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Lee Kirksey, MD  
Male
Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Is Universal Coverage Enough...No!!

Sep 13, 2009 - 2 comments
Tags:

universal insurance coverage

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Obama

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healthcare

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Obesity

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Heart Attack

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Diabetes

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Stroke

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limbaugh rush

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sean hannity



Like many of you, I have watched intently as the heated debate regarding healthcare reform plays out in front of us. To be clear, the discussion to date is more about universal healthcare coverage than it is about reform of how we manage medical illness. As a practicing vascular surgeon, I see the consequences that lack of insurance has with Americans. No American should feel comfortable with the  contrast that in the wealthiest country in the world, 20,000 people per year should die from otherwise treatable illness because of lack of insurance.  The idea is horrifying and I think it is a moral imperative that we make a decision about how to care for all Americans.

That was the socially conscious part of me. The Ted Kennedy liberal if you will. The fiscally responsible part of me cannot understand the discussion that does not include any mention of how we plan to address the purple elephant in the room, Childhood and Adult obesity. In a little over 3 decades the obesity rate has doubled in adults and tripled in children. By various studies, obesity is responsible for up to 30% of our increased health spending over that time. Diseases like diabetes, heart attack and stroke and arthritis all brought on and worsened by obesity cost hundreds of billions of dollars to manage each year.  These disorders occur disproportionately in people of lower socio economic class and minorities.

So I don’t understand the reasoning that America, the most overweight and obese country in the world will now provide healthcare to all citizens.  Obesity is clearly a cause of multiple costly chronic diseases.  The rate of obesity is increasing at an alarming rate to the extent that this generation of adolescents may be the first generation to routinely die before their parents.  In some groups of Americans, the rate of obesity and overweight is expected to be nearly 90% within 30 years.  

Without any well elucidated plan laid out to me to address the obesity epidemic, I ask all of you to tell me where the money will come from to support our obese Country.  I referred to it as the purple elephant because Im not the only one that knows the absence of logic about the feasibility of this type of reform without a multi pronged attack successful attack on obesity.

To be clear, the theory of universal coverage makes complete sense from a moral and ethical standpoint.The practicality of me, my children and generations to come paying for it with increasing taxes because it was poorly thought out does not.

Will your next xray lead to Cancer?

Aug 30, 2009 - 16 comments
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Cancer

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X ray

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cardiac cath

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stress test

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Breast Cancer

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mammogram

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Chest Pain

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xray

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dose




A new article published in the New England Journal of Medicine suggests that physicians may be overusing xray tests. The cumulative exposure to radiation that patients experience may be harmful and cause long term problems such as cancer. Unfortunately, there has been very little discussion with patients regarding the potentially harmful consequences of commonly ordered xray tests. Furthermore, physicians and patients will need to become more vigilant in determining that the benefits of x ray exams outweigh the detriment going forward. Question: has your doctor ever discussed the potential harm before you underwent and x ray??

Atlanta, GA - Medical imaging procedures expose many nonelderly patients to substantial doses of ionizing radiation, according to the results of a new study [1]. Myocardial perfusion imaging alone accounts for 22% of the radiation dose from all study procedures, while computed-tomography (CT) scans of the abdomen, pelvis, and chest account for nearly 38%, report investigators.

"Our findings that in some patients worrisome radiation doses from imaging procedures can accumulate over time underscores the need to improve their use," write lead investigator Dr Reza Fazel (Emory University School of Medicine, Atlanta, GA) and colleagues. "Unlike the exposure of workers in healthcare and the nuclear industry, which can be regulated, the exposure of patients cannot be restricted, largely because of the inherent difficulty in balancing the immediate clinical need for these procedures, which is frequently substantial, against the stochastic risks of cancer that would not be evident for years, if at all."

The analysis, which studied 952 420 adults aged 18 to 64 years in five US cities, is published in the August 27, 2009 issue of the New England Journal of Medicine.

During the study period, which ran from 2005 to 2007, 655 613 adults underwent at least one imaging procedure associated with radiation exposure. The mean effective dose was 2.4 mSv per person per year, although a wide distribution was noted. Moreover, the proportion of subjects undergoing procedures and their mean doses varied according to age, sex, and city. For example, approximately 50% of adults aged 18 to 34 years underwent a medical imaging procedure requiring radiation, whereas 86% of adults 60 to 64 years of age were sent for similar testing. Women also underwent imaging procedures significantly more often than men.



Smoking, Hypertension Diabetes lead to Dementia-What's bad for the heart is bad for the Brain

Aug 22, 2009 - 0 comments
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Heart Attack

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Stroke

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dementia

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Diabetes

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hypertension

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Smoking

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SHORTNESS OF BREATH

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arhythmia

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palpitations

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Cardiac catheterization

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Mitral valve prolapse

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high cholesterol

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statin



Smoking, high blood pressure, and diabetes may lead to dementia
August 20, 2009 | Allison Gandey
Adapted from Medscape Medical News—a professional news service of WebMD



London, UK - Middle-aged people who smoke or have high blood pressure or diabetes are more likely to develop dementia later in life, according to a new study [1]. In an article published online August 19, 2009 in the Journal of Neurology, Neurosurgery and Psychiatry, researchers suggest that controlling cardiovascular risk factors in midlife may prevent dementia later on.

"Our study population included both whites and African Americans," said lead author Dr Alvaro Alonso (University of Minnesota, Minneapolis). "We were able, for the first time, to show that cardiovascular risk factors in midlife are associated with dementia later in life in both racial and ethnic groups."

Overall, blacks had a 2.5 times higher rate of hospitalization for dementia than whites. Black women 75 years and older had the highest rates of all.



Predictors more predictive at younger ages


Current smokers were 70% more likely than those who had never smoked to develop dementia. People with high blood pressure were 60% more likely than those without high blood pressure to develop dementia, and people with diabetes were more than twice as likely as those without diabetes to experience cognitive impairment.

The researchers also demonstrated that cardiovascular risk factors measured earlier in life are better predictors of dementia than risk factors measured in older age. "These results, again, support the need for paying special attention to cardiovascular risk factors in midlife," Alonso said.

Investigators studied more than 11 000 people who were part of the Atherosclerosis Risk in Communities (ARIC) study. Participants were aged 46 to 70 years and underwent a physical examination and cognitive testing. Patients were followed up for more than a decade to see how many would later develop dementia.

Researchers identified 203 patients hospitalized with dementia. Smoking, high blood pressure, and diabetes were all strongly associated with this diagnosis.

In analyses including updated information on risk factors during follow-up, the hazard ratio of dementia in hypertensive vs nonhypertensive participants was 1.8 at age <55 compared with 1.0 at age 70 or older. Researchers observed similar results for diabetes, with a hazard ratio of 3.4 at age <55 and 2.0 in those older than 70. For smoking, the hazard ratio was 4.8 at age <55 and 0.5 in patients aged 70 or older.

"We were able to identify only individuals with dementia who were attended in a hospital," Alonso pointed out. "Therefore, it is very likely that we missed some people with dementia. Still, we did a number of additional analyses to determine whether this could bias our results. Overall, we are confident that this limitation is not having a major impact in our overall conclusions."

The authors point to another criticism that could explain the study results. "An unmeasured factor in our population could be associated with the presence of cardiovascular risk factors and also increase the risk of dementia," Alonso added. For example, a genetic marker that increases both the risk for hypertension and dementia could be at play. "This is a possibility," he said, "but in our analysis, we adjusted for the most important variables associated with cardiovascular risk factors and dementia, including some genetic factors such as apolipoprotein E."



Bad for the heart, bad for the brain


In the August 2009 issue of Dementia and Geriatric Cognitive Disorders, researchers came to a similar conclusion and reported that elevated cholesterol in midlife may increase dementia risk [2].

The authors, led by Dr Alina Solomon (University of Kuopio, Finland), followed 9844 patients over more than 40 years using data from the Kaiser Permanente Northern California Medical Group. During that time, 469 patients developed Alzheimer's disease and 127 developed vascular dementia.

The hazard ratio (HR) associated with total cholesterol of at least 240 mg/dL (compared with <200 mg/dL) for development of Alzheimer's was a significant 1.57 (95% CI 1.23-2.01) but for vascular dementia was a nonsignificant 1.26 (0.82-1.96). The vascular-disease HR was 1.50 (1.01-2.23) for total cholesterol 200 to 239 mg/dl.

In an analysis by total-cholesterol quartiles, the risk of developing Alzheimer's disease increased significantly when levels exceeded 220 mg/dL. "Both physicians and patients need to know that elevated cholesterol increases the risk not only for heart disease, but also for dementia," Solomon said.

Dr Robert Stewart (King's College London, UK), who isn't connected with the study, said in an interview that the data are convincing and consistent with those from other studies that have screened community populations for this disorder.

"In general," Stewart said, "there is now a large body of evidence that indicates that what is bad for the heart is bad for the brain—that is, that the well-known risk factors for coronary heart disease and stroke are also risk factors for dementia."


As if you needed another reason to avoid Beef

Aug 10, 2009 - 6 comments
Tags:

Cardiovascular Disease

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Heart Attack

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Chest Pain

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palpitations

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SHORTNESS OF BREATH

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PAD

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arrhythmia

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Stroke

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Heart

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artery

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risk factor

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blockage

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stress test

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Prevention



Red meat has been conclusively linked to increased risk of heart attack, stroke and peripheral artery disease. Researchers have shown that independent of other risk factors, the risk of cardiovascular disease is increased. As if that isnt enough to compel you to step away from the next hamburger, I came across another story of contaminated beef that has been widely distributed throughout the states. Lets face it:spinach, peanut butter, beef. Everyone is cutting corners to make a profit and unless your growing it in your backyard. Good luck!!

28 Illnesses Are Linked to Recalled Ground Beef
THE ASSOCIATED PRESS
Published: August 8, 2009
SAN FRANCISCO (AP) — Health officials in three Western states said Friday that at least 28 people had reported illnesses tied to recalled ground beef that might be tainted with salmonella.

On Thursday, Beef Packers Inc. of Fresno recalled nearly 826,000 pounds of ground beef produced from June 5 to 23.

The Food Safety and Inspection Service of the Agriculture Department said the beef was sent to retail distribution centers in Arizona, California, Colorado and Utah, with some sold at Safeway Inc. and Sam’s Club.

On Friday, the department confirmed that California, Colorado and Wyoming had reported illness linked to the recalled beef.

Colorado health officials said 21 people there had been sickened, and all were recovering. California officials said five people had reported feeling sick. Wyoming health officials reported that two people had fallen ill.

Officials are investigating other reported illnesses in Arizona, Idaho, Illinois, Nebraska, New Mexico, Nevada, South Dakota and Texas that may be linked to the same strain of salmonella, the Agriculture Department said.

Federal officials do not yet know if those cases are associated with the beef recalled Thursday.

Because the beef was repackaged under different retail names, the department recommends consumers check with the store where they bought the beef to determine whether what they bought has been recalled.

Salmonella can result in abdominal cramps, diarrhea and fever. Most people recover without treatment, but some require hospitalization. In rare cases the organism can get into the blood and produce more severe illnesses.