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Chronic Lyme Disease

Chronic Lyme Disease

Chronic Lyme Disease

This week, on Dr. Andrew Pugliese’s monthly special edition of Top Docs Radio we talked about chronic lyme disease.  Also known as post-treatment lyme disease syndrome, this chronic, debilitating condition is frequently overlooked outside of the Northeast, where it’s known to be prevalent.

As we learned from David Baird, a patient experiencing chronic lyme disease, and Karen Huppert, the mother of a college-age student who dealt with the illness, its severe symptoms, and treatment for several years as well.  They both shared their poignant stories and described how they moved from specialist to specialist trying to find a diagnosis.  And they shared how they were told that, “Lyme disease doesn’t exist in Georgia,” leading to a significant delay in the diagnosis that allowed them to seek appropriate care.

David brought his wife, a local veterinarian, also talked about how comparatively easy it is to diagnose a canine, for whom there are straight-forward tests that identifies the infection, and treatment is also effective and readily available.  She talked about how frequently she treats pets for Lyme disease here in her local Atlanta office.

We strongly encourage patients to seek second opinions and to seek to learn all they can about their symptoms and diseases to facilitate timely treatment, which can affect outcomes.

I was also pleased to host Dr. Leanna Kart, DC, a chiropractor whose practice is located on Howell Mill Road in west Atlanta.  May is National Posture Awareness Month.  We talked about how technology has affected neck/back health through creating a tendency to sit with the head in a chin-down orientation for long periods of time.  This causes an increased strain on the connective tissues and muscles in the neck, which can lead to headaches, neck and back pain, and neurologic symptoms.

Special Guests:

Andrew Pugliese, MD, Infectious Disease Consultants twitter_logo_small  linkedin_small1  facebook_logo_small3  Blogger 2  

Infectious Disease Consultants

  • Doctorate in Medicine, St. George University School of Medicine
  • Fellowship, Infectious Disease, Winthrop University Hospital
  • Triple Board Certified in Internal Medicine and Infectious Disease
  • Pioneer in non-surgical treatment of acute and chronic sinusitis
  • President of Sinus Solutions

David Baird, Chronic Lyme Disease Patient

Karen Huppert, Parent of a young Chronic Lyme Disease patient

Dr. Leanna Kart, DC, of NW Chiropractic  linkedin_small1


  • Doctor of Chiropractic, Life University
  • Owner of NW Chiropractic for over 26 years
  • Board Member, Georgia Chiropractic Association


Senate Bill 158

Medical Association of Georgia


Senate Bill 158

On this week’s show we continued our monthly series with the Medical Association of Georgia.  MAG’s CEO/Executive Director, Donald J. Palmisano, Jr. stopped by for a discussion on the state of Senate Bill 158, changes in the insurance contracting arena, and other topics on the MAG agenda.  Donald also shared how he and a colleague were able to raise over $40,000 to support the Think About It campaign to raise awareness and fight prescription drug abuse/addiction in Georgia, participating in a 100 mile race and completing it in under 24 hours.  In the days since Donald joined us on the show, Senate Bill 158 was passed.

MAG continues to take steps to enhance the relationship between health insurer Blue Cross Blue Shield of Georgia, Inc. (BCBSGa) and physicians in the state.

At the end of 2014, Georgia Insurance Commissioner Ralph Hudgens rescinded physician contract amendments that BCBSGa had put into place in Georgia following “numerous complaints from physicians (and their practices).”

First MAG/BCBSGa “Physician Advisory Group” meeting took place on February 12. It is forum for physicians to express their concerns, it will give Blue Cross the opportunity to disseminate information about new payer initiatives, it will be a venue for improving communications, and it will serve as a mechanism for physicians to weigh in on Blue Cross’ clinical policies, operations and contracting practices.

The advisory group consists of four MAG member physicians as well as MAG Health Policy and Third Party Payer Advocacy Department Director Susan Moore and BCBSGa Senior Clinical Officer Mark Kishel, M.D., and BCBSGa Director of Network Management/Georgia Provider Solutions Hayden Mathieson. They will meet a minimum of three times a year.

Rental Networks


MAG supports legislation that would limit rental networks in Georgia. A rental network involves a health insurer that rents or sells its network of physicians to another health insurer. These second-level insurers then include the physicians in their health insurance plans – and pay the physicians an even deeper discount – even though they don’t have a contract with the physicians.


It’s not uncommon for physicians to offer their services to a health insurer at a discounted rate because the higher patient volume offsets the costs. However, the aforementioned insurers rent or sell their networks without the physician’s knowledge – so the physicians often aren’t aware that they are in a given network or that they are contractually obligated to deliver patient care at a greater discount.


Rental networks result in mass confusion and higher administrative costs (e.g., the additional staff time that is required to verify a patient’s health insurance coverage and/or confirm the proper payment). Rental networks can also reduce the accessibility of care because physicians are forced to accept the lower (i.e., “re-priced” or “re-rented”) payment or refuse to see the patient for any follow-up or future care.


Rental networks are an inappropriate, profit-driven tactic that undermines the practice environment in Georgia that will exacerbate the physician shortage in the state. Sixteen states have now adopted laws that regulate or limit or prohibit rental networks.


Insurers are prohibited from using rental networks in federal employee health benefits plan contracts.



All-Products Clauses


Insurance companies use ‘all-products or all-or-nothing’ clauses as a cost-control tactic to force physicians to participate in every health insurance product that they offer or be blocked from caring for patients in the insurer’s plan altogether.


By forcing physicians and their practices to agree to all-products clauses, health insurers are undermining the economic viability of the medical profession in Georgia – keeping in mind that a report that was prepared by IMS Health for the American Medical Association determined that physicians in Georgia “created a total of $29.7 billion in direct and indirect economic output (i.e., sales revenues) in 2012… [and] each physician supported $1,559,494 in [economic] output.” It is also worth noting that the report found that “…physicians supported 205,869 jobs (including their own)…[and] $1,089.6 million in local and state tax revenues in 2012.”


Because physicians are constantly wrestling with these manipulative contract provisions, they have less time to spend with their patients.


All-products clauses violate several individual rights, including the right to contract and an owner’s right to operate a business in a free and autonomous way.


Physicians and medical practices in Georgia should be free to accept the health insurance products of their choice versus the ones that’s imposed on them by profit-driven insurance companies.


Eleven states have enacted prohibitions on all-products clauses, including Alaska, Arkansas, Florida, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Minnesota, Ohio, and Virginia – as well as Washington, D.C.


Special Guest

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia  twitter_logo_small  linkedin_small1  facebook_logo_small3

Medical Association of Georgia

  • JD Law, Loyola School of Law
  • Board of Directors, Physician Advocacy Institute
  • Medical Payment Subcommitte Member, State Board of Workers’ Compensation
  • Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
  • Former Director, Government Relations/General Counsel/Director, GAMPAC

Common Foot Injuries

Ankle & Foot Centers of Georgia

Common Foot Injuries

This week our friend, Dr. Shamir Bhikha, DPM with Ankle & Foot Centers of Georgia stopped by to talk about common foot injuries often seen as the weather begins to warm and people decide to get out and start running/walking.  He talked about the fact that after the New Year as folks set goals to lose weight and especially during spring, folks tend to go out and jump into a training regimen that doesn’t allow for adaptation to occur in the connective tissues, muscles, and bones of the lower legs and feet.

This leads to several common injuries that can derail our ability to continue training for months (or even longer).  We talked about plantar fasciitis, which causes often-debilitating heel pain that is particularly painful after having been at rest or in bed for a period of time, Morton’s neuroma, an injury to the nerve between the toes that makes affected toes feel like they’re broken, Achilles tendonitis, which is a painful aggravation of the tendon behind the heel bone, and issues that can occur with poorly-fitted shoes.

Shamir talked about the importance of having a running pro help you choose a training shoe that is appropriate for your gait as well as properly fitted for the activities you plan to use them for.  Not doing this can result in toenail injury (including loss of the nail), toenail fungus, toe deformities, stress fractures, and other painful problems.

Before you head out to the trail you need to take a few minutes and listen to this foot/ankle expert who focuses his clinical practice on sports-related injuries through a conservative approach to helping his clients recover and ideally prevent further problems.  We readily recommend Dr. Bhikha as an expert for foot/ankle-related problems.

Special Guest:

Dr. Shamir Bhikha, DPM  of Ankle & Foot Centers of Georgia  facebook_logo_small3  twitter_logo_small-e1403698475314  youtube logo  

Ankle & Foot Centers of Georgia

  • Doctorate with Honors, Podiatric Medicine, Barry University School of Podiatric Medicine
  • Residency, Inova Fairfax Hospital 2010-13 & Limb Salvage Center at Georgetown University Hospital 2013
  • Skilled in Sports Medicine/Trauma to the foot/ankle, Podopediatrics and Reconstructive foot/ankle surgery
  • Comprehensive training in diabetic limb salvage, plastic surgery and wound care


True North Partnering

Peter North talks Mindfulness on Top Docs Radio



This week I sat down with Peter Vajda.  He’s a Certified Professional Coach and PhD in Education and Cognitive Psychology.  We talked about how we can apply the practice of meditation and mindfulness to bring about a more centered “You”, becoming better able to handle conflict and reduce one’s over-all level of anxiety.  Peter is an astute observer of the human condition and is a passionate pioneer in the field of mind-body-spirit integrative functioning and development. Dr. Vajda is dedicated to supporting individuals and groups to enhance their understanding of how to live consciously – from the inside out – which deeply supports an individual’s ability to change, grow and evolve.

Peter brings a diversified base of professional expertise – as an entrepreneur, an educator, a facilitator, and a manager. He is sensitive to the diverse perspectives,  demands and dynamics of relationships. Since 1981, he has facilitated individuals, couples, groups and organizations.

His life and the orientation he brings to coaching, consulting, facilitating and writing are deeply influenced by his understanding of, and his experience in, the psychology of personal growth and development.

For over thirty years, Peter’s has been committed to his own personal and spiritual development. His experience in working with the “whole body” is based on his studies of psychodynamics, ego development, bioenergetics as well as energy healing.

Peter earned his Ph.D. in Education and Cognitive Psychology from Fordham University. His post-graduate work is in organizational behavior at NYU’s Stern School of Business.

For six years, Dr. Vajda has written a weekly column – “Know Thyself” – for the widely-acclaimed international Management-Issues website.

His book– Becoming a Better You, Who You Are vs. Who You Think You Are – was published in October, 2013.

Special Guest:

Peter Vajda, Phd, CPC, True North Partnering  facebook_logo_small3  linkedin_small1

True North Partnering

  • PhD, Education-Cognitive Psychology, Fordham University
  • Former Director, Academic Services, Information Technology Institute, New York University
  • Previous Manager, Instructional Design Dept. , Gulliver Ritchie Associates
  • Published Author