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FROM THE DOC
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"POTPOURRI FOR 200"
Does The Jeopardy Show still have the category 'Potpourri'?
I vividly remember that topic back in the 70's when I watched a lot of game shows on TV. Potpourri was a mixture of topics and my comments today are a mixture, so I thought this would be an appropriate header for my column.
The first topic is about being boring....and how that is a good thing. Among the best comments I can say to a patient when I see them for their yearly physical is that I find them boring. Of course, I mean this in a medical sense. You don't want doctors to find you interesting, or worse yet to be 'an interesting case'. This always spells trouble, testing, and lots of bothersome medications. So here's to the boring patients....may your boring ways never change.
The second topic is about our new patient portal, MyHealthRecord.com. We are rolling it out this month, and know it will be a simpler and more pleasant on-line experience for you and we are looking forward to offering the latest in on-line sites. We have been on the cutting edge of computerization in our office, and in fact, we have the oldest medical website in Phoenix. This new patient portal is connected to your electronic medical record, and will give you simpler access to information from your own chart as well as an easy method for interacting with our staff.
Please sign up for the new portal on October 11th so that you can take advantage of the information it provides and the access it gives you to the office.
The third and final topic relates to the movie, The Magnificent Seven, a new version of which is at the movie theaters this month.
This movie derives from the famous Kurosawa film, The Seven Samurai, and I heard the director of the new version, Antoine Fuqua, made this connection and in so doing he said that samurai means 'to serve others.' I found that concept very inspiring, the idea of serving others, as that is what we do in our office and in medicine every day. It is one of the aspects that makes medicine a wonderful career, and it gives us purpose each day in this office when we have the opportunity to 'be in service'.
- Yours in good health, Dr. Lakin
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| VOL 12 / Issue: #4 | Autumn/ 2016 |
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Sitting Really Can Kill You,
Heart Experts Say. . . . .
|  Evidence is building that sitting for too long can cause heart disease and diabetes - even in people who exercise, the American Heart Association said Monday.
The trouble is, it's hard to measure just how inactive people are and there's not enough evidence yet to show just how much, or how often, you have to exercise to counteract the effects of sitting, the group said in a scientific update. In the meantime, then, people should try to sit less and move more, the heart association's team of experts advised.
"The evidence to date is suggestive, but not conclusive, that sedentary behavior contributes to cardiovascular disease and diabetes risk," a team led by Deborah Rohm Young, of Kaiser Permanente, Southern California wrote. "Given the current state of the science on sedentary behavior and in the absence of sufficient data to recommend quantitative guidelines, it is appropriate to promote the advisory, 'Sit less, move more'." At least 30 minutes a day of moderate exercise - walking briskly rather than strolling around the house - should be the minimum goal, they advise.
And it may be worthwhile to encourage desk-bound workers to get up and move a bit every hour or so. Yet even this may not outweigh the effects of sitting at a computer all day, driving home in a car, and then relaxing in front of the TV or with a tablet computer. "Regardless of how much physical activity someone gets, prolonged sedentary time could negatively impact the health of your heart and blood vessels," Young said in a statement. "There are many important factors we don't understand about sedentary time yet. The types of studies available identify trends but don't prove cause and effects," she added.
They did define sedentary behaviors: They include sitting, reclining, or lying down while awake as well as reading, watching television or working on the computer. Light housework or slow, leisurely walking doesn't rise to the level of moderate to vigorous physical activity. "Based on existing evidence, we found that U.S. adults are sedentary for about six to eight hours a day," Young said. "Adults 60 years and older spend between 8.5 - 9.6 hours a day in sedentary time."
The researchers cited a study that showed half of all jobs required some sort of activity in the 1960s, but now fewer than 20 percent do.
"There are clearly physiological changes that occur when physically active individuals become inactive," Young's team wrote in the journal Circulation. This includes changes in the way the body uses insulin to convert food efficiently to glucose that the body can use. "Despite these potentially relevant findings on how physical inactivity can be associated with biological dysregulation, we do not have direct evidence that this leads to cardiovascular disease."
The American Heart Association has tips on how to get active here. - By Maggie Fox, Healthy Living
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DR. LAKIN'S NEW SECURE PATIENT PORTAL
'MyHealthRecord.com'
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COMING October 11th!
Dr. Lakin and staff are very excited to announce we are upgrading our secure patient portal soon!
We are changing vendors, and our new secure portal, MyHealthRecord.com, will be easier to use and easier for us to respond to your requests.
At your convenience
- View your health record from any Internet-enabled device
- Exchange secure messages with Dr. Lakin or our staff
- Request and manage appointments
Anytime access
- Lab orders
- Test results
- Upcoming appointments
To access our new patient portal, MyHealthRecord.com, you will be required to complete a short questionnaire. This will be a very simple process.... quick and easy. If you need assistance, we are always here to help.
Watch for your invitation email!
It will give you all the information you need to continue using our secure portal, MyHealthRecord.com, for your medical care!
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October is Breast Cancer Awareness Month. . . . .
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October is Breast Cancer Awareness Month, which is an annual campaign to increase awareness of the disease.
While most people are aware of breast cancer, many forget to take the steps to have a plan to detect the disease in its early stages and encourage others to do the same.
We have made a lot of progress but still have a long way to go and need your help!
Here is a great website to learn about way you can protect and help in the fight against breast cancer.
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Schedule For Dr Lakin's Flu Vaccine
Clinic NOW!
|  Our Flu Vaccine Clinics are on Wednesdays, 1 - 2:30pm, through the month of October and November.
Please call to schedule your flu vaccine today! 480.614.5800
Influenza (flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness. Serious outcomes of flu infection can result in hospitalization or death. Some people, such as older people, young children, and people with certain health conditions, are at high risk for serious flu complications. Dr Lakin highly recommends to get your flu vaccine in late September, through October to have full coverage for our Arizona flu season.
Also the best way to prevent the flu is by getting vaccinated each year. The upcoming season's flu vaccine will protect against the influenza viruses that research indicates will be most common during the season. This includes an influenza A (H1N1) virus, an influenza A (H3N2) virus, and one or two influenza B viruses, depending on the flu vaccine. Back To Top
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Dental Tips From Dr. Marie. . . .
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| | Dr. Marie Jacobs
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Troubled by Dry Mouth?
Dry mouth or xerostomia (zeer-o-STOE-me uh), refers to any condition in which your mouth is unusually dry. It is not a disease, but an indication of impaired function of the salivary glands and is becoming a rapidly growing oral health problem, affecting 25% of North Americans in some form. Dry mouth, most often the result of a decrease in saliva produced by oral salivary glands, frequently is a side effect of medication. Less often, it may be caused by conditions which directly affect the salivary glands.
Dry mouth is a common problem, can affect all ages, and varies from being merely a nuisance to something that has a major impact on your general health, oral health, as well as affecting ones appetite, the enjoyment of food, and even speech.
Saliva is crucial in helping to prevent tooth decay by neutralizing acids produced by bacteria, limiting bacterial growth and washing away food particles. It also enhances the ability to taste, facilitates swallowing, enzymes in saliva aid in digestion, and it assists in maintaining the health of the soft tissue of the mouth.
Treatments for dry mouth will depend on the cause, of which there are many. A significant number of medications, including over-the-counter drugs, result in dry mouth as a side effect. Some of the more likely types of drugs that cause dry mouth issues are those used to treat depression, nerve pain (neuropathy), and anxiety. Also, antihistamines, decongestants, muscle relaxants and pain medications. Snoring and open-mouth breathing also can contribute to dry mouth and tobacco use can increase dry mouth symptoms.
While dry mouth is not an age-related change, older adults are more likely to use medications that may cause dry mouth and, additionally, they are more likely to have other health issues that can cause it.
Radiation treatments to the head and neck can affect salivary glands resulting in a decrease in saliva production, depending on the radiation dose and area treated. Chemotherapy drugs may temporarily change the nature of saliva and the quantity produced. Nerve injury or surgery in the head and neck area can also result in dry mouth.
Xerostomia may be the consequence of general health conditions, such as autoimmune diseases, diabetes, rheumatoid arthritis, hypertension, Sjogren's syndrome, or Mikulicz's disease. In some instances, stroke and Alzheimer's disease can create the perception of dry mouth, even though salivary gland function is normal.
Signs and symptoms of dry mouth include: dryness in the mouth and or throat, saliva that seems thick or stringy, bad breath, difficulty in chewing, swallowing, speaking, altered sense of taste, increase incidence of tooth decay, and gum irritation and/or disease.
Should you experience persistent dry mouth signs and symptoms, see your physician or dentist. Depending on the cause, treatment for dry mouth may involve an adjustment in medications or the use of products such as prescription or over-the-counter rinses or moisturizers to lubricate the mouth. If severe, there are medications available that stimulate saliva. In addition, to protect your teeth, fluoride applications and/or scheduled at-home medication rinses may be prescribed. to control tooth decay.
Some self-help hints to assist in relieving symptoms are: sip liquids (sugar-free) throughout the day or use ice chips, drink water during meals to aid chewing and swallowing. Try over-the-counter saliva substitutes that contain carboxymethylcellulose or hydroxyethylcellulose (such as Biotene or Oral Balance). Add moisture to the air when sleeping with a humidifier and be sure to moisturize your lips periodically through the day.
It is advised to avoid products that may cause dryness and irritation which can make symptoms worse: caffeine and alcohol, sugary (foods or candies), or acidic, spicy or salty foods.
Maintain the health of your teeth and soft tissues of the mouth. Always brush with a fluoride toothpaste and floss your teeth. Seek advise regarding use of a prescription fluoride toothpaste, gel or rinse. It is recommended that you see your dentist at least every six months in order to maintain a health mouth and smile.
Here's to your good health.
Marie C. Jacobs, D.D.S.
Professor Emerita Loyola University Chicago
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NEW VIDEO: Taking Control, By Linda Stehling MD & Douglas M. Lakin MD
|  "Advance care Planning Guide for When You Become Seriously Ill"
Get your copy at the office or read online
HERE!
 Dr. Linda Stehling and Dr. Lakin will give a live presentation, 'Advance Care Planning Information Session,'
November 12, 2016, 9:30am - 11am at Assumption Greek Orthodox Church.
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Pat's Book Review. . . .
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 "We Were Soldiers Once ....and Young" Lt. General Harold G. Moore (Ret.) and Joseph Galloway (authors) Post Traumatic Stress Disorder(PTSD) is/has been defined as "a severe emotional reaction to a traumatic event that impairs one's life". The above is an abbreviated definition of PTSD which appeared in the New York Times Health section (9/13/16 edition). A possible example of one of many bases of PTSD occurring can be found....is found and is experienced on the battlefields of war. "We were Soldiers Once and Young" is an impactful, well presented and effectively written example of traumatic events with lasting results on the lives of young soldiers who experienced traumas to such a degree that the effects could and would remain with them (and their families) always. "We Were Soldiers Once and Young" is a book to be experienced and its consequences always remembered. * * * * * * "We Are Soldiers Still" (Same authors: Moore and Galloway)
The authors return to the scarred battlefields of Vietnam years later accompanied by some of the remaining soldiers who fought in these fields...... memories come and go. The now quiet fields still echo the traumas of war in the form of memories of napalm bombs, the overwhelming waves of attacking Vietnam soldiers by the thousands surrounding outnumbered American troops and other memories of the terrors of the battles fought. The traumas of war still echo. Fierce, constant overwhelming conditions of battle still in the memories of these soldiers who fought these battles. The soldiers who fought here SHOULD be remembered WILL be remembered and |
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their lives honored through the harsh realities found in the written words of the authors.
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Insights By Steve: Check it Out!
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| | Insight By Steve (Author)
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Think About It!
"Enjoy the little things in life, for one day you look back and realize they were the big things...."
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Don't Read This If You Like Beer. . . .
|  It's still hot outside, and it might be time for a frosty one to combat the Autumn temperatures. Now you will know what that will cost you.
Beer producers said earlier this month they'll start putting calorie counts on their labels, something consumer groups have been demanding for more than a decade.
One of them, the Center for Science in the Public Interest, offered a preview Wednesday. They posted calorie counts for dozens of popular drinks, from light beers to restaurant cocktails.
It shows that pre-dinner cocktail can cost you anywhere from a mere 50 calories to 780 calories (OK, that last one is probably a dessert drink).
"Brewers are allowed to artificially color, flavor, sweeten and preserve their products, as well as use foam enhancers," CSPI said. "If the industry takes pride in its ingredients it should list them on labels and not simply on the Web."
The full list is here. Here's a taste of what they found:  |
Question On Your Lab Results?
Check out:
DoctorDoug's Academy 
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Dr. Lakin's guide videos on how to better understand your lab work results.....
Check the first edition here: | | DoctorDoug's Academy: Lesson #1 CBC |
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Secondhand Smoke More Insidious Than Thought. . . . .
|  Nonsmokers can be exposed to secondhand cigarette smoke without realizing it, and be unaware that they are at increased risk for lung cancer and heart disease, a new study suggests.
The discovery highlights the need for a more accurate way to assess secondhand smoke exposure than having patients fill out questionnaires. "A crucial finding of this study is that nonsmokers are exposed to secondhand smoke without even realizing it," said lead researcher Dr. Raja Flores. He is chair of thoracic surgery at the Icahn School of Medicine at Mount Sinai in New York City.
The researchers used blood levels of cotinine, a byproduct of nicotine, as a marker for secondhand smoke exposure in more than 20,000 nonsmokers. The investigators found a significant increase in years of life lost across all levels of cotinine in the blood. The lowest levels of cotinine were associated with 5.6 years of life lost and the highest levels with 7.5 years of life lost. Increased cotinine levels were associated with lung cancer, all cancers and heart disease, though the study did not prove a cause-and-effect link.
"Questionnaires show that responders do not know they were exposed to smoke, but cotinine blood levels are more accurate in determining their exposure and subsequent risk of lung cancer and other smoking-related disease," Flores said in a school news release.
Along with pointing to a more accurate way to measure secondhand smoke exposure, the study highlights the need for tighter smoking restrictions and increased preventive screenings for people more likely to have been exposed to secondhand smoke, the study authors said. Dr. Emanuela Taioli is director of the Institute for Translation Epidemiology at Mount Sinai. She said, "Using cotinine level to measure exposure to secondhand smoke has important public health implications, because increasing the scope of smoke-free environments would likely decrease cotinine levels in the general population, and ultimately death."
And, Taioli added, "Exposure to secondhand smoke is unequally distributed in the population. Children, non-Hispanic blacks, people living in poverty and those who rent their housing are disproportionally affected and most vulnerable." - Icahn School of Medicine at Mount Sinai Back To Top |
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A Word From Jeff, Our Pre-Auth RX Specialist. . . .
|  Pre-Authorization - A Prescription for Success
Filling a prescription used to be a private affair between a patient and his/her primary care doctor. A doctor would diagnose, recommend a treatment, usually in the form of tablets or capsules, and then write or call in a prescription to a patient's pharmacy to have filled. Most medications were reasonably priced and purchased with cash. Patients with a personal health insurance plan or coverage through a job or Medicare expected their medications to be paid with maybe a small co-pay. Perhaps this was the golden age of health insurance.
Today, most prescription services are contracted and handled by pharmacy benefit managers (PBMs). The three largest PBMs are Express Scripts, CVS Health and OptumRx. They make their money charging your insurance company service fees for processing claims, operating mail order pharmacies and helping negotiate prices with drug companies. More importantly, they can stand between you and your medications being paid for by your insurance provider.
PBMs purport that their oversight saves the patient overpaying for medications. It also usually delays having your prescription filled/re-filled and/or the denial of many of your medications. If your prescription is denied coverage, you may still pay cash for it, switch to a formulary alternative, or ask your doctor to appeal your plan's denial via a pre-authorization or PA.
We submit most PA's electronically. It's fastest and most efficient, however a re-determination can take anywhere from 48 hours to 4 weeks. It depends on the questions your insurer asks, any additional forms and proof they require: such as evidence of try/fail of other medications in your plan's formulary, copies of lab data and perhaps even a letter from your doctor attesting to your need to have a particular medication. Much of this "dialogue" occurs by fax or phone. A positive outcome is never guaranteed. The most common rejections are usually due to one of the following: 1) the medication is not in your plan's formulary. They want you to "try" one of their suggested medications, usually cheaper, before they will allow something not in your plan. 2) The medication is too costly. You must try a covered generic or alternative, and "step therapy" is required showing you tried/failed a formulary choice. 3) The medication is considered "high risk." This is most common for older and Medicare patients, and also if you take other drugs your plan feels could cause negative interactions. 4) The amount of medication prescribed exceeds what your plan considers "therapeutic" or what's allowed within a certain timeframe. It's termed a "quantity exception," and a PA must ask to override your plan's established amount.
What can you, as the patient, do to help? Be "patient." Our office can only move forward as fast as PBMs cooperate. Keep you Rx insurance card updated with our office. Let us know promptly if/when you change plans or providers. Call the toll-free number on your card if a decision is delayed or denied. Ask why. Even if it's denied for a "valid" reason, you are the customer and your interest or information may spur your PBM to expedite your request or even reconsider a determination. They will hear from us but let them also hear from you.
- Jeff, Pre-Auth Rx Specialist
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We Need Your Help!
|  Keeping you on your correct medication is as important to us as it is to you. With your help, we can be more efficient and be sure you are getting your refill requests on time and to your correct pharmacy.
Tips:
1. If you need a refill, be sure to call your pharmacy FIRST, not our office. They will know if you have more refills, and if not, they will call/fax/electronically message us with your request. Then we will contact you if there is a question or concern.
2. Remember to call your pharmacy in plenty of time so you do not run out of your medications. Sometimes we need up to 48 hours to complete a request and we do not want this to be a hardship for you.
3. Register and use our SECURE PATIENT PORTAL for refill requests. We monitor this continually and again will contact you if there is a problem.
4. Remember we do not refill pain or routine medications on Fridays or weekends and all pain medications must be picked up at our office. We cannot mail or any medications outside our office. Please plan ahead and make arrangements!
We are always here to help you and appreciate the opportunity to care for your healthcare needs!
Yours in good health,
Dr. Lakin & Staff
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Have You Scheduled Your Autumn Physical Yet?
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| | Dr. Lakin |
As you all know, Dr Lakin is a strong supporter of annual physicals, and Autumn is a time we can visit and explore any unresolved medical problems and any new health issues that need to be addressed. Annual physicals are one of the best ways to safeguard your health. The American Medical Association recommends that if you are between the ages of 40 - 49 years, physicals should be done every two years. If you are 50 years plus, it is recommend you have yearly exams, especially if you have any chronic medical conditions that need to be monitored. Call to schedule your well care visit today!
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Karon's Corner
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Going Up!
Very soon, you'll be getting a letter from your Part D plan provider. That's the part of
Medicare that pays for prescriptions. It is likely to tell you that your monthly cost will
increase on January 1, 20017. Co-pays for drugs might also increase. Drugs may be added to or dropped from formularies. Rules for what counts toward your deductible
might change. Preferred retail outlets, which dispense medications to you at the lowest prices, also can change. Some plans will no longer be offered, while new ones are made available. The government does not control prices, so charges for various plan components can and do vary greatly from one plan to another.
There's no sense in paying more than you have to for your pills. There are more fun ways to spend money, such as going to the movies Barb recommends. To ensure that you don't overpay, you have to take action.
Once a year, from October 15 to December 7, you are permitted to select a Part D plan for the coming calendar year. It might take a couple of hours, but it's easy to do. Just don't wait until the last minute; if you miss the deadline, you'll get no sympathy from the government.
Here's how to do it:
Go to www.medicare.gov
Click on Find health/drug plans
Answer all the questions
Enter all the prescription medications you take
Ignore the list under Refine your search and click on Prescription Drug
Plans with Original Medicare
Under Sort, select lowest to highest retail cost.
The first three plans listed will cover the drugs you take at the lowest cost. Choose those three, and click on Compare. Choose the plan that best meets your needs, but be aware that you'll get nothing extra from paying more. Click enroll to select a new plan. You will be enrolled in the new plan and your old one will be cancelled as of December 31. Your new membership card and copies of the plan rules and formulary will arrive in the mail, probably in December. And you are done for a
year.
Now go reward yourself with that movie!
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AT THE MOVIES WITH BARB A.
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| | | Barb A. | |
GREAT + + + +
ENTERTAINING + + +
RENT THE MOVIE + +
FORGET IT! +
**EMAIL ME! ???
+ + +
CAFÉ SOCIETY
You know me.......I never miss a Woody Allen movie. It had mixed reviews, and I think most people just don't like him so don't go to his films or pan them. I certainly don't approve of him but think he is a genius at films. I feel this one of his best yet. Have you ever wondered what would have happened if you had taken "another road". That is what this is about.The quiet shadow of a romance that might have been. I often think of my old friend Frank Stafford. Actors are all superb.
+ + + +
LITTLE MEN....
This was a real sleeper. It was kind of done in a "woodyallenesque" fashion. It is about two 13 year old lads who live in Brooklyn. One is very athletic and the other is quite artistic. The interaction between the two is fascinating,. The issue is what follows a problem with the parents and how it affects the relationship of the boys. The music and the photography is wonderful.
+ + + + +
SULLY
I wasn't going to go to this movie. I felt I watched the whole thing on TV when it happened. Actually the film starts with the FAA interrogation of Sully and his copilot. It was apparently felt that Sully could have returned to La Guardia Airport rather than the Hudson River. I had no idea that this investigation occurred. Consequently it was fascinating. Only at the end of the film do they show the actual landing. In terms of acting, it's all Tom Hank's show. You actually forget that you are watching an actor. It's really a "must see".
That's it for now... See you at the movies!
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Autumn Harvest Cobbler Recipe. . . .
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Ingredients  - 1/2 cup sugar
- 1 teaspoon ground cinnamon
- 1/2 teaspoon salt
- 1/2 teaspoon ground nutmeg
- 2 cups cold water, divided
- 6 large tart apples, peeled and thinly sliced
- 1 cup golden raisins
- 1 cup dried apricots, halved
- 1 tablespoon lemon juice
- 2 tablespoons cornstarch
- TOPPING:
- 2 cups biscuit/baking mix
- 3/4 cup 2% milk
- 1 tablespoon coarse sugar
- 2 teaspoons grated lemon peel
- Whipped cream
Directions
- In a large saucepan combine the sugar, cinnamon, salt, nutmeg and 1-3/4 cups water. Bring to a boil. Stir in the apples, raisins, apricots and lemon juice. Return to a boil. Reduce heat; simmer, uncovered, for 10 minutes, stirring occasionally.
- Combine cornstarch and remaining water until smooth. Stir into pan. Bring to a boil; cook and stir for 2 minutes or until thickened. Transfer to a greased 13-in. x 9-in. baking dish.
- In a small bowl combine biscuit mix and milk just until blended. Drop by tablespoonfuls onto hot apple mixture. Sprinkle with coarse sugar and lemon peel.
- Bake at 400° for 15-20 minutes or until topping is golden brown. Serve warm with whipped cream. Yield: 12 servings.
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Have a safe and healthy Autum!
Dr. Douglas Lakin & Staff
Paradise Valley Medical Clinic PC
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