Sorry in advance for the long post. There is a long history and I'm not sure what's relevant and what's not.
26M 170lbs 6'1" Caucasian. Other requirements contained in this post.
I started drinking a lot in high school. The summer after graduating I drank, literally, every single day for about 3 months, blacking out for most of those days. In undergrad I drank 5-6 times a week, often blacking out. I didn’t start getting hangovers until nearly the end of undergrad and they were mostly mental. I started getting “hangxiety” for a couple of days after drinking – really bad social anxiety. It also caused a weird sensation in my head, the strong feeling as though there was something gunky that needed to be pulled out of my brain. Not physically painful, just uncomfortable. This feeling started occurring every time I went on a multi-day bender but never lasted more than a few days.
Fast forward to March 2022: spring break. I went on a multi-day bender, the first in a while as I stopped drinking as much in grad school (since 2020). The anxiety and gunky feeling came on but this time they never really went away. It started feeling as though there was something constantly tugging on my brain, as if it was constantly “recoiling” from anxious thoughts and like it was constantly trying to physically relax but couldn’t. I’m not sure if that makes sense but I don’t know how else to describe it. It was like that gunky feeling but on steroids.
At that time I was wrapping up my thesis and pulling a lot of all-nighters or near all-nighters and so I chalked it up to stress and did my best to ignore it until I defended my thesis. Almost immediately after I defended (April 2022) I went to San Diego with a bunch of classmates and we drank a lot. I blacked out. As we were driving back the next day I started feeling a physical pressure sort of sensation deep inside my head. It wasn’t painful and didn’t feel anything like a headache, just very uncomfortable. Sort of like the gunky feeling I had felt before, but again on steroids and more intense and focused into a pinpoint location somewhere central behind the bridge of my nose.
Since that day it started getting worse and worse. I slowly started developing a bruised, tingling, electric sensation on the bridge of my nose that got progressively more intense and hasn’t gone away, at all, in the last 14 months. This feeling is very superficial (like it’s between the skin and nasal bone) and is reduced when I pinch the bridge of my nose, but comes back as soon as I let go. The gunky pressure, tension, tugging feeling in my brain that is so hard to describe never goes away (almost – more on that below). It feels like it tugs on all areas of my head now – my temples, the back of my head, top of my head, cheeks, etc. At the same time I started not being able to breathe through my nose at all, and trying to do so made the pressure in my head so much worse. I developed a constant tickling sensation that felt super deep inside my nasal passages and I kept blowing out globs of thick, white mucus from very deep inside my nose.
Since then I’ve been to so many doctors I’ve lost count. I’ve been to ENT’s, neurologists, allergists, psychs, even pain clinic doctors and gastros. I started allergy shots and started using neti-pots with budesonide, and now I can breathe pretty well again, though there’s still a constant mild tickling sensation inside my nose. A list of drugs/tests/procedures I’ve had is below. Sort of related, although no tests or imaging showed anything, I did remove some large blockage from my nose myself. Read more in this reddit post. I told all of my doctors but none of them seemed concerned.
The only thing that has really helped is a sphenopalantine ganglion block, transnasal injection method. All the pressure and tension in my head went away, along with a great deal of anxiety and depression. It was the first time I’ve felt like I’ve been able to think clearly in 14 months. But it only lasted for 2 days. On the 3rd day it was back to baseline. It also did absolutely nothing for the bruised, electric feeling on the bridge of my nose. My insurance doesn’t cover it and it’s almost $600 per injection if I want to keep getting them. Gabapentin and tizanidine help a little but not much. More info in the lists below.
I pretty much don’t drink now. I’ve not had a sip for about a month and before that only a couple of drinks at a time. But even a couple of drinks sends me into an intense, anxious depression now for well over a week so I’m not touching it at all. I’m not even sure if all this shit is drinking related. It seems correlated but there’s a ton of variables. None of my symptoms go away even slightly when I stop drinking, besides the anxiety being less intense.
Drugs that didn’t do anything:

• Motrin
  
• Tylenol
  
• Allergy pills
  
• Mucinex
  
• Sudafed
  
• Various types of nasal sprays including Flonase, Astapro, Nasonex
  
• Prednisone
  
• Z-pak antibiotics
  

Drugs that do a little (currently on all of these):

• Montelukast (feels like my nose opens up a bit)
  
• Gabapentin (slightly reduces the bruised, tingling sensation; 900mg 3x/day)
  
• Tizanidine (slightly reduces the tension/pressure in my head; 8mg at bed)
  

Other drugs I’m on:

• Adderall IR 5mg 1x/day (I’ve been on Adderall daily since 2020 for ADHD. The dose I was at, 20mg XR, seemed to exacerbate my symptoms. I stopped taking it completely for ~4 months. Nothing changed. Now I’m back on the IR and it doesn’t really affect my headache anymore.
  
• Strattera 100mg 1x/day (Started this when I stopped taking Adderall but did not discontinue when I resumed).
  

Procedure that did a lot:

• Sphenopalantine ganglion block: eliminated the gunk/tension/pressure in my head almost completely. I haven’t felt so calm and at peace for over a year. Did absolutely nothing for the bruised, electric sensation on my nose however. Effect only lasted for ~2 days.

Tests I’ve had:

• Blood tests. Everything came back normal. If you want to know any specific results let me know and I can tell you.
  
• CT scan and MRI: nothing abnormal – only a few notes that every doctor said was completely normal:
  
  • Incidental cavum septum pellucidum
  • Slight small vessel ischemic disease vs. slight migrainous angiopathy
  • Mild mucosal thickening within the bilateral maxillary sinuses including two small retention cysts or polyps within the right maxillary sinus
• Upper endoscopy: nothing abnormal.
  
• Testosterone: On the lower end of the normal range, but normal.
  

Other things that exacerbate my symptoms:

• External stress from work (pressure and tension)
  
• Driving and meditating (feels like the bruised sensation is intensified when I have nothing else to focus on)
  

Other things that reduce my symptoms:

• Being in nature hiking/backpacking. I’m so much more at peace when I’m out in nature.

If you got this far, thank you. Does anyone have any insight as to what might be going on? The closest thing I can find that is representing my symptoms is idiopathic external nasal neuralgia (see: External Nasal Neuralgia: An Update. 2017. Nierenburg & Swift Morris) but none of my doctors know anything about it as it seems very rare.
If you have any questions or want more information please ask and I will do my best to answer, I know this is a long, possibly scatter-brained post.

More than 50 million Americans have symptoms of allergies throughout allergy season and throughout the year, and these symptoms often interfere with carrying out daily activities that many of us take for granted. What was once a simple walk in the park becomes far more complicated when it’s spring and pollen levels are spiking, exacerbating allergy symptoms. Allergies are the most common health issue affecting children in the United States and are also the sixth most common chronic illness. Many people think of antihistamine medications as the first choice for relieving allergy symptoms, but not everyone understands which allergy medications are antihistamines and which are not. Popular decongestant medications like Zyrtec, Xyzal, Loratadine, Nasacort, Afrin, Azelastine, Cetirizine, Fexofenadine, Nasonex, and Flonase all have different pros and cons, but Flonase is one of the most popular drugs on the market today. Is Flonase an antihistamine, or does it fall into a different drug class?

What is Flonase?

Flonase is an over the counter nasal spray and nasal steroid that is used to treat symptoms of allergies. Flonase is also sold under the generic name fluticasone propionate. Flonase was first approved for the treatment of allergies by the U.S. Food and Drug Administration (FDA) in 1994, when it became available by prescription. In 2014, Flonase was made available for purchase over the counter for the treatment of allergies.

Is Flonase an Antihistamine?

While most people associate antihistamines with allergy relief, Flonase is not an antihistamine. Flonase belongs to a class of drugs called corticosteroids; specifically, it is a synthetic glucocorticoid steroid. When we are exposed to allergens, our bodies produce allergic substances that cause nasal symptoms and allergy symptoms like itchy, watery eyes, nasal congestion, sneezing, and more. Antihistamine medications like Benadryl, Claritin, and Zyrtec only block Unlike antihistamine medications, such as Benadryl, Allegra, and Claritin, which stop one cause of allergic substances in the body (histamines), nasal corticosteroid sprays like Flonase block six key allergic substances, including histamines, to provide relief. Because Flonase is capable of blocking more allergic substances, it is capable of providing more comprehensive relief. Studies have shown that Flonase and other nasal corticosteroids provide more effective allergy symptom relief than oral antihistamines.

What Conditions is Flonase Used to Treat?

Allergic rhinitis, or hay fever, refers to a common group of symptoms that occur when an individual with allergies is exposed to an allergen. Allergens are substances in the environment that do not cause problems for most people but can produce a strong reaction in people who are allergic to them. Allergens are found in both indoor and outdoor environments, and people can be allergic to a variety of different substances. The immune system of a person with allergies responds to the presence of an allergen by attacking it, causing an inflammatory response. Inflammatory mediators, including histamines, are released during an allergy attack, causing a number of reactions that are commonly associated with hay fever, including runny nose, nasal congestion, sinus pressure, itchy/watery eyes, and itchy nose or throat. Inflammatory mediators cause these symptoms by binding to the receptors in cells in the nasal passages.
The symptoms of allergic rhinitis can be triggered by many different substances. Indoor allergens like pet hair, pet dander, mold, smoke, dust mites, and perfumes are some of the most common causes of perennial (year-round) allergies. Outdoor allergens, including pollen that is produced by grasses, trees, weeds, and flowers, are more likely to cause seasonal allergies. Some people experience only seasonal allergies, while others experience only perennial allergies. Some people are allergic to both indoor and outdoor allergens and experience some symptoms of allergic rhinitis seasonally and others perennially.

How Does Flonase Work?

Glucocorticoid steroids like Flonase pack some extra punches that give them an advantage over antihistamines when it comes to controlling allergies. Glucocorticoid steroids decrease swelling and inflammation that is typically caused by allergic responses to allergens. Unlike antihistamines, which only block the allergic response caused by histamines, corticosteroids treat allergy symptoms by blocking allergic responses from six different types of cells in the nasal passages. As a result, glucocorticoid steroids are more effective at reducing and preventing symptoms of allergic rhinitis than antihistamines. Inflammation in the nasal passages during an allergy attack causes symptoms that include runny nose, sneezing, excess mucus production and other upper respiratory symptoms. Corticosteroids reduce the inflammation, which in turn reduces the symptoms.

How Do I Use Flonase?

Flonase can be purchased over the counter under the brand name medication or in its generic form, fluticasone propionate. The medication is sold in the form of a nasal spray, and it delivers 50 mcg of the active ingredient, fluticasone propionate, regardless of whether the generic or brand name drug is purchased. Flonase is available in a formula that has been specially formulated for children, and it is also available as part of a new line of products called Flonase Sensimist. Flonase Sensimist was developed in response to patients that appreciate the effectiveness of Flonase but wanted to avoid a powerful spray or strong scent. Flonase Sensimist provides a gentle mist that does not include any alcohol or have a noticeable scent. The Sensimist line has also eliminated the occurrence of post nasal drip, which is a common side effect of nasal sprays. Adults can use Flonase for up to six months, while the maximum recommended duration for children is two months. Flonase is approved for use and adults and children ages 4 and older.

How Much Does Flonase Cost?

Over the counter medications like Flonase are accessible and affordable for most patients because there are many options regarding where they can be purchased. Flonase can be found at any pharmacy, drug store, or big box store, and it is sold in a generic form as well as the brand name form. Patients who know that they will be using Flonase on a long term basis can purchase the generic version of the medication at a very low cost from warehouse membership clubs like Costco and Sam’s Club. Pharmacy discount cards can also provide additional savings; you can expect to pay about 12 to 13 dollars for the generic version of Flonase, which is about half of the cost of the brand name medication. One bottle of the medication usually contains 120 sprays.

What Risks are Associated With Flonase?

Flonase is generally considered safe for use by most people, which is why it has been approved by the FDA for over the counter sales. Nonetheless, corticosteroid nasal sprays like Flonase do carry certain risks of use, which are often more notable for people with certain medical conditions. It’s important to give your doctor a complete medical history prior to using Flonase, particularly if you have any of the following conditions:

• Eye infections caused by herpes
• Liver problems
• Nose sores, injury, or surgery
• Eye infections
• Tuberculosis
• Any untreated viral, bacterial, or fungal infection
• Recent exposure to chickenpox or measles
• Eye problems such as cataracts or glaucoma
• Weakened immune system

What Side Effects are Associated With Flonase?

Thanks to its excellent safety record and low incidence of side effects, Flonase was approved by the FDA in 2014 for over the counter sales. Most people will not experience any side effects while taking Flonase, but those who do will generally experience mild side effects that do not require medical attention. Common side effects of Flonase that usually do not include medical attention include:

• Burning, irritation, or inflammation in the nose
• Asthma symptoms
• Headache
• Bloody nose
• Sore throat
• Cough

Rarely, Flonase causes serious side effects that require medical attention, including allergic reactions. Although rare, it is also possible for both Flonase and Nasacort to cause serious side effects that may require medical attention, including allergic reactions. Serious side effects of Flonase that may require medical attention include:

• Cataracts
• Worsening of infections even with eye drops
• Nose bleeds and sores in the nose
• Decreased wound healing
• Severe allergic reaction
• Slowed growth rate in children and adolescents
• Puncture of the nasal septum
• Glaucoma

What Drugs Does Flonase Interact With?

Flonase doesn’t interact with many prescription drugs, but it’s still important for patients to check the list of drug interactions for any medications they may be taking in order to ensure that using Flonase will not impact the effectiveness of their other medications. Make sure to check with your doctor or pharmacist if you have any questions about drug interactions between your current medications and Flonase or Nasacort, speak to your doctor or pharmacist. Flonase is known to interact with the following HIV medications:

• Saquinavir
• Atazanavir
• Ritonavir
• Indinavir
• Nelfinavir
• Lopinavir

Hi everyone,
I’ve been taking nasonex (mometasone furoate) since my my early 20s or so and it’s been life changing (I’m 26 years old now). It’s so effective I haven’t thought about it in years. Anyway, something brought my attention to my allergies and my doc told me about immunotherapy. My concern with it is, though it might lessen symptoms it mightn’t completely stop my allergies, and therefore I’d be taking nasonex with it anyway, so maybe it’s not worth the time? I’d really appreciate some advice and/or experience on this. Allergic to dust mites I believe, though confirming on Wednesday.
Thanks for your time :)

Is there any difference for nasal polyps? Especially for the clogged nose?

Tìm hiểu viêm xoang mạn tính
Viêm xoang mạn tính là một bệnh lý thường gặp khi các khoảng trống trong mũi (xoang) bị viêm và sưng lên ít nhất 12 tuần cho dù bạn có điều trị hay không.
​
Bệnh này còn được gọi là bệnh viêm xoang mũi mạn tính, làm cản trở quá trình dẫn lưu các chất dịch, gây ra dịch mủ. Người mắc bệnh này sẽ gặp khó khăn khi thở bằng mũi, vùng quanh mắt và mặt sẽ sưng lên và cảm thấy đau vùng mặt.
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Bệnh viêm xoang mạn tính có thể do nhiễm trùng, polyp mũi hoặc bị sẹo vách ngăn mũi. Bệnh này thường xảy ra ở người trẻ và trung niên nhưng cũng có thể gặp ở trẻ em.
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Triệu chứng viêm xoang mãn tính
Dấu hiệu và triệu chứng của bệnh viêm xoang mạn tính
Để xác định chẩn đoán bệnh viêm xoang mạn tính, bác sĩ sẽ dựa vào 2 trong 4 triệu chứng sau:
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Dịch tiết từ mũi đổi màu, dày hoặc chảy ngược vào họng (dẫn lưu mũi sau)
Nghẹt hoặc sung huyết mũi dẫn đến khó thở bằng đường mũi
Đau và sưng quanh mắt, cằm, mũi hoặc trán
Giảm khả năng ngửi và nếm ở người lớn hoặc trẻ em.
Các triệu chứng khác có thể bao gồm:
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Đau tai
Đau răng hàm trên
Ho có thể nặng về đêm
Đau họng
Hơi thở hôi
Mệt mỏi
Buồn nôn.
Bệnh viêm xoang mạn tính và cấp tính có các triệu chứng giống nhau nhưng bệnh cấp tính là tình trạng các xoang nhiễm trùng tạm thời khi trời lạnh. Triệu chứng của bệnh mạn tính thì kéo dài hơn và làm bạn mệt mỏi nhiều hơn. Sốt không thường gặp trong bệnh viêm xoang mạn tính nhưng có thể gặp trong viêm xoang cấp tính.
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Bạn có thể gặp các triệu chứng khác không được đề cập. Nếu bạn có bất kỳ thắc mắc nào về các dấu hiệu bệnh, hãy tham khảo ý kiến bác sĩ.
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Khi nào bạn cần gặp bác sĩ?
Bạn nên gặp bác sĩ nếu có bất kỳ triệu chứng sau:
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Viêm xoang kéo dài không dứt sau khi điều trị
Các triệu chứng kéo dài hơn 7 ngày
Các triệu chứng không cải thiện sau đi khám bác sĩ.
Đặc biệt, bạn nên đến khám bác sĩ ngay lập tức nếu có các triệu chứng nặng sau:
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Sốt cao
Sưng hay đỏ quanh mắt
Đau đầu nghiêm trọng
Nhìn mờ, nhìn đôi
Cứng cổ.
Nếu bạn có bất kỳ dấu hiệu hoặc triệu chứng nêu trên hoặc có bất kỳ câu hỏi nào, xin vui lòng tham khảo ý kiến bác sĩ. Cơ địa mỗi người là khác nhau. Vì vậy, hãy hỏi ý kiến bác sĩ để lựa chọn được phương án thích hợp nhất.
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Nguyên nhân gây bệnh viêm xoang mãn tính
Nguyên nhân gây ra bệnh viêm xoang mạn tính
Một số nguyên nhân gây ra bệnh viêm xoang mạn tính bao gồm:
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Polyp mũi phát triển gây tắc nghẽn đường thoát lưu dịch của mũi hoặc xoang.
Lệch vách ngăn mũi, phần nằm giữa 2 lỗ mũi dẫn đến tắc nghẽn đường thoát lưu dịch mũi.
Các bệnh như biến chứng của xơ nang, trào ngược dạ dày thực quản, HIV hoặc bệnh gây suy giảm miễn dịch làm tắc nghẽn đường thoát lưu dịch mũi.
Nhiễm trùng đường hô hấp, thường là cảm lạnh có thể gây viêm và làm dày màng lót các xoang, gây tắc nghẽn đường thoát lưu dịch. Nhiễm trùng có thể do vi khuẩn, virus hoặc nấm.
Di ứng như sốt mùa làm tắc nghẽn đường thoát lưu dịch.
Nguy cơ mắc phải viêm xoang mãn tính
Những yếu tố làm tăng nguy cơ mắc bệnh viêm xoang mạn tính
Có nhiều yếu tố làm tăng nguy cơ mắc bệnh viêm xoang mạn tính như:
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Đường thoát lưu dịch mũi bất thường, như lệch vách ngăn hay polyp mũi
Hen suyễn có liên quan đến bệnh viêm xoang mạn tính
Việc nhạy cảm với aspirin gây ra các triệu chứng đường hô hấp
Rối loạn hệ thống miễn dịch, như HIV/AIDS hoặc bệnh xơ nang
Tiếp xúc thường xuyên với hóa chất như khói thuốc lá.
Bạn có thể kiểm soát bệnh này bằng cách giảm thiểu các yếu tố nguy cơ. Hãy tham khảo bác sĩ để biết thêm thông tin chi tiết.
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Điều trị hiệu quả viêm xoang mãn tính
Những thông tin được cung cấp không thể thay thế cho lời khuyên của các chuyên viên y tế. Hãy luôn tham khảo ý kiến bác sĩ.
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Những kỹ thuật y tế dùng để chẩn đoán bệnh viêm xoang mạn tính
Bác sĩ sẽ tìm ra những chỗ đau ở mũi, mặt và khám bên trong mũi.
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Các xét nghiệm khác để chẩn đoán bao gồm:
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Nội soi mũi: ống nội soi mềm, dài có gắn đèn được đưa vào mũi giúp bác sĩ thấy rõ bên trong xoang.
Xét nghiệm hình ảnh: CT scan hoặc MRI cho hình ảnh chi tiết các xoang và mũi giúp xác định lớp viêm dày hoặc tình trạng tắc nghẽn làm khó đưa ống nội soi vào.
Cấy mũi xoang: phương pháp này thường không cần thiết. Tuy nhiên, khi bệnh không đáp ứng với điều trị hay ngày càng nặng hơn, cấy dịch có thể xác định nguyên nhân do vi trùng hay nấm gây ra.
Kiểm tra dị ứng: nếu nghi ngờ bệnh được kích hoạt bởi dị ứng, bác sĩ sẽ xét nghiệm dị ứng da. Phương pháp này rất an toàn và nhanh chóng giúp bác sĩ xác định nguyên nhân gây bệnh.
Những phương pháp nào dùng để điều trị bệnh viêm xoang mạn tính?
Mục tiêu điều trị bệnh viêm xoang mạn tính bao gồm:
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Giảm tình trạng viêm
Giữ đường thoát lưu dịch thông thoáng
Hạn chế các nguyên nhân gây bệnh
Giảm tần số bùng phát bệnh.
Các phương pháp điều trị để làm giảm các triệu chứng bao gồm:
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Nhỏ hoặc xông mũi bằng nước muối giúp giảm tắc nghẽn và rửa sạch các chất kích thích gây dị ứng.
Corticosteroid: thuốc giúp ngăn ngừa và điều trị viêm, như fluticasone (Flonase®, Veramyst®), triamcinolone (Nasacort 24®), budesonide (Rhinocort®), mometasone (Nasonex®) và beclomethasone (Beconase AQ®, Qnasl®). Nếu không hiệu quả, bác sĩ sẽ rửa mũi kếp hợp nước muối và vài giọt budesonide (Pulmicort Respules®) hoặc khí dung mũi.
Corticosteroid uống hoặc tiêm: những thuốc này được dùng để giảm viêm khi bạn bị viêm xoang nặng, đặc biệt là do polyp mũi. Corticosteroid uống có thể gây ra các tác dụng phụ nghiêm trọng khi sử dụng thời gian dài, vì vậy chúng chỉ được dùng để điều trị những triệu chứng nặng.
Thuốc làm giảm nhạy cảm với aspirin nếu như nguyên nhân là do aspirin. Dưới sự theo dõi của bác sĩ, bạn sẽ được tăng liều aspirin hàng ngày lên nhằm tăng sức chịu đựng.

Generic Flonase (Fluticasone)

Product Details:
Flonase (Fluticasone) is used to treat inflammation, allergy, pruritus which appear in patients with allergic rhinitis, asthma, eczema, Hyde prurigo nodularis, psoriasis, neurodermatitis, Vidal's disease (lichen simplex chronicus), lichen planus, contact hypersensitivity, discoid lupus erythematosus, generalized erythroderma, insect bites, miliaria rubra, seborrheic dermatitis. Its active component, Fluticasone propionate, inhibits proliferation of mast cells, eosinophils, lymphocytes, macrophages and neutrophils, reduces production and release of inflammation mediators and other biological active substances (histamine, eicosanoids, leukotrienes and cytokines).
Precautions
Cautiousness should be exercised after systemic use of glucocorticoids, especially in patients with adrenal gland disorders. Inhalations of Flonase cannot be used in individuals with pulmonary tuberculosis. Treatment with help of Flonase nasal spray is recommended to be done at regular intervals. Flonase inhalations should not be stopped suddenly. Avoid spraying or getting a cream and ointment in eyes. Steroid medications may increase the risk of infections such as chickenpox and measles, so avoid contact with infected or sick people. Steroid medications can stunt the growth in children and adolescents, so regular monitoring of height and weight is important.
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Hello,
My 4 year old daughter has never complained of any headache (or other issues). On July 23rd she started having diarrhea and high fever. After a few days and worsening symptoms we brought her to the ER with a fever of 104. After tests were completed (blood, stool, urine, etc) she was diagnosed with having samonella poisoning + mild dehydration. She was released after 36 hours in hospital.
The following day in the evening she first complained of a headache above her left eye brow. The next day she complained several times about a headache in the exact same spot. This continued for another 3 days with no particular pattern (sometimes mornings, sometimes afternoon. with exercise or without, etc). We brought her back to the hospital worried about bacterial infection spread, etc (though she had no fever and the samonella had pretty much fully improved). They suggest it was likely mild dehydration still and to wait and see.
A full week went by with continued daily headaches. So we went her pediatrician who did an xray and saw some mild sinus infection (though she had no sinus symptoms whatsoever). Prescribed nasonex for 10-14 days and sent us in our way.
After a week on Nasonex headaches were still occurring with the exact same pattern. So we went back to the children's hospital as since being released with samonella she has had 4-10 headaches daily going on 20+ days.
All the doctors performed physical and neurological tests and found nothing wrong. At the children's hospital they also opted to do a CT scan to rule out anything dangerous as it is atypical for a 4 year old to have headaches. The CT scan came back completely normal according to docs.
The recommended trying to "break" the headache by IV dose of an anti-nausea drug (can't remember the name) + anti-histamines. Following that they released her a few hours later and told us to administer Advil every 6-8 hours for 3 days. For 72 hours she did not complain of a headache once. We gave her last dose before bed after 3 days and the very next day the headaches returned. Same pattern.
We had a follow up with our pediatrician today who assured us that because neurological exams were good, symptoms are consistent and the CT scan was clear that it was nothing dangerous. Despite that, we are beside ourselves with worry.
Next steps is waiting for an appointment at pediatric neurologist and we have an optometrist appointment in a few days. In the meantime she has been prescribed 200mg B2 to see if that helps (treating as a migraine).
Relevant details:

• 4-10 episodes daily (not skipping days, ever). Lasting from 30 second to maximum ~5 minutes. Ongoing ~ 24-25 days. Always, without exception in the exact same spot: above left eye brow.
• Happens any time of day. Sometimes the first of the day is around 7am, other times 11am-12pm or later. Even distribution approximately between early in the day VS late in the day.
• Appears suddenly, like within an instant.
• Pain seems mild/discomfort and not severe/excruciating. It'll stop her in her tracks and she holds her head for a minute and then she is back running and playing within minutes like it never happened. Never any tears or seeming too upset, more just telling us.
• No nausea, vomiting. We asked if anything looks "strange or fuzzy" and she says no (aura). No other symptoms and before/after the episodes she is a regular 4 year old running, playing, etc.
• Advil 100% controlled it over 72 hours, but we had to stop for risk of rebound headache
• Her mother is prone to migraines and has been diagnosed + treated for them start around the same age (but her presentation was of severe pain, light sensitivity, etc that lasted hours).
• It all started the day after being released from hospital with samonella. Never had a single headache complaint ever before that.
• There has been some regression since getting out of hospital. We noticed she is sucking her thumb again while sleeping (stopped 1.5 years ago), she also gets very anxious about doctor appointments now (blood tests + IV were very traumatizing for her)

Does anyone have any idea what might be causing this? It seems this pattern is quite atypical based on everything I have been told and read about. At the same time all doctors we have talked to said that based on the current investigation it is very unlikely to be anything dangerous. Would you agree?
Thanks for the input while we wait for the next appointments.

Hi all!
I am back with another skin conditions post. This one is on perioral dermatitis.
Admittedly, when I began researching this, I knew zilch about PD except that it was acne-like breakouts around the mouth, and as I began to research it, it seems that there isn't a whole lot that is known about it. Fortunately, it is a highly treatable condition that seems to overlap to a degree with rosacea (earning it the earlier name of "steroid rosacea") and even seborrheic dermatitis.
As always, please feel free to correct or inform me of anything wrong, and also feel free to post/discuss what helps your PD.

What is Perioral Dermatitis

Perioral dermatitis (PD) is a chronic, recurrant inflammatory disease that most commonly occurs in the perioral region of the face (the area around the mouth). It can also affect the area around the nose, and in roughly 20% of cases, it can manifest around the eyes (though it goes by another name if around the eyes: peri-orificial dermatitis).
It afflicts around 1% of the population of the United States, particularly those with fair skin, and predominately occurs in women between 18-45, with 20s and 30s having peak incidence.
It presents as small, red, tender, sometimes itchy bumps that can flake and burn. While commonly mistaken for acne, it is distinct from acne in that it only presents in specific locations, spares the small area around the lips, and lacks pustules (whiteheads).

Causes of Perioral Dermatitis

The causes of perioral dermatitis are unclear. It is a relatively "young" disease that was only first described as a distinct condition in 1964. It is first and foremost an inflammatory condition, and is aggravated by ingredients and habits that can create inflammation either in the skin or in the body.
While I was researching PD, the one constant that showed up again and again is that it is aggravated by corticosteroid use -- both topical and inhaled. To specify, that means not just creams like kenalog, triamcinolone, and over-the-counter hydrocortisone, but also asthma inhalers (including Advair, Flovent, and ProAir aka Albuterol) and nasal allergy mists like Beconase, Flonase, Nasonex, Omnaris, and Veramyst.
Less commonly, but still a factor to consider are hormones, where monthly shifts can put the condition into overdrive. More frustrating is that oral contraceptives can worsen PD in some.
Other causes can be fluoridated toothpaste, high SPF value sunscreens¹, sunscreens with the filters zinc oxide and titanium dioxide, the ingredient "isopropyl myristate," improperly removing makeup or sleeping in makeup, occlusive ointments (Vaseline, Aquaphor, and oils, for example), heavy creams with occlusive ingredients, and cold creams (wipe-off cleansing creams that leave a residue, like Pond's). In one case, a woman's favorite lip balm (containing the ingredient propyl gallate) caused her PD.⁶

Treatment

PD can look like many other conditions, such as acne, angular cheilitis, rosacea, or seborrheic dermatitis, and requires treatment of a professional due to the inflammatory nature of the condition.
The most important thing for anyone suffering from PD is to discontinue steroid use - whether cold-turkey or weened off with the management of a healthcare professional. While topical steroids can seem to improve the condition, they frequently create a rebound effect, which can make the condition worse.
Once steroids are removed, the skin will get worse before getting better. This is the toughest part of PD for most people. Topical antibiotics or topical immunosuppresants (such as Pimecrolimus or Elidel) are frequently prescribed due to their tremendously helpful anti-inflammatory effects on PD, and azelaic acid can prove useful in some cases. In very severe cases, oral antibiotics can be prescribed in addition to topicals.
While healing from PD, the skin should not be cleansed with any cleanser, and makeup and skincare products should be avoided completely until the condition resolves. And no matter how tempting, PD should never be scrubbed, as this worsens the inflammation.
Once treated, it is encouraged to use liquid or gel sunscreens as well as soap-free cleansers that do not dry out the skin, as TEWL (trans-epidermal water loss) is significant in people who suffer from PD.

Long-Term Care

Some people have PD once in their lives, while others may combat it on and off for several years. If you fall into the latter, it is important to try to avoid triggers that can cause the condition to reoccur (particularly steroid use). That means cleansing your skin each day with gentle cleansers, always removing makeup (removing it with a wipe does NOT count - you need to cleanse it away thoroughly with an oil cleanser that rinses cleanly), and using light products, particularly around the areas typically affected.
Prescriptions like azelaic acid and over-the-counter .1% adapalene (Differin)² may also help to manage the condition in the long-term.
I've put together a list below of some cleansers and moisturizers that are recommended for people suffering from PD. Again, like with my rosacea list, this is not a be-all-end-all list. None of the products listed contain isopropyl myristate or heavy occlusive ingredients.

Recommended Products

Creamy Cleansers

CeraVe Hydrating Cleanser

Ingredients: Purified Water, Glycerin, Behentrimonium Methosulfate and Cetearyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Cholesterol, Polyoxyl 40 Stearate, Glyceryl Monostearate, Stearyl Alcohol, Polysorbate 20, Potassium Phosphate, Dipotassium Phosphate, Sodium Lauroyl Lactylate, Cetyl Alcohol, Disodium EDTA, Phytosphingosine, Methylparaben, Propylparaben, Carbomer, Xanthan Gum.

Aquanil

Ingredients: Purified Water, Glycerin, Cetyl Alcohol, Benzyl Alcohol, Sodium Laureth Sulfate, Stearyl Alcohol and Xanthan Gum.

La Roche-Posay Toleriane Hydrating Gentle Face Cleanser

Ingredients: Aqua/WateEau (La Roche-Posay Prebiotic Thermal Water),​ Glycerin​,​ Pentaerythrityl Tetraethylhexanoate​,​ Propylene Glycol​,​ Ammonium Polyacryloyldimethyl Taurate​,​ Polysorbate 60​,​ Ceramide NP​,​ Niacinamide​,​ Sodium Chloride​,​ Coco-Betaine​,​ Disodium EDTA​,​ Caprylyl Glycol​,​ Panthenol​,​ T-Butyl Alcohol,​ Tocopherol​.

La Roche-Posay Toleriane Dermo Cleanser

Ingredients: Wate/Aqua, Ethylhexyl Palmitate, Glycerin, Dipropylene Glycol, Carbomer, Sodium Hydroxide, Capryl Glycol/Caprylyl Glycol, Ethylhexylglycerin.

Avene Extremely Gentle Cleanser Lotion

Ingredients: Avene Thermal Spring Water (avene Aqua), Cetearyl Alcohol, Serine, Cetrimonium Bromide, Coco-Glucoside, Dipotassium Phosphate, Disodium Edta, Disodium Phosphate, O-Phenylphenol, Sodium Cetearyl Sulfate, Water (Aqua).

Spectro Jel Cleanser for Blemish-Prone Skin - Fragrance Free

Ingredients: Aqua, Butylene Glycol, Glycerin, Hydroxypropyl Methocellulose, Polysorbate 20, Cetyl Alcohol (moisturizer), Hydrated Silica, PEG-12 Dimethicone, Diazolidinyl Urea, Carbomer, Triethanolamine, Sorbitan Oleate.

Foaming Cleansers

CeraVe Foaming Cleanser

Ingredients: Purified Water, Cocamidopropyl Hydroxysultaine, Glycerin, Sodium Lauroyl Sarcosinate, PEG-150 Pentaerythrityl Terastearate, PEG-6 Caprylic/Capric, Glycerides, Niacinamide, Propylene Glycol, Sodium Methyl Cocoyl Taurate, Ceramide 3, Ceramide 6-II, Ceramide I, Hyaluronic Acid, Cholesterol, Sodium Chloride, Phytosphingosine, Citric Acid, Edetate Disodium, Dihydrate, Sodium, Lauroyl Lactylate, Methylparaben, Propylparaben, Carbomer, Xanthan Gum.

Olay Foaming Face Wash Sensitive

Ingredients: WateEau, Glycerin, Sodium Myristoyl Sarcosinate, PEG-120 Methyl Glucose Dioleate, Sodium Lauroamphoacetate, Aloe Barbadensis Leaf Juice, Polyquaternium-10, PEG-150 Pentaerythrityl Tetrastearate, Glycol Distearate, Sodium Laureth Sulfate, Cocamide MEA, Laureth-10, Disodium Lauroamphodiacetate, Sodium Trideceth Sulfate, Citric Acid, Disodium EDTA, Phenoxyethanol, DMDM Hydantoin.

La Roche-Posay Toleriane Purifying Foaming Cleanser

Ingredients: Aqua/WateEau (La Roche-Posay Prebiotic Thermal Water),​ Glycerin​,​ Coco-Betaine​,​ Propylene Glycol​,​ Sodium Cocoyl Glycinate​,​ PEG-120 Methyl Glucoside Dioleate,​ Sodium Chloride​,​ Ceramide NP​,​ Niacinamide​,​ Sodium Hydroxide​,​ Disodium EDTA​,​ Capryloyl Glycine​,​ Caprylyl Glycol​,​ Citric Acid​,​ Acrylates Copolymer​.

Makeup Removers

Clinique Take the Day Off Cleansing Balm

Ingredients: Ethylhexyl Palmitate, Carthamus Tinctorius (Safflower) Seed Oil, Caprylic / Capric Triglyceride, Sorbeth-30 Tetraoleate, Polyethylene, PEG-5 Glyceryl Triisostearate, Water / Aqua / Eau, Tocopherol, Phenoxyethanol.

Kose Softymo Speedy Cleansing Oil

Ingredients: Mineral Oil, PEG-8 Glyceryl Isostearate, Cetyl Ethylhexanoate, Cyclomethicone, Water, Simmondsia Chinensis (Jojoba) Seed Oil, Isostearic Acid, Glycerin, Phenoexyethanol.

Moisturizers

CeraVe PM Facial Moisturizing Lotion

Ingredients: Purified Water, Glycerin, Caprylic/Capric Triglycerides, Niacinamide, Cetearyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide 1, Phytosphingosine, Hyaluronic Acid, Sodium Hydroxide, Dimethicone, Behentrimonium Methosulfate, Ceteareth-20, Polyglyceryl-3 Diisostearate, Cholesterol, Xanthan Gum, Carbomer, Disodium EDTA, Dipotassium Phosphate, Potassium Phosphate, Sodium Lauroyl Lactylate, Methylparaben, Propylparaben.

CeraVe Daily Moisturizing Lotion

Ingredients: Purified Water, Glycerin, Caprylic/Capric Triglyceride, Behentrimonium Methosulfate and Cetearyl Alcohol, Ceteareth-20 and Cetearyl alcohol, Cetyl Alcohol, Polyglyceryl-3-Diisosterate, Dimethicone, Hyaluronic Acid, Ceramide 1, Ceramide 3, Ceramide 6-II, Cholesterol, Phytosphingosine, Potassium Phosphate, Dipotassium phosphate, Methylparaben, Propylparaben, Disodium EDTA, Sodium Lauroyl Lactylate, Polysorbate 20, Carbomer, Xanthan Gum.

CeraVe Baby Moisturizing Lotion

Ingredients: Active - Dimethicone, 1\%. Inactive - Purified Water, Caprylic/Capric Triglyceride, Cetostearyl Alcohol, Cetyl Alcohol, Emulsifying Wax, Niacinamide, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Allantoin, Tocopheryl Acetate, Lauric Acid, Zinc Citrate, Polygylceryl-3 Diisotearate, Behentrimonium Methosulfate, Sodium Lauroyl Lactylate, Arginine PCA, Potassium Phosphate, Dipotassium Phosphate, EDTA, Sodium PCA, Phytosphingosine, Cholesterol, Xanthan Gum, Carbomer.

La Roche-Posay Toleraine Facial Fluid

Ingredients: Aqua/Water, Squalane, Glycerin, Dipropylene Glycol, Sodium Carbomer, Ethylhexyloxyglycerin/Ethylhexyglycerin, Capryl Glycol/Caprylyl Glycol.

EltaMD PM Therapy Facial Moisturizer

Ingredients: Purified Water, Ethylhexyl Isononanoate, Niacinamide, Glyceryl Stearate, PEG-100 Stearate, Hydroxyethyl Acrylate/ Sodium Acryloyl Dimethyl Taurate Copolymer, Hydrolyzed Rice Protein, Linoleic Acid, 1-3-Bis (N-2-(Hydroxyethyl) Palmitoylamino) -2- Hydroxy Propane, C10-30 Cholesterol/Lanosterol Esters, Sodium Hyaluronate, Glycereth-26, Cetearyl Glucoside, Thioctic Acid, Distearyldimonium Chloride, Tocopheryl Acetate, Xanthan Gum, Oleth-3 Phosphate, Butylene Glycol, Phenoxyethanol, Iodopropynyl Butylcarbamate, Disodium EDTA, Sodium Bisulfite, Sodium Hydroxide.

Sources

1. Physical sunscreens with high sun protection factor may cause perioral dermatitis in children
2. Perioral dermatitis successfully treated with topical adapalene
3. Perioral dermatitis00159-8/abstract)
4. The Treatment of Perioral Dermatitis, Acne Rosacea, and Seborrheic Dermatitis
5. Guideline: Perioral dermatitis
6. Lip and Perioral Dermatitis Caused by Propyl Gallate

All of My Posts

Guides

• Purging, Irritation, and Gram-Negative Folliculitis
• Dehydrated Skin: An Updated Guide
• A Guide to Your Dermatologist: When to go, picking a doctor, prepping for your first visit, and tackling shame and depression
• Perioral Dermatitis
• Keratosis Pilaris: An Updated Guide
• Rosacea
• Rosacea: Recommended Products
• Evaluating Your Routine: Hydroxy Acids
• Evaluating Your Routine: Sunscreen
• Evaluating Your Routine: Moisturizers
• Evaluating Your Routine: Cleansers

Tryna decide between these two. Any personal experiences on which one has worked better for you?

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Date: 2013-12-07
Link to submission (Has self-text)

Questions	Answers
What would be your ideal healthcare system? I.e. What country do you believe has it "right"?	Every possible system will have its flaws. What makes our system so unique is that it seems to found a way to have all the flaws of every other health care system while avoiding any of the benefits.
	Seriously though, I think one way to improve our system is to cap how much hospitals can bill. It's been done in Maryland since 1977 and works fin there. It won't fix all of our problems but I like to approach problems one step at a time.
	Here's a blog I wrote about it: Link to www.huffingtonpost.com
What do you think of this PBS Frontline episode that examines five different national health care systems? Link to www.pbs.org.	I hope I'll have time to watch it later, thanks.
Why do you think price caps would work on a national scale?	I actually think it would be better to do it for hospitals State by State partly because we already have a model for it in Maryland and also because the US Congress couldn't pass gas let alone an effective bill right now. It's also easier to get things done at the State level.
I would to tell you my situation, then you could comment on it. Several years ago I had to have an umbilical hernia (I was an adult) repaired. I did not have health insurance of any kind and so paid cash for everything. So, in my state, no specialist or surgeon will see you unless you first get a referral from a GP or family care practice... It was obviously something that required surgery, since there was this soft fleshy bit poking in from the side of my navel; I had already diagnosed myself before I was able to get to my GP. I go in, tell him I think I have a UH, he pokes and prods for a few minutes ... yes, he agrees. ** Bill: about $140 (first time visit adds about $75 over a regular visit).** Surgeon's visit - I pay one price, $850 or so, for all consult and the surgery itself. Note that the surgeon is the guy who is most responsible for the patient outcome in all this! I think I visited him 1 or 2 times prior and 1 time after surgery. I have a prescription for an abdominal CT scan. I call around - the 2 hospitals in the area want between $2750 and $4000 including interpretation. I remember an outpatient imaging place that my wife used a while back for an MRI - we call them, and find out that one of the above hospitals, BOUGHT THEM OUT AND THEN SHUT THEM DOWN - why did they do that, doesn't make sense or does it???... But, they have 1 independant place that the hospital did not buy, still running in a depressed area 3 hours' drive away. Their price? "Well if you pay on the day of service with cash or credit card, the price is $264." It gets better - the owner of this imaging clinic, who sold off the other branches to the big hospital? He is the Head of Radiology Deparment at a well-respected hospital about 1 hour away. So the hospitals bought him out, only because he was undercutting their prices! CT scan in hand, surgeon ready to go ... I check out surgery prices at the places the surgeon has privileges at... Hospital 1 - flat fee, about $3500 Hospital 2 - won't give me a price over the phone - because they charge by the minute! And it will matter if the OR is used for 45 or 55 minutes as to the price ... note how stupid this is, because ORs are not utilized anything near 8 or 12 hours a day, continuously. ** Shiny-new Surgical Center, cleaner, less hectic, nicer nurses, etc. - $1800, but, "oh, if you pay cash or credit card on the day, the price is $1200"** Anesthesia - $660 (note: almost as much as the surgeon, just for a nurse anesthetist!) Add up the difference between what I paid cash for and what the "retail price" was ... to me, the shocking 10X difference in abdominal CT scan makes you wonder, "what exactly, is a fair price for CT scans?" I welcome your comments on any part of this.	Your story is exactly why I'm doing what I'm doing. Health care in this Country is a scam that disproportionately a scam affects the uninsured and it needs to stop.
I live in the UK so I don't know much about your healthcare system, but I'm curious: the general consensus over here is that people in the USA might be avoiding going to see medical professionals due to the costs. Do you think this is true at all?	Yes, if you don't have insurance it's a minefield. If you do have insurance you're still not always safe. Just watch this and see for yourself: Link to www.youtube.com
This makes me feel seriously ill to watch. Bad enough to be ill but then to be ripped off by the ones who are supposed to help look after you, that's unbelievable. I hope this changes soon.	I'm trying.
I have MS so I take a specialty drug called copaxone. With my insurance my copay is/would be over $6000/month. That's gone up about $1000 in the last year. Since there is no way that amount is even remotely affordable I'm able to qualify for the copay assist program. That brings my bill to about $35/month. The organization that admins the copay assist is the manufacturer. So, do they write off the balance? Their reaping in money from my insurance and essentially waiving the cost to me. How is this? Are taxpayers having to foot the bill? How and why is this happening? Do you know if obamacare will address this issue is any way?	No, the drug costs the pharmaceutical company about $50 to make so they make more than enough money to be charitable at times.
This is very relevant to me. Can you provide some source material on drug manufacture cost vs. price? Especially for Copaxone?	No, that's a proprietary secret but it's only a polypeptide made with four amino acids so I don't see why it would be very expensive to make. Most low molecular weight molecules are very inexpensive to make.
	I have a couple of patients who worked as chemists for pharmaceutical companies and they confirmed that a couple of kilograms of most standard medicines can be manufactured for a few dollars.
	About the only drugs that are expensive to make are the biological agents like monoclonal antibodies. How expensive? I don't know and we'll probably not know for a long time since none of them will likely be generic for decades, if ever.
When are you doing to hire a professional web designer to make your website more appealing to read and navigate through?	You have to understand, I'm not getting paid for this so, whatever I spend on it comes out of my pocket. A few people have written me to offer help but they live in other States making it a bit more complicated.
What can I do to help you?	Post my site and my videos anywhere you can. If you show people the three minute videos I made on, for example, the cost of generic medications you can get them interested. Those videos play well on a smart phone so you can show them to anyone.
I have year-round sinus congestion issues. There is a nasal spray that almost completely eliminates my symptoms (heavenly!) but it would cost me about $140/mo to purchase it. My insurance doesn't cover it and there's no generic. What's your take on this? It's not life threatening, so should I just live without? Do you think that it's reasonable for a drug company to charge that price with the help of the government (preventing other companies from producing the same drug)? Something else?	Which nasal spray do you use? Also, I think the drug companies do abuse the patent laws. They'd make plenty of money if they sold you nasal spray for $20 but, in our system, drugs are sold at the maximum price the market will bear because so many people use insurance to buy them.
Veramyst is the one that really works.	Veramyst is fluticasone. It's the same active ingredient that's in flonase. Here's the price at costco: Link to www2.costco.com
It's not often I get to school an attending and get away with it. So here goes. Veramyst is not Flonase. Source:Link to www.ncbi.nlm.nih.gov.	I admit I just googled Veramyst because there are dozens steroid preparations out there. I'm assuming then Flonase didn't work for you?
What measures to do you take so as not to be killed by the government?	I live in a city that has no tall buildings so snipers can't get me. I also don't have a very regular schedule so it's hard to predict when I'll be going anywhere.
I want to believe that you're kidding… But I have this nagging feeling that you're being completely serious.	)
David Belk, thank you for the work you are doing. I have seen your work in the past and even cited it in a paper I wrote.	I'm not sure I'd like government work but, thanks for asking. Anyway, I'm definitely in favor commissions that cap how much hospitals can charge. It works in Maryland and, quite frankly I can't think of a better way to reign in the insane billing practices of most hospital. Here's a blog I wrote about it: Link to www.huffingtonpost.com
What it's the most earth shattering discovery of your investigation?	The fact that so few people in health care seemed to care about what I found. I thought they would find it helpful but most doctors really don't seem to want to know any of this.
You are fucking with their business model. I doubt they will thank you for it.	Agreed.
Is there anything that can realistically be done to stop the monopolization of medical supply companies? Part of the reason hospital visits cost so much is the fact that the supplies are ridiculously overcharged by the few approved suppliers.	Monopolization is a problem we have in most industries. In health care it's worse because there are no anti-gouging laws as well. As far as hospital costs are concerned, I've written a lot about them. You might find this interesting. It's an analysis of the financial records for nearly every California hospital over nine years: Link to www.truecostofhealthcare.org
The only use for pennies is to keep yourself from getting more pennies.	)
despite a few attempts we have refused to adopt the use of dollar coins which would save our economy billions.	I know.
What are your thoughts on the subject of improperly tested meds being rushed through their clinical trials by an FDA that accepts "consultation" fees from the same drug companies they're supposed to be monitoring? How often would you say dangerous drugs go to market without proper testing or necessary rejection, and how many lives are affected?	That's a good question. Part of the problem is that the FDA is underfunded. As far as drugs getting "rushed" that really started with the AIDS epidemic when a lot of activist were complaining that anti HIV medications are taking too long to get on the market. Streamlining the process improved the situation for getting some urgent lifesaving meds out early but, as with any relaxation in policy, it opened the door for abuse.
	Link to blogs.scientificamerican.com
I remember a post on reddit a few weeks-month ago showing how these tiny little metal hospital trays cost $700+. If memory serves, the poster compared it to the corruption/over pricing we saw during Taft's presidency, do you consider this an accurate comparison?	Health care is a corrupt system with no price controls, I guess I'm not familiar enough with what happened under Taft to make a comparison though.
Can you see Obamacare leading up to Universal Single payer? IOW, is it possible that Obama re-packaged RomneyCare as a stepping stone to achieve the eventual goal of necessitating a single payer system?	It's hard to say. It would more likely lead to a system similar to what they have in Germany where the private insurance companies are highly regulated. Our problem isn't so much public vs. private for payers. It really boils down to the fact that health insurance companies operate like protection rackets because billing charges for most medical services are so high.
What can be done, realistically, to change the view of healthcare in the U.S. and to get people to wake up and make a change? Also, did you see Michael Moores doc. Sicko, your thoughts on it?	I saw sicko. Michael Moore was wrong on a few points but did a great job of exposing how intentionally evil health insurance companies are. I guess the answer to your first question is the focus of my crusade. People have to know exactly what's wrong with our health care system before we can really fix it.
Mind expanding on what you thought was wrong?	It's a bit hard since I saw the movie several years ago. I remember thinking at the time that I would love to sit down with him and explain a few things about our system that only someone on the inside would understand. One example is how the role of hospitals in treating sick people has been shrinking in this Country. It's not entirely because people are being kicked out too early (though that does happen unfortunately). It has more to do with the fact that hospitals were over-utilized tremendously in the past. I wrote an essay about that a couple of years ago. I should say, I wrote the essay before I got a hold of all the financial records for California's hospitals so I know more now but I think it's still worth reading if you like: Link to truecostofhealthcare.org
What are your thoughts on accountable care organizations? Will they bring down costs and improve care or will they make not much of a difference at all?	I confess, I don't understand them but I think they are intended to push doctors to provide more preventive care. In theory that's always a good idea. We'll see how that works in practice.
How much of the cost of health care is attributable to the fact that insurance policies, for lack of a better way to put it, are trying to nickle and dime you at every step of the way? In other words, at what point do the bureaucratic costs of administering all of these various plans, all of which are ridiculously complicated, exceed the cost savings of denying care?	It's more complicated than that. The short answer is that insurance companies deliberately obscure how much health care costs so that they can function more like a protection racket. That's where the money is and that's why everything in health care is so confusing. Confused people are easier to take advantage of.
What made you decide to do this research?	All of the deceptions and misunderstandings at every level of this business were driving me nuts so I felt I had to do something about it.
I have an underlying medical condition- Ulcerative Colitis. Got diagnosed about 6 years ago. Its fairly mild, controlled by daily meds. I'm under a low-key but always available 'watch' by my docs and nurses, and I can turn to them at any time. Case in point: I had a little bit of "gastric flu" last week for 4 or 5 days, and a bit of a lazy gut for a day or so afterwards. Got some cramps because I couldn't pass wind, called my docs to get an emergency appointment. In there an hour later, and he confirmed that all was well. Now, I'm lucky because I'm in the UK, and this is all paid for out of general taxation. I'm a taxpayer. We get a better deal all round because of the economy of scale that a country buying its healthcare from providers can give. Its not perfect, but it sounds about 1,000,000% better than in the US. What I've never understood is why those who defend it say that the American system is democratic, that other nations are 'socialist' (as though that's degenerative). Why can't America just see that they have a system that's designed to bilk them?	Whenever a system is inefficient, a lot of players will make huge amounts of money on the inefficiencies. Those players will do anything they can to prevent change.
Would a better reform of healthcare in the US have been to rein in costs rather than to make the changes the Affordable Care Act is attempting to make?	Our health care system is broken in so many ways no one solution will fix everything. However, the focus of my website is actual health care costs because so few people seem to understand them. As far as reigning in costs are concerned, I have proposed an idea that I think will help. Here's a blog I wrote about it: Link to www.huffingtonpost.com
Why is an insurance based system preferred over a healthcare service funded directly from taxation? UK citizen here also.	Many Americans just hate the government. It's like a religion with them.
I'm from the UK so only know about the NHS, which is heavily overstretched but in my opinion a very good healthcare system. From my very limited knowledge of the US system, it seems so messed up that in a western country that one hospital admission can bankrupt a person if they are not insured, which leads to patients not getting health issues checked and causing further distress to the family during medical emergencies. What do you think of the British system(pros and cons)? And what would the implications be of implementing the British system in the US?	We'd be better off with the British system but it's not going to happen here. I address that here: Link to www.youtube.com
Hello, and thanks for doing this AMA, I'm a premed student who's studying for the MCAT at the moment. Do you have anything you'd like to impart onto students who are looking to get into health care, given what you know of its financial hardships?	That's tough. I went to USC medical school in the 90's (California not Carolina). The year I graduated (97) USC had the dubious honor of having the highest tuition for a medical school in the Country. It was just over $30,000 a year. Now I hear Public medicals schools cost about that much. It's insane by I can only address one scam at a time so University tuition will have to wait.
Is insurance strictly needed? (There are many things we buy that do not involve insurance companies.) Is it not in the interest of insurance companies that health care becomes increasingly expensive to firstly, scare people into buying insurance and, secondly, justify high premiums?	It's needed for emergencies and high priced things you couldn't afford on your own. Most people would have a lot of trouble paying for a new liver if they needed one.

Last updated: 2013-12-11 20:11 UTC
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