Ky. Hospital Assn. gets grant for emergency-room software that tracks patient histories from other sites; could discourage 'ER hopping'

By Melissa Patrick
Kentucky Health News

The Kentucky Hospital Association has been awarded a $250,000 grant to equip Kentucky's emergency departments with software designed to help physicians have access to patient information from multiple sources in real time.

The grant for the software, called EDie, came from Anthem Foundation, the philanthropic arm of Anthem Inc., a major health insurer.

“Information is a powerful tool in medicine, especially emergency medicine when life and death decisions must be made quickly,” Harold C. Warman, president of Highlands Regional Medical Center in Prestonsburg, the first hospital in Kentucky to go live with the software, said in a news release. “EDie instantly consolidates information from multiple sources that would otherwise take hours to obtain, and lets emergency physicians make faster, more informed clinical decisions.”

EDie works by collecting data from thousands of hospitals, urgent cares, clinics and health plans and then packages the data and delivers it to emergency room physicians in real time.

"In one concise report, the ED team can see patient history, visit summaries, medical providers, security events, and even care recommendations like preferred language and drug allergies," says the release.

The grant funds, combined with discounts from Collective Medical Technologies, a Salt Lake City firm that developed the software, will cover one year's costs for nearly every hospital in the state, said Ginger Dreyer, director of communications for the hospital association.

"There are also separate grants to pay the cost for small, rural hospitals to have access to the EDie solution," Dreyer said.

The release says 10 Kentucky hospitals have adopted the technology and 28 others are in the process of installing it.

Dreyer said six of the 10 that have adopted the program are actively using it, In addition to Highlands Regional, they are Breckinridge Memorial Hospital in Hardinsburg; Hardin Memorial Health in Elizabethtown; Wayne County Hospital in Monticello; St. Claire Regional Medical Center in Morehead; and Twin Lakes Regional Medical Center in Leitchfield.

The release notes that this software will help hospitals identify and support high-risk patients across care settings, with the goal of reducing avoidable readmissions and further enabling statewide efforts to address the opioid epidemic,

“One particularly powerful application of this technology is in fighting Kentucky’s opioid epidemic,” KHA President Nancy Galvagni, said in the release. “Emergency-room hopping is a serious obstacle in helping people suffering from addiction and this software can tell a treating physician if the patient has a history of ER visits for pain treatment. EDie can be the difference between enabling addiction and treating it.”

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One Affordable Care Act insurer in Kentucky wants a 12% rate hike next year, the other one has asked for a drop of 4.5%

By Melissa Patrick
Kentucky Health News

One of the two insurers offering government-subsidized individual health plans in Kentucky for 2020 is asking for a 12 percent increase, while the other is asking for a 4.5% decrease.

Insurers offering plans for small groups under the Patient Protection and Affordable Care Act are asking for average hikes of 10.5%. These overall percentages reflect an average that will vary, depending on whether individuals smoke, how old they are and where they live.

Anthem Health Plans of Kentucky requested an average 12% increase for its 13 different plans offered.

CareSource Kentucky requested an average rate decrease of 4.5% for its 12 plans.

The requests are preliminary and subject to change. The Kentucky Department of Insurance can approve, lower or raise the rates. The department said in a press release that it expects to finalize the rates by August, which is also when it will finalize any expansion of the plans' service areas.

This year, Anthem offered plans in 93 counties and CareSource offered plans in 61 counties.
Thirty-four counties offered plans by both insurers, though 16 of them had Anthem plans with a narrow provider network.

“From our initial review, it appears that the popular silver and bronze plans offered by both insurers receive either a much smaller average increase or comprise the majority of the decreases when compared to other plans,” Insurance Commissioner Nancy G. Atkins said in the release. “Over 90% of the participants select one of these plans, and we anticipate this trend to continue.”

Last year, Anthem asked for an average 3.5% increase and CareSource asked for a 19.4 % hike. The Insurance Department gave Anthem a higher increase than it asked for at 4.3% and CareSource got the 19.4% it requested.

Kentucky had 84,620 residents enroll in subsidized coverage through Healthcare.gov during the open enrollment period for this year. That was a 5.5% decrease from 2018, when 89,569 Kentuckians enrolled, but up 4.3% from 2017, when 81,155 enrolled. Kentucky has yet to reach the same number of enrollees as it did in 2015, when 106,330 enrolled. The state shifted enrollment to the federal exchange in 2016, away from the state-based exchange called Kynect.

Open enrollment for 2020 begins Nov. 1.

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Program that addresses childhood trauma and teaches resilience shows results in Louisville; expanding to Lake Cumberland area

By Melissa Patrick
Kentucky Health News

A pilot program in several Louisville elementary schools that focused on building resiliency in children who suffer from childhood trauma saw results: fewer students with behavior referrals, improved staff skills, increased parental participation and increased teacher retention -- and it's a model that could be replicated.

Studies show that adverse childhood experiences, a term used for all types of abuse, neglect and family dysfunction that occur under the age of 18, are linked to negative health outcomes in adulthood.

ACEs have been linked to chronic health conditions, like heart disease and obesity, risky behaviors, like substance abuse, mental-health issues, like depression, and even early death.

When determining if a child has experienced trauma, 10 types of ACEs are measured, largely because they are the ones that children experience most often.

They include five personal measures, including physical, verbal and sexual abuse and physical and emotional neglect. The other five relate to other family members: having an alcoholic parent, a mother who is a victim of domestic violence, a family member in jail, a member diagnosed with a mental illness, and the disappearance of a parent through divorce, death or abandonment.

The more ACEs a child experiences, the greater his or her chances of experiencing poor health outcomes in adulthood. Nearly 27 percent of Kentucky's children have two or more ACEs.

ACEs are the root cause of many serious academic, social and behavioral problems that have the potential to prevent a child from succeeding in school, and as noted before, more than one of four children in Kentucky are showing up to school having experienced two or more of them.

The pilot program in Louisville, called the Bounce Coalition, was created to address this trauma. It was funded in part by a six-year, $300,000 grant from the Foundation for a Healthy Kentucky that was matched by local funds.

"Abuse, neglect or situations such as parental drug use or incarceration that kids experience not only cause many of them to act out. It may mean they'll have poor health as adults that could lead to an early death," Ben Chandler, foundation president ad CEO, said in a news release. "This grant program was about finding ways to mitigate the impact of ACEs early on, while patterns can be changed, with the goal of preventing both the short-term and the long-term problems ACEs create."

Foundation for a Healthy Kentucky photo

The Bounce Coalition trained teachers and staff in several Louisville elementary schools to recognize ACEs and gave guidance on how to address them. It taught students strategies to promote resilience and included activities for parents. It also expanded its work to organizations outside the school setting.

The release notes that the program's trauma training is built around an approach of "What happened to you?" instead of "What's wrong with you?"

An evaluation of the two schools that implemented the program the longest showed improvements in student suspensions and behavioral referrals; a 56-point jump in the percentage of staff who felt they were adequately trained to deal with trauma, from 30% in 2014 to 86% in 2017; an increase of 195% in parent-teacher conferences between 2014 and 2017; and PTA membership grew from zero to 213.

The schools also showed improvements in all nine categories of their student school climate surveys, while the control school failed to show gains for any of the measures, and the district showed gains in five. And teacher retention in those schools increased to 90.2% in 2017, from 87.8% in 2014.

"Bounce has shown us that adults have the ability to change children's lives by re-framing their interactions," Betty J. Adkins, co-lead of the project, said in the release. "Children need at least one caring adult to believe in them. It is really that simple."

The Bounce Coalition is expanding its work to rural Kentucky to see if the same training will be beneficial there. Bounce received a two-year $200,000 foundation grant in May to work with Russell County Schools and the Lake Cumberland District Health Department to implement the ACEs program there.

Chandler said, "Our goal is to create a blueprint for successfully addressing ACEs that coalitions across Kentucky can use to secure funding from other sources to implement in their own school districts and communities."

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Picnic season has arrived in Ky, which calls for extra food-safety precautions; CDC offers four rules to follow: Clean, Separate, Cook and Chill

By Melissa Patrick
Kentucky Health News

Summer picnic and barbecue season is in full swing, which also means it's the season for an uptick in the number of people who get food borne illnesses, which most people call food poisoning.

According to the Centers for Disease Control and Prevention, each year in the U.S., about 48 million, or one in six, people get ill, 128,000 are hospitalized, and 3,000 die from foodborne disease.

All of those people didn't get sick at a picnic, but foodborne illnesses increase in the summer, largely because the bacteria that cause such illnesses multiply faster in warmer temperatures and preparing food outdoors makes safe food handling more difficult.

One problem is that most of us give little thought to how our food is stored, prepared and handled at these fun summer events, let alone if those preparing our food are washing their hands -- but we should, because it only takes one small mishap to sicken all of  the guest.

CDC graphic

The CDC and the state health department offers four simple rules to decrease the likelihood of anyone getting a food borne illness when eating outdoors: Clean; Separate; Cook; and Chill.
.
Clean: Wash your hands and clean your work and dining surfaces. If there is not a source of safe drinking water at your outdoor location, bring enough water for both preparation and cleaning. Otherwise, make sure you bring wet, disposable washcloths, wipes, or hand-sanitizer. Wash your hands both before and after handling any raw meat.

If you are serving multiple meals in an outdoor setting, take a lesson from seasoned campers and bring three large pans, biodegradable dish soap, bleach and plenty of extra water to set up a cleaning station. Pan one is the wash pan, with hot water and a few drops of soap; pan two is for a hot-water rinse; and pan three is for a sanitizing soak, with a small amount of bleach added to kill bacteria.

Separate: Cross-contamination during preparation, grilling and serving food is a prime cause of foodborne illness. To minimize this risk, wrap raw meats securely to keep their juices away from all other food; throw out marinades and sauces that have touched any raw meat; and remove cooked meat from the grill with clean utensils and place it on a clean plate.

Cook: The best way to ensure that meat is cooked hot enough to kill harmful germs is to use a food thermometer. Temperatures for beef, pork, veal and lamb needs to be 145° F, with a stand-time of three minutes at this temperature; 145° F for fish; 165° F for poultry and all pre-cooked meats, like hot-dogs; and 145° F for fish. After cooking, meats need to be kept at 140°F or warmer until served. Grilled foods can be kept hot by moving it to the side of the grill rack away from the coals.

Chill: Keep all meats at 40°F or lower in an insulated cooler with ice or frozen gel packs. Pack canned beverages in one cooler and food in another, since the beverage cooler is likely to be opened frequently. Meat, poultry, and seafood can also be packed while still frozen so that they stay colder longer. When driving, keep the cooler in the coolest part of the car and once outside place it in the shade if possible. Bring extra ice and pack it in a separate cooler. Don't use loose ice used to keep food cold in beverages.

The CDC also notes that it's important to not let food sit out for more than two hours, and if the temperature is 90°F or above, it should sit out for no more than one hour. One way to keep track of how it's been sitting out is to bring a timer, or set a timer on your cell phone. And it's not just meats; all perishable food should be monitored closely, especially salads made with mayonnaise or anything dairy-based. And a good rule of thumb: If you have any doubt, throw it out!

The health department also warns that if you clean your grill using a wire-bristle brush, check to make sure that no detached bristles have made their way into grilled food.

The CDC says symptoms of food poisoning can range from mild to severe and may differ depending on the germ you swallowed, but the most common ones are: upset stomach, stomach cramps, nausea, vomiting, diarrhea and fever. Symptoms may take hours or days to develop, and can be life-threatening. And see a doctor if you have severe symptoms that include blood in your stool, fever over 102 degree, frequent vomiting, dehydration and diarrhea that last more than three days.

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State Sen. Ralph Alvarado, Bevin's running mate and a physician, agrees with him that state shouldn't require kids to be vaccinated

State Sen. Ralph Alvarado and Gov, Matt Bevin bumped fists
as they filed in January. (Photo: Mark Mahan, Lexington Herald-Leader)

Gov. Matt Bevin's running mate for lieutenant governor told a Northern Kentucky Tea Party group June 27 that he agrees with Bevin on immunization policy, that government shouldn't require children to be vaccinated.

State Sen. Ralph Alvarado of Winchester, a physician, said “I think it’s good health policy to administer vaccines, but if people don’t want them, we shouldn’t force people to take them.”

Alvarado was recorded by American Bridge, a group supporting Democratic Attorney General Andy Beshear for governor. The group posted the recording on YouTube.

Alvarado "was responding to a question about a student in Northern Kentucky who had been pulled out of school for refusing to get the chickenpox vaccine," reports Daniel Desrochers of the Lexington Herald-Leader. "The debate over vaccines has captured national attention as the anti-vaccine movement has contributed to a rise in measles cases in the U.S."

Alvarado said, “I think it’s a very fine balance. I don’t think we should force anybody to do something they don’t want to do to their own bodies. We are seeing outbreaks, you’re seeing measles outbreaks and other things that are happening and a lot of people forget that a lot of these diseases can be fatal.” 

Asked about “all the kids who are dying from vaccines,” Alvarado said, “Again, we could debate a lot of that. That’s been studied . . . but to your question, you should have the right to say no if you don’t want that for your kids.” Desrochers notes that the World Health Organization says “so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically.”

Bevin said in a radio interview in March that he had exposed his children to chicken pox to immunize them. “If you are worried about your child getting chickenpox or whatever else, vaccinate your child,” he said. “But for some people, and for some parents, for some reason they choose otherwise,” he said. “This is America. The federal government should not be forcing this upon people.”

The federal government does not force states to require vaccinations, only recommends that they do. The National Conference of State Legislatures says all 50 states have laws requiring specific vaccines for students; 47 grant religious exemptions and 18 allow philosophical exemptions.

Kentucky only allows medical and religious exemptions. In 2017 the Bevin administration made it easier for parents to invoke the religious exemption. They can now download a form, have it notarized and submit it to their school upon enrollment, instead of having to get a signed form from a health-care provider. Spectrum News reported that the number of Kentucky parents claiming the religious exemption increased 59 percent in the 2017-18 school year.

A Cabinet for Health and Family Services representative told legislators in 2017 that the changes had been in the works for several years, in response to complaints that a medical entity should not have authority over a religious exemption; that a co-payment was often required to get a provider’s signature; and that parents and guardians were having trouble finding providers to sign the forms.

Assertions that governments shouldn’t require vaccinations don’t take into account the principle of “herd immunity,” which occurs when enough people have been immunized against a disease to protect others who are not immunized. Some are not immunized because their immune systems are too weak to allow them to be vaccinated, or because they are too young to be vaccinated.

People with weakened immune systems include those with cancer, especially if they are being treated with an aggressive chemotherapy, people who have had bone-marrow transplants, people who have had an organ transplant, people with auto-immune disorders, like rheumatoid arthritis or Lupus, or people with acquired immunodeficiency syndrome, or AIDS.

“Those people are absolutely reliant upon herd immunity because we can’t immunize them,” Dr. Sean McTigue, an infectious disease specialist at the University of Kentucky, told Kentucky Health News in March. “The only way that we have to protect them is to ensure that everybody around them is immunized so that the chances of them actually coming into contact with somebody who has one of these very infectious viruses or bacteria is very, very low.”

McTigue said herd immunity is vitally important to protect babies, because they can’t be vaccinated for measles, mumps and rubella or chickenpox until they are a year old because these vaccines are made with very weak, but live viruses.

“So, every single baby less than one year old is unvaccinated and unprotected against those conditions,” McTigue said. “And the young babies who cannot yet be immunized against those conditions are exactly the patients that we worry about the most if they get those infections because they are at greatest risk of complications.”

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Colorectal cancer screening before age 50?

Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. There is strong evidence that screening for CRC with colonoscopy, other visual exams, or stool-based tests can reduce CRC mortality. As a result, several expert organizations have long recommended regular CRC screening for US adults ages 50 to 75.

In 2018, the American Cancer Society (ACS) became the first major organization to recommend CRC screening starting at 45.

Why did the ACS recommend CRC screening starting at 45?

The incidence of CRC and mortality from the disease has declined over the last several decades among adults over 50, which may reflect the effectiveness of screening in this age group. In contrast, since the early 1990s, there has been an increase in CRC incidence and mortality among individuals younger than 50.

The absolute risk of any given individual younger than 50 developing CRC remains substantially lower than in older adults. But due to delays in diagnosis, younger patients are often diagnosed at later stages, when the disease is more challenging to treat. And they tend to experience greater loss of high-quality and productive years of life due to premature death from CRC.

The ACS recommendation was based, in part, on a prediction model that considered the trend of increasing CRC incidence in younger individuals. Theirs was a “qualified” recommendation, by which the ACS indicates that “there is clear evidence of benefit of screening but less certainty about the balance of benefits and harms or about patient’s values and preferences, which could lead to different decisions about screening.”

What accounts for the increase in early-onset CRC?

The bottom line is that we still do not know why more people are being diagnosed with CRC before 50. There are established genetic risk factors for CRC, including hereditary syndromes that increase the risk of developing CRC at a young age. However, the vast majority of early-onset CRCs occur among individuals with no family history.

Thus, recent trends in early-onset CRC are likely due to changes in environmental exposures. Initial epidemiologic studies point to risk factors such as childhood obesity, dietary habits, and antibiotic usage early in life.

Will starting screening at an earlier age reduce early-onset CRC?

It is still too early to tell. Modeling studies, like the one considered by the ACS, rely on assumptions and are limited by inherent uncertainties. For example, the ACS model assumes that screening will have a similar level of benefit in those younger than 50 as it does on those 50 to 75. But there are no direct clinical data to support this. In addition, the potential harms of screening in those younger than 50, such as false positive results that could lead to additional testing, are not well quantified.

Other organizations with established expertise in assessing the risks and benefits of CRC screening have yet to modify their recommendations. Thus, for the time being, individuals between 45 and 50 should discuss with their doctors whether to begin screening at 45 or wait until 50.

What else can people do to prevent CRC?

In addition to screening, quitting smoking, maintaining a high level of physical activity, avoiding overweight and obesity, and consuming alcohol in moderation are all known to reduce the risk of CRC. Limiting consumption of processed meats and red meat, particularly those that are prepared at high temperatures (such as through grilling and charring) is also prudent.

Finally, there are strong data supporting the use of aspirin to prevent CRC. The US Preventive Services Task Force has recommended regular aspirin use for the prevention of CRC. However, given potential risks associated with aspirin, such as bleeding, anyone considering aspirin for disease prevention should discuss this with their doctor.

The post Colorectal cancer screening before age 50? appeared first on Harvard Health Blog.

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National foundation study estimates Medicaid work rules would lead to 86,000 to 136,000 in Ky. losing coverage the first year

Commonwealth Fund chart, adapted by Kentucky Health News; click on it for a larger version

If Kentucky and eight other states persuade federal courts to let them add work requirements to their Medicaid programs, Kentucky would lose more people from its Medicaid rolls than any of the states but Michigan, says a study by The Commonwealth Fund, a New York City-based foundation.

"These are losses only associated with the work requirements, and do not account for other elements like monthly premiums or new paperwork requirements that may trigger additional losses," researchers Leighton Ku and Erin Brantley write for the fund, which says it exists to "promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable and the elderly."

Ku is director of the Center for Health Policy Research, and Brantley is senior research associate, in the School of Public Health at George Washington University in Washington, D.C.

They write, "Most adult Medicaid beneficiaries work or are limited in their ability to work because of health problems, schooling, child care, or other needs. Many who would lose Medicaid eligibility are working or trying to work, but are unable to comply with the rules because they face major barriers to steady employment or cannot navigate the procedural barriers."

Kentucky officials have estimated that the state's Medicaid rolls would have 95,000 fewer people in five years with their plan than without it, in large measure from noncompliance with reporting requirements. (Tens of thousands of Kentuckians go on and off Medicaid each month as they become eligible or ineligible; the income limit is 138 percent of the federal poverty line: $17,236 for an individual and $35,535 for a family of four.)

The researchers estimated that the losses in Kentucky would be much greater; 86,000 to 136,000 merely in the first year, assuming full implementation of the program. That is based on an estimate that the state's "community engagement" requirements for "able-bodied" beneficiaries would affect up to 331,000 of the approximately 450,000 on the expanded version of Medicaid. That is higher than other estimates; the study estimates a loss of 26 to 41 percent in the expansion population.

In Arkansas, the only state that has terminated people for not complying with work rules, 18,000 lost coverage in the first six months before a federal judge blocked the program. He has also kept Kentucky from starting its program. The rulings have been appealed.

Many in Arkansas lost coverage "in large measure because of confusion about the policies," wrote the researchers, citing a recent study. "One-third did not know about the requirements; only half of those who were eligible and needed to report work activities were doing so. Arkansas’ work requirements were not associated with increased employment," which advocates say is an objective of the program.

Kentucky officials say they don't expect the state to see the results Arkansas did, largely because they have an aggressive outreach campaign and are committed to changing tactics if they see too many dropping off the Medicaid rolls. They say Kentucky's rollout has been longer than that in Arkansas, giving more preparation time; and they have strategic partners committed to the program's success, such as the Foundation for a Healthy Kentucky, employers and regional workforce boards.

Seven other states have federal authorization for work requirements: Arizona, Indiana, Michigan, New Hampshire, Ohio, Utah and Wisconsin. They "are either just starting to phase in their programs or have not yet begun to do so," James Romoser reports for Inside Health Policy. The study "is based on the initial coverage losses that occurred in Arkansas . . . as well as the national effects when similar work requirements were added to the Supplemental Nutrition Assistance Program" and policy differences among the states. "The smallest impact is expected in Wisconsin, because its waiver permits 48 months of non-compliance before beneficiaries are penalized. As a result, the researchers said significant coverage losses due to work requirements might not occur in the first year."

Seven of the nine states have imposed work requirements for SNAP, once called food stamps, and "should have been aware of consequences of work requirements after seeing how they worked" in SNAP, the researchers write. "Within 12 months, participation fell by 440,000. Several rigorous studies found that SNAP work requirements reduce enrollment and have little to no employment benefits."

The director of Kentucky's program, Kristi Putnam, says Medicaid and SNAP offer different benefits and should not be compared. She told Kentucky Health News that because American health benefits are typically tied to hours worked, it is important to help Kentuckians learn that system.

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McConnell bill to raise tobacco age to 21 passes first hurdle, with controversial provision requiring states to follow suit

By Melissa Patrick
Kentucky Health News

U.S. Senate Majority Leader Mitch McConnell's bill to raise from 18 to 21 the nationwide minimum age to buy all tobacco products, including electronic cigarettes, has passed the Senate health committee. It includes a controversial provision that some say could leave an opening for the tobacco industry to push its agenda in state legislatures.

“I’m grateful to my colleagues for advancing our legislation to help curb the spike of youth tobacco use,” McConnell said in a news release. "Because children are extremely vulnerable to becoming addicted to nicotine and suffering its lifelong consequences, we must do everything we can to keep these products out of their hands."

The bill is co-sponsored by U.S. Sen. Tim Kaine, a Democrat from Virginia.

In Kentucky, about one in four 10th and 12th graders and one in seven eighth graders vaped in 2018, according to the 2018 Kentucky Incentives for Prevention Survey.

The bill is now part of a 246-page amendment to the proposed Lower Health Care Costs Act of 2019, which includes legislation on a long list of health topics, including ending surprise medical bills, reducing the prices of prescription drugs, improving transparency in health care, improving public health, and improving the exchange of health information.

The Campaign for Tobacco-Free Kids issued a statement on June 25 that says while it supports raising the minimum age of purchase to 21, it opposes a provision "that would require each state to pass its own law raising the tobacco age to 21 (in addition to the federal requirement) and put at risk needed federal substance abuse block grant funds if a state didn't do so."

Opponents of the provision worry that it would weaken state and local efforts to reduce tobacco use and creates an opportunity for the tobacco industry to add special-interest provisions to state laws.

For example, the Campaign for Tobacco-Free Kids notes that in the past year, tobacco companies in a number of states have sought to add provisions to Tobacco-21 bills blocking localities from taking additional actions to reduce youth tobacco use, such as prohibiting the sale of flavored tobacco products. The organization says it supports "compromise legislation" that addresses these concerns.

The tobacco industry, which is moving into electronic cigarettes, has supported a higher legal age to purchase tobacco products as a way to reduce pressure for youth-oriented regulations.

As of June 20, 16 states had already raised the tobacco age to 21, along with Washington, D.C., and at least 470 localities, according to the Campaign for Tobacco-Free Kids. It notes that the strength of each law "varies substantially." Such a bill was introduced in Kentucky during the last legislative session, but failed to get out of the Senate Agriculture Committee.

An editorial in The Winchester Sun applauds the concept of raising the legal age, but adds that McConnell's bill doesn't do enough, and suggest that this piece of legislation should simply be an "opening bid."

"Public outcry over companies making money by selling flavored addiction juice to kids has forced those companies and their supporters to the table," the editorial says. "National T-21 legislation is their dream scenario. The legal age to buy e-cigarette products is already 18, so the law extends that prohibition by three years. In exchange for those three years, they want to be free to make their products as addictive and enticing as possible, including in ways that might appeal to minors."

Kaine has said requiring states to raise their own laws would "get more enforcement," similar to fair-housing laws. As for concerns that it could give the tobacco industry the ability to “play mischief” in states, "He said that’s already happening, with or without the bill," Inside Health Policy reports.

Another bipartisan bill, called Tobacco to 21, has also been introduced in the Senate that does not include the provision. The two Democratic sponsors of this bill, Sens. Brian Schatz of Hawaii and Dick Durbin of Illinois, said in a May 21 news release that "forcing state action creates a dangerous loophole that gives the tobacco industry an opening to intensify their efforts at the state level ... "

The McConnell press release provided a list of nearly 60 organizations that support his bill. Ten of them were from Kentucky, including: the Foundation for a Healthy Kentucky; the Kentucky Chamber of Commerce; the Kentucky Hospital Association; the Kentucky Medical Association; Kentucky Youth Advocates; the Kentucky Academy of Child and Adolescent Psychiatry; CHI Saint Joseph Health; the Kentucky Chapter of the American College of Cardiology; St. Elizabeth's Healthcare in Northern Kentucky; and Hosparus Health.

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Trouble reading? Try these workarounds

Once you learn how to read, it’s easy to take the skill for granted. Like breathing or walking, we don’t give the ability much thought unless it begins to deteriorate. But trouble reading can develop at any age for a variety of reasons, including difficulty concentrating, mild cognitive impairment, and physical changes.

Mental roadblocks can cause trouble reading

Fuzzy thinking and difficulty concentrating can get in the way of reading. “If your attention isn’t focused on the sentence you’re reading, you’re not likely to register enough of the sentence to understand what your eyes just passed over,” notes Dr. Joel Salinas, a neurologist at Harvard-affiliated Massachusetts General Hospital.

You might experience fuzzy thinking or difficulty concentrating because of

• a lack of sleep
• stress
• nutrient deficiency
• a medication that makes it harder to concentrate
• reading or learning disabilities.

Sometimes age-related cognitive changes affect reading skills. Reading requires attention, short-term memory, and recall, which decline a little as we get older. “It’s normal when you’re older that your reading might be slower or that you have to occasionally read a sentence more than once to get its meaning. Your ability to read and retain information may take more effort,” Dr. Salinas explains.

Mild cognitive impairment can cause trouble reading

Mild cognitive impairment (MCI) may also be behind a decline in reading skills. MCI can make it harder to understand or retain what you’re reading.

MCI is a noticeable change in thinking and memory skills, but not enough that it becomes a huge barrier to your ability to take care of yourself and accomplish your daily tasks. You may miss some appointments, lose things often, have more difficulty recalling names or words you’d like to use, or have a harder time finding familiar places and keeping track of important dates.

Physical challenges can cause trouble reading

Physical changes, such as accidents or chronic disease, can also affect your ability to read. Examples include:

• Poor vision. Maybe you have double vision, or you can’t see up close, or maybe it’s hard to read in a room that isn’t well lighted.
• Arthritis. “Osteoarthritis at the base of the thumb, wrist, or fingers is common with age and can affect your ability to hold a book,” says Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center.
• Neuropathy (pain or numbness in the extremities). This may result from diabetes or back pain, and can make it uncomfortable to hold reading material for extended periods.
• Traumatic brain injury. A concussion that you suffer from a sports injury, fall, or car accident might create difficulties concentrating or seeing (such as blurry vision).
• Shaky hands from essential tremor, multiple sclerosis, or other conditions may keep you from holding a book still enough to read the words.

When to seek help

Talk to your doctor when you notice trouble reading. Start with your primary care doctor, who can perform a mini evaluation or send you to a neuropsychologist for a thorough evaluation. “Neuropsychologists can test for how fast you read, how much you understand, and what you recall from what you read,” Dr. Salinas says.

When physical changes are the problem, treating the underlying condition can help you read better. For instance, maybe you just need a new pair of glasses.

Try these workarounds

Sometimes using a few simple strategies can make reading easier. If you have pain or tremors, Dr. Shmerling recommends propping up a book on a pillow or book holder. If you find it’s hard to flip pages, try an electronic reading device like an iPad or Kindle. With an electronic device, the page stays steady, and it’s just a tap to turn the page. For vision challenges, electronic reading devices and large-print books can help greatly.

When attention is the challenge, Dr. Salinas suggests reading in a quiet space, reading out loud, mouthing the words as you read, listening to the audiobook recording while you read, or using a sheet of paper to reveal one line of text at a time so you don’t skip ahead.

The important thing is to try. “There are solutions that work for most obstacles to reading,” says Dr. Shmerling, “and for most people, it’s a great way to keep up with what’s happening in the world and to keep the mind working.”

The post Trouble reading? Try these workarounds appeared first on Harvard Health Blog.

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At opioid summit, Chamber urges employers to update policies, beseeches legislature to reduce penalties for simple possession

The Kentucky Chamber of Commerce is calling on the state's business community to update its drug and alcohol policies to bring more help to their employees who suffer from addictions, and keep working to get state legislators to downgrade criminal penalties for simple drug possession.

Kentucky Chamber of Commerce President and CEO
David Adkisson spoke at the Chamber's opioid summit.

At an "opioid summit" in Lexington June 24, the business lobby also announced that its Kentucky Chamber Workforce Center has won about $700,000 to identify how businesses can prevent opioid addiction in the workplace and help employees recover, Rebekah Alvey reports for the Lexington Herald-Leader.

The Kentucky Office of Drug Control Policy put up $350,000 for the program, and private donors matched it.

The center's director, Beth Davisson, said the "Opioid Response Program for Business" will work with employers to provide free audits of human-resource policies and procedures related to addiction and recovery, with a long-term goal of connecting them with recovery programs. The grant will also fund a 15-month study of how the epidemic is affecting the workforce.

Kentucky Health Secretary Adam Meier told the group that it's important to be able to show companies that "There's a business case to be made to be a part of this solution."

Mark LaPalme, CEO and founder of the Isaiah House, an addiction-treatment center in Willisburg, told the group that placing recovering addicts in a strong community, such as a college or job, causes a 90 to 95 percent sober success rate beyond a year, Alvey reports.

Alvey writes that in the past, places of employment have been "toxic environments for people in recovery," but La Palme says, "Now we're not looking to fire people, now we're not looking to discipline people necessarily for disease and addiction. We're actually partnering to try and help them and help them get better."

The chamber also announced it would keep asking the Kentucky General Assembly to downgrade some drug possession charges from felonies to misdemeanors, Alex Acquisto reports for the Herald-Leader in a separate story.

“It’s not just a budgetary issue,” Ashli Watts, the chamber's senior vice president of public affairs, told Acquisto. “We have a workforce issue. We know we’re spending too much on corrections and we’re not seeing the [intended] outcomes. Our communities are not getting safer.”

“Treating it like an addiction and not necessarily a crime” is how the state should proceed, she said. “This is a population that needs second chances.”

In 2017, nearly 1,600 people in Kentucky died from an opioid-involved overdose. Since 2012, that rate has increased by 117% for heroin and by 564% for synthetic opioids, like fentanyl.

In Kentucky, anyone possessing either of these substances or other scheduled drugs is charged with a Class D felony, which can result in a one- to five-year prison sentence, even for a first offense. Not every Class D conviction results in a prison sentence; some are given the option of "rehabilitative diversion programs" to treat their substance use disorder in lieu of prison time, Acquisto notes.

Kentucky lawmakers have tried unsuccessfully to minimize drug-possession sentence through what is sometimes called a "peddler distinction" to exempt addicts. Last year, a chamber-backed bill to downgrade non-violent felony charges, including reducing drug-related Class D felonies to Class A misdemeanors, died in committee.

A 2017 state report commissioned by Gov. Matt Bevin to address the state's rising prison and jail population and recidivism rate found that between 2012 and 2016, there was a 38% growth in Class D felony admissions and a doubling of drug-possession admissions, Acquisto notes. At the end of 2016, the number of Class D inmates grew to 10,000, at an annual cost of roughly $18,400 each.

“What’s driving our prison population, to a great extent, is technical violations related to substance use disorder,” such as a positive drug screen or missing a meeting with a parole officer, ODCP Executive Director Van Ingram told Acquisto. “We’re trying to increase the odds of that success.”

The chamber "is urging the state to adopt comprehensive policies that prioritizes rehabilitative options over penalties, particularly for first- or second-time offenders," Acquisto writes.

In addition to reclassifying drug-possession charges, the chamber wants more state support for substance-abuse treatment, more efforts to promote hiring people who are in recovery, and adding more harm-reduction programs such as syringe exchanges. The state has about 60 such programs, which are subject to local-government approval, which is often an obstacle.

The chamber represents 3,800 member businesses that employ over half of the state's workforce, according to its website. The chamber's Jacqueline Pitts detailed each topics on the lobby's news site, The Bottom Line.

Pitts wrote about personal stories of addiction, including that of former University of Kentucky basketball star Rex Chapman, who played 12 years in the NBA. He told the crowd that he became addicted to Oxycodone after an emergency surgery during his final season, and that he was "in love" with the drug after just two days of taking it. He said it took him several stints in treatment to get sober, but has been so for five years now.

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Men’s Health Month is a medical marketing marvel

As a kid, I remember the song, “June is bustin’ out all over” from the musical Carousel. These days, June is Men’s Health Month, and with it comes some helpful reminders. But Twitter is bustin’ out all over with balderdash, baloney and BS on many men’s health topics.

If you visit the #MensHealthMonth hashtag on Twitter you will fall down a rabbit hole of Tweets reminding you about what’s probably wrong with you if you’re a man.  Behind almost all of these Tweets are product promotions, medical center marketing, physician practice PR, or other ways to turn men’s health issues into money-makers.

There’s no harm in trying to make a buck, per se.  But there is harm in promoting things that are not backed up by evidence, and in converting normal states of health into sickness by redefining what it is that people should worry about.

Among the marketing messages that caught our eye on Twitter:

 – Research suggests #astragalus may help reverse the natural shortening of telomeres on chromosomes that occurs with #aging to slow #hairloss.

– Help the men you know live happier, healthier lives! #CheckYourCalcium

– Simple tests like the CT Scan can be lifesavers even when you don’t think there’s a health concern.

– “Some men worry that their penis is too small.”

And what would Men’s Health Month be without warnings about low testosterone?

One reader was concerned about the following Tweet from a big name medical center in Chicago:

There’s nothing troublesome about the Tweet itself.  It’s the information in the hyperlink that’s provided that goes too far.

I asked Dr. Richard Hoffman, professor of internal medicine and epidemiology, and director of the division of general internal medicine at the University of Iowa – and a longtime contributor to our project – to address the claims.

• Rush urges men to “Think Zinc” – telling them to “Make sure that you’re getting the recommended daily allowance — 15 milligrams per day — of zinc through foods such as pumpkin seeds (in the shell), oysters, nuts and beans, or by taking a zinc supplement.”

But Dr. Hoffman responded: “The zinc claims are unfounded.  Observational data (Leitzmann et al in 2003 and Zhang et al in 2008) actually suggest that zinc supplements are associated with an increased risk of prostate cancer, though evidence is insufficient to determine whether this a causal effect or due to confounding (such as men who see urologists are more likely to be on zinc, screened for, and diagnosed with prostate cancer).  I’m not finding any studies looking at whether increasing zinc intake improves lower urinary tract symptoms in men with prostate enlargement.”

• Rush tells men to “Eat More Tomato Sauce.” They say, “Research has shown that eating large quantities of cooked or processed tomato products — including tomato paste, spaghetti sauce and ketchup — may be associated with a reduced risk of prostate cancer.”

But Dr. Hoffman wrote: “This has not been proven in controlled trials. Tomatoes are part of the healthy Mediterranean diet, though the recommendation for consuming ketchup reminds me of the school lunch kerfluffle during the Reagan administration.”

• “Most important — get screened,” emphasizes Rush.  And this is also probably the most repeated recommendation in Men’s Health Month.  Rush states: “Most prostate cancers are silent, meaning they don’t have symptoms until they’re more advanced. So even if you don’t experience symptoms of prostate problems, it’s crucial to have regular physical exams and screenings to check for prostate cancer.”

Dr. Hoffman, who worked on shared decision-making educational materials on prostate cancer for years, wrote me: “When even the American Urological Association suggests supporting informed decision making, the recommendations to get regular screening without any consideration of overdiagnosis and overtreatment is ludicrous.  In catching cancers early, screening finds substantial proportions of indolent cancer—these cancers will not progress so treatments are unnecessary, albeit expensive and associated with complications adversely affecting urinary, sexual, and bowel function.  While guidelines recommend DISCUSSING screening with high-risk men at an earlier age, there is no evidence (because these men were not included in the randomized trials) that screening and early treatment is beneficial.”

This is a reminder that a promotion like the declaration of Men’s Health Month, and all of the marketing and misinformation that comes with it, is not always helpful.  People can be harmed by misleading misinformation or claims that go beyond the boundaries of what evidence has shown.

When I initially asked Dr. Hoffman to respond, his first comment to me was: “Haven’t we commented on all of this before?”  Yes, we have.  But that’s why it’s important to keep doing so.  The flow of polluted information to the public continues and it needs to be cleaned up whenever and wherever we can.

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Showering daily — is it necessary?

Do you shower or bathe daily? If you do, you’re not alone.

Approximately two-thirds of Americans shower daily. In Australia it’s over 80%. But in China, about half of people report bathing only twice a week.

In the US, the daily shower tends to start around puberty and becomes lifelong. But have you ever stopped to ask yourself why?

Perhaps your answer is: “because it’s healthier than showering less often.” Think again. For many — perhaps most — the daily shower is more about habit and societal norms than health. Perhaps that’s why the frequency of bathing or showering varies so much from country to country.

Are there reasons to shower every day?

Besides considering it healthier, people may choose to shower daily for a number of reasons, including:

• concerns about body odor
• help waking up
• a morning routine that includes working out.

Each of these has merit, especially considering that personal or work relationships can be jeopardized by complaints about body odor or personal hygiene. But what is considered acceptable in this regard varies from culture to culture. And some (perhaps a lot) of what we do when it comes to cleaning habits is influenced heavily by marketing. Ever notice that directions on shampoo bottles often say “lather, rinse, repeat”? There is no compelling reason to wash your hair twice with each shower, but it does sell more shampoo if everyone follows these directions.

When it comes to concerns about health, however, it’s not at all clear that a daily shower accomplishes much. In fact, a daily shower may even be bad for your health.

What are the health impacts of showering (or bathing) every day?

Normal, healthy skin maintains a layer of oil and a balance of “good” bacteria and other microorganisms. Washing and scrubbing removes these, especially if the water is hot. As a result:

• Skin may become dry, irritated, or itchy.
• Dry, cracked skin may allow bacteria and allergens to breach the barrier skin is supposed to provide, allowing skin infections and allergic reactions to occur.
• Antibacterial soaps can actually kill off normal bacteria. This upsets the balance of microorganisms on the skin and encourages the emergence of hardier, less friendly organisms that are more resistant to antibiotics.
• Our immune systems need a certain amount of stimulation by normal microorganisms, dirt, and other environmental exposures in order to create protective antibodies and “immune memory.” This is one reason why some pediatricians and dermatologists recommend against daily baths for kids. Frequent baths or showers throughout a lifetime may reduce the ability of the immune system to do its job.

And there could be other reasons to lose your enthusiasm for the daily shower: some people suggest that the water with which we clean ourselves may contain salts, heavy metals, chlorine, fluoride, pesticides, and other chemicals. These may cause problems, too.

The case for showering less

Overcleaning your body is probably not a compelling health issue. Yes, you could be making your skin drier than it would be with less frequent showering. This is not a public health menace. However, daily showers do not improve your health, could cause skin problems or other health issues — and, importantly, they waste a lot of water. Also, the oils, perfumes, and other additives in shampoos, conditioners, and soaps may cause problems of their own, such as allergic reactions (not to mention their cost).

While there is no ideal frequency, experts suggest that showering several times per week is plenty for most people (unless you are grimy, sweaty, or have other reasons to shower more often). Short showers (lasting three or four minutes) with a focus on the armpits and groin may suffice.

If you’re like me, it may be hard to imagine skipping the daily shower. But if you’re doing it for your health, it may be a habit worth breaking.

The post Showering daily — is it necessary? appeared first on Harvard Health Blog.

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Tick-borne disease in Ky. is relatively rare, but does occur; best defense against these tiny disease-carrying vectors is prevention

Top three tick posters from a contest that was held by the Kentucky Department of Public Health and the Northern Kentucky Health Department and attracted more than 700 entries

By Melissa Patrick
Kentucky Health News

Ticks and summertime go hand-in-glove, but that doesn't mean you can't enjoy outdoor summer activities; you just have to take extra precautions. Tick season in Kentucky runs through August.

“Spring and early summer are peak times for tick bites, which coincide with people venturing outdoors in the warmer weather,” Dr. Jeff D. Howard, commissioner of the state Department for Public Health, said in a news release. “It's important that people take preventive measures against tick bites and also check for ticks after visiting affected areas.”

Ticks are most likely to be hanging out in wooded areas; the boundaries between woods and fields; low-hanging tree limbs; under leaves, plants and ground cover; and around stone walls and woodpiles that are home to mice and other small mammals that carry ticks.

The health department recommends that Kentuckians remember four steps when it comes to protecting themselves from ticks: Protect; Check; Remove; and Watch.

Protect: To protect yourself from tick bites, avoid tick-prone areas, but if you are going to be in those areas use a tick repellent that has 20 percent DEET, picardin, IR3535 or lemon eucalyptus. Wear light-colored, long-sleeved shirts and pants tucked into socks. Use permethrin-based clothing sprays, unless you have cats, to which permethrin is toxic.

Check: After you've spent time outdoors, do a head-to toe check for ticks using a hand-held or full-length mirror. Parents should check children. Common places to find ticks are behind the knees, around the waist, under arms, and on the neck and head. It is also important to check your gear and pets for ticks. If possible, change your clothes and shower after going outdoors. To kill ticks on dry clothes, put them in a dryer on high heat for 10 minutes. If clothes require washing, use hot water.

CDC illustration

Remove: Remove an embedded tick as soon as possible by grasping it as close to the skin as possible with tweezers and pulling straight out with gentle, even pressure. Do not jerk or twist the tick. Wash your hands with soap and water after the tick is removed. Apply an antiseptic to the bite site. Do not use alcohol, matches, liquid soap or petroleum jelly to remove a tick. Dispose of the tick by submerging it in alcohol, placing it in a sealed bag or container, wrapping it tightly in tape, or flushing it down the toilet. Never crush a tick with your fingers. Don't delay; remove a tick as soon as it is detected, because the longer it is attached, the higher the risk that it may transmit disease.

Watch: Watch for symptoms of tick-borne illness, including sudden fever and rash, severe headache, muscle or joint aches, nausea, vomiting, and diarrhea. Symptoms can arise within several weeks of removing a tick. Contact your health-care provider if symptoms occur.

Tick types and diseases in Kentucky


Overall, the incidences of tick-borne disease remains low in Kentucky, but that doesn't mean you shouldn't take precautions to protect yourself.

The lone star tick and the American dog tick are the most common ticks in Kentucky. And though bites from these ticks typically just cause local irritation and itching, a small percentage of them carry disease.

In particular, the adult female lone star tick, which has a white spot on its back and is about the size of a pencil eraser, can carry erlichiosis, a disease that can cause fever, headache, chills, muscle pain and in some cases a rash. Symptoms generally occur within one to two weeks of a bite. The first line of treatment is an antibiotic; if not treated properly, it can be fatal.

The CDC reports that Kentucky has one of the highest rates for cases of this disease, 9.7 per 1 million people. The lone star tick can also cause some people to become allergic to red meat.

The American dog tick is reddish-brown with mottled white markings on the back and is about the size of a pencil eraser. It can carry Rocky Mountain spotted fever, which usually begins with a sudden onset of fever and headache two to 14 days after being bitten by an infected tick.

Kentucky had 249 probable cases of Rocky Mountain spotted fever and one confirmed case in 2017, according to the state health department. Though rare, the bacterial disease can be deadly if not treated with the right antibiotics, with children under 10 making up most of the deaths, the CDC says.

Earlier this month, a 2-year-old Kentucky boy came down with a case of Rocky Mountain spotted fever that caused him to be unconscious for nearly a week, Lindsey Bever reports for The Washington Post. Kayla Oblisk told Bever that her son, Jackson, was bitten by a tick and they had just pulled it off and thrown it away without much worry. Within three days, he developed a dangerous high fever and developed a light pink rash all over his body. She said he was first diagnosed with a viral infection, but was eventually admitted to the hospital where he was diagnosed and treated for this rare but potentially fatal disease.

Both the American dog tick and the lone star tick can carry tularemia, a disease that infects animals and people and is often spread by rabbits. Symptoms of tularemia vary depending on how long the bacteria have been in the body and where the person contracted the disease. All forms of the disease are accompanied by fever. It can be life-threatening, but most infections can be treated successfully with antibiotics. In 2017, Kentucky had two cases of tularemia, according to the CDC.

A much smaller tick that is becoming more common in Kentucky is the blacklegged tick, also known as the deer tick. It carries Lyme disease, symptoms of which can range from mild to severe, including fever, headache, fatigue and a skin rash that looks like a bull's-eye, although not everyone gets the rash. This tick can also carry ehrilichiosis, which can weaken the immune system.

In 2017, Kentucky had six confirmed cases of Lyme disease and 14 probable cases, the CDC says.

Veterinarians in Kentucky now have access to a new program sponsored by the health department and the University of Kentucky that allows them to submit ticks for identification and testing. For more information about the program contact the program manager at tori.amburgey@ky.gov or the state public health veterinarian: kelly.giesbrecht@ky.gov.

A deeper dive

Elemental, a Medium publication for health-and-wellness journalism supported by science, has produced a multi-part special report about ticks called "Tickpocalypse" that explores in great detail the exploding tick population and the growing number of diseases that come with it.

The introduction to the series alarmingly refers to Lyme disease as a pandemic, a word that is only assigned to diseases that occur over a wide geographic area and affects an exceptionally high proportion of the population.

"It's estimated that 300,000 people contract Lyme each year in the U.S.," with victims found in all 50 states and Washington, D.C., it says. Further, it notes that Lyme is also on the rise in Europe, Africa and Asia.

Lyme disease is so bad that Mary Beth Pfeiffer, author of Lyme: The First Epidemic of Climate Change, calls for a "huge national and concerted international effort to bring it under control," Alex Bhattachari reports in one of the stories, "Lyme Disease Cases Are Exploding. And It's Only Going to Get Worse."

Bhattachari writes, "A public health crisis is hiding in plain sight, with tick-borne diseases creating millions of sick people at an economic cost running into the billions, and little has been done so far to mount a meaningful defense."

Other stories in the series are titled: "What It's Like to Have Lyme Disease Forever"; "Worrying About, Worrying About Lyme Disease"; "When Lyme Kills"; "What It's Like to be a Creepy-Crawler Field Researcher"; "Know Your Enemy: The Blacklegged Tick"; "When That Tick Bites"; "Lyme Prevention 101"; and "The Mouse Cure."

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Thunderclap headache: The “worst headache of my life”

Not all headache disorders are the same. An excruciating, sudden-onset headache known as thunderclap headache (TCH) is a medical emergency, very different from more common headache disorders such as migraine and tension headache. If you develop TCH, you should call 911 or immediately go to the closest hospital.

TCH is associated with a variety of causes, ranging from benign to potentially fatal. Urgent evaluation in an emergency setting is needed to quickly identify and treat any underlying condition.

Diagnosing and treating secondary thunderclap headache

When you arrive at the hospital, the medical team will want to confirm or rule out a potentially serious, secondary cause of the TCH. The initial history and examination will focus on red flags that suggest specific secondary causes.

A secondary TCH has an underlying cause, other than the headache itself. For example, neck stiffness or sleepiness may suggest a ruptured brain aneurysm or infection; a drooping eyelid may indicate a tear in the carotid artery (the main artery supplying the brain); seizures or sudden limb weakness may suggest clots in a blood vessel, or bleeding in the brain (hemorrhage). Absence of these signs and symptoms does not definitively rule out these causes, which is why you will likely undergo imaging of the brain and its blood vessels with either computed tomography (CT) or magnetic resonance imaging (MRI). If imaging does not reveal a clear secondary cause, a lumbar puncture, or spinal tap, may be needed.

If a secondary cause is identified, the underlying problem will be treated. For example, if your TCH was caused by a blood clot in an artery, it would be treated with clot-busting medications or the clot would be removed via a catheter-based procedure.

Primary thunderclap headache and RCVS

If no obvious cause is found, TCH is considered “primary,” or “idiopathic.” Primary TCH typically affects young adults. It is commonly associated with physical triggers such as cough, exercise, and sexual activity.

Rarely, people can develop multiple, recurrent TCHs within a span of a few days. In such cases, imaging invariably shows alternating areas of narrowing and dilation (the appearance is described as “a sausage on a string”) of multiple brain arteries. This condition is called reversible cerebral vasoconstriction syndrome, or RCVS. RCVS can also develop in patients with a single TCH.

Approximately 30% to 50% of patients with RCVS go on to develop brain hemorrhage, strokes, and brain swelling. Thus, if you are diagnosed with RCVS, you will likely be admitted to the hospital for a few days of observation. Despite these possible complications, people with RCVS generally do well; the flurry of TCHs usually subsides within days, and the arterial narrowing resolves on its own within a few weeks.

Treating primary thunderclap headache and RCVS

There is no known preventive medication for primary TCH or RCVS. Bed rest is recommended, since exercise, anxiety, and sexual activity can precipitate more TCHs. Laxatives and stool softeners are also recommended, since straining or bearing down can trigger TCH.

The extreme head pain usually settles in a few minutes, but moderate to severe headache can persist for several hours. Common pain relievers such as acetaminophen (Tylenol) and ibuprofen (Advil) may help. Treatment with more potent drugs, such as morphine and other opioids, may be prescribed for prolonged or very severe head pain.

Certain medications should not be used to treat TCH. These include glucocorticoids, triptans, and other anti-migraine medications, which induce narrowing of brain arteries and can worsen the situation. People with RCVS should also avoid certain drugs for several weeks. These include serotonin-enhancing antidepressants (SSRIs and SNRIs), ecstasy, cannabis, and sympathomimetic and amphetamine derivatives such as pseudoephedrine (a common ingredient in many cough-and-cold remedies, exercise stimulants, and diet pills).

Primary TCH can recur intermittently for several years. Recurrence of an episode of RCVS is extremely rare. Most people can resume routine physical activities and gradually increase the intensity of exercise two to four weeks after the sudden-onset headaches subside.

The extreme head pain of primary TCH and RCVS can understandably evoke significant anxiety. But the long-term outcome is nearly always benign.

The post Thunderclap headache: The “worst headache of my life” appeared first on Harvard Health Blog.

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