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Ask Dr. Nancy: Important information about prescription drugs

Note: This article is over 60 days old, and may contain information that is out of date, or has been superseded by newer information.

Question:How can I improve the benefits of my prescription drugs while reducing the risks?

Answer: In the last 25 years, we’ve seen a major increase in the number of drugs available to us. There are many obvious advantages to that availability, but one negative effect is that we expect there to be an effective pill for every condition. What we may not realize is not all pills are effective for everyone, many carry side effects that can outweigh their advantages, or many may simply control the adverse results of an unhealthy lifestyle rather than address underlying issues with diet and exercise.  To make informed decisions about your medical care, here are some things you should keep in mind about prescription drugs.  

Most medications are tested in young, healthy people who are not on other drugs. The effectiveness and safety of a drug is very different, for example, when taken by an elderly person with tired kidneys who is also taking six other drugs.

The problem is that over time, multiple doctors can continue to prescribe you medications without considering your total health picture. Some may be for symptoms which are bothersome but not life threatening. Those drugs may cause side effects and you may be prescribed more drugs to reduce the side effects.  You may be reluctant to stop any medication once you start it. And that can all add up to a real mess.  

Being proactive and knowledgeable about your prescriptions is very important in the event of a hospital stay. Let’s say you have an emergency and go to the hospital. Hospital

staff will try to find out what medications you are taking. If you or your family members don’t know the names and dosages of your medications, it can be hard for them to give you the best medical care. 

More complications can come when you are released from the hospital. Nurses try to reconcile medications you were taking before you went into the hospital with any new prescriptions from your hospital visit. They will develop a list and give it to you with instructions. You may be overwhelmed by all the new information. Make an appointment to follow up with your primary care physician who knows your medical history best. Be prepared to discuss new medications and any new side effects you may be experiencing. 

There are other simple things you can do to help avoid complications from prescriptions medications. Be honest with your physician about how regularly you take your medications. Let your physician know your goals. Do you want to minimize cost, maximize convenience, or minimize your medications? Working along with your physician, you can experience the advantages to the vast advances in prescription drugs, and avoid the disadvantages. 

Ask Dr. Nancy: Urinary Incontinence, More than Just Embarrassing.

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

Urinary incontinence in adults is a common, often undisclosed problem. This unwanted leakage of urine occurs in both men and women but is more common in women. It can range from mild leaking of urine to uncontrollable wetting. Unfortunately it worsens with age. What starts out as an annoyance can become a significant social and economic problem.

About 50% of nursing home admissions are related to some extent to urinary incontinence. It’s expensive for individuals and families. The direct cost of treating urinary incontinence in men and women of all ages was estimated at $26.3 billion in 1995 for bladder control products, healthcare costs and nursing home costs.

Most urinary incontinence is treatable. The first thing to do is to tell your primary care physician. Keep a diary of urination and bring it with you to your visit. Here is some information so you are organized for your visit.

The underlying mechanism: Keeping urine in the bladder is a balance between the pressure in the bladder and the pressure in the urethra, the tube that drains urine from the bladder to the outside of the body. If the pressure in the bladder is greater than the pressure in the urethra, urine exits. See if you recognize some of these symptoms.

Stress incontinence is the involuntary loss of urine during activities such as coughing, laughing or exercising. The underlying abnormality is typically poor support from the pelvic floor muscles which support the “bladder neck,” the junction between the bladder and the urethra. This decreases the pressure in the urethra, so activities like coughing, which increase pressure on the bladder from above, force urine out below. Lack of normal usual pressure within the urethra is another factor. Tissue thinning associated with age in women, previous vaginal surgery and certain neurologic lesions are associated with poor urethral sphincter function.

An overactive bladder causing the involuntary loss of urine preceded by a strong urge to void, whether or not the bladder is full, is a symptom of the condition commonly referred to as "urge incontinence." Some cases of overactive bladder can be attributed to specific conditions, such as urinary tract infection, bladder cancer and bladder stones, but most cases result from an inability to suppress bladder muscle contractions.

Overflow incontinence is urine loss associated with over stretching of the bladder. Frequent or constant dribbling can be present, sometimes in association with overactive bladder or stress incontinence. Over distension is typically caused by an underactive bladder muscle and/or obstruction of the urethra. The bladder muscle may be underactive secondary to drug therapy or conditions such as diabetic neuropathy. Outlet obstruction in women is almost always a result of urethral occlusion from pelvic organs sagging downward or previous anti-incontinence surgery. Outlet obstruction in men is commonly related to enlargement of the prostate gland.


The treatment is determined by the type of incontinence. If the type isn’t obvious from the patient’s history, tests can be done to measure bladder dynamics. As with every medical problem, the appropriate treatment has to be matched up with the right diagnosis. Here are some simple suggestions to get started.

First possible reversible causes should be addressed such as infection and certain drugs.

For stress incontinence, conservative treatment works. Overweight women need to lose only 5% - 10% of their weight to achieve a 50% decrease in urinary leakage according to a recent New England Journal of Medicine article. Tampons can be effective, especially for exercise-induced incontinence. Exercises that strengthen the pelvic floor to provide support to the bladder neck are recommended based on good and consistent scientific evidence. See article Consider Physical Therapy.

Overactive bladder treatment involves bladder retraining. Some medications have been shown to have a small beneficial effect on improving symptoms.

Overflow incontinence requires a medication review to see if this is a side effect of medication. Evaluation for obstruction to urine flow is essential and oftentimes can be successfully treated by surgery.

The American College of Physicians, American College of Obstetricians and Gynecologists, and the American Urological Association offer great resources for more information.

The key to success is to start early on urinary incontinence treatment.

CHP Medicare Advantage (HMO) Plans Receive 5 Stars

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






The Center for Medicare and Medicaid Services (CMS) has published the 2010 health plan star ratings for health plans at on the Health Plan Finder. Capital Health Plan is the only Medicare Advantage plan in Florida, and one of only three in the nation, to receive 5 stars for the summary rating of health plan quality from CMS.

Stars for each plan show how well the plan performs in that particular category. Star ratings range from 1 star to 5 stars, where 1 star means "poor" quality and a rating of 5 stars means "excellent" quality.

“These rankings are based on clinical performance, member satisfaction and accreditation information. CHP is always finding ways to improve the quality of the health care services we provide, and we are honored to receive this prestigious recognition,” said CHP Chief Medical Officer Dr. Nancy Van Vessem. “It is a reflection of the commitment of our physicians and clinical staff to consistently deliver quality service.”

If you have questions please contact our local Member Services.


Ask Dr. Nancy: Osteoarthritis

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 knees hurt more and more as the years go by. How would I know if I have osteoarthritis?

Osteoarthritis (OA), also called degenerative joint disease, is the most common type of arthritis. It is caused by a breakdown of the cartilage that cushions the ends of bones. As that cushion wears down, the tendons and ligaments around the joint may weaken and the bones may rub together which causes pain, stiffness and swelling.

Because cartilage wears down over time, osteoarthritis is more common in older people and in people who have had a previous injury to a joint. Joints that bear the weight of the body such as knees and hips are affected the most. Finger joints at the middle and ends of your fingers can also be affected. Unlike other types of arthritis, osteoarthritis only leads to joint problems; it does not cause problems with the skin, internal organs or any other part of the body. Often there is a family history, and it appears that some people have cartilage that is more prone to wear-and-tear than others.

A recent panel with osteoarthritis experts from 12 countries found that 3 symptoms and 3 signs lead to the diagnosis of osteoarthritis with 99% accuracy. The 3 symptoms are: pain on use, short-lived morning stiffness, and limitations on how the joint functions such as stiffness. The 3 signs on exam are: crepitus (a grinding noised with bending of the joint), restricted movement, and bony enlargement. The most obvious place that bony enlargement can be seen is in the finger joints. When bony knobs form on the middle joint of the finger they are called Bouchard’s nodes and when they form on the end joints they are called Heberden’s nodes. You might want to think about whether or not these symptoms sound like ones you have and check in with your primary care physician.

Treatment for osteoarthritis has more to do with lifestyle than medical intervention. The Agency for Healthcare Quality and Research ( recently published a guide, “Osteoarthritis of the Knee”, based on available scientific evidence.

There is a lot of good information in that guide about what helps. The top recommendations are to lose weight, keep moving with low impact exercises, and take mild pain relievers. You might also ask your physician about physical therapy. Strengthening the muscles that move the knee, particularly the large thigh muscle in front, the quadriceps, can lead to improved function and support of the knee.

The guide also discusses other treatments that usually do not reduce pain or improve knee movement for people with osteoarthritis: Glucosamine/ chondroitin supplements, joint lubricant shots (not the same as cortisone shots) and arthroscopic knee surgery to smooth out cartilage.

Ultimately knee osteoarthritis can lead to surgery for joint replacement but it is best to put that possibility off into the future by protecting your knees now.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).


Dr. Nancy Represents CHP at NCQA Press Conference

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


On October 22nd the National Committee for Quality Assurance (NCQA) held a news conference in Washington, DC to release “The State of Health Care Quality: 2009.” The report is produced annually to monitor performance trends over time, track variations in patterns of care and provide recommendations for future quality improvement. It also provides an exclusive look at how well the health system performed over the past year in key areas of care and service. Data is drawn from audited data conveyed to NCQA through its Health Care Effectiveness Data and Information Set (HEDIS®) -- the most widely used performance measurement tool in health care -- as well as the Consumer Assessment of Healthcare Providers and Systems (CAHPS®).

Dr. Nancy Van Vessem represented Capital Health Plan at the press conference, which focused on the achievements of a few notable health plans in the country. She highlighted Capital Health Plan’s achievements in Diabetes and Coronary Heart Disease Relative Resource Use (RRU) measures. NCQA will start publicly reporting HEDIS® RRU measures in 2010. These measures, unlike previous HEDIS® measures, assess the efficiency of care delivered by health plans for certain chronic diseases. In general, CHP members require less “rescue” such as inpatient admission and emergency room visits than members in other health plans.

Dr. Van Vessem emphasized that the long-term success of CHP is rooted in its high member satisfaction, high levels of trust, and low disenrollment. This means members with diabetes and coronary heart disease have been involved with local physicians and disease management programs over many years. They have fewer gaps in care attributed to a consistent approach to chronic disease and stable benefits.

“At Capital Health Plan we encourage every member to have a primary care physician. Our goal is to help the physicians manage the chronic disease of their patients,” said Dr. Van Vessem. One of the newest enhancements is that primary care physician offices can access its patients’ information related to gaps in care for a variety of quality measures via CHPConnect. This collaboration between Capital Health Plan, physicians and members has led to continued success measured by consistently excellent results on quality and member satisfaction scores. Now, that success has continued with notable performance on relative resource use measurements.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).


Ask Dr. Nancy: H1N1 Flu

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

I’m worried about Swine Flu. What do I need to know?

Novel H1N1 flu (previously called Swine flu) is in our community now and has been percolating across the country all summer long, passing from infected people to non-infected people. It can range from a mild to a severe illness. The concern is that the number of cases will increase dramatically when the children return to school and start sharing their secretions. Other concerns are that cooler weather is the preferred environment for all influenza viruses and mutations may occur which can make the virus more dangerous and resistant to treatment. New information is coming quickly so refer to the Florida Department of Health’s web site at or the Center for Disease Control’s web site at or call 1-800-CDC-INFO.

The best defense will be to avoid the spread of flu from infected people to non-infected people through control of droplet spread. Infected people cough, sneeze and spread the virus to other people directly. Indirect spread occurs when infected secretions land or are placed by hands on surfaces which are then transferred to others when handled. Here’s an example: an infected person transfers the virus to a handrail and the uninfected person holds onto the handrail, gets the virus on their hand, touches their nose, mouth or eyes, and ends up with the flu. These modes of transmission are true for any flu and most other respiratory infections so taking precautions protects you from more than novel H1N1.

(Please see information regarding seasonal influenza vaccine in this Healthline. The recommendations for who should get this vaccine have been expanded. This is obtained from your Primary Care Physician’s office.)

People who are sneezing or coughing should cough into their arm or a tissue (then throw the tissue away). Everyone should wash their hands frequently. Alcohol-based sanitizers are also effective. The CDC recommends that anyone with flu-like symptoms stay at home as long as they are ill since they can be contagious as long as they are symptomatic. The latest recommendation is for the infected person to stay home from work and/or school as long as he/she has a fever >100 degrees. The body temperature should be less than 100 degrees for 24 hours without fever reducing medication before returning to school/work. Remember that anyone younger than age 18 should not be given any aspirin containing products because of a rare, but potentially awful, complication called Reye’s syndrome.


What about testing and treatment? The CDC does not recommend testing for the novel H1N1 unless the person is seriously ill or to establish the cause of an outbreak. If the person has the symptoms of flu, assume flu. Those symptoms are fever, sore throat, cough, headache, muscle aches, chills and fatigue. Treatment with antivirals is also not recommended for everyone, rather it is recommended for patients who are severely ill, those at high risk for complications from the flu, health care workers with significant exposure and pregnant women. Close contacts of people who are at high risk for complications should be offered prophylaxis. Overuse of antivirals will increase the likelihood of resistance meaning that people who really need treatment may end up with no treatment options as the season progresses and if the virus mutates.


What about a vaccine for novel H1N1? The government has contracted with multiple vaccine manufacturers for H1N1 vaccine and the hope is that it will be available in October. It will be distributed through the Departments of Health in each state and county to the highest risk groups. The targeted groups for the vaccine are: children/young adults ages 6 months to 24 years, pregnant women, people who work with children and in health care and people under age 65 with a condition, such as diabetes, that makes them more susceptible to catching the flu and having complications. Just how the vaccine will be distributed through the Health Department is being worked out in advance of its arrival.

Complications from the flu include other infections that take advantage of the person’s weakened immunity like pneumonia. People who are in the age ranges to have the pneumococcal vaccine should make sure they are up to date. The pneumococcal vaccine recommendations are also included in this Healthline.

There has been a tremendous effort by the U.S. public health agencies to reduce the health impact from novel H1N1 ever since it made its appearance earlier this year. We all should do our part to follow recommendations not only because it will help us protect ourselves and our families, but also because we can all participate in the efforts to reduce illness in our community.


Dr. Nancy Van Vessem, MD Chief Medical Officer

Dr. Nancy Van Vessem is board certified in internal medicine. She has developed innovative disease management and quality improvement programs promoting the use of best evidence medicine and propelling CHP to national recognition for quality of care.




Savvy Senior Programs

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

Now Available on Podcast

Are you one of our Savvy Seniors? If so, I know you are interested in keeping up with the latest in health care, wellness and prevention. You may have attended one of our monthly Savvy Senior programs. If you have been unable to attend a Savvy Senior program in person, you can now view and hear the presentation through a Podcast on Check out what you have missed at


The Savvy Senior programs are health related and geared toward older adults. Each program is thoughtfully prepared and presented by a CHP physician or other health care professional. The programs are held monthly in each county of our four-county service area – Gadsden, Jefferson, Leon and Wakulla. For upcoming programs, visit the Community Events Calendar on our Web site or call Member Services at 850-523-7441. We can give you the time, location and topic of our next program and add you to our mailing list. Or just go to, and view the Podcast in the comfort of your home.


Join the Trend with Colon Screening by Tara Loucks, ARNP-C

Communicating Effectively with your Physician by Mary Goble, RN, BSN

Depression and Older Adults by Dr. Esaias Lee

Get Smart: How to Improve Your Brain Health as You Age by Dr. Nancy Van Vessem





Ask Dr. Nancy

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

Nancy Van Vessem, M.D.

Chief Medical Officer, Capital Health Plan

Q: I received a letter about CHP's new benefit CHP Health Coaching for "health information and support," 24 hours a day. Can I really call a Health Coach at any time? Who will be taking the phone call?

CHP Health Coaches are mostly registered nurses, but other professionals such as dietitians and respiratory therapists are available. The nurses are ready to talk with you 24/7 about health questions, decisions, procedures, or tests. They cannot provide emergency care or answer questions about benefits. However, you may ask the Health Coach about diabetes, breathing problems, back pain, heart disease, cancer, procedures like hysterectomies, and other concerns or choices you and your family face. For this one-on-one guidance, the coach uses evidence-based medical information, meaning that the information is up-to-date and supported by valid research.

The CHP Health Coach can send you additional information, including DVDs and brochures, if that is appropriate for your situation. You can choose to be followed by the same Health Coach by scheduling phone calls. Your primary care physician will receive a notice that you are participating in health coaching and can also refer you to the Health Coaches. The primary goal is for you to have information to do what is medically in your best interest, including understanding and following your physician's treatment plans.

Another new resource is the Dialog Center through A vast array of tools helps you manage your health, including a Health Survey (find out where you stand and get recommendations for improvements), Healthwise (an encyclopedia of health information), and Balance modules (on-going help with weight loss, back pain, smoking cessation, stress reduction, and healthy eating).

Please take advantage of these new tools to improve your own health . . . and Live Well!

Call a CHP Health Coach at 850-383-3400 or 1-888-372-6608 or log onto at any time. For the hearing or speech impaired, call 1-888-277-1586. This membership service has no additional cost.