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Ask Dr. Nancy: Diabetes

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

My mother is a diabetic and so am I. She recently had a stroke and her physician told her that it was a complication of diabetes. What can I do to help her and to reduce my chances of having a stroke?

If you have diabetes then it’s likely you already have or will develop abnormalities, such as fatty deposits, in your blood vessels. Since functioning blood vessels are necessary for providing every cell in your body with nutrients and oxygen, if the blood vessels can’t deliver, then cells die.

There are two categories of vascular disease: macrovascular (larger blood vessels) and microvascular (smaller blood vessels).

Macrovascular complications: Larger blood vessels keep your heart, brain and legs alive. If blood vessels to the heart become blocked, then a heart attack is the result. This is the most common cause of death for diabetics. Blockage of the blood vessels carrying blood to the brain results in a stroke or series of mini-strokes leading to brain dysfunction. Blockage of the blood vessels going to the legs is the primary cause for amputations in diabetics.

What to do? Control of blood lipids and high blood pressure reduces the risk of macrovascular complications. The best approach is to lose weight through healthy diet and exercise. If that’s not going to happen…..then it’s important to know that a recent study led to a reduction in macrovascular complications in the first year for diabetics (age 55 or older) by over 60% with the use of three drugs: Daily aspirin (less platelet clumping on rough areas in the blood vessels), a generic statin (reduces LDL cholesterol and blood vessel inflammation) and a generic ACE inhibitor (relaxes blood vessels and lowers blood pressure) Taking these three medications was an inexpensive way to substantially reduce the risk of disability and death.

Microvascular complications: Smaller blood vessels go to smaller organs including the eyes, kidneys, and nerves. Blood vessel problems in the back of the eye (the retina) are the leading cause of blindness in people with diabetes. Renal failure leading to dialysis results from small blood vessel damage in the kidneys. Nerve damage leading to chronic pain or numbness, called neuropathy, is caused when the small blood vessels no longer deliver nutrients to the nerves.

What to do? Studies have shown that good glucose control to near normal levels is the best defense against microvascular complications. Again, the best way to accomplish this is to reduce calories in and increase calories out. Burn that sugar! Otherwise there are a number of medications that are prescribed to improve blood glucose levels.

The bad news is that diabetes is reaching epidemic proportions worldwide due in no small part to increased availability of food and reduction in the need to move. Following a healthy lifestyle can keep you out of this unfortunate crowd and reduce risk if you are already part of the diabetic group. In addition, take this article to your physician and ask if you could reduce your risk by the treatments noted above.



New Physical Therapy Program for Those Aching Joints

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Peripheral joint pain (shoulder, elbow, hip and knee) is the second most common reason that North Americans go to see their doctor. Though some people have pain due to a significant trauma, the majority of these problems develop spontaneously or during activity that is considered normal or typical for the individual.

So, what causes most joint pain? Here’s what we know to be true: mechanical factors are the leading cause of painful joints and the most significant mechanical change is the decrease in the ability to move the joint through its full range of motion. This gradual loss of motion begins in the middle age years as a result of the routine movement patterns occurring in our daily activities. Only 50-60% of joint range of motion is utilized during walking, sitting and lying and the other portion of the range of motion is seldom ever used. It’s the lack of movement that tends to start our journey towards stiffness in our joint structures. This change is typically not recognized because most people never pay attention to how well their knee, hip, etc. moves, especially near the end of the range of motion. This is the basis for the adage of "If you don’t use it, you lose it."

So if joint pain develops, should I have an MRI? The problem with imaging is that 60% of people over 50 years old without joint pain have a meniscus tear or torn rotator cuff present on their image. What that means is that these conditions can be present and are often not the cause of pain which leads to confusion and the potential for unnecessary treatment.

Should I have surgery if I develop joint pain? The good news is regardless of the findings on your imaging study or how painful a joint becomes, most people do not require surgery to improve their symptoms. Joint pain can be resolved with end range stretching, strengthening and restoration of joint mechanics. A joint that moves well, through full range of motion are less likely to hurt. Joints that stiffen or lose motion become painful. Scientific studies and clinical trials demonstrate that there are effective methods of management for these problems and have lead to improvements in care for musculoskeletal pain and injury.

CHP in cooperation with The Center for Orthopedic and Sports Physical Therapy (COSPT), has developed the Hip and Knee pilot program to provide additional access to evidence-based therapy for joint pain. COSPT is located at 1834-A Jaclif Court and their phone number is 656-1837. They currently employ 8 physical therapists trained to deliver care for musculoskeletal pain and injury. Ask your PCP if this type of program can be of help in the treatment of your musculoskeletal pain or injury.



When a Virus Attacks Be Careful How You FIght Back

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Antibiotics are not always the answer. Most illnesses, like colds and the flu, are caused by viruses. Unfortunately, antibiotics are not effective against viruses. With this in mind, don’t rush to your doctor the next time you get the sniffles. Chances are your illness is viral and will resolve itself on its own within 10-14 days. Remember, antibiotics are strong medications. Use them only when necessary. This helps them to be fully effective when you need them to be. For more information, go to and search "antibiotics."

Advantage Primetime

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Medicare Advantage (HMO) vs Medicare Supplemental Insurance

At Capital Health Plan, Medicare members are offered Medicare Advantage (HMO) plans. Medicare Advantage plans are different than Medigap (Medicare Supplemental Insurance) plans. This is because we are a Health Maintenance Organization and not a supplement to Original Medicare. Capital Health Plan Medicare Advantage plans actually become your Medicare and provide all of your Medicare coverage. Medicare members wondering if the Medicare Advantage plan is the right choice for them should know the difference between a Medicare Advantage and a Medigap plan.

The Medigap plan is a supplement to Original Medicare. It can help pay some of the costs that Original Medicare does not cover, like copayments, coinsurance, and deductibles. Original Medicare generally pays 80% of the cost of services after meeting deductibles (when they apply). The patient is responsible for the deductible and 20% of the cost. Costs vary by policy and by company. Some prevention services may not be covered. Medigap plans purchased after 2006 do not include prescription drug coverage, so individuals need an additional prescription drug plan or Medicare Part D plan. The Medigap premiums, deductibles, copayments, coinsurance and the extra cost of a prescription drug plan can add up.

Capital Health Plan’s Medicare Advantage plans are an excellent value. There are no deductibles – just copayments or coinsurance to pay. Some services have a $0 copayment. The CHP plans are comprehensive and offer all the benefits of Original Medicare plus MORE. They include prescription drug coverage (Medicare Part D) and wellness benefits not generally covered by supplemental plans. There is no need to worry about primary and secondary payers, no need to file claims or seek reimbursement like there could be with a Medigap plan.

If you have additional questions about the different Medicare plans please call our Member Services department.



High Risk Medications for Patients Aged 65 & Older

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.


Did you know that our bodies begin to respond differently to medications as we get older?

As we age, various changes occur throughout the body. For example, the liver or kidneys may not clear a medication from our system as efficiently as it once did. Likewise, receptors in the body may become more sensitive to certain drugs. These changes have the potential to make us more susceptible to serious and unwanted effects, such as: confusion, depression, falling, and other health consequences. A group of medical experts developed a list of drugs potentially inappropriate for patients aged 65 or older. This list is called the Beer’s Criteria. Some of the drugs are shown below, along with concerns and possible alternatives to these drugs.

Because the risks associated with these medications may outweigh the benefits, talk with your physician about some of the possible alternatives. However, do not stop taking them without first consulting with your doctor.


Generic (Brand) Name Concerns Possible Alternatives

Propoxyphene (Darvocet, Darvon)


Combination no better than acetaminophen (Tylenol) alone, less effective than ibuprofen (e.g. Motrin, Advil), and may cause narcotic adverse effects. FDA revised labeling includes: Black Box warning concerning risk of overdose, a warning of severe adverse reactions, occurring with concomitant use with CNS depressants (including alcohol), and precautions concerning additional susceptibility of this age group to CNS effects.

Mild Pain: acetaminophen (Tylenol), ibuprofen (e.g. Motrin, Advil)

Moderate or servere pain: hydrocodone/acetaminophen, oxycodone/acetaminophen, oxycodone, fentanyl patch

Note: Sudden discontinuation of chronic therapy can result in withdrawal symptoms. Gradual tapering is recommended.

Cyclobenzaprine (Flexeril) Questionable efficacy at doses tolerated by this age group and efficacy past 2-3 weeks is not proven. Can cause sedation, weakness, confusion, drug mouth, urine retention and may increase the risk of falls in this age group. Spasticity: baclofen (Lioresal), tizanidine (Zanaflex)
Hydroxyzine (Atarax, Vistaril) Can cause sedation, confusion, dry mouth, urinary retention and may increase the risk of falls in this age group.

Allergic conditions: fexofenadine (Allegra), cetirizine (Zyrtec), loratidine (Claritin), desloratadine (Clarinex), azelastine (Astelin)

Anxiety: citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft), venlafaxine (Effexor), buspirone (Buspar)

Promethazine (Phenergan) Can cause sedation, confusion, dry mouth, urinary retention and may increase the risk of falls in this age group.

Allergic conditions: fexofenadine (Allegra), cetirizine (Zyrtec), loratidine (Claritin), desloratadine (Clarinex), azelastine (Astelin)

Nausea: ondansetron (Zofran), granisetron (Kytril), dolasetron (Anzemet)

Oral Estrogens (Premarin, Prempro) Carcinogenic potential (breast, endometrial cancer), not cardioprotective in this age group. May increase the incidence of dementia in this age group.

Hot flashes: paroxetine (Paxil), gabapentin (Neurontin), venlafaxine (Effexor)

Bone density: calcium, Vitamin D, alendronate (Fosamax), raloxifene (Evista)



Colon Screening: A Healthy Resolution

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Recently many Americans made a list of New Year’s resolutions. Maybe you committed to improving your health or learning something new. If improving your health was on your list, you might have thought to do that colon check that your friends, family, or doctor have mentioned in the past.

Since the Capital Health Plan Colon Screening Program debuted in 2002, colon screening participation has increased from 48% to 77% in 2009. Make 2010 the year you join the 28,500 members who are current with colon screenings. For some this will mean getting your first screening. For others it will mean updating your participation. But everyone age 50-75 should be screened, and African Americans should begin screening at age 45.

In 2009 Capital Health Plan made colon screening participation easier than ever with a new stool testing kit. Unlike the previous kit, the new stool test is simple and convenient. The test collects only one small sample, and there are no dietary or medication restrictions. Like the old kit, the sample is collected at home. It can be returned by mail or delivered to either CHP location when completed. The results are sent by mail.

Testing stool for non-visible blood is one test for colon cancer screening, but it is also recommended that you have an examination of the colon (flexible sigmoidoscopy or colonoscopy). Please discuss with your primary care physician the test that is best for you based on the risks and benefits.

In order to cross learn something new off that New Year’s resolution list, we encourage you to learn more about your colon health. To help determine how often and how early colon screening should be done, educate yourself on your personal and family history of colon cancer and colon polyps.

Many people are not aware that having a biopsy at the time of a colon exam (which is painless) does not necessarily mean you have a polyp. After the biopsy is done, a pathologist determines the type cells in the biopsied tissue. Often the tissue is simply an area of normal or thickened tissue, and is not a polyp. True polyps are called "adenomas" and have the potential to change into cancer cells. Therefore, people with a personal or close family history of adenomas are at increased risk for colon cancer. It is important to be informed and work with your doctor to determine the colon screening schedule best for you.



National Colorectal Cancer Awareness Month

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

March is National Colorectal Cancer Awareness Month. Although we focus on colon cancer screening year round, the nation makes a particular effort to bring attention to this most important health care issue in March. If you are up to date with screening, get involved by encouraging your friends, family, and neighbors to initiate or update their screening. If you are age 50-75 or an African American age 45-75, call the Colon Screening Program now at 523-7350 to get a stool testing kit, and then consider doing a colon exam this year.



Making It Easy to Get the Care You Need

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

At Capital Health Plan, we strive to make it easy for you to get the care, tests and treatments you need. We continually look for new ways to improve the quality and accessibility of our services. Here are some of the ways that we have worked to make it easy for you to get care:


  • Capital Health Plan’s large network now includes over 125 Primary Care Physicians and over 300 Specialists.
  • Most local participating specialists do not require prior authorization for an appointment.
  • Preventive screenings such as mammograms and colon screenings do not require an authorization prior to the services.
  • Two CHP Eye Care Centers provide vision services when you need it.
  • CHP has a network of over 62,000 participating pharmacies nationwide to make it easy and convenient to fill your prescriptions.
  • When you need immediate care, CHP’s Urgent Care is available by appointment, Monday through Friday from 11am to 10pm, and weekends from 9am to 8pm.
  • CHPConnect allows you access to your medical information and test results 24/7.
  • While traveling outside the service area, CHP provides coverage for emergency services through Blue Cross Blue Shield providers nationwide.
  • Our local Member Services Staff is Available to Assist you and answer your questions.


Ask Your Local Member Services Department

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Capital Health Plan strives to provide our Members with outstanding customer service. We understand how complex the medical and insurance system can be, and we are here to help answer any questions that you may have. This new section of the HealthLine will focus on answering general coverage questions that we receive on a regular basis.


Question: I will be traveling outside of Capital Health Plan’s coverage area for a vacation. What do I do if I become ill or have an injury? Will Capital Health Plan cover this care?

Answer: Your Capital Health Plan benefits include coverage for emergency care or urgently needed care while you are temporarily out of our service area. You do not need to get approval or a referral first from your Primary Care Physician (PCP). If you are given a prescription, you may use one of over 62,000 pharmacies nationwide to fill it using your CHP ID card. Visit and register to locate a participating pharmacy in the area you are in or call Member Services to assist you in locating one. Notify your PCP and Capital Health Plan of the care you received as soon as possible. Follow up care needs to be coordinated through Capital Health Plan’s network of practitioners.

Member Services: Five days a week 8 a.m. – 5 p.m.

850.383.3311 or 800.390.1434

Medicare Member Services: Five days a week 8 a.m.– 8 p.m.

850.523.7441 or 877.247.6512

TTY/ TTD: 850.383.3534 or 800.955.8771



The Secret to Your Health: Your Primary Care Physician

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

One of the most important health care decisions you will ever make is selecting your primary care physician – your health care partner and central coordinator for everything pertaining to your good health. As a Capital Health Plan member, your primary care physician knows you well and provides expert health care advice tailored to your needs. Primary care physicians include family physicians, internal medicine physicians and pediatricians. You have the choice of over 125 primary care physicians across the Capital City region, including practitioners at two CHP medical centers dedicated exclusively to Capital Health Plan members.

Finding the right physician for you is now easier than ever with the Physician Search Tool on Advanced search options allow you to search by a variety categories including specialty, affiliation, and closeness to you. For best results, start with a broad search and add specifications to narrow the results.

  • Check out this NEW feature! The status flag tells you if each physician is accepting new patients. Hover over the flag with your mouse to find out more information.