Pushing back on back surgery: Insurers, and some physicians, are questioning the need for aggressive spinal surgery

August 9th, 10 - Star Tribune

Three years ago, Amy Leyden took her 10-year-old son, Luke, on a vacation to Oregon. Her back hasn't been the same since.

In a furious game of touch football, Leyden made a spectacular catch but landed flat on her back. That night, she slept on a friend's couch, and the next day, the fearless duo went on an ill-advised dune buggy ride on the Oregon coast.

5 toxics that are everywhere: Protect yourself

Is enough being done to protect us from chemicals that could harm us? Watch "Toxic America," a special two-night investigative report with Sanjay Gupta M.D., June 2 and 3 at 8 p.m. ET on CNN.

(CNN) -- A growing body of research is linking five chemicals -- among the most common in the world -- to a host of ailments, including cancer, sexual problems and behavioral issues.

We encounter them every day -- in plastic bottles, storage containers, food wrap, cans, cookware, appliances, carpets, shower curtains, clothes, personal care products, furniture, television sets, electronics, bedding, cushions and mattresses. In short, every room in almost every house in the United States is likely to contain at least one of these chemicals, many of which did not exist a century ago.

They are bisphenol A, or BPA; phthalates; PFOA; formaldehyde; and polybrominated diphenyl ethers, or PDBEs. Tests reveal most of us now carry them in our bodies, but are they putting our health -- and the health of our children -- in jeopardy?

Here's what you should know about:

BPA - Bisphenol A

What it does: BPA is a building block of a lightweight, clear, heat-resistant and almost unbreakable plastic called polycarbonate. It's also used in epoxy resins.

Where it's found: Water bottles, baby bottles, reusable food containers, plastic tableware, infant feeding cups, linings of infant formula cans and other cans, jar lids, CDs, electrical and electronic equipment, dental sealants.

How we're exposed: Eating food or drinking liquids stored in containers containing BPA. Infants and small children may also be exposed from hand to mouth contact with materials containing BPA. BPA also migrates from dental sealants into patients' mouths. Fetuses are exposed in the womb by their mothers. Almost everyone has been exposed. The Centers for Disease Control and Prevention found BPA in the urine of 93 percent of the people it tested.

Special Report: Toxic America

Health effects: The American Chemistry Council, an industry trade group, says exposure is so low there are no ill health effects. A new five-year Kaiser Permanente study of Chinese factory workers found higher BPA exposure linked to reduced male sexual function. This research joins a growing body of research on animals that suggests BPA poses a potential cancer risk and may mimic the female hormone estrogen and disrupt the extremely sensitive chemical signals in the body called the endocrine system. According to the Food and Drug Administration, these studies suggest BPA could affect "the brain, behavior and prostate gland in fetuses, infants and young children."

Regulation: BPA is an Environmental Protection Agency "chemical of concern," one of five substances the agency has targeted for increased scrutiny and potential new regulation. (The others are phthalates, short-chain chlorinated paraffins, PBDEs, and perfluorinated chemicals including PFOA.)

The Food and Drug Administration allows BPA in flexible food packaging.

What you can do to reduce exposure: Buy stainless steel bottles and glass food storage containers. If you buy plastic, check for the recycle number on the bottom. If there is a number 7, assume the container contains BPA unless it explicitly says otherwise. Switch to fresh or frozen vegetables instead of canned. Other precautions include not microwaving or putting hot liquids in BPA plastic containers and throwing away baby bottles and feeding cups that are scratched.

Phthalates

What they do: This family of chemicals softens plastics. They also are used to bind chemicals together.

Where they're found: Shampoos, conditioners, body sprays, hair sprays, perfumes, colognes, soap, nail polish, shower curtains, medical tubing, IV bags, vinyl flooring and wall coverings, food packaging and coatings on time-release pharmaceuticals.

How we're exposed: Absorbed into the body through personal care products, ingested in drugs, on food, in water and dust. Infants can be exposed through infant care products like baby shampoos, lotions and powders. Fetuses are exposed in the womb. Virtually everyone is exposed to phthalates.

Health effects: A new study by the Mount Sinai Center for Children's Environmental Health and Disease Prevention Research found a statistical association between prenatal exposure to phthalates and incidence of attention deficit hyperactivity disorder years later. Phthalates are considered endocrine disrupters, and studies have shown a statistical association between phthalate exposure and male sexual development. Research has also shown phthalates disrupt reproductive development of male laboratory animals.

Tell us: Is your town toxic?

Regulation: Phthalates are an EPA "chemical of concern." The FDA allows for plastic containing phthalate in flexible food packaging. The U.S. government last year banned or restricted six phthalates for use in children's toys and children's products.

What you can do to reduce exposure: Avoid shampoos, conditioners and other personal care products that list "fragrance" as an ingredient. These may contain phthalates. (Companies are not required to disclose the ingredients in their scents, and the industry says this phthalate is safe.) The federal government recently ended one source of exposure, banning the sale of toys containing any of six phthalates.

PFOA -- Perfluorooctanoic acid (also called C8)

What it does: PFOA is used to make Teflon and thousands of other nonstick and stain- and water-repellent products.

Where they're found: PFOA is present in Teflon and other nonstick or stain- and water-repellent coatings as a trace impurity. These coatings are used on cookware, waterproof breathable clothing, furniture and carpets and in a myriad of industrial applications. PFOA can also be produced by the breakdown of these products.

How we're exposed: Inhaling contaminated air, eating contaminated food and drinking contaminated water. Some researchers say nonstick pans give off PFOA vapors, which contaminate food.

Health effects: Almost everyone has PFOA in his or her blood. PFOA causes cancer and developmental problems in laboratory animals. The EPA concludes research on PFOA is "suggestive of carcinogenicity but not sufficient to assess human carcinogenic potential."

Regulation: PFOA is an EPA "chemical of concern."

What you can do to reduce exposure: The EPA does not recommend any steps to reduce exposure to PFOA. You can reduce potential exposure by using stainless steel or cast iron cookware. If you use nonstick cookware, do not overheat, which releases toxic gas.

How toxic is your air?

Formaldehyde

What it does: Formaldehyde is an ingredient in resins that act as a glue in the manufacture of pressed wood products.

Where it's found: Pressed wood products such as particle board, plywood, paneling and fiberboard; also, glues and adhesives and durable press fabrics like drapes.

How we're exposed: Breathing "off-gassing" from products containing formaldehyde. Car exhaust and cigarette smoke also contain formaldehyde.

Health effects: Formaldehyde is a known human carcinogen, causing cancers of the respiratory or gastrointestinal tract. Formaldehyde fumes can also cause nausea, skin irritation, watery eyes, or burning eyes, nose and throat.

What you can do to reduce exposure: Buying furniture free from formaldehyde eliminates much of the exposure we face from the chemical. One option to reduce "off-gassing": purchase "exterior grade" pressed-wood products, which emit formaldehyde at significantly lower rates. If you have wood products containing formaldehyde, increase ventilation, reduce humidity with air conditioning or dehumidifiers and keep your home cool.

PBDEs - Polybrominated diphenyl ethers

What they do: PBDEs are a group of chemicals used as flame retardants, meaning they reduce the chance of something catching fire and slow how fast it burns when it does catch fire.

Where they're found: PBDEs are found in televisions, computers and wire insulation, and furniture foam. Over time, televisions and other products shed PBDEs, which accumulate in dust. More than 124 million pounds of PBDEs are produced annually worldwide and they do not break down easily.

How we're exposed: Swallowing PBDE-contaminated dust and contact with this dust are the primary routes into our bodies, where they collect in fat tissue. We can also be exposed through food and water. Breast-feeding infants are exposed to PBDEs through their mother's milk and have the highest exposure compared to their body weight, followed by infants and toddlers, according to the data collected by the Centers for Disease Control and Prevention. Levels in humans have been rising rapidly since PBDEs were introduced in the 1960s and '70s.

Health effects: PBDEs accumulate in the body. Toxicology tests show PDBEs may damage the liver and kidneys and affect the brain and behavior, according to the EPA.

Regulation: In December, the EPA named PBDEs "chemicals of concern."

What you can do to reduce exposure: Try to find products without PBDE flame retardants and be sure to sweep up dust.

Obesity Rates Keep Rising, Troubling Health Officials

Americans are continuing to get fatter and fatter, with obesity rates reaching 30 percent or more in nine states last year, as opposed to only three states in 2007, health officials reported on Tuesday.

The increases mean that 2.4 million more people became obese from 2007 to 2009, bringing the total to 72.5 million, or 26.7 percent of the population. The numbers are part of a continuing and ominous trend.

But the rates are probably underestimates because they are based on a phone survey in which 400,000 participants were asked their weight and height instead of having it measured by someone else, and people have a notorious tendency to describe themselves as taller and lighter than they really are.

“Over the past several decades, obesity has increased faster than anyone could have imagined it would,” said Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention, which issued a report on the prevalence of obesity. Obesity rates have doubled in adults and tripled in children in recent decades, Dr. Frieden said.

If the numbers keep going up, he added, “more people will get sick and die from the complications of obesity, such as heart disease, stroke, diabetes and cancer.”

The report estimates the medical costs of obesity to be as high as $147 billion a year, and notes that “past efforts and investments to prevent and control obesity have not been adequate.”

Researchers blame the usual suspects: too little exercise and too much of the wrong kind of food, which means not enough fruits and vegetables and too many high-calorie meals full of sugar and fat, like French fries, soda and other sweet drinks. Children do not get enough exercise during the school day; Dr. Frieden noted that even in gym classes, students are active for only about a third of the time.

A 5-foot-4-inch woman is obese if she weighs 174 pounds, as is a 5-foot-10-inch man who weights 209 or more, according to the disease centers. Both would have a body-mass index, or BMI, of 30; that index is calculated from height and weight, and scores of 30 or over are defined as obese.

The nine states with obesity rates of 30 percent or more are Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee and West Virginia. The highest rate, 34.4 percent, was in Mississippi.

People over 50 had higher rates of obesity than those who were younger. The aging of the population may account for some of the general increase in obesity, but not all of it, said Dr. Heidi Blanck, chief of the disease centers’ obesity branch of the division of nutrition, physical activity and obesity.

Non-Hispanic black women had the highest obesity rate, 41.9 percent. Over all, blacks and Hispanics were more likely than whites to be obese, and the more education people had, the less likely they were to be heavy.

Only Colorado and Washington, D.C., had obesity rates under 20 percent. Researchers are not sure why. Dr. William Dietz, director of the nutrition, physical activity and obesity division, said that Colorado had spent money from a state lottery on biking and walking trails and that many people were using them. The state seems to have “a culture of physical activity,” he said.

Dr. Dietz said the relatively low prevalence of obesity in Washington was harder to explain, particularly because the area has a large black population.

He said one explanation may be that many residents ride the subway; studies have shown that compared with people who drive, those who use public transportation tend to be thinner because it involves more walking. In addition, Dr. Dietz said, there is evidence of above-average fruit and vegetable consumption, and higher rates of breast-feeding, both of which are linked to lower rates of obesity.

Junk food diet puts children at higher risk of allergies

Scientists compared youngsters from a rural African village who had diets rich in fibre with another group living in Florence in Italy and found a dramatic difference.

The African children had less obesity-linked bacteria and a greater abundance of fatty acids which protect against inflammation causing asthma, eczema and other allergic reactions.

The diet of the children living in the small village of Boulon in Burkina Faso was similar to that of people living in the modern Western world thousands of years ago, shortly after the birth of agriculture.

It consisted mainly of cereals, beans, nuts and vegetables.

But the Italian children ate higher quantities of meat, fat and sugar.

Only those who were still breast-feeding harboured bacteria resembling the African children's - indicating diet may dominate other factors such as ethnicity, sanitation, geography or climate, say the researchers.

The trillions of microbes that inhabit the human gut are considered an essential 'organ' that helps to digest food, protect against disease-causing bugs and limit inflammation.

Paediatrician Dr Paolo Lionetti, of Florence University, and colleagues said children in industrialised countries who eat low-fibre, high-sugar 'Western' diets may reduce microbial richness - potentially contributing to a rise in allergic and inflammatory diseases in the last half-century.

They said: "Western developed countries successfully controlled infectious diseases during the second half of the last century, by improving sanitation and using antibiotics and vaccines.

"At the same time, a rise in new diseases such as allergic, autoimmune disorders, and inflammatory bowel disease (IBD) both in adults and in children has been observed, and it is hypothesized that improvements in hygiene together with decreased microbial exposure in childhood are considered responsible for this increase.

"The gastrointestinal microflora plays a crucial role in the pathogenesis of IBD and recent studies demonstrate obesity is associated with imbalance in the normal gut microbiota."

The researchers, whose findings are published in Proceedings of the National Academy of Sciences, added: "The lessons learned from the Burkina Faso children's microbiota prove the importance of sampling and preserving microbial biodiversity from regions where the effects of globalisation on diet are less profound.

"The worldwide diversity of the microbiome from ancient communities, where gastrointestinal infections can make the difference between life and death, represents a goldmine for studies aimed at elucidating the role of gut microbiota on the subtle balance between health and disease and for the development of novel probiotics."

Arthritis patients 'may benefit from weight training'

A regular weight training regime may help treat rheumatoid arthritis, research suggests.

A study of 28 patients funded by Arthritis Research UK found those who pumped iron saw improvements in basic physical function, such as walking.

Researchers at Bangor and Gwynedd Hospital said such high intensity exercising could play a key role alongside drug treatment.

Experts said the exercise regime would not be appropriate for all patients.

RA is mainly a disease affecting the joints, but a less well known symptom is that it also severely reduces muscle mass and strength and this occurs even among patients whose disease is well managed.

Those with the condition are often given mild home exercises to do to stop their joints stiffening and becoming painful.

Weight training

To test how effective the weight training was the researchers split the 28 participants into two groups, the Arthritis Care and Research journal reported.

One did regular weight training for 24 weeks, while the others did the less strenuous standard home exercise regimes.

They found physical function improved by between 20% to 30% in the group doing weight training. Strength also increased by nearly 120%.

The high intensity training was found to increase the levels of an insulin-like growth factor (1GF-1) and insulin-like growth binding protein 3 - both of which promote the growth of muscles, bone and cartilage.

Study leader Dr Andrew Lemmey said muscle loss was a major contribution to the disability associated with the condition.

"Lifting, carrying, walking, climbing stairs are impaired.

"It is logical that if you can restore muscle, that strength and consequently functional capacity will also be restored. And this is what we have found."

He said the patients, who were mainly women in their 50s and had the disease for up to a decade, had responded well.

"In fact, the improvements in function were so significant that following training these patients with established RA were performing as well as or better than healthy individuals of the same age and sex."

He said he would like to see this sort of high intensity treatment funded along with drug therapies, but said that a multi-centre trial would be needed before this could be agreed and that they had received no funding for this.

Benefits were thought to be lost four to eight months after training ended.

A spokesman for Arthritis Research UK said: "Weight-training, especially at this level, is not for everyone with rheumatoid arthritis, but for those who are very well-motivated and physically able, we have proved that it can dramatically improve muscle strength and tone."

A spokesman for the National Rheumatoid Arthritis Society agreed, but urged caution.

"Of course RA can affect different people in very different ways so pumping iron may not be appropriate for everyone. People should discuss [this] with their physio."