ࡱ> ~stuvwxyz{|}ym bjbj  jj:l*nnnf\*"Z"@>#>#># %|*O,]|~~~~~~$ ?pd$@ %ddf>#>#fffdd>#>#|fd|f\fmd>#N c3*Dn-ed0H8 ef** EMBED PBrush  GE FINANCIAL ASSURANCE* Long Term Care Division Long Term Care Agent's Field Underwriting Manual gotobutton toc EMBED Word.Picture.8   To use manual: double click on caduceus above, this will get you to the Table of Contents (TOC), the TOC is arranged alphabetically, find the history you are looking for and double click on the history (in red). To get back to the TOC, double click on the history heading. 8-6-03 Wherever used herein, GE Capital Assurance (GECA), or the Company includes its affiliate New York domiciled insurer, GE Capital Life Assurance Company of New York.  GOTOBUTTON toc INFORMATION YOU SHOULD ALWAYS GATHER  XE "Information You Should Always Gather" \b\i  If any medical conditions are admitted:What is the current status (the same, better, or worse)? Are there any current symptoms? What is the current treatment? Are there any complications? Is the condition under evaluation or has surgery been suggested? REFER TO GUIDELINES ON SPECIFIC CONDITIONS For what reason or for what illness are you taking each of the medications you have listed on the application? Have you needed home health care, physical therapy, occupational therapy, speech therapy, or any type of rehabilitation program within the past 12 months? If so, for what reasons? If currently receiving any therapy, what is the anticipated date of discontinuation? Have you had any medical conditions in the past 10 years that have impacted your health? Have you seen any other physicians in the past 5 years? Why were they seen? If you answered yes to the disability question on the application, please explain why you are on disability. When did it begin? Are you currently receiving disability income, workers compensation, or Social Security Disability benefits? Is there any other information, not covered on the application, that you feel is significant? If you require further clarification on any of the guidelines, or encounter one not covered in this manual, please contact our UNDERWRITING HOTLINE at 1-800-354-6892, for further assistance.  GOTOBUTTON toc FOREWORD  The purpose of this manual is to help those involved in the risk selection process by: SYMBOL 183 \f "Symbol" \s 8 \h describing some of the conditions that are significant determinants of a need for long term care. SYMBOL 183 \f "Symbol" \s 8 \h providing a list of questions to ask in order to elicit pertinent information. SYMBOL 183 \f "Symbol" \s 8 \h providing the general guidelines used by the Company in evaluating the risk. SYMBOL 183 \f "Symbol" \s 8 \h listing significant medications. The manual is not all-inclusive. As our knowledge and experience increase, we will expand, amend, and refine the manual. The information contained in the manual reflects our claim and underwriting experiences over a twenty-year period. This manual is a tool that should be used in combination with your experience, observations, and sound judgment. If you require further clarification on any of the guidelines, or encounter one not covered in this manual, please contact our UNDERWRITING HOTLINEXE "HOTLINE"XE "UNDERWRITING HOTLINE" at 1-800-354-6892, for further assistance. THE HOME OFFICE UNDERWRITER WILL MAKE FINAL RISK DETERMINATION. AGENT'S LTC FIELD UNDERWRITING MANUAL Table of Contents  TOC \o "1-2" Information You Should Always Gather  GOTOBUTTON information see inside front cover   GOTOBUTTON foreword FOREWORD   GOTOBUTTON intro INTRODUCTION   GOTOBUTTON ltcu LONG TERM CARE UNDERWRITING  Field Underwriting Home Office Underwriting - Underwriting Requirements  GOTOBUTTON five THE FIVE I's  (1) Intellectual Impairment (2) Immobility (3) Instability (4) Incontinence (Bowel and Bladder) (5) Iatrogenic Drug Reactions  GOTOBUTTON decision DECISION TERMINOLOGY   GOTOBUTTON uninsurable UNINSURABLE CONDITIONS   GOTOBUTTON specific SPECIFIC UNINSURABLE MEDICAL CONDITIONS   GOTOBUTTON functional UNINSURABLE FUNCTIONAL DEFICIT   GOTOBUTTON combo UNINSURABLE COMBINATION MEDICAL HISTORIES   GOTOBUTTON build HEIGHT/WEIGHT TABLE  Overweight: Underweight:  GOTOBUTTON addisons ADDISON'S DISEASE   GOTOBUTTON ETOH ALCOHOLISM  (Alcohol abuse, Ethanolism, ETOH disease)  GOTOBUTTON dementia ALZHEIMER'S DISEASE   GOTOBUTTON ALS AMYOTROPHIC LATERAL SCLEROSIS (ALS) ) Lou Gehrig's Disease  GOTOBUTTON incontinence ANAL & RECTAL IMPAIRMENTS, BOWEL INCONTINENCE   GOTOBUTTON anemia ANEMIA   GOTOBUTTON anemia ANEMIA, IRON DEFICIENCY   GOTOBUTTON anemia ANEMIA, MEGALOBLASTIC   GOTOBUTTON anemia ANEMIA OR CHRONIC DISEASE   GOTOBUTTON pancytopenia ANEMIA, APLASTIC  (Pancytopenia)  GOTOBUTTON aneurysms ANEURYSMS   GOTOBUTTON aortic ANEURYSMS, AORTIC   GOTOBUTTON cerebrovascular ANEURYSMS, CEREBROVASCULAR   GOTOBUTTON angina ANGINA PECTORIS  Coronary Artery Disease, CAD  GOTOBUTTON AS ANKYLOSING SPONDYLITIS (AS)  (Rheumatoid Spondylitis, Marie-Strumpell Disease)  GOTOBUTTON arrhythmias ARRHYTHMIAS  (Conduction Disturbances, Palpitations, Rapid Heartbeat)  GOTOBUTTON asthma ASTHMA  (Bronchial & Allergic Asthma)  GOTOBUTTON atherosclerosis ATHEROSCLEROSIS & THE CAROTID ARTERIES   GOTOBUTTON a_fib ATRIAL FIBRILLATION (A-FIB)   GOTOBUTTON bladder_incontinence BLADDER DYSFUNCTION OR INCONTINENCE  (Neurogenic Bladder, Stress Incontinence, Urinary Incontinence)  GOTOBUTTON cancer CANCER  (Carcinoma, CA, malignancy, neoplasm)  GOTOBUTTON breast CANCER OF THE BREAST   GOTOBUTTON colon CANCER OF THE COLON AND RECTUM  (LARGE BOWEL)  GOTOBUTTON esophagus CANCER OF THE ESOPHAGUS   GOTOBUTTON head CANCER OF THE HEAD, NECK AND THROAT   GOTOBUTTON kidney CANCER OF THE KIDNEY   GOTOBUTTON lung CANCER OF THE LUNG   GOTOBUTTON ovary CANCER OF THE OVARY   GOTOBUTTON prostate CANCER OF THE PROSTATE   GOTOBUTTON skin CANCER OF THE SKIN   GOTOBUTTON gastric CANCER OF THE STOMACH (GASTRIC)   GOTOBUTTON thyroid CANCER OF THE THYROID   GOTOBUTTON urinary_bladder CANCER OF THE URINARY BLADDER   GOTOBUTTON uterus CANCER OF THE UTERUS   GOTOBUTTON carcinoid CARCINOID TUMORS   GOTOBUTTON CHF CARDIAC FAILURE, CONGESTIVE HEART FAILURE (CHF)  CONGESTIVE HEART FAILURE (CHF)  GOTOBUTTON cardiomyopathies CARDIOMYOPATHIES   GOTOBUTTON palsy CEREBRAL PALSY   GOTOBUTTON CFS CHRONIC FATIGUE SYNDROME  (CFS)  GOTOBUTTON COPD CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)  Asthma, Chronic Bronchitis, Emphysema  GOTOBUTTON cirrhosis CIRRHOSIS, ALCOHOLIC LIVER DISEASE ( ALS)  GOTOBUTTON biliary PRIMARY BILIARY CIRRHOSIS   GOTOBUTTON CABG CORONARY ARTERY BYPASS SURGERY OR CORONARY ANGIOPLASTY  (Coronary Artery Bypass Graft [CABG], Percutaneous Transluminal Coronary Angioplasty [PTCA])  GOTOBUTTON crohns CROHN'S DISEASE, IRRITABLE BOWEL SYNDROME , ---------------------------------------- ULCERATIVE COLITIS, DIVERTICULITIS (Colitis, Regional Enteritis, Ileitis, Proctitis, Spastic colitis)  GOTOBUTTON cushings CUSHING'S SYNDROME --------------------------------------------------------------------------------  GOTOBUTTON depression DEPRESSION  (Anxiety, Mania, Manic Depression, Bipolar Disorder)  GOTOBUTTON DM DIABETES MELLITUS (DM)   GOTOBUTTON dizziness DIZZINESS   GOTOBUTTON COPD EMPHYSEMA  (see COPD)_________ ___________________________________________  GOTOBUTTON epilepsy EPILEPSY  (Seizures)  GOTOBUTTON eye EYE DISORDERS   GOTOBUTTON fibromyalgia FIBROMYALGIA   GOTOBUTTON fractures FRACTURES   GOTOBUTTON hemochromatosis HEMOCHROMATOSIS   GOTOBUTTON hemoptysis HEMOPTYSIS   GOTOBUTTON hepatitis HEPATITIS  (Acute and Chronic Viral Hepatitis)  GOTOBUTTON hodgkins HODGKIN'S DISEASE   GOTOBUTTON HTN HYPERTENSION  (High Blood Pressure)  GOTOBUTTON kidney_stones KIDNEY STONES (Nephrolithiasis) (Renal Colic, Calculus or Stone)  GOTOBUTTON leukemia LEUKEMIA   GOTOBUTTON CLL LEUKEMIA, CHRONIC LYMPHOCYTIC (CLL)   GOTOBUTTON HCL LEUKEMIA, HAIRY CELL (HCL)   GOTOBUTTON lymphoma LYMPHOMA   GOTOBUTTON melanoma MALIGNANT MELANOMA   GOTOBUTTON memory_loss MEMORY LOSS  (Frequent/persistent forgetfulness)  GOTOBUTTON meningitis MENINGITIS   GOTOBUTTON myeloma MULTIPLE MYELOMA   GOTOBUTTON MS MULTIPLE SCLEROSIS (MS)   GOTOBUTTON MS DEMYELINATING DISEASE   GOTOBUTTON dystrophy MUSCULAR DYSTROPHY   GOTOBUTTON myasthenia MYASTHENIA GRAVIS   GOTOBUTTON MI MYOCARDIAL INFARCTION (MI)  (Heart Attack, Coronary)  GOTOBUTTON neuropathy NEUROPATHY   GOTOBUTTON non_hodgkins NON-HODGKIN'S LYMPHOMA (see Lymphoma)   GOTOBUTTON NPH NORMAL PRESSURE HYDROCEPHALUS (NPH)   GOTOBUTTON OA OSTEOARTHRITIS (OA)  (Degenerative Joint Disease [DJD], hypertrophic arthritis)  GOTOBUTTON OP OSTEOPOROSIS (OP)   GOTOBUTTON pagets PAGET'S DISEASE OF THE BONE   GOTOBUTTON parkinsons PARKINSON'S DISEASE   GOTOBUTTON PVD PERIPHERAL VASCULAR DISEASE (PVD)  (Peripheral Atherosclerostic Disease) PHYSICAL THERAPY  GOTOBUTTON polio POLIOMYELITIS - POST POLIO SYNDROME   GOTOBUTTON PCKD POLYCYSTIC KIDNEY DISEASE (PCKD)   GOTOBUTTON polycythemia POLYCYTHEMIA   GOTOBUTTON PMR POLYMYALGIA RHEUMATICA (PMR)   GOTOBUTTON polymyositis POLYMYOSITIS - DERMATOMYOSITIS   GOTOBUTTON BPH PROSTATE DISORDERS   GOTOBUTTON ARF RENAL FAILURE, ACUTE (ARF)  (Kidney Failure, Acute)  GOTOBUTTON CRF RENAL FAILURE, CHRONIC (CRF)  (Kidney Failure, Chronic)  GOTOBUTTON RA RHEUMATOID ARTHRITIS (RA) )  GOTOBUTTON RA SJOGRENS SYNDROME   GOTOBUTTON sarcoidosis SARCOIDOSIS   GOTOBUTTON psychosis SCHIZOPHRENIA OR OTHER PSYCHOSIS  (Paranoia and Delusional States)  GOTOBUTTON scleroderma SCLERODERMA   GOTOBUTTON scleroderma (CREST Syndrome)   GOTOBUTTON sleep_apnea SLEEP APNEA   GOTOBUTTON slipped_disc SLIPPED/RUPTURED DISC  (Herniated Nucleus Pulposus)  GOTOBUTTON spinal_stenosis SPINAL STENOSIS   GOTOBUTTON CVA STROKE (CVA)  Cerebral Vascular Accident (CVA)  GOTOBUTTON surgery SURGERY   GOTOBUTTON syncope SYNCOPE  (Fainting or Black out)  GOTOBUTTON SLE SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)  Disseminated Lupus, Discoid Lupus Erythematosus  GOTOBUTTON thrombocythemia THROMBOCYTHEMIA  (Thrombocytosis)  GOTOBUTTON thrombocytopenia THROMBOCYTOPENIA   GOTOBUTTON thromboembolism THROMBOEMBOLISM  (Venous, Arterial or Pulmonary embolism)  GOTOBUTTON TGA TRANSIENT GLOBAL AMNESIA (TGA)   GOTOBUTTON TIA TRANSIENT ISCHEMIC ATTACK (TIA)   GOTOBUTTON marrow TRANSPLANTATION OF BONE MARROW   GOTOBUTTON cornea TRANSPLANTATION OF THE CORNEA   GOTOBUTTON of_heart TRANSPLANTATION OF THE HEART   GOTOBUTTON of_kidney TRANSPLANTATION OF THE KIDNEY   GOTOBUTTON of_liver TRANSPLANTATION OF THE LIVER   GOTOBUTTON tremors TREMORS AND OTHER INVOLUNTARY MOVEMENTS DISORDERS   GOTOBUTTON TB TUBERCULOSIS (TB)   GOTOBUTTON ulcer_skin ULCERS OF THE SKIN   GOTOBUTTON valvular_disease VALVULAR HEART DISEASE   GOTOBUTTON drugs DRUG INDEX   GOTOBUTTON glossary GLOSSARY   GOTOBUTTON index INDEX    GOTOBUTTON toc INTRODUCTION  xe "INTRODUCTION"  GOTOBUTTON toc LONG TERM CARE UNDERWRITING  xe "LONG TERM CARE UNDERWRITING" The primary objective of the underwriting process is to collect, review and correlate all available information regarding an applicant for LTC coverage and to evaluate the risk to the Company of issuing coverage to that applicant. Field Underwriting XE Field Underwriting"  XE Underwriting, Field "  The purpose of the Field Underwriting process is to: symbol 183 \f "Symbol" \s 8 \h evaluate and report on the applicants past and present health current functional status symbol 183 \f "Symbol" \s 8 \h determine if all factors would be acceptable to the Company symbol 183 \f "Symbol" \s 8 \h submit a completed application for qualified applicants to the Home Office Home Office Underwriting xe "Underwriting, Home Office"xe "Home Office Underwriting" The purpose of Home Office Underwriting is to: symbol 183 \f "Symbol" \s 8 \h evaluate the completed application and any attachments containing additional information completed Agent's Report section of the application copies of medical records results of the Health Interviewxe "interview: health", when required results of a telephone interview XE "interview:telephone, Personal History Interview (PHI)" , when required (Personal History Interview [PHI])xe "Personal: History Interview (PHI)" issue coverage to those applicants who qualify. Unique factors of Long Term Care Underwriting xe unique factors of long term care underwriting"The underwriting of long term care insurance differs from the underwriting of other products (such as life insurance) in that the Field Underwriter and the Home Office underwriter must consider many things which, for another type of insurance, might not seem important. A few of these unique factors are listed below. symbol 118 \f "Wingdings" \s 10 \h Cognitive statusxe cognitive status" symbol 118 \f "Wingdings" \s 10 \h Functional capacity xe "Functional capacity " - The ability to perform the Activities of Daily Living xe "Activities of Daily Living (ADL)" (e.g. dressing, transferring) - The ability to perform the Instrumental Activities of Daily Living xe "Instrumental Activities of Daily Living (IADL)" (e.g. shopping, meal preparation) symbol 118 \f "Wingdings" \s 10 \h Medical historiesxe "medical histories" that may result in a need for care (e.g. osteoporosis, falls, and fractures) symbol 118 \f "Wingdings" \s 10 \h Multiple medical problems XE "medical problems, multiple"  that, in combination, are more significant than each problem alone (e.g. diabetes in combination with heart disease) symbol 118 \f "Wingdings" \s 10 \h Multiple medications XE "medication: multiple "  (being taken for multiple medical problems) that may have adverse effects symbol 118 \f "Wingdings" \s 10 \h Treatment modalitiesxe "treatment modalities" (e.g. current physical therapy XE "physical therapy" ) symbol 118 \f "Wingdings" \s 10 \h Chronological Age vs Physiological Age - There may be a significant difference between the applicant's chronological agexe "age: chronological"xe "chronological age" and physiological agexe "physiological age"xe "age: physiological" (e.g. The applicant may seem much younger or older than his/her actual age) symbol 118 \f "Wingdings" \s 10 \h Frailty -  XE "frailty" Serious disabilities can result from relatively minor accidents and illnesses symbol 118 \f "Wingdings" \s 10 \h Personal Independence Factorsxe "Personal: Independence Factors" that play an important role in maintaining an applicant's personal independence are: symbol 183 \f "Symbol" \s 8 \h Working XE "Working"  XE "Working:full or part-time" \b , either full or part-time symbol 183 \f "Symbol" \s 8 \h A spouse in good health symbol 183 \f "Symbol" \s 8 \h Family or friend(s) living in the household symbol 183 \f "Symbol" \s 8 \h Volunteering at service clubs symbol 183 \f "Symbol" \s 8 \h Participating in hobbies and outside activities symbol 183 \f "Symbol" \s 8 \h The current ability to drive symbol 183 \f "Symbol" \s 8 \h The ability to travel and visit independently UNDERWRITING REQUIREMENTS REQUIREMENT ORDERING IS DRIVEN BY CLIENT AGE AND PREFERRED DISCOUNT QUALIFICATIONNo RequirementTelephone InterviewMedical Records (MRR) Health Interview18 to 64 PD = YesX18 to 64 PD = No PCP Seen within 2 YearsX18 to 64 PD = No PCP Not Seen within 2 YearsX65 to 79 PCP Not Seen within 2 YearsX65 to 71 PCP Seen within 2 Years X72 to 79 PCP Seen within 2 YearsXX  GOTOBUTTON toc THE FIVE I's xe "FIVE I's" xe "THE FIVE I's" The elderly are subject to certain problems that are called the Five I's of geriatrics. They are: (1) Intellectual impairmentxe "Intellectual impairment" (2) Immobilityxe "Immobility" (3) Instabilityxe "Instability" (4) Incontinencexe "Incontinence" (5) Iatrogenic drug reactionsxe "Iatrogenic drug reactions" (1) Intellectual Impairment Senile dementiaxe "dementia:senile" or senilityxe "senility" is a major cause of LTC usage. It is estimated that senility affects approximately 10% of the population over age 70 and greater than 20% of the people over age 80. More than half of these people suffer from Alzheimer'sxe "Alzheimers Disease: Five Is" type of senility. Other conditions that may mimic senility include multiple drug effects, depression,xe "depression" or brain tumorsxe "brain:tumors, Five Is". (2) Immobility Specific conditions that contribute to immobility include malnutrition, anemiaxe "anemia", orthopedic conditions (such as osteoarthritisxe "osteoarthritis (OA):immobility" and osteoporosisxe "osteoporosis (OP):immobility"), neurologic conditions (such as strokexe "stroke:immobility"), and psychiatric conditions (such as depressionxe "depression"). (3) Instability Instability may result in falls and injuries. Causes of instability include vertigo xe "vertigo"(dizziness), musculoskeletal conditions (e.g. arthritisxe "arthritis:instability"), alcohol, xe "alcohol:instability "or drugs. (4) Incontinence (Bowel and Bladder) Incontinence is a lack of bowel XE "bowel:incontinence"  XE "bladder:incontinence"  XE "incontinence:bowel"  XE "incontinence:bladder"  and/or bladder control. This may be caused by conditions such as multiple sclerosis (MS)xe "multiple sclerosis (MS):incontinence", stroke (CVA)xe "stroke:incontinence", benign prostatic hypertrophy (BPH)xe "benign prostatic hypertrophy (BPH):incontinence", drug effects, or urinary tract problems. Some of these conditions can be treated with surgery or medication. (5) Iatrogenic Drug Reactions Iatrogenic drug reactions XE "drug reactions"  are common in the elderly. Older applicants are more likely to be taking various prescription medications XE "medications"  XE "medications"  XE "prescription medications:drug reactions"  and over-the-counter (OTC) drugs. Studies have shown that the average geriatric patient takes eight different medications daily. Thus, there is a significant potential for drug interactions, drug toxicity, and dosage errors that may adversely affect intellectual capacity and/or physical ability.  GOTOBUTTON toc DECISION TERMINOLOGY  xe "Decision Terminology"\i The following defines the decision terminology used by the Home Office Underwriter. APPROVEDxe Approved" XE "Decision Terminology:Approved" : Requested benefits were approved. DECLINEDxe "Declined" Xe Decision Terminology:Declined" : Coverage is not issued as the risk is uninsurable. RECONSIDERATION AVAILABLE:xe "Reconsideration Available" Xe Decision Terminology:Reconsideration Available" A conditional offer to review another application at a later date. RECONSIDERATION NOT AVAILABLE:xe "Reconsideration Not Available"  Xe Decision Terminology:Reconsideration Not Available"There is no offer to reconsider at a later date as the risk is uninsurable.  GOTOBUTTON toc UNINSURABLE CONDITIONS  Uninsurable conditions include functional deficits XE "functional deficits"  and medical conditions that have a high probability of resulting in a need for long term care use. The risk associated with these conditions is unacceptable. Most uninsurable conditions XE "uninsurable conditions: reconsideration not available"  cannot be reconsidered because: symbol 183 \f "Symbol" \s 10 \h recovery is rare or a cure is not available at this time (e.g. Alzheimer's disease). symbol 183 \f "Symbol" \s 10 \h the symptoms are severe and tend to be progressive (e.g. emphysema requiring oxygen). Applications should not be taken on individuals with known uninsurable conditions. If an application containing one or more of these uninsurable conditions is submitted, the application will be declined without medical records or a personal interview. Processing an application containing a declinable history is costly and time consuming for all. Do not submit applications for individuals with functional deficits, or medical/cognitive impairments that are uninsurable.  GOTOBUTTON toc SPECIFIC UNINSURABLE MEDICAL CONDITIONS  XE Uninsurable: Specific Medical Conditions" Below is a list of specific uninsurable medical conditions that will not be acceptable at any time. xe Specific Uninsurable Medical Conditions"\b \i Acquired Immune Deficiency Syndrome (AIDS XE "AIDS" \b \i ) xe Acquired Immune Deficiency Syndrome (AIDS)"\b \i  ADL limitation XE "ADLs:Specific Uninsurable Medical Conditions "\b \i , present AIDS Related Complex (ARC) XE "AIDS Related Complex (ARC)"\b\i  Alzheimer's Diseasexe "Alzheimers Disease" \b \i  Amputation XE "Amputation" \b \i  due to disease, e.g. diabetes or atherosclerosis Amyotrophic Lateral Sclerosis XE "Amyotrophic Lateral Sclerosis" \i  (ALS XE "ALS, Amyotrophic Lateral Sclerosis" , Lou Gehrig's Disease XE "Lou Gehrig's Disease" \b \i ) Antiphospholipid Syndrome Aplastic Anemia XE "anemia:aplastic" \b \i  XE "Aplastic Anemia" \b \i  Ascitesxe Ascites" \b \i  present Ataxia, Cerebellar XE "Cerebellar Ataxia" \b \i  XE "Ataxia:cerebellar" \b \i  Autonomic Neuropathy XE "Neuropathy:autonomic" \b \i xe Autonomic: Neuropathy" \b \i  (excluding impotence) Autonomic Insufficiency XE "Insufficiency:Autonomic"  xe "Autonomic: Insufficiency " \b \i (Shy-Drager Syndrome XE "Shy-Drager Syndrome" \b \i ) Beurgers Disease Binswangers Disease Blindness XE "blindness" \b \i  due to disease or with ADL/IADL limitations Brain Disorder (Organic Brain Syndrome XE "Organic Brain Syndrome (OBS)" \b \i ) XE "Brain: Disorder (Organic Brain Syndrome)" \b \i  Cerebral Vascular Accident (CVA) XE "Cerebral: Vascular Accident (CVA)" \b \i  Chorea XE "Chorea" \b \i  Chronic Memory Loss XE "memory: loss, chronic" \b \i  XE "chronic: memory loss" \b \i  Cystic Fibrosis XE "Fibrosis:cystic" xe Cystic Fibrosis" \b \i  Dementia XE "Dementia" \b \i  Dialysis, Kidney XE "Kidney:dialysis" \b \i  (Renal Xe renal (kidney):dialysis" \b \i ) XE "Dialysis" \b \i  Diabetes treated with insulin DWR failed XE "Failed:DWR" \b \i xe DWR failed" \b \i  Forgetfulness XE "forgetfulness" \b \i  (frequent or persistent) Gangrenexe Gangrene"\b \i  due to diabetes or peripheral vascular disease Gauchers Disease Hemiplegia Hoyer Lift Huntingtons  XE "Huntingtons" or other forms of Chorea XE "Chorea" \b \i  Immune Deficiency Syndrome XE "Immune Deficiency Syndrome" \b \i  Incontinence  XE "incontinence" \b \i  Bowel incontinence XE "bowel:incontinence" \b \i  XE "incontinence:bowel" \b \i  Bladder incontinence XE "bladder:incontinence" \b \i  requiring assistance Korsakoffs Psychosis XE "incontinence:bladder" \b \i  Leukemiaxe Leukemia"\b \i -except for Chronic Lymphocytic Leukemia (CLL) and Hairy Cell Leukemia (HCL) Memory Loss, chronic Mesothelioma XE "memory: loss, chronic" \b \i  Multiple Sclerosis XE "Sclerosis: Multiple (MS)" \b \i  (MS)xe Multiple Sclerosis (MS)"\i\b Muscular Dystrophy (MD) XE "Muscular Dystrophy (MD)"  Organ Transplants, XE "transplantation:organ" \b \i xe organ transplants"\b \i  except a kidney & liver transplant Organic Brain Syndrome (OBS) XE "Organic Brain Syndrome (OBS)" \b \i  Oxygen usexe oxygen: use" \b \i  except if used for headaches or sleep apnea Paralysis XE "Paralysis" \b \i /Paraplegiaxe Paraplegia" \b \i  Parkinson's Diseasexe "Parkinson's:Disease" \b \i  Pneumocystis Pneumonia Postero-Lateral Sclerosis Quad Cane use XE "Pneumonia:Pneumocystis" \b \i  XE "Pneumocystis Pneumonia" \b \i  Quadriplegiaxe Quadriplegia"\b \i  Senilityxe senility"\b \i  Short Portable failed XE "failed:Short Portable" \b \i  XE "Short Portable failed" \b \i  Spinal Cord Injury XE "Spinal: cord injury" \b \i  with ADL/IADL limitations Stroke (CVA XE "CVA (stroke)" \b \i ) xe stroke " \b \i  Surgery xe surgery "\b \i scheduled or anticipated (except cataract surgery under local anesthesia) Total Parenteral Nutrition (TPN XE "TPN" \b \i ) XE "Total Parenteral Nutrition (TPN)" \b \i  for regular or supplementary feeding or administration of medication Walker use Wernicke-Korsakoff Syndrome XE "walker" \b \i  Wheelchair use XE "wheelchair" \b \i   GOTOBUTTON toc UNINSURABLE FUNCTIONAL DEFICIT  XE "Uninsurable: Functional Deficits"  It is important that you know which applicants are successful candidates for Long Term Care insurance. One of the most difficult aspects is determining how well your applicant functions independently with both the Activities of Daily Living (ADLs) and the Instrumental Activities of Daily Living (IADLs). Observing your applicant during your initial interview can provide you with vital information. Observations you should make: Does the applicant walk without difficulty? Do you notice any imbalance or obvious limp? Do you notice a tremor? Do you notice any shortness of breath after minimal activity? Questions you should ask: Does the applicant require any assistance with daily activities? Is an assistive devise used? What type? Does the use of an assistive device prevent the applicant from independently carrying the groceries or laundry? Can housekeeping, shopping, cooking, and laundry be performed independently? Can the applicant use the phone book, arrange transportation, write checks, balance the checkbook, and select items at the grocery store independently? Uninsurable ADL Deficits:  XE "Uninsurable ADL Deficits\"  XE " Deficits, Uninsurable ADL \"  XE " ADL, Uninsurable Deficits\"  Any suggestion of current disability requiring supervision or assistance in any of the following ADLs is uninsurablexe "Activities of Daily Living (ADL)": Dressingxe "dressing" Bathingxe "bathing" Eatingxe "eating" Toiletingxe "toileting" Transferring (e.g. moving from bed to chair)xe "transferring from bed to chair" Continence XE "continence" \t "See Incontinence" , either Bowel or Bladderxe "continence: bowel or bladder" Mobility/Ambulationxe "ambulation"xe "mobility" Uninsurable IADL Deficits:  XE "Uninsurable IADL Deficits\"  XE " Deficits, Uninsurable IADL \"  XE " IADL, Uninsurable Deficits\"  Any information implying current supervision or assistance by someone in two or more of the following IADLsxe "Instrumental Activities of Daily Living (IADL)": Shoppingxe "shopping" Meal Preparationxe "meal preparation" Transportationxe "transportation" Housework (Chores)xe "housework (chores)" Managing Financesxe "finances, managing" Laundryxe "laundry" Using the Telephonexe "telephone use" Taking Medications (uninsurable if assistance needed with this single IADL)xe "medication:taking, IADLs " Additional Uninsurable Deficits:  XE "Additional Uninsurable Deficits\"  XE " Uninsurable Deficits, Additional \"  XE "Deficits, Additional Uninsurable \"  Use of a walker,xe "walker:functional deficits" quad cane XE "quad cane:functional deficits " , wheelchair,xe "wheelchair:functional deficits " electric cart or scooter XE "electric cart or scooter:functional deficits"  XE "scooter or electric cart:functional deficits", electric chair lift XE "electric chair lift:functional deficits" XE "chair lift, electric:functional deficits", Hoyer lift XE "Hoyer lift:functional deficits" XE "lift, Hoyer:functional deficits" , or hospital bed XE "hospital bed:functional deficits"  XE " bed, hospital:functional deficits"  The use of oxygenxe "oxygen:functional deficits ", respirator,xe "respirator:functional deficits " or kidney dialysis XE "dialysis:functional deficits " xe "kidney: dialysis,functional deficits " Current institutionalizationxe "institutionalization" in any facility (e.g., hospital, nursing homexe "nursing home", Assisted Living/Care Facilityxe "sssisted living/care facility", home for the agedxe "home for the aged", xe "hospital"etc.) Current use of Home Care Servicesxe "Home Care Services" (e.g. Skilled XE "skilled care" xe "home care services: skilled", Custodial XE "custodial care" xe "home care services: custodial", Hospice XE "hospice" xe "home care services: hospice care" Care, etc.), or Adult Day Care Usexe "adult day care use" Beginning use within 6 months of any of the following: Catheterxe "catheter:functional deficits " or Other Drainage Device XE "drainage device:functional deficits "  Hospital Bedxe "hospital bed:functional deficits " Ostomy Carexe "ostomy care:functional deficits " Any Nursing Home Usexe "nursing home use " (Skilled, Intermediate or Custodial) within the past 12 months Any Home Care Servicexe "home care service use" Use (Skilled, Custodial, or Hospice Care) within the past 12 months Any Adult Day Carexe "adult day care use" Services within the past 12 months  GOTOBUTTON toc UNINSURABLE COMBINATION MEDICAL HISTORIES  XE "Uninsurable Combination Medical Histories" XE "Combination Medical Histories, Uninsurable" The following combination medical histories are not acceptable: Asthma XE "Asthma" \t "See uninsurable combination medical histories"   XE "Asthma"  Congestive heart failure (CHF) within 5 years/Cardiomyopathy Chronic Bronchitis XE "Chronic Bronchitis" \t "See uninsurable combination medical histories"   XE "Chronic Bronchitis"  Congestive heart failure (CHF) within 5 years /Cardiomyopathy Congestive Heart Failure (CHF) within 5 years  XE "Congestive Heart Failure (CHF)" \t "See uninsurable combination medical histories"  XE "Congestive Heart Failure (CHF)"  Heart attack or angina Emphysema/COPD Asthma/chronic bronchitis Diabetes Tuberculosis (TB) COPD (Chronic Obstructive Pulmonary Disease)/Emphysema XE "COPD (Chronic Obstructive Pulmonary Disease)/Emphysema" \t "See uninsurable combination medical histories"   XE "COPD (Chronic Obstructive Pulmonary Disease)/Emphysema"  Congestive heart failure (CHF) within 5 years /Cardiomyopathy Diabetes XE "Diabetes" \t "See uninsurable combination medical histories"   XE "Diabetes"  Congestive heart failure (CHF) within 5 years Diabetic skin ulceration or infections Amputation due to diabetes Diabetic blindness Heart disease or heart surgery Kidney failure TIA or Amaurosis fugax Heart surgery XE "Heart surgery" \t "See uninsurable combination medical histories"   XE "Heart surgery"  TIA Cardiomyopathy/Post-surgical congestive heart failure (CHF) Diabetes Joint Replacement XE "Joint Replacement"  XE "Joint Replacement" \t "See uninsurable combination medical histories"  Rheumatoid arthritis Within 12 months with Ankylosing spondylitis or Polymyosisitis-Dermatositis Significantly overweight Rheumatoid Arthritis XE "Rheumatoid Arthritis"  XE "Rheumatoid Arthritis" \t "See uninsurable combination medical histories"  Joint replacement Osteoarthritis TIA (Transient Ischemic Attack) XE "TIA (Transient Ischemic Attack)"  XE "TIA (Transient Ischemic Attack)" \t "See uninsurable combination medical histories"  Diabetes Atrial fibrillation Cardiomyopathy Cerebrovascular aneurysm Heart attack Heart surgery Carotid artery stenosis or blockage (>90%) Polycythemia Rheumatic heart disease Refer to Specific Medical Conditions  GOTOBUTTON toc HEIGHT/WEIGHT TABLE (build)  The relationship of height to weight (build) XE "Build" \t "See Height/Weight Table"  is an important risk factor. Significant changes in weight may prove to be unacceptable. The following are general build guidelines. OVERWEIGHT: xe "Overweight" \b \i Obesity XE "Obesity" \b \i  increases an individual's likelihood of developing cardiovascular-renal diseases. Obesity can also create problems in treating other conditions. For example, there can be increased difficulties during surgery or delayed recovery from injuries to weight bearing bones. The weights listed in column (1) represent the maximum acceptable build configuration when it is present with other significant impairments, and there is evidence of active lifestyle with full functionality. The weights listed in column (2) represent the maximum acceptable build configuration when it is present without any other significant impairment, and there is evidence of active lifestyle with full functionality. Obesity XE "Obesity: in combination with"  in combination with heart disease, high blood pressure, joint replacement(s), and arthritis may render unacceptable an otherwise insurable history. If there is a history of Diabetes, refer to Diabetic Build chart in the diabetes matrix.  GOTOBUTTON toc UNDERWEIGHT:  xe "Underweight" \b \i Abnormally thin people may be unable to gain weight because of nervous problems, chronic illness, or because of nutritional deficiencies (possibly alcoholism). More significantly, they often have a poor resistance to acute illnesses. The weights listed below represent the minimum acceptable build configuration with evidence of active lifestyle and full functionality. Any unintentional/unexplained weight loss or gain of more than 15% of normal weight within a 12-month period, could be considered uninsurable. See next page for overweight / underweight build chart, Effective 9/1/03 The weights listed below represent the maximum and minimum acceptable build configuration with evidence of active lifestyle and full functionality. If over or under the height/weight limits stated below, the application should not be submitted. Effective 9/1/03   GOTOBUTTON toc ADDISON'S DISEASE  XE "Addisons Disease" \i  Addisons disease refers to a condition where the adrenal glands XE "adrenal glands"  are non-functioning, with the resultant decrease in the bodys natural amount of cortisone as well as aldosterone. There are several causes of adrenal gland failure, including the inability of the pituitary gland XE "pituitary gland"  to secrete the adrenal stimulating hormone XE "adrenal stimulating hormone" . In addition, circulating antibodies can attack and destroy the glands. Lastly, spontaneous hemorrhage within the glands may reduce function. The typical symptoms of Addisons include weakness, weight loss XE "weight loss:Addison's" , hyperpigmentation of the skin XE "hyperpigmentation of the skin"  and electrolyte imbalance XE "electrolyte imbalance" . Fortunately, treatment is simple once the diagnosis has been confirmed. Replacement therapy with both cortisone XE "cortisone:Addison's disease"  and, if necessary, aldosterone XE "aldosterone"  improves general well being and corrects the electrolyte imbalances. Questions You Should Ask and Criteria:Is a work-up underway and/or cause unknown?not acceptableHas there been significant weight loss XE "weight loss"  of greater than 15 %?not acceptable  GOTOBUTTON toc ALCOHOLISM  XE "ALCOHOLISM" \t "See depression"  XE "ALCOHOLISM" \t "See cirrhosis, alcoholic liver disease"  (Alcohol abuse, Ethanolismxe ethanolism"\b \i , ETOH diseasexe ETOH disease"\b \i ) Alcoholism XE "Alcoholism" \t "See Depression"  XE "Alcoholism" \t "See Cirrhosis, alcoholic liver disease "  is the abuse of alcohol, which interferes with health, economic, or social functioning. There is compulsive behavior and loss of control due to the continued use of alcohol despite adverse consequences. Potential effects from alcoholism XE "alcoholism:effects from "  include: dementiaxe "dementia: alcoholism"; heart, gastrointestinal XE "gastrointestinal:disorders, alcoholism"  and nervous disorders XE "nervous disorders:alcoholism" ; and fractures xe "fractures:alcoholism "from frequent fallsxe "falls:alcoholism".xe "alcoholism:falls". Alcoholism is frequently associated with depression, and this combination of histories is a poor risk. Questions You Should Ask and Criteria:How long has there been abstinence XE "abstinence from alcohol" /sobriety XE "sobriety" ?not acceptable with less than 24 months of abstinence/sobrietyHave there been any ER visits or hospitalizations for alcohol related problems within the past 24 months? not acceptableAre there any physical or mental abnormalities due to alcoholism?not acceptableHas there been a diagnosis of or any symptoms of manic depression within the past 24 months?not acceptableHave there been any symptoms of psychosis / schizophrenia within the past 4 years?not acceptableHas there been any halfway house or sheltered living within the past 24 months?not acceptableHas there been any unintentional weight loss XE "weight loss"  of more than 15% in the past 12 months? not acceptable Has antabuse treatment been initiated in the past 12 months? not acceptableHave Benzodiazepines or Lithium been initiated within the past 24 months?not acceptableHave Haldol, Mellaril or Ritalin been initiated within the past 4 years?not acceptableIs neurological work up planned or underway (CT, MRI, neuro referral)?not acceptable Cross-references:  GOTOBUTTON depression Depression  XE "Depression" \t "See alcoholism"   GOTOBUTTON cirrhosis Cirrhosis, alcoholic liver disease  XE "Cirrhosis, alcoholic liver disease" \t "See alcoholism"   GOTOBUTTON toc ALZHEIMER'S DISEASE  xe "Alzheimers Disease"\b \i DEMENTIAxe "Dementia"\b \i  (Organic Brain Syndrome [OBS]xe "Brain:Organic Brain Syndrome (OBS)"\b \i xe "Organic Brain Syndrome (OBS)", Senile Dementia XE "Senile Dementia:Alzheimer's" \b \i ) Alzheimer's disease/dementia is the progressive degeneration of the brainxe "Brain: progressive degeneration of" with resulting loss of function. The physical signs include memory lossxe "memory: loss, Alzhemiers", and impairments of thinking, reasoning,xe "reasoning, impaired logical" and judgmentxe "judgment, impaired". In advanced stages, behavioral disturbancesxe "behavioral disturbances: Alzheimers" and loss of control of bodily functions occur. General Criteria: Alzheimer's disease or other types of dementia XE "Dementia:Alzheimer's"  XE "Dementia:other types of"  are Specific Uninsurable Medical Conditions.  GOTOBUTTON toc AMYOTROPHIC LATERAL SCLEROSIS (ALS)  xe "Sclerosis:Amyotrophic Lateral Sclerosis (ALS) " \ixe "Amyotrophic Lateral Sclerosis(ALS) " \i xe "Lateral Sclerosis, Amyotrophic (ALS) " \i Lou Gehrig's Diseasexe "Gehrig's Disease, Lou"\b \i xe Lou Gehrig's Disease"\b \i  XE "ALS, Amyotrophic Lateral Sclerosis" \i  Amyotrophic Lateral Sclerosis is the degeneration of nerves that affect the muscles of the body. Spastic weaknessxe "Spastic:weakness, ALS" and atrophy of the limb muscles XE "muscle:limb muscles atrophy (ALS)"  XE "atrophy of the limb muscles"  occur first with later involvement of the torso muscles. The disorder is sometimes associated with dementiaxe "dementia: ALS", Parkinsonismxe "Parkinsonism: ALS", and other neurologic disorders XE "neurologic disorders: ALS" . The cause is unknown and the course is progressive. General Criteria: Amyotrophic Lateral Sclerosis is a Specific Uninsurable Medical Condition.  GOTOBUTTON toc ANAL & RECTAL IMPAIRMENTS  BOWEL INCONTINENCExe "Incontinence:bowel "\b \i xe "bowel: incontinence"\b \i  Listed below are impairments affecting the lower bowelxe "lower bowel, impairments affecting": Anal Fissurexe "fissure, anal"xe "anal: fissure"a longitudinal tear in the skin of the anal canal.Anal Ulcerxe "ulcers: anal"xe "anal:ulcers"an acute or chronic ulcer in the skin of the anal canal.Anorectal Abscessxe "abscess, anorectal"xe "anorectal:abscess"a localized bacterial infection of the perirectal tissue.Anorectal Fistulaxe "fistula, anorectal"xe "anorectal:fistula"a tract between the anal canal and the perianal skin.Bowel Incontinencethe inability to voluntarily control bowel function.Hemorrhoidxe "Hemorrhoids"enlarged veins that line the lower rectum, anal canal, and external anal sphincter, and may be internal and/or external.Rectal Stricture (rectal stenosisxe "stenosis:rectal"xe "rectal:stenosis")xe stricture, rectal"xe "rectal:stricture"the abnormal narrowing of the anus or rectum by either a congenital malformation or scarring from previous anorectal disease.Rectal Prolapsexe "prolapse: rectal"xe "rectal:prolapse"a protrusion of the rectal mucosa through the anus. Questions You Should Ask and Criteria:Is surgery planned or been completed within the past 6 months? not acceptable (excludes hemorrhoid surgery)Is bowel incontinence XE "bowel incontinence"  present, 1 or more times per week? not acceptableHas there been any unintentional weight loss XE " weight loss: unintentional "  of more than 20% within the past 12 months? not acceptableIs a work-up underway or diagnosis uncertain for a new onset of symptoms, including bowel incontinence? not acceptableHas there been a need for tube feeding within the past 12 months? not acceptableHas there been any genital skin break down within the past 24 months? not acceptable  GOTOBUTTON toc ANEMIA   XE "blood:anemia" xe "Anemia"\b \i The anemias are a collection of blood conditions in which there is a reduction in the concentration of circulating red blood cells. This reduction is usually expressed as a decrease in the hemoglobin (Hgb)xe "hemoglobin (Hgb)", hematocrit (Hct)xe "hematocrit (Hct)", or red blood cell count (RBC)xe "red blood cell count (RBC)". Anemia can reflect serious underlying disease and the potential for disability. In the elderly population, it can also be a marker of deteriorating general health and the approaching loss of independence. The three principal causes of anemiaxe "anemia:causes of " are a significant blood loss, failure of the bone marrow to produce sufficient red blood cells, and a decrease in the red blood cell survival time. ANEMIA, IRON DEFICIENCY xe "Iron Deficiency: Anemia "(Microcytic Anemiaxe "anemia:microcytic "xe "microcytic anemia") Iron deficiency anemiaxe "anemia:iron deficiency " is one of the more common anemias. It usually occurs as the result of chronic bleeding from the gastrointestinal tract due to gastritisxe "gastritis", ulcers, xe "ulcers:anemia "or polypsxe "polyps". Insufficient dietary intake or inadequate absorption of iron can also be implicated in some cases. Regular supplementation of oral or injection iron may be acceptable. Any iron deficiency anemia that has not been thoroughly investigated or explained may be the result of a serious medical problem. ANEMIA, MEGALOBLASTIC xe "anemia:megaloblastic" \b\ixe "megaloblastic anemia " \b\i(Vitaminxe "Bl2 deficiency" Bl2 deficiencyxe "vitamin Bl2 deficiency", Folic acid deficiencyxe "folic acid deficiency") Megaloblastic anemia is usually attributed to vitamin Bl2 or folic acid deficiency, but may also be associated with alcoholismxe "megaloblastic anemia: alcoholism", administration of certain drugs, or inborn errors of metabolism. Regular supplementation with Vitamin Bl2 may be acceptable. The neurologic manifestations of vitamin Bl2 deficiency have a high likelihood of causing significant disability because they involve the peripheral nerves (peripheral neuropathyxe "peripheral: neuropathy, vitamin B12 deficiency "), spinal cord (weakness, poor coordination), or central nervous system (dementiaxe "dementia:vitamin B12 deficiency", psychosisxe "psychosis:vitamin B12 deficiency", ataxia).xe "ataxia:vitamin B12 deficiency" ANEMIA OF CHRONIC DISEASE xe "Anemia:chronic disease "\iAnemia of chronic disease is the second most common type of anemia in American adults, and may be the number one cause of anemia in those over the age of 70. It is associated with ongoing inflammatory processes including chronic infections XE "chronic: infections, Anemia of Chronic Disease" , inflammatory bowel disease XE "inflammatory bowel disease: anemia of chronic disease" , collagen vascular disease XE "collagen vascular disease: anemia of chronic disease" , severe traumatic or thermal injury, malignancy, and diabetes XE "diabetes: anemia of chronic disease" . Often times this anemia is complicated by ironxe "iron deficiency:anemia", Bl2xe "Bl2 deficiency", or folate deficiencies XE "folate deficiencies: Anemia of Chronic Disease"  that may also be a result of the chronic underlying inflammatory conditions. Treatment is directed at the underlying disease process. The prognosis is generally dependent upon the severity of the anemia and its cause.  GOTOBUTTON toc ANEMIA  Questions You Should Ask and Criteria:Has the cause of the anemia been identified?not acceptable if currently being evaluatedHas there been significant weight loss XE "weight loss"  of more than 20% of normal weight, without dieting, within the past 12 months ?not acceptableWhat is the current treatment?not acceptable if erythropoietin (Epogen) or Procrit  XE "erythropoietin" have been used within the past 12 months Has there been any hospitalization due to anemia in the past 12 months? not acceptable Are there any ADL XE "ADLs:anemia"  or IADL XE "IADLs:anemia"  limitations due to fatigue associated with anemia? see Uninsurable Functional Deficits Has there been a nonoperative transfusion within the past 12 months?not acceptable Is the average Hematocrit less than 33 or Hemoglobin less than 10.0?not acceptable Has there been a bleeding history secondary to Coumadin within the past 24 months?not acceptable Has there been alcohol abuse or illicit drug use within the past 24 months?not acceptable Have there been 2 or more ER visits for blood loss, neurological symptoms, fatigue or Congestive Heart Failure (CHF) within the past 24 months?not acceptable   GOTOBUTTON toc ANEMIA, APLASTIC  xe aplastic anemia"\b\ixe "anemia: aplastic"\b\i(Pancytopeniaxe Pancytopenia") Aplastic anemia describes the total failure of the bone marrow to produce any cell line (pancytopenia). A partial failure is called hypoplastic anemiaxe "Hypoplastic Anemia"xe "anemia:hypoplastic ". The acquired form of aplastic anemia is thought to be due to the injury or destruction of early blood cell precursors in the bone marrow. The destruction can be the result of exposure to specific medications, toxins, or viral agents. Often no etiology is ever discovered. The prognosis is generally poor. General Criteria: Aplastic anemia is a Specific Uninsurable Medical Condition.  GOTOBUTTON toc ANEURYSMS  XE "Aneurysms"  xe "aneurysm"\b\iAn aneurysm is an abnormal dilatation of an artery.xe "artery:abnormal dilatation" The most common sites for aneurysmsxe "aneurysm:most common sites" are the thoracicxe "aorta: thoracic"xe "thoracic aorta" or abdominal aortaxe "aorta:abdominal"xe "abdominal aorta", and the carotid,xe "arteries:carotid"xe "carotid artery" intracranial xe "intracranial arteries"xe "arteries:intracranial"or femoral xe "femoral arteries"xe "arteries:femoral "arteries. The aneurysm may produce local pressure or rupture. Treatment generally involves surgical repair. The prognosis depends on the cause and location of the aneurysm, the resulting organ damage, and the type of treatment. Information you should gather:Location of aneurysm --Aortic XE "Aortic" Cerebrovascular XE "Cerebrovascular" Carotid artery (contact Underwriting Hotline) XE "Carotid artery" Peripheral artery (use peripheral vascular disease [PVD] criteria) XE "Peripheral artery"  GOTOBUTTON toc ANEURYSMS, AORTIC  xe "aneurysm: aortic"\ixe "aortic: aneurysm"\iAn aortic aneurysm is an abnormal dilatation of the aortaxe "aorta: abnormal dilatation ". The aorta xe "aorta "is the large artery that carries blood from the heart to branch arteries throughout the body. The aorta is divided in two sections: ascending and descendingxe "aorta:ascending and descending "xe "descending aorta"xe "ascending aorta". The ascending aorta extends from the aortic valve of the heart to the great vessels of the head and neck. The descending portion of the aorta is considered the abdominal aorta and feeds the large arteries to the kidneys and the lower extremities. The recommended treatment for all ascending aortic aneurysms is surgery. Morbidity and mortality tend to be higher with ascending aortic aneurysms. Surgery is recommended for a descending aortic aneurysm when the size is 5 cm or greater. Smaller aneurysms may be treated surgically or medically. Medical treatment requires careful follow-up and good control of hypertensionxe "hypertension (HTN): aneurysm, aortic". Aneurysms may also be classified as dissecting aneurysmsXE "dissecting aneurysms" XE " aneurysms, dissecting". Dissection is most common in the aorta. There are three major complications of aortic dissection: blockage of other major vessels, rupture (bleeding), and dissection into the aortic valve of the heart. Questions You Should Ask and Criteria:Is this an ascending or descending aneurysm?not acceptable if there is an ascending aneurysm presentnot acceptable if there is a descending aneurysm greater than or equal to 5 cm in size, or if rapid progression in sizeIs there a history of untreated dissecting aortic aneurysm XE "untreated dissecting aortic aneurysm"  XE "aneurysm, untreated dissecting aortic " ?not acceptable if untreated, or surgically corrected within the past 2 yearsHas surgery been planned or recommended, or surgical repair completed within the past 6 months?not acceptable Was there a heart attack during or after the surgical aneurysm repair?not acceptable within 2 yearsWas there a coronary bypass surgery and/or aortic valve replacement at the time of the aortic aneurysm repair?not acceptable Is there a history of hypertension?not acceptable if the hypertension is poorly controlledIs there a history of diabetesnot acceptable Is there a history of a transient ischemic attack?not acceptable  GOTOBUTTON toc ANEURYSMS, CEREBROVASCULAR  XE CVA: Aneurysms, Cerebrovascular" \i xe "aneurysm: cerebrovascular "\b\ixe "cerebrovascular: aneurysm"\iCerebrovascular (brain) aneurysmsxe "aneurysm: brain "\ixe "brain: aneurysm"\i can cause two types of hemorrhagexe "hemorrhage: aneurysms": subarachnoidxe "hemorrhage:subarachnoid (SAH)"xe "subarachnoid hemorrhage (SAH)" and intracerebralxe "hemorrhage:intracerebral (ICH)"xe "intracerebral hemorrhages (ICH)"\i.  XE "cerebrovascular: aneurysm, subarachnoid hemorrhages"  XE "subarachnoid hemorrhage (SAH): cerebrovascular aneurysm" Subarachnoid hemorrhages (SAH) are most often due to aneurysms or vascular malformations, which produce bleeding into the space surrounding the brain. There is an increased risk of another bleed in the months following the initial bleed. Intracerebral hemorrhages (ICH) XE "intracerebral hemorrhages (ICH): Cerebrovascular Aneurysm"  are most often due to hypertension, which causes bleeding from vessels within the deep portions of the brain. The bleeding leads to the formation of a hematoma xe "hematoma "(a local collection of blood) within the brain. If bleeding has occurred these cases are underwritten as a Stroke. (A history of Stroke is not acceptable.) Questions You Should Ask and Criteria: Has any bleeding or rupture occurred as a result of the aneurysm?not acceptable Has surgery been recommended or performed? not acceptable if surgery recommended or completed within the past 12 monthsWas there a heart attack during or after the surgical aneurysm repair?not acceptable within 12 monthsIs there a history of diabetes XE "hypertension (HTN):aneurysm, cerebrovascular" ?not acceptable Is there a history of a Transient Ischemic Attack (TIA) XE "hypertension (HTN):aneurysm, cerebrovascular" ?not acceptable Is there a history of hypertension XE "hypertension (HTN):aneurysm, cerebrovascular" ?not acceptable if the hypertension is poorly controlled  GOTOBUTTON toc ANGINA, PECTORIS   XE "ANGINA PECTORIS" \t "See cardiac failure"  XE "ANGINA PECTORIS" \t "See congestive heart failure (CHF)"  XE "ANGINA PECTORIS" \t "See CABG"  XE "ANGINA PECTORIS" \t "See coronary artery bypass grafts" xe "angina:pectoris"\b\ixe "pectoris, angina "\iCoronary Artery Diseasexe "artery:disease, coronary(CAD)"\ixe "coronary: artery disease (CAD)"\i, CAD XE "CAD, Coronary Artery Disease"\i  Angina pectoris is the chest painxe "chest pain" that results when not enough oxygen reaches the heart muscles. This condition is also called myocardial ischemiaxe "myocardial ischemia"xe "ischemia, myocardial". In the elderly, myocardial ischemia may not always be associated with chest pain, but may cause shortness of breathxe "shortness of breath", irregular heart rate XE "heart:rate,irregular" , mental confusion XE "mental: confusion, myocardial ischemia"  and loss of consciousness. Angina can be either stable or unstable. Stable angina XE "angina:stable"  only occurs when exercise or stress increases the demand for oxygen. Unstable anginaxe "angina:unstable "xe "unstable angina" appears as repeated episodes of chest pain at rest, with low-level activity, or with increasing frequency and duration. Questions You Should Ask and Criteria:Have episodes of angina become more frequent or severe within the past 6 months have episodes of angina become more frequent and severe?not acceptable Has there been a hospitalization for angina within the past 6 months ? not acceptable Is there angina at rest? not acceptable Are there any ADL XE "ADLs:angina pectoris"  or IADL XE "IADLs:angina pectoris"  limitations due to angina? see Uninsurable Functional DeficitsIs there a history of symptomatic Congestive Heart Failure (CHF) within the past 5 years or Cardiomyopathy?not acceptableHas there been a heart attack or heart surgery?not acceptable if there has been a heart attack or heart surgery within the past 6 months; not acceptable if diabeticIs heart surgery recommended or scheduled?not acceptableIs there a history of diabetes?not acceptable Cross-references:  GOTOBUTTON CHF Cardiac failure  Cardiomyopathy XE "Cardiac failure" \t "See angina pectoris"   GOTOBUTTON CHF Congestive heart failure (CHF)  XE "Congestive heart failure (CHF)" \t "See angina pectoris"   GOTOBUTTON CABG CABG  XE "CABG" \t "See angina pectoris"   GOTOBUTTON CABG Coronary artery bypass grafts (CABG) Diabetes XE "Coronary artery bypass grafts" \t "See angina pectoris"   GOTOBUTTON toc ANKYLOSING SPONDYLITIS (AS) xe "spondylitis, ankylosing "xe "ankylosing spondylitis" (Rheumatoid Spondylitisxe "Spondylitis, Rheumatoid"xe "Rheumatoid: Spondylitis", Marie-Strumpell Diseasexe Marie-Strumpell Disease") Ankylosing spondylitis (AS) is a quite common, chronic inflammatory arthritisxe "arthritis:chronic inflammatory " affecting primarily the spine and the large joints of the body. A distinctive feature of the disease is fixation of the joints involved. Destructive arthritisxe "arthritis:destructive" of the hips and shoulders can be extremely disabling and joint replacementxe "replacement: joint, ankylosing spondylitis"xe "joint replacement: ankylosing spondylitis" is often necessary. Falls xe "falls: ankylosing spondylitis "resulting from poorly functioning hips and spine can lead to fractures xe "fractures:ankylosing spondylitis "of the brittle, fused spine. Excessive or low body weight can increase symptoms. Breathing problems can also occur with this condition due to fusion of the spine, which restricts expansion of the lungs. Questions You Should Ask and Criteria:Is there evidence of any functional limitation?see Uninsurable Functional Deficits XE "ADLs:ankylosing spondylitis"  XE "IADLs:ankylosing spondylitis" Are narcotics such as Demerol XE "Demerol:ankylosing spondylitis" , Methadone, Morphine XE "morphine:ankylosing spondylitis" , OxyContin, Percodan XE "Percodan: ankylosing spondylitis" , or Talwin XE "Talwin:ankylosing spondylitis"  used to control pain within the past 12 months?not acceptableHas Physical Therapy been required within the past 6 months?may be acceptable Has joint replacement surgery been recommended or completed within the past 12 months?not acceptable Have there been multiple falls, and/or a single fall with fracture within the past 2 years?not acceptable Has there been any hospitalization for complications of anklylosing spondylitis within the past 12 months?not acceptable  Cross-references:  GOTOBUTTON fractures Fractures  XE "Fractures" \t "See ankylosing spondylitis (AS)"   GOTOBUTTON functional Uninsurable functional deficits  XE "Uninsurable functional deficits" \t "See ankylosing spondylitis (AS)"   XE "Height/Weight Table" \t "See ankylosing spondylitis (AS)"   GOTOBUTTON toc ARRHYTHMIAS  XE "ARRHYTHMIAS" \t "See angina"  XE "ARRHYTHMIAS" \t "See atrial fibrillation"  XE "ARRHYTHMIAS" \t "See cardiac failure"  XE "ARRHYTHMIAS" \t "See congestive heart failure (CHF)"  XE "ARRHYTHMIAS" \t "See cardiomyopathy"  XE "ARRHYTHMIAS" \t "See TIA"  (Conduction Disturbances, Palpitations, Rapid Heartbeat XE "Rapid Heartbeat" ) xe "disturbances, conduction "xe "conduction disturbance"Arrhythmias XE "Arrhythmias" \i  are a variation in the normal rhythm of the heartbeat. The heart contracts in response to electrical impulses originating in the sinus nodexe "sinus node" (sinoatrial or SA node) located at the upper border of the atria. The impulses spread rapidly through the atrial myocardium and then throughout the ventricular myocardium. Cardioversion is the restoration of a normal rhythm with medication or an electrical shock (DC) to the heart . The other three main types of Arrhythmias: Paroxysmal Atrial Tachycardia (PAT)xe "Atrial, Paroxysmal Tachycardia (PAT)"xe "Paroxysmal Atrial Tachycardia (PAT)" is characterized by an abrupt onset and termination with a rate between 150-230 beats per minute. Premature Ventricular Contractions (PVC'S)xe "Ventricular Contractions, Premature (PVC'S)"xe "Premature Ventricular Contractions (PVC'S)" are beats that originate from the ventricle rather than the atrium. Sick-Sinus Syndrome (SSS)xe "Sick-Sinus Syndrome (SSS)" encompasses a variety of rhythm disturbances reflecting dysfunction of the SA node. SSS is often associated with dysfunction elsewhere in the conduction system. It often results in bradycardia XE "bradycardia"  (slow heart rate). These arrhythmias may result in a variety of symptoms including dizziness, palpitations, rapid heartbeat, xe "palpitations "or faintingxe "fainting". Treatment of arrhythmias can be with medication, electro-cardioversionxe "cardioversion:electro "xe "electro cardioversion", or pacemaker or defibrillator XE "defibrillator"  insertion. xe "pacemaker" Questions You Should Ask and Criteria:Is a Pacemaker placement recommended or scheduled? not acceptable until after complete recovery (excludes battery replacements)Is there any limitation of activities due to this history? not acceptableHas there been any symptomatic CHF (shortness of breath; fluid retention or swelling in feet, ankles, legs; difficulty breathing when flat in bed) within the past 12 months? not acceptableHas there been any ablation procedures within the past 3 months?not acceptable Cross References for Arrhythmias:  GOTOBUTTON angina Angina  XE "Angina" \t "See arrhythmias"   GOTOBUTTON a-fib Atrial fibrillation  XE "Atrial fibrillation" \t "See arrhythmias"   GOTOBUTTON CHF Cardiac failure  XE "Cardiac failure" \t "See arrhythmias"   GOTOBUTTON CHF Congestive heart failure (CHF)  XE "Congestive heart failure (CHF)" \t "See arrhythmias"   GOTOBUTTON cardiomyopathies Cardiomyopathies  MI XE "Cardiomyopathy" \t "See arrhythmias"   GOTOBUTTON TIA TIA  XE "TIA" \t "See arrhythmias"   GOTOBUTTON toc ASTHMA  XE "ASTHMA" \t "See Chronic Obstructive Pulmonary Disease (COPD)"  xe asthma"\b\i (Bronchial XE "Bronchial asthma" \t "See chronic obstructive pulmonary disease (COPD)"  xe bronchial asthma"\i\b & Allergic Asthma XE "Allergic Asthma" \t "See chronic obstructive pulmonary disease" xe allergic asthma"\i\b)  GOTOBUTTON COPD See chronic obstructive pulmonary disease (COPD)   GOTOBUTTON toc ATHEROSCLEROSIS AND THE CAROTID ARTERIES  XE "ATHEROSCLEROSIS AND THE CAROTID ARTERIES" XE "ATHEROSCLEROSIS" XE "CAROTID ARTERIES" Atherosclerosis, commonly called the hardening of the arteries XE "hardening of the arteries" \t "See atherosclerosis" XE "hardening of the arteries" XE " arteries, hardening of ", is the gradual narrowing of arteries throughout the body. It is caused by the accumulation of fat and other material along arterial walls and is a natural part of the aging process. Atherosclerotic plaques XE "atherosclerotic plaque"  XE " plaque, atherosclerotic "  frequently form in the carotid arteries XE "arteries, carotid". Sometimes, small plaque fragments called emboli XE "emboli"  break away from the plaque XE "plaque" , blocking arteries downstream and leaving behind craters called ulcers. With age, fat and other materials collect in the wall of the artery, forming the arterial plaque XE "arterial plaque"  XE " plaque, arterial" . As plaques get larger, blood flow can be disrupted. Later, some arteries, including the carotids (located in the neck), may become blocked. Blockage of a carotid artery  XE "carotid artery: blockage"  XE " blockage: carotid artery: " (or its branches) on one side of the brain can cause symptoms to appear on the opposite side of the body. For example, with TIA there may be a temporary loss of feeling or muscular strength in the left arm when the blockage is in the right carotid. Bruit is heard on the same side of the neck where the blockage is located. TIA XE "TIA" s (transient ischemic attack) occur when emboli or plaques temporarily block blood flow. Bruit XE "bruit"  is the result of blood flowing in a rough or turbulent manner through an artery partly blocked by plaque. Strokes (cerebral vascular accident) XE "strokes (cerebral vascular accident)"  occur when blood flow is blocked for extended periods; irreparable damage to the brain often results. Diagnosis of carotid artery problems: In order to confirm the diagnosis of carotid artery disease XE "carotid artery disease" the physician will take a complete medical history, conduct a physical examination, and perform a number of special tests. These procedures are aimed at finding out if the symptoms are in fact due to blockage of the carotid arteries, and, if so, how far they have progressed. Tests: Doppler Imaging XE "Doppler Imaging" XE " Imaging, Doppler"  is a painless test. Sound waves above the range of human hearing are sent into the neck. Echoes bouncing off the moving blood can be made into an image of the carotid artery. OPG (Occuloplethysmography) XE "OPG (Oculoplethysmography)"  measures the pulsation of arteries at the back of each eye as an indirect check for blockages farther down in the carotids. CT (Computed Tomography) XE "CT (Computed Tomography)" is a scan that produces a series of cross-sectional x-rays of the head or body and may reveal conditions other than carotid artery problems. Arteriography XE "Arteriography"  are x-rays that are taken of the carotid while a special dye is injected into another artery in the leg or arm. A blockage can be seen where the dye cannot get through. DSA (Digital Subtraction Angiography)  XE "DSA (Digital Subtraction Angiography)"  XE " Angiography, Digital Subtraction (DSA)"is another x-ray examination of the carotid. The test is similar to arteriography except less dye may be used. General Indications for Surgery: When diagnostic tests show significant blockages or extensive ulceration of plaques in the carotid, surgery (endarterectomy) XE "endartectomy"  may be recommended to reduce the chance of a stroke. Questions You Should Ask and Criteria:If surgery has been performed, what symptoms prompted the surgery? What treatment is currently being used? Has a stroke been diagnosed? History of stroke is a Specific Uninsurable Medical ConditionAre there any current TIA symptoms XE "Congestive Heart Failure (CHF):emphysema" ? not acceptableHas there been a single TIA within the past 5 years? not acceptableHas there been more than one TIA XE "shortness of breath" xe "breath, shortness of "? not acceptableWith a history of TIA, is there a history of diabetes, any heart surgery (e.g., angioplasty, bypass grafts, valve replacements)?Is there a history of Diabetes XE "shortness of breath" xe "breath, shortness of "? Has surgery been recommended or scheduled XE "shortness of breath" xe "breath, shortness of "? Please see surgery timeframe guidelines  Cross-references: Diabetes  GOTOBUTTON thromboembolism Thromboembolism (venous, arterial, or pulmonary embolism)  XE "Thromboembolism (venous, arterial, or pulmonary embolism)" \t "See atherosclerosis & carotid arteries"   GOTOBUTTON TIA Transient Inschemic Attack (TIA)  XE "Transient Ischemic Attack (TIA)" \t "See atherosclerosis & carotid arteries"   GOTOBUTTON ulcer_skin Ulcers of the Skin  XE "Ulcers of the Skin" \t "See atherosclerosis & carotid arteries"   GOTOBUTTON aneurysms Aneurysms  Peripheral Vascular Disease (PVD) XE "Aneurysms" \t "See atherosclerosis & carotid arteries"   GOTOBUTTON toc ATRIAL FIBRILLATION (A-FIB)  XE "ATRIAL FIBRILLATION (A-FIB)" \t "See Angina"  XE "ATRIAL FIBRILLATION (A-FIB)" \t "See congestive heart failure (CHF)"  XE "ATRIAL FIBRILLATION (A-FIB)" \t "See cardiomyopathy"  XE "ATRIAL FIBRILLATION (A-FIB)" \t "See TIA"  xe "atrial fibrillation (A-FIB)"\ixe "A-Fib: Atrial Fibrillation "\ixe "fibrillation, atrial (A-FIB)"\iAtrial fibrillation is the rapid and irregular contraction of the atrium (upper chamber of the heart), which leads to irregular contractions of the ventricles (the lower chambers of the heart XE "heart:atrial fibrillation" ). This causes a drop in cardiac outputxe "cardiac: output, A-FIB" and may produce the following symptoms: light headedness, syncope (fainting) , or angina.  XE "A-Fib:chronic"  XE "A-Fib:paroxysmal (intermittent)" A-FIBxe "atrial fibrillation (A-FIB): chronic" may be paroxysmal (intermittent)xe "atrial fibrillation (A-FIB): paroxysmal (intermittent)" or chronic and may be associated with underlying heart disease such as coronary artery disease (CAD)xe "coronary: artery disease (CAD), A-FIB" and valvular diseasexe "valvular:disease, A-FIB". A-FIB often causes strokesxe "stroke:A-Fib", Transient Ischemic Attacks (TIAs),xe "Transient Ischemic Attack (TIA):A-Fib" and Congestive Heart Failure XE "heart:failure"  (CHF)xe Congestive Heart Failure (CHF):A-FIB". Treatment may be with medication or with an electrical shock (cardioversionxe "DC Conversion")xe "electrical shock (DC Conversion)" to the heart to restore the regular rhythm. Coumadin XE "Coumadin:A-Fib"   XE "bleeding:associated with Coumadin use" is usually prescribed to decrease the risk of blood clot, TIA, or stroke. Questions You Should Ask and Criteria:Has the atrial fibrillation been diagnosed or symptomatic within the past 6 months?Not acceptable; 12 months with valvular heart diseaseHas there been a defibrillator implant within the past 12 months?Not acceptableHave there been any ablation procedures within the past 3 months?Not acceptableHas there been any history of symptomatic congestive heart failure Xe Congestive Heart Failure (CHF):A-Fib"  (CHF) (shortness of breath; fluid retention or swelling in feet, ankles, legs; difficulty breathing when lying flat) within the past 24 months  XE "falls:A-Fib" ?not acceptableHas there been any history of fainting XE "syncope:A-Fib"  within the past 12 months XE "falls:A-Fib" ?not acceptableHave there been any hospitalizations and/or ER visits within the past 6 months?Not acceptableHas there been any cardioversion required within the past 6 months?Not acceptableHas there been a single Transient Ischemic Attack (TIAs) within the past 5 years? . not acceptable Have there been multiple TIAs?not acceptableHas there been a history of a heart attack within the past 12 months?Not acceptable Cross-references:  GOTOBUTTON angina Angina   GOTOBUTTON CHF Congestive Heart Failure (CHF)  TIA XE "Congestive heart failure (CHF)" \t "See atrial fibrillation"   GOTOBUTTON arrhythmias Arrhythmias   GOTOBUTTON cardiomyopathies Cardiomyopathy  MI XE "Arrhythmias" \t "See atrial fibrillation"   GOTOBUTTON CHF Cardiac failure  Valvular Heart Disease  GOTOBUTTON toc BLADDER DYSFUNCTION OR INCONTINENCE  xe "bladder: dysfunction"\b\ixe "incontinence"\b\i(Neurogenic Bladderxe "spastic: bladder"\ixe "neurogenic bladder"\i, Stress Incontinencexe "stress incontinence"\i, Urinary Incontinencexe "urinary: incontinence"\i) A neurogenic or spastic bladder  XE "bladder:spastic"  XE "bladder:neurogenic" lacks normal control because of nerve damage, brain damage from a stroke, or spinal cord dysfunction. Stress incontinence XE "incontinence:stress"  is the involuntary loss of urine upon coughing, sneezing, straining, lifting, or other movements that increase abdominal pressure upon the bladder. Bladder incontinence XE "incontinence:bladder" /urinary incontinence XE "incontinence:urinary"  is the inability to maintain voluntary control over bladder function. Medications you may see to improve bladder function are: Urispas, ditropan, oxybutynin chloride. Questions You Should Ask and Criteria:What is the cause of the condition?if the incontinence is due to a medical condition refer to that section in the manual Are adaptive devices used (i.e. catheter)xe "catheter"? not acceptable if the need for adaptive devices began within the past 6 months not acceptable if assistance is needed with adaptive deviceIs there a need for assistance with personal care? not acceptableAre there any complications, such as skin breakdown?not acceptable if within the past 24 monthsHas surgery been recommended or scheduled, or completed within the past 3 months?not acceptable   GOTOBUTTON toc CANCER  (xe cancer"\b\iCarcinomaxe carcinoma", CAxe CA", malignancyxe malignancy", neoplasmxe neoplasm") Cancer is the uncontrolled, invasive growth of tissue. All normal tissues grow, live for a time and die, and all are replaced by new tissue. A cancerous growth does not follow this orderly pattern, but rather has an increased metabolic, growth and reproductive rate, and an increased blood supply. The cancerous growth process is not controlled by the laws of normal growth and continues unchecked. The tumor cells may invade locally and/or by distant metastasis. Based on our experience, cancer is the fourth most common reason for long term care use. Metastatic cancer XE "metastatic cancer"  XE "cancer, metastatic" , wherein cancer spreads to a distant organ via the lymph or circulatory system, is often encountered. Common sites for cancer XE "cancer:common sites of"  in the elderly include the brain, breast, lungs, prostate, colon, and lymphatic system. Treatment: Treatment of cancer XE "cancer:treatment"  may involve surgery, radiation therapy XE "radiation: therapy, cancer treatment" , chemotherapy XE "chemotherapy"  or hormonal therapy XE "hormonal therapy" . In some cases, treatment may involve multiple modalities. The treatments themselves can cause other health problems. Some examples are: anemia, gastrointestinal problems, and genitourinary disorders. Tumor Markers XE "cancer:tumor markers" \b \i  XE "Tumor Markers" \b \i : Tumor markers are blood tests that are used initially to help identify the presence of tumors, and then to monitor the success of treatment and to identify any recurrence. CEA (carcinoembryonic antigen): CEA XE "CEA (carcinoembryonic antigen)"  XE "antigen, carcinoembryonic" is the most widely used tumor marker, and is produced abnormally by cancers of the colon, lung, breasts, and pancreas. Although nonmalignant factors may result in temporary elevations of this antigen (i.e., smoking), a level of greater than 10 mg/ml is highly suggestive of active cancer. PSA (prostate-specific antigen):  XE "PSA (prostate-specific antigen)\" XE " antigen, prostate-specific\" This tumor marker is obviously associated with prostate cancer as well as benign prostate disorders (i.e., benign prostatic hypertrophy XE "BPH:benign prostatic hypertrophy" ). Two commonly used assays are available with upper limits of normal being 2.8 mg/ml and 4.0 mg/ml. However, it should be emphasized that following definitive prostate cancer surgery, the PSA level should be undetectable in the patients blood. The post-operative presence of this antigen or an increasing level of this antigen is likely persistence or recurrence of prostate cancer. CA-125 XE "CA-125" : This antibody is associated with ovarian cancer is rarely elevated by nonmalignant causes. A level greater than 35 U/ml is considered abnormal and consistent with persistent ovarian cancer.  XE "cancer:staging" Staging XE "staging, cancer" \b \i : Staging can be thought of as a system for describing cancers to determine the treatment for a given tumor and the prognosis for the patient. When staging a cancer, the physician takes into consideration the size of the tumor, how deeply it has invaded into the surrounding tissue, whether it has spread to adjacent lymph nodes, and whether it has spread to other organs. The physician will also describe the specific cell type that makes up the tumor. (In some cancers, the cell type is significant because some cancer cell types are more aggressive and more invasive than others.) Physicians use two basic systems for describing (staging) cancers: a numerical system from Stage 0 to Stage IV and an alphabetical system from Stage A to Stage D. Stage 0 and Stage A describe the smallest tumors and thus have the best prognosis. Stage IV and Stage D describe large tumors that have spread and thus have the worst prognosis. Cancer of the breast, kidney, lung, ovary, stomach, and uterus are staged by the numerical system. Cancer of the colon, prostate, and urinary bladder are staged by the alphabetical system. Underwriting: When evaluating the risk of a cancer history, an underwriter XE "cancer:underwriting of"  takes many factors into consideration: the location of the cancer the date the cancer was diagnosed the type of treatment and the date of the final treatment whether there have been complications associated with treatment whether there has been a recurrence of the cancer the Stage of the cancer the cancer cell type persistence or change in tumor marker levels The home office underwriter depends on the field underwriter to gather as many details as possible about the location of the cancer, the date of diagnosis, type of treatment, date of the final treatment, and any other information available. The home office underwriter reviews the medical records, especially the records from the oncologist, to determine the stage of the cancer, the cancer cell type, whether or not the cancer has recurred, and the level of the tumor marker. Underwriting will always require medical records from the doctor following any history of cancer, if the history took place within 5 years. General Criteria: Cancers XE "cancer:metastasized"  which have spread to other organs (metastasized) or which have recurred are not acceptable. Cancers of the Bone, Brain, Esophagus, Liver, Lung, Ovary, Pancreas, Stomach, or Testes are not acceptable within 48 months from the date of the last treatment. (See Insurability Profile section of the application). Cancers of other internal organs are generally not acceptable within 12 months. (Refer to the particular cancer in the following section.) Cancers that are classified as Stage 0, Stage I, Stage II, Stage A, or Stage B may be acceptable after an appropriate waiting period. (Refer to the particular cancer in the following section.) Cancers that are classified as Stage III or Stage C are usually not acceptable. (A few may be acceptable after an appropriate waiting period. Refer to the particular cancer in the following section.) Cancers that are classified as Stage IV or Stage D are not acceptable. Whenever there is a waiting period XE "waiting period"  before the history can be evaluated, the waiting period starts from the date the last treatment is completed.  GOTOBUTTON toc CANCER OF THE BREAST  xe "breast:cancer"Cancer of the breastxe "cancer:breast" is the most common malignancy among women in the United States accounting for 27% of all cancers in women. Although no specific cause has been identified, groups at high risk for the development of breast cancer include first-degree relatives of patients with breast cancer, and women with proliferative changes on breast biopsyxe "breast:biopsy" (atypical hyperplasiaxe "atypical hyperplasia"). Radiation exposurexe "radiation: exposure", hormonesxe "hormones", and diet also have been suggested as causative factors in this disease. Breast lumpsxe "breast:lumps" are detectable in over 90% of individuals with breast cancer, and constitute the most common symptom reported on history and physical exam. Typically, these lesions are solitary, unilateral, solid, irregular, non-mobile, and non-tender and may be associated with nipple discharge. The usefulness of mammographyxe "mammography" in the detection of breast cancer in early stages has been well documented. Because of the combination of increased self examination and appropriate mammography studies, more than 50% of primary breast cancers are now diagnosed as Stage I or better. The following stages XE "breast cancer: stages"  and treatment(s) XE "breast cancer: treatment(s)"  are used for breast cancer: Stage 0 (carcinoma in situ XE "carcinoma in situ"  XE "breast cancer: carcinoma in situ" ) is a very early cancer. The tumors are usually found in the duct area. Lumpectomy XE "Lumpectomy"   XE "breast cancer: lumpectomy" is the usual surgical treatment and may include radiation. Stage I has not spread outside the breast and is less than 2 centimeters in diameter. Treatment consists of the surgical resection of the tumor and may involve post-surgical radiation or chemotherapy. Stage II may include either of the following: (1) the cancer is between 2 and 5 centimeters (from 1 to 2 inches). The cancer may or may not have spread to the lymph nodes under the arm. (2) The cancer is larger than 5 centimeters (larger than 2 inches) but has not spread to the lymph nodes under the arm. Treatment consists of the surgical resection of the breast with post-surgical radiation or chemotherapy. Hormonal therapy with tamoxifen (Nolvadex) and megestrol (Megace) may be used on an on-going basis following initial surgical treatment. Individuals treated for Stage 0, Stage I, or Stage II disease, which have been disease-free with regular follow-up examinations, may be acceptable. Stage III or IV breast cancers are not acceptable. Inflammatory breast cancer XE "Inflammatory breast cancer"  XE "breast cancer: inflammatory"  is a special class of breast cancer that is rare. The breast looks inflamed because of its red appearance and warmth. The skin may show signs of ridges and wheals or it may have a pitted appearance. Inflammatory breast cancer tends to spread quickly. This history is not acceptable. General Criteria: The LTC underwriting of breast cancer includes consideration of the pathology report, staging, treatment, and any post-treatment complications (e.g., hospitalization, radiation problems, recurring infections, cellulitis XE "cellulitis" , or edema XE "edema" ). Questions You Should Ask and Criteria:What was the stage of the cancer and how much time has elapsed since the end of treatment? Stage 0 or 1 tumors may be acceptable 3 months following treatment Stage II tumors may be acceptable 12 months following treatment  XE "chemotherapy:breast cancer" Stage III or IV tumors are not acceptable Were there any lymph nodes positive for cancer? If yes, how many? 1 3 lymph nodes may be acceptable 12 months following treatment 4 or more lymph nodes involved not acceptableIs there ongoing need for chemotherapy (excluding Nolvadex and Megace)? not acceptable  XE "Nolvadex:breast cancer"  XE "tamoxifen:breast cancer"  XE "Megace:breast cancer"  XE "megestrol:breast cancer"  Has there been any mention of inflammatory breast cancer? not acceptableHas there been any recurrence in the same breast or evidence of metastasis XE "metastasis"   XE "breast cancer: metastasis" ? not acceptable  GOTOBUTTON toc CANCER OF THE COLON AND RECTUM  XE cancer:rectal"\i  XE rectal: cancer"\i  XE cancer:colon" \i (LARGE BOWEL) Cancer of the large bowel XE "large bowel cancer" xe "cancer:large bowel"\i (colonxe "colon, cancer of " and rectumxe "rectum, cancer of") is the second most common malignancy in the United States after lung cancer. There are approximately 65,000 deaths per year from colorectal cancer. The risk of developing colorectal cancer increases with age beginning at the age of 40 and reaching a peak incidence between the ages of 60 and 75. Cancers of the colon occur more frequently in females, while cancers of the rectum occur more frequently in males. Colon cancer prevention includes regular bowel surveillance (i.e. stool guaiacsxe "stool guaiacs", fiber optic sigmoidoscopyxe "sigmoidoscopy, fiber optic" and colonoscopyxe "colonoscopy"). Increased dietary fiber and decreased fat intake appear to reduce the risk of colorectal cancer. Cancers of the colon and rectum have a slow growth rate and many reach a large size and a fair degree of invasiveness prior to producing symptoms. In fact, almost one-third of patients presenting with colorectal cancers will have metastases XE "metastasis"  at the time of initial diagnosis. These cancers are treated by surgical excision. The post-operative use of either chemotherapy XE "chemotherapy:colon cancer"  XE "radiation: colon cancer"  XE "surgery:colon cancer"  or radiation therapy suggests more advanced disease with a poor prognosis. Dukes Staging of Bowel Cancer  XE "Dukes Staging of Bowel Cancer"  XE "Staging of Bowel Cancer, Dukes"  XE "Cancer: Bowel, Dukes Staging "  Dukes A Confined to the bowel mucosa, with no involvement of the bowel wall muscularis. Dukes B There is involvement of the bowel wall muscularis but no involvement of adjacent structures or of proximal lymph nodes. Dukes C There is penetration of the bowel wall, together with involvement of adjacent structures and proximal lymph nodes. C1 tumors may be acceptable. C2 tumors are not acceptable. Dukes D There is involvement of distant lymph nodes and organs; not acceptable. Complications: Significant post-treatment complications may include problems with colostomy management XE "colostomy management" , rectal incontinence XE "rectal incontinence" , or radiation enteritis XE "radiation enteritis"  (inflammation of the intestines). Questions You Should Ask and Criteria:What was the stage of the cancer, and how much time has elapsed since the end of treatment? Stage A tumors may be acceptable 3 months following treatment Stage B tumors may be acceptable 12 months following treatment Stage C1 or C2 tumors may be acceptable 5 years following treatmentStage D tumors may be acceptable 10 years following treatmentHas there been any radiation enteritis within the past 12 months? not acceptable Has there been any use of chemotherapy within the past 12 months? not acceptable  GOTOBUTTON toc CANCER OF THE ESOPHAGUS xe esophageal cancer"\i Cancer of the esophagusxe "cancer:esophageal"\i is a common cause of progressive dysphagiaxe "dysphagia" (difficult swallowing) in the elderly. Odynophagiaxe "odynophagia" (pain with swallowing), back pain, and weight loss XE "weight loss:cancer of the esophagus"  are the usual presenting symptoms of esophageal cancer. Unfortunately, by the time that most esophageal cancers are found, they have widely metastasized and are beyond cure. Questions You Should Ask and Criteria:When was the cancer diagnosed & the date of last treatment?not acceptable within the past 48 months Has there been any recurrence or evidence of metastasis?not acceptableHas there been any on-going weight loss XE "weight loss:cancer of the esophagus" ?not acceptableHas there been a need for tube feeding XE "tube feeding:cancer of the esophagus" xe "feeding, tube:enteral"xe "feeding, tube:parenteral" within the past 12 months?not acceptable   GOTOBUTTON toc CANCER OF THE HEAD, NECK AND THROAT  xe "head and neck cancer"\iCancers of the head and neckxe "cancer:head and neck"\i account for 5% of all malignancies. This group of tumors can occur at a large number of different sites, especially the oral cavityxe "oral cavity, cancer site" (lip, tongue, floor of the mouth, gums, and hard palate), the pharynx, and larynx. The prognosis of these tumors varies greatly depending on the site (oral cavity is more favorable) and the stage. Unfortunately, a large number of patients are asymptomatic until the cancer has become quite large. Common symptoms include a persistent sore throat, difficulty swallowing, and hoarseness, loosening of the teeth, dentures that will not fit, earache, and disturbances in hearing. Non-healing lesions of the oral cavity or unexplained persistent swollen glands of the neck may indicate local or metastatic XE "metastatis"  disease. Treatment: The standard treatment for head and neck cancer includes surgery or radiation therapy. Chemotherapy can be included with surgery and radiation for advanced disease Complications: Significant post-treatment complications may include swallowing difficulties XE "swallowing difficulties"  of fluids and solids, regurgitation with aspiration, or frequent lung infections XE " lung infections, frequent ". Questions You Should Ask and Criteria:What is the stage of the cancer and how much time has elapsed since the end of treatment? Stage I tumors may be acceptable 12 months following treatment Stage II tumors may be acceptable 24 months following treatment Stage III or Stage IV tumors are not acceptableHas there been any recurrence, evidence of distant metastasis, or lymph node involvement?not acceptableHas there been a need for tube feeding XE "tube feeding:cancer of the esophagus" xe "feeding, tube:enteral"xe "feeding, tube:parenteral" within the past 12 months?not acceptable Have there been any significant complications related to the cancer treatment? generally not acceptable  GOTOBUTTON toc CANCER OF THE KIDNEY  XE "CANCER OF THE KIDNEY" \t "See renal failure, acute" XE "CANCER OF THE KIDNEY" \t "See renal failure, chronic" xe "kidney: cancer"\iEach year in the United States there are approximately 18,000 cases of cancer of the kidneyxe "cancer:kidney"\i. These tumors account for approximately 3% of adult malignancies and are most common in the 50-70 age group. The ratio of males to females affected is 2:1. Symptoms include abdominal or flank pain, abdominal mass, weight lossxe "weight loss:kidney cancer", and fever. Hypertensionxe "Hypertension (HTN):kidney cancer" is often present. In addition, anemiaxe "anemia:kidney cancer" is present in 20-40% of cases. Treatment: Nephrectomy XE "nephrectomy"   XE "surgery:kidney removal" (surgical removal of the kidney) is usually curative. The post-operative use of either chemotherapy XE "chemotherapy:kidney cancer"  XE "radiation:kidney cancer"  or radiation therapy suggests more advanced disease with a poor prognosis. Complications: Significant post-treatment complications may include blood in the urine XE "hematuria: blood in the urine"  (hematuria), protein in the urine XE "proteinura: protein in the urine"  (proteinura), unstable renal function XE "renal function: unstable" , or chronic/acute renal failure. XE "renal failure: acute" . XE "renal failure: chronic"  Questions You Should Ask and Criteria:What is the stage of the cancer and how much time has elapsed since the end of treatment?Stage I, II, or IIIA tumors may be acceptable 12 months following treatmentStage IIIB or IV tumors are not acceptableHas there been any recurrence or evidence of metastasis XE "metastasis" ? not acceptableHas there been any use of chemotherapy or radiation treatment? not acceptableHas there been unstable or declining renal function within the past 2 years? not acceptable Cross Reference:  GOTOBUTTON ARF Renal Failure, acute  XE "Renal Failure, acute" \t "See cancer of the kidney"   GOTOBUTTON CRF Renal Failure, chronic  XE "Renal Failure, chronic" \t "See cancer of the kidney"   GOTOBUTTON toc CANCER OF THE LUNG  XE "CANCER OF THE LUNG" \t "See COPD"  XE "CANCER OF THE LUNG" \t "See cardiomyopathy"  XE "CANCER OF THE LUNG" \t "See emphysema"  XE "CANCER OF THE LUNG" \t "See asthma"  XE "CANCER OF THE LUNG" \t "See lung resection"  xe "lung:cancer"\iLung cancerxe "cancer:lung"\i is the most common cause of cancer death in the United States accounting for 35% of cancer deaths in men and 20% in women. Lung cancer is now a major health problem in women and exceeds breast cancer as a cause of cancer death. The ratio of men to women affected is now 2:1, whereas only ten years ago it was 5:1. The single most important causative factor in lung cancer is cigarette smokexe "cigarette smoke". Clinical manifestations of lung cancer are variable and depend on the location of the tumor, cell type, rate of growth, and the presence of underlying pulmonary disease. Frequent symptoms include: new or changing cough, hoarseness, hemoptysis xe "hemoptysis "(coughing up blood), chest pain, and wheezing. Treatment: Generally, lung cancer is treated by surgical excision. XE "surgery:lung cancer"  The post-operative use of either chemotherapy XE "chemotherapy:lung cancer"  or radiation XE "radiation:lung cancer"  therapy suggests more advanced disease with a poor prognosis. Complications: Significant post-treatment complications may include cardiomyopathy, pulmonary fibrosis XE "pulmonary fibrosis"  XE " fibrosis:pulmonary " , or pulmonary insufficiency (resulting from resection of the lung). Questions You Should Ask and Criteria:What is the stage of the cancer and how much time has elapsed since the end of treatment?Stage I tumors may be acceptable 36 months following treatmentStage II or III tumors may be acceptable 5 years following treatment Stage II or III tumors may be acceptable 10 years following treatmentIs there current smoking or tobacco use?not acceptableIs there any liver involvement?not acceptableIs there a history of cardiomyopathy or pulmonary fibrosis?not acceptableIs there any ongoing weight loss?not acceptable Cross-references:  GOTOBUTTON COPD COPD  XE "COPD" \t "See cancer of the lung"   GOTOBUTTON cardiomyopathies Cardiomyopathy  XE "Cardiomyopathy" \t "See cancer of the lung"   GOTOBUTTON COPD Emphysema  XE "Emphysema" \t "See cancer of the lung"   XE "Lung resection" \t "See cancer of the lung"   GOTOBUTTON toc CANCER OF THE OVARY  xe "ovarian cancer"\iOvarian cancerxe "cancer:ovarian "\i is the most lethal of all the gynecological cancerxe "cancer: gynecological"sxe "gynecological cancers". The peak incidence occurs in women in their 50s and the average age at time of diagnosis is 55 years. Symptoms include vague lower abdominal discomfort, mild digestive irregularities, anorexia, abnormal vaginal bleeding, and mild increase of abdominal girth. Treatment: Surgical excision may be successful in early stage disease. However, chemotherapy is often required because most women have an advanced stage at time of diagnosis. Complications: Significant post-treatment complications may include bowel problems or weight loss. Questions You Should Ask and Criteria:What is the stage of the cancer and how much time has elapsed since the end of treatment?Stage I or II tumors may be acceptable 36 months following treatmentStage III o IV tumors are not acceptable Has there been any recurrence or evidence of metastasis XE "metastasis" ?not acceptableHas there been any ongoing need for chemotherapy? not acceptableHas there been any radiation enteritis within past 12 months?not acceptable Has there been any ongoing weight loss? not acceptableHas there been any history of pulmonary fibrosis or kidney failure? not acceptableHas there been any liver involvement? not acceptable  GOTOBUTTON toc CANCER OF THE PROSTATE  xe "prostate:cancer"\iProstate cancerxe "cancer:prostate "\i is frequently asymptomatic and is usually detected on a routine rectal exam, or from tissue removed during a TURP (transurethral resection of the prostate)xe "transurethral: prostatectomy (TURP)" performed for BPH (benign prostatic hypertrophyxe "prostatic hypertrophy")xe "benign prostatic hypertrophy (BPH)". Hesitancy, urgency, nocturia, and dribbling are common symptoms in elderly men for benign reasons. However, if such symptoms appear suddenly or progress, the diagnosis of prostate cancer becomes more probable. A blood test, the PSA (Prostate Specific Antigen), XE "PSA (Prostate Specific Antigen)"  is frequently done as a first line test if cancer is suspected. The PSA can be detected in all males. However, its level is increased when prostate cancer is present. As the PSA increases, there is a greater chance for cancer and a higher stage of cancer. This test is also used for monitoring the response to cancer treatment. Successful surgery, radiation, or hormone treatment should result in a marked reduction in the PSA level. A normal level is <4 mg/ml. A level up to 10 usually indicates a benign condition, BPH or prostatitis, or a very low stage of cancer. A level of 10 20 can still be benign, but frequently indicates a cancer and warrants a work-up to determine the cause. Anything greater than 20 is suggestive of cancer and the higher the number the greater the stage and risk for metastasis. Staging XE "Staging"  is a classification system based on the size of the tumor, and its extension within the prostate gland, whether lymph nodes are involved, and whether there is a distant metastatic spread. Prostate cancer is staged from A to D. Stages A and B are generally acceptable after successful treatment and an appropriate waiting period. Some Stage C cancers (with limited involvement) may also be acceptable. Stage D is not acceptable. Gleason Scoring XE "Gleason Scoring"  is a classification of the histologic differentiation of the prostate cancer. Scores of 5 or less have relatively early stages and an excellent prognosis. Scores of 6 through 9 generally represent a Stage B or C cancer and an intermediate prognosis. Scores of 10 and greater usually have a poor prognosis. Treatment: Consists of surgical excision, radiation, orchiectomy, and/or hormonal therapy. Generally, a combination of treatments indicates a higher stage. Prostate cancer may be relatively slow growing especially in older men, and the doctor may take a watch and wait stance with the patient. Complications: May include bowel and/or urinary problems.  GOTOBUTTON toc CANCER OF THE PROSTATE  Questions You Should Ask and Criteria:What is the date of the original diagnosis? What was the original PSA level? What type of treatment was performed? What is the current PSA level? What is the stage of the cancer?Stage A or B tumors may be acceptable 3 months following diagnosis Stage C tumors with limited involvement of adjacent structures may be acceptable 2 years following diagnosisStage C tumors with extended involvement Age 75 & below, not acceptable Age 76 and above, may be acceptable 2 years following diagnosisStage D tumors not acceptableIs there a current need for radiation therapy? not acceptable within the past 12 months; Seed implant may be acceptable 3 months following treatment Has there been any recurrence?following a prostatectomy, not acceptable if treated with TURP or radiation therapy, may be acceptable 12 months following date of last treatmentHas there been any distant metastasis? not acceptable  GOTOBUTTON toc CANCER OF THE SKIN   XE "cancer:skin"\i  XE "skin cancer"\i  There are many types of skin lesions, most of which are benign and therefore insignificant. Some of the more common benign skin lesions are: seborrheic keratoses, actinic keratoses, skin tags, various types of nevi, and freckles. Some nevi and actinic keratoses may develop into cancer and are usually excised if they develop suspicious features. The incidence of skin cancer has been increasing during recent years, largely because of the popularity of sunbathing and outdoor activities, which lead to excessive sun exposure. The three major types of skin cancer are: squamous cell, basal cell, and malignant melanoma. Squamous cell skin cancers XE squamous cell skin cancers"   XE "skin cancer:squamous cell"  XE "cancer:squamous cell" may develop alone or arise out of actinic or solar keratoses. They usually develop slowly over a period of a few months. They appear as red, conical, hard nodules that quickly ulcerate. Squamous cell cancers of the lip, oral cavity, tongue, and genitalia are potentially serious cancers and require special care and treatment. Basal cell skin cancers XE basal cell skin cancers"   XE "skin cancer:basal cell"  XE "cancer:basal cell" occur mostly on exposed parts of the body. They grow slowly and rarely spread to other parts of the body, though neglected lesions may ulcerate and cause great destruction. The cause of malignant melanoma XE "malignant melanoma"  XE " melanoma:malignant "  is unknown, but probably relates in part to excessive sun exposure. In the United States, the incidence of malignant melanoma has significantly increased over the past twenty years. It is now the eighth most frequently diagnosed cancer. Malignant melanoma is usually presented as a pigmented skin lesion, which may show multiple colors, irregular halo, and irregular or notched borders. It may also show irregular surface characteristics, bleeding, or ulceration. The level of invasion into the skin and underlying tissues determines the staging XE "staging"  and prognosis. Treatment: The treatment of choice for squamous cell, basal cell, and malignant melanoma cancers is total surgical excision. General Criteria: Squamous cell and basal cell skin cancers may be acceptable, provided there is no evidence of metastasis XE "metastasis"  (spreading). Squamous cell cancers of the lip, oral cavity, tongue, and genitalia will be given individual consideration.  GOTOBUTTON toc CANCER OF THE SKIN  Questions You Should Ask and Criteria:What type of skin cancer was diagnosed? if basal cell or squamous cell with no evidence of spreading acceptable if malignant melanoma, proceed to the next question What is the stage of the cancer?Superficial or early stage lesions (depth less than 1.7 mm) may be acceptable after recovery from proceduredeeper or higher stage lesions (depth 1.7 mm to 3.5 mm) may be acceptable 12 months following treatment lesions with depth greater than 3.5 mm are not acceptableHas there been any recurrence or metastasis?not acceptableHas there been any lymph node involvement?not acceptableIs there a history of ocular melanoma?not acceptable within 2 years  GOTOBUTTON toc CANCER OF THE STOMACH (GASTRIC)  xe "stomach (gastric) cancer"Cancer of the stomachxe "cancer:stomach" is a disease with poor survival rates. Symptoms of gastric cancerxe "gastric cancer" include anorexiaxe "anorexia", abdominal discomfort with pain, weight lossxe "weight loss: stomach cancer", dysphagia XE "dysphagia: stomach cancer" , and symptoms resulting from anemiaxe "anemia: stomach cancer". Treatment: Surgical excision and may include chemotherapy. Questions You Should Ask and Criteria:What is the stage of the cancer and how much time has elapsed since the end of treatment?Stage 0 tumors may be acceptable 48 months following treatmentStage I tumors may be acceptable 6 years following treatmentStage II, III, or IV tumors are not acceptableHas there been any recurrence or evidence of lymph node or distant metastasis?not acceptableHas there been any ongoing weight loss?not acceptableHas there been a need for tube feeding XE "tube feeding:cancer of the esophagus" xe "feeding, tube:enteral"xe "feeding, tube:parenteral" within the past 12 months?not acceptable Has there been any liver involvement?not acceptable   GOTOBUTTON toc CANCER OF THE THYROID  xe "thyroid cancer"\iCancer of the thyroidxe "cancer:thyroid"\i is relatively common in all age groups, but especially in people who have received prior radiation of the head and neck area. The radiation may have been administered to treat the tonsils, adenoids, thymus gland, or severe acne. Thyroid cancer is much more common in women. The principal signs of thyroid cancer are an enlarged thyroid gland, a hard painless nodule within the gland, or palpable lymph nodes. Treatment:  XE "surgery:thyroid cancer" Surgical excision and may include post-operative radiation XE "radiation:thyroid cancer"  therapy. Questions You Should Ask and Criteria:How much time has elapsed since the end of treatment?Most thyroid cancers may be acceptable 24 months following treatmentIs surgery recommended or scheduled? not acceptableHas there been any evidence of lymph node or distant metastasis XE "metastasis" ?  GOTOBUTTON toc CANCER OF THE URINARY BLADDER xe "cancer: urinary bladder "\i xe "urinary: bladder cancer"\iBladder tumorsxe "bladder: tumors"\i are seen twice as often in men as in women. The average age of the bladder cancer XE "cancer:bladder"\i xe "bladder: cancer"\i patient is 65 years and fortunately, the disease is usually localized at the time of diagnosis. The predominant symptom is hematuriaxe "hematuria" (blood in the urine). Blood is usually noted throughout urination. Symptoms include increased urinary frequency, dysuria (painful urination), urgency, and nocturia (night time urination). Symptoms may also be experienced after treatment. Unlike other cancers, local recurrences are common and may be acceptable. Treatment: Often includes surgical excision with ileal conduit, bladder irrigations XE "bladder irrigations"  XE "irrigations:bladder"  (BCG; are common and usually acceptable), and chemotherapy XE "chemotherapy:bladder cancer"  XE "surgery:bladder cancer" . Complications: Significant post-treatment complications may include urinary problems or on-going chemotherapy (excluding bladder irrigations, BCG). Questions You Should Ask and Criteria:What is the stage of the cancer and how much time has elapsed since the end of treatment?Stage 0, A or B1 tumors may be acceptable 3 months following treatmentStage B2 tumors may be acceptable 48 months following treatment Stage C, D1, or D2 tumors are not acceptableHas there been any evidence of lymph node or distant metastasis? not acceptableHas there been an ongoing need for chemotherapy (excluding bladder irrigations or BCG treatments)? not acceptable Was bladder removed (and replaced with an external/interal drainage system)? not acceptable if within 36 monthsHas there been any hospitalization for obstructive uropathy (difficulty with urination) within the past 12 months? not acceptable Cross Reference: Uninsurable Functional Deficits XE "Uninsurable Functional Deficits" \t "See cancer of the urinary bladder"   GOTOBUTTON toc CANCER OF THE UTERUS  xe "uterine cancer"\iCancer of the uterusxe "cancer:uterus"\i is the most common malignancy of the female genital tract. The peak incidence occurs in women in their 6th and 7th decade of life. A majority of the cases are diagnosed at an early stage because symptoms develop early in the disease and the endometrial tissue is easily accessed via dilatation and curettage (D&C). xe "D&C, dilatation and curettage " Treatment: Surgical excision and may include chemotherapy XE "chemotherapy:uterine cancer"  and radiation XE "radiation:uterine cancer"  therapy. XE "surgery:uterine cancer"  Complications: Significant post-treatment complications may include bowel problems. Questions You Should Ask and Criteria:What is the stage of the cancer and how much time has elapsed since the end of treatment? Stage 0 tumors may be acceptable 3 months following treatmentStage I and II tumors may be acceptable 6 months following treatmentStage III tumors may be acceptable 48 months following treatmentStage IV tumors are not acceptableHas there been any recurrence or evidence of metastasis XE "metastasis" ?not acceptableHas there been any use of chemotherapy within the past 4 years?not acceptableHas there been any use of Medroprogesterone (Depoprovera), Megastrol (Megase), or Tamoxifen (Nolvadex) within the past 4 years?not acceptable xe "carcinoid: tumors"\i GOTOBUTTON toc CARCINOID TUMORS xe "tumors: carcinoid"\i A group of intestinal tumorsxe "tumors: intestinal"\ixe "intestinal tumors"\i, first described in 1907, appeared to be more benign than malignant and as such were named carcinoid (resembling cancer) tumors. One cannot differentiate benign from malignant carcinoids XE "cancer:carcinoid tumors" \i. Malignancy can only be determined if there is regional lymph node or distant metastasis. In addition to gastrointestinal locations, these tumors may also occur in the lungs. Some of these tumors are associated with a syndrome that includes flushing, diarrhea, wheezing, and valvular heart disease. This is called the carcinoid syndromexe "carcinoid: syndrome". The cause of the flush is unknown, but may be precipitated by the ingestion of food or alcohol, or the administration of calcium, epinephrine, or isoproterenol. The diarrhea is usually watery and associated with abdominal cramping. Bronchial spasm and wheezing are common, and right-sided heart lesions may develop, leading to right-sided congestive heart failurexe Congestive Heart Failure (CHF): carcinoid tumors". Many patients with carcinoid syndrome have liver XE "liver:metastases, carcinoid syndrome"  metastases. Lymph node XE "Lymph node:carcinoid syndrome"  metastases may also be present. Treatment: Surgical excision and may include chemotherapy XE "surgery:carcinoid tumors"  XE "chemotherapy:carcinoid tumors" . Questions You Should Ask and Criteria:Has any treatment or medication been received for the condition? If so, what type? may be acceptable if treated surgicallynot acceptable if treatment was with chemotherapyIs the tumor size greater than 2 cm? not acceptableHas there been any lymph node metastasis? not acceptable when primary site involves the rectum or stomach Has there been any evidence of distant metastasis XE "metastasis" ? not acceptableHave there been any episodes of carcinoid syndrome? not acceptable within 12 months  GOTOBUTTON toc CARDIAC FAILURE xe "cardiac: failure"\i CONGESTIVE HEART FAILURE (CHF)xe "heart:failure(CHF), congestive"\i\bxe "Congestive Heart Failure (CHF)"\i\b The function of the heart XE "heart:congestive failure"\  is to pump an adequate volume of blood to various tissues of the body. Congestive heart failure occurs when the heart fails as a pump causing increased fluid retention in the lungs and lower parts of the body. Causes of CHF include coronary artery diseasexe "coronary: artery disease (CAD), CHF", valvular heart disease,xe "valvular: heart disease, CHF" and cardiomyopathyxe "cardiomyopathy". Symptoms and signs include shortness of breathxe "shortness of breath: congestive heart failure", cough, fatiguexe "fatigue: congestive heart failure", heart enlargement, and swelling of the legs. Treatment: CHF is treated with medications that improve heart and kidney function. Questions You Should Ask and Criteria:Has there been a diagnosis of or symptomatic CHF within the past 12 months? not acceptableHave there been 3 or more episodes of CHF? not acceptable Is there a history of any of the following within the past 5 years? Within 5 years for MI, diabetes, emphysema/COPD, TB, asthma, or chronic bronchitis - Heart attack or angina - Emphysema/COPD - Diabetes - Tuberculosis (TB) - Asthma or chronic bronchitisnot acceptable Has there been any CHF after heart surgery (coronary artery bypass, angioplasty/stent, or heart valve replacement)? not acceptableHas there been any symptomatic CHF in combination with cardiomyopathy within the past 24 months? not acceptableHas there been an onset of atrial fibrillation within the past 24 months? not acceptableHas a heart transplant been discussed or recommended? not acceptable Cross Reference:  GOTOBUTTON a_fib Atrial Fibrillation  CABG or Angioplasty XE "Atrial Fibrillation" \t "See cardiac failure"  XE "Atrial Fibrillation" \t "See congestive heart failure"   GOTOBUTTON cardiomyopathies Cardiomyopathy  XE "Cardiomyopathy" \t "See cardiac failure"  XE "Cardiomyopathy" \t "See congestive heart failure"   GOTOBUTTON arrhythmias Conduction Disturbances  Diabetes Heart Transplantation XE "Conduction disturbances" \t "See cardiac failure"  XE "Conduction disturbances" \t "See congestive heart failure"   GOTOBUTTON toc CARDIOMYOPATHIES  xe "cardiomyopathies"\iCardiomyopathies are a collection of diseases of the heart musclexe "heart:diseases of muscle"xe "diseases of the heart muscle" that can result from a number of disorders. The common effect of these disorders is either acute inflammationxe "heart:acute inflammation" or, more often, chronic fibrosisxe "heart: chronic fibrosis"xe "chronic: fibrosis of the heart" of the heart muscle. Symptoms may include shortness of breath with exertion or at rest, cough, fatigue, edema, chest pain, lightheadedness, or palpitations. There are 3 types of cardiomyopathiesxe "cardiomyopathy: types of ": 1) dilated (congestive)xe "dilated (congestive) cardiomyopathy"xe "cardiomyopathy:dilated (congestive)", 2) non-dilated (restrictive)xe "non-dilated (restrictive) cardiomyopathy"xe "cardiomyopathy:non-dilated (restrictive)", and 3) hypertrophicxe "hypertrophic: cardiomyopathy"xe "cardiomyopathy:hypertrophic". - Dilated (congestive) cardiomyopathy is the dilation of the heart chambers resulting in poor ventricular function. - Non-dilated (restrictive) cardiomyopathy exhibits heart chambers that are normal in size, but the walls are thickened resulting in restriction of the blood flow into the heart. - Hypertrophic cardiomyopathy is characterized by a normal heart chamber size, but disproportionate enlargement of the left ventricle wall. Questions You Should Ask and Criteria:Has there been symptomatic CHF within the past 24 months? not acceptableIs there a current use of steroids or Imuran XE "Imuran:cardiomyopathies" ? not acceptable Is there a history of any of the following? - Heart attack or angina - Emphysema/COPD - Diabetes - Tuberculosis (TB) - Angioplasty or heart - Asthma or chronic bronchitis surgery (CABG, Valve Replacement, Ablation) not acceptable Has there been any reference to or suggestion of heart transplantation? not acceptable Cross-references:  GOTOBUTTON a_fib Atrial Fibrillation  CABG or PTCA XE "Atrial Fibrillation" \t "See cardiomyopathies"   GOTOBUTTON CHF CHF  XE "CHF" \t "See cardiomyopathies"   GOTOBUTTON arrhythmias Conduction Disturbances  Diabetes Valvular Heart Disease XE "Conduction disturbances" \t "See cardiomyopathies"   GOTOBUTTON toc CEREBRAL PALSY  xe "palsy, cerebral"\ixe "cerebral: palsy"\iCerebral palsy is a commonly used term for a variety of neurologic disorders XE "neurologic disorders: Cerebral Palsy"  usually caused by brain traumaxe "brain: trauma, cerebral palsy"xe "trauma:brain". Physical signs may include spastic paralysisxe "paralysis: spastic"xe "spastic:paralysis", muscle weaknessxe "muscle:weakness, cerebral palsy, involuntary movementsxe "involuntary movements: cerebral palsy", speech difficulties,xe "speech difficulties: cerebral palsy" and occasionally mental retardationxe "retardation, mental:cerebral palsy"xe "mental: retardation, cerebral pasly". The neurological deficitsxe "neurological: deficits, cerebral palsy" tend to be stable and non-progressive, and can vary greatly in degree of severity and involvement. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLsxe "ADLs:Cerebral Palsy" or IADLsxe "IADLs:Cerebral Palsy"? see Uninsurable Functional Deficits  GOTOBUTTON toc CHRONIC FATIGUE SYNDROME  (CFS)xe emphysema"\i This syndrome is defined by the Center for Disease Control as follows: Chronic, persistent fatigue with a definite onset that is not the result of ongoing exertion. All symptoms must be present for at least six months. Symptoms must include at least four of the following in addition to fatigue: Short-term memory or concentration problems Sore throat Tender lymph nodes Joint pain without swelling Headaches Unrefreshing sleep Debility after exercise lasting more than 24 hours No clear diagnostic tool, such as a blood test, has been developed for Chronic Fatigue Syndrome, and no specific cause has been identified. For this reason, other illnesses must first be ruled out before a diagnosis of CFS can be made. CFS is estimated to have a prevalence in the United States of 4 to 10 cases per 100,000 adults 18 years or age or older. The majority of patients are women. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs or IADLs? not acceptableAre assistive devices XE "assistive devices:fractures"  such as a wheelchair, XE "wheelchair:fractures" walker, quad cane, or crutches XE "walker:fractures"  XE "quad cane:fractures"  XE "crutches:fractures"  currently being used? not acceptable Is the diagnosis still uncertain or medical evaluation still ongoing? not acceptableHas there been any physical therapy required within the past 12 months? not acceptableHave narcotics such as Demerol XE "Demerol:rheumatoid arthritis" , Methadone, Morphine XE "morphine:rheumatoid arthritis" , OxyContin, Percodan XE "Percodan:rheumatoid arthritis"  or Talwin XE "Talwin:rheumatoid arthritis"  been used to control pain within the past 12 months?not acceptable  GOTOBUTTON toc CHRONIC OBSTRUCTIVE PULMONARY DISEASE -EMPHYSEMA Asthma XE asthma"\i , Chronic Bronchitis XE bronchitis" \ixe chronic bronchitis"\i, Emphysemaxe emphysema"\i Chronic obstructive pulmonary disease (COPD) refers to a number of diseases characterized by a chronic, relatively irreversible obstruction to airflow. Individuals with COPD may exhibit an asthmatic component. The three most common forms of COPD XE "COPD" \t "See CHF"  XE "COPD:asthma"  XE "COPD:chronic bronchitis"  XE "COPD:emphysema" : Chronic bronchitisxe chronic bronchitis" is characterized by a chronic productive (sputum producing) cough. The hypersecretion of mucus obstructs airways causing hypoventilationxe "hypoventilation", inflammation, and bronchospasmxe "bronchospasm". Emphysema xe "emphysema "is the obstruction of small airways causing the destruction of the bronchioles and alveoli where the air exchange takes place. Signs and symptoms of progressive emphysema include labored breathing XE "breathing, labored" (dyspneaxe "dyspnea") on exertion, easy fatigue, weight loss XE "weight loss:emphysema" , "barrel chestxe "barrel chest"", and expiratory wheezes. Asthma is a reversible obstructive pulmonary disorder characterized by an increased reactivity of the bronchial passages to a variety of stimuli. Airways are narrowed by contraction of the muscle lining the walls of both small and large bronchial passages. This narrowing causes the typical symptoms of wheezing and shortness of breath. Treatment for all of these conditions may consist of inhalers, nebulizers, or pulmo-aids in addition to oral medication. Questions You Should Ask and Criteria:Has there been daily or intermittent use of oxygen XE "oxygen:emphysema" , IPPB therapy or home respiratory therapy within the past 12 months? not acceptableHave there been any hospitalizations for this condition within the past 6 months? not acceptableHave there been 2 or more ER visits within the past 12 months for respiratory symptoms? not acceptableHas there been a history of symptomatic Congestive Heart Failure (CHF) within the past 5 years or Cardiomyopathy XE "Congestive Heart Failure (CHF):emphysema" ? not acceptableAre activities restricted due to shortness of breath XE "shortness of breath" xe "breath, shortness of "? not acceptableAre symptoms worsening (Fatigue, shortness of breath, pulmonary rehabilitation, poor height to weight ratio) XE "shortness of breath" xe "breath, shortness of "? not acceptableAre more than 20 mgs per day of Prednisone XE "Prednisone:COPD"  XE "Prednisone:emphysema"  used?not acceptable Cross Reference: CHF Cardiomyopathy  GOTOBUTTON toc CIRRHOSIS, ALCOHOLIC LIVER DISEASE  xe alcoholic liver disease (ALD)"\i Alcoholic liver disease (ALD) describes the damage to the liver resulting from chronic alcohol ingestionxe "alcohol:ingestion". The three principal alcohol induced liver diseases are: 1) fatty liverxe "liver:fatty"xe "fatty liver", 2) hepatitisxe "hepatitis", and 3) cirrhosis. Alcoholic fatty liver usually is the earliest stage of alcohol liver disease. As the seriousness of the disease progresses, hepatitis in acute or subacute form may develop. Cirrhosis, the late stage of this process, is the deposition of fibrous tissue in the liver. Complications of end stage liver diseasexe "liver:disease " are ascites (fluid in the abdominal cavity), edema XE "edema: liver disease" , and gastrointestinal bleeding. XE "gastrointestinal: bleeding, liver disease"  Hepatic Cirrhosis Questions You Should Ask and Criteria:Has there been any alcohol use within the past 4 years? not acceptableHas the hepatic cirrhosis been active within the past 4 years (i.e.; ascites, encephalopathy, esophageal varices, portal hypertension, splenomegaly) XE "liver transplantation:primary biliary cirrhosis" ? not acceptable  Cross Reference: Alcoholic Liver Disease (below) Primary Billiary Cirrhosis (below) Alcoholic Liver Disease Questions You Should Ask and Criteria:Has there been active hepatic cirrhosis within the past 4 years? not acceptableHas there been any alcohol use within the past 2 years? XE "liver transplantation:primary biliary cirrhosis"  not acceptable Has there been a diagnosis of alcoholic hepatitis within the past 2 years? not acceptableHas there been a Liver Transplant recommended or completed within the past 5 years?not acceptableHas there been any hospitalization for liver disease within the past 2 years?not acceptableHas there been any gastrointestinal bleeding within the past 2 years?not acceptableIs there a history of liver cancer?not acceptable  GOTOBUTTON toc PRIMARY BILIARY CIRRHOSIS  The cause of primary biliary cirrhosis is unknown but characterized by the progressive destruction of bile ducts within the liver. This leads to eventual fibrosis XE "fibrosis"  and cirrhosis diseases. Associated diseases include Sjogrens syndrome XE "Sjogrens syndrome" , severe osteoporosis XE "osteoporosis" , thyroiditis XE "thyroiditis"  and renal conditions XE "renal conditions" . Advanced disease may benefit from liver transplantation. Symptoms most commonly include pruritus (severe itching) and fatigue. Some individuals, without symptoms, are diagnosed on the basis of laboratory test results. Treatment: Consists of the use of Colchidine (slows down the progression of the disease), Imuran, Thioprine, supplements of vitamin D and calcium. The current use of Colchicine, Imuran or Thioprine can be underwritten if there is no indication of disease progression or associated complications. Questions You Should Ask and Criteria:Has there been active hepatic cirrhosis within the past 4 years? not acceptableHas there been a recommendation for a liver transplantation, or transplant completed within the past 4 years XE "liver transplantation:primary biliary cirrhosis" ? not acceptable Is there a history of liver cancer XE "liver cancer"  XE "liver cancer:primary biliary cirrhosis" ? not acceptableHas there been any alcohol use within the past 2 years?not acceptable  GOTOBUTTON toc CORONARY ARTERY BYPASS SURGERY xe "Coronary: artery bypass surgery"\i OR CORONARY ANGIOPLASTYxe "angioplasty:coronary"\ixe "coronary: angioplasty"\i (Coronary Artery Bypassxe bypass: coronary artery"\i Graft [CABG]xe Coronary: Artery Bypass Graft (CABG)"\i, Percutaneous Transluminal Coronary Angioplasty [PTCA XE PTCA"\i ]xe Percutaneous Transluminal Coronary Angioplasty (PTCA)"\i) Coronary Artery Bypass Grafting (CABG XE "CABG" ) and Percutaneous Transluminal Coronary Angioplasty (PTCA) are the surgical treatments for ischemic heart diseasexe "heart: ischemic heart disease, treatments of "xe "ischemic heart disease treatments". Bypass surgery XE "surgery:bypass"  is accomplished through the use of a section of a vein to bypass an area of obstruction in the coronary artery(s). Angioplasty is carried out by maneuvering a balloon tipped catheter through the skin and into the arterial system to the coronary arteries. The balloon tip is expanded against the obstructing lesion to widen the narrowed artery. Symptoms may include fatigue, palpitations, angina, shortness of breath, or limitations of activities. Questions You Should Ask and Criteria:Has coronary artery surgery been recommended or scheduled? not acceptableWhat type of coronary artery surgery XE " surgery: coronary artery "  was performed and when was it done? not acceptable if there has been a: PTCA/Stent within the past 3 months CABG within the past 6 monthsIs there a history of Cardiomyopathy or post-surgical Congestive Heart Failure XE "Congestive Heart Failure"  (CHF)? not acceptableIs there a history of Transient Ischemic Attack (TIA XE "TIA" ) or stroke XE "stroke" ?not acceptableIs there a history of Diabetes? not acceptableHave there been increasing symptoms of angina or angina at rest XE "angina: angioplasty"  within the past 6 months?not acceptable Has there been any post surgical angina resulting in marked limitation of physical activity?not acceptable Are there any physical restrictions due to heart disease? not acceptable if there is a history of any restrictions or limitations to activities Cross-references:  GOTOBUTTON a_fib Atrial Fibrillation  Conduction Disturbances XE "Atrial fibrillation" \t "See coronary artery bypass surgery"  XE "Atrial fibrillation" \t "See coronary angioplasty"   GOTOBUTTON angina Angina  Diabetes XE "Angina" \t "See coronary artery bypass surgery"  XE "Angina" \t "See coronary angioplasty"   GOTOBUTTON CHF CHF  TIA XE "CHF" \t "See coronary artery bypass surgery"  XE "CHF" \t "See coronary angioplasty"   GOTOBUTTON cardiomyopathies Cardiomyopathy   XE "Cardiomypoathy" \t "See coronary artery bypass surgery"  XE "Cardiomypoathy" \t "See coronary angioplasty"   GOTOBUTTON toc CROHN'S DISEASE - IRRITABLE BOWEL SYNDROME XE "bowel: irritable bowel syndrome (IBS) "\i  XE "irritable bowel syndrome (IBS)" \b \i  (IBS XE IBS" \b \i ) - ULCERATIVE COLITIS XE colitis: ulcerative"\i  XE ulcerative colitis" \b \i  - DIVERTICULITIS XE diverticulitis" \b \i  (Colitis, Regional Enteritis XE Enteritis" \b \i , Ileitis XE Ileitis" \b \i , Proctitis XE Proctitis" \b \i , Spastic colitis XE Spastic:colitis" \b \i ) XE colitis:spastic"\i  CROHNS DISEASE is an inflammation involving the entire bowel wall (mucosa, muscular layers, and serosa), which can involve any portion of the gastrointestinal tract, but usually involves the distal portion of the small bowel and portions of the large bowel (colon). ULCERATIVE COLITIS is an inflammation that is restricted to the mucosal layer of the bowel and usually occurs in the large bowel (colon). If the involvement is localized to specific portions of the bowel it is also known as: - COLITIS when there is involvement of the colon. - PROCTITIS when there is involvement of the rectum. Symptoms for these conditions include: abdominal pain, diarrhea and rectal bleeding. Nausea, vomiting, weight loss and intestinal obstruction may develop as well as perforation and severe bowel dilatation (megacolon). Treatment: Very severe or acute cases may be treated with intravenous steroids XE "intravenous: steroid, treatment of colitis"  and hyperalimentation XE "hyperalimentation:treatment of colitis"  (intravenous feeding XE "intravenous: feeding, treatment of colitis"  of a complete diet), surgical resection of the diseased area of the bowel or total bowel resection. Treatment of chronic disease includes oral anti-inflammatories XE "anti-inflammatories:oral, colitis"  and steroid enemas XE "enemas, steroid:treatment of colitis"  XE "steroid enemas, treatment of colitis" . DIVERTICULITIS is the inflammation of small outpockets in the colon (diverticulosis). It is an acute disorder, which may cause perforation with resulting peritonitis, abscess formation and large bowel obstruction. Treatment for uncomplicated cases of diverticulitis is often with diet control and antibiotics whereas complications may warrant surgical intervention. IRRITABLE BOWEL SYNDROME (IBS) also known as Mucous Colitis XE "Mucous Colitis"  XE "colitis:mucous"  or Spastic Colitis is a very common functional disorder of the gastrointestinal tract and can cause a great deal of physical and emotional distress to those affected. Common symptoms are abdominal pain, constipation or diarrhea. A history of IBS without ADL XE "ADL: IBS"  or IADL XE "IADL: IBS"  restriction is generally acceptable.  GOTOBUTTON toc CROHN'S DISEASE - IRRITABLE BOWEL SYNDROME XE "bowel: irritable bowel syndrome (IBS) "\i  XE "irritable bowel syndrome (IBS)" \b \i  (IBS XE IBS" \b \i ) - DIVERTICULITIS Questions You Should Ask and Criteria:Is Crohns Disease active & symptomatic?not acceptable Has surgery been recommended or scheduled, or completed within the past 12 months?not acceptableHas there been an unintentional weight loss XE "weight loss:colitis"  of more than 15% in the past 12 months? not acceptableAre steroids currently being used?not acceptable if current use of corticosteriods (Prednisone) is greater than 20mg dailyHas there been any hospitalization within the past 12 months?not acceptableHave there been any complications?not acceptable if there is any evidence of: - severe diarrhea within the past 6 months - bowel obstruction or perforation or fistulas within the past 12 months Has there been any tube feeding within the past 12 months?not acceptable ULCERATIVE COLITIS XE colitis: ulcerative"\i  XE ulcerative colitis" \b \i  Questions You Should Ask and Criteria:Is Ulcerative Colitis active & symptomatic?not acceptable Have there been multiple attacks of inflammation within the past 12 months?not acceptable Has surgery been recommended or scheduled, or completed within the past 12 months?not acceptableHas there been an unintentional weight loss XE "weight loss:colitis"  of more than 15% in the past 12 months? not acceptableWhat is the current treatment?not acceptable if treated with intravenous steroids or intravenous feeding not acceptable if there is a current use of corticosteriods (Prednisone) greater than 20mg dailyHave there been any complications?not acceptable if there is any evidence of: - severe, bloody diarrhea within the past 6 months - cholangitis or gastrointestinal bleeding within the past 12 months Has there been any hospitalization within the past 12 months? not acceptableHas there been any debilitating arthritis, limiting ADLs & IADLs? not acceptableHas there been any tube feedings within the past 12 months? not acceptable  GOTOBUTTON toc CUSHING'S SYNDROME   XE "Cushings syndrome" \i  (Hypercortisolism XE "hypercortisolism" \i ) Cushings syndrome is the term that refers to the overproduction of the bodys natural amounts of cortisol and is due to a number of different causes. The most common is over-secretion by the pituitary gland of the adrenal stimulating hormone XE "adrenal stimulating hormone" . This causes excessive secretion of cortisol by the adrenal gland. Cushings syndrome may also result from benign tumors of the adrenal gland and the over-administration on a chronic basis of corticosteroid medications for a number of conditions, which require its usage. The typical symptoms in Cushings syndrome are obesity, diabetes, weakness, advanced osteoporosis, and a number of skin conditions, including acne and recurrent skin ulcerations. Treatment requires knowledge of the underlying cause. Pituitary or adrenal surgery XE "surgery:pituitary"  XE "surgery:adrenal"  may be necessary. Reduction of corticosteroids XE "corticosteroids: Cushing's syndrome" , e.g. Prednisone, may also be helpful. The use of steroid saving medications such as Cytoxan XE "Cytoxan: Cushing's syndrome"  may allow Prednisone XE "Prednisone:Cushing's syndrome"  reduction if its use is required for the treatment of other conditions. Questions You Should Ask and Criteria:Is a work-up underway and/or cause unknown?not acceptableIs pituitary or adrenal surgery XE "surgery:adrenal"  scheduled or anticipated?not acceptableHas there been advanced osteoporosis?not acceptableHave there been pathologic (spontaneous) fractures XE "fractures: spontaneous" ?not acceptable  GOTOBUTTON toc DEPRESSION  xe Depression"\i(Anxiety, Maniaxe Mania"\i, Manic Depressionxe Manic Depression"\i, Bipolar Disorderxe Bipolar Disorder"\i) Depression is a loss of interest in friends and in every day pursuits, and feelings of helplessness and worthlessness. Symptoms include loss of appetite, weight lossxe "weight loss: depression", sleep disturbancexe "sleep disturbance: depression ", fatiguexe "fatigue: depression", and weakness. There are many types of depressive illnesses, and depression is common among the elderly. Older people may experience cognitive symptoms associated with depression, such as memory loss and confusion that may be difficult to distinguish from dementia. A type of depressive illness called bipolar or manic-depressive disorder is characterized by periods of severe depression alternating with manic episodes. (Mania XE "mania"  refers to distinct episodes where the predominant mood is elevated, expansive or irritable, and may include hyperactivity, pressured speech, flight of ideas, less need for sleep, distractibility, and inflated self-esteem.) The risk for long-term care derives from the depressed individuals inability or unwillingness to perform activities independently, the side effects of medications used to treat this condition, and self-inflicted injuries. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs xe "ADLs: depression "or IADLs xe "IADLs: depression"?see Uninsurable Functional DeficitsWhat treatments or medications have been prescribed?not acceptable if: there is a history of electro convulsive (shock XE "shock therapy: depression" ) therapy (ECT) XE "Electro Convulsive (shock) Therapy (ECT): depression"  in the past 48 monthsManic depression or anti-psychotics medications were initiated within the past 24 monthsHas there been a hospitalization XE "hospitalization:depression"  XE "emergency room visit:depression"  or emergency room visit for depression within the past 12 months? not acceptable Has there been a hospitalization XE "hospitalization:bipolar disorder"  XE "emergency room visit:bipolar disorder"  or emergency room visit for bipolar disorder within the past 24 months? not acceptable Has there been a history of alcohol or drug dependency within the past 24 months?not acceptableHas there been an unintentional weight loss XE "weight loss:colitis"  of more than 15 % in the past 12 months? not acceptableHave there been cognitive symptoms XE "cognitive symptoms:depression"  XE "cognitive symptoms:bipolar disorder"  such as memory loss, forgetfulness, confusion, or disorientation within the past 36 months?not acceptableIs there a neurologic or psychiatric work-up planned or in progress? not acceptable Cross Reference: Alcoholism Memory Loss  GOTOBUTTON toc DIABETES MELLITUS (DM)  xe "diabetes: mellitus (DM)"\ixe "mellitus, diabetes (DM)"\iDiabetes XE "diabetes"\i  is a chronic disease of carbohydrate metabolismxe "carbohydrate metabolism, chronic disease of" where either the pancreas XE "insufficiency:pancreas"  XE "pancreas: diabetes"  produces insufficient amounts of insulinxe "insulin" or insulin is produced in sufficient quantity but cannot be fully utilized. Hyperglycemia xe "Hyperglycemia "(elevated blood sugarxe "blood: sugar, elevated") is the result. Persistent hyperglycemia eventually damages virtually all organ systems. There are two basic types of diabetesxe diabetes:types of ":  XE "diabetes:type I"  XE "diabetes:type II" Type I insulin-dependent diabetesxe "Type I insulin-dependent diabetes mellitus " mellitus (IDDM XE "IDDM" ), and Type II non-insulin-dependent diabetes xe "Type II non-insulin-dependent diabetes mellitus "mellitus (NIDDM XE "NIDDM" ). Type II is sometimes called Adult Onset Diabetes Mellitus XE "diabetes:adult onset"  XE "Adult Onset Diabetes Mellitus"  (AODM XE "AODM" ). Diabetes is of increased significance when combined with obesity, high blood pressure, heart disease, and other circulatory problems. These combination histories are underwritten very conservatively. The major underwriting considerations of this disease include the stability of the disease and the presence and severity of complications. Obesity is the number one contributor to contracting Type II Diabetes and a key factor in maintaining control of diabetes. The current epidemic of diabetes in children and young adults is due mainly to obesity. Questions You Should Ask and Criteria:Is there a history of symptomatic coronary artery disease, cardiomyopathy, heart attack (MI), bypass surgery, vascular surgery, or valvular surgery?not acceptableHas there been a Transient Ischemic Attack Xe Transient Ischemic Attack (TIA): diabetes"  (TIA), amaurosis fugax, or stroke?not acceptableIs there a history of Congestive Heart Failurexe Congestive Heart Failure (CHF): diabetes" (CHF) within the past 5 years?not acceptableHas there been a hospitalization within the past 24 months for diabetic complications XE "diabetic complications" ? not acceptable Has there been any history of insulin use?not acceptable if insulin used within the past 12 monthsHas there been a history of skin complications (e.g. diabetic skin breakdownxe "skin:breakdown", leg/foot ulcersxe "ulcers: foot"xe "foot ulcers", and infectionsxe "infections: diabetes")? not acceptable Has there been any PVD, cerebrovascular insufficiency/ischemia, or intermittent claudication?not acceptableHas there has been an amputation xe "amputation "or blindness due to diabetesxe "blindness:due to diabetes"?not acceptableIs there any associated kidney diseasexe "blindness:due to diabetes"?not acceptableIs the most recent glycosylated hemoglobin/A1C greater than 10%xe "blindness:due to diabetes"?not acceptableIs there associated obesity? not acceptable (see build table on the following page, Effective 9/1/03) If over the height/weight limits stated below, the application should not be submitted: Effective 9/1/03 Build Table (DIABETIC)HEIGHTMaximum Weight (ALL)Minimum Weight (ALL)4' 06''124714' 07''129734' 08''134764' 09''139794' 10''144824' 11''149845' 0''154875' 1''159905' 2''164935' 3''169965' 4''175995' 5''1801025' 6''1861065' 7''1921095' 8''1971125' 9''2031155' 10''2091195' 11''2151226' 0'' 2211266' 1''2271296' 2''2341336' 3''2401366' 4''2461406' 5''2531446' 6''260147BMI3017 Cross-references: Cardiomyopathy / Congestive Heart Failure Coronary Artery Bypass or angioplasty  GOTOBUTTON MI Heart Attack - MI  XE "Heart" \t "See diabetes mellitus"   GOTOBUTTON PVD Peripheral Vascular disease  XE "Peripheral vascular disease" \t "See diabetes mellitus"   GOTOBUTTON CRF Renal Failure  XE "Kidney" \t "See diabetes mellitus"   GOTOBUTTON toc DIZZINESS  xe "dizziness"\iDizziness is one of several terms used to describe an unpleasant sensation of insecure balance. There are three broad categories, which may be useful in determining the underlying cause: Vertigo xe "Vertigo "(spinning): is a distortion of orientation or an erroneous perception of motion. Generally, it is secondary to an inner ear disorder or circulation problems. It may be either continuous or positional. Disequilibrium xe Disequilibrium "(unsteadinessxe "unsteadiness"-imbalancexe "imbalance"): is a feeling of imminent fall (without loss of consciousness) and may be indicative of an underlying neurologic disorder. Near Syncopexe Near Syncope" (faintingxe "fainting"-lightheadednessxe "lightheadedness"): is a feeling of impending loss of consciousnessxe "loss of consciousness, feeling of ". It is frequently due to a cardiovascular disorder (See Syncope REF syncope \* MERGEFORMAT  REF syncope \* MERGEFORMAT ). Questions You Should Ask and Criteria:Are there any limitations in performing the ADLs xe "ADLs:dizziness "or IADLsxe "IADLs:dizziness"?not acceptable if any deficits (see Uninsurable Functional Deficits)Has there been a diagnosis of an underlying cause for the dizziness? refer to specific impairment in IndexHave there been any fractures xe "falls: dizziness " as a result of this condition? not acceptable if there have been: 1 fracture within 6 months 2 or more fractures due to falls any pelvic or long bone fracturesIs a workup ongoing or anticipated?not acceptableHas there been any ENT or neurological surgery within the past 12 months?not acceptable Cross Reference: Fractures Uninsurable Functional Deficits  GOTOBUTTON toc EPILEPSY  xe epilepsy "(Seizuresxe seizures") Epilepsy is a disease of generalized or localized seizures, often producing a loss of consciousnessxe "loss of consciousness: epilepsy"xe "consciousness: loss of, epilepsy". The most common causes of epilepsy arexe "epilepsy:causes of ": symbol 118 \f "Wingdings" \s 7 \h Traumaxe "Trauma:cause of epilepsy" symbol 118 \f "Wingdings" \s 7 \h Tumors in the brainxe "Tumors:cause of epilepsy " symbol 118 \f "Wingdings" \s 7 \h Vascular disordersxe "Vascular: disorders, cause of epilepsy " including stroke symbol 118 \f "Wingdings" \s 7 \h Metabolic disordersxe "Metabolic disorders:cause of epilepsy " including diabetes, renal failure, or drug/alcohol withdrawal symbol 118 \f "Wingdings" \s 7 \h Post brain surgery If the cause is known, we will evaluate according to the cause. Questions You Should Ask and Criteria:How long ago was the last seizure?a single seizure of unknown cause within the past 12 months is not acceptable multiple seizures of unknown cause within the past 24 months are not acceptable petit mal seizures only, one or more, within the past 12 months may be considered  GOTOBUTTON toc EYE DISORDERS  XE eye disorders"\i   XE "cataract"  XE "eye disorders:cataract" Cataract is a gradual loss of lens transparency that can result in a progressive loss of vision XE "vision:eye disorders" . Causes may be due to heredity, systemic diseases, X-rays or age related degeneration of the lens. When useful vision is lost, lens extraction surgery becomes necessary. This usually is of little underwriting concern. Glaucoma  XE "glaucoma"  XE "eye disorders:glaucoma" is an eye disorder characterized by increased pressure within the eye, which may result in impaired vision or total  XE "eye disorders:blindness" blindness XE "blindness: eye disorders"  in the most severe cases. Glaucoma may be  XE "glaucoma:congenital(infantile)" congenital (infantile) or secondary XE "glaucoma:secondary"  (due to other eye diseases or cataracts). In most cases medication controls the symptoms and lessens the pressure within the eye. Underwriting consideration is based on any loss of independence or the need for assistance with ADL XE "ADLs:glaucoma" s/ IADLs as a result of visual impairment. XE "IADLs:glaucoma"  Macular Degeneration XE "macular degeneration"  XE "eye disorders:macular degeneration"  is a leading cause of vision loss in the elderly. This results from a disturbance in the macula of the eye, which leads to a progressive build up of scar tissue, and gradual loss of vision. There is no known treatment for this disorder. Underwriting consideration is based on any loss of independence or the need for assistance with ADLs XE "ADLs:macular degeneration" / IADLs XE "IADLs:macular degeneration"  as a result of visual impairment. Amaurosis Fugax  XE "amaurosis fugax"  XE "eye disorders:amaurosis fugax" is a temporary monocular (one eye) partial blindness lasting less than 24 hours. This condition is caused by an embolus, thrombosis or spasm of the retinal artery. It is often seen in hypertensive atherosclerosis and usually poses no underwriting concern unless there are multiple episodes. Multiple episodes of amaurosis fugax is an unacceptable history. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs or IADLs?see Uninsurable Functional Deficits XE "ADLs:neuropathy"  XE "IADLs:neuropathy"  Cross Reference: Diabetes  GOTOBUTTON TIA TIA ( for Amaurosis Guidelines) XE "TIA" \t "See eye disorders"   GOTOBUTTON toc FIBROMYALGIA  Fibromyalgia is a poorly understood syndrome of pain and fatigue. It was once called fibrositis because it was thought to be an inflammation of the fibrous tissues. However, studies usually fail to show any inflammation. A diagnosis of fibromyalgia is based on a clinical picture of widespread pain and tenderness described as aching all over, fatigue, exhaustion after minimal effort, and sleep disturbance. True fibromyalgia affects approximately 2-4% of the population, and is more common among women. A diagnosis of fibromyalgia includes documentation of significant tenderness in at least 11 of 18 possible locations in the body. The sleep disturbance may be described as difficulty falling asleep or staying asleep. Other symptoms may include intestinal troubles (Irritable Bowel Syndrome), anxiety and other mood disturbances, headaches, allergies, and Raynauds phenomenon (intermittent cold white hands). Fibromyalgia is commonly associated with Chronic Fatigue Syndrome (CFS). Treatment consists primarily of antidepressants such as Elavil. Graded aerobic exercise has also been found to be of help. Questions You Should Ask and Criteria: Are there any limitations with performing the ADLs or IADLs? Any limitation not acceptable (See Uninsurable Functional Deficits)Have narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan, or Talwin been used to control pain within the past 12 months?not acceptableAre assistive devices such as a wheelchair, walker, quad cane, straight cane, or crutches currently being used XE "osteoporosis" ? not acceptable Has any physical therapy been required within the past 12 months? not acceptableHas major weight bearing joint surgery been recommended or scheduled, or completed within the past 3 months? not acceptableHave there been any falls or fractures XE "physical therapy:fractures" ?see Fractures guidelines  Cross Reference: Fractures Physical Therapy Uninsurable Functional Deficits  GOTOBUTTON toc FRACTURES  xe "fractures"\i\bFractures are more common in women than men, probably due to postmenopausal osteoporosisxe "osteoporosis (OP):post menopausal " and the tendency for women to outlive men. Dizzinessxe "dizziness:fractures", syncopexe "syncope:fractures", peripheral neuropathyxe "neuropathy:peripheral "xe "peripheral: neuropathy, fractures", arthritis, xe "arthritis:fractures "and over-medicationxe "medication:over-medication leading to falls"xe "over-medication:leading to falls" can lead to fallsxe "falls:fractures". The presence of osteoporosis XE "osteoporosis (OP):fractures"  often determines whether a fall results in a fracture or not. The most common sites of fracturesxe "fractures:most common sites " are the hips XE "hip:fracture"  followed by compression fractures  XE "compression fractures" of the spinal column XE "spinal: fractures" ,  XE "fractures:spinal"  XE "fractures:compression" fractures of the pelvis XE "fractures:pelvis" , shoulders XE "fractures:shoulders" , and wrist XE "fractures:wrist" . Healing of fractures in the elderly is often delayed because of a reduced blood supply to the area, pre-existing arthritis, reduced nutrition, and decreased physical activity. XE "fractures:knee"  Pathological fractures XE "pathological (spontaneous) fractures" xe fractures:pathological (spontaneous) " (spontaneous, i.e. unassociated with a fall or trauma) are common in the elderly. Osteoporosis, metastatic tumors, multiple myeloma, and Paget's disease can cause spontaneous fractures.  XE "bone:fractures"  Questions You Should Ask and Criteria: What bone was fractured and what was the date of the fracture?fractures of the hip, femoral, tibia or vertebral body may be acceptable 3months after recovery fractures of the pelvis may be acceptable 12 months after recovery two or more pelvic fractures due to falls, Osteoporosis or Pagets disease xe "multiple fractures"xe "fractures: multiple" are not acceptablethree or more long bone fractures due to falls, Osteoporosis or Pagets disease xe "multiple fractures"xe "fractures: multiple" are not acceptablethree or more vertebral body compression fractures due Ankylosing Spondylitis, Osteoporosis, Pagets disease or Rheumatoid Arthritis xe "multiple fractures"xe "fractures: multiple" are not acceptableHas surgery been recommended?hip replacement surgery xe "hip: replacement, fractures"xe "replacement:hip " XE "surgery:knee"  XE "surgery:hip"  xe "knee: replacement"xe "replacement:knee"may be acceptable 3 months after return to full functional status and release from medical follow-upHas there been a pathologic fracture XE "osteoporosis" ?not acceptable Is there any evidence of functional or movement limitations or is human assistance required?not acceptableAre assistive devices XE "assistive devices:fractures"  such as a wheelchair, XE "wheelchair:fractures" walker, or quad cane, currently being used? not acceptableIs physical therapy XE "physical therapy:fractures"  currently required?may be acceptable within 6 monthsAre narcotics such as Demerol XE "Demerol:fractures" , Methadone, Morphine XE "morphine:fractures" , OxyContin, Percodan XE "Percodan:fractures" , or Talwin XE "Talwin:fractures"  used to control pain within the past 12 months? not acceptableCross Reference: Dizziness Osteoporosis Uninsurable Functional Deficit  GOTOBUTTON toc HEMOCHROMATOSIS  xe "hemochromatosis"\iHemochromatosis XE "blood: disorders: hemochromatosis"  is a unique genetic disorder that results in excessive absorption of dietary iron XE "iron: dietary,excessive absoption of" . As a result, the body's iron stores increase markedly. The disease's clinical manifestations result from the damage to organ systems by the iron deposited within the system. Since this is a genetic condition, it is not preventable. This condition may be successfully treated and controlled if the diagnosis is made early and treatment begun promptly. Treatment of this disease consists of frequent phlebotomies xe "phlebotomies "(removal of blood), which over a period of months to years can result in the significant removal of excessive iron stores. Except for patients with advanced liver disease, the prognosis is good. Questions You Should Ask and Criteria:Is there any evidence of cancer of the liver, cirrhosis of the liver, esophageal bleeding, or Congestive Heart Failure (CHF XE "Congestive Heart Failure (CHF): hemochromatosis " ) XE "diabetes:hemochromatosis" ? not acceptableIs hemochromatosis due to repeated transfusions, excessive iron supplements,  XE "transfusions:hemochromatosis"  or alcoholic cirrhosis XE "alcoholism:hemochromatosis" ?not acceptableHas there been any IV medication to treat this condition within the past 12 monthsnot acceptable  GOTOBUTTON toc HEMOPTYSIS  xe "hemoptysis"\i XE "blood: disorders: hemoptysis" Hemoptysis is the coughing or spitting up of blood. It may be a symptom of a benign disorder (such as acute/chronic bronchitis) or a more serious condition such as pulmonary embolism XE "pulmonary:embolism" xe "embolism:pulmonary, cause of hemoptysis", bronchiectasisxe "bronchiectasis:cause of hemoptysis", lung abscess, tuberculosis xe "tuberculosis (TB): cause of hemoptysis "(TB), or cancer XE "cancer:cause of hemoptysis" . If the cause is known, we will evaluate according to the cause. Questions You Should Ask and Criteria:Is there a history of  XE "cancer:hemoptysis" bronchiectasis XE "bronchiectasis:hemoptysis" , lung abscess XE "lung abscess:hemoptysis" , pulmonary fistula, pulmonary hypertension, or tuberculosis XE "tuberculosis:hemoptysis"  (TB)?not acceptableHas there been any pulmonary hospitalizations within the past 12 months? not acceptableHave there been 2 or more ER visits or hospitalizations within the past 24 months? not acceptable Cross Reference:  GOTOBUTTON COPD Bronchiectasis  Tuberculosis XE "Bronchiectasis" \t "See hemoptysis"   GOTOBUTTON cancer Cancer  XE "Cancer" \t "See hemoptysis"   GOTOBUTTON toc HEPATITIS  xe Hepatitis"\i\b(Acute and Chronic Viral Hepatitis XE hepatitis:acute"\i  XE hepatitis:chronic viral" xe "Acute: Hepatitis"\ixe "chronic: viral hepatitis"\i) Hepatitis refers to a viral inflammation of the liverxe "liver:viral inflammation of "xe "viral inflammation of the liver". There are five viral agents proven to cause hepatitis in humans: hepatitis Axe "hepatitis:A", hepatitis Bxe "hepatitis:B", hepatitis non-A-non-Bxe "hepatitis:non-A-non-B" or hepatitis Cxe "hepatitis:C", hepatitis Dxe "hepatitis:D", and hepatitis Exe "hepatitis:E". The spectrum of severity ranges from an asymptomatic mild disease to a severe and fatal infection. A liver biopsyxe "liver:biopsy for hepatitis" is used to determine the severity. Hepatitis B & C may develop into a chronic form of hepatitis, which can be either chronic persistent hepatitis XE "chronic: persistent hepatitis" xe "persistent: hepatitis" or chronic active hepatitis XE "hepatitis:chronic active"  XE "hepatitis:chronic persistent"  XE "chronic: active hepatitis" xe "active hepatitis". Chronic active hepatitis is the more serious, aggressive form of this disease and may ultimately lead to cirrhosis and liver failure. Treatment is with medication and, rarely, liver transplantation XE "transplantation: liver, hepatitis" . Questions You Should Ask and Criteria:What is the type of viral hepatitis? not acceptable if:symptomatic hepatitis A is present, not fully recoveredsymptomatic auto immune hepatitis, currently treated with steroidsthere has been a diagnosis of hepatitis B, C, or D within the past 12 months there has been chronic active hepatitisChronic persistent hepatitis may be acceptableIs a liver biopsy anticipated or scheduledxe "liver: biopsy"?not acceptable until completed and the results knownHas cirrhosis of the liver been diagnosed within the past 4 years?not acceptableHas there been associated gastrointestinal XE "gastrointestinal:bleeding, hepatitis"  bleeding within the past 24 months? not acceptableHas Prednisone XE "Prednisone:hepatitis" , Azathioprine, or interferon XE "interferon:hepatitis"  been used for underlying liver disease within the past 12 months?not acceptableHas a liver transplant been recommended, or transplant completed within the past 5 yearsxe "liver: transplantation, hepatitis"?not acceptableHas there been any hospitalization within the past 12 months for underlying liver diseasexe "liver: transplantation, hepatitis"? not acceptableHas there been a history of liver cancer?not acceptable   GOTOBUTTON toc HODGKIN'S DISEASE  XE "HODGKINS DISEASE" \t "See Lymphoma"  See Lymphoma  GOTOBUTTON toc HYPERTENSION  (High Blood Pressure) Hypertension (HTNxe "HTN (Hypertension)"\ixe "HBP, (high blood pressure)"\i)xe "hypertension (HTN)"\i is persistently high arterial blood XE "blood pressure:high"  pressure XE "high blood pressure (HBP)"  (HBP). It is an independent and important risk factor for coronary artery diseasexe "coronary: Artery Disease (CAD), hypertension", strokexe "stroke:hypertension", Congestive Heart Failure (CHF)xe Congestive Heart Failure (CHF):hypertension", peripheral vascular disease,xe "Peripheral: Vascular Disease (PVD): hypertension" and kidney diseasexe "kidney: disease, hypertension". Its presence has a high potential for morbidity and disability. Questions You Should Ask and Criteria:What are the most recent blood pressure readings? not acceptable if the: average systolic blood pressurexe "blood pressure: systolic "xe "systolic blood pressure" is greater than 200average diastolic blood pressurexe "diastolic blood pressure" XE "blood pressure:diastolic"  is greater than 110Is there a history of Transient Ischemic Attack (TIA) within the past 5 years?not acceptable Is there a history of hypertensive crisis within the past 24 months?not acceptableIs there any history of associated kidney disease (creatinine > 2.5)? not acceptable Has there been any hospitalization / ER visit for Hypertension within the past 24 months in combination with a history of Congestive Heart Failure (CHF) not acceptable   GOTOBUTTON toc KIDNEY STONES (Nephrolithiasis XE "nephrolithiasis" \i) (Renal Colic Xe renal (kidney):colic"\i , Calculus XE Calculus: kidney stones"  or Stone XE stone, kidney" ) Renal Colic is the pain produced by spasmodic contractions of the kidney, pelvis and walls of the ureter due to the presence of a stone. The majority of the stones are passed spontaneously, but larger ones may lodge in the ureter or urethra and may require surgery (nephrotomy XE "nephrotomy" , pyelotomy XE "pyelotomy" , cytoscopy XE "cytoscopy"  and most recently, lithotripsy XE "lithotripsy" ). Repeated obstructions lead to infection, hydronephrosis XE "hydronephrosis"  and destruction of kidney tissue.  XE "surgery: kidney stones"  Questions You Should Ask and Criteria:Is surgery recommended or scheduled?not acceptable until fully recovered from surgery  GOTOBUTTON toc LEUKEMIA  xe "Leukemia"\i\bSometimes called cancer of the bloodxe "blood:cancer of the"\ixe "cancer:blood"\i, leukemia is a malignant disorder of the blood forming tissues that most often affects the white blood cells. It is characterized by the appearance of abnormal white blood cells and is classified on the basis of the type of these cells, the number present, and whether the clinical course is acute or chronic.  XE "leukemia:acute"\i  XE "leukemia:chronic"\i Acute leukemia is usually a rapidly progressive disease, and often fatal without prompt intervention. Nearly all cases of leukemia are of the following types: acute lymphocytic leukemia (ALL)xe "acute: lymphocytic leukemia (ALL)"xe "leukemia:acute lymphocytic(ALL)", acute myelogenous leukemia xe "acute: myelogenous leukemia "(AML)xe "leukemia:acute myelogenous (AML)", acute monocytic leukemia (AMOL)xe "leukemia:acute monocytic (AMOL)"xe "acute: monocytic leukemia (AMOL)", acute and chronic granulocytic leukemiaxe "leukemia:chronic granulocytic (CGL)"xe "chronic: granulocytic leukemia (CGL)", chronic lymphocytic leukemiaxe "chronic: lymphocytic leukemia (CLL)" (CLL)xe "leukemia:chronic lymphocytic (CLL)", and hairy cell leukemia (HCL)xe Hairy Cell Leukemia (HCL)"xe "leukemia:hairy cell (HCL)". General Criteria: All leukemia, other than CLL and HCL, are Specific Uninsurable Medical Conditions.  GOTOBUTTON toc LEUKEMIA, CHRONIC LYMPHOCYTIC (CLL)  xe "Chronic: Lymphocytic Leukemia (CLL)"\i\bxe "leukemia:chronic lymphocytic (CLL)"Chronic lymphocytic leukemia is a disease of later life, usually occurring after the age of 50. Symptoms include fatigue, enlarged lymph nodes, and enlargement of the liver or spleen. Marked increase in the number of circulating lymphocytes are usually seen in blood counts. Lymphocytic involvement of nodes and major organs may also be noted. Underwriting consideration must include satisfactory medical follow-up documenting stability of the condition, to include stable lab results. Treatment: Includes the use of Leukeran. Questions You Should Ask and Criteria:When was the diagnosis made?What was the stage and when did treatment end? (including the use of Leukeran XE "Leukeran: leukemia, hairy cell" ) Stage 0 may be acceptable 6 months following diagnosis Stage I may be acceptable 12 months following treatment Stage II, III, or IV is not acceptable if treated within the past 3 years Has there been any chemotherapy treatment within the past 3 years? not acceptable  GOTOBUTTON toc LEUKEMIA, HAIRY CELL (HCL)  xe "leukemia:hairy cell (HCL)"xe Hairy Cell Leukemia (HCL)"Hairy cell leukemia is a disease of the B-lymphocytexe "B-lymphocyte, disease of " and is so named because cells appear hairy on a blood smear and bone marrow biopsy XE "bone marrow:biopsy, hairy cell leukemia" . Signs and symptoms include fatigue, spleen enlargement XE "spleen: enlargement,hairy cell leukemia" , and reductions in red cells, white cells, and platelets. Hairy cell leukemia is usually an indolent disorder characterized by recurrent infections XE "recurrent infections:hairy cell leukemia" , including tuberculosisxe "tuberculosis (TB):hairy cell leukemia". HCL requires no specific therapy. Spleen removalxe "spleen: removal:hairy cell leukemia" is often done because of very low blood counts (cytopeniaxe "cytopenia") or recurrent infections. As a result, normal blood counts return in 50% of cases. Questions You Should Ask and Criteria:Has the condition been diagnosed and treated within the past 24 months? (infections) not acceptableHave there been any infections within the past 24 months? not acceptableHas there been any hospitalization or spleen removal for leukemia within the past 24 months? not acceptable   GOTOBUTTON toc LYMPHOMA  xe "Lymphomas:Non-Hodgkins "\ixe "Non-Hodgkins Lymphomas"\iLymphomas are malignancies of the lymphatic system. There are two broad categories of lymphomasxe "chemotherapy:lymphomas": Hodgkins disease and non-Hodgkins lymphoma. Hodgkins disease primarily affects individuals under the age of 50. The cause is unknown and it occurs much less frequently than non-Hodgkins lymphomas. Diagnosis is based on a biopsy of a lymph node. There are 4 major sub-groupings of Hodgkins disease, but each has approximately the same prognosis because of the effectiveness of modern treatment. Treatment is with radiation and/or chemotherapy. Non-Hodgkins lymphomas occur about 3 times more frequently than Hodgkins disease. Median age of onset is in the 60s. Like Hodgkins disease, treatment is with radiation and/or chemotherapy. Staging XE "Staging"   XE "staging: lymphoma"  XE "staging: Hodgkins disease"  XE "Staging: Non-Hodgkins lymphoma"  of both Hodgkins disease and Non-Hodgkins lymphomas is based on the lymph node region involved: Stage IOne lymph node region, i.e., neck, groinStage IIMore than one lymph node regionStage IIILymph nodes are involved on both sides of the diaphragm (approximately above and below the waistline)Stage IVOther organs (e.g., bone marrow, liver, lungs) are involved Hodgkins Disease Questions You Should Ask and Criteria:What is the Stage of the disease and when was treatment completed?Stage I, II, IIIA may be acceptable 12 months following treatmentStage III may be acceptable 36 months following treatmentStage IV may be acceptable 48 months following treatmentHas there been any recurrence within the past 6 years?not acceptableHas there been any ongoing need for chemotherapy or radiation treatment?not acceptableHas there been any hospitalization for Hodgkins disease complications within the past 36 months?not acceptable Non-Hodgkins Lymphoma Questions You Should Ask and Criteria:What is the Stage and/or the Grade of the disease and the date of last treatment?Stage I or II may be acceptable 12 months following treatmentStage III or IV may be acceptable 5 years following treatmentAny high grade lymphoma is not acceptableHas there been any recurrence?not acceptableHas there been any ongoing need for chemotherapy or radiation treatment?not acceptableHas there been any radiation enteritis within the past 12 months?not acceptable  GOTOBUTTON toc MALIGNANT MELANOMA  xe "malignant melanoma "\i XE "skin cancer:malignant melanoma" \i XE "cancer:malignant melanoma"\i  GOTOBUTTON skin See Cancer of the Skin   GOTOBUTTON toc MEMORY LOSS  xe loss, memory "\ixe memory:loss "\b\i(Frequent/persistent forgetfulness XE forgetfulness:frequent/persistent"\i xe forgetfulness:memory loss"\ixe "frequent forgetfulness"\ixe persistent: forgetfulness"\i) Chronic memory loss or frequent/persistent forgetfulness may be early symptoms of dementia or other serious disease XE "dementia:memory loss" . Both short term XE "short term memory loss" \i  XE "long term memory loss" \i  and long term memory XE "memory:long term"  XE "memory:short term"  may be affected. General Criteria: Underwriting of this history (which includes confusionxe "confusion", delirium, xe "delirium "and disorientationxe "disorientation") is very conservative. Questions You Should Ask and Criteria:Is there a history of chronic memory loss or frequent/persistent forgetfulness?not acceptableHave any medications been taken to improve memory (i.e. Hydergine XE "Hydergine:memory loss" , Cognex XE "Cognex:memory loss" , Tacrine, Aricept, Cyclospasmal, Ergoloid, Cerespan, or Exelonxe "Tacrine")?not acceptable if there is current or prior use of memory medicationsxe "memory:medications"Has there been any complaint by the applicant of memory loss, forgetfulness or confusion within the past 36 months, or multiple / progressive complaints by the applicant?not acceptableHas there been any reference by the family or MD of memory loss, forgetfulness or confusion?not acceptable  GOTOBUTTON toc MENINGITIS  xe "meningitis "\iMeningitis is a bacterial or viral infection of the fluid and membrane enclosing the brain and spinal cord XE "spinal: cord, Meningitis"  XE "brain:infection of: Meningitis" . While recovery is often complete, there may be neurologic residuals (i.e. dementia or paralysis). Questions You Should Ask and Criteria:Was this condition treated within the past 12 months? not acceptableAre there any limitations with performing the ADLs or IADLs? xe "ADLs:Meningitis "xe "IADLs:Meningitis"see Uninsurable Functional Deficits  GOTOBUTTON toc MULTIPLE MYELOMA  xe "multiple myeloma "\i  XE "cancer:plasma cells"  XE "cancer:multiple myeloma" Multiple myelomaxe "myeloma:multiple" results from an abnormal growth of plasma cellsxe "plasma cells, abnormal growth". This abnormal growth usually occurs within the bone marrow XE "bone marrow:multiple myeloma" , but rarely may occur as solitary lesions outside of the bone marrow (extra medullary). These malignant plasma cellsxe "malignant plasma cells" produce large quantities of abnormal proteins. The tumor and/or the abnormal proteins can cause bone pain or fracturexe fractures:multiple myeloma", renal failurexe "renal (kidney): failure, multiple myeloma"xe "kidney:failure, multiple myeloma", susceptibility to infection, anemiaxe "anemia:multiple myeloma", clotting abnormalities, and neurologic symptoms. Questions You Should Ask and Criteria: What is the stage of the cancer?Stage IA not requiring treatment may be acceptable 12 months following diagnosisStage I or IIA requiring treatment within 5 years is not acceptableStage IIB or greater is not acceptableHas there been a bone marrow transplant or chemotherapy within the past 5 years?  XE "bone marrow: transplantation, multiple myeloma"  XE "chemotherapy:multiple myeloma" not acceptableHave there been any spontaneous fractures, blood clots XE "blood: clot, multiple myeloma"  or strokes XE "stroke: multiple myeloma" ?not acceptable   GOTOBUTTON toc MULTIPLE SCLEROSIS (MS)  xe "Multiple Sclerosis (MS) "\b\ixe "Sclerosis: Multiple (MS) "\i\bDEMYELINATING DISEASExe demyelinating disease"\i\b Multiple sclerosis (MS) is a demyelinating disease. Demyelination refers to the destruction or removal of the myelin sheath of a nerve. It causes sensory, visual, and muscular abnormalities and is marked by remissions and exacerbations. General Criteria: symbol 114 \f "ZapfDingbats" \s 13 \h Multiple sclerosis (MS) / Demyelinating disease is a Specific Uninsurable Medical Condition.  GOTOBUTTON toc MUSCULAR DYSTROPHY  xe "muscular dystrophy"  This group of inherited diseases of the muscles is characterized by progressive weakness and wasting. Muscular dystrophy is classified according to its mode of inheritance, age at onset, and clinical features. There is no specific treatment for this condition. General Criteria: Muscular Dystrophy is a Specific Uninsurable Medical Condition XE "surgery:thymus gland removal"   GOTOBUTTON toc MYASTHENIA GRAVIS  xe "Gravis, Myasthenia "\ixe "Myasthenia Gravis"\iMyasthenia gravis is a disease, which causes muscular weakness XE "muscle: weakness, myasthenia gravis"  due to abnormalities at the neuromuscular junction. Muscles become progressively weaker when used in repetition and only partially recover after rest. If the thymus gland XE "thymus gland:removal, myasthenia gravis"  is not removed, or if the surgery fails to induce a remission, medical treatment is generally successful. XE "surgery:thymus gland removal"  Questions You Should Ask and Criteria:Has there been symptomatic myasthenia gravis (e.g., progressive muscular weakness, swallowing or chewing difficulties) within the past 12 months? not acceptableAre more than 20 mgs per day of Prednisone being used?  XE "Prednisone:myasthenia gravis" not acceptableIs thymus gland surgery anticipated? not acceptableHas there been any hospitalization within the past 24 months for complications / plasmapheresis? not acceptable  GOTOBUTTON toc MYOCARDIAL INFARCTION (MI) xe "Infarction, Myocardial (MI)"\ixe Myocardial Infarction (MI)"\i (Heart Attackxe Heart: Attack"\i, Coronaryxe Coronary"\i) A myocardial infarction (MI) occurs when the blood flow in a coronary artery is abruptly blocked or markedly reduced by a clot. The heart muscle supplied by the coronary artery dies. If the affected heart muscle is located in the left ventricle, the heart can no longer function efficiently as a pump and Congestive Heart Failure (CHF)xe Congestive Heart Failure (CHF):myocardial infarction" may result. If the conduction system is damaged, irregular and sometimes fatal heart rhythms xe "arrhythmias:myocardial infarction "may result. Following an acute MIxe "acute: MI", treatment consists of measures aimed at dissolving the clot, as well as prevention of fatal heart rhythms. Questions You Should Ask and Criteria:What was the date of the heart attack?not acceptable within 3 months ; 6 months with valvular heart diseaseIs there any history of angina XE "angina"  that restricts activity?not acceptable Has there been an onset of or symptomatic Congestive Heart Failure (CHF) within the past 5 years? not acceptable Is there a history of Cardiomyopathy?not acceptableHave angioplasty XE "angioplasty"  or heart surgery XE "heart surgery"  been recommended or scheduled?not acceptableHave there been increasing symptoms of angina or angina at rest XE "angina: angioplasty"  within the past 6 months?not acceptableHas there been any symptomatic heart arrhythmia or cardioversion within the past 12 monthsnot acceptableHave there been 2 or more ER visits or hospitalizations for angina within the past 12 months?not acceptableIs there a history of Diabetes? not acceptable Cross Reference:  GOTOBUTTON a_fib Atrial Fibrillation   GOTOBUTTON CHF CHF  XE "CHF" \t "See myocardial infarction (MI)"   GOTOBUTTON cardiomyopathies Cardiomyopathy  XE "Cardiomyopathy" \t "See myocardial infarction (MI)"   GOTOBUTTON arrhythmias Conduction Disturbances  Diabetes XE "Conduction disturbances" \t "See myocardial infarction (MI)"   XE "Atrial Fibrillation" \t "See myocardial infarction (MI)"   GOTOBUTTON toc NEUROPATHY  XE "neuropathy" \i\b  (Peripheral Neuropathy XE "Peripheral: Neuropathy" \i , XE "Neuropathy:peripheral" \i\b  Neuralgia XE "Neuralgia" \i , Neuritis XE "Neuritis" \i ) Neuropathy is a disease of the nerves. XE "nerves:disease, neuropathy"  Symptoms include weakness, pain, or numbness. It generally affects the legs, but may also be present in the arms. While the cause can be unknown, it usually results from complications of diabetes XE "diabetes:neuropathy" , alcoholism XE "alcoholism:neuropathy" , malnutrition XE "malnutrition:neuropathy"  or infection XE "infection:neuropathy" . The risks associated with this condition include falls XE "falls:neuropathy" , foot and leg ulcers, and disability due to the progressive nature of the disease. Questions You Should Ask and Criteria:Is the cause of the condition known?not acceptable if currently under evaluationAre there any limitations with performing the ADLs or IADLs?see Uninsurable Functional Deficits XE "ADLs:neuropathy"  XE "IADLs:neuropathy" Is there any history of falls?not acceptable Is there any history of foot/leg ulcers in combination with diabetes?not acceptableIs the condition progressing?not acceptableAre narcotics such as Demerol XE "Demerol:neuropathy" , Methadone, Morphine XE "morphine:neuropathy" , OxyContin, Percodan XE "Percodan:neuropathy" , or Talwin XE "Talwin:neuropathy"  used to control pain within the past 12 months?not acceptable Cross Reference:  GOTOBUTTON DM Diabetes Mellitus  Peripheral Vascular Disease XE "Diabetes Mellitus" \t "See neuropathy"   GOTOBUTTON ulcer_skin Ulcers of the Skin  XE "Ulcers of the Skin" \t "See neuropathy"   GOTOBUTTON toc NON-HODGKIN'S LYMPHOMAS  XE "NON-HODGKINS LYMPHOMAS" \t "See Lymphoma"   GOTOBUTTON lymphoma See Lymphoma   GOTOBUTTON toc NORMAL PRESSURE HYDROCEPHALUS (NPH)  xe "Normal Pressure Hydrocephalus (NPH)"\ixe "Hydrocephalus, Normal Pressure (NPH)"\iNormal pressure hydrocephalus is a condition in which the ventricles within the brain XE "brain:normal pressure hydrocephalus"  enlarge and damage the surrounding brain tissue. However, the pressure of the Cerebral Spinal Fluidxe "spinal: Fluid, Cerebral (CSF)" (CSF)xe "Cerebral: Spinal Fluid (CSF)" within the ventricles is normal. Typical symptoms of NPH include walking difficulties, bowel/bladder incontinence XE "incontinence:NPH" , and dementia XE "dementia:NPH" . The most common treatment is the placement of a sterile tube between the ventricle in the brain and the peritoneal cavity in the abdomen (ventriculoperitoneal shuntxe "ventriculoperitoneal shunt"xe "shunt:ventriculoperitoneal "). Questions You Should Ask and Criteria:Is the condition untreated  XE "IADLs:normal pressure hydrocephalus" ?not acceptableHas there been a surgical placement of a shunt?not acceptable if: there has been shunt placement within the past 24 monthsthere is evidence of shunt obstructionxe "shunt:obstruction" within the past 12 months there have been any falls after shunt placementAre there any limitations with performing the ADLs XE "ADLs:normal pressure hydrocephalus"  or IADLs XE "IADLs:normal pressure hydrocephalus" ?see Uninsurable Functional DeficitsHas there been any complaint of memory loss, forgetfulness of confusion  XE "IADLs:normal pressure hydrocephalus" ?not acceptableHas there been any incontinence  XE "IADLs:normal pressure hydrocephalus" ?not acceptable  GOTOBUTTON toc OSTEOARTHRITIS (OA) xe "OA (Osteoarthritis) "\i\bxe Osteoarthritis (OA)"\b\i (Degenerative Joint Diseasexe "Joint Disease, Degenerative"\i [DJD]xe "Degenerative Joint Disease (DJD)", hypertrophic arthritis)xe "arthritis:hypertrophic "xe "hypertrophic: arthritis"  XE "arthritis:Osteoarthritis (OA)"  Osteoarthritis is characterized by degeneration of joint cartilage and new bone formation at the joint margins. OA results from the aging process and trauma to the joint from wear and tear. On physical exam, the joints are tender and inflamed. There is often joint enlargement, pain with weight bearing, and decreased range of motion. Surgical correction of the joint deformities can relieve pain and restore most function. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs or IADLs?see Uninsurable Functional Deficits XE "ADLs:osteoarthritis"  XE "IADLs:osteoarthritis" Are narcotics such as Demerol XE "Demerol:osteoarthritis" , morphine XE "morphine:osteoarthritis" , OxyContin, Percodan XE "Percodan:osteoarthritis" , or Talwin XE "Talwin:osteoarthritis"  used to control pain within the past 12 months?not acceptable Are assistive devices XE "assistive devices:osteoarthritis"  such as a wheelchair,  XE "wheelchair:osteoarthritis" walker, or quad cane  XE "quad cane:osteoarthritis" currently being used?not acceptableIs physical therapy XE "physical therapy:osteoarthritis "  currently required?May be acceptable if symptoms are improvingHas major weight bearing joint surgery XE "surgery:major weight bearing joint"  been completed within the past 3 months or been recommended or planned?not acceptableOsteoarthritis in combination with Rheumatoid Arthritisnot acceptableHave there been any falls XE "falls:osteoarthritis"  or fractures XE "fractures:osteoarthritis" ?see Fracture guidelines  Cross Reference: Fractures Rheumatoid Arthritis Spinal Stenosis Uninsurable Functional Deficits  GOTOBUTTON toc OSTEOPOROSIS (OP)  xe "Osteoporosis (OP)"\iOsteoporosis is a generalized decrease in bone mass that can progress to below the point necessary to maintain adequate mechanical body support. The principal clinical manifestations of osteoporosis in the elderly are fractures XE "fractures:osteoporosis"  of the spine XE "spinal: fractures, osteoporosis"  XE "wrist fractures:osteoporosis" , hip, and wrist. Osteoporosis usually develops at older ages (senile osteoporosisxe "osteoporosis (OP):senile"xe "senile osteoporosis") or after menopause (post-menopausal osteoporosisxe "post menopausal: osteoporosis"xe "osteoporosis (OP):post menopausal ") and can be traced back to inadequate calcium intake and post-menopausal estrogen deficiency XE "estrogen deficiency:osteoporosis" xe "post menopausal: estrogen deficiency". Occasionally, osteoporosis may be secondary to the chronic administration of steroids or to prolonged immobilization or inactivity. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs or IADLs?Not acceptable if any assistance required (see Uninsurable Functional Deficits)  XE "ADLs:osteoporosis"  XE "IADLs:osteoporosis" Are narcotics such as Demerol XE "Demerol:osteoporosis" , Methadone, morphine XE "morphine:osteoporosis" , OxyContin, Percodan XE "Percodan:osteoporosis"  or Talwin XE "Talwin:osteoporosis"  used to control pain within the past 12 months?not acceptable Have there been any falls or fractures?not acceptable if there has/have been: a femoral shaft, tibial or vertebral body fracturexe "hip: fractures, osteoporosis" within 3 months a pelvic fracture within the past 12 months 2 or more pelvic fractures due to falls or osteoporosis3 or more long bone fractures due to falls or osteoporosis three or more vertebral body fractures due to osteoporosis any pathological fractureWhat are the bone density scores?if greater than 4.0, not acceptable  XE "ADLs:osteoporosis"  XE "IADLs:osteoporosis" Are assistive devicesxe "assistive devices:osteoporosis" such as a wheelchair, xe "wheelchair:osteoporosis "walker, or quad canexe "quad cane:osteoporosis "xe "crutches:osteoporosis " currently being xe "walker:osteoporosis "used?not acceptableIs physical therapy XE "physical therapy:osteoporosis"  currently required?may be acceptable if symptoms are improving Is pulmonary function XE "pulmonary function: osteoporosis"  impaired? not acceptable Cross Reference: Fractures Physical Therapy Uninsurable Functional Deficits  GOTOBUTTON toc PAGET'S DISEASE OF THE BONE  xe "Pagets disease of the bone"\i Paget's disease of the bone XE "bone: Paget's disease "  is a chronic disorder of the adult skeleton in which localized areas of hyperactive bone are subject to excessive resorption. The bone is then replaced by a softened and enlarged bony structure. This produces bone that is often painful, structurally weak, fractures easily, and causes physical deformity. It may be either localized to specific bones or be more generalized affecting such areas as the skull, pelvis, spine, and long bones. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs or IADLs?see Uninsurable Functional Deficits  XE "ADLs:Paget's disease"  XE "IADLs:Paget's disease" Are narcotics such as Demerol XE "Demerol:Paget's disease" , Methadone, Morphine XE "morphine:Paget's disease" , OxyContin, Percodan XE "Percodan:Paget's disease"  or Talwin XE "Talwin:Paget's disease"  used to control pain within the past 12 months?not acceptable Have there been any falls XE "falls"  or fractures XE "fractures" ? not acceptable if : a vertebral body fracture within the past 3 months a pelvic fracture within the past 12 months 3 or more vertebral body fractures due to Pagets disease 3 or more long bone fractures due to falls or Pagets disease any pathological fractureAre assistive devices XE "assistive devices:Paget's disease"  such as a wheelchair XE "wheelchair:Paget's disease" , walker, or quad cane XE "quad cane:Paget's disease"  XE "crutches:Paget's disease"  XE "walker:Paget's disease"  currently being used?not acceptableIs physical therapy XE "physical therapy:Paget's disease"  currently required?May be acceptable if symptoms are improvingIs there any history of bone cancer?not acceptable Cross Reference: Congestive Heart Failure Fractures Uninsurable Functional Deficits  GOTOBUTTON toc PARKINSON'S DISEASE  xe "Parkinsons:disease"\iParkinson's disease is a neurological diseasexe "neurological: disease, Parkinsons" producing tremors, xe "tremors:Parkinsons Disease "rigidity (resistance to passive movement), and bradykinesia xe "bradykinesia "(slowness of voluntary movements, and a reduction of automatic movements). A progressive dementia may also occur. There is postural instability xe "postural instability"demonstrated by difficulty in getting up from a chair, and a gait characterized by small shuffling steps, as well as demonstrated unsteadiness on turning, and difficulty stopping. See guidelines on Tremors General Criteria: symbol 114 \f "ZapfDingbats" \s 13 \h Parkinson's disease is a Specific Uninsurable Medical Condition.  GOTOBUTTON toc PERIPHERAL VASCULAR DISEASE (PVD)  (Peripheral Atherosclerotic Disease XE "Peripheral: Atherosclerostic Disease" \i) Peripheral vascular disease is characterized by a reduction of the blood supply to the lower extremities. Atherosclerotic plaquesxe "Atherosclerotic plaques"xe "plaques, Atherosclerotic " form in the arteries, thereby narrowing the vessel and reducing the flow of blood. Leg pain with minimal exercise (claudicationxe "claudication") is the most common symptom. As the disease progresses, it further compromises the vascular system with resultant skin ulcers XE "ulcers:skin" xe "skin ulcers:peripheral vascular disease", gangrene, xe "gangrene:peripheral vascular disease "and the need for amputationxe "amputation:peripheral vascular disease". Treatment of PVD may be with life style changes (diet, exercise, smoking cessation) or with medication. In severe cases, angioplasty XE "angioplasty:peripheral vascular disease"  or bypass graft surgery XE "bypass graft surgery:peripheral vascular disease"  may be needed. Questions You Should Ask and Criteria:Has there been associated gangrene or an amputation?not acceptableIs there pain (claudication XE "claudication: peripheral vascular disease (PVD)" ) in the lower extremities at rest or after walking less than one-half mile, or with marked increase in severity of symptoms? not acceptableHave there been any skin ulcers XE "skin ulcers: peripheral vascular disease (PVD)"  or skin breakdown or treatment with a unna boot XE "skin breakdown: peripheral vascular disease (PVD)" ? not acceptable: within the past 24 monthsif there have been recurrent skin ulcersHas there been a vascular bypass graft XE "vascular: bypass graft, PVD"  or surgery XE "surgery:PVD"  of the lower extremities within the past 12 months?not acceptable Has there been kidney stenosis surgery XE "surgery:PVD"  within the past 12 months?not acceptable Is there a history of Diabetes?not acceptable Is there a history of intestinal ischemia?not acceptable Have there been any hospitalization or ER visits for PVD or complications within the past 12 months?not acceptable  Cross-references: Diabetes  GOTOBUTTON ulcer_skin Ulcer of the Skin  XE "Skin ulcers" \t "See peripheral vascular disease (PVD)"  PHYSICAL THERAPY Questions You Should Ask and Criteria:Has there been a need for Physical Therapy (PT) within the past 6 months for a benign or acute conditionMay be acceptable if symptoms are improvingWas Physical Therapy (PT) required greater than 6 months ago for a significant or chronic condition?may be acceptable if symptoms are improving greater than 12 months ago for fibromyalgiaHas there been a need for Physical Therapy (PT) within the past 6 months for a significant or chronic condition?Not acceptable not acceptable within 12 months for fibromyalgia  GOTOBUTTON toc POLIOMYELITIS/POST POLIO SYNDROME  XE Polycystic Kidney Disease (PCKD)" \i  XE "surgery:polycystic kidney disease (PCKD)"  Poliomyelitis (polio, infantile paralysis) is an acute viral infection that first invades the intestine and then migrates to the spinal cord, brain stem, and brain. Polio may result in paralysis of various muscles in the shoulder, arms, diaphragm, torso, and legs. A type of polio called bulbar polio XE "bulbar polio"  may also affect the cranial nerves and brain stem, which control swallowing, speaking, chewing, breathing, and circulation. Half of polio patients recover without permanent effects. The other half will experience muscle paralysis and atrophy that may cause shortening and deformity of the extremities and spine. XE "mitral valve: prolapse"  XE "aortic: root dilatation"  XE "cerebral: aneurysm, polycystic kidney disease"  For these patients, permanent use of braces, crutches, canes, and wheelchairs may be required. Post Polio Syndrome (PPS) XE "post polio syndrome (PPS)"  describes a condition in which progressive paralysis and atrophy occur 25 to 35 years after the original onset of the disease. This syndrome is thought to be the result of the physiological changes of aging with further loss of spinal nerve cells depleted by the original polio virus. PPS may cause fatigue, weakness, muscle pain/atrophy, and deterioration of function. Patients with bulbar polio may experience increased difficulty swallowing and speaking, and an increased incidence of choking and sleep apnea. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs XE "ADLs: poliomyelitis"  XE "ADLs: post polio syndrome"  or IADLs XE "IADLs: poliomyelitis"  XE "IADLs: post polio syndrome" ?not acceptable if any deficits (see Uninsurable Functional Deficits)Is any medical equipment such as a wheelchair, XE "walker:poliomyelitis"  XE "walker:post polio syndrome"  XE "wheelchair:poliomyelitis"  XE "wheelchair:post polio syndrome"  XE "quad cane:poliomyelitis"  XE "quad cane:post polio syndrome"  XE "crutches:poliomyelitis"  XE "crutches:post polio syndrome"  walker, electric cart, hospital be, or quad cane currently being used?not acceptable Has there been any bowel or bladder incontinence (excluding stress incontinence)? not acceptableHave there been any active or progressive Post Polio Symptoms within the past 12 months XE "IADLs: poliomyelitis"  XE "IADLs: post polio syndrome" ?not acceptableHas there been any difficulty swallowing with progressive weight loss?not acceptableHas there been more than one fall within the past 6 months?not acceptableHas there been one fall and fracture within the past one year?not acceptableAre narcotics such as Demerol, Methadone, Morphine, OxyContin, Percodan, or Talwin needed to control pain within the past 12 months?not acceptable  GOTOBUTTON toc POLYCYSTIC KIDNEY DISEASE (PCKD)  XE Polycystic Kidney Disease (PCKD)" \i  XE "surgery:polycystic kidney disease (PCKD)"  Polycystic kidney disease XE "kidney: polycystic disease"  is an inherited bilateral malformation of the kidneys typified by multiple cysts (masses). The cysts gradually enlarge at the expense of normal renal Xe renal (kidney): disease, polycystic kidney disease"  tissue. Symptoms may not appear until adult life, but asymptomatic cases may be detected at younger ages by ultrasound. PCKD is also associated with an increased frequency of mitral valve prolapse XE "mitral valve: prolapse" , aortic root dilatation XE "aortic: root dilatation"  and cerebral aneurysm XE "cerebral: aneurysm, polycystic kidney disease" . Treatment may include chronic dialysis XE "dialysis:polycystic kidney disease"  or kidney transplantation XE "transplantation:kidney, polycystic kidney disease"  XE "kidney: transplantation,polycystic kidney disease" . Questions You Should Ask and Criteria:Has dialysis been required within the past 2 years?not acceptable Has kidney transplantation been performed within the past 5 years?not acceptable Has dialysis XE "dialysis"  or kidney transplant XE "surgery"  been recommended or scheduled?not acceptableHas there been any hospitalization within the past 24 months for complications of polycystic kidney disease?not acceptable  Cross-references:  GOTOBUTTON CRF Renal Failure, chronic   GOTOBUTTON of_kidney Kidney Transplant  XE "CRF" \t "See polycystic kidney disease (PCKD)"   GOTOBUTTON toc POLYCYTHEMIA  Polycythemia is a chronic blood disease XE "blood: disease, polycythemia"  of unknown cause in which there is an increase in the number of red blood cells. The disease has an association with leukemia, xe "leukemia:polycythemia "and chronic myelogenous leukemia XE "leukemia:chronic myelogenous: polycythemia"  may develop. A secondary form of polycythemia is seen in individuals with underlying pulmonary disease XE "pulmonary: disease, polycythemia" . This causes inadequate oxygenation of red cells, leading to a reactive increase of cells to compensate. Treatment of polycythemia includes the use of low dose chemotherapeutic drugs as well as phlebotomies XE "phlebotomies" . Questions You Should Ask and Criteria:If phlebotomy is being used, how often is it performed?not acceptable if more than 4 phlebotomies per year Is Hydrea being used? May be acceptable Are alkylating agents being used (Leukeran,  XE "Leukeran: polycythemia" Cytoxan, Platinol, or Cyclophosphamide XE "Cytoxan: polycythemia" )?not acceptableIs there a history of a TIA?not acceptable  GOTOBUTTON toc POLYMYALGIA RHEUMATICA (PMR) xe "Polymyalgia Rheumatica (PMR)"\i Polymyalgia rheumatica (PMR)xe "Rheumatica, polymyalgia (PMR)" is a syndrome of unknown cause characterized by severe pain and stiffness of the muscle XE "muscle:pain and stiffness, Polymyalgia rheumatica"  groups. Fever, anorexia XE "anorexia:polymyalgia rheumatica" , weight loss XE "weight loss:polymyalgia rheumatica" , and anemia may also be present. Separate, but closely related clinical entities are temporal arteritis (TA)xe "Temporal Arteritis (TA):polymyalgia rheumatica"xe "Arteritis: Temporal (TA), polymyalgia rheumatica " or giant cell arteritis (GCA)xe "Arteritis: Giant Cell (GCA), polymyalgia rheumatica "xe "Giant Cell Arteritis (GCA): polymyalgia rheumatica ". These conditions are characterized by inflammation of the medium sized arteries, especially the temporal artery of the forehead, which could result in sudden blindness XE "blindness:due to vascular obstruction, polymyalgia rheumatica"  due to vascular obstruction. Treatment with corticosteroids (Prednisone) is often effective in controlling symptoms. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs or IADLs?see Uninsurable Functional Deficits XE "ADLs:polymyalgia rheumatica"  XE "IADLs:polymyalgia rheumatica" Are assistive devices XE "assistive devices:polymyalgia rheumatica"  such as a wheelchair XE "wheelchair:polymyalgia rheumatica" , walker, or quad cane XE "quad cane: polymyalgia rheumatica"  currently being used? not acceptableHas physical therapy been required within the past 6 months? not acceptableHas there been difficulty swallowing or depression with progressive unintentional weight loss? not acceptableAre more than 20 mgs per day of Prednisone xe "Prednisone: polymyalgia rheumatica "being used?not acceptableHave there been any falls XE "falls:polymyalgia rheumatica"  or fractures XE "fractures:polymyalgia rheumatica" ? see Fracture guidelines Are narcotics such as Demerol XE "Demerol:polymyalgia"  XE "morphine:polymyalgia"  XE "Percodan:polymyalgia"  XE "Talwin:polymyalgia" , Methadone, Morphine, OxyContin, Percodan, or Talwin used to control pain within the past 12 months? not acceptable Are there any eye problems secondary to giant cell arteritis (GCA) XE "GCA: current eye problems" ? not acceptable  GOTOBUTTON toc POLYMYOSITIS - DERMATOMYOSITIS  xe "Dermatomyositis, Polymyositis "xe "Polymyositis - Dermatomyositis"Polymyositis is an inflammatory muscle XE "muscle:polymyositis dermatomyositis"  disorderxe "muscle:inflammatory disorder"xe "inflammatory muscle disorder" of unknown cause that may be accompanied by inflammation at other sites including the joints, lungs, and heart. Dermatomyositis is the name used for the disorder when the skin XE "skin:polymyositis-dermatomyositis"  is also involved. There is a strong association with increased incidence of cancer, as well as systemic lupus erythematosus (SLE) and scleroderma. Muscle weakness, particularly of the pelvis and shoulders, is the primary feature of the disease. This results in problems with getting up from a sitting position or working with the arms overhead. Difficulty swallowing may also occur if the esophageal muscles are involved, possibly resulting in malnutrition and weight loss. Questions You Should Ask and Criteria:Was polymyositis-dermatomyositis diagnosed within the past 12 months?not acceptableAre there any limitations with performing the ADLs or IADLs?not acceptable if any deficits (see Uninsurable Functional Deficits) XE "IADLs:polymyositis-dermatomyositis" Are narcotics such as Demerol XE "Demerol:polymyositis-dermatomyositis" , Methadone, Morphine XE "morphine:polymyositis-dermatomyositis" , OxyContin, Percodan XE "Percodan:polymyositis-dermatomyositis"  or Talwin XE "Talwin:polymyositis-dermatomyositis"  used to control pain within the past 12 months?not acceptable Are assistive devices XE "assistive devices:polymyositis-dermatomyositis"  such as a wheelchair XE "wheelchair:polymyositis-dermatomyositis" , walker, or quad cane currently being used? not acceptableHas physical therapy XE "physical therapy:polymyositis-dermatomyositis"  been required within the past 6 months? may be acceptable if symptoms are improvingAre more than 20 mgs per day of Prednisone XE "Prednisone:polymyositis-dermatomyositis"  being used?not acceptable Have there been any vertebral body (compression) fractures XE "fractures:polymyositis-dermatomyositis" ?one fracture within 3 months not acceptable 3 or more fractures not acceptableHas there been any history of cancer?not acceptableHas there been difficulty swallowing or depression with progressive unintentional weight loss? not acceptableHas joint surgery been recommended or completed, or performed within the past 12 months?not acceptable Cross Reference: Fractures Physical Therapy Uninsurable Functional Deficits  GOTOBUTTON toc PROSTATE DISORDERS  XE "Prostate:disorders" \i  (Benign Prostatic Hypertrophy [BPH] XE "Benign Prostatic Hypertrophy (BPH)" , Prostatitis XE "Prostatitis"  XE "Prostatism" ) Benign Prostatic Hypertrophy (BPH) and Prostatitis (prostate infection) are non-malignant conditions of the prostate. BPH is an enlargement of the prostate that can have several causes.  XE "nocturia:prostate disorders"  XE "hematuria:prostate disorders" The enlargement (hypertrophy) of the gland usually results in incomplete emptying of the bladder and frequency of urination. This condition is generally of no significance if a complete work-up has been done to rule out cancer and may be treated medically with Proscar XE "Proscar:prostate disorders"  XE "Hytrin:prostate disorders"   XE "TURP:surgery;prostate disorders"  or Hytrin, or surgically by TURP or roto-rooter  XE "Roto rooter:surgery;prostate disorders" . Prostatitis is an infection of the prostate gland and is treated with antibiotics. Both BPH and prostatitis may cause a slight to moderate elevation of the PSA (Prostate Specific Antigen). XE "prostatitis:acute"  XE "prostatitis:chronic"  Questions You Should Ask and Criteria:Has surgery been recommended or scheduled, or performed within the past 3 months? may be acceptable after complete recovery from surgeryHas there been an elevated or rising PSA level that has not been fully evaluated? not acceptable  GOTOBUTTON toc RENAL FAILURE, ACUTE (ARF)  (Kidney Failure, Acute) xe "acute:Acute Renal Failure (ARF)"\ixe "kidney:Acute Renal Failure(ARF)"xe "renal (kidney): Acute Renal Failure (ARF)"Acute renal failure is the sudden decline in the ability of the kidneys to function properly. The causes of acute renal failure are numerous and include infections, medication side effects, and trauma. Questions You Should Ask and Criteria:Has Prednisonexe "Prednisone:renal failure, xe "Leukeran:renal failure, acute "Cytoxan, Chlorambucil, or Cyclophosphamide XE "Cytoxan:renal failure"  been used within the past 24 months?not acceptable Has dialysis xe "dialysis:renal failure"been required within the past 24 months?not acceptableHas there has been any hospitalization XE "hospitalization:renal failure (acute)"  within the past 24 months for complications of renal failure?not acceptableHas a kidney transplant XE "kidney transplantation; ARF"  XE "transplantation:acute renal failure"  been recommended or performed? not acceptable if performed within the past 5 years (see kidney transplantation guideline) not acceptable at all if diabeticCreatinine level greater than 3.0? not acceptableIs an indwelling catheter being used? not acceptable if beginning use was within the past 12 months  GOTOBUTTON toc RENAL FAILURE, CHRONIC (CRF)  (Kidney Failure, Chronic) xe "Chronic: Renal Failure (CRF)"xe "renal (kidney): Chronic Renal Failure (CRF) "xe "kidney: Chronic Renal Failure (CRF) "Chronic renal failure refers to permanent irreversible damage to both kidneys. Depending on the severity of the damage, chronic dialysis may be necessary. General Criteria: This risk can only be considered with documentation of stability of renal function. This condition in combination with diabetes mellitus is generally a poor risk. Questions You Should Ask and Criteria:Has dialysis XE "dialysis:chronic renal failure" xe "kidney: dialysis" been required within the past 24 months?not acceptableHas a kidney transplant XE "kidney transplantation; ARF"  XE "transplantation:acute renal failure"  been recommended or performed? not acceptable if performed within the past 5 years (see kidney transplantation guideline) not acceptable at all if diabetic Creatinine level greater than 3.0 . not acceptableIs there a history of hydronephrosis or pyelonephritis that is chronic & unresponsive to treatment?not acceptable  GOTOBUTTON toc RHEUMATOID ARTHRITIS (RA)  xe "Rheumatoid: Arthritis (RA)"\i\bSJGRENS SYNDROMExe "Sjgrens syndrome"\i Rheumatoid arthritis (RA)xe "arthritis:Rheumatoid (RA)"\i is a systemic diseasexe "systemic: disease, rheumatoid arthritis" that is characterized by a bilateral inflammation and stiffness of the joints XE "joints:bilateral inflammation and stiffness, rheumatoid arthritis" . It may also involve major organs, especially the heart and lungs. The term Sjgrens refers to symptoms of dryness of the eyes and mouth seen in patients with RA. The clinical course of rheumatoid arthritis is highly variable. In some cases, symptoms are mild, while in others, the disease rapidly progresses to severe disability. This often results in ADL and IADL deficiencies. General Criteria: Active or progressive disease is demonstrated by frequent emergency room or doctor visits, multiple joint injections, recent or current courses of high-risk medications, or recent, frequent medication changes. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs or IADLs?see Uninsurable Functional Deficits XE "ADLs:rheumatoid arthritis"  XE "IADLs:rheumatoid arthritis" Have narcotics such as Demerol XE "Demerol:rheumatoid arthritis" , Methadone, Morphine XE "morphine:rheumatoid arthritis" , OxyContin, Percodan XE "Percodan:rheumatoid arthritis"  or Talwin XE "Talwin:rheumatoid arthritis"  been used to control pain within the past 12 months?not acceptable Are more than 20 mg per day of Prednisone XE "Prednisone: rheumatiod arthritis"  being used? not acceptableAre assistive devices XE "assistive devices:rheumatoid arthritis"  such as a wheelchair, walker, or quad cane XE "wheelchair:rheumatoid arthritis"   XE "quad cane:rheumatoid arthritis"  XE "crutches:rheumatoid arthritis" currently being used?not acceptableHas physical therapy XE "physical therapy:rheumatoid arthritis"  been required within the past 6 months?may be acceptable if symptoms are improving Has any joint replacement surgery XE "surgery:major joint replacement, rheumatoid arthritis"  related to rheumatoid arthritis xe "joint replacement: surgery, rheumatoid arthritis"been recommended or performed?not acceptable Has there been active rheumatoid arthritis with progressive symptoms, multiple medication changes, and/or unresponsive to treatment within the past 24 months?not acceptableHave there any been vertebral body (compression) fractures XE "fractures:polymyositis-dermatomyositis" ?one fracture within 3 months not acceptable 3 or more fractures not acceptableIs there a history of osteoarthritis . not acceptableHas the rheumatoid arthritis affected any major weight bearing joints? not acceptableHas there been any hospitalization or more than one ER visit within the past 24 months for rheumatoid arthritisnot acceptableCross Reference: Fractures Osteoarthritis Physical Therapy Uninsurable Functional Deficits  GOTOBUTTON toc SARCOIDOSIS  xe "Sarcoidosis"\i\bSarcoidosis is a disease of unknown cause that primarily affects the lungs XE "lung:sarcoidosis"  although it may affect other organs. Sarcoidosis is characterized by the presence of granulomas xe "granulomas "(nodules) in various tissues. It is classified into three stages according to the degree of involvement. It is generally treated with cortico-steroids; i.e., Prednisonexe "Prednisone:sarcoidosis. Questions You Should Ask and Criteria:What is the Stage of the disease and when was this condition diagnosed?not acceptable if :Stage I has been diagnosed within the past 12 months Stage II has been diagnosed within the past 36 months Stage IIIAre there any current symptoms or evidence of residual complications? not acceptable Are more than 20 mgs per day of Prednisone used?not acceptable  GOTOBUTTON toc SCHIZOPHRENIA OR OTHER PSYCHOSIS  (Paranoia and Delusional States)xe PSYCHOSIS"\i xe Schizophrenia"Schizophrenia is a heterogeneous group of mental disorders comprising most major psychotic disorders and characterized by disturbances in form and content of thought (loose associations, delusions, and hallucinations), mood (blunted, flattened, or inappropriate affect), sense of self in relationship to the external world (loss of ego or autistic withdrawal), and bizarre and apparently purposeless behavior. Questions You Should Ask and Criteria:Have there been any symptoms of schizophrenia or psychosis within the past 48 months?not acceptableHave there been any hospitalization XE "hospitalization:schizophrenia or other psychosis" s, day care use XE "day care use:schizophrenia or other psychosis" , or ER visits XE "ER visit:schizophrenia or other psychosis"  within the past 48 months for schizophrenia, psychosis, or related complications?not acceptableHas there been any active alcoholism XE "alcoholism:schizophrenia or other psychosis"  XE "drug use:schizophrenia or other psychosis"  or drug use within the past 48 months? not acceptable Are there any limitations with performing the ADLs XE "ADLs:schizophrenia or other psychosis"  XE "IADLs:schizophrenia or other psychosis"  or IADLs? not acceptable if any deficits (see Uninsurable Functional Deficits) Any current signs of psychological dependency XE "dependency:psychological; schizophrenia"  XE "dependency:psychological; other psychosis" ? not acceptable Have any anti-psychotic medications been initiated within the past 48 months? not acceptable Has there been unintentional weight loss of greater than 15% within the past 12 months?not acceptable  GOTOBUTTON toc SCLERODERMA  (CREST Syndromexe "CREST Syndrome") Scleroderma is a disease characterized by deposition of fibrous tissue in the skin XE "skin:scleroderma" , lung XE "lung:scleroderma" , heart XE "heart:scleroderma" , kidney XE "kidney:scleroderma" , musculoskeletal XE "musculoskeletal:scleroderma" , gastrointestinal XE "gastrointestinal:scleroderma" , and central nervous systems XE "central nervous system:scleroderma" . CREST syndrome is a similar condition, but with a better prognosis, because involvement is limited to the skin, joints XE "joints:crest syndrome" , and esophagus XE "esophagus:crest syndrome" . The skin is often the first organ system involved. Scleroderma is usually manifested by diffuse and mild swelling of the skin. The skin gradually loses pliability and becomes tightly drawn and bound to underlying structures. There is no effective treatment for this condition other than managing the complications [i.e. hypertensionxe "hypertension (HTN):scleroderma", Congestive Heart Failure (CHF)xe Congestive Heart Failure (CHF):scleroderma", and pulmonary disease] XE "pulmonary: disease, scleroderma" . General Criteria: Scleroderma and CREST Syndrome (Calcinosis, Raynauds phenomenon, Esophageal dysfunction, Sclerodactyly, Telangiectasia) without complications may be acceptable. Questions You Should Ask and Criteria:Have there been any complications of Scleroderma or significant heart or kidney involvement within the past 24 months (ie.; CHF, arrhythmia, heart block, pericarditis, or cor pulmonale; increased creatinine or proteinuria)?not acceptableHave there been any complications of CREST Syndrome such as esophageal strictures, esophageal dysmotility, kidney failure, poorly controlled hypertension, Raynauds, or skin thickening? not acceptableHas there been any history of pulmonary fibrosis?not acceptableAre more than 20 mgs per day of Prednisone XE "Prednisone:scleroderma"  used?not acceptable Has there been any history of skin ulcers XE "skin ulcers:scleroderma"  or chronic non-healing skin infections within the past 24 months?not acceptableIs there poorly controlled hypertension (consistent systolic of >200 or diastolic >100)? not acceptable  GOTOBUTTON toc SLEEP APNEA  xe "Sleep apnea"\iSleep apnea is a sleep related breathing disorderxe "breathing disorder:sleep apnea" in which there are pauses in respiration lasting 10 seconds or longer. During these pauses, there is a decrease in oxygen saturation and there may be a variety of cardiac arrhythmias XE "cardiac:arrhythmias,sleep apnea" . Sleep apnea  XE "sleep apnea:classifications"is generally classified as: central, obstructive, or mixed. The obstructive type comprises 90% of all sleep-related disorders. A Continuous Positive Airway Pressure apparatus (CPAP XE "CPAP:sleep apnea" )xe "Continuous Positive Airway Pressure (CPAP) apparatus " is used in treatment. If there is severe upper airway obstruction XE "airway obstruction" , surgery XE "surgery:sleep apnea"  may be needed. Questions You Should Ask and Criteria:Did the use of a Continuous Positive Airway Pressure (CPAP) apparatus begin within the past 3 months?not acceptableHas use of CPAP apparatus been recommended but not used?not acceptableHas there been more than 1 hospitalization XE "hospitalization:sleep apnea"  in the past 12 months for complications from sleep apnea? not acceptable Is surgery XE "surgery:sleep apnea"  recommended or scheduled?not acceptable Is supplemental oxygen XE "oxygen:sleep apnea"  required for sleep apnea? may be acceptable  GOTOBUTTON toc SLIPPED/RUPTURED DISC xe "Disc: slipped/ruptured "\ixe "ruptured/slipped disc"\i xe "slipped/ruptured disc"\i(Herniated Nucleus Pulposusxe "herniated:nucleus pulposus") A slipped or ruptured disc results from the tearing of spinal ligaments XE "spinal: ligaments, slipped disc" , which normally hold the disc in place between the vertebral bones. The disc may then become displaced resulting in pressure on the spinal column or spinal nerves. XE "back/spine:slipped or ruptured disc"  The most common site of a herniated discxe "herniated:disc" xe "disc: herniated "is in the lumbar areaxe "lumbar area", followed by the cervical areaxe "cervical area". Symptoms of a herniated disc include muscle weakness, atrophy, pain, and diminished sensation. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs or IADLs?not acceptable if any deficits (see Uninsurable Functional Deficits) XE "ADLs:slipped or ruptured disc"  XE "IADLs:slipped or ruptured disc" Are narcotics such as Demerol XE "Demerol:slipped or ruptured disc" , Methadone, Morphine XE "morphine:slipped or ruptured disc" , OxyContin, Percodan XE "Percodan:slipped or ruptured disc"  or Talwin XE "Talwin:slipped or ruptured disc"  used to control pain within the past 12 months?not acceptable Are assistive devices XE "assistive devices:slipped or ruptured disc"  such as a wheelchair, walker, or quad cane XE "wheelchair:slipped or ruptured disc"   XE "walker:slipped or ruptured disc"  XE "quad cane:slipped or ruptured disc"  XE "crutches:slipped or ruptured disc"  currently being used? not acceptableHas physical therapy been required within the past 6 months? may be acceptable if symptoms are improvingHas surgery XE "surgery:slipped disc"  XE "surgery:ruptured disc"  been recommended or scheduled, or performed within the past 6 months?not acceptable Cross Reference: Fractures Physical Therapy Uninsurable Functional Deficits  GOTOBUTTON toc SPINAL STENOSIS xe "stenosis:spinal "\ixe "spinal: stenosis"\i Spinal stenosis is usually caused by osteoarthritis XE "osteoarthritis (OA):spinal stenosis" , but may also result from a ruptured disc XE "ruptured disc:spinal stenosis" , trauma, spinal surgeryxe "spinal:surgery, spinal stenosis", scoliosis, xe "scoliosis:spinal stenosis "or Paget's disease XE "Paget's disease of the bone:spinal stenosis" . There is a progressive narrowing of the spinal canal. This causes pressure on the spinal nerves or spinal cord producing pain and weakness of the back XE "back/spine:spinal stensosis"  and lower extremities. Questions You Should Ask and Criteria:Are there any limitations with performing the ADLs or IADLs?see Uninsurable Functional Deficits  XE "ADLs:spinal stensosis"  XE "IADLs:spinal stensosis" Are narcotics such as Demerol XE "Demerol:spinal stensosis" , Methadone, Morphine XE "morphine:spinal stensosis" , OxyContin, Percodan XE "Percodan:spinal stensosis"  or Talwin XE "Talwin:spinal stensosis"  used to control pain within the past 12 months?not acceptable Are assistive devices XE "assistive devices:spinal stensosis"  such as a wheelchair, XE "wheelchair:spinal stensosis"  walker, or quad cane  XE "walker:spinal stensosis"  XE "quad cane:spinal stensosis"  XE "crutches:spinal stensosis"  currently being used?not acceptableHas physical therapy been required within the past 6 months?not acceptableHas surgery XE "surgery:spinal stensosis"  been recommended or scheduled, or performed within the past 6 months?not acceptableIs there marked progression or increase in the severity of symptoms within the past 12 months?not acceptableIs there leg pain with walking less than one-half mile?not acceptable Cross Reference: Fractures Physical Therapy Uninsurable Functional Deficits  GOTOBUTTON toc STROKE (CVA)  xe Stroke"\i\bCerebral Vascular Accident (CVA XE CVA:stroke" \i \b)xe Cerebral: Vascular Accident (CVA)"\i\b Stroke is the sudden onset of a neurologic deficitxe "neurological: deficit, stroke" lasting longer than 24 hours. Stroke is usually caused by xe "cerebrovascular: disease, stroke"the occlusionxe "occlusion, cerebral:stroke "xe "cerebral: occlusion, stroke" of the cerebral arteries due to atherosclerosisxe "atherosclerosis:stroke". Less commonly, a stroke may be caused by a blood clot to the brain XE "brain:stroke" xe "blood: clot to the brain"xe "brain:blood clot" or bleeding within the brainxe "bleeding: brain, within the ". Strokes are generally classified as: Hemorrhagic Embolic Thrombotic General Criteria: symbol 114 \f "ZapfDingbats" \s 13 \h History of stroke is a Specific Uninsurable Medical Condition. Cross Reference:  GOTOBUTTON aneurysms Aneurysm   GOTOBUTTON thromboembolism Thromboembolism   XE "Aneurysm" \t "See stroke"   GOTOBUTTON toc SURGERY xe Surgery" These time frames relate to the waiting period following surgical procedures. After completion of a waiting period, surgical procedures are acceptable after full recovery, discharge from medical care, and resumption of normal activities. SurgeryActionBack / spine6 monthsCABG6 months; not acceptable if DiabeticCarotid or femoral endarterectomy12 months; not acceptable if DiabeticCarpal Tunnel Syndrome Surgery recommended or scheduledPostpone until after complete recoveryCholecystectomy3 monthsColon resection (excluding cancer)1-3 months; 12 months for Crohns diseaseGastric Bypass Surgery12 monthsHip or knee replacement for fracture or arthritis3 months; 12 months with Ankylosing SpondylitisDefibrillator implant12 monthsHeart valve replacement6 months; not acceptable if DiabeticPacemaker implant Surgery recommended or scheduledPostpone until after complete recoveryPTCA3 months; not acceptable if DiabeticSurgery recommended or scheduled (including outpatient, requiring a general anesthetics excludes local anesthetics)Postpone  Questions You Should Ask and Criteria:Is there any surgery that is recommended or scheduled?not acceptable   GOTOBUTTON toc SYNCOPE  (Fainting XE "fainting:syncope"\i  or Black out XE "black out:syncope"\i ) xe "Syncope"\iSyncope is a brief loss of consciousnessxe "consciousness: brief loss" with complete and spontaneous recovery. The most common cause is a sudden decrease in blood flow to the brain XE "brain:syncope" . This is usually due to cardiac arrhythmiasxe "arrhythmias: cardiac, syncope "xe "cardiac: arrhythmias,syncope", which reduce cardiac XE "cardiac:output, syncope"  output. Vasovagal syncope XE "syncope:vasovagal" xe "vasovagal syncope" is also quite common and often occurs in healthy individuals due to emotional stress, fear, or pain. General Criteria: symbol 114 \f "ZapfDingbats" \s 13 \h The underwriting of syncope is based on the frequency and cause. Questions You Should Ask and Criteria:What was the cause of the syncopal episode?not acceptable within 6 months if the cause is unknownHave there been multiple episodes of syncope within the past 12 months?not acceptableHave any fractures XE "fractures:syncope"  occurred as a result of this condition? see Fracture guidelines  Cross-references:  GOTOBUTTON a_fib Atrial Fibrillation  XE "Atrial fibrillation" \t "See syncope"   GOTOBUTTON arrhythmias Conduction Disturbances   XE "Conduction disturbances" \t "See syncope"   GOTOBUTTON toc SYSTEMIC LUPUS ERYTHEMATOSUS (SLE)  xe "SLE "\ixe "Systemic: Lupus Erythematosus (SLE) "\iDisseminated Lupusxe "lupus: disseminated "\ixe "disseminated lupus"\i, Discoid Lupus Erythematosusxe "discoid lupus erythematosus"\ixe "lupus:erythematosus, discoid" Systemic lupus erythematosus is a chronic inflammatory disease of the connective tissues XE "chronic: inflammatory disease of the connective tissues, lupus"  thought to be the result of an autoimmune process. The most common symptoms consist of a febrile illness with polyarthritis XE "polyarthritis:lupus" , a rash on the cheeks and bridge of the nose, fatigue, chest pain, and enlarged lymph nodes. The prognosis varies widely, depending on the extent and number of organs involved and the degree of inflammation. Discoid lupus is a chronic skin disorder with lesions that are usually confined to the face, neck, arms, and scalp. General Criteria: Well-documented history of Discoid Lupus present for at least 24 months may be acceptable. Questions You Should Ask and Criteria: Has Discoid Lupus been diagnosed within the past 24 months? may be acceptableHas there been symptomatic systemic Lupus within the past 24 months?not acceptableHave there been any complications within the past 36 months (i.e. kidney XE "kidney:systemic lupus" ,  XE "lung:systemic lupus"  brain XE "brain:systemic lupus" , or heart XE "heart:systemic lupus"  involvement)?not acceptableWhat type of treatment or medication was received for this condition? not acceptable if there is: treatment with cytotoxic agentsxe "cytotoxic drugs:systemic lupus such as Imuran XE "Imuran:systemic lupus" , Cytoxan XE "Cytoxan:systemic lupus" , Leukeranxe "Leukeran:systemic lupus, or cyclosporinexe "cyclosporine:systemic lupus" within the past 24 monthsdaily use of narcotics  XE "narcotic analgesics" \t "See Demerol, morphine, Percodan, Talwin"  such as Demerol XE "Demerol:systemic lupus" , Methadone, Morphinexe "morphine:systemic lupus", OxyContin, Percodanxe "Percodan:systemic lupus", or Talwin within the past 12 months XE "Talwin:systemic lupus" Prednisone XE "Prednisone:systemic lupus"  use of more than 20 mgs a dayPlasmapheresis within the past 48 monthsHave there any been vertebral body (compression) fractures XE "fractures:polymyositis-dermatomyositis" ?one fracture within 3 months not acceptable 3 or more fractures not acceptableHas there been any physical therapy or joint surgery within the past 12 months?not acceptable Cross Reference: Fractures  GOTOBUTTON toc THROMBOCYTHEMIA  xe Thrombocythemia"\i\b(Thrombocytosisxe "Thrombocytosis"\i\b)  XE "blood:disorders: thrombocythemia" Thrombocythemia is a condition in which there is an increase in the number of platelets in the blood XE "increase of platelets in the blood: thrombocythemia" \i . This increase can result in the formation of  XE "bleeding:thrombocythemia" blood clots and in hemorrhage (due to dysfunction of the abnormal platelets). There are two types of thrombocythemia: Primary thrombocythemiaxe "Primary thrombocythemia"xe "Thrombocythemia:primary" results from an abnormality in the cells that form the platelets. Reactive thrombocythemiaxe "Reactive thrombocythemia"xe "Thrombocythemia:reactive" occurs in response to some other disorder (e.g. rheumatoid arthritis XE "rheumatoid: Arthritis (RA), reactive thrombocythemia" , Hodgkin's disease XE "Hodgkin's disease:reactive thrombocythemia" , or iron deficiency XE "iron deficiency:reactive thrombocythemia" ). Treatment: May include the use of chemotherapeutic XE "chemotherapy:thrombocythemia"  drugs such as Hydrea and Leukeran XE "Leukeran:thrombocythemia" . Questions You Should Ask and Criteria:Has there been a history of blood clots or bleeding?not acceptable Has treatment with Argylin, Leukeran, Platinol, or Cyclophosphamide been required within the past 12 months not acceptable Has Hydrea been initiated within the past 12 months? may be acceptable Platelet count over 600K . not acceptable   GOTOBUTTON toc THROMBOCYTOPENIA  xe "Thrombocytopenia" XE "blood:disorders: thromocytopenia" Thrombocytopenia is a condition in which there is a decrease in the number of platelets in the blood XE "decrease of platelets in the blood:thrombocytopenia " \i . This decrease can result in spontaneous bruising XE "bruising: thrombocytopenia" and bleeding XE "bleeding:thrombocytopenia" . Treatment is with Prednisone XE "Prednisone:thrombocytopenia"  or by spleen removal XE "spleen:removal,thrombocytopenia" . Questions You Should Ask and Criteria:Have there been any bleeding episodes within the past 12 months?not acceptableHas there been Prednisone use for thrombocytopenia within the past 12 months?not acceptableIs spleen removal anticipated?not acceptable ( Platelet count under 60,000 not acceptable  GOTOBUTTON toc THROMBOEMBOLISM  xe Thromboembolism "\i\b(Venousxe venous:embolism"\i\b, Arterialxe "arterial:embolism"\i\b or Pulmonary embolismxe pulmonary: embolism"\i\b) An embolism xe "embolism "\iis a blood clot XE "blood: clot, thromboembolism" , which moves through the blood stream. It can lodge in a blood vessel suddenly blocking the flow of blood. A thrombus xe "thrombus "is a blood clotxe "blood: clot" adhering to the wall of a blood vessel. When a thrombus breaks loose and moves through the blood stream it is referred to as a thromboembolism. A venous thromboembolism originates as a clot in the deep veins of the lower extremities. The clot may migrate into the major blood vessels returning to the heart and then to the lungs (pulmonary embolism). An arterial thromboembolism occurs when a clot forms in the arteries. A clot may form as the result of damage to a vessel, or the presence of a prosthetic device (such as an artificial heart valve XE "heart:valve,artificial" ). The clot may migrate into the coronaryxe "coronary: artery, thromboembolism", carotidxe "carotid artery: thromboembolism", or other arteries. Treatment is usually with Coumadin XE "Coumadin:thromboembolism"  to reduce the risk of further clot formation. Questions You Should Ask and Criteria:How many episodes have occurred? What type? What was the date of the last occurrence?not acceptable if there: has been an arterial embolism within the past 12 monthshas been a pulmonary (lung) embolismxe "embolism: pulmonary (lung) "xe "lung: embolism"xe "pulmonary:embolism" within the past 6 monthshave there been multiple episodes of pulmonary embolism within the past 12 months Are there any other significant histories? not acceptable if there is: poorly controlled high blood pressure limb amputation XE "limb amputation:thromboembolism"  or bowel resection congestive heart failure (CHF) with arterial embolism diabetes with arterial embolism  XE "skin ulcers:thromboembolism" Has coumadin been initiated within the past 6 months? not acceptableHave there been any bleeding XE "bleeding:associated with Coumadin use"  episodes in association with Coumadin XE "Coumadin:thromboembolism"  use within the past 12 months? not acceptableHas there been symptomatic arrhythmia, atrial fibrillation, or cardioversion within past 6 months with arterial embolism? not acceptableHas heart valve replacement been recommended or surgery completed xe "valve replacement"xe "heart:valve replacement" within the past 24 months with arterial embolism?not acceptableHas there been a history of Transient Ischemic Attack within the past 5 years? not acceptableHas here been any surgical treatment or insertion of filters for pulmonary embolism within the past 24 months? not acceptable Thromboembolism Cross-references: Arrhythmia Atrial Fibrillation Diabetes Congestive Heart Failure  GOTOBUTTON CVA Stroke  XE "Stroke" \t "See thromboembolism"   GOTOBUTTON TIA TIA  Valvular Heart Disease  XE "TIA" \t "See thromboembolism"   GOTOBUTTON toc TRANSIENT GLOBAL AMNESIA (TGA)  Transient global amnesia XE "Transient Global Amnesia (TGA)"\i  is a term used to describe a syndrome of uncertain etiology where there is abrupt and usually permanent loss of the memory for the prior hour to several hours. This acute confusional state generally clears within twenty-four hours, although there remains a permanent memory deficit for the period of amnesia XE "amnesia" . The most common cause of this syndrome appears to be either a migraine attack, or transient ischemia of posterior circulation to the brain. Less common causes are unusual seizure disorders, medication reactions, and rarely, occult head trauma. Psychological factors such as hysteria have also been known to induce these symptoms. Questions You Should Ask and Criteria:Has the episode of TGA occurred within the past 6 months?not acceptableHave there been two or more episodes of TGA within the past 2 years?not acceptableIs the cause undetermined or is a work-up anticipated or currently underway?not acceptable Cross Reference Memory Loss  GOTOBUTTON toc TRANSIENT ISCHEMIC ATTACK (TIA)  RETINAL ARTERY OCCLUSION / EMBOLISMxe Attack, Transient Ischemic (TIA)"\i xe Transient Ischemic Attack (TIA)"\ixe Ischemic Attack (TIA), Transient "\iTransient Ischemic Attacks (TIAs) are episodes of temporary cerebral dysfunction of vascular origin, which resolve within 24 hours. Numbnessxe "Numbness:TIA", weaknessxe "weakness:TIA", dizzinessxe "dizziness:TIA", faintingxe "fainting:TIA", vision defects,xe "vision: defects, TIA" or loss of speechxe "speech, loss of:TIA" (aphasiaxe "aphasia:TIA") are the typical signs. TIAs are often a precursor to more significant cerebrovascular XE "cerebrovascular: precursor event, TIA"  events (i.e. strokesxe "stroke:precursor, TIA"). TIAs occur when emboli or plaques temporarily block the arterial blood flow to the brain, resulting in temporary symptoms. When diagnostic tests show significant blockage or extensive ulceration or plaque in the carotid arteries, surgery (endarterectomy XE "endarterectomy:TIA"  XE "TIA:endarterectomy" ) may be recommended to reduce the chance of stroke. Strokes occur when blood flow to the brain is blocked for extended periods of time; irreparable damage to the brain often takes place resulting in loss of function or paralysis. Treatment may include anti-coagulant drugs, such as, Coumadin XE "Coumadin:TIA"  XE "TIA:Coumadin"  XE "TIA:Ticlid"  XE "Ticlid:TIA" , Ticlid, or Plavix. Questions You Should Ask and Criteria:Has there been a history of a TIA or retinal artery occlusion within the past 5 years?not acceptableHas there been more than one TIA or retinal artery occlusion? not acceptableIs there a history of Atrial Fibrillation, AV Malformation, Cardiomyopathy, Cerebrovascular Aneurysm, Diabetes, MI, Polycythemia, or Rheumatic Heart Disease  XE "diabetes:TIA" ?not acceptableHave there been symptoms suggestive of TIA within 5 years (temporary numbness, tingling, loss of vision or garbled speech)?not acceptableHas there been a single episode of amaurosis fugax within the past 6 months XE "diabetes:TIA" ?not acceptableHave there been multiple episodes of Amaurosis Fugax XE "Amaurosis Fugax:TIA"  XE "TIA:Amaurosis Fugax"  (temporary loss of vision)? not acceptable Is there a history of any heart surgery XE "heart:surgery,TIA"  (e.g., angioplasty XE "angioplasty:TIA" , aortic aneurysm repair, bypass grafts XE "bypass grafts:TIA" , valve replacements XE "valve replacement:TIA" )?not acceptable Cross-references:  GOTOBUTTON CVA Stroke  XE "Stroke" \t "See TIA (Transient Ischemic Attack)"   GOTOBUTTON DM Diabetes Mellitus   XE "Amaurosis" \t "See TIA (Transient Ischemic Attack)"   GOTOBUTTON toc TRANSPLANTATION OF BONE MARROW  OR STEM CELL xe "Transplantation:bone marrow"\i\bxe "bone marrow: transplantation"\i\bBone marrow transplantation has become accepted therapy for many blood disorders XE "blood: disorders: Bone Marrow Transplantation"  such as aplastic anemiaxe "aplastic anemia:bone marrow transplant", severe immune deficiency diseases XE "immune deficiency diseases:bone marrow transplant" , acute leukemiaxe "leukemia: acute, bone marrow transplant "xe "acute: leukemia, bone marrow transplant ", and chronic granulocytic leukemiaxe "leukemia: chronic granulocytic, bone marrow transplant "xe "chronic: granulocytic leukemia, bone marrow transplant ". The recipient of a bone marrow transplant is given massive amounts of chemotherapeutic drugs xe "chemotherapeutic drugs:bone marrow transplant"prior to the transplant to destroy his/her own bone marrow and the targeted malignancy. The recipient then receives the donor's bone marrow intravenously. Anti-rejection treatment is continued for an indefinite period of time following the transplant. Questions You Should Ask and Criteria:Did the transplant occur within the past 5 years?not acceptable  GOTOBUTTON toc TRANSPLANTATION OF THE CORNEA   XE "Surgery:cornea transplant" Transplants XE "Transplantation:cornea"  of the cornea are usually required for individuals with inadequate cellular lining in the eye or as a complication in those who have undergone cataract XE "cataract"  extraction and lens implant. While largely successful, there is a percentage of graft failure with this procedure, which typically occurs within the first few weeks following surgery. Failure is usually the result of surgical trauma, infection or secondary glaucoma XE "glaucoma:transplantation of the cornea" . General Criteria: A history of Corneal Transplant is generally acceptable after recovery, provided there are no deficiencies of the ADLs XE "ADLs:corneal transplant"  or IADLs XE "IADLs:corneal transplant" .  GOTOBUTTON toc TRANSPLANTATION OF THE HEART  XE Transplantation:heart" \b \i  XE Surgery:heart transplant"\\i\b Heart transplantation XE "heart:transplantation" \b \i  is now a viable option for patients with previously untreatable end-stage heart disease. This procedure in selected patients not only prolongs life, but also improves the quality of life. Over the past decade, heart transplantation has gone from an experimental procedure to the treatment of choice for patients with end-stage heart disease. Significant advances in surgical technique, tissue preservation, and prevention of post-transplant complications have allowed for a greatly increased number of heart transplantations, as well as an increase in survival rates worldwide. The limited number of donor hearts, unfortunately, makes this procedure unavailable to many otherwise suitable recipients. At this time, heart transplantation patients are not considered for LTC coverage due to the frequent number of unforeseen complications, especially during the first five years post-transplant. General Criteria: History of or consideration for a heart transplant is Not Acceptable.  GOTOBUTTON toc TRANSPLANTATION OF THE KIDNEY  xe "Transplantation:kidney "\ixe "kidney: transplantation"\iThe treatment of choice for patients with advanced or end stage renal Xe renal (kidney):transplantation of the kidney" \i disease (ESRD)xe "end stage renal disease (ESRD)" is kidney transplantation. Complications include rejection, infections, and increased incidence of skin cancer due to the administration of immunosuppressant medications XE "immunosuppressant medications: transplantation of the kidney"  and the presence of associated chronic illnesses. Questions You Should Ask and Criteria:Has there been a kidney transplant within the past 5 years?not acceptableHas there been any evidence of rejection XE "rejection:kidney transplantation"  XE "kidney transplantation:rejection"  ?not acceptableIs there been any history of diabetes XE "diabetes:kidney transplantation"  or heart disease XE "heart disease:kidney transplantation" ? not acceptable Has there been a failed kidney transplant XE "kidney transplantation:failed" ?not acceptableHas there been any abnormal kidney function XE "abnormal kidney function:kidney transplantation"  post transplant?not acceptableHave there been hospitalizations for complications of the transplant or immunosuppression/opportunistic infections  XE "immunosuppression:kidney transplantation"  XE "kidney transplantation:immunosuppression "  within the past 24 months?not acceptable Has there been a history of lymphoma or other cancer following the kidney transplant  XE "skin cancers:kidney transplantation"  XE "kidney transplantation:skin cancers " ? not acceptableAre more than 10 mgs per day of Prednisone xe "Prednisone: polymyalgia rheumatica "being used?not acceptable  GOTOBUTTON toc TRANSPLANTATION OF THE LIVER  XE Transplantation:liver"\i   XE "Surgery:liver transplant"\i Liver transplantations XE "Liver:transplantation"\i  are performed in patients with terminal or end-stage liver disease, typically due to cirrhosis or liver cancer. While public awareness of the success of this procedure has increased in recent years, it is still subject to a high percentage of failure due to graft rejection and technical complications. General Criteria: May be acceptable 5 years after liver transplant is completed  GOTOBUTTON toc TREMORS AND OTHER INVOLUNTARY MOVEMENT DISORDERS  xe "Tremors: & other involuntary movement disorders"\ixe "involuntary movement disorders: tremors"\ixe "movement disorders, involuntary:tremors"\iA tremor is an involuntary movement usually involving the hands and occasionally the arms and head. While common in the elderly due to benign causes, tremors can be associated with significant neurological diseasesxe "neurological:tremors" (i.e. Parkinson's XE "Parkinson's: tremors" ). Benign tremors are usually identified or diagnosed as: Intention tremor Familial tremor Essential tremor These are generally acceptable as long as the symptoms are not progressive, have been present for 24 months or longer, and a neurological work-up has ruled out Parkinsons disease. Questions You Should Ask and Criteria:Has the cause been identified?not acceptable if due to Parkinson's diseaseHas there been any progression of symptoms? not acceptable Have Artanexe "Artane:tremors", Cogentinxe "Cogentin:tremors", Eldeprylxe "Eldepryl:tremors", Larodopa xe "Larodopa:tremors "(L- dopa), Sinemet xe "Sinemet:tremors "or Symmetrel xe "Symmetrel:tremors "been prescribed?not acceptableAre there any limitations of ADLs xe "ADLs:tremors"or IADLsxe "IADLs:tremors"?see Uninsurable Functional DeficitsHas there been any hospitalization for psychiatric or neurological symptoms within the past 12 monthsxe "IADLs:tremors"?not acceptableIs there a history of Huntingtons Chorea, Wilsons disease or tremor at rest?not acceptableIs there a history of multiple sclerosis? not acceptable Cross Reference:  GOTOBUTTON parkinsons Parkinson's Disease  XE "Parkinsons disease" \t "See Tremors"  XE "Parkinsons disease" \t "See Voluntary Movement Disorders"   GOTOBUTTON toc TUBERCULOSIS (TB)  xe "Tuberculosis (TB)"\i\bTuberculosis is a communicable disease caused by the bacillus mycobacterium tuberculosis xe "bacillus mycobacterium tuberculosis"\i\b. The lungs XE "lung:TB"  are the primary site of infection, but TB may also involve the genitourinary system XE "genitourinary system:TB" , gastrointestinal system XE "gastrointestinal: system, TB" , musculoskeletal system, and skin XE "skin:TB" . This infection is treated with specific anti-tuberculosis drugs e.g. isoniazid XE "Isoniazid:TB"  (INH). Treatment often requires 6-12 months of daily medication. In rare cases partial lung resection may also be required. Questions You Should Ask and Criteria:Is there an active infection currently under treatment?not acceptableAre there any limitations with performing the ADLs or IADLs?see Uninsurable Functional Deficits XE "ADLs:TB"  XE "IADLs:TB" Has there been symptomatic Congestive Heart Failure (CHF) within the past 5 years XE "Congestive Heart Failure (CHF):TB" ? XE "Chronic: Obstructive Pulmonary Disease (COPD),TB" not acceptable Cross Reference: CHF Uninsurable Functional Deficits  GOTOBUTTON toc ULCERS OF THE SKIN  XE ulcers:skin" \b \i  The following are four types of commonly encountered skin ulcers XE "skin ulcers"\i . Venous Ulcersxe "ulcers:venous"xe "venous: ulcers": Venous ulcerations are often preceded by stasis dermatitisxe "stasis dermatitis". This is due to venous hypertension in the lower extremities. Ulcerations may occur spontaneously or follow a superficial injury. The ulcers are usually located on the ankle, but may occur anywhere. Arterial Ulcersxe "ulcers:arterial"xe "arterial:ulcers": Arterial ulcerations are due primarily to atherosclerosis of the limb vessels, which produces ischemia of the skin. The ulcers are located primarily on the toes and the lower leg. Even small ulcers can be very painful and are often deep, going down to the subcutaneous tissue, muscle, and even into the bone. Diabetic Ulcersxe "ulcers:diabetic"xe "diabetic ulcers": Diabetic ulcers are also associated with an increased incidence of atherosclerosis xe "atherosclerosis "of the medium and large arteries. Because of diminished blood flow, diabetics are prone to arterial ulcers, frequently in the toes or elsewhere on the foot. Healing is slow and difficult because of the diabetic's lower resistance to infection. Pressure Ulcers: Pressure ulcersxe "ulcers:pressure "xe "pressure ulcers", also known as decubitus ulcersxe "ulcers: decubitus"xe "decubitus ulcers", are a common problem among people with spinal cord injuries and chronic neurological disease (such as stroke). More than 90% of pressure ulcers are located in the lower part of the body over bony prominences. Common sites include the sacrum, heel, ankle, and hip. Questions You Should Ask and Criteria:Has there been a venous ulcer (single occurrence) within the past 12 months? not acceptable Has there been an arterial, or pressure ulcer (single occurrence) within the past 24 months?not acceptableHas there been a diabetic ulcer?not acceptableIs there a history of multiple/recurrent skin ulcers XE "skin ulcers:recurrent"  XE "skin ulcers:multiple" ?not acceptableHas there been any lower extremity or by-pass surgery?not acceptable if: within 12 months there is a history of diabetesHas there been any prolonged wheelchair XE wheelchair:skin ulcers  or bed confinement XE bed confinement:skin ulcers ?not acceptableIs there any history of  XE deep vein thrombosis:skin ulcers gangrene XE gangrene:skin ulcers , amputation, or recurrent deep vein thrombosis  XE amputation:skin ulcers ?not acceptable Cross Reference: Diabetes Uninsurable Functional Deficits  GOTOBUTTON toc VALVULAR HEART DISEASE  xe "heart:disease,valvular"\ixe "valvular: heart disease"\iValvular heart disease involves the four valves within the heart: aortic XE "aortic: valve, valvular heart disease" , mitral XE "mitral valve: valvular heart disease" , pulmonic XE "pulmonic valve:valvular heart disease" , and tricuspid XE "tricuspid valve:valvular heart disease" . The aortic and mitral valves are the most often affected. Heart murmurs XE "heart:murmurs"  may be important clinical indicators of valvular heart disease. When the valves are opening and closing in a healthy fashion, very little noise is produced by the flow of blood over the valves. However, when the valves fail to open completely (stenosisxe "stenosis:heart values"), or close completely (regurgitation xe "regurgitation:heart valves "or insufficiencyxe "insufficiency:valvular heart disease"), turbulence to the blood flow produces an abnormal sound or murmur. Causes of valvular disease can be congenital (present at birth), secondary to rheumatic feverxe "rheumatic fever:valvular disease", muscle dysfunction due to coronary artery disease XE "coronary: Artery Disease (CAD), valvular disease" , prolapsexe "prolapse:valvular disease", or calcificationxe "calcification:valvular disease". Treatment is usually the surgical replacement of the abnormal valve XE "surgery:valve replacement" . Questions You Should Ask and Criteria:Has a heart valve replacement been recommended or scheduled, or valve replaced within the past 6 months?not acceptableHas more than one valve been replaced?not acceptable Is there any history of cardiomyopathy or post-surgical congestive heart failure (CHF)? XE "Congestive Heart Failure (CHF):valvular heart disease" not acceptableHas Coumadin been initiated within the past 6 months? XE "Congestive Heart Failure (CHF):valvular heart disease" not acceptableHas there been any post-surgical bleeding secondary to Coumadin XE "Coumadin:valvular heart disease"  use  XE "bleeding:associated with Coumadin use" within the past 12 months?not acceptable Is there a history of diabetes in combination with a heart valve replacement? XE "Congestive Heart Failure (CHF):valvular heart disease" not acceptableIs there a history of endocarditis within the past 24 months? XE "Congestive Heart Failure (CHF):valvular heart disease" not acceptableHas there been any symptomatic arrhythmia, including cardioversion, within the past 12 months? XE "Congestive Heart Failure (CHF):valvular heart disease" not acceptableHas there been any angina at rest, increasing angina, or diagnosis of Myocardial Infarction (MI) within the past 6 months? XE "Congestive Heart Failure (CHF):valvular heart disease" not acceptableHave there been 2 or more hospitalizations or ER visits for angina within the past 12 months? XE "Congestive Heart Failure (CHF):valvular heart disease" not acceptableHave there been any blood clots within the past 24 months? XE "Congestive Heart Failure (CHF):valvular heart disease" not acceptable Cross-references: Angina Diabetes Atrial Fibrillation Myocardial Infarction  GOTOBUTTON CHF CHF   GOTOBUTTON cardiomyopathies Cardiomyopathy   GOTOBUTTON toc DRUG INDEX  xe " DRUGS INDEX"xe "medications" XE "prescription medications:Drug Index" Below is a partial list of drugs. The medications in bold face type denote significant underlying disease. Their current use may warrant adverse decisions. Please determine why the medication is being taken and for how long. Then, look up the medical condition in the manual and proceed accordingly. For further information or information on additional medications, books listing commonly used drugs are readily available at local bookstores. Brand NameUsed in the Treatment of:Accolate Accupril Activaseasthma hypertension heart attack, stroke, pulmonary embolismAdriamycincancer/leukemia/lymphomaAeroBid Inhaler AgrylinAsthma Essential thrombocythemiaAldomethypertensionAlkeran Alphagan AltaceCancer Ocular hypertension/glaucoma Hypertension/chronic heart failureAlupent Amaryl Ambien Amergeasthma/COPD/emphysema non-insulin dependent diabetes insomnia migraineApresoline Amplex AriceptHypertension Alzheimers disease Alzheimers diseaseArtane Arthotec ArvinParkinson's disease/tremor Osteoarthritis/rheumatoid arthritis Anticoagulant therapyAtarax Ativananxiety/panic/itching anxietyAtrovent Avapro Avandia Avonex AxidCOPD Hypertension Non-insulin diabetes (handle as Rezulin) Multiple sclerosis Acid-reflux disorders (GERD)/peptic ulcerAzmacort Azulfidine Baycol Betapace Betaseronasthma/COPD/emphysema Crohns disease (ulcerative colitis) Hyperlipidemia (high cholesterol) Arrhythmias Multiple sclerosisBrethineCOPD/emphysema Brand NameUsed in the Treatment of:Bretylol BricanylArrhythmia COPD/emphysema/asthmaBumex BuSparHypertension/chronic heart failure anxiety/depressionCalanangina/arrhythmia /hypertensionCalcimar Campto CamptosarOsteoporosis Advanced colorectal cancer Advanced colorectal cancerCapoten CarafateHypertension Duodenal ulcersCarduraHypertension urinary obstructionCatapres CataflamHypertension Rheumatoid arthritisCelexa Cerespan antidepressant diminished blood flow to the brain/TIAs/memory loss/dementia/ peripheral vascular disease/arterial ulcersCerebyx Ceredase Cerezymeseizures/epilepsy Gauchers disease Gauchers diseaseCiprourinary tract infectionsClinorilpain/inflammationClozarilPsychosis/schizophreniaCodeinepainCogentinParkinson's disease/tremorCognexdementia/confusion/delirium/ disorientation/forgetfulness/ memory lossColchicineSclerodermaCompazine CopaxonePsychosis Multiple sclerosisCordarone CoregArrhythmia hypertensionCorgardhypertension/anginaCoumadin Covera-HS Cozaarcardiac arrhythmias/heart valve disease/stroke/coronary artery disease/emboli hypertension/angina hypertensionCupriminescleroderma/Lupus Brand NameUsed in the Treatment of:Cyclospasmol Cylert CytotecTIAs/memory loss/dementia Attention deficit hyperactivity disorder Peptic ulcer diseaseCytoxancancer/kidney failure/lupus/scleroderma Darvon DeltasonePain Endocrine disordersDemerolpainDepakene/Depakoteseizures/epilepsyDepenscleroderma/LupusDepo-ProveracancerDeprynelParkinson's diseaseDESprostate cancerDesferalhemochromatosisDestinexParkinsons diseaseDesyreldepressionDiabenesediabetes mellitusDiaBetadiabetes mellitusDidronelosteoporosisDilantin Dilaudid Diovan Divalproex Donnatal Dovonex Duract Dynacirc Edecin Effexorepilepsy/seizures narcotic for chronic pain hypertension seizure epilepsy irritable bowel syndrome psoriasis pain hypertension hypertension/chronic heart failure depressionElavildepressionEldeprylParkinson's disease/tremorEpogensevere anemiaErgoloid Ergomardementia/confusion/delirium/ disorientation/forgetfulness/ memory loss migraine headacheEskalith Ethmozinemajor mental disorders arrhythmiaEulexinprostate cancerEvistaosteoporosis Brand NameUsed in the Treatment of:Famvir Fareston Felbatol FemaraHerpes zoster (shingles) Breast cancer Epilepsy Breast cancerFeldenepain/inflammationFibracol FioricetDiabetic foot ulcers painFiorinal Flexeril FlomaxPain Muscle spasm Benign prostatic hyperplasiaFlorinef Fosamax Fragmin Gabitril Gemzar Glucophagecomplications of diabetes/ Addisons disease Osteoporosis Anticoagulant therapy Anti-epileptic Pancreatic cancer Non-insulin dependent diabetes mellitusGlucotrol Glynasediabetes mellitus diabetes mellitusGlyburidediabetes mellitus HalcioninsomniaHaldolmajor mental disorders/ alcohol dependencyHumalog Hycamtin HydergineDiabetes mellitus Ovarian cancer dementia/confusion/delirium/ disorientation/forgetfulness/ memory lossHydreablood disordersHydrodiurilhypertensionHytrinhypertension/benign prostatic hypertrophy(BPH) ImferonanemiaImurancardiomyopathy/lupus/ scleroderma/liver disease/hepatitisInderalhypertension/angina/MI/arrhythmia/ benign tremorsINHtuberculosis (TB) Brand NameUsed in the Treatment of:Insulin (Regular, NPH, Lente, Humalin)diabetes mellitusIsordilangina/CHFIsuprelasthma KemadrinParkinson's diseaseKlonopinseizures, depression L-DopaParkinson's disease/tremorLanoxinarrhythmia/CHFLarodopaParkinson's disease/tremorLasixCHFLeukerancancer/kidney failure/lupus/ scleroderma/blood disorders Libriumanxiety/panicLimbitrol LioresalDepression Multiple sclerosisLithiummajor mental disordersLithobidmajor mental disordersLodinepain/inflammationLoxitanepsychosisLudiomildepressionLupron Manoplaxprostate cancer congestive heart failure (CHF)MarplandepressionMaxairasthma/COPDMegaceBreast cancer/uterine cancerMellarilmajor mental disordersMestinonmyasthenia gravisMethotrexate Miacalcinlupus/scleroderma/leukemia/ lymphoma/ rheumatoid arthritis osteoporosisMicronasediabetes mellitusMiltown Mirapeanxiety/panic Parkinsons diseaseMiraplexParkinsons diseaseMithracinPaget's DiseaseMobanpsychosisMorphinepainMysolineseizures/epilepsy Naprosynpain/inflammationNardildepression Brand NameUsed in the Treatment of:Navane Navelbine Neurontin NilandronPsychosis Lung cancer Epilepsy Prostate cancerNiloricdementia/confusion/delirium/ disorientation/forgetfulness/ memory lossNitrobid/ NitroDur/ Nitrol/ Nitrostat/ Transderm-NitroanginaNolvadex Novantronebreast cancer prostate cancerNorvaschypertension/angina/CHFOrap OrinaseTourette Syndrome diabetes mellitusPamelordepressionParlodelParkinson's diseaseParnatedepressionParsidolParkinson's diseasePavabid Paxildiminished blood flow to the brain/ TIAs/memory loss/dementia/peripheral vascular disease/ arterial ulcer depressionPercodanpainPeritrateanginaPermaxParkinson's diseasePersantineTIA/valve replacementPhenobarbital Photofrinseizures/epilepsy esophageal cancerPlaquenilscleroderma/rheumatoid arthritisPlatinol Plavixcancer/polycythemia unstable angina, stroke preventionPrandindiabetes mellitusPrecosediabetes mellitus Prednisone lupus/polymyalgia/asthma/ arthritis/ liver disease/ hepatitis/renal failure/ thrombocytopeniaProlixinmajor mental disorders Brand NameUsed in the Treatment of:PronestylarrhythmiasProscarbenign prostatic hypertrophy (BPH)Prostigminmyasthenia gravisProventilasthma/COPD/emphysemaProzacdepressionPurinetholleukemia/lymphoma Quinidexarrhythmia Referon-A Regranexliver disease/hepatitis/leukemia diabetic ulcerRelafen Remeronpain/inflammation depressionRequipParkinsons diseaseRezulindiabetes mellitusRheumatrexlupus/scleroderma/leukemia/ lymphoma/rheumatoid arthritisRitalin RituxanDepression Non-Hodgkins lymphomaSabril Sandimmuneseizures lupus/scleroderma/cancer/ organ transplantSerlect Seraxschizophrenia anxiety/panicSerentilpsychosisSinemetParkinson's disease/tremorSinequandepressionSorbitrateangina/CHFSparinepsychosisStelazineschizophrenia/severe anxietySymmetrelParkinson's disease/tremor/acute influenza Tacrinedementia/memory loss/confusion/ forgetfulness/disorientationTalwinpainTambocorarrhythmiasTaractanpsychosisTasmar Taxol TaxotereParkinsons disease Ovarian cancer Breast/ovarian cancerTegretolconvulsions/seizures/neuropathyTenorminhypertension Brand NameUsed in the Treatment of: Theo-Dur asthma/COPD/emphysemaTiclidstroke/TIATofranildepressionTolinase Tornalatediabetes mellitus asthmaTranxeneanxiety/panicTrentalperipheral vascular disease/ arterial ulcersTriavildepressionTrilafonpsychosisTyloxpain Valiumanxiety/seizuresVancerilasthmaVasotechypertension/CHFVentolinasthma/COPD/emphysemaVespirinpsychosisViagramale erectile dysfunctionVicodinpainVoltarenpain/inflammation Wellbutrindepression Xanax Zanflexanxiety/panic spasticityZarontinseizures/epilepsyZoladexprostate cancerZoloft ZyprexaDepression schizophrenia Or search the Web at the following sites:  HYPERLINK http://www.mayohealth.org/mayo/common/htm/search.htm http://www.mayohealth.org/mayo/common/htm/search.htm  HYPERLINK http://www.rxlist.com/ http://www.rxlist.com/  HYPERLINK http://www.pslgroup.com/newdrugs.htm http://www.pslgroup.com/newdrugs.htm Personal List of Additional Drugs Brand NameUse Generic Name Used in the Treatment of:acarbosediabetes mellitusacebutololhypertensionacetaminophenpainacridineforgetfulness/disorientationacyclovirherpes zoster (shingles)adenosinearrhythmiaalbuterolasthma/COPD/emphysemaalendronate sodiumosteoporosisalprazolamanxiety painamantadineParkinsons disease/tremor/acute influenzaaminoguanidinetype I and type II diabetesamiodaronearrhythmiaamiodipine besylatehypertension/angina/congestive heart failure Generic Name Used in the Treatment of:amitriptylinedepressionamlodipinehypertensionancrodanticoagulant therapyaspirinpainatenololhypertensionatorvastationelevated high cholesterolazathioprinecardiomyopathy/lupus/scleroderma/liver disease/hepatitis/severe, active rheumatoid arthritisbaclofenmuscle spasms due to multiple sclerosisbecaplermindiabetic ulcersbeclomethasone dipropionateasthmabenazeprilhypertension/chronic heart failurebenztropine mesylateParkinsons disease/tremorbitolterolasthmabretyliumarrhythmiabromfenacacute painbrominide tartratereduction of intraocular pressure/open-angle glaucomabromocriptine mesylateParkinsons disease/pituitary tumorbumetanidehypertension/chronic heart failurebupropiondepressionbuspironeanxiety/depressionbutalbitaltension headachecalcipotrienemoderate plaque psoriasiscalcitonin-salmonosteoporosiscaptoprilhypertensioncarbamazepineconvulsions/seizures/neuropathycarbidopa-levodopaParkinsons disease/restless leg syndromecarvedilalhypertensioncerivastatinhigh cholesterolchlorambucilcancer/kidney failure/lupus/scleroderma/ blood disorders/rheumatoid arthritischlordiazepoxideanxiety/panicchlorothiazideedema/hypertension/congestive heart failurechlorpromazinepsychosis Generic Name Used in the Treatment of:chlorpropamidenon-insulin-dependent diabetes mellituschlorprothixenepsychosischlorthalidonehypertension/chronic heart failurecimetidineacid-reflux disorders/peptic ulcer diseaseciprofloxacinurinary tract infectioncisapridegastro-esophageal reflux diseasecisplatincancer/polycythemiaclomipramine hydrochlorideobsessive-compulsive disorderclonazepamseizures/depressionclonidinehypertension/chronic heart failureclopidrogelprevention of ischemic eventsclorazepateanxiety/panicclozapineschizophreniacodeinepaincolchicinescleroderma/arthritiscollagen-alginate topicalfoot ulcers in diabetic patientscyclandelateTIAs/memory loss/dementiacyclobenzaprinemuscle spasmcyclophosphamidecancer/kidney failure/rheumatoid arthritiscyclosporinelupus/scleroderma/cancer/organ transplantdalteparinanticoagulant therapydeferoxaminehemochromatosisdiazepamanxiety/seizuresdiclofenacpain/inflammationdiethylstilbestrolprostate cancerdigoxinarrhythmia/congestive heart failurediltiazemhypertension/anginadipyridamoleTIA/valve replacementdivalproexseizures/epilepsydocetaxelbreast/ovarian cancerdonepezilAlzheimers diseasedorzolamide HCIreduction of intraocular pressure/open-angle glaucomadoxazosinhypertension/urinary obstruction symptoms of BPHdoxepindepressiondoxorubicincancer/leukemia/lymphomad-penicillaminescleroderma/lupus Generic Name Used in the Treatment of:enalaprilhypertension/congestive heart failureenalapril-felodipinehypertensionenoxaparinprevention of deep vein thrombosisentacaponeParkinsons diseaseergoloid mesylatedementia/confusion/delirium/disorientation/ forgetfulness/memory lossergotamine tartratemigraine headacheserythritylanginaerythropoietinsevere anemiaethodolacpain/inflammationethopropazineParkinsons diseaseethosuximideseizures/epilepsyetidronateosteoporosisfamciclovirherpes zosterfelbamateepilepsyfelodipinehypertensionfenoprofen calciumpainfinasteridebenign prostatic hypertrophy (BPH)flecainidearrhythmiaflosequinancongestive heart failurefludrocortisonecomplications of diabetes/Addisons diseaseflunisolideasthmafluoxetinedepressionfluphenazinemajor mental disordersflutamidemetastatic prostate cancerfluvastatinhypercholesterolemiafluvoxamine maleateobsessive-compulsive disorderfosinoprilhypertension/chronic heart failurefosphenytoinseizuresfurosemidehypertension/chronic heart failuregabapentinepilepsygemcitabinepancreatic cancergemfibrozilhyperlipidemiaglibenclamidediabetes mellitusglimepiridenon-insulin-dependent diabetes mellitusglipizidenon-insulin-dependent diabetes mellitus Generic Name Used in the Treatment of:glyburidenon-insulin-dependent diabetes mellitusgold sodium thiomalaterheumatoid arthritisgoserelinprostate cancerhaloperidolmajor mental disorders/alcohol dependencyhydralazinehypertensionhydrocholorothiazidehypertensionhydrocodone/acetaminophenpainhydroxychloroquinescleroderma/rheumatoid arthritishydroxyureablood disordershydroxyzineanxiety/panic/itchingimiglucerase injectionGauchers diseaseimipraminedepressioninsulindiabetes mellitusinsulin lisprodiabetes mellitusinterferonliver disease/hepatitis/leukemiaipratropriumCOPDirbesartanhypertensionirinotecanadvanced colon canceriron dextrananemiaisocarboxaziddepressionisoniazidTB (tuberculosis)isoproterenolasthmaisosorbide dinitrateangina/CHFlamotriginepartial seizureslaradopaParkinsons disease/tremorletrozolebreast cancerleuprolideprostate cancerlevetiracetamseizureslevodopaParkinsons disease/tremorlithium carbonatemajor mental disordersloxapinepsychosismaprotilinedepressionmedroxyprogesteronecancermegestrolbreast cancer/uterine cancermelphalancancermeperidinepainmeprobamateanxiety/panic6-mercaptopurineleukemia/lymphoma Generic Name Used in the Treatment of:mesoridazinepsychosismetaproterenolasthma/COPD/emphysemametformindiabetes mellitusmethotrexatelupus/scleroderma/leukemia/lymphoma/ rheumatoid arthritismethyldopahypertensionmethylphenidatedepressionmirtazapinedepressionmithramycinPagets diseasemitoxantronehormone-resistant prostate cancermolindonepsychosismorphine sulfatepainmyotrophinALS, Lou Gehrigs diseasenabumetonepain/inflammationnadololhypertension/anginanaproxenpain/inflammationneostigminemyasthenia gravisnifedipinehypertension/anginanilutamideprostate cancernitroglycerineanginanortriptylinedepressionolanzapineschizophreniaoxazepamanxiety/panicoxcarbazepineepilepsyoxycodone/acetaminaphenpainoxycodone/aspirinpainpaclitaxelbreast and ovarian cancerpapaverinediminished blood flow to the brain/TIAs/memory loss/dementia/peripheral vascular disease/arterial ulcersparoxetinedepressionpentaerythritol tetranitrateanginapentazocinepainpentoxifyllineperipheral vascular disease/arterial ulcersperbuterolasthma/COPDpergolide mesylateParkinsons diseaseperphenazinepsychosisperphenazine/amitryptilinedepressionphenelzinedepression Generic Name Used in the Treatment of:phenobarbitalseizures/epilepsyphenytoinseizures/epilepsypimozidechronic schizophreniapiroxicampain/inflammationporfimer sodiumesophageal and lung cancerpramipexoleParkinsons diseasepramlintideType 1 diabetes mellitusprazosinhypertensionprednisonelupus/polymyalgia/asthma/arthritis/liver disease/hepatitis/renal failure/thrombocytopeniaprimadoneseizures/epilepsyprocainamidearrhythmiaproclorperazinepsychosisprocyclidineParkinsons diseasepromazinepsychosispropranololhypertension/angina/MI/arrhythmia/benign tremorpropoxyphenepainpyridostigminemyasthenia gravisquetiapine fumaratepsychotic disordersquinaprilhypertensionquinidinearrhythmiaraloxifeneosteoporosis preventionrepaglinidediabetes mellitusriluzoleALS, Lou Gehrigs diseaserituximabrecurrent non-Hodgkins diseaseropineroleParkinsons diseasesalmon calcitoninosteoporosisselegilineParkinsons diseasesertindoleschizophreniasertralinedepressionsildenafilmale erectile dysfunctionsulindacpain/inflammationtacrine THAdementia/confusion/memory loss/delirium/ disorientation/forgetfulnesstamoxifenbreast cancertamsulosinBPH, enlarged prostatetrazodonedepression Generic Name Used in the Treatment of:terazosinhypertension/benign prostatic hypertrophy (BPH)terbutalineCOPD/emphysematetrahydroamino acridine (THA)dementia/memory loss/ confusion/forgetfulness/disorientationtheophyllineasthma/COPD/emphysemathioridazinemajor mental disordersthiothixenepsychosisticlopadinestroke/TIAtizanidinedecrease spasticitytolazamidediabetes mellitustolbutamidediabetes mellitustolcaponeParkinsons diseasetopotecanovarian cancertoremifenemetastatic breast cancertriamcinoloneasthma/COPD/emphysematriazolaminsomniatrifluoperazineschizophrenia/severe anxietytrifluopromazinepsychosistrihexphenidylParkinsons disease/tremortroglitazonediabetes mellitus (not acceptable)valproate/divalproexseizures/epilepsyverapamilangina/arrhythmia/hypertensionvivabatrinrefractory seizuresvinorelbine tartratelung cancerwarfarincardiac arrhythmia/heart valve disease/stroke/ coronary artery disease/emboli Personal List of Additional Drugs Generic NameUseOr search the Web at the following sites:  HYPERLINK http://www.mayohealth.org/mayo/common/htm/search.htm http://www.mayohealth.org/mayo/common/htm/search.htm  HYPERLINK http://www.rxlist.com/ http://www.rxlist.com/  HYPERLINK http://www.pslgroup.com/newdrugs.htm http://www.pslgroup.com/newdrugs.htm   GOTOBUTTON toc GLOSSARY  XE "Glossary"  Activities of Daily Living (ADLs): The self-care, communication, and mobility skills required for independence in everyday living. These include: bathing, dressing, toileting, transferring, bowel/bladder continence, and eating. Atherosclerosis: Commonly called hardening of the arteries, this is a gradual narrowing of the arteries throughout the body. It is caused by the accumulation of fat and other material along arterial walls. When the narrowing becomes too severe, complications such as heart attacks, peripheral vascular disease with leg pain, and strokes may occur, depending upon the location of the affected artery(ies). Arteriography: Dye is injected into an artery and an x-ray is taken. A blockage may then be seen where the dye cannot penetrate. Cardiac catheterization: This is the diagnostic gold standard for evaluation of the heart chambers, heart valve function, and degree of patency (openness) of the various coronary arteries that supply the heart. This procedure is accomplished through the insertion of a plastic catheter into an artery in the groin. The catheter is extended up the aorta into the left ventricle of the heart. Dye is injected and serial x-rays are performed. The catheter is then withdrawn and selectively placed into the various coronary arteries where dye is also injected and additional x-rays are performed. CAT (computerized axial tomography) scans: An imaging technique in which planes of tissue are swept by a pinpoint x-ray beam and a computerized analysis produces a precise reconstructed image of that area. This technique has a greater sensitivity in showing the relationship of structures than conventional x-rays and has been used most successfully in diagnostic studies of the brain, although it is also used in other areas of the body. Cerebral Vascular Accident (CVA): a general term most commonly applied to cerebrovascular conditions that accompany either ischemic (narrowing of blood vessels) or hemorrhagic (bleeding) lesions. These conditions are usually secondary to atherosclerotic disease, hypertension, or a combination of both. Also commonly called stroke. Digital Subtraction Angiography (DSA): This is a type of x-ray examination of a blood vessel. It is similar to arteriography, except that less injectable dye may be used. Disorientation: The loss of bearings, or a state of mental confusion as to time, place, or identity. This may be the result of an underlying disease, stress, mental illness, or medication. DWR (Delayed Word Recall): A screening exercise to assess short-term memory. The subject is asked to use each of several simple words in a sentence. He/she is then asked to use each of the words in sentences again. In addition, the words are shown on flash cards. This is know as the encoding phase of the exercise. After an elapse of no fewer than 5 minutes and no more than 15 minutes, the subject is asked to remember as many of the words as possible. The subject is asked to take as long as he/she wishes for this recall phase of the exercise. Instrumental Activities of Daily Living (IADLs): Those daily living skills, such as, shopping, housework, laundry, meal preparation, managing finances, using the telephone, arranging for transportation, and taking medications, that are necessary for maintaining the home environment. Memory Loss: Loss of ability to remember events of the recent past (short-term memory) or the remote past (long-term memory). Loss of some short-term memory (such as the ability to remember names) is a normal part of the aging process. However, severe or progressive memory loss may be an indication of a developing dementia or other serious disease. Magnetic Resonance Imaging (MRI): Also known as Nuclear Magnetic Resonance Imaging. This is an imaging technique that subjects atomic nuclei to a strong magnetic field to provide precise images of the heart, large blood vessels, brain, and soft tissues. MRIs can often detect defects that are missed on CAT scans. PSA (Prostate specific antigen): a glycoprotein produced only in prostatic tissue, which is measurable through blood analysis. It is normally present in minimal amounts but becomes elevated with prostate cancer and certain benign prostate disorders such as BPH (benign prostatic hypertrophy) and prostatitis. There is a greater likelihood of cancer as the PSA increases. Short Portable Mental Status Questionnaire (SPMSQ): A 10-part questionnaire that assesses an individuals orientation to person, place, and time. Questions include personal information such as the subjects date of birth and phone number, and more general questions such as the names of the current and previous presidents. In addition, the subject is asked to perform a simple mathematical computation. Staging of Cancer Tumors: The process of classifying malignant tumors according to the extent of the tumor. TNM, staging of tumors according to three basic components: primary tumor (T), regional lymph nodes (N), and metastasis/spread (M). See Introduction to the Cancer section for more details on staging. Transient Ischemic Attack (TIA): Temporary interference with blood supply to the brain. The symptoms may last for only a few moments or several hours (but less than 24 hours). After the attack no evidence of residual brain damage or neurological damage remains. Individuals who experience TIAs are at an increased risk for additional TIAs or strokes.  GOTOBUTTON toc INDEX  Note: ( Primary medical histories discussed in this manual are in bold heading (Information related to primary medical histories or cross references are identified in lower case and/or indented sub-headings  INDEX \h "A" A abdominal aorta, 20 abnormal kidney function kidney transplantation, 105 abscess, anorectal, 17 abstinence from alcohol, 15 Acquired Immune Deficiency Syndrome (AIDS), 6 active hepatitis, 66 Activities of Daily Living (ADL), 1, 8 acute Acute Renal Failure (ARF), 88 leukemia, bone marrow transplant, 103 lymphocytic leukemia (ALL), 69 MI, 75 monocytic leukemia (AMOL), 69 myelogenous leukemia, 69 Acute Hepatitis, 66 Addisons Disease, 14 Additional Uninsurable Deficits", 9 ADL IBS, 56 ADL, Uninsurable Deficits", 8 ADLs anemia, 19 angina pectoris, 23 ankylosing spondylitis, 24 Cerebral Palsy, 51 corneal transplant, 103 CREST syndrome, 92 depression, 59 dizziness, 61 glaucoma, 62 macular degeneration, 62 Meningitis, 72 myasthenia gravis, 74 neuropathy, 62, 76 normal pressure hydrocephalus, 78 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 poliomyelitis, 83 polymyalgia rheumatica, 85 post polio syndrome, 83 rheumatoid arthritis, 89 schizophrenia or other psychosis, 91 scleroderma, 92 slipped or ruptured disc, 94 Specific Uninsurable Medical Conditions, 6 spinal stensosis, 95 TB, 107 tremors, 106 adrenal glands, 14 adrenal stimulating hormone, 14, 58 adult day care use, 9 Adult Onset Diabetes Mellitus, 60 A-Fib Atrial Fibrillation, 30 chronic, 30 paroxysmal (intermittent), 30 valvular heart disease, 109 age chronological, 1 physiological, 1 AIDS, 6 AIDS Related Complex (ARC), 6 airway obstruction, 93 alcohol ingestion, 54 instability, 4 alcohol use primary biliary cirrhosis, 54 alcoholic liver disease (ALD), 54 alcoholism effects from, 15 falls, 15 hemochromatosis, 65 neuropathy, 76 schizophrenia or other psychosis, 91 Alcoholism. See Cirrhosis, alcoholic liver disease . See Depression ALCOHOLISM. See cirrhosis, alcoholic liver disease. See depression aldosterone, 14 allergic asthma, 27 Allergic Asthma. See chronic obstructive pulmonary disease ALS, Amyotrophic Lateral Sclerosis, 6, 16 Alzheimers Disease, 6, 16 Five Is, 4 Amaurosis. See TIA (Transient Ischemic Attack) amaurosis fugax, 62 Amaurosis Fugax TIA, 102 ambulation, 8 amnesia, 101 amputation peripheral vascular disease, 82 skin ulcers, 108 amputation, 60 Amputation, 6 Amyotrophic Lateral Sclerosis, 6 Amyotrophic Lateral Sclerosis(ALS), 16 anal fissure, 17 ulcers, 17 anemia, 4 aplastic, 20 aplastic, 6 causes of, 18 hypoplastic, 20 iron deficiency, 18 kidney cancer, 39 megaloblastic, 18 microcytic, 18 multiple myeloma, 73 stomach cancer, 45 Anemia, 18 chronic disease, 18 aneurysm, 20 aortic, 21 brain, 22 cerebrovascular, 22 most common sites, 20 Aneurysm. See stroke aneurysm, untreated dissecting aortic, 21 Aneurysms, 20. See atherosclerosis & carotid arteries aneurysms, dissecting, 21 angina, 75 angioplasty, 55 pectoris, 23 stable, 23 unstable, 23 Angina. See coronary angioplasty. See coronary artery bypass surgery. See atrial fibrillation. See arrhythmias ANGINA PECTORIS. See coronary artery bypass grafts. See CABG. See congestive heart failure (CHF). See cardiac failure Angiography, Digital Subtraction (DSA), 28 angioplasty, 75 coronary, 55 peripheral vascular disease, 82 surgery, 96 TIA, 102 ankylosing spondylitis, 24 anorectal abscess, 17 fistula, 17 anorexia, 45 polymyalgia rheumatica, 85 antigen, carcinoembryonic, 32 antigen, prostate-specific", 32 anti-inflammatories oral, colitis, 56 anti-psychotic medications depression, 59 AODM, 60 aorta abdominal, 20 abnormal dilatation, 21 ascending and descending, 21 thoracic, 20 aorta, 21 aortic aneurysm, 21 root dilatation, 83, 84 valve, valvular heart disease, 109 Aortic, 20 aphasia TIA, 102 aplastic anemia, 20 bone marrow transplant, 103 Aplastic Anemia, 6 Approved, 5 Approved with Modifications (AWM), 5 kidney transplantation, 88 arrhythmias cardiac, syncope, 97 myocardial infarction, 75 Arrhythmias, 25. See atrial fibrillation ARRHYTHMIAS. See TIA. See cardiomyopathy. See congestive heart failure (CHF). See cardiac failure. See atrial fibrillation. See angina Artane tremors, 106 arterial embolism, 100 ulcers, 108 arterial plaque, 28 arteries carotid, 20 femoral, 20 intracranial, 20 arteries, carotid, 28 arteries, hardening of, 28 Arteriography, 28 Arteritis Giant Cell (GCA), polymyalgia rheumatica, 85 Temporal (TA), polymyalgia rheumatica, 85 artery abnormal dilatation, 20 disease, coronary(CAD), 23 arthritis chronic inflammatory, 24 destructive, 24 fractures, 64 hypertrophic, 79 instability, 4 Osteoarthritis (OA), 79 Rheumatoid (RA), 89 ascending aorta, 21 Ascites, 6 assistive devices fractures, 52, 64 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 polymyalgia rheumatica, 85 polymyositis-dermatomyositis, 86 rheumatoid arthritis, 89 slipped or ruptured disc, 94 spinal stensosis, 95 asthma, 27, 53 Asthma, 10. See uninsurable combination medical histories ASTHMA. See Chronic Obstructive Pulmonary Disease (COPD) ataxia vitamin B12 deficiency, 18 Ataxia cerebellar, 6 atherosclerosis stroke, 95 atherosclerosis, 108 ATHEROSCLEROSIS, 28 ATHEROSCLEROSIS AND THE CAROTID ARTERIES, 28 atherosclerotic plaque, 28 Atherosclerotic plaques, 82 Atrial fibrillation. See syncope. See coronary angioplasty. See coronary artery bypass surgery. See arrhythmias Atrial Fibrillation. See myocardial infarction (MI). See cardiomyopathies. See congestive heart failure. See cardiac failure atrial fibrillation (A-FIB), 30 chronic, 30 paroxysmal (intermittent), 30 valvular heart disease, 109 ATRIAL FIBRILLATION (A-FIB). See TIA. See cardiomyopathy. See congestive heart failure (CHF). See Angina Atrial, Paroxysmal Tachycardia (PAT), 25 atrophy of the limb muscles, 16 Attack, Transient Ischemic (TIA), 102 atypical hyperplasia, 34 Autonomic Insufficiency, 6 Neuropathy, 6 B bacillus mycobacterium tuberculosis, 107 back/spine slipped or ruptured disc, 94 spinal stensosis, 95 surgery, 96 barrel chest, 53 basal cell skin cancers, 44 bathing, 8 bed confinement skin ulcers, 108 bed, hospital functional deficits, 9 behavioral disturbances Alzheimers, 16 benign prostatic hypertrophy (BPH), 42 incontinence, 4 Benign Prostatic Hypertrophy (BPH), 87 Biliary cirrhosis. See cirrhosis, alcoholic liver disease Bipolar Disorder, 59 Bl2 deficiency, 18 black out syncope, 97 bladder cancer, 46 dysfunction, 31 incontinence, 4, 7 neurogenic, 31 spastic, 31 tumors, 46 bladder irrigations, 46 bleeding associated with Coumadin use, 30, 100, 109 brain, within the, 95 thrombocythemia, 99 thrombocytopenia, 99 blindness, 6, 85 due to diabetes, 60 due to vascular obstruction, polymyalgia rheumatica, 85 eye disorders, 62 blockage carotid artery blood anemia, 18 cancer of the, 69 clot, 100 clot to the brain, 95 clot, multiple myeloma, 73 clot, thromboembolism, 100 disease, polycythemia, 84 disorders Bone Marrow Transplantation, 103 hemochromatosis, 65 hemoptysis, 65 disorders thrombocythemia, 99 thromocytopenia, 99 sugar, elevated, 60 blood pressure diastolic, 68 high, 68 systolic, 68 B-lymphocyte, disease of, 69 bone fractures, 64 Paget's disease, 81 bone marrow biopsy, hairy cell leukemia, 69 multiple myeloma, 73 transplantation, 103 transplantation, multiple myeloma, 73 bowel incontinence, 17 incontinence, 4, 7 irritable bowel syndrome (IBS), 56 perforations, 57 bowel incontinence, 17 bowel resection thromboembolism, 100 BPH benign prostatic hypertrophy, 32 bradycardia, 25 bradykinesia, 81 brain aneurysm, 22 blood clot, 95 infection of Meningitis, 72 normal pressure hydrocephalus, 78 stroke, 95 syncope, 97 systemic lupus, 98 trauma, cerebral palsy, 51 tumors, Five Is, 4 Brain Disorder (Organic Brain Syndrome), 6 Organic Brain Syndrome (OBS), 16 progressive degeneration of, 16 breast biopsy, 34 cancer, 34 lumps, 34 breast cancer carcinoma in situ, 34 inflammatory, 34 lumpectomy, 34 metastasis, 35 stages, 34 treatment(s), 34 breath, shortness of, 29, 53 breathing disorder sleep apnea, 93 breathing, labored, 53 bronchial asthma, 27 Bronchial asthma. See chronic obstructive pulmonary disease (COPD) bronchiectasis cause of hemoptysis, 65 hemoptysis, 65 Bronchiectasis. See hemoptysis bronchitis, 53 bronchospasm, 53 bruising thrombocytopenia, 99 bruit, 28 Build. See Height/Weight Table bulbar polio, 83 bypass coronary artery, 55 bypass graft surgery peripheral vascular disease, 82 bypass grafts TIA, 102 C CA, 32 CA-125, 32 CABG, 55. See angina pectoris CAD, Coronary Artery Disease, 23 calcification valvular disease, 109 Calculus kidney stones, 68 cancer, 32 basal cell, 44 bladder, 46 blood, 69 breast, 34 carcinoid tumors, 48 cause of hemoptysis, 65 colon, 36 common sites of, 32 esophageal, 37 gynecological, 41 head and neck, 38 hemoptysis, 65 kidney, 39 large bowel, 36 lung, 40 malignant melanoma, 71 metastasized, 33 multiple myeloma, 73 ovarian, 41 plasma cells, 73 prostate, 42 rectal, 36 skin, 44 squamous cell, 44 staging, 32 stomach, 45 thyroid, 45 treatment, 32 tumor markers, 32 underwriting of, 33 urinary bladder, 46 uterus, 47 Cancer. See hemoptysis Bowel, Dukes Staging, 36 CANCER OF THE KIDNEY. See renal failure, chronic. See renal failure, acute CANCER OF THE LUNG. See lung resection. See asthma. See emphysema. See cardiomyopathy. See COPD cancer, metastatic, 32 carbohydrate metabolism, chronic disease of, 60 carcinoid syndrome, 48 tumors, 48 carcinoma, 32 carcinoma in situ, 34 cardiac arrhythmias,sleep apnea, 93 arrhythmias,syncope, 97 failure, 49 output, A-FIB, 30 output, syncope, 97 Cardiac failure. See atrial fibrillation. See arrhythmias. See angina pectoris cardiomyopathies, 50 cardiomyopathy, 49 dilated (congestive), 50 hypertrophic, 50 non-dilated (restrictive), 50 types of, 50 Cardiomyopathy. See Valvular Heart Disease. See myocardial infarction (MI). See congestive heart failure. See cardiac failure. See cancer of the lung. See atrial fibrillation. See arrhythmias Cardiomypoathy. See coronary angioplasty. See coronary artery bypass surgery cardioversion electro, 25 cardioversion, 25 CAROTID ARTERIES, 28 carotid artery, 20 blockage, 28 endarterectomy, 96 thromboembolism, 100 Carotid artery, 20 carotid artery disease, 28 cataract, 62, 103 catheter, 31 functional deficits, 9 urinary, 88 CEA (carcinoembryonic antigen), 32 cellulitis, 35 central nervous system scleroderma, 92 Cerebellar Ataxia, 6 cerebral aneurysm, polycystic kidney disease, 83, 84 occlusion, stroke, 95 palsy, 51 Cerebral Spinal Fluid (CSF), 78 Vascular Accident (CVA), 6, 95 cerebrovascular aneurysm, 22 aneurysm, subarachnoid hemorrhages, 22 disease, stroke, 95 precursor event, TIA, 102 Cerebrovascular, 20 cervical area, 94 chair lift, electric functional deficits, 9 chemotherapeutic drugs bone marrow transplant, 103 chemotherapy, 32 bladder cancer, 46 breast cancer, 35 carcinoid tumors, 48 colon cancer, 36 kidney cancer, 39 lung cancer, 40 lymphomas, 70 multiple myeloma, 73 thrombocythemia, 99 uterine cancer, 47 chest pain, 23 CHF. See myocardial infarction (MI). See coronary angioplasty. See coronary artery bypass surgery. See cardiomyopathies Chorea, 6 chronic active hepatitis, 66 fibrosis of the heart, 50 granulocytic leukemia (CGL), 69 granulocytic leukemia, bone marrow transplant, 103 infections, Anemia of Chronic Disease, 18 inflammatory disease of the connective tissues, lupus, 98 lymphocytic leukemia (CLL), 69 memory loss, 6 persistent hepatitis, 66 viral hepatitis, 66 Chronic Lymphocytic Leukemia (CLL), 69 Obstructive Pulmonary Disease (COPD),TB, 107 Renal Failure (CRF), 88 chronic bronchitis, 53 Chronic Bronchitis, 10. See uninsurable combination medical histories chronological age, 1 cigarette smoke, 40 cigarettes use emphysema, 53 Cirrhosis liver, 6 Cirrhosis, alcoholic liver disease. See alcoholism claudication, 82 peripheral vascular disease (PVD), 82 Cogentin tremors, 106 Cognex memory loss, 72 cognitive status, 1 cognitive symptoms bipolar disorder, 59 depression, 59 colitis mucous, 56 spastic, 56 ulcerative, 56 collagen vascular disease anemia of chronic disease, 18 colon, cancer of, 36 colonoscopy, 36 colostomy management, 36 Combination Medical Histories, Uninsurable, 10 compression fractures, 64 conduction disturbance, 25 Conduction disturbances. See syncope. See myocardial infarction (MI). See coronary angioplasty. See coronary artery bypass surgery. See cardiomyopathies. See congestive heart failure. See cardiac failure confusion, 72 Congestive Heart Failure, 55 Congestive heart failure (CHF). See atrial fibrillation. See arrhythmias. See angina pectoris Congestive Heart Failure (CHF), 10, 49. See uninsurable combination medical histories A-Fib, 30 A-FIB, 30 carcinoid tumors, 48 diabetes, 60 emphysema, 29, 53 hemochromatosis, 65 hypertension, 68 myocardial infarction, 75 scleroderma, 92 TB, 107 valvular heart disease, 109 consciousness brief loss, 97 loss of, epilepsy, 61 continence. See Incontinence bowel or bladder, 8 Continuous Positive Airway Pressure (CPAP) apparatus, 93 COPD. See CHF. See cancer of the lung asthma, 53 chronic bronchitis, 53 emphysema, 53 COPD (Chronic Obstructive Pulmonary Disease)/Emphysema, 10. See uninsurable combination medical histories coronary angioplasty, 55 artery disease (CAD), 23 artery disease (CAD), A-FIB, 30 artery disease (CAD), CHF, 49 Artery Disease (CAD), hypertension, 68 Artery Disease (CAD), valvular disease, 109 artery, thromboembolism, 100 Coronary, 75 artery angioplasty, 96 Artery Bypass Graft (CABG), 55, 96 artery bypass surgery, 55 Coronary artery bypass grafts. See angina pectoris corticosteroids Cushing's syndrome, 58 cortisone Addison's disease, 14 Coumadin A-Fib, 30 atrial fibrillation, 30 thromboembolism, 100 TIA, 102 valvular heart disease, 109 CPAP sleep apnea, 93 CREST Syndrome, 92 CRF. See polycystic kidney disease (PCKD) crutches fractures, 52, 64 functional deficits, 9 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 poliomyelitis, 83 polymyalgia rheumatica, 85 polymyositis-dermatomyositis, 86 post polio syndrome, 83 rheumatoid arthritis, 89 slipped or ruptured disc, 94 spinal stensosis, 95 CT (Computed Tomography), 28 Cushings syndrome, 58 custodial care, 9 CVA Aneurysms, Cerebrovascular, 22 stroke, 95 CVA (stroke), 7 cyclosporine systemic lupus, 98 Cystic Fibrosis, 6 cytopenia, 69 cytoscopy, 68 cytotoxic drugs systemic lupus, 98 Cytoxan Cushing's syndrome, 58 Irritable bowel syndrome, 57 polycythemia, 84 renal failure, 88 systemic lupus, 98 D D&C, dilatation and curettage, 47 day care use schizophrenia or other psychosis, 91 DC Conversion, 30 Decision Terminology, 5 Approved, 5 Approved with Modifications (AWM), 5 Declined, 5 No Increases Allowed, 5 Reconsideration Available, 5 Reconsideration Not Available, 5 Declined, 5 decrease of platelets in the blood thrombocytopenia, 99 decubitus ulcers, 108 deep vein thrombosis skin ulcers, 108 defibrillator, 25 Deficits, Additional Uninsurable ", 9 Deficits, Uninsurable ADL ", 8 Deficits, Uninsurable IADL ", 8 Degenerative Joint Disease (DJD), 79 delirium, 72 dementia alcoholism, 15 ALS, 16 memory loss, 72 NPH, 78 senile, 4 vitamin B12 deficiency, 18 Dementia, 6, 16 Alzheimer's, 16 other types of, 16 Demerol ankylosing spondylitis, 24 fractures, 64 neuropathy, 76 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 polymyalgia, 85 polymyositis-dermatomyositis, 86 rheumatoid arthritis, 89 slipped or ruptured disc, 94 spinal stensosis, 95 systemic lupus, 98 demyelinating disease, 73 dependency psychological, 91 psychological, 91 depression, 4 Depression, 59. See alcoholism Dermatomyositis, Polymyositis, 86 descending aorta, 21 diabetes, 60 adult onset, 60 anemia of chronic disease, 18 hemochromatosis, 65 kidney transplantation, 105 mellitus (DM), 60 neuropathy, 76 TGA, 101 thromboembolism, 100 TIA, 102 type I, 60 type II, 60 types of, 60 Diabetes, 10. See peripheral vascular disease (PVD). See uninsurable combination medical histories Diabetes Mellitus. See neuropathy Diabetes treated with insulin or Rezulin, 6 diabetic complications, 60 diabetic ulcers, 108 dialysis, 84 chronic renal failure, 88 functional deficits, 9 polycystic kidney disease, 84 renal failure, 88 Dialysis, 6, 7 diastolic blood pressure, 68 dilated (congestive) cardiomyopathy, 50 disc herniated, 94 Disc slipped/ruptured, 94 discoid lupus erythematosus, 98 diseases of the heart muscle, 50 Disequilibrium, 61 disorientation, 72 dissecting aneurysms, 21 disseminated lupus, 98 disturbances, conduction, 25 diverticulitis, 56 dizziness, 61 fractures, 64 TIA, 102 Doppler Imaging, 28 drainage device functional deficits, 9 dressing, 8 drug reactions, 4 drug use schizophrenia or other psychosis, 91 DRUGS INDEX, 110 DSA (Digital Subtraction Angiography), 28 Dukes Staging of Bowel Cancer, 36 DWR failed, 6 dysphagia, 37 stomach cancer, 45 dyspnea, 53 E eating, 8 edema, 35 liver disease, 54 Eldepryl tremors, 106 electric cart or scooter functional deficits, 9 electric chair lift functional deficits, 9 electrical shock (DC Conversion), 30 electro cardioversion, 25 Electro Convulsive (shock) Therapy (ECT) depression, 59 electrolyte imbalance, 14 emboli, 28 embolism pulmonary (lung), 100 pulmonary, cause of hemoptysis, 65 embolism, 100 emergency room visit bipolar disorder, 59 depression, 59 emphysema, 52, 53 emphysema, 53 Emphysema. See cancer of the lung end stage renal disease (ESRD), 105 endartectomy, 29 endarterectomy TIA, 102 Endarterectomy carotid, 96 femoral, 96 enemas, steroid treatment of colitis, 56 Enteritis, 56 epilepsy causes of, 61 epilepsy, 61 ER visit schizophrenia or other psychosis, 91 erythropoietin, 19 esophageal cancer, 37 esophagus crest syndrome, 92 estrogen deficiency osteoporosis, 80 ethanolism, 15 ETOH disease, 15 eye disorders, 62 amaurosis fugax, 62 blindness, 62 cataract, 62 glaucoma, 62 macular degeneration, 62 F failed Short Portable, 7 Failed DWR, 6 fainting, 25, 61 syncope, 97 TIA, 102 falls, 81 A-Fib, 30 alcoholism, 15 ankylosing spondylitis, 24 dizziness, 61 fractures, 64 neuropathy, 76 osteoarthritis, 79 polymyalgia rheumatica, 85 polymyositis-dermatomyositis, 86 rheumatoid arthritis, 89 slipped or ruptured disc, 94 spinal stensosis, 95 fatigue congestive heart failure, 49 depression, 59 fatty liver, 54 feeding, tube enteral, 37 enteral, 38 parenteral, 37 parenteral, 38 femoral arteries, 20 Femoral Endarterectomy, 96 fibrillation, atrial (A-FIB), 30 fibrosis pulmonary, 40 fibrosis, 54 Fibrosis cystic, 6 Field Underwriting, 1 finances, managing, 8 fissure, anal, 17 fistula, anorectal, 17 FIVE I's, 4 folate deficiencies Anemia of Chronic Disease, 18 folic acid deficiency, 18 foot ulcers, 60 forgetfulness, 6 frequent/persistent, 72 memory loss, 72 fractures, 64, 81 alcoholism, 15 ankylosing spondylitis, 24 compression, 64 dizziness, 61 knee, 64 most common sites, 64 multiple, 64 multiple myeloma, 73 multiple, Paget's disease, 81 osteoarthritis, 79 osteoporosis, 80 pathological (spontaneous), 64 pelvis, 64 polymyalgia rheumatica, 85 polymyositis-dermatomyositis, 86 rheumatoid arthritis, 89 shoulders, 64 slipped or ruptured disc, 94 spinal, 64 spinal stensosis, 95 spontaneous, 58 syncope, 97 wrist, 64 Fractures. See ankylosing spondylitis (AS) frailty, 2 frequent forgetfulness, 72 Functional capacity, 1 functional deficits, 6 G gangrene peripheral vascular disease, 82 skin ulcers, 108 Gangrene, 6 gastric cancer, 45 gastritis, 18 gastrointestinal bleeding, hepatitis, 66 bleeding, liver disease, 54 disorders, alcoholism, 15 scleroderma, 92 system, TB, 107 GCA blindness, 85 current eye problems, 85 Gehrig's Disease, Lou, 16 genitourinary system TB, 107 Giant Cell Arteritis (GCA) polymyalgia rheumatica, 85 glaucoma, 62 congenital(infantile), 62 secondary, 62 transplantation of the cornea, 103 Gleason Scoring, 42 Glossary, 125 granulomas, 90 Gravis, Myasthenia, 74 gynecological cancers, 41 H Hairy Cell Leukemia (HCL), 69 hardening of the arteries, 28. See atherosclerosis HBP, (high blood pressure), 68 head and neck cancer, 38 heart acute inflammation, 50 atrial fibrillation, 30 attack, diabetes, 60 chronic fibrosis, 50 congestive failure, 49 disease,valvular, 109 diseases of muscle, 50 failure, 30 failure(CHF), congestive, 49 ischemic heart disease, treatments of, 55 murmurs, 109 rate,irregular, 23 scleroderma, 92 surgery,TIA, 102 systemic lupus, 98 transplantation, 104 valve replacement, 100 valve,artificial, 100 Heart. See myocardial infarction (MI). See diabetes mellitus Attack, 75 valve replacement, 96 heart disease kidney transplantation, 105 heart surgery, 75 Heart surgery, 10. See uninsurable combination medical histories Height/Weight Table. See ankylosing spondylitis (AS) hematocrit (Hct), 18 hematoma, 22 hematuria, 46 blood in the urine, 39 prostate disorders, 87 hemochromatosis, 65 hemoglobin (Hgb), 18 hemoptysis, 65 hemoptysis, 40 hemorrhage aneurysms, 22 intracerebral (ICH), 22 subarachnoid (SAH), 22 Hemorrhoids, 17 hepatitis, 54 A, 66 acute, 66 B, 66 C, 66 chronic active, 66 chronic persistent, 66 chronic viral, 66 D, 66 E, 66 non-A-non-B, 66 Hepatitis, 66 herniated disc, 94 nucleus pulposus, 94 high blood pressure TGA, 101 thromboembolism, 100 high blood pressure (HBP), 68 hip fracture, 64 fractures, osteoporosis, 80 replacement, fractures, 64 Hip replacement, surgery, 96 HODGKINS DISEASE. See Lymphoma Hodgkin's disease reactive thrombocythemia, 99 home care service use, 9 home care services custodial, 9 hospice care, 9 skilled, 9 Home Care Services, 9 home for the aged, 9 Home Office Underwriting, 1 hormonal therapy, 32 hormones, 34 hospice, 9 hospital, 9 hospital bed functional deficits, 9 functional deficits, 9 hospitalization angina pectoris, 23 atrial fibrillation, 25 atrial fibrillation, 30 bipolar disorder, 59 depression, 59 renal failure (acute), 88 schizophrenia or other psychosis, 91 sleep apnea, 93 HOTLINE, iv housework (chores), 8 Hoyer lift functional deficits, 9 HTN (Hypertension), 68 Huntingtons, 6 Hydergine memory loss, 72 Hydrocephalus, Normal Pressure (NPH), 78 hydronephrosis, 68 hyperalimentation treatment of colitis, 56 hypercortisolism, 58 Hyperglycemia, 60 hyperpigmentation of the skin, 14 hypertension, 68 hypertension (HTN), 68 aneurysm, aortic, 21 aneurysm, cerebrovascular, 22 scleroderma, 92 Hypertension (HTN) kidney cancer, 39 hypertrophic arthritis, 79 cardiomyopathy, 50 Hypoplastic Anemia, 20 hypoventilation, 53 Hytrin prostate disorders, 87 I IADL IBS, 56 IADL, Uninsurable Deficits", 8 IADLs anemia, 19 angina pectoris, 23 ankylosing spondylitis, 24 Cerebral Palsy, 51 corneal transplant, 103 CREST syndrome, 92 depression, 59 dizziness, 61 glaucoma, 62 macular degeneration, 62 Meningitis, 72 myasthenia gravis, 74 neuropathy, 62, 76 normal pressure hydrocephalus, 78 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 poliomyelitis, 83 polymyalgia rheumatica, 85 polymyositis-dermatomyositis, 86 post polio syndrome, 83 rheumatoid arthritis, 89 schizophrenia or other psychosis, 91 scleroderma, 92 slipped or ruptured disc, 94 spinal stensosis, 95 TB, 107 tremors, 106 Iatrogenic drug reactions, 4 IBS, 56 IDDM, 60 Ileitis, 56 Imaging, Doppler, 28 imbalance, 61 Immobility, 4 immune deficiency diseases bone marrow transplant, 103 Immune Deficiency Syndrome, 7 immunosuppressant medications transplantation of the kidney, 105 immunosuppression kidney transplantation, 105 Imuran cardiomyopathies, 50 systemic lupus, 98 incontinence, 7, 31 bladder, 4, 7, 31 bowel, 4, 7 NPH, 78 stress, 31 urinary, 31 Incontinence, 4 bowel, 17 increase of platelets in the blood thrombocythemia, 99 Infarction, Myocardial (MI), 75 infection neuropathy, 76 infections diabetes, 60 inflammatory bowel disease anemia of chronic disease, 18 Inflammatory breast cancer, 34 inflammatory muscle disorder, 86 Information You Should Always Gather, iii Instability, 4 institutionalization, 9 Instrumental Activities of Daily Living (IADL), 1, 8 insufficiency pancreas, 60 valvular heart disease, 109 Insufficiency Autonomic, 6 insulin, 60 diabetes mellitus, 60 Intellectual impairment, 4 interferon hepatitis, 66 interview health, 1 telephone, Personal History Interview (PHI), 1 intestinal tumors, 48 intracerebral hemorrhages (ICH), 22 Cerebrovascular Aneurysm, 22 intracranial arteries, 20 intravenous feeding, treatment of colitis, 56 steroid, treatment of colitis, 56 INTRODUCTION, 1 involuntary movement disorders tremors, 106 involuntary movements cerebral palsy, 51 iron dietary,excessive absoption of, 65 iron deficiency anemia, 18 reactive thrombocythemia, 99 Iron Deficiency Anemia, 18 irrigations bladder, 46 irritable bowel syndrome (IBS), 56 ischemia, myocardial, 23 Ischemic Attack (TIA), Transient, 102 ischemic heart disease treatments, 55 Isoniazid TB, 107 J Joint Disease, Degenerative, 79 joint replacement ankylosing spondylitis, 24 surgery, 96 surgery, rheumatoid arthritis, 89 Joint Replacement, 10. See uninsurable combination medical histories joints bilateral inflammation and stiffness, rheumatoid arthritis, 89 crest syndrome, 92 judgment, impaired, 16 K kidney Acute Renal Failure(ARF), 88 cancer, 39 Chronic Renal Failure (CRF), 88 dialysis, 88 dialysis,functional deficits, 9 disease, hypertension, 68 failure, multiple myeloma, 73 polycystic disease, 84 scleroderma, 92 systemic lupus, 98 transplantation, 105 transplantation, (CRF), 88 transplantation,polycystic kidney disease, 84 Kidney. See diabetes mellitus dialysis, 6 Dialysis, 7 kidney transplantation failed, 105 immunosuppression, 105 rejection, 105 skin cancers, 105 knee replacement, 64 replacement, surgery, 96 L large bowel cancer, 36 Larodopa tremors, 106 laser surgery diabetes, 60 Lateral Sclerosis, Amyotrophic (ALS), 16 laundry, 8 leukemia acute, 69 acute lymphocytic(ALL), 69 acute monocytic (AMOL), 69 acute myelogenous (AML), 69 acute, bone marrow transplant, 103 chronic, 69 chronic granulocytic (CGL), 69 chronic granulocytic, bone marrow transplant, 103 chronic lymphocytic (CLL), 69 chronic myelogenous polycythemia, 84 hairy cell (HCL), 69 polycythemia, 84 Leukemia, 7, 69 Leukeran leukemia, hairy cell, 69 polycythemia, 84 renal failure, acute, 88 systemic lupus, 98 thrombocythemia, 99 lift, Hoyer functional deficits, 9 lightheadedness, 61 limb amputation thromboembolism, 100 Lithium depression, 59 lithotripsy, 68 liver biopsy, 66 biopsy for hepatitis, 66 disease, 54 fatty, 54 metastases, carcinoid syndrome, 48 transplantation, hepatitis, 66 viral inflammation of, 66 Liver Cirrhosis of, 6 transplantation, 105 liver cancer, 54 primary biliary cirrhosis, 54 liver transplantation primary biliary cirrhosis, 54 LONG TERM CARE UNDERWRITING, 1 long term memory loss, 72 loss of consciousness epilepsy, 61 loss of consciousness, feeling of, 61 loss, memory, 72 Lou Gehrig's Disease, 6, 16 lower bowel, impairments affecting, 17 lumbar area, 94 Lumpectomy, 34 lung cancer, 40 embolism, 100 resection,TB, 107 sarcoidosis, 90 scleroderma, 92 systemic lupus, 98 TB, 107 lung abscess hemoptysis, 65 lung infections, frequent, 38 Lung resection. See cancer of the lung lupus disseminated, 98 erythematosus, discoid, 98 Lymph node carcinoid syndrome, 48 Lymphomas Non-Hodgkins, 70 M macular degeneration, 62 Malabsorption, 57 malignancy, 32 malignant melanoma, 44 malignant melanoma, 71 malignant plasma cells, 73 malnutrition neuropathy, 76 mammography, 34 mania, 59 Mania, 59 Manic Depression, 59 Marie-Strumpell Disease, 24 meal preparation, 8 medical histories, 1 medical problems, multiple, 1 medication multiple, 1 over-medication leading to falls, 64 taking, IADLs, 8 medications, 4, 110 Megace breast cancer, 35 Megacolon, 57 megaloblastic anemia alcoholism, 18 megaloblastic anemia, 18 megestrol breast cancer, 35 melanoma malignant, 44 mellitus, diabetes (DM), 60 memory long term, 72 loss, 72 loss, Alzhemiers, 16 loss, chronic, 6, 7 medications, 72 short term, 72 meningitis, 72 mental confusion, myocardial ischemia, 23 retardation, cerebral pasly, 51 Metabolic disorders cause of epilepsy, 61 metastasis, 35, 36, 39, 40, 41, 43, 44, 45, 47, 48 metastatic cancer, 32 metastatis, 38 microcytic anemia, 18 mitral valve prolapse, 83, 84 valvular heart disease, 109 mobility, 8 morphine ankylosing spondylitis, 24 fractures, 64 neuropathy, 76 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 polymyalgia, 85 polymyositis-dermatomyositis, 86 rheumatoid arthritis, 89 slipped or ruptured disc, 94 spinal stensosis, 95 systemic lupus, 98 movement disorders, involuntary tremors, 106 Mucous Colitis, 56 multiple fractures, 64, 81 multiple myeloma, 73 multiple sclerosis (MS) incontinence, 4 Multiple Sclerosis (MS), 7 Multiple Sclerosis (MS), 73 muscle inflammatory disorder, 86 limb muscles atrophy (ALS), 16 pain and stiffness, Polymyalgia rheumatica, 85 polymyositis dermatomyositis, 86 weakness, cerebral palsy, 51 weakness, myasthenia gravis, 74 muscular dystrophy, 73 Muscular Dystrophy (MD), 7 musculoskeletal scleroderma, 92 Myasthenia Gravis, 74 myeloma multiple, 73 Myocardial Infarction (MI), 75 myocardial ischemia, 23 N narcotic analgesics. See Demerol, morphine, Percodan, Talwin Near Syncope, 61 neoplasm, 32 nephrectomy, 39 nephrolithiasis, 68 nephrotomy, 68 nerves disease, neuropathy, 76 nervous disorders alcoholism, 15 Neuralgia, 76 Neuritis, 76 neurogenic bladder, 31 neurologic disorders ALS, 16 Cerebral Palsy, 51 neurological deficit, stroke, 95 deficits, cerebral palsy, 51 disease, Parkinsons, 81 tremors, 106 neuropathy, 76 peripheral, 64 Neuropathy autonomic, 6 peripheral, 76 NIDDM, 60 No Increases Allowed, 5 nocturia prostate disorders, 87 Nolvadex breast cancer, 35 non-dilated (restrictive) cardiomyopathy, 50 Non-Hodgkins Lymphomas, 70 NON-HODGKINS LYMPHOMAS. See Lymphoma Normal Pressure Hydrocephalus (NPH), 78 Numbness TIA, 102 nursing home, 9 nursing home use, 9 O OA (Osteoarthritis), 79 Obesity, 12 in combination with, 12 occlusion, cerebral stroke, 95 odynophagia, 37 OPG (Oculoplethysmography), 28 oral cavity, cancer site, 38 organ transplants, 7 Organic Brain Syndrome (OBS), 6, 7, 16 osteoarthritis (OA) immobility, 4 spinal stenosis, 95 Osteoarthritis (OA), 79 osteoporosis, 54, 63, 64 primiary biliary cirrhosis, 54 Osteoporosis. See fractures osteoporosis (OP) fractures, 64 immobility, 4 post menopausal, 64, 80 senile, 80 Osteoporosis (OP), 80 ostomy care functional deficits, 9 ovarian cancer, 41 over-medication leading to falls, 64 overweight skin ulcers, 108 Overweight, 12 oxygen emphysema, 53 functional deficits, 9 sleep apnea, 93 use, 7 P pacemaker, 25 Pacemaker implant, 96 Pagets disease of the bone, 81 Paget's disease of the bone spinal stenosis, 95 palpitations, 25 palsy, cerebral, 51 pancreas diabetes, 60 Pancytopenia, 20 paralysis spastic, 51 Paralysis, 7 Paraplegia, 7 Parkinsons disease, 81 Parkinsons disease. See Voluntary Movement Disorders. See Tremors Parkinsonism ALS, 16 Parkinson's Disease, 7 tremors, 106 Paroxysmal Atrial Tachycardia (PAT), 25 pathological (spontaneous) fractures, 64 pectoris, angina, 23 pelvic fracture osteoporosis, 80 Percodan ankylosing spondylitis, 24 fractures, 64 neuropathy, 76 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 polymyalgia, 85 polymyositis-dermatomyositis, 86 rheumatoid arthritis, 89 slipped or ruptured disc, 94 spinal stensosis, 95 systemic lupus, 98 Percutaneous Transluminal Coronary Angioplasty (PTCA), 55 peripheral neuropathy, fractures, 64 neuropathy, vitamin B12 deficiency, 18 Peripheral Atherosclerostic Disease, 82 Neuropathy, 76 Vascular Disease (PVD) hypertension, 68 Peripheral artery, 20 Peripheral vascular disease. See diabetes mellitus persistent forgetfulness, 72 hepatitis, 66 Personal History Interview (PHI), 1 Independence Factors, 2 phlebotomies, 84 phlebotomies, 65 physical therapy, 1, 24 fractures, 63, 64 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 polymyalgia rheumatica, 85 polymyositis-dermatomyositis, 86 rheumatoid arthritis, 89 slipped or ruptured disc, 94 spinal stensosis, 95 physiological age, 1 pituitary gland, 14 plaque, 28 plaque, arterial, 28 plaque, atherosclerotic, 28 plaques, Atherosclerotic, 82 plasma cells, abnormal growth, 73 Pneumocystis Pneumonia, 7 Pneumonia Pneumocystis, 7 polyarthritis lupus, 98 Polycystic Kidney Disease (PCKD), 83, 84 Polymyalgia Rheumatica (PMR), 85 Polymyositis - Dermatomyositis, 86 polyps, 18 post menopausal estrogen deficiency, 80 osteoporosis, 80 post polio syndrome (PPS), 83 postural instability, 81 Prednisone COPD, 53 Cushing's syndrome, 58 emphysema, 53 hepatitis, 66 myasthenia gravis, 74 polymyalgia rheumatica, 85 polymyositis-dermatomyositis, 86 renal failure, 88 rheumatiod arthritis, 89 sarcoidosis, 90 scleroderma, 92 systemic lupus, 98 thrombocytopenia, 99 Premature Ventricular Contractions (PVC'S), 25 prescription medications Drug Index, 110 drug reactions, 4 pressure ulcers, 108 Primary thrombocythemia, 99 Proctitis, 56 prolapse rectal, 17 valvular disease, 109 Proscar prostate disorders, 87 prostate cancer, 42 Prostate disorders, 87 prostatic hypertrophy, 42 Prostatism, 87 prostatitis acute, 87 chronic, 87 Prostatitis, 87 proteinura protein in the urine, 39 PSA (Prostate Specific Antigen), 42 PSA (prostate-specific antigen)", 32 psychosis vitamin B12 deficiency, 18 PSYCHOSIS, 91 PTCA, 55 pulmonary disease, polycythemia, 84 disease, scleroderma, 92 embolism, 100 embolism, 65, 100 pulmonary fibrosis, 40 pulmonary function osteoporosis, 80 pulmonic valve valvular heart disease, 109 pyelotomy, 68 Q quad cane fractures, 52, 64 functional deficits, 9 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 poliomyelitis, 83 polymyalgia rheumatica, 85 polymyositis-dermatomyositis, 86 post polio syndrome, 83 rheumatoid arthritis, 89 slipped or ruptured disc, 94 spinal stensosis, 95 Quadriplegia, 7 R radiation breast cancer, 35 colon cancer, 36 exposure, 34 kidney cancer, 39 lung cancer, 40 therapy, cancer treatment, 32 thyroid cancer, 45 uterine cancer, 47 radiation enteritis, 36 Rapid Heartbeat, 25 Reactive thrombocythemia, 99 reasoning, impaired logical, 16 Reconsideration Available, 5 Reconsideration Not Available, 5 rectal cancer, 36 prolapse, 17 stenosis, 17 stricture, 17 rectal incontinence, 36 rectum, cancer of, 36 recurrent infections hairy cell leukemia, 69 red blood cell count (RBC), 18 regurgitation heart valves, 109 rejection kidney transplantation, 105 renal (kidney) Acute Renal Failure (ARF), 88 Chronic Renal Failure (CRF), 88 colic, 68 dialysis, 6 disease, polycystic kidney disease, 84 failure, multiple myeloma, 73 transplantation of the kidney, 105 renal conditions, 54 renal failure acute, 39 chronic, 39 Renal Failure, acute. See cancer of the kidney Renal Failure, chronic. See cancer of the kidney renal function unstable, 39 replacement heart valve, 100 hip, 64 joint, ankylosing spondylitis, 24 knee, 64 surgery, 96 respirator functional deficits, 9 retardation, mental cerebral palsy, 51 Rezulin diabetes mellitus, 60 rheumatic fever valvular disease, 109 Rheumatica, polymyalgia (PMR), 85 rheumatoid Arthritis (RA), reactive thrombocythemia, 99 Rheumatoid Arthritis (RA), 89 Spondylitis, 24 Rheumatoid Arthritis, 10. See uninsurable combination medical histories Roto rooter surgery, 87 ruptured disc spinal stenosis, 95 ruptured/slipped disc, 94 S Sarcoidosis, 90 Schizophrenia, 91 Sclerosis Amyotrophic Lateral Sclerosis (ALS), 16 Multiple (MS), 7 Multiple (MS), 73 scoliosis spinal stenosis, 95 scooter or electric cart functional deficits, 9 seizures, 61 Senile Dementia Alzheimer's, 16 senile osteoporosis, 80 senility, 4, 7 shock therapy depression, 59 shopping, 8 Short Portable failed, 7 short term memory loss, 72 shortness of breath, 23, 29, 53 congestive heart failure, 49 shunt obstruction, 78 ventriculoperitoneal, 78 Shy-Drager Syndrome, 6 Sick-Sinus Syndrome (SSS), 25 sigmoidoscopy, fiber optic, 36 Sinemet tremors, 106 sinus node, 25 Sjogrens syndrome, 54 Sjgrens syndrome, 89 skilled care, 9 skin breakdown, 60 polymyositis-dermatomyositis, 86 scleroderma, 92 TB, 107 skin breakdown peripheral vascular disease (PVD), 82 skin cancer, 44 basal cell, 44 malignant melanoma, 71 squamous cell, 44 skin cancers kidney transplantation, 105 skin ulcers, 108 multiple, 108 peripheral vascular disease, 82 peripheral vascular disease (PVD), 82 recurrent, 108 scleroderma, 92 systemic lupus, 98 thromboembolism, 100 Skin ulcers. See peripheral vascular disease (PVD) SLE, 98 sleep apnea classifications, 93 Sleep apnea, 93 sleep disturbance depression, 59 slipped/ruptured disc, 94 Smoking/Tobacco Use, 11. See uninsurable combination medical histories sobriety, 15 spastic bladder, 31 paralysis, 51 Spastic colitis, 56 weakness, ALS, 16 Specific Uninsurable Medical Conditions, 6 speech difficulties cerebral palsy, 51 speech, loss of TIA, 102 spinal cord, Meningitis, 72 Fluid, Cerebral (CSF), 78 fractures, 64 fractures, osteoporosis, 80 ligaments, slipped disc, 94 stenosis, 95 surgery, spinal stenosis, 95 Spinal cord injury, 7 spleen enlargement,hairy cell leukemia, 69 removal hairy cell leukemia, 69 removal,thrombocytopenia, 99 spondylitis, ankylosing, 24 Spondylitis, Rheumatoid, 24 squamous cell skin cancers, 44 sssisted living/care facility, 9 staging, 44 Hodgkins disease, 70 lymphoma, 70 Staging, 42, 70 Non-Hodgkins lymphoma, 70 Staging of Bowel Cancer, Dukes, 36 staging, cancer, 32 stasis dermatitis, 108 stenosis heart values, 109 rectal, 17 spinal, 95 steroid enemas, treatment of colitis, 56 stomach (gastric) cancer, 45 stone, kidney, 68 stool guaiacs, 36 stress incontinence, 31 stricture, rectal, 17 stroke, 55 A-Fib, 30 hypertension, 68 immobility, 4 incontinence, 4 multiple myeloma, 73 precursor, TIA, 102 stroke, 7 Stroke, 95. See TIA (Transient Ischemic Attack). See thromboembolism strokes (cerebral vascular accident), 28 subarachnoid hemorrhage (SAH), 22 cerebrovascular aneurysm, 22 surgery coronary artery, 55 surgery, 57, 84 adrenal, 58 back/spine, 96 bladder cancer, 46 breast cancer, 35 bypass, 55 carcinoid tumors, 48 colon cancer, 36 COPD, 57 coronary artery angioplasty, 96 coronary artery bypass graft, 96 endarterectomy, 96 heart valve replacement, 96 hip, 64 hip or knee replacement/fracture, 96 kidney removal, 39 kidney stones, 68 knee, 64 lung cancer, 40 major joint replacement, rheumatoid arthritis, 89 major weight bearing joint, 79 other major, 96 pacemaker impant, 96 pituitary, 58 polycystic kidney disease (PCKD), 83, 84 PVD, 82 ruptured disc, 94 sleep apnea, 93 slipped disc, 94 spinal stenosis, 95 spinal stensosis, 95 thymus gland removal, 73, 74 thyroid cancer, 45 uterine cancer, 47 valve replacement, 109 surgery, 7 Surgery, 96 cornea transplant, 103 heart transplant, 104 liver transplant, 105 swallowing difficulties, 38 Symmetrel tremors, 106 syncope A-Fib, 30 fractures, 64 vasovagal, 97 Syncope, 97 systemic disease, rheumatoid arthritis, 89 Systemic Lupus Erythematosus (SLE), 98 systolic blood pressure, 68 T tachycardia, 55 Tacrine, 72 Talwin ankylosing spondylitis, 24 fractures, 64 neuropathy, 76 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 polymyalgia, 85 polymyositis-dermatomyositis, 86 rheumatoid arthritis, 89 slipped or ruptured disc, 94 spinal stensosis, 95 systemic lupus, 98 tamoxifen breast cancer, 35 telephone use, 8 Temporal Arteritis (TA) polymyalgia rheumatica, 85 TGA diabetes, 101 high blood pressure, 101 THE FIVE I's, 4 thoracic aorta, 20 Thrombocythemia, 99 primary, 99 reactive, 99 Thrombocytopenia, 99 Thrombocytosis, 99 Thromboembolism, 100 Thromboembolism (venous, arterial, or pulmonary embolism). See atherosclerosis & carotid arteries thrombus, 100 thymus gland removal, myasthenia gravis, 74 thyroid cancer, 45 thyroiditis, 54 TIA, 28, 55. See thromboembolism. See eye disorders. See atrial fibrillation. See arrhythmias Amaurosis Fugax, 102 Coumadin, 102 endarterectomy, 102 Ticlid, 102 TIA (Transient Ischemic Attack), 11. See uninsurable combination medical histories Ticlid TIA, 102 tobacco products use, emphysema, 53 toileting, 8 Total Parenteral Nutrition (TPN), 7 TPN, 7 transferring from bed to chair, 8 transfusions hemochromatosis, 65 Transient Global Amnesia (TGA), 101 Transient Ischemic Attack (TIA), 102. See atherosclerosis & carotid arteries A-Fib, 30 diabetes, 60 transplantation acute renal failure, 88 chronic renal failure, 88 kidney, polycystic kidney disease, 84 liver, hepatitis, 66 organ, 7 Transplantation bone marrow, 103 cornea, 103 heart, 104 kidney, 105 liver, 105 transportation, 8 transurethral prostatectomy (TURP), 42 trauma brain, 51 Trauma cause of epilepsy, 61 treatment modalities, 1 tremors Parkinsons Disease, 81 Tremors & other involuntary movement disorders, 106 tricuspid valve valvular heart disease, 109 tube feeding cancer of the esophagus, 37 cancer of the head and neck, 38 tuberculosis hemoptysis, 65 Tuberculosis. See hemoptysis tuberculosis (TB) cause of hemoptysis, 65 hairy cell leukemia, 69 Tuberculosis (TB), 107 Tumor Markers, 32 tumors carcinoid, 48 intestinal, 48 Tumors cause of epilepsy, 61 TURP surgery, 87 Type I insulin-dependent diabetes mellitus, 60 Type II non-insulin-dependent diabetes mellitus, 60 U ulcerative colitis, 56 ulcers anal, 17 anemia, 18 arterial, 108 decubitus, 108 diabetic, 108 foot, 60 pressure, 108 skin, 82, 108 venous, 108 Ulcers of the Skin. See neuropathy. See atherosclerosis & carotid arteries Underweight, 13 UNDERWRITING HOTLINE, iv Underwriting, Field, 1 Underwriting, Home Office, 1 Uninsurable Functional Deficits, 8 Specific Medical Conditions, 6 Uninsurable ADL Deficits", 8 Uninsurable Combination Medical Histories, 10 uninsurable conditions reconsideration not available, 6 Uninsurable Deficits, Additional ", 9 Uninsurable functional deficits. See fractures. See ankylosing spondylitis (AS) Uninsurable Functional Deficits. See cancer of the urinary bladder Uninsurable IADL Deficits", 8 unique factors of long term care underwriting, 1 unstable angina, 23 unsteadiness, 61 untreated dissecting aortic aneurysm, 21 urinary bladder cancer, 46 incontinence, 31 uterine cancer, 47 V valve replacement, 100 surgery, 96 TIA, 102 valvular disease, A-FIB, 30 heart disease, 109 heart disease, CHF, 49 vascular bypass graft, PVD, 82 surgery, diabetes, 60 Vascular disorders, cause of epilepsy, 61 vasovagal syncope, 97 venous embolism, 100 ulcers, 108 Ventricular Contractions, Premature (PVC'S), 25 ventriculoperitoneal shunt, 78 vertebral fractures osteoporosis, 80 vertigo, 4 Vertigo, 61 viral inflammation of the liver, 66 vision defects, TIA, 102 eye disorders, 62 vitamin Bl2 deficiency, 18 W waiting period, 33 walker, 7 fractures, 52, 64 functional deficits, 9 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 poliomyelitis, 83 polymyalgia rheumatica, 85 polymyositis-dermatomyositis, 86 post polio syndrome, 83 rheumatoid arthritis, 89 slipped or ruptured disc, 94 spinal stensosis, 95 weakness TIA, 102 weight sleep apnea, 93 weight loss unintentional, 17 weight loss, 14, 15, 19, 85 Addison's, 14 cancer of the esophagus, 37 colitis, 57 depression, 59 emphysema, 53 kidney cancer, 39 polymyalgia rheumatica, 85 stomach cancer, 45 wheelchair, 7 fractures, 52, 64 functional deficits, 9 osteoarthritis, 79 osteoporosis, 80 Paget's disease, 81 poliomyelitis, 83 polymyalgia rheumatica, 85 polymyositis-dermatomyositis, 86 post polio syndrome, 83 rheumatoid arthritis, 89 skin ulcers, 108 slipped or ruptured disc, 94 spinal stensosis, 95 Working, 2 full or part-time, 2 wrist fractures osteoporosis, 80  PAGE  PAGE ii PAGE  PAGE 70 MN#[\{|#ùëң~wwwww 6B*ph B*phjB*UphjB*Uph B*ph5>*5>*B*phjX: UVmHnHujB*Uph B*phjB*Uph 5B*ph56B*ph56>*B*ph jbx56 Ujbx56 UV jU.1NOPQRSTUe *]^*$a$$a$" & Fh$If^hf&dP]f$f&dP]fa$$ & Fa$ $*]^*a$ $*]^*a$ "#\|$%&  x & Fh$If^h & Fh$If^h`$If & F$IfV$$Iflt""04 la #$ ;  F ] ^ a b { | } X Y w x 67UVno{} 1BCDRS6B*OJQJphj6B*OJQJUph56B*ph 5B*ph56B*ph 5B*ph5B*phj5B*UphjB*Uph B*phjB*Uph5 B*ph5>*B*ph B*ph 5B*ph0 I J ; < jhhhV$$Iflt""04 la & Fh$If^h & Fh$If^h & Fh$If^h$If & Fh$If^h ^ _ ` a } X 6xy $,&dP],a$ h^h` &dP! !  1C%9SrFy4^ky  % % %$,&dP],a$S}~"#%79QrsBCFGvwyz1245[\ɹ>*OJQJmHnHuj>*OJQJUmHnHuCJOJQJmHnHu B*CJOJQJmHnHphujOJQJUmHnHuOJQJmHnHuD\^ikwyzQRSUprs   5689fgijȹפפ B*CJOJQJmHnHphu)jB*CJOJQJUmHnHphuB*OJQJmHnHphujOJQJUmHnHuCJOJQJmHnHu#>*B*CJOJQJmHnHphuOJQJmHnHu:Ur 8i7^Pn V % %4578[\^NPQkln   STV^ "#TUWlno*+-5B*OJQJmHnHphuB*OJQJmHnHphuOJQJmHnHujOJQJUmHnHuO"Wn-WSHmW %-.TUWXPQST|}EFHIjkmnPQUWX)+356st  6B*phB*OJQJmHnHphuOJQJmHnHujOJQJUmHnHuR+5  !.!!!!!","\"""""#.#k#### %  0 1 !! ! !+!,!.!/!J!K!L!!!!!!!!!!!!""" 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