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After taking a hiatus from The Medicine Bag, I have returned … with a question.

Do you think it’s fair and/or accurate to see Oklahoma ranked at or near the bottom of, well, just about every study of health that comes our way? We can’t be worst in everything health-related, can we?

I say this after reading about Wednesday’s report from The Commonwealth Fund. The nonprofit ranked children’s health in states on 13 indicators that included access to and quality of care, outcomes, equity and cost.

Oklahoma pulled up the rear. Fifty-first. Behind the District of Columbia and Mississippi. Leading the rankings were Iowa, Vermont, Maine, Massachusetts and New Hampshire.

Now, I know the devil’s in the details, and I admit I haven’t looked at the methodology of this report. I usually do, however, which is why I ask about the fairness of all this. I imagine this report would pass muster if you agree what it measures accurately sums up the state of children’s health.

Ah, here’s where it gets tricky: Are the measures used fair? Are small differences in rates or percentages blown out of proportion? Is the information current, or as current as possible?

See the state’s “scorecard” for yourself here.

The interesting thing about these reports is they are all largely slicing and dicing the same data. Sometimes it gets hard to tell them apart.

Anyone who honestly assesses the state’s health will find huge problems. But last or near-last every time? Perhaps I’m becoming desensitized, but my reaction is getting to be “C’mon!?!”

What’s yours? Tell me what you think by posting a comment on this blog.

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

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 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

 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

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

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

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

Many people know someone who stutters or stammers — an embarrassing trait that can cause a lifetime of social misery and discomfort. They won’t raise their hand in class and they try to avoid painfully embarrassing situations. The Memphis-based Stuttering Foundation believes that if parents notice their child beginning to stutter, they should seek help as quickly as possible.

The foundation also offers these seven tips:

1 ) Speak with your child in an unhurried way, pausing frequently. Wait a few seconds after your child finishes speaking before you begin to speak. Your own slow, relaxed speech will be far more effective than any criticism or advice such as “slow down” or “try it again slowly.” 

2) Reduce the number of questions you ask your child. Children speak more freely if they are expressing their own ideas rather than answering an adult’s questions. Instead of asking questions, simply comment on what your child has said, thereby letting him know you heard him.

3 ) Use your facial expressions and other body language to convey to your child that you are listening to the content of her message ,  and not to how she’s talking.  

4 ) Set aside a few minutes at a regular time each day when you can give your undivided attention to your child. During this time, let the child choose what he would like to do. Let him direct you in activities and decide himself whether to talk or not. When you talk during this special time, use slow, calm, and relaxed speech, with plenty of pauses. This quiet, calm time can be a confidence-builder for younger children, letting them know that a parent enjoys their company.  

5) Help all members of the family learn to take turns talking and listening. Children, especially those who stutter, find it much easier to talk when there are few interruptions and they have the listeners’ attention.  

6 ) Observe the way you interact with your child. Try to increase those times that give your child the message that you are listening to her and she has plenty of time to talk. Try to decrease criticisms, rapid speech patterns, interruptions, and questions.  

7) Above all, convey that you accept your child as he is. The most powerful force will be your support of him, whether he stutters or not.

Jim Killackey, Medical Writer