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Request for AG Approval of Sale

Pursuant to California Corporations Code Section 5914 et seq. and California Code of Regulations, Title 11, Chapter 15, Section 999.5, Gardens Regional Hospital and Medical Center, Inc., d/b/a Gardens Regional Hospital and Medical Center and formerly d/b/a Tri City Regional Medical Center, a California nonprofit public benefit corporation (“Gardens”), hereby provides notice and requests the Attorney General’s consent in connection with the proposed sale of substantially all of the assets of Gardens to Strategic Global Management, Inc., a California corporation (“Strategic”).

The proposed sale of substantially all of the assets of Gardens to Strategic is pursuant to the sale order on July 28, 2016 by the United States Bankruptcy Court for the Central District of California, Los Angeles Division (“Bankruptcy Court”). Prior to that, on June 6, 2016, Gardens filed a voluntary petition for relief under Chapter 11 of Title 11 of the United States Bankruptcy Code in the Bankruptcy Court.

The filing by Gardens for bankruptcy protection was the result of the convergence of many factors. A significant contributor was the reduction in disproportionate share hospital payments that Gardens received for serving a large number of Medi-Cal and uninsured individuals. The percentage of Gardens’ resources devoted to care for indigent patients was significant because Gardens largely serves the low-income and depressed communities of Hawaiian Gardens, Artesia, Bellflower and other surrounding cities. Gardens has been and continues to be a vital part of Los Angeles County’s health care safety net, serving some of Los Angeles’ most medically vulnerable residents.

As a small independent hospital operating in a challenging health care environment of mounting cost and consolidation pressure, Gardens has been unsuccessful in its efforts to negotiate significant increases in reimbursement rates from commercial payors. The decline in patient volume and the increasing costs of salaries, wages and benefits have compounded the financial decline of Gardens.

In connection with the bankruptcy process, Gardens completed an auction, selling substantially all of its assets to Strategic, the best and highest bidder. In the absence of the proposed transaction, the closure of Gardens is likely. Closing Gardens would result in substantial health deficits in the communities served. Avoidance of such an outcome is the essence of the public interest in this transaction.

In bidding for Gardens’ assets, Strategic has committed to invest millions of dollars and to leverage its significant resources and experience in hospital operations to help revitalize Gardens. In addition, Strategic has agreed to several non-monetary factors that the Board of Directors (“Board”) of Gardens has set forth in the bidding procedures, including (i) keeping Gardens in operation as a general acute care facility with a fully-functioning Emergency Department, (ii) retaining more than 50% of Gardens’ employees and (iii) maintaining the existing collective bargaining agreement. The proposed transaction with Strategic will enable the Gardens Board to meet one of its foremost goal of finding a successor to preserve health care jobs for Gardens’ current employees, maintain the existing collective bargaining agreement and to continue Gardens’ mission of serving the health care needs of the community.

Consent to the transaction does not only avoid negative impacts. The transaction offers to sustain Gardens by bringing it into a large health enterprise offering better economies of scale, tum-around experience and committed capital. In addition to submitting the highest and best bid of $19.5 million for the Gardens assets, the experience and operational capabilities of Strategic set it apart in comparison to other final bidders. Strategic is affiliated with KPC Global Management, LLC, Dr. Kali P. Chaudhuri and KPC Gardens Medical Center, Inc. (“KPC Gardens”) (collectively, the “Group”). The Group owns, operates and/or manages seven hospitals, three medical groups and independent physician associations, and several ancillary providers (including skilled nursing facilities, sub-acute rehabilitation recovery centers, home health, urgent cares, outpatient radiology centers, and others). Strategic will take Gardens into the Group, with all the support functions and established capabilities such an enterprise brings to the task of stabilizing and sustaining the assets of Gardens. The experience and commitment of Strategic best meet the fiduciary goal that the Gardens Board has set: preserve access to health care services for the community.

Click this link to download the full PDF copy of the request to the California Attorney General for the approval of the sale of Gardens Regional Hospital and Medical Center.

Click this link to download additional material regarding the request to the California Attorney General for the approval of the sale of Gardens Regional Hospital and Medical Center.

Click this link to download additional material regarding the request to the California Attorney General for the approval of the sale of Gardens Regional Hospital and Medical Center. (Supplemental 2)

Click this link to download additional material regarding the request to the California Attorney General for the approval of the sale of Gardens Regional Hospital and Medical Center. (Supplemental 3, Special and Regular Minutes)

Click this link to download additional material regarding the request to the California Attorney General for the approval of the sale of Gardens Regional Hospital and Medical Center. (Response to Wendi Horwitz)

 

 

 

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“Low Back Pain Basics” by Dr. Philip Yuan, MD

Low back pain affects 80% of people at least one time in their life.  It is second to the common cold as a cause of missed days at work.  Low back pain is one of the most common reasons people pursue medical attention.  Oftentimes people do not recall a specific incident or injury that resulted in their symptoms.  On some occasions a specific trauma such as lifting or bending is the obvious etiology.  The good news is that low back pain is usually self- limited.

The most common cause of low back pain is injury or strain to the muscles of the lumbar spine. These muscles are especially susceptible when they are deconditioned or inflexible.  However, even in the fittest of people these muscles can become sore and inflamed.  Injury to the lumbar musculature results in discomfort and tightness with difficulty moving.  Muscle spasms are another common symptom.  Symptomatic treatment is the first line of treatment for lumbar strain.

Initial therapy should consist of rest, activity modification, and over the counter medications.  Non-steroidal anti-inflammatories and Tylenol usually prove beneficial in relieving most of the symptoms.  A brace or lumbar corset can also relieve low back pain and allow for the muscles to rest promoting a faster recovery.   If there are no associated symptoms (i.e. fever, neurologic deficit) and no history of trauma, most cases of low back pain will resolve in a few days to a few weeks.  If symptoms persist, it is wise to seek medical attention.  .  In elderly individuals, especially those with osteoporosis, attention should often be sought out sooner as vertebral compression fractures are more likely in this population.

Radiographs are typically obtained when low back pain does not resolve within a month of onset.  Physical therapy is the mainstay of treatment for low back pain that persists and requires a physician’s prescription.  An appropriate exercise regimen, along with massage and stretching will allow the majority of individuals to improve without further intervention.  Prescription pain medications can also be helpful in these cases.  For recalcitrant cases of low back pain, advanced imaging studies are warranted to evaluate the patient’s anatomy.

Magnetic resonance imaging (MRI) is the gold standard for evaluating spinal anatomy and the potential source of one’s pain.  CT scan is another advanced imaging study that can provide diagnostic information.  Low back pain can be caused by disk degeneration, facet arthritis, spinal stenosis, vertebral compression fractures, among other things and these tests can help elucidate the potential etiology.   Cancer and infection are much less common causes of low back pain, but if pain persists; it is wise to seek medical attention.

By: Dr. Philip Yuan, MD

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womens health fair release

 CONTACT:           Jay Geer/Sandy Nesheiwat

                                       Miller Geer & Associates

562-493-6023/714-606-7075

Jay@millergeer.com / Sandy@millergeer.com

                                                                                  FOR IMMEDIATE RELEASE

 

 

 FREE WOMEN’S HEALTH FAIR APRIL 20TH IN HAWAIIAN GARDENS

 

Meet Women’s Health Care Specialists, Get Free Check-Ups

and Learn about New Treatment Options for Women

 

HAWAIIAN GARDENS – To improve access to important preventive health care services for women in the community and to share new advanced treatment options for some of the most common health conditions for women, Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center is hosting a free health fair on Saturday, April 20th, from 10 a.m. to 1 p.m. on the campus of Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center, 21530 Pioneer Blvd., Hawaiian Gardens.

The women’s health fair will feature free health screenings and interactive physician lectures on gynecological and urological issues such as heavy bleeding, pelvic pain and more.  The health fair is designed to help you learn about your health status that may help prevent serious medical conditions in the future.

Free health screenings will include blood pressure, colon cancer, podiatry (feet), cholesterol, glucose, dental and BMI (weight loss). It will also feature educational programs featuring physicians from Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center.

Doctors will be on hand to discuss minimally invasive treatments using the da Vinci robot, which was recently acquired by the hospital, the only one available in the area. In addition, there will be “Ask the Doctor” booths to meet with individual doctors who will answer your health and wellness questions.

For more information about the health fair, please call 877-877-1104 or visit www.tcrmc.org.

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Advancements in Minimally Invasive Spine Surgery

Dr. Moshe Wilker is a board certified orthopedic and spine surgeon on staff at Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center. Below, he discusses the advancements in minimally invasive spine surgery.

 

Q: What is minimally invasive Spine Surgery?

A: Minimally invasive surgery attempts to accomplish the same treatment goal as with traditional surgery, but with much less trauma to muscle and other tissues. Reducing such trauma generally leads to a shorter time to return to activities. Minimally invasive spine surgery is performed through small incisions and frequently uses specialized x-ray techniques in surgery to localize the areas to be worked on instead of opening the area for direct inspection. Some of the types of surgery that can be done using minimally invasive techniques are discectomy, fusion and the placement of screws and rods in the spine. Minimally invasive surgery techniques are sometimes used in conjunction with other spinal procedures to treat spondylolisthesis herniated disc, degenerated disc and possibly other conditions. However this method cannot be applied to all patients.

As with traditional lumbar spinal fusion, there are many specific techniques available to try to fuse the vertebrae together using minimally invasive techniques. This can be done through the abdomen, from the back, from the side, or with any combination of these.

 

Q: What tools are used for the procedure?

A: We use a microscope that focuses down into the nerves and gives you stereoptic vision with excellent light, or an endoscope that goes down into the patient. We use small instruments that are specially made for the job. They often have handles that are bent so they don’t get in your way and you can see down this long narrow tube to do your operation.

 

Q: How are minimally invasive procedures performed?

A: Microdiscectomies and laminectomies are done through an inch incision and patients leave the hospital or surgery center within a few hours after surgery,  depending on the number of levels I operate on and their medical comorbidities

Patients who have indications for a single level lumbar fusion can have as small as one and a half inch incision.   The screws are being placed percutaneously or over the lumbo-dorsal fascia under the X-ray guidance. This is a dramatic change in the way we used to perform spine surgery where we stripped and violated the normal healthy soft tissues that did not need to be accessed in order to perform the operation.

Multilevel fusion with screws and rods can be performed through the back using several 1-2 inch incisions. In these cases a series of increasingly larger dilators are inserted through the incisions to help spread the muscles apart. Once the muscles have been moved away, the screws and rods can be placed through the dilator tubes. In some cases an operating microscope is used to help the surgeon see more clearly.

One of the most recent advances in minimally invasive lumbar spinal fusion is the ability to perform fusion surgery through the patient’s side. There are several techniques that allow the surgeon to make a small incision, approximately 2 inches in the patient’s side, directly over the planned fusion site. The muscles are then carefully moved aside, and a series of increasing larger dilators are inserted down to the lumbar spine. Specialized instruments can then be used through the dilator tube to remove the intervertebral disc and place a bone graft or metal or plastic spacer in its place. This technique is typically combined with a procedure from the back to place rods and screws for additional support.

 

Q: What are the clinical benefits of minimally invasive procedures?

A: By not violating the normal healthy soft tissues, patients experience much less discomfort in their back and neck postoperatively. Therefore, their pain medication requirements are much less. We also perform the same technique with screw placement either in a subfascial or percutaneous fashion when doing deformity surgery in the thoracic spine. The results are similar, although generally speaking these patients may end up walking post-op day one instead of post-op day zero because the length of their procedure is longer. Even in these patients, pain requirements postoperatively are significantly less than with percutaneous screws and minimally invasive TLIF.

 

Q:   What is the disadvantage of minimally invasive lumbar spinal fusion?

A:  As with any new technique, one of the major disadvantages is the additional time needed to perform the procedure. While a surgeon may be very comfortable with the traditional surgical fusion techniques, it will take time to be able to achieve the same outcome using these new methods. Surgeons with more experience can now perform lumbar spinal fusion in equal or even less time than with the traditional techniques.

Not all surgeons perform these techniques, so it may not be available from your current surgeon or in your area.

There are limits to what you can do right now with minimally invasive techniques. If you’re doing multi-level fusion — fusing more than two vertebrae — it becomes quite difficult to do minimally invasive. And there are cases where you would want more exposure and be able to see more. For example, certain tumors, birth defects and fractures are not well-treated this way. The technology is changing rapidly, though.

 

Q:  Can cervical procedures be performed with minimally invasive techniques?

A: In regard to the cervical spine, for patients who have anywhere from one to three levels I perform an anterior cervical decompression and fusion. These patients have an incision that is approximately one inch long.  Before I make my incision, I make sure I’m at the correct levels by using a Kocher Clamp and C-arm fluoroscopy once again so I know I’m directly over the area that needs to be addressed. The technique that I recommend for multilevel fusions, which can certainly be performed with the same length incision, is to use the skin incision as a mobile window and focus on adequate undermining the cervical soft tissues medial, lateral, cephalad, and caudal, followed by a generous split in the platysma muscle.

I am able to access three or four levels to perform surgery using a surgical microscope without significant retraction of esophagus, trachea or carotid sheath. Therefore, patients have less difficulty swallowing or hoarseness postoperatively. Most of them are eating soft food the night of surgery and a regular breakfast the morning after they are discharged.

 

Q:  How effective is minimally invasive lumbar spinal fusion?

A:  The results of the minimally invasive procedures through the back have been promising. Experienced surgeons are able to perform lumbar spinal fusion through the back quicker, with similar fusion rates, less blood loss, and quicker recovery times than using traditional techniques.

The newer minimally invasive lumbar spinal fusion techniques though the patient’s side are still being refined. The initial techniques had some increased risk of damage to nerves, but more recent changes have made these even safer and more effective. The results so far are very promising for this technique, but there have been a limited number of studies. Additionally, since this was only recently developed, there are fewer surgeons performing this technique.

 

Q: What are the economic benefits of minimally invasive procedures?

A: To begin with, the patient’s hospital stay is shorter, meaning the overall global cost of the hospital stay is lessened. The amount of blood loss is lessened so the patients almost never require a transfusion. Many of these patients are just under observation stay — it’s not a true inpatient stay — so the insurance company and patient are responsible for less in the global cost analysis. Smaller incisions have the added benefit of decreasing infection rate because there is less exposure. Fewer complications also bring down the length of stay and rate of readmissions.

 

Q:  Am I a candidate for minimally lumbar invasive spinal fusion?

A:  First, you and your doctor need to determine if you are a candidate for spinal fusion. Remember, the majority of patients with low back pain recover within six weeks regardless of treatment. If you have had prolonged symptoms you should see your physician. If it is decided you may need surgery you will be referred to a spinal surgeon for further evaluation. If a fusion is thought to be potentially beneficial for you, the option of minimally invasive techniques can then be discussed with your surgeon.

 

Q: Where do you see minimally invasive procedures heading in spine surgery?

A:  Twenty years ago, people used to take out gallbladders using a great big incision. In the 1980s people started removing gallbladders laparoscopically — meaning doing it through some sort of a camera device. And a lot of the technology used in that was adapted to do minimally invasive spine surgery.

We use a microscope because it gives us a much better view than a camera. When you use a camera you see it on a TV screen, so it’s only two-dimensional. But a microscope gives us three-dimensional vision, and we have depth perception, which is very important in spine surgery.

The technique is becoming widespread. I would predict that in another 20 years 90 percent of back surgeries will be minimally invasive.

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Dr. Finkelstein / Tri-City in MSN Healthy Living

I save up my one-drink-a-day allowance for the weekends and enjoy it all at once instead

Numerous studies show the health benefits of a glass of red wine a day. Abstaining from alcohol all week and over-imbibing on weekends, however, is not advisable and could even prove dangerous, says Dr. Stuart Finkelstein of Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center in Hawaiian Gardens, Calif.” All things in moderation, and that particularly means drinking alcohol,” says Finkelstein. “Even studies that say one drink a day is good for your heart also mention that the one drink a day may also increase your risk of other conditions like cancer.” The one-drink findings were based on the fact that some alcohol may thin the blood a bit and may reduce your risk of blood clots. “Drinking to excess is not good for your heart or any other part of your body and may even increase the risk of a cardiac event,” says Finkelstein.

http://healthyliving.msn.com/health-wellness/men/12-health-delusions-to-ditch#13

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Former State Legislator Tony Mendoza Joins Activate Hawaiian Gardens

Artesia Resident and Educator, Mendoza will Serve as Senior Project Advisor

HAWAIIAN GARDENS, CA (February 00, 2013) — Former California State Assembly member and local educator Tony Mendoza has been appointed Senior Project Advisor for Activate Hawaiian Gardens, a landmark childhood obesity education and wellness initiative.

A member of the Assembly for the last six years, Mendoza recently termed out of his legislative post. Before his sojourn to Sacramento, Mendoza served as a City Council member and as Mayor of Artesia, where he and his family still reside.

“Health and education are areas I hold dear to my heart as a parent, a former member of the legislature and as a classroom teacher,” Mendoza said. “Activate Hawaiian Gardens is unique in its approach, and could be a national model for addressing childhood obesity in high-risk minority communities.”

Mendoza’s experience as a leading member of the State Assembly as well as a classroom teacher in elementary schools will be a valued addition to the health and wellness program, according to officials from Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center, which is funding and leading the program.

“We are very excited about Tony’s contributions to Activate Hawaiian Gardens,” said Alexander Khananashvili, wellness program coordinator for Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center who created the effort after spending more than two years researching the country’s best practices and scientific evidence to address childhood obesity. “His grass-roots experience in the community is unparalleled and his passion for a healthier community is without reproach.”

Mendoza is advising the program on educational and community outreach and fund development, added Khananashvili.

Activate Hawaiian Gardens launched its multi-year program recently, with about 300 kindergarten students being studied as a benchmark measurement for the program. In partnership with Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center, ABC Unified School District and the City of Hawaiian Gardens, the program will also begin teaching parents about obesity-reducing tactics in the coming weeks.

For more information about Activate Hawaiian Gardens, please visit www.tcrmc.org.

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Are Seniors Hooked on Drugs?

By Stuart Finkelstein, MD

HAWAIIAN GARDENS, CA– Do you know what the fastest growing US population is? Here’s a hint. This population is expected to double in the next twenty years. If your answer was adults over 65 years old you were correct. What age group do you think uses more psychoactive medications than any other group? That’s right, our seniors, and that’s possibly your Grandma or Grandpa or even your Mom or Dad who take prescription medication on a daily basis.

Stuart Finkelstein, MDAccording to a recent report by the National Institute on Drug Abuse, as many as 1,800,000 Americans over the age of 65 may be dependent on Medicare-provided prescription drugs. The National Institute on Drug Abuse (NIDA) has released a report that suggests that older adults tend to use prescription medication three times more frequently than the general population and have the poorest compliance rates related to taking medications as directed.

Senior Substance Misuse & Nationwide Health Care Dilemma

Our senior citizens currently are at risk of addiction from regularly using benzodiazepines or a group of central nervous system depressants such as tranquilizers Xanax, Klonipian, Valium, Ativan, and Librum; along with sleeping medications like Ambien, Holician, Calmane, and Restoril; muscle relaxants such as Soma, Flexeril, and Robaxsin; and alcohol. In addition, opiates and analgesics for pain relief such as Vicadin, Codiene, Oxicotin, Ultram, Morphine, and duragesics are put our seniors at risk.

Causes of Misuse. Our older adults may have been misusing or abusing alcohol or drugs for years or now they may have problems of chronic pain, anxiety and insomnia or emotionally suffer from the loss of a spouse or other traumatic events creating feelings of grief or loneliness complicated by possibly financial or medical problems.

Discontinuation Difficulty. In general, seniors want to feel calmer and sleep better; however, many find it difficult to discontinue the use of their drugs and are unaware or ashamed to admit when they are become dependent. What’s worse is family members tend to ignore their drug problems because who could imagine their aging parent or grandparent was hooked on drugs? Maybe its depression or they are just getting sick. Could drugs have caused that accident or simple fall?

Accidents later in life often lead to complications that can become deadly or seriously hurt someone else if under the influence while driving. In fact, Ambien can cause both retrograde amnesia and antregrade amnesia when seniors will often eat in their sleep, sleep walk, drive their cars in their sleep and not remember they are doing it.

Easy Access. It’s easy for a senior to get a prescription. All they have to do is mention pain to get the drug they want. Did you know that older adults are prescribed higher doses of some medications for longer periods of time than younger adults even though there is a decrease in ability to metabolize medication latter in life? Unfortunately, it’s easy for seniors to get hooked on drugs from the high numbers of prescriptions they use. Family members may not understand that mood swings, depression, irritability, fatigue, insomnia, and inability to stay focused or involved in a conversation are not just signs of old age, but misuse or addiction.

Generational Influences. This Baby Boomer age group generation grew up in a time when “hard core” drugs were more widely accepted and were known to use a number of drugs at one time. They believe if a doctor prescribed the drugs they must be safe, and do not realize that these drugs cause dependency and interact with one another resulting in confusion. They may also believe they are immune to addiction and experience the misconception that mixing medications or doubling up on their medications are a fast fix to their health problems It’s also a fast way to an accidental overdose from combining sedatives and opiates with alcohol. Consequently, this fast fix mentality is leading to a nationwide health care dilemma.

Have you reached the age period of parenting your parents? If you have, you are about to face watching your loved ones suffer symptoms of aging complicated by solutions of mixing medications.

The Slippery Slope of Side Effects to Senility

The slippery slope to senility begins when you notice some common signs and symptoms of aging. The common signs and consequent physical side effects to watch for in your loved ones follow.

Symptoms:

  • Metabolism Decrease. As seniors mature their metabolism decreases. Decreases in metabolism cause declines in renal and hepatic functions which result in more accumulation of the chemicals in their body and for longer periods of time. What this really means is the drugs attain higher peak and last longer.
  • Dehydration. They often become dehydrated either from decreasing their fluid intake due to congestive heart failure or renal failure, or even from use of diuretics. This results in higher peek levels and longer duration of drug concentration in the blood stream even though they have not increased their dose of medication.
  • Insomnia.

    Older adults require less sleep and they often cat nap during the day causing a pattern of insomnia and resulting anxiety. Regarding insomnia, pharmaceutical companies are now directly advertising to consumers. There are frequent ads on television, radio, and magazines for pharmacological sleep aids such as Ambien or Lunesta. These ads are often accompanied by a coupon for free trial pills and this is when the free slide to senility starts.

    What if a medical provider refuses to give patients prescriptions for free medications? Often times our seniors will see other health care providers and the dilemma continues. One prescription for Ambien for 7 days is just enough time to get a senior dependant on the medication, and if they stop taking it, they will experience rebound insomnia and anxiety.

    This situation is similar to seniors being placed on benzodiazepines in the 1980’s for anxiety, depression, insomnia, and then the discontinuation of these drugs resulted in insomnia and consequently justified their continued use. Stopping these medications could result in seizures and delirium.

  • Chronic Pain. As seniors mature, arthritic pains may develop placing them on opiate analgesics for degenerative back disease, and their worn out hip and knees. In fact, 25-45% of older adults suffer from chronic pain conditions. However, discontinuation of opiate analgesics is often manifested by a well documented withdrawal syndrome which includes myalgias and arthralatgies, the same symptoms for which the patients have started to take medication in the first place. The opiates also affect their gastrointestinal track causing constipation and diaherra when the drug wears off. Now these patients are diagnosed as having irritable bowel syndrome and they actually have narcotic bowel syndrome.
  • Neurological Diseases. Seniors may develop neurological diseases such as Parkinson’s disease, dementia, neuropathy and restless leg syndrome, and stroke which necessitate the need for treatment with psychoactive medication leading to possible misuse and interactions with other medications.

Solutions:

  • Multiple Specialists. Seniors are often referred to multiple specialists and placed on additional medications that may completely inhibit the metabolism of their existing medications. This is called polypharmacy often causing the primary care physician to become unaware of all the medications their patients may be receiving.
  • Polypharmacy. Polypharmacy can cause mixing medications as a solution to our senior’s mixed problems. Several medications will cause several physical effects. For example, opiates cause constipation, antihistamines cause urinary retention, opiate withdrawal cause diarrhea, and benzodiapenes withdrawal causes anxiety and insomnia and early alcohol withdrawal does the same thing causing anxiety, insomnia and tremors. Late alcohol withdrawal can cause tremors, seizures, and delirium hallucinations.

Side Effect Sequences

Senior Secrets. Seniors are often reluctant to give their physicians accurate substance abuse histories or doctors fail to ask the questions. How much do you drink? How often do you drink? If the patient is experiencing mild alcohol withdrawal he often goes to the doctor and complains of the symptoms of alcohol withdrawal with anxiety and insomnia and then are prescribed a benzodiapene for the anxiety and insomnia which will only over time make things worse if they continue to drink and use pills.

Misdiagnosis. Sometimes the side effects of a medication may generate a new diagnosis and further treatment with still more medication. For instance, if you look up in the physician desk reference you will see the number one side effect of Klonipin, Valium, and Lorazapan is depression. Now the doctors may misdiagnosis the patient not realizing the depression is caused by the pill, and will treat the depression as a primary disease and start him with an antidepressant such as Prozac. If the patient is currently taking codeine for his arthritic pain and he is given Prozac. The Prozac will inhibit the breakdown of metabolism of the codeine to its active metabolite which is morphine, and the patient will no longer get pain relief from the medication.

  • Many elderly patients are treated with opiate narcotics which cause constipation when you first take them and diarrhea when they withdrawal. This patient is often diagnosed as having irritable bowel syndrome when they actually have narcotic bowel syndrome. The constipation can be so severe.
  • Using over the counter antihistamines often found in cold and allergy medication can cause urinary retention and a patient will be diagnosed as having BHP. These patients may be treated with Proscar or Avadar which will decrease the already heavily declining testosterone levels. Long term opiate analgesics also have been associated with declining testosterone levels through the inhibition of hypothalamic pituitary axis.
  • Episodic ailments such as cold and allergies will often require over the counter medication that can further complicate drug metabolism and impair mental gonadal status
  • Chronic back pain is often treated with opiate analgesics that can lower a patient’s serum testosterone, never allowing the patient to regain his strength or muscle tone to recover from his initial injury.
  • Patients are given opiates analgesics for back pain. When the medication wears off, the early withdrawal symptoms are often myalgias and arthralgies and then the patient gets diagnosed with fibromyalgia. Subsequently they are treated with more opiate analgesics at higher and higher doses until they become physically dependent and cannot discontinue the medication without going through opiate withdrawal syndrome which feels like a bad flu consisting of muscle aches, joint aches, runny nose, and sneezing, abdominal cramps and diaherra, severe anxiety and insomnia. All of this justifies continued use and supports the misdiagnosis.

Senility

Drug interactions and mixing medications as discussed often mimic medical and psychotic illnesses in the senior citizen. For instance, opiates analgesics and benzos have for a long time been associated with cognitive impairment. Use of opiates and benzos at bedtime can cause sleep disturbances and exasperated sleep apnea causing a further decline in patient’s cognitive ability.

Stop Time….Detoxify or Die

Senior drug addiction is something most seniors thought they would not have to overcome. Withdrawal symptoms are devastating and a safe and slow withdrawal is protocol with a board certified physician trained in addiction medicine who has specific experience with senior addiction issues and medical needs. Recognizing senior drug addiction is complicated. If you or someone you love is dealing with addiction, know detoxification is better than senility or death. It can be amazing to witness the cognitive improvement a patient will experience once you can assist him through the 3-5 hard days it takes to detoxify your grandmother or grandfather to get off this medication.

It is a shame that these seniors are rarely treated because the primary care physician rarely has the time or the training it takes to assist these patients through the detoxification process.

These patients do not seem to do well in psychiatric hospitals as they are not really depressed or anxious or senile and they resent the stamp of being in a psychiatric hospital because they are not crazy. And often times in psychiatric they are then placed on more psychoactive medication not less. May times these psychiatric hospitals are not licensed to provide detoxification services, but their patients are told to complain about their symptoms, (i.e. the depression or anxiety).

Remember, these patients are better treated by a Board Certified Addiction Medicine Specialist, ABAM, who can treat these patients in an ambulatory setting and in the comfort of their own homes. Unfortunately ABAM is a new specialty board and there are few specialists around. In addition, many HMO’s and third party payers do not recognize the specialty and refer patients to mental health specialists where they are quick often diagnosed as being bipolar patient and placed on more medications.

It’s time to stop the slippery slope of side effects to senility of your loved ones and contact a Board Certified Addiction Medicine Specialist.

(Dr. Stuart Finkelstein is an internal medicine and addiction specialists who is a member of the Society of Addiction Medicine. He is a member of the Medical Staff at Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center in Hawaiian Gardens.)

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Free Community Health Fair Slated For October 6th In Hawaiian Gardens

HAWAIIAN GARDENS – To make it easier to access important preventive health care services for members of the community, The City of Hawaiian Gardens and Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center are joining together to host a free health fair on Saturday, October 6, from 11 a.m. to 3 p.m. on the campus of Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center, 21530 Pioneer Blvd., Hawaiian Gardens.

The health fair will feature free health screenings designed to help you learn about your health. Screenings, education and early diagnosis may help prevent serious medical conditions such as heart disease, stroke and others. Health events such as these provide a relaxed environment for you to learn key facts about your health and that of your loved ones.

Free health screenings will include blood pressure, podiatry (feet), stroke, diabetes, dental, vision, and spine and orthopedic conditions. It will also include educational programs featuring physicians from Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center.

The health fair will also feature fun events for the whole family, including a Kid’s Corner area with bouncer, face painting and other activities.

Representatives from area health plans will also be on hand to inform visitors about options in Medicare and Medi-Cal during the annual open enrollment period.

For more information about the health fair,
please contact Alexander Khananashvili at ak@tri-cityrmc.org

Health Fair Flyer

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Community Health Screenings, Wellness and Education 2011

Community Health Screenings, Wellness and Education 2011

TCRMC shows its Services and does Screenings at Seal Beach Health Fair

  • On March 3, 2011, Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center offered body fat and BMI analysis to more than 75 people at the Rebuild Me Health Fair in Los Angeles.
  • On April 2, 2011, Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center participated in the Community Fair at Furgeson Elementary in Hawaiian Gardens and offered testing for blood glucose and blood pressure, and provided the pneumonia vaccine.
  • On May 18, 2011, Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center offered testing for blood glucose and blood pressure, and provided the pneumonia vaccine, at the Mini Health Fair at Hawaiian Gardens City Hall.
  • Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center offered testing for blood glucose and blood pressure, and provided the pneumonia vaccine, to attendees of the Fedde Community Center Grand Opening on May 31, 2011.
  • On June 18, 2011, Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center participated in the Corporate Challenge at Furgeson Elementary in Hawaiian Gardens and offered blood glucose and blood pressure screenings.
  • July 11, 2011, Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center attended the Employee Wellness event at Precision Resources in Huntington Beach and offered blood glucose and blood pressure screenings to more than 100 people.
  • On July 16, 2011, Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center offered blood glucose, blood pressure and cholesterol screenings to more than 100 people at the Carson Mall health screening.
  • Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center attended the Hawaiian Gardens Car Show on July 16, 2011 at Furgeson Elementary in Hawaiian Gardens. While there, nurses conducted blood glucose and blood pressure screenings for more than 50 attendees.
  • Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center participated in a Senior Health Fair at Paramount Park in Paramount on August 31, 2011. Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center offered blood glucose, blood pressure, BMI and cholesterol screenings to hundreds of attendees.  Congresswoman Linda Sanchez was in attendance.
  • Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center performed nearly 100 health screenings for blood glucose, blood pressure and cholesterol to patrons at the Los Cerritos Center Mall in Cerritos on September 9, 2011.
  • Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center also attended the Artesia High School Carnival at Artesia High School on September 9, 10 and 11, and offered more than 200 students and members of their families blood glucose, blood pressure and cholesterol screenings.
  • At the Taste of Cerritos, which was held on September 15, 2011 at the Cerritos Center for the Performing Arts, Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center offered blood glucose and blood pressure screening for the numerous foodies in attendance.
  • Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center offered nearly 100 flu vaccinations and blood glucose screenings at the Boeing Company Retirees Health Fair in Lakewood on October 12, 2011.
  • Nearly 75 flu vaccinations were provided by Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center to local seniors at the Hawaiian Gardens Senior Center in Hawaiian Gardens on October 13, 2011.
  • Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center offered flu vaccinations at the Adult Health Care Center in Carson on October 14, 2011.
  • On October 15, 2011, Gardens Regional Hospital and Medical Center formerly doing business as Tri-City Regional Medical Center welcomed walk-ins to its facility for flu vaccinations, and ended the day vaccinating about 50 local residents.
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Tips to Help Your Loved One in the ER

From the American College of Emergency Physicians:

  1. Write down all the patient’s medications or put them in a resealable bag and bring them with you. And don’t forget to include over-the-counter pills and any herbal medications.
  2. If English isn’t the patient’s native language, bring an adult translator. Often, people recruit school-aged children to translate, but medical procedures can be too complicated or inappropriate for them to talk about. The ER staff can call a translation service in a pinch. But things will go much more smoothly if a bilingual adult is available.
  3. Don’t leave the emergency department without written instructions. And don’t be afraid to ask questions and have the doctor clarify all aspects of the patient’s condition and follow up care. Carefully follow the aftercare instructions, including any additional doctor or specialist appointments.
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