Tuesday, July 22, 2014

As Virginia governor fights to follow Kentucky's lead on Medicaid, free-clinic user says she doesn't want government handout

Kentucky's success with federal health reform hasn't been mirrored in adjoining states. It is a complex topic that was made more complex by the Supreme Court ruling that made it easy for states to reject the law's main device for helping the poor, expansion of the federal-state Medicaid program. That added political complexity to a subject that has philosophical complexity, which showed up at the end of an recent article in The Washington Post about Virginia Gov. Terry McAuliffe's campaign to expand Medicaid against the wishes of his Republican-led legislature.

To illustrate the need, McAuliffe attended a free medical and dental clinic in Wise, in Virginia's southwestern coalfield, just across Cumberland Mountain from Kentucky's Letcher County. The Post's Laura Vozzella ended the story with her interview of Gilda Mountcastle, who had been waiting in line since 5:30 a.m. Mountcastle said she would not have access to a dentist or eye doctor without the free clinic, but said "she did not support Medicaid expansion, which she saw as a government handout." She told told reporters, “We’re hardworking, hillbilly mountain people. We’re too proud to beg and bum.” From the government, at least. (Read more)

Sunday, July 20, 2014

Smoking-ban supporters on 'Road to a Healthier Kentucky Tour' next week to rally support for the 2015 legislative session

The Smoke-Free Kentucky Coalition is kicking off its 2015 campaign to rally support for comprehensive, statewide smoke-free laws on its "Road to a Healthier Kentucky" Tour, from Monday, July 28 to Saturday, August 2.

The tour plans to make at least 10 media appearances across the state on its way to its final stop at the annual Fancy Farm Picnic in Graves County. The coalition says its goal is to get Kentuckians active and engaged in supporting smoke-free policy as the campaign gears up for the next legislative session. The message: "It's time to take a stand for better health by making Kentucky a smoke-free state."

The coalition says 24 other states have comprehensive, statewide smoke-free laws that cover all indoor workplaces and public places, including bars and restaurants. State Rep. Susan Westrom, D-Lexington, has introduced such legislation during the last four legislative sessions but it has not gotten a floor vote in the full House. Last year's bill apparently died because legislators feared backlash in an election year.

Almost 30 percent of Kentuckians still smoke, more than any other state in the nation, but a poll last fall showed 65 percent of Kentuckians favored a smoke-free workplace law, and 90 percent of Kentucky Chamber of Commerce members support such a law.

“2015 is the year we are finally going to pass a smoke-free law and protect everyone’s right to breathe clean air in Kentucky,” said Amy Barkley, chair of the coalition. “We know Kentuckians support going smoke-free, and we’re touring the state to call attention to those supporters.”

Here's the tour schedule:
Monday, July 28: King's Daughters Medical Center, 2201 Lexington Ave, Ashland, noon.
Tuesday, July 29: Appalachian Regional Healthcare, 110 Medical Center Dr., Hazard, 11 a.m.; Manchester City Hall, 123 Town Square, 3 p.m.
Wednesday, July 30: Markey Cancer Center, 800 Rose St., Lexington, 11 a.m.; Norton Cancer Institute, 676 S. Floyd Street, Louisville, 3 p.m.
Thursday, July 31: Big Dawg Country Radio, 101 E. Main St., Campbellsville, 11 a.m.; Fountain Square Park, Bowling Green, 2 p.m.
Friday, Aug. 1: Smothers Park, 199 West Veterans Blvd., Owensboro, 10 a.m.; Baptist Health (formerly Trover Clinic), 900 Hospital Dr. Madisonville, 12:30 p.m.; Baptist Health Paducah, 2501 Kentucky Ave., 3:30 p.m.
Saturday, August 2: Fancy Farm Picnic, St. Jerome Church, Fancy Farm, 10 a.m. to 4 p.m.

Barkley says she can be reached at 502-777-8148 or abarkley@tobaccofreekids.org to inquire about additional stops. For more information visit www.smokefreekentucky.org or contact Betsy Janes, 502-797-0638 or betsyjanes@ymail.com.

The coalition includes the American Cancer Society Cancer Action Network, the American Lung Association, the American Heart Association, the Campaign for Tobacco-Free Kids and other local health, businesses and community partners.

U.S. measles cases highest in 2 decades; blamed mainly on Americans' foreign travel, but also on opting out of vaccination

By Melissa Patrick
Kentucky Health News

In the wake of the highest number of measles outbreaks in the U.S. in the last 20 years, it is important to make sure you and your children are fully immunized, especially if you are traveling abroad.

"The current increase in measles cases is being driven by unvaccinated people, primarily U.S. residents, who got measles in other countries, brought the virus back to the U.S. and spread (it) to others in communities where many people are not vaccinated," Ann Schuchat, director of the Center for Immunizatons and Respiratory Diseases of the federal Centers for Disease Control and Prevention, said in a press release.

Centers for Disease Control photo
Measles is a virus and is one of the most contagious diseases known. It spreads through the air when an infected person coughs or sneezes and will infect 90 percent of those who are exposed if they are not protected. It starts with a fever, followed by a cough, runny nose and red eyes. Then a rash of tiny, red spots breaks out, which starts at the head and spreads to the rest of the body. It can lead to pneumonia, swelling of the brain and death. Of every 1,000 children who get the disease, one or two will die, the CDC says.

Kentucky requires measles immunizations for children in child care and school, with exemptions made only for medical or religious purposes.

The Kentucky Annual School Immunization Survey for Kindergarten and Sixth Grade reports that for the 2013-2014 school year: 148 kindergarten students (0.3 percent) and 228 sixth graders (0.4 percent) opted out of immunization under the medical exemption, while 359 kindergartners (0.6 percent) and 249 sixth graders (0.5 percent) opted out for religious reasons.

As of May 23, measles cases have been reported in 18 states and New York City, with most reported from Ohio (138), California (60), and New York City (26). Ninety percent have been among people who have not been vaccinated or have unknown vaccination status, according to the CDC. Most of the patients report religious, philosophical or personal reasons for avoiding vaccines. Through May 23, no deaths had been reported.

Saturday, July 19, 2014

Daytime mental-health programs shrink, citing problems with managed-care Medicaid; pastoral counselors to be licensed

Access to daytime mental-health care "is on a steep decline in Kentucky, leaving what some fear is a gap in care that isolates the mentally ill at home or drives them out into the streets, hospitals or jail," Mike Wynn of The Courier-Journal's Frankfort Bureau reports. The Kentucky Association of Regional Programs, the lobby for community mental-health centers, "reports that 33 of the roughly 50 programs offered across the state have closed in the past 18 months while four others have reduced their hours by half," affecting an estimated 1,000 people.

The state Department for Behavioral Health, Developmental and Intellectual Disabilities says these community mental-health centers should embrace "a shift away from using day programs," Wynn writes, but mental-health advocates "say the centers have struggled to get enough coverage authorized under Kentucky's Medicaid managed-care system to keep the services operating. That has forced programs to close before new services are available to replace them, they argue."

The advocates say that among companies that manage care in Kentucky under Medicaid, Coventry Cares and its subsidiary MHNet "are by far the worst about denying coverage or reducing hours for therapeutic day programs. Coventry and MHNet are owned by insurance provider Aetna," which "says complaints are off target and that it is committed to providing patients with high-quality care. MHNet has approved two-thirds of the requests it received for therapeutic rehabilitation since January 2013, Aetna said in a statement."

Steve Shannon, executive director of the centers' lobbying group, "said that even mild reductions — such as approving services for three days a week rather than five — can wreak havoc on a program's financial viability," Wynn writes. "He also argues that centers may have stopped requesting services once they realized that MHNet would not approve them." (Read more)

Meanwhile, Kentucky has become the sixth state to license pastoral counselors under a new law that will also allow them to be paid for their services. The sponsor of Senate Bill 61, Sen. Alice Forgy Kerr of Lexington, told Jack Brammer of the Lexington Herald-Leader that the counselors must have a master of pastoral counseling degree, in addition to the same qualifications as other licensed counselors, and must also pass a written examination. (Read more)

Friday, July 18, 2014

Some odors we emit make us more attractive to mosquitoes; various repellents, including plant oils, are available

Mosquitoes are attracted to some people more than others because of skin odors or chemicals they emit, Jill Richardson writes for Salon. Carbon dioxide, heat, moisture, scent and appearance attract mosquitoes, but it's the chemicals you emit that make them want to take a bite, she writes.

Photo from Lexington Herald-Leader
Kentucky has about 60 of the 150 species of mosquitoes found in the U.S., according to the University of Kentucky Public Health Entomology Laboratory. Not all bite, and if one does, it is always a female, which needs the protein found in blood to make her eggs, UK extension entomologist Lee Townsend writes in The Courier-Journal.

Each species differs in biting persistence, habits and ability to transmit disease and even flying ability, Richardson writes, but it is the chemicals we emit that dictate their preference of who to bite.  L-lactic acid, ammonia, carboxylic acids and octenol, especially in combination with each other, are the chemicals most likely to attract them.

Scientist have found that adding l-lactic acid to the scent of someone who is not normally bitten by mosquitoes will make them more attractive to certain kinds of mosquitoes, Richardson reports. The presence of carbon dioxide has also been found in studies to be attractive to certain mosquitoes. Ammonia, which occurs from a pH change when bacteria in sweat multiply, is also appealing to mosquitoes.

So are smelly feet. Studies with Limburger cheese, which resembles human foot odor, have confirmed this. However, malarial mosquitoes are most attracted to this odor, so the saying that "If you keep your feet clean then mosquitoes won't bite," is good advice only if you are traveling in the tropics, Richardson writes.

Human odor that attracts mosquitoes may be genetically driven, but theories vary. One says individuals who are not attractive to mosquitoes don't produce the odors that attract them; and another says some people actually emit an inherited odor that keeps mosquitoes from finding them.

For those who consider themselves "mosquito bait," Richardson makes several suggestions: bathe at dusk, when mosquitoes come out, to minimize sweat odor, rub your body with antimicrobial plants like sage, wear a full-body mosquito net suit or use a repellent, which is the most convenienct, effective protection.

The most common repellent is DEET, available over the counter in many preparations. A prescription repellent is permethrin, which Richardson says may be carcinogenic though it is approved by the Environmental Protection Agency.

A young jewelweed plant
Many people use essential plant oils, though they evaporate quickly, requiring frequent application. The one most commonly recommended is lemon eucalyptus oil, which has proven effective. Richardson's article has details about other plant oils, and recommends crushed jewelweed as a remedy for mosquito bites.

Darla Carter of The Courier-Journal also had a good roundup of mosquito information in the Louisville paper's July 18 edition: http://www.courier-journal.com/story/life/wellness/health/2014/07/17/guard-mosquitoes-summer/12786213/.

Thursday, July 17, 2014

As Edelen begins hearings on rural hospitals' finances, state gives figures on Medicaid expansion and reimbursement

By Al Cross
Kentucky Health News

The expansion of the federal-state Medicaid program funneled $284 million to Kentucky health-care providers in the first quarter of the year, the state Cabinet for Health and Family Services says in a report prepared for the hearings state Auditor Adam Edelen has begun to examine the fiscal health of rural hospitals.

Under the Patient Protection and Affordable Care Act, states could expand Medicaid eligibility to people with household incomes up to 138 percent of the federal poverty level, and Gov. Steve Beshear did that. The federal government, which normally pays about 70 percent of Medicaid costs, is paying the entire cost of the newly eligibles through 2016. The state will pay 3 percent in 2017, rising to a cap of 10 percent in 2020.

Beshear says the expansion will pay for itself by creating more jobs and tax revenue in health care, but some rural hospitals are saying the combination of reduced reimbursements under Obamacare, and delayed and rejected reimbursements under managed-care Medicaid, have left them with the short end of the stick.

Auditor Adam Edelen
“Rural hospitals are teetering on the edge of survival in many Kentucky communities,” Edelen said in a press release last week announcing the schedule of 10 hearings, which began Tuesday in Prestonsburg and Hazard and continued Wednesday in Pineville. They will resume Wednesday, July 23 in Morehead.

"Aside from members, hospitals have been the primary beneficiaries of Medicaid expansion," says the report from the Cabinet for Health and Family Services. "They are beginning to see their share of uncompensated visits drop significantly as Medicaid begins to reimburse for the previously uninsured."

The report said $135 million of the $284 million in Medicaid reimbursements went to hospitals. The report covered the first half of the year, but said "due to the billing and payment cycle, these totals most likely only represent completed claims for January through March."

Rural Kentucky hospitals' reimbursements have not increased as fast as those of urban hospitals in the state. In the fiscal year that ended June 30, they received total Medicaid reimbursements of $452 million, up 3.2 percent from $438 million in the previous fiscal year. Urban hospitals' reimbursements went up 7 percent, to $836 million from $781 million.

"Some hospitals are experiencing declining Medicaid reimbursements while others are flourishing," the report said. "For example, Caldwell and Crittenden counties share a border, they have similar populations, and they both have small rural hospitals with 25 and 48 beds respectively.  Despite their geographic closeness and similarity, Crittenden County has experienced 50 percent reimbursement growth in the past three years while Caldwell County reimbursements have declined by 33 percent."

The report includes tables listing all Medicaid reimbursements to rural hospitals for the last three state fiscal years (SFY 2014 figures likely omit most of the final quarter because of billing and payment cycles):
The report lists the hospitals that had received more than $2 million in Medicaid reimbursements. An Excel spreadsheet of Medicaid payments to all hospitals can be downloaded here. Here's a list of the reimbursements to all providers for treatment of newly eligible Medicaid recipients, by county:
Edelen has scheduled other hearings at Madisonville Baptist Health July 31 at 10 a.m.; Caldwell Medical Center in Princeton July 31 at 2:30 p.m.; the Leitchfield campus of Elizabethtown Community and Technical College Aug. 6 at 10:30 a.m.; Westlake Regional Hospital in Columbia Aug. 12 at 10 a.m.; and Taylor Regional Hospital in Campbellsville Aug. 12 at 2:30 p.m.

Pediatric therapist says ADHD rising because kids don't move their bodies enough; says they need to play outside

The percentage of children diagnosed with attention-deficit and hyperactivity disorder, or ADHD, is on the rise. While many reasons are mentioned, one that is not heard often is the length of time children are forced to sit while they are in school, writes Angela Hanscom, a pediatric occupational therapist, in the TimberNook blog, which was picked up by Valerie Strauss of the Washington Post.

Kentucky leads the nation in the percentage of children with a current diagnosis of ADHD, at 14.8 percent, a jump from 10.2 percent diagnosed in 2007, according to the U.S. Centers for Disease Control and Prevention. An even higher 19 percent of Kentucky children ages 4-17, compared to 11 percent nationally, have ever been diagnosed with ADHD at some point. (CDC map)
Reasons given for this rise in diagnosis include changes in "diagnostic criteria, medication treatment and more awareness of the condition," Strauss writes. Over-diagnosis, genetic predisposition and "financial incentives" that can go along with an ADHD diagnosis are other possible reasons for this increase in diagnosis, reports Laura Ungar of The Courier-Journal.

Hanscom says the amount of time children are forced to sit while they are in school is also a contributing factor. She reflects in her article about a recent phone call from a parent of a 6-year-old whose self-esteem is being crushed because he is told every day at school that his behavior isn't good enough simply because he can's sit for long periods of time. She also writes about a local elementary teacher who told her that "at least eight of her 22 students have trouble paying attention on a good day."

The problem, Hanscom writes, is that "Children are constantly in an upright position these days" and are not moving their bodies enough.

Hanscom writes about her recent observations of a fifth-grade classroom where she found fidgeting, kids tilting chairs, kids rocking their bodies back and forth and one child hitting a water bottle against her head in a rhythmic pattern. She writes, "This was not a special-needs classroom, but a typical classroom at a popular, art-integrated charter school."

She noted that some of this behavior could have been because it was the end of the day, but she also did testing on the students' core strength and balance in several of the classrooms and found it to be poor, with "only one" out of 12 of the students having normal strength and balance when compared to children from the early 1980s.

Hanscom says children have underdeveloped balance systems today because of so much restricted movement. To develop a strong balance system, she says, children need to move their bodies in all directions for hours at a time daily.

Children often fidget in the classroom to get the movement their bodies need, which helps to "turn their brain on." But, subsequently the fidgeting gets them in trouble and so when they sit still as required, their brains "turn off," Hanscom writes. "Children are going to class with bodies that are less prepared to learn than ever before."

Hanscom suggests that the solution is to fix the underlying issues: put recess back into our schools and let kids play outside for hours when they get home from school, and "20 minutes of movement a day is not enough! In order for children to learn, they need to be able to pay attention. In order to pay attention, we need to let them move."

Wednesday, July 16, 2014

Smoking among Kentucky youth dropped by one-fourth from 2011 to 2013, biennial CDC survey determines

Photo from TobaccoPreventionK12
By Melissa Patrick
Kentucky Health News

Fewer Kentucky high-school students are smoking cigarettes. The state dropped to sixth place from first in high-school smoking in the 2013 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System report.

In the survey, which is done in odd-numbered years, 17.9 percent of Kentucky high-schoolers reported that they were smoking cigarettes, down one-fourth from 24.1 percent in 2011. Nationwide, the current rate is 15.7 percent.

In 1997, when the CDC first started tracking student smoking, 47 percent of Kentucky youth reported smoking.  The state has now cut that bu more than half, and gone beyond its "Healthy Kentuckians 2020" goal of reducing youth smoking to 19 percent.

The survey sampled 1,626 Kentucky high-school students and got responses from 85 percent. The final sample of 1,382 is subject to an error margin of plus or minus 2.6 percentage points, leaving no doubt that youth smoking in Kentucky declined significantly from 2011 to 2013 -- by 25.7 percent, if the figures are without sampling error.

Before state officials knew about the big drop in 2011-13, they set a goal of decreasing youth smoking by another 10 percent by 2019 as part of the "kyhealthnow" initiative.

“When I announced our ambitious goals for kyhealthnow in February of this year, smoking was one of the most obvious areas we needed to address,” Gov. Steve Beshear said in a news release. “I am pleased to see teen smoking trending downward, but I remain committed to further reducing cigarette use among our youth.”

Kyhealthnow is an aggressive plan to improve the state's collective health. One component of the plan to cut youth smoking by 10 percent includes comprehensive smoke-free policies and tobacco-free schools.

Only 33 of Kentucky's 173 public school districts are tobacco-free, according to the state Department for Public Health. Since nearly nine out of 10 smokers start by age 18, early intervention is a "key element in reducing the overall burden of tobacco use in Kentucky," the release says.

Youth who smoke can develop cardiovascular disease, smaller lungs that don’t function normally, wheezing that can lead to asthma, and eventually cellular damage that can lead to cancer, rheumatoid arthritis, type 2 diabetes and a host of other diseases, according to the release.

“While we’re pleased to see a reduction in youth smoking, it’s important to note that we still have too many youth who smoke and others who are exposed to secondhand tobacco smoke,” said state Health Commissioner Stephanie Mayfield. “The health consequences of smoking are seen throughout many of the diseases impacting Kentuckians. Smoking cessation could significantly reduce the rates of cancer, cardiovascular and respiratory diseases which are linked to tobacco use.”

Smoking cessation programs are available to people 15 and older in Kentucky, and are available in multiple languages. For more information call 1-800-784-8669 or go to www.QuitNowKentucky.org.

Tuesday, July 15, 2014

Paducah Baptist and Ashland hospitals 'above average' in Consumer Reports' ratings of hospitals for heart surgery

Baptist Health Paducah
(formerly Western Baptist Hospital)
By Melissa Landon
Kentucky Health News

Consumer Reports has reported ratings of hospitals for heart-valve and coronary artery bypass surgery based on hospitals' reports to the Society of Thoracic Surgeons. More than 400 hospitals in 45 states have been rated, based on "medical records showing whether patients survived the procedure and how they fared on other important measures, including complications," the magazine says.

Although more than 1,000 hospitals send data to STS, only 400 allowed it to be shared with Consumer Reports. Of those did, "20 percent (83) were above average, 75 percent (310) were average and 4 percent (18) were below average," the magazine reports. Robbin Cohen, a cardiothoracic surgery professor at the University of Southern California, said the STS has very high standards, so hospitals with average scores do a very good job.

King's Daughters Hospital, Ashland
King's Daughters Hospital in Ashland and Baptist Health Paducah (formerly Western Baptist Hospital) were the only Kentucky hospitals ranked above average for either type of procedure (and in their cases, only for bypasses). King's Daughters recently agreed to a huge settlement with the federal government for doing unnecessary heart procedures.

Four Kentucky hospitals were listed as below average for both procedures: Lourdes Hospital in Paducah and Jewish Hospital, Norton Hospital and Norton Audubon Hospital. Two were listed as below average for bypass and were not listed for valve: Baptist Health Lexington and Baptist Health Madisonville.

Several hospitals near Kentucky were on the list. Mercy Health-Anderson Hospital in Cincinnati was rated below average for bypass and was not listed for valve surgery. In Missouri, Poplar Bluff Regional Medical Center and Cape Girardeau's Saint Francis Medical Center were rated below average on both.

In Tennessee, Nashville's Tristar Centennial Medical Center and Saint Thomas Midtown Hospital were below average on both, but Saint Thomas West Hospital, was above average for bypass and below average on valves. In Knoxville, the Univerity of Tennessee Medical Center and its Fort Sanders Regional Medical Center were below average on both, and Parkwest Medical Center was above average on bypass and below average on valve. Wellmont Holston Valley Medical Center in Kingsport was below average on both, and Johnson City Medical Center was above average on bypass and below average on valves.

The top hospitals in the nation were Baystate Medical Center in Springfield, Mass., Borgess Medical Center in Kalamazoo, Mich., and Cleveland Clinic, which attracts some Kentuckians. To see the full list of ratings, click here.

Study indicates that vitamin D can help prevent early death from cardiovascular disease and cancer

Elderly people with a vitamin D deficiency are more at risk for death from cardiovascular disease and cancer, according to a large-scale study by the Mount Sinai health system of New York and a group of international collaborators, published in the June issue of BMJ, formerly British Medical Journal.

Paolo Boffetta of the Tisch Cancer Institute at Mount Sinai led a collection and analysis of data that showed a significant association between low vitamin D levels and risk of death not only from cardiovascular diseases and cancer in older people with a history of cancer, but death from all causes.

Other studies showed that vitamin D helps prevent issues like hypertension, diabetes and bone loss, but these new findings suggest it might be even more important than previously known. "Going into our study, the effect of vitamin D supplementation on risk of death was not clear," Boffetta said. "Our analysis confirms the protective nature of this substance, especially in elderly patients."

Sunlight, as well as food and supplements, provide vitamin D. Because elderly people generally get less sun, they're more likely to have a vitamin D deficiency. Though researchers don't yet know how much vitamin D is ideal, the study results do argue that people with a vitamin-D deficiency are more likely to die early than those who don't have such a deficiency, Boffetta said.

Researchers use data from eight different studies including 26,018 men and women between ages 70 and 79. During the study, 6,695 participants died—2,624 from cardiovascular diseases and 2,227 from cancer. Participants with the lowest levels of vitamin D had a risk ratio of 1.57, which was double the death risk of the people with high concentrations of the vitamin.

"Vitamin D's protective effect is clear," Boffetta said. "If our results are confirmed in additional studies, it could lead to recommendations for greater vitamin D supplementation in foods and to a better understanding of its role in cancer prognosis." (Read more)

Monday, July 14, 2014

July is Minority Mental Health Month; experts discuss mental-health complications among African Americans

By Melissa Landon
Kentucky Health News

July is Minority Mental Health Month. KET's Renee Shaw interviewed Sycarah Fisher, associate professor in the College of Education at the University of Kentucky, and Shambra Mulder, an assistant professor in the School of Education at Kentucky State University, about challenges and differences professionals face in providing care for African Americans with mental health conditions. The show is available online and airing on KET's secondary channels.

"Getting the right diagnosis and treatment for mental health issues are difficult tasks, and can be even more challenging for ethnic and racial minority groups," Shaw said at the beginning of the interview on her weekly show, "Connections."

Fisher said mental illness is particularly stigmatized in African American communities and other ethnic or racial groups, perhaps because some "feel like getting help, especially from medical professionals, makes [them] weak, and [they're] expected to be strong and be able to take care of [themselves]."

Mulder agreed, adding that "The church and spirituality play a big role in the African American community," so those who seek medical help might be seen as lacking the faith to be healed. It may also have to do with the lack of minorities working in the field, she said. Research shows that African-Americans are more inclined to seek or stay in therapy if they have a minority therapist.

Fisher discussed ways more minorities might be recruited to the field. She called that "a very, very big task," noting that it can be uncomfortable to be the only African American in a program. Even the students who do make it into Ph.D. programs have more difficulty graduating, she said. Many programs are seeking grants to bring in minority psychologists.

Mulder added that if people haven't seen or heard of many black psychologists, they might think it's really difficult or might not think they couldn't do it. Shaw clarified that they weren't saying a doctor must be black to understand a black patient, it's just that mental health is a sensitive issue that people are sometimes uncomfortable discussing.

Fisher said it's important for people, especially African Americans, to talk about their disorders and treatments and how it is helping so that others will feel comfortable seeking medical attention that they need. Mulder said that even taking medication can be stigmatized.

Adding to the problem is that racial and ethnic minorities are more often misdiagnosed. Fisher "A lot of measures that are used to identify different types of behavior disorders aren't normed on African American samples," Fisher said. "We're taking and giving measures to African-American individuals, but yet when we're comparing them to different cultural groups."

Mulder agreed, adding that some people may not want to be forthcoming about their symptoms. If they will not accurately explain what they're dealing with, it's difficult to make the correct diagnosis. Shaw pointed out that this and other factors can lead to delayed treatment, which can have serious consequences. Fisher said, "The earlier you intervene, the better your outcomes are going to be. . . . The longer you wait, the more severe the problem behaviors are going to get."

The experts also discussed diagnosis of children. Shaw asked how professionals perceive the difference between a child who has a mental health issues and a child who is being abused or something similar. Fisher said environmental factors must be addressed, and Mulder said, "The behavior might be age appropriate, but the environment might not be age-appropriate," such as asking kindergartners to sit for a long time.

Shaw said people may wonder what schools can do to help. Fisher said a school psychologist's job is to make sure the student can function in the school environment. They may not have enough time to talk with the students and provide all the help they need, so they can "rally the troops" and "connect our services with the services they're receiving in the community."

Mulder noted that although it's important for school psychologists to make sure students are diagnosed so they can get the help they need, doctors are supposed to notice the early symptoms in young children. Later on, teachers may notice something is amiss but usually only if it is externalized behavior. Parental input is also important although they often don't have sufficient knowledge of what symptoms would be. Schools are moving to a more preventative approach, Fisher said. Teachers will report things that disrupt the classroom and miss the internalized behaviors.

Click here to watch the show.

Saturday, July 12, 2014

WKYT anchor Sam Dick finishes radiation treatment for recurring prostate cancer; encourages others to monitor their health

Photo from www.mediabistro.com 
Longtime WKYT-TV anchor Sam Dick believed that his battle with prostate cancer was over, but found out six months ago that some of the cancer remained. He reported on his diagnosis and treatment as he neared the end of a seven-week course of radiation.

"Being told you have cancer is life-changing," Dick said. "Three and a half years ago, many of you followed my journey fighting prostate cancer and were very supportive as I decided to have surgery to remove the prostate. I was told by doctors at the time, I was cured."

But six months ago his prostate specific antigen levels, which had stayed undetectable for two years after his prostate was removed, crept up, so he started daily treatments at Lexington Clinic's John D. Cronin Cancer Center. PSA levels can vary widely and can be unreliable, but are the best diagnostic tool available. "In my case, a rising number means cancer is likely still present," he explained. Dick's treatment was tailored to his medical condition and cancer history.

Dick has maintained his regular schedule of anchoring WKYT's evening newscasts and had told only a handful of people about the cancer's recurrence, but as he approached his last radiation treatment he said he wanted to remind others about the importance of watching for warning signs.

"We can't see the cancer cells in a situation when we're treating for a rising PSA after surgery, but we know where we need to treat because there is an overwhelming likelihood that the reason that the PSA is going up is because there is residual disease in the pelvis so that's our target," Dr. Janalyn Prows, a radiation oncologist, said in the WKYT report.

"It's not uncommon for men who've had their prostate removed because of cancer to find out years later some cancer" remains, but it's not what I expected, or centrality wanted," Dick said.

His father, journalist and author David Dick, battled prostate cancer for more than a decade before dying of it a few years ago. He referred to that and said, "I feel blessed. They had nothing like this available. The advances of medical technology are a blessing I'm taking advantage of, and I'm hopeful and optimistic it's going to work."

Dick will have his follow up PSA in two months. "At that time, we'll see where I am," Dick said. "Until then, I appreciate all the emails, Facebook posts, and notes of support and prayers. Thank you from the bottom of my heart!"

Prostate cancer is the second most common cancer among men after skin cancer, according to the American Cancer Society. For more information about it, click here.