Dr. Kevin Most: Sharing colds, ACA, and Headaches

Dr. Kevin Most

It may seem to you that you are having more and more headaches lately is it due to stress? Falls ? Or just watching the news. Well lets discuss headaches and some of the news that may be causing them.

Headaches are extremely common, in fact it would be very unusual if anyone listening now has never had a headache. The spectrum of headaches is wide, from the simple headache, the migraine headache and the trauma headache. Each is an inconvenience but how do we know which goes beyond just that simple headache and can be more severe or concerning.

Let’s take the headache from trauma today, we have all fell and struck our heads and ended up with a headache. But how do we know which ones to be concerned about. A few simple rules, if the individual lost consciousness from the fall, that individual needs to be seen and evaluated immediately. Don’t just put that person to bed and tell them to sleep it off. A blow to the head hard enough to knock you out deserves the evaluation from a doctor and the emergency room is the place for this.

Now I am sure we all remember playing football as kids and we hit heads and you saw stars but did not black out. Blows like this are in that grey area, was it a concussion, very possibly. Does every concussion need to be seen by a physician? Well I can assure you that many of them are not. The big issues with concussions are to not to get a second one before the first has healed. When we think of football players they used to “get their bell rung” and sit out a play or two then go back in and play more, these are the individuals who are having long term problems.

So not so much about concussions but when you or a family member hit their head, what should you do? Do you need to go to the ER every time? It is difficult to decide what to do. Well lets take a few simple things to consider. If the individual is older and taking any blood thinners, that person should be seen in the ER. If the individual complains of any neck discomfort when falling, do not move that patient and call 911. The patient who falls and has neck pain should be moved by professionals as it can be a fracture in the neck that needs to be handled very carefully.

If the individual gets up and said they saw “stars” or complains of a headache following a fall, some early monitoring can be done at home as long as the patient remembers the incident and is acting appropriately. Is their gait and coordination OK, is there vision OK? Are their pupils equal? Are they bleeding ? Speech normal? A quick review can be done in a few seconds to rate how serious it generally appears to be.

Asking some simple questions, name, age Birthday, who is the president, what day is it, what is your address, where do you work, what is the name of your pet, simple math questions. All questions they should be able to answer quickly and accurately.

If they can’t or they have physical signs that are concerning – they go to the ER, not the Urgent Care. They may need imaging that is not found in the Urgent care setting.

Individuals who have a headache but are moving around ok and appear to be thinking and moving normally may be monitored at home. Those individuals should be closely monitored with frequent checks. Asking them the same questions and looking for consistent correct answers. Monitoring their physical activity as being normal and no throwing up. An individual with a head injury that throws up is concerning for us. Symptoms to be concerned about, confusion, inability to answer simple questions, not remembering the incident, any motor skill issues and any headache that is continuing to worsen.

What about medication? Giving the individual Tylenol or motrin is fine, do not give them one of the old pain meds you saved from your dental surgery. We want to help the headache but not block some of the signs we would be looking for, so nothing stronger than OTC meds.

Often these individuals will want to sleep following that injury, short segments of sleep are fine as long as you are waking them every 2-3 hours to check on their status and making sure nothing is getting worse. The first 12 hours are the most important, but some signs of concussion may not show up for a few days. The most important thing is to not put them back in a position when they could strike their head again.

If you find yourself having a headache while watching TV, I suggest a few things, one is to turn off the TV and get outside, if you can’t get out and want to watch TV, turn off the news channels and watch a movie. All of the talk about the new health law is causing angst and headaches in many of us. We can go thru a few of the proposal but understand that they are changing everyday.

So what are the biggest concerns.

Guaranteed coverage for people with preexisting conditions would remain, insurers would not be able to turn away individuals with medical conditions.

Pretty much everything else has some changes, some minor some major.

One of the biggest is that we have no idea of the numbers behind this bill. We don’t know how many people will lose their coverage, although estimates are quite high. We also do not know how much this will cost. The individual mandate being removed and replaced by a surcharge for those who do not get coverage appears to be flawed from an actuary view. We all know how insurance works , we pay in with the hopes that we never need to use it. The individual who pays in and does not use it allows for those who need it to tap into the reserve to pay their bills and in the end game there is enough money left over for the Insurance company to make a reasonable profit while paying for the care its members need.

We all saw the impact of the enforcement of the mandate for the first few years, as the fine was low, the healthy did not jump in. As the fine approached the amount of the annual premium we saw more get in. The bad thing is that the insurance companies did not gage the numbers well and lost large amounts of money in the first 2 years, this required the rates to skyrocket this year. If the individual mandate is cancelled and the penalty is a 30% surcharge we may see the healthy individuals once again coming off the insurance lists which will again place a large financial burden on the insurance companies with the risk of more dropping out or raising premiums higher.

The allowance to raise the contributions to your Health Savings Accounts may sound good to some but the portion of the population we are concerned about does not have additional funds to put in these accounts, many are living check to check.

The restructuring of Medicaid is probably the biggest concern as it impacts our most vulnerable populations. The per capita cap is concerning to patients and to care givers as well, it certainly appears to eliminate or minimize coverage to many and again place the burden back on the hospital where those without insurance will turn for care. Now I am not a cynic, but giving the state of Illinois a pile of money to manage their Medicaid participants without a Federal backstop does not sound like a good idea to me. Currently Medicaid works like regular insurance but at very low rates to hospitals and doctors. The new plan will force states to manage these patients as the state will now be at risk for utilization. There is also the risk that physicians decide to not care for Medicaid patients at all.

If we see a shift of doctors away from Medicaid we will see more patients in the ER for care, as they may not have anywhere to turn. The ER is not the place to treat high blood pressure, diabetes, arthritis …. This care should be provided in the Primary care office more efficiently and with much lower cost.

There is also the concerns about the subsidies and tax credits, This new plan links subsidy to age where the previous ACA linked it to income. For the AHCA, individuals who don’t get insurance from their employers would qualify for a tax credit based on their age. This does bring a risk that those younger individuals with lower incomes may not have enough financial aid to afford insurance, especially as we have seen the premiums rise dramatically.

There are other small items that are not hitting the headlines that will still have a great impact on our health. For example the new bill would cut one billion dollars from the Center for Disease Control for its work on infection control. This is the fund that protects us from bioterrorism and emerging outbreaks, think Zika and Ebola.