Taunya English, WHYY, Author at ��ϳԹ�� News

Caring For A Loved One At Home Can Have A Steep Learning Curve

Taunya English, WHYY — Mon, 12 Dec 2016 13:41:07 +0000

Dementia has been slowly stealing Ruth Perez’s memory and thinking ability for 20 years. Her daughter, Angela Bobo, recalled��when it was clear that her mother was never going to be the same.

“She would put food together that didn’t belong together — hamburger and fish in a pot. Mom never cooked like that,” she said.

The mother and daughter live together in Yeadon, Pa., just outside of Philadelphia.

Perez is literally in the center of the family. She spends much of her day tucked under a fleece blanket on a recliner in the middle of the living room. The 87-year-old doesn’t seem to notice as her daughter and grown grandchildren come and go, but they keep up a steady one-sided conversation with her anyway.

“If I kiss her, she might lean towards me, and sometimes she’ll nod,” said Bobo. “What she can do, at times, is smile at you and say a word like, ‘uh huh.'”

Perez can’t lift her arms or move her legs.

A rotating crew of family members takes turns caring for her. They are experienced and they have routines and schedules, but a few months ago, the pressure of lying in one place created a small blister on Perez’s hip. The blister burst and that became a bedsore and wouldn’t heal.

Angela Bobo holds the hand of her mother, Ruth Perez. Bobo is Perez’s at-home caregive

“I couldn’t get it to go away,” Bobo said. “When I say we were at our wits’ end to fix this, we were beyond there.”

About 44 million Americans are unpaid family caregivers like Bobo — sometimes for a child with special needs, more often for a frail older adult, according to a 2015 from the National Alliance for Caregiving. They are often women with a full-time job and children, though now 40 percent of caregivers are men, and millennials are becoming more involved in caring for someone at home, says , CEO of the Caregiver Action Network.

“In too many cases, people just learn this stuff by themselves and that’s really kind of dangerous,” Schall said.

That’s because many people don’t have the necessary skills. Thirty-three states have adopted legislation requiring medical centers to give caregivers basic training or instructions when a patient heads home from the hospital, though how this is carried out is largely up to the hospital.

Ken Everhart, a retired tech guy from North Carolina, became a caregiver for his wife, Genie, for just a few months 10 years ago, when the two were in their mid-50s.

“What we needed was for someone to sit me down in a class and say, ‘Here’s how you change the sheets while she’s still in the bed. Here’s how you take her blood pressure. Here’s how you monitor her breathing,'” Everhart said.

He worried he’d drop her as they struggled to get to the bathroom. He wasn’t sure when to call 911. That uncertainty weighed on Ken — especially when Genie was rushed back to the hospital three times.

“I had given her a straw to drink out of, and a sippy cup, and I went to make a phone call. I wasn’t gone five minutes and I came back in and she was choking,” he said. “I should have sat her up, and I should not have allowed her to have anything to drink while I wasn’t in there to watch. But I didn’t know that.”

Many families can’t afford to use trained caregivers. Hiring help at home for just a few hours a week can cost $10,000 to $15,000 a year.

Bobo gives her mother a kiss. Her mother can’t talk or move her arms or legs.

“When patients leave the hospital, they generally leave quick and sick,” said Susan McAllister, medical director of quality in the Division of Hospital Medicine at Cooper University Health Care in Camden, N.J. Her team includes the social workers, home health nurses and others who help plan a patient’s discharge from the hospital.

McAllister said these days it’s common to come in with a heart attack, get medicine to open a blocked artery, and leave just 48 hours later. The short hospital stay isn’t a problem, she said, but the transition home has to be done right.

In October, Minnesota became the latest state to pass laws to prepare potential caregivers to know what the sick person may need. California, New Jersey, Oklahoma and New York also have versions of a Caregiver Advise, Record, Enable (CARE) Act. Across the country, has lobbied strongly for the proposals.

These laws generally require hospitals and rehabilitation facilities to record the name of the caregiver in the patient’s medical chart. Medical centers and rehab centers must offer caregivers basic training or instructions, and the caregiver is supposed to be notified if a patient is discharged to another family member or back home.

McAllister said years ago, Cooper realized it needed to do a lot more to make sure people were healing safely at home. From day one, caregivers are part of discharge planning, she said. On day two, a social worker might help the family shop for help at home.

“On day three, we may start teaching inside the hospital,” McAllister said.

Hospitals don’t get paid more for those extra steps. But now Medicare hits��medical centers with a financial penalty if too many patients bounce back to the hospital and have to be readmitted. The federal government’s was created under the Affordable Care Act.

Many at-home caregivers say the responsibility weighs heavily.

“It scares you,” said Angela Bobo. “When I’m in pain, I can tell you. She can’t tell me that’s she’s in pain.” So when her mother’s bedsore wouldn’t heal after so many days, Bobo said, “That’s when I said: ‘I’m going to take her to the doctor’s, because I don’t know what’s going on with this.’ “

Bobo with her mother and home health nurse Dave Wilson; her son David’s fiance, Angel; and David.

Bobo took her mother to the doctor, and he basically wrote a prescription saying her mom needed more help. That way, Medicare paid for skilled nursing care at home, and Angela Bobo got lessons in cleaning and dressing her mother’s wound. Now she knows what to expect.

“I told her it’s going to get worse before it gets better,” said David Wilson, a registered nurse from who went to Bobo’s house. He’s a wound-care specialist whose job is house calls.

“To get a wound better, you have to remove the dead tissue and start from the ground up,” Wilson said.

Some nurses come to the house, do their job and leave, but Wilson said teaching is part of his work. Lots of times he’s the one nudging reluctant family caregivers who worry they’re going to do the wrong thing.

“I will tell you in home care, the biggest thing is fear,” Wilson said.

Wilson made several visits. He recommended a new wound-care regimen for Ruth Perez’ bedsore, and Perez got an airflow mattress that relieved the pressure on her skin. Medicare paid for that, too. The nurse returned several times to check on the family, and Bobo said that gave her more confidence that she was doing the right things to care for her mother.

This story is part of a partnership that includes WHYY’s health show , and Kaiser Health News.

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Skeptics Question The Value Of Hydration Therapy For The Healthy

Taunya English, WHYY — Mon, 24 Oct 2016 09:00:15 +0000

Yana Shapiro is a partner at a Philadelphia law firm with an exhausting travel schedule and two boys, ages 9 and 4. When she feels run-down from juggling everything and feels a cold coming on, she books an appointment for an intravenous infusion of water, vitamins and minerals.

“Anything to avoid antibiotics or being out of commission,” the 37-year-old said.

After getting a 100-milliliter drip of a liquid the clinic calls ��pumped directly into her bloodstream via a needle in her arm, Shapiro said she feels like “a new person.” The infusion, which costs $179, takes less than a half-hour. While she waits, she can recline in one of the cushy seats, watch the 64-inch, flat-screen TV or dim the lights in the room.

“I take this time as ‘me time’ — to relax and kick back and close my eyes for a couple of minutes,” she said.

But if you mostly eat your kale and quinoa, why would you need a boost of vitamins delivered straight to the vein? Skeptical physicians say you probably don’t need it. A healthy gut absorbs all the nutrients we need from food. And anyone well enough to drink fluid, they say, can get all the rehydration they need by mouth.

Still, clinics that market treatments of intravenous fluid to the stressed out and worried well can now be found nationwide.

Shapiro gets her infusions at in Philadelphia, but there are similar clinics in New York, Las Vegas, New Orleans, Santa Monica and Dallas, with names like or . The first wave of such companies billed their treatments as a remedy for excess alcohol and partying or too little sleep. You could get the treatment in a mobile van parked at a music festival, say, or in your hotel room.

Newer firms offer a menu of drips that claim to help , balance hormones, improve chronic medical conditions or simply give the skin a healthier glow.

Osteopathic medicine physician Jason Hartman, who launched RestoreIV with a partner out of his Philadelphia , said��people want the experience he offers. Hartman’s specialty is using touch to diagnose and treat patients.

He sometimes helps people remedy a hangover, he said, but his business also includes people with more serious illnesses, including chronic fatigue and migraines. For those patients, he says, IV treatment supports healing. Other clients are generally healthy and want to stay that way.

The basic IV therapy cocktail includes vitamin C, zinc and B vitamins. If you have a headache, the doctor might add a little magnesium.

“These are your natural pharmacy,” Hartman said, “and in chronic diseases these things can be depleted [by] just a stressful lifestyle. And if they become deficient enough, it alters your internal pharmacology enough to possibly manifest as a symptom or disease.”

The promised benefits of this sort of intravenous treatment vary from company to company.

At the bottom of the website for , you’ll find this warning:

“These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. This service is intended only for healthy adults.”

Hartman said��any intravenous infusion comes with a small risk of infection — or pain, bruising or bleeding if the needle misses the vein. Moreof an IV treatment can include a blood clot, or inflammation of the vein.

And people with certain medical conditions — some metabolic diseases, for example, or congestive heart failure — shouldn’t get these treatments, Hartman cautions. That’s why, he said, his clinic questions every client about their medical history before a treatment begins.

At RestoreIV, the treatments cost from $150 to $200, and there’s an initial $35 fee to consult with the doctor. The business doesn’t accept health insurance; patients pay Hartman’s office directly.

So, with the out-of-pocket expense, and only anecdotal evidence of benefit, why do people sign up for these sessions?

, a doctor of naturopathic medicine and health researcher at the Yale School of Medicine, said��that if an IV infusion of this type makes people feel better, it’s probably because of the placebo effect. And the placebo effect can be powerful.

Several years ago, Ali and his colleagues tested a popular IV treatment called the�� on a small group of people with fibromyalgia, a syndrome of muscle pain and fatigue that can be hard to ease. Half the 34 participants in his got Myers’ intravenous cocktail of vitamins and minerals in weekly treatments for eight weeks, and the other half got without vitamins.

“The interesting finding,” Ali said, “was that everyone got better.” People in both groups reported less pain, and said they were better able to do the things they need to do every day.

The placebo phenomenon is more complicated than many people understand, Ali explains. Research has shown, for example, that injections, or other invasive procedures, can generate a than dummy pills do.

If, as in the case of his study, people feel a fairly innocuous treatment is helping them, and they haven’t been able to get relief in other ways, that may be a reason to use it, Ali said��— even if the “fix” is 100 percent placebo effect.

“When your child falls down and scrapes their knee, you give them a kiss,” he said. “There’s value in that, whether or not there’s clinical trial data showing that giving a kiss is better than doing nothing.”

Still, Ali said��he can’t ethically recommend the intravenous vitamin treatments for healthy patients.

“If people are just using it to feel good or for an energy boost,” he said, “I would just say go exercise for 30 minutes and you’ll get more out of that.”

This story is part of a partnership that includes , and Kaiser Health News.

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In Philadelphia, Neighbors Learn How To Help Save Shooting Victims

Taunya English, WHYY — Wed, 07 Sep 2016 09:00:00 +0000

When a young African-American man dies in the city of Philadelphia, more than half the time there’s one main reason why, says Scott Charles.

“It’s because somebody pointed a gun at him and pulled that trigger. It’s not because of cancer; it’s not because of car accidents; it’s not because of house fires. It’s because somebody pointed a trigger,” he says.

Charles is at Temple University Hospital. The medical center now offers bystander first-aid training, called Fighting Chance, to give friends and family something to do in the minutes before help arrives.

At 6 o’clock one evening, kids run around while their parents and neighbors gather in an elementary school cafeteria. There are training stations set up, and at the back a nurse is showing people how stop blood flow from a gunshot wound.

“The pressure point is located on the inside of the arm,” he explains. “And basically, you’re going to take your hand and get up underneath the inside of the arm and clamp it down.”

Each person takes a turn, taking an old towel or T-shirt and wrapping it around the fake bloody arm tight until help arrives.

Everyone’s talking, but emergency medicine doctor Tim Bryan’s voice is the loudest. He’s a Navy veteran, a former combat medic, and he’s used to giving commands. A shooting scene is chaotic and frightening, but Bryan says in just two hours of training, people get enough of the basics so they will know how to respond.

“You have that ‘aha’ moment and people are like, ‘Wow, I can do this. I can control the scene. I can remember to call 911 and tell the person to put direct pressure on even if I don’t do anything else.’ And it does make a difference,” he says.

The topic is serious, but the mood isn’t. Alice Kellam, 63, wears a camouflage tracksuit and rhinestone hoop earrings. She’s chatty and laughs with friends all evening — except when she talks about her husband, who was murdered in 1990. She doesn’t have a lot to say about that, except that it was senseless.

“They took his sneaks and his hat. That was it,” she says.

Amanda McMacken, a registered nurse at Temple University Hospital, shows North Philadelphia residents how to slow bleeding in trauma victims. (Kimberly Paynter/WHYY)

Many people in this North Philadelphia neighborhood have a story about someone and remember a moment when they felt helpless.

Louise Smith (“Everybody calls me Miss Midge,” she says) is a perpetual volunteer, and at the big summer block party at 12th and Cambria, she’s the lady who hands out the flavored water ice.

“About a year ago, we seen a shooting around here,” she says. “It was a shame the two boys died right on the sidewalk, there wasn’t nobody there to help them.”

A severely injured person can bleed to death in less than 10 minutes. But it can take much longer for police to arrive and calm the situation, so the trainers teach the class how to move a victim away from danger and flying bullets.

Registered nurse Maureen Quigg explains how to do a two-person lift-and-carry.

“The knee closest to the victim is down and the other knee is up, and that’s what you stand up with, the power from your legs and not your back,” she says.

Quigg reassures the smaller women that they indeed can help a 200-pound person.

Registered nurse Danielle Vetter demonstrates use of a tourniquet. (Kimberly Paynter/WHYY)

“If it’s someone you care about or in a situation where there’s a lot of activity, your adrenaline is going — you have all this extra energy, you have all this extra power,” she says. “And if you focus on doing it and doing it the right way, you can lift someone you’d never think you could lift, and you can do it without hurting yourself.”

Advocates say learning first-aid skills to stop bleeding is the essential step in bystander education, not unlike learning CPR or making sure a defibrillator is nearby to jump-start someone’s heart. The federal Department of Homeland Security provides an introduction to these lifesaving techniques online in its program.

At the end of the evening, the trainers stage a minidrama to test the group.

Bryan sets the chaotic scene and calls out directions. One person is the victim. There’s a pretend shooter.

“Remember, you can ask somebody: ‘Help me control the scene.’ That’s good,” he calls out.

Charles helped develop the first-aid education program after a local resident came to him to complain that he was sick and tired of hearing about young men who died before getting to the ER.

“As we wait for laws to be changed, many people are going to find themselves on the wrong end of a gun,” Charles says. “While those things are certainly important, we have to put the power in people’s hands to address this issue.”

The goal is to saturate one neighborhood with people who have basic lifesaving skills. About 250 people have been trained so far.

This story is part of a reporting partnership with NPR, WHYY’s health show and .

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The Stethoscope: Timeless Tool Or Outdated Relic?

Taunya English, WHYY — Wed, 02 Mar 2016 10:00:02 +0000

To hear a patient’s heart, doctors used to just put an ear up to a patient’s chest and listen. Then, in 1816, things changed.

Lore has it that 35-year-old Paris physician was caring for a young woman who was apparently plump, with a bad heart and large breasts.��, an obstetrician at East Tennessee State University who collects vintage stethoscopes, said the young Dr. Laennec didn’t feel comfortable pressing his ear to the woman’s bosom.

“So he took 24 sheets of paper and rolled them into a long tube and put that up against her chest, listened to the other end and found that not only could he hear the heart sounds very, very well, but it was actually better than what he could hear with his ear,” Davis said.

Or, maybe it was��poor 19th century hygiene — lice and the smell of an unwashed body — that kept Laennec from getting too close to his patient.

Either way, he went home and crafted a wooden cylinder with a hole down the middle and that became the first stethoscope.

It took a while for the art of listening to the body through a tube to catch on. But the new tool fit into an evolving idea that doctors needed a more focused approach to diagnosis, “that you should distinguish tuberculosis from a lung abscess — and not just call it all consumption,” said��, a professor at Drexel University College of Medicine.

He said doctors used to get praise if they had the “ear” to hear and interpret the subtle body sounds that travel through a stethoscope’s rubber tubing; the stethoscope is the iconic symbol of a physician.

, a first-year student at the University of Pennsylvania’s Perelman School of Medicine, is still getting used to hers.

“You don’t realize until you are wearing it and trying to use it, how pokey it is in your ears,” she said. “I’m almost embarrassed to wear it because it implies I have knowledge I don’t have yet.”

Medical schools teach the art of listening.

“I am astounded at the things I’ll find with my stethoscope,” said��, a third-year student at the Perelman School of Medicine. “I had a patient who��had pneumonia, and it was really wonderful to be able to listen to her and say, ‘This is what I think it is.’ And then, later, see on the chest X-ray that, that was exactly what it was.”

But some argue that the stethoscope is becoming less useful in this digital age.��, an emergency medicine physician at Mt. Sinai Hospital in New York, said clinicians now get a lot more information from newer technology.

Some doctors say clinicians can now get much more information from newer technology than they can get from a stethoscope. Clinging to the old tool isn’t necessary, they say. (Kimberly Paynter/WHYY)

An ultrasound, for example, turns sound waves into moving images of blood pumping and heart valves clicking open and shut; those visual cues are easier to interpret than muffled murmurs and may produce a more accurate diagnosis, Nelson said.

He admits the stethoscope is an icon, but doesn’t buy the argument that if you lose the stethoscope, you lose the tradition of “healing touch.”

“Pulling an ultrasound machine out of my pocket, or wheeling the cart over next to the patient [and] talking through with them exactly what I’m looking for and how I’m looking for it — the fact that they can see the same image on the screen that I’m seeing, strengthens that bond more than anything in the last 50 years,” Nelson said.

Nelson is 42 years old and graduated from medical school 16 years ago. He teaches medical students and said it’s helpful to show new learners what “lies beneath.” At Mt. Sinai, when medical students are taught to examine a heart, they learn how to use the stethoscope and an ultrasound machine on the same day.

“They know how to feel it, they know how to listen to it, and they know how to look at it,” Nelson said.

Still, obstetrician George Davis wants to keep the stethoscope around for a while. High-tech machines and imaging scans are great backup resources, he said, but his stethoscope helps him figure out which patients actually need additional testing.

“How much do those ultrasound machines cost?” Davis asked. “I can get a good stethoscope for less than $20. We are not going to sit there and do an echocardiogram on every patient who walks through the door.”

Davis worries that a whole generation of doctors is learning to rely too much on technology; he wants to hold on to first-line tools that are safe, effective and cheaper.

“Shouldn’t we be using what is low-tech and practical?” he asked.

Nelson counters that point-of-care imaging is becoming less expensive every day. Twenty years ago, he says, an ultrasound machine was as big as a refrigerator and cost $400,000. Today, a handheld, portable device plugs into a computer tablet, and costs less than $10,000.

Many care providers in the community may even have an ultrasound in their pocket one day soon, he says, combined in a single device with, “a slide rule, a calculator, a flashlight, a phone, a computer terminal and 36 video games.” In other words: on their smartphone.

This story is part of a reporting partnership with WHYY’s health show��, and Kaiser Health News.

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Biking Behind Bars: Female Inmates Battle Weight Gain

Taunya English, WHYY — Wed, 14 Oct 2015 09:00:46 +0000

The gym at Riverside Correctional Facility in Philadelphia is through the metal detector, two heavy doors and down the hall.

There’s a basketball court like one you’d see at any high school, except there’s a corrections officer on guard near the three-point line.

Sixteen stationary bikes are set up in a half circle in the corner. On bike number two, Lakiesha Montgomery, 32, from Philadelphia, is pedaling��fast and singing along to the Nicki Minaj’s song “Fly.”

“I didn’t think I’d be able to keep up, I’m not the skinniest thing in the bunch,” she says.

But she is keeping up.

In 2011, biking advocates from the nonprofit group persuaded prison administrators to let them bring in bikes to teach indoor cycling. Founder Kristin Gavin says before that she had mentored ex-offenders in the community.

“Over and over I had conversations with women who were saying, ‘While I was incarcerated, I put on 60 pounds, I put on 70 pounds,’ ” she says. Then she would ask them how long they were in prison and she says they’d typically respond, “six months.”

At Riverside, Montgomery spends time in the prison yard most days but doesn’t get much exercise there.

“The outside is not a real outside, it’s like a mini garage. They have a basketball court there, but I don’t play basketball. It’s a lot of people that come out so you don’t have room to really jog or walk. It’s like you sit out to just get some air,” she says.

She has arm tattoos and a sprinkle of freckles across her nose. Her hair is braided back into cornrows. She also has high cholesterol.

Montgomery was charged with assault this year, among other charges, and has been in county jail for about six months.

Leahya Ellis and other spinning class participants use exercise as a way to shake away stress, anger and depression. (Photo by Bastiaan Slabbers for NPR)

“First time, last time,” she says. In the meantime, spin class is something to do.

“Keep away frustration being locked up, it helps you get through,” Montgomery says.

The Department of Justice surveyed the health of state and federal inmates in 2012 and found that women are more likely than men to be obese.

A study of prison health in Kentucky found greater weight gain for women compared to men. Women on average gained nearly 11 pounds, men only gained 2.5 pounds.

Gearing Up is working with researchers at Temple University to track the weight and body image of the women who spin at Riverside Correctional. The study was just eight weeks long and small, but they’ve already found small improvements in resting and recovery heart rate—two preliminary measures of heart health.

Instructor Erica Tibbetts uses a portable audio system to provide a soundtrack for the spinning class. (Photo by Bastiaan Slabbers for NPR)

Gavin says often the women come to class initially to stop gaining weight then later find other reasons to keep coming back.

“I can speak to myself, if I weren’t given the opportunity to be physically active, I’d probably go a little crazy. I probably wouldn’t be able to manage my emotions, my temper, my anger. I think anger management is a huge issue for a lot of women who are in prison; they are victims of trauma and abuse,” Gavin says.

And, of course some of the women have hurt other people.

Exercise can be a way to release all sorts of emotions.

Erica Tibbetts from Gearing Up often leads the spin class.

Tibbetts is in bike shorts. Everyone else has on prison blues: long navy pants and a white t-shirt.

“The worst seems to be women don’t have good sports bras in here,” she says.

No one has a water bottle and exercise shorts aren’t allowed. Tibbetts says the women come to class anyway and work with what they have.

Climb on a bike and there’s a sense of freedom, even if you’re not going anywhere.

At the beginning of class, one by one, the women call out their intention for the ride. The ritual is called “clearing.”

Christina wants to leave behind shakedowns. Jean wants to forget “cough and squat.”

Sheik is leaving behind “wrongful mistakes.”

Others want to shake off the past, stress and depression.

In a 2010 survey, women at Riverside gained about 36 pounds in a year, on average. But after some changes at the facility, that weight gain dropped to 26 pounds when the medical team checked again in 2015.

Bruce Herdman, the prison’s chief of medical operations, says weight gain is a problem, but it’s not the most urgent health problem his team is managing.

“The chlamydia rate — 6.6 percent on admission. We’ll treat a thousand people for HIV. The hepatitis C rate here, largely because of intravenous drug use, is 13 percent. Then you have hypertension, diabetes, all the regular things,” he says.

The prison pays Gearing Up to hold spin class three times a week. There’s also an occasional yoga class, but the big change affecting women’s weight was the food. The meals are certified heart healthy by a nutritionist. There’s a lot of it, but portion sizes are smaller now. Last year, the prison cut calories from nearly 2,900 a day to 2,500 for men and women.

That helped, but the facility-provided meals aren’t the only food around. Inmates also make do-it-yourself meals with food from the prison commissary. A favorite is called “chi-chis.”

“It’s where you mix Ramen Noodles with cheese puffs. You put it in hot water, you put the meat inside, you can do honey mustard sauce or ranch on top, and you just put in a potato chip bag and you mix it up. It’s actually pretty good,” explains Amanda Cortes.

Cortes has been in jail for five years and eating that way for most of that time. She’s facing several charges including involuntary manslaughter and is waiting for a court date. She says lots of women use food to cope with boredom and depression.

“Some people get two or three trays, so they get fat like that. They take whole loaves of bread to their room,” Cortes says.

So Cortes cycles to keep the weight off, and on visiting day, her 10-year-old son noticed.

“When he first seen me he was like: ‘Mommy you got skinny!’ So I was excited,” she says, smiling.

During a year, going to three spin classes a week, Cortes dropped 90 pounds.

At the end of the Gearing Up class, just before the goodbyes and sweaty hugs, there’s one last ritual.

The women share what they’ve brought back from the ride.

One women says she’s “bringing sexy back.” She and everyone around the circle has a wish: “I’m Jean, and I’m bringing back my bikini. I’m Ruth, and I’m bringing back faith and confidence.”

This story is part of a reporting partnership with NPR, WHYY and Kaiser Health News.

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In South Jersey, New Options For Primary Care Are Slow To Take Hold

Taunya English, WHYY — Wed, 03 Apr 2013 06:03:00 +0000

Camden, New Jersey, has serious health problems, with too many people going to local emergency rooms unnecessarily. But progress is being made – albeit slowly.

John Pike, age 53, is an example of a Camden resident who used to be a frequent flier at the ER.��Pike has a smoker’s cough, and when that cough, or pain in his bad hip flared up, he’d go to the ER — maybe eight or nine times a year. But when he did, ER staffers didn’t really remember him or his medical history.

“You get to feeling you are irritating them,” he says. “It would be a simple problem. I’m wasting their time where they could be dealing with a real emergency.”

Once, he says an ER nurse pulled him aside and said, “This is something your doctor can deal with.”

“Not much I could say, because she was telling the truth,” he says.

But Pike didn’t have a primary care doctor until a community group called the��opened a doctor’s office right inside Pike’s apartment building.

, the director of research and evaluation for the coalition,��says the idea was to get “super users” like Pike to stop going to the hospital so frequently.

Gross says the group saw ER overuse in Camden as “a sign for us, from the data, that you don’t have a source of primary care, or you have a loose relationship with primary care or you can’t get an appointment with your primary care because of your work hours.”��

Gross leads a team of��at the coalition. For several years they gathered hospital billing information from across Camden. Then they mapped the data block by block.

It turns out that John Pike’s building is marked as a bright-red “hot spot” on the map. John and his neighbors at the Northgate II building had been racking up more than $1 million a year in hospital admissions and trips to the emergency room��for about a decade.

Dr. Madhumathi Gunasekarn examines John Pike at the Northgate II clinic in Camden. Pike is one of over 100 residents of the apartment complex who make the clinic their primary care provider. (Photo by Emma Lee for KHN)

These days, Pike rides an elevator to the doctor, just six floors down from his apartment. The space is bare bones, with just two exam rooms and a tiny file office, but Pike has his own doctor now. Her name is Dr. Madhumathi Gunasekaran.

“I feel comfortable with her. I can talk to her; she doesn’t shove you off like some doctors,” Pike says.

Dr. Jon Regis is a longtime member of the Camden coalition. His company, the��operates 21 offices across New Jersey, including the practice at Northgate II. The subsidized housing there is home to many low-income seniors and people with disabilities. Many people who live in Northgate II now see Dr. Gunasekaran for check-ups and other medical issues. But Regis says it took longer than he hoped to win over residents — almost two years.

“We thought that since they were having such a difficult time, we could just open up the door and they would come down. That wasn’t the case,” he says.

Regis says some residents told him that they didn’t want their neighbors to know they’re going to the doctor. But Regis was persistent in trying to get residents to use Dr. Gunasekaran instead of the ER.

“We had to do a number of different things, like health fairs and meet-and-greets. We had to engender a sense of trust in the residents before they would come down to see us. I think that was somewhat surprising. But we’re starting to get past that now,” he says.

About a year ago, only about 80 people got their primary care at the office. That number has grown to nearly 130 or about 19 percent of the building’s residents. It was a slow start, but Regis is pleased with the progress.

Reliance uses revenue from private pay and private insurance patients at other office locations to help finance the clinic at Northgate II. This way, he says, “We don’t have to turn anybody away, and we’ve been able to make this work.”

This story is part of a reporting partnership that includes , and Kaiser Health News.

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FDA Dilemma: Melt-In-Your-Mouth Nicotine

Taunya English, WHYY — Fri, 20 Jan 2012 14:47:00 +0000

This story is part of a reporting partnership that includes , and Kaiser Health News.

The U.S. Food and Drug Administration has gathered scientists and tobacco policy experts to study the potential health risks and benefits of dissolvable tobacco products. The met this week and advocates from all sides lined up to give their pitch to the FDA panel.
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Dissolvables, which are made with finely milled tobacco, aren’t new, but they drew new attention last year when R.J. Reynolds and Philip Morris introduced new flavors and varieties in a few cities across the country. Some health officials and lawmakers dubbed the flavored melt-in-your mouth orbs and tongue strips “nicotine candy” and complained to the FDA.

Supporters say dissolvables could help smokers “step down” from their nicotine dependence on cigarettes. Opponents say it’s not clear how consumers actually use the products and who is using them. Will young people try dissolvables, develop a taste for nicotine, then graduate to smoking? Could dissolvables keep people hooked when some former smokers would have–eventually–become nicotine free?

Tobacco companies aren’t allowed to promote dissolvables as a stop-smoking aid, but there’s lots of Internet chatter from individual consumers who report that they’ve given up cigarettes or cigars with the help of dissolvables.

Rutgers University law student Gregory Conley was a smoker for eight years, but quit in August. The 24-year-old used electronic cigarettes—another smokeless product—to quit, and he says dissolvables suppress his cravings when he’s in class. He likes the tobacco-dipped toothpicks and says they give him a satisfying nicotine tingle along with a hit of mint or java flavor.
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“You just put it in your mouth and hold it as if you were holding a piece of straw between your teeth,” Conley said.
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He volunteers as a legal policy director for the and testified during the FDA’s meeting this week. Conley says electronic cigarettes, dissolvables and other smokeless alternatives are powerful tools to help smokers avoid the most toxic aspects of cigarettes.
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The Centers for Disease Control and Prevention one in five deaths each year to tobacco use, about 440,000 people. Cigarette smoking costs America $193 billion a year, according to government estimates for 2000 to 2004. About half of that economic cost is direct health care spending, the other half lost productivity.

The FDA’s review of dissolvables was mandated by the 2009 . Matthew Myers, president of the , says the advisers will weigh the science and report on the consequences for population health, not just individual smokers.
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“The FDA law recognizes that even if the product is less harmful, if it’s marketed in a way that its primary appeal is to young people, the net result will be more people becoming addicted to tobacco,” Myers said.
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“What we’ve seen is that the colorful way that dissolvables have been promoted and the talk that they have generated has led a lot of people to believe that these products are less harmful—before there’s been an FDA review,” Myers said.
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Right now, FDA regulates dissolvables like other smokeless tobacco. They’re stocked behind the counter at convenience and grocery stores, not sold to minors and they have some of the same warning labels as snuff and chew: “Smokeless tobacco is addictive.” “This product is not a safe alternative to cigarettes.”

The newer products have been available in just a handful of markets so far, including Denver, Indianapolis, Portland, Ore., Columbus, Ohio, and Charlotte, N.C. The Colorado Board of Health passed a resolution asking R.J. Reynolds to remove the products from its market, but the company with the request.

A group of U.S. lawmakers wants stricter rules for dissolvables. Some public health groups say the products should be removed from store shelves until the FDA has weighed in on the science behind dissolvables. Other advocates, sometimes called “harm reductionists” say smokeless products like dissolvables can lessen the disease, death and disability caused by smoking.
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Jennifer Ibrahim, associate professor in the Department of Public Health at Temple University, says–done right–harm reduction is a good idea. “I think that everyone in the business of smoking cessation is realistic that people can’t quit cold turkey, but you don’t want to send the wrong message: that nicotine is safe at any level, because it’s not.”
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“That’s absolutely true, nothing is absolutely safe,” said Conley, but he says smokers are dying while public health officials wait for definitive proof.

Psychologist Anna Tobia, director of the smoking cessation program at Thomas Jefferson University Hospital in Philadelphia, points out that the new dissolvables are not the only nicotine products meant to be ingested.

“To be fair, they are very similar to smoking cessation products that have been on the market for a very long time–a lozenge or a gum for people who are trying to get off of tobacco,” said Tobia.

Kenneth Warner, a health economist at the University of Michigan School of Public Health, says there’s reason to be skeptical of the tobacco industry’s intention for dissolvables and concerned about what the new products will do.
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“The public health community got bamboozled” in the past, he said. When the tobacco makers began selling low-tar nicotine cigarettes, Warner says they were marketed as “mild, mellow,” and safer than regular cigarettes—and it turned out they weren’t.
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The FDA’s advisers are wading in to a long-standing debate that shows up evolving and changing ideas about what’s acceptable and what’s safe. ��Health policy expert Ibrahim says electronic cigarettes and melt-in-your mouth tobacco are just the latest in a long line of novel products aimed at smokers and people trying to kick the habit.
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“I won’t let my kids near the e-cigarettes, because I just don’t know what’s in the vaps [water vapor] that’s coming out of them. Once upon a time people thought exposure to second-hand smoke was safe and clearly that’s not the case,” Ibrahim said. “I don’t intend to expose myself or my family to things which 10, 15 years down the road, we’ll say: ‘Oh, yeah, that’s not good for you.’”
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“We will take anything to get our patients better and to get them to reduce the amount of cigarettes that they are smoking,” said stop-smoking expert Anna Tobia. “If this is a good first step, and—maybe–if they can see that they can manage with less nicotine, that would be wonderful.” Many are waiting for the FDA to answer the question: Do dissolvables pose a greater or lesser risk to population health?

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African American Women And The Obesity Epidemic

Taunya English, WHYY — Mon, 19 Dec 2011 07:23:32 +0000

This story is part of a reporting partnership that includes��,�� and Kaiser Health News.

It’s not news that Americans are dealing with an obesity epidemic. But the problem is particularly acute among African-American women.

Four in five African-American women are obese or overweight, according to the U.S. Office of Minority Health, and carrying those excess pounds can spike the risk for several conditions including heart disease, Type 2 diabetes, high blood pressure and stroke.

Members of the Anderson Monarchs soccer team practice as their coach looks on. The team, which was started at Philadelphia’s Marian Anderson Recreation Center, gives game time to girls who have little chance to play another sport (Photo by Todd Vachon/WHYY).

About half of African-American women in the U.S. are obese, compared to 30 percent of white women.��Black women not only carry more weight, but they start adding extra pounds years before their white counterparts.

So when does it begin, this excess and unhealthy weight? Research suggests the problem starts early, and it may have a lot to do with when girls give up regular exercise.

Experts want kids to exercise at least 60 minutes every day, but among all children, black girls are most likely to report they got no physical activity in the past week. A lack of access to exercise opportunities may be one big reason why, says , an epidemiologist and public health professor at the University of Pennsylvania.

Research shows that opportunities for recess, sports, physical education — or just to go outside — aren’t spread evenly among children.

“If you kind of add up those situations in urban, inner-city neighborhoods — where most African-Americans live — they are not as available. That’s been documented,” says Kumanyika, who studies patterns of illness and health behavior.

But research suggests that even those girls who do engage in sports and other forms of regular physical activity tend to abandon it in their teen years — and that’s true not just for urban girls or black girls, but all girls.

A National Institutes of Health that followed girls for 10 years, beginning at age 8 or 9, found that, over time, leisure-time physical activity declined dramatically. That drop off was steepest for African-Americans girls.

“What they found was that by the age of 17 — so that’s the junior, senior year of high school — more than half of black girls, and nearly a third of white girls were reporting no leisure time physical activity at all,” says Temple University researcher .

There are lots of reasons why teen girls drop exercise from their lives, says Lenhart: “They have found changes in enjoyment of activities, in peer support or social support for physical activity. They found a lot of competing interests — be it part-time jobs or caring for younger siblings or other family members.”

Walter Stewart says he’s witnessed the phenomenon first-hand. He’s the longtime coach of the Anderson Monarchs, a soccer team of mostly African-American girls from inner-city Philadelphia.

Members of the Anderson Monarchs soccer team gather as their coach Walter Stewart talks to them. The team, which was started at Philadelphia’s Marian Anderson Recreation Center, gives game time to girls who have little chance to play another sport (Photo by Todd Vachon/WHYY).

“Eighth grade — that’s where it gets to be difficult,” he says. “They are making the transition from young kids to more teenagers, and they are more interested in boys and what boys think.”

Jennifer Johnson was determined not to let that happen to her daughter, Alexandria. Johnson discovered the Monarchs when she was looking for an affordable way to keep Alexandria active.

Alexandria is now 15 and an assistant coach with the team, but her interest in soccer dipped in middle school, around age 12, says Johnson.

“In come the friends, and in come the extracurricular activities at school, and as a parent you really have to press on. I said to her, ‘If it’s not this, you will be involved in something,'” Johnson says.

So Alexandria stuck with soccer, and so did her mother — Johnson is on the sidelines at games and during most practices.

That’s an approach that obesity researchers would approve of. Researchers say that family support — especially mom’s presence — may motivate girls to keep playing.

Researchers are beginning to count up the cost of obesity, and say women can pay a hefty price in dollars– and health.

A sedentary lifestyle and obesity may account for 25 to 30 percent of some major cancers, including colon, kidney and breast cancer in postmenopausal women, according to the National Cancer Institute. Avoiding weight gain, by contrast, can cut cancer risk.

In September 2011, researchers at Boston University reported that overweight and obesity in African-American women increases their risk of death, particularly from heart disease. The investigators reviewed body mass index–a measure of body fat–and death rates for participants in the ongoing Black Women’s Health Study. A BMI of 25 is considered overweight. The study found a significant increased death risk at a BMI of 27.5–that’s the BMI for a 5-foot-4-inch tall woman who weighs 160 pounds.

Nearly 10 percent of all health care spending in the United States, $147 billion a year, is related to the obesity epidemic. Individually, obese people cost nearly $1,500 more a year in medical expenses compared to healthy-weight people, according to estimates from researchers at George Washington University. Some of that extra expense is paid by individuals, some is passed along to their employers.

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Clash Between Hospital, Insurer May Reach Pa. Statehouse

Taunya English, WHYY — Wed, 30 Nov 2011 21:21:19 +0000

This story is part of a reporting partnership that includes , and Kaiser Health News.

State lawmakers are signaling a willingness to referee a fight between southwest Pennsylvania’s dominant health insurer and the region’s largest medical system.

Highmark, a Blue Cross Blue Shield affiliate, and UPMC, the University of Pittsburgh Medical Center health system, tried for months to set a new reimbursement rates for doctors’ visits and medical procedures.

Negotiations broke down when Highmark announced plans to buy Pittsburgh’s No. 2 hospital network, the much smaller and struggling West Penn Allegheny Health System.

UPMC officials say that move makes Highmark a competitor.

Last week during a speech at the Pennsylvania Press Club in Harrisburg,��Gov. Tom Corbett said he’s “deeply” concerned.

“In my mind, they are both charities and they are both nonprofits and something is getting lost in between,” he said. “And I will work with the Legislature, if necessary, to address this.”

Corbett didn’t say just what outcome he’d like to see.

A health system spokesman says it’s time to educate the public about the end of the UPMC-Highmark contract, but many still hope to push the parties back to the negotiating table.

A lobbyist with the Pennsylvania Insurance Federation said the end of the contract will bring much-needed competition and insurer choice to southwest Pennsylvania.

Some consumer health advocates say it could mean the end of discounts and in-network pricing for thousands of plan holders.

Erin Gill-Ninehouser, an organizer for the Pennsylvania Health Access Network, said consumers are worried they’ll lose access to doctors they know and trust if Highmark buys the smaller health system, and then shifts its discounted pricing to new health providers affiliated with West Penn.

“If the choice is sticking with your doctor but paying 40 percent more because they are out-of-network now, that’s a choice that’s already made for people who are living on tight budgets,” Gill-Ninehouser said.

Lawmakers have proposed a rash of bills in response to the dispute.

One proposal would allow the state insurance commissioner to step in and extend the existing UPMC-Highmark contract.

The quarrel has drawn attention from far beyond the Pittsburgh region because of consumer fears and because both organizations receive tax breaks due to their nonprofit status.

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Managing Asthma With More Than Medicine

Taunya English, WHYY — Thu, 27 Oct 2011 17:34:00 +0000

This is part of the series “In the Gap: Voices from the Health Divide,” a news and dialogue partnership between WHYY and 900 AM WURD. Taunya English is participating in a reporting partnership that includes , member stations, and Kaiser Health News.

In any given year, five to 15 children in Philadelphia die of asthma.��Uncontrolled asthma doesn’t take as many young lives as cancer, but most asthma deaths are preventable. And pediatricians admit to a poor track record helping families keep the condition in check.

“Even if it doesn’t fit into their life, we say: ‘You have to do this,’ said pediatrician��Hal Byck, who cares for kids at Nemours Children’s Clinic in Northeast Wilmington, Del. Byck’s philosophy is different from what he described as the prevailing attitude of the medical system that he thinks needs to change: “If they don’t do it, it’s not our fault: it’s their fault.”

Asthma is a chronic inflammatory disease that requires lifestyle changes to tamp down triggers and vigilance to ward off attacks. In a typical attack, airways become inflamed and swollen; muscles squeeze and tighten; and mucus build-up makes breathing difficult. But it’s the time after the attack that can make managing the disease a challenge.

“When you no longer have that asthma attack, there’s so many other pressing issues in your life, that the asthma takes the back seat until the next asthma attack,” ��Byck said. “We have to try to get them in again, when they are not wheezing, to discuss the importance of taking preventive medicine.”

Byck says managing asthma often means taking maintenance medication twice a day—every day.

“I think a lot of people are fine with that the first two weeks, three weeks, four weeks, but as time goes on and they see their child not really having these wheezing episodes, people in their mind think giving a medicine everyday might be harmful, so they stop it because the child is doing well,” Byck said.

Pediatrician Tyra Bryant-Stephens leads the asthma prevention program at the Children’s Hospital of Philadelphia. She says it never works to just send parents home with medicine. They need to understand the drug side effects, and why the medication is less harmful than not using it.

Bryant-Stephens says many parents struggle to accept that asthma is a chronic illness.

“Who wants to say my child is sick every day of his life?” she said.

On the policy side, Bryant-Stephens would like to see insurance companies pay for a bundle of care services including time with a health educator and help making the home asthma friendly.

The team approach can help all children with asthma, but Bryant-Stevens points out that the stakes are particularly high for black and Latino communities. A screening study at 16 Philadelphia schools found the highest asthma rates at schools with the most African-American students.

“Kids who are black, kids who are Latino, they have two to three times more hospitalizations and are five times more likely to die,” Bryant-Stephens said.

Genetics likely plays a role, but poverty and living in an urban environment also contribute to risk.

Truly treating asthma takes a team, so Children’s Hospital offers extra help to some of its community clinic patients.��Lay health educators visit patients at home and hold information sessions for kids and adults.

“The families that attend our classes were better able to manage their medications, less likely to go to the emergency room and hospital,” Bryant-Stephens said.

The program enrolls about 100 children each year, but Bryant-Stephens guesses that 3,200 patients could probably use the help.

Barbara Washington worked as an asthma educator for the Health Promotion Council before that program lost its funding two years ago. She says moving patients into regular treatment starts with asking lots of questions.

“When was the last time you saw your doctor? Do you have a regular doctor? Is the school aware your child has asthma?” Washington said.

She also understands how frightening it is when your child can’t breathe. Washington’s��daughter is an adult now, but developed asthma at age 6.

“Not knowing what to do, I would just wrap her up and we would rush off to the emergency room,” she said.

The experts say a few inexpensive at-home changes, and some new habits, can keep kids breathing easier.

Now that his asthma is controlled with medication, Cameron James says that when playing tag, his legs give out long before his breath does. (Photo by Taunya English/WHYY)

In Wilmington, mom LaSheena James vacuums a little more often and keeps her son’s daily inhaler medicine right beside his toothbrush.��Cameron is a first-grader.

“He did miss quite a few days. It would happen in the spring, he’d miss a few days, then he’d come back to school. The change of season is when it occurs more frequently,” James said.

Cameron carries an inhaler in his bookbag and has a backup stored in his classroom. The Jameses have no pets and smoking is strictly forbidden in their home.

“It’s very scary. I’m constantly watching the news for the pollen count. I’m kind of afraid to have him participate in outdoor activities,” James said.

Actually, Cameron says, recess is no problem these days.

“Tamir, Elan and Nazir and Jaden–we play catch and tag.��I’m faster than the little kids and the big kids, except for Tamir. He’s faster than all of us,” he said.

Cameron says his legs give out long before his breath does, and pediatricians say that’s one sign that a child’s asthma is under control.

Hal Byck is Cameron’s doctor and says that, working by himself, a doctor is not enough.

“Without getting into the community we are never going to make great strides in treating asthma,” Byck said.

“I do think it is reasonable to pay for community health workers, to have at least a couple of visits, [it] doesn’t cost that much to do that and one hospitalization you’re talking thousands of dollars,” said Children’s Hospital pediatrician Bryant-Stephens.

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