Thursday, October 3, 2013

Treating lymphoma in dogs and cats

Because single-agent lomustine has demonstrated therapeutic activity for the treatment of refractory canine lymphoma, intuitively, it would be expected that lomustine should possess efficacy when used against drug-naïve, high-grade, multicentric canine lymphoma. Given lomustine's oral formulation, relative low cost, therapeutic effectiveness against refractory lymphomas, and reported low incidence of hepatotoxicity, lomustine appears to be an excellent anticancer drug, but keep in mind that conventional, multiagent systemic chemotherapy is still considered the gold standard for treating canine lymphoma. Carefully consider using single-agent lomustine as a first-line treatment option, and make sure you understand and recognize the potential hazards of using lomustine.

FIGURE 6. A laparoscopic view of the gross morphologic appearance of the liver in a standard poodle with hepatotoxicity attributed to chronic lomustine therapy. Morphologic changes are not specific for lomustine-induced hepatotoxicity.

As already demonstrated in dogs treated for refractory lymphoma, the long-term administration of lomustine may result in cumulative thrombocytopenia. When lomustine is used in a rescue setting, lomustine-induced cumulative thrombocytopenia may be of marginal consequence because few effective treatment options remain for heavily treated, relapsing patients. However, in dogs with relapsing lymphoma treated with first-line lomustine, cumulative thrombocytopenia may limit the safe institution of additional myelosuppressive agents, including doxorubicin and cyclophosphamide. In addition to cumulative thrombocytopenia, lomustine's hepatotoxic potential should be carefully considered before its liberal use in cancer-bearing dogs (Figure 6). Although the reported rate of hepatotoxicity is quite low, a recent abstract suggests that the incidence of hepatotoxicity, defined as greater than fourfold elevations in serum alanine transaminase activities, is much higher in dogs treated with a combination of lomustine and oral prednisone. In this study, 23 of 45 dogs treated with lomustine and prednisone had moderately to severely elevated serum alanine transaminase activities.¹⁹ Additionally, most dogs (74%) developed pathologic serum alanine transaminase activity elevations with three or fewer lomustine treatments. These findings suggest that combining lomustine with prednisone may markedly increase the likelihood for acute liver injury, and veterinary practitioners should vigilantly monitor patients with serial serum chemistry profiles before each subsequent dose of lomustine, whether alone or in combination with prednisone. Lomustine should be considered a viable treatment option for dogs with lymphoma, especially in a rescue setting. However, the recommended use of lomustine as a first-line, single-agent should be reserved primarily for pet owners who actively choose to forgo conventional multiagent chemotherapy for their ailing pets. Currently, no published reports define the efficacy of first-line, single-agent lomustine for the treatment of canine lymphoma. Until that information becomes available, it remains difficult to enthusiastically recommend single-agent lomustine therapy rather than the use of a known effective monotherapy such as doxorubicin.

Adjuvant radiation Radiation therapy induces programmed cell death in both normal and malignant lymphocytes. Given the sensitivity of malignant lymphocytes to radiation-induced injury, the efficacy of external beam, megavoltage radiation therapy has been evaluated for the adjuvant treatment of high-grade, multicentric lymphoma in dogs. In one study, 52 dogs were treated with a short course of induction chemotherapy (11 weeks), immediately followed by staged, half-body irradiation.²⁰ Radiation therapy was administered to cranial and caudal body halves for a total dose of 8 Gy, given in two fractions of 4 Gy on consecutive days with cobalt-60 photons and a three-week interval between halves. The side effects associated with half-body irradiation were generally mild and included reversible myelosuppression and gastrointestinal upset. In addition to the safety of combined chemotherapy and adjuvant radiation, the investigated protocol was therapeutically effective, with treated patients achieving a first median remission time of 311 days.²⁰ The findings of this study emphasize that long-lasting remissions can be achieved in dogs with lymphoma by using short treatment protocols that combine chemotherapy and radiation.
Nodal irradiation for chemoresistant lymphoma
Malignant lymphocytes expressing multidrug-resistant phenotypes are afforded a survival advantage when exposed to cytotoxic agents. Attempting to treat resistant lymphocyte clones, even with novel chemotherapeutic agents, still may result in disease progression. Because of the limitations of chemical cytotoxic agents, in conjunction with the inherent radiosensitivity of malignant lymphocytes, the use of total lymphoid irradiation (TLI) for confirmed chemoresistant lymphoma has been investigated. In one study, 11 dogs with confirmed multidrug-resistant lymphoma were treated with total nodal irradiation. A dose of 2 Gy given in six fractions over two weeks was administered to all affected peripheral lymph nodes. By the fourth radiation fraction, all treated lymph nodes had returned to normal size, and dogs treated with nodal irradiation survived for a median of 143 days.²¹ The results of this pilot study demonstrate that dogs with chemoresistant lymphoma may still appreciably benefit from alternative treatment options such as nodal irradiation.
TREATING FELINE LYMPHOMA
Systemic chemotherapy

TABLE 3. Summary of Selected Feline Lymphoma Protocols

Unlike canine lymphoma in which several innovative treatment options have been investigated, the treatment of cats with high-grade lymphoma has not markedly changed during the past decade. Several systemic chemotherapeutic protocols have been evaluated for treating feline lymphoma (Table 3). In general, with the institution of multiagent systemic chemotherapy, most (about 60% to 70%) cats will achieve complete remission, with median survival times approximating six to nine months.¹ Although the treatment of cats with lymphoma has not changed greatly over the past several years, it has been suggested that cats diagnosed with lymphoma are afforded with better quality-of-life scores and survival times, as compared with a decade ago. In part, this suggestion is based on the dramatic decrease in the number of cats infected with FeLV, a reported negative prognostic factor in cats with lymphoma.²²

TABLE 3. Summary of Selected Feline Lymphoma Protocols

Floyd County newpspaper editor calls on readers to make lifestyle changes to address area's diabetes health crisis

The editor of an Eastern Kentucky newspaper has joined an advocacy group's call for residents in his county to make simple, healthy lifestyle changes, serving as an example of how local newspapers and community members can engage the public to confront poor health status of the area, which is often put on the back-burner despite alarming warning signs.

Recently, the Tri-County Diabetes Partnership declared the rate of diabetes in Floyd, Johnson and Magoffin counties (map) "a crisis of epidemic proportions." The rate in 2002-10, the latest available, was 14 percent.

If the federal Centers for Disease Control and Prevention "saw a similar increase in any other illness, they would probably declare a national emergency,” said J.D. Miller, vice president of medical affairs for Appalachian Regional Healthcare, who chaired the meeting.

The group's statement was an appropriate response to direct public's attention to the imperative of addressing the area's skyrocketing rate of the disease, Ralph Davis of The Floyd County Times wrote in an editorial.

Diabetes will remain a crisis unless we do something about it, said Davis, and "if you have been waiting for a crisis before making healthy lifestyle changes, we’ve got one for you. In fact, we have several," Davis said.

The Central Appalachian region suffers from disproportionate rates of diabetes, cancer and heart disease, and Floyd, Magoffin and Johnson counties have much higher rates of obesity than state and national averages, Davis notes. Floyd County ranks last among the state’s 120 counties in overall health measures, and Johnson and Magoffin counties are ranked 108th and 104th, respectively.

To do something about this problem, Davis calls for concentrated attention by health care providers and government officials, but the problem won't be solved without action from the community and individuals, he says. Simple, healthy lifestyle changes are needed.

"It’s going to require the conscious decision by everyone in the region to do what they can to improve their diet and exercise habits, and to encourage their friends and family to do the same," said Davis.

Calls like Davis's are needed even more in most of the counties that surround the three counties, based on data from the CDC's Behavioral Risk Surveillance System. The counties in dark blue had rates above 14 percent; the highest was Greenup, at 17 percent.

Thinking outside the (litter) box

Grigg EK, Pick L and Nibblett B. Litter box preference in domestic cats: covered versus uncovered. J Feline Med Surg. 2013; 15: 280-4.

The most common behavior problem in cats leading to their relinquishment to animal shelters is inappropriate elimination or housesoiling. In this situation, cats eliminate urine, feces, or both around the house, but outside the litter box. Litter box management is one area of focus for prevention of elimination disorders of either medical or behavioral origin. Some of the common recommendations associated with improving litter box management are:

1) cleanliness – boxes should be cleaned at least once per day and litter completely replaced weekly,
2) type of litter – the fine-grained clumping clay litter is the most commonly recommended,
3) number of litter boxes – the general yet untested rule of the number of cats plus one,
4) litter box size – larger box size especially for larger cats and,
5) style of box – recommending against self-cleaning boxes or covered boxes.

Little research has been done to look at box style, such as a preference for uncovered versus covered litter boxes. The authors wanted to determine if cats did prefer uncovered litter boxes when all other factors are equal. Twenty-eight cats were enrolled in the study. Nineteen of the cats showed no preference between a covered or uncovered box. Some individual cats did have preferences for one box type or the other – four cats for uncovered boxes, four cats for covered boxes. With a minority of cats exhibiting a litter box style preference, offering a ‘cafeteria’ choice of litter boxes, including a covered box, might be beneficial. Additional studies related to litter box management are recommended, such as evaluating scented versus unscented litters. [VT]

See also: Sung W and Crowell-Davis SL. Elimination behavior patterns of domestic cats (Felis catus) with and without elimination behavior problems. Am J Vet Res. 2006; 67: 1500-4.

More on cat health:
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Veteran journalist offers advice on covering mental health issues: Be careful, creative, and balanced, not discriminatory

The term 'mental health' has been tossed around a lot lately in stories about Kentucky's mental health funding and mental health coverage through Medicaid expansion. It's important to use precise language when writing about the topic, because a fourth of Americans are affected by mental-health issues each year, and many don't seek treatment due to its stigma.

"Fair, accurate and balanced portrayals of mental health in the news media are so important," says Melissa McCoy of the California Newspaper Publishers Association. She notes that studies show coverage of mental health is mostly reactive, responding to a school shooting or n act of violence, which could skew public perceptions about mental illness. She says journalists should "provide accurate coverage of mental health without adding to its stigma" or to the discrimination faced by those with mental illness.

Journalists can seek balance by asking themselves about the relevance of mental health to the story and making sure to use the right type of language, says McCoy; be creative about mental health coverage by integrating it into stories about general health, veterans returning from war, substance abuse recovery, unemployment or even stress among students.

Pike County settles its part of Oxycontin lawsuit against Purdue Pharma for $4 million; state remains a plaintiff

Officials of Pike County, Kentucky, announced this week that Purdue Pharma, the maker of OxyContin, will pay $4 million to settle the county's part of a lawsuit the county and state filed in 2007 seeking damages for the addiction OxyContin caused "after the company aggressively marketed it to doctors as a safe option for pain relief," Russ Cassady reports for the Appalachian News-Express in Pikeville.

The state remains a plaintiff in the suit, which is largely based on admissions of guilt made by the company and several top-ranking company officials in a May 2007 Virginia federal court settlement. Purdue Pharma, its president, chief legal counsel and former medical director pleaded guilty to misleading doctors, regulators and patients about OxyContin during that case.

The nation's prescription-drug epidemic apparently began in Central Appalachia, largely because of the introduction and high rate of prescription of OxyContin. The lawsuit sought reimbursement for drug-abuse programs, law-enforcement actions and prescription payments through Medicaid and the Kentucky Pharmaceutical Alliance Program. The local officials indicated the settlement could increase the size of a planned rehabilitation facility for people convicted of drug charges.

Drinking Soda Increases Stroke Chance

It doesn't matter whether it's sugary or diet: High consumption of carbonated soft drinks significantly increases your risk of stroke, research shows.

Researchers found that those with higher consumptions of both sugar-sweetened and low-calorie soda were significantly more likely to suffer from strokes.

"Greater consumption of sugar-sweetened and low-calorie sodas was associated with a significantly higher risk of stroke," the researchers wrote. "This risk may be reduced by substituting alternative beverages for soda."

Read The Whole Soda Causes Stroke Story Here

Drinking Soda Increases Stroke Chance

Antibiotics Cause Long Term Damage To Good Gut Bacteria

Gut Biota Never Recover from Antibiotics: Damages Future Generations

The misuse of antibiotics is not only causing new, never-before known diseases like E. coli and MRSA, the flesh-eating bacteria, it's also destroying the gut biome with devastating effects on our ability to deal with infections and destroying our ability to absorb nutrients from food.

Emerging research shows that the harmful effects of antibiotics go much further than the development of drug resistant diseases. The beneficial bacteria lost...Read More HERE

Gut Biota Never Recover from Antibiotics: Damages Future Generations

Rural cancer survivors are less healthy than urban counterparts; 25 percent of rural cancer survivors smoke

A quarter of rural cancer survivors smoke.

Cancer survivors from rural areas live less healthier lives than survivors from urban areas. That's the diagnosis of a study by the Wake Forest Baptist Medical Center in Winston-Salem, N.C., which asked a random sample of rural and urban survivors their body weight, and if they smoked, drank alcohol, and exercised.

The study found that 25 percent of rural cancer survivors smoked, compared to 16 percent from urban areas. It didn't have state-by-state figures, but Kentucky has high rates of both cancer and smoking.

Fifty-one percent of rural survivors didn't participate in any physical activities at all, compared to 39 percent for urban survivors, and 66 percent of rural survivors were obese, while 63 percent of urban ones were. Fewer rural survivors drank alcohol, a difference of 46 percent to 59 percent, and 18 percent of them were more likely to be unemployed because of health reasons, compared to 11 percent for urban survivors.

"Rural cancer survivors may not be receiving messages from their health-care providers about how important quitting smoking and being physical active are after cancer," said Kathryn E. Weaver, assistant professor of social sciences and health policy at Wake Forest Baptist. "It is concerning that we found higher rates of health-compromising behaviors among rural survivors, when we know cancer survivors who smoke, are overweight, or are inactive are at higher risk for poor outcomes, including cancer recurrence and second cancers." (Read more)

A quarter of rural cancer survivors smoke.

Fewer families report having trouble paying medical bills; near-poor struggle more than poor families

Fewer American families are having problems paying medical bills, but 20 percent of them, particularly those without insurance and those that are "near poor" but not :poor," still struggle with health costs, says a study released Tuesday by the National Center for Health Statistics.

The report says 54.2 million people, or 20.3 percent of families headed by someone under the age of 65, had difficulty covering medical expenses in the first half of 2012. During the first half of 2011, 21.7 percent of families, or 57.8 million people, found it difficult to pay medical bills.

Hispanics (25.2 percent) and blacks (27.9 percent) were more likely than whites (20.1 percent) or Asians (10.3 percent) to report trouble paying their medical bills, says the report. It says families with incomes from 100 to 199 percent of the poverty line were most likely to have difficulty paying medical bills, probably because those below the poverty line qualify for Medicaid. State income limits vary; in Kentucky, income-based Medicaid is available to those with incomes less than 70 percent of the poverty line.

'Poor' are below the poverty line. 'Near poor' had incomes of 100 to 199 percent of the poverty line.

Among families with insurance, 14 percent of those with private insurance and 25.6 percent with Medicaid or other public insurance had similar problems paying bills in the first half of 2012, which represents a 1.7 percent and 2.5 percent decrease from 2011, respectively. For a report on the study, click here.

'Poor' are below the poverty line. 'Near poor' had incomes of 100 to 199 percent of the poverty line.

Study finds that daily use of sunscreen prevents aging of skin

Sunscreen doesn't just prevent sun burns and skin cancer; using it daily can slow down your skin's aging too, says a study published in the Annals of Internal Medicine.

Australian researchers found that when adults regularly used broad-spectrum sunscreen, they were less likely to show increased wrinkling over a four-and-a-half-year period compared to adults who used sunscreen every once and a while, reports Barbara Mantel of NBC News.

This is the first study showing that sunscreen prevents skin aging, and the results show year-round use of sunscreen significantly slows the aging of skin caused by the sun's ultraviolet rays, Dr. Adele Green of Royal Brisbane Hospital in Queensland told the Gupta Guide.

"Previous research has shown that skin aging is associated with an increased risk of actinic keratoses and melanoma, and now we have the first randomized trial to show that sunscreen retards skin aging," Green said.

The sunscreen used in the study had a SPF of 15, which blocks about 94 percent of ultraviolet B rays. Stronger preparations have only a small additional effect; one with an SPF of 40 filters about 97.5 percent, Green told Mantel.

"The more important issue is applying the sunscreen well and reapplying it often," and you should make sure that sunscreen is broad spectrum, he said. The study also found that daily beta-carotene supplementation had no effect on skin aging.

The study shows that just 15 minutes of sun on any part of your body can age the skin, and it is never too late to start using sunscreen, said Dr. Nancy Snyderman of NBC News. Even in middle age, if you start using sunscreen, you can role back the aging of your skin, she said. Here's NBC's video clip:

The University of Kentucky and St. Mary’s Medical Center in Huntington, W.Va., are joining the Eastern Kentucky Healthcare Coalition, originally comprising Highlands Regional Medical Center of Prestonsburg, Our Lady of Bellefonte Hospital of Ashland and St. Claire Regional Medical Center of Morhead.

“UK HealthCare and St. Mary’s will make excellent additions to the coalition’s efforts to develop a clinically integrated network of providers to enhance the health status of our communities,” coalition Executive Director Jim Fuzy said in a UK press release.

Although each medical center remains autonomous, the coalition promotes integration Dr. Michael Karpfto help coordinate for collective efficiencies, adapt to health reform, deal with vendor contracts and have combined health events, while increasing patient access to quality care, said the release.

"As Kentucky’s largest academic medical center, focused on providing advanced sub-specialty patient care, we at UK HealthCare are committed to improving the health of the people of Eastern Kentucky and through our collaboration with other members of the Eastern Kentucky Healthcare Coalition, we will be able to impact and improve the access and quality of care for Kentuckians,” said Dr. Michael Karpf, UK's executive vice president for health affairs.

Juicing and Smoothies: Opt for Organic foods for a longer and healthier life!

Health is Wealth! - and thus, it is important to look after it. There are various ways which we adopt to maintain a healthy lifestyle, such as running on the treadmill, early morning walks, etc. But you would be surprised to know that Bernando LaPallo from Arizona has been living for more than 110 years. He walks miles on his own and speaks over the phone to people all over the world. Generally, it is presumed that when you are over a certain age, there would be physical complications. But this man is as healthy as a horse. Organic food and good lifestyle seemed to be his secret to a long life without medications nor medical complications.

Being vegetarian also helps. Find out more from the Natural News report on this topic:

http://www.naturalnews.com/034666_longevity_aging_prevention.html#ixzz2TYaNuPZY

Green leafy vegetables, organic juices, organic honey, etc help a lot in keeping you fit and healthy. Even the vegetable pulps can be put to use as flavoring agents for the foods. Hence, instead of falling prey for weight reducing tablets and other medical treatments, it is always better to maintain a healthy lifestyle naturally.

In case you think that vegetarian foods are not quite tasty, think again. Given that you use the right ingredients in right order, you can always end up with tasty and healthy foods and beverages. Summer always remind us of beverages, such as, smoothies. So opt for green smoothies this summer and stay healthy. Although mostly the smoothies are considered to have been made from fruits, it is actually vegetables that are widely used also.

Check out the following link for some incredible smoothie recipes:

http://www.naturalnews.com/040374_smoothie_recipies_green_smoothies_healthy_living.html#ixzz2TYWN0j4s

Smoothies are actually considered supplements to dairy products. So instead of running after the packaged health foods, rustle up something healthy by reading from the above mentioned recipes.

To gather more information on the smoothies, their history and how they help to stay healthy, flip through the following: http://www.helium.com/items/2357920-drinks-smoothies-from-around-the-world

Being vegetarian also helps. Find out more from the Natural News report on this topic:

http://www.naturalnews.com/034666_longevity_aging_prevention.html#ixzz2TYaNuPZY

Check out the following link for some incredible smoothie recipes:

http://www.naturalnews.com/040374_smoothie_recipies_green_smoothies_healthy_living.html#ixzz2TYWN0j4s

Smoothies are actually considered supplements to dairy products. So instead of running after the packaged health foods, rustle up something healthy by reading from the above mentioned recipes.

To gather more information on the smoothies, their history and how they help to stay healthy, flip through the following: http://www.helium.com/items/2357920-drinks-smoothies-from-around-the-world

State officials tell health-care providers to meet with managed-care companies to get paid, say new system is improving health

By Molly Burchett and Al Cross
Kentucky Health News

At the latest in a series of forums on Medicaid managed care, state officials said the new system has improved the quality of care, but you could cut the tension with a scalpel in the packed auditorium at the University of Kentucky as they fielded complaints and questions and urged the providers to work out the problems with managed-care companies themselves.

Gov. Steve Beshear and the Cabinet for Health and Family Services say the forums are designed to improve relations between providers and the managed-care organizations, but reactions from capacity crowd of health care providers and staff -- reactions that included a roomful of laughter about the MCOs' low count of transferred phone calls from providers -- suggested that the state’s solutions to providers' problems with the companies aren’t quite the solutions sought by providers.

Kentucky's transition to Medicaid managed care

In 2011, Kentucky was faced by spiraling Medicaid costs that gave the state two options: cut reimbursement rates to providers by a third or moving from a fee-for-service model to a managed- care system, in which MCOs get a specified fee for each patient they manage and use the money to pay providers, said Lawrence Kissner, commissioner of the Department for Medicaid Services.

The change is driving improvements in health for Medicaid clients while saving the state money, said Kissner: It has increased well-child visits for children aged 3-6 from 2 percent to 53 percent, has increased diabetes testing from 6 percent to 59 percent, and has improved adult access to preventative and ambulatory health services.

MCOs also have numerous quality initiatives underway, said Kissner, including one in improving anti-depressant medication management and compliance. One company, Wellcare, has worked to improve oral health through a campaign that offered $10 gift cards for dental visits, but no one hears about this, he said.

What we've heard are complaints from physicians, hospitals, pharmacies and other health-care providers who aren’t getting some claims paid in a timely manner, or at all. Providers say manage care's complicated pre-approval process, designed to limit costs, delays critical treatment for patients and adds unsustainable administrative burdens.

Read more here: http://www.kentucky.com/2012/02/08/2061060/health-care-providers-say-medicaid.html#storylink=cpy

State officials' response: meet with the MCOs

Kissner said the new system denies 6 percent of providers' requests for pre-authorization, compared to the fee-for-service model that only denied 1 percent of such requests, but he says that's about the same as other states that use managed care.

About 20 percent of providers' claims have either been denied or suspended. In the first 14 months of managed care, 22 million of the 28.3 million claims, or 78 percent, were paid within 30 days. Kissner said 4.9 million (17 percent) were denied in 30 days and 1.2 million (4 percent) were suspended; he did not mention the monetary amount of the denied or suspended claims.

Kissner speaks to crowd at UK; Cabinet Secretary Audrey Haynes looks on from first front-row seat.

When an audience member questioned the lack of payment for hospice services, Cabinet Secretary Audrey Haynes replied, “There are some providers around the state that have been quite vocal about how much we owe them, but when there’s been an attempt to sit down and work it out with them, they will not make an appointment.” She said it is a provider’s responsibility to reach out to MCOs about the payments they are owed.

“It is about you going to each one of them and setting an appointment for them to work out with them you’re accounts receivable," Haynes said. “If you really want to get paid and if you are really owed, and I believe most of you are, then let’s get an appointment set” with the MCO.

“We want this worked out,” said Haynes. “The time has come and gone for us to still be having problem getting payment if your contract says you deserve payment. These folks know they are on the hook. Let's all work together to get it fixed.”

Meetings with MCOs are part of the plan Beshear outlined after vetoing House Bill 5, which the last session of the General Assembly passed to help providers receive prompt payments from MCOs. The plan also requires the state Department of Insurance to investigate payment complaints and to conduct audits of this process. The department began this work in April and says it does not yet have statistics about 'clean claim' approval rates.

However, audits by the state's managed-care branch have shown Kentucky Spirit and Coventry Cares to be deficient in their financial management, and the state has implemented "corrective action plans" to address those deficiencies, said Kissner.

Providers' response to dispute-resolution plan

It may be an unwelcome change for providers as they now may have to set up consultations with MCOs to receive the money owed to them. They may ask: How many other business-to-business contracts require the service provider to meet face-to-face with the payor in order for the provider to be paid for contracted services that have already been provided? They argue that delayed payments and fee cuts could stretch medical practices and hospitals so thin that those needing care might be at more risk.

One provider in the audience addressed this concern, asking how general dentists are supposed to continue giving high-quality care to all patients if their fees are getting cut, but our expenses are going up? None of the officials on the panel answered the question.

Another audience member asked about provider fee cuts, and after the microphone was passed around to Kissner, he said the reductions are a part of the transition process to managed care, which was initiated to avoid a 35 percent Medicaid rate cut.

"When managed care enters into a a fee-for service environment, there's savings in a variety of pockets," Kissner said. "How do they control costs and try to make a profit in the system?"

The forum wrapped up with question from another skeptical audience member: Will this really make a difference?

"Well, you tell me, said Haynes. "And I'm sorry for those of you that feel like it will not make a difference because everyone in this room would have seen a 35 percent cuts in your rate, in all rates, had we not gone to managed care. Not only that, our folks were not getting healthier, and we have proof of that." In her opening remarks, she said the state has spent billions of dollars on health care for the poor without seeing an improvement in the state's health status, so a different approach was needed.

Future forums

Kissner said the forums between the MCOs and providers are expected to resolve disputes by January, the deadline given to the cabinet by Rep. Bob Damron, D-Nicholasville, during a meeting of the joint Administrative Regulations Review Subcommittee. Damron and other legislators have "vowed to lead a legislative revolt" if the administration doesn't fix these late payment issues between providers and MCOs by then, reports Ronnie Ellis of CNHI News Service.

All the managed-care forums follow the same agenda, which can be found along with additional information at the Medicaid website. The dates and locations of the remaining forums are:

Region 2, June 20: Main Lodge, Pennyrile Forest State Resort Park (20781 Pennyrile Lodge Road., Dawson Springs)
Region 3, June 24: Kent School of Social Work, University of Louisville Shelby Campus (312 N. Whittington Pkwy., Louisville)
Region 4, June 26: VP Henry Auditorium, Lindsey Wilson College (210 Lindsey Wilson St., Columbia)
Region 6, June 27: Student Union Building, Northern Kentucky University (20 Kenton Drive, Highland Heights)
Region 1, July 15: Curris Center, Murray State University (102 Curris Center, Murray)

Read more here: http://www.kentucky.com/2012/02/08/2061060/health-care-providers-say-medicaid.html#storylink=cpy

Kissner speaks to crowd at UK; Cabinet Secretary Audrey Haynes looks on from first front-row seat.

Region 2, June 20: Main Lodge, Pennyrile Forest State Resort Park (20781 Pennyrile Lodge Road., Dawson Springs)
Region 3, June 24: Kent School of Social Work, University of Louisville Shelby Campus (312 N. Whittington Pkwy., Louisville)
Region 4, June 26: VP Henry Auditorium, Lindsey Wilson College (210 Lindsey Wilson St., Columbia)
Region 6, June 27: Student Union Building, Northern Kentucky University (20 Kenton Drive, Highland Heights)
Region 1, July 15: Curris Center, Murray State University (102 Curris Center, Murray)

Kentucky Spirit can't terminate its Medicaid contract with the state a year early without facing fines, judge rules

By Molly Burchett
Kentucky Health News

A Frankfort circuit judge ruled Friday that Kentucky Spirit, one of three companies hired by the state in November 2011 to manage health care for more than 540,000 Medicaid recipients, cannot pull out of its contract with the state a year early with no financial penalty.

Kentucky Spirit, a subsidiary of St. Louis-based Centene Corp., announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing money, but the company could face fines if it terminates its three-year contract before expiration in July 2014, Franklin Circuit Judge Thomas Wingate said in his ruling.

Kentucky Spirit argued in its lawsuit that the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million. It made the lowest bid, and on average, gets about $100 less per month for each patient than the other two MCOs, Coventry Cares and WellCare.

The Cabinet for Health and Family Services replied that Kentucky Spirit had breached its contract with the state. Wingate said it had not, because it gave notice of early termination, but it will be subject to fines if it pulls out of the state before July 2014, reports Beth Musgrave of the Lexington Herald-Leader.

Kentucky Spirit had argued that its contract allows it to to be terminated with six months notice. The six-month provision could only be interpreted to mean six months prior to the end of the three-year contract, said Wingate, because there has to be enough time for the state to move hundreds of thousands of Medicaid patients from Kentucky Spirit to another managed-care provider.

Jill Midkiff, a spokeswoman for the cabinet, told Musgrave that state officials were thrilled with Wingate's decision. "The cabinet's priorities are the members who receive health care through Medicaid and the taxpayers who pay for the program," she told Musgrave. "This is the right decision for both."

Friday's decision came three days after another Franklin Circuit Court judge ruled that Kentucky Spirit must reimburse health departments for services provided by school nurses to Medicaid-eligible children, which is estimated include about $8 million in back payments.

Centene officials say they are considering options for both cases, which include appeals.

Kentucky Spirit's legal battles are part of ongoing tensions between health-care providers and managed-care companies, and providers have repeatedly complained that the companies are delaying payments for services. The cabinet is hosting a series of forums across the state designed to help providers resolve such issues with the managed care companies.

2013 Winn feline health grants

The Winn Feline Foundation is pleased to announce the award of nine feline medical research grants funded through the generous support of private and corporate donations from around the world. Winn Board President Vicki Thayer, DVM, DABVP (Feline) commented, “We had a very large pool of grant proposals this year, and were impressed by the scope of studies and commitment of the researchers. The review committee considered 59 proposals and, based on a number of criteria including the quality of the science, impact of results and available funding, selected the top nine studies by consensus. This year we awarded $176,752 in grants for studies on a variety of diseases including asthma, FIP, cardiomyopathy in Norwegian Forest Cats, ringworm, pain management, kidney disease and tear disorders of the eyes.”

BRIA FUND STUDIES:
W13-020: In vivo efficacy study of virus protease inhibitors against feline coronaviruses in a mouse model; $19,920
Yunjeong Kim; Kansas State University
This study is available for sponsorship

Despite the importance of FIP as the leading infectious cause of death in young cats, there is no specific treatment approved for FIP. Therefore, it is highly desirable to develop antiviral drugs for FIP to prolong the length and quality of life for cats affected by this devastating disease. The feline coronavirus uses protease enzymes for virus replication. These researchers recently discovered novel inhibitors against the feline coronavirus 3CL protease, and these inhibitors potently inhibited the replication of feline coronaviruses in cells. The goal of this project is to test the antiviral activity of protease inhibitors in a mouse model.

W13-019: Host immune response of feline kidney cells to pathogenic and non-pathogenic feline coronavirus strains: Developing biomarkers for FIP; $25,000
Yvonne Drechsler, PhD and Pedro Diniz, DVM, PhD; Western University of Health Sciences

Feline infectious peritonitis (FIP) is a devastating disease cause by a coronavirus that is almost always fatal, especially in young cats. It causes subtle onset of signs such as persistent fever that does not respond to treatment, weight loss, and sometimes fluid accumulation in the abdomen and chest. FIP remains one of the most difficult diseases to definitively diagnose in feline medicine. There is also very limited information on how the immune system of an infected cat responds to the virus. The feline coronavirus occurs in two different forms, one infecting the gut causing only mild symptoms (FECV, feline enteric coronavirus) and the second one causing the fatal disease (FIPV). There is currently no method to distinguish between those two forms and no information on the difference in immune response to these viruses. The goal of this study is to investigate the immune response of various feline cells infected by FIPV and FECV to identify markers that can be used to distinguish between the two virus forms in order to better understand the immunity of infected cats. These results will enable researchers to develop better diagnostics and improved treatments for FIP.

BREED SPECIFIC STUDY:
W13-029: Phenotypic characterization of feline cardiomyopathy in Norwegian Forest cats using echocardiography, plasma biomarkers and histopathology; $23,577
Virginia Luis Fuentes; Royal Veterinary College, University of London
This study is available for sponsorship

Norwegian Forest cats (NFC) are at risk of an inherited form of heart muscle disease (NFC cardiomyopathy) that can result in heart failure and early death in young cats. The diagnosis can be confirmed by necropsy. Mild thickening of heart muscle may be present in less severely affected cats despite an outwardly healthy appearance. The disease usually goes undetected without special diagnostic tests, as most affected cats are normal on a physical exam. An ultrasound exam of the heart (echocardiogram) is the standard test used, but must be carried out by trained, experienced cardiologists for accurate results, thus limiting the availability of this test. Preliminary studies suggest that even for trained cardiologists, NFC cardiomyopathy may be particularly difficult to identify with a heart ultrasound test in the early stages. New blood tests (biomarkers) are showing promise as a means of identifying early heart disease in cats, and could be particularly useful in NFC cardiomyopathy. This study will compare the results of a heart ultrasound with the newer blood tests (‘NT-proBNP’ and ‘hsTnI’) as a means of identifying cats with NFC cardiomyopathy. DNA samples will also be stored from each screened cat to be used in genetic studies looking for the inherited mutation responsible for NFC cardiomyopathy. Identifying the underlying genetic mutation could lead to a blood test or even cheek swab test for identifying cats with NFC cardiomyopathy, thus making it easier for breeders to exclude affected cats from the breeding population.

WINN GENERAL FUND STUDIES:
W13-002: Longitudinal evaluation of effects of mesenchymal stem cells in feline chronic allergic asthma: Phase II; $24,983
Carol Reinero, DVM, DACVIM, PhD, University of Missouri

Asthma is a common breathing disorder in cats, decreasing quality of life and sometimes causing death. Currently asthma is managed using corticosteroids, which have many unpleasant side effects or may not be appropriate for cats with concurrent diseases like diabetes. Importantly, these medications only suppress inflammation and do nothing to reverse the underlying abnormal immune response that triggers the asthmatic syndrome. There is a need for new safe and effective treatments for feline asthma. Pilot data from an earlier Winn-funded study indicates that stem cells can be administered safely and alter some aspects of the immune response initially after administration. Other exciting data suggests the most dramatic response to stem cell therapy occurs months after administration. This study will continue the earlier work with evaluation of the long term effects of stem cells on the key features of asthma, which include airway inflammation and airway constriction.

W13-012: Detection of dermatophytosis in cats by PCR; $10,670
Stephen Kania, PhD and Linda Frank, MS, DVM, DACVD; University of Tennessee
This study is available for sponsorship

Ringworm is a condition affecting cats that is caused by a fungal infection. Humans and pets can acquire ringworm from infected cats. Shelter cats are at high risk and should be screened before being introduced to other pets. The current method of testing, fungal culture, may take weeks to provide a definitive answer. This study involves the development of molecular techniques to provide rapid diagnosis so cats can be effectively treated, thus reducing the threat of owners and other pets contracting ringworm.

W13-042: Investigating feline morbillivirus molecular epidemiology in cats in the North Eastern United States and potential associations with chronic kidney disease; $24,734
Claire Sharp and Martin Ludlow; Tufts Cummings School of Veterinary Medicine

Chronic kidney disease (CKD) has been described by distinguished researchers as feline enemy number one, since it is very common and associated with high morbidity and mortality. Frustratingly, despite considerable research in the field, we still do not know what causes CKD in cats. Recently, a newly discovered virus, called feline morbillivirus (FMV) was associated with CKD in cats in Hong Kong and China. FMV is related to other viruses that cause serious disease in other species such as distemper virus in dogs, and measles virus in people. Given the potentially huge implications of this virus for cats, this group proposes to further investigate this virus in cats in the United States. The objectives of the proposed study are to attempt to identify FMV in cats in New England and evaluate for a potential association between FMV infection and CKD in cats. Additionally, isolation of the virus will be vital in order to perform future studies evaluating the disease causing potential of this virus.

W13-044: Novel methods for assessing the tear film and ocular surface in cats; $21,665
David J. Maggs; University of California-Davis

In all species, including cats, the surface of the eye is coated by a thin film of tears, critical for comfort, eye health, and vision. The tear film improves vision, provides corneal lubrication, nutrition, and protection from infection, and flushes debris from the ocular surface. The tear film is composed of three layers: an outer lipid layer, a middle aqueous layer, and an inner mucous layer. Abnormalities in these tear layers are associated with rapid evaporation of the tears and drying of the conjunctiva and cornea, which is highly painful and potentially blinding. Tear film abnormalities are an important part of many common feline diseases such as dry eye, feline herpesvirus, Chlamydia and Mycoplasma infections, where they lead to increased discomfort and exacerbate inflammation. Despite this, current understanding of the feline tear film and methods of assessing it are rudimentary. Although “artificial tear” eye-drops provide temporary relief in such conditions, they require accurate and convenient tests to identify the affected tear film layer and for monitoring response to treatment. Recently, new, non-painful, tests have been developed for diagnosing and monitoring tear film disorders in humans. It is predicted that these tests will have similar value in cats. Therefore, in this study the researchers will establish normal values for these new tests in cats. This information will be of immediate use to veterinarians worldwide because it will allow early diagnosis and treatment of tear film abnormalities in cats, which will minimize ocular pain and the potential for severe or chronic complications.

W13-046: Pain Management in Cats: Studying the Interaction of Buprenorphine and Hydromorphone with Fentanyl; $2,878
Barbara Ambros; Western College of Veterinary Medicine-University of Saskatchewan

Opioids are considered the best type of pain medication for moderate to severe pain in cats after undergoing surgery or trauma. Common opioids include morphine, buprenorphine, hydromorphone and fentanyl. When an opioid binds to an opioid receptor, it causes an analgesic (pain alleviating) response. Buprenorphine is deemed preferable over other opioids because its effects last longer and it has limited side effects. Although buprenorphine binds very strongly to opioid receptors in the central nervous system, it does not achieve a maximal analgesic response. Therefore, it may be necessary to supplement use of buprenorphine with a more powerful opioid. However, the unique binding behavior of buprenorphine might leave more powerful opioids, such as fentanyl, relatively ineffective if the two drugs are used together. The purpose of this study is to investigate the analgesic interaction between buprenorphine and fentanyl in cats. The hypothesis is that pre-treatment with buprenorphine will decrease the pain relieving action of fentanyl. Researchers will also investigate the interaction between hydromorphone and fentanyl. Hydromorphone and fentanyl have a similar binding affinity to the opioid receptor and expect an increased pain relieving effect when these drugs are combined. Pain relief will be tested using thermal and mechanical pain thresholds as a direct indicator of pain. This method is a humane method of assessing pain and is in accordance with Winn’s humane policies. An increase in pain threshold to a thermal or pressure stimulus will be used to give an adequate representation of clinical analgesia. These findings will be used to guide veterinarians in drug selection for pre-surgical pain management or treatment for trauma in cats.

W13-053: A Reproducible Protocol to Isolate a Characterized Population of Adult Feline Progenitor Cells - Continuation; $23,325
Mandi J. Lopez, DVM, MS, PhD and Nan Zhang; Louisiana State University School of Veterinary Medicine

Adult stem cells have significant promise to fulfill medical needs of feline companions. An earlier Winn-funded study developed a way to isolate enough stem cells from adipose tissue (fat) removed during routine castration for standard treatments. This study will expand upon this success by further improving the technique to isolate those cells that are best for transplantation into cats that are not related to the donor. The ultimate goal is to isolate stem cells from tissues removed during elective castration with the best tissue formation in cats with limited healing capacity due to injury or disease. Cells will initially be selected based on the presence of stem cell proteins on their surfaces. They will then be subdivided into three groups depending on whether or not they express proteins that allow the immune system to distinguish self from foreign cells. The growth rate and ability to turn into different tissues will be compared among the groups before and after cryopreservation. It is predicted that stem cells that do not express the “self” complexes will have better tissue generation and faster growth rates than those that do. This study will provide vital information about a “universal” stem cell pool with the best tissue formation and least likelihood for rejection when used to treat feline patients. The results will significantly enhance knowledge surrounding adult stem cell therapies in feline companions.

Winn has funded over $4 million in feline health research – read about our other projects.
Our projects are funded by generous donations from cat lovers around the world – donate now to help us fund next year’s projects.

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New report ranks Kentucky 45th in overall senior health

By Molly Burchett
Kentucky Health News

Everyone dreams about retirement being a happy, healthy time to finally settle down, take time for yourself, travel and count your blessings, but a recent reports suggests that if you want to retire right now in a healthy environment, don't stay in Kentucky.

Kentucky ranks 45th in overall health rankings for seniors and last in two measures: total health outcomes for seniors and preventable hospitalizations, says United Health Foundation's America’s Health Rankings Senior Report. Kentucky was next to last in cognition and education of seniors and prevalence of dental visits, and likewise second worst in premature death rate for seniors.

The report shows Minnesota at the top of the list, with Vermont and New Hampshire following closely and Mississippi as the least healthy state for older adults.

This report aims to point out the health challenges affecting today’s seniors and encourage action that improves communities' overall health. In Kentucky, the reports shows community support is low, with total community expenditures at $358 per person aged 65 and older living in poverty, much lower than Minnesota's $542 per capita.

Not all of the report's findings about Kentucky were bad; the state is strong in three areas: underweight seniors, activity-limiting arthritis pain and low-care nursing home residents. And, on another positive note, Kentucky ranks 15th in the number of seniors receiving flu vaccines and 10th in pain management for seniors. Click here for details.

Determinants that were considered in the state's ranking include behaviors like smoking and dental visits; micro and macro community and environment measures like poverty and social support; policy measures like the state's geriatrician shortfall; and measures of clinical care like home health or hospital care and diabetes management.

The health of our state's seniors is critical, especially as baby boomers age. The number of Americans age 65 and older is expected to more than double by 2050, from 40.3 million to 88.5 million, according to the federal Centers for Disease Control and Prevention. About 13.5 percent of Kentuckians are 65 or older, which is higher than the national average. Considering this, the report generates a provoking question. If our state's seniors are unhealthy, can Kentucky be healthy?

Scoliotrack is a Safe and Innovative Way to Track One's Scoliosis Condition: Now Available for Android and 17 Languages!

Singapore

23 May 2013

www.ScolioTrack.com

FEATURES VIDEO: http://www.youtube.com/watch?v=xkmn8Edu3yc

Announcing to a global audience, innovation, technology, and clinically proven method of tracking your Scoliosis condition. Scoliotrack who’s technology and innovation was recognized and invited to the Wall Street Journal 2011 Asia Innovative Awards, is now in the hands of those that need it. By consumer demand, easy, affordability, and designed for patients, Scoliotrack has now been released as an App.

Functions include:

- New easy to use design.

- Monthly reminders for scoliosis for simple scoliosis monitoring.

- Designed and compatible for iPhone 4 and 5 with retina display compatibility.

- Compatible with iPhone and Android.

- Expanded help and tutorial video to provide the ultimate in ease and convenience of use.

- 17 new languages supported: Korean, Japanese, Chinese, French, German, Spanish, Italian, Greek, Finnish, Russian, Swedish, Vietnamese, Thai, Brazilian, Portuguese, and Portugal Portuguese.

The power of the App and the system lies in the technology. In lieu of the costly and most cases unaffordable Scoliometers, Scoliotrack was designed for immediate and affordable use. Scoliometers ranged in cost of $50.00(USD). Now with Scoliotrack, you can own yours for $4.99(USD). Now you can safely, easily, and affordably diagnose, monitor, and track your monthly progression. Dr. Lau, with this clinically tested and proven App shows that anyone, from any walk of life, with no medical training can use this App and ensure their health and progression in dealing with Scoliosis.

Scoliotrack, safer than x-ray technology, can be used in between doctor visits to accurately access the progression of condition. From the abnormal spine curve, rib humps, hip protrusion, body alignment, or spinal deviation on your phone. All your data is securely saved for future use, with all the up to date information you need.

Proven, ease, life changing. All of the adjectives used to describe this innovation. Do not delay. Go to www.ScolioTrack.com today and download this app from the iTunes store or Google Play. Dr. Kevin Lau’s books and DVD on Nautral Scoliosis Treatment and Prevention having been empowering the lives of scoliosis sufferers worldwide, and this App is the an important extension to your treatment option to keep Health in Your Hands.

About Dr Kevin Lau

Dr Kevin Lau is a Singapore chiropractor and the founder of Health In Your Hands, a series of tools for Scoliosis prevention and treatment. The set includes his book Your Plan for Natural Scoliosis Prevention and Treatment, a companion Scoliosis Exercises for Prevention and Correction DVD and the innovative new iPhone application ScolioTrack. Dr Kevin Lau is a graduate in Doctor of Chiropractic from RMIT University in Melbourne Australia and Masters in Holistic Nutrition. He is a member of International Society On Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), the leading international society on conservative treatment of spinal deformities. In 2006 I was awarded the "Best Health-care Provider Awards" by the largest Newspaper publication in Singapore on October 18 2006 as well as being interviewed on Primetime Channel News Asia as well as other TV and Radio. For more information on Dr Kevin Lau, watch his interviews or get a free sneak peek of his book, go to:

Website - http://www.hiyh.info.
ScolioTrack Website - http://www.ScolioTrack.com.
Facebook - https://www.facebook.com/HealthInYourHands.
Youtube - http://www.youtube.com/user/DrKevinLau.
Twitter - http://www.Twitter.com/DrKevinLau.

Singapore

23 May 2013

www.ScolioTrack.com

FEATURES VIDEO: http://www.youtube.com/watch?v=xkmn8Edu3yc

Functions include:

- New easy to use design.

- Monthly reminders for scoliosis for simple scoliosis monitoring.

- Designed and compatible for iPhone 4 and 5 with retina display compatibility.

- Compatible with iPhone and Android.

- Expanded help and tutorial video to provide the ultimate in ease and convenience of use.

- 17 new languages supported: Korean, Japanese, Chinese, French, German, Spanish, Italian, Greek, Finnish, Russian, Swedish, Vietnamese, Thai, Brazilian, Portuguese, and Portugal Portuguese.

About Dr Kevin Lau

Natural News Blogs tell the truth about America and plight

Ever heard the story of the prison guard who loved breaking the rules himself, until he winded up on the other side of the barbed wire, where the repeat offenders talk about their “innocence” and their “Bill of Rights” that is gone? The IRS is the new bull on the “block” and they might not like reaping what they’ve sown:

http://naturalnewswatch.wordpress.com/2013/05/28/top-irs-official-now-seeks-refuge-in-bill-of-rights-even-after-her-departments-attack-on-the-constitution/

When natural disaster strikes a city, town, state, or region in the U.S., the President and CNN are always quick to “cover” the tragedy, but how fast is FEMA to react. In the recent past, we’ve seen nothing but extended wait nightmares. It’s time to rely on yourself, before the next disaster spins your way:

http://naturalnewstracker.wordpress.com/2013/05/28/natural-news-health-news-on-line-tornado-tears-oklahoma-apart-natural-news-offers-help/

http://naturalnewswatch.wordpress.com/2013/05/28/top-irs-official-now-seeks-refuge-in-bill-of-rights-even-after-her-departments-attack-on-the-constitution/

http://naturalnewstracker.wordpress.com/2013/05/28/natural-news-health-news-on-line-tornado-tears-oklahoma-apart-natural-news-offers-help/

Judge orders Medicaid managed-care firm to pay for school health services, including $8 million in claims; appeal possible

Medicaid managed care company Kentucky Spirit must cover preventive care services provided by local health departments in schools, a judge has ruled.

Circuit Judge Phillip Shepherd of Frankfort said the company must pay $8 million for the services already provided by school nurses, which would be only .07 percent of its estimated profit for 2013, according to the updated earnings report of Centene Corp. of St. Louis, the parent company for Kentucky Spirit. The company is the only one of the five managed care organizations in Kentucky that had disputed the coverage of school health services.

Kentucky Spirit stopped providing coverage for school health services last summer, saying its state contract didn't require payment for such services,but Shepherd noted that the state reimbursed health departments for school services before it transitioned to managed care, reports Tom Loftus of The Courier-Journal. “Kentucky Spirit is not free to disregard this longstanding interpretation of Medicaid eligibility and unilaterally re-interpret these to the detriment of local health departments,” Shepherd wrote.

Health departments and school districts will now find some relief because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for services. “It’s great news because there have been dozens of districts that have had to either say they are going to cut back on nurses, or that they are going to close clinics, or that they are going to dip into their reserves to try to cover the additional costs,” Kentucky School Boards Association spokesman Brad Hughes told Loftus.

Gov. Steve Beshear said Kentucky Spirit had “sought a loophole” in its contract to avoid paying for school health services covered by Medicaid, writes Loftus. Centene released a statement later Tuesday saying that the company is reviewing options and considering an appeal.

This isn't the only payment Centene is trying to avoid. A ruling is expected soon in a lawsuit the company filed against the state last year seeking to end its contract a year early, saying the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million.

Appalachian Regional Healthcare, the largest health-care system in Eastern Kentucky, filed suit in April of this year against Kentucky Spirit for $5.9 million in unpaid claims. This suit is still pending, and was filed just before Centene raised its full-year forecast for premium and service revenue to $10.1 billion to $10.4 billion, Reuters reports.

Sick of all the bad facts about Kentucky's health? Here's encouraging news about oral health and drug treatment

Despite the plethora of bad news about Kentucky's poor health status, there are many positive initiatives for Kentucky's oral health and substance abuse treatment, which were stories buried under health news headlines about Medicaid expansion and low health rankings.

The Kentucky Board of Dentistry recently established the position of public heath dental hygienist, permitting hygienists to go into Kentucky schools to assess teeth on the front lines, which will provide basic preventive dental care to underserved kids with tooth problems through local health departments, Al Smith, left, reports in an opinion piece for the Lexington-Herald Leader.

"These hygienists will be able to do school fluoride varnish programs, place sealants, refer kids in pain, and promote dental health programs (like brushing and better nutrition) in the schools without being supervised by a dentist," Dr. Rankin Skinner, director of the Clark County Dental Health Initiative, told Smith. "I think this is a major step in developing dental health program like ours across the state and moving our kids towards better health in general."

The initiative, comprising 17 dentists and 127 volunteers, was selected as a national model by a national association of all the health departments. "It isn't often that a private volunteer program in Kentucky sets a national standard," Skinner told Smith.

Meanwhile, in Florence, Kentucky's first lady, Jane Beshear, a Democrat, joined her Republican co-chair of Recovery Kentucky, Lexington homebuilder Don Ball, to celebrate the Brighton Recovery Center's fifth birthday and nearly 800 graduates.

Brighton is one of the 10 new homes for Recovery Kentucky, a program that is also becoming a national model, Smith writes. Since its inception during the Fletcher administration, the program has provided supportive housing and addiction recovery programs to over 10,000 men and women, writes Smith.

Beshear said the next steps are for her and Ball to create more drug-free housing and jobs for graduates of the program, Smith reports. This goal creates hope for other successful initiatives and shines a ray of light at the end of a dark and dreary tunnel.


Pikeville Medical Center President Walter May and Dr. Stephen Lange, Mayo Clinic's Southeast medical director

Pikeville Medical Center joined the Mayo Clinic Care Network last week, extending the clinic's knowledge and expertise to PMC staff, which the hospital says will improve health care delivery for 420,000 Appalachians while allowing them to stay close to home.

Some of the resources that will now be available to PMC physicians and providers include its online point-of-care information system and electronic consulting that connects physicians with Mayo Clinic specialists about diagnosis, therapy or care management, says a PMC news release.

“Pikeville Medical Center is honored that we have been asked to become a member of Mayo Clinic Care Network,” says Walter E. May, president and chief executive officer of PMC. “I have admired Mayo Clinic for many years and tried to make Pikeville Medical Center more like the Mayo Clinic. This new agreement will take our hospital to the next level.”

The primary goal of the Mayo Clinic Care Network is to offer Mayo Clinic expertise close to home so that patients only travel when necessary, says the release. The network was launched in 2011 and has member organizations based in Arizona, Florida, Illinois, Kentucky, Michigan, Minnesota, Missouri, Montana, New Hampshire, North Dakota, Puerto Rico and Mexico. See details about specific hospitals in the map below.

“We are pleased to welcome Pikeville Medical Center and its more than 2,000 employees into our Mayo Clinic Care Network family,” says Stephen Lange, M.D., southeast medical director of the Mayo Clinic Care Network. “Our mission is to work collaboratively to improve the quality of health care and value for our patients. We are very excited to work together with Pikeville to find bold and innovative ways to enhance the quality of life for the patients in that region of the country.”

PMC serves 420,000 people and 15 counties in Kentucky, Virginia and West Virginia, and the hospital is currently undergoing a $150 million expansion.


Pikeville Medical Center President Walter May and Dr. Stephen Lange, Mayo Clinic's Southeast medical director

Religious business owners and corporations have filed half the lawsuits over health reform mandate to cover contraception

By Molly Burchett
Kentucky Health News

Some religious business owners are filing suit against the government, saying the health-reform law violates the constitutional freedom of religion by mandating employee contraceptive and abortion-inducing drug coverage; the lawsuits are expected to land in the U.S. Supreme Court, and a case filed by Hobby Lobby is the first of this kind to be heard by a federal appeals court.

Challenges to the mandate that will require businesses with more than 50 employees to provide no-cost coverage of all contraceptives, sterilization procedures, plus education and counseling, are not just coming from Catholic entities with a religious, moral objection to contraception. About half of the cases have been filed by corporations, reports Robert Barnes of The Washington Post.

There are now 60 cases involving 190 individuals representing hospitals, universities, businesses, schools and people opposed to the mandate, says the Becket Fund for Religious Liberty. The Becket Fund maps the cases, as shown below; for the interactive version, click here.

Since the law mandates contraceptive coverage, groups such as Catholic bishops have accused the Obama administration of waging war on religious liberty, reports Barnes. In February, the administration announced an exemption for faith-based organizations from covering employees' contraception costs because the conceptions would be covered by a third party. Self-insured organizations like Catholic schools sued, arguing that the accommodation would not apply to them because there is no third-party insurer to cover contraception. But those cases have been dismissed in court because such organizations are given a one-year grace period to comply with the mandate, reports Laura Bassett of the Huffington Post.

Businesses don't qualify for faith-based exemption from mandates


Hobby Lobby's David and Barbara Green

Business do not meet the new exemption either, because they are not religious organizations. However, some businesses like Hobby Lobby, which was founded and is still owned by an evangelical Christian family that believes life begins at conception and already covers contraceptives through existing employee health coverage, are fighting the law's mandate to cover abortion-inducing drugs or devices, like morning-after and week-after pills.

"They ought to be able — just like a church, just like a charity — to have the right to opt out of a provision that infringes on their religious beliefs," said Kyle Duncan, who argued the case Thursday before the 10th Circuit Court of Appeals on behalf of the Green family, and a sister company, Christian booksellers Mardel Inc, reports The Associated Press.

Other suits have been filed by religious business owners of diverse enterprises, from a company that makes wooden cabinets to owners of Panera Bread restaurants, reports Barnes, but all the cases base their arguments on the First Amendment guarantee of free exercise of religion and on the Religious Freedom Restoration Act of 1993. The Hobby Lobby case also specifies that the mandate violates freedom of speech and the Administrative Procedure Act because it was imposed without prior notice or sufficient time for public comment.

In the early stages of litigation, lower courts have split on the issue. Some have rejected Hobby Lobby's request for an exemption to the mandate, and requests by other businesses for a temporary injunction, saying for-profit businesses aren't covered by the faith-based exemption. However, courts in St. Louis and the Seventh Circuit have granted temporary injunctions. (Read more)


Hobby Lobby's David and Barbara Green

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