Sunday, January 30, 2011

The Hot Spotters Lower Medical Costs

Author physician, Atul Gawande has done it again with his well written article in The New Yorker magazine called, The Hot Spotters.  It deals with the fact that 5% of people with chronic illness make up over 50% of all health costs.  If we can zero in on providing better preventive care for those people, we can finally get our arms around runaway health costs.   How great that you don't even have to have a New Yorker  subscription to read it.  Here are a few cliff notes until you get to it:

  • In Camden, New Jersey, one % of patients account for 1/3 of the city's medical costs.  By just focusing attention on the social and medical out-patient needs of those people, they not only get healthier but costs were cut in half.
  • Our current system is unable to reign in costs.  We need to completely re-design and fund how we do primary care.
  • Charging high co-payments to people with health problems just backfires.  They avoid preventive care and end up hospitalized with expensive and life-threatening illnesses that are much worse and more costly.  
  • Our current system is not designed for patients with complex medical problems who incur high costs.  The patient with heart failure, obesity, gout and on 11 different medicines needs a different kind of care than the traditional emergency room, hospital and multiple specialists handling one specific organ.  That  patient needs care-coordination.
  • Doctors are financially penalized for providing care-coordination.
  • The health system is designed to say "no".  We need to shift into a mind-set that says "yes" and really understands the patient's need at that moment.
  • To bring the cost of care down, we need less hospital beds.  The more health services in an area, the higher the cost.  Preventive and comprehensive care means less expensive (hospital) care.
  • Medical companies, hospitals  and specialists profiting from the excess of scans and procedures will get squeezed.  This will provoke retaliation, counter-campaigns, and intense lobbying for Washington to obstruct reform.  It is already happening.
  • For every dollar spent in school districts to finance smaller class sizes and better teachers' pay, that money was diverted instead to covering rising health care costs.  For every dollar, the cost of maintaining teacher health benefits took a dollar and forty cents!
  • High-touch health care will face the obstruction of lobbies that want to keep the status quo. 
These bullets don't do the article justice.  Take some time and read it and learn how we can do things differently.

Thursday, January 27, 2011

First Trimester Abortions Don't Cause Psychologic Problems

The New England Journal of Medicine published a new study that shows there is no increased psychologic impact for women who have early abortions.  The researchers from Denmark looked at almost 85,000 women who had first trimester abortions over a 13 year period and compared them with women who gave birth to live babies.  They found that there was no increase in women who sought psychiatric counseling after the abortion from those that sought help before the abortion.  They also found that women who had a baby sought help more frequently in the year after birth than before.

The most common problems among women in both the abortion and the delivery groups were anxiety, stress and depression. 

Changes in hormone levels, sleep deprivation and just the demands of caring for a new baby could lead to anxiety and depression.  Women who have abortions don't fact those stresses.

This study confirms what others have found...that having an early abortion does not increase mental disorders, at least not in Denmark.   It would be interesting to do the same study in the U.S. and see if the results held.    Denmark legalized abortion in 1973, the same year as Roe v. Wade in the United States. 

Wednesday, January 26, 2011

EverythingHealth Anniversary

Thanks to faithful reader, KM for this graphic and reminding me that I've been a blogger for 4 years!  Almost 1,000,000 visitors have been to EverythingHealth from every part of the world.  I have met other wonderful and creative health bloggers and developed cyber-friendships and learned so much from other health bloggers. I never run out of material or ideas because life and science and medicine are endlessly fascinating and topical.

Thank you, readers of EverythingHealth for allowing me to indulge in this hobby.  I would never do it if I didn't have my stat counter that shows thousands of visits a day and know that I am communicating with people across the United States as well as across the globe.

  Anniversary Quiz:  Who can recognize this famous person?  (hint: he was even famous at Woodstock)

Older Physicians and Safety

One third of all physicians in the United States are older than 65.  A 2006 study found that mortality rates among patients in complicated operations were higher when the physician was 60 or older.  The New York Times  recently ran an article  about the need for safeguards to protect patients from physicians who suffer from cognitive decline as they age and it is sparking debate about older physicians and patient safety.  Pilots are required to undergo biannual physical and mental exams beginning at age 40 and they must retire at age 65.  There are no such guidelines for physicians, some of whom proudly practice into their 90s.

Interestingly, the physicians who make up the credentials committee at hospitals where I work,  recently discussed the issue of aging physicians and the wisdom of mandating an annual physical exam and letter from the treating physician attesting to the health of a doctor after age 70.   One large medical center had already instituted such a practice and the others are considering it.  But when you start digging a bit deeper, the simple solution of an annual exam becomes more complex.

The debate between the physician leaders was that a routine physical would not pick up subtle cognitive decline that might affect decision making.  Annual physical exams generally do not test dexterity or judgment and would find only the most blatant physical deficits.  Should we expect all older physicians to undergo expensive and time-consuming psychological and cognitive tests?  Is there a way to test function under stress?  These questions remain unanswered.

We are truly entering a time of more public scrutiny and better self-policing by physicians.  The fact that we are having these discussions within the organized medical staff is great.  We already have policies in place that address medical error and the disruptive physician and our increasingly aging medical staff is next for review.


Monday, January 24, 2011

Rest In Peace Jack Lalanne

 “Exercise is King, nutrition is Queen, put them together and you’ve got a kingdom”

"The only way you get that fat off is to eat less and exercise more."

"That is the beautiful part about weights: even if you are 100 years old, you can lift something.  Maybe it's only a half a pound or a pound or two pounds.  It will still do something"

                                Jack Lalanne (1915-2011)

Wall-Mart Pushes Healthy Food

The retail giant Wal-Mart has announced it will start selling healthier food by reducing salt and sugar and eliminate trans fats in packaged foods.  They also promised to drop prices on fresh fruits and vegetables and to build Wal-Mart stores in low-income neighborhoods.  Wal-Mart plans to design a special logo to help its consumers identify healthier food options.  Siding with First lady Michelle Obama and her campaign to build a healthy America and reduce childhood obesity,  Wal-mart has pledged to make thousands of the packaged food items that it sells to be more healthful and affordable by 2015.

Let me applaud Wal-Mart for a socially responsible position.  Millions of Americans shop at Wal-Mart for groceries as well as just about everything else.  They have a huge influence on the shopping habits of Americans and they also influence manufactures and suppliers due to their market clout.   Wal-Mart is often the only option for people that are struggling financially. (And these days that is a lot of people!)

I am tired of jaded, critical pundits that can't ever applaud a good act.  Rush Limbaugh said on his radio show, "So now, Mooch-elle Obama, the First Lady, is now in charge of what you eat at Wal-Mart and what it costs.  ...his  (Obama's) wife shows up there the other day and has somehow bullied or pressured Wal-Mart, which already sells things for low prices, into selling healthy food at lower prices..."

According to Fox Business, Freedom Watch, "The president, through his wife of all people, says to Wal-Mart, 'start selling what we want you to sell, or we'll make it illegal for you to sell the other stuff.'"

Can't we just give Wal-Mart credit for doing the right thing?  Do we have to point fingers, criticize and politicize every act?  Does no good deed go unpunished?

 I hope it ends up being a good business decision and that Wal-Mart sparks other corporations to start thinking of the consumer and how they can have an impact on the rebuilding of America.  As to the critics?  Get a life!

Thursday, January 20, 2011

Health Insurers Continue to Gouge Americans

 This Video is from congressional hearings in 2010 after Anthem Blue Cross announced its 39% rate increase in California.

 In California, Blue Shield has just announced to its customers that it is raising insurance rates as much as 59% because of its own rising costs. The State Insurance Commissioner, Dave Jones asked them to delay the planned hike for 60 days. The reply was equivalent to "get lost, you have no power over us". And guess what?   He doesn't. 

The four other large insurance plans in California have also raised their premiums by double digits. Blue Cross Anthem had already increased rates in October as much as 20% for nearly 800,000 individual California policyholders.  They now want more.

Why do I make the bold statement that they are gouging Americans?  Researchers at Goldman Sachs Group  (as reported in the Wall Street Journal) estimate that the top four publicly traded plans will show earnings increases averaging 21% in the 4th quarter of 2010 compared to a year earlier.   Aetna, Inc could see a 65% jump in the quarter just ended. "It is a very good time for profits in the health-insurance industry," says Robert Laszewski, president of consulting firm Health Policy and Strategy Associates.

It's also a good time to be an executive at a Health Insurance Company. WellPoint (parent to Anthem and it's steep rate increase) CEO Angela Braly earned a 51% pay increase from 2008 to 2009 to $13.1 million. Hey, did someone mention a recession?

I can assure you that physicians are not receiving payment increases from these insurers.  Hospitals in California are contracting with them only enough to cover cost of living and inflation (a few percentage points).  As families are struggling to hang on and employers are struggling to stay in business, the Insurance Industry is fat and happy. 

Wednesday, January 19, 2011

Cigarette Ads Lure Teens To Smoke

They must be running out of things to study when Pediatrics publishes a study that shows tobacco ads have an impact on getting teens to smoke.  It doesn't take a scientist to figure out that cigarette manufacturers would not be spending billions of dollars on advertising if it weren't effective in luring new business.  But Dr. James Sargent of Dartmouth Medical School along with other German researchers said, "This study shows that it is the specific images from tobacco ads that predict smoking and not a character trait."  He goes on to point out that after viewing an ad, teens develop favorable thoughts about smoking  and then, when given an opportunity, they try it.

Tobacco companies spend about $30 million a day on advertising in the United States alone.  That is an incredible amount, especially since tobacco advertising is banned on American television.  But have you noticed how many actors on TV and in movies smoke?  I notice they smoke, even when it has nothing to do with the script.  Did Carrie Bradshaw in Sex in the City really need smokes to look appealing?

Prior studies have shown that teenage girls who have never smoked are far more likely to start smoking if their favorite move star smokes in movies.  Who are these influential smokers?  Try Sandra Bullock (In Love and War, The Net, Speed, A Time to Kill).  Demi Moore (The Juror, Now and Then) Winona Ryder (How to Make an American Quilt, Reality Bites) and Keira Knightley (Atonement, Domino, the Jacket).  Did Will Ferrell need to smoke for Anchorman, Bewitched and Starsky & Hutch?

  DiCaprio, Sharon Stone, Julia Roberts and John Travolta had numerous movies where they smoked.  Clive Owen, Vince Vaughn, Paul Giamatti and Jaimie Foxx all played various smoking roles and it was not necessary.   Even Spider Man had smokers for no apparent reason and the list goes on and on.  Start noticing how the script doesn't really need the character to be a smoker.

Movies and TV are likely where much of that $30 million ad budget is going.  And, as this and prior studies show, that money is well spent.  It works.

Monday, January 17, 2011

Eating Big Calories at Breakfast Can Make You Fat

Haven't we all learned that breakfast should be our biggest meal?  "Start the day off with "fuel" and you can burn it off as the day goes on." "Eat a big breakfast and you will eat fewer calories all day long".  This advice is probably not true, and in fact a new study published in Nutrition Journal shows that people ate the same at lunch and dinner, regardless of what they had at breakfast.  If a person ate 1000 calories at breakfast  (which is easy to do with bacon, eggs, toast, hashbrowns, juice), they had a total increase in calories eaten throughout the day by 1000 cals.

This doesn't mean we should be skipping breakfast.  The problem may be what we historically think of as an American breakfast.  It might have worked for the farmer in the past or the laborer hauling lumber but it's just too many calories for our current level of activity.

But there is nothing wrong with a "European" breakfast of whole grain cereal and fruit.  Or yogurt and fruit.  Or one egg and toast.  Or cheese and bread (whole grain of course) like the French.

What about a muffin from Starbucks and coffee?  The blueberry muffin carries 470 calories and almost 1/2 of those are fat.  The Starbucks coffee cake is a whopping 630 calories.  The tall latte adds another 204 calories. (90-126 calories for a nonfat latte).

If you are happy with your weight you can ignore this article because you have already learned the appropriate caloric intake for your level of activity.  But if you are one of the millions of readers who are trying to lose weight, this study shows that overweight subjects should pay attention to those breakfast calories and eat less as a way to reduce total calories for the day.

Sunday, January 16, 2011

Martin Luther King "I have a dream"

This is the greatest speech ever given. Listen to the entire 17 minutes and feel yourself carried higher and higher as this great man uses repetition of theme words and moral justice to ground his arguments.
He uses the word "freedom" 20 times. "We" is used 30 times, "our" 17 times and "you" 8 times. He mentions States and other geographic references to make his message more inclusive; "From every mountainside", "slums and ghettos of our northern cities".

Dr. King uses metaphors to highlight contrasting concepts like "rise from the dark and desolate valley of segregation to the sunlit path of racial justice." He does it over an over.

Or don't pay attention to any of that and just experience the moment in 1963, before the Civil Rights Act was passed, when segregation was a part of American life, when blacks and whites could not co-mingle and dogs were allowed to attack peaceful marchers. Think of the time and the power of a man like Martin Luther King, Jr.

Saturday, January 15, 2011

Kidney Transplant Sisters Get Prison Release

Here is a bizarre story on many fronts.   Two sisters, Gladys (age 36) and Jamie (age 38) Scott have been serving life sentences in Mississippi for robbing two men at gunpoint of $11.00  in 1993.   No one was injured in the crime.  They had no prior criminal record and were sentenced to two (not one but two) life terms each.  Gladys has two children and Jamie has three children, who have been cared for by their grandmother since the sisters were sentenced to life at age 19 and 21 years old.

I could write a blog on that sentence alone!

Jamie Scott has kidney failure and is receiving dialysis three times a week.  Her sister could possibly be a kidney donor match even though she has not yet been tested as a donor.  Efforts by the N.A.A.C.P. and other grass-roots groups to get them released have finally paid off.   Republican Governor Haley Barbour has paroled the sisters on the condition that one donate a kidney to the other.   Why did he come to this decision?  Because the dialysis treatment is a financial burden to the State of Mississippi.

This story points out so many issues that are just plain wrong.

1.  How could two young women get life sentences for armed robbery ($11 with no injury sustained)?
2.  Organ donation should be a voluntary act of kindness, not a coerced or business decision.
3.  No-one knows the state of these womens health after 16 years in a Mississippi prison.
4.  Why does the United States have 5% of the world's population and 25% of the world's prisons?
5.  Why do we have a health system that shifts costs from States (Medicaid) to the Feds (Medicare) to the Prisons to the Military (VA) to the private sector?  Does this system work?  (The answer is NO)

Only in America.

Wednesday, January 12, 2011

Fraud Behind Vaccine Autism Scare

Most parents and all Pediatricians are aware of the 1998 study published in The Lancet by Dr. Andrew Wakefield that mentioned a causal link between Measles, Mumps, Rubella (MMR) vaccine and the increased incidence of childhood Autism.  It shook the medical community and created an international movement of parents questioning the extensive combination of immunizations that are given to children.  Could these immunizations be the cause of the increase in Autism cases we have seen since the 1960s?

In 2010, The Lancet  formally retracted the link from the study and 10 of the original authors denounced it,  but that didn't make top news.  The movement, now has a celebrity spokesperson in Jenny McCarthy, and more and more stories of children who were perfect before the vaccine and then suddenly regressed.

Now the British Medical Journal has published a series of articles that shows how Wakefield, now 54, was judged by a five member panel to be guilty of some 30 charges, including four counts of dishonesty and 12 of causing children to be subjected to invasive procedures that were clinically unjustified.  Dr. John Walker-Smith, 74, professor of pediatric gastroenterology and  a collaborator of Wakefield,  was deemed irresponsible and unethical also as they developed their theory together and trolled the halls and clinics for patients they could investigate and then report had developed bowel symptoms after vaccines. 

Around the same time,  Dr. Wakefield and several business colleagues launched a business venture that would sell diagnostic tests for vaccine-induced diseases and transfer factor-based vaccines and therapies. The BMJ authors found that a prospectus distributed to potential investors said the venture was expected to make more than $40 million within three years.  In addition, Wakefield received more than $650,000 from lawyers trying to build a case against vaccine manufacturers.  The same lawyers funded his clinical research that was later published, (and never duplicated),  an unbelievable conflict of interest and frankly fraudulent.

The fantastic investigative reporting in BMJ ends with a very nice timeline so you can see the events that started the vaccine scare in 1998 and where it ended up today.  In the meantime, Dr. Wakefield became a very rich man.

"The MMR scare was based not on bad science but on a deliberate fraud," BMJ Editor-in-Chief Fiona Godlee said in a prepared statement, "Such clear evidence of falsification of data should now close the door on this damaging vaccine scare."

It is a sad black mark on science and it shows again the corruptive influence of money, greed, power, anecdotal reporting by the press, bad peer review by professional journals,  and just plain fraud and how it can influence decades of patient care.   Here we are 13 years later and thousands of parents are afraid of vaccinating their children because of this fraudulent scheme.

Check out the link and always remember that Science is an evolving, changing field.  One study or one case is not proof of anything.  There are no wonder drugs.  There are few (or no)  simple answers to complex questions in life.

Sunday, January 9, 2011

Growing Brain Synapses

This amazing time lapse video of 9 month old Baby Edward shows his exploration and activity.  (turn off the music if it drives your brain crazy as it did to me)

Neurobiologists have found that babies at this age are growing and remodeling millions of synaptic connections in the brain.  This is the peak of this growth and it is called "synapse exuberance".
The brain is constantly remodeling it's connections throughout life but watching Baby Edward at 9 months do his thing is truly eye-opening.

Here he is up close:

Saturday, January 8, 2011

Answer to the Medical Challenge

I apologize to anxious readers for the tardy answer. 

The answer to the "tender ear lesion" is #4 Candida.
Congrats to the brilliant diagnosticians who got it.  This was very hard because the ear is not a common site for a yeast infection and only 7% of the doctors taking the quiz online got it right.  The most common answer from physicians was squamous cell carcinoma.

A few give-aways:
1. Impetigo (caused by staph or strep) usually responds quickly to antibiotics
2. The lesion appeared suddenly and cancer and other growths are usually slow growing
3.  A candida infection can mimic the bacterial disease.

Candida albicans is a common fungal infection that causes diaper rash, thrush (mouth) and "yeast" infections. It usually needs a moist environment to grow and the normal skin bacteria usually acts as a barrier from letting Candida take hold.  Antibiotics that get rid of the normal flora allow Candida to take hold (as it did in this case).

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Thursday, January 6, 2011

Image Challenge

Here is your challenge for today.  This tender, crusting lesion appeared on this 69 year old man 10 days ago.  It did not respond to antibiotic treatment.  He had no trauma and is healthy. What is the diagnosis?

1.  Actinic Keratosis
2.  Impetigo
3.  Squamous Cell Carcinoma
4. Candida infection
5. Inflamed Seborrheic Keratosis

Make your best choice and the answer will be posted tomorrow.

(Image from Consultant-Live)

Wednesday, January 5, 2011

Young Woman Dies Getting Liposuction

Thanks to blogger,  Dr. Bates at Suture for a Living for tipping me off to the article about the 35 year old woman in South Florida who recently died while getting liposuction.  Lidvian Zelaya went to Strax Rejuvenation Center in Lauderhill, Fla to have fat liposuctioned from her waist and added to her buttocks, according to her husband.  Three hours later she was rushed to an emergency medical center where she died.  An autopsy is pending.

This horror story is more common that you think.  Breast augmentation and liposurgery are the most common procedures in the U.S. and over 1.5 million cosmetic surgical procedures are performed annually.  Most of these are not done in a hospital and Med Spas in strip malls, doctors offices and surgi-centers have no emergency capacity to handle complications.  High profile patients who die, like Kanye West's mother or the former Miss Argentina,  make the news but most complications (infection, blood clots, bleeding, poor outcome) are never made public.

I went to one site on the Internet called "Smart Plastic Surgery" and it mentioned "pre-op steps".  As a comprehensive Internist I thought great, this will steer patients in my direction.  Wrong.  Their steps included costs of the procedures, good candidates for surgery (just about everyone) and finding the right plastic surgeon.

When I say "Pre-op" I mean an appointment with your primary care physician at least 2 weeks prior to surgery where you undergo a physical exam and all other risks of surgery are fully analyzed with your personal health conditions considered.  The pre-op assessment is critical before any surgery.  We are looking for heart and breathing problems, diabetes, silent heart attacks, risks of blood clots or strokes, prior anesthesia history, blood abnormalities and silent infections.  Even mild systemic diseases put a patient at higher risk for complications.

I don't know if Lidvian Zelaya underwent a pre-op exam but I am willing to bet she did not.  I do not know if a pre-op exam would have uncovered what ever problem led to her death.  There are many questions here that have not yet been answered.

I do know that I have adjusted medication and halted or delayed surgery in the past on patients that needed further "tuning-up" before surgery.  I have also insisted that their surgery be done only at accredited facilities.  I believe those delays may have saved their lives.

Monday, January 3, 2011

Know Thy Calories

As part of the new health care legislation (Affordable Care Act), the FDA has now published it's guidelines for restaurants to inform consumers of the calorie counts of food.   It establishes requirements for nutrition labeling of standard menu items for chain restaurants  and chain vending machine operators.  This is important because Americans now consume an estimated 1/3 of their total calories on foods prepared outside the home.  Consumers are generally unaware of the number of calories they consume from these foods and being overweight or obese increases the risk of a number of diseases, including heart disease, type 2 diabetes, stroke and cancer.

Here is what the guidelines say:
  • Restaurants with 20 or more locations must disclose the number of calories in each standard menu item on menus and menu boards.  (19 chain locations?  You get a pass.  Daily specials also get a pass)
  • Additional written nutrition information must be available to consumers upon request. (Total fat, saturated fat, cholesterol, sodium sugars, carbs, fiber, protein etc etc)
  • The menu must say that the additional nutritional information is available
  • The calorie information (per serving or per food item) for self-service items must be on a sign adjacent to each food item.
  • Chain vending machines must also show the calories for articles of food.
Here's a preview of what you will find:
  • 576 calories  -   Big Mac without cheese
  • 320 calories  -   One slice thin crust pepperoni Domino's Pizza  (who only eats one slice?)
  • 670 calories  -   Medium cappuccino blast shake Baskin Robbins
  • 280 calories  -   4 oz scoop Baskin Robbins Pralines 'n Cream Ice Cream  (extra for the cone)
  • 217 calories  -   1/2 cup Chinese chicken salad from Fresh Choice  (who eats 1/2 cup?)
  • 142 calories  -   1/2 cup zesty Italian spaghetti from Fresh Choice
  • 1890 cals      -    Nachos Grande from Chevys Fresh Mex
  • 380 calories  -    Carnitas soft taco from Chevys Fresh Mex
  • 1320 cals      -    Fajita burrito from Chevys Fresh Mex
  • 1060 cals      -    Either a kids cheese quesadilla or a kiddie cheeseburger from Chevys (!!!)
This is so much fun...I could go on and on but you get the point.

The jury is out whether this type of information will have an impact on the diets of Americans but at least people can't say they didn't know.

Sunday, January 2, 2011

The Hangover

You know what it feels like and you know you never want to feel that way again.  But what is going on in your body when you experience a hangover...and how can you prevent them?

Your body makes a remarkable set of enzymes called alcohol dehydrogenase for the sole purpose of breaking down the alcohol in your bloodstream to be metabolized by the liver.  Alcohol itself is toxic and it is broken down into aldehydes, ketones and sugar for the body's use.  The amount and activity of alcohol dehyrogenase is genetically determined and young women have less than young men,  and older people and different populations (think: American Indians) also express different levels.  When a person drinks too much or too fast, the alcohol dehydrogenase is overwhelmed and cannot metabolize the toxic alcohol.

If you failed to drink in moderation or to hydrate and eat while drinking, you've already blown it.  Here are some proven hangover helpers:
  • Drink water.  Drink it between alcohol beverages and before you go to bed.  Dehydration is one cause of pounding headaches and dry mouth.  You cannot over hydrate so drink a lot of water.
  • Don't drink more alcohol in the morning.  That myth of the "Hair of the Dog" only adds to the toxicity that your body is dealing with.  A virgin Bloody Mary is good for the tomato juice and the salt.
  • Sleep.  Rest your body so it can repair the damage you have done.
  • After you have rested, exercise.  Make sure you hydrate and then try to work up a sweat by walking, cycling or just about anything that makes you sweat.
  • Take  Ibuprofen with some food on your stomach.  It will help with the symptoms.
  • Take a vitamin containing Vitamin B complex and Vitamin C.  There is no proof that this will help but alcohol depletes these vitamins from the body.  If you can get to a health food store and drink a wheat grass shake that is a good way to get healthier.
  • Try this recipe: 
    • 2 liters water (about 8 ½ cups)
    • 1 teaspoon freshly grated ginger
    • 1 medium cucumber, peeled and thinly sliced
    • 1 medium lemon, thinly sliced
    • 12 small spearmint leaves.  
Dude, you have poisoned yourself.  A hangover is the Divine Universe telling you that you over indulged.  You are getting a clear message from every cell in your body.  Listen and learn.

Saturday, January 1, 2011

Welcome 2011

On the last day of 2010 I had visitors from  China, Canada, Russia, Estonia, Chile, India, Mexico, Philippines, Australia, United Kingdom, Romania, Brazil,  Poland, Ireland, Germany, Bahamas, Malaysia, Hungary, Denmark, Iceland, Egypt, Turkey, HongKong, Finland, Iran, Saudi Arabia, Puerto Rico, Tunisia, Spain, Bulgaria, France and Kenya.

We are truly connected in ways we never dreamed possible.

EverythingHealth wishes all readers across the globe,  a peaceful and wonderful new year.

When to Use Urgent Care

We all know that Emergency Departments are over-crowded with long waits and exorbitant fees.  Free standing Urgent Care is a great solu...