In the Spotlight

On June 26, FRONTLINE (PBS) aired an investigation about the nation’s dental care system. WebMD readers were invited to view the show and join a chat with the reporters on the story the following day.  Below is a transcript of the Q&A.

Watch Dollars and Dentists on PBS. See more from FRONTLINE.

Dental care can be a matter of life and death. Yet millions of Americans can’t afford a visit to the dentist, resulting in preventable diseases, bankruptcy, and sometimes even death.

Why is dental care out of reach for so many?

In the new film “Dollars and Dentists,” FRONTLINE and the Center for Public Integrity reveal the shocking consequences of a ruptured dental care system, and explore some solutions to fix it.

Poor children are especially at risk — most dentists won’t see children on medicaid because there’s no profit margin. One in four children have untreated tooth decay, now the most common chronic illness among school-aged children.

Correspondent Miles O’Brien investigates how privately backed pediatric dental chains are popping up to treat these kids at Medicaid rates. But there’s suspicion some of these chains could be taking advantage of their young patients.

For adults with dental disease, the situation can be as dire — and bankrupting. While millions of Americans use emergency rooms for dental care, at a cost of more than half a billion dollars, corporate dental chains are filling the gaps in care, in some cases allegedly overcharging patients or loading them with high priced credit card debt.

On June 27, reporters Miles O’Brien, David Heath, and Jill Rosenbaum took your questions about  “Dollars and Dentists” and American’s dental care crisis during a live chat.

You can read the chat transcript below.

Joseph Nowinski, PhD is the coauthor of Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem? (Hazelden, April 2012). Dr. Nowinski is a clinical psychologist who is currently Supervising Psychologist at the University of Connecticut Health Center, in addition to running his own private practice in Tolland, CT. He is internationally recognized for his work in substance abuse treatment. He has a private practice in Tolland, Connecticut. Learn more at http://www.thealmosteffect.com/.

Think about these scenarios:

• A father who falls asleep on the couch after having several drinks three or four days a week, thereby missing out on time with his kids and wife.
• A sales executive who likes to “sip” scotch on the rocks from the time he finishes his dinner to the time he goes to bed.
• A college student who repeatedly has trouble making it to class because he was drunk the night before.
• A mother who looks forward to her daily double glass of wine to help her get through the day.
• An assisted living resident who finds that two or three brandies every day helps to relieve her boredom.

What do all of the above people have in common? They are almost alcoholics. And there are many more almost alcoholics like them than there are true alcoholics in the world.

A New Look at an Old Problem

For many years health care professionals like myself have been accustomed to thinking about drinking in terms of just two diagnostic categories: alcohol abuse and alcohol dependence. In order to qualify for one of these diagnoses an individual has to suffer some fairly severe and obvious consequences directly related to drinking: a major health crisis, an arrest, loss of a job, etc. And to be diagnosed as alcohol dependent a person also has to experience physical symptoms of withdrawal if he or she stops drinking.

But what about all those men and women whose drinking does not qualify them for a diagnosis? Until now, because of this black-and-white way we’ve looked at drinking (either you’re an alcoholic, or you’re not), we’ve essentially considered all these people “normal.” But is that accurate? Might there be people who are suffering consequences because of their drinking, even though they are not alcoholics? The answer, in my opinion, is a resounding yes.

Could You (or a Loved One) be an Almost Alcoholic?

Rather than thinking in terms of just three categories (Normal, Alcohol Abuse, Alcoholism), it is probably more productive to look at drinking in terms of a spectrum like that depicted below:

I believe this illustration more accurately reflects the real “drinking world.” What it suggests is that an individual’s drinking can range anywhere from normal social drinking at one end of the spectrum, to almost alcoholic in the mid-range, to alcohol abuse or dependence. Moreover, these different areas are not separated by sharp lines; rather, they blend into one another. Of the three “problem” zones, the almost alcoholic zone is by far the largest.

Normal social drinking is the person who has a beer or two, or a glass of wine or two, not more than a few times a month, and almost always in a social context. This is the man or woman who meets friends for happy hour after work on Friday, who joins friends to watch a game on television, or who is invited to a party. Millions of people are normal social drinkers, and many of them never go on to be more than normal social drinkers.

As the illustration suggests, there is a large “gray area” that lies beyond normal social drinking but falls short of alcohol abuse and dependence. Many people slip into this gray zone. Some go only a short distance; others venture much deeper over time and may stay there, yet still are not alcoholics. Many men and women whose drinking patterns lie in the almost alcoholic zone are likely to be suffering, though, as are their loved ones. For example, they may be experiencing one or more of the following:

• Trouble sleeping soundly
• Mild depression
• Marital or family conflict
• Health problems that aren’t  recognized as related to drinking
• Declining performance at work

Connecting the Dots

One thing that has become very clear—and a major motivation for writing the book—is that most almost alcoholics (as well as health care professionals) often fail to see the link between drinking and any problems these people may complain of.  Being able to “connect the dots” and see the relationship between drinking and such problems allows the almost alcoholic to make a decision: to remain in the almost alcoholic zone (and risk venturing further toward alcoholism), or to choose to move back toward normal social drinking.

Senior Medical Editor Louise Chang, MD, (right), participates at a White House Town Hall on senior health.

By Louise Chang, MD

Earlier this week, the White House invited WebMD to a live town hall event focused on seniors’ health. I was excited  to represent WebMD alongside HHS Secretary Kathleen Sebelius, Kathy Greenlee, Assistant Secretary for Aging, HHS, and others.

There were many great questions from WebMD users, the audience, Facebook, and Twitter. Senior health is clearly a priority issue. The  latest figures show 49 million people rely on Medicare already, and that number is expected to grow.

Topics of concern brought up during the town hall included cost, access to care, elder abuse, fraud, patient-doctor relationship, advanced directives, long term care, variability in quality of services, safer transition of care when patients are discharged from the hospital. I was able to ask four questions that came from WebMD readers, and provide patient insight into concerns about hospital discharge. See how the panelists responded to questions here http://www.youtube.com/watch?v=_IsoZL7KSSg&feature=plcp

Both Medicare and the health care reform law have many provisions and benefits, particularly cost-free preventive health services. Whether or not the law survives its challenge in the Supreme Court,  preventive health is important. Currently, the law covers a yearly wellness visit with your doctor in addition to screenings for important medical conditions.  Still, most people aren’t taking advantage of the services. See the current list here:  http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx

Groups like the National Council on Aging and the National Association of Area Agencies on Aging offer resources to help inform and educate people about benefits and services that they qualify for, but that often still requires the initial step of seeking out the information. This website is a great tool to find benefit programs to help you pay for medical care, medicines, food, utilities and more www.benefitscheckup.org.

Remember that many conditions, including high blood pressure, high cholesterol, diabetes, cancer, heart disease can be “silent.” By the time you feel the effect of the condition or suffer a complication like heart attack or kidney disease, your body has already suffered damage.  Being proactive earlier is key, and preventive health measures are the means to catch potential problems early to help avoid or minimize complications later.

WebMD talks to TV personality Star Jones about her heart disease and her work as a National Volunteer for the American Heart Association. Jones was diagnosed in March 2010 and underwent open heart surgery.

What do women need to know about heart disease?

Did you know that more women die of heart disease than all forms of cancer combined? Heart disease is the No. 1 killer of women and affects more than 42 million women in the US. Talk about a sisterhood. It’s not like I planned to be a heart sister. But Lord knows I didn’t do anything to avoid it. My genetic history screamed heart disease (I’m a 5^th generation heart sister) and my lack of discipline and sedentary lifestyle (remember I used to weigh over 300 pounds!) exacerbated it. Thank God I made the decision to get my mind and body in shape (I lost over 150 pounds after weight loss surgery…and have kept it off through a real commitment to diet and exercise!) and began a laser-like commitment to heart health. You see, this particular sisterhood is made up of strong, courageous women who are not only the face of heart disease…they are the voice of compassion, comfort, and care.

How do you reach out to women through the American Heart Association?

For more than two years now, I’ve served as the National Volunteer for the American Heart Association (AHA). I’m thankful for the voice I have when it comes to fighting what I once thought was an old white man’s disease. During this time, I’ve seen, first hand, how passionate women involved in the Go Red For Women movement are about fighting their No. 1 killer. I’ve also experienced a zealous spirit of sisterhood among this group.

As with any inspiring group of women, they can move mountains when they harness their energy, passion, and encouragement for the greater good. The AHA’s Go Red For Women movement has done just that through a new peer-to-peer support program called the Go Red Heart Match. This program is made up of a community of female heart disease survivors who’ve experienced similar situations – from the shock of a diagnosis, to treatment and rehab, to recovery, and finally to survivorship. They can relate to one another’s fears, share their own courageous stories, offer around-the-clock encouragement, and truly be a voice of strength and survival.

I want women to know they don’t have to fight heart disease alone. I want women to know they have heart sisters – no matter where they live or what their diagnosis – who can be the voice of encouragement. And I want women to know they can find support through the Go Red Heart Match.

What was your rehab process like?

Six days after my open heart surgery, I walked out of the hospital and began a new journey – cardiac rehabilitation. I elected to do a full round of Cardiac Rehab and it was the second best decision of my life. The discipline necessary to strengthen your heart after open heart surgery is relentless and exhausting, but oh so worth it. Who cares that I was the youngest one in my rehab sessions? I arrived every day ready to conquer a new obstacle. Twenty-four sessions over 3 months and I got my paper graduation hat and celebrated by walking the 12 blocks home!

Cardiac rehab provided me with the medical care I needed, but just as important, it introduced me to a significant support group during my recovery process. So, not only do I encourage women fighting heart disease to seek support in their heart sisters, I encourage them to join – and complete – cardiac rehab. It gave me the confidence I needed to move forward as a heart disease survivor.

By Kiersten Aschauer

When I woke up in the hospital in 2002 – not knowing where I was or how I got there – the last thing I was thinking was “brain tumor.” Migraines, yes. Memory problems, definitely. But brain tumor? The doctors had no idea yet whether it was benign or cancerous (though they had a good idea that if it was cancerous, I was looking at a five-year lifespan).

I only knew I had one thought: Get this thing out of my head.

Perhaps I wasn’t as graceful as Sheryl Crow, who revealed she has a benign meningioma.  “Please don’t worry about my ‘brain tumor,’ it’s a non-cancerous growth,” she wrote on her Facebook page. “Really appreciate everyone’s love and concern, I feel so blessed to have the support of all my fans, but I’m good – really!”

Knowing what I do now about brain tumors, my hope is that Crow doesn’t have to undergo brain surgery or radiation. I hope her condition doesn’t result in seizures, or vision and memory problems, as some meningiomas do. Of course, many symptoms have to do with where the tumor resides; what part of the brain it applies pressure upon.

According to the American Brain Tumor Association (ABTA), meningiomas represent about one-third of all primary brain tumors, occurring most frequently in middle-aged women. They are often slow-growing — many people live a good majority of their lives not even knowing they have one.

My tumor, as it turned out, was orange-sized and cancerous. It wasn’t a meningioma, like Crow has. It was a stage II oligodendraglioma. But before I even knew that – before I went in for my surgery — I had a decision to make. I could go one of two ways:

1. I could let my surgeon remove the tumor. The negative? I might lose my speech or other functions.
2. I could elect for an awake craniotomy. In this case, the neurosurgeon uses brain mapping techniques to avoid cutting away parts of the brain that would affect my speech or motor skills.

 I went with the latter. If I was going to live, I was going to I choose quality vs. quantity of life.

Unfortunately, my cancer only stayed quiet for two years after surgery, then returned again in 2004, resulting in many months of radiation and chemotherapy. Is it still stage II? I don’t even know, because my doctors  haven’t had to go back into my noggin to see.

For now, I simply celebrate 8 years of “no change” MRIs. It’s the best I can ask for and I’ll take it.

Like so many women before me – and much like Sheryl Crow did with her breast cancer six years ago – cancer definitely changed the fabric of who I am. I’m stronger for it. I’m more empathetic. I’m just a completely different person. And I’ll take that, too.

First Lady Michelle Obama participates in a roundtable with online women’s outlets to discuss her book “American Grown: The Story of the White House Kitchen Garden and Gardens Across America,” in the White House Kitchen Garden, June 5, 2012.

By Kristin Hammam
Vice President of Content, WebMD

First Lady Michelle Obama sat down with WebMD and a small group of online reporters at the White House Tuesday to talk about her new book, “American Grown: The Story of the White House Kitchen Garden and Gardens Across America.”

The conversation took place on the South Lawn, at a picnic table next to the garden, which was in full bloom with rows of green, leafy vegetables including broccoli, herbs, and peppers. “We had a lot of peas and snap peas, which Malia hates snap peas. So she was very happy to see all those vines gone,” the First Lady told us, laughing.

“American Grown” chronicles four seasons of the White House garden and includes tips for starting your own, even if it’s just a pot on a windowsill. Mrs. Obama also writes about her own personal history as well as the history of gardens at the White House. (Thomas Jefferson was apparently obsessed with growing four-foot long cucumbers).

Mrs. Obama says that planting a garden is a way to start a national conversation about the health of our children. She wants the book to be just that – a conversation starter – and doesn’t want gardening to be one more worrisome thing to pressure overworked moms. If “it’s not fun, then it’s a headache and if it’s a headache for you, then your kids are going to feel that and vegetables will be a horrible concept in your household. And that’s what we don’t want,” she says.

What about parents who don’t have time tend to a garden? Think about Farmer’s Markets as your garden, she says, or “maybe you don’t start your own garden, but you start working with your school and their garden; or your community center, and you do it that way.”

The First Lady and “Mom-in-Chief” also shared some of her healthy eating tips:

• Start healthy eating early. Your homemade mac & cheese with whole wheat pasta and cauliflower tastes different from the store-bought kind. Kids get used to sodium in processed food so when they have your healthier version their first reaction will be “this isn’t mac & cheese.”

• Wean them off of store bought juices. “Juices are fresh juices. And they have trouble going back to the store-bought juice because it’s too sweet, so they have to water it down,” says Mrs. Obama. “And that kind of transition can happen in a matter of weeks, but you’ve got to go through that period of, I hate this, I can’t eat, I won’t eat, I hate you mom, you’re horrible.”

• Treats are ok, as long as they’re in the minority. Her philosophy is to eat what you’re supposed to eat 80 or 90% of the time. “I don’t want my kids to have to worry about food,” she says. “If we have a birthday party, if we’re going out or if they’re going out with friends, I don’t want them counting calories and looking at anything.  But I do encourage them — they’re going to camp this summer — and I do say, think about how you should feed yourself. “

Author proceeds from “American Grown” will go to the National Park Foundation.