Beshear's medical cannabis order takes effect, but access for most isn't easy; prospect of legislative action remains unclear

USA Today map adapted by Kentucky Health News; data from Marijuana.procon.org

By Al Cross
Kentucky Health News

People with a medical provider's statement saying they have at least one of 21 specified medical conditions can now possess up to eight ounces of marijuana for medicinal purposes in Kentucky, if they bought it legally in another state, under an executive order issued by Gov. Andy Beshear that took effect Jan. 1.

But for most Kentuckians, exercising the new right is not convenient, because cannabis is not legal in any form in Indiana and Tennessee, and the medical-cannabis laws of Ohio and West Virginia do not apply to out-of-state residents.

Missouri and Virginia have passed laws to legalize cannabis for recreational use, but the Missouri law is not expected to take effect until at least February, and Virginia is not expected to have cannabis dispensaries until next year, reports Joe Sonka of the Courier Journal. That leaves Illinois.

Asked about that at his year-end press conference, Beshear said, "The executive order isn’t going to make it convenient for anyone . . . What it will ensure is that they’re not a criminal" if they qualify and have eight ounces or less, the amount that is otherwise a misdemeanor in Kentucky. Beshear's order uses his pardon power to prevent prosecution of those who qualify.

"I don't want them to have to drive to Illinois, but that takes an act of the legislature," Beshear said. "I want our people to be able to get it close to home."

It is unclear what the Republican-controlled General Assembly will do in reaction to the Democratic governor, who is on the ballot this year. The state Senate has twice refused to move medical-cannabis bills passed by the House, so there is some feeling that the bill should start in the Senate this time, but Senate Majority Floor Leader Damon Thayer, R-Georgetown, says it should start again in the House.

That does not suit Rep. Jason Nemes, R-Louisville, the sponsor of those two bills. "This is a Senate question; it is no longer a House question,: Nemes said Jan. 1. "There's no reason to go through the House again, becase that would delay the prospect of the bill." The current session is a short one, with only 30 legislative days, unlike the 60 days in even-numbered years.

Beshear said Thursday that Kentucky law-enforcement officers would have by Jan. 1 a palm card instructing them how to handle cases in which they find eight ounces or less of marijuana (any more would be a felony) possessed by someone authorized to possess it under the executive order.

The medical provider's written certification must include their medical license number, a statement of a the provider-patient relationship, their diagnosis of the qualifying medical condition, and their dated signature. It must also have the provider's and patient's names, addresses and phone numbers.

The 21 qualifying conditions are including cancer, HIV or AIDS, multiple scleroisis, muscular dystrophy, epilepsy, intractable seizures, intractable pain, severe and chronic pain, severe arthritis, neuropathy, Parkinson's disease, fibromyalgia, glaucoma, Crohn's disease, sickle-cell anemia, post-traumatic stress disorder, hepatitis C, cachexia (wasting syndrome), Huntington's disease, amytrophic lateral sclerosis (Lou Gehrig's disease) or another terminal illness.

Exercise increases the body's cannabis-like substances, which can help reduce chronic inflammation, English study shows

Photo: Shutterstock

Exercise can reduce chronic inflammation by increasing the body's own cannabis-like substances, which have the potential to treat conditions ranging from arthritis to cancer to heart disease.

In a study published in Gut Microbes, researchers from the University of Nottingham in England split 78 people with arthritis into two groups. One group performed muscle-strengthening exercises for 15 minutes every day for six weeks, and the other group did nothing. At the end of the study, the participants in the exercise group not only reduced their pain and the amount of inflammatory substances but also increased the amount of cannabis-like substances. Exercise caused these improvements by altering the participants' gut bacteria.

Doctor Amrita Vijay, the first author of the paper, said, “Our study clearly shows that exercise increases the body’s own cannabis-type substances, which can have a positive impact on many conditions."

Study says older adults with arthritis need 45 minutes of moderate activity per week, much less than federal guidelines recommend

Daily Mail photo

Older adults with arthritis need 45 minutes of "moderate activity" a week to maintain functional independence, a study has concluded.

That's about one-third the amount called for by federal guidelines, which say people need 150 minutes of moderate activity per week. Only one in 10 older Americans with arthritis in their knees meet that guideline, says the news release from Northwestern University, where the research was conducted.

“Even a little activity is better than none,” Dorothy Dunlop, the study's lead author, said in the release. “For those older people suffering from arthritis who are minimally active, a 45-minute minimum might feel more realistic.” Researchers said more than 20 minutes of exercise a day is "daunting" for people as they age, especially with arthritis.

The study found that approximately one-third of people in the study improved or had higher function after two years of increased exercise, and those who had at least 45 minutes of moderate activity, like brisk walking, had the best results: 80 percent of them were more likely to improve or sustain a high level of functioning over two years, compared to those who did less.

The study, published online in the journal Arthritis Care & Research, used movement-monitoring equipment to measure the physical activity of 1,600 adults who had pain, aching or stiffness in their bones, knees or feet.

The federal guidelines say 150 minutes a week of moderate activity, in sessions last at least 10 minutes, is good for cardiovascular health. This study found that if the goal is to maintain functionality, the 45 suggested minutes of moderate activity could be spread out and did not have to be done in 10-minute sessions.

“We’re looking for an older population who can be functionally independent,” Dunlop said. “And we were interested in seeing what kind of physical activity might be beneficial to promote good function down the road. We found moderate-intensity activity rather than light activity, such as pushing a grocery cart, to be more valuable to promote future function.”

Partial knee replacement using a robotic arm used in Ky. for first time; offers hope of longer lasting knees that feel more natural

A partial knee replacement surgery that utilizes a robotic arm was performed for the first time in Kentucky in May, Mark Hansel reports for the Northern Kentucky Tribune.

RIO, Robotic Arm System
(Photo from NKYTribune)

Dr. Matthew Hummel of Commonwealth Orthopaedic Physicians, which serves the greater Cincinnati area, performed the Stryker MAKOplasty partial knee resurfacing procedure at St. Elizabeth Edgewood May 19.

Hummel said "benefits of the minimally invasive procedure are expected to include a more natural feeling post-surgery and improved recovery time," Hansel writes.

“Stryker MAKOplasty allows us to treat patients with knee osteoarthritis at earlier stages and with greater precision,” Hummel said. “Because it is less invasive and preserves more of the patient’s natural knee, the goal is for patients to have relief from their pain, gain back their knee motion, and return to their daily activities.”

Osteoarthritis is the most common form of arthritis and a leading cause of disability worldwide, according to the American Academy of Orthopaedic Surgeons.

Hummel said the procedure has been "around for several years," and that he has been tracking its progress, including recent results and upgrades in technology, before using it on his patients.

Hansel explains that the procedure is performed using RIO, a highly advanced, surgeon-controlled robotic arm system. The system correlates a pre-surgical plan that was created by using a CT scan of the patient's knee taken before the surgery with a three-dimensional, virtual view of the patient's bone surface during the procedure.

Hummel told Hansel that some patients are "apprehensive about having a robot perform the procedure," but assures them that "I am actually operating and doing all the work, but it is helping me apply the best laser lines and guiding techniques."

In addition to a more rapid recovery, the procedure is expected to result in reduced pain, a smaller scar, minimal hospitalization, less implant wear and loosening, and better motion that feels more natural, Hansel reports.

“If my implants completely match my plan CT scan, I’m hopeful that with today’s technology, we can have knees that last 25 and 30 years,” Hummel said

Hummel has since performed the procedure on at least one other patients at St. Elizabeth Edgewood. It is anticipated that this procedure will be expanded to total hip and total knee replacements, but these procedures have not yet gained the U.S. Food and Drug Administration's approval.

Kentucky ranks fifth in obesity and its high-schoolers rank first

By Melissa Patrick
Kentucky Health News

Obesity and health problems go hand in hand, and Kentuckians are known for both.

Kentucky now has the fifth highest adult obesity rate in the nation, up from ninth last year, and Kentucky's high-school students are the nation's most obese, according to a report by the Trust for America's Health and the Robert Wood Johnson Foundation.

At least one out of every three adults in Kentucky is considered obese (33.2 percent). This rate keeps going up; significantly higher than the 25.3 percent rate in 2004 or the 12.7 percent rate in 1990.

Baby boomers are the heaviest adults, with 37.1 percent of them considered obese. The report also found that 42 percent of black adults, 24.5 percent of Latino adults and 31 percent of white adults are obese.

Kentucky is joined by 20 other states with obesity rates of at least 30 percent. In 1980, no state was above 15 percent, according to the report, but times have changed. West Virginia and Mississippi tied for the highest rates of adult obesity at 35.1 percent and Colorado has the lowest rate at 21.3 percent, well above that long ago 15 percent.

Not only are the adults in Kentucky obese, so are its children, and kids who are heavy, tend to remain heavy as adults.

Kentucky's high schoolers have the worst obesity rate in the nation at 18 percent. The national average, according to the Youth Risk Behavior Surveillance System, is 13.7 percent. Utah has the fewest obese kids with only 6.4 percent of its high schoolers considered obese.

Obesity rates among 10-to 17-year-olds in Kentucky is also high, ranking 8th with 19.7 percent considered obese. Mississippi ranks highest in this category at 21.7 percent. Obesity rates among Kentucky's 2-to 4-year-olds from low-income families also fall in the top ten of most obese, ranking sixth with a rate of 15.5 percent.

Why does it matter? Obesity takes a huge toll on health, particularly with diabetes, high blood pressure, heart disease, arthritis and certain cancers. Kentucky struggles with each of these diseases.

Kentucky ranks 17th in diabetes. The foundation projects an increase of 51 percent of people with diabetes by 2030, going from 394,029 people with diabetes in 2010 (or 10.6 percent) to 594,058. More than 80 percent of people with diabetes are overweight or obese, says the report.

The projection for high blood pressure in Kentucky is an increase of 33 percent by 2030, going from 881,343 people with high blood pressure in 2010 to 1,175,750 in 2030. Kentucky ranks fifth among states for high blood pressure. High blood pressure is a leading cause of stroke and people who are overweight are more likely to have high blood pressure, says the report.

The foundation projects a whopping 382 percent increase in heart disease in Kentucky by 2030, going from 264,958 people with heart disease in 2010 to 1,278,342 in 2030. Heart disease is the leading cause of death - responsible for one in three deaths - in the U.S., says the report.

Obesity related cancer is expected to increase 158 percent, from 68,075 cases to 176,260 in 2030. Approximately 20 percent of cancer in women and 15 percent of cancer is attributable to obesity, says the report.

Arthritis, however, is projected to decrease by 15 percent from 876,143 cases in 2010 to 748,558 cases in 2030. Almost 70 percent of individuals with arthritis are overweight or obese, says the report.

“Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling,” Jeffrey Levi, executive director of Trust for America’s Health, said in a release. “We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities – so every American has the greatest opportunity to have a healthy weight and live a healthy life.”

The annual report, titled "The State of Obesity: Better Policies for a Healthier America," was formerly known as "F as in Fat." Adults in the study are considered obese if their BMI is 30 or more.Children are graded on the curve, so to speak; a child is considered obese if his or her BMI is above the 95th percentile for children of the same age and sex.

Report links smoking with rheumatoid arthritis, other diseases

By Melissa Landon
Kentucky Health News

Smoking is even more harmful than previously thought. It not only can cause lung cancer but also rheumatoid arthritis and a long list of other diseases, according to The Health Consequences of Smoking—50 Years of Progress, a report of the surgeon general. Kentucky leads the nation in the habit, with 28.3 percent of adults smoking.

Since 1964, more than 20 million Americans have perished from smoking-related illnesses. Although most of the deaths were deliberate smokers, 2.5 million were nonsmokers who are believed to have died from exposure to secondhand smoke. "The burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other combusted tobacco products; rapid elimination of their use will dramatically reduce this burden," the report says.

The report provides supporting evidence that smoking often causes people to die early. Besides respiratory disease, cardiovascular diseases, and diabetes, new information gathered for this study reveals that smoking can also cause reproductive effects, such as ectopic pregnancy; eye disease, such as age-related macular degeneration; and immune and autoimmune disorders such a rheumatoid arthritis.

Because smoking weakens the immune system and causes systemic inflammation, it can not only cause RA but also impede treatment of it. RA is a chronic disease that involves inflammation of the joints and sometimes other parts of the body, according to WebMD. The report also found that women who smoke are just as likely as men to die from smoking-related illnesses—including lung cancer.

Though smoking has become less common since 1964, the costs associated with it are still high. The cost every year for direct medical care needed to treat smoking-related issues is $130 billion annually, and the cost for loss of productivity resulting from premature deaths are greater than $150 billion.

Regardless of constant warnings about the harmfulness of smoking, almost 42 million adults and over 3.5 million middle- and high-school children still smoke. "Each year for every adult who dies prematurely from a smoking-related cause, more than two youth or young adults become replacement smokers," the report says. Advertisements and marketing influence young people to begin smoking at a young age—88 percent begin before age 18—then the addiction to nicotine makes them continue.

The report suggests the following five measures for fighting the smoking battle in our society: raising the price of cigarettes and tobacco products, forming media campaigns, providing access to cessation treatments and funding statewide tobacco control programs.

Mayo Clinic experts offer advice on preventing and coping with osteoarthritis, especially in the knees

Experts from the Mayo Clinic offer tips for both those trying to prevent and those suffering from a painful condition that affects at least 27 million Americans: osteoarthritis.

It is the most common form of arthritis, which most almost everyone is bound to get if they live long enough. One particular form, knee osteoarthritis, may afflict as many as half of Americans at some point in their lives, says a Mayo Clinic release.

Obesity, joint injuries, joint overuse, a family history and aging are among risk factors for knee osteoarthritis. Dr. Aaron Krych, a Mayo Clinic orthopedic surgeon, says maintaining a healthy weight is one key to preventing knee osteoarthritis. “Every pound lost can result in up to a 4-pound reduction in the load on the knee,” Dr. Amin says.

Amin says other tips for prevention including doing exercises to strengthen muscles around joints and preserve your range of motion and using assistive devices, such as special grips to open jars and protect finger joints or a cane, to ease the burden on your knees.

It is also important to maintain overall fitness through low-impact aerobic exercises, such as bicycling and water exercises, said Amin.  If you're an athlete, learn techniques to protect your muscles and joints, he said.

For people already suffering form osteoarthritis, water-based exercises like swimming and water aerobics are good ways to get a workout while taking it easy on joints, said Amin. Tai chi and yoga are also good forms of exercise that can strengthen muscles and help maintain balance.

You can work with a physical therapist to develop a specific exercise program.  And, if osteoarthritis is making life difficult at home or work, making a list of those challenges and working with an occupational therapist can help, says Amin. It may also help to get proper cushioning and insoles for your shoes for both exercise and daily living.  Click here for more tips from the Mayo Clinic.

New type of artificial knee, designed for individual patients, is being implanted at St. Joseph East in Lexington

Saint Joseph East hospital in Lexington is Kentucky's first hospital to offer a customized total knee replacement system in which each the knee implant is made to match the individual patient’s anatomy, says a news release from ConforMIS, manufacturer of the implants. So far, about 20 patients in Lexington have received the ConforMIS total-knee replacement surgery, says the release.

“With this new technology, we’re able to offer an implant that is molded to each individual patient precisely,” said Wallace Huff of Bluegrass Orthopaedics, part of KentuckyOne Health, which includes Saint Joseph. “We’re seeing patients healing faster and more easily acclimating to the new knee.”

Typically, knees are replaced due to osteoarthritis and its breakdown and eventual loss of cartilage of one or more joints. Unlike traditional knee replacements, the ConforMIS system uses technology to design and manufacture knee implants for each individual patient, so less bone is removed during the surgical procedure. This provides the potential for faster recovery from the surgery.

Does gum disease indicate future joint problems? Study links gum-disease bacterium to collagen-caused rheumatoid arthritis

Although researchers and clinicians have long known about an association between two prevalent chronic inflammatory diseases - periodontal disease and rheumatoid arthritis - the microbiological links have been unclear; a new study suggests this link is causative and that the bacteria responsible for gum disease leads to a faster progression of rheumatoid arthritis.

In a recent article published in PLoS Pathogens by University of Louisville School of Dentistry researchers say, "The bacterium responsible for periodontal disease, Porphyromonas gingivalis, worsens rheumatoid athritis by leading to earlier onset, faster progression and greater severity of the disease, including increased bone and cartilage destruction," according to a U of L news release.

The study says the bacterium produces an enzyme that worsens collagen-induced arthritis, a form of arthritis similar to rheumatoid arthritis produced in the laboratory.

The study was led by Oral Health and Systemic Diseases Group researcher Dr. Jan Potempa and a team that also studied another oral bacterium for the same effect, and found it did not affect collagen-induced arthritis or suggest a link to rheumatoid arthritis.

“This ground-breaking conclusion will need to be verified with further research,” said Potempa. Although the specific cause for the disease remains unknown, Potempa said he hopes these findings will shed new light on the treatment and prevention of rheumatoid arthritis.

An estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition, says 2010 data from the Center for Disease Control and Prevention; this represents approximately 1 in every 250 children in the U.S. An estimated 1.5 million adults had rheumatoid arthritis in 2007. Click here for more information from the CDC.

Health care decisions by and for Medicare patients differ widely by place; Lexington big in back surgery, low in mastectomy

All medicine involves decisions and, according to a new series of nine reports published by the Dartmouth Atlas Project, those decisions differ drastically by location for Medicare patients. In the East South Central region -- Kentucky, Tennessee, Alabama and Mississippi), the variation between how things are diagnosed and treated can change when one crosses county lines.

An example, with numbers but without explanation: The total knee replacement rate in Harlan is 3.3 per 1,000 Medicare beneficaries; in Bardstown, it's 13.8. As the report goes on to note: "If you have heart disease and live in Huntsville, Ala., you are half as likely to undergo balloon angioplasty than if you live in Hattiesburg, Miss., and twice as likely to undergo back surgery if you live in Lexington, Ky." The greatest variation in the region was seen in mastectomy, ranging from a low of 0.3 percent per 1,000 female Medicare beneficiaries in Lexington to 2.1 per 1,000 in Tupelo, Miss.

The point, researchers say, is that providers and patients need to work together to determine care. The report looked at rates for early-stage breast cancer, stable angina, low back pain, arthritis of the knee or hip, carotid artery disease, gallstones, enlarged prostate, and early-stage prostate cancer. Read the report here.

Report: Two-thirds of Kentuckians obese by 2030 if trends continue; cost to nation's future unquestionably high

Nearly two-thirds of adults in Kentucky will be obese by 2030 if rates continue to climb as they are now, an analysis reported Tuesday. The level of obesity, defined as being roughly 30 or more pounds overweight, is projected to reach 60.1 percent in Kentucky in 2030, up from 30.4 percent in 2011, according to an analysis commissioned by the nonprofit Trust for America’s Health and the Robert Wood Johnson Foundation. Nancy Hellmich and Laura Ungar of The Courier-Journal in Louisville report that if states’ obesity rates continue on their current trajectories, the number of new cases of type 2 diabetes, coronary heart disease and stroke, hypertension, and arthritis could increase 10 times between 2010 and 2020, and double again by 2030. Medical costs associated with treating preventable obesity-related diseases could increase by up to $66 billion per year by 2030, and the loss in economic productivity could be as high as $580 billion annually. (Read more)

The joint report also shows that states could prevent obesity-related diseases and dramatically reduce health care costs if they reduced the average body mass index (BMI) of their residents by just 5 percent by 2030. Doing so would spare millions of Americans serious health problems, and the country could save billions of dollars in health spending. See the interactive map showing how much improvement could be made if that small change were made here.

The report also features a series of joint policy recommendations from TFAH and RWJF, including full implementation of the Healthy, Hunger-Free Kids Act, protection of the federal health reform law's Prevention and Public Health Fund, and inclusion of additional physical education and activity components in the Elementary and Secondary Education Act. To download the full report, go here.