My mum used to often say to me when I was a kid “I have had it up to here” whilst gesturing to her forehead and it’s a good way to explain how I feel and how pain has changed me.

We can all mentally handle a certain amount and that could be dealing with finances, traffic, people, bad news etc. Being in pain means that I struggle daily to keep on going, I am tired and I really honestly actually don’t know how I keep going and pain means that I have already had my fill of what I can handle.

So when I moan or verbally explode over what people perceive as being trivial, it’s because I literally can’t handle anymore, a pint of water isn’t much in a 500 pint container but if that already full than that small amount of water is just going to spill over and that is what happens with me on quite a regular basis.
I totally understand that this must make being around me quite difficult, I know I couldn’t put up with me!

I have tried to address this but the problem is that when I wake up, I wake up in more pain than I would wish on an enemy and already I’m wondering how I’m going to get through another day. I guess the truth is that I don’t get through the day, I crash through it just trying to make it until bedtime, then of course the pain doesn’t stop, I fact it gets worse because there are no distractions at night.
It was last night that I suddenly realised that I am most likely unbearable, yes I have to get through the day coping with pain, but my family have to get through the day with me and that’s without medication.

My grandad died when I was seven, we lived with him and he had a room downstairs in what was the dining room. He wasn’t well and he was grouchy, a treat for me would be to sit with him and watch TV and he would have Old Jamaica Rum chocolate and he would drink Lift lemon tea, to this day that chocolate reminds me of him sat there watching Hawaii Five O on the TV. Even though he was grouchy I have fond memories because he was after all my grandad, but I swore that I wouldn’t be like that with my grandchildren and now I am just like him and I understand why now.

Anxiety and emotional distress also affect tics in an indirect manner, as parents or teachers will alter their child’s environment by accommodating that anxiety—such as allowing the child to leave the room when ticking or not making a child with Tourette syndrome present in front of the class—rather than making children face their fears.

Rather than helping the child, this kind of accommodation actually can reinforce tics, said the study’s lead author Cyd Eaton, a doctoral candidate in clinical psychology in UGA’s Franklin College of Arts and Sciences.

What is helpful is getting the child to use a competing response to combat an oncoming tic, a component of comprehensive behavioral intervention for tics, said study co-author Anna Jones, also a doctoral candidate in clinical psychology.

“For example, if my tic is to shrug my shoulder, then a competing response may be to push the pressure down,” Jones said. “It’s really hard to shrug your shoulder when you’re applying pressure, when you’re pushing down.”

The take-home message of the study, Eaton said, “is that the child’s environment can make a big difference in how they are experiencing tics and having Tourette syndrome. That’s really encouraging because families can really help their kids cope with having this disorder. And it just involves making small changes to their environment and how they interact with the child.”

Health care delivery systems have been intentionally reorganizing to become more patient-centered, which means that patients’ preferences, needs, and values help guide clinical decisions. Integrating mental health and substance use services into primary care settings, also known as behavioral health integration (BHI), is a core component of such efforts. To identify where BHI has been successful and where there is still room for improvement, we should have a clear idea of what BHI is and understand what policies exist or are needed to implement BHI. This issue brief provides an overview of BHI, including how it is defined and why it is important for improving patient care.

This may be THE most important, articulate speech I’ve seen about profound progress in patient power – and why it matters.

This talk by Mark Wilson about OpenAPS, at last Friday’s DiabetesMine D-Data ExChange 2016, contains a metaphor that’s just brilliant, explaining why patients would want to do this. Below the video are a few words for people who don’t yet know what OpenAPS is. (Thank you to Hugo Campos for highlighting this on his Facebook last night – patients spreading the word!) Twenty minutes plus Q&A.

The #OpenAPS movement (Open Artificial Pancreas System) is exploding with articulate patient voices. On this blog we posted twice about it last month from the Quantified Self Public Health event in San Diego and the O’Reilly #OSCON Open Source conference (two talks by Dana Lewis) and last week at the American Diabetes Association conference in New Orleans, for my own blog I interviewed Dana and co-creator Scott Leibrand, and finally met OpenAPS pioneer Ben West … I need to get clear on who did what when!

Industry observers, notice: this is a great big live specimen of what patient experience looks like when patients take the wheel. And notice that it’s not just about a more pleasant “drive” – they’re getting measurably better clinical results.

Eight years ago at the 2008 Connected Health conference in Boston, internet visionary Clay Shirky said “The patients on ACOR don’t need our permission and they don’t need our help.” I never would have imagined that it would go this far, but here we are.

Medicaid is the largest payer of high-cost services like long-term care, MACPAC noted in its June 2016 Report to Congress. The program finances one-third of the country's nursing facilities; and spent $169 billion on long-term supports and services in fiscal year 2012.

That amount added up to roughly 43% of Medicaid's total expenditures for FY 2012, despite just 6.2% of Medicaid beneficiaries needing LTSS, the report found. Those “disproportionate” statistics highlight the importance of functional assessment tools — questions that gather data on beneficiaries' conditions and needs — in determining Medicaid eligibility.

Results from quantitative MRI and neuropsychological testing show unprecedented improvements in ten patients with early Alzheimer’s disease (AD) or its precursors following treatment with a programmatic and personalized therapy. Results from an approach dubbed metabolic enhancement for neurodegeneration are now available online in the journal Aging.

The study, which comes jointly from the Buck Institute for Research on Aging and the UCLA Easton Laboratories for Neurodegenerative Disease Research, is the first to objectively show that memory loss in patients can be reversed, and improvement sustained, using a complex, 36-point therapeutic personalized program that involves comprehensive changes in diet, brain stimulation, exercise, optimization of sleep, specific pharmaceuticals and vitamins, and multiple additional steps that affect brain chemistry.

“All of these patients had either well-defined mild cognitive impairment (MCI), subjective cognitive impairment (SCI) or had been diagnosed with AD before beginning the program,” said author Dale Bredesen, MD, a professor at the Buck Institute and professor at the Easton Laboratories for Neurodegenerative Disease Research at UCLA, who noted that patients who had had to discontinue work were able to return to work and those struggling at their jobs were able to improve their performance. “Follow up testing showed some of the patients going from abnormal to normal.”

The guidelines would put Michigan in line with states like Alabama, Iowa, Kansas, Georgia, Texas, California and Tennessee, all of which have moved to limit practice contact to 90 minutes a week. Ohio and Wisconsin are even more restrictive, limiting full-contact practice to just 60 minutes a week.

There’s just one catch: The guideline is a recommendation only – the official requirement of the Michigan High School Athletic Association still allows six hours of full-contact practice a week. Sports safety advocates and concussion researchers say Michigan should fall in line with other states and make the new, 90-minute guideline a mandate.

Purdue University concussion researcher Larry Leverenz noted to Bridge that repeated studies have shown that potential brain damage in football players is directly tied to the number of blows to the head, whether or not a player suffered a concussion.

“Our research is showing that changes that we are seeing in brain activity are related directly to the number of hits that a person receives to the head,” said Leverenz, a clinical professor in the Department of Health & Kinesiology.

“You can decrease the risk without changing the game. Limiting the amount of hits in practice is one way of doing that.

“It would make sense (in Michigan) to make that a policy,” he said.

Despite interventions by Medicare officials, the number of appeals from health care providers and patients challenging denied claims continues to spiral, increasing the backlog of cases and delaying many decisions well beyond the timeframes set by law, according to a government study released Thursday.

The report from the Government Accountability Office, said the backlog “shows no signs of abating.” It called for the Department of Health and Human Services to improve its oversight of the process and to streamline appeals so that prior decisions are taken into account and repetitive claims are handled more efficiently.

Growing Wait Time

The average wait for a Medicare appeal decision by an administrative law judge has spiraled over the past eight years

Average Processing Time By Fiscal Year

Fiscal Year	Number of Days
FY09	94.9
FY10	109.6
FY11	121.3
FY12	134.5
FY13	220.7
FY14	414.8
FY15	661.1
FY16 Average	819.4
1st Qtr	795.8
2nd Qtr	860.6

Research led by Andreas Bäumler, professor of medical immunology and microbiology at UC Davis Health System, has identified a new mechanism explaining how antibiotics change the gut microbiota, increasing nutrients that benefit the growth of pathogens, like Salmonella.

The research, published June 15 in the journal Nature, is important because changes in the gut microbiota underpin many human diseases and identifying a mechanism responsible for altering microbial communities opens the door to the development of new therapies designed to interrupt the chain of events that give these pathogens a growth advantage after antibiotic treatments.

"Research has traditionally focused on the mechanisms by which antibiotics help control the growth of bacteria or inform the development of new forumulations when bacteria become resistant to existing drugs," Franziska Faber, first author of the study, said. "But our research study is the first to show that Salmonella was able to flourish in the gut after antibiotic treatment because of the increased availability of oxidized sugars."

Gastroenteritis is a common side effect of taking antibiotics. While diarrhea may be mild and clear up after antibiotic therapy is completed, in some cases, it can lead to colitis, an inflammation of the colon, or more serious conditions that cause abdominal pain, fever and bloody diarrhea.

Bäumler's research found that oral antibiotic treatment increased the synthesis of a host enzyme that generates nitric oxide radicals, which can oxidize sugars into sugar acids, such as galactarate, a key driver of Salmonella growth.