Cold weather poses increased risks for heart attacks and strokes

Centers for Disease Control illustration

By CHI Saint Joseph Health

As the temperatures drop and winter weather approaches, CHI Saint Joseph Health urges Kentuckians to be proactive in knowing the adverse effects winter weather can have on their heart health.

“Regardless of background, age or gender, it is important to be aware of the cold and how it could impact your heart health,” said Dr. Sharat Koul, an interventional cardiologist with CHI Saint Joseph Medical Group. “Cold temperatures put extra stress on your heart by pushing your blood pressure up, which can precipitate a range of cardiovascular events.”

When your body is experiencing extreme cold temperatures, it can add a burden to your cardiovascular system. The cold causes your heart to work overtime to keep you warm and constricts your arteries, limiting the blood flow to your heart. This heightened workload can elevate heart rate and blood pressure, potentially leading to a heart attack or stroke.

While maintaining regular physical activity is critical for heart health, exercise caution when engaging in outdoor activities during the winter. 

Whether you’re shoveling snow in the driveway or running through the neighborhood, be mindful that physical exertion in colder temperatures can cause additional strain on your heart. 

Particularly with activities like snow removal, it is important to steer clear of overexertion and refrain from pushing yourself beyond your limits. Snow removal is a very strenuous activity, and your heart is already working overtime to combat the cold.

People with heart conditions such as arrhythmia or high blood pressure, or those with risk factors such as being overweight, smoking or having diabetes, should be particularly vigilant during winter as they are at a greater risk of heart issues during colder temperatures.

To protect your heart during the winter months, CHI health-care providers advise dressing in layers when venturing outdoors, limiting exposure to the cold weather, staying informed of the extreme temperature forecasts, and remaining dry during freezing rain and snow. 

Additionally, keep up with your heart health year-round by staying hydrated, eating a balanced diet, getting plenty of sleep, and exercising at least 150 minutes weekly. These proactive measures can collectively help safeguard your heart during winter months.

Recognizing the warning signs of a heart attack is also crucial for timely intervention.

Symptoms include chest pain or discomfort; pain in the jaw, neck or back; shortness of breath; dizziness; and nausea or vomiting. Women may also experience upper abdomen pain, indigestion and faintness. 

If you suspect someone is having a heart attack, dial 911 immediately and, if able to, administer hands-only CPR. If you are not already CPR-certified, acquire the necessary skills at https://cpr.heart.org/en/.

Identifying a stroke is equally critical, and the acronym FAST helps:

• F: face drooping
• A: arm weakness
• S: speech difficulty
• T: time to call 911

Every minute counts when someone is experiencing a stroke, so it is paramount to act fast.

Op-ed looks at ways to address loneliness, which is linked to a number of health conditions; Ky. is above average for loneliness

Kentucky ranks in the top 20 states for loneliness, which can involve far more than feelings of sadness from being alone. Research shows it is linked to strokes, heart disease, dementia, inflammation and suicide.

"It breaks the heart literally as well as figuratively," opinion columnist Nicholas Kristof writes for the New York Times as part of a series titled "How America Heals," aimed at finding ways to fix this problem. 

The physical and societal harms that come from loneliness are so bad that America's top public-health official, Surgeon General Vivek H. Murthy, issued a rare advisory with a framework to rebuild social connection and community in the U.S. in May.

Graph from surgeon general's advisory,
"Our Epidemic of Loneliness and Isolation" 

Loneliness is as deadly as smoking 15 cigarettes a day and more lethal than consuming six alcoholic drinks a day, according to Murthy. It is also more dangerous than physical inactivity, obesity and air pollution, he says. 

Research also shows America has been growing lonelier. A majority of adults (58 %) report experiencing loneliness, according to a Morning Consult survey commissioned by The Cigna Group, a health-insurance company.

An Aging In Place study found that Kentucky tied with Arkansas for loneliness at 18th among states, with scores of 5.16 on a 10-point scale. Maine was first at 7.6, and Utah was best off, at 0.72. The study noted that more than half of Utahns identify as Mormons, which "may contribute to the low numbers of divorce and single-person households."

The study looked at a range of factors, including the percentage of single-person households, number of people widowed, number of people divorced, searches for dating apps per 10,000 people and searches for friendship apps per 10,000 people, to determine which states struggle the most with loneliness.

Kristof writes that there are ways to build connections that bind us together and writes about some of those approaches taken by the United Kingdom, which he says "is the pioneer of these efforts, having established the post of minister for loneliness in 2018. Britain oversees public-private partnerships that collectively knit millions of people together with programs like nature walks, songwriting workshops and community litter pickups." And, he adds, other countries have followed suit.  

"That’s because if the researchers are correct, social isolation probably kills far more people in the West each year than terrorists and murderers, and it costs the public enormous sums in unnecessary health costs," Kristof writes. "Countermeasures can make a huge difference: One review of 148 studies concluded that social connections increase the odds of an individual’s surviving over roughly the next seven years by about 50 percent." 

Kristof says he writes from troubles he's witnessed: "More than one-quarter of the children who rode the No. 6 school bus with me in Yamhill, Oregon, have died from drugs, alcohol, suicide and other so-called deaths of despair. These pathologies are linked to social isolation." 

However, he notes that despite the economic devastation of during the Great Depression, mortality then didn’t rise but actually fell." He attributes this to the "strength of community institutions -- like churches, men's and women's clubs and extended families -- that existed during that time." 

Ninety-odd years later, "Those community institutions have frayed," he writes. "Now we’re on our own, and perhaps that’s why so many are also dying alone." 

Kristof says he recognizes that it's not easy to rebuild such networks, but says we have to try, and offers some suggestions. 

"The steps to tackle loneliness aren’t grand, high-tech or expensive. In fact, one of the strategies is simply to get people back into old-fashioned patterns like eating meals together, holding parties and volunteering to help one another out," he writes.

He notes that the U.K. ministry has spent "some $100 million" to address loneliness since 2018, often to support local initiatives. One of those is a local, weekly family-style luncheon for women and children, many of them immigrants who struggle with English. 

He says decline of religious attendance has left a gap in community building, but "church buildings can still provide a physical architecture for connections, even if the faith architecture has eroded." 

He also points to several community-wide events to combat loneliness, including an event held for King Charles's coronation in May called “The Big Help-Out” to encourage people to come together and volunteer, and 6 million people, almost a tenth of the nation's population, did so. "The response was so impressive that this may become an annual event," he writes.

Why did loneliness increase? Kristof says the trends toward larger homes and longer working hours has left less time to share meals, and he notes studies that show social media has led to people being more lonely. Pets and talking robots have been suggested as solutions, he writes, but "It seems that there’s something to be said for friends who are living, breathing human beings." 

In his advisory, Surgeon General Murthy offered a strategy to address loneliness that begins with building up infrastructure that enables social connection: physical infrastructure such as parks and libraries, and social infrastructure to weave together volunteers or enthusiasts with similar interests.

Britain can serve as a model for this, Kristof writes. He points to a town that has has trained more than 1,100 volunteers to be “community connectors" who engage people and encourage them to join events or participate in programs. He also points to the idea of a "chatty bench" adopted in the U.K., Sweden and Australia, a bench with a sign encouraging strangers to talk to each other. 

"Solutions to loneliness are like that — little nudges to encourage us to mingle the way we evolved to," Kristof writes, suggesting that government do more: "President Biden, how about creating a senior government post analogous to a minister for loneliness? And mayors and governors, how about some chatty benches in American parks, along with volunteers deputized to bring us out for nature walks and sing-alongs?"

More than 1/3 of U.S. heart-attack and stroke survivors don't take aspirin to prevent a second one, 40 years after it was first advised

People who have experienced a heart attack or stroke have prevented another one from happening by taking a daily aspirin. But fewer than half of heart attack or stroke victims worldwide take the inexpensive medication, according to a study in the Journal of the American Medical Association.

“Survivors of heart attacks and stroke often face a high risk of having subsequent events,” said lead researcher Dr. Sang Gune Yoo,  a cardiovascular disease fellow at the Washington University School of Medicine in St. Louis. “In fact, many people die from having recurring attacks. Aspirin offers one effective and relatively low-cost option for reducing the likelihood of additional events in individuals with established cardiovascular disease, and yet most people who could benefit from a daily aspirin don’t take it.”

Graphic by Mike Worful, Washington University, adapted by Ky. Health News

For more than 40 years, research has established that aspirin can reduce the risk of a second heart attack or stroke, by about 25 percent. But more than a third of survivors in the United States and other high-income countries do not take it, according to the study, which looked at a wide range of countries. Generally, the lower a country's average per-capita income, the less likely survivors were to take aspirin; in low-income nations, only 17% do.

The study didn't explain those figures, but Yoo said likely reasons include varying access to health care, inconsistent messaging surrounding use of the drug, and the fact that aspirin is a prescription drug in some countries.

Aspirin is a blood thinner, preventing small blood cells called platelets from forming clots. These clots can block arteries and contribute to a reduction in the amount of oxygen-rich blood being delivered to vital organs. Such blockage also can cause other complications, including a heart attack or stroke.

The study notes that cardiovascular disease, including heart attack and stroke, is the world's leading cause of death. Contributing factors include smoking, diabetes, unhealthy diet, genetics, lack of exercise, obesity and air pollution. 

The researchers analyzed data from nationally representative health surveys in 51 countries. The surveys included questions about people’s medical history of cardiovascular disease and on aspirin use. The study included 125,505 people, with 10,590 self-reporting a history of cardiovascular disease.

Women, trust your gut if you suspect a stroke; here's how to judge

Stroke is the fourth-most common cause of death in women, and rural women are particularly in danger because stroke victims must get treatment quickly to improve their odds of a good outcome, and that can be harder to find in rural areas, Madelyn Ostendorf reports for Successful Farming. 

When women have a stroke, they're more likely than men to experience sudden confusion as an initial symptom. Here are some other common symptoms:

• sudden loss of limb control
• loss of vision
• difficulty speaking
• drooping of one side of the face

Less common but still important signs to watch for are:

• difficulty reading
• double vision
• trouble balancing
• tingling in the limbs

To assess whether someone, including oneself, is having a stroke, remember the acronym FAST:

• F: Face drooping. Does one side of the face droop, or is it numb? Ask the person to smile. Is the person's smile uneven?
• A: Arm weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S: Speech difficulty. Is speech slurred?
• T: Time to call 911.

As emergency rooms fill up across the country, two doctors give guidance on what to consider before going to an ER

Waiting in an emergency department (RogerStanmore.com)

Emergency rooms across the country are overrun, largely due to Covid-19 and other respiratory diseases, and people who go to ERs face long wait times. Two doctors at the University of Michigan, Marisa Louie and Brad Uren, offered tips for determining whether or not an ER trip is the best option.

The fundamental rule, Uren said, is this: "If you have a medical issue that you or a family member believes puts your life, limb or body function at risk, come to the emergency room." For example, chest pain, facial droop, weakness in the arms or legs, or altered consciousness can be signs of a heart attack or stroke.

"These conditions are time-sensitive, meaning the more time that passes, the more brain or heart tissue that may be permanently damaged," Uren said. "Don’t delay care if you believe you may be having a heart attack or a stroke. It is always safest to call 9-1-1 or your local emergency number rather than driving yourself in such cases."

How about children? "If they have difficulty breathing, that is a sign to come and get checked at the ER, whether you think it’s Covid-19 or another issue," Louie said in a news release. "Not drinking or urinating may be a sign of dehydration, another reason to get seen."

Despite concerns about coronavirus transmission in hospitals, Louie said that ERs are "definitely safe. . . . Even during heightened periods of Covid-19 before the vaccine, transmission of the coronavirus in healthcare settings was very low due to the health precautions taken by hospital staff. The emergency department is a safe place to be."

Common precautions such as wearing masks and social distancing are great for preventing virus transmission, but Louie and Uren said vaccination is the most effective way to prevent hospitalization. "The vast majority of our patients sick with Covid are not vaccinated," Uren said. That's also true in Kentucky.

UK and other Ky. partners get grant to expand and coordinate prevention of stroke, which kills over 2,000 in state each year

The University of Kentucky, the state Department for Public Health, the University of Louisville and other state partners have been awarded a prestigious grant to expand and coordinate prevention of stroke, which is a major health issue in Kentucky.

The $1.8 million grant, for an initial three-year period, is from the Paul Coverdell National Acute Stroke Program, named for a widely admired U.S. senator from Georgia who died of a cerebral hemorrhage in 2000.

A stroke is interruption of blood supply to the brain. More than 2,000 Kentuckians die each year from stroke or stroke-related complications each year, among the highest rates in the country, said Dr. Larry Goldstein, principal investigator for the grant. He is chairman of neurology at UK and co-director of UK HealthCare's Kentucky Neuroscience Institute.

Larry Goldstein, MD, FAAN, FANA, FAHA

Goldstein said Kentucky ranks high in rates of stroke-risk factors such as smoking, obesity, diabetes, high blood pressure, excessive alcohol use, and physical inactivity, "particularly portions of the Commonwealth under significant socioeconomic stress. The state’s Appalachian counties are disproportionately affected; stroke mortality in the region is 14% higher than the national average and 8% higher than the rest of the state."

He added, "Although there are several existing stroke prevention and care programs in Kentucky, the Coverdell award will allow us to coordinate and expand these efforts. The program establishes the Kentucky Stroke Improvement Cooperative, bringing together a variety of groups and programs to provide leadership for improving the quality of stroke care in the commonwealth. The Coverdell award will allow us to better bring information to the public and organize systems of care to better implement proven stroke prevention and treatment strategies."

Goldstein said people at risk for stroke have many ways of reducing their risk: "Have a balanced diet that is low in salt and high in grains and vegetables, such as a Mediterranean or a 'DASH' diet; have 30 minutes of at least moderate activity most days of the week; maintain a targeted body weight; do not smoke, and avoid environmental tobacco smoke; moderate alcohol consumption; check your pulse for skipped beats and check your blood pressure several times a year."

The symptoms of a stroke can be remembered by the acronym BE-FAST: abrupt loss of Balance or leg weakness, loss of Eyesight in one or portions of both eyes, drooping of one side of the Face, weakness of an Arm, or difficulty Speaking or understanding speech.

The acronym also describes how one should react to a stroke. "Time is of the essence," Goldstein advises. "Call 911 to be taken to the nearest, appropriate certified stroke center or hospital, if a certified stroke center is not available nearby."

Rural stroke survival rates worse, partly because rural hospitals don't quickly transfer patients to bigger hospitals

Rural stroke patients have less access to newer treatments and substantially higher mortality rates than their urban counterparts, according to a newly published study in the journal Stroke.

Researchers from the Washington University School of Medicine in St. Louis examined records for more than 790,000 patients who had strokes in 2012-17. The study is the first of nationwide rural-urban comparison after modern stroke treatments became available. Past studies have focused on single medical centers or individual states, or were conducted before modern care was available.

The researchers found that the more rural the hospital, the higher the mortality rate, with 27 percent of patients in the most rural areas dying. They also found that more rural patients were less likely to get either of two advanced stroke treatments.

It's unrealistic to expect small, rural hospitals to be able to perform advanced, specialized procedures, senior author Karen Joynt Maddox, an assistant professor of medicine, said in a press release. But such hospitals must recognize when patients need more advanced treatment and transfer them quickly, and health systems don't have consistent, widespread procedures in place to do so.

"Our data suggest rural patients are missing out on access to more advanced stroke therapies and that action is needed to address these disparities and ensure that people can get the care they need, no matter where they live," Joynt Maddox said. "In this day and age, it’s unacceptable that people don’t have access to advanced care. But since stroke therapy is complex, solutions are not going to be one-size-fits-all. We need to think fundamentally differently about how we deliver stroke care in rural areas to begin reducing these disparities."

Moderate drinking increases risk of stroke, study says

USA Today: No, moderate drinking can't protect against stroke. It actually increases risk, study says

Advocates for heart health urge raising cigarette tax by $1 to reduce smoking, a major cause of heart disease

Representatives and volunteers with the American Heart
Association and the state chapter of the American College
of Cardiology rallied in Frankfort on Valentine's Day to urge
lawmakers to raise the cigarette tax by $1 for heart health.

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- At a Feb. 14 rally in the state Capitol, advocates for heart health urged lawmakers to raise Kentucky's cigarette tax as a way to reduce smoking, a known cause of heart disease.

"We are here on Valentine's Day, the day which celebrates love, to ask our legislators and governor to do something that will have a profound and long lasting impact on the health of all of us Kentuckians," said Dr. Andy Henderson, president of the American Heart Association's Central Kentucky Board of Directors. "We are asking them to protect the hearts of all Kentuckians by raising the tax on cigarettes by at least $1 per pack."

Smoking kills about 9,000 Kentuckians every year, with about one-third of those deaths from heart disease caused by smoking or second-hand smoke, according to the AHA. It is also responsible for many other heart related diseases, including stroke and chronic obstructive pulmonary disease (COPD), of which Kentucky has the second highest rate in the nation.

Republican Sen. Ralph Alvarado, a Winchester physician, told the advocates that "the message is starting to soak in" with legislators, especially this budget year that is trying to address such a huge deficit. He noted that this tax, which would raise $266 million, could help to fill a half-billion-dollar gap.

Alvarado, who has sponsored several anti-tobacco bills, pointed out that support for raising the cigarette tax by $1 is backed by 70 percent of Kentuckians, the Kentucky Chamber of Commerce, medical groups and the education system.

"We've got to do something to help reduce our youth smoking [rates], which are the worse in the country, and adult smoking rates and this would help us get there," he said."Continue to be advocates, contact your legislators and let them know what your stance is, advise them on how they could use those funds to help us with the current budget crisis."

Henderson, who is also the CEO of Lexington Clinic, reminded the crowd that Kentucky has some of the highest smoking rates in the nation for both teens and adults. He said raising the cigarette tax by $1 a pack would not only keep teens from smoking, but would cause an estimated 2,900 smokers to quit, saving the state an estimated "millions and millions of dollars in health care costs year after year." The Campaign for Tobacco-Free Kids estimates that raising the tax by $1 would result in 23,200 fewer Kentucky teens smoking.

Henderson said that he primarily supported this measure for its many health benefits, but added that there was no denying it would bring new revenue to a state that sorely needs it.

Withrow wields cigarette (Melissa Patrick photos)

"I've heard our leaders say they don't want any new taxes. This is not a new tax and no-one is being forced to pay the tax. If you don't want to pay it, don't smoke. It's that simple," he said.

While holding a huge mock-up of a cigarette, Dr. Patrick Withrow of Paducah, the 2018 governor-elect of the Kentucky chapter of the American College of Cardiology, also called on the state's lawmakers to raise the tax, noting that at 60 cents a pack, Kentucky has one of the lowest cigarette taxes in the nation. The national average is $1.72 per pack.

"The cigarette smoking tax is a win-win-win," said Withrow, a long-time volunteer of the American Heart Association. "It will improve the health of Kentuckians. It will reduce tobacco use. It will lower health care cost and it will help businesses -- and it will improve the coffers."

The rally was the fourth in a series sponsored by the Coalition for a Smoke-Free Tomorrow, which comprises nearly 150 organizations that support efforts to decrease smoking in the state, including the tax hike. The other rallies have focused on smoking and pregnancy, teenagers and behavioral health. The next rally, set for 11 a.m. Feb. 21 in the Capitol rotunda, will focus on smoking and cancer.

10-year study: Having one or more diet sodas a day nearly triples the risk of having a stroke or Alzheimer's; overall risk is still low

A study suggests a connection between diet soda and both stroke and dementia, "with people drinking diet soda daily being almost three times as likely to develop stroke and dementia as those who consumed it weekly or less," Fred Barbash reports for The Washington Post.

The lead researcher, Matthew Pase of Boston University, said the findings “included a higher risk of ischemic stroke, where blood vessels in the brain become obstructed, and Alzheimer’s disease dementia, the most common form of dementia.”

Pase stressed that the study, published in the journal Stroke, showed only correlation, not causation, and a low overall risk of stroke and dementia, but said diet drinks “might not be a healthy alternative” to sugary ones. And he cautioned that diet-soda drinkers shouldn't go back to sugared drinks.

"They have been associated not only with obesity and its consequences, such as diabetes, but with poorer memory and smaller overall brain volumes," Barbash notes. "A parallel study of sugary drinks did not find an association with stroke or dementia."

The 10-year study looked at 2,888 people 45 and over for the development of a stroke, and 1,484 older than 59. It “found that those who reported consuming at least one artificially sweetened drink a day, compared to less than one a week, were 2.96 times as likely to have an ischemic stroke, caused by blood vessel blockage, and 2.89 times as likely to be diagnosed with dementia due to Alzheimer’s disease,” the American Heart Association said.

“So, the bottom line is, ‘Have more water and have less diet soda,” Christopher Gardner, director of Nutrition Studies at the Stanford Prevention Research Center, said in the AHA news release.

Barbash writes, "The artificial sweeteners consumed by those in the study included saccharin, acesulfame-K, and aspartame. Other sweeteners, including sucralose, neotame and stevia have been approved by the FDA since, the study said."

The American Beverage Association replied:  “Low-calorie sweeteners have been proven safe by worldwide government safety authorities as well as hundreds of scientific studies and there is nothing in this research that counters this well-established fact. . . . While we respect the mission of these organizations to help prevent conditions like stroke and dementia, the authors of this study acknowledge that their conclusions do not — and cannot — prove cause and effect.”

Americans eat way too much salt, mostly from 25 commonly consumed foods; cutting back reduces risk of high blood pressure

Americans eat too much salt, and a new study found that most of it comes from 25 commonly consumed foods. The top five culprits are bread, pizza, sandwiches, cold cuts and other cured meats, and soup. Salty snacks came in seventh, behind burritos and tacos, says the study.

Salt helps the body maintain its fluid balance, but too much of it increases the risk for high blood pressure, which then increases the risk for heart attack and stroke. Thirty-nine percent of Kentucky adults have high blood pressure and the state ranks 47th for heart disease, according to America's Health Rankings.

Hypertension in Kentucky adults, 2013-2015 (Map and chart from www.KentuckyHealthFacts.org)

The study found that in 2013-14, Americans ate about 3,400 mg of salt daily, far exceeding the Healthy People 2020 goal of 2.300 mg and the "ideal limit" of 1,500 mg recommended by the American Heart Association.

"If everyone reduced the amount of sodium in their diet by 1,200 mg per day, up to 99,000 heart attacks and 66,000 strokes could be prevented in the United States every year," according to the CDC.

Data for the Centers for Disease Control and Prevention study comes from the 2013-14 National Health and Nutrition Examination Survey. It only measured salt consumed in foods and did not take into account any salt added at the table. One teaspoon of table salt has 2,300 mg of sodium.

The study found that most dietary salt (61 percent) comes from packaged, processed and restaurant foods, the report said.

While most foods have a moderate amount of salt, the problem is that they are eaten all day long, Zerleen Quader, lead researcher, told Steven Reinberg of HealthDay.

"When cooking at home, use fresh herbs and other substitutes for salt. When eating out, you can ask for meals with lower salt," she said, adding that it's important to read food labels, and to choose the lowest salt option available. She also said the food industry needs to lower the amount of salt it adds to its products.

The study found that 44 percent of the salt people eat comes from just 10 foods and 70 percent of salt in the diet comes from 25 foods. Some other foods in the top 25 include bacon, casserole type dishes, salad dressing, French fries and cereal

Samantha Heller, a senior clinical nutritionist at New York University Medical Center in New York City, said that processed foods not only raise blood pressure, but may also increase the risk for cancer, noting that the World Health Organization classifies processed meats, like bologna, ham, bacon, sausages and hot dogs, as carcinogens.

"Parents need to understand that feeding hot dogs, fries, and ham and cheese sandwiches to their kids (and themselves) is significantly increasing their risk for certain cancers, hypertension and heart disease," Heller told Reinberg.

The CDC offers tips for reducing salt intake:

• Choose a heart-healthy diet like the "Dietary Approaches to Stop Hypertension," diet (DASH). Click here for more details.
• Buy fresh, frozen or no salt canned vegetables
• Use fresh meats, rather than canned or processed meats
• Read labels, choose product with lowest sodium content
• If you eat two servings, then account for two servings of salt
• Limit sauces, mixes and "instant" product"
• Choose spices and seasonings that do not list sodium on their label

When eating out:

• Choose restaurants that offer low-sodium options
• Ask server if sodium information is available
• Request that no salt be added to your food
• Ask for salad dressings and sauces on the side

Is sugar our nutritional enemy? New book claims it is

For about a decade as the century started, more and more Americans appeared to obey the U.S. Department of Agriculture's advice to eat less sugar.

But that trend of improvement has leveled off, according to statistics released Thursday by the federal Centers for Disease Control and Prevention. The data show that about half of American adults drink at least one sugar-sweetened beverage daily and the average adult consumes about 150 calories from sodas or other sugary drinks each day.

Gary Taubes
(Photo from Twitter)

That's a big problem, says Gary Taubes, author of The Case Against Sugar. The book points to sugar to explain why two-thirds of American adults are overweight or obese, one in seven is diabetic and about one in five will die from cancer, Jere Downs writes for The Courier-Journal.

The book makes sugar the villain in "metabolic syndrome," a term coined by medical researchers as early as 1987. Metabolic syndrome is the name for a group of risk factors that raises a person's risk for heart disease and other health problems, such as diabetes and stroke, according to the National Institutes of Health. Risk factors are traits, conditions, or habits that increase the likelihood of developing a disease.

Taubes's book points to sugar as the culprit
behind obesity, diabetes, and other lifestyle-
related diseases. (Photo via garytaubes.com)

"If you are overweight with a thickening middle and especially if you are approaching middle age or older, chances are good your body is wrestling with the effects of prolonged exposure to too much sugar," Downs notes.

The body manufactures insulin, a hormone that unlocks sugar's energy at the cellular level, in response to consuming sugar. Insulin can be elevated in the blood for years before the onset of Type 2 diabetes, as the pancreas produces more of the hormone to cope with the excess sugar. Even if the pancreas remains strong and diabetes does not develop, elevated insulin turns up blood pressure and levels of triglycerides, Downs writes. Such disturbances create and aggravate inflammation and hardening of the arteries.

Taubes's book, like others before it, attempts to dispel the myth that all calories are created equal, whether they come from candy bars or carrots. Straight sugar and highly refined carbohydrates, like white bread, trigger metabolic syndrome, which tells the body's cells to hoard fat, which in turn keeps a person overweight and sick, Downs notes.

"Remove the sugar and the insulin resistance improves, and weight is lost," Taubes told Downs.

However, there has been no definitive proof of sugar's role in metabolic syndrome, obesity, diabetes, and other illnesses and it is not likely to come soon. There are only a handful of small, limited clinical trials underway exploring sugar’s direct role in metabolic disease in the U.S., Taubes told Downs. Long-term lifestyle studies are expensive and face opposition from the sugar industry and other lobbies.

As far back as 1977, some Department of Agriculture researchers were so convinced of sugar's role in diabetes and heart disease that they called for Americans to reduce consumption by 60 percent, Downs writes. The average American today consumes 100 to 130 pounds of sugar a year; the estimates vary with the source of information.

In an effort to help combat the problem, new food labels emphasizing "added sugar" in packaged products are supposed to become mandatory on July 26. Whether the Food and Drug Administration will continue the Obama-era mandate under the new Trump administration is unclear.

Percentage of adults 20 and older who consumed sugary beverages on a given day, 2011-14 (Source: CDC)

Be careful in cold weather, which makes heart attacks, strokes and blood clots more likely; also, watch out for holiday stress

Heart attacks are 30 percent more likely during winter because of the weather, but there are precautions you can take to reduce your risk.

“The winter months can put even a healthy person at risk for a heart attack or other heart health problems,” said Dr. Suresh Sharma of KentuckyOne Health Cardiology Associates in Lexington. “To help protect yourself and those around you, be aware of the warning signs of heart attack, which include pressure, tightness or pain in the chest or arms, nausea, shortness of breath, cold sweat, lightheadedness and fatigue.”

Very cold weather can increase heart rate and blood pressure, and cause blood vessels to narrow, requiring more pressure to force blood through narrowed veins and arteries, increasing your risk of having a heart attack or stroke.

Shoveling snow can be risky.

Shoveling snow or exercising in the cold can also cause blood vessels to narrow and raise blood pressure. "Your heart also has to work much harder to keep your body warm in the cold," a KentuckyOne news release says. "With heart rate and blood pressure already elevated due to the low temperatures, this can cause blood clots to form and provoke coronary artery spasms. . . . When shoveling snow or exercising outdoors, remember to dress warmly to keep your blood flowing, and warm up your muscles prior to doing physical activity. Do not drink alcohol before or immediately after shoveling snow, as this can increase your risk for heart attack."

Stress related to the holidays "can also lead to heart problems," the release says. "People who display symptoms of heart-related illnesses might delay getting treatment because they don’t want to disrupt holiday festivities. Or, holiday travelers might take longer to find medical care away from home, which heightens the risk.

"Overindulgence during the holidays can also put your heart in danger. At family gatherings and holiday parties, people tend to consume alcohol and eat more than usual, including unhealthy foods that are high in sodium. Busy schedules due to holiday engagements cause people to neglect their exercise routines, which can put even more strain on the heart."

Sharma says, “Many people let their health take a backseat during the winter, but it’s actually even more important to ensure your heart is healthy during the colder months. Try to maintain a healthy lifestyle throughout the holiday season, and talk to your primary care provider about ways to protect your heart during the colder months.”

The release says, "If you or someone near you is presenting symptoms of a heart attack, call 911 immediately. Then, if you are able, perform hands-only CPR by placing your hands on the victim’s chest and administering compressions hard and fast, 100 times per minute, in the center of the chest. Don’t stop until help arrives." For more about heart-disease risk factors, or to take a heart-health risk assessment, visit www.kentuckyonehealth.org/heart-disease-risk-factors.

Studies: Hour of daily activity counters deathly effects of sitting, but 'inactive lifestyles are just accepted,' even by teenagers

image: medicaldaily.com

By Melissa Patrick
Kentucky Health News

Most of us spend too many hours sitting, and research says it's slowly killing us, but a new study says that just one hour of physical activity a day could eliminate the risk of early death that comes from sitting eight hours a day -- a level of activity 29 percent of Kentucky adults fail to achieve.

"There has been a lot of concern about the health risks associated with today's more sedentary lifestyles," lead researcher Ulf Ekelund told Medical News Today. "For many people who commute to work and have office-based jobs, there is no way to escape sitting for prolonged periods of time. For these people in particular, we cannot stress enough the importance of getting exercise, whether it's getting out for a walk at lunchtime, going for a run in the morning or cycling to work. An hour of physical activity per day is the ideal, but if this is unmanageable, then at least doing some exercise each day can help reduce the risk."

The study found that only one in four participants in the study exercised an hour or more a day, which reflects the national average. The rate is a bit higher in Kentucky, where 29 percent of adults are physically inactive and 40 percent of those aged 65 and older are, according to the 2013 Behavioral Risk Factor Surveillance System, a continuing national poll by the federal Centers for Disease Control and Prevention.

In addition, Kentucky's youth could be setting themselves up for early deaths by not being physically active. Almost 17 percent of the state's high school students reported that they had not been physically active for at least 60 minutes in the previous seven days, and 63 percent said they had not been physically active at least 60 minutes per day on five or more days in the same time frame, according to the 2015 Youth Risk Behavior Surveillance System.

The CDC recommends 2 hours and 30 minutes of weekly, moderate-intensity, aerobic activity such as brisk walking. That amounts to 30 minutes a day, at least five days a week. It also recommends muscle-strengthening activities that work all muscle groups at least two days a week. For information on how individuals and organizations can promote physical activity, from the "Step it Up, Kentucky" campaign, see http://www.fitky.org/2016/06/15/are-you-ready-to-step-it-up-kentucky/.

The research, which analyzed 16 studies that included data from over a million people, also found that watching television for three hours or more a day was linked with an increased risk of early death, regardless of physical activity, except among those who were the most physically active. Death was significantly increased in those who watched television for five hours or more a day, says the report. It was published July 27 in The Lancet, the leading British medical journal.

Many of Kentucky's high-school students fall into this risk for early death, with 40 percent saying that on an average school day, they played videos or computer games or used a computer three or more hours a day on something that was not school related. One-fourth said they watch three or more hours of TV per day on an average school day.

The World Health Organization says physical inactivity, which is linked to heart disease, stroke, diabetes, some cancers, depression and an increased risk of falls, has been identified as the fourth-leading risk factor for death for people all around the world.

A separate article published in the same issue of The Lancet found that the total worldwide cost of physical inactivity is at least $67.5 billion, and is expected to rise if not addressed. The estimated costs to the the United States, in 2013 dollars, is about $28 billion annually, Health Day reports.

"The current economic cost of physical inactivity is borne mainly by high-income countries. However, as low- and middle-income countries develop, and if the current trajectory of inactivity continues, so too will the economic burden in low- and middle-income countries who are currently poorly equipped to deal with chronic diseases linked to physical inactivity," researcher Dr. Melody Ding, of the University of Sydney in Australia, said in a statement.

Another article in the same journal issue found that there hasn't been much change in physical inactivity since the original research in this series of articles was published in 2012, which reported physical inactivity was a global pandemic that required urgent action.

"Physical inactivity contributes to an estimated 5.3 million deaths each year, similar to the number of deaths attributed to tobacco use and obesity," lead author James F. Sallis said in a University of California San Diego news release.

“Because activity has not changed, how many lives have been lost?” he asked. “We’ve wasted four years. There is great evidence that this is one of the big challenges in public health, but the actionable response has not been impressive or systematic. Inactive lifestyles are just accepted.”

Eastern Kentucky stroke survivors in community support program get the support they need to keep from returning to the hospital

Early results of a new program show that stroke patients who get support with education, resources and care coordination after they leave the hospital are less likely to be readmitted, according to the University of Kentucky.

Community Transition Program Stroke Support Group (UKNow image)

The Community Transition Program, which serves Perry and surrounding counties in Eastern Kentucky, has provided this type of support to 23 stroke survivors since July 2015 by connecting a "patient navigator" with stroke survivors before they leave the hospital. The navigator communicates with the survivor during the next year or longer, helping them to better understand their health-care and insurance needs, and connecting them with community resources, including a support group.

“A lot of people who have had a stroke get home and they feel like they’re lost. They don’t know what to do, they don’t know who to contact for questions, they don’t get all the education they need about stroke and co-morbidities,” Keisha Hudson, the patient navigator for the program, said in a UK news release. “They get lost in the system, and therefore some of them end up back in the hospital. Our goal is to keep them out.”

And while the most recent data are still being finalized, Patrick Kitzman, director of the program, said its readmission rates are well below comparison groups. As of late January, none of the stroke survivors who participated in the program have been readmitted for stroke-related issues.

“It’s showing that our population is very involved and requires a lot of help,” Kitzman said. “Standard of care is that you send them home and one week later you check on them, and then that’s it. But we’re showing that you need to be much more hands on. A lot of data now show that these folks require support for an extended period of time, and our data is bearing that out at as well.”

After a pilot period, the program has been funded since July 2015 by Appalachian Regional Healthcare and the UK Center for Excellence in Rural Health.

Lloyd Cornett, a stroke survivor from Slemp, said he "couldn't have survived" without the program as he had gotten so "downhearted" because people were telling him he would have another stroke within a year, and it would be worse than the first one. He said Hudson and the physicians helped him understand that that wasn't true.

"They sit you down and they’ll talk to you, tell you every little thing to look for, what to do, and how to do it. I’m a diabetic, and they have people come to the stroke meetings to talk about that, or blood pressure or health things we need to know. I just can’t say enough about how good they are," said Cornett, whose stroke made him unable to speak and numb on his right side.

The program has led to some life-saving interventions, including: discovering one patient in a diabetic coma, finding an infected surgical site, and directing medical care for a patient who was breathing heavily during a telephone call and was hospitalized with dangerous levels of fluid on her lungs.

Kitzman said such close-call stories show the need for coordinated care, especially in Kentucky, which ranks 47th for incidence of stroke. He noted that stroke rates are higher in Appalachian Kentucky.

In the region, Kitzman said, many stroke survivors have some of the greatest needs for care and some of the heaviest financial burden, and need dedicated support to navigate the health-care system.

Kitzman said there is a need to have programs like this for other conditions and in other geographic areas.

“The more that we do this program, the more I’m so absolutely convinced that the only way we can have proper support for people whose conditions are so complex is to have programs like this,” Kitzman said. “They have the fewest resources available to them, and they’re the furthest away from specialized care and from what they need. Many of them don’t know what resources exist. They need someone to walk them through this change in their life. And you absolutely need someone from their community who knows where all the little pockets of support exist.”

A looming danger: About 1 in 3 U.S. adults are pre-diabetic, but only about 11% say they have received such a diagnosis

Before Type 2 diabetes develops, most people experience what is called prediabetes, where the blood sugar levels are above normal, but below diabetic, Dr. Philip A. Kern, University of Kentucky professor and director of the Center for Clinical and Translational Science, writes in a UK news release.

In America, approximately one in three adults are pre-diabetic, but only around 11 percent are aware of that condition, according to the federal Centers for Disease Control and Prevention. In Kentucky, 289,000 adults, or almost 9 percent, reported that they had been diagnosed as pre-diabetic, according to the 2015 Kentucky Diabetes Report.

"Without intervention, there is a high likelihood that prediabetes will progress to diabetes within three to 10 years," Kern writes. "People with prediabetes are also at 50 percent higher risk for heart disease and stroke."

When a person is prediabetic, many of the diabetic disease processes, like nerve damage, eye problems and heart disease, begin in the body even though the person doesn't have diabetes.

And because prediabetes often has no symptoms and can affect people of all ages, Kern writes, it is important to know your blood sugar levels, especially if you have one of the following risk factors: overweight or obese, fat distributed around the abdomen, history of gestational diabetes, family history of diabetes, symptoms of diabetes (increased thirst, frequent urination, fatigue, and blurred vision), or history of elevated blood sugar levels.

Kern suggests the following lifestyle changes to help prevent the progression of prediabetes to diabetes; he notes that these changes will also help reduce your risk of heart disease, stroke, high cholesterol and high blood pressure:

• Weight loss: Losing just 10 to 20 pounds can reduce the liklihood of prediabetes progressing to diabetes.
• Healthy diet: Choose low fat, low calorie and high fiber foods, like fruits, vegetables and whole grains.
• Exercise: Incorporate 30 to 60 minutes of moderate physical activity most days of the week.
• Sleep: Research has found that getting at least six hours of sleep each night can help reduce insulin resistance. He also notes that sleep apnea can worsen prediabetes.
• Medications: Some diabetes medications are prescribed to prediabetics to prevent the condition from progressing.

If you're interested in learning about opportunities to participate in research about prediabetes at UK, visit ukclinicalresearch.com or call (859) 323-2737.

Most women are unaware of female-specific stroke symptoms and risks, according to a national survey by Ohio State

Most women are unaware of the symptoms and risks of stroke for females, according to a national survey by the Ohio State University's Wexner Medical Center. The survey found that just 11 percent of the 1,000 respondents knew that pregnancy, lupus, migraine headaches and oral contraception or hormone replacement therapy are female-specific stroke risks.

Also, only 10 percent of those surveyed knew that hiccups and atypical chest pain with or followed by typical stroke symptoms are early warning signs. According to the National Stroke Association, stroke is the third leading cause of death for women, and Diana Greene-Chandos, a neurologist and director of the neuroscience critical care at Ohio State's Wexner Medical Center, said, "We have a ways to go when it comes to educating women about stroke and their unique risk factors."

Other symptoms unique to women include dizziness that is not class vertigo, headaches, atypical chest pain and/or numbness of the body, especially if one side is more numb than the other. Early recognition and treatment are key for strokes.

"Women do not think they are going to have a stroke," said Greene-Chandos. "They think of it as a man's disease." The reality is that 60 percent of stroke deaths occur in females and 40 percent for males. Every year, 137,000 Americans die from a stroke. Smoking, failing to exercise and having high blood pressure are risk factors for both men and women. To take an assessment created by Ohio State's stroke experts to determine risk of stroke, click here.

Study shows that removing a clot that causes a stroke leaves victims with higher functional independence

In Kentucky, strokes cause about 5 percent of deaths, and the state had the 11th highest stroke mortality rate in 2009, according to data from the Kentucky Cabinet for Health and Family Services. Fewer than 40 percent of severe stroke victims regain functional independence if they get only the standard drug intervention, but a study has found that also removing the clot both helps restore blood flow to the brain and can lead to more favorable long term outcomes.

"The outcomes are the difference between patients being able to care for themselves after stroke and being dependent," said Demetrius Lopes, surgical director of the comprehensive stroke center at Rush University Medical Center.

The traditional treatment for ischemic stroke—a stroke that involves clots in vessels bringing blood to the brain—is intravenous tissue plasminogen activator (tPA), a medication to dissolve the clot. However, doctors can also perform thrombectomy, a minimally invasive procedure to remove the clot that is allowed only in clinical trials.

In the study, patients with severe ischemic strokes were split into two groups. One group received only tPA, while the other group received tPA as well as thrombectomy. After 90 days, those who received both treatments had less disability and had a functional independence rate of 60 percent, compared to 35.5 percent of those who received only tPA. Also, patients who received thrombectomy had better blood flow rates in the brain.

"Ethically, we can't deny patients a treatment when we have such strong evidence it's better for them," Lopes said. Now thrombectomy is a standard treatment for severe strokes at Rush and some other locations. The study is published in the online edition of the New England Journal of Medicine.

New health-related laws deal with heroin, dating violence, end-of-life care, prescriptions, colon-cancer and newborn screening

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The Kentucky General Assembly passed several health-related bills this session, including high-profile measures on heroin and dating violence. It did not pass many others, including one that would have a great influence on the state's health: a statewide smoking ban, which passed the House for the first time ever, but never got out of an unfavorable committee in the Senate. Here's a roundup:

Heroin: Kentucky's heroin-overdose epidemic was caused partly by a 2012 legislative crackdown on prescription painkillers, which steered users to the illegal drug. Last year's bill died because of deadlock over sentences for traffickers and needle-exchange programs for addicts, and Gov. Steve Beshear and legislators gave this year's bill top priority. It was not finally negotiated until a few hours before passage, but Beshear signed Senate Bill 192 into law less than 12 hours after it passed so that its emergency clause could put it into effect immediately.

SB 192 includes both a needle-exchange program and harsher penalties against traffickers, the main points of contention between the House and Senate, but requires local governments to approve needle exchanges and allows judges to be lenient in sentencing addicts, to help them get treatment. It allocates money for drug-treatment programs, allows increased access to Naloxone, a drug that reverses the effects of an overdose, and allows jailers to provide medically assisted treatment for inmates with opiate addiction.

Dating violence: After 10 years of lobbying and debate, the dating violence bill will allow dating partners to get interpersonal protective orders from a judge if they have been the victim of dating violence, sexual abuse or stalking. This year's bill largely dissolved social conservatives' opposition by creating a new chapter in the law for dating violence, with the same protections as the domestic-violence law. Kentucky is the last state to offer protection to dating-violence victims. House Bill 8 was sponsored by Rep. John Tilley, D-Hopkinsville, who also sponsored the House heroin bill.

Beshear has signed these bills into law:

Prescription synchronization: SB 44, sponsored by Sen. Julie Raque Adams,R -Louisville, will allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

Medical order scope of treatment: SB 77, sponsored by Sen. Tom Buford, R-Nicholasville. will create a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care.

Colorectal cancer screening: SB 61, sponsored by Sen. Ralph Alvarado, R-Winchester, will require that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The governor also signed a similar measure, HB 69, sponsored by Rep. Tom Burch, D-Louisville, which contains an amendment by Sen. Julian Carroll, D-Frankfort, for a Medicaid savings study.

Newborn screenings for fatal disease: SB 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, will require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur.

Spina bifida: SB 159, sponsored by Adams, will require medical providers to supply written, up-to-date, accurate information to parents when their unborn child is diagnosed with spina bifida so they can make informed decisions on treatment.

Emergency care for strokes: SB 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, requires that local emergency services have access to a list of stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky. Emergency medical providers will set their own protocols for assessment, treatment and transport of stroke patients.

Alcohol and drug counselors: HB 92, sponsored by Rep. Leslie Combs, D-Pikeville, creates an enhanced licensing program to recognize three levels of certified alcohol and drug counselors, with different levels of education. The goal is to increase the number of counselors in the state.

UK cancer research center: HB 298, sponsored by Rep. Rick Rand, D-Bedford, revises the state budget to authorize $132.5 million, half of the cost, for a new medical research center at the University of Kentucky. The university says it will raise money to cover the other half.

These health bills awaited the governor's signature Monday morning:

Physician assistants: HB 258, sponsored by Rep. Denver Butler, D-Louisville, to allow physicians to supervise up to four physicians at the same time, rather than two.

In-home care: HB 144, sponsored by Burch, to establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services.

Pharmacist-practitioner collaboration: HB 377, sponsored by Rep. Dean Schamore, D-Hardinsburg, to allow collaboration between pharmacist and practitioners to manage patients' drug-related health needs.

Tax refund donations: SB 82, sponsored by Sen. Max Wise, R-Campbellsville, to put an income tax check-off box on tax forms to allow people the option of donating a portion of their tax refund to support pediatric cancer research, rape crisis centers or the Special Olympics.

Health related bills that were left hanging:

The smoking ban, HB 145, sponsored by Rep. Susan Westrom, D-Lexington, never got a hearing in the Senate Veterans, Military Affairs and Public Protection Committee, and neither did the Senate companion bill, SB 189, sponsored by Adams.

Three bills challenged Medicaid managed-care companies. SB 120, sponsored by Alvarado, would have created a process for health-care providers to appeal the companies' decisions to the state passed the Senate, but not the House.  And the following two bills that never got out of the Senate: SB 88, also sponsored by Alvarado, which challenged the $50 "triage fees" MCOs pay for emergency-room visits that they conclude were not emergencies, and would have required them to pay contracted fees instead and SB 31, sponsored by Buford, which would limited the amount of co-payments. Also not getting House action was Alvarado's SB 6 would have created review panels for lawsuits seeking damages from health-care providers.

As session nears end, bills on heroin, dating-violence orders, managed-care appeals and lawsuit review panels are hanging fire

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The General Assembly has sent Gov. Steve Beshear four health-related bills, and several more could reach his desk in the legislative session that ends Wednesday. Legislators will return briefly after 10 days to reconsider any bills Beshear vetoes; they could also pass more bills, but would not be able to override any vetoes.

Here are some of the health-related bills that were pending on Monday; bills with two readings are ready for floor action.

Heroin: tougher penalties and needle exchanges?

Both the Senate and the House have heroin bills and both remain in committee in the other chamber, but hope remains high in both chambers that a compromise can be reached so that a heroin bill will pass this session. Senate Bill 5 is sponsored by Sen. Christian McDaniel, R-Latonia; House Bill 213 is sponsored by Rep. John Tilley. The main differences are how traffickers would be punished and whether to start needle-exchange programs for addicts. The Senate's penalties are tougher and it has opposed needle exchanges, which advocates say prevent disease and death from dirty needles and can lead addicts to treatment.

Now the Senate is moving toward accepting needle exchanges, James Pilcher reports for The Cincinnati Enquirer. Rep. Dennis Keene, D-Wilder, and Sen. Wil Schroder, R-Wilder, said exchanges "are much more likely to be included than when the session started," Pilcher writes. Schroeder told him, "I think there is a real possibility that we could include needle exchanges and then get our tougher penalties." Pilcher reports, "The possible legislative position shift comes as health officials throughout the Tristate have expressed deep concerns about the spread of diseases that can be contracted using dirty needles."

Protective orders for dating violence

House Bill 8, sponsored by Rep. John Tilley, D-Hopkinsville, has received its second reading and is awaiting passage in the Senate. This bill would allow dating partners to petition for interpersonal protective orders if they have been the victim of domestic violence, sexual abuse or stalking. Such orders are now available only to those who are married, live together or have lived together, or an unmarried couple with a child in common.

Kentucky is the only state that offers no protection for such victims. Legislation to do that has stalled in the Senate in earlier sessions, but a Senate committee substitute addresses a key objection, by creating a new chapter in the statutes for the bill, separate from the existing domestic-violence chapter.

Advocates say domestic violence is a health issue not just because of the physical injuries it causes. They say victims are more likely to be depressed, have unplanned and premature pregnancies, go to fewer prenatal visits, and to miss more well-child visits with their children.

Prescription synchronization, managed-care appeals

Senate Bill 44, sponsored by Sen. Julie Raque Adams, R-Louisville, has had its second reading in the House. This bill would allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

House Majority Caucus Chair Johnny Bell, D-Glasgow, has filed a floor amendment on an unrelated issue, to create a state appeals process for health-care providers to appeal decisions of Medicaid managed-care companies. It is the same as or similar to Senate Bill 120, sponsored by Sen. Ralph Alvarado, which has given it a first reading without assigning it to a committee. The Cabinet for Health and Family Services opposes a state appeals process, saying it would have a conflict of interest (successful appeals would cost the state money) and providers have the courts available to them to resolve contractual issues. UPDATE: Bell withdrew his floor amendment to Senate Bill 44 March 9. 

Review panels for suits against health-care providers: Senate Bill 6, filed by Alvarado, remains in the House Judiciary Committee, but a discharge petition was filed March 4 to bring it to the floor, bypassing leaders of the House's Democratic majority. This bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court, but not legally binding. Opponents say that Kentucky already has laws to punish attorneys for filing frivolous cases and that this just adds another barrier for patients seeking justice.

Newborn screenings for fatal disease: Senate Bill 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, has had two readings. It would require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur. Treatment with stem cells from an umbilical cord blood transplant is sometimes successful it the infant is treated early enough. The cabinet opposes the bill, saying the screening will cost half a million dollars a year at a time when local health departments are suffering budget cuts.

Spina bifida: Senate Bill 159, sponsored by Sen. Julie Raque Adams, R-Louisville, is in the House and the three-day posting rule has been waived. This bill would require medical providers to supply written, up to date, accurate information to parents when their unborn child is diagnosed with spina bifida so parents can make informed decisions on treatment

Physician assistants: House Bill 258, sponsored by Rep. Denver Butler, D-Louisville, is awaiting Senate passage. This bill allows a physician to supervise up to four physician assistants at the same time, rather than two.

In-home care: House Bill 144, sponsored by Rep. Tom Burch, D-Louisville, is awaiting Senate passage. It would establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services. The daily cost would have to be less than the average daily nursing home payment allowed by Medicaid. The bill would also provide non-medical support services to the applicant as needed.

BILLS SENT TO THE GOVERNOR

Colorectal cancer screening: Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, received final passage in the House March 4. This bill requires that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The bill would apply to health plans issued or renewed on or after Jan. 1, 2016, if it becomes law. A similar measure, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, is awaiting passage in the Senate with a committee substitute by Sen. Julian Carroll, D-Frankfort, calling for a Medicaid savings study.

Medical order scope of  treatment (MOST) form: Senate Bill 77, sponsored by Sen. Tom Buford, R-Nicholasville, received final passage in the House March 3. This bill creates a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care. It is considered a physician's order, travels with the patient between health care facilities, and must be reviewed annually. The bill clearly defines the order of controlling documents for end-of-life care: the living will first, the MOST form second and the health-care surrogate, which is chosen by the patient and listed on the form, third. The MOST form is already used in 32 states.

Emergency care for strokes: Senate Bill 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, received final passage in the House March 4. The bill requires that a list of all acute stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky be posted to the cabinet's website and be made available to all emergency medical services providers, who are required to set their own internal protocols toward assessment, treatment and transport of stroke patients.

Funding for UK cancer research center: House Bill 298, sponsored by Rep. Rick Rand, D-Bedford, received final passage in the Senate March 4. This bill authorizes the state to appropriate $132.5 million, half of the cost, for construction of a new medical research center at the University of Kentucky. The university will raise money to cover the other half. The facility will target prevalent diseases in Kentucky, including cancer, diabetes and cardiovascular disease. The bill required a 60 percent vote in each chamber because it affects the state budget and the legislature is in a non-budget session; it passed the House 83-9 and the Senate 36-1 (Sen. John Schickel, R-Union).