After several groups say Pap smears aren't needed every year, ob/gyns recommend an annual 'well-woman' visit

Though several groups have said women don't need a Pap smear every year, obstetricians and gynecologists still recommend an annual "well-woman" visit and annual pelvic exams for all females over 21.

These new recommendations by the American College of Obstetricians and Gynecologists were published Monday. They come a few months after the American Cancer Society, the U.S. Preventive Services Task Force and other groups said most women only need a Pap smear every three years starting at age 21. After the age of 30, they can get them less often if they also get tests for the human papillomavirus, known to cause cervical and other cancers.

The visit "can be used to check blood pressure and weight, update immunizations, counsel patients on healthy lifestyles, screen for sexually transmitted infections and other health problems, perform breast exams and build relationships between doctors and patients," reports Kim Painter for USA Today.

But some critics question if these visits are just a way to make money. "We estimate that about $8 billion a year is spent on preventive yearly physicals of all kinds," said Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine. "The question is whether we could spend those $8 billion more wisely." (Read more)

Though several groups have said women don't need a Pap smear every year, obstetricians and gynecologists still recommend an annual "well-woman" visit and annual pelvic exams for all females over 21.

These new recommendations by the American College of Obstetricians and Gynecologists were published Monday. They come a few months after the American Cancer Society, the U.S. Preventive Services Task Force and other groups said most women only need a Pap smear every three years starting at age 21. After the age of 30, they can get them less often if they also get tests for the human papillomavirus, known to cause cervical and other cancers.

The visit "can be used to check blood pressure and weight, update immunizations, counsel patients on healthy lifestyles, screen for sexually transmitted infections and other health problems, perform breast exams and build relationships between doctors and patients," reports Kim Painter for USA Today.

But some critics question if these visits are just a way to make money. "We estimate that about $8 billion a year is spent on preventive yearly physicals of all kinds," said Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine. "The question is whether we could spend those $8 billion more wisely." (Read more)

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Kentucky students will get extra education in nutrition, exercise

Kentucky children will get extra nutrition education at school starting Oct. 1, thanks to a $6 million federal grant intended to instill better eating and physical-activity habits in families eligible for food stamps.

The education will be provided by local health departments. It will encourage students to:
• Fill half their plates with fruits and vegetables; drink fat-free or low-fat milk; and make sure they eat whole grains.
• Increase physical activity and cut down on sedentary behaviors.
• Consume the appropriate amount of calories for their age.

Kentucky students will get more nutrition education
aimed at getting those eligible for the Supplemental
Nutrition Assistance Program to make healthy food
choices. (Photo from The Lane Report)

Details about how many children will benefit from the education and how many minutes of instruction they will receive per week have not yet been ironed out, said Beth Fisher, spokeswoman for the Cabinet for Health and Family Services.

"Sometimes children can be the best teachers, so our hope is that they will pass on to their parents some of what they have learned at school about the importance of nutrition and physical activity," said Teresa James, acting commissioner of the Department of Community Based Services. "If children ask their parents to serve more fruits and vegetables, or take a walk instead of watching TV and the parents comply, this effort can benefit the entire household — just look at the influence children have had on recycling." (Read more)

Kentucky children will get extra nutrition education at school starting Oct. 1, thanks to a $6 million federal grant intended to instill better eating and physical-activity habits in families eligible for food stamps.

The education will be provided by local health departments. It will encourage students to:
• Fill half their plates with fruits and vegetables; drink fat-free or low-fat milk; and make sure they eat whole grains.
• Increase physical activity and cut down on sedentary behaviors.
• Consume the appropriate amount of calories for their age.

Kentucky students will get more nutrition education
aimed at getting those eligible for the Supplemental
Nutrition Assistance Program to make healthy food
choices. (Photo from The Lane Report)

Details about how many children will benefit from the education and how many minutes of instruction they will receive per week have not yet been ironed out, said Beth Fisher, spokeswoman for the Cabinet for Health and Family Services.

"Sometimes children can be the best teachers, so our hope is that they will pass on to their parents some of what they have learned at school about the importance of nutrition and physical activity," said Teresa James, acting commissioner of the Department of Community Based Services. "If children ask their parents to serve more fruits and vegetables, or take a walk instead of watching TV and the parents comply, this effort can benefit the entire household — just look at the influence children have had on recycling." (Read more)

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Pneumothorax in cats

Mooney ET, Rozanski EA, King RG and Sharp CR. Spontaneous pneumothorax in 35 cats (2001-2010). J Feline Med Surg. 2012; 14: 384-91.
 
Pneumothorax, or free air in the pleural (thoracic) space, is usually the result of trauma but it can appear to be spontaneous. This study reviewed 35 cases of spontaneous pneumothorax (SP) in cats over a 10-year period. The objective was to identify causes, evaluate treatment options, and report the case outcomes. The majority of the cats were male with a median age of 8 years. The most common presenting complaint was acute onset of respiratory distress. In all the cases of cats with an established etiology, SP was associated with lung disease. The underlying associated diseases included inflammatory airway disease (most common), neoplasia, heartworm infection, pulmonary abscess, and lungworm infection. Many of the patients were managed successfully with only observation or needle thoracocentesis to remove air, and specific treatment for their primary lung disease. In contrast to dogs, surgery was associated with a poor outcome in 4 of 5 cats. [VT]

See also: White H, Rozanski E, Tidwell A, Chan D and Rush J. Spontaneous pneumothorax in two cats with small airway disease. J Am Vet Med Assoc. 2003; 222: 1573-5.

More on cat health:
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Mooney ET, Rozanski EA, King RG and Sharp CR. Spontaneous pneumothorax in 35 cats (2001-2010). J Feline Med Surg. 2012; 14: 384-91.
 
Pneumothorax, or free air in the pleural (thoracic) space, is usually the result of trauma but it can appear to be spontaneous. This study reviewed 35 cases of spontaneous pneumothorax (SP) in cats over a 10-year period. The objective was to identify causes, evaluate treatment options, and report the case outcomes. The majority of the cats were male with a median age of 8 years. The most common presenting complaint was acute onset of respiratory distress. In all the cases of cats with an established etiology, SP was associated with lung disease. The underlying associated diseases included inflammatory airway disease (most common), neoplasia, heartworm infection, pulmonary abscess, and lungworm infection. Many of the patients were managed successfully with only observation or needle thoracocentesis to remove air, and specific treatment for their primary lung disease. In contrast to dogs, surgery was associated with a poor outcome in 4 of 5 cats. [VT]

See also: White H, Rozanski E, Tidwell A, Chan D and Rush J. Spontaneous pneumothorax in two cats with small airway disease. J Am Vet Med Assoc. 2003; 222: 1573-5.

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Read the Cat Health News Weekly
Join us on Google+

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Cost of long-term-care insurance going up, but it's still a wise investment, depending on your income

Judy Witte says her long-term-care insurance premiums
are going up at a worrying rate. C-J photo by Matt Stone.

Seniors are facing increases in their premiums for long-term-care insurance as insurance companies scramble to deal with increasing longevity of seniors and low interest rates that are "crimping investment returns," Chris Otts reports for The Courier-Journal.

Louisville retiree Judy Witte, 72, said she received a letter from her insurance company recently saying her premiums will go up by 77 percent, from $986 to $1,746 per year.

Her situation is part of a larger trend in which the cost of an average policy has increased by 6 to 17 percent from 2011 to 2012. Long-term-care insurance helps pay for the cost of assisted living, nursing homes, hospice care and home care.

In the Louisville area, assisted living costs about $45,000 per year and nursing homes cost about $72,000 per year and more.

People should buy long-term-care insurance if they can't afford the care they might need without dipping into their savings, Otts reports. "For example, someone who receives $100,000 a year in retirement income but spends only $30,000 might be able to afford an assisted-living center or nursing home," Otts notes. But if that same person spends $80,000 a year, then it would be a wise investment to buy long-term-care insurance because they would not be able to afford the assisted living or nursing home costs.

The right time to buy long-term-care insurance is between age 50 and 60. If Witte had waited to buy hers today, it would have cost her more than $26,000 a year, Otts reports. "To me, it's a precious possession," she said. "It helps me sleep at night to know I have this." (Read more)

Judy Witte says her long-term-care insurance premiums
are going up at a worrying rate. C-J photo by Matt Stone.

Seniors are facing increases in their premiums for long-term-care insurance as insurance companies scramble to deal with increasing longevity of seniors and low interest rates that are "crimping investment returns," Chris Otts reports for The Courier-Journal.

Louisville retiree Judy Witte, 72, said she received a letter from her insurance company recently saying her premiums will go up by 77 percent, from $986 to $1,746 per year.

Her situation is part of a larger trend in which the cost of an average policy has increased by 6 to 17 percent from 2011 to 2012. Long-term-care insurance helps pay for the cost of assisted living, nursing homes, hospice care and home care.

In the Louisville area, assisted living costs about $45,000 per year and nursing homes cost about $72,000 per year and more.

People should buy long-term-care insurance if they can't afford the care they might need without dipping into their savings, Otts reports. "For example, someone who receives $100,000 a year in retirement income but spends only $30,000 might be able to afford an assisted-living center or nursing home," Otts notes. But if that same person spends $80,000 a year, then it would be a wise investment to buy long-term-care insurance because they would not be able to afford the assisted living or nursing home costs.

The right time to buy long-term-care insurance is between age 50 and 60. If Witte had waited to buy hers today, it would have cost her more than $26,000 a year, Otts reports. "To me, it's a precious possession," she said. "It helps me sleep at night to know I have this." (Read more)

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Six of 41 child-abuse fatalities show improper follow-up by Cabinet for Health and Family Services, Herald-Leader analysis finds

The way child-abuse deaths are reviewed in Kentucky continues to be problematic. Looking at the 41 child fatalities in 2009 and 2010, Lexington Herald-Leader reporters Beth Musgrave and Bill Estep found at least six cases in which the Cabinet for Health and Family Services "did not do an internal review even though there were previous reports involving the family before the child died."

State law requires the cabinet to conduct such a review when a child dies or nearly dies because of abuse or neglect and the cabinet had prior involvement with the family.

That didn't happen in the case of 2-year-old Derek Cooper, whose father placed his hands over the crying boy's mouth "until the child was silent," a state report said. Cooper's father, Brandon Fraley, had had contact with the cabinet when he was a child himself, and in 2006 there was an allegation of domestic violence against him, Musgrave and Estep report. Cabinet spokeswoman Jill Midkiff said the cabinet doesn't do internal reviews when the contact with the cabinet occurred when the alleged abuser was a child, but Midkiff "provided no explanation about why the 2006 domestic violence investigation of Fraley didn't trigger an internal review," the newspaper reports.

The analysis also showed vast differences in the way internal reviews are conducted in different parts of the state. "Some of the reviews appeared to be thorough, but in others, child-protection workers produced only one-page reports with little detail on what happened to the children and no assessment of potential improvements," Musgrave and Estep report.

"The cabinet for so long has hidden everything it could," said state Rep. Susan Westrom, D-Lexington, who tried earlier this year to pass a bill that would create an external child-fatality review panel. Gov. Steve Beshear has issued an order to create such a panel, whose members will review cases and make recommendations. The panel will not have cabinet staff as members.

Westrom's bill got hung up partly over the cabinet's attempt to impose further restrictions on the sort of information it is required to make public. The newspaper's analysis the result of a long fight the Herald-Leader and The Courier-Journal have waged to make the child-abuse documentation available to the public. C-J lawyer Jon Fleischaker said on KET yesterday that the cabinet continues to redact more information that it should, in an effort to protect its own interests. The fight continues in the appellate courts. (Read more)

The way child-abuse deaths are reviewed in Kentucky continues to be problematic. Looking at the 41 child fatalities in 2009 and 2010, Lexington Herald-Leader reporters Beth Musgrave and Bill Estep found at least six cases in which the Cabinet for Health and Family Services "did not do an internal review even though there were previous reports involving the family before the child died."

State law requires the cabinet to conduct such a review when a child dies or nearly dies because of abuse or neglect and the cabinet had prior involvement with the family.

That didn't happen in the case of 2-year-old Derek Cooper, whose father placed his hands over the crying boy's mouth "until the child was silent," a state report said. Cooper's father, Brandon Fraley, had had contact with the cabinet when he was a child himself, and in 2006 there was an allegation of domestic violence against him, Musgrave and Estep report. Cabinet spokeswoman Jill Midkiff said the cabinet doesn't do internal reviews when the contact with the cabinet occurred when the alleged abuser was a child, but Midkiff "provided no explanation about why the 2006 domestic violence investigation of Fraley didn't trigger an internal review," the newspaper reports.

The analysis also showed vast differences in the way internal reviews are conducted in different parts of the state. "Some of the reviews appeared to be thorough, but in others, child-protection workers produced only one-page reports with little detail on what happened to the children and no assessment of potential improvements," Musgrave and Estep report.

"The cabinet for so long has hidden everything it could," said state Rep. Susan Westrom, D-Lexington, who tried earlier this year to pass a bill that would create an external child-fatality review panel. Gov. Steve Beshear has issued an order to create such a panel, whose members will review cases and make recommendations. The panel will not have cabinet staff as members.

Westrom's bill got hung up partly over the cabinet's attempt to impose further restrictions on the sort of information it is required to make public. The newspaper's analysis the result of a long fight the Herald-Leader and The Courier-Journal have waged to make the child-abuse documentation available to the public. C-J lawyer Jon Fleischaker said on KET yesterday that the cabinet continues to redact more information that it should, in an effort to protect its own interests. The fight continues in the appellate courts. (Read more)

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Questions about health-care reform law answered in comprehensive Courier-Journal report

Reporter Laura Ungar has put together an excellent primer in The Courier-Journal that appears to answer all the key questions people have about the federal health-care reform law. Reporters would do well to refer to Ungar's report when writing about the Patient Protection and Affordable Care Act.

The piece breaks down how the law will affect adults, young people, senior citizens and business owners. "Experts agree the changes will be sweeping," Ungar reports.

Ungar asks questions like:
• What is the individual mandate? It means everyone must have health insurance by 2014 or pay a fine. By 2016, the penalty will increase to $695 for individuals and $2,085 for families or 2.5 percent of their income.

• Will I become eligible for Medicaid under the new law? That's not yet clear because Kentucky hasn't decided whether or not to expand the program. If it does choose to expand, people who earn up to 138 percent of the federal poverty level will qualify, which means individuals who earn up to $15,415 or a family of four that earns up to $31,809.

• Are there any new taxes under the law? Yes. The individual mandate can be interpreted as a tax. Also people who earn more than $200,000 and married couples who earn $250,000 combined will pay a payroll tax of 2.35 percent, up from 1.45 percent.

• How will I find health insurance? A state health insurance exchange will be set up by 2014 so people who earn up to 400 percent of the federal poverty level — an annual income of about $90,000 for a family of four —can buy health insurance.

• How can young people stay on their parents' health insurance plan? They are eligible under the new law to stay on their parents' plan until the age of 26. So far, 35,600 young adults in Kentucky have gotten coverage this way.

• What if my young child gets married or pregnant? The child will be covered and so would the pregnancy if the parents' plan allows for that. The plan doesn't have to cover the baby, however.

• Will my premiums go up if I get insurance through my job? That's still unclear. "There are provisions that could push up premiums slightly, such as the elimination of lifetime caps on coverage, but there are also provisions that could push them down, such as the influx of many more healthy young people," Ungar reports.

• How does the law affect Medicare coverage? Benefits have not changed, but there will no longer be co-pays for preventive services like mammograms and prostate-cancer screenings, "a provision that has affected more than 1.2 million seniors in Kentucky," Ungar reports.

The report is worth reading in its entirety and could be used as a regular reference about the law. (Read more)

Reporter Laura Ungar has put together an excellent primer in The Courier-Journal that appears to answer all the key questions people have about the federal health-care reform law. Reporters would do well to refer to Ungar's report when writing about the Patient Protection and Affordable Care Act.

The piece breaks down how the law will affect adults, young people, senior citizens and business owners. "Experts agree the changes will be sweeping," Ungar reports.

Ungar asks questions like:
• What is the individual mandate? It means everyone must have health insurance by 2014 or pay a fine. By 2016, the penalty will increase to $695 for individuals and $2,085 for families or 2.5 percent of their income.

• Will I become eligible for Medicaid under the new law? That's not yet clear because Kentucky hasn't decided whether or not to expand the program. If it does choose to expand, people who earn up to 138 percent of the federal poverty level will qualify, which means individuals who earn up to $15,415 or a family of four that earns up to $31,809.

• Are there any new taxes under the law? Yes. The individual mandate can be interpreted as a tax. Also people who earn more than $200,000 and married couples who earn $250,000 combined will pay a payroll tax of 2.35 percent, up from 1.45 percent.

• How will I find health insurance? A state health insurance exchange will be set up by 2014 so people who earn up to 400 percent of the federal poverty level — an annual income of about $90,000 for a family of four —can buy health insurance.

• How can young people stay on their parents' health insurance plan? They are eligible under the new law to stay on their parents' plan until the age of 26. So far, 35,600 young adults in Kentucky have gotten coverage this way.

• What if my young child gets married or pregnant? The child will be covered and so would the pregnancy if the parents' plan allows for that. The plan doesn't have to cover the baby, however.

• Will my premiums go up if I get insurance through my job? That's still unclear. "There are provisions that could push up premiums slightly, such as the elimination of lifetime caps on coverage, but there are also provisions that could push them down, such as the influx of many more healthy young people," Ungar reports.

• How does the law affect Medicare coverage? Benefits have not changed, but there will no longer be co-pays for preventive services like mammograms and prostate-cancer screenings, "a provision that has affected more than 1.2 million seniors in Kentucky," Ungar reports.

The report is worth reading in its entirety and could be used as a regular reference about the law. (Read more)

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To implement law aimed at prescription drug abuse, licensing boards issue regulations that some say are too expansive

Ambien and Ritalin are among the drugs that will be tracked through the state's drug monitoring system, with medical licensure boards issuing emergency regulations that are more expansive than originally required in a law aimed at curbing prescription drug abuse and so-called pill mills.

Rep. John Tilley, D-Hopkinsville, said "there's an honest debate" about why the Cabinet for Health and Family Services and the boards wish to track all Schedule II and III drugs and 15 more Schedule IV drugs. "The statute only called for tracking Schedule II drugs and those Schedule III drugs that contain hydrocodone," reports Ronnie Ellis for Community Newspaper Holdings Inc.

Among the 15 listed Schedule IV drugs are Ambien, Valium, Librium, anorexic drugs and Soma. Ritalin, usually used to help with Attention Deficit Disorder, is a Schedule II drug and will be tracked for patients who are prescribed it for more than 30 days. Lloyd Vest, the Kentucky Board of Medical Licensure's general counsel, said some parents "doctor shop" to get the drug. The new regulations have prompted "some prescribers to cease prescribing the drug, causing parents and children to scramble for prescriptions before school begins next month," Ellis reports.

Dr. Steven Sack, an emergency room doctor from St. Joseph East in Lexington, said the regulations "have gone well beyond the initial intent" of the legislation and will "result in unnecessary suffering in the commonwealth with patients not getting the care they need."

He said running a report in the drug-monitoring system known as KASPER takes an "enormous" amount of time. He asked why doctors must run reports on, say, an 80-year-old with chronic pain. Ellis reports the average KASPER report can be electronically transmitted in 15 seconds, and Tilley said running a report might "prevent prescriptions which might adversely interact with other medication the patient is taking."

Changes can be made to the regulations before the September deadline and they can be revised in the 2013 General Assembly. Physicians had until last week to sign up for a KASPER account. As of last Friday, there were 17,048 master accounts. In 2011, there were just 879.  (Read more)

Ambien and Ritalin are among the drugs that will be tracked through the state's drug monitoring system, with medical licensure boards issuing emergency regulations that are more expansive than originally required in a law aimed at curbing prescription drug abuse and so-called pill mills.

Rep. John Tilley, D-Hopkinsville, said "there's an honest debate" about why the Cabinet for Health and Family Services and the boards wish to track all Schedule II and III drugs and 15 more Schedule IV drugs. "The statute only called for tracking Schedule II drugs and those Schedule III drugs that contain hydrocodone," reports Ronnie Ellis for Community Newspaper Holdings Inc.

Among the 15 listed Schedule IV drugs are Ambien, Valium, Librium, anorexic drugs and Soma. Ritalin, usually used to help with Attention Deficit Disorder, is a Schedule II drug and will be tracked for patients who are prescribed it for more than 30 days. Lloyd Vest, the Kentucky Board of Medical Licensure's general counsel, said some parents "doctor shop" to get the drug. The new regulations have prompted "some prescribers to cease prescribing the drug, causing parents and children to scramble for prescriptions before school begins next month," Ellis reports.

Dr. Steven Sack, an emergency room doctor from St. Joseph East in Lexington, said the regulations "have gone well beyond the initial intent" of the legislation and will "result in unnecessary suffering in the commonwealth with patients not getting the care they need."

He said running a report in the drug-monitoring system known as KASPER takes an "enormous" amount of time. He asked why doctors must run reports on, say, an 80-year-old with chronic pain. Ellis reports the average KASPER report can be electronically transmitted in 15 seconds, and Tilley said running a report might "prevent prescriptions which might adversely interact with other medication the patient is taking."

Changes can be made to the regulations before the September deadline and they can be revised in the 2013 General Assembly. Physicians had until last week to sign up for a KASPER account. As of last Friday, there were 17,048 master accounts. In 2011, there were just 879.  (Read more)

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