Articles from prior issues of The Advocate

May/June, 1996

“North to Alaska” Covers Medical Issues and Telemedicine
by Mary Gabriel and Merle Berg

MEDICAL ISSUES WERE A MAJOR part of this educational meeting hosted by the Alaska chapter. H.G. Bischoff, Ph.D., presented the new definition of mental retardation. The American Association on Mental Retardation is dropping IQ tests as the determinate factor in mental retardation and moving toward determining mental retardation based on the need for extended support, and the individual’s ability to learn and perform daily activities. The new definition is a multidimensional approach which gives strengths as well as weaknesses. Some of the areas of focus are sequential, linear, and simultaneous processing. Based on these changes, we can expect to depend even more heavily on the input from teachers, parents, employers, and sheltered workshops as we adjudicate these claims.

Doug Smith, M.D., Ph.D. from the Alaska Psychiatric Institute, discussed clinical examples of physical illnesses causing psychiatric symptoms. He advised the attendees that psychiatric complaints are not always the result of psychiatric disorders. He provided some case studies that provided good examples. One patient, who turned out to have exhausted his body’s supply of vitamin B-12 was diagnosed with mania. Without the ability to metabolize B-12, he began to suffer hypovitaminosis and eventually became manic. Another patient diagnosed with schizophrenia turned out to have a sleep disorder.

Pulmonary issues were discussed by Norman Wilder, M.D. He reviewed the respiratory listings and reminded us that FEV1 (Forced Expiratory Volume) is the amount of air a person can expel in one second after taking a deep breath, and FVC (Forced Vital Capacity) is the total amount of air expelled after a deep breath. The DLCO (Diffusion Lung Carbon Monoxide), is a test that measures the diffusion of carbon monoxide in the lung. Hemoglobin has 200 times the affinity for carbon monoxide (CO) in the lung. By having a person breathe a known amount of CO, hold it for the diffusion to take place, then measuring the amount of CO in the expelled air, you can determine whether there is a problem with the lung or with circulation to the lung. This test can be used in many cases in place of the Arterial Blood Gases test. He pointed out an interesting fact about CO poisoning as well. In the past, a fairly common form of suicide involved closing the garage door, sitting in the car with the windows down and leaving the engine running. This method is no longer viable as new cars with catalytic converters burn so cleanly that the car will run out of gas before the CO reaches a toxic concentration.

Dr. Wilder also tested our fund of useful geographic information with the question, “What is the northern, western and eastern most post in the United States?” If you didn’t answer Alaska to all three, you may have overlooked the fact that the Aleutian Islands extend over the international dateline into the Eastern Hemisphere.

Beth Baker, M.D., gave a breathtaking slide presentation describing Alaska in a way few have seen, from the eyes of a dogsled driver in the Iditarod. This grueling winter race covers over 1000 miles from Fairbanks to Nome. Dr. Baker was a local heroine when she competed because she saved the lives of a number of drivers who were over come by carbon monoxide in a tent along the way.

The Alaska Telemedicine Project is attempting to revolutionize the health care delivery system in Alaska. The cost and time required to move people and material from one place to another in “The Last Frontier” is expensive and can be delayed as a result of weather and remote, inaccessible populations. Healthcare providers in Alaska are collaborating to develop a functional statewide community health information network. Their goal is to have medical records available online. Everything from discharge summaries to X-rays to MRI scans will be available digitally. This telemedicine technology will empower health providers to better serve their patients. Our nation has incredible medical services, but delivering them to the most remote communities is difficult. Telemedicine will be cost effective, a major factor in driving technological advances.