Stress

Stress is one of the most misused words in the English language, and its precise meaning is often forgotten. It is defined in the Shorter Oxford Dictionary as a ‘demand upon energy’. This is a difficult concept to apply to the human body and not a factor that can easily be measured. Although breaking a leg is caused by undue stress, it is not this mechanical use of the word that is usually intended; more often, the implication is a strain on the mind (psyche) with a consequent decreased ability to cope. There are some people to whom stress is a challenge to be overcome who are unhappy without tension in their lives; there are others who cannot tolerate any form of stress. Most people fell between the two extremes, their responses depending on the situation. Many studies have been undertaken on stress, particularly in its part in relation to heart disease; based on these studies people have been classified into two groups: ‘A’ type and ‘B’ type. The ‘A’ type takes stress badly, almost as a personal affront, getting tense, edgy, ‘rushing about’, and exhibiting a high degree of tension; the ‘B’ type is much more relaxed and, when under stress, tends to utilize the situation in a constructive manner. It is found that type ‘A’ is almost twice as likely to develop heart attacks as type ‘B’. Comparable studies have not yet been done in migraine but personality does seem to play a large part in determining who gets migraine, and it may well be that different responses to stress are important in determining the frequency of attacks.

It is not known whether stress provokes migraine by increasing the production of adrenaline or noradrenalin or whether its effect is unrelated to biochemical changes.

Exercise

Exercise can provoke attacks of migraine but it has also been recommended as a prevention of attacks. The truth is that exercise is a particular form of stress, so that the same chemical changes take place, e.g. an outpouring of adrenal hormones which makes the heart beat faster to supply more blood to the exercising muscles.

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A rice dish with a protein and three coloured vegetables. Salad on the side.

A legume dish with a variety of beans such as chickpeas, soy beans and kidney beans, mixed with sauteed vegetables and a spice such as ginger, chilli, garlic or all three.

Choose a protein from the following list: fish, eggs, chicken, beef, legumes, tofu. Grill, casserole or bake. Choose three coloured vegetables to accompany it, preferably 50 per cent cooked and 50 per cent as a raw salad.

A pasta with a protein; for example, bolognaise or seafood sauce (use cream sauces very moderately). Thai or curry spices with meat or fish could be used as a sauce with egg noodles.

Try to avoid eating a heavy meal late in the evening. You should aim to eat your evening meal approximately four hours before you go to bed.

If you are trying to lose weight, a thick soup and a small serve of a protein plus salad is appropriate.

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People with HIV infection report that among their biggest worries are the problems of financing medical care. Unfortunately, many of their worries are justified. Although the average medical bill for the care of HIV infection is no greater than the average bill for most other serious medical conditions, people with HIV infection should be prepared for expensive medical care.

The average cost of medical care for HIV infection over a lifetime, in 1990 dollars, varies in different reports from $62,000 to $94,000. Most of the costs are incurred after the first

AIDS-defining diagnosis. The greatest part of this cost is for hospitalization—from $55,000 to $70,000—though expanded use of alternatives to hospital care has lowered that cost. Outpatient services average about $12,000 altogether. The cost of drugs is hard to estimate: drugs are much more expensive when first released than they are later, and new drugs are being released rapidly.

The mechanisms for financing medical care in the United States are phenomenally complicated and full of jargon. People finance their medical care either by themselves (called self-pay), or through private insurance, or through publicly funded state and federal programs. Private insurance and public programs are together called third-party payers. Most people finance their care through a combination of self-pay and third-party payers.

Private third-party payers include commercial insurance companies, Health Maintenance Organizations (HMOs), and the nonprofit conglomerate that is Blue Cross/Blue Shield. The main public third-party payers include Medicare, Medicaid, and the Veterans Administration. Medicare accounts for 17 percent of the financing for all health care in the United States; Medicaid for 10 percent; other government agencies for 14 percent; private insurance for 31 percent; self-pay for 25 percent; and private sponsors for 3 percent. An estimated 35 million Americans are uninsured.

Several aspects of financing medical care are unique to HIV infection:

1.  People with HIV infection make up a disproportionately large number of those who receive Medicaid. By 1990, many large cities had reported that 40 percent of all persons with AIDS were receiving Medicaid; this percentage is increasing.

2.  Most third-party payers will not reimburse the full range of services commonly required for people with HIV infection; services that are reimbursed insufficiently or not reimbursed at all include home care, long-term care facilities, and prescription drugs.

3. Private third-party payers have many ways—some of them devious—of avoiding reimbursement of the costs of medical care for HIV infection. They do this despite the fact that the average lifetime cost of the care of a person with HIV infection is no different than the cost of care of people with most other serious conditions.

4.   Many physicians are reluctant to care for people with HIV infection because the medical care is unusually complex and because reimbursement for professional services is unusually poor due to the disproportionate number who are uninsured or recipients of Medicaid.

5.  Public funds, both from the states and from the federal government, are increasingly available to people with HIV infection. However, eligibility for many of the special programs often requires a diagnosis of AIDS.

The following sections go into what may strike you as tiresome detail about financing medical care. But the more you know about what is standard or required or forbidden, the better you will be able to control your options for financing care.

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