Dr. Kevin Most: Hossa and Health Care Insurance

Dr. Kevin Most on the Steve Cochran Show

We have discussed in the past many sports related injuries most of the injuries are muscle, bone or tendon injuries. Last week we heard the news that Marian Hossa will be unable to play this upcoming season due to allergies related to his hockey equipment. Occupational allergies are not uncommon and often will limit an individual from an occupation. The physician who is allergic to latex would be limited to what they could do in healthcare. The gardener who is allergic to the chemicals used in lawn care would be limited, the dog groomer who develops an allergy to dog dander would be limited. The list goes on.

For Marian Hossa, the report out is he has a progressive skin condition caused by allergy to his equipment. This condition has been noted in many players in the past and has driven others to retirement as well. As is true with other hockey conditions, the actual diagnosis is not shared, and in Hossa’s case it is reported as a “progressive skin disorder”. In hockey the team will often share a generic comment about an injury, “upper body injury” versus a specific diagnosis. For Hossa the skin disorder appears to have been kept in some fashion of control with medication, however the reports are that the medication needed to treat this condition has hit a point of effectiveness that no longer is tolerable.

Now to be clear, I am not diagnosing Mr. Hossa or guessing what medications he is on. My comments are more generic about allergic skin disorders and the medications needed to treat them. The most common skin disorder from exposure is called a “contact dermatitis”. We see this in close to 15 million Americans a year. This is a condition that occurs when the skin is exposed to something the body finds foreign. In some cases, think poison ivy, the condition occurs quickly and almost 100% of individuals will have the response to the poison ivy oil. Other cases may have more of a delayed response and also a more minor response, that is barely noted.

You know the old saying, “Doc it hurts when I do this”, The doc say stop doing that. The same with allergies and dermatitis, if we know you have an issue with an item we will work to eliminate that item from your environment and thus eliminate the rash. For individuals being away from the item that causes the irritation will often clear up the condition, in some individuals where the irritant is part of the work site that avoidance is more difficult. For Hossa he has to wear the equipment to play hockey and he wears it daily so the skin does not get a break from being exposed. An irritation that is not allowed to resolve can lead to bigger problems like infections and skin breakdown.

It is not unusual to have individuals allergic to clothes, the dye in clothes or the chemicals we use to clean the clothes. You are seeing more high tech clothing that are anti-fungal, anti-bacterial as well as SPF treated. Each of these additional chemicals increases the chance of a skin reaction. For athletes the chances are even higher as they often have skin breakdown from activity which then exposes the chemicals directly to damaged tissue, allowing for a faster and stronger response. We see more and more equipment coming out to protect the skin from irritation of sporting equipment.

Treatment for these conditions can range from over the counter steroid creams to strong IV immune suppressing drugs. Often steroids are used as they are strong anti-inflammatory medications and they can calm the bodies response. However we know that long term use of steroids is not something that can be tolerated. The symptoms from contact dermatitis is often noted to be severe itching from the release of histamine in the body. For many of these cases simple oral antihistamines may keep the itching sensation in check, but for others the medications have little to know response and thus the patient is left with severe itching. As we have discussed this can cause skin breakdown and sets us up for possible bacterial infection of the skin.

So although Hossa has a unique condition with allergies to his hockey equipment we all need to know we are exposed to things every day that cause skin irritation, here is a list of the most common

1. Soap- we live in a germophobe world right now and use soap or anti-bacterial gels daily. These soaps often will remove the natural oils we have on our skin and cause dry cracked irritated skin
2. Fabric dyer sheets – these have been known to cause irritation. The classic nature of this is that the irritation is where skin is in contact with clothing.
3. Latex is a common irritant and is found in many products
4. Plants- poison ivy, poison oak, poison sumac. Each of these has an oil – urushiol which is very irritating to the skin. ( Wash clothes, clean chairs, sheets…anywhere the oil may have been)
5. Nickel- this is a metal that is found in costume jewelry and causes irritation to many individuals
6. Sunscreen- yes some sunscreen has chemicals which can cause irritation ozybenzone is an organic chemical that is found in some sunscreens and can be irritating to the skin.
7. Food allergies- some food allergies will cause you to have hives and itching

So the take homes, if you have an allergic reaction, try to identify it and eliminate the culprit from your environment. Initial treatments may include steroid creams and antihistamines.

AHCA

Well we got our first look at the senate healthcare bill and many concerns have been raised. Although we were told that the Senate would have a completely new bill we unfortunately are seeing some similarities to the house bill.

Although we expect that the current bill will change before any vote this week the chance of it passing as it is currently listed is close to zero, as 4-5 Republican Senators have openly stated that as written they would vote no.
Concerns currently include but are not limited to….

1. The protections currently in place regarding preexisting conditions are still present, however states could limit coverage for people with preexisting conditions, so limit not decline coverage.

2. The individual and employer mandate are also removed and replaced with enticements of tax credits based on age and income to help pay premiums. The thought that these tax cuts will encourage the young healthy individual to buy insurance was one of the stumbling blocks noted by insurance companies in the early times of the ACA

3. The senate bill also slows and stops the expansion of Medicaid programs and then using a block grant to limit the access. Currently Medicaid is essentially a pay as you go, or pay as you need, with the funding coming from a combination of state and federal budgets. With a block grant the state would be given a set amount of money each year and then told to manage the care delivered to stay within the amount of the grant.

4. The planned cuts will impact patients, doctors and hospitals and states. States will be forced to decide what services to eliminate or cut back on. Some hospitals will be forced to close others will cut back on expansion of some services. Unfortunately many hospitals run on very thin margins and these changes will have a large impact on the hospitals and the communities they serve. This is a concern as the staff in many hospitals will look for more stable employment and place the hospital in a spiral. Doctors will start refusing to see medicaid patients and the preventative care will halt forcing patients to seek care in the emergency room, the most expensive place care is delivered.

5. The cuts will have a trickle down effect, hospitals will be forced to care for more uninsured and then increase the charges to insurance companies, the increases will be handed down to the employer and the employer will hand it down to the employee. The employee will then make a decision to go without insurance which puts this is a spiral that is not sustainable.

It will be interesting to see what the final bill looks like and if they can get to a point where support is noted from both parties.