What is Cerebral Palsy?

Of the many diseases and conditions that can afflict a child and his or her brain, cerebral palsy (CP) is one of the toughest. This disorder is the result of brain damage that occurs during the brain’s early development. The damage can be congenital, which means it occurs as a fetus develops, or during or following birth, often before the child turns two years old. There are a few different types of cerebral palsy, and each affects movement differently.

As of June 2013, the Centers for Disease Control and Prevention estimates that for every 1,000 live births there will be between one and four children who develop cerebral palsy. Congenital cerebral palsy makes up 85 – 90% of cases, while the remaining percentage is “acquired cerebral palsy”. Acquired CP can occur during the birthing process or within the first couple of years and is often the result of a head injury or infection. There are three types of cerebral palsy. Patients are diagnosed based on the part of the brain that suffers damage and affects specific movements.

Spastic CP is the most prevalent form for children. Muscle tone is much higher, resulting in chronic muscle stiffness. Stiffened muscles cause unnatural movement in the affected section of the body. Spastic diplegia causes leg stiffness and difficulty walking. Hemiplegia occurs on one side of the body and generally affects the arm more. Quadriplegia causes stiffness in all the muscles of the arms, legs, chest, and face.

Dyskinetic CP causes a difficulty with sitting and walking. Muscles can be too loose or stiff at any given time. One minute the patient can suffer from stiffness that causes rapid jerking, and the next, the muscles are limp and uncooperative, causing slow movement. The legs, feet, arms, and hands are commonly affected, which causes the trouble with sitting and walking.

Coordination and balance trouble are classified as ataxic CP. Unsteadiness while walking is common. Patients may also have trouble with controlled movements. They may also be unable to perform quick movements, such as running or jumping. Patients with this form may appear as though they are dizzy or that their body will not cooperate with how they try to move.

Cerebral palsy does not currently have a cure. Treatment to help children reach developmental milestones is crucial. These treatments include medications to help with muscle control and ongoing physical, speech, and occupational therapies to help with motor function. Some children may need surgery and braces, particularly if they have suffered severely bowed legs or cannot walk without aid.

Sources:
http://www.cdc.gov/NCBDDD/cp/data.html
http://www.cdc.gov/NCBDDD/cp/facts.html

With Exponentially Rising Medical Expenses, Are West Coast Payout Caps a Joke?

A recent study published by Public Citizen shows that medical malpractice is one of the biggest contributors to rising medical costs. Yet somehow, according to the statistics reported, 2012 medical malpractice payments were the lowest on record since 1991. Eight west coast states – California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon and Utah – have caps on medical malpractice awards, yet medical expenses continue to rise.

California

California’s medical malpractice cap is $250,000 on non-economic damages, a decision that was upheld in Fein v. Permanente Medical Group (38 Cal 3d 137, 695 P.2d 665 (1985)). California was one of the first states to begin tort reform by instituting award limits in 1975. However, 12 years after the implementation of those caps, malpractice insurance rates were 190% higher than they were before the implementation of the caps.

In addition to an increase in malpractice premiums, in 2009, Californians averaged approximately $6,238 per year in healthcare costs. Arizona, which has no cap on medical malpractice awards, spends an average of $5,434, almost 15% less than those who live in California.

Colorado

Colorado’s medical malpractice cap is slightly less restrictive than California, with a $1 million cap on total damages, and the tort reform allows the court to award more than the cap if it is determined the award would be unfair. Even with the ability for courts to adjust caps in the state, residents of Colorado still spend, on average, $5,994 annually on healthcare, approximately 10% more than Arizona residents.

Idaho

Idaho imposes a limit of $250,000 on personal injury and wrongful death actions, but the cap is adjusted annually based on the average annual wage. The cap also does not apply to willful or reckless actions. In 2009, Idaho residents spent approximately $5,658 on health care costs, just over 4% higher than that spent by Arizona residents.

Montana

In Montana, there is a cap of $250,000 on non-economic damages per occurrence, but if a single incidence of malpractice injures multiple patients, the $250,000 cap applies to each patient and all claims. Even higher than that paid in California, Montana residents spend 22% more than Arizona residents in healthcare costs at $6,640.

Nevada

Nevada residents are limited to a $350,000 cap on non-economic damages to each plaintiff from each defendant. However, Nevada’s annual cost for healthcare is only 5% higher than Arizona, at $5,735.

New Mexico

New Mexico’s medical malpractice cap is slightly more complicated than that of surrounding states, as total damage awards are limited to $600,000, excluding punitive damages. Past and future medical-care are also not included in those amounts. However, a healthcare provider’s personal liability is limited to $200,000. Like Montana, healthcare costs for New Mexico residents are 22% higher than Arizona, averaging $6,651 per person per year.

Oregon

Oregon sets a limit for wrongful death damages at $500,000, but a $500,000 cap for non-economic damages was overturned in 1999. In 2009, Oregon residents spent an average of $6,580 in healthcare, 21% more than residents of Arizona.

Utah

For cases arising after July 1, 2002, but before May 15, 2010, a $400,000 cap on non-economic damages exists in Utah. For actions arising after May 15, 2010, there is a hard cap of $450,000 in the state. Of the west coast states with medical malpractice caps, Utah is the only state with healthcare costs lower than that of Arizona, with residents spending, on average, $5,031. This 2009 figure gives Arizona an 8% higher expenditure than Utah.

These statistics demonstrate that tort reform in the area of medical malpractice claims do not work to keep healthcare costs down. A review throughout the United States shows that states with malpractice limits often have higher healthcare costs than those that do not.

Sources:
http://www.citizen.org/documents/medical-malpractice-payments-do-not-increase-health-care-costs-report-2013.pdf
http://kff.org/other/state-indicator/health-spending-per-capita/

Most Commonly Misdiagnosed Symptoms

Chest pain, nausea, abdominal discomfort and fatigue are common symptoms that everyone experiences at some point in their lives. In many cases, these symptoms are just transitory and are of no cause for concern. However, in some cases, they could signal a serious health condition that warrants emergency care such as a heart attack or stroke. Since certain symptoms may appear across many different diseases, it is not uncommon for doctors to misdiagnose a patient with a minor condition when the condition is much more serious. Below are a few of the most commonly misdiagnosed conditions.

Lupus

Lupus is a chronic disease that causes inflammation triggered by the immune system. This disorder causes the immune system to attack important organs such as the brain and heart, as well as joints and tissue. According to WebMD, this chronic disease currently affects approximately 1.5 million Americans. Symptoms of Lupus include fatigue, rash, joint pain, chest pain, dry eyes, shortness of breath and skin lesions (after sun exposure). Lupus is often misdiagnosed as fatigue, fibromyalgia or allergies.

Heart Attack

According to the National Heart Lung and Blood Institute, 1.2 million Americans suffer heart attacks each year. In some cases the person can be treated, but due to self-diagnosis or misdiagnosis in medical facilities, many die from the condition. A heart attack occurs as a result of a blockage in the arteries that delivers blood to the heart. This causes a severe spasm that disrupts blood flow to and from the heart. Symptoms of a heart attack include: chest pain, shortness of breath, dizziness, nausea, fatigue and cold sweats. Some people with heart attack symptoms may be misdiagnosed as having anxiety or panic attacks, indigestion or heartburn.

Fibromyalgia

Fibromyalgia is a chronic condition that has no direct cause. This being the case, it is often misdiagnosed as minor conditions such as typical joint or muscle pain or fatigue. Several tests must be administered in order to determine if a person has the condition — it cannot be ruled out upon physical examination alone. Symptoms of fibromyalgia include: chronic pain in the muscles or joints, inflammation and fatigue.

Cancer

Since several screening tests are required to determine whether a person has cancer, it is considered to be one of the most evasive conditions to-date according to AARP. The symptoms of cancer range from chronic fatigue and joint pain to nausea and light-headedness, to cases where there are no symptoms at all. Cancer is often misdiagnosed as several minor conditions due to its gradual onset and commonly experienced symptoms.

Although the above conditions are quite severe, there are less severe conditions that can be easily misdiagnosed. When these lesser conditions go undetected, they may become severe over time. This is the case with conditions such as bronchitis, pneumonia and food allergies.

Sources:
http://www.cnn.com/2007/HEALTH/conditions/09/26/ep.misdiagnosed.diseases/
http://www.aarp.org/health/conditions-treatments/info-11-2012/common-diagnostic-errors-in-icu.3.html
http://www.aarp.org/health/conditions-treatments/info-06-2011/commonly-misdiagnosed-illnesses.2.html
http://www.mayoclinic.com/health/lupus/DS00115/DSECTION=symptoms
http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/
http://www.mayoclinic.com/health/fibromyalgia/DS00079
http://www.health.com/health/gallery/0,,20307285,00.html
http://www.cancer.gov/cancertopics/cancerlibrary/what-is-cancer
http://lupus.webmd.com/arthritis-lupus

Heart Stents “Highly Overused,” Say Experts

A breakthrough coronary procedure that has saved the lives of many, coronary stints are implanted in more than 500,000 Americans who have been diagnosed with narrowed coronary arteries. However, studies indicate that many patients may receive a stint when the procedure offers little to no benefit.

Stent placement, formally referred to as angioplasty, was listed in a report issued by two leading medical institutions that named five commonly overused medical procedures. The report focused on elective angioplasty procedures that were performed in patients who had stable coronary disease, a condition through which patients may generally experience chest pain and discomfort only after physical exertion. Research findings suggest that patients with stable coronary disease often do not receive additional benefit from stent placement when compared to using medication to prevent heart attacks.

According to the American Medical Association and the Joint Commission, approximately one in every ten elective angioplasties may be inappropriate, while an additional one-third of all elective stint placements may be questionable. While complications are not common, cases in which the procedure results in tears in the blood vessel may have severe outcomes, and the financial cost of the operation is around $30,000. Some experts believe doctors may be motivated to perform elective angioplasty procedures for financial gain and an increased revenue stream for the hospital. However, others believe unnecessary procedures may be performed simply as the result of a misunderstanding of the nature of coronary disease among doctors and patients.

The report noted that implementing tools like random case reviews and standardized reporting may reduce instances of unnecessary angioplasty surgeries. The report also argued that a greater emphasis should be placed on informed consent and full disclosure of the benefits and risks of the treatment before a patient elects to have the procedure. By doing this, patients and families may have a better idea of the possible outcomes that may arise from having the surgery. Dr. Rothberg, who conducted a small study that was published in The Annals of Internal Medicine, offered the suggestion that doctors may be oversimplifying when explaining the nature of coronary disease and the role of medication to their patients, leaving the patients to conclude that the issue is simply a matter of correcting the blockage.

Read more at: http://well.blogs.nytimes.com/2013/08/15/heart-stents-continue-to-be-overused/?_r=1

Risks of Anesthesia for Young Patients

Recent studies done on young children that have undergone anesthesia have returned some worrisome results. The research indicated that children who received anesthesia while they were under the age of three had later suffered several types of learning disabilities. Some of the disabilities have included a deficiency in learning, language, and certain behaviors. A lack of abstract reasoning and ADHD were also found at a higher rate among children under three who were exposed to anesthesia.

In order to further research the subject, scientists studied the effects of anesthesia on young rhesus monkeys. It took the monkeys much longer to learn basic concepts, and after they learned them they were much less accurate. Several years after this study was done, scientists found that the same rhesus monkeys still had trouble with learning comprehension.

Some scientists say that it is too early to get overly worried about anesthesia’s possible effects on young children. There is a chance that the culprit might be the medical problems for which children receive anesthesia. Most of the researchers agree that more studies need to be done to determine how anesthesia affects the brains of children and what kinds of anesthesia are to blame. At the moment, there is not enough evidence to deny anesthesia to young children who require it. Most young children who undergo anesthesia cannot wait because the known benefits outweigh the potential risks.

As a parent, one option can be to discuss with your pediatrician putting off certain surgeries until after the age of three. This can work with minor surgeries such as the removal of tonsils, ear tubes for chronic ear infections, dental procedures, hernia repairs, and circumcisions.

In the meantime, several organizations, including the FDA, SmartTots, and the American Academy of Pediatrics, are conducting more research into the matter. Some of the questions they are looking into include what forms of anesthesia are affecting the brains of small children, and how long they can affect the children. Some of the types of anesthesia included in studies to date have been ketamine and halothane.

Additional Resources

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm364078.htm
http://thechart.blogs.cnn.com/2012/08/20/anesthesia-in-young-kids-may-carry-developmental-risks-embargo-monday-820-1201am/
http://www.webmd.com/parenting/baby/news/20120820/anesthesia-may-harm-childrens-brains?page=3