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Ppo health guarnatee Plans - The Pros & Cons

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Ppo is short for beloved supplier Organization. Ppo health guarnatee plans are based on contractual relationships that the guarnatee clubs have with the organizations. The term "organizations" refers to the healthcare providers, doctors, hospital, clinics, etc.

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Thus, Ppo plans have pre-approved lists of healthcare providers called the Participating (In-Network) supplier list. But they also allow you to see healthcare providers who are not on the list called the Non-Participating (Out-of-Network) supplier list.

Note that when you use a non-participating supplier you will end up paying more than if you had used one in-network.

Pros:

Access: You have access to a larger estimate of doctors and facilities. Choice: You can chose anything physician you want to see for your healthcare needs. Specialists: you do not have to have a referral to a specialist. primary Care Physician: You do not have to chose and be tied to a primary care physician. Negotiated Fees: When you use a participating provider, the estimate charged will be a negotiated estimate less than the supplier would payment someone without the plan.
Cons:Deductible: There is roughly all the time a deductible to be met. Co-Insurance: After the deductible is met, there is a co-insurance estimate that you are responsible for paying the average being 30% of the cost. Out of Pocket Expenses: Overall, Ppo plans cost you more in the middle of the deductible and co-insurance and other out-of-pocket expenses. In the end it comes down to what is important to you. Are you willing to pay extra for open access to the healthcare supplier of your choice?

Whether you want a Ppo, Hmo, or Hsa, you should consult a local health guarnatee agent or broker to help you find the right plan.

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Disadvantages of Electronic Health Records System

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Electronic health record system is definitely a better way to do store patient's medical health records. It allows for accurate record keeping, increased level of healthcare and a reduction in malpractice insurance premiums. It involves doing away with the pen and paper system of keeping medical records and embracing the digitalizing of all information. Like every new thing, change is not always welcome. A few physicians are stuck in their ways and are not embracing this new system without a fight.

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The good news is that you can work around disadvantages to turn them into positive territory or find a replacement. Some of the disadvantages include:-

Privacy Protection
There will always been privacy issues in the healthcare system on who has access to your medical records. With a pen and paper system, with the physical file located at a particular institution there is a limit to who can see your records. Even if there was a security breach and your information is not secured, it is only available to people in that proximity.

But in a situation where your information is sent to a centralized information repository in digital format, all bets are off. This privacy concern is a big issue with many people and will continue to be an issue until it is addressed for good.

Medical records synchronization
Until recently with centralized information repositories, individuals being treated at different facilities could not have their information updated at the same time which could lead to healthcare providers not having updated information when they become available. However, with centralized repositories this problem has been solved, but it has given rise to the above mentioned issue of data security and protection.

High start up cost
There is a high start up cost when transforming a pen and paper system to EHR. Some physicians do not see any immediate benefit to their practice in the short run and drag their feet in implementing EHR.

Legal issues
Taking the healthcare industry to court has in the past few decades been a lucrative venture for attorneys trying to right the wrong done to a patient, whether by omission or commission.

Doctors are already practicing defensive medicine and electronic health record system brings a new potential avenue for litigation and revenue stream for lawyers. With a new system, anything can go wrong, the system could fail or the stored data stolen. Improper uses of collected information are all potential avenues for a law suit.

Gradually, electronic health record system is gaining traction. More and more doctors are embracing it, and depending on the part of the country you are looking at, conversion could be as high as 40%. With government involvement and the amount of resources it is investing, the time will come when digital medical record keeping will be the norm.

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Verify Your health provider is a Participating provider With Your health insurance Plan

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A lot of patients know for a fact their original care supplier participates with their assurance plan. These same patients fail to verify specialists, labs, and even hospitals. Failing to confirm whether a supplier is a participating supplier can lead to very high-priced medical bills.

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The failure to verify participating providers is ordinarily due the fact that individuals automatically assume that their original care doctor will only send them to providers that accept the their insurance. Most medical offices are real good at ensuring that you will see a participating provider. Mistakes can be made and you will be responsible for those mistakes.

How do you ensure your supplier is a participating provider?

Check with both your assurance firm and the health care supplier you which to see before showing up for your appointment. Make two easy phone calls. One to your health care provider. One to your assurance company. Why make two calls?

Call your assurance carrier first.

The first call should be to your assurance company. Call your assurance carrier and verify services provided by this health care supplier is covered by the plan. While you have them on the phone ask them if there are services that may not be covered. Not everything your supplier recommends is covered under your assurance plan. Knowing what will not be covered can save you a lot of money.

Then call your health care provider.

A lot of patients think that one call to their assurance firm should enough. That is not the case. Many times a health care supplier has decided not to accept an insurance. For anything reason, the assurance firm still has them listed. Therefore, it is also leading call your supplier and your assurance firm to verify coverage.

Make sure to verify your health care supplier accepts your medical insurance! Doing so can preclude you from paying unnecessary medical bills.

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Presenting - Glenn Cochrane - Media Personality, Author and Expert Fundraiser

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When I recently talked to several people about my Celebrate Toronto project, which starts with an article & interview series and a photo exhibition about the Beach, about 4 or 5 different people concurred that one person should not be missed: Glenn Cochrane.

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How is Presenting - Glenn Cochrane - Media Personality, Author and Expert Fundraiser

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When I approached Glenn, the former CFTO news personality kindly invited me into his beautiful condominium high above Queen Street and gave me a chance to sit down with a real veteran of Toronto's Beach neighbourhood. After explaining my mission to Glenn, he was very forthcoming welcoming and willing to share his life's experiences and his neighbourhood's stories with me.

He first clarified that the true Beach area is bounded by Kingston Road and Lake Ontario, as well as Woodbine Avenue and Victoria Park Avenues on the west and east sides respectively. Particularly due to the increasing demand for real estate in this popular area, the term "Beach(es)" has expanded in recent years to include other adjoining areas. Beach residents are quick to point out that this is a real estate term.

Glenn himself was born in Hamilton and came to Toronto in 1964. He worked at Canadian Press and moved to the CFTO Television Station where he started out as a writer. His particular talent lay in light writing, and Glenn was often assigned to write the closing remarks for Ken Cavanagh, the anchorman at the time, who liked to close his newscasts with a light comment.

His career in front of the camera started accidentally when an assignment editor sent Glenn out with a cameraman to cover a local story as the regular television reporter was not available. Glenn's talent in front of the camera got noticed and he received rave reviews from the audience and his peers. From that point forward he had a weekly feature in the news called "Our Man Friday" and later got a daily spot in the newscast, focusing on human interest stories.

Glenn fondly recalls this time as he was given free reign to interview people as he wished and to cover stories that he found interesting. One story that comes to his mind was about a life-long farm worker, an individual without a lot of formal education, but a lot of practical talent. This gentleman would turn disused farm machinery and implements into creatively re-functioned objects. Glenn mentioned a big tractor wheel that was equipped with flower pots that could be watered by turning the wheel.

For a practical example of this gentleman's creative handiwork Glenn took me out onto his balcony and showed me a small round garden table, handrafted by this individual from a round heating grate while the feet were made from railroad spikes. Glenn fondly recalls this person as a quiet very humble individual.

Glenn and Jean Cochrane have been living in the Beach for almost 40 years now. As a matter of fact, Jean was the one who discovered the neighbourhood when she did an interview with a local resident as the woman's editor for Canadian Press. Right around 1970 the Cochranes moved into their first owned home on Beech Avenue.

At that time, Glenn adds, the Beach was really a forgotten neighbourhood. During the 1970s the Beach had an aging population and the area was not nearly as pristine as it is today. Glenn explained that the boardwalk was located about half an inch below the lake, and routinely in the spring, shards of ice would lift up the boards and big gaping holes would appear in this treasured waterfront promenade, regularly requiring expensive repairs.

When Glenn and Jean first moved here, most of the commercial activity on Queen Street was concentrated between Woodbine and Lee Avenue. As a matter of fact, Kingston Road further north was thriving much more than Queen Street. According to Glenn's research for the book he is currently working on (his new book will be about the Beach), Queen Street was not a particularly exciting destination in the 1930s and 1940s as it was mostly characterized by gas stations and discount stores. These so-called "junk stores" were frequently visited by the police, until their owners decided to call them "antique stores". With the name change, the image of these stores changed as well and the frequent police visits stopped.

Glenn really credits the revival of this neighbourhood to the rebuilding of the Balmy Beach School. The school was old and cramped and in a public hearing with the local residents, an expert demographer proclaimed that the school would need to be rebuilt in order to attract young families. And so it happened, the school got rebuilt and the entire Beach neighbourhood became attractive to families with young children. Large houses that were originally built in the 1920s for large families were filled with life again.

Referring to the transitions in his neighbourhood, Glenn mentioned that the Beach has never really been known as a primary destination for fashion shopping although there are several established retailers selling men's and women's fashions. He indicated that the demolition of the race track in the early 1990s had a big influence on the neighbourhood. While the race track was still in existence, local residents experienced significant problems with race track customers parking in their driveways and front lawns. A shortage of parking is a common refrain in the Beach.

That does not prevent the neighbourhood from throwing major parties throughout the course of the year. The most well-known event is the Beaches Jazz Festival held over four consecutive days every summer. Although a delight to the revelers and music fans that descend on Queen Street East every year, the residents were affected by the increased traffic, congestion and crowds at that time. Many of these concerns have now been addressed in collaboration with Sandra Bussin, the City Councillor for the Beach area. Activity generally shuts down at 11 pm so local residents can still get a good night's sleep while visitors are able to enjoy a great street party. Compromise solutions have helped to address the needs of residents and visitors alike.

Glenn's eyes twinkle when he tells me that right in front of his condo a percussion band regular sets up during the Jazz Festival and their repeated drumming sessions can get to you after a while. Some local Beach residents will actually make a point to get out of town during the festival for a weekend of rest and relaxation in the country. Glenn and his wife Jean love the Jazz Festival, the only downside is that actually very little jazz music is played during the festival. Glenn explains that today there are very few New Orleans-style jazz bands left, and the ones that do exist are very expensive to bring to the city. One group of oldtimer jazz musicians still participates every year at the corner of Lee and Queen, but due to their advanced age, jazz fans need to contend with frequent breaks in their program so these jazz veterans can catch some rest and recharge their batteries.

Particularly since his retirement, Glenn Cochrane has become even more involved in local community work. One of his early introductions to charity work was when he purchased a wooden hand-carved rocking horse from a local artist, sold draw tickets for the horse and raised 0 for the Beaches Library, a local community institution that the entire Beach neighbourhood is very proud of.

Centre 55, a local community centre and social services agency, is another one of Glenn's endeavours: he is the Chairman the Board of Centre 55 and claims that he is not a dominant figure in the running of this important organization. He defers all the credit for the work of this institution to Bob Murdoch, the executive director, who in Glenn's words, doesn't like to be praised. Gene Domagala, who I recently interviewed, and Glenn Cochrane were both voted "Citizens of the Year" in consecutive years (2001 and 2002) and Glenn says that they are very good friends. Glenn regularly volunteers as the master of ceremony for the Christmas Tree Lighting Ceremony and he also donates his time to the Jazzfest Winegarden Fundraiser and many other local causes.

One of Glenn's important causes is architectural preservation, and along with Gene Domagala they almost singlehandedly saved the famous Leuty Lifesaving Station from sure destruction. Glenn explains that when the city no longer deems a building useful they bestow it with "benign neglect" which sometimes results in the destruction of a historic building. In this case a committee of concerned citizens led by Glenn Cochrane and Gene Domagala started a major fundraising drive to save the Leuty Lifesaving Station. The campaign was called "SOS" ("Save Our Station") and through the sale of mugs, t-shirts ("by the truck load", as Glenn says) and a wide variety of special events, the group raised tens of thousands of dollars and the Leuty Lifesaving Station was saved. He even organized several harp concerts as fundraisers. The historic structure was completely saved in all its glory; the only difference to the original version was the installation of a female change room, reflecting the fact that times had changed and that lifesaving today was no longer an exclusively male domain.

Another fundraising event involved a replica of the Leuty Lifesaving Station: slightly bigger than a garden shed, the "Little Leuty" would be given away in a draw to the lucky winner, and the funds raised went to important local causes. A woman finally ended up winning the draw and the "Little Leuty" found a welcome spot in her backyard as a playhouse for your young daughter. Creative fundraising has long been one of Glenn Cochrane's strengths.

Community action kicked into high gear again when the Greenwood Racetrack lands were closed in 1993, and demolition was set to start. Glenn and a group of concerned citizens lobbied to turn the former race track area into parkland. Unfortunately, and perhaps not surprising considering this was prime real estate, the lobbying effort failed, and the developments of new townhouses and condos on the former race track lands went ahead. However, the developers were open to the idea of integrating some space for the community, and according to Glenn, this sent an important signal that Beach residents were not just going to be pushed around.

We discussed that residents of the Beach are very protective of their neighbhourhood and would like to keep it the way it is. Currently, the neighbourhood is experiencing some degree of controversy over a new proposed program called "Come in from the Cold" which would have homeless people pend one night in a local church in the Beach. The program has already been operational in other parts of the city. A small group of local residents has expressed concern about this initiative, and there has been some negative media attention, accusing Beachers of having a certain NIMBY (not-in-my-backyard) attitude.

On the other hand, a drop-in program that is open to homeless people and various disadvantaged residents, has been successfully in operation for the last 6 years. Four churches in the Beach and the Beach Hebrew Institute each open their oors once a week from Monday to Friday, welcoming anyone off the street to a healthy and nutritious lunch that is run by local volunteers. Glenn's wife Jean regularly volunteers for this program and helps prepare the meals for this drop-in program.

Glenn further explains that it is a common misconception that everyone who lives in the Beach is wealthy. There are a significant number of low-income families in the Beach and a variety of community programs is dedicated to helping impoverished residents. One of the most important ones is Centre 55's Christmas program which delivers food and toys to hundreds of low income families. Glenn's wife Jean has also been very involved in the Neighbourhood Link Support Services, a ommunity organization that helps seniors, newcomers, unemployed and homeless individuals and provides transportation services to seniors. Many businesses in the Beach are ongoing supporters of Neighbourhood Link Support Services - the spirit of charity and neighbourly help is alive and well in the Beach.

In addition, both Jean and Glenn Cochrane are highly respected authors: Jean has penned a book about Kensington, one of Toronto's colourful neighbourhoods. In 2005 Glenn published his book "Glenn Cochrane - Tales of Toronto" which features a history of Toronto that won't be found in travel guides or city archives. Glenn is currently working on another book, as yet untitled, which will be about the Beach and hopefully will be available later this year.

What I really enjoyed about meeting Glenn Cochrane (and his wife Jean) was that they so graciously opened their home to me and so freely shared their stories and insights. Glenn and I share a passion about Toronto, our respective chosen home towns, and he most willingly shared his stories and experiences with me, another writer who loves to celebrate Toronto and its neighbourhoods. When I mentioned that to Glenn he simply said "The more the merrier". Toronto can probably use as much support from as many different people as it can get.

After our conversation we put on our heavy winter coats and headed out for a nice walk in the neighbourhood. We emerged on Queen Street near Beech Avenue where Glen pointed out Quigley's Pub, a neighbourhood institution for good food and entertainment. A few doors down is Ed's Ice cream, a real success story in the Beach, and a place that I have visited many a time for a sinfully sweet treat. From there we walked south towards the Balmy Beach Club where Glenn invited me into this private members club which, in his words, has the "best patio in all of Toronto". Talking about Toronto and our mutual observations, we then strolled further east on the boardwalk, past the "Legend of the Lake" mural that adorns the south wall of the Balmy Beach Club.

Having reached the end of the Boardwalk we turned around and headed back west to the former location of the Scarbourough Beach Amusement Club that is marked today with a historic plaque. Just across the street are some older apartment buildings with a long history (including the Ramona and the Hubbard Street Apartment Buildings, named after one of the first black City Councillors in Toronto's history). Up we strolled on Wineva Avenue, named after daughters Winnie and Eva of one of the Beaches early residents and then headed back east on Queen Street.

There is no doubt that Glenn Cochrane is an expert on the Beach, and he gives a lot back to his beloved neighbourhood. I for one can't wait to read all the stories in his upcoming book on the Beach.

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How primary Chinese health Beliefs and Chinese Culture affect health and Illness?

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Traditional Chinese health beliefs adopt a holistic view emphasizing the significance of environmental factors in increasing risk of disease. Agreeing to Quah (1985), these factors work on the equilibrium of body's harmony, yin and yang. These are two opposite but complementary troops and, together with qi (vital energy), they operate the universe and by comparison the association between citizen and their surroundings. Imbalance in these two forces, or in the qi, results in illness.

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How is How primary Chinese health Beliefs and Chinese Culture affect health and Illness?

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In order to restore the balance, primary restorative practices may be needed. For example, excess `hot' power can be counterbalanced by cooling herbal teas, and vice versa. These beliefs are deeply ingrained among the Chinese, and have been found to be unchanged following migration to Singapore.

Lee, et. Al. (2004), found that patients with exact continuing diseases, namely arthritis, musculoskeletal diseases and stroke, were more likely to use primary Chinese rehabilitation (Tcm). This was strongly considered by the 'chronic disease triad', perceived pleasure with care and cultural health beliefs.

Hence the use of Tcm is not connected with the capability of doctor-patient interaction. Astin (1998) also agreed that it was seen as being more compatible with the patients' values, spiritual and religious philosophy, or beliefs with regard to the nature and meaning of health and illness.

In primary Chinese culture, taking medication is idea to be aversive, hence medications tend to be taken only until symptoms are relieved and then discontinued; if symptoms are not obvious, medications will probably never be taken.

Apart from parental cultural beliefs, minor side effects of sure antibiotics such as stomach upset may lead to the poor adherence of medication. The use of "leftover", "shared" antibiotics and over-the-counter buy of antibiotics by parents are tasteless situations in the community.

They think that their children suffer from the same illnesses judging by the similar symptoms, so they would give the "leftover" or "shared" antibiotics to their children and only bring them to their doctors if there is no correction (Chang & Tang, 2006). This may cause their conditions to deteriorate and may necessitate aggressive treatments later which may have unnecessary side effects.

However, there are small groups of Chinese who also blamed ill-health or misfortunes on supernatural forces, or on divine retribution, or on the malevolence of a 'witch' or 'sorcerer' (Helman, 1994). Such groups will normally seek cures from their religions.

In Singapore, the Ministry of health has drawn up the Tcm Practitioners' Ethical Code and Ethical Guidelines to preclude any unscrupulous practitioners from preying on their patients and taking advantage of their beliefs, for example, molesting ignorant patients.

The degree of acculturation has been evidenced in the following case. An old man was brought into our hospital with a week-long history of malaise, nausea and vomiting, and sudden jaundice. He was diagnosed to have an obstructive mass in the liver.

A biopsy revealed hepatocellular carcinoma. The serological test recommend continuing active hepatitis B. When the news broke to his son that his father had cancer, he requested not to disclose that to his father.

When we discussed end of life issues such as hospice care and "do-not-resuscitate" (Dnr) orders, the son tried to divert the argument to other issues such as when his father could go home.

Cultural Issues that may be complicated in this case are:

The Chinese tend to protect the elderly from bad news.

Believing in karma - the older folk believe that discussing illnesses or death/dying is bad luck. They think that talking about something bad will cause it to come true.

There is an increased incidence of liver cancer resulting from Hepatitis B due to delayed rehabilitation in the elderly, as it may take a long time for them to accept the preliminary diagnosis.

Reference:

Astin Ja. (1998). Why patients use alternative medicine. J Am Med Assoc 1998; 279: 1548-1553.

Chan, G. C. & Tang, S. F. (2006) Parental knowledge, attitudes and antibiotic use for acute upper respiratory tract infection in children attending a primary healthcare clinic in Malaysia. Singapore medical Journal, 47(4):266

Helman, C. G. (1990) Culture, health and Illness. Wright, London.

Quah, S. R. (1985) The health belief Model and preventive health behaviour in Singapore. Social Science and Medicine, 21, 351-363.

Lee Gbw, Charn Tc, Chew Zh and Ng Tp. (2004). Complementary and alternative rehabilitation use in patients with continuing diseases in primary care is connected with perceived capability of care and cultural beliefs. Family Practice, 21(6): 654-660.

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Symbolism Behind the Chess Pieces

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You should basically know what the different types of Chess pieces are. They have generally become a well-known part of culture and anyone should be able to look at a Chessboard and recognize it for what it is. The King, Queen, Bishop, Knight, Rook, and Pawn are all highly symbolized pieces which each have a special set of rules, moves, and uses. What many people do not realize, however, even if they have experience with the game, is exactly why those pieces are called the names they are. These Chess pieces did not originate as Kings, Queens, and the like, but simply found their most popular form in them.

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The Chess pieces, when the game was originally conceived in India, were all based on war elements. Infantry and calvary, elephants and chariots were all represented by pieces much like Pawns, Knights, Bishops, and Rooks. These pieces played out the game, trying to gain dominance over the other player's army. As the game spread to Eastern Asia, the pieces changed somewhat but still kept a military theme. The most importance piece at this stage, instead of being called the King, was usually referred to as the General. Even when the game eventually moved to Europe, the game did not catch on until the pieces were redesigned with a court-like theme instead of the popular military one.

Pawns kept the idea of the infantry and grew to represent the peasants from a court. They were considered expendable pieces, as the entire game was built around protecting the court. During the phase of Medieval Chess, however, these pieces were given a little more substance, and each particular Pawn was generally given a name relating to a certain commoner's occupation. Some Pawns were considered to be city guards, farmers, merchants, doctors, and innkeepers. While these special ranks did not denote anything special upon the Pawns, it attempted to give a little more story to the game of Chess and make things a little more diverse.

The Rook was originally symbolizing of a chariot and the word itself sounds remarkably familiar to the Persian word for "chariot." These Persian war chariots were often heavily armored with fortified stone work, giving the Chess piece the image of a mobile building. The design eventually reshaped itself into a turret and the modern Rook was born. Knights are usually represented by horses and are rather straightforward in their history and appearance. They never have had drastic meaning changes or appearance.

Bishops seem to generate from the Staunton Chess set. They are given a tall hat, much like a Bishop's mitre. This form, however, also pays homage to the original form of the Bishop, with the traditional deep groove also symbolizing the tusks of the elephant that the piece initially represented. The Queen, however, has had the most transformation over time. Originally only being allowed to move one space diagonally and to make a jump like a Knight only once in a game, by 1600, the piece was given the powers it is granted today. Additionally, the King was changed from a General to keep with the modern court theme. Just as with a General leading a war, a country is powerless without its King, making it be the most important piece of a Chess game.

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Used Umpire tool

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Cincinnati Address - Used Umpire tool

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Buying used umpire tool requires, as Will Ferrell's George Bush once said, "strategery." The buy of some used items is just plain gross (e.g. A protective cup). The buy of other used gear may be a smart move.

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Mask

At first blush using person else's mask sounds just nasty. However, an umpire mask is composed of two parts, the frame and the padding. Most most mask manufacturers make change pads. For instance, diamond offers change pads for its widely favorite Dfm-Ump that sell for about . Most used masks on Ebay sell for around . If you can buy the mask for and pop in new padding for .00, you can save a few dollars off the retail price.

[editor's note: I have easily seen a new Dfm-Ump on sale for as low as online. It seems to me a little legwork on the internet is a best selection than buying used umpire equipment.]

Chest Protector

Let's face it: umpires sweat - a lot. Some umpires do not use undershirts (gross). Luckily some chest protectors are washable (e.g. Pro Nine Chest Protector Cpu).

Leg Guards

Some leg guards are washable. Some leg guards can be disassembled for washing.

My notion is that the above tool can be purchased new for around 0. Used you may get it for . Personally I would rather pay the extra for tool that is my own and does not remind me of rotten fish. Use umpire tool is commonly not worth the savings. With that said, I would think a great deal on an perfect lightweight mask if I could replace the pads and save more than 50%.

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Brain And Neurological Problems Affect Almost Half Of Celiacs Even With A Gluten Free Diet

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Pediatric Physicians - Brain And Neurological Problems Affect Almost Half Of Celiacs Even With A Gluten Free Diet

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There is reasonable evidence of neurological problems in Celiac disease (CD) even those well treated on a gluten-free diet should undergo periodic neurological screening. Peripheral neuropathy is found in almost half of people with CD. Previously, neurological complications in Celiac disease were reported to be as high as 36% or more than a third. Some unexplained neurological problems are present but not recognized by the patient or their doctor in many patients and some have several problems. Unfortunately, since brain imaging is not routinely done or recommended in those who are newly diagnosed we don't really know how high these numbers may be really be. More staggering is the fact that we are still learning about people who fail to meet diagnostic criteria for Celiac disease but are being found to have gluten related neurological problems that respond to a gluten-free diet.

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There are many neurological problems that in undiagnosed and untreated Celiac disease but include neuropathy, balance problems (ataxia), seizures, MS-like symptoms, headaches, memory impairment, depression and anxiety, inattention (ADD/ADHD), schizophrenia, dementia, muscle weakness, childhood developmental delay, autism (Asperger's). The sad truth is that many patients have delays in diagnosis that result in delayed treatment and poor response even while adopting a strict gluten free diet. The average delay of diagnosis in adults is between eleven and thirteen years. Dr. Hadjivassiliou, a neurologist in England who is considered the world's expert in gluten related neurological problems has communicated to me by e-mail and written that responses to a gluten-free diet may take five years and if the neurological condition has been longstanding complete recovery is not likely.

The symptoms of neuropathy are paresthesia (numbness) or dysthesia (burning, tingling, heaviness, "pins and needles" sensation"). Many of my patients also describe hypersensitivity of their skin such that they do not like air blowing on them or their children or spouses against their skin. Some admit to "bug crawling" sensation on their skin, something called vermiculation in medical terms but rarely asked about or given much thought by most doctors. Odd muscle movements under the skin that some call a "bag of worms" medically known as fasiculations are also very common but dismissed by many doctors. My wife, a physician with Celiac disease, actually had these occur while undergoing an EMG (electromyleograph, recording of muscle activity by placing needle electrode into the muscle) exam by an older neurologist. Despite observing these occurring visually and the monitor showing "static like noise" the neurologist dismissed them as "normal".

Many patients with Celiac disease also have what the radiologists and neurologists call "UBO's" on MRI exams of the brain. These unidentified bright objects (think UFO) are white spots that show up on images of the brain. When found in certain locations of the brain they are highly suggestive of multiple sclerosis (multiple scarring spots in the brain). However, though many people with CD have MS like symptoms and these symptoms often respond to a gluten free diet when started early enough, the UBO's seen on MRI of the brain are typically not in the classic areas of MS. Instead it is common to find them in areas of the brain associated with migraines or balance difficulty (ataxia).

Some are seen in children associated with strange seizure problems even without obvious intestinal symptoms. A classic specific syndrome is very well recognized associated with epilepsy in both children and adults who have calcifications in their brain that can be detected by CT scan or MRI. Epilepsy is well documented but the studies are confusing enough that there is not a good consensus regarding the risk and recommended screening of all children with epilepsy.

Personally and professionally I have observed all of the neurological complications of Celiac disease and most of them I have also noted in patients in whom I have not been able to confirm CD but who have what I believe are objective signs and/or genetic risk for gluten sensitivity. I have patients with MS-like symptoms, chronic unexplained neuropathy, headaches, attention difficulties, autistic behaviors and developmental delays who have responded to gluten-free diet but if they had listened to doctors who maintained such a "restrictive, expensive, hard to follow" diet should only be "imposed" on those with a established diagnosis of Celiac disease.

If you have neurological problems get testing for Celiac disease before starting a gluten-free diet. If you test negative for CD, make sure they test you for the complete HLA DQ genetics that includes the high-risk white blood cell patterns DQ2 and DQ8 for Celiac disease AND get blood tests that include IgG and IgA gliadin antibodies. If your blood tests, including gliadin IgA and IgG antibodies, are negative or normal then consider stool testing for gliadin antibodies in the stool (, http://www.enterolab.com).

The evidence continues to accumulate, though often ignored or missed, that gluten is toxic to some people's brains, even if they do not have CD. If you do have Celiac disease it is likely you already have neurological problems and may be at risk despite being on a gluten-free diet. Borrowing from the old advertisement against drug abuse "this is your brain on drugs" maybe we should be getting the word out "this is your brain on gluten". Despite your test results, consider a trial of gluten-free diet after you have your testing done if you have unexplained or unresponsive neurological problems. You owe to your brain. Like my seven-year-old son said to one of our friends, "maybe you should lay off the gluten".

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