Health, Doctors and Common Sense

Clinical coordinator David Buettner, left, trains paramedic student Bobby Blanco on a birthing simulator at UC Davis Medical Center last week. UCD also has a lifelike dummy that can blink, breathe and on cue mimic a full-blown heart attack – one of many innovations being tried to cut costs and save time.

In a warehouse tucked among rows of nondescript office buildings, medical wizardry is taking place.

A wand remotely controls beams of light, a robotic cart dashes through the hallways, and camera-equipped metal arms hang from ceilings, poised for surgical duty.

At Kaiser Permanente’s laboratory for innovations in San Leandro, emerging tools in medicine – as well as some low-tech problem-solving – are being put to the test.

The talking robotic cart, known as TUG, might not have the bedside manner of an affable doctor, but soon could be wheeling through the corridors of Kaiser hospitals in the Sacramento region.

So could hand-held electronic tablets that might serve as conduits for better medicine, bringing new tools to a patient’s bedside, said Sean Chai, senior technology manager at the Kaiser lab.

In the long run, saving time saves money, Chai said. “Everything we do here is geared toward saving money.”

There’s a national focus on taming health care costs and improving the quality of care. For institutions such as Kaiser and Sacramento’s UC Davis Medical Center, scouting innovations is critical for improving hospital efficiency and patient safety.

“We have to be better at delivering care more effectively and more efficiently. Technology will play a critical role,” said Dr. Javeed Siddiqui, associate medical director at the Center for Health and Technology at the UC Davis Medical Center.

As a teaching institution, UC Davis Medical Center is also at the forefront of technological advances, sometimes testing medical tools in real-life hospital settings.

At the Center for Virtual Care at the UC Davis Medical Center, lifelike dummies blink, breathe and on cue mimic a full-blown heart attack. They act as simulators to train the next generation of doctors. There are also robotic surgical arms that perform less-invasive surgeries, saving time for doctors in the operating room and patients in recovery wards.

“We’re focused on helping to develop the next generation of technologies,” said Betsy Bencken, a clinical instructor at the virtual care center.

The health system’s Innovation Center, housed within the Center for Health and Technology, serves as a think tank for expanding telemedicine to far-flung reaches, not just in the rural areas of California but around the globe.

At the Garfield Health Care Innovation Center in San Leandro, Kaiser assembles teams of doctors, nurses – sometimes volunteer Kaiser members – to test the latest in medical research.

Nothing is too minor, such as testing the healing properties of paint colors. To enhance patient convenience, one room is equipped with a wand that directs beams of overhead light.

And there’s TUG, the robotic courier that ferries supplies and equipment from one spot to the next. The robot already has been darting through the hallways of some Kaiser facilities in Southern California on a trial basis.

This summer, hand-held LCD monitors – which could extend the portability of electronic health records – will be tested at the Kaiser Sacramento Medical Center to help evaluate products that could become standard issue across the health system’s facilities.

The San Leandro center, which sprawls over 37,000 square feet, opened in June 2006 and is the only one of its kind in the Kaiser health system. It is equipped with patient rooms, mock-ups of workstations, operating rooms – and a living room equipped with gadgets that turn the home into a control center for personal health.

“By 2015, the home will become the hub of care,” Chai predicted.

Home-based equipment will connect a patient at home to the doctor, who can monitor vital signs and other health care metrics.

But it’s not always about high-tech gadgetry. Useful changes often come after simple brainstorming, said Sherry Fry, operations specialist for the Kaiser facility.

A case in point: How to keep nurses charged with administering medication from being interrupted during their rounds.

There were no bells and whistles. At first it was just a neon-green vest, to be worn while on duty. But the vest wasn’t exactly a fashion statement. In the end, the team settled on a simple white sash to be worn during rounds, meant to deliver the message: “Don’t bother me.”

Tags: Associate Medical Director, Beams Of Light, Bedside Manner, Better Medicine, Clinical Coordinator, David Buettner, Davis Medical Center, Emerging Tools, Hospital Efficiency, Hospital Settings, Innovations, Kaiser, Kaiser Hospitals, Kaiser Permanente, Medical Tools, National Focus, Patient Care Costs, Sacramento Region, Senior Technology, Siddiqui, Uc Davis Medical, Uc Davis Medical Center, Ucd

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Female surgeons enjoy their specialty and would choose it again, but they are much less likely to have children than male surgeons, a nationwide survey conducted by a UC Davis doctor found.

“I was surprised by the large difference in parenting – women were five times less likely to have children,” said Dr. Kathrin Troppmann, who oversees medical students during their surgical training.

Troppmann isn’t sure whether surgery attracts women who are less interested in having families, or whether women who plan to be surgeons delay having babies during their lengthy training, then have trouble conceiving.

Her study does indicate that maternity leave and part-time work schedules are important to female surgeons and should be discussed by hospitals and professional groups, she said.

Surgery, long seen by medical students as a “hard core,” rigid specialty, is still about 85 percent male, Troppmann said, but that is beginning to change.

The residency programs that train the next generation of surgeons are attracting more women, and around the country nearly 30 percent of surgical residents are female, she said.

“As more women are entering, we’re more representative of the population we’re serving. It’s been a very important change,” she said.

Her survey, published in the July edition of the Annals of Surgery, captured the views of nearly 900 surgeons.

Along with the child gap, male and female surgeons also had different home situations, the survey found. While most were married, more than half the male surgeons had spouses who did not work outside the home. Fewer than 10 percent of the women did.

It takes “good support” to be a surgeon and raise children, Troppman said, adding that she was speaking from experience.

She and her husband, who is also a surgeon, have a daughter about to turn 1 and a son who soon will be 3. UC Davis, she said, has been “incredibly supportive of my parenting.”

Like many of those she surveyed, Troppmann started her family relatively late. She is 44.

Tags: Annals Of Surgery, Davis Doctor, Gap, Having Babies, Home Situations, Hospitals, Kathrin, Maternity Leave, Medical Students, Nationwide, Next Generation, Parenting, Part Time Work, Population, Professional Groups, Residency Programs, Surgical Residents, Survey, Uc Davis, Work Schedules

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The emergency room at UC Davis Medical Center is bustling, its waiting room more crowded than ever and its doctors and nurses caring for an increasing stream of patients who can’t possibly pay for services.

These days, more patients are arriving without jobs or health insurance.

As a result, the university medical center is forced to absorb the financial burden of caring for many of the capital’s medically indigent, uninsured and financially strapped – a burden that eventually is passed on to paying customers.

“We saw it coming, but the train was bigger than we thought,” said William McGowan, the chief financial officer for the UC Davis Health System.

“We didn’t think the recession would be this long or this deep.”

From July 1, 2008, to June 30, the university health system was left footing the bill for $165.7 million in charity services – up from $96.9 million the year before.

Bad debts climbed to $54.9 million for the just-completed fiscal year, up from $38.3 million the previous year.

Across California, hospitals have seen a surge in the amount of care they provide for free – known in the health care industry as charity care.

Last year, hospitals across California wrote off nearly $1.2 billion in bad debts and provided $973.4 million in charity care – an 89 percent increase from four years earlier.

The growing number of patients who can’t pay has had a “devastating effect” on hospitals, said Jan Emerson, spokeswoman for the California Hospitals Association.

“It’s a significant burden on us, and it’s getting bigger as the days go by.”

Nonprofits’ role debated

Nonprofit hospitals such as UC Davis Medical Center are required by the Internal Revenue Service to benefit the community in exchange for billions of dollars in tax breaks.

Hospitals typically comply by providing health screenings, smoking cessation programs and free medical care to those who cannot pay.

As Congress plunges into the health care debate, the role that nonprofit hospitals play in caring for the poor and medically underserved is part of the broad and contentious discussion in Washington to revamp the country’s health care system.

The Obama administration has made health care a top priority, arguing that systemic changes are needed to bring down costs and widen access to health care to the country’s 46 million uninsured. Nearly 7 million Californians do not have medical coverage.

If Washington succeeds in passing comprehensive health care legislation, there may be no need for charity care, according to Reatha Clark, a health industries partner for PricewaterhouseCoopers.

If there is universal health coverage, she said, “who would be left for charity care?” Universal health care is certainly one of the goals for overhauling the country’s health care system, but the question is still open about how truly universal the current proposals would be, said Marian Mulkey, a senior program officer with the California Healthcare Foundation.

Few of those watching the health care debate unfold believe that a universal insurance company would truly provide coverage to every person in the United States.

Some people may decline to participate. Also, coverage is unlikely to be extended to undocumented immigrants, who account for about 10 percent of uncompensated care, according to the state hospital association.

Critics: Hospitals fall short

Not everyone involved in the health care debate is sympathetic to the hospitals’ plight. Some critics say hospitals aren’t doing enough to provide free care.

Key federal legislators want to reduce the tax breaks nonprofit hospitals enjoy and set minimum amounts they must spend on free community care. The critics include Sen. Chuck Grassley, the ranking Republican on the Senate Finance Committee.

A state hospital group official took issue with this criticism. Hospitals have done more than their share to help those in need, particularly in times of financial distress, said Scott Seamons, regional vice president for the Hospital Council of Northern and Central California.

“We don’t want to be an industry that’s always crying about money, but without money, we can’t continue to serve the community in the way we do,” said Seamons.

UC Davis isn’t the only Northern California hospital hit hard by the rising number of people without health insurance. From July 2007 to June 2008, Catholic Healthcare West’s 41 hospitals provided $569 million in charity care – more than three times the $168 million of free service given four years earlier.

The uninsured “are impacting our emergency departments. There are more people coming in,” said Rosemary Younts, the community benefit director for Catholic Healthcare West’s Sacramento service area, which includes Methodist Hospital and the Mercy chain of facilities.

And at Sutter Medical Center, charitable care has more than doubled since 2004, rising from $23.5 million that year to $48.9 million last year, according to data filed with the Office of Statewide Health Planning and Development.

Financial strain widespread

As the debate continues in Washington, the ranks of the uninsured keep growing. For every percentage point rise in the unemployment rate, 1.1 million more people go without health insurance, according to the Kaiser Family Foundation.

This year alone, more than 330,000 people are expected to lose coverage in California, according to Families USA. The Washington, D.C.-based health care advocacy group predicts that by 2010, nearly 1 million Californians, more people than in any other state, will have lost their health insurance during a three-year period. As employers struggle, growing numbers are eliminating health insurance programs.

Others are expecting their employees to carry more of the burden for rising premiums. From 1999 to 2008, the average cost of health insurance premiums more than doubled, from $5,791 to $12,680, according to the Kaiser Family Foundation.

Even those with health insurance are struggling to pay for higher premiums and deductibles.

Unaffordable medical bills were partly blamed for 62 percent of all personal bankruptcies in 2007, according to a study released this year by researchers at Harvard and Ohio universities.

Three-fourths of those debtors had health insurance, according to a recent study in the American Journal of Medicine.

The study notes that more people are mortgaging their homes in a failed attempt to pay their medical bills.

Unpaid medical bills translate to bad debts that hospitals must absorb or pass on to other health care consumers.

Charity care isn’t necessarily free, and unpaid bills don’t necessarily vanish into thin air. They are partly recouped and collected when hospitals shift costs to their paying customers.

Bills for health services rise, and so do insurance premiums. The de facto subsidy is what is known within the industry as cost shifting.

To make up the difference, some hospitals have attempted to negotiate more favorable contracts with insurers, with mixed results, and are trying to extract deeper discounts from suppliers. Hospitals have also slowed hiring, cut services, delayed construction projects and put off big ticket purchases.

At UC Davis Medical Center, historically the health provider of last resort for the area’s medically indigent, officials expect continuing financial strain.

“We’ll continue to see those patients in need,” said McGowan, the medical center’s financial officer. His hospital, he said, is projecting as much as $175 million in charity care by the end of the fiscal year next summer, while the tally for bad debts is expected to rise to $62 million.

“In our budgetary process, we try to anticipate this kind of thing happening,” he said. “But we hadn’t anticipated the magnitude.”

Tags: Bad Debts, California Hospitals, Charity Care, Charity Services, Davis Health System, Davis Medical Center, Doctors And Nurses, Free Medical Care, Health Care Debate, Internal Revenue Service, Nonprofit Hospitals, Smoking Cessation, Smoking Cessation Programs, Uc Davis Health, Uc Davis Health System, Uc Davis Medical, Uc Davis Medical Center, University Health System, University Medical Center, William Mcgowan

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Jessica Read, wife of Airman 1st Class Colton Read, discusses the situation Monday with Dr. David Dawson, a UC Davis vascular surgeon. Listening and waiting with her at UC Davis Medical Center are her husband’s grandmother Terry DeBrow, and his father, Steve Read.

A 20-year-old airman was in critical condition at UC Davis Medical Center on Monday, after losing both legs in what his family described as complications of routine gallbladder surgery.

Neither the medical center nor Travis Air Force Base, where Airman 1st Class Colton Read underwent surgery earlier this month, would comment on specifics of his case.

Travis said only that a “serious medical incident” occurred at its David Grant Medical Center on July 9 and is being investigated by the base, a national hospital accrediting commission and the U.S. surgeon general.

Read, who was stationed at Beale Air Force Base east of Marysville, was supposed to get his gallbladder removed laparoscopically at the Travis hospital, said his wife, Jessica Read.

Instead, a device being threaded into his belly nicked or punctured the aorta, a large artery that carries blood from the heart throughout the body, she said.

Surgeons opened his abdomen and were able to repair the breach well enough to save his life, but in the process or afterward, something apparently disrupted the blood supply to his legs.

Jessica Read said she was told the aorta was sewn together incompletely and began leaking, and her husband was flown to UC Davis Medical Center late that afternoon for more specialized vascular surgery.

Her uncle, Dr. Michael Hines, a Texas surgeon, said he was told by the UC Davis surgeon who operated on Colton Read that two branching vessels from the aorta that carry blood to the legs were clotted and closed.

When the surgeon restored the blood supply to those iliac vessels, the legs were so badly swollen and damaged that blood circulated only down to the knees, leaving dead tissue below, Hines said.

Colton Read has undergone multiple surgeries that removed first the lower-right leg, then the lower-left and more of the right, his wife said. The latest surgery, which began Monday evening, was expected to take more tissue from his right thigh, perhaps up to his hip, she said.

The remaining portion of his left leg now appears to be healing well, but it, too, was amputated above the knee, Jessica Read said.

She has heard conflicting accounts of what happened to her husband at Travis – that the surgeon made the initial error, or that it was a mistake by a second-year surgical resident.

Hines, her uncle, said that as a surgeon who has been in practice for 30 years, “I understand how you can puncture something that you don’t mean to. That’s a recognized complication. The measure of a surgeon is how well they handle those complications.”

Hines said he had “a hard time understanding how he ended up with no legs … how you leave an operation without assuring that there is blood flow.”

For her part, Jessica Read anguishes over the nearly nine hours, by her count, that passed from the initial surgical error until her husband was flown to Sacramento. She wonders if his legs could have been saved had he been moved more quickly.

“They were wasting time doing a sonogram, doing an angiogram, wasting so much time,” she said.

When she arrived at UC Davis Medical Center, the surgeon there told her there was “a very real chance” that her husband would not survive.

Since then, he has been doing a little better each day, gradually regaining kidney function and slipping in and out of consciousness, she said.

He knows he has lost his legs, but “I don’t know how much of it sticks,” she added.

Colton Read is an imagery analyst at Beale, interpreting photos and other data gathered by reconnaissance equipment, his wife said. The couple met in high school in Arlington, Texas, and have been in California a little more than a year, living first in Olivehurst and then Plumas Lake.

Tags: Accrediting Commission, Aorta, Beale Air Force, Beale Air Force Base, Blood Supply, David Dawson, David Grant Medical Center, Davis Medical Center, Dead Tissue, Gallbladder, Gallbladder Surgery, Grant Medical Center, Legs, Medical Incident, Michael Hines, Texas Surgeon, Travis, Travis Air Force Base, Uc Davis Medical, Uc Davis Medical Center, Vascular Surgeon, Wife Jessica

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American River College freshman Nathan Miller jumps from a special force plate as UC Davis biomechanical engineer Judd Van Sickle prepares to measure how hard he comes down on the device. Van Sickle hopes to develop a quick, lowcost test to predict which athletes are most at risk for anterior cruciate ligament tears, a common but serious knee injury.

One after another, aspiring football and soccer players mounted a low blue bench, jumped off, then leaped up again, as high as they could.

Their landings were tracked by two video cameras, two computers and a special force plate that measured how hard they came down.

The man behind the high-tech gear last week in the American River College gym is hoping to develop a quick, low-cost screening test to spot athletes most at risk for a common – but serious – knee injury.

Judd Van Sickle, a biomechanical engineer with UC Davis’ sports medicine performance program, is fascinated by tears to the anterior cruciate ligament because he thinks they’re so preventable.

“It’s a non-impact injury. It’s not someone running into your knee. It’s you turning and your ACL pops,” Van Sickle said.

A torn ACL often requires surgery and a recovery that can cost an athlete a season or a year – sometimes knocking a high school player off a scholarship path.

Van Sickle’s project is part research and part prevention. A few studies suggest the two things he’s measuring – how hard an athlete lands and the position of the knees – correlate with vulnerability to ACL tears.

Athletes who land hard on the force plate, especially in relation to the force of their takeoff when they jump back up in the air, seem to be the ones likeliest to injure their knees, Van Sickle said. The harder landing indicates less control, and so less support for the knee.

The second indicator is whether the knees turn in on landing, in a sort of knock-kneed position, or are aligned directly above the feet. The inward turning knees could be a sign of poor hip stability or just improper technique, both leaving the knee more prone to injury.

Once he finishes writing the computer code that will give him a quick analysis of each student athlete’s landing, Van Sickle will give American River College coaches a list of those who seem most prone to ACL problems.

“It’s definitely helpful to detect those things,” said Gil Bejarano, one of the community college’s trainers. “This way we know what to strengthen for.”

Bejarano and fellow trainer Anna August work with about 500 student athletes a year, and their most common injuries are to knee and ankle ligaments, August said.

The young people lined up for their team physicals on Thursday at American River College had their own tales of seeing teammates or relatives hobbled by knee injuries. Some had gotten detailed injury prevention advice in high school, others none.

Most ACL tears come in sports with lots of jumping and cutting, or rapid changes of direction. Basketball, soccer, volleyball and football are rich breeding grounds for ACL problems.

Proper turning techniques can lessen the risk of injury; so can strength and neuromuscular training, which build a better support structure for the knee.

The students Van Sickle pinpoints will get extra help in all those areas, August said.

That extra help – aimed at preventing injuries – will make it tougher to tell whether tests really did spot the most injury-prone players.

But Van Sickle said he’ll get useful data anyway. He will track students who his tests indicate are less likely to tear an ACL. If those students end up getting injured at higher than expected rates, he’ll know a more robust test is needed.

There are more detailed ways to look for potential knee problems, including skeletal reconstructions that involve a full, three-dimensional analysis of each athlete, Van Sickle said. Those take hours of computer processing time and equipment that costs around $100,000.

By contrast, the simple force plate and video testing system he is using takes just a few minutes. It should cost well under $100 per athlete.

He plans to collect data on more than 100 American River College student athletes as part of routine physicals they’re required to take before playing.

It’s a pilot program he hopes will grow, even though right now “I’ve got zero funding for this,” Van Sickle said.

Among those hoping he succeeds is Joseph Iese, a freshman from Santa Cruz who has watched over the years as his father, mother and sister underwent knee surgery for ligaments torn during basketball games.

“I really don’t want to have the surgery,” Iese said. “I’ll take all the help I can get.”

Tags: Acl Tears, Anterior Cruciate Ligament, Biomechanical Engineer, Blue Bench, College Freshman, College Gym, Impact Injury, Knee Injury, Knee Ligaments, Ligament Tears, Nathan Miller, Performance Program, Screening Test, Soccer Players, Sports Medicine, System Checks, Torn Acl, Uc Davis, Van Sickle, Video Cameras

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Fireplaces and wood-burning stoves may be the last thing on most people’s minds in July, but that’s just what city officials want the public to start thinking about.

Come November, if you live in the area, you may be dealing with a newer, stricter set of rules when it comes to burning wood.

The Sacramento Metropolitan Air Quality Management District is proposing an overhaul to Rule 421, which limits the use of wood-burning stoves and fireplaces during the winter months on bad air days.

Starting this week, air quality officials will launch a series of five open forums where they will present the proposed changes. The air quality board wants people to weigh in with their comments and recommendations.

“With the current rule, we still have too many unhealthy days,” said program supervisor Aleta Kennard.

“At these forums, we’ll lay out what we’ve done with our analysis and what we’re considering to change, and give the public an opportunity to respond.”

The district wants to revamp its system, which currently allows some exceptions for burning on bad air days. It wants to create a program in which all burning would be prohibited – regardless of the type of stove or the material being burned.

Currently, Stage 1 of the “Check Before You Burn” program bans the use of fireplaces and wood-burning stoves, unless they are pellet stoves or U.S. Environmental Protection Agency-certified fireplace inserts or stoves. On Stage 2 days, burning any solid fuel, including wood, synthetic logs and pellets, is illegal.

“On a no-burn day you get a 22 percent reduction in particulate emission, while on a Stage 1 day, when you have exceptions, you only get about a 10 percent reduction,” Kennard said.

Rather than a districtwide ban on all burning on those days, some retailers suggest that the district should focus on getting residents to use more environmentally friendly devices.

Mitchell Heller, owner of Custom Fireside, said the city is approaching the issue the wrong way.

He said government should crack down on open fireplaces, providing incentives for residents to use wood pellets or EPA-approved fireplace inserts or stoves.

“I’m not supporting this, because there are two options that they don’t have on the table,” Heller said. “One, leave the current system we have in place; or two, enact more severe restrictions and rules on open fireplaces, which will make people put in EPA or pellet stoves.”

Heller said his customers are required by law to purchase EPA-certified inserts or pellet stoves. The clean-burning appliances emit from 2 to 7 grams of smoke per hour, while uncertified devices emit 60 to 80 grams of smoke per hour.

During the winter, wood smoke combined with calm weather conditions in Sacramento can make the air extremely unhealthy and potentially dangerous, said Brigette Tollstrup, the air quality district’s division manager.

“When you burn, you emit particulates,” Tollstrup said. “And in the wintertime, we get those calm cool nights where … the smoke gets trapped low to the ground, causing really bad air.”

Officials say exposure to air laden with smoke particulates worsens existing asthma, increases the likelihood of stroke and heart attacks in postmenopausal women, causes chronic bronchitis, and poses a particular threat to children, who take in more air in relation to their size than adults do.

In addition to particulate problems, Sacramento is also ranked seventh-worst in the nation for ozone pollution, according to the American Lung Association.

The air board declares an average of 23 no-burn days per season.

Air quality officials said that if their proposal is approved, the number of complete no-burn days could increase to 31.

That, they said, would ultimately lead to more clean-air days in the future.

Tags: Air Quality Management, Air Quality Management District, Air Quality Officials, Burn Day, Environmental Protection Agency, Fireplace Inserts, Fireplaces Stoves, Fireside, Kennard, Metropolitan Air Quality, Particulate Emission, Pellet Stoves, Program Supervisor, Quality Board, Quality Management District, Sacramento Metropolitan Air Quality Management District, Solid Fuel, Stage 1, Wood Burning Stoves, Wood Stoves

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Mikaela Espinoza, 17, talks on her cell phone while checking her MySpace page. After she complained of migraines, Espinoza’s doctor advised her to put away the devices at night and get more sleep. Studies show a link between technology and sleep disorders.

To many parents, text messaging is an enigma – a practice their children engage in when they could just make a phone call or walk down the street to their friends’ houses. It seems to be a strange but harmless means of communication.

What most don’t know is that too much texting can actually be detrimental to their teens’ health. That’s because new technologies, such as cell phones and social networking sites, give teenagers easy access to their friends 24 hours a day.

“The more technology we develop, the more we rely on technology,” said Dr. Myrza Perez, a pediatric pulmonologist at Capital Allergy & Respiratory Disease Centers in Roseville and Folsom. A specialist in sleep disorders, she says “before technology, we went to sleep when the sun went down. Now, with all these distractions, teenagers alone in their rooms stay up to extremely late hours on their cell phones and computers. Their parents have no idea.”

The trend of sleep deprivation is leading to many daytime problems for teenagers, including headaches, impaired concentration, weakened immune systems, crankiness, increased use of nicotine or caffeine and hyperactive behavior often misconstrued as attention deficit hyperactivity disorder.

These symptoms are often interpreted by doctors as problems meriting medication, when in fact the best cure might be to turn off their cell phones at night.

Mikaela Espinoza, 17, always used to sleep with her phone at her bedside, just in case a friend called or text-messaged her in the middle of the night. Sometimes, she said, she would receive calls or messages as late as 3 a.m. – and she would wake right up to call or text right back.

“Whenever I’d hear my phone ring I would just, like, wake up and answer it,” Espinoza said. “I think a whole bunch of kids text like all night long.”Espinoza soon found herself suffering from near-debilitating migraine headaches throughout the day. She couldn’t concentrate in school, she couldn’t go out with her friends, she couldn’t be herself, she said.

Her primary physician’s first instinct was to check her eyes. When that yielded no solutions, he sent her in for a CAT scan. It came back clear.

“Nobody knew what was wrong with me,” Espinoza said.

Eventually, Espinoza was diagnosed with a condition growing more and more common among teenagers: too much texting.

“After they realized I wasn’t getting enough sleep, they told me I needed to turn off my phone or have it taken away from me at night,” she said. “My mom was real mad at me.”

According to the National Sleep Foundation, school-age children and adolescents need at least nine hours of sleep a night. But in a national survey conducted in 2006, only 20 percent of American teens said they get nine hours a night. Nearly half sleep less than eight hours on school nights and 28 percent of high school students reported falling asleep in school at least once a week.

The problem, experts estimate, has only worsened since then.

“We all have this 24/7 lifestyle and as technologies become more prevalent, the problem just gets worse,” Perez said. “They’re distractions and they lead to sleep deprivation. I feel like it’s getting worse with newer technologies.”

Cell phones are not the only culprits of sleep deprivation, Perez added. Video games and computers contribute to teenagers’ inclination to stay up all night.

“Cell phones, computer screens and even televisions emit light rays that keep you awake,” Perez said. “Light automatically stimulates the retinas. Before bed, people should turn off those devices and switch to a quieter, healthier activity, like reading.”

Dr. Amer Khan, a pediatric neurologist who practices at Sutter Roseville Medical Center and Sutter Medical Center in Sacramento, said part of the problem lies in an all-around ignorance of sleep disorders, one of his specialties.

“Sleep problems are often masked and hidden behind daytime problems,” Khan said. “The patients don’t realize it’s a sleep problem, and their physicians don’t realize it’s a sleep problem, so they get treated and diagnosed as daytime problems when that’s not the case.”

Marvin Green, 19, suffers from sleep apnea, a condition characterized by pauses in breathing during sleep. He was not diagnosed until he was 17 years old.

Sleep problems, like sleep apnea, are often misdiagnosed in young patients because the symptoms that manifest during the day can be misleading.

“Kids manifest a lack of sleep with hyperactivity,” Perez said. “A lot of people in the sleep field would know that should at least prompt a sleep assessment. But most people don’t go to a pediatrician saying they’re having trouble sleeping, and there’s always so much ground to cover in one general health checkup that sleep problems just get overlooked.”

Green said he was put on medication for other conditions and never thought much about the quality of sleep he was receiving.

“I would get these terrible migraines and would fall asleep in school sometimes,” Green said. “I thought it was stress. I started not sleeping as much because of the headaches, and then the headaches would get worse because of the lack of sleep. It was a Catch-22.”

Part of the problem, experts say, is that individuals are not sleep-conscious and are never taught how to maintain healthy sleep habits like going to sleep and waking up at a consistent time every day, not eating or exercising right before bed and turning off noise – and light-emitting devices including televisions, computers and cell phones.

Green said he was unaware of just how important sleep is, noting it was never taught or discussed in health classes and was not discussed by his primary care physician.

“I learned about the birds and the bees in school, but sleep was never really a high priority,” Green said. “There is no education about sleep problems. It’s not like we don’t know these problems exist, we’re just never taught about them and were never really told how important sleep is to your all-around health.”

Now he, like Espinoza and countless other teenagers who have experienced the debilitating effects of a lack of sleep, understands that a little shut-eye can go a long way.

“You can’t really function in the daytime without it,” Green said.

Marvin Green, 19, meets with Dr. Amer Khan, a pediatric neurologist, about his migraines and sleep problems at the Sutter Cancer Center. Sleep disorders can be difficult to diagnose.

Tags: Allergy, Attention Deficit Hyperactivity Disorder, Concentration, Distractions, Easy Access, Friends Houses, Headaches, Hyperactive Behavior, Hyperactivity, Immune Systems, Means Of Communication, Nicotine, Pediatric Pulmonologist, Respiratory Disease, Risk, Sleep Deprivation, Sleep Disorders, Sleep Studies, Social Networking Sites, Teens Health, Text Messaging

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Sutter Roseville Medical Center – whose doctors each perform 150 angioplasty and stenting procedures a year – wants to be designated as a “heart attack center” as part of a state experimental program.

The state health department later this year will pick six hospitals for the pilot program to offer both kinds of procedures without on-site cardiac surgery services.

“With heart attacks, the first 90 minutes are crucial,” said Dr. George Fehrenbacher, Sutter’s chief of staff. “You want to give (people) the best chance possible.”

If Sutter Roseville is picked for the program, patients who are experiencing heart-attack symptoms would be taken directly there instead of to nearby emergency rooms. Once there, they could undergo angioplasty and stenting procedures.

An angioplasty is a common heart procedure typically performed by threading a slim balloon-tipped catheter from an artery in the groin to the problematic region of a cardiac artery.

The balloon at the tip of the catheter is then inflated, compressing the plaque and opening up the narrowed coronary artery so that blood can flow more easily.

This is often accompanied by insertion of an expandable metal stent – a wire mesh tube used to prop open arteries and keep them open.

Designating heart attack centers that don’t have full cardiac surgery backup on site is somewhat controversial.

Some suggest that only high-volume cardiac specialists – those who do 100 interventions a year – with meticulous track records should consider performing the coronary procedures without a surgical safety net.

Sutter and other hospitals fought for a statewide trial of the program for more than three years, saying that having a designated cardiac treatment center that can operate 24 hours a day and 365 days per year is key to improving patient care.

“When a person is having a heart attack, it’s very important to open up a blocked artery as quickly as possible,” said Fehrenbacher, who is also Sutter Roseville’s co-medical director of cardiology. “In order to reduce it to its normal rate, you need to have very fast availability to performing stents. If there’s a designated heart attack center, we can do that.”

So far, 28 states allow both elective and emergency coronary interventions to be performed without surgical backup. Seven states – Arkansas, Delaware, Mississippi, North Dakota, South Dakota, Wyoming and Vermont – prohibit this practice.

Sutter Roseville physicians say the program would save lives.

“Three years ago, it was a more controversial subject,” Fehrenbacher said. “But more recently, the data has been overwhelmingly supportive of performing this procedure in facilities that have a quality program.

“There is no mortality difference or disadvantage to doing this,” he said, “as long as there is good quality review, measuring all of our outcomes.”

Tags: Angioplasty And Stenting, Cardiac Specialists, Cardiac Surgery, Cardiac Treatment, Catheter, Coronary Artery, Days Per Year, Dr George, Emergency Rooms, Fehrenbacher, Having A Heart Attack, Heart Attack, Heart Attack Symptoms, Heart Procedure, Improving Patient Care, Open Arteries, Pilot Program, State Health Department, Surgery Services, Wire Mesh Tube

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Dining at some restaurants will be a new experience starting today, when California becomes the first state to require that chain restaurants supply calorie counts for virtually everything they serve.

“Consumers should be able to make informed decisions about their health and it will raise the consciousness of how much we eat,” said John Rogers, Sacramento County environmental health division chief.

There will be no guessing – or denial – about that double Western Bacon Cheeseburger from Carl’s Jr.: 960 calories. Side of Chili Cheese Fries to go with that? 990 calories. Maybe stick to the fried zucchini at 330 calories?

The new law requires restaurants with at least 20 stores in California – about 17,000 locations statewide – to provide a brochure on site listing calories, sodium, saturated fat and carbohydrates for each menu item. Both sit-down and drive-through restaurants must comply.

Drive-through menus must notify customers that the information is available at the pickup window.

A second phase, effective January 2011, will require restaurants to list calorie counts directly on menus or menu boards.

Alcoholic drinks aren’t included. Also, at restaurants that serve only buffets, such as Hometown Buffet, you’ll be on your own.

Menu labeling was conceived as a way to help customers make choices, said Rogers. His department conducts restaurant inspections, which will include monitoring for proper menu labeling.

Consider this information from Rogers’ department: An estimated one-third of all calories ingested by Americans are from restaurant food, and studies show that diners will shave off as much as 100 calories a meal when presented with calorie counts.

And consider this: Restaurants that fail to comply face a $50 to $500 fine, followed by other charges, such as unfair business practices.

Kim Simon and co-worker Julie Hereth emerged from a midtown Subway at noon Tuesday after splitting a tuna submarine: 530 calories for each.

“I looked to see what the cheapest one was,” said Hereth, explaining her method for choosing lunch.

Carrying a soda and an empty bag of chips, Simon said she welcomed menu-labeling and would put it to good use. She said she switched to a more modest coffee drink after she found out the latte she had been drinking had 500 calories.

“I’ve saved lots of money,” said Simon, 36.

Hereth said she always opts for what she believes are healthier choices, such as grilled chicken, but calorie counts can only help.

“It’s definitely a good idea,” said Hereth, 47.

The state’s restaurants generally endorse menu labeling, said Lara Dunbar, senior vice president of government affairs for the California Restaurant Association.

Statewide standards are preferable to a hodgepodge of cumbersome local ordinances, she said, but there are still gray areas.

For example, Sacramento County’s Rogers is unclear on whether See’s Candy – definitely a chain – qualifies as a restaurant.

Dunbar said extending menu labeling to independent restaurants would cripple that segment, even though there are computer software and online subscription services to formulate nutrition information.

Fine-dining independents, such as Waterboy in Sacramento, face other constraints, she said.

“A chef considers the food more like art and he decides maybe to add a dollop of sour cream here or there. It’s very difficult to standardize a process for a Waterboy,” she said.

Menu labeling began in New York City in 2008 after legal challenges and other controversy, followed by King County in Washington, which started in January.

King County, which includes Seattle, has found that 85 percent to 90 percent of qualifying restaurants are complying, said Dennis Worsham, regional health officer for Seattle-King County.

Restaurants were concerned that menus would rival “War and Peace” with all the new information, but that didn’t happen, Worsham said.

Whether menu labeling changes behavior is still debatable, but some restaurants have changed: One major coffee chain switched from whole milk to 2 percent milk to post a lower calorie count, Worsham said.

New York City and King County are collaborating on studies to determine to what extent behaviors change with menu-labeling.

Subway, with 2,200 restaurants in California and 22,500 nationwide, has been providing nutritional information for more than a decade, said Kevin Kane, a company spokesman.

Subway uses in-house dieticians and researchers for menu development but turns to independent analysis to get nutrition information, he said.

It is useful for some, inconsequential for others, he said.

“If someone is looking for that info, I’m glad it’s up there for them, but for others, they still want the oil, cheese on both sides, it doesn’t matter what you post up there,” he said.

Strings Cafe, a Sacramento-based chain with 29 stores, has worked with suppliers to gather nutritional information on about 40 menu items, said Al DiCaprio, president of the company.

Once they got that information, the company paid about $2,000 for an online service that breaks down Army-sized nutrition information into serving portions, he said.

His fettuccine Alfredo weighs in at 950 calories, he said.

It’s no cottage cheese and fruit, but DiCaprio said that diners generally eat healthy at home and treat themselves at restaurants – like to a plate of fettuccine Alfredo.

“I don’t care how many calories it is, it’s always a big seller,” he said.

Tags: Alcoholic Drinks, Bacon Cheeseburger, California Chain, Calorie Counts, Chain Restaurants, Chili Cheese Fries, County Environmental Health, Division Chief, Environmental Health Division, Fried Zucchini, Hometown Buffet, John Rogers, Kim Simon, Menu Boards, New Experience, Proper Menu, Restaurant Food, Restaurant Inspections, Sacramento County, Unfair Business Practices

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