LTC America, LLC
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GE FINANCIAL ASSURANCE*
Long Term Care Division
Long Term Care
Agent's Field Underwriting Manual
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To use manual: double click on ‘caduceus’ above, this will get you to the Table of Contents (TOC), the TOC is arranged alphabetically, find the history you are looking for and double click on the history (in ‘red’). To get back to the TOC, double click on the history heading.
8-6-03
• Wherever used herein, GE Capital Assurance (GECA), or the Company includes its affiliate New York domiciled insurer, GE Capital Life Assurance Company of New York.
|If any medical conditions are admitted: |
|What is the current status (the same, better, or worse)? |
|Are there any current symptoms? |
|What is the current treatment? |
|Are there any complications? |
|Is the condition under evaluation or has surgery been suggested? |
|REFER TO GUIDELINES ON SPECIFIC CONDITIONS |
| |
|For what reason or for what illness are you taking each of the medications you have listed on the application? |
| |
|Have you needed home health care, physical therapy, occupational therapy, speech therapy, or any type of rehabilitation program |
|within the past 12 months? If so, for what reasons? If currently receiving any therapy, what is the anticipated date of |
|discontinuation? |
| |
|Have you had any medical conditions in the past 10 years that have impacted your health? |
| |
|Have you seen any other physicians in the past 5 years? Why were they seen? |
| |
|If you answered yes to the disability question on the application, please explain why you are on disability. When did it begin? |
|Are you currently receiving disability income, worker’s compensation, or Social Security Disability benefits? |
| |
|Is there any other information, not covered on the application, that you feel is significant? |
If you require further clarification on any of the guidelines, or encounter one not covered in this manual, please contact our UNDERWRITING HOTLINE at 1-800-354-6892, for further assistance.
The purpose of this manual is to help those involved in the risk selection process by:
describing some of the conditions that are significant determinants of a need for long term care.
providing a list of questions to ask in order to elicit pertinent information.
providing the general guidelines used by the Company in evaluating the risk.
listing significant medications.
The manual is not all-inclusive. As our knowledge and experience increase, we will expand, amend, and refine the manual.
The information contained in the manual reflects our claim and underwriting experiences over a twenty-year period. This manual is a tool that should be used in combination with your experience, observations, and sound judgment.
If you require further clarification on any of the guidelines, or encounter one not covered in this manual, please contact our UNDERWRITING HOTLINE at 1-800-354-6892, for further assistance.
THE HOME OFFICE UNDERWRITER WILL MAKE FINAL RISK DETERMINATION.
AGENT'S LTC FIELD UNDERWRITING MANUAL
Table of Contents
Information You Should Always Gather
Field Underwriting
Home Office Underwriting
- Underwriting Requirements
(1) Intellectual Impairment
(2) Immobility
(3) Instability
(4) Incontinence (Bowel and Bladder)
(5) Iatrogenic Drug Reactions
Overweight:
Underweight:
(Alcohol abuse, Ethanolism, ETOH disease)
)
Lou Gehrig's Disease
(Pancytopenia)
Coronary Artery Disease, CAD
(Rheumatoid Spondylitis, Marie-Strumpell Disease)
(Conduction Disturbances, Palpitations, Rapid Heartbeat)
(Bronchial & Allergic Asthma)
(Neurogenic Bladder, Stress Incontinence,
Urinary Incontinence)
(Carcinoma, CA, malignancy, neoplasm)
(LARGE BOWEL)
CONGESTIVE HEART FAILURE (CHF)
(CFS)
Asthma, Chronic Bronchitis, Emphysema
ALS)
(Coronary Artery Bypass Graft [CABG], Percutaneous Transluminal Coronary Angioplasty
[PTCA])
, ----------------------------------------
ULCERATIVE COLITIS, DIVERTICULITIS
(Colitis, Regional Enteritis, Ileitis, Proctitis, Spastic colitis)
--------------------------------------------------------------------------------
(Anxiety, Mania, Manic Depression, Bipolar Disorder)
(see COPD)_________ ___________________________________________
(Seizures)
(Acute and Chronic Viral Hepatitis)
(High Blood Pressure)
(Nephrolithiasis)
(Renal Colic, Calculus or Stone)
(Frequent/persistent forgetfulness)
(Heart Attack, Coronary)
(Degenerative Joint Disease [DJD], hypertrophic arthritis)
(Peripheral Atherosclerostic Disease)
PHYSICAL THERAPY
(Kidney Failure, Acute)
(Kidney Failure, Chronic)
)
(Paranoia and Delusional States)
(Herniated Nucleus Pulposus)
Cerebral Vascular Accident (CVA)
(Fainting or Black out)
Disseminated Lupus, Discoid Lupus Erythematosus
(Thrombocytosis)
(Venous, Arterial or Pulmonary embolism)
The primary objective of the underwriting process is to collect, review and correlate all available information regarding an applicant for LTC coverage and to evaluate the risk to the Company of issuing coverage to that applicant.
Field Underwriting
The purpose of the Field Underwriting process is to:
evaluate and report on the applicant’s
past and present health
current functional status
determine if all factors would be acceptable to the Company
submit a completed application for qualified applicants to the Home Office
Home Office Underwriting
The purpose of Home Office Underwriting is to:
evaluate the
3. completed application and any attachments containing additional information
4. completed Agent's Report section of the application
5. copies of medical records
6. results of the Health Interview, when required
7. results of a telephone interview, when required (Personal History Interview [PHI])
issue coverage to those applicants who qualify.
Unique factors of Long Term Care Underwriting
The underwriting of long term care insurance differs from the underwriting of other products (such as life insurance) in that the Field Underwriter and the Home Office underwriter must consider many things which, for another type of insurance, might not seem important. A few of these unique factors are listed below.
Cognitive status
Functional capacity
- The ability to perform the Activities of Daily Living (e.g. dressing, transferring)
- The ability to perform the Instrumental Activities of Daily Living (e.g. shopping, meal preparation)
Medical histories that may result in a need for care (e.g. osteoporosis, falls, and fractures)
Multiple medical problems that, in combination, are more significant than each problem alone (e.g. diabetes in combination with heart disease)
Multiple medications (being taken for multiple medical problems) that may have adverse effects
Treatment modalities (e.g. current physical therapy)
Chronological Age vs Physiological Age - There may be a significant difference between the applicant's chronological age and physiological age (e.g. The applicant may seem much younger or older than his/her actual age)
Frailty - Serious disabilities can result from relatively minor accidents and illnesses
Personal Independence Factors that play an important role in maintaining an applicant's personal independence are:
Working, either full or part-time
A spouse in good health
Family or friend(s) living in the household
Volunteering at service clubs
Participating in hobbies and outside activities
The current ability to drive
The ability to travel and visit independently
UNDERWRITING REQUIREMENTS
|REQUIREMENT ORDERING IS DRIVEN BY CLIENT AGE AND PREFERRED DISCOUNT QUALIFICATION |
|Is a work-up underway and/or cause unknown? |
|not acceptable |
|Has there been significant weight loss of greater than 15 %? |
|not acceptable |
(Alcohol abuse, Ethanolism, ETOH disease)
Alcoholism is the abuse of alcohol, which interferes with health, economic, or social functioning. There is compulsive behavior and loss of control due to the continued use of alcohol despite adverse consequences.
Potential effects from alcoholism include: dementia; heart, gastrointestinal and nervous disorders; and fractures from frequent falls..
Alcoholism is frequently associated with depression, and this combination of histories is a poor risk.
|Questions You Should Ask and Criteria: |
|How long has there been abstinence/sobriety? |
|not acceptable with less than 24 months of abstinence/sobriety |
|Have there been any ER visits or hospitalizations for alcohol related problems within the past 24 months? |
|not acceptable |
|Are there any physical or mental abnormalities due to alcoholism? |
|not acceptable |
|Has there been a diagnosis of or any symptoms of manic depression within the past 24 months? |
|not acceptable |
|Have there been any symptoms of psychosis / schizophrenia within the past 4 years? |
|not acceptable |
|Has there been any halfway house or sheltered living within the past 24 months? |
|not acceptable |
|Has there been any unintentional weight loss of more than 15% in the past 12 months? |
|not acceptable |
|Has antabuse treatment been initiated in the past 12 months? |
|not acceptable |
|Have Benzodiazepines or Lithium been initiated within the past 24 months? |
|not acceptable |
|Have Haldol, Mellaril or Ritalin been initiated within the past 4 years? |
|not acceptable |
|Is neurological work up planned or underway (CT, MRI, neuro referral)? |
|not acceptable |
Cross-references:
DEMENTIA
(Organic Brain Syndrome [OBS], Senile Dementia)
Alzheimer's disease/dementia is the progressive degeneration of the brain with resulting loss of function. The physical signs include memory loss, and impairments of thinking, reasoning, and judgment. In advanced stages, behavioral disturbances and loss of control of bodily functions occur.
General Criteria:
Alzheimer's disease or other types of dementia are Specific Uninsurable Medical Conditions.
Lou Gehrig's Disease
Amyotrophic Lateral Sclerosis is the degeneration of nerves that affect the muscles of the body. Spastic weakness and atrophy of the limb muscles occur first with later involvement of the torso muscles.
The disorder is sometimes associated with dementia, Parkinsonism, and other neurologic disorders. The cause is unknown and the course is progressive.
General Criteria:
Amyotrophic Lateral Sclerosis is a Specific Uninsurable Medical Condition.
BOWEL INCONTINENCE
Listed below are impairments affecting the lower bowel:
|Anal Fissure |a longitudinal tear in the skin of the anal canal. |
|Anal Ulcer |an acute or chronic ulcer in the skin of the anal canal. |
|Anorectal Abscess |a localized bacterial infection of the perirectal tissue. |
|Anorectal Fistula |a tract between the anal canal and the perianal skin. |
|Bowel Incontinence |the inability to voluntarily control bowel function. |
|Hemorrhoid |enlarged veins that line the lower rectum, anal canal, and external anal sphincter, and |
| |may be internal and/or external. |
|Rectal Stricture |the abnormal narrowing of the anus or rectum by either a congenital malformation or |
|(rectal stenosis) |scarring from previous anorectal disease. |
|Rectal Prolapse |a protrusion of the rectal mucosa through the anus. |
|Questions You Should Ask and Criteria: |
|Is surgery planned or been completed within the past 6 months? |
|not acceptable (excludes hemorrhoid surgery) |
|Is bowel incontinence present, 1 or more times per week? |
|not acceptable |
|Has there been any unintentional weight loss of more than 20% within the past 12 months? |
|not acceptable |
|Is a work-up underway or diagnosis uncertain for a new onset of symptoms, including bowel incontinence? |
|not acceptable |
|Has there been a need for tube feeding within the past 12 months? |
|not acceptable |
|Has there been any genital skin break down within the past 24 months? |
|not acceptable |
The anemias are a collection of blood conditions in which there is a reduction in the concentration of circulating red blood cells. This reduction is usually expressed as a decrease in the hemoglobin (Hgb), hematocrit (Hct), or red blood cell count (RBC). Anemia can reflect serious underlying disease and the potential for disability. In the elderly population, it can also be a marker of deteriorating general health and the approaching loss of independence.
The three principal causes of anemia are a significant blood loss, failure of the bone marrow to produce sufficient red blood cells, and a decrease in the red blood cell survival time.
ANEMIA, IRON DEFICIENCY
(Microcytic Anemia)
Iron deficiency anemia is one of the more common anemias. It usually occurs as the result of chronic bleeding from the gastrointestinal tract due to gastritis, ulcers, or polyps. Insufficient dietary intake or inadequate absorption of iron can also be implicated in some cases. Regular supplementation of oral or injection iron may be acceptable.
Any iron deficiency anemia that has not been thoroughly investigated or explained may be the result of a serious medical problem.
ANEMIA, MEGALOBLASTIC
(Vitamin Bl2 deficiency, Folic acid deficiency)
Megaloblastic anemia is usually attributed to vitamin Bl2 or folic acid deficiency, but may also be associated with alcoholism, administration of certain drugs, or inborn errors of metabolism.
Regular supplementation with Vitamin Bl2 may be acceptable.
The neurologic manifestations of vitamin Bl2 deficiency have a high likelihood of causing significant disability because they involve the peripheral nerves (peripheral neuropathy), spinal cord (weakness, poor coordination), or central nervous system (dementia, psychosis, ataxia).
ANEMIA OF CHRONIC DISEASE
Anemia of chronic disease is the second most common type of anemia in American adults, and may be the number one cause of anemia in those over the age of 70. It is associated with ongoing inflammatory processes including chronic infections, inflammatory bowel disease, collagen vascular disease, severe traumatic or thermal injury, malignancy, and diabetes. Often times this anemia is complicated by iron, Bl2, or folate deficiencies that may also be a result of the chronic underlying inflammatory conditions. Treatment is directed at the underlying disease process. The prognosis is generally dependent upon the severity of the anemia and its cause.
|Questions You Should Ask and Criteria: |
|Has the cause of the anemia been identified? |
|not acceptable if currently being evaluated |
|Has there been significant weight loss of more than 20% of normal weight, without dieting, within the past 12 months ? |
|not acceptable |
|What is the current treatment? |
|not acceptable if erythropoietin (Epogen) or Procrit have been used within the past 12 months |
|Has there been any hospitalization due to anemia in the past 12 months? |
|not acceptable |
|Are there any ADL or IADL limitations due to fatigue associated with anemia? |
|see Uninsurable Functional Deficits |
|Has there been a nonoperative transfusion within the past 12 months? |
|not acceptable |
|Is the average Hematocrit less than 33 or Hemoglobin less than 10.0? |
|not acceptable |
|Has there been a bleeding history secondary to Coumadin within the past 24 months? |
|not acceptable |
|Has there been alcohol abuse or illicit drug use within the past 24 months? |
|not acceptable |
|Have there been 2 or more ER visits for blood loss, neurological symptoms, fatigue or Congestive Heart Failure (CHF) within the past 24 |
|months? |
|not acceptable |
(Pancytopenia)
Aplastic anemia describes the total failure of the bone marrow to produce any cell line (pancytopenia). A partial failure is called hypoplastic anemia. The acquired form of aplastic anemia is thought to be due to the injury or destruction of early blood cell precursors in the bone marrow. The destruction can be the result of exposure to specific medications, toxins, or viral agents. Often no etiology is ever discovered. The prognosis is generally poor.
General Criteria:
Aplastic anemia is a Specific Uninsurable Medical Condition.
An aneurysm is an abnormal dilatation of an artery. The most common sites for aneurysms are the thoracic or abdominal aorta, and the carotid, intracranial or femoral arteries.
The aneurysm may produce local pressure or rupture. Treatment generally involves surgical repair. The prognosis depends on the cause and location of the aneurysm, the resulting organ damage, and the type of treatment.
|Information you should gather: |
|Location of aneurysm -- |
|Aortic |
|Cerebrovascular |
|Carotid artery (contact Underwriting Hotline) |
|Peripheral artery (use peripheral vascular disease [PVD] criteria) |
An aortic aneurysm is an abnormal dilatation of the aorta. The aorta is the large artery that carries blood from the heart to branch arteries throughout the body. The aorta is divided in two sections: ascending and descending.
The ascending aorta extends from the aortic valve of the heart to the great vessels of the head and neck. The descending portion of the aorta is considered the abdominal aorta and feeds the large arteries to the kidneys and the lower extremities.
The recommended treatment for all ascending aortic aneurysms is surgery. Morbidity and mortality tend to be higher with ascending aortic aneurysms.
Surgery is recommended for a descending aortic aneurysm when the size is 5 cm or greater. Smaller aneurysms may be treated surgically or medically. Medical treatment requires careful follow-up and good control of hypertension.
Aneurysms may also be classified as dissecting aneurysms. Dissection is most common in the aorta. There are three major complications of aortic dissection: blockage of other major vessels, rupture (bleeding), and dissection into the aortic valve of the heart.
|Questions You Should Ask and Criteria: |
|Is this an ascending or descending aneurysm? |
|not acceptable if there is an ascending aneurysm present |
|not acceptable if there is a descending aneurysm greater than or equal to 5 cm in size, or if rapid progression in size |
|Is there a history of untreated dissecting aortic aneurysm? |
|not acceptable if untreated, or surgically corrected within the past 2 years |
|Has surgery been planned or recommended, or surgical repair completed within the past 6 months? |
|not acceptable |
|Was there a heart attack during or after the surgical aneurysm repair? |
|not acceptable within 2 years |
|Was there a coronary bypass surgery and/or aortic valve replacement at the time of the aortic aneurysm repair? |
|not acceptable |
|Is there a history of hypertension? |
|not acceptable if the hypertension is poorly controlled |
|Is there a history of diabetes |
|not acceptable |
|Is there a history of a transient ischemic attack? |
|not acceptable |
Cerebrovascular (brain) aneurysms can cause two types of hemorrhage: subarachnoid and intracerebral.
Subarachnoid hemorrhages (SAH) are most often due to aneurysms or vascular malformations, which produce bleeding into the space surrounding the brain. There is an increased risk of another bleed in the months following the initial bleed.
Intracerebral hemorrhages (ICH) are most often due to hypertension, which causes bleeding from vessels within the deep portions of the brain. The bleeding leads to the formation of a hematoma (a local collection of blood) within the brain.
If bleeding has occurred these cases are underwritten as a Stroke. (A history of Stroke is not acceptable.)
|Questions You Should Ask and Criteria: |
|Has any bleeding or rupture occurred as a result of the aneurysm? |
|not acceptable |
|Has surgery been recommended or performed? |
|not acceptable if surgery recommended or completed within the past 12 months |
|Was there a heart attack during or after the surgical aneurysm repair? |
|not acceptable within 12 months |
|Is there a history of diabetes? |
|not acceptable |
|Is there a history of a Transient Ischemic Attack (TIA)? |
|not acceptable |
|Is there a history of hypertension? |
|not acceptable if the hypertension is poorly controlled |
Coronary Artery Disease, CAD
Angina pectoris is the chest pain that results when not enough oxygen reaches the heart muscles. This condition is also called myocardial ischemia.
In the elderly, myocardial ischemia may not always be associated with chest pain, but may cause shortness of breath, irregular heart rate, mental confusion and loss of consciousness.
Angina can be either stable or unstable. Stable angina only occurs when exercise or stress increases the demand for oxygen. Unstable angina appears as repeated episodes of chest pain at rest, with low-level activity, or with increasing frequency and duration.
|Questions You Should Ask and Criteria: |
|Have episodes of angina become more frequent or severe within the past 6 months have episodes of angina become more frequent and |
|severe? |
|not acceptable |
|Has there been a hospitalization for angina within the past 6 months ? |
|not acceptable |
|Is there angina at rest? |
|not acceptable |
|Are there any ADL or IADL limitations due to angina? |
|see Uninsurable Functional Deficits |
|Is there a history of symptomatic Congestive Heart Failure (CHF) within the past 5 years or Cardiomyopathy? |
|not acceptable |
|Has there been a heart attack or heart surgery? |
|not acceptable if there has been a heart attack or heart surgery within the past 6 months; not acceptable if diabetic |
|Is heart surgery recommended or scheduled? |
|not acceptable |
|Is there a history of diabetes? |
|not acceptable |
Cross-references:
Cardiomyopathy
(CABG)
Diabetes
(Rheumatoid Spondylitis, Marie-Strumpell Disease)
Ankylosing spondylitis (AS) is a quite common, chronic inflammatory arthritis affecting primarily the spine and the large joints of the body. A distinctive feature of the disease is fixation of the joints involved.
Destructive arthritis of the hips and shoulders can be extremely disabling and joint replacement is often necessary. Falls resulting from poorly functioning hips and spine can lead to fractures of the brittle, fused spine. Excessive or low body weight can increase symptoms.
Breathing problems can also occur with this condition due to fusion of the spine, which restricts expansion of the lungs.
|Questions You Should Ask and Criteria: |
|Is there evidence of any functional limitation? |
|see Uninsurable Functional Deficits |
|Are narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan, or Talwin used to control pain within the past 12 months? |
|not acceptable |
|Has Physical Therapy been required within the past 6 months? |
|may be acceptable |
|Has joint replacement surgery been recommended or completed within the past 12 months? |
|not acceptable |
|Have there been multiple falls, and/or a single fall with fracture within the past 2 years? |
|not acceptable |
|Has there been any hospitalization for complications of anklylosing spondylitis within the past 12 months? |
|not acceptable |
Cross-references:
(Conduction Disturbances, Palpitations, Rapid Heartbeat)
Arrhythmias are a variation in the normal rhythm of the heartbeat. The heart contracts in response to electrical impulses originating in the sinus node (sinoatrial or SA node) located at the upper border of the atria. The impulses spread rapidly through the atrial myocardium and then throughout the ventricular myocardium. Cardioversion is the restoration of a normal rhythm with medication or an electrical shock (DC) to the heart .
The other three main types of Arrhythmias:
Paroxysmal Atrial Tachycardia (PAT) is characterized by an abrupt onset and termination with a rate between 150-230 beats per minute.
Premature Ventricular Contractions (PVC'S) are beats that originate from the ventricle rather than the atrium.
Sick-Sinus Syndrome (SSS) encompasses a variety of rhythm disturbances reflecting dysfunction of the SA node. SSS is often associated with dysfunction elsewhere in the conduction system. It often results in bradycardia (slow heart rate).
These arrhythmias may result in a variety of symptoms including dizziness, palpitations, rapid heartbeat, or fainting.
Treatment of arrhythmias can be with medication, electro-cardioversion, or pacemaker or defibrillator insertion.
|Questions You Should Ask and Criteria: |
|Is a Pacemaker placement recommended or scheduled? |
|not acceptable until after complete recovery (excludes battery replacements) |
|Is there any limitation of activities due to this history? |
|not acceptable |
|Has there been any symptomatic CHF (shortness of breath; fluid retention or swelling in feet, ankles, legs; difficulty breathing |
|when flat in bed) within the past 12 months? |
|not acceptable |
|Has there been any ablation procedures within the past 3 months? |
|not acceptable |
Cross References for Arrhythmias:
MI
(Bronchial & Allergic Asthma)
Atherosclerosis, commonly called the hardening of the arteries, is the gradual narrowing of arteries throughout the body. It is caused by the accumulation of fat and other material along arterial walls and is a natural part of the aging process.
Atherosclerotic plaques frequently form in the carotid arteries. Sometimes, small plaque fragments called emboli break away from the plaque, blocking arteries downstream and leaving behind craters called ulcers.
With age, fat and other materials collect in the wall of the artery, forming the arterial plaque. As plaques get larger, blood flow can be disrupted. Later, some arteries, including the carotids (located in the neck), may become blocked.
Blockage of a carotid artery (or its branches) on one side of the brain can cause symptoms to appear on the opposite side of the body. For example, with TIA there may be a temporary loss of feeling or muscular strength in the left arm when the blockage is in the right carotid. Bruit is heard on the same side of the neck where the blockage is located.
TIAs (transient ischemic attack) occur when emboli or plaques temporarily block blood flow.
Bruit is the result of blood flowing in a rough or turbulent manner through an artery partly blocked by plaque.
Strokes (cerebral vascular accident) occur when blood flow is blocked for extended periods; irreparable damage to the brain often results.
Diagnosis of carotid artery problems: In order to confirm the diagnosis of carotid artery disease the physician will take a complete medical history, conduct a physical examination, and perform a number of special tests. These procedures are aimed at finding out if the symptoms are in fact due to blockage of the carotid arteries, and, if so, how far they have progressed.
Tests:
• Doppler Imaging is a painless test. Sound waves above the range of human hearing are sent into the neck. Echoes bouncing off the moving blood can be made into an image of the carotid artery.
• OPG (Occuloplethysmography) measures the pulsation of arteries at the back of each eye as an indirect check for blockages farther down in the carotids.
• CT (Computed Tomography) is a scan that produces a series of cross-sectional x-rays of the head or body and may reveal conditions other than carotid artery problems.
• Arteriography are x-rays that are taken of the carotid while a special dye is injected into another artery in the leg or arm. A blockage can be “seen” where the dye cannot get through.
• DSA (Digital Subtraction Angiography) is another x-ray examination of the carotid. The test is similar to arteriography except less dye may be used.
General Indications for Surgery: When diagnostic tests show significant blockages or extensive ulceration of plaques in the carotid, surgery (endarterectomy) may be recommended to reduce the chance of a stroke.
|Questions You Should Ask and Criteria: |
|If surgery has been performed, what symptoms prompted the surgery? |
|What treatment is currently being used? |
|Has a stroke been diagnosed? |
|History of stroke is a Specific Uninsurable Medical Condition |
|Are there any current TIA symptoms? |
|not acceptable |
|Has there been a single TIA within the past 5 years? |
|not acceptable |
|Has there been more than one TIA? |
|not acceptable |
|With a history of TIA, is there a history of diabetes, any heart surgery (e.g., angioplasty, bypass grafts, valve replacements)? |
|Is there a history of Diabetes? |
|Has surgery been recommended or scheduled? |
|Please see surgery timeframe guidelines |
Cross-references:
Diabetes
Peripheral Vascular Disease (PVD)
Atrial fibrillation is the rapid and irregular contraction of the atrium (upper chamber of the heart), which leads to irregular contractions of the ventricles (the lower chambers of the heart). This causes a drop in cardiac output and may produce the following symptoms: light headedness, syncope (fainting) , or angina. A-FIB may be paroxysmal (intermittent) or chronic and may be associated with underlying heart disease such as coronary artery disease (CAD) and valvular disease. A-FIB often causes strokes, Transient Ischemic Attacks (TIAs), and Congestive Heart Failure (CHF).
Treatment may be with medication or with an electrical shock (cardioversion) to the heart to restore the regular rhythm. Coumadin is usually prescribed to decrease the risk of blood clot, TIA, or stroke.
|Questions You Should Ask and Criteria: |
|Has the atrial fibrillation been diagnosed or symptomatic within the past 6 months? |
|Not acceptable; 12 months with valvular heart disease |
|Has there been a defibrillator implant within the past 12 months? |
|Not acceptable |
|Have there been any ablation procedures within the past 3 months? |
|Not acceptable |
|Has there been any history of symptomatic congestive heart failure (CHF) (shortness of breath; fluid retention or swelling in feet,|
|ankles, legs; difficulty breathing when lying flat) within the past 24 months ? |
|not acceptable |
|Has there been any history of fainting within the past 12 months? |
|not acceptable |
|Have there been any hospitalizations and/or ER visits within the past 6 months? |
|Not acceptable |
|Has there been any cardioversion required within the past 6 months? |
|Not acceptable |
|Has there been a single Transient Ischemic Attack (TIAs) within the past 5 years? |
|. not acceptable |
|Have there been multiple TIA’s? |
|not acceptable |
|Has there been a history of a heart attack within the past 12 months? |
|Not acceptable |
Cross-references:
TIA
MI
Valvular Heart Disease
(Neurogenic Bladder, Stress Incontinence,
Urinary Incontinence)
A neurogenic or spastic bladder lacks normal control because of nerve damage, brain damage from a stroke, or spinal cord dysfunction.
Stress incontinence is the involuntary loss of urine upon coughing, sneezing, straining, lifting, or other movements that increase abdominal pressure upon the bladder.
Bladder incontinence/urinary incontinence is the inability to maintain voluntary control over bladder function.
Medications you may see to improve bladder function are: Urispas, ditropan, oxybutynin chloride.
|Questions You Should Ask and Criteria: |
|What is the cause of the condition? |
|if the incontinence is due to a medical condition refer to that section in the manual |
|Are adaptive devices used (i.e. catheter)? |
|not acceptable if the need for adaptive devices began within the past 6 months |
|not acceptable if assistance is needed with adaptive device |
|Is there a need for assistance with personal care? |
|not acceptable |
|Are there any complications, such as skin breakdown? |
|not acceptable if within the past 24 months |
|Has surgery been recommended or scheduled, or completed within the past 3 months? |
|not acceptable |
(Carcinoma, CA, malignancy, neoplasm)
Cancer is the uncontrolled, invasive growth of tissue. All normal tissues grow, live for a time and die, and all are replaced by new tissue. A cancerous growth does not follow this orderly pattern, but rather has an increased metabolic, growth and reproductive rate, and an increased blood supply. The cancerous growth process is not controlled by the laws of normal growth and continues unchecked. The tumor cells may invade locally and/or by distant metastasis.
Based on our experience, cancer is the fourth most common reason for long term care use. Metastatic cancer, wherein cancer spreads to a distant organ via the lymph or circulatory system, is often encountered. Common sites for cancer in the elderly include the brain, breast, lungs, prostate, colon, and lymphatic system.
Treatment: Treatment of cancer may involve surgery, radiation therapy, chemotherapy or hormonal therapy. In some cases, treatment may involve multiple modalities. The treatments themselves can cause other health problems. Some examples are: anemia, gastrointestinal problems, and genitourinary disorders.
Tumor Markers: Tumor markers are blood tests that are used initially to help identify the presence of tumors, and then to monitor the success of treatment and to identify any recurrence.
• CEA (carcinoembryonic antigen): CEA is the most widely used tumor marker, and is produced abnormally by cancers of the colon, lung, breasts, and pancreas. Although nonmalignant factors may result in temporary elevations of this antigen (i.e., smoking), a level of greater than 10 mg/ml is highly suggestive of active cancer.
• PSA (prostate-specific antigen): This tumor marker is obviously associated with prostate cancer as well as benign prostate disorders (i.e., benign prostatic hypertrophy). Two commonly used assays are available with upper limits of normal being 2.8 mg/ml and 4.0 mg/ml. However, it should be emphasized that following definitive prostate cancer surgery, the PSA level should be undetectable in the patient’s blood. The post-operative presence of this antigen or an increasing level of this antigen is likely persistence or recurrence of prostate cancer.
• CA-125: This antibody is associated with ovarian cancer is rarely elevated by nonmalignant causes. A level greater than 35 U/ml is considered abnormal and consistent with persistent ovarian cancer.
Staging: Staging can be thought of as a system for describing cancers to determine the treatment for a given tumor and the prognosis for the patient. When staging a cancer, the physician takes into consideration the size of the tumor, how deeply it has invaded into the surrounding tissue, whether it has spread to adjacent lymph nodes, and whether it has spread to other organs. The physician will also describe the specific cell type that makes up the tumor. (In some cancers, the cell type is significant because some cancer cell types are more aggressive and more invasive than others.)
Physicians use two basic systems for describing (staging) cancers: a numerical system from Stage 0 to Stage IV and an alphabetical system from Stage A to Stage D. Stage 0 and Stage A describe the smallest tumors and thus have the best prognosis. Stage IV and Stage D describe large tumors that have spread and thus have the worst prognosis. Cancer of the breast, kidney, lung, ovary, stomach, and uterus are staged by the numerical system. Cancer of the colon, prostate, and urinary bladder are staged by the alphabetical system.
Underwriting:
When evaluating the risk of a cancer history, an underwriter takes many factors into consideration:
the location of the cancer
the date the cancer was diagnosed
the type of treatment and the date of the final treatment
whether there have been complications associated with treatment
whether there has been a recurrence of the cancer
the Stage of the cancer
the cancer cell type
persistence or change in tumor marker levels
The home office underwriter depends on the field underwriter to gather as many details as possible about the location of the cancer, the date of diagnosis, type of treatment, date of the final treatment, and any other information available. The home office underwriter reviews the medical records, especially the records from the oncologist, to determine the stage of the cancer, the cancer cell type, whether or not the cancer has recurred, and the level of the tumor marker. Underwriting will always require medical records from the doctor following any history of cancer, if the history took place within 5 years.
General Criteria:
Cancers which have spread to other organs (metastasized) or which have recurred are not acceptable.
Cancers of the Bone, Brain, Esophagus, Liver, Lung, Ovary, Pancreas, Stomach, or Testes are not acceptable within 48 months from the date of the last treatment. (See Insurability Profile section of the application).
Cancers of other internal organs are generally not acceptable within 12 months. (Refer to the particular cancer in the following section.)
Cancers that are classified as Stage 0, Stage I, Stage II, Stage A, or Stage B may be acceptable after an appropriate waiting period. (Refer to the particular cancer in the following section.)
Cancers that are classified as Stage III or Stage C are usually not acceptable. (A few may be acceptable after an appropriate waiting period. Refer to the particular cancer in the following section.)
Cancers that are classified as Stage IV or Stage D are not acceptable.
Whenever there is a waiting period before the history can be evaluated, the waiting period starts from the date the last treatment is completed.
Cancer of the breast is the most common malignancy among women in the United States accounting for 27% of all cancers in women. Although no specific cause has been identified, groups at high risk for the development of breast cancer include first-degree relatives of patients with breast cancer, and women with proliferative changes on breast biopsy (atypical hyperplasia). Radiation exposure, hormones, and diet also have been suggested as causative factors in this disease.
Breast lumps are detectable in over 90% of individuals with breast cancer, and constitute the most common symptom reported on history and physical exam. Typically, these lesions are solitary, unilateral, solid, irregular, non-mobile, and non-tender and may be associated with nipple discharge. The usefulness of mammography in the detection of breast cancer in early stages has been well documented. Because of the combination of increased self examination and appropriate mammography studies, more than 50% of primary breast cancers are now diagnosed as Stage I or better.
The following stages and treatment(s) are used for breast cancer:
Stage 0 (carcinoma in situ) is a very early cancer. The tumors are usually found in the duct area. Lumpectomy is the usual surgical treatment and may include radiation.
Stage I has not spread outside the breast and is less than 2 centimeters in diameter. Treatment consists of the surgical resection of the tumor and may involve post-surgical radiation or chemotherapy.
Stage II may include either of the following: (1) the cancer is between 2 and 5 centimeters (from 1 to 2 inches). The cancer may or may not have spread to the lymph nodes under the arm. (2) The cancer is larger than 5 centimeters (larger than 2 inches) but has not spread to the lymph nodes under the arm. Treatment consists of the surgical resection of the breast with post-surgical radiation or chemotherapy.
Hormonal therapy with tamoxifen (Nolvadex) and megestrol (Megace) may be used on an on-going basis following initial surgical treatment.
Individuals treated for Stage 0, Stage I, or Stage II disease, which have been disease-free with regular follow-up examinations, may be acceptable.
Stage III or IV breast cancers are not acceptable.
Inflammatory breast cancer is a special class of breast cancer that is rare. The breast looks inflamed because of its red appearance and warmth. The skin may show signs of ridges and wheals or it may have a pitted appearance. Inflammatory breast cancer tends to spread quickly. This history is not acceptable.
General Criteria:
□ The LTC underwriting of breast cancer includes consideration of the pathology report, staging, treatment, and any post-treatment complications (e.g., hospitalization, radiation problems, recurring infections, cellulitis, or edema).
|Questions You Should Ask and Criteria: |
|What was the stage of the cancer and how much time has elapsed since the end of treatment? |
|Stage 0 or 1 tumors may be acceptable 3 months following treatment |
|Stage II tumors may be acceptable 12 months following treatment |
|Stage III or IV tumors are not acceptable |
|Were there any lymph nodes positive for cancer? If yes, how many? |
|1 – 3 lymph nodes may be acceptable 12 months following treatment |
|4 or more lymph nodes involved – not acceptable |
|Is there ongoing need for chemotherapy (excluding Nolvadex and Megace)? |
|not acceptable |
|Has there been any mention of inflammatory breast cancer? |
|not acceptable |
|Has there been any recurrence in the same breast or evidence of metastasis ? |
|not acceptable |
(LARGE BOWEL)
Cancer of the large bowel (colon and rectum) is the second most common malignancy in the United States after lung cancer. There are approximately 65,000 deaths per year from colorectal cancer. The risk of developing colorectal cancer increases with age beginning at the age of 40 and reaching a peak incidence between the ages of 60 and 75. Cancers of the colon occur more frequently in females, while cancers of the rectum occur more frequently in males.
Colon cancer prevention includes regular bowel surveillance (i.e. stool guaiacs, fiber optic sigmoidoscopy and colonoscopy). Increased dietary fiber and decreased fat intake appear to reduce the risk of colorectal cancer.
Cancers of the colon and rectum have a slow growth rate and many reach a large size and a fair degree of invasiveness prior to producing symptoms. In fact, almost one-third of patients presenting with colorectal cancers will have metastases at the time of initial diagnosis. These cancers are treated by surgical excision. The post-operative use of either chemotherapy or radiation therapy suggests more advanced disease with a poor prognosis.
Duke’s Staging of Bowel Cancer
Duke’s A – Confined to the bowel mucosa, with no involvement of the bowel wall muscularis.
Duke’s B – There is involvement of the bowel wall muscularis but no involvement of adjacent structures or of proximal lymph nodes.
Duke’s C – There is penetration of the bowel wall, together with involvement of adjacent structures and proximal lymph nodes. C1 tumors may be acceptable. C2 tumors are not acceptable.
Duke’s D – There is involvement of distant lymph nodes and organs; not acceptable.
Complications: Significant post-treatment complications may include problems with colostomy management, rectal incontinence, or radiation enteritis (inflammation of the intestines).
|Questions You Should Ask and Criteria: |
|What was the stage of the cancer, and how much time has elapsed since the end of treatment? |
|Stage A tumors may be acceptable 3 months following treatment |
|Stage B tumors may be acceptable 12 months following treatment |
|Stage C1 or C2 tumors may be acceptable 5 years following treatment |
|Stage D tumors may be acceptable 10 years following treatment |
|Has there been any radiation enteritis within the past 12 months? |
|not acceptable |
|Has there been any use of chemotherapy within the past 12 months? |
|not acceptable |
Cancer of the esophagus is a common cause of progressive dysphagia (difficult swallowing) in the elderly. Odynophagia (pain with swallowing), back pain, and weight loss are the usual presenting symptoms of esophageal cancer.
Unfortunately, by the time that most esophageal cancers are found, they have widely metastasized and are beyond cure.
|Questions You Should Ask and Criteria: |
|When was the cancer diagnosed & the date of last treatment? |
|not acceptable within the past 48 months |
|Has there been any recurrence or evidence of metastasis? |
|not acceptable |
|Has there been any on-going weight loss? |
|not acceptable |
|Has there been a need for tube feeding within the past 12 months? |
|not acceptable |
Cancers of the head and neck account for 5% of all malignancies. This group of tumors can occur at a large number of different sites, especially the oral cavity (lip, tongue, floor of the mouth, gums, and hard palate), the pharynx, and larynx. The prognosis of these tumors varies greatly depending on the site (oral cavity is more favorable) and the stage.
Unfortunately, a large number of patients are asymptomatic until the cancer has become quite large. Common symptoms include a persistent sore throat, difficulty swallowing, and hoarseness, loosening of the teeth, dentures that will not fit, earache, and disturbances in hearing. Non-healing lesions of the oral cavity or unexplained persistent swollen glands of the neck may indicate local or metastatic disease.
Treatment: The standard treatment for head and neck cancer includes surgery or radiation therapy. Chemotherapy can be included with surgery and radiation for advanced disease
Complications: Significant post-treatment complications may include swallowing difficulties of fluids and solids, regurgitation with aspiration, or frequent lung infections.
|Questions You Should Ask and Criteria: |
|What is the stage of the cancer and how much time has elapsed since the end of treatment? |
|Stage I tumors may be acceptable 12 months following treatment |
|Stage II tumors may be acceptable 24 months following treatment |
|Stage III or Stage IV tumors are not acceptable |
|Has there been any recurrence, evidence of distant metastasis, or lymph node involvement? |
|not acceptable |
|Has there been a need for tube feeding within the past 12 months? |
|not acceptable |
|Have there been any significant complications related to the cancer treatment? |
|generally not acceptable |
Each year in the United States there are approximately 18,000 cases of cancer of the kidney. These tumors account for approximately 3% of adult malignancies and are most common in the 50-70 age group. The ratio of males to females affected is 2:1.
Symptoms include abdominal or flank pain, abdominal mass, weight loss, and fever. Hypertension is often present. In addition, anemia is present in 20-40% of cases.
Treatment: Nephrectomy (surgical removal of the kidney) is usually curative. The post-operative use of either chemotherapy or radiation therapy suggests more advanced disease with a poor prognosis.
Complications: Significant post-treatment complications may include blood in the urine (hematuria), protein in the urine (proteinura), unstable renal function, or chronic/acute renal failure..
|Questions You Should Ask and Criteria: |
|What is the stage of the cancer and how much time has elapsed since the end of treatment? |
|Stage I, II, or IIIA tumors may be acceptable 12 months following treatment |
|Stage IIIB or IV tumors are not acceptable |
|Has there been any recurrence or evidence of metastasis? |
|not acceptable |
|Has there been any use of chemotherapy or radiation treatment? |
| not acceptable |
|Has there been unstable or declining renal function within the past 2 years? |
| not acceptable |
Cross Reference:
Lung cancer is the most common cause of cancer death in the United States accounting for 35% of cancer deaths in men and 20% in women. Lung cancer is now a major health problem in women and exceeds breast cancer as a cause of cancer death. The ratio of men to women affected is now 2:1, whereas only ten years ago it was 5:1. The single most important causative factor in lung cancer is cigarette smoke.
Clinical manifestations of lung cancer are variable and depend on the location of the tumor, cell type, rate of growth, and the presence of underlying pulmonary disease. Frequent symptoms include: new or changing cough, hoarseness, hemoptysis (coughing up blood), chest pain, and wheezing.
Treatment: Generally, lung cancer is treated by surgical excision. The post-operative use of either chemotherapy or radiation therapy suggests more advanced disease with a poor prognosis.
Complications: Significant post-treatment complications may include cardiomyopathy, pulmonary fibrosis, or pulmonary insufficiency (resulting from resection of the lung).
|Questions You Should Ask and Criteria: |
|What is the stage of the cancer and how much time has elapsed since the end of treatment? |
|Stage I tumors may be acceptable 36 months following treatment |
|Stage II or III tumors may be acceptable 5 years following treatment |
|Stage II or III tumors may be acceptable 10 years following treatment |
|Is there current smoking or tobacco use? |
|not acceptable |
|Is there any liver involvement? |
|not acceptable |
|Is there a history of cardiomyopathy or pulmonary fibrosis? |
|not acceptable |
|Is there any ongoing weight loss? |
|not acceptable |
Cross-references:
Ovarian cancer is the most lethal of all the gynecological cancers. The peak incidence occurs in women in their 50s and the average age at time of diagnosis is 55 years.
Symptoms include vague lower abdominal discomfort, mild digestive irregularities, anorexia, abnormal vaginal bleeding, and mild increase of abdominal girth.
Treatment: Surgical excision may be successful in early stage disease. However, chemotherapy is often required because most women have an advanced stage at time of diagnosis.
Complications: Significant post-treatment complications may include bowel problems or weight loss.
|Questions You Should Ask and Criteria: |
|What is the stage of the cancer and how much time has elapsed since the end of treatment? |
|Stage I or II tumors may be acceptable 36 months following treatment |
|Stage III o IV tumors are not acceptable |
|Has there been any recurrence or evidence of metastasis? |
|not acceptable |
|Has there been any ongoing need for chemotherapy? |
| not acceptable |
|Has there been any radiation enteritis within past 12 months? |
|not acceptable |
|Has there been any ongoing weight loss? |
| not acceptable |
|Has there been any history of pulmonary fibrosis or kidney failure? |
| not acceptable |
|Has there been any liver involvement? |
| not acceptable |
Prostate cancer is frequently asymptomatic and is usually detected on a routine rectal exam, or from tissue removed during a TURP (transurethral resection of the prostate) performed for BPH (benign prostatic hypertrophy). Hesitancy, urgency, nocturia, and dribbling are common symptoms in elderly men for benign reasons. However, if such symptoms appear suddenly or progress, the diagnosis of prostate cancer becomes more probable.
A blood test, the PSA (Prostate Specific Antigen), is frequently done as a first line test if cancer is suspected. The PSA can be detected in all males. However, its level is increased when prostate cancer is present. As the PSA increases, there is a greater chance for cancer and a higher stage of cancer. This test is also used for monitoring the response to cancer treatment. Successful surgery, radiation, or hormone treatment should result in a marked reduction in the PSA level. A normal level is 2.5)? |
|not acceptable |
|Has there been any hospitalization / ER visit for Hypertension within the past 24 months in combination with a history of |
|Congestive Heart Failure (CHF) |
|not acceptable |
(Nephrolithiasis)
(Renal Colic, Calculus or Stone)
Renal Colic is the pain produced by spasmodic contractions of the kidney, pelvis and walls of the ureter due to the presence of a stone. The majority of the stones are passed spontaneously, but larger ones may lodge in the ureter or urethra and may require surgery (nephrotomy, pyelotomy, cytoscopy and most recently, lithotripsy). Repeated obstructions lead to infection, hydronephrosis and destruction of kidney tissue.
|Questions You Should Ask and Criteria: |
|Is surgery recommended or scheduled? |
|not acceptable until fully recovered from surgery |
Sometimes called cancer of the blood, leukemia is a malignant disorder of the blood forming tissues that most often affects the white blood cells. It is characterized by the appearance of abnormal white blood cells and is classified on the basis of the type of these cells, the number present, and whether the clinical course is acute or chronic. Acute leukemia is usually a rapidly progressive disease, and often fatal without prompt intervention.
Nearly all cases of leukemia are of the following types: acute lymphocytic leukemia (ALL), acute myelogenous leukemia (AML), acute monocytic leukemia (AMOL), acute and chronic granulocytic leukemia, chronic lymphocytic leukemia (CLL), and hairy cell leukemia (HCL).
General Criteria:
All leukemia, other than CLL and HCL, are Specific Uninsurable Medical Conditions.
Chronic lymphocytic leukemia is a disease of later life, usually occurring after the age of 50. Symptoms include fatigue, enlarged lymph nodes, and enlargement of the liver or spleen. Marked increase in the number of circulating lymphocytes are usually seen in blood counts. Lymphocytic involvement of nodes and major organs may also be noted.
Underwriting consideration must include satisfactory medical follow-up documenting stability of the condition, to include stable lab results.
Treatment: Includes the use of Leukeran.
|Questions You Should Ask and Criteria: |
|When was the diagnosis made? |
|What was the stage and when did treatment end? (including the use of Leukeran) |
|Stage 0 may be acceptable 6 months following diagnosis |
|Stage I may be acceptable 12 months following treatment |
|Stage II, III, or IV is not acceptable if treated within the past 3 years |
| Has there been any chemotherapy treatment within the past 3 years? |
|not acceptable |
Hairy cell leukemia is a disease of the B-lymphocyte and is so named because cells appear hairy on a blood smear and bone marrow biopsy.
Signs and symptoms include fatigue, spleen enlargement, and reductions in red cells, white cells, and platelets. Hairy cell leukemia is usually an indolent disorder characterized by recurrent infections, including tuberculosis.
HCL requires no specific therapy. Spleen removal is often done because of very low blood counts (cytopenia) or recurrent infections. As a result, normal blood counts return in 50% of cases.
|Questions You Should Ask and Criteria: |
|Has the condition been diagnosed and treated within the past 24 months? (infections) |
|not acceptable |
|Have there been any infections within the past 24 months? |
|not acceptable |
|Has there been any hospitalization or spleen removal for leukemia within the past 24 months? |
|not acceptable |
Lymphomas are malignancies of the lymphatic system. There are two broad categories of lymphomas: Hodgkin’s disease and non-Hodgkin’s lymphoma.
Hodgkin’s disease primarily affects individuals under the age of 50. The cause is unknown and it occurs much less frequently than non-Hodgkin’s lymphomas. Diagnosis is based on a biopsy of a lymph node. There are 4 major sub-groupings of Hodgkin’s disease, but each has approximately the same prognosis because of the effectiveness of modern treatment. Treatment is with radiation and/or chemotherapy.
Non-Hodgkin’s lymphomas occur about 3 times more frequently than Hodgkin’s disease. Median age of onset is in the 60s. Like Hodgkin’s disease, treatment is with radiation and/or chemotherapy.
Staging of both Hodgkin’s disease and Non-Hodgkin’s lymphomas is based on the lymph node region involved:
|Stage I |One lymph node region, i.e., neck, groin |
|Stage II |More than one lymph node region |
|Stage III |Lymph nodes are involved on both sides of the diaphragm (approximately above and below the waistline) |
|Stage IV |Other organs (e.g., bone marrow, liver, lungs) are involved |
Hodgkin’s Disease
|Questions You Should Ask and Criteria: |
|What is the Stage of the disease and when was treatment completed? |
|Stage I, II, IIIA may be acceptable 12 months following treatment |
|Stage III may be acceptable 36 months following treatment |
|Stage IV may be acceptable 48 months following treatment |
|Has there been any recurrence within the past 6 years? |
|not acceptable |
|Has there been any ongoing need for chemotherapy or radiation treatment? |
|not acceptable |
|Has there been any hospitalization for Hodgkin’s disease complications within the past 36 months? |
|not acceptable |
Non-Hodgkin’s Lymphoma
|Questions You Should Ask and Criteria: |
|What is the Stage and/or the Grade of the disease and the date of last treatment? |
|Stage I or II may be acceptable 12 months following treatment |
|Stage III or IV may be acceptable 5 years following treatment |
|Any “high grade” lymphoma is not acceptable |
|Has there been any recurrence? |
|not acceptable |
|Has there been any ongoing need for chemotherapy or radiation treatment? |
|not acceptable |
|Has there been any radiation enteritis within the past 12 months? |
|not acceptable |
(Frequent/persistent forgetfulness)
Chronic memory loss or frequent/persistent forgetfulness may be early symptoms of dementia or other serious disease. Both short term and long term memory may be affected.
General Criteria:
Underwriting of this history (which includes confusion, delirium, and disorientation) is very conservative.
|Questions You Should Ask and Criteria: |
|Is there a history of chronic memory loss or frequent/persistent forgetfulness? |
|not acceptable |
|Have any medications been taken to improve memory (i.e. Hydergine, Cognex, Tacrine, Aricept, Cyclospasmal, Ergoloid, Cerespan, or |
|Exelon)? |
|not acceptable if there is current or prior use of memory medications |
|Has there been any complaint by the applicant of memory loss, forgetfulness or confusion within the past 36 months, or multiple / |
|progressive complaints by the applicant? |
|not acceptable |
|Has there been any reference by the family or MD of memory loss, forgetfulness or confusion? |
|not acceptable |
Meningitis is a bacterial or viral infection of the fluid and membrane enclosing the brain and spinal cord.
While recovery is often complete, there may be neurologic residuals (i.e. dementia or paralysis).
|Questions You Should Ask and Criteria: |
|Was this condition treated within the past 12 months? |
|not acceptable |
|Are there any limitations with performing the ADLs or IADLs? |
|see Uninsurable Functional Deficits |
Multiple myeloma results from an abnormal growth of plasma cells. This abnormal growth usually occurs within the bone marrow, but rarely may occur as solitary lesions outside of the bone marrow (extra medullary). These malignant plasma cells produce large quantities of abnormal proteins. The tumor and/or the abnormal proteins can cause bone pain or fracture, renal failure, susceptibility to infection, anemia, clotting abnormalities, and neurologic symptoms.
|Questions You Should Ask and Criteria: |
|What is the stage of the cancer? |
|Stage IA not requiring treatment may be acceptable 12 months following diagnosis |
|Stage I or IIA requiring treatment within 5 years is not acceptable |
|Stage IIB or greater is not acceptable |
|Has there been a bone marrow transplant or chemotherapy within the past 5 years? |
|not acceptable |
|Have there been any spontaneous fractures, blood clots or strokes? |
|not acceptable |
DEMYELINATING DISEASE
Multiple sclerosis (MS) is a demyelinating disease. Demyelination refers to the destruction or removal of the myelin sheath of a nerve. It causes sensory, visual, and muscular abnormalities and is marked by remissions and exacerbations.
General Criteria:
Multiple sclerosis (MS) / Demyelinating disease is a Specific Uninsurable Medical Condition.
This group of inherited diseases of the muscles is characterized by progressive weakness and wasting. Muscular dystrophy is classified according to its mode of inheritance, age at onset, and clinical features.
There is no specific treatment for this condition.
General Criteria:
□ Muscular Dystrophy is a Specific Uninsurable Medical Condition
Myasthenia gravis is a disease, which causes muscular weakness due to abnormalities at the neuromuscular junction. Muscles become progressively weaker when used in repetition and only partially recover after rest.
If the thymus gland is not removed, or if the surgery fails to induce a remission, medical treatment is generally successful.
|Questions You Should Ask and Criteria: |
|Has there been symptomatic myasthenia gravis (e.g., progressive muscular weakness, swallowing or chewing difficulties) within the |
|past 12 months? |
|not acceptable |
|Are more than 20 mgs per day of Prednisone being used? |
|not acceptable |
|Is thymus gland surgery anticipated? |
|not acceptable |
|Has there been any hospitalization within the past 24 months for complications / plasmapheresis? |
|not acceptable |
(Heart Attack, Coronary)
A myocardial infarction (MI) occurs when the blood flow in a coronary artery is abruptly blocked or markedly reduced by a clot. The heart muscle supplied by the coronary artery dies. If the affected heart muscle is located in the left ventricle, the heart can no longer function efficiently as a pump and Congestive Heart Failure (CHF) may result.
If the conduction system is damaged, irregular and sometimes fatal heart rhythms may result.
Following an acute MI, treatment consists of measures aimed at dissolving the clot, as well as prevention of fatal heart rhythms.
|Questions You Should Ask and Criteria: |
|What was the date of the heart attack? |
|not acceptable within 3 months ; 6 months with valvular heart disease |
|Is there any history of angina that restricts activity? |
|not acceptable |
|Has there been an onset of or symptomatic Congestive Heart Failure (CHF) within the past 5 years? |
|not acceptable |
|Is there a history of Cardiomyopathy? |
|not acceptable |
|Have angioplasty or heart surgery been recommended or scheduled? |
|not acceptable |
|Have there been increasing symptoms of angina or angina at rest within the past 6 months? |
|not acceptable |
|Has there been any symptomatic heart arrhythmia or cardioversion within the past 12 months |
|not acceptable |
|Have there been 2 or more ER visits or hospitalizations for angina within the past 12 months? |
|not acceptable |
|Is there a history of Diabetes? |
|not acceptable |
Cross Reference:
Diabetes
(Peripheral Neuropathy, Neuralgia, Neuritis)
Neuropathy is a disease of the nerves. Symptoms include weakness, pain, or numbness. It generally affects the legs, but may also be present in the arms. While the cause can be unknown, it usually results from complications of diabetes, alcoholism, malnutrition or infection.
The risks associated with this condition include falls, foot and leg ulcers, and disability due to the progressive nature of the disease.
|Questions You Should Ask and Criteria: |
|Is the cause of the condition known? |
|not acceptable if currently under evaluation |
|Are there any limitations with performing the ADLs or IADLs? |
|see Uninsurable Functional Deficits |
|Is there any history of falls? |
|not acceptable |
|Is there any history of foot/leg ulcers in combination with diabetes? |
|not acceptable |
|Is the condition progressing? |
|not acceptable |
|Are narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan, or Talwin used to control pain within the past 12 months? |
|not acceptable |
Cross Reference:
Peripheral Vascular Disease
Normal pressure hydrocephalus is a condition in which the ventricles within the brain enlarge and damage the surrounding brain tissue. However, the pressure of the Cerebral Spinal Fluid (CSF) within the ventricles is normal.
Typical symptoms of NPH include walking difficulties, bowel/bladder incontinence, and dementia.
The most common treatment is the placement of a sterile tube between the ventricle in the brain and the peritoneal cavity in the abdomen (ventriculoperitoneal shunt).
|Questions You Should Ask and Criteria: |
|Is the condition untreated ? |
|not acceptable |
|Has there been a surgical placement of a shunt? |
|not acceptable if: |
| there has been shunt placement within the past 24 months |
|there is evidence of shunt obstruction within the past 12 months |
|there have been any falls after shunt placement |
|Are there any limitations with performing the ADLs or IADLs? |
|see Uninsurable Functional Deficits |
|Has there been any complaint of memory loss, forgetfulness of confusion ? |
|not acceptable |
|Has there been any incontinence ? |
|not acceptable |
(Degenerative Joint Disease [DJD], hypertrophic arthritis)
Osteoarthritis is characterized by degeneration of joint cartilage and new bone formation at the joint margins. OA results from the aging process and trauma to the joint from wear and tear.
On physical exam, the joints are tender and inflamed. There is often joint enlargement, pain with weight bearing, and decreased range of motion. Surgical correction of the joint deformities can relieve pain and restore most function.
|Questions You Should Ask and Criteria: |
|Are there any limitations with performing the ADLs or IADLs? |
|see Uninsurable Functional Deficits |
|Are narcotics such as Demerol, morphine, OxyContin, Percodan, or Talwin used to control pain within the past 12 months? |
|not acceptable |
|Are assistive devices such as a wheelchair, walker, or quad cane currently being used? |
|not acceptable |
|Is physical therapy currently required? |
|May be acceptable if symptoms are improving |
|Has major weight bearing joint surgery been completed within the past 3 months or been recommended or planned? |
|not acceptable |
|Osteoarthritis in combination with Rheumatoid Arthritis |
|not acceptable |
|Have there been any falls or fractures? |
|see Fracture guidelines |
Cross Reference:
Fractures
Rheumatoid Arthritis
Spinal Stenosis
Uninsurable Functional Deficits
Osteoporosis is a generalized decrease in bone mass that can progress to below the point necessary to maintain adequate mechanical body support. The principal clinical manifestations of osteoporosis in the elderly are fractures of the spine, hip, and wrist.
Osteoporosis usually develops at older ages (senile osteoporosis) or after menopause (post-menopausal osteoporosis) and can be traced back to inadequate calcium intake and post-menopausal estrogen deficiency. Occasionally, osteoporosis may be secondary to the chronic administration of steroids or to prolonged immobilization or inactivity.
|Questions You Should Ask and Criteria: |
|Are there any limitations with performing the ADLs or IADLs? |
|Not acceptable if any assistance required (see Uninsurable Functional Deficits) |
|Are narcotics such as Demerol, Methadone, morphine, OxyContin, Percodan or Talwin used to control pain within the past 12 |
|months? |
|not acceptable |
|Have there been any falls or fractures? |
|not acceptable if there has/have been: |
|a femoral shaft, tibial or vertebral body fracture within 3 months |
|a pelvic fracture within the past 12 months |
|2 or more pelvic fractures due to falls or osteoporosis |
|3 or more long bone fractures due to falls or osteoporosis |
|three or more vertebral body fractures due to osteoporosis |
|any pathological fracture |
|What are the bone density scores? |
|if greater than –4.0, not acceptable |
|Are assistive devices such as a wheelchair, walker, or quad cane currently being used? |
|not acceptable |
|Is physical therapy currently required? |
|may be acceptable if symptoms are improving |
|Is pulmonary function impaired? |
|not acceptable |
Cross Reference:
Fractures
Physical Therapy
Uninsurable Functional Deficits
Paget's disease of the bone is a chronic disorder of the adult skeleton in which localized areas of hyperactive bone are subject to excessive resorption. The bone is then replaced by a softened and enlarged bony structure. This produces bone that is often painful, structurally weak, fractures easily, and causes physical deformity. It may be either localized to specific bones or be more generalized affecting such areas as the skull, pelvis, spine, and long bones.
|Questions You Should Ask and Criteria: |
|Are there any limitations with performing the ADLs or IADLs? |
|see Uninsurable Functional Deficits |
|Are narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan or Talwin used to control pain within the past 12 |
|months? |
|not acceptable |
|Have there been any falls or fractures? |
|not acceptable if : |
|a vertebral body fracture within the past 3 months |
|a pelvic fracture within the past 12 months |
|3 or more vertebral body fractures due to Paget’s disease |
|3 or more long bone fractures due to falls or |
|Paget’s disease |
|any pathological fracture |
|Are assistive devices such as a wheelchair, walker, or quad cane currently being used? |
|not acceptable |
|Is physical therapy currently required? |
|May be acceptable if symptoms are improving |
|Is there any history of bone cancer? |
|not acceptable |
Cross Reference:
Congestive Heart Failure
Fractures
Uninsurable Functional Deficits
Parkinson's disease is a neurological disease producing tremors, rigidity (resistance to passive movement), and bradykinesia (slowness of voluntary movements, and a reduction of automatic movements). A progressive dementia may also occur.
There is postural instability demonstrated by difficulty in getting up from a chair, and a gait characterized by small shuffling steps, as well as demonstrated unsteadiness on turning, and difficulty stopping.
See guidelines on Tremors
General Criteria:
Parkinson's disease is a Specific Uninsurable Medical Condition.
(Peripheral Atherosclerotic Disease)
Peripheral vascular disease is characterized by a reduction of the blood supply to the lower extremities. Atherosclerotic plaques form in the arteries, thereby narrowing the vessel and reducing the flow of blood. Leg pain with minimal exercise (claudication) is the most common symptom. As the disease progresses, it further compromises the vascular system with resultant skin ulcers, gangrene, and the need for amputation.
Treatment of PVD may be with life style changes (diet, exercise, smoking cessation) or with medication. In severe cases, angioplasty or bypass graft surgery may be needed.
|Questions You Should Ask and Criteria: |
|Has there been associated gangrene or an amputation? |
|not acceptable |
|Is there pain (claudication) in the lower extremities at rest or after walking less than one-half mile, or with marked increase |
|in severity of symptoms? |
|not acceptable |
|Have there been any skin ulcers or skin breakdown or treatment with a unna boot? |
|not acceptable: |
|within the past 24 months |
|if there have been recurrent skin ulcers |
|Has there been a vascular bypass graft or surgery of the lower extremities within the past 12 months? |
|not acceptable |
|Has there been kidney stenosis surgery within the past 12 months? |
|not acceptable |
|Is there a history of Diabetes? |
|not acceptable |
|Is there a history of intestinal ischemia? |
|not acceptable |
|Have there been any hospitalization or ER visits for PVD or complications within the past 12 months? |
|not acceptable |
Cross-references:
Diabetes
PHYSICAL THERAPY
|Questions You Should Ask and Criteria: |
|Has there been a need for Physical Therapy (PT) within the past 6 months for a benign or acute condition |
|May be acceptable if symptoms are improving |
|Was Physical Therapy (PT) required greater than 6 months ago for a significant or chronic condition? |
|may be acceptable if symptoms are improving |
|greater than 12 months ago for fibromyalgia |
|Has there been a need for Physical Therapy (PT) within the past 6 months for a significant or chronic condition? |
|Not acceptable |
|not acceptable within 12 months for fibromyalgia |
Poliomyelitis (polio, infantile paralysis) is an acute viral infection that first invades the intestine and then migrates to the spinal cord, brain stem, and brain.
Polio may result in paralysis of various muscles in the shoulder, arms, diaphragm, torso, and legs. A type of polio called bulbar polio may also affect the cranial nerves and brain stem, which control swallowing, speaking, chewing, breathing, and circulation.
Half of polio patients recover without permanent effects. The other half will experience muscle paralysis and atrophy that may cause shortening and deformity of the extremities and spine. For these patients, permanent use of braces, crutches, canes, and wheelchairs may be required.
Post Polio Syndrome (PPS) describes a condition in which progressive paralysis and atrophy occur 25 to 35 years after the original onset of the disease. This syndrome is thought to be the result of the physiological changes of aging with further loss of spinal nerve cells depleted by the original polio virus.
PPS may cause fatigue, weakness, muscle pain/atrophy, and deterioration of function. Patients with bulbar polio may experience increased difficulty swallowing and speaking, and an increased incidence of choking and sleep apnea.
|Questions You Should Ask and Criteria: |
|Are there any limitations with performing the ADLs or IADLs? |
|not acceptable if any deficits (see Uninsurable Functional Deficits) |
|Is any medical equipment such as a wheelchair, walker, electric cart, hospital be, or quad cane currently being used? |
|not acceptable |
|Has there been any bowel or bladder incontinence (excluding stress incontinence)? |
|not acceptable |
|Have there been any active or progressive Post Polio Symptoms within the past 12 months? |
|not acceptable |
|Has there been any difficulty swallowing with progressive weight loss? |
|not acceptable |
|Has there been more than one fall within the past 6 months? |
|not acceptable |
|Has there been one fall and fracture within the past one year? |
|not acceptable |
|Are narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan, or Talwin needed to control pain within the past 12 |
|months? |
|not acceptable |
Polycystic kidney disease is an inherited bilateral malformation of the kidneys typified by multiple cysts (masses). The cysts gradually enlarge at the expense of normal renal tissue.
Symptoms may not appear until adult life, but asymptomatic cases may be detected at younger ages by ultrasound. PCKD is also associated with an increased frequency of mitral valve prolapse, aortic root dilatation and cerebral aneurysm.
Treatment may include chronic dialysis or kidney transplantation.
|Questions You Should Ask and Criteria: |
|Has dialysis been required within the past 2 years? |
|not acceptable |
|Has kidney transplantation been performed within the past 5 years? |
|not acceptable |
|Has dialysis or kidney transplant been recommended or scheduled? |
|not acceptable |
|Has there been any hospitalization within the past 24 months for complications of polycystic kidney disease? |
|not acceptable |
Cross-references:
Polycythemia is a chronic blood disease of unknown cause in which there is an increase in the number of red blood cells. The disease has an association with leukemia, and chronic myelogenous leukemia may develop.
A secondary form of polycythemia is seen in individuals with underlying pulmonary disease. This causes inadequate oxygenation of red cells, leading to a “reactive” increase of cells to compensate.
Treatment of polycythemia includes the use of low dose chemotherapeutic drugs as well as phlebotomies.
|Questions You Should Ask and Criteria: |
|If phlebotomy is being used, how often is it performed? |
|not acceptable if more than 4 phlebotomies per year |
|Is Hydrea being used? |
|May be acceptable |
|Are alkylating agents being used (Leukeran, Cytoxan, Platinol, or Cyclophosphamide)? |
|not acceptable |
|Is there a history of a TIA? |
|not acceptable |
Polymyalgia rheumatica (PMR) is a syndrome of unknown cause characterized by severe pain and stiffness of the muscle groups. Fever, anorexia, weight loss, and anemia may also be present.
Separate, but closely related clinical entities are temporal arteritis (TA) or giant cell arteritis (GCA). These conditions are characterized by inflammation of the medium sized arteries, especially the temporal artery of the forehead, which could result in sudden blindness due to vascular obstruction.
Treatment with corticosteroids (Prednisone) is often effective in controlling symptoms.
|Questions You Should Ask and Criteria: |
|Are there any limitations with performing the ADLs or IADLs? |
|see Uninsurable Functional Deficits |
|Are assistive devices such as a wheelchair, walker, or quad cane currently being used? |
|not acceptable |
|Has physical therapy been required within the past 6 months? |
|not acceptable |
|Has there been difficulty swallowing or depression with progressive unintentional weight loss? |
|not acceptable |
|Are more than 20 mgs per day of Prednisone being used? |
|not acceptable |
|Have there been any falls or fractures? |
|see Fracture guidelines |
|Are narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan, or Talwin used to control pain within the past 12 |
|months? |
|not acceptable |
|Are there any eye problems secondary to giant cell arteritis (GCA)? |
|not acceptable |
Polymyositis is an inflammatory muscle disorder of unknown cause that may be accompanied by inflammation at other sites including the joints, lungs, and heart. Dermatomyositis is the name used for the disorder when the skin is also involved. There is a strong association with increased incidence of cancer, as well as systemic lupus erythematosus (SLE) and scleroderma.
Muscle weakness, particularly of the pelvis and shoulders, is the primary feature of the disease. This results in problems with getting up from a sitting position or working with the arms overhead. Difficulty swallowing may also occur if the esophageal muscles are involved, possibly resulting in malnutrition and weight loss.
|Questions You Should Ask and Criteria: |
|Was polymyositis-dermatomyositis diagnosed within the past 12 months? |
|not acceptable |
|Are there any limitations with performing the ADLs or IADLs? |
|not acceptable if any deficits (see Uninsurable Functional Deficits) |
|Are narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan or Talwin used to control pain within the past 12 |
|months? |
|not acceptable |
|Are assistive devices such as a wheelchair, walker, or quad cane currently being used? |
|not acceptable |
|Has physical therapy been required within the past 6 months? |
|may be acceptable if symptoms are improving |
|Are more than 20 mgs per day of Prednisone being used? |
|not acceptable |
|Have there been any vertebral body (compression) fractures? |
|one fracture within 3 months – not acceptable |
|3 or more fractures – not acceptable |
|Has there been any history of cancer? |
|not acceptable |
|Has there been difficulty swallowing or depression with progressive unintentional weight loss? |
|not acceptable |
|Has joint surgery been recommended or completed, or performed within the past 12 months? |
|not acceptable |
Cross Reference:
Fractures
Physical Therapy
Uninsurable Functional Deficits
(Benign Prostatic Hypertrophy [BPH], Prostatitis)
Benign Prostatic Hypertrophy (BPH) and Prostatitis (prostate infection) are non-malignant conditions of the prostate. BPH is an enlargement of the prostate that can have several causes. The enlargement (hypertrophy) of the gland usually results in incomplete emptying of the bladder and frequency of urination. This condition is generally of no significance if a complete work-up has been done to rule out cancer and may be treated medically with Proscar or Hytrin, or surgically by TURP or “roto-rooter” .
Prostatitis is an infection of the prostate gland and is treated with antibiotics. Both BPH and prostatitis may cause a slight to moderate elevation of the PSA (Prostate Specific Antigen).
|Questions You Should Ask and Criteria: |
|Has surgery been recommended or scheduled, or performed within the past 3 months? |
|may be acceptable after complete recovery from surgery |
|Has there been an elevated or rising PSA level that has not been fully evaluated? |
|not acceptable |
(Kidney Failure, Acute)
Acute renal failure is the sudden decline in the ability of the kidneys to function properly. The causes of acute renal failure are numerous and include infections, medication side effects, and trauma.
|Questions You Should Ask and Criteria: |
|Has Prednisone, Cytoxan, Chlorambucil, or Cyclophosphamide been used within the past 24 months? |
|not acceptable |
|Has dialysis been required within the past 24 months? |
|not acceptable |
|Has there has been any hospitalization within the past 24 months for complications of renal failure? |
|not acceptable |
|Has a kidney transplant been recommended or performed? |
|not acceptable if performed within the past 5 years (see kidney transplantation guideline) |
|not acceptable at all if diabetic |
|Creatinine level greater than 3.0? |
|not acceptable |
|Is an indwelling catheter being used? |
|not acceptable if beginning use was within the past 12 months |
(Kidney Failure, Chronic)
Chronic renal failure refers to permanent irreversible damage to both kidneys. Depending on the severity of the damage, chronic dialysis may be necessary.
General Criteria:
This risk can only be considered with documentation of stability of renal function. This condition in combination with diabetes mellitus is generally a poor risk.
|Questions You Should Ask and Criteria: |
|Has dialysis been required within the past 24 months? |
|not acceptable |
|Has a kidney transplant been recommended or performed? |
|not acceptable if performed within the past 5 years (see kidney transplantation guideline) |
|not acceptable at all if diabetic |
|Creatinine level greater than 3.0 |
|. not acceptable |
|Is there a history of hydronephrosis or pyelonephritis that is chronic & unresponsive to treatment? |
|not acceptable |
SJÖGRENS SYNDROME
Rheumatoid arthritis (RA) is a systemic disease that is characterized by a bilateral inflammation and stiffness of the joints. It may also involve major organs, especially the heart and lungs. The term Sjögrens refers to symptoms of dryness of the eyes and mouth seen in patients with RA.
The clinical course of rheumatoid arthritis is highly variable. In some cases, symptoms are mild, while in others, the disease rapidly progresses to severe disability. This often results in ADL and IADL deficiencies.
General Criteria:
Active or progressive disease is demonstrated by frequent emergency room or doctor visits, multiple joint injections, recent or current courses of high-risk medications, or recent, frequent medication changes.
|Questions You Should Ask and Criteria: |
|Are there any limitations with performing the ADLs or IADLs? |
|see Uninsurable Functional Deficits |
|Have narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan or Talwin been used to control pain within the past 12|
|months? |
|not acceptable |
|Are more than 20 mg per day of Prednisone being used? |
|not acceptable |
|Are assistive devices such as a wheelchair, walker, or quad cane currently being used? |
|not acceptable |
|Has physical therapy been required within the past 6 months? |
|may be acceptable if symptoms are improving |
|Has any joint replacement surgery related to rheumatoid arthritis been recommended or performed? |
|not acceptable |
|Has there been active rheumatoid arthritis with progressive symptoms, multiple medication changes, and/or unresponsive to |
|treatment within the past 24 months? |
|not acceptable |
|Have there any been vertebral body (compression) fractures? |
|one fracture within 3 months – not acceptable |
|3 or more fractures – not acceptable |
|Is there a history of osteoarthritis |
|. not acceptable |
|Has the rheumatoid arthritis affected any major weight bearing joints? |
|not acceptable |
|Has there been any hospitalization or more than one ER visit within the past 24 months for rheumatoid arthritis |
|not acceptable |
Cross Reference:
Fractures Osteoarthritis Physical Therapy Uninsurable Functional Deficits
Sarcoidosis is a disease of unknown cause that primarily affects the lungs although it may affect other organs. Sarcoidosis is characterized by the presence of granulomas (nodules) in various tissues. It is classified into three stages according to the degree of involvement. It is generally treated with cortico-steroids; i.e., Prednisone.
|Questions You Should Ask and Criteria: |
|What is the Stage of the disease and when was this condition diagnosed? |
|not acceptable if : |
|Stage I has been diagnosed within the past 12 months |
|Stage II has been diagnosed within the past 36 months |
|Stage III |
|Are there any current symptoms or evidence of residual complications? |
|not acceptable |
|Are more than 20 mgs per day of Prednisone used? |
|not acceptable |
(Paranoia and Delusional States)
Schizophrenia is a heterogeneous group of mental disorders comprising most major psychotic disorders and characterized by disturbances in form and content of thought (loose associations, delusions, and hallucinations), mood (blunted, flattened, or inappropriate affect), sense of self in relationship to the external world (loss of ego or autistic withdrawal), and bizarre and apparently purposeless behavior.
|Questions You Should Ask and Criteria: |
|Have there been any symptoms of schizophrenia or psychosis within the past 48 months? |
|not acceptable |
|Have there been any hospitalizations, day care use, or ER visits within the past 48 months for schizophrenia, psychosis, or related|
|complications? |
|not acceptable |
|Has there been any active alcoholism or drug use within the past 48 months? |
|not acceptable |
|Are there any limitations with performing the ADLs or IADLs? |
|not acceptable if any deficits (see Uninsurable Functional Deficits) |
|Any current signs of psychological dependency? |
|not acceptable |
|Have any anti-psychotic medications been initiated within the past 48 months? |
|not acceptable |
|Has there been unintentional weight loss of greater than 15% within the past 12 months? |
|not acceptable |
(CREST Syndrome)
Scleroderma is a disease characterized by deposition of fibrous tissue in the skin, lung, heart, kidney, musculoskeletal, gastrointestinal, and central nervous systems. CREST syndrome is a similar condition, but with a better prognosis, because involvement is limited to the skin, joints, and esophagus.
The skin is often the first organ system involved. Scleroderma is usually manifested by diffuse and mild swelling of the skin. The skin gradually loses pliability and becomes tightly drawn and bound to underlying structures. There is no effective treatment for this condition other than managing the complications [i.e. hypertension, Congestive Heart Failure (CHF), and pulmonary disease].
General Criteria:
Scleroderma and CREST Syndrome (Calcinosis, Raynaud’s phenomenon, Esophageal dysfunction, Sclerodactyly, Telangiectasia) without complications may be acceptable.
|Questions You Should Ask and Criteria: |
|Have there been any complications of Scleroderma or significant heart or kidney involvement within the past 24 months (ie.; CHF, |
|arrhythmia, heart block, pericarditis, or cor pulmonale; increased creatinine or proteinuria)? |
|not acceptable |
|Have there been any complications of CREST Syndrome such as esophageal strictures, esophageal dysmotility, kidney failure, poorly|
|controlled hypertension, Raynaud’s, or skin thickening? |
|not acceptable |
|Has there been any history of pulmonary fibrosis? |
|not acceptable |
|Are more than 20 mgs per day of Prednisone used? |
|not acceptable |
|Has there been any history of skin ulcers or chronic non-healing skin infections within the past 24 months? |
|not acceptable |
|Is there poorly controlled hypertension (consistent systolic of >200 or diastolic >100)? |
|not acceptable |
Sleep apnea is a sleep related breathing disorder in which there are pauses in respiration lasting 10 seconds or longer. During these pauses, there is a decrease in oxygen saturation and there may be a variety of cardiac arrhythmias. Sleep apnea is generally classified as: central, obstructive, or mixed. The obstructive type comprises 90% of all sleep-related disorders.
A Continuous Positive Airway Pressure apparatus (CPAP) is used in treatment. If there is severe upper airway obstruction, surgery may be needed.
|Questions You Should Ask and Criteria: |
|Did the use of a Continuous Positive Airway Pressure (CPAP) apparatus begin within the past 3 months? |
|not acceptable |
|Has use of CPAP apparatus been recommended but not used? |
|not acceptable |
|Has there been more than 1 hospitalization in the past 12 months for complications from sleep apnea? |
|not acceptable |
|Is surgery recommended or scheduled? |
|not acceptable |
|Is supplemental oxygen required for sleep apnea? |
|may be acceptable |
(Herniated Nucleus Pulposus)
A slipped or ruptured disc results from the tearing of spinal ligaments, which normally hold the disc in place between the vertebral bones. The disc may then become displaced resulting in pressure on the spinal column or spinal nerves.
The most common site of a herniated disc is in the lumbar area, followed by the cervical area. Symptoms of a herniated disc include muscle weakness, atrophy, pain, and diminished sensation.
|Questions You Should Ask and Criteria: |
|Are there any limitations with performing the ADLs or IADLs? |
|not acceptable if any deficits (see Uninsurable Functional Deficits) |
|Are narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan or Talwin used to control pain within the past 12 months? |
|not acceptable |
|Are assistive devices such as a wheelchair, walker, or quad cane currently being used? |
|not acceptable |
|Has physical therapy been required within the past 6 months? |
|may be acceptable if symptoms are improving |
|Has surgery been recommended or scheduled, or performed within the past 6 months? |
|not acceptable |
Cross Reference:
Fractures
Physical Therapy
Uninsurable Functional Deficits
Spinal stenosis is usually caused by osteoarthritis, but may also result from a ruptured disc, trauma, spinal surgery, scoliosis, or Paget's disease. There is a progressive narrowing of the spinal canal. This causes pressure on the spinal nerves or spinal cord producing pain and weakness of the back and lower extremities.
|Questions You Should Ask and Criteria: |
|Are there any limitations with performing the ADLs or IADLs? |
|see Uninsurable Functional Deficits |
|Are narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan or Talwin used to control pain within the past 12 months? |
|not acceptable |
|Are assistive devices such as a wheelchair, walker, or quad cane currently being used? |
|not acceptable |
|Has physical therapy been required within the past 6 months? |
|not acceptable |
|Has surgery been recommended or scheduled, or performed within the past 6 months? |
|not acceptable |
|Is there marked progression or increase in the severity of symptoms within the past 12 months? |
|not acceptable |
|Is there leg pain with walking less than one-half mile? |
|not acceptable |
Cross Reference:
Fractures
Physical Therapy
Uninsurable Functional Deficits
Cerebral Vascular Accident (CVA)
Stroke is the sudden onset of a neurologic deficit lasting longer than 24 hours. Stroke is usually caused by the occlusion of the cerebral arteries due to atherosclerosis. Less commonly, a stroke may be caused by a blood clot to the brain or bleeding within the brain.
Strokes are generally classified as:
Hemorrhagic
Embolic
Thrombotic
General Criteria:
History of stroke is a Specific Uninsurable Medical Condition.
Cross Reference:
These time frames relate to the waiting period following surgical procedures. After completion of a waiting period, surgical procedures are acceptable after full recovery, discharge from medical care, and resumption of normal activities.
|Surgery |Action |
|Back / spine |6 months |
|CABG |6 months; not acceptable if Diabetic |
|Carotid or femoral endarterectomy |12 months; not acceptable if Diabetic |
|Carpal Tunnel Syndrome – Surgery recommended or scheduled |Postpone until after complete recovery |
|Cholecystectomy |3 months |
|Colon resection (excluding cancer) |1-3 months; 12 months for Crohn’s disease |
|Gastric Bypass Surgery |12 months |
|Hip or knee replacement for fracture or arthritis |3 months; 12 months with Ankylosing |
| |Spondylitis |
|Defibrillator implant |12 months |
|Heart valve replacement |6 months; not acceptable if Diabetic |
|Pacemaker implant – Surgery recommended or scheduled |Postpone until after complete recovery |
|PTCA |3 months; not acceptable if Diabetic |
|Surgery recommended or scheduled (including outpatient, requiring a general anesthetics|Postpone |
|– excludes local anesthetics) | |
|Questions You Should Ask and Criteria: |
|Is there any surgery that is recommended or scheduled? |
|not acceptable |
(Fainting or Black out)
Syncope is a brief loss of consciousness with complete and spontaneous recovery. The most common cause is a sudden decrease in blood flow to the brain. This is usually due to cardiac arrhythmias, which reduce cardiac output.
Vasovagal syncope is also quite common and often occurs in healthy individuals due to emotional stress, fear, or pain.
General Criteria:
The underwriting of syncope is based on the frequency and cause.
|Questions You Should Ask and Criteria: |
|What was the cause of the syncopal episode? |
|not acceptable within 6 months if the cause is unknown |
|Have there been multiple episodes of syncope within the past 12 months? |
|not acceptable |
|Have any fractures occurred as a result of this condition? |
|see Fracture guidelines |
Cross-references:
Disseminated Lupus, Discoid Lupus Erythematosus
Systemic lupus erythematosus is a chronic inflammatory disease of the connective tissues thought to be the result of an autoimmune process. The most common symptoms consist of a febrile illness with polyarthritis, a rash on the cheeks and bridge of the nose, fatigue, chest pain, and enlarged lymph nodes. The prognosis varies widely, depending on the extent and number of organs involved and the degree of inflammation.
Discoid lupus is a chronic skin disorder with lesions that are usually confined to the face, neck, arms, and scalp.
General Criteria:
Well-documented history of Discoid Lupus present for at least 24 months may be acceptable.
|Questions You Should Ask and Criteria: |
|Has Discoid Lupus been diagnosed within the past 24 months? |
|may be acceptable |
|Has there been symptomatic systemic Lupus within the past 24 months? |
|not acceptable |
|Have there been any complications within the past 36 months (i.e. kidney, brain, or heart involvement)? |
|not acceptable |
|What type of treatment or medication was received for this condition? |
|not acceptable if there is: |
|treatment with cytotoxic agents such as Imuran, Cytoxan, Leukeran, or cyclosporine within the past 24 months |
|daily use of narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan, or Talwin within the past 12 months |
|Prednisone use of more than 20 mgs a day |
|Plasmapheresis within the past 48 months |
|Have there any been vertebral body (compression) fractures? |
|one fracture within 3 months – not acceptable |
|3 or more fractures – not acceptable |
|Has there been any physical therapy or joint surgery within the past 12 months? |
|not acceptable |
Cross Reference:
Fractures
(Thrombocytosis)
Thrombocythemia is a condition in which there is an increase in the number of platelets in the blood. This increase can result in the formation of blood clots and in hemorrhage (due to dysfunction of the abnormal platelets).
There are two types of thrombocythemia:
Primary thrombocythemia results from an abnormality in the cells that form the platelets.
Reactive thrombocythemia occurs in response to some other disorder (e.g. rheumatoid arthritis, Hodgkin's disease, or iron deficiency).
Treatment: May include the use of chemotherapeutic drugs such as Hydrea and Leukeran.
|Questions You Should Ask and Criteria: |
|Has there been a history of blood clots or bleeding? |
|not acceptable |
|Has treatment with Argylin, Leukeran, Platinol, or Cyclophosphamide been required within the past 12 months |
|not acceptable |
|Has Hydrea been initiated within the past 12 months? |
|may be acceptable |
|Platelet count over 600K |
|. not acceptable |
Thrombocytopenia is a condition in which there is a decrease in the number of platelets in the blood. This decrease can result in spontaneous bruising and bleeding.
Treatment is with Prednisone or by spleen removal.
|Questions You Should Ask and Criteria: |
|Have there been any bleeding episodes within the past 12 months? |
|not acceptable |
|Has there been Prednisone use for thrombocytopenia within the past 12 months? |
|not acceptable |
|Is spleen removal anticipated? |
|not acceptable |
|( Platelet count under 60,000 |
|not acceptable |
(Venous, Arterial or Pulmonary embolism)
An embolism is a blood clot, which moves through the blood stream. It can lodge in a blood vessel suddenly blocking the flow of blood.
A thrombus is a blood clot adhering to the wall of a blood vessel. When a thrombus breaks loose and moves through the blood stream it is referred to as a thromboembolism.
A venous thromboembolism originates as a clot in the deep veins of the lower extremities. The clot may migrate into the major blood vessels returning to the heart and then to the lungs (pulmonary embolism).
An arterial thromboembolism occurs when a clot forms in the arteries. A clot may form as the result of damage to a vessel, or the presence of a prosthetic device (such as an artificial heart valve). The clot may migrate into the coronary, carotid, or other arteries.
Treatment is usually with Coumadin to reduce the risk of further clot formation.
|Questions You Should Ask and Criteria: |
|How many episodes have occurred? What type? What was the date of the last occurrence? |
|not acceptable if there: |
|has been an arterial embolism within the past 12 months |
|has been a pulmonary (lung) embolism within the past 6 months |
|have there been multiple episodes of pulmonary embolism within the past 12 months |
|Are there any other significant histories? |
|not acceptable if there is: |
|poorly controlled high blood pressure |
|limb amputation or bowel resection |
|congestive heart failure (CHF) with arterial embolism |
|diabetes with arterial embolism |
|Has coumadin been initiated within the past 6 months? |
|not acceptable |
|Have there been any bleeding episodes in association with Coumadin use within the past 12 months? |
|not acceptable |
|Has there been symptomatic arrhythmia, atrial fibrillation, or cardioversion within past 6 months with arterial embolism? |
|not acceptable |
|Has heart valve replacement been recommended or surgery completed within the past 24 months with arterial embolism? |
|not acceptable |
|Has there been a history of Transient Ischemic Attack within the past 5 years? |
|not acceptable |
|Has here been any surgical treatment or insertion of filters for pulmonary embolism within the past 24 months? |
|not acceptable |
Thromboembolism Cross-references:
Arrhythmia
Atrial Fibrillation
Diabetes
Congestive Heart Failure
Valvular Heart Disease
Transient global amnesia is a term used to describe a syndrome of uncertain etiology where there is abrupt and usually permanent loss of the memory for the prior hour to several hours. This acute confusional state generally clears within twenty-four hours, although there remains a permanent memory deficit for the period of amnesia. The most common cause of this syndrome appears to be either a migraine attack, or transient ischemia of posterior circulation to the brain. Less common causes are unusual seizure disorders, medication reactions, and rarely, occult head trauma. Psychological factors such as hysteria have also been known to induce these symptoms.
|Questions You Should Ask and Criteria: |
|Has the episode of TGA occurred within the past 6 months? |
|not acceptable |
|Have there been two or more episodes of TGA within the past 2 years? |
|not acceptable |
|Is the cause undetermined or is a work-up anticipated or currently underway? |
|not acceptable |
Cross Reference
Memory Loss
RETINAL ARTERY OCCLUSION / EMBOLISM
Transient Ischemic Attacks (TIAs) are episodes of temporary cerebral dysfunction of vascular origin, which resolve within 24 hours. Numbness, weakness, dizziness, fainting, vision defects, or loss of speech (aphasia) are the typical signs. TIAs are often a precursor to more significant cerebrovascular events (i.e. strokes).
TIAs occur when emboli or plaques temporarily block the arterial blood flow to the brain, resulting in temporary symptoms. When diagnostic tests show significant blockage or extensive ulceration or plaque in the carotid arteries, surgery (endarterectomy) may be recommended to reduce the chance of stroke.
Strokes occur when blood flow to the brain is blocked for extended periods of time; irreparable damage to the brain often takes place resulting in loss of function or paralysis.
Treatment may include anti-coagulant drugs, such as, Coumadin, Ticlid, or Plavix.
|Questions You Should Ask and Criteria: |
|Has there been a history of a TIA or retinal artery occlusion within the past 5 years? |
|not acceptable |
|Has there been more than one TIA or retinal artery occlusion? |
|not acceptable |
|Is there a history of Atrial Fibrillation, AV Malformation, Cardiomyopathy, Cerebrovascular Aneurysm, Diabetes, MI, Polycythemia,|
|or Rheumatic Heart Disease ? |
|not acceptable |
|Have there been symptoms suggestive of TIA within 5 years (temporary numbness, tingling, loss of vision or garbled speech)? |
|not acceptable |
|Has there been a single episode of amaurosis fugax within the past 6 months? |
|not acceptable |
|Have there been multiple episodes of Amaurosis Fugax (temporary loss of vision)? |
|not acceptable |
|Is there a history of any heart surgery (e.g., angioplasty, aortic aneurysm repair, bypass grafts, valve replacements)? |
|not acceptable |
Cross-references:
OR STEM CELL
Bone marrow transplantation has become accepted therapy for many blood disorders such as aplastic anemia, severe immune deficiency diseases, acute leukemia, and chronic granulocytic leukemia.
The recipient of a bone marrow transplant is given massive amounts of chemotherapeutic drugs prior to the transplant to destroy his/her own bone marrow and the targeted malignancy. The recipient then receives the donor's bone marrow intravenously. Anti-rejection treatment is continued for an indefinite period of time following the transplant.
|Questions You Should Ask and Criteria: |
|Did the transplant occur within the past 5 years? |
|not acceptable |
Transplants of the cornea are usually required for individuals with inadequate cellular lining in the eye or as a complication in those who have undergone cataract extraction and lens implant. While largely successful, there is a percentage of graft failure with this procedure, which typically occurs within the first few weeks following surgery. Failure is usually the result of surgical trauma, infection or secondary glaucoma.
General Criteria:
A history of Corneal Transplant is generally acceptable after recovery, provided there are no deficiencies of the ADLs or IADLs.
Heart transplantation is now a viable option for patients with previously untreatable end-stage heart disease. This procedure in selected patients not only prolongs life, but also improves the quality of life. Over the past decade, heart transplantation has gone from an experimental procedure to the treatment of choice for patients with end-stage heart disease.
Significant advances in surgical technique, tissue preservation, and prevention of post-transplant complications have allowed for a greatly increased number of heart transplantations, as well as an increase in survival rates worldwide. The limited number of donor hearts, unfortunately, makes this procedure unavailable to many otherwise suitable recipients.
At this time, heart transplantation patients are not considered for LTC coverage due to the frequent number of unforeseen complications, especially during the first five years post-transplant.
General Criteria:
History of or consideration for a heart transplant is Not Acceptable.
The treatment of choice for patients with advanced or end stage renal disease (ESRD) is kidney transplantation. Complications include rejection, infections, and increased incidence of skin cancer due to the administration of immunosuppressant medications and the presence of associated chronic illnesses.
|Questions You Should Ask and Criteria: |
|Has there been a kidney transplant within the past 5 years? |
|not acceptable |
|Has there been any evidence of rejection ? |
|not acceptable |
|Is there been any history of diabetes or heart disease? |
|not acceptable |
|Has there been a failed kidney transplant? |
|not acceptable |
|Has there been any abnormal kidney function post transplant? |
|not acceptable |
|Have there been hospitalizations for complications of the transplant or immunosuppression/opportunistic infections within the |
|past 24 months? |
|not acceptable |
|Has there been a history of lymphoma or other cancer following the kidney transplant ? |
|not acceptable |
|Are more than 10 mgs per day of Prednisone being used? |
|not acceptable |
Liver transplantations are performed in patients with terminal or “end-stage” liver disease, typically due to cirrhosis or liver cancer. While public awareness of the success of this procedure has increased in recent years, it is still subject to a high percentage of failure due to graft rejection and technical complications.
General Criteria:
May be acceptable 5 years after liver transplant is completed
A tremor is an involuntary movement usually involving the hands and occasionally the arms and head. While common in the elderly due to benign causes, tremors can be associated with significant neurological diseases (i.e. Parkinson's).
Benign tremors are usually identified or diagnosed as:
Intention tremor
Familial tremor
Essential tremor
These are generally acceptable as long as the symptoms are not progressive, have been present for 24 months or longer, and a neurological work-up has ruled out Parkinson’s disease.
|Questions You Should Ask and Criteria: |
|Has the cause been identified? |
|not acceptable if due to Parkinson's disease |
|Has there been any progression of symptoms? |
|not acceptable |
|Have Artane, Cogentin, Eldepryl, Larodopa (L- dopa), Sinemet or Symmetrel been prescribed? |
|not acceptable |
|Are there any limitations of ADLs or IADLs? |
|see Uninsurable Functional Deficits |
|Has there been any hospitalization for psychiatric or neurological symptoms within the past 12 months? |
|not acceptable |
|Is there a history of Huntington’s Chorea, Wilson’s disease or tremor at rest? |
|not acceptable |
|Is there a history of multiple sclerosis? |
|not acceptable |
Cross Reference:
Tuberculosis is a communicable disease caused by the bacillus mycobacterium tuberculosis . The lungs are the primary site of infection, but TB may also involve the genitourinary system, gastrointestinal system, musculoskeletal system, and skin.
This infection is treated with specific anti-tuberculosis drugs e.g. isoniazid (INH). Treatment often requires 6-12 months of daily medication. In rare cases partial lung resection may also be required.
|Questions You Should Ask and Criteria: |
|Is there an active infection currently under treatment? |
|not acceptable |
|Are there any limitations with performing the ADLs or IADLs? |
|see Uninsurable Functional Deficits |
|Has there been symptomatic Congestive Heart Failure (CHF) within the past 5 years? |
|not acceptable |
Cross Reference:
CHF
Uninsurable Functional Deficits
The following are four types of commonly encountered skin ulcers.
Venous Ulcers: Venous ulcerations are often preceded by stasis dermatitis. This is due to venous hypertension in the lower extremities. Ulcerations may occur spontaneously or follow a superficial injury. The ulcers are usually located on the ankle, but may occur anywhere.
Arterial Ulcers: Arterial ulcerations are due primarily to atherosclerosis of the limb vessels, which produces ischemia of the skin. The ulcers are located primarily on the toes and the lower leg. Even small ulcers can be very painful and are often deep, going down to the subcutaneous tissue, muscle, and even into the bone.
Diabetic Ulcers: Diabetic ulcers are also associated with an increased incidence of atherosclerosis of the medium and large arteries. Because of diminished blood flow, diabetics are prone to arterial ulcers, frequently in the toes or elsewhere on the foot. Healing is slow and difficult because of the diabetic's lower resistance to infection.
Pressure Ulcers: Pressure ulcers, also known as decubitus ulcers, are a common problem among people with spinal cord injuries and chronic neurological disease (such as stroke). More than 90% of pressure ulcers are located in the lower part of the body over bony prominences. Common sites include the sacrum, heel, ankle, and hip.
|Questions You Should Ask and Criteria: |
|Has there been a venous ulcer (single occurrence) within the past 12 months? |
|not acceptable |
|Has there been an arterial, or pressure ulcer (single occurrence) within the past 24 months? |
|not acceptable |
|Has there been a diabetic ulcer? |
|not acceptable |
|Is there a history of multiple/recurrent skin ulcers? |
|not acceptable |
|Has there been any lower extremity or by-pass surgery? |
|not acceptable if: |
|within 12 months |
|there is a history of diabetes |
|Has there been any prolonged wheelchair or bed confinement? |
|not acceptable |
|Is there any history of gangrene, amputation, or recurrent deep vein thrombosis ? |
|not acceptable |
Cross Reference:
Diabetes
Uninsurable Functional Deficits
Valvular heart disease involves the four valves within the heart: aortic, mitral, pulmonic, and tricuspid. The aortic and mitral valves are the most often affected.
Heart murmurs may be important clinical indicators of valvular heart disease. When the valves are opening and closing in a healthy fashion, very little noise is produced by the flow of blood over the valves. However, when the valves fail to open completely (stenosis), or close completely (regurgitation or insufficiency), turbulence to the blood flow produces an abnormal sound or murmur.
Causes of valvular disease can be congenital (present at birth), secondary to rheumatic fever, muscle dysfunction due to coronary artery disease, prolapse, or calcification. Treatment is usually the surgical replacement of the abnormal valve.
|Questions You Should Ask and Criteria: |
|Has a heart valve replacement been recommended or scheduled, or valve replaced within the past 6 months? |
|not acceptable |
|Has more than one valve been replaced? |
|not acceptable |
|Is there any history of cardiomyopathy or post-surgical congestive heart failure (CHF)? |
|not acceptable |
|Has Coumadin been initiated within the past 6 months? |
|not acceptable |
|Has there been any post-surgical bleeding secondary to Coumadin use within the past 12 months? |
|not acceptable |
|Is there a history of diabetes in combination with a heart valve replacement? |
|not acceptable |
|Is there a history of endocarditis within the past 24 months? |
|not acceptable |
|Has there been any symptomatic arrhythmia, including cardioversion, within the past 12 months? |
|not acceptable |
|Has there been any angina at rest, increasing angina, or diagnosis of Myocardial Infarction (MI) within the past 6 months? |
|not acceptable |
|Have there been 2 or more hospitalizations or ER visits for angina within the past 12 months? |
|not acceptable |
|Have there been any blood clots within the past 24 months? |
|not acceptable |
Cross-references:
Angina Diabetes
Atrial Fibrillation Myocardial Infarction
Below is a partial list of drugs. The medications in bold face type denote significant underlying disease. Their current use may warrant adverse decisions. Please determine why the medication is being taken and for how long. Then, look up the medical condition in the manual and proceed accordingly. For further information or information on additional medications, books listing commonly used drugs are readily available at local bookstores.
|Brand Name | |Used in the Treatment of: |
|Accolate | |asthma |
|Accupril | |hypertension |
|Activase | |heart attack, stroke, pulmonary embolism |
|Adriamycin | |cancer/leukemia/lymphoma |
|AeroBid Inhaler | |Asthma |
|Agrylin | |Essential thrombocythemia |
|Aldomet | |hypertension |
|Alkeran | |Cancer |
|Alphagan | |Ocular hypertension/glaucoma |
|Altace | |Hypertension/chronic heart failure |
|Alupent | |asthma/COPD/emphysema |
|Amaryl | |non-insulin dependent diabetes |
|Ambien | |insomnia |
|Amerge | |migraine |
|Apresoline | |Hypertension |
|Amplex | |Alzheimer’s disease |
|Aricept | |Alzheimer’s disease |
|Artane | |Parkinson's disease/tremor |
|Arthotec | |Osteoarthritis/rheumatoid arthritis |
|Arvin | |Anticoagulant therapy |
|Atarax | |anxiety/panic/itching |
|Ativan | |anxiety |
|Atrovent | |COPD |
|Avapro | |Hypertension |
|Avandia | |Non-insulin diabetes (handle as Rezulin) |
|Avonex | |Multiple sclerosis |
|Axid | |Acid-reflux disorders (GERD)/peptic ulcer |
|Azmacort | |asthma/COPD/emphysema |
|Azulfidine | |Crohn’s disease (ulcerative colitis) |
|Baycol | |Hyperlipidemia (high cholesterol) |
|Betapace | |Arrhythmias |
|Betaseron | |Multiple sclerosis |
|Brethine | |COPD/emphysema |
|Brand Name | |Used in the Treatment of: |
|Bretylol | |Arrhythmia |
|Bricanyl | |COPD/emphysema/asthma |
|Bumex | |Hypertension/chronic heart failure |
|BuSpar | |anxiety/depression |
| | | |
|Calan | |angina/arrhythmia /hypertension |
|Calcimar | |Osteoporosis |
|Campto | |Advanced colorectal cancer |
|Camptosar | |Advanced colorectal cancer |
|Capoten | |Hypertension |
|Carafate | |Duodenal ulcers |
|Cardura | |Hypertension urinary obstruction |
|Catapres | |Hypertension |
|Cataflam | |Rheumatoid arthritis |
|Celexa | |antidepressant |
|Cerespan | |diminished blood flow to the brain/TIAs/memory loss/dementia/|
| | |peripheral vascular disease/arterial ulcers |
| | | |
| | | |
|Cerebyx | |seizures/epilepsy |
|Ceredase | |Gaucher’s disease |
|Cerezyme | |Gaucher’s disease |
|Cipro | |urinary tract infections |
|Clinoril | |pain/inflammation |
|Clozaril | |Psychosis/schizophrenia |
|Codeine | |pain |
|Cogentin | |Parkinson's disease/tremor |
|Cognex | |dementia/confusion/delirium/ |
| | |disorientation/forgetfulness/ |
| | |memory loss |
|Colchicine | |Scleroderma |
|Compazine | |Psychosis |
|Copaxone | |Multiple sclerosis |
|Cordarone | |Arrhythmia |
|Coreg | |hypertension |
|Corgard | |hypertension/angina |
|Coumadin | |cardiac arrhythmias/heart valve disease/stroke/coronary |
| | |artery disease/emboli |
| | |hypertension/angina |
|Covera-HS | |hypertension |
|Cozaar | | |
|Cuprimine | |scleroderma/Lupus |
|Brand Name | |Used in the Treatment of: |
|Cyclospasmol | |TIAs/memory loss/dementia |
|Cylert | |Attention deficit hyperactivity disorder |
|Cytotec | |Peptic ulcer disease |
|Cytoxan | |cancer/kidney failure/lupus/scleroderma |
|Darvon | |Pain |
|Deltasone | |Endocrine disorders |
|Demerol | |pain |
|Depakene/Depakote | |seizures/epilepsy |
|Depen | |scleroderma/Lupus |
|Depo-Provera | |cancer |
|Deprynel | |Parkinson's disease |
|DES | |prostate cancer |
|Desferal | |hemochromatosis |
|Destinex | |Parkinson’s disease |
|Desyrel | |depression |
|Diabenese | |diabetes mellitus |
|DiaBeta | |diabetes mellitus |
|Didronel | |osteoporosis |
|Dilantin | |epilepsy/seizures |
|Dilaudid | |narcotic for chronic pain |
|Diovan | |hypertension |
|Divalproex | |seizure epilepsy |
|Donnatal | |irritable bowel syndrome |
|Dovonex | |psoriasis |
|Duract | |pain |
|Dynacirc | |hypertension |
|Edecin | |hypertension/chronic heart failure |
|Effexor | |depression |
|Elavil | |depression |
|Eldepryl | |Parkinson's disease/tremor |
|Epogen | |severe anemia |
|Ergoloid | |dementia/confusion/delirium/ disorientation/forgetfulness/ |
| | |memory loss |
| | |migraine headache |
|Ergomar | | |
|Eskalith | |major mental disorders |
|Ethmozine | |arrhythmia |
|Eulexin | |prostate cancer |
|Evista | |osteoporosis |
|Brand Name | |Used in the Treatment of: |
|Famvir | |Herpes zoster (shingles) |
|Fareston | |Breast cancer |
|Felbatol | |Epilepsy |
|Femara | |Breast cancer |
|Feldene | |pain/inflammation |
|Fibracol | |Diabetic foot ulcers |
|Fioricet | |pain |
|Fiorinal | |Pain |
|Flexeril | |Muscle spasm |
|Flomax | |Benign prostatic hyperplasia |
|Florinef | |complications of diabetes/ |
| | |Addison’s disease |
|Fosamax | |Osteoporosis |
|Fragmin | |Anticoagulant therapy |
|Gabitril | |Anti-epileptic |
|Gemzar | |Pancreatic cancer |
|Glucophage | |Non-insulin dependent diabetes mellitus |
|Glucotrol | |diabetes mellitus |
|Glynase | |diabetes mellitus |
|Glyburide | |diabetes mellitus |
|Halcion | |insomnia |
|Haldol | |major mental disorders/ |
| | |alcohol dependency |
|Humalog | |Diabetes mellitus |
|Hycamtin | |Ovarian cancer |
|Hydergine | |dementia/confusion/delirium/ disorientation/forgetfulness/ |
| | |memory loss |
|Hydrea | |blood disorders |
|Hydrodiuril | |hypertension |
|Hytrin | |hypertension/benign prostatic hypertrophy(BPH) |
|Imferon | |anemia |
|Imuran | |cardiomyopathy/lupus/ |
| | |scleroderma/liver disease/hepatitis |
|Inderal | |hypertension/angina/MI/arrhythmia/ |
| | |benign tremors |
|INH | |tuberculosis (TB) |
|Brand Name | |Used in the Treatment of: |
|Insulin (Regular, NPH, Lente, | |diabetes mellitus |
|Humalin) | | |
|Isordil | |angina/CHF |
|Isuprel | |asthma |
|Kemadrin | |Parkinson's disease |
|Klonopin | |seizures, depression |
|L-Dopa | |Parkinson's disease/tremor |
|Lanoxin | |arrhythmia/CHF |
|Larodopa | |Parkinson's disease/tremor |
|Lasix | |CHF |
|Leukeran | |cancer/kidney failure/lupus/ scleroderma/blood disorders |
|Librium | |anxiety/panic |
|Limbitrol | |Depression |
|Lioresal | |Multiple sclerosis |
|Lithium | |major mental disorders |
|Lithobid | |major mental disorders |
|Lodine | |pain/inflammation |
|Loxitane | |psychosis |
|Ludiomil | |depression |
|Lupron | |prostate cancer |
|Manoplax | |congestive heart failure (CHF) |
|Marplan | |depression |
|Maxair | |asthma/COPD |
|Megace | |Breast cancer/uterine cancer |
|Mellaril | |major mental disorders |
|Mestinon | |myasthenia gravis |
|Methotrexate | |lupus/scleroderma/leukemia/ |
| | |lymphoma/ rheumatoid arthritis |
|Miacalcin | |osteoporosis |
|Micronase | |diabetes mellitus |
|Miltown | |anxiety/panic |
|Mirape | |Parkinson’s disease |
|Miraplex | |Parkinson’s disease |
|Mithracin | |Paget's Disease |
|Moban | |psychosis |
|Morphine | |pain |
|Mysoline | |seizures/epilepsy |
|Naprosyn | |pain/inflammation |
|Nardil | |depression |
|Brand Name | |Used in the Treatment of: |
|Navane | |Psychosis |
|Navelbine | |Lung cancer |
|Neurontin | |Epilepsy |
|Nilandron | |Prostate cancer |
|Niloric | |dementia/confusion/delirium/ disorientation/forgetfulness/ |
| | |memory loss |
|Nitrobid/ | |angina |
|NitroDur/ | | |
|Nitrol/ | | |
|Nitrostat/ | | |
|Transderm-Nitro | | |
|Nolvadex | |breast cancer |
|Novantrone | |prostate cancer |
|Norvasc | |hypertension/angina/CHF |
|Orap | |Tourette Syndrome |
|Orinase | |diabetes mellitus |
|Pamelor | |depression |
|Parlodel | |Parkinson's disease |
|Parnate | |depression |
|Parsidol | |Parkinson's disease |
|Pavabid | |diminished blood flow to the brain/ TIAs/memory |
| | |loss/dementia/peripheral vascular disease/ |
| | |arterial ulcer |
| | |depression |
|Paxil | | |
|Percodan | |pain |
|Peritrate | |angina |
|Permax | |Parkinson's disease |
|Persantine | |TIA/valve replacement |
|Phenobarbital | |seizures/epilepsy |
|Photofrin | |esophageal cancer |
|Plaquenil | |scleroderma/rheumatoid arthritis |
|Platinol | |cancer/polycythemia |
|Plavix | |unstable angina, stroke prevention |
|Prandin | |diabetes mellitus |
|Precose | |diabetes mellitus |
| | | |
|Prednisone | |lupus/polymyalgia/asthma/ |
| | |arthritis/ liver disease/ |
| | |hepatitis/renal failure/ |
| | |thrombocytopenia |
|Prolixin | |major mental disorders |
|Brand Name | |Used in the Treatment of: |
|Pronestyl | |arrhythmias |
|Proscar | |benign prostatic hypertrophy (BPH) |
|Prostigmin | |myasthenia gravis |
|Proventil | |asthma/COPD/emphysema |
|Prozac | |depression |
|Purinethol | |leukemia/lymphoma |
|Quinidex | |arrhythmia |
|Referon-A | |liver disease/hepatitis/leukemia |
|Regranex | |diabetic ulcer |
|Relafen | |pain/inflammation |
|Remeron | |depression |
|Requip | |Parkinson’s disease |
|Rezulin | |diabetes mellitus |
|Rheumatrex | |lupus/scleroderma/leukemia/ |
| | |lymphoma/rheumatoid arthritis |
|Ritalin | |Depression |
|Rituxan | |Non-Hodgkin’s lymphoma |
|Sabril | |seizures |
|Sandimmune | |lupus/scleroderma/cancer/ |
| | |organ transplant |
|Serlect | |schizophrenia |
|Serax | |anxiety/panic |
|Serentil | |psychosis |
|Sinemet | |Parkinson's disease/tremor |
|Sinequan | |depression |
|Sorbitrate | |angina/CHF |
|Sparine | |psychosis |
|Stelazine | |schizophrenia/severe anxiety |
|Symmetrel | |Parkinson's disease/tremor/acute influenza |
|Tacrine | |dementia/memory loss/confusion/ |
| | |forgetfulness/disorientation |
|Talwin | |pain |
|Tambocor | |arrhythmias |
|Taractan | |psychosis |
|Tasmar | |Parkinson’s disease |
|Taxol | |Ovarian cancer |
|Taxotere | |Breast/ovarian cancer |
|Tegretol | |convulsions/seizures/neuropathy |
|Tenormin | |hypertension |
|Brand Name | |Used in the Treatment of: |
| | | |
|Theo-Dur | |asthma/COPD/emphysema |
|Ticlid | |stroke/TIA |
|Tofranil | |depression |
|Tolinase | |diabetes mellitus |
|Tornalate | |asthma |
|Tranxene | |anxiety/panic |
|Trental | |peripheral vascular disease/ |
| | |arterial ulcers |
|Triavil | |depression |
|Trilafon | |psychosis |
|Tylox | |pain |
|Valium | |anxiety/seizures |
|Vanceril | |asthma |
|Vasotec | |hypertension/CHF |
|Ventolin | |asthma/COPD/emphysema |
|Vespirin | |psychosis |
|Viagra | |male erectile dysfunction |
|Vicodin | |pain |
|Voltaren | |pain/inflammation |
|Wellbutrin | |depression |
|Xanax | |anxiety/panic |
|Zanflex | |spasticity |
|Zarontin | |seizures/epilepsy |
|Zoladex | |prostate cancer |
|Zoloft | |Depression |
|Zyprexa | |schizophrenia |
Or search the Web at the following sites:
Personal List of Additional Drugs
|Brand Name |Use |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
| | |
|Generic Name |Used in the Treatment of: |
|acarbose |diabetes mellitus |
|acebutolol |hypertension |
|acetaminophen |pain |
|acridine |forgetfulness/disorientation |
|acyclovir |herpes zoster (shingles) |
|adenosine |arrhythmia |
|albuterol |asthma/COPD/emphysema |
|alendronate sodium |osteoporosis |
|alprazolam |anxiety pain |
|amantadine |Parkinson’s disease/tremor/acute influenza |
|aminoguanidine |type I and type II diabetes |
|amiodarone |arrhythmia |
|amiodipine besylate |hypertension/angina/congestive heart failure |
| | |
|Generic Name |Used in the Treatment of: |
|amitriptyline |depression |
|amlodipine |hypertension |
|ancrod |anticoagulant therapy |
|aspirin |pain |
|atenolol |hypertension |
|atorvastation |elevated high cholesterol |
|azathioprine |cardiomyopathy/lupus/scleroderma/liver |
| |disease/hepatitis/severe, active rheumatoid arthritis |
| | |
|baclofen |muscle spasms due to multiple sclerosis |
|becaplermin |diabetic ulcers |
|beclomethasone dipropionate |asthma |
|benazepril |hypertension/chronic heart failure |
|benztropine mesylate |Parkinson’s disease/tremor |
|bitolterol |asthma |
|bretylium |arrhythmia |
|bromfenac |acute pain |
|brominide tartrate |reduction of intraocular pressure/open-angle glaucoma |
|bromocriptine mesylate |Parkinson’s disease/pituitary tumor |
|bumetanide |hypertension/chronic heart failure |
|bupropion |depression |
|buspirone |anxiety/depression |
|butalbital |tension headache |
| | |
|calcipotriene |moderate plaque psoriasis |
|calcitonin-salmon |osteoporosis |
|captopril |hypertension |
|carbamazepine |convulsions/seizures/neuropathy |
|carbidopa-levodopa |Parkinson’s disease/restless leg syndrome |
|carvedilal |hypertension |
|cerivastatin |high cholesterol |
|chlorambucil |cancer/kidney failure/lupus/scleroderma/ blood |
| |disorders/rheumatoid arthritis |
|chlordiazepoxide |anxiety/panic |
|chlorothiazide |edema/hypertension/congestive heart failure |
|chlorpromazine |psychosis |
| | |
|Generic Name |Used in the Treatment of: |
|chlorpropamide |non-insulin-dependent diabetes mellitus |
|chlorprothixene |psychosis |
|chlorthalidone |hypertension/chronic heart failure |
|cimetidine |acid-reflux disorders/peptic ulcer disease |
|ciprofloxacin |urinary tract infection |
|cisapride |gastro-esophageal reflux disease |
|cisplatin |cancer/polycythemia |
|clomipramine hydrochloride |obsessive-compulsive disorder |
|clonazepam |seizures/depression |
|clonidine |hypertension/chronic heart failure |
|clopidrogel |prevention of ischemic events |
|clorazepate |anxiety/panic |
|clozapine |schizophrenia |
|codeine |pain |
|colchicine |scleroderma/arthritis |
|collagen-alginate topical |foot ulcers in diabetic patients |
|cyclandelate |TIAs/memory loss/dementia |
|cyclobenzaprine |muscle spasm |
|cyclophosphamide |cancer/kidney failure/rheumatoid arthritis |
|cyclosporine |lupus/scleroderma/cancer/organ transplant |
| | |
|dalteparin |anticoagulant therapy |
|deferoxamine |hemochromatosis |
|diazepam |anxiety/seizures |
|diclofenac |pain/inflammation |
|diethylstilbestrol |prostate cancer |
|digoxin |arrhythmia/congestive heart failure |
|diltiazem |hypertension/angina |
|dipyridamole |TIA/valve replacement |
|divalproex |seizures/epilepsy |
|docetaxel |breast/ovarian cancer |
|donepezil |Alzheimer’s disease |
|dorzolamide HCI |reduction of intraocular pressure/open-angle glaucoma |
|doxazosin |hypertension/urinary obstruction symptoms of BPH |
|doxepin |depression |
|doxorubicin |cancer/leukemia/lymphoma |
|d-penicillamine |scleroderma/lupus |
| | |
|Generic Name |Used in the Treatment of: |
|enalapril |hypertension/congestive heart failure |
|enalapril-felodipine |hypertension |
|enoxaparin |prevention of deep vein thrombosis |
|entacapone |Parkinson’s disease |
|ergoloid mesylate |dementia/confusion/delirium/disorientation/ |
| |forgetfulness/memory loss |
|ergotamine tartrate |migraine headaches |
|erythrityl |angina |
|erythropoietin |severe anemia |
|ethodolac |pain/inflammation |
|ethopropazine |Parkinson’s disease |
|ethosuximide |seizures/epilepsy |
|etidronate |osteoporosis |
| | |
|famciclovir |herpes zoster |
|felbamate |epilepsy |
|felodipine |hypertension |
|fenoprofen calcium |pain |
|finasteride |benign prostatic hypertrophy (BPH) |
|flecainide |arrhythmia |
|flosequinan |congestive heart failure |
|fludrocortisone |complications of diabetes/Addison’s disease |
|flunisolide |asthma |
|fluoxetine |depression |
|fluphenazine |major mental disorders |
|flutamide |metastatic prostate cancer |
|fluvastatin |hypercholesterolemia |
|fluvoxamine maleate |obsessive-compulsive disorder |
|fosinopril |hypertension/chronic heart failure |
|fosphenytoin |seizures |
|furosemide |hypertension/chronic heart failure |
| | |
|gabapentin |epilepsy |
|gemcitabine |pancreatic cancer |
|gemfibrozil |hyperlipidemia |
|glibenclamide |diabetes mellitus |
|glimepiride |non-insulin-dependent diabetes mellitus |
|glipizide |non-insulin-dependent diabetes mellitus |
| | |
|Generic Name |Used in the Treatment of: |
|glyburide |non-insulin-dependent diabetes mellitus |
|gold sodium thiomalate |rheumatoid arthritis |
|goserelin |prostate cancer |
| | |
|haloperidol |major mental disorders/alcohol dependency |
|hydralazine |hypertension |
|hydrocholorothiazide |hypertension |
|hydrocodone/acetaminophen |pain |
|hydroxychloroquine |scleroderma/rheumatoid arthritis |
|hydroxyurea |blood disorders |
|hydroxyzine |anxiety/panic/itching |
| | |
|imiglucerase injection |Gaucher’s disease |
|imipramine |depression |
|insulin |diabetes mellitus |
|insulin lispro |diabetes mellitus |
|interferon |liver disease/hepatitis/leukemia |
|ipratroprium |COPD |
|irbesartan |hypertension |
|irinotecan |advanced colon cancer |
|iron dextran |anemia |
|isocarboxazid |depression |
|isoniazid |TB (tuberculosis) |
|isoproterenol |asthma |
|isosorbide dinitrate |angina/CHF |
| | |
|lamotrigine |partial seizures |
|laradopa |Parkinson’s disease/tremor |
|letrozole |breast cancer |
|leuprolide |prostate cancer |
|levetiracetam |seizures |
|levodopa |Parkinson’s disease/tremor |
|lithium carbonate |major mental disorders |
|loxapine |psychosis |
| | |
|maprotiline |depression |
|medroxyprogesterone |cancer |
|megestrol |breast cancer/uterine cancer |
|melphalan |cancer |
|meperidine |pain |
|meprobamate |anxiety/panic |
|6-mercaptopurine |leukemia/lymphoma |
| | |
|Generic Name |Used in the Treatment of: |
|mesoridazine |psychosis |
|metaproterenol |asthma/COPD/emphysema |
|metformin |diabetes mellitus |
|methotrexate |lupus/scleroderma/leukemia/lymphoma/ rheumatoid arthritis |
|methyldopa |hypertension |
|methylphenidate |depression |
|mirtazapine |depression |
|mithramycin |Paget’s disease |
|mitoxantrone |hormone-resistant prostate cancer |
|molindone |psychosis |
|morphine sulfate |pain |
|myotrophin |ALS, Lou Gehrig’s disease |
|nabumetone |pain/inflammation |
|nadolol |hypertension/angina |
|naproxen |pain/inflammation |
|neostigmine |myasthenia gravis |
|nifedipine |hypertension/angina |
|nilutamide |prostate cancer |
|nitroglycerine |angina |
|nortriptyline |depression |
| | |
|olanzapine |schizophrenia |
|oxazepam |anxiety/panic |
|oxcarbazepine |epilepsy |
|oxycodone/acetaminaphen |pain |
|oxycodone/aspirin |pain |
| | |
|paclitaxel |breast and ovarian cancer |
|papaverine |diminished blood flow to the brain/TIAs/memory |
| |loss/dementia/peripheral vascular disease/arterial ulcers |
|paroxetine |depression |
|pentaerythritol tetranitrate |angina |
|pentazocine |pain |
|pentoxifylline |peripheral vascular disease/arterial ulcers |
|perbuterol |asthma/COPD |
|pergolide mesylate |Parkinson’s disease |
|perphenazine |psychosis |
|perphenazine/amitryptiline |depression |
|phenelzine |depression |
| | |
|Generic Name |Used in the Treatment of: |
|phenobarbital |seizures/epilepsy |
|phenytoin |seizures/epilepsy |
|pimozide |chronic schizophrenia |
|piroxicam |pain/inflammation |
|porfimer sodium |esophageal and lung cancer |
|pramipexole |Parkinson’s disease |
|pramlintide |Type 1 diabetes mellitus |
|prazosin |hypertension |
|prednisone |lupus/polymyalgia/asthma/arthritis/liver |
| |disease/hepatitis/renal failure/thrombocytopenia |
|primadone |seizures/epilepsy |
|procainamide |arrhythmia |
|proclorperazine |psychosis |
|procyclidine |Parkinson’s disease |
|promazine |psychosis |
|propranolol |hypertension/angina/MI/arrhythmia/benign tremor |
|propoxyphene |pain |
|pyridostigmine |myasthenia gravis |
| | |
|quetiapine fumarate |psychotic disorders |
|quinapril |hypertension |
|quinidine |arrhythmia |
| | |
|raloxifene |osteoporosis prevention |
|repaglinide |diabetes mellitus |
|riluzole |ALS, Lou Gehrig’s disease |
|rituximab |recurrent non-Hodgkin’s disease |
|ropinerole |Parkinson’s disease |
| | |
|salmon calcitonin |osteoporosis |
|selegiline |Parkinson’s disease |
|sertindole |schizophrenia |
|sertraline |depression |
|sildenafil |male erectile dysfunction |
|sulindac |pain/inflammation |
| | |
|tacrine THA |dementia/confusion/memory loss/delirium/ |
| |disorientation/forgetfulness |
|tamoxifen |breast cancer |
|tamsulosin |BPH, enlarged prostate |
|trazodone |depression |
| | |
|Generic Name |Used in the Treatment of: |
|terazosin |hypertension/benign prostatic hypertrophy (BPH) |
|terbutaline |COPD/emphysema |
|tetrahydroamino acridine (THA) |dementia/memory loss/ |
| |confusion/forgetfulness/disorientation |
|theophylline |asthma/COPD/emphysema |
|thioridazine |major mental disorders |
|thiothixene |psychosis |
|ticlopadine |stroke/TIA |
|tizanidine |decrease spasticity |
|tolazamide |diabetes mellitus |
|tolbutamide |diabetes mellitus |
|tolcapone |Parkinson’s disease |
|topotecan |ovarian cancer |
|toremifene |metastatic breast cancer |
|triamcinolone |asthma/COPD/emphysema |
|triazolam |insomnia |
|trifluoperazine |schizophrenia/severe anxiety |
|trifluopromazine |psychosis |
|trihexphenidyl |Parkinson’s disease/tremor |
|troglitazone |diabetes mellitus (not acceptable) |
|valproate/divalproex |seizures/epilepsy |
|verapamil |angina/arrhythmia/hypertension |
|vivabatrin |refractory seizures |
|vinorelbine tartrate |lung cancer |
| | |
|warfarin |cardiac arrhythmia/heart valve disease/stroke/ |
| |coronary artery disease/emboli |
Personal List of Additional Drugs
|Generic Name |Use |
| | |
| | |
| | |
| | |
| | |
|Or search the Web at the following sites: | |
| | |
| | |
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| | |
| | |
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Activities of Daily Living (ADLs): The self-care, communication, and mobility skills required for independence in everyday living. These include: bathing, dressing, toileting, transferring, bowel/bladder continence, and eating.
Atherosclerosis: Commonly called hardening of the arteries, this is a gradual narrowing of the arteries throughout the body. It is caused by the accumulation of fat and other material along arterial walls. When the narrowing becomes too severe, complications such as heart attacks, peripheral vascular disease with leg pain, and strokes may occur, depending upon the location of the affected artery(ies).
Arteriography: Dye is injected into an artery and an x-ray is taken. A blockage may then be seen where the dye cannot penetrate.
Cardiac catheterization: This is the diagnostic “gold standard” for evaluation of the heart chambers, heart valve function, and degree of patency (openness) of the various coronary arteries that supply the heart. This procedure is accomplished through the insertion of a plastic catheter into an artery in the groin. The catheter is extended up the aorta into the left ventricle of the heart. Dye is injected and serial x-rays are performed. The catheter is then withdrawn and selectively placed into the various coronary arteries where dye is also injected and additional x-rays are performed.
CAT (computerized axial tomography) scans: An imaging technique in which planes of tissue are swept by a pinpoint x-ray beam and a computerized analysis produces a precise reconstructed image of that area. This technique has a greater sensitivity in showing the relationship of structures than conventional x-rays and has been used most successfully in diagnostic studies of the brain, although it is also used in other areas of the body.
Cerebral Vascular Accident (CVA): a general term most commonly applied to cerebrovascular conditions that accompany either ischemic (narrowing of blood vessels) or hemorrhagic (bleeding) lesions. These conditions are usually secondary to atherosclerotic disease, hypertension, or a combination of both. Also commonly called stroke.
Digital Subtraction Angiography (DSA): This is a type of x-ray examination of a blood vessel. It is similar to arteriography, except that less injectable dye may be used.
Disorientation: The loss of bearings, or a state of mental confusion as to time, place, or identity. This may be the result of an underlying disease, stress, mental illness, or medication.
DWR (Delayed Word Recall): A screening exercise to assess short-term memory. The subject is asked to use each of several simple words in a sentence. He/she is then asked to use each of the words in sentences again. In addition, the words are shown on flash cards. This is know as the encoding phase of the exercise. After an elapse of no fewer than 5 minutes and no more than 15 minutes, the subject is asked to remember as many of the words as possible. The subject is asked to take as long as he/she wishes for this recall phase of the exercise.
Instrumental Activities of Daily Living (IADLs): Those daily living skills, such as, shopping, housework, laundry, meal preparation, managing finances, using the telephone, arranging for transportation, and taking medications, that are necessary for maintaining the home environment.
Memory Loss: Loss of ability to remember events of the recent past (short-term memory) or the remote past (long-term memory). Loss of some short-term memory (such as the ability to remember names) is a normal part of the aging process. However, severe or progressive memory loss may be an indication of a developing dementia or other serious disease.
Magnetic Resonance Imaging (MRI): Also known as Nuclear Magnetic Resonance Imaging. This is an imaging technique that subjects atomic nuclei to a strong magnetic field to provide precise images of the heart, large blood vessels, brain, and soft tissues. MRIs can often detect defects that are missed on CAT scans.
PSA (Prostate specific antigen): a glycoprotein produced only in prostatic tissue, which is measurable through blood analysis. It is normally present in minimal amounts but becomes elevated with prostate cancer and certain benign prostate disorders such as BPH (benign prostatic hypertrophy) and prostatitis. There is a greater likelihood of cancer as the PSA increases.
Short Portable Mental Status Questionnaire (SPMSQ): A 10-part questionnaire that assesses an individual’s orientation to person, place, and time. Questions include personal information such as the subject’s date of birth and phone number, and more general questions such as the names of the current and previous presidents. In addition, the subject is asked to perform a simple mathematical computation.
Staging of Cancer Tumors: The process of classifying malignant tumors according to the extent of the tumor. TNM, staging of tumors according to three basic components: primary tumor (T), regional lymph nodes (N), and metastasis/spread (M). See Introduction to the Cancer section for more details on staging.
Transient Ischemic Attack (TIA): Temporary interference with blood supply to the brain. The symptoms may last for only a few moments or several hours (but less than 24 hours). After the attack no evidence of residual brain damage or neurological damage remains. Individuals who experience TIAs are at an increased risk for additional TIAs or strokes.
Note: ( Primary medical histories discussed in this manual are in bold heading
(Information related to primary medical histories or cross references are identified in lower case and/or indented sub-headings
A
abdominal aorta, 20
abnormal kidney function
kidney transplantation, 105
abscess, anorectal, 17
abstinence from alcohol, 15
Acquired Immune Deficiency Syndrome (AIDS), 6
active hepatitis, 66
Activities of Daily Living (ADL), 1, 8
acute
Acute Renal Failure (ARF), 88
leukemia, bone marrow transplant, 103
lymphocytic leukemia (ALL), 69
MI, 75
monocytic leukemia (AMOL), 69
myelogenous leukemia, 69
Acute
Hepatitis, 66
Addison’s Disease, 14
Additional Uninsurable Deficits", 9
ADL
IBS, 56
ADL, Uninsurable Deficits", 8
ADLs
anemia, 19
angina pectoris, 23
ankylosing spondylitis, 24
Cerebral Palsy, 51
corneal transplant, 103
CREST syndrome, 92
depression, 59
dizziness, 61
glaucoma, 62
macular degeneration, 62
Meningitis, 72
myasthenia gravis, 74
neuropathy, 62, 76
normal pressure hydrocephalus, 78
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
poliomyelitis, 83
polymyalgia rheumatica, 85
post polio syndrome, 83
rheumatoid arthritis, 89
schizophrenia or other psychosis, 91
scleroderma, 92
slipped or ruptured disc, 94
Specific Uninsurable Medical Conditions, 6
spinal stensosis, 95
TB, 107
tremors, 106
adrenal glands, 14
adrenal stimulating hormone, 14, 58
adult day care use, 9
Adult Onset Diabetes Mellitus, 60
A-Fib
Atrial Fibrillation, 30
chronic, 30
paroxysmal (intermittent), 30
valvular heart disease, 109
age
chronological, 1
physiological, 1
AIDS, 6
AIDS Related Complex (ARC), 6
airway obstruction, 93
alcohol
ingestion, 54
instability, 4
alcohol use
primary biliary cirrhosis, 54
alcoholic liver disease (ALD), 54
alcoholism
effects from, 15
falls, 15
hemochromatosis, 65
neuropathy, 76
schizophrenia or other psychosis, 91
Alcoholism. See Cirrhosis, alcoholic liver disease . See Depression
ALCOHOLISM. See cirrhosis, alcoholic liver disease. See depression
aldosterone, 14
allergic asthma, 27
Allergic Asthma. See chronic obstructive pulmonary disease
ALS, Amyotrophic Lateral Sclerosis, 6, 16
Alzheimer’s Disease, 6, 16
Five I’s, 4
Amaurosis. See TIA (Transient Ischemic Attack)
amaurosis fugax, 62
Amaurosis Fugax
TIA, 102
ambulation, 8
amnesia, 101
amputation
peripheral vascular disease, 82
skin ulcers, 108
amputation, 60
Amputation, 6
Amyotrophic Lateral Sclerosis, 6
Amyotrophic Lateral Sclerosis(ALS), 16
anal
fissure, 17
ulcers, 17
anemia, 4
aplastic, 20
aplastic, 6
causes of, 18
hypoplastic, 20
iron deficiency, 18
kidney cancer, 39
megaloblastic, 18
microcytic, 18
multiple myeloma, 73
stomach cancer, 45
Anemia, 18
chronic disease, 18
aneurysm, 20
aortic, 21
brain, 22
cerebrovascular, 22
most common sites, 20
Aneurysm. See stroke
aneurysm, untreated dissecting aortic, 21
Aneurysms, 20. See atherosclerosis & carotid arteries
aneurysms, dissecting, 21
angina, 75
angioplasty, 55
pectoris, 23
stable, 23
unstable, 23
Angina. See coronary angioplasty. See coronary artery bypass surgery. See atrial fibrillation. See arrhythmias
ANGINA PECTORIS. See coronary artery bypass grafts. See CABG. See congestive heart failure (CHF). See cardiac failure
Angiography, Digital Subtraction (DSA), 28
angioplasty, 75
coronary, 55
peripheral vascular disease, 82
surgery, 96
TIA, 102
ankylosing spondylitis, 24
anorectal
abscess, 17
fistula, 17
anorexia, 45
polymyalgia rheumatica, 85
antigen, carcinoembryonic, 32
antigen, prostate-specific", 32
anti-inflammatories
oral, colitis, 56
anti-psychotic medications
depression, 59
AODM, 60
aorta
abdominal, 20
abnormal dilatation, 21
ascending and descending, 21
thoracic, 20
aorta, 21
aortic
aneurysm, 21
root dilatation, 83, 84
valve, valvular heart disease, 109
Aortic, 20
aphasia
TIA, 102
aplastic anemia, 20
bone marrow transplant, 103
Aplastic Anemia, 6
Approved, 5
Approved with Modifications (AWM), 5
kidney transplantation, 88
arrhythmias
cardiac, syncope, 97
myocardial infarction, 75
Arrhythmias, 25. See atrial fibrillation
ARRHYTHMIAS. See TIA. See cardiomyopathy. See congestive heart failure (CHF). See cardiac failure. See atrial fibrillation. See angina
Artane
tremors, 106
arterial
embolism, 100
ulcers, 108
arterial plaque, 28
arteries
carotid, 20
femoral, 20
intracranial, 20
arteries, carotid, 28
arteries, hardening of, 28
Arteriography, 28
Arteritis
Giant Cell (GCA), polymyalgia rheumatica, 85
Temporal (TA), polymyalgia rheumatica, 85
artery
abnormal dilatation, 20
disease, coronary(CAD), 23
arthritis
chronic inflammatory, 24
destructive, 24
fractures, 64
hypertrophic, 79
instability, 4
Osteoarthritis (OA), 79
Rheumatoid (RA), 89
ascending aorta, 21
Ascites, 6
assistive devices
fractures, 52, 64
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
polymyalgia rheumatica, 85
polymyositis-dermatomyositis, 86
rheumatoid arthritis, 89
slipped or ruptured disc, 94
spinal stensosis, 95
asthma, 27, 53
Asthma, 10. See uninsurable combination medical histories
ASTHMA. See Chronic Obstructive Pulmonary Disease (COPD)
ataxia
vitamin B12 deficiency, 18
Ataxia
cerebellar, 6
atherosclerosis
stroke, 95
atherosclerosis, 108
ATHEROSCLEROSIS, 28
ATHEROSCLEROSIS AND THE CAROTID ARTERIES, 28
atherosclerotic plaque, 28
Atherosclerotic plaques, 82
Atrial fibrillation. See syncope. See coronary angioplasty. See coronary artery bypass surgery. See arrhythmias
Atrial Fibrillation. See myocardial infarction (MI). See cardiomyopathies. See congestive heart failure. See cardiac failure
atrial fibrillation (A-FIB), 30
chronic, 30
paroxysmal (intermittent), 30
valvular heart disease, 109
ATRIAL FIBRILLATION (A-FIB). See TIA. See cardiomyopathy. See congestive heart failure (CHF). See Angina
Atrial, Paroxysmal Tachycardia (PAT), 25
atrophy of the limb muscles, 16
Attack, Transient Ischemic (TIA), 102
atypical hyperplasia, 34
Autonomic
Insufficiency, 6
Neuropathy, 6
B
bacillus mycobacterium tuberculosis, 107
back/spine
slipped or ruptured disc, 94
spinal stensosis, 95
surgery, 96
barrel chest, 53
basal cell skin cancers, 44
bathing, 8
bed confinement
skin ulcers, 108
bed, hospital
functional deficits, 9
behavioral disturbances
Alzheimer’s, 16
benign prostatic hypertrophy (BPH), 42
incontinence, 4
Benign Prostatic Hypertrophy (BPH), 87
Biliary cirrhosis. See cirrhosis, alcoholic liver disease
Bipolar Disorder, 59
Bl2 deficiency, 18
black out
syncope, 97
bladder
cancer, 46
dysfunction, 31
incontinence, 4, 7
neurogenic, 31
spastic, 31
tumors, 46
bladder irrigations, 46
bleeding
associated with Coumadin use, 30, 100, 109
brain, within the, 95
thrombocythemia, 99
thrombocytopenia, 99
blindness, 6, 85
due to diabetes, 60
due to vascular obstruction, polymyalgia rheumatica, 85
eye disorders, 62
blockage
carotid artery
blood
anemia, 18
cancer of the, 69
clot, 100
clot to the brain, 95
clot, multiple myeloma, 73
clot, thromboembolism, 100
disease, polycythemia, 84
disorders
Bone Marrow Transplantation, 103
hemochromatosis, 65
hemoptysis, 65
disorders
thrombocythemia, 99
thromocytopenia, 99
sugar, elevated, 60
blood pressure
diastolic, 68
high, 68
systolic, 68
B-lymphocyte, disease of, 69
bone
fractures, 64
Paget's disease, 81
bone marrow
biopsy, hairy cell leukemia, 69
multiple myeloma, 73
transplantation, 103
transplantation, multiple myeloma, 73
bowel
incontinence, 17
incontinence, 4, 7
irritable bowel syndrome (IBS), 56
perforations, 57
bowel incontinence, 17
bowel resection
thromboembolism, 100
BPH
benign prostatic hypertrophy, 32
bradycardia, 25
bradykinesia, 81
brain
aneurysm, 22
blood clot, 95
infection of
Meningitis, 72
normal pressure hydrocephalus, 78
stroke, 95
syncope, 97
systemic lupus, 98
trauma, cerebral palsy, 51
tumors, Five I’s, 4
Brain
Disorder (Organic Brain Syndrome), 6
Organic Brain Syndrome (OBS), 16
progressive degeneration of, 16
breast
biopsy, 34
cancer, 34
lumps, 34
breast cancer
carcinoma in situ, 34
inflammatory, 34
lumpectomy, 34
metastasis, 35
stages, 34
treatment(s), 34
breath, shortness of, 29, 53
breathing disorder
sleep apnea, 93
breathing, labored, 53
bronchial asthma, 27
Bronchial asthma. See chronic obstructive pulmonary disease (COPD)
bronchiectasis
cause of hemoptysis, 65
hemoptysis, 65
Bronchiectasis. See hemoptysis
bronchitis, 53
bronchospasm, 53
bruising
thrombocytopenia, 99
bruit, 28
Build. See Height/Weight Table
bulbar polio, 83
bypass
coronary artery, 55
bypass graft surgery
peripheral vascular disease, 82
bypass grafts
TIA, 102
C
CA, 32
CA-125, 32
CABG, 55. See angina pectoris
CAD, Coronary Artery Disease, 23
calcification
valvular disease, 109
Calculus
kidney stones, 68
cancer, 32
basal cell, 44
bladder, 46
blood, 69
breast, 34
carcinoid tumors, 48
cause of hemoptysis, 65
colon, 36
common sites of, 32
esophageal, 37
gynecological, 41
head and neck, 38
hemoptysis, 65
kidney, 39
large bowel, 36
lung, 40
malignant melanoma, 71
metastasized, 33
multiple myeloma, 73
ovarian, 41
plasma cells, 73
prostate, 42
rectal, 36
skin, 44
squamous cell, 44
staging, 32
stomach, 45
thyroid, 45
treatment, 32
tumor markers, 32
underwriting of, 33
urinary bladder, 46
uterus, 47
Cancer. See hemoptysis
Bowel, Duke’s Staging, 36
CANCER OF THE KIDNEY. See renal failure, chronic. See renal failure, acute
CANCER OF THE LUNG. See lung resection. See asthma. See emphysema. See cardiomyopathy. See COPD
cancer, metastatic, 32
carbohydrate metabolism, chronic disease of, 60
carcinoid
syndrome, 48
tumors, 48
carcinoma, 32
carcinoma in situ, 34
cardiac
arrhythmias,sleep apnea, 93
arrhythmias,syncope, 97
failure, 49
output, A-FIB, 30
output, syncope, 97
Cardiac failure. See atrial fibrillation. See arrhythmias. See angina pectoris
cardiomyopathies, 50
cardiomyopathy, 49
dilated (congestive), 50
hypertrophic, 50
non-dilated (restrictive), 50
types of, 50
Cardiomyopathy. See Valvular Heart Disease. See myocardial infarction (MI). See congestive heart failure. See cardiac failure. See cancer of the lung. See atrial fibrillation. See arrhythmias
Cardiomypoathy. See coronary angioplasty. See coronary artery bypass surgery
cardioversion
electro, 25
cardioversion, 25
CAROTID ARTERIES, 28
carotid artery, 20
blockage, 28
endarterectomy, 96
thromboembolism, 100
Carotid artery, 20
carotid artery disease, 28
cataract, 62, 103
catheter, 31
functional deficits, 9
urinary, 88
CEA (carcinoembryonic antigen), 32
cellulitis, 35
central nervous system
scleroderma, 92
Cerebellar Ataxia, 6
cerebral
aneurysm, polycystic kidney disease, 83, 84
occlusion, stroke, 95
palsy, 51
Cerebral
Spinal Fluid (CSF), 78
Vascular Accident (CVA), 6, 95
cerebrovascular
aneurysm, 22
aneurysm, subarachnoid hemorrhages, 22
disease, stroke, 95
precursor event, TIA, 102
Cerebrovascular, 20
cervical area, 94
chair lift, electric
functional deficits, 9
chemotherapeutic drugs
bone marrow transplant, 103
chemotherapy, 32
bladder cancer, 46
breast cancer, 35
carcinoid tumors, 48
colon cancer, 36
kidney cancer, 39
lung cancer, 40
lymphomas, 70
multiple myeloma, 73
thrombocythemia, 99
uterine cancer, 47
chest pain, 23
CHF. See myocardial infarction (MI). See coronary angioplasty. See coronary artery bypass surgery. See cardiomyopathies
Chorea, 6
chronic
active hepatitis, 66
fibrosis of the heart, 50
granulocytic leukemia (CGL), 69
granulocytic leukemia, bone marrow transplant, 103
infections, Anemia of Chronic Disease, 18
inflammatory disease of the connective tissues, lupus, 98
lymphocytic leukemia (CLL), 69
memory loss, 6
persistent hepatitis, 66
viral hepatitis, 66
Chronic
Lymphocytic Leukemia (CLL), 69
Obstructive Pulmonary Disease (COPD),TB, 107
Renal Failure (CRF), 88
chronic bronchitis, 53
Chronic Bronchitis, 10. See uninsurable combination medical histories
chronological age, 1
cigarette smoke, 40
cigarettes use
emphysema, 53
Cirrhosis
liver, 6
Cirrhosis, alcoholic liver disease. See alcoholism
claudication, 82
peripheral vascular disease (PVD), 82
Cogentin
tremors, 106
Cognex
memory loss, 72
cognitive status, 1
cognitive symptoms
bipolar disorder, 59
depression, 59
colitis
mucous, 56
spastic, 56
ulcerative, 56
collagen vascular disease
anemia of chronic disease, 18
colon, cancer of, 36
colonoscopy, 36
colostomy management, 36
Combination Medical Histories, Uninsurable, 10
compression fractures, 64
conduction disturbance, 25
Conduction disturbances. See syncope. See myocardial infarction (MI). See coronary angioplasty. See coronary artery bypass surgery. See cardiomyopathies. See congestive heart failure. See cardiac failure
confusion, 72
Congestive Heart Failure, 55
Congestive heart failure (CHF). See atrial fibrillation. See arrhythmias. See angina pectoris
Congestive Heart Failure (CHF), 10, 49. See uninsurable combination medical histories
A-Fib, 30
A-FIB, 30
carcinoid tumors, 48
diabetes, 60
emphysema, 29, 53
hemochromatosis, 65
hypertension, 68
myocardial infarction, 75
scleroderma, 92
TB, 107
valvular heart disease, 109
consciousness
brief loss, 97
loss of, epilepsy, 61
continence. See Incontinence
bowel or bladder, 8
Continuous Positive Airway Pressure (CPAP) apparatus, 93
COPD. See CHF. See cancer of the lung
asthma, 53
chronic bronchitis, 53
emphysema, 53
COPD (Chronic Obstructive Pulmonary Disease)/Emphysema, 10. See uninsurable combination medical histories
coronary
angioplasty, 55
artery disease (CAD), 23
artery disease (CAD), A-FIB, 30
artery disease (CAD), CHF, 49
Artery Disease (CAD), hypertension, 68
Artery Disease (CAD), valvular disease, 109
artery, thromboembolism, 100
Coronary, 75
artery angioplasty, 96
Artery Bypass Graft (CABG), 55, 96
artery bypass surgery, 55
Coronary artery bypass grafts. See angina pectoris
corticosteroids
Cushing's syndrome, 58
cortisone
Addison's disease, 14
Coumadin
A-Fib, 30
atrial fibrillation, 30
thromboembolism, 100
TIA, 102
valvular heart disease, 109
CPAP
sleep apnea, 93
CREST Syndrome, 92
CRF. See polycystic kidney disease (PCKD)
crutches
fractures, 52, 64
functional deficits, 9
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
poliomyelitis, 83
polymyalgia rheumatica, 85
polymyositis-dermatomyositis, 86
post polio syndrome, 83
rheumatoid arthritis, 89
slipped or ruptured disc, 94
spinal stensosis, 95
CT (Computed Tomography), 28
Cushing’s syndrome, 58
custodial care, 9
CVA
Aneurysms, Cerebrovascular, 22
stroke, 95
CVA (stroke), 7
cyclosporine
systemic lupus, 98
Cystic Fibrosis, 6
cytopenia, 69
cytoscopy, 68
cytotoxic drugs
systemic lupus, 98
Cytoxan
Cushing's syndrome, 58
Irritable bowel syndrome, 57
polycythemia, 84
renal failure, 88
systemic lupus, 98
D
D&C, dilatation and curettage, 47
day care use
schizophrenia or other psychosis, 91
DC Conversion, 30
Decision Terminology, 5
Approved, 5
Approved with Modifications (AWM), 5
Declined, 5
No Increases Allowed, 5
Reconsideration Available, 5
Reconsideration Not Available, 5
Declined, 5
decrease of platelets in the blood
thrombocytopenia, 99
decubitus ulcers, 108
deep vein thrombosis
skin ulcers, 108
defibrillator, 25
Deficits, Additional Uninsurable ", 9
Deficits, Uninsurable ADL ", 8
Deficits, Uninsurable IADL ", 8
Degenerative Joint Disease (DJD), 79
delirium, 72
dementia
alcoholism, 15
ALS, 16
memory loss, 72
NPH, 78
senile, 4
vitamin B12 deficiency, 18
Dementia, 6, 16
Alzheimer's, 16
other types of, 16
Demerol
ankylosing spondylitis, 24
fractures, 64
neuropathy, 76
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
polymyalgia, 85
polymyositis-dermatomyositis, 86
rheumatoid arthritis, 89
slipped or ruptured disc, 94
spinal stensosis, 95
systemic lupus, 98
demyelinating disease, 73
dependency
psychological, 91
psychological, 91
depression, 4
Depression, 59. See alcoholism
Dermatomyositis, Polymyositis, 86
descending aorta, 21
diabetes, 60
adult onset, 60
anemia of chronic disease, 18
hemochromatosis, 65
kidney transplantation, 105
mellitus (DM), 60
neuropathy, 76
TGA, 101
thromboembolism, 100
TIA, 102
type I, 60
type II, 60
types of, 60
Diabetes, 10. See peripheral vascular disease (PVD). See uninsurable combination medical histories
Diabetes Mellitus. See neuropathy
Diabetes treated with insulin or Rezulin, 6
diabetic complications, 60
diabetic ulcers, 108
dialysis, 84
chronic renal failure, 88
functional deficits, 9
polycystic kidney disease, 84
renal failure, 88
Dialysis, 6, 7
diastolic blood pressure, 68
dilated (congestive) cardiomyopathy, 50
disc
herniated, 94
Disc
slipped/ruptured, 94
discoid lupus erythematosus, 98
diseases of the heart muscle, 50
Disequilibrium, 61
disorientation, 72
dissecting aneurysms, 21
disseminated lupus, 98
disturbances, conduction, 25
diverticulitis, 56
dizziness, 61
fractures, 64
TIA, 102
Doppler Imaging, 28
drainage device
functional deficits, 9
dressing, 8
drug reactions, 4
drug use
schizophrenia or other psychosis, 91
DRUGS INDEX, 110
DSA (Digital Subtraction Angiography), 28
Duke’s Staging of Bowel Cancer, 36
DWR failed, 6
dysphagia, 37
stomach cancer, 45
dyspnea, 53
E
eating, 8
edema, 35
liver disease, 54
Eldepryl
tremors, 106
electric cart or scooter
functional deficits, 9
electric chair lift
functional deficits, 9
electrical shock (DC Conversion), 30
electro cardioversion, 25
Electro Convulsive (shock) Therapy (ECT)
depression, 59
electrolyte imbalance, 14
emboli, 28
embolism
pulmonary (lung), 100
pulmonary, cause of hemoptysis, 65
embolism, 100
emergency room visit
bipolar disorder, 59
depression, 59
emphysema, 52, 53
emphysema, 53
Emphysema. See cancer of the lung
end stage renal disease (ESRD), 105
endartectomy, 29
endarterectomy
TIA, 102
Endarterectomy
carotid, 96
femoral, 96
enemas, steroid
treatment of colitis, 56
Enteritis, 56
epilepsy
causes of, 61
epilepsy, 61
ER visit
schizophrenia or other psychosis, 91
erythropoietin, 19
esophageal cancer, 37
esophagus
crest syndrome, 92
estrogen deficiency
osteoporosis, 80
ethanolism, 15
ETOH disease, 15
eye disorders, 62
amaurosis fugax, 62
blindness, 62
cataract, 62
glaucoma, 62
macular degeneration, 62
F
failed
Short Portable, 7
Failed
DWR, 6
fainting, 25, 61
syncope, 97
TIA, 102
falls, 81
A-Fib, 30
alcoholism, 15
ankylosing spondylitis, 24
dizziness, 61
fractures, 64
neuropathy, 76
osteoarthritis, 79
polymyalgia rheumatica, 85
polymyositis-dermatomyositis, 86
rheumatoid arthritis, 89
slipped or ruptured disc, 94
spinal stensosis, 95
fatigue
congestive heart failure, 49
depression, 59
fatty liver, 54
feeding, tube
enteral, 37
enteral, 38
parenteral, 37
parenteral, 38
femoral arteries, 20
Femoral Endarterectomy, 96
fibrillation, atrial (A-FIB), 30
fibrosis
pulmonary, 40
fibrosis, 54
Fibrosis
cystic, 6
Field Underwriting, 1
finances, managing, 8
fissure, anal, 17
fistula, anorectal, 17
FIVE I's, 4
folate deficiencies
Anemia of Chronic Disease, 18
folic acid deficiency, 18
foot ulcers, 60
forgetfulness, 6
frequent/persistent, 72
memory loss, 72
fractures, 64, 81
alcoholism, 15
ankylosing spondylitis, 24
compression, 64
dizziness, 61
knee, 64
most common sites, 64
multiple, 64
multiple myeloma, 73
multiple, Paget's disease, 81
osteoarthritis, 79
osteoporosis, 80
pathological (spontaneous), 64
pelvis, 64
polymyalgia rheumatica, 85
polymyositis-dermatomyositis, 86
rheumatoid arthritis, 89
shoulders, 64
slipped or ruptured disc, 94
spinal, 64
spinal stensosis, 95
spontaneous, 58
syncope, 97
wrist, 64
Fractures. See ankylosing spondylitis (AS)
frailty, 2
frequent forgetfulness, 72
Functional capacity, 1
functional deficits, 6
G
gangrene
peripheral vascular disease, 82
skin ulcers, 108
Gangrene, 6
gastric cancer, 45
gastritis, 18
gastrointestinal
bleeding, hepatitis, 66
bleeding, liver disease, 54
disorders, alcoholism, 15
scleroderma, 92
system, TB, 107
GCA
blindness, 85
current eye problems, 85
Gehrig's Disease, Lou, 16
genitourinary system
TB, 107
Giant Cell Arteritis (GCA)
polymyalgia rheumatica, 85
glaucoma, 62
congenital(infantile), 62
secondary, 62
transplantation of the cornea, 103
Gleason Scoring, 42
Glossary, 125
granulomas, 90
Gravis, Myasthenia, 74
gynecological cancers, 41
H
Hairy Cell Leukemia (HCL), 69
hardening of the arteries, 28. See atherosclerosis
HBP, (high blood pressure), 68
head and neck cancer, 38
heart
acute inflammation, 50
atrial fibrillation, 30
attack, diabetes, 60
chronic fibrosis, 50
congestive failure, 49
disease,valvular, 109
diseases of muscle, 50
failure, 30
failure(CHF), congestive, 49
ischemic heart disease, treatments of, 55
murmurs, 109
rate,irregular, 23
scleroderma, 92
surgery,TIA, 102
systemic lupus, 98
transplantation, 104
valve replacement, 100
valve,artificial, 100
Heart. See myocardial infarction (MI). See diabetes mellitus
Attack, 75
valve replacement, 96
heart disease
kidney transplantation, 105
heart surgery, 75
Heart surgery, 10. See uninsurable combination medical histories
Height/Weight Table. See ankylosing spondylitis (AS)
hematocrit (Hct), 18
hematoma, 22
hematuria, 46
blood in the urine, 39
prostate disorders, 87
hemochromatosis, 65
hemoglobin (Hgb), 18
hemoptysis, 65
hemoptysis, 40
hemorrhage
aneurysms, 22
intracerebral (ICH), 22
subarachnoid (SAH), 22
Hemorrhoids, 17
hepatitis, 54
A, 66
acute, 66
B, 66
C, 66
chronic active, 66
chronic persistent, 66
chronic viral, 66
D, 66
E, 66
non-A-non-B, 66
Hepatitis, 66
herniated
disc, 94
nucleus pulposus, 94
high blood pressure
TGA, 101
thromboembolism, 100
high blood pressure (HBP), 68
hip
fracture, 64
fractures, osteoporosis, 80
replacement, fractures, 64
Hip
replacement, surgery, 96
HODGKIN’S DISEASE. See Lymphoma
Hodgkin's disease
reactive thrombocythemia, 99
home care service use, 9
home care services
custodial, 9
hospice care, 9
skilled, 9
Home Care Services, 9
home for the aged, 9
Home Office Underwriting, 1
hormonal therapy, 32
hormones, 34
hospice, 9
hospital, 9
hospital bed
functional deficits, 9
functional deficits, 9
hospitalization
angina pectoris, 23
atrial fibrillation, 25
atrial fibrillation, 30
bipolar disorder, 59
depression, 59
renal failure (acute), 88
schizophrenia or other psychosis, 91
sleep apnea, 93
HOTLINE, iv
housework (chores), 8
Hoyer lift
functional deficits, 9
HTN (Hypertension), 68
Huntington’s, 6
Hydergine
memory loss, 72
Hydrocephalus, Normal Pressure (NPH), 78
hydronephrosis, 68
hyperalimentation
treatment of colitis, 56
hypercortisolism, 58
Hyperglycemia, 60
hyperpigmentation of the skin, 14
hypertension, 68
hypertension (HTN), 68
aneurysm, aortic, 21
aneurysm, cerebrovascular, 22
scleroderma, 92
Hypertension (HTN)
kidney cancer, 39
hypertrophic
arthritis, 79
cardiomyopathy, 50
Hypoplastic Anemia, 20
hypoventilation, 53
Hytrin
prostate disorders, 87
I
IADL
IBS, 56
IADL, Uninsurable Deficits", 8
IADLs
anemia, 19
angina pectoris, 23
ankylosing spondylitis, 24
Cerebral Palsy, 51
corneal transplant, 103
CREST syndrome, 92
depression, 59
dizziness, 61
glaucoma, 62
macular degeneration, 62
Meningitis, 72
myasthenia gravis, 74
neuropathy, 62, 76
normal pressure hydrocephalus, 78
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
poliomyelitis, 83
polymyalgia rheumatica, 85
polymyositis-dermatomyositis, 86
post polio syndrome, 83
rheumatoid arthritis, 89
schizophrenia or other psychosis, 91
scleroderma, 92
slipped or ruptured disc, 94
spinal stensosis, 95
TB, 107
tremors, 106
Iatrogenic drug reactions, 4
IBS, 56
IDDM, 60
Ileitis, 56
Imaging, Doppler, 28
imbalance, 61
Immobility, 4
immune deficiency diseases
bone marrow transplant, 103
Immune Deficiency Syndrome, 7
immunosuppressant medications
transplantation of the kidney, 105
immunosuppression
kidney transplantation, 105
Imuran
cardiomyopathies, 50
systemic lupus, 98
incontinence, 7, 31
bladder, 4, 7, 31
bowel, 4, 7
NPH, 78
stress, 31
urinary, 31
Incontinence, 4
bowel, 17
increase of platelets in the blood
thrombocythemia, 99
Infarction, Myocardial (MI), 75
infection
neuropathy, 76
infections
diabetes, 60
inflammatory bowel disease
anemia of chronic disease, 18
Inflammatory breast cancer, 34
inflammatory muscle disorder, 86
Information You Should Always Gather, iii
Instability, 4
institutionalization, 9
Instrumental Activities of Daily Living (IADL), 1, 8
insufficiency
pancreas, 60
valvular heart disease, 109
Insufficiency
Autonomic, 6
insulin, 60
diabetes mellitus, 60
Intellectual impairment, 4
interferon
hepatitis, 66
interview
health, 1
telephone, Personal History Interview (PHI), 1
intestinal tumors, 48
intracerebral hemorrhages (ICH), 22
Cerebrovascular Aneurysm, 22
intracranial arteries, 20
intravenous
feeding, treatment of colitis, 56
steroid, treatment of colitis, 56
INTRODUCTION, 1
involuntary movement disorders
tremors, 106
involuntary movements
cerebral palsy, 51
iron
dietary,excessive absoption of, 65
iron deficiency
anemia, 18
reactive thrombocythemia, 99
Iron Deficiency
Anemia, 18
irrigations
bladder, 46
irritable bowel syndrome (IBS), 56
ischemia, myocardial, 23
Ischemic Attack (TIA), Transient, 102
ischemic heart disease treatments, 55
Isoniazid
TB, 107
J
Joint Disease, Degenerative, 79
joint replacement
ankylosing spondylitis, 24
surgery, 96
surgery, rheumatoid arthritis, 89
Joint Replacement, 10. See uninsurable combination medical histories
joints
bilateral inflammation and stiffness, rheumatoid arthritis, 89
crest syndrome, 92
judgment, impaired, 16
K
kidney
Acute Renal Failure(ARF), 88
cancer, 39
Chronic Renal Failure (CRF), 88
dialysis, 88
dialysis,functional deficits, 9
disease, hypertension, 68
failure, multiple myeloma, 73
polycystic disease, 84
scleroderma, 92
systemic lupus, 98
transplantation, 105
transplantation, (CRF), 88
transplantation,polycystic kidney disease, 84
Kidney. See diabetes mellitus
dialysis, 6
Dialysis, 7
kidney transplantation
failed, 105
immunosuppression, 105
rejection, 105
skin cancers, 105
knee
replacement, 64
replacement, surgery, 96
L
large bowel cancer, 36
Larodopa
tremors, 106
laser surgery
diabetes, 60
Lateral Sclerosis, Amyotrophic (ALS), 16
laundry, 8
leukemia
acute, 69
acute lymphocytic(ALL), 69
acute monocytic (AMOL), 69
acute myelogenous (AML), 69
acute, bone marrow transplant, 103
chronic, 69
chronic granulocytic (CGL), 69
chronic granulocytic, bone marrow transplant, 103
chronic lymphocytic (CLL), 69
chronic myelogenous
polycythemia, 84
hairy cell (HCL), 69
polycythemia, 84
Leukemia, 7, 69
Leukeran
leukemia, hairy cell, 69
polycythemia, 84
renal failure, acute, 88
systemic lupus, 98
thrombocythemia, 99
lift, Hoyer
functional deficits, 9
lightheadedness, 61
limb amputation
thromboembolism, 100
Lithium
depression, 59
lithotripsy, 68
liver
biopsy, 66
biopsy for hepatitis, 66
disease, 54
fatty, 54
metastases, carcinoid syndrome, 48
transplantation, hepatitis, 66
viral inflammation of, 66
Liver
Cirrhosis of, 6
transplantation, 105
liver cancer, 54
primary biliary cirrhosis, 54
liver transplantation
primary biliary cirrhosis, 54
LONG TERM CARE UNDERWRITING, 1
long term memory loss, 72
loss of consciousness
epilepsy, 61
loss of consciousness, feeling of, 61
loss, memory, 72
Lou Gehrig's Disease, 6, 16
lower bowel, impairments affecting, 17
lumbar area, 94
Lumpectomy, 34
lung
cancer, 40
embolism, 100
resection,TB, 107
sarcoidosis, 90
scleroderma, 92
systemic lupus, 98
TB, 107
lung abscess
hemoptysis, 65
lung infections, frequent, 38
Lung resection. See cancer of the lung
lupus
disseminated, 98
erythematosus, discoid, 98
Lymph node
carcinoid syndrome, 48
Lymphomas
Non-Hodgkin’s, 70
M
macular degeneration, 62
Malabsorption, 57
malignancy, 32
malignant melanoma, 44
malignant melanoma, 71
malignant plasma cells, 73
malnutrition
neuropathy, 76
mammography, 34
mania, 59
Mania, 59
Manic Depression, 59
Marie-Strumpell Disease, 24
meal preparation, 8
medical histories, 1
medical problems, multiple, 1
medication
multiple, 1
over-medication leading to falls, 64
taking, IADLs, 8
medications, 4, 110
Megace
breast cancer, 35
Megacolon, 57
megaloblastic anemia
alcoholism, 18
megaloblastic anemia, 18
megestrol
breast cancer, 35
melanoma
malignant, 44
mellitus, diabetes (DM), 60
memory
long term, 72
loss, 72
loss, Alzhemier’s, 16
loss, chronic, 6, 7
medications, 72
short term, 72
meningitis, 72
mental
confusion, myocardial ischemia, 23
retardation, cerebral pasly, 51
Metabolic disorders
cause of epilepsy, 61
metastasis, 35, 36, 39, 40, 41, 43, 44, 45, 47, 48
metastatic cancer, 32
metastatis, 38
microcytic anemia, 18
mitral valve
prolapse, 83, 84
valvular heart disease, 109
mobility, 8
morphine
ankylosing spondylitis, 24
fractures, 64
neuropathy, 76
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
polymyalgia, 85
polymyositis-dermatomyositis, 86
rheumatoid arthritis, 89
slipped or ruptured disc, 94
spinal stensosis, 95
systemic lupus, 98
movement disorders, involuntary
tremors, 106
Mucous Colitis, 56
multiple fractures, 64, 81
multiple myeloma, 73
multiple sclerosis (MS)
incontinence, 4
Multiple Sclerosis (MS), 7
Multiple Sclerosis (MS), 73
muscle
inflammatory disorder, 86
limb muscles atrophy (ALS), 16
pain and stiffness, Polymyalgia rheumatica, 85
polymyositis dermatomyositis, 86
weakness, cerebral palsy, 51
weakness, myasthenia gravis, 74
muscular dystrophy, 73
Muscular Dystrophy (MD), 7
musculoskeletal
scleroderma, 92
Myasthenia Gravis, 74
myeloma
multiple, 73
Myocardial Infarction (MI), 75
myocardial ischemia, 23
N
narcotic analgesics. See Demerol, morphine, Percodan, Talwin
Near Syncope, 61
neoplasm, 32
nephrectomy, 39
nephrolithiasis, 68
nephrotomy, 68
nerves
disease, neuropathy, 76
nervous disorders
alcoholism, 15
Neuralgia, 76
Neuritis, 76
neurogenic bladder, 31
neurologic disorders
ALS, 16
Cerebral Palsy, 51
neurological
deficit, stroke, 95
deficits, cerebral palsy, 51
disease, Parkinson’s, 81
tremors, 106
neuropathy, 76
peripheral, 64
Neuropathy
autonomic, 6
peripheral, 76
NIDDM, 60
No Increases Allowed, 5
nocturia
prostate disorders, 87
Nolvadex
breast cancer, 35
non-dilated (restrictive) cardiomyopathy, 50
Non-Hodgkin’s Lymphomas, 70
NON-HODGKIN’S LYMPHOMAS. See Lymphoma
Normal Pressure Hydrocephalus (NPH), 78
Numbness
TIA, 102
nursing home, 9
nursing home use, 9
O
OA (Osteoarthritis), 79
Obesity, 12
in combination with, 12
occlusion, cerebral
stroke, 95
odynophagia, 37
OPG (Oculoplethysmography), 28
oral cavity, cancer site, 38
organ transplants, 7
Organic Brain Syndrome (OBS), 6, 7, 16
osteoarthritis (OA)
immobility, 4
spinal stenosis, 95
Osteoarthritis (OA), 79
osteoporosis, 54, 63, 64
primiary biliary cirrhosis, 54
Osteoporosis. See fractures
osteoporosis (OP)
fractures, 64
immobility, 4
post menopausal, 64, 80
senile, 80
Osteoporosis (OP), 80
ostomy care
functional deficits, 9
ovarian cancer, 41
over-medication
leading to falls, 64
overweight
skin ulcers, 108
Overweight, 12
oxygen
emphysema, 53
functional deficits, 9
sleep apnea, 93
use, 7
P
pacemaker, 25
Pacemaker
implant, 96
Paget’s disease of the bone, 81
Paget's disease of the bone
spinal stenosis, 95
palpitations, 25
palsy, cerebral, 51
pancreas
diabetes, 60
Pancytopenia, 20
paralysis
spastic, 51
Paralysis, 7
Paraplegia, 7
Parkinson’s
disease, 81
Parkinson’s disease. See Voluntary Movement Disorders. See Tremors
Parkinsonism
ALS, 16
Parkinson's
Disease, 7
tremors, 106
Paroxysmal Atrial Tachycardia (PAT), 25
pathological (spontaneous) fractures, 64
pectoris, angina, 23
pelvic fracture
osteoporosis, 80
Percodan
ankylosing spondylitis, 24
fractures, 64
neuropathy, 76
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
polymyalgia, 85
polymyositis-dermatomyositis, 86
rheumatoid arthritis, 89
slipped or ruptured disc, 94
spinal stensosis, 95
systemic lupus, 98
Percutaneous Transluminal Coronary Angioplasty (PTCA), 55
peripheral
neuropathy, fractures, 64
neuropathy, vitamin B12 deficiency, 18
Peripheral
Atherosclerostic Disease, 82
Neuropathy, 76
Vascular Disease (PVD)
hypertension, 68
Peripheral artery, 20
Peripheral vascular disease. See diabetes mellitus
persistent
forgetfulness, 72
hepatitis, 66
Personal
History Interview (PHI), 1
Independence Factors, 2
phlebotomies, 84
phlebotomies, 65
physical therapy, 1, 24
fractures, 63, 64
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
polymyalgia rheumatica, 85
polymyositis-dermatomyositis, 86
rheumatoid arthritis, 89
slipped or ruptured disc, 94
spinal stensosis, 95
physiological age, 1
pituitary gland, 14
plaque, 28
plaque, arterial, 28
plaque, atherosclerotic, 28
plaques, Atherosclerotic, 82
plasma cells, abnormal growth, 73
Pneumocystis Pneumonia, 7
Pneumonia
Pneumocystis, 7
polyarthritis
lupus, 98
Polycystic Kidney Disease (PCKD), 83, 84
Polymyalgia Rheumatica (PMR), 85
Polymyositis - Dermatomyositis, 86
polyps, 18
post menopausal
estrogen deficiency, 80
osteoporosis, 80
post polio syndrome (PPS), 83
postural instability, 81
Prednisone
COPD, 53
Cushing's syndrome, 58
emphysema, 53
hepatitis, 66
myasthenia gravis, 74
polymyalgia rheumatica, 85
polymyositis-dermatomyositis, 86
renal failure, 88
rheumatiod arthritis, 89
sarcoidosis, 90
scleroderma, 92
systemic lupus, 98
thrombocytopenia, 99
Premature Ventricular Contractions (PVC'S), 25
prescription medications
Drug Index, 110
drug reactions, 4
pressure ulcers, 108
Primary thrombocythemia, 99
Proctitis, 56
prolapse
rectal, 17
valvular disease, 109
Proscar
prostate disorders, 87
prostate
cancer, 42
Prostate
disorders, 87
prostatic hypertrophy, 42
Prostatism, 87
prostatitis
acute, 87
chronic, 87
Prostatitis, 87
proteinura
protein in the urine, 39
PSA (Prostate Specific Antigen), 42
PSA (prostate-specific antigen)", 32
psychosis
vitamin B12 deficiency, 18
PSYCHOSIS, 91
PTCA, 55
pulmonary
disease, polycythemia, 84
disease, scleroderma, 92
embolism, 100
embolism, 65, 100
pulmonary fibrosis, 40
pulmonary function
osteoporosis, 80
pulmonic valve
valvular heart disease, 109
pyelotomy, 68
Q
quad cane
fractures, 52, 64
functional deficits, 9
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
poliomyelitis, 83
polymyalgia rheumatica, 85
polymyositis-dermatomyositis, 86
post polio syndrome, 83
rheumatoid arthritis, 89
slipped or ruptured disc, 94
spinal stensosis, 95
Quadriplegia, 7
R
radiation
breast cancer, 35
colon cancer, 36
exposure, 34
kidney cancer, 39
lung cancer, 40
therapy, cancer treatment, 32
thyroid cancer, 45
uterine cancer, 47
radiation enteritis, 36
Rapid Heartbeat, 25
Reactive thrombocythemia, 99
reasoning, impaired logical, 16
Reconsideration Available, 5
Reconsideration Not Available, 5
rectal
cancer, 36
prolapse, 17
stenosis, 17
stricture, 17
rectal incontinence, 36
rectum, cancer of, 36
recurrent infections
hairy cell leukemia, 69
red blood cell count (RBC), 18
regurgitation
heart valves, 109
rejection
kidney transplantation, 105
renal (kidney)
Acute Renal Failure (ARF), 88
Chronic Renal Failure (CRF), 88
colic, 68
dialysis, 6
disease, polycystic kidney disease, 84
failure, multiple myeloma, 73
transplantation of the kidney, 105
renal conditions, 54
renal failure
acute, 39
chronic, 39
Renal Failure, acute. See cancer of the kidney
Renal Failure, chronic. See cancer of the kidney
renal function
unstable, 39
replacement
heart valve, 100
hip, 64
joint, ankylosing spondylitis, 24
knee, 64
surgery, 96
respirator
functional deficits, 9
retardation, mental
cerebral palsy, 51
Rezulin
diabetes mellitus, 60
rheumatic fever
valvular disease, 109
Rheumatica, polymyalgia (PMR), 85
rheumatoid
Arthritis (RA), reactive thrombocythemia, 99
Rheumatoid
Arthritis (RA), 89
Spondylitis, 24
Rheumatoid Arthritis, 10. See uninsurable combination medical histories
Roto rooter
surgery, 87
ruptured disc
spinal stenosis, 95
ruptured/slipped disc, 94
S
Sarcoidosis, 90
Schizophrenia, 91
Sclerosis
Amyotrophic Lateral Sclerosis (ALS), 16
Multiple (MS), 7
Multiple (MS), 73
scoliosis
spinal stenosis, 95
scooter or electric cart
functional deficits, 9
seizures, 61
Senile Dementia
Alzheimer's, 16
senile osteoporosis, 80
senility, 4, 7
shock therapy
depression, 59
shopping, 8
Short Portable failed, 7
short term memory loss, 72
shortness of breath, 23, 29, 53
congestive heart failure, 49
shunt
obstruction, 78
ventriculoperitoneal, 78
Shy-Drager Syndrome, 6
Sick-Sinus Syndrome (SSS), 25
sigmoidoscopy, fiber optic, 36
Sinemet
tremors, 106
sinus node, 25
Sjogren’s syndrome, 54
Sjögrens syndrome, 89
skilled care, 9
skin
breakdown, 60
polymyositis-dermatomyositis, 86
scleroderma, 92
TB, 107
skin breakdown
peripheral vascular disease (PVD), 82
skin cancer, 44
basal cell, 44
malignant melanoma, 71
squamous cell, 44
skin cancers
kidney transplantation, 105
skin ulcers, 108
multiple, 108
peripheral vascular disease, 82
peripheral vascular disease (PVD), 82
recurrent, 108
scleroderma, 92
systemic lupus, 98
thromboembolism, 100
Skin ulcers. See peripheral vascular disease (PVD)
SLE, 98
sleep apnea
classifications, 93
Sleep apnea, 93
sleep disturbance
depression, 59
slipped/ruptured disc, 94
Smoking/Tobacco Use, 11. See uninsurable combination medical histories
sobriety, 15
spastic
bladder, 31
paralysis, 51
Spastic
colitis, 56
weakness, ALS, 16
Specific Uninsurable Medical Conditions, 6
speech difficulties
cerebral palsy, 51
speech, loss of
TIA, 102
spinal
cord, Meningitis, 72
Fluid, Cerebral (CSF), 78
fractures, 64
fractures, osteoporosis, 80
ligaments, slipped disc, 94
stenosis, 95
surgery, spinal stenosis, 95
Spinal
cord injury, 7
spleen
enlargement,hairy cell leukemia, 69
removal
hairy cell leukemia, 69
removal,thrombocytopenia, 99
spondylitis, ankylosing, 24
Spondylitis, Rheumatoid, 24
squamous cell skin cancers, 44
sssisted living/care facility, 9
staging, 44
Hodgkin’s disease, 70
lymphoma, 70
Staging, 42, 70
Non-Hodgkin’s lymphoma, 70
Staging of Bowel Cancer, Duke’s, 36
staging, cancer, 32
stasis dermatitis, 108
stenosis
heart values, 109
rectal, 17
spinal, 95
steroid enemas, treatment of colitis, 56
stomach (gastric) cancer, 45
stone, kidney, 68
stool guaiacs, 36
stress incontinence, 31
stricture, rectal, 17
stroke, 55
A-Fib, 30
hypertension, 68
immobility, 4
incontinence, 4
multiple myeloma, 73
precursor, TIA, 102
stroke, 7
Stroke, 95. See TIA (Transient Ischemic Attack). See thromboembolism
strokes (cerebral vascular accident), 28
subarachnoid hemorrhage (SAH), 22
cerebrovascular aneurysm, 22
surgery
coronary artery, 55
surgery, 57, 84
adrenal, 58
back/spine, 96
bladder cancer, 46
breast cancer, 35
bypass, 55
carcinoid tumors, 48
colon cancer, 36
COPD, 57
coronary artery angioplasty, 96
coronary artery bypass graft, 96
endarterectomy, 96
heart valve replacement, 96
hip, 64
hip or knee replacement/fracture, 96
kidney removal, 39
kidney stones, 68
knee, 64
lung cancer, 40
major joint replacement, rheumatoid arthritis, 89
major weight bearing joint, 79
other major, 96
pacemaker impant, 96
pituitary, 58
polycystic kidney disease (PCKD), 83, 84
PVD, 82
ruptured disc, 94
sleep apnea, 93
slipped disc, 94
spinal stenosis, 95
spinal stensosis, 95
thymus gland removal, 73, 74
thyroid cancer, 45
uterine cancer, 47
valve replacement, 109
surgery, 7
Surgery, 96
cornea transplant, 103
heart transplant, 104
liver transplant, 105
swallowing difficulties, 38
Symmetrel
tremors, 106
syncope
A-Fib, 30
fractures, 64
vasovagal, 97
Syncope, 97
systemic
disease, rheumatoid arthritis, 89
Systemic
Lupus Erythematosus (SLE), 98
systolic blood pressure, 68
T
tachycardia, 55
Tacrine, 72
Talwin
ankylosing spondylitis, 24
fractures, 64
neuropathy, 76
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
polymyalgia, 85
polymyositis-dermatomyositis, 86
rheumatoid arthritis, 89
slipped or ruptured disc, 94
spinal stensosis, 95
systemic lupus, 98
tamoxifen
breast cancer, 35
telephone use, 8
Temporal Arteritis (TA)
polymyalgia rheumatica, 85
TGA
diabetes, 101
high blood pressure, 101
THE FIVE I's, 4
thoracic aorta, 20
Thrombocythemia, 99
primary, 99
reactive, 99
Thrombocytopenia, 99
Thrombocytosis, 99
Thromboembolism, 100
Thromboembolism (venous, arterial, or pulmonary embolism). See atherosclerosis & carotid arteries
thrombus, 100
thymus gland
removal, myasthenia gravis, 74
thyroid cancer, 45
thyroiditis, 54
TIA, 28, 55. See thromboembolism. See eye disorders. See atrial fibrillation. See arrhythmias
Amaurosis Fugax, 102
Coumadin, 102
endarterectomy, 102
Ticlid, 102
TIA (Transient Ischemic Attack), 11. See uninsurable combination medical histories
Ticlid
TIA, 102
tobacco
products use, emphysema, 53
toileting, 8
Total Parenteral Nutrition (TPN), 7
TPN, 7
transferring from bed to chair, 8
transfusions
hemochromatosis, 65
Transient Global Amnesia (TGA), 101
Transient Ischemic Attack (TIA), 102. See atherosclerosis & carotid arteries
A-Fib, 30
diabetes, 60
transplantation
acute renal failure, 88
chronic renal failure, 88
kidney, polycystic kidney disease, 84
liver, hepatitis, 66
organ, 7
Transplantation
bone marrow, 103
cornea, 103
heart, 104
kidney, 105
liver, 105
transportation, 8
transurethral
prostatectomy (TURP), 42
trauma
brain, 51
Trauma
cause of epilepsy, 61
treatment modalities, 1
tremors
Parkinson’s Disease, 81
Tremors
& other involuntary movement disorders, 106
tricuspid valve
valvular heart disease, 109
tube feeding
cancer of the esophagus, 37
cancer of the head and neck, 38
tuberculosis
hemoptysis, 65
Tuberculosis. See hemoptysis
tuberculosis (TB)
cause of hemoptysis, 65
hairy cell leukemia, 69
Tuberculosis (TB), 107
Tumor Markers, 32
tumors
carcinoid, 48
intestinal, 48
Tumors
cause of epilepsy, 61
TURP
surgery, 87
Type I insulin-dependent diabetes mellitus, 60
Type II non-insulin-dependent diabetes mellitus, 60
U
ulcerative colitis, 56
ulcers
anal, 17
anemia, 18
arterial, 108
decubitus, 108
diabetic, 108
foot, 60
pressure, 108
skin, 82, 108
venous, 108
Ulcers of the Skin. See neuropathy. See atherosclerosis & carotid arteries
Underweight, 13
UNDERWRITING HOTLINE, iv
Underwriting, Field, 1
Underwriting, Home Office, 1
Uninsurable
Functional Deficits, 8
Specific Medical Conditions, 6
Uninsurable ADL Deficits", 8
Uninsurable Combination Medical Histories, 10
uninsurable conditions
reconsideration not available, 6
Uninsurable Deficits, Additional ", 9
Uninsurable functional deficits. See fractures. See ankylosing spondylitis (AS)
Uninsurable Functional Deficits. See cancer of the urinary bladder
Uninsurable IADL Deficits", 8
unique factors of long term care underwriting, 1
unstable angina, 23
unsteadiness, 61
untreated dissecting aortic aneurysm, 21
urinary
bladder cancer, 46
incontinence, 31
uterine cancer, 47
V
valve replacement, 100
surgery, 96
TIA, 102
valvular
disease, A-FIB, 30
heart disease, 109
heart disease, CHF, 49
vascular
bypass graft, PVD, 82
surgery, diabetes, 60
Vascular
disorders, cause of epilepsy, 61
vasovagal syncope, 97
venous
embolism, 100
ulcers, 108
Ventricular Contractions, Premature (PVC'S), 25
ventriculoperitoneal shunt, 78
vertebral fractures
osteoporosis, 80
vertigo, 4
Vertigo, 61
viral inflammation of the liver, 66
vision
defects, TIA, 102
eye disorders, 62
vitamin Bl2 deficiency, 18
W
waiting period, 33
walker, 7
fractures, 52, 64
functional deficits, 9
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
poliomyelitis, 83
polymyalgia rheumatica, 85
polymyositis-dermatomyositis, 86
post polio syndrome, 83
rheumatoid arthritis, 89
slipped or ruptured disc, 94
spinal stensosis, 95
weakness
TIA, 102
weight
sleep apnea, 93
weight loss
unintentional, 17
weight loss, 14, 15, 19, 85
Addison's, 14
cancer of the esophagus, 37
colitis, 57
depression, 59
emphysema, 53
kidney cancer, 39
polymyalgia rheumatica, 85
stomach cancer, 45
wheelchair, 7
fractures, 52, 64
functional deficits, 9
osteoarthritis, 79
osteoporosis, 80
Paget's disease, 81
poliomyelitis, 83
polymyalgia rheumatica, 85
polymyositis-dermatomyositis, 86
post polio syndrome, 83
rheumatoid arthritis, 89
skin ulcers, 108
slipped or ruptured disc, 94
spinal stensosis, 95
Working, 2
full or part-time, 2
wrist fractures
osteoporosis, 80
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