May 27th, 2008 by Dr. Val Jones in Expert Interviews, Health Policy
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I attended the STOP Obesity Alliance press conference on May 22, 2008, in Washington, D.C. During the conference a new strategy to reduce obesity rates was announced — which provides employers with an obesity management benefit for their employees. I asked Carl Graziano, the vice president of communications for DMAA: The Care Continuum Alliance, to explain what this new benefit is and how it works. (DMAA was formerly known as the Disease Management Association of America.)
Dr. Val: How does the DMAA “prototype obesity benefit” work?
Graziano: The prototype is just that — a suggested approach based on the best available evidence on effective obesity interventions. While we provide a template for possible covered services and suggested pricing, it will be up to individual end users to tailor this benefit to their particular budgets, corporate cultures and values. Generally, we recommend three tiers of coverage, starting with enhanced primary care services, nutritional counseling and pharmaceuticals. A second tier would add treatment by an obesity specialist, and a third level would provide coverage for bariatric surgery and associated supporting services. Plan participants could be subject to an additional premium and co-payments for these services, as with other “riders,” such as vision and dental benefits.
Dr. Val: Which employers are planning to offer this benefit?
Graziano: We’re pleased to have the support of the Service Employees International Union (SEIU), which will consider our benefit approach as it develops coverage for its members. We expect that as experience with the benefit design and awareness grows, other employers will tailor it to their specific needs. As the STOP Obesity Alliance survey shows, while most employers believe in the appropriateness of obesity-related services, less than half say their companies devote enough attention to the problem of obesity. We believe this reflects a lack of guidance on how to provide obesity benefits, and that’s why we developed our suggested approach.
Dr. Val: What can people do to make sure that their employer offers this benefit or something similar?
Graziano: Because this benefit prototype will be freely available from and promoted by DMAA, we expect growing awareness of it among benefits managers over the next year — both through their own efforts to stay current on benefit design trends and recommendations from employees and others.
Dr. Val: How do we know that this program works? What outcomes have you demonstrated so far?
Graziano: Designing a formal approach to obesity benefits is largely uncharted territory, which is precisely the reason why DMAA saw a need to initiate research in this area. That said, our benefit design is strongly rooted in the best available evidence that interventions deliver high-value, positive outcomes. We are breaking new ground here, but we believe the benefit’s value-based approach offers the best chance of positive clinical and financial outcomes in a real-world setting.
Dr. Val: What’s the most important aspect that the public should know about the DMAA obesity benefit?
Graziano: It’s important that the public understand that personal behavior — eating healthfully, exercising and making other lifestyle changes — is essential to the success of any overweight or obesity intervention. While our benefit approach may ultimately contribute to new and expanded care options for the overweight and obese — a change that’s much needed in the face of a growing obesity epidemic — the commitment of plan participants to these interventions will play a large part in reversing the overweight and obesity trend.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 30th, 2008 by Dr. Val Jones in Health Tips
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May is skin cancer awareness month, and Revolution Health has created an awareness campaign to help people become more educated about their risks. In a unanimous vote, I was selected as the blogger/spokesperson for skin cancer awareness – probably because I’m “the fairest in the land.” Well, the truth is I’m so white I’m actually closer to light blue – couple that with a high freckle count and green eyes and you’ve got one very high risk lady.
So I’ve decided to see a dermatologist once a year for a full skin check. I must admit that the first year I went I was convinced that I’d be biopsied into oblivion. The only way to be sure that a mole is not cancerous is to take a sample and check it under the microscope. So any doctor with a conservative eye would need to do a lot of “rule out melanoma” testing, right? Wrong. I was happily wrong. Dermatologists are trained to recognize individual freckle and mole patterns, and don’t do a biopsy unless they see an “ugly duckling” mole – one that stands out from all the others. I was so excited to escape the office with my skin in tact that I vowed to be obedient and return for a yearly check up.
If you are fair skinned and/or have had a significant amount of sun exposure in your life, or if people in your family have had skin cancer, you should definitely check in with a dermatologist to make sure you don’t have any suspicious moles. The doctor will tell you how frequently you should have follow up exams.
Here are some things you can do right now:
Find out if you’re at risk for skin cancer and learn what you can do to prevent it.
See what skin cancer looks like.
Check out my recent interview with Dr. Stephen Stone, past president of the American Academy of Dermatology, about skin cancer and about tanning salons.
Coming soon: the true story of my blogger friend who had a basal cell carcinoma removed from the side of her nose. She required plastic surgery to fill the gap, but it looks great now!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 10th, 2008 by Dr. Val Jones in True Stories
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I’ve been presenting cases of important diagnoses made simply by physical exam. A ganglion cyst, a foot ulcer, and a dissecting abdominal aortic aneurysm were all correctly identified with a basic physical exam. However, there are times when a physical exam may not be enough – and reliance on it alone can be quite misleading.
A middle aged man was referred to our sports rehabilitation clinic after undergoing an unsuccessful orthopedic surgical procedure. He had been lifting heavy weights at his gym for some time, and was complaining of weakness in his right arm. He eventually got an appointment with an orthopedic surgeon, who noted that his right biceps muscle was severely reduced in its bulk. Assuming he had ruptured his biceps tendon, he was scheduled for repair the next week.
The surgeon was baffled after opening the arm and exploring the anatomy – the biceps tendons were both perfectly in tact, though the muscle was indeed quite atrophic.
What he didn’t realize was that the man had not ruptured his tendon, but had severely impinged his musculocutaneous nerve where it travels through the coracobrachialis muscle. The heavy weight lifting had caused his coracobrachialis muscle to hypertrophy to a point where the nerve supplying the biceps muscle was actually crushed by the size of the muscle.
The man slowly regained nerve function and was fine so long as he didn’t lift heavy weights again. The only long term side effect that he suffered was a surgical scar on the inner side of his right arm.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 8th, 2008 by Dr. Val Jones in True Stories
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I was working in the ER late one night when I was asked to see an elderly woman with the chief complaint of “I almost fainted.” This complaint carries with it one of the broadest differential diagnoses known to man. What could be the cause of a near fainting episode in an elderly woman? It could be anything from dehydration, to an irregular heart beat, to anemia, to malnutrition, to a urinary tract infection or pneumonia. Pretty much anything could make one swoon when you come to think of it.
And so I met the lady, perched atop a stretcher in one of the ER bays. She was chipper and friendly with a shock of curly white hair. She was sitting up, conversing comfortably with no pain or any bodily complaints whatsoever. She was absolutely charming, taking the time to notice my own disheveled condition and inquiring as to when I’d had my last meal.
Her blood pressure was a little bit low, but she had no fever, or heart rate abnormalities. She was not over or underweight, she was well-groomed and alert. I really doubted that there was anything wrong with the woman, frankly, and was kind of assuming that she had stood up too quickly and had a vasovagal episode.
But out of habit I began my physical exam, from head to toe – methodically looking for abnormalities of the head, eyes, ears, nose, throat, cranial nerves, chest, lungs, back, skin, range of motion of arms, strength, sensation, heart sounds, and then the abdomen. As I placed my cold hand nonchalantly on her belly, my arm instinctively jerked away almost before my cerebral cortex was able to interpret the input. Oh my gosh, there was a pulsatile abdominal mass, clear as the nose on her face!
I was barely able to compose myself and asked her to excuse me. I bolted straight for the attending’s desk, and white as a sheet with wide eyes I stammered: “the lady in bed 3 has a pulsatile abdominal mass!”
The attending stood up immediately and followed me to the lady’s room and confirmed my diagnosis. She had a dissecting abdominal aortic aneurysm. We called the trauma surgery team and she was taken to the OR minutes later. The dear lady survived the surgery and was discharged home in her usual state of pleasantness. I’ll never forget that physical exam finding, and how taking the time to place my hand on her belly was all that was needed to save her life. If I had gone with my suspicion prior to the exam (that she was fine but maybe had a UTI) I may have wasted the precious few minutes she had (before her artery ruptured) on getting a urine sample!
***
For other surprising physical exam findings, check out part 1 and part 2.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 4th, 2008 by Dr. Val Jones in Humor
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Today I attended a lecture given by an orthopedic surgeon. He was in his early 40’s, tall, and athletic in appearance. He spoke about spinal injuries the way a young boy would talk about crashing his toys together – vertebrae were “smashed, crunched, or wrecked” in various ways. He showed the audience various CT scans and x-rays of the neck, and proudly described the hardware he used to fuse spinal segments. Here are some choice quotes from his lecture:
“I think I’m losing my voice. I don’t talk that much at home because I have all girls. Um… so the cement from a kyphoplasty can get into the veins and travel to the lungs, but it’s not like a big clump gets in them or anything. It’s more like little tiny microscopic pieces of cement. You know, they kind of cause bronchio… bronchiec… broncho… broncholectasis or something. I don’t remember. But if your vertebral body is smushed, what are you going to do? It’s just really awesome to stick that balloon in there and blow up the area. With kyphoplasty you get less… whatever that word is… spill of cement
…So with the thoracic spine I come at it from the back because otherwise the heart gets in the way. Also, I use a posterior approach because then I don’t need another surgeon in there with me, and it’s hard to find them on Saturday mornings.
…If you see lateral translation of the spine then you know you’ve torn everything up. I mean, that thing is going to be a disaster zone so you may as well just go in there with all you’ve got. Hey, if you need surgery, you need surgery. But if a high c-spine injury isn’t unstable then don’t immobilize it or it’ll freeze up like an elbow. You won’t be able to do much more than move your eyes.
…And here’s a case of a guy with Tuberculosis in his spine. We opened that sucker up and it just poured out all over the place. It was awesome. He’s totally fine now.”
I was trying so hard not to giggle throughout this “academic lecture.” It was actually kind of refreshing to get the straight scoop on spinal surgery from an orthopedist who obviously loves what he does. But at the same time, I felt strangely nervous…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
