Trip and fall lately Tell your doctor
Tue, 12 Feb 2008 02:42:17 GMTWASHINGTON - Trip and fall lately? Seniors often won't mention it unless they're hurt, but new guidelines say that first tumble is a good predictor of who's at risk for another, more serious fall. With deaths from falls increasing, the guidelines urge doctors to ask patients to 'fess up.
Better would be to prevent even that first fall. Now scientists are testing simple wrist monitors that may one day be used to predict who is most likely to topple, by tracking how stable they are with each step on any given day.
"Even the frail elderly individuals, some days they have good days and some days they have bad days," says lead researcher Thurmon Lockhart, who in his Virginia Tech laboratory literally forces volunteers to trip in the name of science to determine what makes one person fall while another stays upright.
It's a question of growing urgency, as fatal falls have spiked in the last decade. The government recorded more than 19,000 deaths from fall-caused injuries in 2005, the latest data available. Three-fourths were among people 65 and older.
Nonfatal falls trigger another half-million hospitalizations and almost 2 million emergency room visits.
Anybody can fall, especially during ice-slick winters or while playing sports. Lockhart even worked with UPS, the brown-truck delivery company, to help train their new drivers to avoid falls while hoisting packages.
But aging brings physical changes that make a fall more likely. Still, falls are something of the Rodney Dangerfield of injury prevention, so commonplace — one in three seniors falls each year — that they receive little attention until someone is seriously harmed, such as breaking a hip or suffering a brain injury.
Hence the emphasis on revealing earlier falls in guidelines published by the American Academy of Neurology last week. Someone who's fallen in the past year without a logical reason, such as a sports injury, has about a 55 percent chance of falling again — and thus may need special attention to prevent injury.
At highest risk of falling, the guidelines found, are people with gait or balance problems, dementia, Parkinson's disease or a history of stroke, weakness or nerve disorders in legs, impaired vision or who use certain medications.
The guidelines are aimed at neurologists, but a specialist in falls says asking about earlier tumbles makes good sense for any physician.
Don't "pass it off as a natural part of the aging process, but see it as a symptom with many possible underlying causes, some of which are highly treatable," says Dr. David Riley of University Hospitals Case Medical Center in Cleveland.
But before that first fall, the specific physical changes that determine why one senior can recover from a slip while another won't are poorly understood. Enter the Virginia Tech research.
First Lockhart tripped up several dozen people, a mix of young and old. Don't worry: Safety harnesses kept fallers dangling harmlessly in the air, instead of crashing. Videotape and sensors captured each movement, to map the physiology of falling.
Younger people recovered balance better so that a slip seldom turned into a fall, although some seniors recovered, too.
Why were others fall-prone? As you age, your gait becomes more variable. Seniors tend to compensate with shorter steps. But if one step varies in speed, length or direction from the next, it wobbles the up-and-down torso motion that is a key to balance while walking, Lockhart found.
So when seniors with an unstable gait encounter an obstacle — a bump in the sidewalk or a slick floor — they're already off-kilter and thus less able to recover, he explains.
Lockhart found that it's possible to measure that gait instability with some small, cheap devices, accelerometers and gyroscopes. Now, with funding from the National Institutes of Health, he has begun experiments to see if a wireless wrist monitor containing the gadgets, made by a company called AFrame Digital Inc., can truly predict who is fall-prone.
If that sounds complicated, there is a simple test anyone can do today to check if their leg muscles are weakening enough to worry about a fall.
It's called the "get up and go" test: Sit in a hard, straight-backed chair. Fold your arms across your chest. Try to stand. If you can't on the first try, tell a doctor so you can be checked for possible problems, says Cleveland's Riley.
For people already known to be fall-prone, specialists advise some commonsense precautions: Ask a doctor about exercises to improve balance and strength. Taper off fall-inducing medications whenever possible. Minimize slipping risks, such as by removing rugs and adding stair rails and hand-grabs in bathrooms.
But fatigue and stress can overcome any precaution, says Riley's patient, Dolly Thomas of Timberlake, Ohio. Her Parkinson's disease makes Thomas, 75, fall so often that she wears knee pads to cushion the blow. Last week, tired from caring for an ill husband, Thomas fell twice in one day.
"It just makes me so mad. I'll get up and darned if it doesn't happen again," says Thomas, who just got a scooter in hopes of falling less. "When you feel good and ... you're an independent person like I've been, it's really hard to sit and take it easy."
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EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
Jailed doctors patients to sue govt.
Tue, 12 Feb 2008 02:55:24 GMTBy ROXANA HEGEMAN, Associated Press Writer
WICHITA, Kan. - Patients of a physician who is charged with running a "pill mill" linked to 56 overdose deaths plan to sue the government, claiming it has put patients in mortal danger and created a public health disaster by prosecuting the doctor.
The lawsuit, which names Attorney General Michael Mukasey, U.S. Attorney Eric Melgren, the state of Kansas and the Kansas Board of Healing Arts as defendants, was to be filed Tuesday by the New Mexico-based Pain Relief Network on behalf of the patients of Dr. Stephen Schneider.
Schneider and his wife, nurse Linda Schneider, were indicted in December on federal charges including conspiracy, unlawful distribution of a controlled substance resulting in death, health care fraud, illegal money transactions, and money laundering.
The state last month suspended Schneider's license to practice, which forced him to close his Haysville clinic.
The group's lawsuit, a copy of which was obtained by The Associated Press, seeks an emergency temporary restraining order. It contends the Board of Healing Arts and a Kansas district court ignored the danger to 1,000 medically vulnerable patients who have been forcibly abandoned and must now fend for themselves. The group contends pain is a significant cause of death, including progressive brain damage.
"Withdrawal for people who are sick is catastrophic," Siobhan Reynolds, president of the Pain Relief Network.
Patients held a candlelight vigil Monday night outside Wesley Medical Center, where one of Schneider's former patients was hospitalized four days after she ran out of prescription painkillers. The hospital would say only that she was stable.
"She was lying in an ICU bed crumpled up, incoherent. ... She was in a very weakened state. She looked very, very ill," said Reynolds, who visited Collins at the hospital over the weekend.
Jim Cross, spokesman for Melgren's office, said officials there haven't seen the lawsuit and couldn't comment on it. The Kansas Board of Healing Arts did not immediately respond to an after-hours call Monday seeking comment.
In its indictment, the government links Schneider's clinic to the deaths of 56 patients, although Schneider and his wife are charged with directly causing only four deaths and contributing to the deaths of 11 others. Prosecutors contend that Schneider wrote unlawful prescriptions for narcotic painkillers, muscle relaxers and other drugs, and that the clinic submitted fraudulent claims to health care benefit programs.
The Pain Relief Network contends that the suspension of Schneider's license served no legitimate government interest but harmed his patients because it forced the closure of his clinic. Since Schneider's arrest, other doctors have been reluctant to take on his patients, the group said.
The group seeks an emergency order forcing the Board of Healing Arts to restore Schneider's medical license. It also seeks to restrain the Justice Department from harassing a new clinic to be opened under a different doctor, Dr. Joseph M. Sack, at Schneider's now-shuttered Haysville facility.
The group wants an injunction against the Justice Department prohibiting it from confiscating patient files or taking any other actions to impede its treatment of patients in severe pain. It also asks that prosecutors return to the clinic patient files taken in what the group alleges is a violation of federal law.
The lawsuit also asks the court to appoint a special master to oversee the reopened clinic's financial operations to protect it from charges of money laundering.
Minn. Web site creates health market
Tue, 12 Feb 2008 02:42:40 GMTBy ELIZABETH DUNBAR, Associated Press Writer
PLYMOUTH, Minn. - You can buy almost anything online these days, but try shopping the Internet for an MRI, strep throat test or even an annual physical exam and you'll run into roadblocks.
A new Twin Cities company called Carol is trying to change that with a Web site that gives consumers a "care marketplace" to search for medical services, compare quality and price and make appointments.
Carol joins an effort to transform the U.S. health care system by putting consumers in charge and letting the market do its work.
"We want to let consumers define value," said Tony Miller, Carol's founder and chief executive officer. "We don't have care competition in the marketplace today."
The free site, which went live in January, generates revenue from health care providers who become "tenants" on the site. When a consumer sets up an appointment with a clinic or doctor on Carol.com, the provider pays the site a fee.
While limited to about 30 providers in the Twin Cities area at its launch, the company is adding others and plans to serve a second U.S. market sometime this year, Miller said.
Health care experts said Carol will face challenges in getting enough doctors and health plans to participate. But they said it goes farther than previous efforts to use the Web to enhance medical choice, and they praised its ease of use.
Instead of going through a list of doctors or clinics, users tell the site what they're looking for by clicking on parts of the body.
For instance, if a consumer clicked on "entire body," then "annual exam," and chose a routine physical for women age 40-64, the results page would show six different options ranging from $207 to $335. After selecting a number of options, consumers can click "compare" and see exactly what each exam would entail. They can also read a description of the doctor or clinic's philosophy and link to ratings by MN Community Measurement, a nonprofit that measures health care performance in Minnesota.
Consumers who have insurance can type in plan information to have Carol.com estimate their out-of-pocket cost.
Miller said Carol is sensitive to consumer privacy, allowing people to search the site without registering, and it won't market to individual consumers even if they do register.
"The fact that they have a basic set of providers and prices and care packages is very impressive," said Greg Scandlen, president of the advocacy group Consumers for Health Care Choices, which lobbies against government regulation of the health care market.
But Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, said the site is nothing more than advertising, and he hoped it wouldn't catch on.
"Among physicians, there's a belief that health care is too critical ... to be left to the usual marketplace," he said.
If the site becomes more comprehensive, Carol.com would be most useful to people with high-deductible plans, health savings accounts or those without health insurance, said Elizabeth Boehm, an analyst with Forrester Research who studies the health care customer's experience.
She was skeptical of the site's prospects because many people's choices are limited by their HMO.
" just not what drives people to make their health care choices," Boehm said. "The challenge for a site like this is that while conceptually it's good ... the reality is there are only a small group of customers looking for that."
But Miller said consumers are starting to realize that choosing cheap health care might come back to haunt them in the form of higher premiums or other increased costs. And he thinks there are plenty of people like him who might want different options for care and are willing to pay more out-of-pocket to get what they want.
He said his idea for Carol came in part from his own experience with a heart condition for which he was told he needed surgery. A second professional recommended medication, which Miller, 41, said worked.
"I had the wherewithal and some of the contacts to help me navigate and find answers in the health care system. Most consumers don't have that," said Miller, a partner in the venture capital firm Lemhi Ventures, which has invested $25 million in Carol.
Park Nicollet Clinic, one of the bigger providers in the Twin Cities with nearly 700 doctors, was one of the first to embrace the Carol idea. Chief executive David Wessner said the clinic was already looking at ways to deliver value to patients and wasn't afraid to reveal prices.
"We just think there really is a crisis in value in health care. One of the things that helps us address that crisis is to package high value services and start to be willing to compete on that," Wessner said.
Psychiatrist Ronald Groat said Carol is important because it makes health care "more visible and transparent to someone who's looking for help."
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On the Net:
http://www.carol.com
