Effects of Oil Spills On Health- Resources For Health Professionals
Written by Cathy on September 2, 2010 – 7:07 pm -Since we just had another oil platform explosion, in the Gulf and Chevron has illegally dumped billions of gallons of toxic waste into the Amazon I though I would do a post on oil spills and other toxic wastes and where to call.
The BP Oil Spill is not the first oil spill and in fact currently there are several other oil spills going on in the world. It just happens to be the worst and a result of someone stepping over a dime to pick up a penny. (i.e. not paying for a $500,000 safety device, now costing billions to both BP and taxpayers and employees)
Over the years the National Institute for Occupational Safety and Health (NIOSH) has been studying 7 oil spills and have reported an increase in respiratory symptoms, headaches, throat and eye irritation, rashes and numerous skin problems among clean up workers and residents. DNA damage has also been found after a beach clean up in Spain. Reports of mental health damage have also been noted. There has already been 1 suicide from a worker in Louisiana.
Information for Health Professionals Health Surveillance
The recent Gulf Coast Oil Spill more likely presents ecological impacts than human health effects. However, depending on the exposure pathways, there may be a risk for human health effects. CDC, along with the affected Gulf Coast states, has developed a surveillance plan to track the potential short-term health effects related to the oil spill in the affected communities.
CDC (Center of Disease Control) recommends using existing mechanisms for surveillance of acute health conditions. However, if existing mechanisms do not exist within an affected gulf coast state, targeted drop-in health care surveillance is recommended. CDC has developed a surveillance tool to be used for drop-in surveillance to monitor health complaints. Complaints captured by the tool include upper respiratory conditions; cardiovascular conditions; eye conditions; and stomach complaints such as nausea.
If people who are experiencing these symptoms have also been exposed to the oil spill, further study may be necessary.
Poison Center Surveillance CDC requested that the nation’s 60 Poison Centers, including those in Alabama, Florida, Louisiana, and Mississippi, assign a temporary code to any calls related to the oil spill. These would include both information calls and calls about potential exposures. This coding will allow CDC to track the number of Poison Center calls and potential health effects.
For more information regarding your local Poison Center: http://www.aapcc.org/dnn/About/FindLocalPoisonCen
Sources
- Grist- Recap of Health Issues from 7 Oil Spills
- National Library of Medicine
- Center For Disease Control www.epa.gov/bpspill/.
- DailyFinance: http://www.dailyfinance.com/story/health-effects-of-oil-spills-on-humans-more-questions-than-an/19530364/?icid=sphere_copyright
- LIst of Oil Spills
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Surgical Removal Of An Eye-Do Not Watch If Squeamish
Written by Cathy on August 26, 2010 – 8:49 pm -Enucleation is performed to remove large-sized eye tumors or as a result of traumatic injury when the eye cannot be preserved. In the case of tumors, the amount of radiation required to destroy a tumor of the eye may be too intense for the eye to bear. Within months to years, many patients who are treated with radiation for large ocular melanomas lose vision, develop glaucoma, and eventually have to undergo enucleation.
Resources:
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CBS Tests UV Protection – Finds Cheap Sunglasses Have 100% UV
Written by Cathy on August 12, 2010 – 7:59 pm -CBS went on the road to test 100 pair of sunglasses from $5 sunlasses to designer sunwear. They then took them to Dr. Mark Werner to test the UV Factor- Dr. Werner finds that $5.00 Sunglass have 100% UV protection. Check out the video here CBS UV Video Posted on YouTube July 19, 2010. (Transcript)
Here is the question that needs to be addressed with staff- How Are You Going To Answer That With Your Patients? The key to responding is be proactive, educated and prepared. We have pulled together some articles we recommend for all staff to discuss and learn about the differences between cheap sunglasses and quality lenses.
- How Stuff Works- Cheap vs Expensive Sunglasses- The biggest problem with cheap sunglasses is in the way the lenses are made. Inexpensive sunglasses have lenses made of ordinary plastic with a thin tinted coating on them. While the tint color and a similar frame design may make them look like Oakley X-Metal Romeos or Ray-Ban Predators, the actual lenses are very different. You will learn exactly how different they are, and how important the differences are, in the following sections.
- The Straight Dope- Do old or cheap Sunglasses increase the risk of eye damage from ultraviolet rays?
- Environmental Graffiti- a nice editorial - UV rays cause exactly the same type of damage to your eyes as your skin, causing burns, blindness, and yes, an elevated cancer risk. Australia, home of the highest skin cancer rates in the world and whose massive population lives next to the ozone hole, has strict standards for sunglasses; as does the European Union. Why won’t America come along?
- Glaucoma Research Foundation A Guide To Sunglasses- Long-term exposure to UV rays can damage the eye’s surface as well as its internal structures, sometimes contributing to cataracts (clouding of the lens) and macular degeneration (breakdown of the macula). Ophthalmologists and optometrists now recommend wearing sunglasses and a brimmed hat whenever you’re in the sun long enough to get a suntan or a sunburn, especially if you live at a high elevation or near the equator.
- Live Science- BeWare Cheap Sunglasses - Unfortunately, the non-prescription sunglasses industry is weakly regulated, and even bold words in its advertising such as “UV absorbing” or “blocks most UV light” might mean nothing. ”There is no government regulating power for the classification of sunglasses,” said Donald D’Amico, chair of ophthalmology at New York-Presbyterian Hospital. As a result, some companies misrepresent how much protection their sunglasses offer.
- Hub Pages- Excellent Articles About UV and lenses and lens labeling. - It’s not about the price! You do not have to pay a premium price for 100% UV protection in a pair of sunglasses. All you need to do is be able to read the label…he tint of the lens has nothing to do with the UV protection of the glasses. A clear lens with no tint and 100% UV protection is better for your eyes than dark, heavily tinted sunglasses without UV protection…Polarized, or anti-glare lenses are NOT all you need to protect your eyes from UV rays. You still MUST have 100% UV protectionour children need sunglasses as much as adults. Children often spend even more time outside than most adults. So, why wouldn’t a child need proper UV protection?
- Best Health Mag- Are Cheap Sunglasses Safe? - Still, you don’t want to take any chances. When shopping, look for a label that states they provide UV 400 or at least 99 percent UVB and 95 percent UVA protection. Ideally, they will also have an “ANSI Z80.3” sticker, which shows the manufacturer paid a licensing fee to the American National Standards Institute (ANSI), guaranteeing the product has met set criteria. “If you see this tag and the sunglasses are made by a quality manufacturer, the lenses will block UV light,” says Chou, who, along with Dain, sits on a committee that’s drafting international standards. If sunglasses don’t have such stickers, or are being sold by a less-than-reliable vendor, don’t risk it.

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Opening Eyes with Santinelli
Written by Shirley on August 8, 2010 – 9:33 pm -We like to bring you reports of our sponsors that are involved in programs that help with the vision requirements of those in need. It is good for the industry as well the people given vision assistance. It helps bring awareness of vision care to the general public and we encourage all in the optical industry to get involved with “Opening Eyes” for those in need whether in a big way like Eyes of Faith Optical who give back 10% of total sales or like Santinelli featured here in our post below who are heavily involved in the Special Olympics or even in a small, local community event one day a year. It is all good.
Today we are featuring Santinelli’s participation in the 2010 National Special Olympic Games held in Lincoln, Nebraska by providing lens edging equipment for the Opening Eyes portion of the Healthy Athletes program, while several company associates volunteered their time and services. Through the program, a total of 564 pairs of prescription eyewear were distributed to athletes.
According to the Special Olympics organization, research has shown that among Special Olympics athletes, 68 percent have not had an eye examination in three years and 37 percent are in need of eyeglasses. Opening Eyes provides diagnosis for vision related problems, as well as corrective and protective eyewear all free of charge. At the end of the screening, athletes receive a certificate detailing their vision needs and follow-up referrals for health care providers in their home areas, if needed. Athletes are also taught how to take better care of their eyes.
Two Santinelli lens edging systems were humming all the way through with company representatives Rick Noonkester, Jaysun Barr, Steve Ruef, Henry Bode and Donald Rosene processing the several hundred jobs for the athletes. Santinelli International has been a supporter of the Special Olympics games for over 12 years.
Great Job Santinelli!
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Marijuana Controversy And EyeCare Professionals
Written by Cathy on August 5, 2010 – 7:17 pm -The Amcon Gazette did this article on Marijuana Rx, which I thought was interesting in light of the fact legalizing marijuana is a hot political topic right now: I asked a few OD’s, if optometrists could prescribe marijuana or if that would be a possibility in the future. He said no but one could recommend someone! According to the latest research Marijuana Requests have jumped. What do our readers think- Should marijuana be legalized? Have you ever recommended marijuana for eye health?
Eye Bogglers
- According to the National Survey on Drug Use and Health, in 2007, 14.4 million Americans aged 12 or older used marijuana at least once in the month prior to being surveyed, which is similar to the 2006 rate. About 6,000 people a day in 2007 used marijuana for the first time—2.1 million Americans. Of these, 62.2 percent were under age 18.
- Researchers found that 42% of people surveyed in the U.S. had tried marijuana at least once, and 16% had tried cocaine. About 20% of residents surveyed in the Netherlands, by contrast, reported Full story at Time Magazine (July 2008)
Amcon Article
Traveling with my ophthalmologist father-in-law, Dr. Tom, this week, I was surprised to learn that he is occasionally asked for a marijuana prescription from his glaucoma patients. Since medical marijuana is illegal in the state of Virginia, (where he practices), and he believes there is little benefit, he has never actually written a prescription for pot.
But why in the world would a patient suffering from glaucoma be asking for marijuana? A quick search on the Internet revealed why. Glaucoma is an eye disease that causes increased fluid pressure inside the eyes. Some studies have demonstrated that smoking (some forms) of marijuana reduce ocular pressure. However none of these studies have shown that it is more effective than current treatments on the market.
The other issue, is that glaucoma is a chronic condition. So to have the desired effect of sufficiently lowering ocular pressure, glaucoma patients would have to be ingest marijuana every 3-4 hours. So, as my father-in-law so eloquently put it… “you would be pretty gorked up.” What else am I going to learn on this trip??
Amcon offers several traditional glaucoma related drugs for optical professionals to administer to their patients. Please visit the Amcon website for a complete listing of our pharmaceuticals.
Resources
Sources: http://www.eyecareamerica.org/eyecare/treatment/alternative-therapies/marijuana-glaucoma.cfm, http://www.ehow.com/how-does_4673720_marijuana-glaucoma.html
www.healthexpertadvice.org/forum/Other-Health/Does-smoking-marijuana-affect-your-eyesight-if-so-what-can-I-do-to-get-my-eyesigt-back-to-normal-174587.htm
http://www.kgbanswers.com/does-smoking-enough-weed-improve-your-eye-sight/4699796
http://www.chacha.com/question/does-smoking-pot-make-your-eye-sight-bad
Medical Coding Certification Did a Article on the 30 Best Blogs To Learn About Medical Marijuana
Here are a few about the Health and Medical from His Site
Health and Medical
These blogs focus more on the health and medical benefits and programs for patients using marijuana.
- Medical Marijuana Blog: Learn about dispensaries, cooking with marijuana, state laws and the benefits of marijuana for different diseases and disorders. Recommended posts: “How to Find the Best Medical Marijuana Doctors” and “Top Five Reasons to Get a Medical Marijuana Card.”
- The Cancer and Marijuana Blog: If you want to learn more about how and why marijuana is used in helping cancer patients, read this blog. Recommended posts: “Does Cannabis Truly Help AIDS Patients” and “Marijuana as Medicine is nothing new!“
- Medical Cannabis of Southern California: Topics covered on this medical marijuana blog include medical ethics, medical marijuana laws, and the different conditions that can benefit from medical marijuana. Recommended posts: “Medical Marijuana and Withdrawal Symptoms” and “Medical marijuana patients show up on time: a friendly reminder.”
- Medical Marijuana Blog: Posts on this blog go into scientific detail about how marijuana is used for medicinal purposes. Recommended posts: “Is Medical Marijuana Coming to New York?” and “Medical Marijuana and Alzheimer’s.”
- Marijuana Reviews: Learn about different strains of marijuana and how they help. This blog also includes forums and free medical marijuana instructional videos. Recommended posts: “Grape Punch” and “Black Cherry.”
- Faded Fools 2.0: Find out what these faded fools are smoking to ease the pain. Detailed photographs accompany reviews, so it may be NSFW. Recommended posts: “Venom OG Kush” and “Exclusive Master Kush (Indica).”
- Medical Marijuana Blog: Get news stories but also learn how to find medical marijuana in certain states. Recommended posts: “Five Little Known Facts About Medical Marijuana” and “California Medical Marijuana Laws and Prop 19.”
- Medical Marijuana USA: Read up on dispensaries: how to open one and how to find them. Also find links to other resources for learning about medical marijuana. Recommended posts: “How to get a medical marijuana card in Colorado” and “How to Open a Medical Marijuana Dispensary.”
- Cannabination: Find scientific research reports and other studies on medical marijuana here. Recommended posts: “Cannabinoid Receptors: A Link Between Genetic Variations and Depression” and “ Scientists Find New Sources of Plant Cannabinoids.”
- The Marijuana Blog: Blog categories here range from growing marijuana to sharing news updates to highlighting videos from YouTube explaining the medical benefits. Recommended posts: “Going to Pot: Would Legal Marijuana Take Bite Out of Crime?” and “US CO: Delay Sought in Medical Pot Issue.”
- Marijuana Policy Project Blog: Visit the MPP blog for information on voting issues, licenses, collectives and health benefits. Recommended posts: “Bringing Out the Marijuana Vote” and “Mike Meno Marijuana Use Rarely Leads to Emergency Room, Study Shows.”
- Medical Marijuana Tracker: Get practical answers to questions you may have about how medical marijuana is used, and what all the jargon means. Recommended posts: “The Future of Marijuana in America” and “What are marijuana cannabinoids?.”
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Top 25 Ways To Reduce Stress-Natural Stress Relievers
Written by Cathy on July 30, 2010 – 6:03 am -Hiding from the world under your pillows? Finding yourself having small panic attacks or just need to relax? Forget binge-drinking and saving up for Club Med, we have 25 surefire ways to soothe your inner stress monster!
1. Take 30 minutes a day to organize yourself.
Making time to organize will make sure you are organized. Being organized will
help you manage your time and make an endless task-list seem less intimidating.
2. Eat healthier!
Taking the time to eat properly will likely cut your stress in half; you’ll feel better
and have more energy. Taking care of yourself is basically the antithesis of stress
because you’re focusing on bettering yourself rather than spreading yourself thin. Try
some of these delicious vegetarian recipes.
3. Consider a detox diet. Try a revitalizing detox to free your body of harsh chemicals and feel lighter, better and like-new.
4. Do something nice for someone else Do-gooding is the selfless secret to decreasing your stress status. Not only will you gain karma, you will temporarily free yourself of your circumstances and have gathered a refreshing new perspective.
5. Free Association: Busy your hands & free your mind. Perfect for anytime you need to relax or when you find yourself obsessing or distracted. Grab a pen (or your keyboard) and write yourself tired. Just write without thinking for twenty minutes, you will exhaust your stressful thoughts and generally feel better. Therapists recommend doing this on a daily basis, but it is also great when you find yourself mulling over isolated stressful incidents or are nervous about an upcoming event.
6. Sleep! But don’t oversleep! You can’t sleep away your stress or hide in bed. Similarly, you can’t stay up all night and get everything done (or at least, not well). Get your rest, even take a 20 minute nap if necessary but don’t go to extremes!
7. Exercise Exercise is the ultimate stress reliever because you simultaneously release endorphins, increase your energy and build confidence. You’ll instantly feel better and be better-suited to handle any upcoming problems or projects. 8. Take a bubble bath Bring the spa to you and soak away your worries. Plus it cuts down on your water and energy intake compared with taking a shower.
9. Take a walk. The quick break and fresh air will re-energize you and clear your mind.
10. Get up earlier. The extra half hour won’t make a significant difference on your sleep but it will make a difference on your attitude for the day. You will be more relaxed and better prepared; people who wake up earlier tend to accomplish more because you’ll have an “Up and at ’em” approach to the day.
11. Do something creative. Paint, garden, cook, feng shui, write haikus… No matter what you choose, doing something fun and hands on will make you feel self-satisfied and have a positive perspective for dealing with other things.
12. Music; Music can easily lift your spirits and pose a stress lubricant for any situation (traffic, work, cleaning, jogging, cooking…) Listening to cheesy music and/or singing along is an instant stress destroyer. It’s impossible to take anything seriously when you’re listening to Richard Cheese or Wham!
13. Limit your internet and cell phone use. Technology makes it incredibly easy to keep in touch with people. It is also an incredibly easy way to drive us crazy! If you find the sound of your phone making you cringe there are two easy ways to handle it: Turn it off for a few hours or change the ringtone to something that always makes you smile. Limiting your internet use is the best way to cut down on mindless procrastination and free your time for better things.
14. Laugh! Laughter is underrated, particularly when dealing with everyday stress. Laughter lets us take life less seriously and gain an instant happier perspective, so make sure laughter is part of your schedule. Listen to stand up comedy at work, have a marathon of a funny show or rewatch your favourite funny movies. Or just practice your fake laugh until you laugh for real!
15. Call a friend. Even if you are addicted to text messaging, taking a break to call a friend will help get your mind off things and remind you that you don’t have to face the world alone! Plus it’s always great to catch up and shake off some stress.
16. Cut down on caffeine. It may seem necessary to tackle your to-do list, but caffeine will only raise your anxiety and too much will make you feel cracked out and more stressed. Opt for herbal teas, cancel that extra shot of espresso or stick to decaf.
17. Start your day positive. Make a habit of doing something you love first thing in the morning, can you think of a better way to start your day? Instead of rushing to work, watch an episode of your favourite show, read, do yoga or anything that will put you in good spirits for the rest of your day.
18. Meditate; If done wrong, you’ve wasted time and are more aware of your problems. If done right (and regular) you will feel in touch with yourself, relaxed and confident. Take ten minutes to just breathe, relate to yourself and clear your mind.
19. Concentrate on what you want to happen and not what you don’t. Take mind over matter and create a can-do mindset rather than a ‘I hope this doesn’t happen’ attitude. You’ll feel much more productive and less hopeless when you focus on what you can do and what you want rather than the worse case scenarios. Or take the Boy Scout method- rather than worry about the worst scenario, prepare for it!
20. Make time for what makes you happy. Dealing with a heavy workload when you’re happy and when you’re miserable are unthinkably different things. Make your happiness a priority and will benefit other areas of your life by pure consequence (unless what makes you happy leads to an unhappy excess).
21. Welcome Routine; Despite fear of falling into a rut, routine is the most basic way to fight stress. You’ll feel organized, healthy and more capable of handling anything thrown your way. A lack of routine can make everything feel messier than it needs to be.
22. Make time for friends and family. It will help you feel connected and not get lost in the everyday stresses of work and city-life. Make stress wait, not your loved ones; there is always opportunity to be busy, worried or anxious, so don’t worry about letting it take the backseat to the people you want to see.
23. Stretch! Whether through yoga or just stretching out your limbs first thing in the morning or during break, loosening up will help your body (and mind) both energize and relax.
24. Don’t make things bigger than they are. Put things into perspective, it may seem like a huge problem, project or decision now, but how important will it be in a few months when you have new problems, projects and decisions? Don’t turn to Nihilism, but understand Kierkegaard’s greatest wisdom of life “Nil Admirari’ (Marvel at nothing) everything is the same even when it’s different!
25. Hugs! Possibly the most effective way to instantly decrease stress, don’t be shy with hugs! It sounds silly but try it and watch your troubles disappear!
Submitted By guest blogger Melanie Kozlan of Four Green Steps
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Social Media Eyes-Chronic Disease And Social Media By Crystal
Written by Cathy on July 19, 2010 – 7:19 pm -A report released this March on Chronic Disease and the Internet by the Pew Internet and American Life Project and the California HealthCare Foundation showed that people fighting chronic illnesses are using social media to connect with other patients and gather more information.
The report begins by stating that those suffering from chronic illness are less likely than healthy adults to have access to the internet, but “Once online, having a chronic disease increases the probability that someone will take advantage of social media to share what they know and learn from their peers.” It goes on to report “having a chronic disease significantly increases an internet user’s likelihood to say they work on a blog or contribute to an online discussion”.
It is easy to find the evidence of this all over the internet. Blogs and support groups for people with similar diseases have popped up all over the web, especially on Facebook. These groups allow patients to connect with others who are sharing their experiences. It also allows for an exchange of health information, and many times, doctor referrals.
One Eyed Girls- My Life with Strabismus is one of my favorite examples of one of these blogs. Blog author Heather takes readers through her lifelong journey with Strabismus and subsequent surgeries. She eloquently describes her vision troubles and the treatments used to help her. She talks about her vision therapy and what works for her and for other people she has met. It is an excellent example of someone using social media to connect with others.
Finding out if patients keep a blog of their vision troubles can help eye doctors connect with the patients and better understand their health needs and concerns. Ophthalmologists can also help a newly diagnosed patient find comfort by recommending a few online support groups or reputable blogs and health sites.
Just remember to advise patients that not everything they read online is true and that they should always defer to their doctor.
Article submitted by Crystal Blaker, founder of CB Consultations- CB Consultations specializes in helping eye care professionals ease into social media. Contact Crystal at (314)749-1939 or CrystalBlaker@gmail.com or visit her website here: www.cbconsultations.com
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National Healthcare Bill Update From OAA
Written by Cathy on July 8, 2010 – 7:40 pm -The Opticians Association of America latest newsletter had these helpful insights as to National Healthcare Bill Reform.
Tax Credit: When and the Run Down…
Small Businesses qualify for a tax credit if they have 25 or fewer employees with an average wage $50,000 or less…it’s a sliding scale.
They don’t qualify for the tax credit if they have more than 25 employees. Also, any employee who earns more than $80,000/year will be excluded from your credit.
Both small for-profit businesses and small not-for-profit organizations are eligible.
Here’s an Example:
Example 1: Main Street Optical
Optical Shop with 10 Employees
Wages: $250,000 total, or $25,000 per worker
Employee Health Care Costs: $70,000
2010 Tax Credit: $24,500 (35% credit)
2014 Tax Credit: $35,000 (50% credit)
Confused yet? Well here is a link to a website that has a tax credit calculator for small business owners, simply put in the number of employees, annual wages for all employees and annual employer premium contribution
http://smallbusinessmajority.org/tax-credit-calculator/
No-Coverage Penalties….
The bill requires small-business employers with more than 50 full-time employees (or 100 part time) to offer health insurance coverage to all full-time employees. Under the bill, you’re considered a full-time employee if you work 30 hours per week, on average. Small businesses must offer full-time employees health-care coverage by 2014 or pay a $2,000 penalty per employee.
NOTE: Businesses with less than 50 employees do not incur non-coverage penalties. Meaning the majority of independent optical shops will not be affected.
SHOP Program….
Effective: Jan. 1, 2014 - The law creates the state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) exchanges, which are marketplaces where individuals and small businesses with up to 100 employees can purchase coverage. The law creates four benefit categories of plans plus a separate catastrophic plan. Health insurance plans participating in the exchange must meet certain requirements in marketing, customer service, provider networks and transparency. States have option to create a basic health plan for uninsured individuals with incomes between 133 and 200 percent of the federal poverty level. (The federal poverty level for individuals in 2009 is $10,830, and for a family of three is $18,310.) Businesses with more than 100 employees can begin purchasing coverage in the SHOP exchange in 2017.
NOTE: the shop exchanges are state specific and will have some variance state to state.
FROM THE EDITOR: The 2700 page bill is massive, complicated and intentionally vague at times, and until regulatory interpretations and court challenges have been established the many things we thought we knew about this bill may change…I will try to keep up to date on any major occurrences that could affect opticians….questions or comments welcome.
Kristopher R. Pickford
OAA Legislative Consultant
Helpful Tips on Pursuing Legislation
1) Legislation is the art of the compromise. Learn the difference between a good fight and a lost cause, in order to avoid wasting valuable political capital.
2) Learn who your key legislators and sponsors are. Learn the legislative cycles and calendars - to use a sports metaphor: poor time management can cause the clock to run out on you. This is a factor even with good time management.
3) Learn the legislative process from beginning to end. Determine if possible, what committees your bill (legislation) will go through. Political support is always desirable to a legislator however; financial support should be approached with deliberation.
4) Support of a bill in the form of letters, phone calls, and emails is absolutely critical for a bill’s chance to be passed. Typically, 20 or more calls on a bill is seismic shift on the legislative landscape. If you don’t want to work for your bill, what message does that send to your sponsoring legislator?
5) Use professional help in the form of a dedicated lobbyist and/or regulatory attorney. Passing legislation is a hardball affair. It cannot be approached with the attitude of conducting a Saturday morning garage sale.
6) Make every effort to determine who the opposition is and what they are capable of doing to derail your bill. In other words, you need to know who has a dog in the fight!
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