Acid reflux may burn you up.

Heartburn affects millions of people in the USA and usually the discomfort resembles a burning sensation that can radiate to the chest, jaw or arm. Sometimes the pain can be squeezing and resemble a heart attack. Gastroesophageal reflux disease (GERD) is the technical term for heartburn.This disease may also cause disease outside of the esophagus. Such problems include cough, sinus disease and asthma. GERD that occurs once a week or more should probably be treated since the risk of cancer of the esophagus increases 8 fold. Still, this cancer is relatively rare in the US.

Nondrug treatments include losing weight, not lying down after meals, avoiding chocolate, mints, fatty food, citrus, caffeine and smoking. Advil, Aleve, aspirin, steroids, estrogen and muscle relaxants may aggravate this condition as well.

Medicines that help GERD include antacids (Maalox, mylanta, Tums) histamine blockers (Zantac, Pepcid, Tagamet) and proton pump inhibitors (Nexium, Aciphex, Protonix, Prevacid and Prilosec). The latter drugs are the best agents for healing and generally should be taken 1 hour before meals. Zelnorm, which is mainly used for irritable bowel syndrome, can sometimes help GERD symptoms by causing the intestine to contract. Such contractions propel the acid out of the stomach.

Unfortunately GERD is a chronic disease and often has to be treated indefinitely. Consider obtaining an endoscopy if you are middle aged and have a longstanding history of GERD. By looking in the esophagus, Barrett's esophagus can be detected. This is a premalignant condition that occasionally turns into cancer of the esophagus. More regular monitoring is needed for these patients. Endoscopy should also be done if you are losing weight or if the heartburn is resistant to treatment. Surgery is a last resort to decrease heartburn. Endoscopic techniques are promising but quite new and complex. Finally if you have cough or asthma that is related to GERD, you will need higher doses of proton pump inhibitors to treat this problem

What are my risk factors for heart disease?

So many people are looking for that one perfect test to detect early heart disease. Certainly EBCT (electron beam computed tomography) is a neat scan to detect plaque in the arteries of the heart but it often costs 300-400dollars.The blood test called high sensitivity CRP is the strongest predictor of heart attacks and stroke.It's still pretty new and you can't follow the test once it is done initially. Stress tests can detect coronary disease but are not good screening tests for the general population.

Everybody wants a magic bullet. The Journal of the American Medical Association (JAMA) clearly shows that in 122,000 patients with heart disease, 80% of them had one of the following risk factors: diabetes, smoking, hypertension and high cholesterol. If you have 1 or more of these risk factors then your risk for heart disease increases. Pay attention to these factors and reduce your risk. There' nothing fancy at all. Just keep it simple!

Neurontin is a drug that has many uses.

Neurontin (Gabapentin) is a neat drug. It has more off-label uses than FDA approved uses.

Neurontin is used and approved for postherpetic neuralgia. This is the pain that occurs after an attack of shingles. The pain can often be severe especially in the elderly.

Migraine headaches occur in 25 million people in the US. If standard treatments to prevent the headache such as beta blockers, Elavil and Depakote don't work, then consider Neurontin. This agent will reduce migraines by 50%.

Hot flashes are not fun when you're experiencing menopause. Treatments include estrogen, SSRI antidepressants such as Paxil and Effexor, Remifenin, an herb and clonidine. Neurontin is a nice alternative.

Neuropathy is a painful condition of the lower extremities that usually causes burning and numbness. It often occurs in people with diabetes, alcoholism, B12 deficiency and many other conditions. Neurontin can be used to reduce the discomfort.

Restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) affect millions of people. RLS is a creepy crawling feeling in your legs that forces you to move your legs to obtain relief. In PLMD nocturnal leg movements occur which disrupts sleep. Additionally your partner will complain that you kick frequently. Neurontin can help both of these disorders. Sometimes iron deficiency anemia and kidney disease may cause RLS.

This drug can sometimes cause drowsiness and has no interactions. Talk to your doctor for more information.

Money management and the stock market.

Many people ask "What's the wealth part of Health and Wealth? I admit that I'm no expert in the financial world but I have learned some of the laws. Money stresses people greatly so I pay attention to this in my practice.

Warren Buffet has two rules of investing: 1) Cut your losses 2) Don't forget rule number one. OK, you say I am being too simplistic? If a stock drops 50% from 10 to 5 do you really think that it will go up 100 % and come back to 10. If you do, you are the ultimate optimist and are headed for depression. Yes, I know you tell me that you love that purse company and just know it will come back.You may be an owner but you don't know the company like the CEO. Don't get emotionally hooked!

Set your mental limit when you are getting out of the stock ahead of time. If you don't, you will be a big NASDAQ loser again. Well, what's a mental limit? It's when you start going crazy about the stock going down! This limit will be different for all of you. I set mine at 15%. I think that a limit of 10-25% is reasonable. Just kiss the stock goodbye and don't look back. Woulda, shoulda, coulda means nothing. Emotions are deadly in gambling and they are just as deadly in the market.

What about if your stock goes up. Somebody once said "Let your profits ride." If the ride is straight up then that is fine but most of the time it's bumpy. I use a 10 % rule for stocks that are going up. Suppose a security goes from 40 to 44. I will sell the stock if it goes back down to 40 (a drop of 10 %). If it continues to go up to 50 then I will sell it at 45 (10% less). This rule allows a stock to have a bumpy ride and at the same time you preserve your profits. Once again, I know you just love that company. Unless you are the CEO, money management is critical.

When your stock hits your mental stop then sell the stock after hours. Sure, it might have come back a bit but it's time to be logical and get out. This way, you don't have to get quotes all day. Good investing to all.

The scoop on drug discounts for seniors.

Over the past several years there has been much attention focused on the need for a Medicare-sponsored drug plan for seniors. In December 2003, such a plan was signed into law. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 will establish a drug benefit program for the nation's seniors and the disabled.

The actual Medicare Voluntary Drug Benefit Program (Part D) will not take effect until 2006. In order to provide seniors with some immediate relief, the transitional Medicare Prescription Drug Discount Card Program will be initiated, and is due to take effect by June 2004. It is expected that from now until 2006, there will be many modifications and amendments to the new Medicare legislation. The following is a brief description of the Medicare reforms, and what we know so far.

Medicare Prescription Drug Discount Card

To help bridge the gap in prescription coverage from now until 2006, Medicare will provide seniors access to a prescription drug discount card. Medicare-approved prescription drug discount cards will be available to Medicare beneficiaries who are enrolled under Part A or B as long as they are not receiving outpatient drug benefits through Medicaid. The cards are mainly intended for beneficiaries who don't have outpatient prescription drug insurance. It is expected that through this program patients will save approximately 10% to 15% on their costs of prescription drugs. Some savings could go as high as 25% for branded drugs and 40% or more for generics, depending on the card sponsors' negotiated discounts from drug companies.

Enrollment for a Medicare-approved prescription drug discount card will begin in May 2004. Patients will be able to use the cards between June 2004 and December 31, 2005. Once the full Medicare drug benefit program takes effect in January 2006, the discount cards will no longer be valid.
For those Medicare beneficiaries with extremely low income levels ($12,123 for single individuals or $16,362 for married individuals in 2003) an additional $600 per year will be provided to apply toward prescription drug purchases. The above income levels will vary slightly year-to-year. To qualify for the additional $600, beneficiaries cannot be receiving outpatient drug coverage from other sources.
Medicare-approved drug discount card programs will be allowed to charge an enrollment fee not to exceed $30 per year. Beneficiaries who qualify for the $600 prescription aid will not be obligated to pay an enrollment fee.

Prescription drugs covered by the Medicare discount card programs could include most drugs available at retail pharmacies (including syringes, needles, alcohol, and gauze). Many card programs will use formularies to provide larger discounts to patients. If a formulary is used, the program must offer discounts on drugs commonly used in more than 200 classes of drugs. Programs may offer discounts on over-the-counter drugs if they choose. However, patients can't use their $600 prescription aid to purchase OTC medications.

Medicare Voluntary Drug Benefit Program

Beginning in 2006, the full Medicare drug benefit program will take effect. Pending any changes to the program before 2006, the following is a description of the standard drug benefit:

• A monthly premium of about $35
• A deductible of $250
• Coinsurance of 25% up to an initial coverage limit of $2,250
  Protection against high out-of-pocket prescription drug costs, with copays of $2 for generics and preferred multiple source drugs and $5 for all other drugs, or 5% of the price, once an enrollee's out-of-pocket spending reaches a limit of $3,600
  Beneficiaries with incomes <135% of the federal poverty level will receive larger benefits:
• A $0 deductible
• A $0 premium
• No gap in coverage
• Copays of $2 for generics and preferred multiple source drugs and $5 for all other drugs, up to the out-of-pocket limit
• $0 copay for all prescriptions once the out-of-pocket limit is reached.

Beneficiaries with incomes <150% of the federal poverty level will receive:

• A sliding scale monthly premium that would be about $35 for beneficiaries with incomes of 150% of the federal poverty level
• A $50 deductible
• No gap in coverage
• Coinsurance of 15% up to the out-of-pocket limit
• Copays of $2 or $5 once the out-of-pocket limit is reached

There will be an "any willing provider" requirement for pharmacy participation. The prescription drug plan sponsors must ensure convenient access by including pharmacies that dispense drugs directly to patients. The plans cannot include "mail order only" pharmacies.

Reimportation of prescription drugs is also addressed in the Medicare legislation. Basically, the new act allows for the creation of a system for importing drugs from Canada by pharmacists, wholesalers, and individuals. Implementation of such a system is dependent on the certification of safety and cost savings by the Secretary of Health and Human Services. As in previous years, it is unlikely that the HHS Secretary Thompson will certify this particular reform agreement. Actually my opinion about importation of drugs has changed. Medication knock offs are common. Fraudulent websites occur frequently. You might think that you are ordering your drugs from Canada, but they may be coming from another country that doesn't have an FDA to scrutinize the drugs composition. Saving your life is more important than saving money. Stay away from importation of drugs for your own protection

Hope you found this helpful. Browse around my site!

All The Best,

Evan L. Lipkis MD

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