Obamacare anew in NY

On the eve of the second enrollment period for Obamacare — which begins November 15 — insurers in the state are not getting what they asked for. During the first six-month enrollment period, which ended officially March 31 of this year but was extended due to website glitches, 370,000 state residents were able to sign up for private health insurance through the Affordable Care Act.

People can sign up for Medicaid at any time during the year. Though not restricted to the enrollment periods, some 600,000 people signed up during the last one, including many who were previously uninsured. This makes nearly a million New Yorkers affected by Obamacare.

The ACA was instituted to control the health insurance industry. There were 44 million uninsured Americans, the highest in history, and the law was designed to require that everyone be insured, with fines to motivate those who didn’t sign up. People who don’t have coverage by 2015 will pay a penalty of $325 per adult, $162.50 per child or two percent of income, whichever is higher. Other factors in the plan include expansion of the Medicaid program and elimination of restrictions on pre-existing conditions.

Continue reading “Obamacare anew in NY”

Sweetening the pot

[wide]sugar photo by Alden Chadwick
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I always thought that artificial sweeteners were kind of silly, for those of us without diabetes, that is, and maybe full of chemicals besides (although in college I had a Tab habit). That teaspoon of real sugar in your coffee or tea gives you only 16 calories, not enough to bust your belt buckle. Granted, some of us have health issues that make us need to limit or cut out sugar, and it doesn’t do our teeth any favors. Refined sugar isn’t health food and has a host of ills, the extent of which depends on your source. But when it’s about counting calories, that little bit of sugar just doesn’t have that many.

According to some recent studies, it now appears that those artificial sweeteners may cause more harm than good. The Calorie Control Council claims that the number of Americans who consume artificially sweetened foods and beverages climbed from 78 million to 187 million between 1986 and 2010. It’s not just those little packets of Equal. We find artificial sweeteners on the shelves lurking in diet sodas, flavored drinks, juices, yogurt, pudding, gum, candy, baked goods, jams and jellies and more.

In the 1970s studies found that saccharine (in Sweet ‘N Low) led to bladder cancer in lab rats. But the National Cancer Institute has since said there’s no risk. Subsequent studies claimed that in limited quantities it was safe, and so has the FDA.

Artificial sweeteners aren’t always so artificial, and may be made of herbs or from isolated parts of the sugar molecule. We like that they have few to no calories. If you normally drink six Cokes a day, the diet ones will pack on fewer pounds.

 

News broke last week that some of the fake sugars could lead to pre-diabetes by affecting the friendly hitchhikers we call the bacteria in our intestines, bacteria which metabolize sugars like glucose or fructose (table sugar is half and half). The journal Nature published a study in which the sweeteners that are used in Sweet ‘N Low, Equal or Splenda (saccharine, aspartame or sucralose) were put into the drinking water of lab mice. Other mice got real sugar and others plain water. Nearly three months later, the first group of mice tested higher for glucose intolerance and blood sugar levels than the others, meaning their guts had lost the ability to metabolize sugar, a condition that can lead to type two diabetes. The researchers tried the same experiment on mice that ate a diet high in fat, and then did a four-week run of antibiotic treatment to destroy all their gut bacteria, which put them all back at the same level of sugar-processing ability.

Studying 381 human members of an ongoing clinical trial on nutrition showed a link between artificial sweeteners and higher weights and higher blood-sugar levels. Besides the diabetes risk, high-fasting blood sugar results can lead to other health problems like eye and kidney diseases.

The researchers then did a short, one-week study on seven subjects who normally didn’t use artificial sweeteners and gave them the equivalent of how much would be in 40 cans of diet soda a day. At the end of the week, four had trouble metabolizing sugar while three were fine.

Bionic back

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Photo by Flickr user aearlsnd/used under Creative Commons license
Photo by Flickr user aearlsnd/used under Creative Commons license

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A newer alternative to the classic spinal fusion surgery for spinal disc problems, disc replacement surgery, takes some of the technology used for artificial hips and knees and applies it to blown discs in the back. Two spine surgeons from Orthopedic Associates of Dutchess County will be speaking to the public this month on this relatively new technique, which was only approved by the FDA ten years ago.

At some point in our lives about three-quarters of us will have low back pain, according to the American Academy of Orthopedic Surgeons. With artificial disc replacement surgery, a mechanical disc — made all of metal (such as cobalt chromium or titanium alloy) or a combination of metal and plastic (medical grade polyethylene) like with artificial knees and hips — stands in for a degenerated disc. Currently the FDA has approved two models for lumbar (lower back) disc replacement and six for the cervical, or neck region, where there are six discs, but that is a less common site for disc replacement surgery than the lumbar region.

The spinal column is made up of bones stacked vertically — sturdier ones at the bottom to support the weight of the torso (lumbar) and more delicate and flexible bones at the top (cervical) to allow for the many and varied movements of the head. The less flexible vertebrae in the middle, attached to ribs, are called thoracic, and disc problems in the region are more rare, and surgery more complicated because of the proximity to the lungs.

The vertebrae are connected with small facet joints that allow flexibility of the spine, and in between them are 23 soft, spongy, shock-absorbing discs. The sturdy exterior of each disc covers a delicate jelly-like interior supported by an outer collagen core. To do its job that inside stuff — made of fibers suspended in mucoprotein gel — has to maintain its strength and gelatinousness both. But as we get older the discs lose water, strength and flexibility and the inner core can ooze out through the outer core and rub against the spinal nerve root; this is a herniated disc. Injury can cause this as well.

Traditionally, if non-surgical treatments failed to alleviate the back pain from disc issues fusion surgery would be considered, and often still is. As the name implies, bone is fused to halt movements that cause pain at the discs, with bone graft from a synthetic source or the patient’s own, using cages or screws to support the spine as the bone fuses. Sometimes this helps and sometimes not so much, so disc replacement (ADR) has emerged as a potential alternative, although not everyone is eligible.

The patients with the best chance of success with the surgery are those who don’t have excessive weight, problems with the nerves or joints of the spine, structural defects of the spine, or a history of previous spinal surgery. Usually screening tests like X-rays, CAT scans or MRIs are performed to determine if the patient is a good candidate for the surgery.

The surgery takes about two or three hours and is performed through an abdominal incision, with internal organs moved to the side to access the spine. There is no altering of the bone structure that would require bone healing, as with fusion surgery, so after surgery the patient can return to moving the torso, standing and walking relatively quickly. The time needed to recuperate in the hospital before going home is about two to four days. The decrease in pain may be another few weeks or longer however, although walking, stretching and gentle trunk twists may be recommended to expedite that. FDA-supervised trials showed that disc replacement usually helps but doesn’t always completely remove all back discomfort, reports the AAOS.

The surgery is riskier than fusion surgery, according to Johns Hopkins, because it requires greater access to the spine. Complications could include loosening, fracture or dislodgement of the disc, infection at the site or nearby areas, or rigidity or stenosis of the spine.

 

Informative talks

The Spine Team at Orthopedic Associates of Dutchess County is making efforts to educate the public about this relatively new technology to alleviate pain and suffering in some of their patients. Their surgeons and non-surgical spine specialists are board certified and fellowship-trained and offer many treatments of spinal problems caused by trauma, deformity and degeneration, with both surgical and non-surgical approaches. In many cases when surgery is advised it is minimally invasive procedures like kyphoplasty, which stabilizes fractures, or microdiscectomy, which promotes nerve healing by removing a small portion of the bone over the nerve root and/or disc material from under it.

For more information see www.orthoadc.com or www.health-quest.org/WellnessSeries.