruation as abnormal, many suffer for years before getting treatment.

Now, researchers at BC Women’s Hospital and Health Centre have launched an experimental program to teach high-school students about endometriosis as part of their sexual-health curriculum.

They hope the one-hour sessions, taught to students at New Westminster Secondary School, will help adolescents recognize what’s normal and what’s not during menstruation, and encourage them to seek help if they experience symptoms.

“What we’re trying to advocate is also empowerment of young females in terms of taking charge of their health,” said Catherine Allaire, medical director of the Centre for Pelvic Pain and Endometriosis at BC Women’s.

Endometriosis occurs when endometrial tissue, which normally lines the interior of the uterus, grows outside of the uterus, which can lead to the formation of lesions, cysts and other growths. Symptoms, which may include severe menstrual cramps, nausea, vomiting, irritable bowels and diarrhea, can cause individuals to miss school or work. Pain can also occur outside of menstruation, such as during ovulation or during sex, Allaire said.

But due in part to taboos around talking about menstruation, there is often an eight-year delay between the onset of symptoms and receiving a diagnosis of endometriosis, she said.

“A young female that is having all these symptoms may not know that it’s not the norm or may not know what to do about it,” she said, adding that when young women do speak up, their symptoms are often dismissed by family members or even health professionals.

More than 60 per cent of women with endometriosis report encountering at least one health professional who dismissed their symptoms, Allaire said.

The in-class sessions are based on a menstrual health and endometriosis educational program in New Zealand, which has been shown to increase students’ awareness about the condition and potentially lead young women to seek specialized health-care services sooner.

The researchers at BC Women’s have partnered with Options for Sexual Health (Planned Parenthood’s affiliate in B.C.) to deliver the lessons to a total of roughly 100 students, grades 8 to 12, as part of a pilot study. The first group of around 20 Grade 12 students participated in a session last month, and the team aims to have four or five more classes each undergo a session early this year. The study is funded by the Michael Smith Foundation for Health Research.

Kristen Gilbert, education director of Options for Sexual Health who is teaching the sessions, said the classes include students of all genders.

“All of us know people who have periods, even if we don’t [have them],” she said, adding in the first class, all the students were interested and engaged.

One student, in particular, informed her afterward that she would share what she learned with a friend, whose menstrual symptoms included vomiting.

“So it wasn’t just that student in the class who’s going to benefit from that lesson. It’s her whole circle,” Gilbert said.

Teacher Chelsie Goodchild, whose Grade 12 anatomy and physiology class participated in that first session, said her students typically learn about the reproductive system in school, but endometriosis is generally not a topic that is covered.

Goodchild said the session was not only informative for her students, but for her as well. Later, when she discussed the study with her parents, she learned her own mother had endometriosis.

“It was pretty eye-opening,” she said. . .

Continue reading.

Later in the article:

. . . Had she learned about endometriosis in high school, Bridge-Cook said she likely would have realized much sooner that the pain she experienced during menstruation was abnormal. Even though she began having symptoms at age 13, the first she heard about endometriosis was when she was in her 20s. She was not diagnosed until she was 34. (A surgical procedure called a laparoscopy is needed to receive an accurate diagnosis.)

The pain became so debilitating when she was in her 30s, she was unable to work for about three years. After four surgeries and a combination of strategies, including nutritional changes, pelvic physiotherapy and medications, she is now able to manage her symptoms but still has chronic pain, partly because her endometriosis was untreated for so long. . .

Written by LeisureGuy

20 January 2020 at 2:07 pm

The weak influence of the “obesity gene”

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Also from How Not to Diet:

To date, about one hundred genetic markers have been linked to obesity, but when you put all of them together, they account for less than 3 percent of the difference in body mass index between people.52 The “fat gene” you may have heard about (called FTO, short for “FaT mass and Obesity associated”) is the gene most strongly linked to obesity,53 but it explains less than 1 percent of the difference between people (a mere 0.34 percent).54

FTO codes for a brain protein that appears to affect your appetite.55 Are you one of the billion people on Earth who carry a full complement of FTO susceptibility genes?56 It doesn’t really matter, because this only appears to result in a difference in intake of a few hundred extra calories a year,57 while what it took to lead to the obesity epidemic is more like a few hundred calories a day.58 FTO is the gene so far known to have the most effect on excessive weight gain,59 but the chances of accurately predicting obesity risk based on FTO status are only slightly better than flipping a coin.60

When it comes to obesity, the power of your genes is nothing compared to the power of your fork. Even the small influence the FTO gene does have appears to be weaker among those who are physically active61 and may be abolished completely in those eating healthier diets. FTO appears to affect only those eat diet higher in saturated fat (predominantly found in dairy, meat, and junk food). Those eating more healthfully appear to be at no greater risk of weight gain even if they inherited the “fat gene” from both their parents.62

As Dr. Greger observes, “obesity does tend to run in families, but so do lousy diets.”

Written by LeisureGuy

19 January 2020 at 6:25 pm

The ileal brake and fiber-rich food

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I have assumed that the reason that I’m able to restrict my eating to a 4-hour window (for me, 10:00am to 12:00pm) and be not at all ravenous when 10:00am rolls round, just a bit peckish and inclined to have a bite of something, was that I avoid refined/processed food (very little if any dietary fiber) and meat, dairy, and eggs (zero fiber) and instead eat whole plant-based foods, and those have a good amount of dietary fiber.

Moreover, I refrigerate (intact whole) grain and beans after I’ve cooked them, and the refrigeration makes part of the starch resistant so that it acts like dietary fiber, making down to the large intestine and (like fiber) nourishing the gut microbiome.

I assumed that the fiber and the resistant starch were why I did not feel terribly hungry, but I didn’t know the mechanism, just my observation that I did not get desperately hungry and my guess at the reason.

I’m now reading How Not to Diet, and I came across this interesting passage that explains the mechanism:

A review entitled “Food Fibre as an Obstacle to Energy Intake” summarized what I call the Four Ds by which dietary fiber results in reduced caloric intake:1205 dilution of calories by expanding the volume of food, distention of the stomach through fluid absorption, delay in stomach emptying of the gelled mass, and dumping of calories by blocking the absorption of other macronutrients, such as carbs and fat. That fourth D triggers a fifth phenomenon known as the ileal brake.

The ileum is the last part of the small intestine before it empties into the colon. When undigested calories are detected that far down our intestines, our bodies put the brakes on eating more by curbing our appetites. This can be shown experimentally. If you insert a nine-foot tube down people’s throats and drip in protein, fat, or sugar, you can activate the ileal brake. Then, if you sit them down to an all-you-can-eat meal, they will eat at least one hundred fewer calories than those in the placebo group who had only gotten a squirt of water through the tube.1206 Activating the ileal brake can make people feel full up to nearly two hundred calories earlier. [And I think the calories in the resistant starch activate the ileal brake. – LG]

Ever since its discovery, the ileal brake has been considered a medical target for appetite control. So did doctors simply advise patients to eat lots of whole, unprocessed plant foods so that the fiber would drag calories down to activate the brake? Not quite. Instead, they developed the first major bariatric surgery, the jejunoileal bypass.

Fiber-depleted foods get absorbed quickly and never make it all the way down to the ileum, but instead of having people eat foods in their natural form, some doctors decided just to cut out the intervening twenty or so feet of intestine. By attaching the end of the ileum right up to within about eighteen inches of the stomach, the ileal brake is activated no matter what you eat. It’s like your emergency brake is always on. You can still drive, but not as fast. So, with the jejunoileal bypass, you can still eat, but not as much because you’re already feeling full.

More than twenty-five thousand patients underwent the procedure in the United States before it was realized that cutting out 90 percent of the intestines wasn’t such a good idea. The jejunoileal bypass resulted in long-term progressive liver scarring in 38 percent of patients.1207 That’s nearly two out of every five patients. Though the surgical approach failed, the medical mind-set still prevails, with researchers teaming up with drug companies and the food industry to exploit the ileal brake for weight loss with “dietary encapsulation or slow release strategies,”1208 failing to recognize that Mother Nature already designed a natural strategy in the form of fiber-rich food.

Intestinal Workout

There are many ways eating more fiber means eating fewer calories, but the “Dietary Fiber and Weight Regulation” review found that study subjects randomized to consume higher-fiber diets lost more weight even when caloric intake was fixed.1209 Think about it: more weight loss even when prescribed the same number of calories. So if it wasn’t the calories-in side of the equation, could it be the calories-out side? Normally, calories out means things like exercise, but, in the case of high-fiber diets, there are literally calories out—as in out the other end and flushed down the toilet. But the same-calorie, higher-fiber groups were losing more weight even after taking into account the excess calorie dumping. Where were the calories going? 

To solve the mystery of the missing calories, researchers fed people different amounts of fiber and sealed them in an airtight chamber called a whole-body calorimeter to closely monitor their metabolic rates.1210 Those with more fiber in their systems burned more calories—even in their sleep. Though it was only about 2 percent more, that translated into about fifty more calories burned a day without getting out of bed. What was going on? . . .

He goes on to answer that question, but the answer I was looking for is covered: because the starch is resistant, some of it reaches the ileum still containing noticeable calories, which activates the ileal brake — so I don’t feel hungry.

Pretty cool.

Also note this about dietary fiber (from the same book):

Crowding Out Calories

The first major review, “Dietary Fiber and Weight Regulation,” included a dozen interventional studies in which people were randomized into higher-or lower-fiber diets. The additional consumption of fourteen grams of fiber a day led to an average weight loss of 1.9 kilograms over 3.8 months.1183 That’s only about a pound a month, but the weight loss was greater among those who needed it; overweight and obese study subjects lost triple the weight compared to lean individuals. How much is fourteen grams of fiber? Not much. Fourteen grams would barely bring the average American’s diet up to the recommended minimum average adequate daily fiber intake.1184

The increased fiber intake appeared to lead to about a 10 percent drop in daily caloric intake.1185 Why would more fiber mean fewer calories? Well, conventionally, fiber is considered to have zero calories, so it adds bulk to food without adding extra calories. To illustrate, let’s compare a food to its fiber-depleted equivalent. Consider a bottle of cold-pressed apple juice, which is basically an apple with its fiber removed. You could chug a regular 15.2-ounce bottle of juice in a matter of seconds, but to get the same number of calories, you would have to eat nearly five cups of apple slices.1186,1187 Which do you think would fill you up more? Obviously, the apple slices. But why?

First, you’d need to chew every apple slice. Fiber-rich foods require more chewing, slowing down eating rate, which itself can improve satiety.1188 This also allows for more secretion of saliva and stomach juices. In one study, researchers spread a barium paste onto slices of different kinds of bread and found that, upon x-ray, the stomach shadow was larger after eating whole-wheat compared to white bread, showing how much fuller you physically get.1189 So, in our cold-pressed apple juice versus apple slices scenario, we have the extra fluid secretion on top of the five cups of slices pushing on the walls of the stomach, which has nerves with stretch receptors that can send fullness signals directly to the brain.1190

One type of fiber in apples is pectin, the gelling agent used to make jams and jellies. Imagine how eating all those apples would not only add a lot of extra bulky volume but could start to form a gel to further slow the rate at which those five cups of slices left your stomach. This would keep you feeling fuller for longer compared to consuming the same number of apple calories in fiber-depleted juice form, which would pass right through you much more rapidly. Other gummy fibers like those found in oats can have the same gelling effect. Five grams of a highly gelling fiber can hold approximately one quart of water as it passes through the stomach and small intestine, so that’s like having an extra two pounds of zero-calorie food mass filling you up.1191

Obviously, juice is going to drain out of your stomach faster than apples, but even the same volume of fiber-depleted solid food exits more quickly. In a study entitled “Gastric Emptying of a Solid Meal Is Accelerated by the Removal of Dietary Fibre Naturally Present in Food,” researchers compared how long it took for a meal that included higher-fiber foods—whole-wheat pasta with puréed fruits and vegetables—to leave the stomach compared to a meal with the same volume and same calories, but made from white pasta and fruit and vegetable juices. The fiber-depleted meal was out of the stomach forty-five minutes earlier than the meal with the fiber intact.1192

Written by LeisureGuy

19 January 2020 at 4:31 pm

America’s favorite poison: Alcohol

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I have cut my use of alcohol from regularly to rarely, and mainly that is because I discovered the degree to which alcohol undermines constancy of purpose. I initially cut back for weight loss, and I’ve not been a heavy drinker in any case: wine with dinner from time to time, plus the occasional cocktail. But it was not rare for me to have a drink, which I enjoyed.

But then when I cut it out, I noticed a difference in how easily I could stick with things—like my diet, for example. The more time that went by without a drink, the more obvious the difference became. I am now quite wary of having a drink, which I’ll still do, but on the order of once a month, and only then for some special occasion.

So this article by Olga Khazan in the Atlantic caught my eye:

Occasionally, Elizabeth Bruenig unleashes a tweet for which she knows she’s sure to get dragged: She admits that she doesn’t drink.

Bruenig, a columnist at The New York Times with a sizable social-media following, told me that it usually begins with her tweeting something mildly inflammatory and totally unrelated to alcohol—e.g., The Star Wars prequels are actually good. Someone will accuse her of being drunk. She, in turn, will clarify that she doesn’t drink, and that she’s never been drunk. Inevitably, people will criticize her. You’re really missing out, they might say. Why would you deny yourself?

As Bruenig sees it, however, there’s more to be gained than lost in abstaining. In fact, she supports stronger restrictions on alcohol sales. Alcohol’s effects on crime and violence, in her view, are cause to reconsider some cities’ and states’ permissive attitudes toward things such as open-container laws and where alcohol can be sold.

Breunig’s outlook harks back to a time when there was a robust public discussion about the role of alcohol in society. Today, warnings about the devil drink will win you few friends. Sure, it’s fine if you want to join Alcoholics Anonymous or cut back on drinking to help yourself, and people are happy to tell you not to drink and drive. But Americans tend to reject general anti-alcohol advocacy with a vociferousness typically reserved for IRS auditors and after-period double-spacers. Pushing for, say, higher alcohol taxes gets you treated like an uptight school marm. Or worse, a neo-prohibitionist.

Unlike in previous generations, hardly any formal organizations are pushing to reduce the amount that Americans drink. Some groups oppose marijuana (by many measures a much safer drug than alcohol), gunspornjunk food, and virtually every other vice. Still, the main U.S. organizations I could track down that are by any definition anti-alcohol are Mothers Against Drunk Driving—which mainly focuses on just that—and a small nonprofit in California called Alcohol Justice. In a country where there is an interest group for everything, one of the biggest public-health threats is largely allowed a free pass. And there are deep historical and commercial reasons why.

Americans would be justified in treating alcohol with the same wariness they have toward other drugs. Beyond how it tastes and feels, there’s very little good to say about the health impacts of booze. The idea that a glass or two of red wine a day is healthy is now considered dubious. At best, slight heart-health benefits are associated with moderate drinking, and most health experts say you shouldn’t start drinking for the health benefits if you don’t drink already. As one major study recently put it, “Our results show that the safest level of drinking is none.”

Alcohol’s byproducts wreak havoc on the cells, raising the risk of liver disease, heart failure, dementia, seven types of cancer, and fetal alcohol syndrome. Just this month, researchers reported that the number of alcohol-related deaths in the United States more than doubled in two decades, going up to 73,000 in 2017. As the journalist Stephanie Mencimer wrote in a 2018 Mother Jones article, alcohol-related breast cancer kills more than twice as many American women as drunk drivers do. Many people drink to relax, but it turns out that booze isn’t even very good at that. It seems to have a boomerang effect on anxiety, soothing it at first but bringing it roaring back later.

Despite these grim statistics, Americans embrace and encourage drinking far more than they do similar vices. Alcohol is the one drug almost universally accepted at social gatherings that routinely kills people. Cigarette smoking remains responsible for the deaths of nearly 500,000 Americans each year, but the number of smokers has been dropping for decades. And few companies could legally stock a work happy hour with joints and bongs, which have never caused a lethal overdose, but many bosses ply their workers with alcohol, which can be poisonous in large quantities.

America arrived at this point in part because the end of Prohibition took the wind out of the sails of temperance groups. When the nation’s 13-year ban on alcohol ended in 1933, alcohol control was left up to states and municipalities to regulate. (This is why there are now dry counties and states where you can’t buy alcohol in grocery stores.) At the national level, anti-alcohol efforts were “tainted with an aura of failure,” writes the wine historian Rod Phillips in Alcohol: A History. Membership in the Woman’s Christian Temperance Union, the original prohibitionist group, declined from more than 2 million in 1920 to fewer than half a million in 1940. Some Christian groups continued to push for restrictions on things such as liquor advertising throughout the ’40s and ’50s. But eventually alcohol dropped off as a major national political issue and was eclipsed by President Richard Nixon’s war on drugs such as marijuana and heroin.

This dearth of anti-alcohol advocacy was met with a gradual shift in the way Americans began to view alcoholism—and with commercial interests that were ready to step into the breach. When Alcoholics Anonymous was founded in 1935, it portrayed alcoholism as a disease rather than a moral scourge on society, says Aaron Cowan, a history professor at Slippery Rock University, in Pennsylvania. (In time, the medical community would come to agree with the idea of alcohol abuse as a medical disorder.) By emphasizing individual rather than social reform, the organization helped cement the idea that the problem was not alcohol writ large, but the small percentage of people who could not drink alcohol without becoming addicted. The thinking became, If you have a problem with alcohol, why don’t you get help? Why ruin everyone else’s fun?

Of course, many people have a normal relationship with alcohol, which has been a fixture of social life since the time of the Sumerians and ancient Egyptians. But today, what actually constitutes a “normal” relationship with alcohol can be difficult to determine, because Americans’ views have been influenced by decades of careful marketing and lobbying efforts. Specifically, beer, wine, and spirit manufacturers have repeatedly tried to normalize and exculpate drinking. “The alcohol industry has done a great job of marketing the product, of funding university research looking at the benefits of alcohol, and using its influence to frame the issue as one of ‘The problem is hazardous drinking, and as long as you drink safely, you’re fine,’” says Michael Siegel, a professor of community health sciences at Boston University.

During World War II, the brewing industry recast beer as a “moderate beverage” that was good for soldiers’ morale. One United States Brewers’ Foundation ad from 1944 . . .

Continue reading.

Written by LeisureGuy

14 January 2020 at 5:36 pm

“The health-care industry is letting surgeons behave like muggers”

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The Best Healthcare System in the World™ has some dissatisfied patients, one of whom is Cynthia Weber Cascio, a principal at M&C Media and a former CBS News correspondent. She writes in the Washington Post:

We’ve been hearing a lot about surprising medical bills lately — horrible stories about wages being garnished because of large unpaid bills, people losing their homes, even people taking their own lives because of medical debt.

Yet the public still seems largely unaware that such horrendous situations could happen to anyone — even those with great health-care plans. That’s because our health-care system is ripe for bad actors to abuse patients in emergency situations. I should know; it happened to me.

About a year ago, I began to have stomach discomfort and thought I had overdone it at Starbucks. The pain got worse overnight. Antacids didn’t help. Then came the nausea, 102-degree fever and pain that had moved to my lower right side, making it difficult to lift my leg. By dawn, I knew it was appendicitis and told my husband we had to go to the hospital.

There were several options, but I felt so sick that we chose a nearby hospital, which we have long trusted for our family’s health. A CT scan and bloodwork quickly confirmed acute appendicitis. I would need surgery immediately. Not to worry, the ER doctor told me. They had a good surgeon on call. Things were moving efficiently and smoothly. We were impressed.

Then we met the surgeon as I was being prepared to be taken into the operating room. He explained that if he didn’t operate right away, I might get sepsis and die. He also said he didn’t take my insurance but assured us I was in capable hands, as he was very experienced. After asking about our occupations, he announced his fee for my laparoscopic appendectomy would be $15,000. We were stunned by the timing and the amount. Was this supposed to be a negotiation?

But there was no time for discussion. I was wheeled off for a straightforward surgery that took about 35 minutes — not much longer than a colonoscopy. The procedure went well.

Eventually, the surgeon’s bill arrived: $17,000 including charges for an ER consult neither my husband nor I recall. I called the insurance company (for which we’re paying more than $25,000 in annual premiums). Sorry, he’s not one of ours. No contract with us.

Fortunately, my insurance covered all other related hospital costs — the ER doctors and tests, the operating room, medications, the anesthesiologist’s fee — but that still left us with the $17,000 charge from the surgeon. That’s more than seven times the out-of-network, uninsured rate for the hospital’s locale, according to FAIRHealth Consumer.

I appealed to the Maryland Insurance Administration, which regulates the state’s insurance industry. MIA was sympathetic, but there was nothing to be done because the surgeon didn’t have a contract with the insurance company.

I wrote to the head of the hospital and patient relations. Surely the surgeon mistakenly added an extra zero? Was the hospital aware business affairs were taking place in pre-op? Can an out-of-network surgeon simply make up any fee on the spot? I felt violated.

Three months later, I got what appeared to be a computer-generated email survey asking if I had any complications. It also said the surgeon who performed my procedure was part of a quality control panel. I have heard from the hospital subsequently — in the form of more general emails, asking me to donate money.

Meanwhile, we appealed our insurance company’s refusal to cover the surgery, and as we waited for its final determination, the surgeon kept asking the status of the claim. In an email exchange, he offered to reduce his fee by 30 percent if it would help.

Finally,  . . .

Continue reading.

Written by LeisureGuy

13 January 2020 at 9:49 pm

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