Monthly Archive for February, 2007

Improve your health. Improve your life.

A healthy lifestyle can have lasting impacts on your overall health and wellbeing. Staying active, eating right and managing your health issues proactively are the first steps to better health. Taking control of your health is an important commitment. It can be challenging. Blue Cross Blue Shield of North Carolina (BCBSNC) can help.

No matter what your health concerns may be, BCBSNC has a health and wellness program that’s just right for you—and programs come automatically with your plan, at no additional cost.

Begin at the beginning. Get a clear picture of your health status by completing a confidential health survey. Your instant results will tell you where you stand, where your potential health risks may be and what you can do to address them.

Better health is at your fingertips—on your computer that is. If you like to get your information on the Web, we have the program for you. Our online health and wellness program let’s you focus on issues like weight, fitness, nutrition and tobacco cessation. You’ll get the latest clinical information, plus access to interactive tools like virtual trainers and meal planners. These programs deliver results. When you finish, a final assessment reveals how far you’ve come.

Most Americans consider exercise to be a dirty word. No wonder, millions of them are obese. Individuals of all ages, genders, races, ethic groups, and backgrounds have their waist lines expanding beyond their control. Obesity leads to various other health problems such as diabetes, heart disease, and liver failure. In such a situation the only hope lies in living a healthy lifestyle, eating a well balanced diet, and exercising regularly.

The unpleasant connotations of exercise come from the image of overactive aerobics teachers in skimpy skintight outfits making people work out until they collapse to the floor from exhaustion. What happens is that excessive exercise leads to frustration and soreness and it’s just too tempting to give up. They go back to their sedimentary lifestyle. This is simply the wrong way to go about it. Instead, if you do regular exercise for fifteen minutes each day, you will be healthier than those who work out for an hour a week.

In order to keep up the tempo it’s best to include a friend or family member. When you work out in numbers you draw strength and motivation from your partner, and even get support that is needed to perform certain tasks that require another individual. However, if there is no one available, you can join an exercise group in a gym or fitness center for a minimal charge. You will get to meet friends and restore your healthy lifestyle.

Set a reachable goal when it comes to exercising. Perhaps your goal is exercising a given amount of time each day or week. Maybe you are striving to run a mile without stopping or increase your stamina level on the stationery bike. Whatever your goal, be sure to set on that is well within your reach.

Many individuals choose to set a long term and short term goal. Your long term goal may be to live a healthier life, whereas your short term goal may be to play a game of soccer with your children without becoming winded. As you accomplish your short term goals, make more as you continue your progress towards a healthy, fit lifestyle.

If you are on a budget, then choose to exercise at home. This is often fulfilling and will provide you with more motivation, since you do not have to travel anywhere to pursue your exercise. You may need to purchase a few basic items, such as weights or mats, when beginning your home gym. Many individuals invest in a stair climber or tread mill in order to best perform in their home.

Besides the work outs, start taking a stroll around the block and exercise outdoors when the weather permits. Gradually you can turn the stroll into a brisk walk. If you have children, use every opportunity to play a game of baseball, football or soccer with them.

The greatest advantage of joining a gym is being able to use various types of equipment available there. Moreover, once you have made a financial commitment you get enough motivation to work out regularly.

Diagnosing and Treating Type 2 Diabetes

People often talk about Adult Onset Diabetes. The thing is we have to know what are the symptoms to this disease so we can be aware if we have it.

It is interesting to note that the word diabetes comes from ‘passing through’ and mellitus is ‘honey’. To put it simply and in a more sensible manner, the high levels of sugar in a person’s urine is pretty much like honey passing through. Adult Onset Diabetes or Type 2 Diabetes is characterized by the high levels of the glucose level in the bloodstream. This results to spilling over in the urine. It is also associated with an increase of carbohydrates in diets.

At the moment, adult onset diabetes is the 7th leading cause of death in the US., but there’s good news to this disappointing statistic. 90% of the diabetics who are non-insulin dependent can be cured as long as they achieve their ideal weight and by practicing a healthy lifestyle and having a balanced diet.

Other causes for insulin deficiency are toxic reaction to nitroso compounds, auto-immune disease and viral infection of the beta cells found in the pancreas. When not cured, risks include stroke, atherosclerosis, premature heart disease, blindness, pancreatic failure and gangrene of the limbs. Also, it runs in the family. If a family member has diabetes, chances are people in his blood line have more risk of getting it too if they do not watch what they eat.

A person’s diet is quite critical in regulating diabetes. Doctors recommend a healthy nutritional approach. In fact there are so many ways to regulate Diabetes Mellitus – from botanical medicine to traditional Chinese medicine, homeopathy and psychological approaches. Prevention is better than cure so the best way to control the disease is to simply regulate what you eat. If you have a sweet tooth the very minute you get up from bed, a grilled cheese sandwich might be a better breakfast as opposed to donuts and coffee.

Steer clear of pastry treats, cookies, pasta and soda-pop. You can have these but in moderation. If this is your diet day in and day out, expect the doctor to be diagnosing you with diabetes. You cannot change your diet overnight, but it can be done slowly and patiently with persistence. Since we are used to eating this and that, it’s hard to ignore the treats that we enjoyed before. But think of it this way, it is for your own good. This change in diet can be done. Plus, it puts you at less risk in getting diabetes.

Here’s a secret. Have a diet that does not contain sugar and high complex carbohydrates. Refined sugar is a carbohydrate that has been chemically altered through bleaching and processing. Examples of foods to ignore include cookies, candy, pastries, boxed cereal, alcohol, honey, soda pops, pizza and ice cream.

The symptoms of adult onset diabetes Type 2 include the following:

  • frequent urination
  • increased appetite
  • increased thirst
  • blurred vision
  • fatigue
  • slow-healing or frequent infections
  • inability to have an erection

In order for the person to be sure that he has Type 2 Diabetes, the following examinations can be conducted:

  • blood glucose level. If the level is above 126 mg/dL during two incidences, the diagnosis is possibly diabetes
  • random blood glucose level testing – if the level is above 200 mg/dL and the person has the symptoms mentioned earlier, the diagnosis is possibly diabetes
  • oral glucose test – if the level is above 200 mg/dL, the diagnosis is possibly diabetes.

People ask how to treat Type 2 diabetes. First, you have to eradicate the causes. You should also regulate the glucose level in the body. By continually doing this, the goal is achieved and a person with diabetes can have a longer life. The key to remember is that the main treatment for adult onset diabetes is diet and exercise.

Plan your meals and choose healthy foods. Eat the right amount and eat meals on schedule. In your free time, learn how much exactly fat, carbohydrates and protein you need in a balanced diet. Meal plans can be customized depending on your preferences and food habits.

Everybody’s advised to exercise regularly. This is a necessity if you’re diagnosed with diabetes because it controls the glucose level in your body. It also burns the extra calories and fat. That helps you mange your weight. In addition, it also helps you to cope with stress better. Adult onset diabetes may have these symptoms detailed here, but a consultation with a medical practicioner is the sensible path to take as soon as you suspect you may have diabetes.

What You Should Know: What are Treatment and Prevention Options?

Type 2 diabetes is a chronic condition that requires life-long treatment by changes in lifestyle AND by medications. Medication and lifestyle changes are not a cure for diabetes, but they can help reduce or eliminate organ damage due to diabetes. Both lifestyle changes and medication reduce the risk of the serious complications that can result from diabetes, such as heart, kidney, eye, and nerve damage.

Lifestyle
As with many other chronic conditions, in type 2 diabetes it is very important that you learn about the lifestyle changes and preventive approaches that will help you live with and manage your condition. Some of these are listed here – be sure to discuss them with your doctor.

Diabetes Education Classes are very important to help you learn the things you need to know to manage your diabetes and keep yourself as healthy as possible. There are professional educators including certified diabetes educators and dietitians that specialize in diabetes education. These classes are often covered by insurance. Be sure the classes have certification by the American Diabetes Association. Some of the things you will learn about in these classes are:

  • Weight – This is extremely important in type 2 diabetes. By losing weight, you may be able to bring your type 2 diabetes under control. A structured weight-loss program that includes frequent meetings has been found to be the most helpful for people trying to lose weight.
  • Diet – How much you eat, what you eat, and how often you eat are important to managing type 2 diabetes. Since this is an important and complex issue, guidelines recommend that patients be taught about proper diet by a registered dietitian. Eating a proper diet is critical, because this can help reduce glucose levels in your blood and maintain a healthy weight.
  • Blood Sugar – You will learn how and when to test your blood sugar. If you need to use insulin injections, you will learn how to give yourself the injections.
  • Exercise – Regular physical activity is very important to managing type 2 diabetes because it helps keep weight down. Diabetes is also easier to control when you exercise because it can lower blood sugar levels. However, you must first check with your doctor before starting any exercise program. Since cardiovascular problems are not uncommon, a cardiovascular evaluation is required before starting any exercise program.
  • Smoking Cessation – It is very important that people with diabetes not smoke. Smoking increases your risk for complications. If you smoke, you will learn tips and resources for quitting smoking.

Drug Therapy
Here are the most common classes of drugs used to treat type 2 diabetes:

  • Sulfonylureas – used to stimulate the pancreas to release insulin.
  • Alpha-glucosidase inhibitors – used to reduce the amount of starch you body absorbs.
  • Biguanides – used to reduce the amount of glucose produced and increase sensitivity to insulin.
  • Meglitinides – used to stimulate the pancreas to release insulin with each meal.
  • Thiazolidinediones – used to increase sensitivity to insulin.
  • Synthetic hormones – use can vary for each.
  • Insulin – used to replace insulin that is lacking.

All of these drugs are oral medications (pills) except for insulin and synthetic hormones, which are only available as injections at this time. An inhaled form of insulin has been approved by the FDA. An oral insulin preparation is also being tested.

Complication-Related Medications
You may also be prescribed other medications to treat other conditions you have because of your diabetes. Examples include ACE inhibitors or ARB’s to treat or prevent kidney complications, statins to lower risk of heart disease, and aspirin to lower the risk of heart attack and stroke.

Team Approach
Diabetes is a very complex disease. The American Diabetes Association’s standards indicate that diabetes is best controlled by a physician-coordinated team. As an example, the team can include physicians, nurses, dieticians, pharmacists, exercise physiologists, and mental health professionals. Other professionals can be included as well. Be sure to discuss this with your doctor. Feel free to request a referral to such multidisciplinary teams for education as well as treatment. The key to success is for the patient to be an active participant in his or her own care.

Contacting BCBSNC Customer Service

After you are officially enrolled with a BCBSNC health-plan, BCBSNC will provide a comprehensive Member Guide mailed to the enrollee’s home address. The Member Guide includes detailed information about your specific benefits and covered services.
Additional information is available by contacting Customer Service toll-free at 1-877-258-3334, Monday through Friday from 8:00 a.m. to 6:00 p.m.
Additionally, BCBSNC provides valuable information and services on this Web site. You can either surf the site for the information you need or log on to My Member Services to access and change your member information instantly. With My Member Services, you can accomplish the following:

  • Request up to two new ID cards
  • Update your policy’s contact information
  • Review your claim status
  • Check eligibility for benefits for you and your family members included on your policy
  • Access a brief benefit summary that includes copayment amounts, coinsurance percentages, deductible amounts and how much of your deductible has been paid
    BCBSNC’s Customer Service representatives are available to answer calls at 1-877-258-3334, Monday through Friday from 8:00 a.m. to 6:00 p.m.

With this same number, you also have the option of using the Customer Service voice response unit. This automated service helps you to order customer materials such as claim forms and ID cards or to change your address. The line can also service routine customer requests automatically during and after normal business hours. Members can utilize this service during the hours of 7:00 a.m. to 10:00 p.m., Monday through Saturday and 8:00 a.m. to 12:00 p.m. on Sunday.

For greater speed and convenience, visit My Member Services. This online service allows you to access and change your member information without having to call Customer Service. Through My Member Services, you can:

  • Request up to two new ID cards
  • Update your policy’s contact information when your address, phone number or e-mail address changes
  • Review claim status.
  • Check eligibility for benefits for you and your family members included on your policy
  • Access a brief benefit summary that includes copayment amounts, coinsurance percentages, deductible amounts and how much of your deductible has been paid

You can change your name or address in several ways:

  • Complete Sections A and B of an Enrollment and Change Application available through Customer Service or your employer
  • Contact Customer Service at 1-877-258-3334
  • Log on to our Web site at bcbsnc.com and access My Member Services (With My Member Services you can request up to two new ID cards or update your policy’s contact information when your address, phone number or e-mail address changes.)

BCBSNC’s Customer Service representatives are available to answer calls at 1-877-258-3334, Monday through Friday from 8:00 a.m. to 6:00 p.m. You may also utilize the voice response unit on the Customer Service line, or log on to My Member Services to complete a number of Customer Service transactions.

For the most up-to-date provider information, access our online Provider Search. Here, providers are located by name, specialty, county or zip code. The Provider Search information is updated weekly.

You can also contact Customer Service at 1-877-258-3334 for assistance in locating a provider or to obtain a paper copy of a directory. Many employers stock directories in their Benefits Department.

Your prescription drug benefit offers an open formulary, which means no drugs are considered non-formulary. If your prescription drug benefit is based on copayments, the formulary can help you determine your copayment for a specific drug. It also provides a list of possible therapeutic alternatives that may be available at a lower copayment. If your prescription drug benefit is based on coinsurance, the formulary can help you identify any low cost generic drugs that are available. For more formulary information, visit our Prescription Drug Search.

If you would like an updated copy of the formulary, free of charge, please call Customer Service at 1-877-258-3334. Don’t forget, you should bring your copy of the formulary when you visit the doctor.

(In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately. Please refer to your Member Guide to confirm that your pharmacy benefits are offered through BCBSNC.)

Will BCBSNC Help Pay for Laser Tattoo Removal?

People like to get tattoos when they are younger and sometimes do so for stupid reasons. Often, after ten years of so of having a tattoo, the person may decide they don’t want it any more. There are many reasons that a person may want to have a tattoo removed. Perhaps they have a named of an old lover tattooed on them, or they have a gang tattoo that there are no longer associated with. Some people have tattoos in places that will prevent them from getting a job they want. Some people might also have a tattoo that symbolizes hate or racism, and they no longer feel this way. Whatever the reason is, there are methods of tattoo removal out there.

Laser tattoo removal is one option for people considering the removal of a tattoo which is the most common method of tattoo removal. Laser removal involves targeting the tattooed area with pulses of concentrated light that will in turn break the ink fragments up into tiny particles which are then removed by you’re immune system. This process does not happen after one session, however, and the more treatment you have, the more likely the laser will destroy the ink. However, the more treatments you have also means heightened damage done to your skin. Excess treatments can lead to blistering of the skin, painful sores on your skin, scabs and even scarring.
Since technology has advanced so much, the risks of skin damage have become minimal and many experts say it is very rare for scaring to occur. However, there is always some risk involved. Laser tattoo removal can be quite painful, as some people have described it as feeling like being splattered with hot grease. Laser tattoo removal can also hurt your wallet though. Depending on the size and detail of your tattoo, you might need to have up to ten sessions in order to fully remove all of the ink. Each session costs in the range of $250 to $850.

There are many other options for you to consider before you decide if laser tattoo removal is right for you. No method is 100% effective and guaranteed, but many will get you the results that will satisfy you. Laser removal is one of the best treatments for removing a tattoo, but remember, if you have a large colorful tattoo, you may spend thousands of dollars on treatment and it will not even be fully removed.

Blue Cross Blue Shield of North Carolina (BCBSNC) offers special discounts only, not insurance coverage because laser tatoo removal is a cosmetic procedure. Cosmetic Surgery Blue is BCBSNC’s information and discount resource for cosmetic surgery. Through this program, eligible BCBSNC members can receive a discount on cosmetic surgery procedures at participating Cosmetic Surgery Blue network physicians across North Carolina. Cosmetic Surgery Blue also provides a convenient online resource that gives you easy access to information about cosmetic surgery.

Cosmetic Surgery Blue is designed to discount services that are not typically covered by insurance. Examples of these types of services include rhinoplasty, facelifts and liposuction. Members will receive a 15% flat rate discount on the physician’s regular surgical fees. Since cosmetic surgery charges are typically divided into three parts (surgery, anesthesia and facility), your discount will apply to the surgery portion only. If you have further questions on what is and is not covered, consult your participating Cosmetic Surgery Blue physician.

Choosing to have cosmetic surgery is a decision that requires careful thought and preparation. If you have your initial consultation but ultimately decide not to have the procedure, your Cosmetic Surgery Blue 15% discount will still apply to the initial consultation fee. Even better, if you do decide to have the procedure, the entire initial consultation fee is applied toward the total cost of your surgery. Either way, you save money.

In order to be participate, Cosmetic Surgery Blue network physicians must have the following qualifications:

  1. Must be a credentialed BCBSNC plastic surgeon
  2. Must be a member of one of the following two leading plastic surgery organizations:
    • The American Society of Plastic Surgeons (ASPS)
    • The American Society for Aesthetic Plastic Surgery (ASAPS)
  3. If the Cosmetic Surgery Blue participating physician has a surgical suite within their office, it must be licensed or accredited by one of the following:
    • The Accreditation Association for Ambulatory Health Care (AAAHC)
    • The merican Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)
    • The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
    • The State Licensure for North Carolina Ambulatory Surgical Facilities

Avoiding and Treating Migraines

When a migraine hits you unexpectedly and you are desperate to rid yourself of the migraine here are some tips that will help you control the migraine and get back to your lives.

Treating a Migraine

Its best to take a break and relax to ease your mind. Take a pain reliever that is guaranteed not to make you drowsy. The pain reliever can take up to half an hour to begin working on reliever your pain. Although the pain may not be completely gone you will have had some time at this point to adjust to the discomfort of the pain for the time being.

If a migraine should occur while driving it is best to pull over to a rest stop and try to rest for a few minutes. A migraine can cause you to lose your side vision temporarily, see white spots, or even color blind you for the moment. If there is another person in the vehicle with you that is able to drive it is best to have them do so.

Always take the safety of yourself and others in to account in these situations. If these migraines persist it is best to see a doctor.

Defining Migraines

A migraine is caused by a chemical imbalance in your body. If there is a high amount of a certain chemical flowing through your body your blood veins will shrink, and will not cause you any pain. If your body is lacking a certain chemical or has a low amount of chemical in the body then your blood veins will swell, causing pressure to build up that can be very painful. This is when you know you have a migraine.

There are many things that can cause a migraine. Light, sound, smells, and foods are just a few things that can trigger a migraine. The only clue your body can give you that you are about have a migraine is through abnormal weakness, being depressed, or sometimes having a sudden burst of abnormal energy.

You should take a migraine seriously because it could lead to serious illness and physical problems such as side vision loss or color blindness.

If you get reoccurring migraines you should seek medical attention as soon as possible so that the problem can be resolved.

Common Causes of Migraines and Headaches

  • stress
  • fatigue
  • dental problems
  • missed meals
  • hormonal changes
  • changes in barometric pressure or altitude
  • alcohol
  • food
    • chocolate, cheese, onions, citrus, eggplant, bay leaf, chili, cinnamon, fried or fatty foods, and pickled or processed foods
  • certain food additives (MSG and coloring or flavor enhancers)
  • caffeine
  • eye strain
  • muscle tension

Keeping a Migraine Diary

Often when you continue to get migraines a doctor will suggest that when you begin to get one you should start documenting what you did before, during, and at the end of your migraine. This is to see if there are patterns that are causing migraines and what might be helping you rid yourself of the pain. Here are some of the things you should be noting in your migraine diary.

  1. First document the date and time of your migraine attack down to the minute
  2. What is the severity of your attack: mild, moderate, sever, etc.
  3. Where the pain is located: left, right, or both sides of the head
  4. What type of pain is it: throbbing, Non-stop, on and off, dull, etc.
  5. What are some of the symptoms: nausea, vomiting, sensitivities to light, sound or smell, etc.
  6. Did you have any warning signs/auras and what were they?
  7. Your environment: everything about it including weather, allergies from environment, strong smells, loud noises, lighting, etc.
  8. What you ate or drank from when you woke up to the actual attack, and if you ate or drank anything during the attack and if it helped or made it worse.
  9. Was there any stress or stress related thing from the day or days before that may have lead up to the attack?
  10. Also you may include if there was any depression and where it may have came from.
  11. Also if you have been taking any medications document what kind or brand and the dosage. Write why you were taking the medication and the affect it had on you.

Copyright © 2006 www.TriggerOptics.com

Obtaining coverage for Gastric Bypass Surgery with BCBSNC

Gastric bypass surgery is a common form of weight loss surgery that results in outstanding weight loss with minimal side effects. But once you undergo the gastric bypass surgery procedure you have to accept lifelong changes in your diet. The post-diet of gastric bypass surgery includes an adequate intake of protein, taking vitamin and mineral supplements including multivitamin, iron and calcium, B12 and avoiding sweets and fatty foods.

BCBSNC Covers Gastric Bypass Surgery for those eligible

Blue Cross Blue Shield of North Carolina (BCBSNC) covers gastric bypass surgery; the requirements for coverage is listed below. Please inquire further to confirm your eligibility to be covered for gastric bypass surgery.

Surgery for Morbid Obesity is covered when all six of the following criteria are met:

  1. The patient must have morbid obesity as defined below:
    1. have a BMI > 40 or
    2. have a BMI > 35 associated with at least one of the following problems:
      1. The obesity interferes with daily function to the extent that performance is severely curtailed(i.e., impending job loss or job loss with documented disability); or
      2. The obesity causes incapacitating physical trauma as documented by the medical historyrecords including x-ray findings and other diagnostic test results; or
      3. There is significant respiratory insufficiency or sleep apnea documented by respiratory function studies, blood gases, sleep studies, etc.; or
      4. There is significant circulatory insufficiency documented by objective measurements; or
      5. There is documentation that management of primary diseases such as arteriosclerosis, diabetes, heart disease, hypertension, etc., is significantly (e.g. requiring prescription drug treatment) complicated by morbid obesity; AND
  2. Morbid obesity (BMI > 35 associated with at least one of the problems listed in A.1.b. or BMI > 40) has been present for four of the previous five years; AND
  3. The patient has no specifically correctable cause for the obesity, e.g., an endocrine disorder; AND
  4. Patient has achieved full growth (for adolescents-bone age shows closure of epiphyseal plates); AND
  5. A thorough evaluation (see Policy Guidelines section) has been documented to assess the patient’s suitability for surgery and their ability to comply with lifelong follow up; AND
  6. Surgery for morbid obesity is eligible for coverage when it is part of a comprehensive pre-surgical, surgicaland post-surgical program (see Policy Guidelines Section).

Types of gastric bypass surgery

In gastric bypass surgery, the surgeon takes off a large portion of the stomach leaving behind a tiny pouch. It is this small pouch that prevents overdose of eating as it can take very less amount of food. Moreover, with large parts of your stomach and small intestine bypassed, most of the nutrients and calories in the food do not get absorbed at all. This helps the person from gaining excess weight.

There are several types of bypass surgery operations:

  • Roux-en-Y gastric bypass (RGB) – this is a common surgery where a small stomach pouch is created by stapling part of the stomach together or by vertical banding. This reduces the amount of food to be taken. Then a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum as well as the first portion of jejunum. This causes reduced calorie and rapid nutrient absorption.
  • Extensive gastric bypass (biliopancreatic diversion) – in this complicated surgery, the lower portion of the stomach is removed. The small pouch that remains connected to the final segment of the small intestine completely bypasses both duodenum and jejunum.

People who undergo gastric bypass surgery always lose two-thirds of their excess weight within two years.

Risks of gastric bypass surgery

Gastric bypass surgery causes “dumping syndromes” where the stomach contents move too rapidly through the small intestine. The usual symptoms of gastric bypass surgeries include weakness, sweating, fainting, nausea, diarrhea, as well as inability to eat sweets.

People who undergo this procedure are at risk of:

  • Band erosion – the band closing off part of the stomach disintegrates
  • Pouch stretching – stomach gets bigger overtime, stretching back to its normal size before surgery
  • Leakage of stomach contents into the abdomen (acid can eat away other organs)
  • Nutritional deficiencies causing health problems
  • Breakdown of staple lines – band and staple fall apart, reversing procedure
    Gastric bypass diet

Gastric bypass diet helps the patients to drop 50% to 90% of their overall excess fats. The diet is designed to bring about significant weight loss. It basically includes foods that are high in protein and low in fat, fiber, calories, and sugar. You should have lots of vitamins and minerals. Iron, vitamin, folate and calcium are the best nutrients for patients undergoing gastric bypass surgery.

You can undergo gastric bypass surgery only if you have been obese for at least 5 years, do not have a history of alcohol abuse, and do not possess untreated depression and range between the ages 18 to 65.