Monthly Archives: July 2009

Is it a stroke? Diagnosing by email

Deviated tongue in Golden Retriever

Source: Down Maine Veterinary Clinic

Click photo for larger view.

There’s an email that makes the rounds on the Internet about three signs for identifying a stroke: Can the person smile, raise both arms, and speak a simple sentence.
“The Smile Test” was originally presented at a conference hosted by the American Stroke Association (ASA) in 2003. The ASA makes a point of not endorsing this test as a way to identify stroke. The research that came up with these three signs was based on a very small study.

Stick out your tongue

Since 2006 there’s been an additional sign of stroke circulating in emails: Ask the person to stick out their tongue and see if comes out straight or if it’s “crooked,” that is, if it deviates to one side. This is a less reliable indicator of stroke simply because “crooked” is open to interpretation.

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Without the public option, it's not health care reform

Howard Dean is not one of my favorite politicians, but he has a good point about leaving the public option out of health care reform.
Dean and former Senate Majority Leader Bill Frist, both MDs, were interviewed last night on the Charlie Rose Show. Towards the end of the interview, Rose asked Dean about Democratic liberals in Congress. Would the Democratic left rebel against the President if there was no public option in health care legislation?
“I hope so,” Dean replied.
Dean went on to make the argument that, without the public option, the legislation simply amounts to insurance reform. Certainly that’s worth something. It would be great if insurance companies could no longer cancel a policy once someone got sick. Or refuse coverage for a pre-existing condition. But insurance reform, by itself, doesn’t require any spending. And this is an $800 billion bill.

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Get thee glass eyes

Telescope in the eyeMy mother was decidedly vain her whole life. She’d been exceptionally good looking in her youth, which made it especially difficult to accept the slow physical decay of aging.

Surely it must be easier in our culture to accept the wrinkles, sags and bulges that come with advancing age if one has never thought of oneself as particularly attractive. Or if one has cared little about appearances. Admittedly, this is an increasingly rare point of view in contemporary Western societies.

My mother slept in her wig. She didn’t want anyone to see her bald spot, in case she died in her sleep. The bald spot was caused by the wig, which she wore because her hair had turned gray.

Scientists have not yet discovered that vanity is transmitted through the genes. Macular degeneration, on the other hand, is genetically transmitted. When my mother died of a heart attack at age 91, the doctor told her children she was about to be declared legally blind. She had macular degeneration and had never mentioned it to anyone.
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You want salt with that Moons Over My Hammy?

You already know Denny’s doesn’t exactly serve health food, so is it worth getting worked up over how much salt is in a typical Denny’s meal? The Center for Science in the Public Interest (CSPI) thinks so. They’ve initiated a lawsuit against Denny’s over the salt content of their meals.
Salt is 40% sodium, and it’s the sodium you want to limit in your diet, especially if you have high blood pressure. The recommended amount of sodium in the daily diet of a normal, healthy person is 2,300 mg. People with high blood pressure are advised to limit their sodium to 1,500 mg. The lawsuit claims that 75% of Denny’s meals contain more than 1,500 mg and that this puts the health of unsuspecting diners in jeopardy.
Not only is there too much salt at Denny’s, but it’s almost impossible to find out how much you’re eating. Some information is online, and if you’re very persistent, you may be able to get one of Denny’s little pamphlets with nutritional facts. According to the lawsuit (PDF), however, “the nutrition information available from Denny’s is so incomprehensible that calculation of each meal’s sodium content is impossible for the reasonable consumer to perform.”

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Health care reform: Politics and substance

With health care reform reduced to a sporting event – or as Hendrik Hertzberg calls it in the latest New Yorker, a brawl — I sometimes find myself wishing I lived in a benevolent dictatorship. (Just kidding.)
As President Obama pointed out in his press conference on health care last week, his political opponents see the derailment of health care reform as a big political win for the Republicans. He quoted Republican Senator Jim DeMint: “If we’re able to stop Obama on this, it will be his Waterloo. It will break him.”
Why does Obama continue to pursue Republican votes?

The politics: Is bipartisanship worth it?

Adam Nagourney, veteran political journalist for The New York Times, has an excellent article that addresses this issue. Here are some points to consider:

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My limbs are made glorious

As a follow-up to yesterday’s post on joyful dancing, here’s the video Where the Hell is Matt? Thanks to a Rosen Method friend, Joanna, for sending it.


The video includes dancing in 42 countries. I especially like the crabs on the beach on Christmas Island, Australia and the dog in Kuwait City. And that short kid on the left in Sydney who dances by kicking his legs out to the side? I love to do that. It just happens! Everybody loves to dance. It doesn’t matter how you do it. Read more

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Dance for joy: Rosen Method Movement and a Minnesota wedding

When I try to explain Rosen Method Movement (RMM) to people, I like to quote Marion Rosen on the way you feel after a movement class: “Our goal is to make people feel happy and motivated to dance, rather than drag themselves around. We would like them to feel physically well when their bodies move, and emotionally cheerful.”

The secret to Rosen movement classes is the music. Everyone responds to rhythm with their muscles, bones, and soul. With the right music, you just can’t help moving. When you move with a group, the joy is contagious.

I’m a Rosen movement teacher, so it’s no wonder I was moved to tears watching this Minnesota bridal party express their joy as they move down the aisle, feeling the music with their bodies and souls.

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Obama's press conference: Health care as a herd of rhinos

Nick Brandt: Three Rhinos

Source: Nick Brandt

Click photo for larger view.

My favorite conservative columnist, David Brooks, responded to Barack Obama’s press conference on health care this week with a piece that characterizes rising costs as a “stampede of big ugly rhinos. They are trampling your crops, stomping on your children’s play areas and spoiling your hunting grounds.”
Despite our best efforts to control cost inflation — research, legislation, corporate reform — the rhinos keep coming. “They are ubiquitous, powerful, protean and inexorable.”

They feed on fuel sources deep in our system: expensive technological progress, the self-interest of the millions of people who make their living off the system, the public’s desire to get the best care for nothing, the fee-for-service payment system and so on.
The rhinos are closing off your future.

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Why bike when you can trikke?

girl-on-trikkeThe trikke (pronounced “trike”) is essentially a scooter with two wheels at the rear instead of one. You don’t push your feet against the ground to go forward, however. You lean from side to side, similar to the way you’d propel yourself on skis. It takes a little practice, but it’s not hard to learn. If you watch the video at the end of this post, you can see how it’s done.

Fans of trikking claim that it’s great exercise. On a bike, you use your legs. They move the pedals, which drive a chain, which turns a wheel. On a trikke, you use your whole body to create forward motion. You can even alternate between using your upper body to tilt the handlebars from side to side, using your pelvis to sway the trikke from side to side, or using a combination of both. Riders claim it has the potential to use and tone all the muscles in the body. Read more

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Things that make you go "Oooohhhh!" Why we can’t resist babies

angelina-jolieMascara, eye-liner, and shadow can make the eyes stand out and look much larger than they actually are. Lipstick can make the lips look rounder and puffier. Why do we find this attractive? Properly applied, eye make-up and lipstick will emphasize facial features that make an adult look more like a baby. And we are irresistibly attracted to the faces of babies.

What is it about the way babies look that makes them so cute?

babyIn addition to those eyes that are extra large compared to the size of their heads, babies’ foreheads are large for their faces, and their heads are large relative to their bodies. They have soft, round, non-angular features. Their cheeks are large and puffy, with no visible cheekbones. Their little hands and fingers, and the joints on their stubby arms and legs, are soft and dimpled.

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Want your wallet returned? Include a baby pic

wallet-with-baby-picIf you want to increase the chances recovering a lost wallet, be sure to include baby photos.

Researchers set up an experiment in which 240 wallets were left on the streets of Edinburgh. Some of the wallets had photos, either a baby, a cute puppy, a family snapshot, or an elderly couple. One group of wallets contained a card indicating a recent charity donation. The last group was a control: No photos, no cards. None of the wallets contained money. All of the wallets contained a return address.

42% of the wallets were returned. Did the photos make a difference? Here are the results for the returned wallets:

  • Photo of infant – 88% return rate
  • Photo of puppy – 53% returned
  • Family snapshot – 48%
  • Elderly couple – 28%
  • Charity card – 20%
  • Control group – 15%

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How cats control their humans

cat-asking-for-foodNever underestimate a cat. Researchers in Britain have analyzed a special “meow” many cats use when they want something right now: Food, toys, an open door. It’s called a “solicitation purr” and combines a high-frequency cry within an otherwise pleasant purr. Insistent meowing might be ignored as annoying, but by embedding the high-frequency sound in a purr, cats can convey a subtle sense of urgency.

According to Dr. Karen McComb, the lead author of the study, “Solicitation purring is probably more acceptable to humans than overt meowing, which is likely to get cats ejected from the bedroom.”

The experiment was difficult to design, since cats won’t exhibit this behavior on demand. Cat owners learned to record the sounds their cats made when asking for food. Normal purring in a non-solicitation context was also recorded. Test subjects, who listened to the recordings, included individuals who had never owned cats. When asked to evaluate what they heard, the ‘solicitation’ purrs were consistently identified as more urgent and less pleasant.

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Congress finds health insurance industry fundamentally flawed

Henry Waxman

Source: Hogue News

After a year investigating practices of the health insurance industry, a Congressional committee chaired by Representative Henry Waxman concluded that the system is “fundamentally flawed.” Regulations governing insurance are a mishmash of state and federal laws. The insurance industry takes advantage of inconsistencies to engage in “controversial practices.”
According to the federal HIPAA law (Health Insurance Portability and Accountability Act), insurance companies cannot rescind (cancel) a policy unless there has been fraud or intentional misrepresentation. But insurance companies cancel health insurance even when policy holders have done something by accident or unintentionally. (See yesterday’s post: Why health insurance isn’t there when you need it most)

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Why health insurance isn't there when you need it most

Robin Beaton, a retired nurse from Waxahachie, Texas, was diagnosed with an aggressive form of breast cancer in 2008. Fortunately she had health insurance. Three days before she was scheduled for double mastectomy surgery, however, Blue Cross cancelled her insurance. The company claimed she had once seen a doctor for acne and hadn’t disclosed this on her insurance application.
Robin couldn’t have anticipated this. She didn’t know her dermatologist had written a word on her medical record that was misinterpreted by Blue Cross. The doctor immediately tried to intervene with the insurance company, but they wouldn’t budge. First they wanted a three-month review of the last five years of Robin’s medical history, and then they decided just to cancel.

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The Sicko files

Wendell Potter, who was once the head of Public Relations at health insurance giant CIGNA, recently testified before Congress on the nefarious practices of the insurance industry. Last Friday he did an extended interview with Bill Moyers. In the video excerpt below, Moyers and Potter discuss the insurance industry’s comprehensive strategy to discredit Michael Moore’s Sicko.
The insurance industry was extremely nervous about the release of Moore’s film. Their trade association prepared a document full of talking points and tactics for lobbyists and insurance industry staffers. The contents were highly confidential, but not any more. Moyers not only obtained a copy, but has posted the complete document online (PDF). It’s as fascinating as one of those secret tobacco industry memos.

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Is the Internet bad for your health?

Doctor Patient Computer Internet

Source: Mayo Clinic

Do you research medical information on the Internet? Do you use Google as your starting point? Do you read entries on medical conditions at Wikipedia and assume what you read is accurate and complete?
Kevin Pho, primary care physician and author of the popular medical blog KevinMD.com, has a column in USA Today on the use of Wikipedia by patients and doctors:

“I researched my condition on Wikipedia.” That’s what more doctors, myself included, are hearing from patients every day.

One reason online medical research leads to Wikipedia is that two-thirds of health inquiries start with a search engine, such as Google. Wikipedia entries appear near the top of search results. Are patients influenced by what they find? Half of those who did Internet research say it made a difference in how they took care of themselves or someone else.

Pharmaceutical companies caught in the act

Wikipedia is a great resource, and its popularity and success are well-deserved. However, its entries can be manipulated by anyone who values their own profit or reputation more than accuracy.

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Oh #^@%$#!+

Does swearing decrease pain? Definitely, according to a recent study from Keele University. Here are a few details most reports didn’t cover.
Study volunteers were able to hold their non-dominant hand in a bucket of ice water (41° F) for two minutes while swearing, but for only one minute and 15 seconds while refraining from the use of expletives.
Before subjecting themselves to pain, the volunteers were asked to come up with five words they might use if they hit their thumb with a hammer. One test subject had to be eliminated because none of his words were curse words. Since the study was in England, a common choice was “bullocks.”
It’s not clear why swearing helps relieve pain. The author of the study, Richard Stephens, speculates that it activates the fight-or-flight response, which produces physiological changes.
He suggests it might be a good idea to refrain from swearing in casual, non-painful situations. “Swearing is emotional language but if you overuse it, it loses its emotional attachment.”

Sources:

(Links will open in a separate window or tab.)

Swearing ‘helps to reduce pain’, BBC News, July 13, 2009
Nicholas Bakalar, Cursing and Pain Relief, The New York Times, July 13, 2009
Detecting Cold, Feeling Pain: Study Reveals Why Menthol Feels Fresh, ScienceDaily, May 31, 2007

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Sotomayor's diabetes: A legitimate reservation or discrimination?

Sonia Sotomayor

Source: 103.7 The Buzz

Just how important are medical issues when considering a nominee for the Supreme Court? Living to a ripe old age is important, since justices serve for life. Clarity of mind is also important, given the nature of the job. Low blood sugar, for example, could theoretically impair judgment. Both of these health issues have been raised in connection with Supreme Court nominee Sonia Sotomayor’s Type I (juvenile) diabetes.
Diabetes increases the risk of kidney and heart disease, stroke and nerve damage. According to Joana Casas, who’s with the Juvenile Diabetes Research Foundation, “The average life expectancy for people with Type One is lowered by an average of ten years.” According to other sources, a woman with Type I diabetes who has already reached age 50 can expect her life to be shortened by eight years. Sotomayor appears to be healthier than most, with no evidence of eye, kidney, nerve, or heart problems, so her prospects may be even better.

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Will health care reform stop the rising cost of health care?

healthcare-costsAs we get into the nitty-gritty of health care reform, critcs from both left and right are asking whether current proposals will reduce costs. Here we have a historic opportunity to make major changes in health care, but it appears no one is willing to address the problem of escalating costs.

The public insurance option might reduce the cost of insurance by competing with for-profit insurers. But this doesn’t reduce the number of unnecessary procedures. As David Brooks points out in a NY Times column, the public option, as it’s currently formulated, would have no effect on the fundamental incentives that lead to higher costs. Read more

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The enduring benefits of saving children

save-the-children-ethiopiaA child’s health depends on the child’s environment. Children who live in poor households are more likely to die, more likely to suffer the irreversible effects of poor nutrition, and less likely to benefit from a health-care system if one is available.

It’s estimated that 9.2 million children under the age of five die each year in developing countries due to easily preventable or treatable diseases or medical conditions. The international organization Save the Children has published a new report called Lasting Benefits, The role of cash transfers in tackling child mortality. (PDF) It explains why regular donations (cash transfers) to poor communities make a difference, whether the money comes from sponsoring a child, making an online purchase, or a simple donation.
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Help! My child swallowed a magnet (or two)

Children love to put things in their mouths and, unfortunately, there’s always the danger of swallowing small objects. About 80 percent of these “foreign bodies” pass through the digestive system without incident, especially if they’re small and not sharp. Curious children might wonder what would happen if they swallowed a magnet or two. What happens can be a serious problem.
The photo shows an x-ray of a 9-year-old Italian boy who swallowed 23 magnets, some of them round, most of them rectangular. You can actually count all 23, aligned end-to-end like a string of dominos, punctuated by a few large dots.
One small magnet might pass uneventfully through the digestive system. If there are multiple magnets, however, they are very likely to attract each other through the intestinal wall. This can cause severe damage. Problems include cell or tissue death (pressure necrosis), a hole in the intestines (perforation), an abnormal connection between two segments of the intestines (intestinal fistulas), a twisting of the intestines (volvulus) that blocks the passage of food (or magnets), and obstruction.

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Importing drugs from Canada: Will lobbyists win or lose this round?

Canadian Mounty stops drug imports

Artist: Robert Parada. Source: AARP

When a government is directly involved in health care, the sheer size of its purchasing power allows it to negotiate lower prices for drugs. That’s why drugs cost less in Canada over the Internet.
In the US, drug company lobbying is so powerful that it can convince Congress to prohibit the negotiation of discounts (the 2003 Medicare Prescription Drug Act). As if that weren’t enough, it’s illegal for Americans to order drugs from Canada. (You’re allowed to carry a 90-day supply over the border.)
President Obama has, in the past, favored changing legislation that prohibits drug purchases from Canada. (Congress calls this drug reimportation.) John McCain was in favor of change. (It’s a popular position when running for election.) Democrats have been advocating this change for years. Between 70 and 80 percent of Americans favor this option.

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Where does the health care money go?

Man with Money

Source: Newsweek

Well, some of it goes to pay executives at health insurance and pharmaceutical companies.
Here are some income figures for top executives at leading health insurance companies. The numbers are for total compensation in 2008, obtained from proxy statements required by the U.S. Securities and Exchange Commission. The total compensation includes base salary, bonuses, plus an “other” category, which can include things like stock awards and options. It doesn’t include use of the company jet, a car, and 401K contributions.
$24.3 million – Ron Williams – Aetna
$12.2 million – Edward Hanway – CIGNA
$9.8 million – Angela Braly – WellPoint
$9 million – Dale Wolf – Coventry Health Care
$8.8 million – Michael Neidorff – Centene
These numbers come from one of the many Fierce websites on health-related industries, this one from FierceHealthcare: Daily News for Healthcare Executives. There’s more detail on the top ten insurance earners at “Leading health plan CEO paychecks.”

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Big Pharma lobbies against health reform: Big time

According to the Center for Responsive Politics, the pharmaceutical industry spent $1.2 million a day on lobbying during the first quarter of this year. Not surprisingly, the biggest spender has been the largest pharmaceutical lobbying group, PhRMA, which has spent $7 million. Pfizer was a close second at $6 million.
Meanwhile, The Washington Post reports that the largest hospitals, medical groups, and insurers have hired more than 350 lobbyists who are either former government staff members or retired members of Congress. Three out of every four major health-care firms have at least one lobbyist on their payroll who’s been recruited from inside the government. Nearly half of these come from either key Congressional committees that are currently debating health care legislation or from the staff of key lawmakers, such as Senators Max Baucus and Charles Grassley.

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High school students should sleep in

Teenager Dozing Off

There’s a physiological reason why teenagers want to stay up late and sleep as long as they can in the morning. It has to do with the production of melatonin.

The body produces melatonin, a natural hormone related to our daily (circadian) rhythm, about an hour before we’re ready to fall asleep. Before adolescence, melatonin secretion starts about 9:30 PM. In teenagers, this doesn’t happen until an hour later. So teenagers aren’t ready to fall sleep — physiologically — until 11:30 PM or later. They like to sleep later because they still need the same amount of sleep each night as children in elementary school: 9.25 hours.
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Climate change: Bad news for children’s health

Climate change has a much bigger effect on our health than we realize, and it’s possibly the greatest public health threat of the coming century. This is the opinion of pediatrician Aaron Bernstein, quoted in a recent issue of The Journal of the American Medical Association. Consider infectious diseases. As the climate changes, birds, insects… Read more

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Skateboard art: From Adam and Eve to modern medicine

Source: Process Recess Anatomical skateboard art by James Jean. Jean’s statement, which explains skating as the inspiration for his image, is pure poetry. Skating has always seemed to me a courageous activity, and what is courage but an absence of shame. Adam and Eve were expelled from Eden, pitiful in their nakedness, shameful in their… Read more

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Getting health care right: Paris and Amsterdam

Source: Forbes Jonathan Cohn, senior editor at The New Republic, has an article in today’s NY Times on what we can learn from the health systems of other countries. Republican opponents of health care reform are fond of saying: “I don’t want America to begin rationing care to their citizens in the way these other… Read more

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