Thursday, November 22, 2012

Treatment of feline colonic adenocarcinoma

Arteaga TA, McKnight J and Bergman PJ. A review of 18 cases of feline colonic adenocarcinoma treated with subtotal colectomies and adjuvant carboplatin. J Am Anim Hosp Assoc. 2012; 48: 399-404.

Adenocarcinoma is the second most common gastrointestinal tumor in cats and the most common tumor found in the colon. Colonic adenocarcinoma is both locally invasive and frequently has advanced metastasis at the time of presentation. Aggressive local surgery (subtotal colectomy) improves survival time in cats, but patients eventually succumb to metastasis, warranting adjuvant treatment with chemotherapy. Carboplatin is an alkylating platinum-based chemotherapeutic agent and has been shown to have efficacy in humans and dogs with carcinomas. Limited previous studies have shown mild to moderate efficacy and safety of carboplatin in cats with carcinomas, meriting its investigation as an adjuvant therapy for colonic adenocarcinomas.

This retrospective study evaluated signalment, diagnostic findings, disease-free interval, survival time, chemotherapeutic toxicoses, and prognostic factors for 18 cats with colonic adenocarcinoma treated with subtotal colectomy and monthly carboplatin. Interestingly, cats initially presenting with weight loss had a longer median disease-free interval (290 days versus 75 days), suggesting that a more chronic disease course occurs when weight loss is present. Four cats without weight loss had distant metastasis and a more acute presentation. Median survival time for all cats was 269 days, with cats without distant metastasis surviving 340 days and cats with distant metastasis surviving 200 days. For comparison, in a previous study, cats treated with subtotal colectomy alone lived only 56 days. Carboplatin toxicities reported included low-grade neutropenia, thrombocytopenia, and gastrointestinal toxicity, none of which required reduction or delay in treatment. One cat developed azotemia and carboplatin treatment was stopped after the fifth monthly dose. In conclusion, cats with colonic adenocarcinoma commonly present with colonic obstruction and usually remain patent after subtotal colectomy, but in the end, they are often euthanized due to metastasis, warranting early adjuvant chemotherapy. In this study, carboplatin was shown to have minimal toxicity and to be a viable adjunct for treating this disease. [GO]

See also: Green ML, Smith JD and Kass PH. Surgical versus non-surgical treatment of feline small intestinal adenocarcinoma and the influence of metastasis on long-term survival in 18 cats (2000-2007). Can Vet J. 2011; 52: 1101-5. [Free, full text article]

Related blog articles:
Feline intestinal cancer (March 2011)

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Winn Feline Foundation Library
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Judge rules University of Louisville's hospital is public and subject to Open Records Act; it may appeal

The University of Louisville's hospital is a public entity, a Jefferson Circuit Court judge has ruled in a lawsuit filed to get access to the university's deals with other health providers.

Judge Martin McDonald ruled yesterday in favor of The Courier-Journal, WHAS-TV and the American Civil Liberties Union, noting that the university makes or approves all appointments to University Hospital's board of directors. The university had argued that the board, and thus the hospital, was not a public agency under the state Open Records Act.

The hospital said it might appeal the ruling. McDonald gave it 30 days to give him the records being sought, along with arguments about why they should be exempt" under exceptions to the law, reports The C-J's Andrew Wolfson. "He gave the news organizations at the ACLU 20 days to respond to any claimed exemptions." The hospital has said revealing contracts would put it at a competitive disadvantage.

The suit began after the university refused to let the plaintiffs see records related to its proposed merger with Jewish Hospital & St. Mary's HealthCare and Lexington-based St. Joseph Health Care System. Gov. Steve Beshear vetoed the merger on grounds that a public hospital should not be bound by a religious organization's health-care policies. This month the hospital announced a new deal with KentuckyOne Health, which includes the faith-based entities, but said reproductive services would not be affected despite a policy of "respect" for Catholic health directives. (Read more)

Christian Co. Health Dept. to stop providing cancer screens, contraceptives to residents of other counties

As of Jan. 1, the Christian County Health Department will not provide contraceptives or cancer screening to indigent patients if they do not reside in the county. Nick Tabor of the Kentucky New Era reports the department will provide those services to other counties' residents if the county in which they reside has signed a contract with Christian County before the Jan. 1 deadline agreeing to repay Christian County for those services. Tabor writes that the policy is not applicable to those services that are covered by state or federal government reimbursements.

The health department's move was prompted by a budget deficit that is close to $200,000, some of it traceable to a lack of reimbursement for contraceptive care. Mark Pyle, director of the department, told Tabor that residents of both Todd and Trigg counties often seek services in Christian County and Christian county taxpayers foot that bill. Pyle explained that there’s nothing in state law saying the health departments have to serve anyone who comes in, regardless of residence.

The New Era is behind a paywall. To obtain a subscription, go here.

The death rate from heart disease is nearly twice as high in Perry County (Wikipedia map) as in Kentucky as a whole, so there's no better time than now to announce that the University of Kentucky Medical Center is close to finalizing a three-year agreement with Hazard Appalachian Regional Healthcare Medical Center to provide continuing care, outreach and education to local physicians and county residents, including more and better information about heart-healthy food choices. Bailey Richards of the Hazard Herald reports that this last task is daunting, particularly since availability of good food is an issue in remote parts of the county.

Richards writes that a 2011 study of the heart-healthy food options in Perry County "showed that the area severely lacks low-fat and low-sodium options." Kevin Luley, a registered nurse at the UK Medical Center and winner of the "Heart Health in Rural Kentucky" grant, surveyed all of the restaurants and grocery stores in Perry County and found that most do not have many off-the-shelf options for a healthy diet. Of all of the items available at the restaurants in Perry County, fewer than 6 percent were considered healthy. (Residents can consult their own smartphones for that information. It should also be posted or available upon request.) Of a standard list of produce items, on average only 60 percent were found at the local grocery stores, Luley found. (Read more)

UK music therapy helps manage surgical anxiety, pain, recovery

A University of Kentucky study has found that music therapy can reduce pain before, during and after a surgical procedure, and shorten recovery time. The study report, published in the Southern Medical Journal, showed music was also useful in managing surgical anxiety. According to Lori Gooding, UK director of music therapy and lead author of the report, the music should be selected by trained personnel with a mind toward specific guidelines for music selection in order to maximize its positive effect on patients, though the patient's musical tastes should still be considered. Gooding suggests patients be offered several playlists from which to choose so they can have something to suit their tastes as well as the medical protocol. (UK video)

Gooding writes that the tempo, rhythm and volume of the music should be carefully controlled to maximize its effect. Calm, slow, gentle music was shown to produce the most positive results and facilitate relaxation and pain reduction in patients. UK began providing music therapy for patients in Kentucky Children’s Hospital, UK Chandler Hospital and UK Good Samaritan Behavioral Health in October 2010. The UK Music Therapy program was established as part of the Lucille Caudill Little Performing Arts in HealthCare Program, a unique partnership between the UK School of Music and UK HealthCare. (Read more)

High Levels Of LDL Cholesterol Better For Living Healthy Lives!

High Levels Of LDL Cholesterol Better For Living Longer, Healthier Lives!

The Japan Society for Lipid Nutrition has drawn up new guidelines stating that high cholesterol levels are better for living longer, defying conventional wisdom.

Research is now disproving those that state the LDL Cholesterol is BAD Cholesterol Myth!

In 2007, the Japan society set diagnostic criteria for hyperlipemia, or elevated levels of lipids in the bloodstream, flagging LDL cholesterol levels of at least 140 mg/dl and HDL levels less than 40 mg/dl as dangerous for both men and women. To explain why they set the levels as they did they stated:

"According to domestic and foreign research, the higher LDL levels become, the more arterial stiffening advances. Correspondingly, incidence of heart disease also rises. We concluded that LDL cholesterol levels more than 140 mg/dl could easily cause heart disease," said Hirotsugu Ueshima, professor emeritus at Shiga University of Medical Science, who devised the atherosclerosis society's criteria.

However, Tomohito Hamazaki, a professor at Toyama University's Institute of Natural Medicine, who, in fact, compiled the new cholesterol levels guidelines for the Japan Society for Lipid Nutrition, countered Ueshima's argument.

"When examining all causes of death, such as cancer, pneumonia and heart disease, the number of deaths attributable to LDL cholesterol levels exceeding 140 mg/dl is less than people with lower LDL cholesterol levels." –Prof. Tomohito Hamazaki

The lipid nutrition society guidelines do not posit new criteria, but Hamazaki cited some study results to prove his thesis.

According to a eight-year study of about 26,000 men and women in Isehara, Kanagawa Prefecture, the death rate of men whose LDL cholesterol levels were between 100 mg/dl and 160 mg/dl was low, while the rate rose for those with LDL cholesterol levels of less than 100 mg/dl!

The LDL figures exhibited less influence on women, but the death rate still rose for women with LDL cholesterol levels less than 120 mg/dl.

A separate study of 16,850 patients nationwide who had suffered a cerebral stroke showed the death rate for people with hyperlipemia (high blood fatty acid levels) from a cerebral stroke was lower, and their symptoms more slight than those whom had lower lipid levels.

"Cholesterolis an essential component for the creation of cell membranes and hormones. It's not recommended to lower LDL figures by means of dietary intake and medication," stated Hamazaki.

Additional differences exist between men and women's LDL figures.

"When women reach menopause, their cholesterol figures rise sharply, yet do not affect the arteriosclerosis process or development of heart diseases. At the very least, cholesterol criteria is not necessary for women,"-Hiroyuki Tanaka, director of Niko Clinic in Takeo, Saga Prefecture.

This study, along with other studies, leads one to the conclusion that optimal LDL levels are within the 120-160 mg/dl range.

The body needs LDL in the healing process for things such as Autoimmune Diseases, Heart Attacks and Strokes. Why would you ever want to hinder the healing processes of the human body?

-Dr. Walter K. Crooks

High Levels Of LDL Cholesterol Better For Living Longer, Healthier Lives!

The Japan Society for Lipid Nutrition has drawn up new guidelines stating that high cholesterol levels are better for living longer, defying conventional wisdom.

Research is now disproving those that state the LDL Cholesterol is BAD Cholesterol Myth!

The lipid nutrition society guidelines do not posit new criteria, but Hamazaki cited some study results to prove his thesis.

The LDL figures exhibited less influence on women, but the death rate still rose for women with LDL cholesterol levels less than 120 mg/dl.

"Cholesterolis an essential component for the creation of cell membranes and hormones. It's not recommended to lower LDL figures by means of dietary intake and medication," stated Hamazaki.

Additional differences exist between men and women's LDL figures.

This study, along with other studies, leads one to the conclusion that optimal LDL levels are within the 120-160 mg/dl range.

The body needs LDL in the healing process for things such as Autoimmune Diseases, Heart Attacks and Strokes. Why would you ever want to hinder the healing processes of the human body?

-Dr. Walter K. Crooks

U of L doctors wary of KentuckyOne's promise of autonomy

Doctors at Louisville's University Hospital are expressing concerns that the partnership with KentuckyOne Health and the Catholic health rules that come with that merger might affect patient care. Assurances that their concerns are unfounded have been coming from KentuckyOne's majority owner, Denver-based Catholic Health Initiatives. Anxiety over doctors' medical freedom to treat patients as they feel is necessary is being fueled as staff and physicians are being asked to "respect" Catholic health directives, The Courier-Journal reports.

Sheila Reynertson, advocacy coordinator for the New York-based MergerWatch Project, who tracks secular-religious hospital mergers, told The C-J's Laura Ungar that such language puts doctors in "a difficult position." For instance, she explains, "cancer doctors may wonder about prescribing birth control to prevent pregnancy, she said. Catholic directives include a ban on sterilization, abortions, and euthanasia and say Catholic health institutions can't "promote or condone contraceptive practices." Gary Mans, spokesman for the U of L Health Sciences Center, said he doesn't believe doctors and staff will feel constrained by the directives. (Read more)

By Al Cross
Kentucky Health News

The lobby for makers of over-the-counter drugs, which has fought laws to tighten controls on sale of cold medicine that is used to make methamphetamine, is starting a public-education campaign to discourage evasion of the system that tracks purchases of pseudoephedrine. The targeted states are Kentucky and Alabama, which could be key to preventing passage of laws like the one in Mississippi, which requires a prescription for pseudoephedrine. UPDATE, 4/19/13: Missouri has been added.

The Consumer Products Healthcare Association rolled out the campaign in Alabama last month. It joined with the Kentucky Pharmacists Association and the Kentucky Retail Federation yesterday to announce the program in Kentucky, and won the blessing of its primary adversary in the state's legislative battle, Senate Republican Leader Robert Stivers of Manchester. Also on hand at Wheeler's Pharmacy in Lexington was Democratic Gov. Steve Beshear, who had stayed out of the fight until he signed the bill.

Stivers, who is in line to become Senate president, was asked if the drug makers' move signaled a truce in the battle. He indicated that he would wait to see the impact of this year's law, which reduced the amount of pseudoephedrine that can be bought during one a month, before trying to tighten it. "Let's look at the history and see what happens," he said. Earlier, he said: "I appreciate the fact that they're coming here in a very conciliatory way, a very open way, to say we all know there is a problem."

Beshear noted that fewer meth labs have been found in Kentucky this year, but said the success of the law depends on educating the public: "As laws are passed, criminals adapt and find new ways of getting around them."

Preventing that is the goal of CHPA's "Anti-Smurfing Campaign," named for the practice of meth makers using others, "smurfs," to buy pseudoephedrine for them. Beshear noted that the new law makes smurfing a felony, and said the posters are "designed to make smurfers think twice" and "think of the moral and criminal consequences of their actions." He told cn|2 Politics, "I think will be a good deterrent in this situation."

CHPA's director of state government affairs, Carlos Gutiérrez, said the posters were tested in 2011 with focus groups of Kentuckians and strike a balance of educating potential smurfers without alarming law-abiding buyers of pseudoephedrine.

In its efforts to kill Stivers' prescription bill during the 2012 legislative session, CHPA spent more than any other lobbying group has ever reported spending on a legislative session, and that did not include hundreds of thousands of dollars it spent on radio commercials urging listeners to lobby legislators about the bill. Lobbies in Kentucky do not have to report what they spend on such indirect lobbying. Guiterrez was asked if CHPA would do that, and he said he would look into it.

First heart-lung transplant in Ky. in 15 years performed at UK

University of Kentucky surgeons performed Kentucky's first combined heart-lung transplant in 15 years this summer, UK announced today.

Dawn Nelson, 29, of Louisville, received two lungs and a heart from the same donor in one procedure at the Albert B. Chandler Medical Center on July 7. She and her parents discussed it with Courier-Journal reporter Laura Ungar in this video by The C-J's Kylene White:

For Ungar's story, click here. Combined heart-lung transplants are rare; only 27 were performed nationwide in 2011. They are generally performed on younger patients who have a fatal disease and cannot be treated with medication or other interventions.

Nelson was diagnosed with systemic lupus erythematosus at 17 and rheumatoid arthritis at 22. Four years ago, she developed pulmonary hypertension, fatal without timely treatment. The disease destroyed her lungs, and her heart began to fail when it could no longer push blood into them.

Dr. Wesley McConnell, a transplant pulmonologist with Kentuckiana Pulmonary Associates in Louisville, began caring for Dawn two and a half years ago at KPA's Pulmonary Hypertension Center. After she didn't respond to drug therapies, McConnell referred Dawn to UK May 11 for a transplant evaluation. "Dawn was extremely ill and it became clear that her only chance for survival would be a heart-lung transplant," he said. "I knew that UK was her best option because they had the most experienced team in the state."

Dr. Charles Hoopes, director of the UK Transplant Center, performed the surgery, only the seventh such procedure to be performed at UK since it began transplantation in 1964. The last time UK performed this surgery was 1996. "Although the surgery itself is relatively simple, combined heart-lung transplants are rare because they require three donor organs and are reserved for patients who are extremely ill with heart and lung failure," said Dr. Jay Zwischenberger, chair of the UK Department of Surgery. "They also require a great deal of infrastructure and support to perform successfully. At UK, we have that team in place, and moving forward we expect to perform one or two of these combined transplants per year."

More than four months after her surgery, Nelson continues to improve and grow stronger. Dr. Enrique Diaz, medical director for lung transplantation, and Dr. Navin Rajagopalan, medical director of cardiac transplantation, both provide followup care for her at UK, and she continues to see McConnell in Louisville. "Dawn is doing quite well. At the time of transplant, she was so sick she only weighed about 80 pounds," Rajagopalan said. "Now, she feels well, is gaining weight, and is able to do things that she had not been able to do for years.”

Nelson's collaborative treatment is a prime example of the partnership UK is trying to cultivate among Louisville and Lexington doctors, said Dr. Michael Karpf, UK executive vice president for health affairs: “Our goal is to continue to provide highly advanced subspecialty care such as Ms. Nelson’s complex transplant to patients like her who otherwise would either have to leave the commonwealth or, worse, not receive the treatment needed.”

In November 2010, UK in collaboration with Norton HealthCare opened up an outreach Transplant and Specialty Clinic at Norton Audubon Hospital to provide comprehensive pre- and post-transplant care for patients. The partnership ensures that patients like Nelson will not have to leave the state to receive complex acute care or followup treatment, a UK press release said.

Thyroid Researchers Say Take T4 Medication Before Bedtime!

“When Should I TakeThyroid Medication?

http://brainbasedtherapy.blogspot.com/2012/11/Thyroid-Dosage.html

I get this question asked a lot because of the difficulty often-times of taking Synthroid, Levothyroxine or Armour first thing in the morning and then having to wait 45-90 minutes before consuming anything else, even other prescriptions or supplements.

Why do medical doctors, particularly our endocrinologists, recommend taking the medications in the morning?
The main reason appears to avoid trouble falling asleep; as for some people thyroid medication can cause trouble with sleep.

The problem with food and thyroid hormone replacement medication is that foods alter the way in which the drug is absorbed with some published studies showing about a 20% drop if Synthroid is taken with food, compared to an empty stomach.

Taking Thyroid Hormones At Bedtime…

The results of two studies that have been done concerning dosage timing have shown that taking the same dose levothyroxine at bedtime may actually be better than taking it first thing in the morning.

A 12-person Dutch study reported in the January 2007 issue of "Clinical Endocrinology" found that levothyroxine was better absorbed when taken at night than during the day

A study reported in the Archives of Internal Medicine (Arch Intern Med 2010;170:1996-2003 ) suggests taking levothyroxine or Synthroid on an empty stomach at bedtime, which may be the key to lower TSH, higher T4 and T3 levels, and improved absorption of thyroid medication.

Why Would Taking Thyroid Medication Night Be Better?

The researchers suggested several explanations for the thyroid results:

The morning dose is questionable for most of us. Why? “On an empty stomach” varies for each person. So, even when waiting at least 30 minutes to eat, breakfast and vitamins and other supplements or medications may be interfering with the intestinal absorption of the medication.

“Bowel motility is slower at night,” which means that it takes longer for the levothyroxine tablet to transit through the intestinal system, resulting in longer exposure to the intestinal wall, and therefore, better uptake of the medication.

The conversion process of T4 to T3 may be more effective in the evening.

Taking Medication At Bedtime Instead Of In The Morning Is Also Just Easier Sometimes

It’s easier, as you don’t have to worry about when to eat breakfast, and then end up not having breakfast, which is adding fuel to the proverbial fire.

Taking the medication at night makes it easier to avoid other medications, supplements and foods. Taking your thyroid medicine with coffee, minerals or fiber such as bran cereal or Citrucel can interfere with its absorption. (Thyroid, March, 2008).

Plus, taking the medication at night might offer some improvement in symptoms to people who are just not getting optimal absorption by taking thyroid medication during the day.

Researchers Stated That Results Were “Striking”!

The studies were prompted by observation that some patients had improved thyroid hormone profiles after they switched from taking their levothyroxine from morning to bedtime.

Not only did they evaluate the impact of thyroid hormone levels by changing the time of medication, they also evaluated the impact this had on TSH and thyroid hormones and thyroidhormone metabolism.

The studies were fairly conclusive in their findings, which the researchers said were “striking” and which have“important consequences for the millions of patients who takelevothyroxine daily.”

Researchers reported that taking medication atbedtime, rather than the morning, results in “higher thyroidhormone concentrations and lower TSH concentrations.”

TSH decreased and Free T4 levels rose in all patients by changing T4 ingestion from early morning to bedtime and T3 levels rose in all but one subject and TSH decreased irrespective of the starting TSH levels, suggesting better absorption of the thyroidmedication when taken in the evening.

What I Am NOT Advocating…

To close please understand that I am not telling you that you should, in any way, alter your medication dosing as set by your treating physician. What I do recommend is that you bring these studies up with your doctor on your next visit with your doctor.

If you decide that you want to try taking your thyroidmedication in the evening, make sure to check your thyroidlevels via blood test within the following six to eight weeks so that your doctor may determine if there is any adjustment to the dosage of your medication.

***CAUTION***

The above research test were done using levothyroxine, which is purely T4 thyroid hormone (Synthroid and Tirosint are two examples) it was not done using hormone replacement drugs that contained T3, such as: NatureThroid, Armour Thyroid or Cytomel.

Because of this fact there is no way of knowing if your sleep would be altered on these types of hormone replacement medications.

Consult with your Primary Physician before altering any medication dosages.

Dr. Walter K. Crooks

Member Pastoral Medical Association

Chiropractic Clinical Neurologist

“When Should I TakeThyroid Medication?

Taking Thyroid Hormones At Bedtime…

The results of two studies that have been done concerning dosage timing have shown that taking the same dose levothyroxine at bedtime may actually be better than taking it first thing in the morning.

A 12-person Dutch study reported in the January 2007 issue of "Clinical Endocrinology" found that levothyroxine was better absorbed when taken at night than during the day

Why Would Taking Thyroid Medication Night Be Better?

The researchers suggested several explanations for the thyroid results:

The morning dose is questionable for most of us. Why? “On an empty stomach” varies for each person. So, even when waiting at least 30 minutes to eat, breakfast and vitamins and other supplements or medications may be interfering with the intestinal absorption of the medication.

“Bowel motility is slower at night,” which means that it takes longer for the levothyroxine tablet to transit through the intestinal system, resulting in longer exposure to the intestinal wall, and therefore, better uptake of the medication.

The conversion process of T4 to T3 may be more effective in the evening.

Taking Medication At Bedtime Instead Of In The Morning Is Also Just Easier Sometimes

It’s easier, as you don’t have to worry about when to eat breakfast, and then end up not having breakfast, which is adding fuel to the proverbial fire.

Taking the medication at night makes it easier to avoid other medications, supplements and foods. Taking your thyroid medicine with coffee, minerals or fiber such as bran cereal or Citrucel can interfere with its absorption. (Thyroid, March, 2008).

Plus, taking the medication at night might offer some improvement in symptoms to people who are just not getting optimal absorption by taking thyroid medication during the day.

Researchers Stated That Results Were “Striking”!

The studies were prompted by observation that some patients had improved thyroid hormone profiles after they switched from taking their levothyroxine from morning to bedtime.

Not only did they evaluate the impact of thyroid hormone levels by changing the time of medication, they also evaluated the impact this had on TSH and thyroid hormones and thyroidhormone metabolism.

What I Am NOT Advocating…

***CAUTION***

Because of this fact there is no way of knowing if your sleep would be altered on these types of hormone replacement medications.

Consult with your Primary Physician before altering any medication dosages.

Dr. Walter K. Crooks

Member Pastoral Medical Association

Chiropractic Clinical Neurologist

Kentucky parents' overall perception of Kentucky children's health doesn't match the statistics, foundation survey finds

Many Kentucky parents' perception of their children's health doesn't match statistics, suggesting that many health problems are going undetected or untreated.

That is the upshot of the Foundation for a Healthy Kentucky's first Kentucky Parent Survey, conducted by the University of Virginia's Center for Survey Research this summer and released today.

Only 4 percent of Kentucky parents said a health professional had told them their child was obese, but the National Survey of Children's Health in 2007 found that almost 37 percent of Kentucky children were obese.

Just 5 percent of Kentucky parents said they had been told that their child had depression or anxiety, but about 25 percent of children 13 to 18 will have struggled with anxiety and 11 percent will have battled depression, according to a 2010 national study. And a recent study found that Kentucky teens were more likely than the national average to have attempted suicide.

About 17 percent of Kentucky parents reported that their child had decayed teeth or cavities, but a national survey of third graders in 2001-02 revealed that 35 percent had untreated dental issues.

Only 3 percent of parents said their child was diagnosed with a hearing problem, but 15 percent of children nationally have measurable hearing loss. And 14 percent reported being told their child had a vision problem, but about one in four preschoolers nationally have vision issues.

Parents also seem not to get enough advice from health care providers about how to treat their children's health issues, even though there are high rates of children suffering from tooth decay, vision problems, asthma, ADHD, depression/anxiety, obesity, hearing impairment and diabetes, the survey found.

While 92 percent of parents said their child had a regular doctor, just 80 percent said their child had a regular dental care provider. And a 74 percent majority of parents surveyed said they were always encouraged by their child's healthcare provider to ask questions during visits. "The exceptions are worth noting," said Susan Zepeda, president and CEO of the foundation. "If three in four parents said their child's provider always encouraged questions, this means that one in four were not always encouraged to ask questions." (Read more)

Lame-duck Congress could cut funding for critical access hospitals; more than two dozen in Kentucky

Critical access hospitals, which in most states are rural facilities with fewer than 25 beds, may be under attack in the lame-duck session of Congress, former national rural-health director Wayne Myers writes for the Daily Yonder. President Obama's "budget proposes to revoke CAH status and special payments for any such hospital within 10 miles of another hospital, and to cut the extra 1 percent payment for all of the critical access hospitals," Myers writes. (Census Bureau map of CAH locations)

This would "have enormous consequences," Myers writes. "Of the hospitals that lose CAH designation probably most will close or merge with another hospital. I've seen no estimates of numbers. There are more than a few congressional budget hawks in both parties who would like to eliminate the special payments to Critical Access Hospitals entirely. If these small hospitals dodge the bullet during the lame duck session, they'll continue to be targets in the next Congress. If they are successful in reducing payments to CAHs, the net effect will be to move health care capacity and jobs from smaller to larger towns."

The issue is complex. Rural areas have less political clout than ever, because of declining population, and many rural people use urban hospitals over CAHs, even for ordinary care. "Those who do use CAHs say their experience there is just as good as that in urban hospitals, even if the quality of care isn't as good as in larger facilities," Myers writes. "Elderly patients stay at CAHs because they know the nurses and doctors and their families live close by."

Issues for CAHs arise out of how Medicare payments are made to them, Myers writes. "A long list of arcane, special funding arrangements has accumulated to try to fit small rural hospitals into a Medicare payment system designed for large city hospitals." The largest program is the "Disproportionate Share Program," or DISH, which gives $15 billion a year to states to hand out to CAHs. The program is being phased out between 2014 and 2020, along with several other programs, as part of the Patient Protection and Affordable Care Act. (Read more)

Canadian study suggests children in day care are more likely to be obese than those cared for by their parents

Children who attend day care regularly are 50 percent more likely to be overweight than those who stay home with parents, according to a new University of Montreal study in Quebec. Lead researcher Marie-Claude Geoffroy said the disparity "cannot be explained by known risk factors such as socioeconomic status of the parents, breastfeeding, body mass index of the mother, or employment status of the mother."

Researchers studied more than 1,600 families with children born in 1997 and 1998 in Quebec, a sample that was representative of the majority of kids in the province. Mothers were interviewed about their children's care at ages 1.5, 2.5, 3.5 and 4. Children were put into groups based on the type of care they received most. Researchers concluded that 65 percent of children spent most of their time in day care. Just 19 percent were cared for mostly by a parent.

Researchers found no clear explanation for the weight disparities, but they argued that day care has the potential to reduce weight problems in children through promotion of physical activity and healthy eating. (Read more)

Efficacy of intranasal vaccination in cats

Bradley A, Kinyon J, Frana T, Bolte D, Hyatt DR and Lappin MR. Efficacy of intranasal administration of a modified live feline herpesvirus 1 and feline calicivirus vaccine against disease caused by Bordetella bronchiseptica after experimental challenge. J Vet Intern Med. 2012; 26: 1121-5.

Upper respiratory tract infections (URTI) are common problems affecting cats in shelters, boarding facilities, breeding catteries, and pet homes. The most common causes of URTI include feline herpesvirus 1 (FHV), feline calicivirus (FCV), Bordetella bronchiseptica, Chlamydophila felis, Mycoplasma spp, and some bacteria. However, vaccines are only available for FHV, FCV, B. bronchiseptica, and C. felis. No single product is available to provide protection against all 4 agents in one vaccine.

Most feline vaccines are formulated for parenteral use, but there are 2 products on the market in the United States designed for intranasal administration. Intranasal administration of vaccines stimulates a nonspecific immune response in addition to the specific immune response against the agent in the vaccine. These investigators examined the effect of intranasal vaccination against FHV and FCV on disease caused by B. bronchiseptica. Two groups of 10 cats each were either inoculated intranasally with the vaccine or left unvaccinated. They were then exposed to B. bronchiseptica seven days later. Vaccinated cats were found to be less likely to be clinically ill than unvaccinated cats. Thus, intranasal vaccination with FHV and FCV decreased disease caused by a different pathogen due to its stimulation of nonspecific immunity. [MK]

See also: Egberink H, Addie D, Belak S, et al. Bordetella bronchiseptica infection in cats ABCD guidelines on prevention and management. J Feline Med Surg. 2009; 11: 610-4.
Free, full text article updated 2012

Related blog articles:
Treatment of feline upper respiratory tract disease (August 2012)
Upper respiratory tract disease in shelters (November 2009)
Understanding chronic respiratory disease in cats (August 2009)

More on cat health:
Winn Feline Foundation Library
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