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Family Medicine Associates

Jury still out on artificial ankle replacement

By RICK RUGGLESWorld-Herald News Service

OMAHA — Nowsome surgeons believethey have the hard-ware and know-how toeffectively replace anarthritic ankle joint,while other surgeonsawait results over thelong term.

Even those who likethe latest generationof artificial anklejoints say they aren’tfor runners, basketballplayers or farmerswho jump off tractors.They are generally ap-propriate for middle-aged and older people,and those who aren’tseverely overweight.

The younger the pa-tient and the morestress he puts on the

ankle, the more likelyan ankle replacementwill break down andhave to be reworked.And fixing an ankle re-placement is tougherthan redoing hip andknee replacements be-cause there is lessbone and tissue towork with.

“The ankle is just aunique joint,” said Dr.Annunziato Amen-dola, a professor of or-thopedic surgery atthe University ofIowa. “The ankle isjust the skin and thebones.”

It doesn’t have a bigenvelope of musclebolstering it the waythe knees and hips do,he said.

Only 1,596 ankle re-placements were done

in the United States in2009, compared with621,029 knee replace-ments and 285,471 hipreplacements, accord-ing to the AmericanAcademy of Or-thopaedic Surgeons.

Dr. Shane Schutt, aMethodist Hospital or-thopedic surgeon, be-lieves that the numberof ankle replacementswill double in the next10 years. Only 33 yearsof age, the Omaha na-tive completed train-ing last year under Dr.Michael Coughlin, aninternationally knownfoot and ankle surgeonin Boise, Idaho.

Including his train-ing, Schutt estimatesthat he has placed an-kle implants in about80 patients. One of sev-

eral metro-area sur-geons who performsankle replacements,Schutt has done threesince joiningMethodist last year.

Doctors in the U.S.have been using thedevice Schutt uses, aScandinavian implantcalled STAR, for onlyabout 10 years includ-ing clinical trials, butthe data appear prom-ising. A report pub-lished last year said 91percent of 84 artificialankle joints remainedin patients after an av-erage of more thannine years.

“The bottom line isthat it’s still early. Andso we don’t know whathappens after that,”Schutt said, referringto an implant that was

placed in a patient’sankle a decade ago. “Inmy opinion, it’s cut-ting edge technologythat I believe is goingto make a big differ-

ence in patients’lives.”

Lee Hohenstein, whorecently sat in Schutt’s

Lee Hohenstein and his wife, Marilyn, discuss his an-kle joint replacement with Dr. Shane Schutt. Schuttsays he likes the potential of the newer implants. “Inmy opinion, I think we’re breaking through,” he said.

Data from clinical trials appears promising

World-Herald News Service

Please see AANNKKLLEE, Page 4

Planning for old age gets costlier By STEVE JORDONWorld-Herald News Service

The federal govern-ment canceled plans forlong-term care coverageaimed at low-incomepeople, even though Con-gress had approved it.

So continues the strug-gle to keep long-termcare insurance a viablebusiness for insurancecompanies and, at thesame time, a choice forconsumers trying toplan ahead for the two-out-of-three chance thatthey will need long-termcare at some point intheir lives.

The cases of two localwomen highlight thechallenges that havedogged long-term careinsurance since it be-came widely available inthe late 1980s. With littlepast history to guidethem, insurers based

premiums on flawed as-sumptions about theclaims they would haveto pay and the number ofpeople who would keeptheir policies in effect.

“The problem is real,”said Tom Alber, aspokesman for the IowaDivision of Insurance.“It’s not just Iowa, it’snot just Nebraska, it’snational. It’s the indus-try.”

A national industrygroup will hold a closed-door brainstorming ses-sion this week in Wash-ington, D.C., to look forsolutions.

But Jesse Slome of theAmerican Associationfor Long-Term Care In-surance said it’s a deadissue for politicians.

“America has no long-term care program inplace, but that doesn’tmean Americans aren’tgetting older. They are,”

Slome said. When it comes to long-

term care, the wealthycan pay their own way.Low-income people can’tafford the insurance.That leaves the middleclass and the upper-mid-dle class, people like Pa-tricia Rief Heskett of LaVista and Joyce Smith ofOmaha, widows who payabout $200 a month for atop-of-the-line policyfrom John Hancock.

They are among 80,000Nebraskans, 149,000Iowans and 8 millionAmericans who havelong-term care coverage.

“You take these poli-cies out so you’re not de-pendent on the govern-ment to take care ofyou,” Heskett said. “Iwanted to take care ofme.”

Her policy warned

Please see AAGGEE, Page 3

about possible raises inpremiums, and she ex-pected some small, occa-sional rate increases, butnot 90 percent. “It maybe legal, but it’s notright,” she said.

Forced into a decision,she kept her premiumsthe same by taking a cutin her policy’s inflationfactor to 3 percent from 5percent a year for thebenefits she would get ifshe makes a claim. Butshe’s still irked and wor-ried about future in-creases.

Smith doesn’t want totrim her benefits andcan’t afford the increase,so she isn’t sure whatshe’ll do. “If they goback on these benefits,why even have it, truly?”

After Heskett talked tothe staff of Sen. Mike Jo-hanns, R-Neb., his officeasked the State of Ne-braska, on her behalf,whether the law hadbeen followed. It had. Sofar, her suggestion thatCongress cap premiumincreases for senior citi-zens has gone nowhere.

Along with many oth-er companies, John Han-cock said it raised ratesbecause it foresees high-er claims than it origi-nally planned. Request-ing 90 percent all at oncegives policyholders op-tions such as lower infla-tion rates, the companysaid. With smaller butmore frequent increases,it would have been diffi-

cult to offer policyhold-ers the option of trim-ming benefits, the com-pany said.

Since the State of Ne-braska allowed the en-tire 90 percent increase,the company said, “webelieve at this time thatthe increased premiumshould be sufficient tomeet our future obliga-tions [but] we cannotguarantee that there willbe no future rate increas-es.”

The same faulty pre-dictions prompted Mutu-al of Omaha and Physi-cians Mutual of Omahato seek rate increases forpolicyholders in Nebras-ka and Iowa. Their raterequests were among 37in Nebraska and 43 inIowa filed last year.

In Nebraska, five ofthe requests were for 40percent or more, withJohn Hancock’s 90 per-cent the biggest. The de-partment granted 14 ofthe increases as request-ed and negotiated small-er increases on the 23others, reducing thoseincreases by between 10and 30 percentagepoints.

The Iowa InsuranceDivision cut the re-quests, which averaged31 percent, to an averageof 15 percent. Thebiggest increase allowedwas 30 percent for a poli-cy by Mutual of Omaha,which had requested a 45percent raise.

Rate increases keepthe policies viable, saidMary Swanson, Mutu-al’s performance direc-

tor for the product. Mu-tual considers long-termcare a core insuranceproduct that meets a con-tinuing need, especiallyamong baby boomers.

“It’s a very importantpart of retirement plan-ning. Some insurance isbetter than no insur-ance,” Swanson said.“Ultimately, your long-term care insurancehelps you decide whereyou want to stay andhow you want to be tak-en care of, when you’renot able to do everythingfor yourself.”

Especially valuable,she said, are “partner-ship” policies that allowpeople to become eligiblefor Medicaid coveragewithout having to de-plete all of their assets.“It’s a very importantselling point. At leastyou know you’ve protect-ed a certain amount ofyour assets under thosesituations.”

Rate increases are notonly legal but also re-quired by Nebraska andIowa laws if an insur-ance company showsthat a policy needs moremoney to pay claims.

The size of those in-creases is a contentiouspoint.

Reducing rate re-quests may sound goodfrom the consumer’sstandpoint, but Nebras-ka Insurance DirectorBruce Ramge said a rateincrease that’s too smallopens the door to laterincreases.

An inability to get in-creases approved by

state regulators was onereason Penn TreatyAmerican Corp. col-lapsed in 2008. It’s now in“rehabilitation,” underPennsylvania state con-trol while its claims arepaid off from its remain-ing assets and, eventual-ly, from a pool of moneyput up by other insur-ance companies.

Adding to the pressurefor rate hikes today arethe near-zero interestrates on governmentbonds and other conser-vative investments thatinsurance companieshold to pay for claims.

If there’s hope for theindustry, it lies in newpolicies with more flexi-bility and stable prices,said actuary StevenShoonveld of Hartford,Conn. He represents theAmerican Academy ofActuaries as co-chair-man of a task force look-ing into long-term careinsurance’s future. Thegroup will hold theclosed-door summitWednesday, hoping forwhat he called “a moreholistic conversation”on the issue.

The goal, he said, is tomake sure Americanscan manage the risksthat come with advanc-ing age in a comprehen-sive way that includesinsurance plans.

“The future is lookingbetter because there is alot of activity in the in-dustry to find betterways and more sustain-able ways to provide cov-erage for the financialrisks that individuals

face,” Schoonveld said.“That means workingon some of these rulesand regulations that areout there.”

For example, a flexi-ble premium policywould let the policy-holder vary premiumsand benefits within acertain range to avoidstraining a family budg-et during cash-poortimes. Policies may en-courage home healthcare rather than more-expensive residentialcare. Maybe a policycould be converted from

monthly premiums to asingle, large premium.

“We’re going to seethat in our lifetimes,”Schoonveld said. “It’scoming.”

Consumers also canlook for flexible combi-nation policies that of-fer life insurance, annu-ity and long-term careelements: You die, lifeinsurance pays. Youneed long-term care, itpays toward that. Youneed income, an annu-ity kicks in. Single-pre-mium policies avoid lat-er rate increases.

AGEfrom Page 2

Long term care insurance basicsn 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 costsyourself; how many years of benefit payments; andyearly inflation factor. More benefits generally meanhigher premiums.

n Consider “combination” products that include ele-ments of life insurance, annuities and long-term care,as well as straight long-term care coverage.

n Consider “partnership” policies, which can shieldassets while qualifying for Medicaid assistance.

n Look for discounts for good health, for making an-nual premium payments or other features.

n Shop around. Rates for the same coverage vary asmuch as 40 percent among insurers.

n Insurers can raise rates on all holders of a certainpolicy but not on individuals.

n Claim payments for nursing homes may require animpaired ability to perform “activities of daily living” —bathing, dressing, eating, toileting and transferringfrom place to place.

n Some policies also allow claims for home healthcare and assisted living if you have less disability.

n You likely will buy a policy once, since policies be-come 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

exam room, said hewas in sales fordecades. “And I literal-ly pounded the pave-ment, and the pave-ment pounded back.”

Hohenstein had se-vere arthritis in hisleft ankle. It hurt bad-ly and hindered hisability to enjoy retire-ment.

At 80 years of age,Hohenstein was a goodcandidate for ankle re-placement, which heunderwent last No-vember. Now in for afollow-up, he sat withhis left shoe and sockoff and smiled abouthis progress.

“Excellent, excel-lent,” Hohenstein said.“I’ve been pleased. Thedoctor’s been pleased.”

His ankle remainedsomewhat swollen,which Schutt said wasto be expected.

“The old gold stan-

dard was the fusion,”Schutt said. “And thatwould have been a fineoption for you.”

But Hohenstein had-n’t wanted his anklefused, a fairly commonprocedure to endarthritis pain. In an-kle fusion, a surgeonremoves the damagedcartilage and connectsthe end of the leg boneto the ankle withscrews, locking thejoint in place.

Hohenstein wantedmore ankle flexibilityso he could fish withease with his grand-children.

The STAR differsfrom its predecessorsin part because it al-lows not only up-and-down flexibility butalso some side-to-sidemotion. A hard plasticpiece moves betweentwo metal components,allowing flexibility.

Schutt said preci-sion cutting equip-ment now enables sur-geons to fit the im-

plant more securelyinto bone. And theyunderstand better theimportance of liningthe ligaments up pre-cisely on both sides ofthe ankle, and of theheel lining up square-ly with the leg bones.That way, the force isdistributed equally onthe gliding plastic de-vice.

“In my opinion, Ithink we’re breakingthrough,” Schutt said.

While ankle replace-ments began about thesame time as knee andhip replacementssome 40 years ago, an-kle replacements haveperformed with muchless success. Designshave been tweaked andwelcomed as havinggreat potential, thenhave fallen away afterfailing at too high arate.

Surgeons reportedin 1996 that 57 of 160devices called “theMayo total ankle re-placement” had to be

removed because ofcomplications. Thesurgeons said they nolonger recommendedusing the device.

Dr. Clifford Boese,an orthopedic surgeonwho practices in Coun-cil Bluffs and Omaha,was enthusiastic 11years ago about a newimplant called theAgility.

But Boese is nolonger excited. “I’vegot to tell you, I quitdoing them about fouryears ago,” he saidthis week. “They justweren’t durableenough.”

He said he put inabout 25 Agility de-vices and roughlyone-third failed with-in 10 years.

Dr. Lori Reed, assis-tant professor of or-thopedic surgery atthe University of Ne-braska Medical Cen-ter, said she put insome ankle implantswhile in training. Shehasn’t chosen to doany in her seven yearsat UNMC.

When ankle im-plants go bad, “it’s notan easy thing to fix,”Reed said. “My mes-sage is not that anklereplacements are bad.You just have to bevery cautious in yourpatient selection.”

Dr. Scott McMullen,an orthopedic sur-geon with GIKK Or-

tho Specialists in Om-aha, said he and apartner put in about 15Agility implants, andthey have placed twoSTAR implants overthe past year.

“I like them,” he saidof the STAR. Never-theless, his view of an-kle implants is neu-tral. An implant isprone to collapsinginto the talus bone be-tween the heel andlower leg, he said. Andthe soft tissue aroundthe ankle isn’t robust,so infection andwound-healing chal-lenges may crop up, hesaid.

“Those anatomicproblems are thingsthat still exist,” hesaid. The STAR im-plant “is another vari-ation of a conceptthat’s been around foryears. But from myperspective, in no wayis it a complete game-changer that will comein and take over thetreatment of anklearthritis.”

Schutt and Dr. JohnGalligan believe thatthe number of anklereplacements in theUnited States will goup significantly be-cause of the STAR,which won Food andDrug Administrationapproval three yearsago.

Galligan, 40, per-forms ankle replace-

ments at Nebraska Or-thopaedic Hospitalwith Dr. MichaelThompson. Galligansaid that they have putin 39 STAR implantsand that 95 percent ofthe patients are doingwell.

Nationwide, the bignames in foot and an-kle surgery are usingSTAR implants, Galli-gan said. “It’s definite-ly the wave of the fu-ture,” he said.

Coughlin, Schutt’smentor, helped overseethe STAR’s trial lastdecade. In Europe, hesaid, where the devicehas been used foryears, it has held upwell in about 80 per-cent of patients after15 years.

Coughlin said pa-tients who undergo theankle replacementsurgery shouldn’tweigh more than 250pounds, shouldn’t bebattling diabetes andshould be about 55 orolder.

The implant canstand up to hiking,fishing and golfing, hesaid, but he would nev-er place one in atriathlete.

He acknowledgedthat there is no con-sensus among orthope-dic surgeons on thevalue of ankle replace-ments. He said: “Ithink that discussionswill continue on.”

ANKLEfrom Page 2

World-Herald News Service

An X-ray of Lee Hohenstein’s new ankle.

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Busy adults can squeeze in workout time

By KATY HEALEY

World-Herald News Service

A full-time job, a fami-ly and just 24 hours in aday. Adulthood is a jug-gling act. Add regularexercise, and it’s morelike juggling fire thanbowling pins.

“The major challengeof course is schedule,”said Todd Mills, manag-er of Better Bodies inOmaha. But finding timefor fitness is possible ifit’s made a priority.

“That’s really the key,”Mills said. “Once it be-comes part of their life,they’ll find a way tomake it work.”

For some, that meanswaking before dawn.Brad Muse, 51, hits thegym shortly after BetterBodies opens at 5 a.m. —a habit he began 17 yearsago.

“I’ve always had thedesire to be as physicallyfit as I can be. I still at-tempt to play sports,

even at my age,” he said.“To be able to do that,there’s time and effortthat I have to put in.”

He finds time fourdays a week before heheads to work at ConA-gra’s finance depart-ment. A spin class twicea week. Cardio andstrength training twice aweek.

If he didn’t, Muse said,he wouldn’t be able toplay basketball in anadult league through theyear, let alone keep upwith the game’s fastpace. When away fromthe court and cardioclasses, Muse mostlysticks to strength exer-cises that use his ownweight.

“I’ve returned to thebasics,” he said. “Push-ups, pull-ups, sit-ups andsquats. I focus on func-tional movements.”

The exercises helphim do everyday activi-ties like carry in gro-ceries and pick up his

kids — and he has six tokeep up with. They moti-vate Muse to stay active,he said.

Mills said many adultclients alternate gymtime with family time.Spouses, like Muse andhis wife, trade shifts.One stays home with thechildren while the otherexercises. Then theyswitch.

Professionals have tofind a balance, too. Theyusually slip in beforework or during theirlunch hour, Mills said.

Despite busy sched-ules, it’s important thatadults not neglect theirhealth.

“Everything about ex-ercise, especially whenwe get older, becomespreventative in nature,”he said.

Regular exercisewards off heart disease,stroke, diabetes, weightgain and some cancers,among other things. Aimfor 150 minutes a week,

but anything is betterthan nothing.

Mills said it’s especial-ly important that olderpeople focus on core ex-ercises — which pro-mote balance and pro-tect the back from in-jury — and resistancetraining, which im-proves strength and pro-

tects bones. “As we age, our bones

and joints age with us,”he said.

But be warned, Musesaid, exercise doesn’thappen as easily whenyou get older.

“The older you get,the harder it is. ThoughI would say, compara-

tively speaking, I’mmore agile than a lot ofpeople my age,” he said.He credits his fitnessregimen.

It boosts his energylevels, too.

“Exercising gives methe opportunity to livethe way I want to live,”Muse said.

Brad Muse, 51, exercises four times a week in the early morning to maintain hishealth.

World-Herald News Service

For some, that means awaking before dawnto get to the gym before heading to work

Long-term care statisticsn 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 assist-

ed 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 in-

flation 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-oldcouple would pay $4,660.

Years of long-term care needed after age 655 years or more: 20-percent2-5 years: 20-percent1-2 years: 12-percent1 year or less: 17-percentNone: 31-percentSource: American Association for Long-Term Care Insurance

By JUDY HORAN

World-Herald News Service

Hair loss, calledalopecia, has manycauses. The sooner yousee a doctor, the betterchance you have of sav-ing some hair from go-ing down the bathroomdrain.

The most commoncause is androgeneticalopecia, a genetic con-dition that could comefrom either side of thefamily. It’s sometimescalled female-pattern ormale-pattern baldness.

In female-patternbaldness, the partwidens over the scalpbut the frontal hairlineis preserved. There isthinning but not bald-ness. In male-patternbaldness, there is reced-ing at the temples andhair is lost over thecrown, which can leadto baldness over thefront hairline.

Other causes of hairloss can be medications,illnesses such as dia-betes or autoimmuneconditions such as lu-pus. Children diagnosedwith alopecia areatacould be losing hair be-cause of a thyroid prob-lem or anemia.

Pregnancy, surgery, ahigh fever or death inthe family can causestress-related hair loss,called telogen effluvi-um, which typically re-

covers on its own with-in three to four months.

“But some people, es-pecially women, can gointo a chronic condi-tion, in which case wetreat it,” said Dr. MaryFinnegan, an Omahadermatologist.

You might have heardthat wearing a hat cancause hair loss, butthat’s a myth, accordingto Dr. Douglas Ramos,an Omaha plastic sur-geon.

“Women that apply alot of traction to theirhair, like corn rows andpermanents or pull attheir hair can losehair,” he said.

Finnegan advises pay-ing attention to yourbody, especially if yousee a sudden change.

“Not everything is at-tributable to aging,” shesaid. “Hair loss can beindicative of an inter-nal medical problem.”

A dermatologist willlook at your medicalhistory and changes inmedication and askabout hair loss over oth-er body sites such aseyebrows, eyelashes,arms and torso.

Is there itching orburning? What sham-poo are you using? Anexam checks the widthof the hair’s part inwomen to see whetherit’s widening and looksfor receding around thetemples and crown of

the scalp for men. “We look for scale

around hair folliclesand for redness andscalp diseases that cancause hair loss,” saidFinnegan.

Blood tests and biop-sies might follow.

“In many cases, biop-sies can give us prog-nostication of a chancefor recovery,” she said.

Some people weartheir baldness proudlyor cover their head withwigs, hats and scarves.Others try medicationssuch as the topical treat-ment minoxidil (onebrand name is Rogaine)or finasteride pills forhair loss from treatablecauses.

Minoxidil can be pur-chased over the counter.Depending on their di-agnosis, many peopleare able to taper off useof the product after hairgrowth. Results areseen in three months;full results take oneyear. Five percentdosages are recom-mended for men; 2 per-cent for women. Howev-er, at times a dermatolo-gist will recommend the5 percent dosage forwomen.

“Finasteride pills arethe most effective treat-ment for male-patternhair loss,” Ramos said.“It will first stop hairloss in young males andgrow hair in approxi-mately half of men inthe back part of thescalp but doesn’t workup front.”

However, finasteridepills (one brand nameis Propecia) are notmeant for women, espe-cially women of child-bearing age. “The useof finasteride inwomen is taken on acase-by-case basis,”Finnegan said. “It de-

pends on the dermatolo-gist’s preference.”

Ongoing researchmay eventually provideadditional medicationoptions for male-pat-tern baldness. Drugsnow being tested for fa-cial flushing and aller-gic inflammation ofnasal pathways block aprotein calledprostaglantin D2, orPGD2, which inhibitshair growth. Some sci-entists believe that re-moving the inhibitionmight prevent hair loss.

Although Ramos per-forms hair transplants,he would rather see peo-ple use other treatmentsat an early stage of hairloss to avoid that laststep.

When performing atransplant, he takesgrafts from the back ofthe scalp and puts thehair where needed.Most of his patients aremen ages 30 to 70, but hecan transplant hair inwomen who have mixedor male-pattern hairloss.

“Patients cannot doany strenuous activityfor seven to 10 days, andit takes a year for all thehair to grow in. Ninetypercent of grafts sur-vive.”

The average cost ofhair transplantation inthe United States is $3 to$5 per graft. The proce-dure can cost $2,400 to$10,000.

Ramos cautions pa-tients to carefully evalu-ate the physician whowill do the transplants.He also recommendschecking with state li-censing and registra-tion boards for anysanctions against thephysician. The informa-tion often is on the In-ternet.

Exploring hair loss treatment optionsThe most common causeis androgenetic alopecia

Check out the Telegraph websiteat www.nptelegraph.com

By RICK RUGGLESWorld-Herald News Service

OMAHA — Some-where between hopeand hype churns regen-erative medicine, thescience that strives togrow tissue and organs.

Alan Russell, an ex-pert in regenerativemedicine, compared hisfield to the Americanspace program in theearly 1960s.

“We’re talking aboutmedical moon shots,”Russell said Wednesdayin an interview in Oma-ha. “We’re at the phasewhere we’re shootingup rockets to see howwell they work.”

Russell, founder ofthe McGowan Institutefor Regenerative Medi-cine in Pittsburgh,spoke at the HollandPerforming Arts Cen-ter.

Regenerative medi-cine already has madehuge gains. Russell hascreated what amountsto an artificial ovary. Ascientist at the Mc-Gowan Institute is ex-perimenting with elas-tic materials to heal hu-man hearts. Cell thera-pies are being used togenerate new muscleand tissue in failinghearts. Some spinal fu-sions now use a sponge-like material that en-

courages cells to cre-ate bone.

Human bladdershave been built frompatients’ cells. A sub-stance called “extra-cellular matrix” helpshernias to repair andinjured rotator cuffs toheal.

Russell, whose doc-torate is in biologicalchemistry, said he seesa gray line between“hope versus hype” inregenerative medicine.He has a friend whosuffers from Parkin-son’s disease. “Whathe reminded me is,don’t ever take awaysomeone’s hope,” hesaid. “Just don’t over-

hype something.”The belief that extra-

cellular matrix can re-grow full fingers ishype, he said. A claimthat stem cells todaycan cure Lou Gehrig’sdisease is worse thanhype.

“That’s crap,” hesaid. “And it’s the kindof hype that will landsome people in jail.

Because very sickpeople are very desper-ate.”

He said he believesthat some 20 years fromnow doctors will usecell therapies to cureheart failure. Severalthousand patients al-ready have been treatedby injecting cells intothe heart to generatenew heart muscle.

But no one knowshow the therapy worksor even whether it truly

works, he said. Somescientists think theyhave begun to figureout, though, which pa-tients will benefit mostfrom it, he said.

“But the one thing Ican assure you: If wedon’t try, it will neverhappen,” he said.

The Holland LectureSeries has broughtspeakers to Omahasince 2005. It’s hostedby the First UnitarianChurch of Omaha withthe financial support ofDick Holland.

Russell disputed theuse of the word “con-troversial” in relationto human embryonicstem cell research.Some opponents decrythat kind of researchbecause a human em-bryo, which they con-sider a human being, isdestroyed in the

process of retrievingthe stem cells.

Russell, 49, said thosepeople’s views are im-portant and deserve tobe heard.

But theology, politicsand the media don’trely on data, he said.Scientists do rely ondata, he said, and thefact is, the vast majori-ty of people don’t op-pose the research.

Artificial bladder, ovaries becoming a realityExpert sees fine line between ‘hopeversus hype’ in regenerative medicine

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Rural docs find mental health info online

By RICK RUGGLES World-Herald News Service

Rural primary carephysicians are do-it-alldocs.

Sometimes there’snobody else to rely on.

So when a patientcomes in with depres-sion, they have to beready to recognize itand treat it.

“You know a little bitabout a lot of diag-noses,” said Dr.Michael Zaruba, a pri-mary care physician inAuburn, Neb. “You’rekind of a jack of alltrades, master of none.... That’s kind of thenature of rural medi-cine.”

A University of Ne-braska Medical Centerbehavioral health teamhas put together a one-hour online lesson forprimary care doctors,physician assistants,nurse practitioners, so-cial workers and oth-ers who see and carefor adolescent patientswith depression. TheUNMC team soon willadd online sessions onadult depression andgeriatric depression.

Primary careproviders are on thefront line of care fordepression and othermental illnesses, saidDr. Howard Liu, aUNMC child and ado-lescent psychiatristwho is project managerfor the online lessons.

The sessions coverdiagnosis of depres-sion, use of medica-tions, and recognitionof the risk of suicide,and offer treatmentscenarios using actorsfrom the University ofNebraska at Omaha.They also test the view-er to make sure he orshe has grasped thematerial.

“The primary careproviders are doing thebest they can,” Liusaid. But in some casesthey aren’t completelyconfident about usingdepression medica-tions, which in rare in-stances can cause sui-cidal thoughts in ado-lescents. “The real con-sequence is under-treatment for a lot offolks.”

University of IowaHospitals and Clinicspsychiatrists have

their own programs toreach out to primarycare doctors. Amongthem are a phone-inservice in which a pri-mary care providercan discuss cases witha university psychia-trist.

The Iowa universityalso holds monthlylunch-hour webinars.In those sessions, auniversity psychiatristspeaks to primary caredoctors, physician as-sistants and othersabout a behavioralhealth topic. Onemonth the subject isdepression, the next itcould be autism.

Dr. JenniferMcWilliams, a childpsychiatrist with the Uof I Hospitals and Clin-ics, said the nation hasa growing shortage ofpsychiatrists.

“And it’s worse in ru-ral counties and it’sworse in poverty-stricken counties,”McWilliams said. Fre-quently the primarycare provider is theonly option, she said.

McWilliams said upto 20 percent of chil-dren suffer seriousmental health disor-ders, and few are seenby mental health spe-cialists. The vast ma-jority receive treat-

ment from primarycare providers, shesaid.

Family physiciansreceive some trainingin mental health diag-noses as med studentsand in residency pro-grams, but not enoughto have a deep under-standing.

Dr. Bob Wergin, afamily practice doctorin Milford, Neb., saidhe sees many patientswho suffer mentalhealth problems. Andeven though there is amental health clinic innearby Seward, somepatients don’t want touse it.

‘They say ‘Dr. Wer-gin, I can’t go up there.Somebody will see mycar,’ “ Wergin said.

Wergin, 57, said medstudents and residencyprograms providetraining in depression,but his experience inseeing mentally ill pa-tients has helped himbecome more confidentin treating them.

But both he andZaruba said they likedthe notion of onlinelessons and would usethem. “I’m probablygoing to go throughtheir program and seehow I can serve mypractice better,” Wer-gin said.

UNL behavorial health teamhas put together online lesson

Check out the Telegraph website at www.nptelegraph.com

Why this year’spollen is different By RICK RUGGLESWorld-Herald News Service

OMAHA — Tree pollen has popped from budsearly this season, prompting many allergy suffer-ers to feel the effects about three weeks earlierthan usual.

Dr. Linda Ford, an allergist in Bellevue whooversees the metro area’s pollen-counting station,said that in the past she has seen tree pollen inlarge quantities in late March or early April.

“But this year is different,” Ford said. She saidthe trees are “exploding out their pollen” muchearlier than in the past.

Dr. Jay Portnoy, who heads the pollen-countingstation in the Kansas City area, agreed. Bothphysicians said it appears that climate change is atwork.

Portnoy said warmer weather and higher car-bon dioxide levels over the past 15 years havecaused tree pollen to emerge earlier and in greaterquantities. Ford said the Midwest gradually hasexperienced more frost-free days and the earlierarrival of spring over the past 20 years or so. Thisalso has been an unusually mild winter.

As a result, many patients who suffer allergiesto pollen from elm, cedar, silver maple and othertrees have already begun to feel their hay feverkick up.

“You can certainly feel it if you have allergies,”said Dr. Jill Poole, an allergist and associate profes-sor at the University of Nebraska Medical Center.

John Hattam, an Omaha chef who owns a cater-ing business, struggles these days to smell andtaste his culinary creations. His allergies struckabout a week ago, driving him to seek Ford’s assis-tance.

He had to ask his assistant chef to make sure hehadn’t overseasoned foods.

“I’m not tasting right,” Hattam said. “Every-thing’s muted.”

Ford gave him a steroid medication, a nasalspray and antihistamine tablets, all of whichhelped settle the watering and pressure in his eyesand sinuses.