West Nile virus season ended a few months ago in Oklahoma, but many Oklahomans are still working to recover from the virus.

For the past few months, I’ve been writing about Bob Matthews, an Oklahoma City resident who contracted West Nile virus and was paralyzed because of it.

Bob Matthews is comforted by his wife, BJ Matthews, as he continues to recover from the effects of West Nile Virus in Oklahoma City, Friday, August 10, 2012. Photo by Bryan Terry, The Oklahoman

Recovering from West Nile virus is not easy. It can be a slow and painful process.

Bob told me in December:

“Therapy is painful, but it has to be because they’re stretching those muscles,” he said. “It’s nothing that’s intentional. It’s just something that comes with the territory.”

The Matthews family is one of many that has been affected by West Nile virus this past year.

Over the past several months, 15 people in Oklahoma have been reported dead because of West Nile virus. A total of 180 residents have contracted the virus since last summer.

These numbers are much higher than Oklahoma’s previous record — in 2007, the state saw 107 cases of West Nile virus and nine deaths.

Health officials think West Nile virus first entered North America in 1999.  The virus is spread through contact with an infected mosquito and can cause serious symptoms, especially in adults older than 50.

The 15 Oklahoma residents who died ranged in age from 47 to 87 years old. As you can see from this map, they were from across the state.

They include Bill Brady, a 77-year-old grandfather from Healdton; Jon Gumerson, a former Guthrie mayor; and Doug Brecht, a former OU women’s golf coach.

Because if it weren’t for Mississippi — and generally, West Virginia and Louisiana — Oklahoma would come in last in a variety of health rankings.

But, really — Are we doing that much better? Let’s take a look.

Each year, the United Health Foundation comes out with its annual report, known as America’s Health Rankings. Although the rankings aren’t the end-all be-all of health rankings, our state leaders pay a fair amount of attention to them. That’s because the rankings provide an overall idea of how Oklahoma is doing in a range of categories.

The good news is, Oklahoma improved its ranking this past year. The bad news? We’re still in the bottom 10.

Oklahoma ranked No. 43 in overall health in the national report, the highest ranking the state has received in eight years.

Meanwhile, the top five worst states were  South Carolina (No. 46), West Virginia (No. 47), Arkansas (No. 48), Louisiana (tied No. 49) and Mississippi (No. 49). Meanwhile, Vermont ranked best for overall health.

As you can see from the comparisons below, in some instances, we’re not that far off from sinking back toward the bottom.

Gov. Mary Fallin has said, rather than expanding Oklahoma’s Medicaid program, Oklahoma will instead create its own health plan that will focus on the future health of residents.

I’m curious about what that plan will be. Oklahoma has some of the highest rates in the nation in obesity, diabetes, heart disease, cancer and stroke, and we have a major shortage of primary care doctors. We also eat the fewest fruits and vegetables of any state. And, to top all of that off, poverty in Oklahoma is at a 10-year high.

The solutions for our state won’t be simple, and it will be interesting to see how receptive our lawmakers will be to Fallin’s plan. In her State of the State address, Gov. Fallin came out in support of a bill before the Oklahoma Legislature that would have allowed cities to make their own smoking laws, an idea that multiple lawmakers have shot down in committee.

The Centers for Disease Control and Prevention has confirmed 35 cases of the rare form of meningitis in six states, and at least five deaths, all associated with the outbreak.

A Massachusetts compounding pharmacy, the New England Compounding Center, is under federal investigation after three lots of a steroid used to treat back pain that the center shipped to 23 states were thought to be the cause of the outbreak.

States where the lots were shipped include: California, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana , Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, Nevada, New York, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, Texas and West Virginia.

The New England Compounding Center does have a license from the Oklahoma State Board of Pharmacy. This means there could be products from the compounding center in Oklahoma. It’s not known whether products outside of the contaminated lot are also contaminated, for the federal investigation is ongoing.

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

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