Rao bulletin 1 June 2016 html edition this bulletin contains the following articles

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NDAA 2017 Update 10 SASC Defense Health Agency Proposal
Calling the military health system slow and inefficient, the Senate Armed Services Committee has proposed eliminating the Army, Navy and Air Force medical commands and folding them into the Defense Health Agency. Under the committee’s draft of the National Defense Authorization Act, the military medical commands would be absorbed into the DHA. The service surgeons general would become advisers to the service chiefs and secretaries as well as the Defense Health Agency, while DHA, led by a three-star, would oversee four two-star organizations: military treatment facilities, personnel and training; current DHA duties; and medical force readiness.
Senators said the current structure, with more than 12,000 military and civilian employees, has “failed to recognize and rapidly correct systemic problems in health care delivery.” “The committee believes that the current inefficient organizational structure … paralyzes rapid decision-making and stifles innovation in producing a modern health care system,” members wrote in the report accompanying the bill, S 2943. The proposal to dismantle the three military medical commands and create a single one has been the topic of debate since the end of World War II, when Gen. Dwight D. Eisenhower first pitched it. More than 15 studies have been done on the topic since, with GAO in 2011 finding that the Defense Department could save from $281 million to $460 million annually by reorganizing medical commands and consolidating common functions.
But that review was done before a DoD task force released its recommendations on reforming the military health system, a two-year effort that resulted in the establishment of the DHA, which oversees core functions like Tricare management, information technology, pharmacy services, training and education, and more. The Pentagon estimates DHA saved the department $236 million in the first two years of operation. A blue-ribbon commission last year recommended a revision of the military health system to include a broad four-star “Joint Readiness Command” with a subordinate unified joint medical command. Group members argued that the proposal would help preserve the combat medical capabilities achieved in the past 15 years of war.
The House version of the defense policy bill also calls for reorganizing the military health system but falls short of abolishing the military medical commands. Instead, it would place military health facilities under the administration of the Defense Health Agency, with the three service surgeons general being responsible for command of military medical personnel, medical readiness, manpower, training and equipment. Since the DoD task force report was released in 2012, the military services have sought to preserve medical capabilities unique to their departments — skills and services that medical leaders say has contributed to the lowest case fatality rate of any U.S. war. Earlier this year, Army Surgeon General Lt. Gen. Nadja West warned against extreme proposals to reform the system. “Reforms must not degrade our combat-tested system or readiness in an environment where we must remain rotationally focused and surge-ready [because] the next large-scale deployment could be tomorrow,” West told a Senate Armed Services subcommittee. [Source: Military Times | Patricia Kime | May 23, 2016 ++]
TRDP Update 18 Program Eligibility Includes "Gray Area" Retirees
TheEnhanced TRICARE Retiree Dental Program is available to all military retirees (including gray area retirees) and their eligible family members, un-remarried surviving spouses and their eligible children, as well as MOH recipients and their eligible immediate family members. The program covers cleanings, exams, fillings, root canals, gum surgery, oral surgery and dental accidents on the first day that coverage becomes effective; after 12 months of being in the program, it then covers crowns, bridges, partials, braces and dental implants. (New retirees who enroll within four months after retirement from the Uniformed Services or transfer to Retired Reserve status are eligible to waive the 12-month waiting period for major services; supporting documentation is required)
The Enhanced TRDP provides every enrollee an annual maximum of $1,300 per person, a $1200 annual maximum for dental accidents and a $1750 lifetime maximum for orthodontics. It is important to note that the money that the TRDP pays out for preventive and diagnostic services doesn't count against the annual maximum – those benefits are in addition to the $1300. Retirees can find more information on the program, as well as enroll 24/7/365, online by visiting trdp.org.
TRDP enrollees realize the maximum program savings (an average of 22%) when seeing a network provider. To find a network provider, as well as utilize the Consumer Toolkit to view processed claims, see annual maximum information, sign up to receive paperless EOBs and more, visit www.trdp.org . You can also obtain more information by contacting Doug Schobel at Dschobel@delta.org. [Source: TRDP Press Release |13 May 2016 ++
UV-A Radiation Car Window Protection
Even if your car windows are closed and tinted, they may fail to protect your skin or eyes from the sun’s harmful ultraviolet rays. New research, published online 12 MAY in the journal JAMA Ophthalmology, shows that side windows offer significantly less protection from UV-A rays than windshields provide. The research was conducted by eye surgeon Dr. Brian S. Boxer Wachler of the Boxer Wachler Vision Institute in Beverly Hills, California. The study involved 29 automobiles from 15 manufacturers. The vehicles’ years ranged from 1990 to 2014, with 2010 being the average year. Boxer Wachler analyzed these vehicles by measuring the level of UV-A radiation:

  • Outside

  • Behind the front windshield

  • Behind the driver’s side window


Here’s what he found:

  • The front windshields blocked 95 percent to 98 percent of UV-A radiation, with 96 percent being the average amount blocked.

  • The side windows blocked 44 percent to 96 percent of UV-A radiation, with 71 percent being the average amount blocked.

  • Only four of the 29 vehicles’ side windows (14 percent) blocked what the study considered “a high level” (90 percent of more) of UV-A radiation.

  • Windshields offer greater protection because, unlike side windows, they are made from two planes of glass, the study explains. Between a windshield’s glass planes is a layer of plastic to make the windshield shatterproof, and most of the UV-A protection is in that plastic layer.

These results may in part explain the reported increased rates of cataract in left eyes and left-sided facial skin cancer. Cumulative UV-A exposure is “a significant risk factor for skin cancer,” according to the study. Multiple studies have found that skin cancer is more common on the left side of the face in countries where cars are driven on the right side of the road. A study from Australia, where cars are driven on the left, found that skin cancers are more common on the right side of the face. Dr. Doris Day, a dermatologist and skin cancer expert at Lenox Hill Hospital in New York City, tells HealthDay that UV-A rays can be especially dangerous: “While UV-B is a shorter wavelength of light and is blocked by glass, UV-A is longer and goes deeper into the skin — causing both skin cancer and premature aging as it breaks down collagen. UV-A also goes through glass, making it a potential issue for those who have daily commutes or spend extended periods in the car.” [Source: MoneyTalksNews | Karla Bowsher | May 13, 2016 ++]

TRICARE Help Q&A 160515

(Q) I am writing this on behalf of my retired Air Force father. He has Medicare as his primary insurance and Tricare for Life as secondary insurance. His question is: Does Tricare cover any long-term care expenditures other than co-pay for skilled nursing facility?
A. As you mentioned, Tricare covers skilled nursing care for beneficiaries living in the United States and U.S. territories. This type of care — live-in care usually required after a hospital stay — provides nursing and rehabilitative services until a patient is able to return home or to a family’s care. Tricare does not cover what many people usually think of as “long-term care,” like a nursing home or assisted living facility. But it does cover some forms of long-term care, to include durable medical equipment when prescribed by a doctor, home health care and hospice care.
Regarding in-home care, Tricare covers part-time and intermittent skilled nursing care; home health aide services; physical, speech and occupational therapy; and medical social services — basically the same in-home services covered under Medicare. But you must obtain prior authorization from Tricare and may be charged separately for certain types of equipment and medications. Hospice care, including continuous home care, general hospice inpatient care, inpatient respite care and routine home care, also is covered. For more details, contact the Tricare for Life contractor, Wisconsin Physician Services, at 866-773-0404.

(Q) Will any of the Tricare managed care plans be subject to the Affordable Care Act’s “Cadillac Tax” in the future? I understand the health benefits are pretty robust.
A. The term “Cadillac” to describe an Affordable Care Act tax to be levied on insurers in 2018 refers to the cost of high-priced insurance policies, not the benefits and treatments provided by individual insurance plans. The tax is a 40 percent excise to be paid by insurers who charge beneficiaries more than $10,200 for an individual annual premium or $27,500 for a family. It is designed to discourage companies from offering high-cost health plans to employees as they trim their spending on plans to get under the excise tax cap. While military beneficiaries are required to carry health insurance under the Patient Protection and Affordable Care Act, much of the law does not apply to Tricare, under the law itself and restated in the Tricare Affirmation Act signed in 2010. Still, none of the Tricare plans would meet the Cadillac tax threshold.
Have a question for the TRICARE Help column. Send it to tricarehelp@militarytimes.com and include the word “Tricare” in the subject line. Do not attach files. [Source: MilitaryTimes | 15 thru 31 May 2016
Penis Transplant Groundbreaking Operation Could Help Some Vets
A 64-year-old cancer patient has received the nation's first penis transplant, a groundbreaking operation that may also help accident victims and some of the many U.S. veterans maimed by roadside bombs. In a case that represents the latest frontier in the growing field of reconstructive transplants, Thomas Manning of Halifax, Massachusetts, is faring well after the 15-hour operation last week, Massachusetts General Hospital said 16 MAY. His doctors said they are cautiously optimistic that Manning eventually will be able to urinate normally and function sexually again for the first time since aggressive penile cancer led to the amputation of his genitals in 2012. They said his psychological state will play a big role in his recovery. "Emotionally he's doing amazing. I'm really impressed with how he's handling things. He's just a positive person," Dr. Curtis Cetrulo, who was among the lead surgeons on a team of more than 50, said at a news conference. "He wants to be whole again. He does not want to be in the shadows."
Manning, who is single, did not appear at the news conference but said in a statement: "Today I begin a new chapter filled with personal hope and hope for others who have suffered genital injuries. In sharing this success with all of you, it is my hope we can usher in a bright future for this type of transplantation." The identity of the deceased donor was not released. In Boston, Cetrulo said the transplanted penis has good blood flow and so far shows no signs of rejection. He said that Manning should be released from the hospital soon, and that the surgery had three aims: ensuring the transplanted penis looks natural, is capable of normal urination — which he hopes will resume in a few weeks — and eventually normal sexual function. Reproduction won't be possible, he said, since Manning did not receive new testes.

Thomas Mannig gives a thumbs up on 13 MAY after being asked how he was

feeling following his penis transplant.

The operation is highly experimental — only one other patient, in South Africa, has a transplanted penis. But four additional hospitals around the country have permission from the United Network for Organ Sharing, which oversees the nation's transplant system, to attempt the delicate surgery. The loss of a penis, whether from cancer, accident or war injury, is emotionally traumatic, affecting urination, sexual intimacy and the ability to conceive a child. Many patients suffer in silence because of the stigma their injuries sometimes carry; Cetrulo said many become isolated and despondent. Unlike traditional life-saving transplants of hearts, kidneys or livers, reconstructive transplants are done to improve quality of life. And while a penis transplant may sound radical, it follows transplants of faces, hands and even the uterus. "This is a logical next step," said Dr. W. P. Andrew Lee, chairman of plastic and reconstructive surgery at Johns Hopkins University School of Medicine.

His hospital is preparing for a penis transplant in a wounded veteran soon, and Lee said this new field is important for "people who want to feel whole again after the loss of important body parts." Still, candidates face some serious risks: rejection of the tissue, and side effects from the anti-rejection drugs that must be taken for life. Doctors are working to reduce the medication needed. Penis transplants have generated intense interest among veterans from Iraq and Afghanistan, but they will require more extensive surgery since their injuries, often from roadside bombs, tend to be more extensive, with damage to blood vessels, nerves and pelvic tissue that also will need repair, Lee noted. The Department of Defense Trauma Registry has recorded 1,367 male service members who survived with genitourinary injuries between 2001 and 2013. It's not clear how many victims lost all or part of the penis.
A man in China received a penis transplant in 2005. But doctors said he asked them to remove his new organ two weeks later because he and his wife were having psychological problems. In December 2014, a 21-year-old man in South Africa whose penis had been amputated following complications from circumcision in his late teens received a transplant. Dr. Andre van der Merwe of the University of Stellenbosch told The Associated Press that the man is healthy, has normal sexual function and was able to conceive, although the baby was stillborn. But his recovery was difficult, with blood clots and infections, the doctor said. For congenital abnormalities or transgender surgery, doctors can fashion the form of a penis from a patient's own skin, using implants to achieve erection. But transplanting a functional penis requires connecting tiny blood vessels and nerves.
A bigger challenge than the surgery itself is finding donor organs. "People are still reluctant to donate," van der Merwe said. "There are huge psychological issues about donating your relative's penis." In the U.S., people or their families who agree to donate organs such as the heart or lung must be asked separately about also donating a penis, hand or other body part, said Dr. Scott Levin, a hand transplant surgeon at the University of Pennsylvania and vice chairman of UNOS' committee on reconstructive transplants. [Source: AP | Philip Marcelo & Lauran Neergaard, May 16, 2016 ++]
Blood Pressure Guidelines Update 03 Potato Consumption
Eating too many potatoes might be bad for your blood pressure. The results of a study published in the medical journal BMJ this week suggest that eating four or more servings of potatoes or french fries per week is associated with an increased risk of hypertension, or high blood pressure. Specifically, when compared with eating less than one serving per month, researchers found these increased risks associated with eating four or more servings per week of:

  • Baked potatoes –11 percent higher

  • Boiled potatoes — 11 percent higher

  • Mashed potatoes — 11 percent higher

  • French fries — 17 percent higher

  • Potato chips were not found to be associated with an increased risk of high blood pressure.

The researchers also found that replacing one serving of baked, boiled or mashed potatoes per day with one serving of a non-starchy vegetable was associated with a decreased risk of high blood pressure. The study was based on data on more than 187,000 men and women who had taken part in three large U.S. studies over a period of more than 20 years. Their diets were assessed with questionnaires and their blood pressure levels were based on professional diagnoses. The researchers, based in Boston at Brigham and Women’s Hospital and Harvard Medical School, took several other risk factors for high blood pressure into account before coming to the conclusion linking potatoes to an increased risk of high blood pressure.
The authors note that such an observational study has limitations and is not proof of a direct cause-and-effect relationship between potatoes and high blood pressure risk. Instead, it only finds an association between the two. Still, the authors conclude the study by noting: These findings have potentially important public health ramifications, as they do not support a potential benefit from the inclusion of potatoes as vegetables in government food programs but instead support a harmful effect that is consistent with adverse effects of high carbohydrate intakes seen in controlled feeding studies.
According to a news release from health care information provider BMJ, potatoes were recently included as vegetables in the federal government’s healthy meals programs due to their high potassium content. One possible explanation for the connection between potatoes and hypertension, according to the researchers, is that potatoes have a high glycemic index compared to other vegetables. Foods with a higher glycemic index can trigger a steeper rise in blood sugar levels.
You can look up the glycemic index of common foods on Harvard Medical School’s website www.health.harvard.edu/diseases-and-conditions/glycemic_index_and_glycemic_load_for_100_foods and learn more about glycemic index in general on the American Diabetes Association’s website http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/glycemic-index-and-diabetes.html?referrer=http://www.moneytalksnews.com/eating-potatoes-might-raise-your-blood-pressure/ [Source: MoneyTalksNews | Karla Bowsher | May 19, 2016 ++]
Osseointegration Titanium Rod Implantation for Amputees
Good health hasn't been with one Iraq War Veteran. Because of complications from a war injury, Sgt. Justin Anderson had to have his left leg amputated in 2014. Months after the amputation, Anderson received a brain cancer diagnosis. Now one year into remission, Anderson is receiving some good news when it comes to his health. Next week Anderson will be flying to Australia to have a medical procedure only about two dozen Americans have had.
http://mediaassets.kmtv.com/photo/2016/05/20/iraq_war_veteran_heads_to_sydney__austra_0_38661500_ver1.0_320_240.jpg x-ray
Anderson enlisted in the army before September 11th, but the day’s events didn’t deter him from his decision. “It just made me even more motivated to go serve my country and do my due diligence,” said Anderson. After boot camp Anderson took part in the initial invasion of Operation Iraqi Freedom. In June of 2003, Anderson was shot by the enemy. “I took a gunshot wound to my left knee and then had some shrapnel injury to my lower back,” said Anderson. A few months later Sgt. Justin Anderson was honorably discharged. “I had a total of 14 surgeries over ten years just to try to save my limb,” said Anderson. Two year ago Anderson’s left leg had to be amputated above the knee.
When KMTV caught up with the veteran in 2014, amputation wasn’t stopping him from being active. A Nebraska winter can’t even slow the veteran. In January, Anderson’s snowplow wheelchair turned him into a viral sensation. So when Anderson began experiencing painful irritation because of the socket he had to wear over his stump, you better believe he found a way to win that battle. “I will be undergoing surgery on June 1st of this year in Sydney, Australia,” said Anderson. Anderson is the first Iraq War Veteran to undergo Osseointegration, a procedure not yet approved in the US. A titanium rod will be implanted into Anderson’s femur. That rod will protrude about three inches out of his stump and act as an adaptor for his prosthetic leg. “I can just click into my leg and go, I don't have to rely on my crutches, my wheelchair or my walker,” said Anderson.
Coincidentally the doctor behind the breakthrough medical procedure is an Iraqi refugee. “This technology is proprietary to him,” said Anderson. Dr. Munjed Al Muderis fled to Australia to get away from Saddam Hussein’s regime. Anderson hopes one day Dr. Muderis can bring the advanced technology to the United States to help other veterans change their lives for the better. “It’s really going to transform everything,” said Anderson. Anderson will be in Australia for five weeks after surgery. Refer to http://www.osseointegrationaustralia.com.au for more on the procedure which will cost close to $80,000. Anderson says a major chunk of that is paid for by insurance, but he still has many medical bills to pay for. A GoFundMe account has been set up for Anderson and can be found at https://www.gofundme.com/gulg5g. [Source: CBS KMTV 3 Omaha NE | May 19, 2016 ++]

* Finances *

Saving Money Buying Used | 10 No-No’s
Buying used items is one of the top ways to consistently save money on everything you purchase. However, not every used item is a good value. Here are 10 things we think are better when bought new.
1. Cribs – Back in 2011, the government changed safety standards for baby cribs in response to infant deaths related to old designs. Whereas drop-side cribs used to be common, they are now banned. Plus, the new rules require stronger supports and hardware. The problem with buying a used crib is the chance you might end up with one of the millions that have been recalled. It may be easy to avoid drop-side cribs, but unless the seller can provide the original sales information, you may not know whether your purchase meets the new safety requirements. Better safe than sorry. Skip the used crib and invest in a new, safer one.
2. Car seats – Another no-no when it comes to buying used. Again, safety is the reason. A used car seat could have been in an accident or exposed to extreme elements, either of which could compromise the seat’s durability. In addition, older seats may not be made to the latest safety standards. You could save a few bucks and get a used seat or spend a little more and give your child the best protection possible. If you can’t afford a new seat, contact your local social services agency or community wellness organization. They may have leads on programs offering free or low-cost car seats.
3. Helmets – Again a safety issue. This could be a helmet for a bike or a helmet for a motorcycle. Here, the main concern with buying used is that the helmet could be compromised from a previous accident. Play it safe and purchase yours new.
4. Computers – A used computer is a giant question mark. You don’t necessarily know how it’s been used, and unless you’re tech-savvy, you might not be able to see what programs are lurking on the hard drive. Laptops, in particular, are prone to all sorts of abuse, from being banged around in a bag to being dropped on the ground. There is one exception when it comes to buying used computers and laptops: We’re talking about buying refurbished computers. These are either used or open-box items that have been inspected and cleared for resale. Buying refurbished items can be a safe way to get a bargain on used electronics. You can learn more at http://www.moneytalksnews.com/refurbished-electronics-101-how-save-50-percent .
5. Digital cameras – Like laptops, a second-hand digital camera may not only be used, it could also have been abused. It’s hard to look at one and determine how well its previous owner cared for it. If you just need a basic point-and-click camera or video recorder, new models aren’t all that expensive. Or you could just use your smartphone and skip the expense completely.
6. Shoes – If you’re interested in having comfy feet and minimizing back pain, you might want to skip past the used shoe section at the thrift store. Shoes often conform to their first owner’s feet, which can make them uncomfortable for you.
7. Makeup – You can find used mascara, lipstick and eye shadow at thrift stores, garage sales and on eBay. There’s even a Reddit makeup exchange board at https://www.reddit.com/r/makeupexchange for people to swap their barely used cosmetics. Used makeup can be a completely harmless bargain — or it might contain scary bacteria or spread disease. It’s not worth the risk, and you’re better off buying your beauty products new.
8. Mattresses – Like shoes, mattresses tend to conform to the bodies of their users. Buying used might mean you end up with a lumpy bed that leaves you tossing and turning all night long. Even worse, a used mattress can harbor all sorts of nasty things like allergens, dust mites and bed bugs. In some cases, retailers may try to pass off used mattresses as new ones. The Federal Trade Commission has some tips help you avoid inadvertently buying a used mattress that has been recovered at https://www.consumer.ftc.gov/articles/0099-shopping-used-mattresses
9. Stuffed animals – Stuffed animals are another item that can contain dust mites and allergens. In addition, some animals may have safety issues, such as eyes that pop off and become a choking hazard. Buying used means you can end up with a toy that has been recalled or one that harbors unpleasantness that you may not want to bring into your house.
10. Underwear – Your call on the “eww factor.” Some people might be concerned that used underwear may carry bacteria or germs, but I’m not convinced it’s anything that can’t be killed with a hot water wash and bleach. The bigger question is why would you want to wear someone else’s stretched out, used undies when so many stores will sell you a new pack for $10? All except the most destitute among us can certainly scrounge up that much money. You’re worth the luxury of spending $10 once a year on new underwear.
Source: MoneyTalksNews | Maryalene LaPonsie | May 12, 2016 ++]
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