Hospital Form Guide

When I first gave up the practice of law in Toronto in favor of early retirement in Oaxaca, I assumed that the years I would add to my life by leading a much more stress-free existence in Mexico, would be lost by the inferior health care system to which I would be exposed, subjected and restricted. This, then, is my assessment of the extent to which my presuppositions have been accurate, together with information and advice for both vacationers to and would-be ex-patriot residents of Oaxaca.

Aside from the small, private hospitals, often referred to as clínicas, there are four publicly funded and insurance – based hospitals in the city, as well as a hospital just outside of the city offering specialized treatment for a number of serious ailments. There is the Red Cross facility available to all, often used for emergency treatment only. The civic hospital provides free services or treatment at a modest cost based on a sliding scale respecting means. ISSSTE is a federally funded facility restricted to government employees who are members of a union. Finally, there is IMSS, a federal insurance program available to ex-pat residents and Mexican citizens alike, with an extensive network of clinic doctors and a large hospital. It’s funding is provided in large part by business owners. Aside from these hospitals, there are several, small, easily accessed clinics scattered throughout suburban and rural neighborhoods.

For the vacationer, and the ex-pat with a VISA permitting residency in the country, the most common means by which to obtain emergency treatment is through Red Cross, IMSS (which accepts patients without coverage on a pay-per-service basis) or a private hospital. However, the last of these three is the only one in which you can be reasonably reassured of being attended in a timely fashion by extremely competent and efficient personnel.

WHAT TO DO AS A VACATIONER

If you do not have out-of-country healthcare coverage, by all means go out and buy it before leaving for your trip. However, it’s advisable to first inquire of your credit card company, to ascertain if in fact you already have at least some coverage simply by virtue of, for example, having a gold or platinum card. You can then make a more informed decision concerned whether or not to purchase coverage, and if so at what level. On the other hand, a broken leg, gastrointestinal problem or other non-life threatening ailment can be attended by a private doctor or clinic without breaking the bank. Of course for an outlay of more than $100, it’s nice to be reimbursed.

If you intend to make a claim to your private carrier, credit card company or government funded health care plan, ensure that you not only keep all receipts, but request a written diagnosis and treatment plan, and that the prescriptions you are given indicate for what purpose each medicine is being prescribed (i.e. antibiotic, analgesic, etc.). Many doctors provide all required information simply as a matter of course. Accepted practice, at least except for when narcotic medications are being prescribed, is for the pharmacy to return prescription forms to you. Often medical plans require translations of each document that is presented to them as a prerequisite for processing and reimbursement. When in doubt, submit all documentation with your claim, making sure to determine if originals are required, and keep copies. Frequently, as is the case with Ontario, it’s a two step process. Treatment receipts and diagnosis is submitted to the provincial plan. Once you’re notified of the portion not covered, prescription receipts together with a request for reimbursement for the amount not covered by the province, is submitted to one’s private plan. In theory, between the two plans, 100% reimbursement is achieved.

You can ask the manager of your hotel or bed and breakfast to do you a favor by translating each of your supporting documents, to save you the trouble upon your return home. Make a note of the then prevailing rate of exchange, and submit a calculation to your plan with your documentation, to more easily facilitate payment. When a member of a clerical staff is processing your claim, he’ll be less inclined to put yours aside for another day or week if it already contains all the necessary and relevant data, organized in a readable format.

Concerning where to go in the event of illness or emergency, your accommodations host should be able to make recommendations for English speaking physicians with private practices, and for private clinics. Regarding competency of the former, while there is a medical school in Oaxaca, many doctors travel out-of-state for their post-graduate training such as to universities in Mexico City or the US, and regularly attend conferences and upgrading courses. Some travel abroad within the context of their specialization training. Indeed the Oaxacan populace appears to take notice of and prefer those physicians who are able to display foreign diplomas.

Our personal experience with emergency treatment over the past 10 years has been nothing but positive for ourselves, our family and our guests, at hospitals Carmen and Molina, both downtown … in terms of competence, speed with which one is attended, and the presence of English speaking ER doctors. On the other hand, we cannot recommend the emergency departments at the civic hospital or IMSS because of delays in receiving treatment, and at minimum in the case of IMSS unavailability of competent medical personnel 24 hours a day to attend to even a commonplace emergency (i.e. suturing). Having said this, many excellent surgeons with private practices perform surgery at the non-private hospitals where there tends to be the more state-of-the-art and sophisticated equipment.

The normal range in price for a consultation with a family doctor, specialist or dentist, is $20 – $50 (all figures are stated in US dollars and are approximate for 2008 unless stated otherwise).

PURELY ELECTIVE AND COSMETIC PROCEDURES

Over the past several years Oaxaca has become a popular destination for Americans and Canadians seeking both plastic surgery and extensive dental work. Word has spread of the competence and quality of work of both nip-and-tuck and dental surgeons, and of course of their extremely reasonable charges relative to those paid to hometown practitioners. Many foreigners, as well as Mexicans from Mexico City and other regions of the country come to Oaxaca for face lifts, breast reductions and augmentations, liposuction and other appearance enhancing procedures. A friend who attended for plastic surgery in Oaxaca by a well-known plastic surgeon a couple of years ago, recently commented that she had read an article in a Canadian magazine indicating the cost for the same procedure which she had performed for $500, was $3500 – $5000 at home. In effect she had a free trip to Oaxaca, and returned home with extra money in her pocket.

Our personal experience with dental treatment has been extremely positive. Cost tends to be about a third to a half of American and Canadian prices, for example for crowns and bridges, implants, root canals, gum and bone work, etc. While the use of nitrous oxide (laughing gas) has not yet arrived in most Mexican cities, a dentist with a gentle touch can more than make up for that lack of temporary high while in the chair.

RESOLVING THE EX-PAT CONUNDRUM

Get whatever coverage is made available to you both in your homeland and in Mexico, subject of course to affordability.

To my thinking, with IMSS coverage costing under $400 annually for a couple, why not go for it regardless of what other coverage you already have. Then supplement IMSS with international coverage for catastrophic injuries unless you have other similar insurance from another source. Our Oaxacan friends tend to disagree, but theirs is a different mindset where insurance in general has historically not been stressed or valued, be it home, car or health.

Some American acquaintances swear by IMSS since it provides regular care including preventive procedures, all dispensed by government employed physicians including specialists, together with lab tests, medication and hospitalization. There are restrictions the first year of enrolment, and there are caveats. The level of cleanliness in the clinic environment tends to be below the standard to which most of us have become accustomed growing up in the US and Canada. Many physicians have not received the quality of medical education of their private counterparts. The medications provided through the clinic pharmacy are often not the best available in the marketplace for treatment of a particular ailment, because of cost. Often the wait to see your designated doctor or for your lab tests can be long, requiring a half day commitment for each step in the process: visiting a general physician, going for one set of tests, then for another, and finally seeing a specialist.

So why bother with IMSS at all, with all these downsides? It’s a failsafe, another form of assurance that you’ll be cared for in the event of a lengthy and serious illness. As suggested earlier, often it’s the largest hospitals such as IMSS which have the best equipment, and surgeons with private practices who perform some of the surgeries. And there is no additional cost for hospitalization once you have full IMSS coverage. While attending a private clinic is more akin to your experiences before moving to Mexico, if you must remain in hospital for a lengthy period of time, the cost of doing so in a clinic could be prohibitive…just like back home.

Visiting private physicians, and even biting the bullet and getting your tests done at privately owned laboratories, reasonably assures you of a familiar quality of care. Coupled with IMSS coverage, you can now be confident that you’re covered in almost all respects. In the event of a protracted hospital stay you can afford to be there for as long as necessary. The best locally available equipment will be used in your diagnosis and treatment, and you have a reasonable likelihood that attending surgeons are those who split their time between private practice and clinic work, and performing procedures in one or more large hospitals.

We maintain IMSS coverage, but rarely use it, preferring to tap our Oaxacan social networks for referrals to specialists to the extent they are required. And in any event, after having been resident in Oaxaca for a few years, those of us who are in our fifties or older have already been introduced to a broad range of specialists. As strange as it still is to be a Canadian and subscribe to the pay-as-you-play philosophy of medical care, it serves our purposes, with the IMSS safety net just in case.

Under certain circumstances you may not want to rely on even the best Oaxaca has to offer. Indeed the stream of Oaxacans traveling to Mexico City flows briskly and wide. The middle and upper classes with contacts in the nation’s capital, there quickly seek out the best in terms of physicians and state-of-the-art equipment, for diagnosis and for treatment of life-threatening diseases.

Even doctors working in Oaxaca at the IMSS and ISSSTE hospitals can make arrangements for patients to receive treatment not available here, to be attended in Mexico City or other larger centers. However, the process can be slow. We know of one case, that of a two-month-old baby with heart problems, who was finally sent to Puebla for surgery at ISSSTE, only to die before the procedure could be performed.

The solution, unless you have quality foreign coverage perhaps as part of your retirement pension plan, is to buy insurance which will pay for treatment in Mexico City, or better yet throughout the world as long as you can make your way to one of the participating top-of-the-line hospitals. In my case, I have a low annual premium, with high deductible which is waived in the event of accident. Again, it’s a failsafe mechanism in the event of, for example, a serious car accident, or cancer, stroke, heart attack, or other catastrophic ailment which would otherwise not be affordable. Oaxaca has less than the best of diagnostic equipment and treatment facilities. My plan provides for a $10,000 deductible, $2,000 annual premium, with member private hospitals in Oaxaca, Mexico City and elsewhere in the republic, and of course abroad including the US, with the Mayo Clinic in Rochester being a participant.

In summary, my medical coverage and plan for treatment is the following. We have our regular family physician, who, along with our Oaxacan friends, refers us to specialists in which we have the utmost confidence, and to whom we pay per visit. The same holds true for dental treatment. We have IMSS coverage which we reluctantly (because we don’t use it) renew on an annual basis, but believe it’s worth the price in the event we need extended hospitalization, or to have surgical procedures performed not available in private clinics. And I have my catastrophic coverage which hopefully I’ll never need to access.

Medical care and coverage can be inexpensive, and just as easily it can be costly. It’s a matter of the individual or family having a philosophy, or set of priorities, before electing to move to Oaxaca. You have to determine how you want to lead your life in terms of balancing having less disposable income as a result of medical and insurance costs, with having greater peace of mind in knowing that whatever is thrown your way will be looked after as best possible given your new life in a foreign land. If you cannot achieve a level of comfort in the resolution of these issues and decisions, then perhaps the move is not for you.

Alvin Starkman together with wife Arlene operates Casa Machaya Oaxaca Bed & Breakfast ( http://www.oaxacadream.com ). Alvin received his masters in social anthropology in 1978, and his law degree in 1984. Thereafter he was a litigator in Toronto until taking early retirement. He and his family were frequent visitors to Oaxaca between 1991 and when they became permanent residents in 2004. Alvin reviews restaurants, writes about life and cultural traditions in Oaxaca, and tours couples and families to the villages.

For most young people, especially those in their twenties, getting health insurance is not a top priority. This is mainly because people in their twenties do not feel that they would face any serious health problem or disorder in the near future. In addition to this, young people also think that getting health insurance is very expensive. Given this, most people postpone getting health insurance until later in their lives. However, there is a way by which young people can get health insurance without having to shell out huge amounts of money, and which can also provide them with the insurance they need for health problems that can arise from accidents. This option is to get a catastrophic or major medical insurance plan.

How does a catastrophic medical insurance plan work?

Basically, a catastrophic or major medical insurance plan is a deductible and an affordable form of health insurance that covers major hospital expenses but not routine medical expenses. This is why it is perfect for young people who do not have any medical conditions. As a rule of thumb, the higher the deductible amount is on the plan, the lower the premium that a plan holder needs to pay. This is why in some cases, the premium that some plan holders need to pay can be as low as $30 per month. However, getting this plan is a calculated risk, as those getting them are gambling that they will not face any major medical problems in the near future. However, given that this kind of health insurance can significantly help a person if in case he does face a major medical problem, it is a better option than not having any insurance at all. This is because the amount of help that this plan can give plan holder in times of major medical problems can go a long way.

For young people who may want to have affordable health insurance that is ideal for their lifestyle, one of the most viable options they can take is to get a catastrophic or major medical insurance plan. This is because doing so can give them access to an affordable health insurance plan, which protects them from some of the major medical conditions, which include accidents, to which they are most vulnerable.

Major Medical Insurance provides detailed information on Major Medical Insurance, Major Medical Insurance Quote, Major Short Term Medical Insurance, Major Medical Insurance Company and more. Major Medical Insurance is affiliated with Travel Medical Insurance.

Facility billing is insurance billing for hospitals, inpatient or outpatient clinics, and other offices such as ambulatory surgery centers. This insurance billing is not the same as billing for a regular doctor or specialist.

Facility billing is required to be submitted on UB04 forms instead of the more common CMS 1500 forms. The information required on UB04 forms is different than the information required on the CMS 1500.

For example, UB04 forms require rev codes and a type of bill code that are not required on the CMS1500 form. There are also a lot of “conditional fields” that for most situations are not required to be completed. It is important that you know how to complete the UB04 form correctly in order to get reimbursed properly from the insurance carrier.

Some offices may bill as both facility and professional billing. We bill for an outpatient drug and alcohol rehab facility that is owned by an LCSW. Some insurance carriers have it credentialed as a facility and require the billing to be done on UB04 forms. This is beneficial to our client because the facility reimbursement rate is higher than the professional reimbursement rate. But other insurance carriers will not credential him as a facility and he must bill services out to them on CMS1500 forms as regular therapy visits.

So you may find yourself in a position where you need to bill out on both the UB04 and the CMS 1500 forms. In any case, it is crucial that you are completing the forms correctly.

When we first learned how to submit UB04 forms, they were actually still the old UB92 forms. We had to purchase a book called the UB92 editor which is a very detailed book on what all the fields on the UB92 form are for. It was helpful, but it actually contained too much information. The book is hard to navigate and is actually quite costly. The information in it is required if you are doing in depth inpatient billing, but for the littler guy, such as outpatient clinics, it is too much info and too difficult to decipher. We receive tons of questions from people who are trying to complete a UB04 form properly.

In order to complete the UB04 forms correctly for facility billing, it is very important to understand the differences in billing procedures between the CMS 1500 forms and the UB04 forms. Make sure your claims are paid correctly the first time they are submitted.

Copyright 2007- Michele Redmond

Michele Redmond and her mother/partner Alice Scott are co-owners of a medical billing service. They offer an informational website for both physician’s offices and the general public looking for information or help with their problems with medical insurance billing. Check out their website for more information on facility billing on UB04 forms, more about important changes now going on in Medical Insurance Billing, or to sign up for their free monthly newsletter.

In many areas of the country, when you get your bill for county property taxes, be prepared for a shock. They are at an all time high across the country, though the overall amounts can vary greatly depending where you live.

On top of all the other taxes that we pay, what are county property taxes used for? The individual tax rate varies from jurisdiction to jurisdiction. Also varying is as how the assessed valuation of the property is calculated on which they base the property tax. Here are the most popular uses for the high county property taxes that you are paying (and just because they are “popular” today might mean the politicians might uncover some other popular cause to fund).

• Schools Systems – In many areas of the country, more than half of each dollar you pay in county property taxes is used to fund your local school district. In most states, the largest funding school districts receive is through local property taxes. These taxes help maintain school buildings and buses, pay teacher and administrative salaries and buy books.

• Roads and Bridges- City and county property taxes are used extensively to keep roads in good working order. They remove the snow in winter, cut grass in the right of way, clear out overhanging branches and trees and make minor road and bridge repairs.

• Police and Fire Services – In most cases, your local police and sheriff’s departments as well as your local fire departments are funded by city and county property taxes. Your taxes support the buildings, vehicles and salaries of our policemen and firefighters.

• Public Libraries – Libraries are typically run by the county, so county property taxes provide their funding. Everything from building maintenance and staff salaries to purchasing new books is primarily funded through taxpayers.

• Hospitals – In some parts of the country, local hospitals receive some funding from local taxpayers. These funds are usually provided to ensure that hospitals in financial trouble don’t have to close. It is in the public’s best interest to have a hospital right in the community, so taxpayers often bear some of the financial burden of keeping the hospital afloat.

• County Government – And, of course, your county taxes fund your local county government to collect the taxes, provide the county court system, provide office space and pay salaries.

In some areas, a portion of your local city and county property taxes may also be given to the state. In most cases, however, at least 90% of the property taxes you pay stay right in your local community. When states take part of the revenue, it is usually a relatively small amount.

It is said that people complain more about their property taxes than any other taxes they pay. However, for the most part these taxes stay in the local communities. They fund the education of the children and pay for police and fire protection. So, while it is your civic duty to keep watch on how your tax dollars are spent and calculated and to speak up about unnecessary spending, local property taxes compared to other taxes tend to stay in the local community and their benefits are most visible. Further, it’s not a big stretch to demonstrate the direct benefit to the property owner.

Andy Andersohn is a small business owner and long time tax preparer. Learn more about property tax resources [http://taxhelpplus.com/] for business owners and individuals. Get your FREE 11 page Tax Saving Guide. Find up to date tax articles. At our tax tips blog [http://taxhelpplus.com/blog/] discover more tax help and good ideas.

Metals have had many uses for us in our everyday life. It has conquered different industries making various gadgets possible. We encounter it everyday. For some nations, it is part of their trains, which make them run fast and float on the rails. For various adventurers and campers, it has given them an advantage to know which way to in the form of compass. In hospitals, it aids doctors to make diagnosis with regard to the illness of their patient with the aid of MRI. It has so many uses in various industries that our lives have stepped up one notch higher to make it more convenient.

In the world of motorcycles, these things have made its contribution too. The magnets are useful in attaching tank bags securely. This will only work with tanks made in metals. Otherwise, it will be rendered useless. However, they really do have a good power grip and it is hassle free when it comes to installation. When you want to reposition it, you can easily remove the bag from its current location and adjust it. There are no straps or a bunch of cords knotted around the tank. When it comes to refueling, you will not consume much time just for you to take it out and give access to the opening of the tank. The use of magnet is one of the most wonderful breakthroughs for motorcycle luggage.

Reminders When It Comes To Magnet Use

These things are convenient to use, but you also have to be careful in using them. They can also cause damage to your bikes if not used the right way. Here are some reminders

When it comes to adjusting the bag:

-Do not drag the tank bag to reposition it instead lift the bag and move it then attach the magnet back to its place.

-Do not attach the bag if the tank is dirty instead clean the area first before proper placement of the bag.

When it comes to your things:

-Do not put any items that are sensitive to magnets in the tank bag. If you do, just make sure that it is away and well-protected from the magnet.

-Do not wear long metal chains around you neck, as the magnets are very powerful that it may pull you chain towards it thus creating a problem when you are driving.

When it comes to Installation:

-Always remember to clean the area first before installation.

-Always use a rubber pad or any kind of material that will stand in between the surface of the tank and your bag.

Do keep these things in mind when handling this kind of motorcycle luggage. What is at risk in here is the paint of your tanks. Installing them on a dirty surface can risk scratching the paint. This is a big price to pay for your convenience and you do not want this to happen. Remember you can enjoy the use of this bag only if you exercise a great deal of care.

For more tips and information about motorcycle luggage, please check out http://www.rockytopleather.com

According to a recent report from the American Institute of Medicine, medical mistakes kill as many as 98,000 people every year and up to 7,000 patients die from errors in prescribing medicine.

This far exceeds the annual number of people killed as a result of traffic accidents (43,450), breast cancer (42,300), or AIDS (16,400).

Under Ohio law, you often have only 1 year from the date of negligence to file a claim. If the victim of medical malpractice is a minor, then additional time is allowed.

Even if a medical mistake is not fatal, it can cause severe, permanent damage, such as brain injury, paralysis, amputation, disability, or disfigurement. Medical malpractice is about far more than dollars or statistics. The errors take a terrible toll on the lives of innocent victims.

Medical malpractice occurs when a doctor fails to act with a reasonable standard of care. When someone who is not a doctor makes a mistake, he or she is often said to have acted negligently. Malpractice is simply negligence applied to healthcare professionals. Tragically, a doctor’s mistake can have severe — or even deadly — consequences for a trusting patient.

What is Medical Malpractice?

Some forms of medical malpractice are unmistakable, like performing surgery on the wrong body part or the wrong patient, or administering the wrong medication.

Other types of medical malpractice may not be obvious. For example, if an individual was not warned about the serious risk of a particular treatment or if treatment unexpectedly causes a horrible injury, malpractice may have occurred.

In general, an individual may have a medical malpractice claim when a doctor or other medical professional failed to provide proper treatment and the incorrect treatment caused the patient to suffer a new injury. The law requires evidence of new injury, because it would be unreasonable to hold the healthcare professional responsible for the original medical problem.

Some examples of medical malpractice include:

Failure to diagnose a medical condition
Misdiagnosis of a medical condition
Failure to treat a patient’s medical condition properly
Failure to administer anesthesia safely
Failure to manage a pregnancy or deliver a baby in a safe manner
Failure of a nurse or other staff member to keep a treating physician informed of a patient’s condition
Failure to administer medications properly
Failure to protect a patient from a fall or other injury on hospital property

The Rights of Ohio Medical Malpractice Victims

Sadly, many Americans die each year from medical mistakes. One of the best ways to help correct this crisis in medicine is to hold the negligent hospitals and physicians accountable for their mistakes.

In Ohio, a patient has the right to file a lawsuit against any physician or hospital, which may have committed malpractice. However, the filing requirements for a malpractice lawsuit are lengthy and complicated.

The laws governing malpractice suits may be the most complex of all Ohio personal injury laws. Failure to meet the Ohio legal requirements for an Ohio medical malpractice claim means that the victim loses all rights to file a lawsuit against the medical professional or hospital which negligently caused severe injury — or even death.

If you or a loved one is the victim of medical malpractice, talk with a dedicated Ohio medical malpractice lawyer.

Attorney Marya Sieminski joined the Law Offices of Sam Bernstein in 2003. She is admitted to practice law in Michigan state courts and in the U.S. District Court for the Eastern District of Michigan. She earned her Bachelor of Science degree at the Massachusetts Institute of Technology and graduated magna cum laude from Wayne State University Law School. Marya has worked as a trial lawyer for 10 years and exclusively represented victims in personal injury litigation and in workers compensation claims. She also was appointed by the Governor to serve on the State of Michigan Workers Compensation Qualifications Advisory Committee.

The Law Offices of Samuel I. Bernstein, our Michigan and Ohio personal injury law firm, has championed the cause of the medical malpractice victims for three generations.

Do you want to try your hand at building a platform bed? For those of you who don’t yet know what a platform bed is, it’s an exciting, old way of sleeping that incorporates a simple, elegant frame and a single mattress. Its lines have been used in Europe, Scandinavia, and Japan for hundreds, if not thousands of years. Platform beds can be made of wood or metal. If you’re looking to build a platform bed, you’re probably thinking about wood.

Platform beds can be extremely simple. The extremely simple platform beds have no headboard or footboard, and certainly no canopy. They incorporate slats, which, in effect, replace the need for a box spring, since, because they are sturdy yet somehow slightly flexible, support the single mattress on top. The result is that you get a good night’s sleep, are very comfortable, and yet don’t end up with back pains or numb muscles in the morning.

It’s ever better for your back than sleeping on the floor. And now, with the rapid proliferation of memory foam, your platform bed can be even more comfortable and healthy. Memory foam is a gel-like polymer that accepts your shapes and bones, but supports it fully. (It was first used in hospitals, and is now a popular mattress and pillow material.)

Platform bed plans can be more complex too; you can add headboards, footboards, canopies, even extra flourishes and storage units. You can build the storage units as one with the bed frame, or you can create rolling drawers supported by castors, so that the drawers are modifiable and easily maneuverable throughout your bedroom.

It’s not the most difficult job in the world for a handyperson. If you want to build a platform bed, you can order platform bed plans from any of a number of plans retailers. Woodworking clubs, furniture enthusiast groups, and other organizations can give or sell you plans. You can also buy plans online.

Platform Beds Info provides detailed information about contemporary, Japanese, discount, and wood platform beds and platform storage beds, as well as platform bed frames and plans. Platform Beds Info is the sister site of Futons Web.

International professional organizations, non-governmental organizations, and other international institutions work to make sure that medical training, medical practices, and medical equipment are standardized around the globe. Diagnostic terminology is set; medications from prescription drugs to anesthesia are globally-available.

Medical tourism takes advantage of this standardization of medical procedures. Doctors overseas—many of whom have trained in the US or Canada, or be members of international professional association—assure their patients that they’ll enjoy the same quality of care as they would at home, if not better.

Thailand is perhaps the best-established destination for medical tourism, and much of that is due to Thai doctors’ and hospital administrators’ global knowledge. Thai facilities’ characteristically high level of health routinism means that patients enjoy medical care and hospital experiences that are higher than, or at least comparable to, standards in their home countries. Not only do many Thai physicians hold US professional certification; a number of Thai hospitals maintain cooperative relationships with facilities in the US as well. Many travel to hospitals in Thailand for plastic surgery or other forms of cosmetic surgery from North America, Europe, and Japan.

India is developing a competitive market in health tourism, and may industry observers credit the expansion of India’s health tourism industry to the profession’s global scope. Leading facilities in India are designed to the same specifications and equipped like research hospitals anywhere else in the globe. India is not alone in transferring the globalization of medicine to the tourist industry’s benefit. So, too, do medical facilities in Singapore and the Philippines offer patients world-class medical and dental procedures.

Just as health routinism is by no means restricted to Thailand, medical tourism’s recent growth is by no means restricted to Asia. Each year, more and more travelers book tickets to Eastern Europe or south in the Americas for dental treatments, to South Africa for aesthetic surgery, or to Canada for laser treatments.

Looking to find a rewarding employment opportunity in the health care field? Find information about medical billing careers, general surgery residency openings, medical office staffing, hospital internship and volunteer opportunities & nursing job vacancies – New York Hospital Staffing is your source for health care career opportunities in New York

One of my first eye openers in clinical practice was an experience that occurred many years ago. A young woman was admitted in the psychiatric hospital. She had complaints of alcohol dependence. I happened to be her doctor. On talking with her, it became apparent that the young lady was very intelligent. She had done well in life. She was a professional. She had married well. But she was having major difficulties in her marriage because of her drinking. Three times before her then admission, she had been treated in various psychiatric hospitals for alcohol problems. Each time, she went back on drink. She was treated each time with medication with little input by counseling services. Her problems had started when she was raped about twelve years previous. She had not talked about it to anyone. Maybe she did not tell her previous doctors about it. I had the opportunity to work with her trauma of rape. She stopped the abuse of alcohol and her life changed.

Addiction can occur in many forms. A person can be addicted to alcohol, street drugs, gambling and even sex. In all these activities the person engages themselves either for a buzz or a crutch. Many people start with alcohol usage to help them sleep. This then becomes a habit and the person cannot control it. It then starts affecting many spheres of their life. The financial, social, family and health neglect occurs. Only then is it considered an ‘addiction’ or ‘dependence’. Sex addiction as a diagnosis does not exist in psychiatry at present. But when a person’s only focus, dream, activity is some form of engagement with sex, it takes the form of an addiction. It may involve chatting on sex lines, visiting pornographic sites on the internet, having the need to engage in sexual intercourse many times a day, visiting and soliciting prostitutes and even engaging in masturbation many times a day.

If we go by the definition of addiction, then one addiction that does not classify itself as addiction is –work addiction. When people engage in any work or a job, it increases their productivity. It is then not destructive. Therefore it does not fit into the addiction category till damage is done to various aspects of a person’s life. Internet addiction is a new form of addiction developing in the developed world.

People engage in such activities because the activities give them pleasure or as in sex addiction, release tension. Scientists have a theory that a chemical neurotransmitter called dopamine is secreted in the brain when we engage in pleasure activities. Many drugs like ecstasy and LSD are non-habit forming drugs. But people still engage in them to get a ‘buzz’. This is a word that many drug users use to describe the effect these drugs have. The other commonly used words are ‘uppers’ and ‘downers’. When the nervous stimulation becomes excessive, a person may decide to take a ‘downer’ like an opiate (heroin) to slow them down mentally.

People need these activities or substances to help them become calm. In physiological terms, the body is trying to seek an internal homeostasis (balance) in the hormonal and neurotransmitter systems in the body. These systems become disturbed when the person has gone through emotional distress or abuse that they are not able to come to terms with. Almost all drug dependent people have gone through traumatic experiences in their lives. If they have not experienced traumas, then they have come from pampered backgrounds.

In these cases, they become sensitive to even slight changes in their life situations. This happens because they have not been brought up to live independently. Such people tend to play ‘victim’ roles and expect someone else to get them out of their problems. So from their subjective perspective, they are traumatized.

Abuse can be in the form of physical abuse-involving beatings and food deprivation. It can be in the form of sexual abuse- in which a powerful figure, uses the individual for their own sexual and power gratification. Abuse can also be emotional in nature. In this case, it can be in the form of neglect, threat or rejection. Almost all the addicts have such abused backgrounds.

The treatment of addictions involves medical or chemical treatment and also dealing with the emotional distress of the traumatic experiences. Treatment without any psychotherapy input by only providing medical treatment may not be sufficient. If the cause is not dealt with, the drives leading to addiction do not change in the body. In the absence of psychotherapy, meditation is the best form of treatment available that a sufferer can use in any form of addiction.

Pradeep K Chadha is a psychiatrist who specialises in helping patients with meditation and imagery using little or no medication. He is the author of The Stress Barrier-Nature’s Way To Overcoming Stress published by Blackhall Publishing, Dublin. His second book -The Road To A Happy Life- is being published this year by Raider Publishing in the UK, USA and Canada. He is based in Dublin, Ireland. His website address is http://www.drpkchadha.com

Iliotibial Band (IT Band) Syndrome is a frustrating source of knee and hip pain for athletes, and is one of the most common causes of lateral knee pain in runners. Most cases of iliotibial band syndrome occur as the result of “too much, too soon” or poor biomechanics and can be prevented with these simple tips and listening to your body.

Anatomy of the Iliotibial Band

The iliotibial band is a thick layer of tissue along the outer part of the leg that runs from the hip to the knee. Irritation can occur either in the hip or the outside part of the knee as the iliotibial band rubs across the greater trochanter and the lateral epicondyle of the femur.

Iliotibial Band Syndrome Symptoms

Symptoms of iliotibial band syndrome include pain at the outside part of the knee that is worse when bending or extending the knee, such as during running or cycling Other symptoms include pain on the outside part of the hip over the greater trochanter.

Causes of Iliotibial Band Syndrome

Tightness in the iliotibial band is a common cause. Weakness in the muscles around the hip and buttocks (gluteus muscles) can cause excessive hip and leg rotation, resulting in increased stress on the iliotibial band. Other factors that can lead to IT band syndrome include running on a sloped surface such as the beach or road and excessive pronation or rolling in of the foot.

Iliotibial Band Syndrome Prevention

Iliotibial band syndrome can be prevented by avoiding overtraining, allowing for adequate recovery and rest, following a regular stretching and strengthening program and selecting proper running shoes for your running style.

Treatment of Iliotibial Band Syndrome

Ice massage to the painful area for 10 to 15 minutes after workouts can decrease the pain. For acute injuries (less than 2 weeks) anti-inflammatory medications such as ibuprofen (Motrin or Advil) or naproxen (Aleve or Naprosyn) can help with pain and irritation. In chronic injuries there is less inflammation of the tissue, therefor acetaminophen (Tylenol) may be more appropriate.

Iliotibial Band Stretches

Stretching of the iliotibial band is an important component of proper rehabilitation if the band is tight. One simple stretch is to stand and cross your injured leg behind your uninjured leg and bend over to touch your toes. A more advanced version of this exercise is to then extend the arms overhead and slowly reach to the opposite side (for the right IT band, extend the arms to the left) and then continue the stretch as the arms reach for the floor. As you perform this exercise, you should feel the stretch in the side and back on the hip. If you experience pain or muscle spasm then reduce the motion during the stretch.

The seated IT band stretch is performed while sitting on the floor with the legs out straight. Bending at the hip and knee, take the injured leg and cross it over the uninjured leg. Twist the upper body towards the injured side to continue the stretch. An alternative method is to slowly extend the knee and leg of the tight IT band to increase the stretch.

Seated Iliotibial Band Stretch

The”Figure-4′ stretch is an exercise that can be done while seated at a desk. While seated, cross the ankle of the injured leg on top of the opposite knee. The stretch can be extended by either lightly pushing the flexed knee down towards the floor or by leaning forward at the waist and allowing your body weight to increase the stretch. Hold the stretch for 5 to 10 seconds and then slowly relax.

Foam Roller Stretch

A foam roller is a great tool to break up scar tissue and help with myofascial release of the iliotibial band. The stretch is performed by rolling the injured leg back and forth across the foam roller. Focus on the hip and outside part of the thigh. The exercise can be done daily for several minutes. Try the rolling with the knee straight and the knee flexed. Gradually increase the amount of time each week.

Strength Exercises for Iliotibal Band Syndrome

Strengthening the gluteus muscles is also important in iliotibial band syndrome . Step lunges and leg squats can help increase gluteal muscle strength and are prevent excessive hip internal rotation and added stress across the knee and iliotibial band. For athletes that are trying to rehab from IT band syndrome, a gradual approach to strength training of the gluteal muscles is recommended.

Side Leg Lifts

Side leg lifts focus on strengthening the lateral gluteal muscles as well as teaching the athlete the correct muscles to focus on. Side leg lifts are performed lying on the side, with the injured leg on top. Keeping the hip and knee straight, slowly lift the top foot twelve to twenty-four inches directly above the bottom foot.

Hold the position for 5 to 10 seconds and slowly return the leg to the starting position. Focus on using the gluteal muscles and not the lateral thigh muscles to lift the leg. Repeat this exercise 5 to 10 times in sets of 2 or 3.

Hip Hitches (Pelvic Drop) Exercises

Hip hitches or pelvic drop exercises are another method of improving gluteal muscle strength. Stand on a step or elevated platform with the injured leg. The unaffected side should hang off the edge of the step. Slowly relax your hips and the pelvis should tilt down towards the unaffected leg as the foot lowers. Concentrate on contracting the gluteal (buttock) muscles on the standing leg and bring the hips back to a straight position.

Wallbangers

Wallbangers help provide another method of improving gluteal muscle strength. Stand perpendicular and one to two feet away from the wall with the injured hip towards the wall. With arms extended out in front, slowly drop and twist away from the wall until the hip lightly contacts the wall. Don’t hold this position – return to the starting position. As you perform this exercise, you should feel the gluteal muscles in the hip closest to the wall contract as you return to the upright position.

Frontal Plane LungesFrontal plane lunges are another simple exercise that increase gluteal muscle strength. Standing with the feet shoulder-width apart, slowly step to the right and lower the body into a squat position. Shift the body weight from the left to the right leg and rise from the squat position as you bring the left leg back underneath your body. Repeat the exercise in the opposite direction by stepping to the left and repeating the above steps.

Sample Exercise Program

Week 1

Every day – Stretching exercises – Once daily for total of 5 to 10 minutes in each session. Ice as needed after stretching.
Days 1, 3 and 5 – Strength exercises – start with 8 to 10 repetitions and one or two sets. Focus upon proper form.

Week 2

Everyday – Stretching exercises – Twice daily for total of 5 to 10 minutes in each session. Ice as needed after stretching.
Days 1, 2,4 and 5 – Strength exercises – start with 10 to 12 repetitions and two to three sets. Continue to focus upon proper form.

Key Points to Remember for Iliotibial Band Syndrome 

There are several key points to remember with iliotibial band syndrome. The focus should be on stretching of the iliotibial band and strengthening the muscles around the hip since weakness in these muscles often is the primary cause of the injury. Limiting increases in running mileage to approximately 10% weekly can help prevent injuries from “too much, too soon”. Proper stretching after warming up and before cooling down can help prevent re-injury.Sometimes, worn running shoes with poor arch support can lead to excessive pronation of the foot and increased stress on the iliotibal band. Remember that most running shoes last for 300 to 400 miles and need to be replaced. Having an expert at a running shoe store can help in selecting the proper shoe for your foot and running style.

Don’t forget the importance of recovery and moderation in an exercise program. While a little soreness is a sign that your body is adapting to the increased training, pain is your body’s signal to slow down.

Return to Running and Activity

The often-asked question of most runners and endurance athletes is when they can return to running with iliotibial band problems. A gradual return to running can begin once an athlete can perform the exercises without pain. While individual results may vary, most iliotibial band syndrome cases resolve with 4 to 6 weeks of rehabilitation.

A return to running program should focus on proper biomechanics and avoid triggering factors (sloped or uneven surfaces). Studies have shown that faster paced running has less irritation of the iliotibial band due to the flexed position of the knee at foot strike versus slow paced jogging.

We recommend easy and short fast-paced running on alternating days on flat ground for the first week with a gradual return to longer, slower paced runs over the next 2 weeks. Additionally, avoiding downhill running or on sloped surfaces (side of the road) can help prevent re-injury.

The rehab stretches and exercises should continue during the return to running phase of the training program.

Download a pdf version with pictures of the stretches from the Coastal Sports and Wellness website.

Dr. John M. Martinez is a primary care sports medicine doctor and medical director of Coastal Sports & Wellness Medical Center, a sports injury clinic in San Diego, CA.

If you would like to reprint or use this article for educational or free purposes, contact us at http://coastalsportsmedicine.com

This article is for educational purposes and does not replace the need for individual medical examination or treatment by a qualified physician or medical professional.

Copyright 2008