We have all heard the saying: “Change is inevitable”. Some fear change, but without change we are stagnant, and with change we evolve. While reflecting on my first column as Medical Director at DAKOTACARE, I could not help but focus on the transformation all around me.

Newspapers, magazines, periodicals…just about any type of journalistic modality that disseminates human interest stories along with current event summaries have considerable focus these days on the United States health care system.  Concerns about cost, access to care and quality of services seem to be regular topics for discussion along with speculation on potential solutions to each issue.  “Managed Care” was the temporary fix that appeared on the health care scene in the U.S. in the early l990s and until very recently, was effective in controlling inflationary health care costs.

How often have you heard the phrase…”grow old gracefully..”?  We all know that the demographics of the U.S. population are shifting gradually in regard to age, as life expectancies extend into the early 80’s, new technologies in health care allow for control or cure of chronic disease, and assistance in financing health care services for the senior citizens is provided through the Medicare system.  For those approaching AARP membership eligibility the following reflections found on the Internet (http://members.aol.com/remember.html) on life as it existed 50 years ago, provides a bit of humor for this otherwise relentless process.

        We were born before TV, penicillin, polio shots, antibiotics, 
        Frisbees, frozen food, nylon, Dacron, Xerox and contact lenses.

We were before radar, fluorescent lights, credit cards, split atoms, laser beams, and ball-point pens.

        In our time, closets were for clothes, not for “coming out of”, and
        being gay meant you were happy and care-free.

In our day, cigarette smoking was fashionable, “grass” was mowed, “coke” was something you drank, “pot” was something you cooked in, “rock music” was a grandmother’s lullaby and AIDS were helpers in the Principal’s office.

We were certainly not before the difference between the sexes was discovered, but we were surely before the sex change…we made do with what we had.

We got married first…and then lived together afterward.  How quaint can you be?

Well, to many of us, those were the “good old days”…when five or ten cents in the store bought something for five or ten cents.  So throw away your cigarettes, exercise for 50 minutes each day, watch your blood pressure and weight…and get set for the next 50 years.

W.O.

Summer months are usually associated with an increase in exposure to bees, hornets and ants…and occasionally, a sting from the aggressive insect may occur.  The stereotypic scenario of a summer picnic in the woods or on the hiking trail, complicated by inadvertent contact with a hive of bees in an old tree…or spreading a picnic blanket near a hill of fire ants…is familiar to most of us.   A recent experience with a relative  who suffered three stings from a hornet while mowing the lawn at his vacation  home in the forests of    western  Montana, followed by a “near-death” experience from an immediate hypersensitivity reaction, prompted interest in highlighting some facts on “bee stings” as recorded in a current standard medical textbook (Harrison:  Principles of Internal Medicine, 12^th  edition.)

Insects included in the phylum Hymenoptera are divided into three separate genera:

1) various species of bees (Apidae)  
2)hornets, yellow jackets, wasps (Vespidae), and

3) fire ants  (Solenopsis).  

The venoms in each of these classes are distinctly different in their antigenic activity and accounts for the fact that an individual may sustain a sting from one class of insect repeatedly over the years without untoward effect, and then experience a life-threatening immediate hypersensitivity reaction  (anaphylaxis) if stung by an insect of another class.  Also, there is a natural sensitization process of the immune system in which the initial exposure quietly  sets the stage for a violent reaction when the body is re-challenged with a second exposure.  Desensitization techniques using purified extracts of the venoms, and made available for use since l979, promote improved production of IgG antibodies by the body.  These antibodies attack the noxious antigens from the venom and assist in neutralizing the adverse effects.

Emergency aid kits providing anti-histamine tablets and pre-loaded syringes of epinephrine (the primary agent for use in reversing the impending collapse of the circulation in an immediate hypersensitivity reaction)  for self-administration are now available in pharmacies.   A prescription is required and the cost approximates $60 per kit.  For those individuals known to have allergies, hayfever, etc., one of these units should be in the fanny pack when venturing into any potentially hostile environment.  Of course, as we all know, even our own backyards can harbor trouble of this type during the spring and summer months

W.

Perhaps the most important component of the delivery system for health services in the United States is the access to health insurance coverage for millions of Americans via their employment.