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When I was asked whether I’d be interested in speaking to a Youth Leadership Exchange class last week, I was ambivalent.

I knew I’d agree to speak, because I consider it to be an important form of outreach that may get kids interested in current events and perhaps even pick up a newspaper now and then, but I’ve had some negative experiences.

Speaking to this group definitely was NOT one of them: Not one of them asked what kind of car I drive, how much money I make or which famous people I have met. I’ll typically answer these questions, but I always hope for better ones.

They didn’t disappoint.

Each member of the class, a part of Leadership Oklahoma City, applied to be there. When I asked what careers they were interested in, many said medicine. It was perhaps appropriate that I spoke on health care day. Speakers included a hospital executive and a scientist. Some of the class toured The Children’s Hospital at OU Medical Center.

(I was able to hold a human heart once while in high school. I never got to tour Children’s.)

For the first time in a while, I was nervous last week. Put me on camera, ask me questions, have me go up and get in a complete stranger’s business — these things have become second nature. Kinda have to be in my line of work. Speaking for a half-hour to smarty-pants sophomores and juniors from throughout Oklahoma County was enough to make my palms sweat.

Although I had a bullet-point presentation prepared, I realized it was too heavy on numbers and policy when my father suggested the kids likely would want to hear about some interesting things I’ve done.

By this point it was too late to change anything, and I’m not organized enough to be able to keep a group of high school students’ attention for 30 minutes without notes. Besides, going up for a flight with the Air Force, while exhilarating, has absolutely nothing to do with being a medical writer. Being cloned, well, I forgot to mention that one.

I told the group things would be a lot less painful for them and for me if we talked back and forth. I threw out some numbers — the uninsured, growth in certain classes of prescription drugs, elective procedures, etc. — and we then discussed what they mean and what to do about them.

Not only were the kids open to discussing these (admittedly) wonkish ideas, they had varying, reasoned opinions. I was impressed.

Should health insurance be mandatory, like car insurance? Is this possible? Is this enough? Is this too much? Should a liver go to a 30-year-old or a 70-year-old teetotaler?

By the time we finished this back and forth, I had gone over my allotted time; it seemed like no time at all.

The only question that caught me completely off guard was whether a girl in the class should attend the University of Tulsa, my alma mater.

It’s nice to be an expert in something. I told her yes.

 Jeff Raymond, Medical Writer

 You can be forgiven for thinking yesterday was anything more than a nice day to watch college hoops.

It was, but it also was National Doctor’s Day.

The American Medical Association uses the day to honor the more than 900,000 physicians in the United States.

“On this day of tribute, Americans can express appreciation for physicians’ continued commitment to providing exceptional medical care,” according to an AMA release.

The nation’s doctors, throughout almost 1 billion patient visits annually, are called to be healers, confidants and advocates, the AMA says.

The organization also says two-thirds of U.S. doctors provide some form of charity care and in 2006 were ranked the nation’s most trusted occupation.

Furthermore, the AMA says:

• Ninety percent of patients say they are very satisfied with their doctor.
• Americans’ life expectancy has increased by seven years since 1960.
• There has been a 77 percent decrease in the infant mortality rate since 1950.
• There has been a 63 percent decrease in the overall death rate for heart disease since 1950.
• There has been a 72 percent decrease in the overall death rate for stroke since 1950.
• There has been a 14 percent decrease in the overall death rates for cancer since 1990.

Do you consider the medical profession admirable and respectable? Do you respect your physician? Are you satisfied with him/her? Drop me a line at The Medicine Bag blog at http://blog.newsok.com/health.  

Now back to basketball!

Jeff Raymond, Medical Writer

USA Today had an interesting story yesterday about how the popularity of angioplasty, a commonly performed procedure in which doctors use a balloon to open blocked coronary arteries, may be eroding.

“The rise of angioplasty procedures has leveled off and appears to be on the decline,” Duke University’s Eric Peterson, who reviewed results of the analysis by the National Cardiovascular Data Registry, told the newspaper.

Three studies in the last two years that indicate that angioplasty may be no more beneficial than medication, and may be riskier. According to the newspaper, the research suggests angioplasty is used too often and its benefits don’t justify the procedure’s $10,000 to $12,000 cost.

The newspaper’s analyses found:

• The number of annual procedures performed each year has declined by 10% to 15% over the last two years.

• Angioplasty and stent use began dropping in June 2006, after two “landmark” studies cast doubt on them. Doctors often implant stents — both bare metal and drug-coated — after angioplasty to keep the artery open.

Angioplasty is used to treat the terrible chest pain, called angina, that comes from a heart without enough oxygen.  The slight decline is important because Centers for Medicare and Medicaid Services guidelines seek to have angioplasty available within 90 minutes of a patient’s arrival at the hospital. This is often called door-to-balloon time.

Many medical authorities tout the benefits of angioplasty.

Because hearts suffer from an inadequate blood supply, Bonnie Weiner, president of the Society for Coronary Angiography, told the newspaper, “(Angioplasty) is very effective at achieving more blood flow to the heart.” 

“I personally wasn’t surprised by the results,” says Michael Rich, a cardiologist at Washington University School of Medicine in St. Louis who will debate the study at the heart meeting.

Michael Rich, a cardiologist at Washington University School of Medicine in St. Louis, said angioplasty won’t prolong a person’s life or decrease the risk of a heart attack but will decrease the symptoms of one.

“The analyses conducted for the newspaper also reflect what may be the beginning of a broader change in medicine: a move toward ‘evidence-based’ care drawing on reams of data from medical research and patient treatment,” USA Today reported.

Jeff Raymond, Medical Writer

Researchers have seen that weight-loss surgery appears to cure type 2 diabetes, which they have attributed to the huge drop in pounds. After all, being overweight is a risk factor for diabetes, and losing weight can effectively take care of the problem.  

An article that appeared in a supplement to last month’s issue of Diabetes Care argues that the bowel is the site of mechanisms that lead to diabetes.

The study’s author, Dr. Francesco Rubino of New York-Presbyterian Hospital/Weill Cornell Medical Center, presents evidence on the mechanisms of diabetes control after surgery.

“Clinical studies have shown that procedures that simply restrict the stomach’s size (i.e., gastric banding) improve diabetes only by inducing massive weight loss. By studying diabetes in animals, Dr. Rubino was the first to provide scientific evidence that gastrointestinal bypass operations involving rerouting the gastrointestinal tract (i.e., gastric bypass) can cause diabetes remission independently of any weight loss, and even in subjects that are not obese,” according to a press release.

Rubino’s previously has shown that the main way gastrointestinal bypass controls diabetes is by skirting the upper small intestine — the duodenum and jejunum.

“It has become increasingly evident that the gastrointestinal tract plays an important role in energy regulation, and that many gut hormones are involved in the regulation of sugar metabolism,” according to the release.

Rubino’s findings suggest bypassing the upper intestine may work by reversing abnormalities of blood glucose regulation.

He guesses the upper intestine of diabetic patients may be the site where an “abnormal signal” is produced that causes or predisposes one to diabetes.

Gastrointestinal surgery offers the possibility of complete disease remission. This is a major shift in the way we consider treatment goals for diabetes. It is unprecedented in the history of the disease,” he said.

What do you think of using surgery to treat diabetes? Have you had an experience with it? Leave me a comment at http://blog.newsok.com/health.

Jeff Raymond, Medical Writer

 Is retirement going to be a luxury for thirty- and forty- something workers? I increasingly think it will be, and a new estimate from investment giant Fidelity does nothing to dispel that.

A 65-year-old-couple retiring this year will need approximately $225K to cover medical costs in retirement, Fidelity estimates. Let’s not lose sight of the fact that this is in addition to the coverage available under Medicare, which may itself not be available when I and others retire.

The hypothetical retirees will still have to have enough money to live, either independently or in long-term care.

Perhaps what’s even more sobering than the estimate is its growth since 2002 — 41 percent.

The roughly 6 percent annual growth in the Fidelity projection about matches the growth of my 401K fund during a slow year. I know that doesn’t take into account contribution matching and interest compounding, but I think it raises a worthwhile point nonetheless.

And health care costs show no signs of flattening or decreasing.

Does paying for retirement terrify you as much as it terrifies me? Leave me a comment at http://blog.newsok.com/health.

Fidelity recommends:

- Creating an individual retirement plan

- Starting early and maximizing opportunities to save

- Assessing health status and becoming a smarter consumer of health care

- Determining details of any employer-sponsored coverage

- Understanding the financial impact of health care costs on Social Security income

Jeff Raymond, Medical Writer

If you’re interested in keeping tabs on your doctor, HealthGrades now offers a notification service.

The Web site, www.healthgrades.com, is best known for its hospital ratings. But given the information it compiles, a physician notification service is a natural addition.

The “Watchdog” e-mail alert service costs $4.95 a month.  

Notification items include board certification, disciplinary actions, malpractice suits and patient safety reviews.

Would you monitor your doctor? Would you pay to have someone notify you of lawsuits and other information of interest? Leave a comment at The Medicine Bag blog at http://blog.newsok.com/health. I’d like to hear what you think.

HealthGrades maintains quality profiles on almost every practicing physician in the country. The profile includes information on the doctor’s medical training, patient ratings, state and federal sanctions, malpractice judgments (in 15 states), procedure costs and hospital affiliations.

Subscribers to the service receive e-mail alerts when a physician’s information changes. Comprehensive physician profiles cost $29.95.

Jeff Raymond, Medical Writer

I worked for six months or so in the emergency room at Saint Francis Hospital and saw a number of interesting things while I was there. Among them were patients who repeatedly visited the ER complaining of chest pains but who weren’t having heart attacks.

The Agency for Healthcare Research and Quality today reported that such chest pain accounted for 16 million ER visits in 23 states in 2005. I’m not sure if Oklahoma was one of the surveyed states, but it’s nonetheless interesting. About one-fifth of the patients — 345,000 of them — were admitted for observation or treatment. 

“Non-specific” chest pain was the fourth most common cause of visits to the ER. The top three were sprains and strains, bruises and other superficial injuries, and abdominal pain.  

AHRQ also found:

• ER visits were almost twice as likely among those from the poorest communities compared with those from the wealthiest communities.
• Uninsured patients accounted for about 18 percent of visits.

If you ran a hospital, how would you handle an uninsured person who isn’t having a heart attack but may need observation? Visit The Medicine Bag blog at http://blog.newsok.com/health to leave a comment.

Jeff Raymond, Medical Writer

We Oklahomans know dust — perhaps better than anyone. Like it or not, the hardscrabble Joad family is as much a part of our cultural heritage as Curly, Laurey and Jud.

The Dust Bowl completely destroyed the state, and some would argue it took us a half-century to recover.

I mention this because University of Colorado researchers have found the West has become 500 percent dustier in the past 200 years because of human activity.

My first thought was how they measured such a thing. Turns out the researchers used sediment records from dust blown into lakes in Colorado’s San Juan Mountains. Co-author Jason Neff, an assistant professor of geological sciences at CU-Boulder, attributed the “sharp rise” in dust deposits to the railroad, ranching and livestock of western expansion.

“From about 1860 to 1900, the dust deposition rates shot up so high that we initially thought there was a mistake in our data,” Neff said in a press release. “But the evidence clearly shows the western U.S. had it’s own Dust Bowl beginning in the 1800s when the railroads went in and cattle and sheep were introduced into the rangelands.”

A paper on the research was published in the Feb. 24 issue of Nature Geoscience. In it, the scientists described a “dust fall” that exceeded that of the previous 5,000 years. Because of the size of the dust particles, the authors concluded the dust particles came from the Southwest.

Neff said the West’s increasing dustiness isn’t drought-related. Instead, he said, it is because of “intensive land use, primarily grazing.” Researchers used radiocarbon dating and lead isotope analysis of soil cores to determine this.

“There were an estimated 40 million head of livestock on the western rangeland during the turn of the century, causing a massive and systematic degradation of the ecosystems,” he said in the release.

The five-fold increase in nitrogen, phosphorus, potassium, calcium, magnesium and other byproducts of ranching, mining and agriculture can affect ecosystems.

Then, of course, there’s dust’s effect on allergies.

“There seems to be a perception that dusty conditions in the West are just the nature of the region,” Neff said. “We have shown here that the increase in dust since the 1800s is a direct result of human activity and not part of the natural system.”

For more health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.

Jeff Raymond, Medical Writer

We Oklahomans know heart attack signs about as well as our peers. What we don’t do so well is call 911.

What gives?

A recent issue of the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report compared how much 71,994 residents of 14 states knew about heart attack symptoms and whether they knew to call 911.

Overall, awareness of all five warning signs was 31 percent.  Eighty-six percent of respondents reported they would first call 911 if someone were having a heart attack. Among Oklahomans, only 81 percent would do so.

In 2005 approximately 920,000 people had heart attacks; approximately 157,000 were fatal. Fewer people would die from heart attacks if they sought medical care more quickly.

“Although emergency care and medical therapies for acute events have improved, studies have shown that the time from symptom onset to treatment overall has not decreased,” according to the report.

I’m guessing that awareness of heart attack is lacking, and people’s first reaction is to call a loved one or drive the victim to the hospital. Maybe loved ones don’t recognize what’s happening or downplay the seriousness of it. Or maybe people in some parts of the state have to wait for an ambulance to respond, making driving the heart attack victim to the hospital more of an option.

Jeff Raymond, Medical Writer

This ran in the Jan. 25 edition of The Oklahoman:

“An Edmond man was killed Thursday morning when he lost control of his pickup and crashed into a bridge pillar in northeast Oklahoma City, according to the Oklahoma Highway Patrol. 

Peter Fuhrmann, 68, died in the accident about 6:15 a.m., the patrol said. He was southbound on Interstate 35 when he lost control of his pickup on the westbound entrance ramp to the Kilpatrick Turnpike. The pickup slid several hundred feet before striking an overpass, the patrol said. The patrol’s report indicated a medical condition may have caused Fuhrmann to lose control of the pickup.

Fuhrmann was wearing a seat belt.”

Now, to shamelessly rip off Paul Harvey, here’s the rest of the story….

Peter Fuhrmann’s wife, Connie, is a health unit coordinator at Integris Baptist Medical Center. She said her husband was having a heart attack and was trying to drive himself to the hospital when he crashed on the turnpike.

Connie Fuhrmann received an anonymous letter two days later from someone who stopped at the scene and tried to help. The person got a blanket from the car and covered Peter Fuhrmann until help arrived, trying to keep him warm.

The anonymous letter, according to an Integris press release, also said nurses from Baptist and Mercy Health Center stopped to help and held Peter Fuhrmann’s hand. One prayed with him before he died.

“Our employee, Connie, was so touched by this act of kindness that she wants to thank them in some way. … She feels like these strangers who stopped to help her husband during his last moments were angels sent from God,” according to the release.

The family even read part of the letter at Peter Fuhrmann’s funeral.

Jeff Raymond, Medical Writer