Ruth Fenner Barash's new book, "For Better or Worse: Lurching from Crisis to Crisis in America's Medical Morass," reveals a medical system gone haywire, a system that's become a nightmare for sick and elderly Americans and their loved ones.

Her cautionary tale traces the long death of her husband, Philip, through a medical journey she says was fraught with mismanagement and excess, useless interventions and a sometimes complete disregard for pain - even when there was no hope of healing.

The Barashes were a long-married couple who tried to keep their heads above the quicksand of illness. Amidst the welter of statistics and cost analyses, their ordeal is a critical and moving look at a medical system that prioritizes itself above its patients.

Barash shares the deeply personal story of a man who, not through his own choice, overused the medical system, resulting in a long, slow death. She laments the state of our wildly expensive MD/hospital/Big Pharma complex, which all too often creates additional suffering for patients and their families.

"Patients and their loved ones cannot blindly turn themselves over to this massive, technology-based system and trust that it will care - or take care of them," says Barash, who adds that she had always expected much more from America's medical system.

"We did experience some wonderful health-care professionals - brilliant, compassionate and helpful doctors and nurses - but they were not the rule. I learned a great deal from our experience, and with so many people now gaining access to health care, I want others to benefit from what I've learned.

"You can navigate the system; you just have to know how. Above all, you have the power to say No."

Each one of us has a stake in advocating for a better health-care system; one that puts the emphasis on the patient and not gratuitous tests, mysterious technology or complicated insurance plans, she says. Until we get to that point as a nation, she says there are many things patients and their families can do to improve the medical experience, including avoiding the emergency room whenever possible, being skeptical and questioning everything, and asking about the costs - no matter who's paying.

About Ruth Fenner Barash

Ruth Fenner Barash studied philosophy at City College of New York and did graduate work at the University of Chicago. In 1958, she met and married Philip Barash, a private practice attorney. She went on to work in public relations and real estate, served on education and civic boards, and taught art in various media. Her long marriage was a "harmonious adventure" despite the couple's treacherous journey through the health-care system. Her husband died in 2012.

JOIN OUR WEBCAST

Ever wonder when food, something seemingly so basic, became such a challenge to understand? We feel that way too, so when the news about a trans fat ban hit our radar, we reached out to the experts for some straight talk on the subject.

Now, we're bringing food experts Toby Amidor, Joy Dubost, Carolyn O'Neil and Jennifer Seymour to you in our Trans Fats: Moving off the Label webcast.

Join us on Tuesday, Feb. 11 from 2-3 p.m. CSTto get the facts about trans fats with straight talk and some humor from four experts who know and love food.

The Center For Food Integrity

Best Food Facts is administered by The Center for Food Integrity (CFI). CFI seeks to share accurate, balanced information and correct misinformation to address issues that are important to consumers. Visit the CFI website here.

Is Your Inner Child Keeping You Trapped in a Bad Relationship?

5 Questions to Ask Yourself; The Answers May Help Set You Free

It happens when we see politicians repeatedly make the same self-destructive mistakes - think former legislator Anthony Weiner's repeated sexting scandals.

Or we hear friends complain repeatedly about the horrible job they're "stuck" in.

Or, in a rare glimmer of insight, we wonder why we're still hanging on to a "romance" that makes us miserable.

"When people seem mentally healthy and it looks like they could easily make a change that would make them happier, we're absolutely baffled by why they don't," says Steven Jay Fogel (www.StevenJayFogel.com), author of the new book Your Mind Is What Your Brain Does for a Living (March 2014).

When you're the "stuck" person, the why may seem more evident: You're scared, or you think, "If I just keep doing the right things, it will all work out."

Either way, it's likely they?and you?aren't making a conscious choice at all, Fogel says.

"We think we're making decisions based on the present, but we're usually not. We tend to operate on automatic pilot, responding to situations based on the coping strategies and thinking patterns we developed in childhood," he says.

"When those strategies are dysfunctional, we just keep repeating the same behaviors over and over again."

The good news is that we can learn to recognize that "default" thinking and rewire the brain to change it, says Fogel.

The cofounder of Westwood Financial Corp., one of the nation's leading private commercial real estate owners, Fogel draws from decades of neuroscience and mindfulness research to offer solutions.

What can you do to get yourself unstuck? Get started, he suggests, by answering these questions?in writing!

· What is causing your pain? Think about whether you're in a relationship or job that's become less and less satisfying and increasingly painful over a long period. Describe in writing the elements of the relationship or situation that are persistently causing you pain and how long you've been experiencing these problems. Knowing that there are three ways to end your suffering - accept the situation, change it, or remove yourself from it - write down the reasons you're staying even though you're suffering and what is preventing you from choosing Door 1, 2 or 3.

· How are you interpreting your partner's behavior? If you repeatedly fight about the same issues, describe the issues. Think about whether you're unconsciously investing the issue with a meaning based on your "autopilot" thinking. For instance, if you're arguing because your partner's messy and ignores your requests to be neat, are you interpreting that as disrespect toward you? Do you further interpret that disrespect as a lack of love for you? Is it possible that your partner is just not a neat person and that has nothing to do with his feelings for you?

· Do you have impulsive autopilot behaviors that are causing problems? We can often check the impulses that stem from our autopilot brain just by stopping to think before we act. Bursts of anger are one example; suppressed anger that turns into passive-aggressive behavior is another.

· Do you feel shamed or blamed by your partner's critical comments? Write down the comments accurately?as they were spoken. Then think mindfully about whether your partner was really shaming you or if you interpreted the comments in that way because of your own inner critic. If it was the former, have a conversation with the person about how you feel when this happens, and state that you'll be more open to the feedback if the criticism can be expressed objectively.

· Did you bring a myth with you into the relationship? If so, describe the myth. For example, you might have believed that you will cure everything that's wrong with the other person. Or that she will fix all of your problems. Describe how you came to believe that myth and what it would take for you to release it.

About Steven Jay Fogel: Steve Fogel is a principal and cofounder of Westwood Financial Corp., one of the largest owner-operators of retail properties in the United States. He is a licensed real estate broker and past chairman of the California Arts Council. Your Mind Is What Your Brain Does for a Living, publishing March 11, 2014, is his third book. He is also the author of My Mind Is Not Always My Friend: A Guide for How to Not Get in Your Own Way (Fresh River Press, 2010) and The Yes-I-Can Guide to Mastering Real Estate (Times Books-Random House).

Nationally Recognized Physician Explains Why
You Should Know the Difference

For a malady that's as common to aging as waning vision, festoons - also called "malar mounds" -- aren't well understood by the public, says Adam J. Scheiner, M.D., an international eyelid and facial cosmetic surgeon specializing in the treatment of Festoons and featured on "The Dr. Oz Show" and "The Doctors."

"The more people know about the causes of Festoons and how they are often misdiagnosed, the better informed they are to be their own effective health-care advocates," says Dr. Scheiner, who educates the public through his popular blog at www.adamscheinermd.com and his new book, The True Definition of Beauty.

"A growing part of my practice is correcting treatments with less than favorable results that patients have had done elsewhere; like fillers used under the eyes to treat 'bags,' or lower eyelid surgery that doesn't address the patients' Festoons," Dr. Scheiner says.

"The lack of awareness around Festoons and how ubiquitous they are ? and how often they are misdiagnosed ? is why my practice has executed an educational marketing campaign to bring clarity to combat the misinformation and confusion surrounding this condition," he adds.

What is the difference between "bags" and Festoons?

"'Bags' are caused by fat protruding through the skin in the lower eyelid area, while Festoons, which also protrude, are primarily on the upper part of the cheek," Dr. Scheiner says. "The two together can look like one large protrusion, but they're separate issues."

Physicians will perform procedures to help a patient's lower eyelid "bags," but often they leave the Festoons behind. This is because Festoons are notoriously hard to treat. The result? When they are not repaired at the same time as the "bags," Festoons can actually look worse compared against the newly rejuvenated lower lid.

Festoons can also be a marker for pre-cancerous skin conditions on other parts of the face ? another good reason to know the difference between Festoons and "bags."

Dr. Scheiner offers tips for evaluating whether you have "bags" or Festoons, the causes of both, and solutions:

· Are they "bags" or Festoons? "Bags" often appear as puffy circles directly beneath the eye. "If you touch them, they're usually firmer, and you can't easily move them from side to side. That's an indication they're 'bags,'" Dr. Scheiner says. "Also, if you look up, they become more prominent."

Festoons, on the other hand, are high on the cheek, although they can extend to the lower lid area. "They feel squishy to the touch, and they can be easily moved from side to side. They don't become more prominent when you look up."

· What causes them? "Bags" are generally associated with aging, although younger people can also get them, Dr. Scheiner says.

Festoons are usually the result of damage. Sun exposure, smoking and aging are among the possible causes, and the results can be worsened by the contrasting pull of underlying facial muscles over the years. Fair-skinned people tend to be more susceptible to Festoons.

· What can you do about them? "Effective treatments for removing 'bags' have been available for quite some time, but physicians have struggled with removing Festoons," Dr. Scheiner says. "Festoons are complicated to treat."

Medications and steroid injections can provide temporary improvement, and some older surgical procedures offer mixed results.

One of the biggest problems with Festoons and eye "bags" is that they occur around the most expressive area of the face?our eyes. The eyes speak volumes, but they can give off the wrong message if they are framed by Festoons or eye "bags."

"My patients say people are always asking them if they're sick or if they're tired," Dr. Scheiner says. "It's hard to hear that over and over again, and it begins to impact how you feel about yourself, as well as your energy level. What I love about the advanced laser and heading protocol that I developed is that it fundamentally changes the quality and the health of the skin?it takes swollen, sun-damaged skin and makes it smooth, tight and younger. It cleans up the messages around the eyes so that people can appear well and rested."

About Dr. Adam J. Scheiner

Adam J. Scheiner, M.D. is world-renowned in laser eyelid and facial plastic surgery for his groundbreaking treatment for Festoons. He wrote the medical text on the condition and treated two complex causes of Festoons for the Dr. Oz and The Doctors TV shows.

Need a little motivation to live healthier and be more active in 2014? Sign up and join the Live Healthy Iowa 10 Week Wellness Challenge that runs from January 27 to April 4. It is a great way to increase physical activity, eat healthier, lose weight, or maintain your current healthy lifestyle.

For a fee of $20, participants will receive a challenge t-shirt, weekly motivational emails, unlimited access to recipes, workouts, health information, free registration for Winter and Summer Iowa Games Fitness Walks, magazine subscription, and chances to win a variety of small and large prizes! Registration is now open!
Get Started Now:

1. Build or join a team of 2 to 10 people and choose a team name.

2. Go to www.livehealthyiowa.org and click 'Join Today'. If there are multiple teams formed from one location or organization, a group ID number will be given to link the teams together.

3. Complete the required registration information and submit payment online.

For more information on the Live Healthy Iowa Wellness Challenge, please visit the Scott County website: www.scottcountyiowa.com/health.

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Two Individuals honored for their dedication and efforts in working with mental illness.

DAVENPORT, Iowa - On January 11, 2014, the Vera French Community Mental Health Center honored two dedicated individuals with the Courage and Compassion in the Advocacy of Mental Health Award for their efforts and contributions to improving conditions for people with mental illness.

For almost 40 years, Chris McCormick Pries has worked at Vera French Community Mental Health Center and is currently a Board Certified Advanced Registered Nurse Practitioner and the Clinical Director. Chris is also a major provider of community services for individuals, educators, counselors, and care givers in the Quad Cities. She is involved with Jason's Box, the Mental Health Legal Task Force, Eating Disorders Consortium, the Safety Net in Peril Committee, a trainer for the Davenport and Bettendorf police and a public speaker bringing awareness to eradicate the stigma of mental illness. Chris has dedicated her life to providing quality, accessible and comprehensive care to those suffering from mental illness and has worked compassionately to make their lives more complete.

Dr. William Nissen has been working with the patients of the Vera French Community Mental Health Center since 1980. He is an Adult Psychiatrist responsible for evaluating patients for the presence of psychiatric disorders, medication management and hospital care.  Dr. Nissen completed his MD, Master of Science in Anatomy, and Bachelor of Science Degrees at the University of Iowa.  He has served as Medical Director of Adult Services and continues as the Medical Director at the Vera French Pine Knoll Residential Facility. Dr. Nissen's work with individuals with persistent mental illness has helped many to live the best lives possible in the community. He encourages patients to understand their illness and to take appropriate steps to maintain their health and safety.

"Both award winners are exemplary examples of courage and compassion, not only for Vera French clients but also for their co-workers, board members and the community," stated Anne Armknecht, CEO of the Vera French Community Mental Health Center. "They have gone above and beyond in leading efforts to combat the negative social stigma and providing services that improve the lives for those suffering from mental illness."

About Vera French Community Mental Health Center:

Vera French Community Mental Health Center serves as mental health advocate for all populations in Scott County,

Iowa. Through the center's clinical and community outreach services, our staff seeks to help people live well, coping

with depression and other forms of mental illness. Services include individual, group and family therapy for children

and adults in a clinic setting. Vera French also offers school-based therapy available in elementary schools in the

Davenport, Bettendorf, Pleasant Valley and North Scott school districts.

 

Additional programs for chronically ill adults include the Pine Knoll Residential care facility for 24-hour support and

three voluntary outpatient programs to assist individuals in gaining new skill sets needed to live independently.

An Adult Day Program offering group therapy helps patients transition to or remaining in a non-hospitalized status.

The Carol Center provides a place for learning skill sets, receiving a subsidized meal and peer interaction.

For more information, visit  http://www.verafrenchmhc.org

Sen. Chuck Grassley of Iowa, ranking member of the Senate Judiciary Committee and co-chairman of the Senate Caucus on International Narcotics Control, today made the following comment on observations from a top official at the Drug Enforcement Administration (DEA) that state efforts to fully legalize marijuana are "reckless and irresponsible." The observations from James Capra, chief of operations at the DEA, came at a drug caucus hearing this week in response to a question from Grassley.

"The comments from this top DEA official echo what I've been hearing in Iowa.  Law enforcement officers in Iowa are reporting increases in marijuana coming to Iowa from Colorado. The Obama Administration's decision not to prioritize the prosecution of the large-scale trafficking and sale of marijuana for recreational use in Colorado will contribute to these problems.  The latest national survey of teen-agers shows high rates of marijuana use and an increase in the number of students who don't view regular marijuana use as harmful.  Meanwhile, in Iowa, marijuana was involved in one-fifth of all drug-related emergency room visits in 2011.  I appreciate the challenges facing law enforcement in dealing with the mixed messages on marijuana being sent by the Obama Administration and some states."

WASHINGTON – Iowa moved from 19th place in 2009 to 11th place in the 2014 American College of Emergency Physicians' (ACEP) state-by-state report card on America's emergency care environment ("Report Card"). The state received an overall C, despite critical health care workforce shortages.

"Limited access to specialists and other health care continue to burden the Iowa health care system," said Dr. Michael Miller, president of the Iowa Chapter of ACEP. "Our state has demonstrated a great commitment to injury prevention funding and disaster preparedness. We need to build on those strengths to address remaining weaknesses in the state's support for emergency care." 

Iowa received its best grade, a B for Public Health and Injury Prevention, for strong funding of injury prevention, which is reflected in the state's low fatal injury rate. Iowa has the eighth lowest rate of homicide and suicide, a very low rate of alcohol-related traffic fatalities and one of the lowest pedestrian fatality rates. The state still has one of the higher rates of fatal occupational injuries. According to the Report Card, funding directed specifically for occupational injury prevention would reduce that rate.

The C+ for Disaster Preparedness ranked Iowa 14th in the nation in this category. The state more than doubled its bed surge capacity since the last Report Card and has the fifth highest percentage of nurses who have received disaster training (47.2 percent). Iowa could improve this grade further by increasing medical professional registration in the Emergency System for Advance Registration of Volunteer Health Professionals.

Iowa received C's in both Quality and Patient Safety Environment and Medical Liability Environment, and ranked in the bottom half of the country in both categories. The state lacks specific triage and destination policies for stroke and heart attack patients and lacks a uniform system for providing pre-arrival instructions. Iowa has few legal protections in place for physicians who provide emergency care to high-risk patients. Iowa's Medical Liability Environment could be improved by the institution of pretrial screening panels to discourage frivolous lawsuits and a cap on non-economic damages.

The C- and 13th place ranking signals a decline for Iowa in the category of Access to Emergency Care from the 2009 Report Card. The state has the lowest per capita rate of emergency physicians in the nation and lacks neurosurgeons, plastic surgeons, orthopedists and hand surgeons. Increased Medicaid fee levels could help attract and retain a skilled health care workforce.

"The best medicine in the world won't help you if there's no physician to deliver it in a timely manner," said Dr. Miller. "Iowa must focus on increasing our medical workforce and enacting medical liability reforms to make Iowa an attractive place to physicians."

"America's Emergency Care Environment:  A State-by-State Report Card - 2014" evaluates conditions under which emergency care is being delivered, not the quality of care provided by hospitals and emergency providers. It has 136 measures in five categories:  access to emergency care (30 percent of the grade), quality and patient safety (20 percent), medical liability environment (20 percent), public health and injury prevention (15 percent) and disaster preparedness (15 percent). While America earned an overall mediocre grade of C- on the Report Card issued in 2009, this year the country received a near-failing grade of D+.

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

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Patient Advocate Warns Those New to Insurance Coverage:
Speak Up for Yourself

With millions of people newly covered by health insurance, and 11,000 more becoming eligible for Medicare every day, more people will be visiting doctors and hospitals.

And while that's a positive, patient advocate Ruth Fenner Barash warns that the U.S. health care system is not always the benevolent safety net many people believe it to be. It can be abusive, incompetent, callous toward patients - and worse.

"Patients and their loved ones cannot blindly turn themselves over to this massive, technology-based system and trust that it will care - or take care of them," says Barash, who shares lessons learned from extensive health-care experiences in a new book, "For Better or Worse: Lurching from Crisis to Crisis in America's Medical Morass," (http://forbetterorworsebook.com/).

Her cautionary tale traces the long medical journey her husband, Philip, endured with her as his advocate. She discovered mismanagement and excess, useless interventions and a sometimes complete disregard for pain - even when there was no hope of healing.

"I learned a great deal from our experience, and with so many people now gaining access to health care, I want others to benefit from what I've learned," she says. "You can navigate the system; you just have to know how."

Barash offers these suggestions for patients and their loved ones, whether it's a trip to the doctor for a checkup or a diagnosis of a catastrophic illness.

• Avoid the emergency room - for your own sake. Emergency rooms were developed with the idea that few people would use them - most people would see their physician. But as health care costs rose, they became a primary care facility for those without insurance or the money to pay for services out of pocket. "Patients and their families were not expected to spend a long time in the E.R. - presumably, they would be seen quickly and either admitted to the hospital or treated and released - so they're not designed for comfort," Barash says. "They've become very crowded, especially in cities, and patients might wait for hours sitting in hard plastic chairs in the waiting room. For someone who's sick or injured, this can be torture."
Sick people usually are not isolated, so waiting rooms also teem with germs, she notes.

• Be skeptical - question everything. Too often, we take the first thing we're told as gospel, Barash says. "If you have the luxury of time, take some of that time to think things through, to research and get second opinions," she says. Research your physician's connections. When you're referred to a specialist, ask why that particular person. If you live in an area with a large academic community, ask around about the physicians and health-care providers with the best reputations. Who has the most experience in a particular niche? Who's doing the most promising research? How many times have you performed this procedure and what is your success rate?

• Ask what it costs - no matter who's paying. Our health-care system is absurd in the number of useless consultations, diagnostic procedures and interventions it foists on patients, Barash says. Whether our hospital bills are fully covered by Medicare, Medicaid or private insurance, or we're paying a portion ourselves, we must all include cost in our discussions with health-care providers. "Part of the blame for having the most expensive health-care system in the world goes to us, the individuals, who don't question purchases or shop for prices as we would for groceries, clothing, or furniture," Barash says.  "If a test or consultation is ordered, understand why. Is it really necessary? You can say no!"

Finally, Barash says, we all must come to terms with the fact that death is a given.

"My husband's problem, and the problem many of us may be doomed to face, is the seemingly endless getting there - a dying we don't want."

About Ruth Fenner Barash

Ruth Fenner Barash studied philosophy at City College of New York and did graduate work at the University of Chicago. In 1958, she met and married Philip Barash, a private practice attorney. She went on to work in public relations and real estate, served education and civic organizations at the executive level, and taught art in various media. Her long marriage was a "harmonious adventure" despite the couple's treacherous journey through the health-care system. Her husband died in 2012.

January 14, 2014

Since the first TRICARE Service Center opened in the mid 1990's, we've seen a shift in how you get information. With today's technology, anything you can do at a TRICARE Service Center can be done online or over the phone. Consequently, walk-in service ends at TRICARE Service Centers in the U.S. by April 1, 2014. Because our overseas areas are unique, walk-in service at TRICARE Service Centers in all overseas areas will continue. This change does not affect any TRICARE benefits or health care services.

For more detailed information and updates go to www.tricare.mil/TSC.

Read the Department of Defense article www.defense.gov/News/NewsArticle.aspx?ID=121473.

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