Did you fall?
No. Do you wanna try it with me?
I was just doing a forward roll
"Do you see that?
Come on man gotta get some pushups in
"Nah i would have a heart attack"
-------------------------------------------
Kim Jong-un gives sister BIG promotion as she makes rare public appearance in North Korea - Duration: 3:07.
Kim Jong-un gives sister BIG promotion as she makes rare public appearance in North Korea
Kim Yo-jong was pictured in the front row of an all-male lineup of senior party officials, clapping as her brother addressed the room. She sat next to Choe Ryonghae, her brother's right-hand man and party vice-chairman.
Kim Yo-jong was also sat near Kim Pyonghae and O Su-yong, the the cruel regimes Worker's Party secretaries.
In a country known for its staged optics, the seating arrangement is believed to suggest that she has been promoted within the ranks of the hermit kingdom.
The news comes after Kim Yo-jong was promoted in October to North Korea's politburo - the nation's most powerful decision making body.
At the time, Michael Madden, a North Korea expert at Johns Hopkins University's 38 North website, said: "It shows that her portfolio and writ is far more substantive than previously believed and it is a further consolidation by the Kim family's power." .
Kim Yo-jong is responsible for developing her brother's cult of personality, and according to defector Thay Yong-ho, organises all public events.
She was born on September 26, 1987, and is the second child of North Korea's late leader Kim Jong-il and his mistress Ko Yong-hui. By 2007 she had been named a junior cadre in the communist Workers' Party of Korea.
After her father's stroke in 2008, she became an active force in establishing Kim Jong-un's succession campaign. She was a regular member of her father's entourage before his death in December 2011.
At his funeral she was seen leading a group of senior leaders and stood between two party elders at the ceremony.
When Kim Jong-un underwent medical treatment in October 2014, it is believed that Kim Yo-jong filled in as leader. In January, the US Treasury blacklisted Kim Yo-jong along with other North Korean officials over "severe human rights abuses".
-------------------------------------------
Economic Update: Public Service VS Private Profit [CLIP] - Duration: 3:38.
Is the idea of a public bank a fantasy, a utopian dream, something in the distant
future, or is it something that exists in the world today, exists perhaps in the
United States today, something we can point to and say we already have an
example, a history, an empirical record of what's been going on? And I mean this is
a rhetorical question, you know and I know that the answer is yes we have
examples, so let's start with the one here in the United States that gets all
the attention, once you learn about this, which is the Bank of North Dakota, tell
us a little bit about it. Right, so the Bank of North Dakota is the only
currently operating public bank in the United States. It's very successful, it
was found in 1919, at the time banks were foreclosing on mass on farms in North
Dakota, mainly banks located in Minneapolis, and the farmers of North
Dakota got together, and they started what they called the nonpartisan League,
which was a sort of not right or left movement, but really a localist, stay out
of our state kind of movement, saying we want to keep our money here, and we want
to make sure our farmers and our banks are thriving, and not out of state banks.
They captured both houses of the legislature in the following election,
and immediately created a state-owned grain mill and elevator, and the public
bank, the Bank of North Dakota. They amended the Constitution in North Dakota
to require that all state revenues and accounts be held at the bank,
guaranteeing at a deposit base, and they put it in chart. they put in charge of
the bank the Industrial Council or committee, which consists of the Governor,
the Attorney General, and the Agriculture Commissioner of the state. They then
proceeded to make loans to farmers, some of them at competitive interest rates,
and others at discounted rates. They did have some trouble. North Dakota, I mean
they kept the money yes inside the state. Yes, and this is a principle of almost
all public banks, is that they're very regionally focused, in fact they're
designed to avoid competition with each other and also commercial banks,
and the Bank of North Dakota is a great example of that, because they have one
branch and have zero ATMs, and that's one way that they keep costs very low, but
they also partner with community banks, and Community Development funds, those
kinds of things, in order to service your sort of retail customers and business
customers. One of the major benefits of that is that North Dakota has the
best community banking industry out of all the other states in the United
States. There are more banks per capita, and those banks perform much better than
community banks in other states, and part of that is because the Bank of North
Dakota acts as sort of a mini Fed, right, it extends credit to these banks, it
allows them repo credit right so your after-hours banking transfers in order
to make sure the balance sheets all match up,
they guarantee loans, they buy loans on a secondary market in order to increase
the liquidity of local banks, and that independent spirit insulated them from a
lot of the turmoil in Wall Street. They survived the credit crunch of 2009,
they're currently thriving, despite an oil bust in that state. They've returned
over a billion dollars in profits to the taxpayers in North Dakota over the last
20 years, it's a per capita of about thirty five hundred dollars per taxpayer,
that they got in free services that they didn't have to pay taxes for.
-------------------------------------------
SRPD Seeks the Public's Assistance: Stabbing at Lola's Market #17-16826 - Duration: 1:36.
Hello, my name is Hector DeLeon.
I'm a detective with Santa Rosa Police Department.
The Santa Rosa Police is seeking the public's help in identifying and locating the suspect
of a stabbing.
The stabbing occurred on December 21st at the Lola's on Dutton Ave. in Santa Rosa at
approximately 6:30pm.
At that time, a 61 year old male was sitting alone, having dinner when he was approached
by the suspect that you see here and the suspect stabbed the victim in the neck.
He then fled the area and has not been identified yet.
The suspect was described as a Hispanic male adult in his 30's to 40's, approximately 5'6"
tall, and approximately 160 to 180 lbs.
He had close-cut, black hair and was wearing a distinct, puffy, dark green jacket.
Also, witnesses describe the suspect having a tattoo similar to the one you see here.
It's described as being a tattoo of the "Grim Reaper" or commonly known as the "Santa Muerte"
in Spanish.
If you have any information, please contact the Santa Rosa Police Department, Violent
Crimes Team at 543-3590.
If you have any information leading to the arrest and conviction of the suspect the Sonoma
County Alliance is offering a $2,500 reward for that information.
And that number again, if you have any information is 543-3590.
Thank you for your assistance.
-------------------------------------------
Family of woman killed by illegal fireworks urges public to stay safe - Duration: 2:04.
For more infomation >> Family of woman killed by illegal fireworks urges public to stay safe - Duration: 2:04. -------------------------------------------
Kim Jong-un gives sister BIG promotion as she makes rare public appearance in North Korea - Duration: 3:02.
Kim Jong-un gives sister BIG promotion as she makes rare public appearance in North Korea
KIM Jong-un's younger sister has cemented her position in his inner circle after she
made a public appearance next to top North Korean officials at a Worker's Party congress,
it has been reported.
Kim Yo-jong was pictured in the front row of an all-male lineup of senior party officials,
clapping as her brother addressed the room.
She sat next to Choe Ryonghae, her brother's right-hand man and party vice-chairman.
Kim Yo-jong was also sat near Kim Pyonghae and O Su-yong, the the cruel regime's Worker's
Party secretaries.
In a country known for its staged optics, the seating arrangement is believed to suggest
that she has been promoted within the ranks of the hermit kingdom.
The news comes after Kim Yo-jong was promoted in October to North Korea's politburo - the
nation's most powerful decision making body.
At the time, Michael Madden, a North Korea expert at Johns Hopkins University's 38
North website, said: "It shows that her portfolio and writ is far more substantive
than previously believed and it is a further consolidation by the Kim family's power."
Kim Yo-jong is responsible for developing her brother's cult of personality, and according
to defector Thay Yong-ho, organises all public events.
She was born on September 26, 1987, and is the second child of North Korea's late leader
Kim Jong-il and his mistress Ko Yong-hui.
By 2007 she had been named a junior cadre in the communist Workers' Party of Korea.
After her father's stroke in 2008, she became an active force in establishing Kim Jong-un's
succession campaign.
She was a regular member of her father's entourage before his death in December 2011.
At his funeral she was seen leading a group of senior leaders and stood between two party
elders at the ceremony.
When Kim Jong-un underwent medical treatment in October 2014, it is believed that Kim Yo-jong
filled in as leader.
In January, the US Treasury blacklisted Kim Yo-jong along with other North Korean officials
over "severe human rights abuses".
-------------------------------------------
Holly Hagan SLAMS Stephen Bear's public declaration of love to Charlotte Crosby - Duration: 2:37.
Holly Hagan SLAMS Stephen Bear's public declaration of love to Charlotte Crosby
Geordie Shore's Holly Hagan certainly wasn't buying Bear's public apology to her former co-star Charlotte. On Friday night Bear, 28, took to Instagram to beg for the forgiveness of his former girlfriend, 27, with a very public apology.
He wrote: "Dear Charlotte, I really messed up, if I could rewind the clock back maybe I wouldn't have done the things I did and say.
"Life's about making mistakes. I've just been really sad recently and need to get it off my chest.
"I know being with me isn't easy and I will probably send you insane in the end and I really do care and still love you. It might be too late, but all I can do is try.
"The New Year's coming up and I would love to spend the rest of my life with you. I've done my best and put it out there.
"I don't show my feelings often so it will be a very long time before you see me open up again.
I would WhatsApp you, but you've changed your number [sic], would be nice [for you] to slide in my DM though if you see this." However it seemed Bear's attempt wasn't successful as he later posted a snap on his Instagram story which simply stated: "It was a no." And now keen to have her bestie's back, Holly has further dug the boot in by sharing her thoughts on the gushing post.
Holly, 25, commented: "Stephen, you know what you've put this girl through, you forced your way back into her life last time and if I'm honest, I admired your persistence which is why I thought you'd have grown up and been on your knees begging for that girl's forgiveness every day.
"Instead, I watched you take her back to the very place she was when she was hurt the first time but now it's twice as hard because she didn't even wanna let you back in – she was doing great.
"I cannot let you do it a third time, if you have any love for that girl whatsoever you'll let her go." Ouch! Looks like Bear won't be expecting a Christmas card off Holly or Charlotte!.
-------------------------------------------
Are You Using These HARMFUL Carbs, the Most DANGEROUS Carbs: Public WARNING - Duration: 9:57.
Does this supplement have HARMFUL carbs maybe even the most DANGEROUS carbs? It's
on the shelves right now and you might even be using it! I'll show you how I
came to this conclusion based on my own research involving some of the most
catabolic people we've ever had on the planet -I offer that without exaggeration.
So we'll break it all down -you're going to be the local expert. You might be able
to help somebody that you know is using this product! So we've got a lot to get to,
let's jump right in! [INTRODUCTION: Science Application Experience] I'm David Barr [CSCS, NSCACPT, TSAC-F, CISSN, RSCC] and if you're looking to get bigger faster
stronger, get leaner, go longer, hit that Subscribe, and then the little bell so
you don't miss any important updates. And I'm going to 1-UP it, because if you
think that objective evidence is a better way to gather information than
"special feelings", [Objective Evidence + Reason vs. Emotion] then be sure to help advance the conversation and Share this
video. So what are we talking about? To really understand the details, you need
to be the local expert. [YOU = Local Expert] This is going to take a minute, so hang in there -there's
learning and it's worth it. So if you've ever had blood sugar taken
aka "fasting serum glucose" that's really just taking [or measuring] the amount of sugar in your blood.
"Blood sugar", "glucose", "dextrose"; it's all the same thing, okay? [Glucose = Dextrose, "Blood Sugar" = Serum Glucose] And all
carbohydrates that we consume are broken down to this blood sugar, ultimately
stored as glycogen in muscle. But [now] we're all on the same page when we talk about
glucose or blood glucose. Okay we'll talk about glucose specifically
right now, because it doesn't have to be digested, it can just be absorbed. [NOTE:All graphs, equations, etc. are simplified for educational purposes] So
we'll make things a little simpler [by starting with glucose ingestion]. You may have even done this, when taking
finger pricks to see what your blood glucose levels are, and if you did this
when your fasted, they're going to be relatively low. Once you consume say 50
grams of glucose, you're going to notice over time that your blood
glucose levels start to go up. Why? Because it's being absorbed from your gut, going
into your blood. [x-axis (y=0) shows Healthy Fasting Glucose level] Now it keeps going up for a while, and then it starts come down. Why
is that? Well it's because it's [the blood glucose] being absorbed, or
taken up into muscle. It's being transported into your muscle, mostly. All
cells need glucose, but our muscle is the biggest sink, especially if you lift. [Blood Sugar, Standard Curve] So
this is a standard curve that we see. Now if we were to take in fewer than 50
grams [of glucose] we would see a very similar curve, but it would be a lot lower. [25 grams Glucose versus 50 grams Glucose] Why? because
we're not consuming as many carbs -we're not consuming as much of glucose. Now
what if we consumed one hundred grams of carbs? Twice our initial dose. Well, you're
going to see a much higher rise, and slightly longer duration in that curve. [100 grams Glucose versus 50 grams Glucose]
Why? Because the area reflects the amount of carbohydrates that we consume,
especially when we're just talking glucose right now, okay? So we have the
lower dose, 25 grams that's going to be a smaller rise in glucose, the bump isn't
going to be as high. 50 grams is more, it's going to be higher, right? [100 grams Glucose versus 50 grams Glucose versus 25 grams Glucose, Area Under the Curve] So you see
how this progresses -the more we consume, the higher it is. Now what if we were to
consume say 50 grams of a slow absorbing carbohydrate, like a waxy maize starch?
[50 grams Slow versus 50 grams Glucose] Then we would see a much longer curve, but it's not going to go up quite as
high. Why? Because it's more of a trickle effect. It's more of a SLOW absorption
into the blood, but then that area is going to be roughly the same. That "Area
Under [the] Curve", showing that yeah it's about 50 grams of carbohydrate. Well if
we consumed a "magical faster than glucose" carbohydrate? 50 grams. Well you're
going to have a higher spike [in blood sugar], but it's going to come down much more quickly. [50 grams Fast versus 50 grams Glucose]
Again, the net area is going to be about roughly the same, because it's going to
be 50 grams [of carbohydrates ingested], so again that net area is going to reflect the total amount. Now
this is where it gets interesting, because of it
this is where it comes back to the research on catabolic patients,
irrespective of their growth hormone use, they were using a lot of substances to
keep them as healthy as possible, and keep them alive. And what we saw was that
they had something called insulin resistance. [Insulin Resistance may be transient, or a prelude to the disease called Type 2 Diabetes] Now a curve showing
insulin resistance -and people have this type of test you might know it is an OGTT,
[Oral Glucose Tolerance Test] a really important test, especially for people who are suspected having type 2
diabetes -very very important for them to get this type of test, and the curve
would look like this. They would have an initial rise in that blood glucose let's
go back to 50 grams of glucose that they're consuming, [Insulin Resistant versus Healthy] they would have that
initial rise in blood glucose, but it stays up. And it stays up, and it stays
elevated for longer. Why is that? Well they have problems getting the sugar
into their cells, especially into their muscle cells. [Blood glucose level = Glucose entering the blood (from the gut) - glucose leaving blood (into muscle)] Okay? So remember that the
curve is not only just based on the amount that's coming INTO the blood,
it's also about how much is LEAVING the blood. And that's the trick! That's a flaw
was something called the Glycemic Index. I'll cover that in another video in the
future, but right now no the people within type-2 diabetes or insulin
resistance, aren't taking up the glucose as well as healthy people like you or I. [Insulin resistance = SAME Glucose entering blood (from gut) - LESS Glucose Leaving Blood (into muscle)]
So what we're seeing ultimately is that this curve, this glucose curve, even
though they're taking in the same amount of glucose that you and I are, they're
having an extended curve. It looks much higher it actually looks like they're
consuming much more carbohydrate, because they can't get it into their cells. They
can get into the blood, but they can't get it OUT of the blood very easily. So
this is where there's a problem with the supplement. Now this supplement actually
claims us on their label. I don't know if they still do actually, when I had this
ingredient, this supplement, they actually showed this curve, this blood
glucose curve, and what they showed was they had a slightly faster rise in blood
glucose compared to glucose -the SAME AMOUNT of glucose. Okay? [50 grams of the carbohydrate supplement versus 50 grams Glucose] They had a slightly
faster rise and then a longer release -a longer curve. Now if they are consuming
the same amount of carbohydrate as the glucose, what does this curve look like?
If they're consuming the same quantity of carbs, what does this curve look like?
What did we just see? [Remember: Glucose can only work if it gets INTO your cells] Well it looks like the type two diabetic curve. It looks like the
insulin resistance curve. So this is where we get into the possibility that
these carbs in this supplement are not only potentially harmful carbs, [This apparent Insulin Resistance may be transient or potentially more serious] but maybe
even the most dangerous carbs, if they are somehow inducing insulin resistance.
[Either way, this effect may imp[air your performance and or body composition] Now their claim is that they have different types of carbs, with slower
release and faster release, so you combine them and then you get this "magic
curve", but we wouldn't see that, right? Remember going back to the total Area
Under that Curve? [This is what we would expect to see with a Fast + Slow carbohydrate blend]That's going to reflect the amount of carbohydrate consumed. So
we're not seeing that with this carb. They're showing us that they are somehow
inducing insulin resistance, because if the carbohydrate had fast and slow
release and it was the same amount, and wasn't inducing insulin resistance, [25 grams Fast carbohydrate PLUS 25 grams Slow, carbohydrate blend] the
curve would be lower, right? Just like we saw with the different speeds of
absorption like that waxy maize starch, the net Area Under the Curve reflects [CONTRAST: Company claim versus what we SHOULD roughly see]
the amount of carbohydrate consumed, except for in disease states, okay? And
this is again where we see this type of curve, is in the most catabolic people
that I've ever seen, [NOTE the rough Area Under the Curve for the Supplement versus our theoretical blend] as well as people with type 2 diabetes and insulin
resistance. So is this carbohydrate causing insulin resistance? And if so, we
need to know! The company needs to explain this! Now the problem with this,
this is a potentially litigious situation because I'm the first person
to report on this, and I don't want to get sued, [I found this while working for a carbohydrate supplement company] so I can't actually mention the
name of the company. So I encourage you do your due diligence. If you are looking
at carbohydrate product, look at their curve. [I no longer work for that company and have NO conflict of interest] If you see this curve that's
higher than the same amount of glucose, call the company, see what's going on, [I am just not smart enough to make money off of supplements]
have them explain it. Now someone suggested to me maybe the company wasn't
as "high fidelity" in terms of their research, maybe they thought this would
be a good marketing idea to show this. So maybe it's not a real curve.
To me that would actually be the best situation because if not, again, they are
causing insulin resistance, at least they appear to be. So again, we don't want
these potentially harmful carbs or even the most dangerous carbs in our body, so
do your due diligence make sure you know what you're putting in your body. Hold
companies accountable for what they're doing and the claims they make. Now when
reviewing an ingredient or supplement, I usually have a three-point checklist
that you can use to decide whether or not you want to use a product. In this case
I'm not going to do that. I mean, not only is it potentially harmful, as indicated
by the company themselves, there's no peer-reviewed published
research on it, OF COURSE. [No "Proof on PubMed"] I mean if there were, it would probably be showing that
it's potentially harmful. So this is not one of those things I'm going to review,
in that way. It's just one of those things -find out what's going on, find out
why we can't get the carbohydrates that we ingest ["into our muscle"] when we consume
the supplement. Now let's be clear, if you're pissed off about this, and you
probably should be, you have every right to contact the company and let them know
how you feel. You're not powerless. In fact, you hold all the power. I've done
this before -reported on potentially dangerous ingredient and the company changed
their formulation. But it wasn't just because of me, it was because of the
RESPONSE. [Glycocyamine aka Creatoxin] The consumer has the power. Let the company know how you feel. It's only
by your action that things are going to change, so consider this to be your call
to action: let the company know! So if you found this information helpful, Share it
with someone, they just might owe you a protein shake. I'm David Barr and until
next time Raise The Barr
-------------------------------------------
Il mercato del Public Speaking - Duration: 4:02.
For more infomation >> Il mercato del Public Speaking - Duration: 4:02. -------------------------------------------
Public School Retirees 2018 Healthcare Plan - BCBSM - Duration: 21:32.
- [Genevieve] Hello, my name is Genevieve Johnson,
and I'm a Sales Administrator
with Blue Cross Blue Shield of Michigan.
I'm here today, to talk with you, about your Medical Plan.
This presentation is geared for
Medicare and non-Medicare Members.
Our presentation today will cover:
key terms and your costs for 2018;
2018 updates to your medical plan;
how to get the most value from your medical plan;
online tools at your fingertips,
and health and wellness information.
Now let's talk about the key terms
that are associated with what you pay
for covered services, and cost share updates for 2018.
Coinsurance is a fixed percentage of the costs
you share with your retirement system.
The percentage you pay is based
on the Blue Cross approved amount.
For most covered services, you pay 10% coinsurance,
when you use in-network providers.
Your retirement system health plan
covers the remaining 90% of the cost, for these services.
Your retirement system limits the amount you pay
each year in coinsurance, to 10% coinsurance.
We keep track of the 10% coinsurance you pay.
You start paying a 10% coinsurance for most covered services
from an in-network provider, at the beginning of the year.
Once you reach the coinsurance maximum,
you stop paying the 10% coinsurance
for the rest of the year.
The good news is, just like last year,
your coinsurance maximum in 2018 is $900.
A copayment, or copay, is a flat dollar amount
that you pay, when you receive certain health care services.
Your retirement system plan has a copay
on two medical care services, emergency room visits
and urgent care visits.
You pay a $100 copay for emergency room visits,
unless you're admitted into the hospital,
within 72 hours of the emergency room visit.
In that case, the $100 copay is waived.
You pay a $65 copay for urgent care visits.
If you're on Medicare, you just pay these copays
for these services, nothing else.
If you're not on Medicare, you initially pay
your coinsurance and deductible, for these services.
Then, once you reach your annual
coinsurance maximum and deductible, you pay the copay
for emergency room and urgent care services,
for the remainder of the calendar year.
In addition to your coinsurance and copay,
you have an annual deductible
that you're responsible for paying,
before your retirement system begins to pay
for covered services.
Until you reach your annual deductible,
you pay 100% of your covered medical expenses.
Your 2018 deductible is $1,000.
However, you can lower your deductible,
by participating in the LivingWell program,
that I will talk about in a little bit.
Medicare members are automatically enrolled,
in the LivingWell program,
and have an $800 deductible in 2018, same as 2017.
Non-Medicare members that fully participate in LivingWell,
can lower their deductible to $800, same as 2017.
Let's take a closer look, at exactly how
your Medicare cost share works.
If you are on Medicare, or if you're not yet on Medicare,
but fully participating in the LivingWell program,
and you had a service with an in-network provider,
and Blue Cross approves $6,000,
your 10% coinsurance would be $600.
10% of $6,000 is $600.
By subtracting your $600 coinsurance,
and $800 deductible,
from the $6,000 approved amount,
your retirement system would pay $4,600.
You would pay $600 plus $800, which equals $1,400.
It's important to know, that your coinsurance
is taken before your deductible.
Now I'm going to direct my comments to Medicare members.
If you're on Medicare, there's a limit
to the amount you pay out of your pocket,
during the calendar year.
With the exception of copays, for routine hearing care,
your coinsurance, copays, and your deductible amounts
are included in an annual out-of-pocket maximum.
Your annual out-of-pocket maximum in 2018 is $1,700.
Once you reach your annual out-of-pocket maximum,
except for routine hearing care copays,
your retirement system begins to pay 100%
of covered medical services, for the remainder of the year.
And now I'm going to direct my comments
to non-Medicare members.
If you are not on Medicare, you can limit
the amount you pay each year, by using PPO network providers
and fully participating in LivingWell,
the program that I'll explain in detail
in a few more minutes.
Once you reach your annual coinsurance maximum,
which is $900 in 2018, and your deductible,
which is $800 in 2018, if you fully participate
in the LivingWell program, the only costs
you'll have to pay for covered services
for the remainder of the calendar year,
are your copays and any additional costs
for using providers outside the PPO network.
So here's the snapshot for your 2018 costs.
The coinsurance maximum of $900,
plus the $800 deductible for Medicare members,
and for non-Medicare members who fully participate
in the LivingWell program, equals $1,700.
Now, as I've said already, keep in mind,
that the $1,700 does not include
copays for routine hearing care, for any members,
Medicare and non-Medicare.
And for non-Medicare members, it does not include copays
for emergency and urgent care visits,
higher deductibles for not participating
in the LivingWell program, and any additional costs,
for using providers outside the PPO network.
We want you to understand, how your cost share works,
because you will receive
an Explanation of Benefits statement in the mail,
or receive an email notification,
following the month you received medical services.
Your Explanation of Benefits will show you
what services your provider billed Blue Cross,
how much your retirement system plan covered,
how much you owe through coinsurance, copay or deductible,
services not covered by your retirement system plan.
It's always wise, to compare bills from your provider,
to your Explanation of Benefits, to make sure
your out-of-pocket costs are correct.
Here's an example of what
your Medicare Explanation of Benefits will look like.
Number One identifies who this Explanation of Benefits
statement is for, explains what is covered
in the report, and customer service information,
if you have questions about something on your statement.
Number Two shows the balances to date, for deductibles
and Three, out-of-pocket costs
for your current benefit period.
If you are not on Medicare, here's an example
of what your statement will look like.
Number One identifies who this
Explanation of Benefits statement is for.
Number Two summarizes claims by doctor, hospital,
or other healthcare provider,
the amount submitted to Blue Cross for the claim,
what you saved by being a Blue Cross member,
what Blue Cross paid,
amount any other insurance paid, what you pay.
You may have already paid, or may still owe this amount.
You should never be asked to be paid more than this amount.
Number Three shows the balances to date,
for deductibles and out-of-pocket maximum
for your current benefit period.
And Number Four, shows customer service information,
if you have questions about something on your statement.
Now that we're all familiar with the key terms
associated with your share of the costs
of your medical care,
let's take a look at what's new in 2018.
At this point, I'm going to again direct my comments
to Medicare members.
If you're on Medicare, routine physical exams,
and standard routine laboratory tests,
done in conjunction with physicals, have not been covered.
Well, we have some very good news for you.
Beginning January 1, 2018, an annual routine physical exam,
as well as standard routine labs, done in conjunction
with a physical exam, will be covered at 100%
of the Blue Cross approved amount.
That's a great benefit enhancement!
Also, starting January 1, 2018,
your emergency room visit copay will be updated,
from $75 per visit, to $100 per visit.
And you will now have a $65 copay,
as opposed to coinsurance on urgent care visits.
Perhaps the best news for many members,
is the enhancement to the routine hearing care benefit.
Your routine hearing care benefits
will be exclusively available through a nationwide network,
of TruHearing providers, starting January 1, 2018.
There will be flat dollar copays,
as opposed to your paying a coinsurance and deductible.
And here's the most important thing.
You'll no longer be charged the difference
between the Blue Cross approved amount,
and the provider's charge for the routine hearing care.
I won't go into that benefit update any further,
because there's a separate presentation,
about your routine hearing care benefits,
that you'll want to hear.
And now I want to direct my comments
to non-Medicare members.
You already have coverage
for an annual routine physical exam.
Starting January 1, 2018, you will now also have coverage
for standard routine laboratory tests,
done in conjunction with your annual physical.
Just like your physical, these labs will be paid at 100%,
when performed by a PPO network provider.
Also, starting January 1, 2018,
your emergency room visit copay will be updated
from $75 per visit, to $100 per visit.
And you will now have a $65 copay, on urgent care visits.
Copays for emergency room and urgent care visits begin
after you have reached your coinsurance maximum,
and paid your annual deductible, and then continue
until the end of the calendar year.
Finally, just like members on Medicare,
perhaps the best news for many of you,
is the enhancement to the routine hearing care benefit.
I urge you to hear that presentation.
You have a rich plan, that offers choice.
Now let's talk about how you can get
the most value from your medical plan,
and help keep your costs down.
If you don't already have a personal physician,
consider choosing one to help you manage and coordinate
all of your healthcare needs, as the first step
in getting the most value from your plan.
This physician will get to know your medical history
and lifestyle, so that he or she will be
in the best position, to perform your regular checkups,
refer you to specialists, or coordinate
any necessary hospital care.
They monitor the big picture of your health,
while specialists manage more focused needs.
To find a provider in the PPO network,
including a PCMH doctor, visit bcbsm.com
and use the Find a Doctor tool.
If you don't have access to a computer,
call us, and we'll help you find a provider.
I will show the phone number at the end
of my presentation, but it's also easily located
on your membership card.
The doctor-patient relationship, and the advantages
that go along with it, are at the core
of the Patient-Centered Medical Home concept,
that's part of the LivingWell program.
A Patient-Centered Medical Home, is a care team
led by a primary care physician,
that focuses on your health goals,
and works with you, to help you manage your care.
Your team is made up of anyone you need,
based on your health goals.
Together, your Patient-Centered Medical Home team
provides you with personalized care plans,
to help you reach your goals.
Other features of the Patient-Centered Medical Home
practices include: extended office hours;
a centralized location for personal medical records;
help coordinating visits to specialists;
training and education,
to help you manage chronic conditions;
and help accessing health and community resources.
I've mentioned the LivingWell program a number of times,
and now we're going to talk about it in greater detail.
Because it's another way to get
the most value from your plan.
LivingWell is a program for retirees
and covered family members, that provides tools
to help you lead a healthier lifestyle,
while rewarding you, for making healthy choices.
As I mentioned before, non-Medicare members
can lower their annual deductible, by up to $200,
when they complete the steps to enroll in the program.
If you're on Medicare, you are automatically enrolled
in the retirement system's LivingWell program,
which gives you the lowest deductible, $800.
To enroll in the 2018 LivingWell program,
you must completes steps one through three
by December 31st, 2017.
The steps include
completing a LivingWell health questionnaire,
selecting a primary care doctor,
and visiting your primary care doctor,
for an annual routine physical exam.
Completing those three steps,
will lower your 2018 deductible, from $1,000 to $850,
a savings of $150.
But the program is about more than cost savings.
Step One, a health questionnaire, is a list of questions
that can help you and your doctor
build a plan for your LivingWell.
The LivingWell questionnaire
was mailed to members in September.
Step Two, is selecting a primary care doctor,
and we've already talked about the advantages
of having one doctor help you coordinate all of your care.
Keep in mind, that a primary care physician
is not a specialist.
They include, for example, general practice doctors,
family practice doctors, and internists.
Step Three, is seeing your primary care physician,
and having a routine physical.
A physical you received anytime during 2017,
will count towards this step.
Something to keep in mind, when you schedule your physical,
is that your doctor may want to get additional tests,
that are not covered, like a screening EKG.
Ask your doctor in advance, what tests they want to perform
with your physical, and call us,
if you're not sure if they are covered,
so you're not surprised when you get a bill
from your providers, that you must pay on your own.
Finally, non-Medicare members can save even more money,
by completing the bonus step.
You can lower your annual deductible by an additional $50,
for a total of $200 off the original $1,000 deductible,
if you choose a primary care physician
that's a Patient-Centered Medical Home doctor.
Even though Medicare members already will have
the lowest LivingWell deductible, $800,
we encourage you to complete the health questionnaire,
to give you a snapshot of your overall health.
We've already talked about
how you can locate network providers,
but there's much more information available
at your fingertips.
As a Blue Cross Blue Shield of Michigan member,
you have access to a powerful tool,
that allows you to see a real-time snapshot
of what you've paid towards out-of-pocket costs,
and your claims history, anytime, anywhere,
through the BCBSM Member Site, or BCBSM mobile app.
Going paperless allows you to know about your claims
and medical plan changes sooner.
Benefits of going paperless are:
faster notices of benefit changes;
view and track claims of Explanation of Benefits;
save space and reduce clutter;
safe and secure location for your medical information.
All you have to do is create an account and login,
to view all of the latest information.
To register, visit bcbsm.com/mpsers,
then press the LOGIN tab, located at the upper-right side
of the page, and then login as a member.
If you have not yet registered as a member,
press Register Now,
which is located at the bottom of the Login box.
Once you register and login, you'll be directed
to a personalized page, for your specific plan,
where you will be able to see the medical claims
Blue Cross has received and processed,
as well as your out-of-pocket costs to date.
In addition to the BCBSM Member Site and mobile app,
you can also visit bcbsm.com/mpsers, to learn more
about what's covered under your medical plan,
and how much you have to pay for covered services.
Click Medical Plans, at the top of the page,
then click Medicare PPO, or non-Medicare PPO,
to view your current coverage documents,
including your Summary of Benefits,
your retirement system plan Benefit Guide,
and your Monthly Insurance rates.
Your 2018 coverage information will be posted
to bcbsm.com/mpsers in December.
Before I wrap up my presentation, I want to remind you
that a great advantage of having Blue Cross
administer your plan, is the wide variety of programs
and resources you have access to,
through Blue Cross Health and Wellness program.
Blue Cross Health and Wellness resources
gives you access to a broad range
of health and wellness information and tools.
The best part, is that it's available
at your fingertips 24 hours a day, 7 days a week,
when you login to your member account at bcbsm.com/mpsers.
Some of these tool include a symptom checker:
use this tool to help determine what to do
about your symptoms.
Recipes: find more than 400 tasty, healthy recipes.
WebMD Interactives: providing calculators, quizzes,
slide shows, and other health information
that you may need.
And a Medical Encyclopedia: this complete
health encyclopedia includes a database of health topics,
medical tests and procedures.
In addition to the online tools you receive,
through Blue Cross Health and Wellness,
you have access to programs like
the Complex Chronic Condition Management program.
This program allows you to get personal help,
to better manage chronic conditions,
such as diabetes, heart failure,
chronic obstructive pulmonary disorder,
coronary artery disease and asthma.
If you're eligible for Complex Chronic Condition Management,
a team of registered nurses, social workers,
and registered dietitians, work with you
to help you manage your condition,
through a unique combination of coordinated care,
education, and support with treatment plans.
A nurse case manager will work closely with you
through the program to help you:
develop self management skills,
such as monitoring your condition,
and learning how to address routine changes,
as well as more serious complications;
adhering to treatment plans; engaging in healthy behaviors
with support programs, to encourage lifestyle changes;
and learning how to communicate clearly and effectively,
with all of your healthcare providers.
If you're unsure about a medical issue or treatment plan,
you can call Blue Cross Health and Wellness
24-Hour Nurse Hotline, 24 hours a day, 7 days a week.
Registered nurses are always available,
to help you determine your next steps,
whether to call your doctor, or head to the emergency room.
But you don't have to wait for an emergency,
to call the Nurse Line.
If you have a common cold, flu-like symptoms,
or a chronic condition, such as asthma or diabetes,
one of our dedicated nurses can talk with you,
about your treatment options,
and tell you what you can do at home,
to start feeling better soon.
You'll get fast, reliable information you can count on,
while avoiding long waits at the emergency room,
or unnecessary trips to your doctor's office.
Here's the phone number I mentioned earlier,
that I would provide you.
It's also on the back of your Blue Cross Membership Card.
You can reach Blue Cross Customer Service
at 1-800-422-9146,
Monday through Friday, 8:30 a.m. to 5 p.m.
Eastern standard time.
-------------------------------------------
FWP hosting public meetings in Northwest Montana - Duration: 1:23.
For more infomation >> FWP hosting public meetings in Northwest Montana - Duration: 1:23. -------------------------------------------
Public (Bad) Buzz : Lewis Hamilton créait la polémique en se moquant de son petit neveu habillée - Duration: 2:32.
For more infomation >> Public (Bad) Buzz : Lewis Hamilton créait la polémique en se moquant de son petit neveu habillée - Duration: 2:32. -------------------------------------------
Tick-Borne Disease Working Group Meeting 1 pt 3 - Public Comment and Meeting 2 Preview - Duration: 54:11.
>> Dazon Dixon Dialo: As you come to the mike, I want to remind you that this is a listening
session for everyone in the room, so, it's your time, it's your three minutes.
Stand in your truth, say what you have to say, say how you need to say it.
But, perhaps you want to hold the others, if it's about something, or someone, or some
entity.
We're all people, we're all human, and we all have our frailties.
So, when you say what you have to say, try holding my heart in your hand while you say
it.
I promise you, you'll be a little more conscientious of what you have to say feels like.
Are we together?
All right, let's call Colonel Nicole Malachowski to the microphone for her time.
>> Nicole Malachowski: Is this thing on?
>> Dazon Dixon Dialo: It's not on.
>> Nicole Malachowski: It's on now?
Great.
Good afternoon, and thank you for the privilege to provide comment.
My name is Nicole Malachowski, I'm an active duty colonel in the United States Air Force.
I am here in my personal capacity, as a patient advocate, my comments are not intended to
represent the Department of the Defense, or the air force.
I've served over 21 years as an officer, and a career fighter-pilot.
In 18 days, I will be permanently, medically, retired from the career I love.
I was found unfit for duty, due to the damage, and ongoing effects, of neurological tick-borne
illness.
My illness began in 2012 when, as the commander of an F-15E Fighter Squadron, I began experiencing
rapid onset of multi-systemic symptoms.
Repeated doctor visits yield no answers, no diagnosis, no treatment, nothing.
Just over a year ago, I suffered from intractable pain, insurmountable fatigue, cognitive disfunction,
and major problems with my speech, and short-term memory.
I endured disorientation, confusion, anxiety, and even moments of temporary paralysis.
I was unsafe to be left alone, I could not play with my children, care for myself, or
interact with my husband, who had to be both caregiver, and single parent, during the worst
of my illness.
There were times I would have welcomed death.
I thought I was tough, as a combat-proven fighter pilot.
But, tick-borne illness destroyed me, brought me to my knees, and ruthlessly broke me.
It would be 1,525 days between my first doctors visit, and my accurate diagnosis.
Often, I was told I was just suffering from stress.
I felt patronized, discounted, and dismissed.
I saw over 20 doctors, military and civilian alike, across eight specialties, and received
three misdiagnoses.
By sheer luck, I was finally able to be seen at the Dean Center for Tick Borne Illness
in Boston, Massachusetts.
They are the only reason I am here today, the reason I am able to, once again, stand,
read, and speak.
Since my diagnosis, I have reviewed my own medical record many times, and I'm profoundly
troubled that other service members, military family members, and veterans, may be enduring
similar, unnecessary suffering.
I am deeply concerned about the impact of these tick-borne diseases on our military.
We are a high-risk population for encountering countless diseases, and I would like to add
special emphasis on Borrelia, and Bartonella.
The tax payers of America invested tens of millions of dollars in my training.
They are not getting the return on investment they should have.
This is a health of the force issue, this is a military readiness issue, and this is
a national security issue.
My doctors, civilian and military alike, were woefully uneducated about the breadth of tick-borne
diseases, and how they present.
The accuracy of diagnostic tests are abysmal, treatment options are inadequate.
The entire life-cycle for a tick-borne disease patient is appalling, from prevention, to
diagnosis, to treatment, to recovery.
I will have spent over 21 years serving my country.
Every day, I was measured and held accountable to the highest, strictest, standards of professionalism.
That's as it should be.
The Departments of Defense and Veterans Affairs need to answer to the same level of accountability
in their care of service members, veterans, and military families, with regard to tick-borne
disease.
I firmly believe they are uniquely suited to take an impactful leadership role in this
area.
Let's empower and resource them to do so, let's them lock their full potential.
Now would be a great time to drastically increase funding to the congressionally directed medical
research program for tick-borne disease.
This working group has the opportunity to harness the rapidly evolving science in a
way that joins forces with clinicians, and patients.
You have my full support, and encouragement.
Thank you.
[applause]
>> Dazon Dixon Dialo: Thank you.
Thank you so much Colonel, and thank you for your service.
Let's welcome Olivia Goodreau.
Olivia?
[applause]
>> Olivia Goodreau: Hello.
My name is Oliva Goodreau, and I am 13 years old, and am from Denver, Colorado, and I have
Lyme disease.
I have had Lyme disease, for half of my life, and I do not remember what it feels like not
to be sick.
The summer in-between my first, and second grade year, when I was seven, I was bitten
by a tick in Missouri, on vacation.
We did not see the tick, and I did not have a bullseye rash.
When my second-grade year began, I started having body aches, brain fog, headaches, tremor
in my right hand, I couldn't hold up my head, my legs would go numb, or burn.
I had balance problems, light and sound sensitivities, and I started blacking out.
My body felt like wood, and it was very hard to get out of bed.
My parents took me to over 50 doctors.
I had MRI's, CAT scans, Spinal Taps, EKG's, liver biopsy, under and lower endoscopy.
I had my adenoids removed, and over 100 blood draws.
I spent a week in the hospital, and was in and out of the E.R. I was told I needed to
drink more water, then I was misdiagnosed with Wilson's Disease, and told that I would
not live past the age of 40.
Then, when the DNA test came back, saying that I did not have Wilson's Disease, I was
asked if maybe I was making this up.
January 29th, 2013, my 51st doctor finally diagnosed me with Lyme Disease.
This doctor put me on 30 days of antibiotics, and said that I would be back to normal.
By the fifth day of being on the antibiotics, my parents said that they had seen the twinkle
in my eye that had been missing for 18 months.
I felt much better, and my third-grade teacher called my mom, and said, "I just met Olivia
for the first time, and she is really funny."
And, they both started to cry.
Unfortunately, after my 30 days of antibiotics were over, all of my symptoms had come back.
My parents knew that they needed to find a Lyme specialist.
For three years, I bounced around to different Lyme doctors in Colorado, but I was not getting
better.
My 54th doctor, is Doctor Richard Horowitz, with his M6 model, not only do I have Lyme
Disease, but he diagnosed me with Bartonella, Barbisio, relapse in fever, POTS Syndrome,
low immune globin's, and anti-one trip zone deficiency in my liver.
This is all from one tick bite that I never saw, and never had a rash, and 53 doctors
missed everything.
What second grader would make up a tremor in her hand, blacking out, and not being able
to hold up her own head?
While my friends were on spring break, I had a liver biopsy, spinal tap, and hundreds of
tests that I did not need.
I read a story about a single mom with an eight-year-old son, who had Lyme Disease,
and how the mom gave up their apartment, and was living in their car, so her son could
get his Lyme Disease medication.
After reading that story, I knew I had to do something to help these kids with Lyme
Disease.
So, on January 18th, 2017, I launched the LivLyme Foundation.
I have raised $288,000 for kids that cannot afford their Lyme medication, and for scientists,
and their research, for better tests, better treatment, and to find a cure for everyone
that is suffering from Lyme disease.
Since January 18th, we have had 41 families, from 22 different states, apply for grants.
The children are ages four to 20, with four families having three, or more, kids with
Lyme Disease.
This Saturday, I will be announcing the 10 families that will be receiving a grant from
the LiveLyme Foundation.
This has been really hard, because I wish I could help all of these families and their
kids.
I have already given $75,000 in research grants to Dr. Sapi, at New Haven, Dr. Zhang, at Johns
Hopkins, and Dr. Rajad is at Stanford.
My next grant will be going to Dr. Lewis at Northeastern.
Having met, and toured, all of these scientists' Lyme Labs, which I learned how hard they,
and their team, are working for the Lyme community.
These scientists give me hope that we will have better treatment, and a cure, in the
future.
So, I am here today to represent all of the children that are told that they are making
it up.
I am here to represent all of the people that are sick with Lyme Disease, and that cannot
help themselves.
I am here to represent all of the people that have lost their savings to help their loved
ones with Lyme Disease.
And, I am here because if a 13-year-old girl from Denver, Colorado can make a small difference
in the Lyme world, think of what this panel of experts can do.
Thank you for your time.
>> Dazon Dixon Dialo: Thank you, Olivia.
[applause]
Thank you so very much.
Let's now hear from Amy Fitzgerald.
Welcome, Amy.
>> Amy Fitzgerald: Thank you for allowing me to speak.
My name is Amy Fitzgerald, and I've been living with Lyme Disease for 22 years.
I was undiagnosed for the first 15 years of my life, when -- first 15 years, and was told
I had Ankylosing Spondylitis, and then Fibromyalgia, even though I didn't meet the criteria for
either diagnosis.
I cannot recall if I was tested during this time for Lyme Disease.
My story is that I woke up one morning as a 24 year old, and could not get out of bed.
My legs were paralyzed.
I was in a wheelchair briefly, and then I moved on to crutches for mobility.
I could not weight bear on my legs.
I had pain in my joints, my back, my hips, I couldn't move my neck, my eye flared up,
and I was diagnosed with Iritis.
I had to sit in my bed, in the dark, as I was sensitive to light.
I couldn't drive, I couldn't go to work, and I was 24 years old.
I suffered from chronic fatigue.
I lived this way for 15 years, going to doctor, to doctor, to doctor.
At one point, I thought I was dying.
Many times, I was told the pain was in my head, and I was told I would never run again.
When I was 39, on Thanksgiving Day, I was tired of being sick, and tired.
I decided to try and run, and it was a very slow start, run-walk.
But, I pushed myself for five miles, with my husband by my side.
I continued to run, walk, and train for my very first long-distance race, a 10-miler.
I had never felt better as the weeks passed.
Remember, the doctor's told me I would never run again.
They told me to rest.
The pain slowly started to disappear, and I put away my crutches, although they still
sit in my room, but I haven't used them for quite a while.
When less than a year had passed, and I developed pain in my wrist, and elbows, and I was so
tired.
I went to an infectious disease doctor, who tested me for Lyme Disease.
My tests show I had a past infection, and currently have positive antibodies showing
current infection of Lyme Disease.
I was perplexed, because I had never been treated for Lyme Disease, and I didn't remember
being bit by a tick, or having a bullseyes rash, currently, or in the past.
It took two months of antibiotics to heal my body, of my Lyme Disease symptoms.
I ran my first marathon, the Marine Corps Marathon, and shortly after finishing my antibiotic
treatment.
It is still my personal best marathon time, after running over 20 marathons, and ultra-marathons,
including the Umstead 100-miler, who I raise funds for, for Nat Cap Lyme.
Two years later, I developed debilitating pain in my ankle bone.
I researched different causes, and one thing that stood out in my research, was the pain
could be caused by Lyme.
But, I was healed from Lyme, I took those two months of antibiotics.
I requested my doctor test me for Lyme, and my antibiotic blood test came back with the
same exact results as it was two years prior.
She called, and told me I have chronic Lyme Disease, which is kind of unheard of in the
medical world.
I was prescribed two months of antibiotic treatment.
This is when I dove into my research, and put the puzzle pieces together, and made the
realization that I've been living with Lyme Disease since that terrible morning I woke
up, and I wasn't able to walk.
My life forever changed, as I knew it.
And, today I still live with chronic Lyme, and recently had a relapse this summer.
I want to introduce my daughter, Kaitlyn Fitzgerald, so, she'll talk about the pediatric side.
Thank you.
[applause]
>> D�zon Dixon Dialo: Thank you, Amy.
Thank you for sharing your story.
Kaitlyn Fitzgerald, please join us at the mic.
>> Kaitlyn Fitzgerald: Hello everybody, I'm Kaitlyn Fitzgerald, and I'm 14 years old.
My Lyme story is, I've been experiencing symptoms for as long as I can remember.
Which include joint pains, muscle spasms, and headaches.
But, there are also a lot more that I didn't realize weren't normal, because I thought
they were, you know, not out of the ordinary.
So, as you saw before, my mom has had Lyme Disease for a very long time, and since I've
been experiencing these symptoms for a very long time, I've -- she's wondered if she had
passed it on, through utero.
So, when we went to the doctor, my mom would always mention my headaches.
They told me I was dehydrated, and I needed to drink more water.
But, I've [laughs] been drinking lots of water, and bringing water bottles with me to school
every day, so that was a little weird.
And, the doctors always called these pains that I had 'growing pains', and I would just
stop getting them eventually.
But, here's the thing: I actually still have them, and they're much worse than they were
before.
One morning, when I was around seven, I woke up, and I couldn't put any weight on my left
leg.
My knee was basically paralyzed, and my mom took me to the Urgent Care center, and they
ran a bunch of tests, and they concluded nothing was wrong with me, which was concerning.
The next morning, I woke up, and I was fine, but one of the tests they didn't run was the
Lyme test.
And, after my mom found out she had Lyme, she did a lot of research, and she got my
siblings and I tested, since we like to play outside a lot when we were younger.
And, I came back positive for Lyme, and my mom asked the pediatrician for me to have
a month of antibiotics.
After I got my antibiotics, I felt great, I didn't really have any symptoms.
But, after a couple months, they came back, along with a lot more, including nerve sensations,
my muscles are wonky [laughs], anxiety, and sight hallucinations, and many more.
When I first told people I had Lyme Disease, I actually didn't really know what it was,
and neither did my friends.
One of my friends actually said, "Isn't that the disease that just makes you really tired?"
And, I thought that was an interesting point to bring up.
So, actually, this summer my mom brought me back to the pediatrician -- it was a different
doctor this time.
And, we told her what was going on, and how my symptoms have gotten worse since I got
treated.
And, she said she wasn't allowed to treat me, or give me anything, because she didn't
want to get in trouble, and she didn't want to do anything she shouldn't do.
Which, is understandable, but the problem is, I'm still sick, I still have symptoms,
and it seems that there's nothing they can do about it for me, which, also, is concerning
because I can't exactly get better.
And, I have pains every day, I have brain fog, it's hard to focus in class, and there's
not much I can do about it.
And I know there's a lot of other people out there like me, who are experiencing the same
thing, and there's nothing they can really do about it either.
So, I'm really excited that I was offered the opportunity to come here today, I found
this an amazing experience, to come and listen to what you guys have to say.
Thank you.
[applause]
>> D�zon Dixon Dialo: Thank you, Kaitlyn.
And, if I may, Kaitlyn, in terms of how you're feeling every day, and in terms of what the
future looks like, you are doing something.
You've done a great thing here, today, and I thank you.
[applause]
Let's welcome to the mic, Jill Auerbach.
Jill.
>> Jill Auerbach: Hello, and thank you.
We need gold standards serology for all tick-borne diseases, two, we need cures to suffering.
Three, tick research to stop ticks, and disease.
Funding -- fourth, funding commensurate with tick-borne diseases.
The last two, we need to accomplish.
All of us -- all of us have a dire need to include tick research as a critical part of
the solution being derived by this work group.
Yet, no tick scientist was included.
The ability for the HHS Secretary to include that is stated in section 26-G2.
Quote, "Other individuals whose expertise is determined by the secretary to be financial
to the functioning of the working group" end quote.
What we have, is a huge environmental -- tick problem, which was first noticed in the Connecticut
area.
It has been allowed to spread, unabated, for 44 years, because of the lack of government
funding, and attention.
Lyme is now in about 50% of the counties in the United States, that's not including the
other tick pathogens, and tick species.
All have increased, and spread like wildfire.
The societal cost of Lyme Disease alone, is about $3 billion, while NIH funding is only
about $24 million, and CDC about $10 million a year.
Does this make any sense?
Ticks and mosquito vectors infect us with voracious pathogens.
In the U.S., tick-borne disease outnumbers mosquito disease by about 80-to-1.
But, funding is in the reverse.
Until the tick population is reduced, and the tick ability is blocked from being able
to transmit pathogens, the scourge of Lyme, and other tick-borne diseases, will continue
to march across the USA, infecting, re-infecting, and co-infecting us, our children, our pets,
and the critters that spread them.
We must protect our future generations; these children should not be getting sick.
The problem has grown way beyond just one disease, and other fatal, hemorrhagic, encephalopathic
tick-borne diseases are certain to reach our shores.
A patch for Lyme disease is not a solution for the environment.
Tick research scientists hold the most potential to bring about fruitful solutions.
About 40 prestigious scientists join Tick Research to Eliminate Disease scientist coalition,
TRED, in support of what I said.
That should be enough to convince everyone of the critical importance of this long-neglected
field.
Just one example, transgenic mosquito research is making great strides.
I ask, why hasn't there been any transgenic research on ticks started?
I urge the secretary to add tick scientists to this work group, and challenge you to include
this as critical part of your discussions.
The time is now.
I add two quick items.
Disturbing, is that missing Steven Wycell, tick researcher, and basic scientists, such
as Monica Embers.
You must -- also, you must discuss a stop-gap measure, which could be Nucatone.
Food great to humans, kills mosquitos, and ticks, but not honey bees.
CDC testing demonstrated that a soap wash caused infected ticks to drop off of mice,
killing 85 percent of them, no mice were infected.
Since most tick-borne pathogens transmit in over 12 hours, a simple nightly shower, or
bath, could prevent many diseases.
Simple, safe, inexpensive.
Better than tick checks.
By the way, it's being funded by the CDC for mosquitos.
Thank you, very much, for your attention.
[applause]
>> D�zon Dixon Dialo: Perfect.
Thank you so much, Jill.
Next up, we have Erica Keys-Land.
>> Erica Keys-Land: Hello, thank you so much for the opportunity to address you this afternoon.
I've also submitted written comments for the record, but I'd like to use this opportunity
today, to share with you my personal story, as well as my suggestions for the mission
of the working group.
Having worked for 13 years as an attorney at the Department of Health and Human Services,
Office of Chief Counsel for the Food and Drug Administration, I wrote, and reviewed, drug
regulations, and also prosecuted those who failed to follow them.
However, I'm here today as a Lyme Warrior, as I've been battling Lyme Disease myself,
for six years.
I never saw the classic bullseye rash, and I never had a positive Western blot test.
My symptoms started with joint pain, and brain fog, which got progressively more debilitating
as I, like so many other Lyme Warriors, went searching from doctor to doctor, and found
no answers.
Finally, I tested positive for Lyme through a clinical diagnosis, from my wonderful infectious
disease specialist, Dr. Joseph Jemsek.
Two of my children have Lyme disease.
My son had a bullseye rash, which was misdiagnosed as ringworm.
He contracted Lyme, by the way, while living in New York City.
We all know, regrettably, that the new data shows that Lyme Disease is an unreported illness,
and at least six times more common than HIV and AIDS.
Thus, I think there should be an HIV, and AIDS style Manhattan Project to combat this
serious pandemic.
My suggestions for your working group are one, revoke the archaic, and ineffective IDSA
Lyme Guidelines, and establish new ones.
Next, establish a new standard for Lyme Disease testing.
Third, review the evidence for the existence of chronic Lyme Disease.
Come up with a new name, if you must, but most importantly, publicly acknowledge that
the scientific evidence proves that Lyme Disease does, in fact, persist.
Make a public health announcement, so that those of us that are affected do not have
to fight this silent battle with our team of scientific-based doctors, and with insurance
companies.
Once you publicly acknowledge the chronicity of Lyme Disease, then internists, rheumatologists,
all doctors around the world, will stop looking at us like we're crazy.
Furthermore, you might even save the lives of so many people who indeed have Lyme, but
might be misdiagnosed with ALS, and M.S., Fibromyalgia, chronic fatigue, and so many
other diseases that are overlooked.
Fourth, conduct further trials of antibiotic therapy, or other alternative forms of treatment,
such as stem cell therapy, and also encourage pharmaceutical, and other alternative medical
industry participation, using the best of both eastern, and western, medicine.
Fifth, stop putting forth efforts, and scarce resources, into the failed Lyme vaccine concepts,
because there's been more than one.
Thank you so much for the opportunity to speak today.
If you need any more Lyme patients, I'm here, would love to help out.
One more thing, Dr. Jemsek, who's here today, if there's any way you could get him up on
the mic to say a few words today, I would -- I'm sure he'd be a benefit to this process.
Thank you so much.
[applause]
>> Dazon Dixon Dialo: Thank you, Erica.
Let's now hear from Kristina Bauer.
Kristina, take your place at the mic, please.
>> Kristina Bauer: Good afternoon.
Thank you all for having us here today, and coming yourselves.
My name is Kristina Bauer, I am a physician facilitator for the North Texas Lyme group,
owner of Yoga Center G-spine Wellness Center for 12 years, and mother of four, ages eight
through 14.
I caught Lyme Disease 35 years ago in Illinois from several tick bites, playing in the woods
by my house.
I've seen countless doctors, and had many different, inaccurate diagnoses.
I treated GI Lyme, misdiagnosed as Chromes Disease ineffectively for 26 years, following
ulcers, and, as well, an obstruction.
Could have killed me.
Gastroenterologists would recommend immuno-suppressants as my only line of treatment, many times.
This type of uneducated recommendation by the GI community could cause the Lyme to take
over my immune system.
In contrast, I started an antimicrobial, and immune building stomach protocol five months
ago, resulting in no more ulcers, pain, or inflammation.
I passed Lyme to all four of my kids, our children, during gestation unnecessarily,
as research shows.
The government knew Gestational Lyme existed back in 1985.
I have the studies today, to talk about after this meeting, if you're interested in those.
Some of my children, and I, have been bedridden in severe pain, had seizures -- my son on
his seventh birthday, which we had to cancel his seventh birthday party because of that,
lost the use of our body, and brain.
One child was in four different schools by the second grade, due to undiagnosed illness
causing severe learning difference.
After treatment, he gets straight A's, and mom's so proud, and he has rebuilt his self-confidence.
We have spent over $100,000 on extended antibiotics, and other validated therapies, and successfully
cleared four, of five, of us of viruses, Lyme and co-infections, but only for now, as it
is lying dormant forever, once you get it.
$52 million over 17 years of government grants studying infections have yielded no tangible
benefits to Lyme patients.
Therefore, I propose to you today, several things.
Number one, anyone who denies persistent Lyme be banned from participating in the tick-borne
disease working group.
[applause]
Thank you.
Non-pharmaceutical therapies is number two, that are peer-reviewed and validated, need
to be covered by insurance companies, so everyone has access to treatment that works.
Number three, encourage the millions of cancer clinics across the United States, and the
world, to integrate Lyme treatment that could provide an immediate ability to treat severely
desperate Lyme sufferers, since Lyme affects the B cells, similarly to cancer.
Number four, patients who have been bankrupted, and disabled by this disease require government
sponsored medical care, to regain the capacity of productive -- being productive members
of society.
In July, after treating for five years, I've had a poor, and a pick line.
I went to Germany, and received 10 million of my own blood cells -- stem cells, and have
seen healthier days then since I was a child.
Number five, I look forward to the U.S. offering the use of auxologist blood stem cells to
repair the damage from Lyme and Co-infections someday.
Number six, and lastly, demand that doctors use the most current, and AMA approved, CME
training online, written by Dr. Maloney, and are free on many websites, including txlda.org
website.
I'm hearing today we are forward thinking, so I'm asking to you, please update the link
on CDC's website to NIH, which still hosts IDSA treatment guidelines with current science,
not old science.
We demand, and deserve better.
Thank you for listening today.
[applause]
>> D�zon Dixon Dialo: Thank you so much, Kristina, thank you.
Next up, Tim Lynagh.
Tim.
And, tell me if I pronounced that incorrectly.
>> Tim Lynagh: Lynagh, actually, you got that right.
Yeah, I think I'm, kind of, a -- well, I feel like I'm in an awkward position, following
all those heart-wrenching patient stories.
And they were, I mean, I was close to tears, over there, at one time, myself.
My name's Tim Lynagh, and I started working on Lyme when I was on -- working on Capitol
Hill.
And, then, when I left the Hill, I started to volunteer with the Lyme Disease Association.
And, I'm not going to do a broad brush, or a broad take, on issues, but to address some
specific issues related to surveillance.
Surveillance of both human disease, and tick vectors, is important, because it provides
us an idea of risk, in terms of prevalence of exposure, and provides data necessary to
estimate disease burden including both morbidity, and mortality, and financial cost to individuals,
and society.
Surveillance issues also have a major impact on the individual's ability to receive diagnosis,
and treatment.
Now, as Gregg Skall had mentioned, significant attention should be paid to the Lyme Disease
case definitions developed by CDC in collaboration with the Council of State and Territorial
Epidemiologists.
Case definitions constitute surveillance criteria, not diagnostic criteria.
A history of surveillance case definitions for Lyme Disease since 1995 show them getting
significantly more stringent.
But, up until the 2017 iteration, they all contained the statement, quote, "This surveillance
case definition was developed for national reporting of Lyme Disease.
It is not intended to be used in clinical diagnoses."
Close quote.
Even before that language was dropped from the case definition, patients across the U.S.
were refused diagnosis, and treatment by physicians who told them, "You do not meet CDC criteria."
And, physicians who did treat were often subject to discipline.
This is particularly relevant to those in the south, and Midwest, who have consistently
been told they have little, or no, Lyme, in what are now called Low Incident States, a
2017 surveillance term.
The definition of high incidents, and its application in the case definition, make it
almost impossible for any state that is not now classified as high incidence to become
so designated.
Tens of thousands of people over time had to travel across the country to high incident
states, to receive care.
Many have progressed to chronic disease, and been severely debilitated, when early diagnosis
and treatment had been denied, based on surveillance criteria.
And, now, the MMWR has even stopped reporting case numbers weekly, although Lyme has one
of the highest reported case numbers in the MMWR.
Only an annual total is now reported.
Access to care is dependent upon accurate surveillance, as is funding, since diseases
with high numbers, and high disease burden are considered more deserving of funding.
The $40-$45 million spent by the federal government, including CDC, NIH, and DOD's CDMRP, is inadequate
to address Lyme, which can be demonstrated to be close to 400,000 new cases in 2015,
based on 90 percent underreporting.
We also need to develop a more systematic, and comprehensive, plan for surveillance of
human TBD's other than Lyme, and co-infections.
As well as a comprehensive vector surveillance strategy.
In a 2017 article, tick-borne zoonoses within the U.S. persistent with emerging threats
to human health, Ben Beard, Christopher Paddock et al, described 12 major TBD caused by 15
distinct disease agents, by the 8 most common human biting exuding ticks in the U.S.
>> D�zon Dixon Dialo: Time.
>> Tim Lyna: Six of the 15 pathogens were recognized in caught illness -- to cause illnesses,
only within the past two decades.
Thank you.
[applause]
>> D�zon Dixon Dialo: Thank you so much, Tim.
So, now I'd like to call to the mic, Gill Lake.
Gill.
>> Gill Lake: Thank you.
I just wanted to point out that this panel here is dedicated to cognitive dissonance
eradication, are we in agreement?
You had a really good display up there, with the hands on the bible, but that is not a
constitutional thing, you could have just as well had a constitution to put your hands
on, it's all I'm going to say, thank you.
>> D�zon Dixon Dialo: Gill.
[applause]
And, I'd like to call to the mic, last but not least in the voices of this afternoon,
Meghan Delaney.
Meghan.
>> Meghan Delaney: Does this -- can I sit?
I'm wondering if that's a -- oh, no -- [inaudible] okay.
I don't trust my autonomic nervous system right now.
So, I wasn't sure if I was going to make it here today, so I don't have anything prepared.
This is really important to me, I'm here as a private citizen, but I've worked for the
Department of Defense my entire career in the healthcare field.
I'm not a clinician.
My story starts off a bit like a "House" episode.
At 29 years old, I got off of a rollercoaster in San Antonio, Texas, and had what looked
to be a heart attack.
And, that didn't really make much sense to most people.
I worked around a lot of physicians who knew me, and knew my work ethic, and knew who I
was, and saw me deteriorate over the next few years, and scratched their heads.
They all believed something was very wrong, but no one was quite sure what it was.
And, because it manifested initially with me as cardiac symptoms, I was pushed through
the system, I was seen all over the place, I was at Hopkins.
It eventually moved into my nervous system.
Again, none of us knew exactly what was going on at the time, I lost the ability to walk,
they started to think I had M.S.
I was seeing rheumatology, neurology, cardiology.
I ended up out at Cleveland Clinic four and a half years later, after now being on disability
for six months.
Didn't really get too far there, and, then, I ended up getting pulled out of my car on
66 unresponsive with another stroke, and as I was in the emergency room at Fairfax hospital,
the doctor recognized me from my work with DOD, and international health, and asked me
what DOD was doing for Ebola.
As I was laying there [laughs], unable to move one side of my body, and unable to talk.
So, there's some irony here.
I knew at that point, after four and a half years of this, and the complete deterioration,
that I was going to possibly end up dead.
I was, thankfully, able to see a Lyme specialist, who got me the right testing eventually.
I want to make it clear that through the journey, there were doctors who truly believed something
was very wrong, and they were more than willing to go through the process -- the lengthy process
of submitting me for NIH rare disease programs.
But, before this all started, I had a bite on my leg, and I showed it to the doctors
that I worked with, who are my colleagues.
And, no one ever put two and two together.
So, unfortunately, this has greatly impacted my life, and my family's life, I had to drop
out of grad school, my career goals have completely changed.
I'm here today -- I'm really happy to see what's happening.
I'm a little concerned, and I'm hoping that this working group can help with the fact
that I work with scientists, I work with clinicians, I know what they need to see, I know what
they want to see, and I know they saw me happening, but I didn't fit their textbook, in what they
learned in med school 30 years ago.
And, I didn't fit the diagnostic criteria, and the blood work that showed up as results.
But, they still believed something was very wrong.
I'm hoping this working group can help highlight the fact to conventional medicine, and mainstream
medicine, that this issue is not case closed.
We might not have all the answers, but don't write people off, and never look at this issue
again.
The amount of money that has been spent on me through the medical system, and what I've
spent, you know, a lot of this probably could have been addressed initially, and I never
would have gotten to the place I'm in.
So, thank you for being here, thank you for your time, and I really look forward to the
progress of the working group.
[applause]
>> Dazon Dixon Dialo: Thank you, Meghan, thank you so much.
For the brave, courageous, honest, direct voices and messages that are all so loving,
that are all so strong, and that are all so determined to see things happen, and to see
something change, please give a rounding, sound of applause for all of the voices we've
heard this afternoon.
[applause]
This is what resilience to revolution looks like.
Thank you all.
What I didn't tell you, as I take my seat, turn this over -- back over to Dr. Wolitski,
is that as a member of ACT UP, and as a part of the women's HIV Aids movement.
Prior to 1994, that was more than 13 years into the epidemic, already with hundreds of
thousands of people already dead, or dying, including women who were sick from day one,
and had never been diagnosed.
There are women who died, never knowing why, and families who were never able to say way,
and it took us three plus years of a determined, hard fought, ugly, awful fight just to be
included.
Because, we knew that women were experiencing things differently.
And, in 1994, the Centers for Disease Control finally expanded the definition of what was
then known as AIDS, to include women, and children, and more homeless people then they
had before.
And, more poor people, who were not getting those diagnoses.
We then went on, because that doesn't end the fight.
We needed more research, to know which drugs work best, were there gender differences,
were there any other differences, and could we do better with treatment?
And, by the way, can't we do better with prevention?
We're 37 years into this epidemic, and we're still fighting for those things, but we have
so, so, so many wins, that we can count along the way.
And, I'm telling you this, because I know that there's that high school chant -- I'm
just going to say this, my high school -- my high school alma mater team just got the state
championship stolen away from them in the state of Georgia, this past week.
So, I can say, I believe that we will win.
I believe that we will win, and I know that you will win, and that you will stop the suffering.
There's a man -- I used to call him my movement husband, maybe because he's really smart,
and really good looking, but he doesn't know me, so I figured that might not be appropriate.
So, I started calling him my movement muse.
He's a human rights lawyer, he fights on behalf of juveniles in the justice system.
He actually won the Supreme Court case to make it unconstitutional to sentence juveniles
to life in prison.
He's an amazing human being, and I heard him speak, and I read his book.
And, he has these four tenants which I define as the most important pillars to sustaining
social change, to sustaining the end result, and the fight, which is always long, and seems
unending, and how to count our battles along the way, when we do know we've won.
And, here are those four tenants, and I want to raise them, because I think that you have
already laid out the foundation to sustain this work, and social change.
Just based on Bryan Stevenson, author of "Just Mercy", director of Equal Justice Initiative.
One, proximity.
You have to be proximate to the issue.
You have people on your working group, you have the voices of people in the room who
are living, or have lived, the experience, and know the ins and outs of what you need
to know of what this looks like, and feels like, and including those voices in the work
that you are about to do.
You are already getting proximate.
Two, change the narrative.
Change the narrative.
I've heard that there needs to be changes in the IDSA, that there need to be changes
in how physicians identify Lyme Disease, and other tick-borne, and other vector related,
I've heard that you might even need to change the name.
Change the narrative, do not let the consistency of status quo stagnate what has to change
in what you are looking to achieve.
Number three, you got to be willing to get, and make, other people uncomfortable.
You got to be willing to step outside of your own comfort zones, speaking in public when
you're not accustomed to it, joining boards that may require you to do a little bit more
work, voluntarily.
All kinds of things, that you might not be as comfortable talking about, or getting involved
in.
Because, I believe that as long as you're comfortable, you aren't trying to change anything.
And, the last one, is protect the hope.
You have to believe every day that you are doing something that's going to make a difference,
and that you're going to win.
And, I truly believe that you are well on your way, and he doesn't know you all either,
maybe, but I have a feeling that Bryan Stevenson would be just as proud of you, as I am.
And, so, thank you so very much for including me in your process today, and for trusting
me to facilitate the sound of your stories.
Thank you very much.
[applause]
We have a thank you to add.
So, this is a sound of appreciation?
>> Jill Auerbach: Yeah.
I want to thank all of you for your dedication, and to the hope that we will find a difference
for the future generations.
I also want to bless, and thank, the doctors who maintained their Hippocratic Oath by not
deserting the patients, by treating us, when I thought my life was completely over.
I had a doctor who did not desert me.
I bless them for their dedication, and for their willingness to even stand up, and be
prosecuted, and everything else, for doing what they knew was right.
Thank you for giving me my life back.
>> D�zon Dixon Dialo: Thank you.
[applause]
>> Jill Auerbach: And, all the others.
>> D�zon Dixon Dialo: And, all the others.
So, you just stole my thunder, I had your last little bit of appreci-love exercise.
That's where, you know, we appreciate, love each other at the same time.
But, I think you've taken care of that for me very well, Jill.
Gratitude is what keeps us moving, and I want to show mine, by handing over the mike to
Rich Wolitski.
Rich, thank you for inviting me, and for having me here today.
>> Richard Wolitski: Thanks, D�zon.
[applause]
I appreciate so much, for making time to do this, between your travels back and forth
between Atlanta, and South Africa, and the work that you do is truly inspirational.
So, I'm going to, before I say anything, ask if Kristin [phonetic sp], and John [phonetic
sp] want to add their comments to the end of it, and then we're going to talk a little
bit about tomorrow.
And, then, we'll be done ahead of schedule.
>> John Aucott: Takes a lot of courage for people to stand up, and it was really inspiring
to see that, and I think that's what we needed to hear, so I really appreciate everyone's
input, and for those of you, you know, attending virtually, we appreciate you as well, and
your time that you spent today.
And, you know, listening's important, and that's what we've done today, so, we're on
the right track.
>> Kristen Honey: Yeah, just, huge gratitude and thanks for all those who stood up and
shared their story, and all those who are still living them.
And, we will follow the four pillars, and not lose the hope.
And, I just want to reiterate before we close and go into tomorrow, that this is an ongoing
process, and a beginning, and decisions here, we can revisit them.
We have 13 members now, we'll have 14.
We're all people, and the decisions we make on this tick-borne disease working group if
we made them, we can unmake them, or remake them, or morph them, to fit the needs.
So, please think of this as an ongoing dialogue, and your contributions will shape the future,
and we'll go into some logistics, how to do that next.
>> Richard Wolitski: Thank you.
So, I'll just state the obvious, as well.
I mean, it's incredibly powerful, to hear directly from people about their experiences,
and, you know, so much to me.
Just brings back all these memories back, you know, in the late '80's, early '90's,
before we had effective HIV treatment, and just remembering what those days were like.
And, the one thing that, just always surprises me when I look back at them, was not that
we were depressed, and scared all the time, but that we had hope.
And, we just always had this sense, that if we just fought a little harder, worked a little
longer, and just kept on going, kept on trying, that somehow things would be better.
And, they have gotten better -- they're where they need to be, or where they could be, but
they're better.
And, I just, kind of, carried that hope with me, for all of you, for all of us, in the
work that we're doing here, that there's a tremendous opportunity.
People have said it a number of different times, the time is now, and I'm confident
that we're going to do you proud, and that we're going to do a great job with this process.
Is it going to be perfect?
No.
Will there be improvements that can be made over time?
Yes.
It's going to be a process.
And, I think, that's, sort of, you know, one of the things, you know, about life in general,
that, you know, you really learn the most when you mess up.
When you don't get it quite right, and you go back to it, and you try again.
And, you work on it until you get it right.
When you really mess up, is when you don't get it right the first time, and you don't
admit that you didn't get it right, or you just say, "I'm done, it's too hard, it's not
going to work for me."
And, so, I think, we've got some heavy issues that have been dealt with for a long time,
by a lot of people, and if they were easy, they would have been solved already.
And, so, I think it's that commitment that the members of the working group, the commitment
that all of you here in the audience, and all of you, who have taken your time at home,
or at work, wherever you are, to watch this on the internet, to build the community that
makes this work possible, and that will hopefully, ultimately, make it sustainable, as D�zon
has mentioned.
So, I really just, kind of, you know, want to thank you all for being here, and for approaching
the issues, and the work in the way that you have.
This has been -- just had great interactions with people, who have really, you know, taken
the time to educate me, share their stories, and I appreciate that.
So, tomorrow, we have a long day.
We're going to be starting the meeting promptly at 9:00 am.
The doors here, will open at 8:30 am, and, so, it will be the same sort of system as
yesterday.
Going through security, encourage you to be early, as so many of you were today.
So, we got a good start, right on time, which is unusual for these types of meetings.
So, we're going to start off the morning by hearing from some additional organizations,
be hearing from some provider organizations, and also hearing from public health organizations
after that.
And, then, it's going to shift into -- really, kind of, talking about the work, and talking
about, what is it that the working group has to do, and how's it going to do it?
And, that's really, kind of, tomorrow is, you know, after we hear from the professional
organization -- it's about the workplan, and it's about figuring out the work that needs
to be done, it's about timeline, it's about the task, and breaking it down, and figuring
out how we together go forward on this.
And, so, with that, I think I will turn it back to you, because I can't end the meeting
-- you have to adjourn it [laughs].
[inaudible]
>> John Aucott: Seconds?
All right, all in favor of adjourning today's meeting session say, "Aye."
>> Multiple Speakers: Aye.
>> John Aucott: Opposed?
The meeting's adjourned, thank you very much.
[applause]
>> Male Speaker: U.S. Department of Health and Human Services, produced at taxpayer expense.
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