I regret to inform you that I will be closing my practice as of March 1, 2012 because of financial reasons.  I have spent several months struggling to keep the practice going but can no longer support the financial losses.  I will continue to see patients until that time.

Some of you who are not current patients because I have seen you once or twice when Dr. Hrach was away or have moved on but are still in my data base.  I would rather notify extra people than miss a regular patient.  You also may be getting this both by email and regular mail.

I am recommending that my current patients, with the exception of the eating disorder patients, transfer their care to my associate, Dr. Hrach.  Her practice is in the same location and she will have access to all of my records without difficulty. We also have a similar practice style. I am working with the local community at identifying a primary care physician who is has an intense interest in the medical management of eating disorders and in participating in team management and ongoing education.

If you elect to see another physician, you will be able to get a copy (CD) of your records to take with you for a fee of $25.00.  They will continue to be available through this office for several years.

I have enjoyed providing care for you all and will miss seeing you.

Sincerely,

Cynthia Bowers, M.D.

Our office is a little bit different than many since we require that our patients pay at the time of service.  We charge standard Medicare rates and then bill Medicare for you and they will bill any secondary insurance you have.  All of those checks will then be sent to you.  Again, if you are in an HMO plan, you must see a provider that is part of the HMO to receive any reimbursement at all.

We also require a free 10-15 minute “meet and greet” appointment before entering into a relationship to be sure that we are compatible.

If my practice sounds like it might be of interest to you, look at your current supplemental plan and see if you are locked in to specific provider panels.  If so, you have until December 7^thto change plans.  If you are thinking of doing this, I would recommend scheduling a “meet and greet” appt now so you can meet me and see if you want to switch to a plan that accepts me as a provider.  I look forward to meeting you.

People over 50 should also get a pneumonia vaccine and consider getting a shingles vaccine.  Shingles is an illness that can cause severe chronic pain and the recommendations have just been changed from getting the vaccine if you are over 60 to if you are over 50.

Please call and let us know when you are coming in so we are sure we have the appropriate staff to administer the vaccinations.

Also, if you haven’t had your yearly physical and wellness visit, please call and make an appointment.

In the last few years, we have discovered that Pertussis also is a disease of people beyond childhood and, although the illness is less severe, it can both produced a prolonged respiratory illness in adults and can infect babies who have not completed their vaccination series, causing life threatening illness.  Since many parents were either unaware of this problem or not following the recommendation for revaccination, the California secondary schools are requiring documentation of Pertussis Vaccine within the past 10 years for admission to classes in the Fall.  This requirement was sent out last spring and I have given many doses of the DTaP (Diphtheria, Tetanus and acellular Purtussis) vaccine in the last few months.  I still hear concerns about the safety of the vaccine and can assure you that since the original vaccine contained cellular pertussis and the new vaccine contains acellular pertussis, the vaccine is now completely safe.  Just so those of you out there who like to wait until the last minute will know, we have the vaccine in stock and can usually provide it on a same day basis.  Please call the office first (805-898-0500) to be sure that we have someone available to give the vaccination.

Most types of meningitis can be prevented by a safe vaccination which is generally available at out office.  Since it has a short expiration date, we do not keep a large supply on hand and it is best to call ahead to be sure it is in stock or that we can order it.  I vaccinated both of my children before they went to college and would recommend that you do so as well.  We are certain that protection lasts 5 years but are waiting on studies to see if and when boosters are needed.

Why might this be happening?  First, many young people are spending more time on electronic games, computers and watching TV rather than going outside. Secondly, we have all been warned to use sunscreen if we go outside that our bodies can’t make Vitamin D even if we do go outside.  To get enough natural Vitamin D, it is recommended that you spend 20 minutes per day outside without sunscreen.  Lastly, many young people don’t drink enough milk because they are wary of the calories because they are chronically dieting (more on that on my web page).  That leads to both calcium and Vitamin D deficiency.  It is critical that young people get enough calcium and Vitamin D because most of your adult bone is formed during childhood and young adulthood.  Inadequate nutrients will result in lower bone mass and an increased risk if developing osteoporosis later in life.

If you plan to take supplements, you should take between 1,200 and 1,500 mg calcium (best in citrate form) a day along with 400-8—units of Vitamin D, depending on your current levels.  Just remember, it is still best to get your vitamin D the natural way and getting outside also has many other health benefits.

As the crisis grew on a daily basis, the risk to the people of Japan grew, both because of the levels of radiation in the air and its appearance in the food supply and drinking water as far away as Tokyo.  The Japanese government quickly took measures to remove unsafe food and water and gradually increased the area of evacuation.

Some of the radiation released breaks down very quickly but there other isotopes that take years to break down. It is now known that there are large areas where the ground is contaminated with the more dangerous isotopes and there are several cities that will probably never be inhabitable.  The short and long term risks to the workers and inhabitants of the area have not been completely identified.  It is likely that some of the workers will develop radiation sickness and their continued efforts to contain the disaster shows great courage on their part.

The more concerning and unknown variable is the radiation contaminated water that is being pumped into the sea.  Some of that radiation also contains the isotopes that are dangerous.  This is really uncharted territory as no one is sure what ocean currents and dilution effects will have.  Researcher from many countries are both studying and monitoring this.  Current belief is that it will also not have an effect on US waters.  The bigger concern is damage to the ocean wildlife and the fishing industry.  Again, there is no clear answer but, again radiation levels are being monitored to insure that the fish supply is not contaminated and to see if the radiation caused disease in marine life.  It is my understanding that at this time, no food is being imported to the US that could have any possible contamination.

Now , becoming a bit political, the biggest question we are asking is if our own nuclear reactors are safe or if we should even be using nuclear power at all.  From initial inspections, it would appear that we could do a better job of providing more layers of safety in the event of a natural disaster.  Utility companies are currently working to provide those extra layers in our current nuclear facilities.  It is my hope that they will be able to provide that level of safety since one of our national goals is to decrease our dependence on oil.  The BP oil spill last year highlights the environmental dangers of oil production.  There are, of course, other options for producing energy but that technology is far from being widely used.  Much as I know there are many who disagree with me, I do believe that with proper safety measures, we should continue to pursue the use of nuclear energy.  As I know this is a controversial topic, I am interested in other input as long as it provided in an appropriate manner and the commenter identifies him or herself.  After review for language and other derogatory comments, I will post your comments on my blog.

Tips for avoiding influenza include frequent hand washing, avoiding shaking hands and washing your hands if you do.  Avoid touching your eyes.  If someone in your household has influenza, follow the guidelines above.  Also, general good hygiene measures should always be taken.

Most of us have been following the recent health reform debate with both hopes that something meaningful will emerge and concern that we may somehow lose important benefits in the massive stack of fine print.  I would like to offer up some of this Santa Barbara Doctor’s major concerns for you to think about as the latest legislation emerges later this week and welcome comments, opinions and other concerns.

1.       Health care accessibility for as many Americans as possible.  This has always been one of the concerns and in an effort to reduce the costs; it is likely that more people will be left without insurance.

2.       Health insurance exchanges managed by the insurance companies vs. a public health insurance option modeled after Medicare to provide access to small employers and individual subscribers.  This is a tough one depending on one’s politics.  I can see pros and cons on each side.  On one hand, to quote a TV commentator on the subject, “Letting the insurance companies manage the health insurance exchange is like hiring a pyromaniac to be the fire marshal”.  On the other hand, the concern over too much governmental control taking over health care decisions is real.  Frankly, right now the insurance companies generally manage medical decisions much more than the government programs so it is hard to know how to land on that issue, but read on as I get to the Medicare issue and apply the information to the idea of the “public option”.

3.       Medicare coverage.  This is a big concern for the elderly fueled by political rhetoric.  Most of the provisions I find in summaries of the bill actually are an improvement to the current program.  Right now, there are many areas in which Medicare patients can’t find a primary care provider because of the low reimbursement levels and specialists are pretty much free to charge much higher fees.  President Obama’s plan would increase the reimbursement to primary care providers while decreasing payments to specialists.  This would allow access to basic medical care for more elderly people.  My biggest concern about the entire package is that in the last iteration, the federal government would be establishing a new department that would make decisions on what kinds of health care is available to whom (both generally and in specific cases) and there would be no option for appeal.  This effectively takes the medical decision making away from physicians and patients and is opposed by physicians.  Since a public option would be modeled after Medicare, it would come under the same rules.

4.       Costs.  A big factor and are really not known but it appears that the new bill will have a lesser total cost per patient.  Something that is not factored in is the long term decrease in costs because of prevention and earlier intervention.

5.       Prescriptions.  I still have not seen any kind of cost controls on medications.  For many people, this is their highest medical cost, with or without insurance.

I’m sure there are more issues, but these will give you some basics on which to focus.  Comments and opinions are welcome as long as they are civil.