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Review recommends surgery as best treatment for scoliosis in cerebral palsy patients

X-ray of my spine when I was 16 years old. Scoliosis.  I was measured and given a brace that covered my torso. It was almost literally a turtle shell. I was meant to wear it every day and sleep in it (which was absolutely painful). I wore it to school onc

I always wondered why people with CP were twisted up. Nice to know there’s something that can be done:

The diagnosis of cerebral palsy (CP) can be devastating for a family. CP is caused by damage to an infant’s brain – either during pregnancy, delivery, or immediately after birth.

It is a lifetime condition that can affect a child’s body movement, muscle control, coordination and tone, as well as a child’s balance, posture, and reflex. They can also suffer from epilepsy, hearing, intellectual, learning, speech, and visual impairments.

One of the most common medical issues that children with CP can develop is scoliosis. Scoliosis is when the spine develops a sideways curvature. It is estimated that between 21 to 64 percent of all CP patients develop the condition.

The effects that cerebral palsy has on a child’s muscles, causing poor control, weakness, and spasms, all contribute to scoliosis risks.

Typically, children with CP will begin developing scoliosis between the ages of 10 through 18. According to a recent review in the Journal of Spinal Surgery, surgery is the only option to treat scoliosis in CP patients.

According to the review, there are two types of distinct scoliosis curves CP patients suffer from. The first, referred to as Group-I, causes double curves with the lower (lumbar) and middle (thoracic) back components.

This type of scoliosis curve is usually found in patients who are ambulatory and suffer from an abnormal pelvic tilt.

The second type, Group-II, involves only single lower or middle back curves which are more pronounced. This type of curve is usually seen in quadriplegic patients.

Although studies have concluded that CP children who suffer from scoliosis can be treated by nonsurgical means, these treatments are only temporary, and eventually, surgery becomes necessary.

One of the more popular nonsurgical treatments for scoliosis is bracing techniques. Some studies found that these techniques were poorly tolerated by CP patients. And although in some cases, the technique slowed the progression of scoliosis, eventually surgery was needed.

Another form of treatment that is often used in CP patients is Intrathecal baclofen (ITB) pumps. Medication is delivered into the spinal fluid via these pumps to help with the pain and spasticity the patient is suffering from.

Although the medication does work in alleviating pain and spasms, there is some evidence that this medication may actually make scoliosis worse.  

The conclusion of the review is that the only option CP patients have for scoliosis treatment is surgery.

One of the most dangerous complications that can occur with any CP patient undergoing surgery is with the respiratory system.

The review stresses that pre-operative non-invasive ventilation (NIV) training should be prescribed to help prevent respiratory infections or complications developing after the surgery.

Spine surgeon Dr. Victor Hayes commented, “When planning for this type of surgery, there needs to be a comprehensive preoperative assessment and involvement of a multi-disciplinary team.”

Although recovery from any surgery can be long and difficult for CP patients, the conclusion of the review was that the majority of patients who have undergone scoliosis surgery have been satisfied with the

Study: No amount of alcohol is good for you

2016.07.15 - #03

Every so often, research surfaces that highlights the supposed benefits of drinking alcohol, but a new study suggests these findings are exaggerated; there is no real connection between alcohol and good health; and even “moderate drinking” may be detrimental, especially in elderly individuals. Although studies have noted a common trend between moderate alcohol consumption and excellent… Continue Reading →

Choke artist

Whitman's Sampler - 19401116 Post

It’s been six years since I had a reaction to eating chocolate candy, and I have to say, I don’t think it’s the chocolate. I have a piece of dark chocolate every day, I have hot cocoa when it’s cold, and there’s no problem at all.

Last night I had a milk chocolate-covered cherry from a Whitman’s Sampler. My throat immediately swelled up and I started coughing uncontrollably. I spit out all but a minute amount. I don’t ordinarily eat milk chocolate — but I’m not allergic to dairy.

What a puzzle.

Shrooms reduce anxiety in cancer patients


In 2010, doctors diagnosed Dinah Bazer with ovarian cancer. After treatment and chemotherapy, it went into remission, but as the months wore on, she became increasingly terrified that the disease might return. Two years after diagnosis, she felt worse than ever. “The fear was eating me alive,” she says. “It was destroying my life.” She heard… Continue Reading →

Patient Zero in AIDS crisis was misidentified, study says, rewriting early history of virus


I was working at a medical publication when the news first started to filter out about what was then called HTLV-III. My boss didn’t want me to write about it (“Who the hell cares about a bunch of faggots?” he said), but I wrote about it, anyway. One of my high school friends was the first in the city to die:

Newly published research is rewriting the earliest chapter of the historical account of how the AIDS epidemic began in the United States. The work, detailed in a study released Wednesday, discounts the long-held notion that a French-Canadian flight attendant, whose story was highlighted in the seminal book “And the Band Played On,” brought the virus to… Continue Reading →

As Hurricane Matthew moves out, Zika could move in

#News:  Virus Zika Mulai Menyebar di Malaysia0

WASHINGTON — As the waters from Hurricane Matthew recede, coastal residents from Florida to the Carolinas may have something else to worry about: Zika. The high winds broke through screen doors and windows, knocked out power and left behind small and large bodies of standing water that could be new breeding grounds for mosquitoes. Scientists raised… Continue Reading →

The dirty hippies were right

Sexy young woman posing in her bedroom while wearing sexy lingerie

For as long as women have had breasts, women have been wearing bras, although the bra that we recognize today was first introduced in 1914. Most women have a love/hate relationship with their bra, refusing to leave the house without one, but counting down the moments until they can take it off again. Are there truly… Continue Reading →

The cavity in health insurance coverage: oral health

2016.8.30 榮總看牙醫

By Susan Sered, Suffolk University

When we talk about the successes and shortcomings of the Affordable Care Act (ACA) – and health care in the U.S. in general – little attention is given to dental care.

While the ACA defines dental coverage as an essential benefit for those under 18, insurers aren’t required to offer dental coverage for adults. Medicare, the nation’s largest insurer, doesn’t cover routine dental work. And coverage for adults through Medicaid varies from state to state.

It is estimated that 108 million Americans have no dental insurance, and that one in four nonelderly Americans has untreated tooth decay.

Oral health isn’t just about nice teeth. As the surgeon general noted in a 2000 report, oral health is intimately connected to general health and can be implicated in or exacerbate diabetes, heart disease and stroke, and complications during pregnancy.

The absence of comprehensive dental care exacts a toll on millions of Americans in terms of poor health, pain and the social stigma associated with bad teeth.

People receive dental treatment at the Care Harbor/LA free clinic in Los Angeles, September 27, 2012.
Lucy Nicholson/Reuters

People desperately need dental care

In 2003 and 2004 (pre-Obamacare), I conducted a national study of uninsured Americans in southcentral Illinois, northern Idaho, the Mississippi delta, the Rio Grande Valley of Texas and in eastern Massachusetts.

I asked nearly 150 interviewees: “If President Bush were to declare universal health care for everyone starting tomorrow, what is the first problem you would take care of?” The most common answer by a landslide echoed this respondent’s: “I’ll be waiting outside the dentist’s office at 5:00 in the morning waiting for it to open.”

Many of the people I interviewed lived with untreated diabetes, asthma or even cancer, yet their oral health problems presented the greatest challenges to their quality of life.

Recently I returned to these communities to reinterview the people I’d met over a decade earlier. Very little has changed. While the majority of the people I interviewed now had health care coverage of some sort (for nearly 20 percent of them, it was as a consequence of becoming sufficiently disabled to be eligible for Social Security), very few had managed to secure dental coverage.

Then and now, people told me about visiting emergency rooms in hopes of alleviating pain or using addictive pain medications to make it through the day. People even told me that they had resorted to pulling out their own teeth.

Take Misty, for instance. When I met her 12 years ago in Mississippi, she was a “dirt poor” (her words) married mother of five, and she was living with diabetes, domestic violence and excruciating headaches. Despite all of these quite serious problems, she told me that she was more troubled by her bad teeth than by anything else. In fact, Misty told me that she’d had such bad toothaches that she pulled her own teeth. When I asked her how she can face the pain of pulling out her own teeth, she said:

[the infected tooth] hurts so bad… it’s a relief just to get it out of there.… I’ve gone two weeks with just being able to eat soup, because they are just so bad.

By 2016 Misty had left her abusive husband, moved to Arkansas and was accepted onto disability (SSI), which allowed her to get health care coverage through Medicaid. Still, however, she suffered because of her teeth.

It can be very hard to find dentists who accept Medicaid, and when Misty finally did, she had the rest of her teeth – 25 in all – pulled in one day.

Misty’s situation isn’t uncommon. I have met women and men of various ages who, like Misty, have pulled their own teeth. I’ve also met people who were able to get part of their dental needs taken care of during brief periods of Medicaid coverage but then were left with unfinished treatment when the coverage ended.

Teeth aren’t included in health insurance policies.
Dental x-ray image via

Insurance stops at the teeth

Even though the link between dental health and overall health is clear, insurance plans tend to ignore teeth.

As health insurance began to appear to appear in the U.S. – initially in the 1920s and then more widely during World War II and in the postwar era – dentistry wasn’t part of the standard package of covered services.

As the nation’s largest insurer, Medicare plays an important role in shaping health care coverage norms. Medicare does not cover dental care. Today, according to government estimates, 70 percent of seniors lack dental coverage.

Since Medicare doesn’t cover dental, Dr. David Kroll, senior program officer at the Robert Wood Johnson Foundation, argues that this “inertia spilled over into the ACA.”

Americans who purchase dental plans typically find that the plans aren’t cheap, and often don’t cover much beyond routine preventative care. Plans often require hefty copays for procedures beyond preventative care and no or very limited coverage for dentures, bridges or periodontic work.

And, in recent years, the cost of dental care has increased faster than the cost of other medical care. For those without dental insurance, there are few low-cost services available.

The ACA provided for an expansion of Medicaid eligibility, though not all states accepted the offer of federal funding to expand Medicaid coverage. Even in the states that expanded Medicaid under the ACA, strict limits on oral health care remain for most low- and moderate-income Americans.

There is one bright spot: children’s dental coverage is a required benefit included on all ACA compliant plans, and Medicaid as well. According to national calculations of the Health Policy Institute and the American Dental Association, dental care utilization among Medicaid-enrolled children increased from 35.3 percent in 2005 to 48.3 percent in 2013.

Not just about nice teeth.
Shannon Stapleton/Reuters

Oral health isn’t just about nice teeth

In the absence of coherent oral health services, too many Americans end up like Gina, a young Idaho woman who holds her hand in front of her mouth while she talks so that no one will see her rotted teeth. She can’t even get a job as a telemarketer because she cannot speak distinctly enough to be hired.

Many Americans incorrectly assume that rotten teeth are the product of bad decision-making; if someone had just brushed and flossed then they’d have nice teeth. But routine dental care – think of the twice-yearly checkups that are routine for people with dental insurance – keeps teeth healthy and can catch problems when they are easy to treat.

The reality is that tooth decay signifies poverty in pernicious ways. Without expanding insurance to cover oral health, millions of Americans will continue to live with pain, stigma and the risks of systemic diseases that could be averted through an accessible and integrated system of dental care.

The Conversation

Susan Sered, Professor of Sociology, Suffolk University

This article was originally published on The Conversation. Read the original article.

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