October 17th, 2008 by Dr. Val Jones in Patient Interviews
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Deanna and Rebecca Sherman
As many as 15% of Americans have a blood disorder (called anti-phospholipid antibody syndrome – APS) that can increase their risk for blood clots and stroke. While these antibodies are especially common in people with certain auto-immune diseases like SLE (systemic lupus erethematosis – or “lupus”) quite a few people have them without ever knowing it. In fact, most people with APS remain asymptomatic their entire lives – but for an unlucky few, the disorder can cause devastating consequences.
I interviewed Rebecca Sherman about her recent stroke caused by APS. Listen to the podcast here.
Dr. Val: Tell me about the events leading up to your stroke.
Sherman: I was a young, healthy 32-year-old with no idea that I had anti-phospholipid antibodies in my blood. One morning when I was washing my face at my boyfriend’s house I suddenly noticed that one side of it was frozen. I was standing in front of the bathroom sink and I fell to the floor with the washcloth in my hand. I couldn’t walk or talk – the whole right side of my body didn’t do what I wanted it to do. So I threw the washcloth at my boyfriend’s head (with my left hand). Luckily my aim was good (he was asleep in bed) and the bed was near the door to the bathroom – the cold, wet object caused him to jump out of bed and find me. Read more »
July 14th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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I had the chance to speak with John Rother, Executive Vice President of Policy and Strategy for the AARP about the intersection of online health, information technology (IT), and the baby boomer generation. Find out what America’s most powerful boomer organization thinks about the future of healthcare in this country.
*Listen to the podcast*
Dr. Val: Recent studies suggest that Americans age 50 and older are more Internet savvy than ever before. How are AARP members using the Internet to manage their health?
Rother: People over the age of 50 are the fastest growing set of online users, and healthcare is the major reason why they’re going online. They’re looking for health related news, help with diagnosis, and finding appropriate healthcare providers.
Dr. Val: What role can online community play in encouraging people to engage in healthy lifestyles that may prevent chronic disease?
Rother: Our experience is that online communities can be extremely helpful in several ways. First, it provides emotional support for people who have a shared experience, whether it’s as a caregiver, or being recently diagnosed with a disease or condition. Second, people seem to feel more comfortable asking questions of others with their condition than they do their own physicians. And third, online communities can reinforce needed behavior change. Whether it’s weight loss, exercise, or quitting smoking – online communities can be just as effective in encouraging behavior change as a face-to-face community.
Dr. Val: Tell me a little bit about the communities on the AARP website.
Rother: Currently our communities are organized around medical topics, but in the future I think the communities will become more geographical. An online community designed to serve the needs of people in a given location can facilitate information sharing about how to navigate a particular hospital system, for example, instead of just general information about coping with a disease or condition.
Dr. Val: Intel just announced that it has FDA approval for its “Intel Health Guide.” The unit enables caregivers to provide their patients with more-personalized care at home, while also empowering patients to take a more-active role in their own care. What do you think of this technology?
Rother: I think information technology is going to have all kinds of beneficial applications for people with health challenges. Personal health records and this Intel Health Guide are very well suited to the needs of individuals with chronic health conditions, and I expect to see more Internet based tools developed to help people to make appropriate decisions and change their behavior.
General information is helpful, but personalized information is the key. The more these technologies allow you to have your own individual information at your fingertips and allow that to be the basis for recommendations and decision support, the more powerful it’s going to be. This is all very promising technology – the next question is, can people afford it and will the people who need it be able to use it?
Dr. Val: In your opinion, what role does health IT have in reducing healthcare costs and improving access to care?
Rother: Health IT can support almost every aspect of healthcare. It can decrease costs by reducing duplication. Many people with chronic conditions see different doctors – and if you have to go through the same set of X-rays or CT scans every time you see a different doctor, that can get very expensive. A good, common medical record system is critical in reducing costs and improving care.
IT can also reduce the cost of health insurance, in the way that online car insurance has reduced car insurance premiums. If we reform our health insurance market, this could offer substantial savings to individuals.
People often use the Emergency Department inappropriately – for minor issues instead of true emergencies. A good decision support system that helps people to figure out when they need to go the ER could be helpful in reducing costs.
Dr. Val: What are the AARP’s major health-oriented initiatives?
Rother: The AARP is very focused on healthcare because our members tell us that it’s their top priority. The cost, quality, safety and accessibility of healthcare are important to us, so we are involved in a broad spectrum of initiatives.
First of all, extending coverage to all Americans, regardless of their age or health condition, is a top priority for the AARP. Second, In terms of health quality, it varies quite broadly among hospitals in the US. If we could get everyone to copy the best hospital practices, we’d have a much more manageable problem.
Dr. Val: What needs to happen to America’s healthcare system in order for it to serve the needs of baby boomers on its limited budget?
Rother: We spend almost 2.5 trillion dollars for healthcare in the United States, so I don’t think of it as a limited budget, but quite an expansive budget. There is enough money in the system to fully respond to the needs of the population. It’s just that we’re not organized very well and the system has become fragmented.
The healthcare system needs to be organized in a more person-centered way, and we need it to shift from a focus on acute care to a chronic care model. We need a different system of health delivery – one that relies more on nurses and other physician extenders. People need to join support groups to modify their behaviors and risk factors and rely on IT to help them make appropriate decisions.
So you put that all together and you have a pretty big agenda for change. I don’t know if we can achieve this all at once, or if it will occupy us for several years. The upcoming election gives us the opportunity to do this at the Federal level, though there are many private sector initiatives that are currently making important contributions.
Dr. Val: Can you give me an example of someone in the private sector who’s making an important contribution to improving healthcare?
Rother: The AARP just met with the leadership of the Mayo Clinic, one of the most outstanding medical institutions in the country. They provide excellent care at a cost that is less than most other parts of the healthcare system – and with improved outcomes. We asked them about their secret to success.
Mayo has an electronic medical record and all their patients have their information online. The physicians are on salary, so there’s no incentive to order unnecessary tests or procedures, and Mayo has an ethic of patient-centered care, with a long history of attracting the best people and rewarding them.
If Mayo can do it, why can’t everyone else? The AARP believes that the potential is there for most communities to have excellent care – we must emulate the care delivery of institutions like the Mayo Clinic, and put in place payment and information systems that will coordinate care management better. It’s a big job and will take some investment, but we have many opportunities to do a better job than we’re doing today.
*Listen to the podcast*
*Learn more about preventing chronic disease*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
July 9th, 2008 by Dr. Val Jones in Celebrity Interviews, Expert Interviews
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I had the pleasure of interviewing Jeanette Bolden, US women’s track and field coach for the Beijing Olympics, about her life-long struggle with asthma and her thoughts on the upcoming Olympics. We were joined by her physician, Dr. Bobby Lanier, on a fascinating call about how the environment in Beijing might affect Olympic athletes and visitors to China.
*Listen to the podcast*
Dr. Val: What was it like growing up with severe asthma? How did you cope?
Bolden: I’ve had asthma all my life, and unfortunately, when I was young my mom used the Emergency Department as the primary source of treatment for my asthma. So I was in and out of the emergency room all the time and my asthma was really out of control. Things got so bad that I was actually sent to a home for asthmatic children, where I had to live for 9 months – away from my family. I did learn how to manage my asthma with the help of the people at the home, and learned to be much less afraid of it.
However, I had problems with other kids picking on me because of my illness. I used to carry my inhaler in my sock and one time it fell out and a boy picked it up and started spraying it all over the place and shouting “asthma face” and “spasma girl” and he would tell others not to play with “asthma girl.”
Dr. Val: What got you interested in track and field? Did anyone discourage you from athletics because of your asthma?
Bolden: When I returned from the home for asthmatic children, I was a pretty normal kid – and I liked to run and play outdoors. One day I was with my younger sister at a park and we met a local track and field coach – so I asked if I could join his team. I told him that I had asthma and was worried that he wouldn’t want me on the team. However, he really surprised me and simply said, “If it doesn’t bother you, it doesn’t bother me.”
Although my dad was worried about me running and having a potential asthma attack, my mom always encouraged me to do my best and not let it hinder me.
Once I started winning races, my asthma became more acceptable. I don’t think I would have accomplished as much in my career if I didn’t have asthma – because it drove me to strive harder to prove myself to others and to show those kids who picked on me that nothing would stop me from excelling.
Dr. Val: How did you manage your asthma when you were at the 1984 Olympics?
Bolden: I had to submit a letter to the United States Olympic committee about my asthma, along with a note from my doctor about the medications I was taking. I always kept my inhaler nearby (though not necessarily in my sock) and tried to stay away from things that I was allergic to.
Dr. Val: What was the turning point for you – to get your asthma under control?
Bolden: My doctors always told me that I’d outgrow my asthma. I’m now 48 years old and still have it. And it wasn’t until lately that I understood that I have a specific type of asthma, called allergic asthma, which responds really well to a new medicine called Xolair (omalizumab). That medicine has made a real difference for me.
Dr. Val: Dr. Lanier, can you explain a little bit about monoclonal antibodies and how they’re now being used to reduce asthma symptoms?
Dr. Lanier: We’ve had effective medicines for the treatment of asthma for a long time, but a lot of them rely on inhaled steroids, which are not healthy for people (especially women) to take long term. So research has focused on getting to the root cause of asthma. About 60% of people who have asthma also have allergies – and we refer to this as “allergic asthma.” Allergies are caused primarily by a certain type of antibody in the blood stream known as IgE (immunoglobulin E). The “Holy Grail” of asthma treatment is to find a way to selectively cripple IgE without affecting the rest of the body.
Xolair is a targeted therapy that sticks to IgE and removes it from the body. It’s like taking away the fuel for the allergic process and this dramatically helps some people.
Dr. Val: Are there any risks associated with Xolair?
Dr. Lanier: There have been reports of people having an allergic reaction to Xolair, but I’ve never seen a patient with this problem, and I’ve treated hundreds of people with the medication. However, I’m always careful to watch out for a potential reaction. In my opinion the risks associated with Xolair are lower than those of standard therapy (steroids) – and when you’re removing IgE from the system, you’re really attacking the disease at its root.
Dr. Val: Jeanette, how did you become the coach of the 2008 women’s track and field team?
Bolden: I was voted to be the coach by my peers in track and field. There are criteria that they use for the selection process, and eligible candidates must have 1) been an Olympian 2) been a coach for a number of years 3) coached Olympians. There is an Olympic coach committee that handles the selection process and I’m pleased that they chose me. My commitment lasts three years and is over on the last day of the Olympics, 2008.
Dr. Val: What is the “asthma on track” program?
Bolden: It’s a fantastic online resource for people to learn more about allergic asthma, IgE testing, and how to find a specialist who can help. People can also learn more about my story on the website. I think education is really important because it’s the only way to free yourself from the fear of an asthma attack. My hope is that this website will teach people with allergic asthma that they don’t have to sit on the sidelines and watch life pass them by. The proper treatment program can put people back in control of their lives so they can train to become Olympians if they want to. And for me, the proper therapy has allowed me to enjoy having my dog live in the house with me for the first time. This makes both of us really happy.
Dr. Val: Do any of this year’s US women’s track and field team members have asthma?
Bolden: Asthma is the leading cause of absenteeism among school age kids. I’m sure that there will be individuals who make the team and also have asthma.
Dr. Val: Tell me about the environmental conditions in Beijing – what are you worried about as a coach?
Bolden: We’ve all heard about the pollution problem – though the Chinese government has scheduled factory and industrial shut downs many months prior to the Olympics. I really think that the main issues are the heat and the humidity, though. And since the Olympic trials are being held in Eugene, Oregon – where it’s been really hot and humid – the athletes will be well-prepared for Beijing.
Dr. Val: Dr. Lanier – as a physician, what are your concerns about environmental risks to Olympians in Beijing this summer?
Dr. Lanier: I don’t think the environmental risks are going to be as great as some think. If you look at historical paintings of Beijing dating back hundreds of years, you’ll always see a foggy cloud around it. That’s just the microclimate of that area of the world. However, there has been significant construction in the area recently – half the steel in the world went to China last year and a lot of that went to Beijing.
I’ve been going to Beijing multiple times a year for 10-15 years now, and although the construction effort has been extensive, I think that with the steps that the Chinese government is taking to improve air quality will make a big difference. It’s also interesting that the incidence of asthma in China overall is much lower than it is in the United States.
Dr. Val: Are visitors with allergic asthma at risk of having flare ups in Beijing?
Dr. Lanier: I think they actually have a lower risk than they would inside the United States. Allergic reactions are a defensive response from the body, and ordinarily that requires that you’ve had a prior exposure to the allergen. People going to Beijing for the first time have never been exposed to their native pollens, so I think the allergic asthma issues will be greatly reduced.
However the heat and humidity, exercise-induced asthma, and upper respiratory tract infections (that come from large crowds of people being in close contact) could all be problematic in Beijing.
Dr. Val: What general medical advice do you have for people traveling to Beijing?
Dr. Lanier: The most important thing for travelers (no matter where they’re flying) is to carry their medications with them in their carry-on luggage. Don’t take your pills out of their original bottles, because you may need the exact prescription labels. That way, even if your luggage is lost, you won’t miss any doses of medicine.
There are some vaccines that are recommended for people traveling to China, so people should check with their doctors before they go.
As far as food is concerned, I think that people will be pleasantly surprised by the variety and quality of food available. Food borne illnesses like salmonella are not common in Beijing, but I can’t speak for the surrounding countryside. Of course, it’s always wise to drink bottled water and not eat unwashed foods that may have been handled by many individuals – like grapes for example.
Dr. Val: Do you have any final thoughts about Beijing?
Bolden: I’m looking forward to a fantastic Olympic games. We have so many wonderful Olympic athletes this year – I just know it’s going to be great.
***
Jeanette Bolden is the head coach of the 2008 U.S. Olympic Women’s Track & Field team and the head coach at UCLA, her alma mater. At the 1984 Los Angeles Olympics, she won gold in the sprint relay despite a life-long struggle with asthma. Jeanette is preparing her team of athletes to compete in Beijing this summer – a city known for its asthma-inducing pollution.
Dr. Bobby Lanier, is a Clinical Professor in the Department of Pediatrics & Immunology at North Texas University Health Science Center and a Clinical Professor of Allergy and Immunology at Peking Union Medical College in Beijing. As a former NBC reporter, Dr. Lanier produced and appeared in over 5000 daily nationally syndicated broadcast radio and television segments. He is currently working on a book entitled The New Epidemic: A Patient Survival Guide to Asthma.
*Listen to the podcast*This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
