Jury still out on artificial ankle replacement Data from clinical trials appears promising By RICK RUGGLES World-Herald News Service
OMAHA — Now some surgeons believe they have the hardware and know-how to effectively replace an arthritic ankle joint, while other surgeons await results over the long term. Even those who like the latest generation of artificial ankle joints say they aren’t for runners, basketball players or farmers who jump off tractors. They are generally appropriate for middleaged and older people, and those who aren’t severely overweight. The younger the patient and the more stress he puts on the
ankle, the more likely an ankle replacement will break down and have to be reworked. And fixing an ankle replacement is tougher than redoing hip and knee replacements because there is less bone and tissue to work with. “The ankle is just a unique joint,” said Dr. Annunziato Amendola, a professor of orthopedic surgery at the University of Iowa. “The ankle is just the skin and the bones.” It doesn’t have a big envelope of muscle bolstering it the way the knees and hips do, he said. Only 1,596 ankle replacements were done
in the United States in 2009, compared with 621,029 knee replacements and 285,471 hip replacements, according to the American Academy of Orthopaedic Surgeons. Dr. Shane Schutt, a Methodist Hospital orthopedic surgeon, believes that the number of ankle replacements will double in the next 10 years. Only 33 years of age, the Omaha native completed training last year under Dr. Michael Coughlin, an internationally known foot and ankle surgeon in Boise, Idaho. Including his training, Schutt estimates that he has placed ankle implants in about 80 patients. One of sev-
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eral metro-area surgeons who performs ankle replacements, Schutt has done three since joining Methodist last year. Doctors in the U.S. have been using the device Schutt uses, a Scandinavian implant called STAR, for only about 10 years including clinical trials, but the data appear promising. A report published last year said 91 percent of 84 artificial ankle joints remained in patients after an average of more than nine years. “The bottom line is that it’s still early. And so we don’t know what happens after that,” Schutt said, referring to an implant that was
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Lee Hohenstein and his wife, Marilyn, discuss his ankle joint replacement with Dr. Shane Schutt. Schutt says he likes the potential of the newer implants. “In my opinion, I think we’re breaking through,” he said.
placed in a patient’s ence in patients’ ankle a decade ago. “In lives.” my opinion, it’s cutLee Hohenstein, who ting edge technology recently sat in Schutt’s that I believe is going to make a big differPlease see ANKLE, Page 4
Planning for old age gets costlier By STEVE JORDON World-Herald News Service
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The federal government canceled plans for long-term care coverage aimed at low-income people, even though Congress had approved it. So continues the struggle to keep long-term care insurance a viable business for insurance companies and, at the same time, a choice for consumers trying to plan ahead for the twoout-of-three chance that they will need long-term care at some point in their lives. The cases of two local women highlight the challenges that have dogged long-term care insurance since it became widely available in the late 1980s. With little past history to guide them, insurers based
premiums on flawed assumptions about the claims they would have to pay and the number of people who would keep their policies in effect. “The problem is real,” said Tom Alber, a spokesman for the Iowa Division of Insurance. “It’s not just Iowa, it’s not just Nebraska, it’s national. It’s the industry.” A national industry group will hold a closeddoor brainstorming session this week in Washington, D.C., to look for solutions. But Jesse Slome of the American Association for Long-Term Care Insurance said it’s a dead issue for politicians. “America has no longterm care program in place, but that doesn’t mean Americans aren’t getting older. They are,”
Slome said. When it comes to longterm care, the wealthy can pay their own way. Low-income people can’t afford the insurance. That leaves the middle class and the upper-middle class, people like Patricia Rief Heskett of La Vista and Joyce Smith of Omaha, widows who pay about $200 a month for a top-of-the-line policy from John Hancock. They are among 80,000 Nebraskans, 149,000 Iowans and 8 million Americans who have long-term care coverage. “You take these policies out so you’re not dependent on the government to take care of you,” Heskett said. “I wanted to take care of me.” Her policy warned
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about possible raises in premiums, and she expected some small, occasional rate increases, but not 90 percent. “It may be legal, but it’s not right,” she said. Forced into a decision, she kept her premiums the same by taking a cut in her policy’s inflation factor to 3 percent from 5 percent a year for the benefits she would get if she makes a claim. But she’s still irked and worried about future increases. Smith doesn’t want to trim her benefits and can’t afford the increase, so she isn’t sure what she’ll do. “If they go back on these benefits, why even have it, truly?” After Heskett talked to the staff of Sen. Mike Johanns, R-Neb., his office asked the State of Nebraska, on her behalf, whether the law had been followed. It had. So far, her suggestion that Congress cap premium increases for senior citizens has gone nowhere. Along with many other companies, John Hancock said it raised rates because it foresees higher claims than it originally planned. Requesting 90 percent all at once gives policyholders options such as lower inflation rates, the company said. With smaller but more frequent increases, it would have been diffi-
cult to offer policyholders the option of trimming benefits, the company said. Since the State of Nebraska allowed the entire 90 percent increase, the company said, “we believe at this time that the increased premium should be sufficient to meet our future obligations [but] we cannot guarantee that there will be no future rate increases.” The same faulty predictions prompted Mutual of Omaha and Physicians Mutual of Omaha to seek rate increases for policyholders in Nebraska and Iowa. Their rate requests were among 37 in Nebraska and 43 in Iowa filed last year. In Nebraska, five of the requests were for 40 percent or more, with John Hancock’s 90 percent the biggest. The department granted 14 of the increases as requested and negotiated smaller increases on the 23 others, reducing those increases by between 10 and 30 percentage points. The Iowa Insurance Division cut the requests, which averaged 31 percent, to an average of 15 percent. The biggest increase allowed was 30 percent for a policy by Mutual of Omaha, which had requested a 45 percent raise. Rate increases keep the policies viable, said Mary Swanson, Mutual’s performance direc-
tor for the product. Mutual considers long-term care a core insurance product that meets a continuing need, especially among baby boomers. “It’s a very important part of retirement planning. Some insurance is better than no insurance,” Swanson said. “Ultimately, your longterm care insurance helps you decide where you want to stay and how you want to be taken care of, when you’re not able to do everything for yourself.” Especially valuable, she said, are “partnership” policies that allow people to become eligible for Medicaid coverage without having to deplete all of their assets. “It’s a very important selling point. At least you know you’ve protected a certain amount of your assets under those situations.” Rate increases are not only legal but also required by Nebraska and Iowa laws if an insurance company shows that a policy needs more money to pay claims. The size of those increases is a contentious point. Reducing rate requests may sound good from the consumer’s standpoint, but Nebraska Insurance Director Bruce Ramge said a rate increase that’s too small opens the door to later increases. An inability to get increases approved by
state regulators was one reason Penn Treaty American Corp. collapsed in 2008. It’s now in “rehabilitation,” under Pennsylvania state control while its claims are paid off from its remaining assets and, eventually, from a pool of money put up by other insurance companies. Adding to the pressure for rate hikes today are the near-zero interest rates on government bonds and other conservative investments that insurance companies hold to pay for claims. If there’s hope for the industry, it lies in new policies with more flexibility and stable prices, said actuary Steven Shoonveld of Hartford, Conn. He represents the American Academy of Actuaries as co-chairman of a task force looking into long-term care insurance’s future. The group will hold the closed-door summit Wednesday, hoping for what he called “a more holistic conversation” on the issue. The goal, he said, is to make sure Americans can manage the risks that come with advancing age in a comprehensive way that includes insurance plans. “The future is looking better because there is a lot of activity in the industry to find better ways and more sustainable ways to provide coverage for the financial risks that individuals
Long term care insurance basics n Must be in good health to qualify; standards vary among insurers. n Benefit choices include monthly or daily payments; length of the “exclusion period” when you pay costs yourself; how many years of benefit payments; and yearly inflation factor. More benefits generally mean higher premiums. n Consider “combination” products that include elements of life insurance, annuities and long-term care, as well as straight long-term care coverage. n Consider “partnership” policies, which can shield assets while qualifying for Medicaid assistance. n Look for discounts for good health, for making annual premium payments or other features. n Shop around. Rates for the same coverage vary as much as 40 percent among insurers. n Insurers can raise rates on all holders of a certain policy but not on individuals. n Claim payments for nursing homes may require an impaired ability to perform “activities of daily living” — bathing, dressing, eating, toileting and transferring from place to place. n Some policies also allow claims for home health care and assisted living if you have less disability. n You likely will buy a policy once, since policies become more expensive and harder to get as you age. n Younger applicants pay lower rates but probably pay for a longer time. n Work with an insurance agent you trust and who knows the business well.
Source: American Association for Long-Term Care Insurance
face,” Schoonveld said. “That means working on some of these rules and regulations that are out there.” For example, a flexible premium policy would let the policyholder vary premiums and benefits within a certain range to avoid straining a family budget during cash-poor times. Policies may encourage home health care rather than moreexpensive residential care. Maybe a policy could be converted from
monthly premiums to a single, large premium. “We’re going to see that in our lifetimes,” Schoonveld said. “It’s coming.” Consumers also can look for flexible combination policies that offer life insurance, annuity and long-term care elements: You die, life insurance pays. You need long-term care, it pays toward that. You need income, an annuity kicks in. Single-premium policies avoid later rate increases.
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exam room, said he was in sales for decades. “And I literally pounded the pavement, and the pavement pounded back.” Hohenstein had severe arthritis in his left ankle. It hurt badly and hindered his ability to enjoy retirement. At 80 years of age, Hohenstein was a good candidate for ankle replacement, which he underwent last November. Now in for a follow-up, he sat with his left shoe and sock off and smiled about his progress. “Excellent, excellent,” Hohenstein said. “I’ve been pleased. The doctor’s been pleased.” His ankle remained somewhat swollen, which Schutt said was to be expected. “The old gold stan-
dard was the fusion,” Schutt said. “And that would have been a fine option for you.” But Hohenstein hadn’t wanted his ankle fused, a fairly common procedure to end arthritis pain. In ankle fusion, a surgeon removes the damaged cartilage and connects the end of the leg bone to the ankle with screws, locking the joint in place. Hohenstein wanted more ankle flexibility so he could fish with ease with his grandchildren. The STAR differs from its predecessors in part because it allows not only up-anddown flexibility but also some side-to-side motion. A hard plastic piece moves between two metal components, allowing flexibility. Schutt said precision cutting equipment now enables surgeons to fit the im-
plant more securely into bone. And they understand better the importance of lining the ligaments up precisely on both sides of the ankle, and of the heel lining up squarely with the leg bones. That way, the force is distributed equally on the gliding plastic device. “In my opinion, I think we’re breaking through,” Schutt said. While ankle replacements began about the same time as knee and hip replacements some 40 years ago, ankle replacements have performed with much less success. Designs have been tweaked and welcomed as having great potential, then have fallen away after failing at too high a rate. Surgeons reported in 1996 that 57 of 160 devices called “the Mayo total ankle replacement” had to be
World-Herald News Service
An X-ray of Lee Hohenstein’s new ankle. removed because of complications. The surgeons said they no longer recommended using the device. Dr. Clifford Boese, an orthopedic surgeon who practices in Council Bluffs and Omaha, was enthusiastic 11 years ago about a new implant called the Agility. But Boese is no longer excited. “I’ve got to tell you, I quit doing them about four years ago,” he said this week. “They just weren’t durable enough.” He said he put in about 25 Agility devices and roughly one-third failed within 10 years. Dr. Lori Reed, assistant professor of orthopedic surgery at the University of Nebraska Medical Center, said she put in some ankle implants while in training. She hasn’t chosen to do any in her seven years at UNMC. When ankle implants go bad, “it’s not an easy thing to fix,” Reed said. “My message is not that ankle replacements are bad. You just have to be very cautious in your patient selection.” Dr. Scott McMullen, an orthopedic surgeon with GIKK Or-
tho Specialists in Omaha, said he and a partner put in about 15 Agility implants, and they have placed two STAR implants over the past year. “I like them,” he said of the STAR. Nevertheless, his view of ankle implants is neutral. An implant is prone to collapsing into the talus bone between the heel and lower leg, he said. And the soft tissue around the ankle isn’t robust, so infection and wound-healing challenges may crop up, he said. “Those anatomic problems are things that still exist,” he said. The STAR implant “is another variation of a concept that’s been around for years. But from my perspective, in no way is it a complete gamechanger that will come in and take over the treatment of ankle arthritis.” Schutt and Dr. John Galligan believe that the number of ankle replacements in the United States will go up significantly because of the STAR, which won Food and Drug Administration approval three years ago. Galligan, 40, performs ankle replace-
ments at Nebraska Orthopaedic Hospital with Dr. Michael Thompson. Galligan said that they have put in 39 STAR implants and that 95 percent of the patients are doing well. Nationwide, the big names in foot and ankle surgery are using STAR implants, Galligan said. “It’s definitely the wave of the future,” he said. Coughlin, Schutt’s mentor, helped oversee the STAR’s trial last decade. In Europe, he said, where the device has been used for years, it has held up well in about 80 percent of patients after 15 years. Coughlin said patients who undergo the ankle replacement surgery shouldn’t weigh more than 250 pounds, shouldn’t be battling diabetes and should be about 55 or older. The implant can stand up to hiking, fishing and golfing, he said, but he would never place one in a triathlete. He acknowledged that there is no consensus among orthopedic surgeons on the value of ankle replacements. He said: “I think that discussions will continue on.”
Busy adults can squeeze in workout time For some, that means awaking before dawn
to get to the gym before heading to work By KATY HEALEY World-Herald News Service
A full-time job, a family and just 24 hours in a day. Adulthood is a juggling act. Add regular exercise, and it’s more like juggling fire than bowling pins. “The major challenge of course is schedule,” said Todd Mills, manager of Better Bodies in Omaha. But finding time for fitness is possible if it’s made a priority. “That’s really the key,” Mills said. “Once it becomes part of their life, they’ll find a way to make it work.” For some, that means waking before dawn. Brad Muse, 51, hits the gym shortly after Better Bodies opens at 5 a.m. — a habit he began 17 years ago. “I’ve always had the desire to be as physically fit as I can be. I still attempt to play sports,
even at my age,” he said. “To be able to do that, there’s time and effort that I have to put in.” He finds time four days a week before he heads to work at ConAgra’s finance department. A spin class twice a week. Cardio and strength training twice a week. If he didn’t, Muse said, he wouldn’t be able to play basketball in an adult league through the year, let alone keep up with the game’s fast pace. When away from the court and cardio classes, Muse mostly sticks to strength exercises that use his own weight. “I’ve returned to the basics,” he said. “Pushups, pull-ups, sit-ups and squats. I focus on functional movements.” The exercises help him do everyday activities like carry in groceries and pick up his
kids — and he has six to keep up with. They motivate Muse to stay active, he said. Mills said many adult clients alternate gym time with family time. Spouses, like Muse and his wife, trade shifts. One stays home with the children while the other exercises. Then they switch. Professionals have to find a balance, too. They usually slip in before work or during their lunch hour, Mills said. Despite busy schedules, it’s important that adults not neglect their health. “Everything about exercise, especially when we get older, becomes preventative in nature,” he said. Regular exercise wards off heart disease, stroke, diabetes, weight gain and some cancers, among other things. Aim for 150 minutes a week,
World-Herald News Service
Brad Muse, 51, exercises four times a week in the early morning to maintain his health. but anything is better than nothing. Mills said it’s especially important that older people focus on core exercises — which promote balance and protect the back from injury — and resistance training, which improves strength and pro-
tects bones. “As we age, our bones and joints age with us,” he said. But be warned, Muse said, exercise doesn’t happen as easily when you get older. “The older you get, the harder it is. Though I would say, compara-
tively speaking, I’m more agile than a lot of people my age,” he said. He credits his fitness regimen. It boosts his energy levels, too. “Exercising gives me the opportunity to live the way I want to live,” Muse said.
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Long-term care statistics n 56 percent of policies are bought by people between 55 and 64 years old. n 67 percent of new claims are for people 80 or older. n Of new claims, 49 percent were for home care, 24 percent for assisted living and 27 percent for nursing homes. n 71 percent of applicants 80 or older were denied coverage for health reasons. Denial rates were 45 percent for ages 70-79, 24 percent for 60-69, 17 percent for 50-59 and 11 percent for 50 or younger. n Of newly sold policies, 43 percent included 5 percent compound inflation factor for benefits. n Yearly premiums for a 55-year-old couple average $2,350 a year for a policy offering $338,000 in benefits for an immediate claim; a 65-year-old couple would pay $4,660.
Years of long-term care needed after age 65 5 years or more: 20-percent 2-5 years: 20-percent 1-2 years: 12-percent 1 year or less: 17-percent None: 31-percent Source: American Association for Long-Term Care Insurance
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Exploring hair loss treatment options The most common cause is androgenetic alopecia By JUDY HORAN World-Herald News Service
Hair loss, called alopecia, has many causes. The sooner you see a doctor, the better chance you have of saving some hair from going down the bathroom drain. The most common cause is androgenetic alopecia, a genetic condition that could come from either side of the family. It’s sometimes called female-pattern or male-pattern baldness. In female-pattern baldness, the part widens over the scalp but the frontal hairline is preserved. There is thinning but not baldness. In male-pattern baldness, there is receding at the temples and hair is lost over the crown, which can lead to baldness over the front hairline. Other causes of hair loss can be medications, illnesses such as diabetes or autoimmune conditions such as lupus. Children diagnosed with alopecia areata could be losing hair because of a thyroid problem or anemia. Pregnancy, surgery, a high fever or death in the family can cause stress-related hair loss, called telogen effluvium, which typically re-
covers on its own within three to four months. “But some people, especially women, can go into a chronic condition, in which case we treat it,” said Dr. Mary Finnegan, an Omaha dermatologist. You might have heard that wearing a hat can cause hair loss, but that’s a myth, according to Dr. Douglas Ramos, an Omaha plastic surgeon. “Women that apply a lot of traction to their hair, like corn rows and permanents or pull at their hair can lose hair,” he said. Finnegan advises paying attention to your body, especially if you see a sudden change. “Not everything is attributable to aging,” she said. “Hair loss can be indicative of an internal medical problem.” A dermatologist will look at your medical history and changes in medication and ask about hair loss over other body sites such as eyebrows, eyelashes, arms and torso. Is there itching or burning? What shampoo are you using? An exam checks the width of the hair’s part in women to see whether it’s widening and looks for receding around the temples and crown of
the scalp for men. “We look for scale around hair follicles and for redness and scalp diseases that can cause hair loss,” said Finnegan. Blood tests and biopsies might follow. “In many cases, biopsies can give us prognostication of a chance for recovery,” she said. Some people wear their baldness proudly or cover their head with wigs, hats and scarves. Others try medications such as the topical treatment minoxidil (one brand name is Rogaine) or finasteride pills for hair loss from treatable causes. Minoxidil can be purchased over the counter. Depending on their diagnosis, many people are able to taper off use of the product after hair growth. Results are seen in three months; full results take one year. Five percent dosages are recommended for men; 2 percent for women. However, at times a dermatologist will recommend the 5 percent dosage for women. “Finasteride pills are the most effective treatment for male-pattern hair loss,” Ramos said. “It will first stop hair loss in young males and grow hair in approximately half of men in the back part of the scalp but doesn’t work up front.” However, finasteride pills (one brand name is Propecia) are not meant for women, especially women of childbearing age. “The use finasteride in of women is taken on a case-by-case basis,” Finnegan said. “It de-
pends on the dermatologist’s preference.” Ongoing research may eventually provide additional medication options for male-pattern baldness. Drugs now being tested for facial flushing and allergic inflammation of nasal pathways block a protein called prostaglantin D2, or PGD2, which inhibits hair growth. Some scientists believe that removing the inhibition might prevent hair loss. Although Ramos performs hair transplants, he would rather see people use other treatments at an early stage of hair loss to avoid that last step. When performing a transplant, he takes grafts from the back of the scalp and puts the hair where needed. Most of his patients are men ages 30 to 70, but he can transplant hair in women who have mixed or male-pattern hair loss. “Patients cannot do any strenuous activity for seven to 10 days, and it takes a year for all the hair to grow in. Ninety percent of grafts survive.” The average cost of hair transplantation in the United States is $3 to $5 per graft. The procedure can cost $2,400 to $10,000. Ramos cautions patients to carefully evaluate the physician who will do the transplants. He also recommends checking with state licensing and registration boards for any sanctions against the physician. The information often is on the Internet.
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Artificial bladder, ovaries becoming a reality Expert sees fine line between ‘hope versus hype’ in regenerative medicine By RICK RUGGLES World-Herald News Service
OMAHA — Somewhere between hope and hype churns regenerative medicine, the science that strives to grow tissue and organs. Alan Russell, an expert in regenerative medicine, compared his field to the American space program in the early 1960s. “We’re talking about medical moon shots,” Russell said Wednesday in an interview in Omaha. “We’re at the phase where we’re shooting up rockets to see how well they work.”
Russell, founder of the McGowan Institute for Regenerative Medicine in Pittsburgh, spoke at the Holland Performing Arts Center. Regenerative medicine already has made huge gains. Russell has created what amounts to an artificial ovary. A scientist at the McGowan Institute is experimenting with elastic materials to heal human hearts. Cell therapies are being used to generate new muscle and tissue in failing hearts. Some spinal fusions now use a spongelike material that en-
courages cells to create bone. Human bladders have been built from patients’ cells. A substance called “extracellular matrix” helps hernias to repair and injured rotator cuffs to heal. Russell, whose doctorate is in biological chemistry, said he sees a gray line between “hope versus hype” in regenerative medicine. He has a friend who suffers from Parkinson’s disease. “What he reminded me is, don’t ever take away someone’s hope,” he said. “Just don’t over-
hype something.” The belief that extracellular matrix can regrow full fingers is hype, he said. A claim that stem cells today can cure Lou Gehrig’s disease is worse than hype. “That’s crap,” he said. “And it’s the kind of hype that will land some people in jail. Because very sick people are very desperate.” He said he believes that some 20 years from now doctors will use cell therapies to cure heart failure. Several thousand patients already have been treated by injecting cells into the heart to generate new heart muscle. But no one knows how the therapy works or even whether it truly
works, he said. Some scientists think they have begun to figure out, though, which patients will benefit most from it, he said. “But the one thing I can assure you: If we don’t try, it will never happen,” he said. The Holland Lecture Series has brought speakers to Omaha since 2005. It’s hosted by the First Unitarian Church of Omaha with the financial support of Dick Holland. Russell disputed the use of the word “controversial” in relation to human embryonic stem cell research. Some opponents decry that kind of research because a human embryo, which they consider a human being, is destroyed in the
process of retrieving the stem cells. Russell, 49, said those people’s views are important and deserve to be heard. But theology, politics and the media don’t rely on data, he said. Scientists do rely on data, he said, and the fact is, the vast majority of people don’t oppose the research.
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Rural docs find mental health info online UNL behavorial health team has put together online lesson By RICK RUGGLES World-Herald News Service
Rural primary care physicians are do-it-all docs. Sometimes there’s nobody else to rely on. So when a patient comes in with depression, they have to be ready to recognize it and treat it. “You know a little bit about a lot of diagnoses,” said Dr. Michael Zaruba, a primary care physician in Auburn, Neb. “You’re kind of a jack of all trades, master of none. ... That’s kind of the nature of rural medicine.” A University of Nebraska Medical Center behavioral health team has put together a onehour online lesson for primary care doctors, physician assistants, nurse practitioners, social workers and others who see and care for adolescent patients with depression. The UNMC team soon will add online sessions on adult depression and geriatric depression.
Primary care providers are on the front line of care for depression and other mental illnesses, said Dr. Howard Liu, a UNMC child and adolescent psychiatrist who is project manager for the online lessons. The sessions cover diagnosis of depression, use of medications, and recognition of the risk of suicide, and offer treatment scenarios using actors from the University of Nebraska at Omaha. They also test the viewer to make sure he or she has grasped the material. “The primary care providers are doing the best they can,” Liu said. But in some cases they aren’t completely confident about using depression medications, which in rare instances can cause suicidal thoughts in adolescents. “The real consequence is undertreatment for a lot of folks.” University of Iowa Hospitals and Clinics psychiatrists have
their own programs to reach out to primary care doctors. Among them are a phone-in service in which a primary care provider can discuss cases with a university psychiatrist. The Iowa university also holds monthly lunch-hour webinars. In those sessions, a university psychiatrist speaks to primary care doctors, physician assistants and others about a behavioral health topic. One month the subject is depression, the next it could be autism. Dr. Jennifer McWilliams, a child psychiatrist with the U of I Hospitals and Clinics, said the nation has a growing shortage of psychiatrists. “And it’s worse in rural counties and it’s worse in povertystricken counties,” McWilliams said. Frequently the primary care provider is the only option, she said. McWilliams said up to 20 percent of children suffer serious mental health disorders, and few are seen by mental health specialists. The vast majority receive treat-
ment from primary care providers, she said. Family physicians receive some training in mental health diagnoses as med students and in residency programs, but not enough to have a deep understanding. Dr. Bob Wergin, a family practice doctor in Milford, Neb., said he sees many patients who suffer mental health problems. And even though there is a mental health clinic in nearby Seward, some patients don’t want to use it. ‘They say ‘Dr. Wergin, I can’t go up there. Somebody will see my car,’ “ Wergin said. Wergin, 57, said med students and residency programs provide training in depression, but his experience in seeing mentally ill patients has helped him become more confident in treating them. But both he and Zaruba said they liked the notion of online lessons and would use them. “I’m probably going to go through their program and see how I can serve my practice better,” Wergin said.
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Why this year’s pollen is different By RICK RUGGLES World-Herald News Service
OMAHA — Tree pollen has popped from buds early this season, prompting many allergy sufferers to feel the effects about three weeks earlier than usual. Dr. Linda Ford, an allergist in Bellevue who oversees the metro area’s pollen-counting station, said that in the past she has seen tree pollen in large quantities in late March or early April. “But this year is different,” Ford said. She said the trees are “exploding out their pollen” much earlier than in the past. Dr. Jay Portnoy, who heads the pollen-counting station in the Kansas City area, agreed. Both physicians said it appears that climate change is at work. Portnoy said warmer weather and higher carbon dioxide levels over the past 15 years have caused tree pollen to emerge earlier and in greater quantities. Ford said the Midwest gradually has experienced more frost-free days and the earlier arrival of spring over the past 20 years or so. This also has been an unusually mild winter. As a result, many patients who suffer allergies to pollen from elm, cedar, silver maple and other trees have already begun to feel their hay fever kick up. “You can certainly feel it if you have allergies,” said Dr. Jill Poole, an allergist and associate professor at the University of Nebraska Medical Center. John Hattam, an Omaha chef who owns a catering business, struggles these days to smell and taste his culinary creations. His allergies struck about a week ago, driving him to seek Ford’s assistance. He had to ask his assistant chef to make sure he hadn’t overseasoned foods. “I’m not tasting right,” Hattam said. “Everything’s muted.” Ford gave him a steroid medication, a nasal spray and antihistamine tablets, all of which helped settle the watering and pressure in his eyes and sinuses.