19 March 2011

Many Over Age 65 Not Getting Preventive Health Services

A new report by several U.S. Department of Health and Human Services agencies, says that many people 65 and older are not getting the preventive health services they are entitled to and should be getting. Also Lynda Anderson, director of the Healthy Aging Program at the U.S. Centers for Disease Control and Prevention, said in a CDC news release that millions of Americans are not getting proven clinical preventive services.

Chief among these services are vaccinations for influenza and pneumococcal disease, including bloodstream infections, meningitis, and pneumonia. Also they are not getting help with quitting smoking, or screening for breast cancer, colorectal cancer, diabetes, high cholesterol, and osteoporosis.

With each passing day, about 10,000 Americans turn 65. The authors report that their report shows that there is a need to promote preventive services for older people and especially among minorities. The report also states that these services are not being utilized by many.

The report also suggests that many older adults may not be aware of the preventive services recommended for their age group and probably do not even know that the services are covered by Medicare.

Although the report list some innovative ways of making people aware of these services I was taken by the one suggesting providing flu shots at polling or voting stations on election days. The report also list increasing awareness through the media and providing services in convenient community settings.

"If we can help patients age 65 and older get the recommended preventive screenings and regular immunizations, we could significantly reduce unnecessary illness," Dr. Edward Langston, an American Medical Association board member, said in the news release.

Read the article about the report here.

18 March 2011

Diabetes Risks Go Beyond Heart Disease

I know how people like to get diverted in believing one thing when they need to maintain an open mind. This study should make you realize that believing only in one dimension can be misleading and when you have diabetes, this can be very misleading.

We have all read that having diabetes doubles the risk of having a heart attack or stroke. This in itself is a good thing because it makes many doctors and patients pay closer attention to blood pressure, cholesterol, and other signs of a cardiovascular system that may be in trouble.

The forgotten causes of death are often set aside and little attention paid to them. This study states that 40 percent of deaths in people with diabetes are due to non-cardiovascular causes. Did that get your attention? It should. What are these causes and why should we include them?

For people with diabetes, your risks of dying from kidney disease has tripled, and your risk of death from infection (excluding pneumonia) or liver cancer has more than doubled. Other risks that have increased slightly are other types of cancers. These include ovarian, pancreatic, colorectal, breast, bladder, and lung cancers.

If you are still not convinced, diabetes raises the risk of death from Alzheimer's disease, chronic obstructive pulmonary disease (COPD), falls, nervous system disorders, digestive disorders, suicide, and liver disease. The study shows that even after accounting for the effects of other influences on the risk of death like body mass index (BMI), age, sex, and smoking, the above risks still remain. And lest anybody forget you can also die from natural causes and that risk seems to remain without the other risks. It is just that this risk does not go away.

This should be a wake up call to doctors and patients to be alert for non-cardiovascular causes as well as cardiovascular risks. Everyone with diabetes should be screened for cancer regularly and regular checks made for the liver and kidney functions. Infections need attention promptly by a doctor by the patient reporting visible ones and the doctor continuing to monitor white cells counts and using other tests.

The patient needs to keep vaccinations current when applicable, especially for pneumonia, hepatitis, and others. Read my blog here for the checklist and then enjoy the article about non-cardiovascular death risks here.

If I have caused fear, that was not intended. What I am seeking is to wake you up to things you may have put out of your mind because your cholesterol, blood pressure, and other cardiovascular problems are in control. You need to work on the other areas while managing the in control areas.

17 March 2011

AHA "Sets the Record Straight" on Bariatric Surgery

The American Heart Association (AHA) on March 14, 2001 published a statement declaring that the AHA only supports bariatric surgery for the severely obese patients who have exhausted all other options to lose weight to lessen their cardiovascular risk.

This I am happy to see as after yesterdays announcement by the International Association for the Study of Obesity in London, United Kingdom suggests bariatric surgery for the pediatric population. While the statement was issued with the appropriate cautions, I was beginning to wonder where the bariatric surgeons were going to stop in their quest for additional patients to increase their cash flow.

At least now there is a voice of reason for not having this extreme surgery. The obesity committee of the AHA Council on Nutrition, Physical Activity, and Metabolism summarizes the most current data on bariatric surgery. "Medical experience acquired up to now supports the efficiency and safety of surgery for weight loss in severely obese patients on the basis of metabolic profile, cardiac structure and function, and related disorders," including diabetes, dyslipidemia, liver disease, systematic hypertension, and sleep apnea. However, the surgery has historically carried an operative mortality risk between 0.1% and 2.0%, and complications include pulmonary embolus, anastomotic leaks, bleeding, anastomotic stricture, anastomotic ulcers, hernias, band slippage, and behavioral maladaptation.

A lot of medical terms are part of the statement, but looking them up was a good lesson in the types of problems encountered and left out of many discussions because people (bariatric surgeons and advocates) intentionally do not want to scare people away.

The definition for anastomotic is derived from anastomosis which means in anatomy, communication between blood vessels by means of collateral channels, especially when usual routes are obstructed. Another meaning is Surgery, Pathology, a joining of or opening between two organs or spaces that normally are not connected. Hope this helps in your understanding.

With this from the AHA, hopefully other medical organizations will add their voice to the discussion against bariatric surgery except for extreme cases. It is time that some science has been added to the discussion and that we can rely on something beside emotion and desire to add to retirement accounts. Hopefully the FDA is listening, but don't count on them soon.

Read the article by the AHA here and the British article here.

16 March 2011

Quality Issues in Websites For Diabetes

A study about the unreliable internet as a source for information about diabetes has surfaced. And a doctor has blogged about it. While he loves the study, he says that patients will continue to ignore him and believe what they read on the internet.

If, and I say if, he was taking a positive attitude about the internet and his recommendations, more of his patients would listen to him. Rather than denouncing the internet, he should take the time to find some of the excellent sites for his patients and recommend they read them. This may be difficult for him as he seems to fail in understanding the dynamics of his patients. It certainly is not the internet as he makes use of it with some success.

Where I do agree with this doctor is the unreliable sites selling “snake oils” and “cures” which we know have only short-term benefits if even then, There are many such sites and when they are called into question, they just change their name and internet service provider and are back in business. I wish there was a way to regulate them, but that is not likely to happen. So the best we can do is ignore them and let people know when they ask about this or that site, how wrong that site is.

I would also agree with the doctor that there are a lot of very misinformed sites and sites putting out very poor messages. These can do almost as much damage as the “snake oil” sites.

Then there are some sites that do not follow the American Diabetes Association's guide and are varying in the recommendations to work for HbA1c's below 7.0 or the American Association of Clinical Endocrinologists recommendation of 6.5 for A1c. Often these sites encourage people with diabetes to work toward a goal of 5.0 or lower. They also tend to encourage more frequent testing of blood glucose levels which the doctors discourage and the medical insurance industry will not reimburse for. I even take this tack and am doing this myself because it has helped in my control. I know why and the reasons behind what I am doing and not blindly following some ideas. I have adjusted for my age and how my body reacts. This is what people need to understand.

This encouragement of more testing is done for the purpose of aiding the patients to understand how foods and other conditions affect their own body to help them develop healthier eating habits based on their own body chemistry. This can be an excellent tool for people to overcome the initial fear of what they can eat and to settle into a variety of foods generally more healthy than they have been eating.

There are many excellent sites on the internet about diabetes, but everyone needs to be aware of the charlatans. Read about the study here to get more information.

15 March 2011

ACOs Can Be Labeled as HMOs

If you are looking for something about the new healthcare plan, you may have found very little that is not technical and very hard to read and make sense from what the writer says. Accountable Care Organizations (ACO) are just that and why the bill passed. Our government will shortly control where the money goes and who gets treated and who does not.

This blog by John Goodman does an excellent job of laying out what is about to happen for us, the patients as well as our hospitals and doctors. The picture does not look good. Medical care rationing will be the name of the business and if they can determine that you are not following the rules, you may find yourself on the short list for medical care rationing.

Those of us that are past the age of 65 had long feared this, but now this may be expanded to people of all ages. Anyone that will use up resources (money) to be treated for chronic diseases will find themselves on the list for medical care rationing whether we desire to be there or not. Those outside the system can forget about medical care unless they have the money to pay for treatment and not draw support (money) from the ACOs.

ACOs are essentially HMOs on steroids. The medical insurance industry will not have a choice in how they insure as they will be required to have ACO plans. This will mean that if your doctor is not a member of an ACO the medical care will not be fully reimbursed and most likely you will not be able to get treated unless you can afford to pay the difference. Co-pays will then mean any part of the bill not covered.

This is how they were able to bypass the “universal healthcare” that the Congress and administration so desperately wanted. You will either have an “ACO plan” or you will not be treated unless you can afford to pay all costs.

Please read the blog by John Goodman.

14 March 2011

Diabetes Often Not Diagnosed or Treated Properly

At one time I believed that America had an excellent core of doctors. We may still have this, but the numbers have decreased dramatically if I am reading my research correctly. This is disturbing and even my current team of doctors is beginning to concern me as some are not paying attention to the list of medications I am currently taking when they prescribe a new medication. Even my pharmacist did not have the courtesy to check.

HealthDay News in an article published on March 4 talks about a study done in seven countries which included the United States. The article said that nearly 90 percent of U.S. adult diabetics 35 years of age and older are receiving ineffective treatment of blood sugar, blood pressure and cholesterol. This is disturbing for several reasons and when they say that people diagnosed with diabetes do not receive treatment for other cardiovascular risks that are just a dangerous as unmanaged blood sugar.

This study is published in the March edition of the Bulletin of the World Health Organization. What bothers me is the statement that too many people are not being properly diagnosed with diabetes and related cardiovascular disease risk factors. Those who are diagnosed aren't being effectively treated.

That this is happening in this country is understandable when we have the American Diabetes Association (ADA) that is functioning for the interest of fund raising and the medical community and not for the interest of patients. They give lip service to the patients and do nothing to upset the medical community. Their mantra of carbs, carbs and more carbs does not work for many people with diabetes. Will they change this? They have tempered it slightly to allow for individual differences, but give no real guidance about this and continue to stress the value of carbohydrates.

With the continuing evidence coming out about the dangers of whole grains and that fat being not problem, the ADA is not working with the American Heart Association to correct the errors. They also are not working with the American Association of Diabetes Educators or the American Dietitian Association to set the records straight and get them off their mantra of carbs, whole grains, and low fat. It seems that these groups are pushing this mantra even more enthusiastically.

So it is easy to understand why 90 percent of the U.S. adults with diabetes are receiving poor treatments for blood sugar, blood pressure, and cholesterol. With the medical community not being pushed to improve, this can only get worse. Then with studies like the ACCORD study warning the medical community to not use tight interventions for older patients with diabetes, no improvements are likely to be made.

Read this short article here, and a longer article here.