Talking Money with Your Doctor: Drugs and Tests for LessWritten by Gary Cordingley
Would you buy groceries without knowing their prices? I suspect not. You probably compare costs of different boxes of cereal in order to get best deal. But when it comes to medical care, do you even ask for prices involved?
While it's true that good health is priceless, and cutting corners on health care is risky, there is still much you can do in order to obtain same good value in medical care that you insist upon in other areas of your life.
If you lack a prescription plan that pays for your medications, it's high time you discussed cost of drugs with your doctor. Your doctor's number-one choice in medication for your medical condition might be expensive. There are usually reasonable alternatives that cost less. You should take advantage of your doctor's expertise in estimating trade-offs involved with each of your options.
Apart from prices, your doctor is already balancing a number of important factors in making a drug recommendation. First, of course, drug needs to be medically effective—otherwise, why bother? The doctor also takes into consideration what other medications you are taking, what other illnesses you have, your age, your gender, drug's side-effect spectrum, and also its convenience aspects, like how many times per day it has to be taken and whether or not blood-tests are required to monitor it. A drug that might score high on effectiveness and side-effects might still be inconvenient. An alterative might be both convenient and effective, but pose a higher risk of side-effects.
So truth of matter is that your doctor is already sorting through all sorts of trade-offs in choosing a medication to prescribe. Factoring in prices of alternative drugs just builds on comparing-apples-to-oranges process you are paying your doctor to do for you in first place. But if doctor doesn't know that you lack a prescription plan, he or she might not include cost of drugs in these reckonings and you might be stuck with a prescription that wrecks your budget.
The next step in obtaining maximum value for your investment in medication is to shop it around. Let your fingers do walking by phoning several pharmacies for a price-check. I even write out a script for my shy patients who get nervous when they talk to medical personnel. It goes something like this: "Hi, I'd like to do a price-check on my prescription medication. How much would it cost to buy thirty furosemide 20 milligram (or whatever) pills? Thank you very much. Have a great day!"
CT and MRI Scans in Neurological Practice: A Quick OverviewWritten by Gary Cordingley
Before computed tomographic (CT) scans became available in 1970s, there was no good method for imaging brain. The available methods and technologies struck around target without quite hitting bull's-eye.
We had skull x-rays which imaged bony brain-case, but not brain itself. We had arteriograms which imaged insides of blood-vessels supplying brain. We had nuclear brain scans which imaged chunks of brain that were recently damaged. We had a particularly nasty test called a pneumoencephalogram (PEG) in which doctor squirted air through a spinal tap needle and encouraged it to bubble around and inside brain by turning patient every which-a-way—including upside-down—while x-ray pictures showed where air could and couldn't go. Finally, most accurate method was not a physical picture at all, but a mind's-eye picture within brain of an examining neurologist. Yet diagnoses still got made and patients did get treated.
CT scans revolutionized practice of neurology. It's not that other methods disappeared (well, yes, PEGs thankfully did disappear) but that CT scans vastly improved accuracy of diagnosis and treatment. Even when CT scans didn't show disease itself (e.g. multiple sclerosis or a fresh stroke) they assisted diagnostic process by proving absence of a brain tumor, abscess or hemorrhage that were also on list of diagnostic possibilities.
CT scans did (and still do) this by sending x-ray beams through head at various angles and collecting x-ray beams on opposite side that were not absorbed by head. Then magic occurs. A series of images appear on a computer monitor or on x-ray film as if head had been run through a giant salami-cutter and slices were laid out flat and in sequence.
On CT pictures different parts of head are displayed in various shades of gray according to how much they absorb x-rays. The skull-bone absorbs x-rays most and shows as whitest component. At other end of gray-scale, watery spaces in and around brain absorb x-rays least and show as blackest components. The brain itself is somewhere in between, showing up in mid-gray range. Abnormal components, like brain tumors and blood-collections, are identified not just by appearing in their own shades of gray, but also by their locations and shapes. Creating a second set of slices after patient receives an infusion of intravenous dye provides an additional dimension to imaging not unlike that provided by older, nuclear scans.
Then in 1980s magnetic resonance imaging (MRI) scans burst upon scene and astonished medical community by not just imaging brain itself, but by doing so in a brand-new way. Instead of imaging extent to which head's different components absorb x-rays, MRIs instead focus on water-molecules. To be more precise, MRIs image rate at which spinning hydrogen-atoms of water molecules within different parts of brain either line-up or fall out or alignment with a strong magnetic field. These differing rates of magnetization or de-magnetization are fed into a computer. Then magic occurs yet again. A series of slice-like images is created and displayed on a computer-screen or x-ray-type film in shades of gray. Abnormal structures, like brain-tumors or plaques of multiple sclerosis, are displayed in their own shades of gray and are also recognizable by their shapes and locations. Obtaining another set of images after intravenous administration of gadolinium—the MRI equivalent of x-ray dye—also adds diagnostic information.