A Guide to the Good Hospitals in Algiers, Algeria

Algeria is an exciting destination that is full of interesting architecture, a lot of history and some stunning landscapes. Some of the best cities in the country are located along the Mediterranean coastline. When vacationing in Algeria you can enjoy proximity to deep blue waters while simultaneously getting a feel for the desert. It is the second largest country in Africa and a large portion of its territory is covered by the Sahara. Algiers is undoubtedly the most popular destination in the country. It is also the largest city and the capital of the country. The city has a wonderful harbor and lots of things to keep you busy like interesting museums and historical buildings. Another important city, Constantine, is well linked to all urban centers including Algiers. The city has a deep ravine running through it which gives a dramatic effect and creates many naturally beautiful sites. The city of Ouargla in southern Algeria is famous for its museums, Saharan handicrafts and the Kharji sect. Getting medical assistance in Algeria should be fairly easy, but it is important to keep in mind that most of the people are not well versed in English.

In case of an emergency situation one can rely on the services of the Al Azhar clinic, located to the west of Algiers. It is an ISO 9001-2000 accredited, private hospital approved by the Ministry of Health of Algeria. The hospital has a medical practitioner available round the clock to take care of all types of emergency situations. The hospital address is Djenane Achabou No. 4, Dely-Ibrahim,Algiers.

IBN SINA is a clinic at par with international standards of hospitals worldwide and is staffed by reputed and well qualified doctors. The address for the hospital is Rue Principale – Tamentefoust – La Marsa – Algiers. The hospital is a multispecialty facility, but it is especially well equipped to deal with cardiovascular and orthopedic problems. The hospital has a host of visiting foreign doctors who specialize in these medical areas. The hospital has modern infrastructure and has a capacity of sixty beds.

The hospital Naoufel- Constantine is a highly specialized clinic in Constantine that has adapted to the changing medical requirements of the people and has kept pace with the fast evolving medical technology. The hospital has the latest infrastructure, a comfortable environment and sophisticated diagnostic and surgical know how. The hospital address is Cite Belhadj Ain El Bey,Constantine, Algeria. You can expect to get good care for general as well as complicated medical problems at this hospital.

To get high quality medical care in the city of Ouragla, one should visit the Clinique Ediya situated at the Avenue of the Republic, NLA. This multidisciplinary clinic is a well equipped, modern clinic that has the latest medical technology and good doctors. The hospital has high tech equipment, medical imaging services, a laboratory and surgical facilities.

Chlamydia Calamity

Most people know of the sexually transmitted disease known as Chlamydia, however, the majority of the public has little idea what it is really all about. Just knowing that it is an STD is not enough. People should know the symptoms, how it is tested for, and the fact that IT IS CURABLE.

So, here are some things you should know about this sexually transmitted disease. First, to get a Chlamydia test, you don’t need a complete physical exam, just a urine sample. However, getting a physical is usually a good idea, just to be on the safe side. If you’re age 24 or younger and you’ve ever had sex, you owe it to yourself to get tested as soon as you can. A yearly Chlamydia test is recommended for all sexually active individuals younger than age 25.

You need to remember that you can infect your partner again, or they to you, after you’ve both been treated. People without symptoms of an infection often forget to take prescribed antibiotics on schedule or stop treatment before they should. The fact is, you can catch Chlamydia over and over again. Treatment doesn’t defend you from having another Chlamydia infection, even if you only have sex once or twice after you’re being treated.

Chlamydia testing is also a must for pregnant women. You should be tested as early in your pregnancy as possible. If your test is positive, you and your partner should both be treated. Also, if you start a new relationship during your pregnancy, tell your provider so you can get tested again. Luckily, uncomplicated Chlamydia is easy to treat and cure with antibiotics. The treatment is the same for men and women. There are two main treatment options.

During and after treatment, it is important to remember a few things, such as:

* Abstain from intercourse for the while you’re on medication and for one week afterwards to prevent any complications.

* If you and your partner finish the medication as directed, it is not necessary to go back to your provider for a recheck.

* If your symptoms persist, for further evaluation make an appointment to see your health provider.

Having a sexually transmitted disease can be embarrassing to talk about, but if you know what to do, or how to deal with the situation, it takes a lot of the stress away. Get informed about other STDs, and be smart.

Chlamydia Facts- learn about how it is tested for, dealt with, and how it can be avoided. Get all the facts on this STD.

Fitness And Nutrition For Health

In the age which we live there is an unprecedented focus on getting and staying healthy. As more and more research points to the effect of fitness and nutrition on our overall health, the findings become more difficult to ignore. There is no doubt that the food that we eat and the physical activity that we perform significantly impact our weight and our body’s overall health and longevity.

When you look at fitness and nutrition and the consequences of ignoring their importance, it is not difficult to see how large a role they play in our health. First and foremost, it is important to understand how powerfully diet can affect us. Natural, whole foods – such as fresh vegetables, fruits, whole grains, and lean proteins – give our bodies the vitamins that it needs to function effectively. We have energy when we eat right. And when we have energy we burn fat. Eating properly allows us to maintain a healthy weight and keep undue stress off of our hearts; it also allows us to keep our blood pressure and cholesterol levels in the healthy range. Most importantly, good nutrition keeps our bodies stocked with antioxidants that fight off a range of illnesses including cancer.

But nutrition does go it alone; fitness and nutrition go hand in hand for achieving good health. When we keep our bodies active through a consistent exercise program, we are adding to our body’s ability to metabolize food and keep weight down. Further, good fitness means strong and limber muscles and a strong cardiovascular system. Exercise also lowers blood pressure and reduces stress levels.

Learning how to pair fitness and nutrition for optimum health means a commitment to a particular lifestyle. It is essential that you revamp your diet to eliminate fatty, high-sodium, and processed food and replace it with fresh, natural – and even organic – choices. But remember, fitness and nutrition work best as a team. Implement a consistent regime of physical activity into your daily schedule including cardiovascular work, stretching, weight training, and even yoga or Pilates.

When you truly understand the importance of fitness and nutrition in your life, you will understand how crucial these lifestyle changes are in order to live a long and healthy life.

How to Use Milk and Yogurt in Vaginosis Treatment – The Simplest Bacterial Vaginosis Natural Cures

Signs and symptoms of vaginosis appear normally with the onset of the infection. Usually women experience a whitish, grey vaginal discharge accompanied by a peculiar fishy odor. This odor becomes pronounced whenever it comes into contact with substances which are alkaline in nature. These include soaps and semen.

Most women when diagnosed with vaginosis go in for conventional methods for treating the infection initially. Bacterial vaginosis antibiotics are useful to provide immediate relief. However antibiotics are useful only if the infection is detected at a very early stage. In all other cases bacterial vaginosis natural cures are far more effective than conventional medicines.

Our body naturally produces good bacterium which is known as lactobacillus. This bacterium is responsible for maintaining the acidic nature of the vagina. If an imbalance is caused due to any reason bad bacteria start multiplying in large numbers resulting in vaginosis. Milk and yogurt are both rich in acidophilus cultures. Hence these can be used to both treat vaginsosis as well as prevent its recurrence.

The purpose of this article is to detail the methods of using milk and yogurt in vaginosis treatment.

To reintroduce good bacteria into your system it would be ideal for you to have a milk bath. In case this is not possible you can apply milk to the vaginal area 3-4 times a day. You can also apply milk lavishly on a clean cotton cloth and place it over the vagina for at least fifteen minutes 3-4 times a day.

Yogurt is one of the most popular and effective bacterial vaginosis natural cures. For treating vaginosis you can either consume it orally or use it for direct vaginal application. For oral consumption 3-4 cups a day is recommended. Alternatively you can soak a tampon in yogurt and insert into the vagina. Yogurt is particularly useful in getting rid of the fishy odor associated with vaginosis.

Both these bacterial vaginosis natural cures help in restoring the acidic nature of the vaginal flora. Once the natural vaginal flora is restored your infection will disappear.

Two Recommended Medical Centers in Curitiba, Brazil

Curitiba – located in ParanĂ¡ state is the most important city in southern Brazil. Curitiba is the second largest car manufacturer and is regarded as the best place for investments in Brazil. Attractions include gardens, an opera house and museums.Curitiba has a developed medical service sector with many modern hospitals.This is a summary of some of Curitiba’s reputable hospitals.

Hospital VITA Curitiba is one of the best hospitals in the country. The 152 bed, modern hospital is operated by one of the leading hospital groups in Brazil. The hospital has attained many famous accreditations including the highest accreditation Level of the country awarded by ONA (National Accreditation Organization). Hospital VITA has full-fledged clinical departments and seven operating rooms, all of which provide excellent medical and surgical service in every specialty.

The hospital’s emergency center features an emergency room, 13 observation rooms and 1 minor surgery room making the center equipped to meet any urgency. It has a 24 bed general ICU, a pediatric ICU with10 beds, a cardiac ICU and a neurological ICU. All of the ICUs in this hospital offer 24- hour specialized care. VITA Curitiba has a nicely equipped diagnostics division that offers over 16 types of advanced procedures. It is also equipped with modern laboratories, a hemodynamics section and a pharmacy. Hospital VITA has110 apartments and it offers accommodations in a friendly environment. Tel: + 55 41 3315 1935

Hospital Santa Cruz is one of the best private hospitals in Brazil and is placed at Avenida do Batel, 1889 Curitiba. This 220 bed multi disciplinary center started in 1966 and has won ONA’s third level approval. The center, popularly known by Holy Cross Hospital, offers excellent medical service in all specialties. Additionally, its preventive medicine, neurosurgery, cardiology and emergency divisions are nationally renowned. The hospital has eleven modern operating rooms including six general surgery theaters. The emergency unit has modern facilities as well as 60 specialized physicians. This specific emergency unit has the highest number of doctors per shift among the Curitiba hospitals. The ICU with 32 beds offers excellent care. The laboratories are also at par with other international hospitals. Warm accommodations are available in luxurious suites and rooms. Tel: + 55 41 3312 3000

The Advantages and Disadvantages of Taking Natural Products

Nature has contributed a lot to the medical field with it stock of herbs to make natural products, whose main advantage is that they do not offer any harmful consequences. The most amazing thing to use natural products is that they are always beneficial.

While natural products have been verified as being highly advantageous, some people are still doubtful about the uses of natural male enhancers over consulted medication.

We should be knowledgeable about the fact that more than half of the constituents used in consulted medicines are taken from nature but their natural features are totally damaged through the process of customization. Some of the many advantages of natural male enhancers as compared to consulted medicines are described as follow.

Neither natural medicines do not need any recommendation like the prescribed drugs nor are they managed by FDA rules and directions. You can always order a natural medicine to be shipped from an internet store to your doorstep without having a checkup from a doctor.

Consulted medication have been assumed to cause many harmful effects like flushing, head pains, stomach pains and even eyesight problems. They have even been associated with heart damages, while on the other side; natural products are likely to proffer extra benefits as a cause of the components used in them. Investigation shows constructive results from patients.

An added benefit of preferring a natural product over a consulted drug is that it is less expensive that a person can easily buy 90 tablets in just $160 from inexpensive internet pharmacies.

The prices highly fluctuate according to the pharmacy from where the medicine has been purchased and even so many internet pharmacies have been suspected of selling useless as well as watered down drugs to patients. So comparatively, natural male enhancers are much less costly than consulted medication.

The advantages of taking natural products are visible to every other person but still the preference of every individual on natural medicines over consulted drugs is the decision of the patient. Selecting the correct natural medicine can definitely cause good outcome.

Nevada Drug Possession, Sale and Trafficking Laws

The impact for a drug conviction can be severe for misdemeanor and felony offenses in Nevada. With the widespread use of background checks, a conviction can shut many doors for future employment opportunities. Certain fields may be especially thorough with background checks and will disqualify individuals with drug convictions. This includes many healthcare fields, law enforcement agencies, and other government bodies. Given what is at stake, it is important to understand the Nevada drug laws, even if you are being represented by a defense attorney.

Currently, Nevada laws severely punish individuals arrested for possession, manufacturing, cultivation and trafficking of illegal drugs. Commonly used drugs in this list include cocaine, heroin, opium, LSD, ecstasy and a variety of other narcotics. Chapter 453 of the Nevada Controlled Substances Act defines the schedule of drugs, offenses and penalties in the state. Some of the defined offenses are:

  • NRS 453.316 – Maintaining a place for unlawful sale, gift or use of a controlled substance
  • NRS 453.321 – Offer, attempt, or commission of unauthorized acts relating to controlled substances
  • NRS 453.322 – Offer, attempt, or commission of manufacturing or compounding of controlled substances
  • NRS 453.331 – Distribution of controlled substances, use of unauthorized registration number and possession of signed blank prescription forms
  • NRS 453.333 – Second or subsequence offense for selling a controlled substance to a minor
  • NRS 453.336 – Unlawful possession not for purpose of sale
  • NRS 453.337 – Unlawful possession for sale of flunitrazepam (Rohypnol), gamma-hydroxybutyrate (GHB) and schedule I or II substances
  • NRS 453.338 – Unlawful possession for sale of schedule III, IV, or V substances
  • NRS 453.3385 – Trafficking in controlled substances Trafficking in controlled substances: Rohypnol, GHB, and schedule I substances (not including marijuana)
  • NRS 453.339 – Marijuana trafficking

Penalties for drug crimes in Nevada can vary, depending on the specific criminal offense, circumstances of the arrest, amount of illegal drugs involved, previous criminal history of the alleged offender, and strength of the defense or prosecution’s case. Under Nevada’s Controlled Substances act, the most common offenses may be punished as follows:

Drug Possession, Not For Sale

  • Class E Felony (1st or 2nd offense,schedule I, II, III, or IV) – 1 to 4 years in state prison or probation and/or up to $5,000 in fines
  • Class D Felony (3rd or subsequent offense, schedule I, II, III, or IV) – between 1 and 4 years in state prison and/or up to $5,000 in fines
  • Class E Felony (1st offense, schedule V) – between 1 and 4 years in prison or probation and/or fines up to $5,000
  • Class D Felony (2nd or subsequent offense, schedule V) – 1 to 4 years in Nevada state prison and/or up to $5,000 in fines

Unlawful Possession of Schedule I or II Drugs, Rohypnol, or GHB

  • 1st offense, category D felony – 1 to 4 years in state prison and/or up to $5,000 in fines
  • 2nd offense, category C felony – between 1 and 4 non-probational years in Nevada state prison and/or up to $10,000 of fines
  • 3rd or subsequent offense, category B felony – punishable by 3 to 15 non-probational years in state prison and/or a fine of up to $20,000 for each offense

Unlawful Possession for Sale of Schedule III, IV, or V Drugs

  • 1st and second offense, category D felony – punishable by 1 to 4 non-probational years in state prison and/or up to $10,000 in fines
  • 3rd or subsequent offense, category C felony – can be punished by 1 to 5 non-probational years in Nevada state prison and/or up to $10,000 in fines

Drug Trafficking (Schedule I)

  • Category B Felony (between 4 and 14 grams) – Punishable by 1 to 6 non-probational (mandatory prison) years in Nevada State Prison and/or up to $50,000 in fines
  • Category B Felony (between 14 and 28 grams) – Punishable by 2 to 15 non-probational (mandatory prison) years in Nevada State Prison and/or up to $100,000 in fines
  • Category A Felony (28 grams or more) – Punishable by 25 non-probational (mandatory prison) years to life and a fine of up to $500,000

However, Nevada has surprisingly moved to a certain level of acceptance regarding marijuana, along with many other states in the country. Nevada decriminalized the use of medical marijuana in 2001 when 65% of the state’s voters moved to amend the state’s constitution to recognize its legitimate use in a medical capacity. However, to remain in compliance with the state law, medical marijuana users must have documented permission from a physician.

Once registered with the Nevada Department of Health and Human Services: State Health Division, the individual can use, possess and grow marijuana to a certain extent (up to 1 ounce possession and up to 7 plants cultivated, only 3 of which can be mature). Note that Nevada has not decriminalized the use of marijuana for the general population like other states such as California, Connecticut and Mississippi have.

Currently there are several legal battles going on regarding the medical marijuana laws and how people can obtain medical marijuana. As the law stands today a person must produce their own medical marijuana to legally obtain medical marijuana. A person cannot get it from a centralized location like a dispensary. Additionally, even though the State of Nevada has approved the use of medical marijuana, the Federal government has not, and is starting to invoke Federal Law against those people using and growing medical marijuana. Be aware that even though you might be following State laws you can be arrested and convicted for violating Federal laws.

Possession of marijuana by non-approved medical users is still a serious criminal offense. Under Nevada’s Controlled Substances Act, possession of non-medical marijuana offense can result in the following punishments:

Possession of 1 Ounce or Less of Marijuana

  • 1st offense, misdemeanor – Fine up to $600 or drug abuse treatment examination
  • 2nd offense, misdemeanor – Fine up to $1000 or drug treatment/rehabilitation program
  • 3rd offense, gross misdemeanor – Up to 1 year in county jail and/or up to $2000 in fines
  • 4th or subsequent offense, category E felony – between 1 and 4 years in state prison or probation and/or a fine up to $5,000

It’s important to remember that an arrest for a drug-related crime does not necessarily mean a conviction will follow, regardless if the individual was charged with a misdemeanor or felony offense. If you have a defense attorney experienced in Nevada drug cases, he or she can use many of the details surrounding the case to your benefit. This can include improper search and investigation procedure, lack of probable cause to make a stop (in cases of vehicular arrests), constitutional right violations, competency of witnesses, and other miscellaneous facts.

Pleading guilty to a drug crime does not necessarily mean the defendant will receive a lighter sentence. Many individuals facing this situation also find it beneficial to retain an attorney from the moment of arrest, regardless of their state of innocence. Prosecution and law enforcement officials do not have the best interests of the accused in mind and details may be overlooked in their pursuit of justice. It is in your best interest to consult with a Nevada defense attorney about your legal options.

Herbal Remedies Vs Synthetic Drugs – Which Is Better?

It is difficult to bring this longstanding debate to an end. Before, when science has not yet come to the level of producing medicines after medicines, most people use what was readily available to cure their sicknesses. People before then discovered various properties (some of which are still being studied until now) that are present in the herbs they planted in their own backyards. They found out that aside from giving them food, plants also have medicinal value which were effective in treating their illnesses.

Then, science got the better of the world and gave it wonders using drugs that are made by man. These are also effective, even more effective than the traditional herbs they used before. More and more people trusted these medicines. However, it doesn’t mean that none of them continued to use the herbs. In fact, it is amazing to note that at present time, where almost everything has become modern and high-tech, there are still many people who use herbal remedies.

The purpose of this article is to weigh which among the two – herbal remedies and chemical drugs – are more effective. Which do you think?

In terms of effectiveness

Herbal remedies: In terms of effectiveness, I think it must be safe to say that yes, herbal remedies are really effective. Why else would the society continue using them even after so many thousands of years? Even doctors recommend some herbal remedies for sicknesses. What is also amazing about herbal remedies is that a single plant can be used to treat so many different diseases, unlike synthetic drugs.

However, when you take an herbal remedy for your sickness, you have to be patient to see the results. Because most herbal remedies are consumed fresh, they are not incorporated with chemicals that hasten the results.

Synthetic drugs: None could also contest the effectiveness of synthetic drugs, which many pharmaceutical companies improve and improve over time. Some people would say that they are not as effective as herbs because they are made with plant extracts, but what makes them more effective is that the compounds needed to cure a certain ailment is already separated from the other components of the plant, which helps it target the disease faster.

Synthetic drugs, aside from plant extracts, are also made with chemicals that hasten the healing process of the body.

In terms of safety

Herbal remedies: Herbal remedies are made with all natural ingredients so you are assured that there is less risk of ever encountering something harmful to the body. Also, most herbal remedies do not have side effects to the body because they are not too strong. In fact, there is less restriction with the kind of herbal medicines safe for children as compared to synthetic drugs.

There is also very little chance that an herbal remedy would trigger allergic attacks on the patient. Then again, it is better to consult the doctor before taking anything to avoid herbs that are poisonous and potentially fatal.

Synthetic drugs: Most synthetic drugs come with warnings on their labels regarding over dosage. This is because some chemicals used in making these drugs are too strong for the body to take. Even the innocent cough syrup becomes fatal once taken without medical supervision. Synthetic drugs are also not very safe for pregnant women to take.

Over dosage of some synthetic drugs may likely cause drug addiction and even organ failure. Failing to stop taking these medicines may eventually lead to death.

In terms of availability

Herbal remedies: It is said that herbal remedies were used before because they were readily available in almost all areas. Most herbal remedies can be found just outside our houses and we only need our kitchen to prepare them for medication. However, in today’s age, not many houses have the privilege of growing their own medicinal plants. Then again, using these herbal remedies is made possible by companies who sell herbs in the form of pills and the like in health stores.

Synthetic drugs: Common synthetic drugs can be bought almost anywhere, in the pharmacy and in the drugstore. You can go to any clinic and you will surely find a medicine for your headache. However, some drugs especially those that are used to treat more serious diseases can be more difficult to find. Sometimes only one hospital in the area has them and sometimes you have to go straight to the pharmaceutical company that manufactures them.

Nutrition Teamwork – How Vitamins and Minerals Work Together

Nutrition teamwork between vitamins and minerals

Vitamins and minerals are team players, so if you want the most nutritional value from each meal, consider which foods work best together. Iron and Vitamin C are the best known nutritional “team” as they work together to increase each other’s absorption. So eating salad with your steak ensures greater absorption of both iron and Vitamin C.

Calcium and Vitamin D are another great team, although combining them into one meal takes a little more forethought. Dairy products are the chief nutritional source of calcium, while our bodies can create Vitamin D from sunlight. We can also absorb Vitamin D from food such as avocado or eggs, so if you don’t fancy drinking a milkshake while basking in the sun, throw a beaten egg into the milkshake or blend an avocado into a cup of Greek yogurt to make avocado dip (add lemon juice and garlic for extra flavour).

Nutrition “teams” can also consist of two minerals. Potassium and magnesium work together to maintain heart function and the neurological system. Magnesium also assists in the transportation of potassium around the body, so a magnesium deficiency can lead to a deficiency in potassium. Both minerals are readily available in most meats, fruits and vegetables, so the right levels can generally be achieved through a balanced diet. Coconut water is a rich and refreshing source of both potassium and magnesium, if you are concerned that you are not achieving the right levels through your everyday diet.

Vitamin A is an independent player, easily absorbed from highly coloured vegetables such as spinach and sweet potato, as well as from meats, eggs and dairy products. Once Vitamin A is stored in the liver, it relies on zinc for transportation into body tissues, so a lack of zinc will increase the risk of Vitamin A deficiency. The most common symptom of Vitamin A deficiency is night blindness, when vision fails to adjust to darkness. So if you lie awake at night feeling as if you’ve been blindfolded, consider a bowl of pumpkin soup before lunch and dinner to supplement your intake. (Stir a spoonful of tahini paste into the soup or nibble on the pumpkin seeds afterwards to ensure you also have enough zinc).

You can have fun matching your favourite foods with their strongest team-mates, but when this seems too complicated, consider some of the foods which work single-handedly as a complete “team”. Blueberries, for example, are a great source of both iron and Vitamin C. Milk contains Vitamin A and zinc, and salmon provides both Vitamin D and calcium. With a wide range of fresh foods available, there is a nutritious “team” to suit everyone at any time of the day.

ED Specific Exception Allows You to Bypass Some HPI Rules

Use these frequently asked questions (FAQs) to reach level 5.

A patient reports to the emergency department (ED) in such severe respiratory distress that she can’t communicate during the history of present illness (HPI) portion of the Evaluation/Management service. The patient also presents to the ED alone via ambulance, which means there was no one else to speak for her.

How can a medical coder decide on the history level for this emergency department E/M service? Knowing an important exception to the HPI rules in emergency department settings will help you report these incidents correctly.

When a doctor documents that an HPI is unobtainable due to patient condition, you can invoke the caveat, says Lori Bettencourt, CPC, PCS, coder at Pro-Medbill LLC in Hampton N.H.

Advantage: The ED caveat can put off E/M downcoding based on the E/M HPI component. Follow this frequently asked question to get the lowdown on all the ED caveat rules you will require to code correctly every time.

What’re the caveat basics?

“In real life, emergency department physicians are not always able to get a thorough and comprehensive history from a patient. The doctor should of course always document any history they can obtain from the patient, family or friends, EMS, nursing home, and the like,” says Michael Lemanski, MD, ED billing director at Baystate Medical Center in Springfield, Mass. If the history is limited, but, the caveat “allows the physician to get full-credit’ for even an all-inclusive history – if you document why the history could not be obtained,” stresses Lemanski.

“The caveat is a CPT omission exclusive to emergency medicine 99285 services. It provides an exception to the Evaluation/Management content requirements when the physician is not able to acuire the required [history] information,” says Caral Edelberg, CPC, CPMA, CCS-P, CHC, president of Edelberg Compliance Associates in Baton Rouge, La. This could be owing to the urgency of the patient’s condition or the mental status of the physician.

For example: The emergency department physician carries out an all-encompassing exam and high-complexity medical decision making for a patient, but she can’t get adequate information from the patient for a comprehensive history. If you invoke the emergency department caveat in this instance, you might be able to go for 99285 (Emergency department visit for the E/M of a patient, which calls for these three vital components within the constraints imposed by the urgency of the patient’s clinical condition and/or mental status: a complete history; a comprehensive exam; and medical decision making of high complexity…).

How about a clinical instance?

Think about this probable ED caveat scenario, courtesy of Edelberg:

A patient, aged 64, presents to the emergency department with altered mental status and left-sided facial droop. The physician examines the patient, however the patient can’t provide any useful history information. The doctor orders a CT scan of the head, the patient is admitted to rule out a stroke. Notes point to the fact that the physician performed a comprehensive exam and high MDM.

In this situation, you might be able to call upon the emergency department caveat if the doctor documented her inability to obtain a full history, and report 99285 for the encounter.

How can I identify potential caveat claims?

In an ideal world, the doctor would stamp “ED caveat” on each relevant claim, however coders will have to be good spotters in order to make the caveat work for them.

How? Coders might be able to spot caveat situations based on terms the doctors uses, Bettencourt says. Some terms that could point to a caveat if they appear in the notes cover:

– history unobtainable

– history obtained by family member owing to altered mental status.

Other possible keys: Lemanski offers these terms that might point to a patient that is not capable to fully communicate:

  • unresponsive
  • obtunded
  • comatose
  • aphasic
  • paralyzed and intubated
  • incoherent owing to intoxication or drugs.

How should I document the caveat situation?

In order to submit a successful caveat claim, however, you need to take in two specific pieces of information. Figure out what they’re by registering for the ED Coding Alert.

Internal Medicine: Characteristics You Want in This Type of Doctor

Having a chronic issue that just won’t resolve itself on its own is extremely frustrating. And while you may have gone to doctor after doctor, it may be time to see someone in internal medicine.

A physician in internal medicine has more specialized education as opposed to a general practitioner. In addition, this doctor does not focus on things like pediatrics or obstetrics. The main role of this doctor is to diagnose, treat and prevent issues associated with all areas of the adult human body. So when trying to find one to fit your needs, be sure to keep a few things in mind.


The whole reason for seeing a doctor in internal medicine is to get an answer to some of your most troubling health conditions. When you’ve exhausted all other options, such as family doctors or general practitioners, an internist is the next logical step. These doctors have made careers out of solving complex medical problems in adults. So be sure to explain the issues you’re having as well as make sure your internist has all your past medical history. This way, he or she can have a leg up in trying to figure out the root of your problem. In addition, a doctor in internal medicine has gone to school for at least seven or eight years, has passed a board exam as well as focused on a particular area of study, so he or she is well prepared to handle your problem, depending on what it is. For instance, if your issue deals with the heart, then you’d want to see a cardiologist. On the other hand, if you have reproductive issues, a reproductive specialist is best.

Good Communication

In addition to expertise, it’s essential that you have great communication with your doctor, especially when it comes to internal medicine. That’s because this doctor has the knowledge and experience to help you figure out what’s causing your issue. Yet, you want him or her to be patient and really listen to your issues. These doctors see numerous patients each day, but that doesn’t mean you should feel rushed through your visit. So when deciding on a good internist, pay attention to how he or she talks with you as well as listens. If you feel like your doctor has not given you the time you need, then you need to keep looking, because communication is key when trying to find a doctor in internal medicine.


When you’ve been referred to an internist, this means your general practitioner hasn’t had any luck figuring out what’s causing your problem. Or if he or she knows the problem, maybe they don’t know how to treat it; yet an internist will. Unfortunately, if your internist cannot see you until two months from now, then that’s a problem. Depending on your issue, you could possibly wait, but for most people, this is not acceptable. Instead, you should keep searching until you can find a specialist that can see you in a decent amount of time. Also, whenever you do find a good doctor in internal medicine and schedule an appointment, you want him or her to honor your appointment time. If you’re always waiting over an hour to see your physician, you may need to start a search for a new doctor.

Segregate Waste by Using Colorful Trash Bags

They said that if you love the environment you should do your part in saving it. There are lots of things we can do to take part for a healthier nature. We can help clean our streets, we can plant new trees, we can recycle our plastic bags, and we can simply segregate our trash.

Trash or waste segregation is basically the process of sorting out the garbage to make sure the right waste go to the right place. This is usually done by putting the same kind of garbage in one trash bag and other kinds in another bag. This is primarily to organize wastes, to reduce litter and segregate those materials that can be reused or recycled.

Sometimes people are having a hard time separating their trash. Often they would just put all kinds of trash-whether wet or dry, plastic or cans, left-over foods and papers-into one bin. Do you think this is a wise way to handle the garbage? This would just clutter your bin, emit unpleasant odor, and make decomposition difficult.

For this reason are the trash bags made specifically with varying colors. They are created so as people can properly segregate any kinds of garbage. While specific colors are assigned to each kind of trash, it is the people’s responsibility to know which trash is for what color so they can segregate their trash accordingly.

Here are the basic colors we need to familiarize ourselves for proper waste segregation:

• CLEAR – is normally used to hold recyclable products or things we can reuse or remake into something new. Clear or white color is beneficial so as materials inside can be easily seen even without opening it. What we can put here are tin cans, bottles, papers, etc.

• BLACK – is generally used to hold non-biodegradable and non-infectious wastes, which means those that cannot be easily decomposed. Examples of which are plastic cans, Styrofoams, candy wrappers, Popsicle sticks, etc.

• GREEN – is mainly used to carry biodegradable materials or those wastes that can be easily decomposed. We can see these as left-over foods, vegetables and fruit peelings, dried leaves, twigs, etc.

• RED – is commonly used for bio-hazardous or infectious waste products or those that could be harmful to the public’s health. Usually these trashes are taken from the hospitals or clinics such as syringe, cotton, disposable cups, plastic food bags, human wastes, etc.

• BLUE – is usually used to handle industrial materials or those bulk goods for businesses. Examples of these are glasses, heavy plastics, fabrics, woods, etc.

So the next time we are going to put away our trash, we already know in what trash bag they need to be placed. By proper waste segregation, we are doing our part for a cleaner environment.

How to Impress Girls in College – Use These Tips to Score When You Hit the Club, it Never Fails!

How to impress girls in college? It seems girls that fall into this category proves to be the most challenging. You have to get all aspects of your game right if you want to tackle them. These girls know that guys would be hitting on them when they hit the club, so how can you be the one that scores? I will show you a few pointers so that you can ace the game.

How To Impress Girls In College

Firstly you have to subdue that instinct to want to be the top dog around to win her over. All you have to do is be at your natural best. Be honest and showcase your best character traits. Girls can sense when you are being sincere and this sets you apart from the crowd a little.

Next find out what things or trends that catch people’s interest without being corny. College girls are trendy people, keep up to date, or wow them with your sophistication. This keeps them interested and will talk with you beyond a few minutes. Once you caught her attention and interest, ask her questions, let her be in the limelight. Remember, it is always about her, not you.

Now this is the tricky part, you do not want the conversation to head into the “friendship zone”. This happens very easily especially with college girls. Try leaning forward and being close to her. If she does not move away, she probably is interested in you. Another thing is not to disclose too many things during this initial interaction, exit the conversation on a high and ask for her contact information.

Follow my steps on how to impress college girls, and you will be scoring like a pro in no time!

Curing Cancer With Mountain Graviola

With the continuous need for less damaging and more affordable treatments, the rise of natural medication is truly inevitable. You may have heard of different herbal alternative medicines being advertised in the market. One such alternative treatment quickly gaining popularity is graviola. However, there is actually a closely-related plant with more curative properties than graviola and that is the mountain graviola.

Mountain graviola, commonly known as mountain soursop, is a tree belonging to the Annona family. The tree is a famous medicinal plant and can be found in Central America and the Caribbean islands. It closely resembles the graviola tree and the two plants are often mistakenly considered the same. But though they look alike and are from the same plant family, they are different as proven by their chemical compositions. Scientific names are used to give distinction when referring to both plants.

Annona montana or mountaian graviola leaves are glossier and are wider as compared to those of Annona muritica or graviola. In addition, montana bears fruits faster. These fruits have fibrous pulps and grow to about 15 meters long. Montana fruits are said to be sourer than muritica’s.

Muritica has risen to fame as an alternative cure for cancer due to the 82 acetogenins it contains. As compared to muritica, montana has more of these beneficial substances. Mountain graviola has 108 acetogenins. The acetogenin annonacin is a major cancer-fighting chemical found in both trees but in larger content in montana.

Mountain graviola has similar ATP-inhibiting effects as the muricata. It also aids in building body resistance against cancer and other fatal illnesses mostly related to the digestive track and the cardiovascular system. Studies showed that mountain graviola destroys cancer cells faster than Andramycin, a drug used in lung cancer chemotherapy. Liver and ovarian cancer patients taking in mountain graviola herbal medicines have also been healed in just a year. Amongst these cured patients, no one has been reported to have acquired recurring cancer. Mountain graviola is said to be most effective with liver cancer, affecting the ATP nucleotides nearest the organ. Ovarian cancers have one of the highest mortality rates yearly. Montana’s acetogenins are effective in pinpointing the tumor and can eliminate the damaged cells before they reach other organs.

Combined extracts of the muricata and montanta are often used by supplement manufacturers for enhanced effectivity. According to researches, the combination of these Annona plants is far more effective in treating cancers than surgeries and chemotherapy. Furthermore, they do not pose any side effects to the body. Using natural supplements and herbal medicines do not damage other organs like conventional cancer treatments do. Even when combined with medication, Annona supplements are still safe. In fact, combination and separate ingestion of muritica and montana, hastened and escalated the effects of antihypertensive drugs in animal test subjects.

Nevertheless, remember that taking Annona supplements is not as effective as taking in muritica and montana as food. Supplements have already been mixed with other synthetic substances, thus reducing the acetogenin contents of the plants.

Mountain graviola can be considered one of the best discoveries in the medical industry. With more than one hundred beneficial acetogenins, it would not be a wonder if this plant can cure more fatal diseases other than cancer.

Basic Facts About IU (Individual Unemployability) in a Veterans VA Compensation Claim

Veterans always have questions about the VA Disability compensation benefit known as IU. It is also known as TDIU (Total Disability – Individual Unemployability), and sometimes as TD (Total Disability).

What is TDIU?

Most Veterans mix their terminology when referring to this benefit. However, all Veterans have the same understanding of what this benefit is. When your service-connected compensation does not adequately compensate you for your in-service military injuries, you can request that the VA grant you a 100% rating.

There are 2 ways to do this. Below, I explain the BASIC eligibility criteria for both forms of TDIU: Schedular and Extra-Schedular.

1) Schedular TDIU

When a Veteran seeks a Total Disability Rating, or IU (Individual Unemployability), the Veteran most commonly refers to Schedular TDIU.

It is available when a Veteran meets one or both of the following 2 eligibility criteria:

a) ONE service-connected disability rated at 60% or more; or,

b) 2 or more service-connected conditions – one of which is rated as 40%, and the total combined percentage, using VA Math, totals 70% or higher

When one or both of these criteria are met, the VA Regional Office is supposed to consider Schedular TDIU.

However, they often fail to (this can lead to an earlier effective date for some Veterans who discover the error later in their appeals process).

Moreover, the VA often requires that a Veteran file a VA Form 21-8940 before they even consider the condition.

This is not lawful – they are required to consider the claim for Schedular TDIU with or without a VA Form 21-8940.

However, Veterans have to ask if it is a battle worth fighting. If a Veteran thinks that they are unemployable because of a service-connected medical condition, or think they will eventually prove they are unemployable, they should just file the VA Form 21-8940 as soon as possible, wherever in the appeal process you are.

The VA Regional Office will most assuredly miscalculate the Veterans Effective Date when there is a claim for Schedular TDIU, so be sure to consult a VA accredited Veterans Benefits attorney whenever you get a ratings decision granting TDIU – the attorney can review that decision and your C-File to determine if the Effective Date was properly calculated.

2) Extra-Schedular TDIU

Again, this is very general information. I could – and probably will someday – write a book on Extra Schedular TDIU. It is not a legal concept that is easily understood or applied by Veterans, VSOs, lawyers, advocates, and BVA judges alike.

Because there are a lot of Myths about what it takes to get a Ratings Decision granting extra-schedular TDIU, I am going to give a very BASIC overview of this type of claim.

The VA says that its policy is to rate veterans as 100% disabled when they are not able to secure employment due to a medical condition, disability or illness that renders them unemployable. In short, if a Veteran can’t work because of the consequences of their military injury (combat or non-combat), then they can be determined “unemployable” by the VA.

This is true regardless of the percentage of their service connected medical conditions, illnesses, or disabilities. If a Veteran is rated 10%, or 30% (or any %) disabled, but is unemployable due to that disability, they may be eligible for “Extra-Schedular” TDIU.

To get a VA Rating Decision granting extra-schedular TDIU, the Veteran will need to show that their service-connected rating does not adequately compensate them for the loss of what is called a “Wage Earning Capacity”.

In short, the Veteran is going to have to show that their medical condition presents such an exceptional or unusual picture that it renders the application of the VA Rating Schedules inadequate. The VA Rater is going to require that you provide evidence of unique circumstances that show that your medical condition, disability or illness renders you unemployable.

Why is such a unique showing required? Because the law presumes that the rating schedule adequately compensates for loss of wage-earning capacity.

So, where a Veteran is rated 30% for Condition X claims she is unemployable due to that condition, then the Veteran is going to have to show why her situation is so unique that her 30% rating is inadequate.

Here are 5 factors that the VA should (and in some cases, should not) consider in an extra-schedular TDIU claim:

Factor #1: Proof of receipt of Social Security Disability for the same condition that the VA determined did not merit a 100% rating.

Factor #2: Non Service-Connected Conditions. Most Veterans don’t know that the VA can’t consider non-service-connected disabilities when trying to determine whether or not a Veteran is entitled to EXTRA-SCHEDULAR TDIU.

Factor #3: Education and Employment History. The VA often messes this up – they think that because one is more educated that they can’t get extra-schedular TDIU, particularly when the Veteran’s education or experience is in a sedentary or non-physical line of work.

For example, let’s say a Veteran is an accountant. She is employed as an accountant on Monday, even though her service-connected conditions affected her daily work activities.

If, all of a sudden, the Veteran is unable to work on Tuesday, the VA is often tempted to conclude that the situation is temporary or, because she was recently employed and highly educated, she can find employment elsewhere.

The VA logic, while not “wrong” in theory, is wrong in its application. The focus of the question of entitlement to extra-schedular TDIU is the totality of the Veteran’s present circumstances – not speculation about what the future MIGHT hold for a highly educated Veteran or a Veteran with a recent and long employment history.

Factor #4: When a Veteran’s frequent hospitalizations (for a service-connected condition or conditions) affects his or her ability to gain work, the VA Regional Office has to consider those hospitalizations in an extra-schedular TDIU claim.

Factor #5: Though it often does just this, the VA may not consider age in the evaluation of extra-schedular TDIU.

As you might be able to tell, proving entitlement to extra-schedular TDIU is a hard path.

Most Veterans will need an expert opinion from a Vocational or Occupational expert or a competent treating physician. The BVA often rules that a Veteran is unable to offer an opinion – as a lay person – that he is unemployable due to a service-connected condition.

What makes an extra-schedular TDIU claim even harder is that the VA Regional Office and the BVA DO NOT have the authority to award extra-schedular TDIU. Only the Director of the VA Compensation and Pension Service may make a final decision on this claim. This is one reason that extra-schedular IU claims take a very long time to decide.

Bottom Line.

Consider claiming BOTH forms of TDIU (or IU as it is often called) when you believe that your service-connected medical conditions, diseases, or disabilities render you unemployable.