Chest pain
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
Going to dust
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
Holding on a heart attack
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
An anonymous thanks
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
C-section stats
Almost 1 in 3 American woman had babies delivered by C-section in 2005, the Agency for Healthcare Research and Quality reports.
The number of C-sections was 38 percent less in 1995.
AHRQ also found:
- -Vaginal deliveries declined from about 3 million in 1995 to 2.9 million in 2005.
-Vaginal deliveries among women who previously had given birth via C-section dropped 60 percent –157,200 in 1995 to 62,300 in 2005.
-Hospitals charged $17.4 billion for deliveries by C-section in 2005.
The Oklahoman’s Heather Warlick wrote this story about C-sections in September.
Jeff Raymond, Medical Writer
Waiting for a liver
The need for donor livers outstrips their supply. Each year, about one-third of those with end-stage liver disease who need an organ will receive one. Some die while on the waiting list.
The February issue of Mayo Clinic Proceedings examines how the current system for allocating organs in the United States affects recipients’ outcomes.
The United Network for Organ Sharing (UNOS) oversees organ allocation. With the goal of giving organs to the most critically ill transplant candidates, UNOS adopted the MELD — Model for End-Stage Liver Disease — scoring system in 2002. The score is calculated from the results of three lab tests.
“Unlike past evaluation systems, the MELD score de-emphasizes the length of time a patient has been waiting for a donor organ. … Research has shown that although the donor liver shortage persists, implementing this allocation system has decreased the number of patients who die while waiting for donor organs,” according to a Mayo Clinic press release.
The study looked at the evaluation practices and acceptance criteria for liver transplant used by the Mayo Clinic Jacksonville Transplant Center after implementation of MELD scoring. Researchers examined medical records from 555 patients referred for liver transplants at the Jacksonville center from Jan. 1 through Dec. 31, 2005. Of these patients, 53 percent were denied for a transplant. Half of those denied were considered too early to have the procedure, while the rest were excluded because of medical conditions and psychosocial issues — poor support systems or continuing substance abuse problems, for example.
Many were subsequently accepted.
“Patients seeking referral often undergo repeated assessments by selection committees, as their eligibility can change over time or following treatment and/or changes in conditions that led to their initial exclusion,” according to the release.
Data suggest a “broad range” of patients could benefit from early referral to a transplant center, according to the release.
Basically, management of their disease and other medical and psychosocial conditions could make them transplant candidates sooner.
To read the report, click here.
People seldom realize transplant waiting lists are anything but static: They constantly change, depending on organ availability and patients’ medical states. They’re definitely moving targets. People move up, they move down; they drop off, they’re added back.
“Our study suggests that early referral for LT (liver transplant) evaluation is beneficial for reasons unrelated to the time patients spend on the LT waiting list. If patients too early for LT were evaluated but not listed, LT centers could initiate management of ESLD (end-stage liver disease) and address psychosocial issues in a sub-group of patients who could also ultimately benefit from LT,” the authors wrote.
Although not exactly the same thing, last month I wrote about this man, Dr. Ludvik Artinyan, left, who registered on organ waiting lists in California and Oklahoma. He was able to receive a liver transplant quicker by traveling to Integris Baptist Medical Center to have the procedure performed rather than having it done in Los Angeles. Because patients’ MELD scores typically are higher in California for various reasons, double-listing likely allowed the Armenia-born physician to shave months off his wait time and perhaps saved his life.
UNOS allows potential transplant recipients to be listed in multiple regions – they must meet each site’s criteria and be ready to respond to the phone call or page when an organ becomes available.
Is the current organ allocation system fair? E-mail me at jraymond@oklahoman.com or post your thoughts at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Keeping men healthy
Statistically speaking, men will die six years sooner than women. We have higher death rates for the 15 leading causes of death.
Here are some stats from the National Center for Health Statistics:
- In 1950 the age-adjusted death rate per 100,000 men was 1,647.2.
- For women it was 1,236.
- In 2000 the rate for men was 1,053.8.
- For women it was 731.4.
- In 2004 the rate for men was 955.7.
- For women it was 679.2.
- In 1950 the death rate among men from heart disease was 697.
- For women it was 484.7.
- In 2000 the rate for men was 320.
- For women it was 210.9.
- In 2004 the rate for men was 267.9.
- For women it was 177.3.
The numbers, whether taken together or broken down by cause of death, show that while age-adjusted death rates of men and women have made huge strides, men still trail.
Check out the rest of the document here.
I bring this up to spotlight Integris Health’s annual Men’s Health University Men’s Fit Club. The program appropriately began the day after the Super Bowl. It is a weight-loss class offered just for men, of all ages. It focuses on eating habits and increasing fitness.
Men-U is a series of events throughout the year to educate men and their loved ones on how to take care of their health. Health checks such as prostate cancer screenings are featured, and then there’s the Man Card, from Integris and WWLS The Sports Animal. Cardholders earn points that can be redeemed for prizes.
The class runs through April 17 and will be every Monday from 5:30 to 7:30 p.m. at Integris Pacer Fitness Center. The cost is $240 — less for those with a Man Card. Call (405) 951-2277 or (888) 951-2277 for more information.
One reason men die earlier may be because they avoid going to the doctor. A 2007 survey of more than 1,000 men for the American Academy of Family Physicians showed almost one-third wait as long as possible before seeking medical attention.
For health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Their bodies, ourselves
On a recent weekend I saw something spectacular. No superlatives — it really deserves to be called spectacular.
The introduction in the dimly lit anteroom at the Science Museum of Oklahoma pretty much sums up the “Our Body: The Universe Within” exhibit: A detailed look inside the human body is something that historically has been limited to doctors and researchers yet has fascinated man for millennia.
Despite its $23.95 cost per adult, the 13,000-square-foot exhibit is something everyone should see. Go now, go this weekend, go whenever — just go before it closes May 11. If you have ever wanted your child to become a physician, as just about every parent has, roll the dice and take him or her to the museum; there’s a good chance your child will leave with an abiding fascination about anatomy.
The exhibit is thought-provoking, gasp-inducing, and a real coup for the Science Museum, formerly the Omniplex. It features 18 complete bodies and 135 other body-system, anatomical and health-related items.
One of the most striking things is how respectfully the bodies on display have been treated. Even when posed, with muscles splayed, or seated, with veins and nerves hanging like plumb lines from thick rings of flesh, the bodies retain their dignity. The only time I was uncomfortable was with a man on a spinning platform who is holding his own skin in front of him. I’m not sure if I was uncomfortable because he was holding his skin or because his skin looked like a hide from any other animal.
I know how similar man is to lesser species. Anatomically, genetically and physiologically, the similarities far outweigh the differences. Still, it’s disconcerting to see how much man, stripped of speech and conscience, resembles other mammals.
The bodies don’t smell because they have been treated with a special solution that “plasticizes” tissue and renders it odorless.
Two things particularly stood out to me:
- The first was how dense veins, arteries and capillaries are in some parts of the body. One memorable part of the exhibit has legs, or at least the vasculature of the legs. Take the lungs, liver and kidneys — all are stocked for blood transport, per their functions. It’s one thing to see a spongy lung and quite another to see the vessels that deliver the blood that allows us to breathe. It’s this sort of big-picture perspective that was always lacking in school. It’s one thing to study the nephons in the kidneys, for example; it’s another to see how they look together, by the millions, life-size.
- Parts of the exhibit show slices down the sagittal and transverse planes (take a look at the picture above to see what I mean). I was able to understand, for the first time, how the internal organs relate and where they are located in body cavities. I saw the ventricles, or chambers, of the brain, and the pillow the lungs provide the heart.
I got the impression the exhibit attracts doctors as well: After hearing one describe what he looks for when examining someone’s ears, I realized docs must be thrilled to share what they do with loved ones in a way words simply can’t convey. The man described looking at a patient’s ear drum, and how he would see internal structures and note them on the patient’s chart. Hearing about this and looking into an actual ear and skull must have made the woman with him understand his work so much better.
Have you been to the exhibit? What did you think? E-mail me at jraymond@oklahoman.com.
Jeff Raymond, Medical Writer
‘I have always felt different’
A paper in this month’s edition of the Journal of Pediatric Nursing describes ADHD from the perspective of college students who have it and have learned to cope.
The subject is interesting for several reasons, not the least of which because it features 16 adults recalling how ADHD affected their lives as children. Plenty of research exists on child and adolescent ADHD, but there is little out there on how the condition affects and has affected adults.
The study, from the University of North Carolina at Greensboro and Wake Forest University, is poignant in interviewees’ descriptions of how it feels to have ADHD — being called “stupid” or “slow,” not having parents understand why things don’t get finished.
The study noted common feelings among the group of loneliness and isolation.
“Can’t anyone see I’m struggling,” one study participant lamented.
Common threads through participants’ lives were:
- Trouble getting along with parents
“In their view, children with ADHD have more trouble than others,” the authors wrote.
One’s adolescence is rough no matter what, “but it tends to be a little rougher on people with special needs,” a participant noted.
Another participant described the “mass chaos fights” with parents and siblings — often due, participants said, to failing to perform chores within an expected time frame.
“Because of their distractibility and hyperactivity, participants said that they had difficulty completing tasks, causing problems with their parents,” the authors wrote.
Some parents provided support, but it was tough for them as well.
“My parents did provide support … with homework; making sure I was on top of things. But it kind of got to the point where it was nagging, but that’s how they got the actual answer from me,” a participant recalled. “They had to play 20 questions. I wasn’t trying to withhold information; it just took 20 questions to get the full description.”
- Missing a lot of material at school
Trouble paying attention and hyperactivity affected participants’ ability to learn.
“In class, I had a kind of lag time, ’cause in-between me figuring out what had been going on, the entire class moved on, so I missed out on information. So that was one of the biggest things — missing out — taking a longer time to get the entire idea,” a participant explained.
Participants learned to cope: They allowed help from their parents, asked for more time on tests or took them in different formats, recorded lectures and re-copied notes after class.
- Feeling different
Children with ADHD felt different in school, and situations such as sitting still and grasping concepts quickly made these differences clear.
“Other kids at school would call them retarded, slow, or stupid, and then ostracize them,” the authors wrote.
As such, they often had trouble making friends, and wondered why people didn’t like them. Social difficulties sometimes persisted into adulthood.
“Not only do I have a tendency to interrupt … but the main problem I have is, you need to think before you say something that can offend other people, or when you ask too many questions … they’ll say it makes them feel uncomfortable,” one participant said.
- Feeling misunderstood
“Friendships for children and adolescents with ADHD were fraught with misunderstandings,” the authors wrote.
One participant described how her friends kidded her about her problem.
“I have friends who say, ‘Oh, it’s my ADD and I don’t want to do my work. It’s my ADD kicking in.’ … and they’ll say it in front of me when they know I have it … and I’ll have it the rest of my life. I’ve gotten very mad at them,” the participant explained.
One participant suggested those with ADHD find friends who understand and will call out their names or tap them on the shoulder when they’re “zoned out.”
In 2003, according to the Centers for Disease Control and Prevention, nearly 8 percent of school-aged children were reported to have ADHD.
I don’t mean to suggest that the themes in the study are unique to those with ADHD, but I do think the research provides a window into how adults with ADHD think and the difficulties they face.
Parents of children with ADHD ought to take a look at it to see what their kids may say about their upbringing a decade from now.
Check out a blog in The New York Times on the study here. To read the study, click here.
For health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Healthy Heart Fair
The Fifteenth Annual Healthy Heart Fair will be from 9 a.m. to 1 p.m. Saturday at the Oklahoma City Community College Union Building, 7777 South May Avenue.
People from across the state are invited to have their cardiovascular health evaluated via a free health screening (fasting is not required for the screening) including cholesterol, blood pressure, glucose and body fat analysis. Attendees can also learn the signs and symptoms of an ailing heart while trained staff will be on-hand to give CPR classes.
An “Ask the Cardiologist” booth will be set up for those that need answers to their heart health questions.
Three one-hour presentations will also be given:
9:30 a.m.
Kris Mullins, M.D.
Heart Checkup: The Many Cardiac Tests Available at Integris Heart Hospital
10:30 a.m.
Terrie Gibson, M.D.
Herbal Medicines: Helpful or Harmful?
11:30 a.m.
Terrie Gibson, M.D.
Health Screenings: Which Ones to Get, Which Ones to Skip
The Healthy Heart Fair is sponsored by Integris Heart Hospital at Baptist Medical Center.
For health and medical news and commentary, visit The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
