CrowdMed online diagnosis healthcare

 

I didn’t even know what crowdsourcing really meant until last week. When I was looking for a logo for a small business I’m launching, my uncle suggested I could save money using a company that “crowdsources.” You submit your specs, he said, and many people bid on the job. They may not all be pros, but for a price lower than what the pros charge you can choose something from the top of the heap of a large group if responds.

Wikipedia offers another example of this process. It offers lots of source material for research that has been contributed by the masses, not by the pros. The information is not necessarily reliable, of course. (I only use it to satisfy idle curiosity, never to research the articles I write.)

Financial crowdsourcing seeks money for such things as investments in creative projects or emergency expenses due to house-burnings or serious medical crises. While not everyone believes in it, crowdsourcing seems here to stay.

But can it work for medical care? Take the fairly young CrowdMed. Although some of its “MDs,” or “Medical Detectives,” are doctors, it is not the traditional professional opinion of one or more physicians you’re getting, but a diagnosis from the collective wisdom of a very large group.

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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.

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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.

A clever pill to swallow

 

It’s reminiscent of Fantastic Voyage, the sci-fi story (both a film and a novel) in which a team of scientists gets tiny and travels through a human body to fix a blood clot. But in real life there are these little pill/cameras that can take pics of what’s going on in the digestive system, from the inside instead of endoscopically, a relatively minimally invasive way of diagnosing intestinal ills. Instead of going under sedation and having the colon probed from that end, you swallow a largish “pill” and wear a special belt and harness for a few hours while the camera travels through your gut, snapping pics.

The latest development in this futuristic technology is Olympus’ Endocapsule, which visualizes the small intestine by the use of a pill-shaped camera and an antenna belt that gets a wireless video signal from the capsule and shows video of the photos on a handheld device that controls it. Improvements on the new Endocapsule include a lighter, smaller over-clothes harness that is said to be more comfortable than previous systems that required being placed directly on the skin. More developments include a 160-degree field of view, a twelve-hour battery life and a three-dimensional tracking function that shows the progress of the capsule either in real time or downloadable for later.

In 1868 German physician Dr. Adolph Kussmaul figured out how to illuminate the process of endoscopy when he examined an open-throated sword swallower, using a light source made of an alcohol and turpentine mixture. However, until 1970 barium x-rays were used much more, in part due to the unpleasant nature of having a scope pushing against the powerful gag reflex, although sometimes inflatable scopes helped with that.

Although Olympus introduced the world’s first gastrocamera in 1950, several other companies have jumped on board since then. Given Imaging, from Israel (now being bought by an Irish company), introduced the M2A, or PillCam, in 2001. And later the same year the Japanese did them one better with the NORIKA3 that turned digestive forces into power to fuel the capsule with an on-board generator. Three years later Given Imaging came back with a capsule that could see the esophagus, and a year after that a Japanese company RF Comp Ltd introduced Sayaka, with higher resolution images. But at that time the large intestine was still unexplored by camera capsules, with nothing yet FDA-approved, mostly because of the folded nature of the organ, which allows growths to hide unseen by the cameras. So the endoscope, with air to puff up and unfold the tube, was still the best bet. But since it got FDA approval earlier this year, Given Imaging’s PillCam Colon can go through the large intestine in about eight hours, taking photos at close to four frames a second, increasable to six — remotely — if it’s going too fast. While some other capsules are still powered by mini-generators, the Colon uses a battery, so it’s a little bigger than its predecessors. The MIRO from the Korean company Kist can also see the large intestine. And Japan has been working on “Mermaid” capsules that can “swim” into the intestinal folds by use of a flapping tail.

Conditions that might call for capsule endoscopy include symptoms like bleeding, chronic abdominal pain, or unexplained anemia or weight loss that can be the result of digestive disorders like inflammatory bowel diseases or benign or malignant tumors. Although benefits of these devices include less discomfort or need for sedation or surgery, as well as less radiation exposure, one risk is a potential loss of the capsule necessitating surgical removal.

The device is contraindicated in patients with pacemakers or other cardiac electronic devices, who have any structural abnormality in the intestine that would hinder the passage of the pill, and for people who are pregnant or have swallowing disorders. And if the traveling capsule finds anything suspicious — a growth or a polyp — it can’t just snip it out as during the traditional endoscopic procedure.