In a report released last week, the Office of the Inspector General (OIG) for the U.S. Department of Veterans Affairs identified problems at the medical center related to surgical services and how leadership there addressed quality management concerns.

“We take allegations of oversight and misconduct seriously and have strengthened our policies and procedures to ensure consistent, high-quality care from licensed professionals,” said Terrence Hayes, the VA’s press secretary, in a Tuesday statement. “We plan to fully implement all recommendations by December.”

The Hampton facility recently confirmed it was replacing several top officials, including its director, chief of staff and chief of surgery.

The OIG launched its review following multiple complaints it received about the center in 2022.

“We got some concerns about surgical quality so we engaged with the facility trying to get some response,” said Julie Kroviak, the department’s principal deputy assistant inspector general for health care inspections. “We then sent further questions to the regional office — and after that we just became more concerned about the quality review processes.”

Kroviak said the report can get a “little bit technical” but shouldn’t be dismissed.

“I think it can be written off as ‘Oh just some detailed processes weren’t followed by clinical leaders.’ But those processes are so critical to the foundation of a patient’s safety program,” she said. “If the highest levels of leadership are not aware of them, truly not aware of them, there are so many places for things to go seriously wrong.”

For example, the report found that after concerns were raised about patient safety, facility leaders issued a summary suspension of the assistant chief of surgery’s clinical privileges in January 2023. But it says the surgeon’s clinical privileges were restored after facility leaders failed to follow required protocol. The surgeon transferred to another VA health facility in June 2023, which “precluded facility leaders from correcting the process, including initiating additional actions,” the report states.

The Hampton center serves southeastern Virginia and northeastern North Carolina. From Oct. 1, 2021, through Sept. 30, 2022, the center served more than 66,000 patients.

The report states OIG received a complaint, which included five patient case examples, in December 2022 that the assistant chief of surgery provided poor surgical care and that the chief of staff was aware of the concerns but did not address them.

After OIG requested additional information, the Veterans Integrated Service Network responded and said the facility conducted a focused clinical care review of 15 cases performed by the assistant chief of surgery. It found six cases did not meet the standard of care and four of those had intraoperative complications, including one patient who experienced a laceration of the liver and another who underwent surgery in concerningly close proximity to having received chemoradiation therapy.

The report states OIG opened its hotline inspection in May 2023. During this review, widespread failures and deficiencies were identified related to facility leaders’ responses to care concerns and subsequent privileging actions involving the assistant chief of surgery, professional practice evaluations of surgeons, surgical service quality management and institutional disclosures.

“The findings identified through this inspection highlight not only failures of facility leaders to ensure that the required processes were appropriately implemented, but also a lack of leaders’ basic understanding of the processes that support delivery of safe health care,” the report states.

The report provided a dozen recommendations, including that summary suspensions, clinical care reviews and proposed revocation of privileges are conducted in accordance with the requirements and policies of the Veterans Health Administration. It further advised the center to ensure that ongoing professional practice evaluations include documentation of all conclusionary outcomes.

In his statement, Hayes said the VA fully supported OIG’s findings.

Hayes said a new team is meeting bi-weekly to address OIG’s recommendations with a target year-end completion goal. He said the facility has introduced a new reporting tool to track clinical care metrics, suspensions, privilege changes, state board reports and ongoing evaluations. Additionally, the facility has initiated monthly patient risk meetings in surgery services.

Hayes noted Michael Harper is taking on the role of acting medical center director until Aug. 5. Harper will then be replaced by Walt Dannenberg, who currently serves as the medical center director of the Long Beach VA Medical Center in California. Hayes said the leadership changes were done to “align with the VA’s commitment to high-reliability principles” but were not directly related to the report.

The House of Representatives’ Committee on Veterans’ Affairs also recently completed an investigation into the Hampton VA Medical Center after lawmakers said they received credible complaints about patient safety concerns and medical incompetence. As a result of the investigation, the committee announced last week that the center was making a series of personnel changes.

Katie King, katie.king@virginiamedia.com

You see them crowding checkout counters at grocery stores — a rainbow of bubble-gum pink, lime green and blueberry packets, slender and upright, like a multicolored chorus line of dancers tempting an impulse purchase. At the gym, they’re dissolved into enormous jugs of cherry-tinted water.

They’re especially prevalent on TikTok. Just search #watertok for a flood of #watergirlies, clutching Stanley tumblers at their #waterstations, which are crammed with neon-bright hydration powders and flavored syrups. #Wateroftheday? How about Strawberry Birthday Cake Water. Or Caramel Apple Sucker Water.

“If your water isn’t turning your mouth blue, you’re apparently hydrating wrong,” one skeptical dietitian observed on TikTok last year.

Hydration supplements in the form of powders, tablets and liquid additives have become a norm among consumers over the last decade, and are more popular than ever. The global electrolyte hydration drinks market was valued at $1.72 billion in 2023, according to Data Bridge Market Research. And it’s growing. The business of boosting one’s H2O is projected to reach $3.26 billion by 2031.

Why hydration is important

This bonanza of new hydration products plays to a basic but critical need: More than 50% of people around the globe, including in the U.S., are chronically underhydrated, according to the National Institutes of Health, which cites worldwide surveys. (“Underhydration” refers to people who don’t meet the recommended daily fluid intake, whereas “dehydration” refers to a more severe fluid deficit.)

Those statistics are concerning, considering hydration is the oil to our body’s engine. It aids in muscle repair, digestion, energy and focus. It’s necessary for lubricating joints, regulating body temperature and removing toxins from the body. It carries nutrients to cells and is crucial for hormonal balance, which can affect blood pressure and the menstrual cycle. Our level of hydration also contributes to our hair and skin health.

“Proper hydration keeps every system of the body running smoothly,” says dietitian-nutritionist Vanessa King, a spokesperson for the Academy of Nutrition and Dietetics.

After years of striving to adhere to a 1945 U.S. Food and Nutrition Board recommendation of eight glasses of water a day, it tracks that we’d want to zhuzh up the ritual. (Some studies, however, suggest we need less water daily and that water requirements vary for individuals.) But is there any actual health value to these water additives? Do they aid with hangovers, enhance our workouts or energize us? Or are they simply there to make plain old water taste like a piña colada?

It depends on what product you’re peppering into your Hydro Flask.

“Hydration supplements can replenish you when your fluid status is down — so after workouts, for hangovers or when you’ve been sick,” says Dr. Vijaya Surampudi, an endocrinologist, nutrition specialist and professor at UCLA. “Depending on their composition, some get better absorbed and improve your hydration. Some are just for flavoring and they can have a lot of sugar or artificial coloring — it can be like drinking a soda.”

She notes that because these powders and tablets are categorized as supplements, they aren’t regulated by the U.S. Food and Drug Administration. “So you just have to trust what’s on the label.” (To fill this gap in regulation, some sleuthing social media users have even carved out a niche content genre in which they analyze the ingredients listed on the labels of celebrity-backed supplements.)

What’s in hydration supplements?

More often than not, a hydration powder or tablet includes a mix of four main ingredients: electrolytes (such as sodium, potassium, magnesium and chloride), a carbohydrate (such as glucose), vitamins (typically B vitamins, sometimes C) and amino acids. Depending on their quantity, and how they interact with one another, those ingredients may help hydrate your body more efficiently.

How these ingredients chemically interact with one another directly affects hydration. Water follows sodium for absorption, for example, and sodium molecules travel best with glucose molecules across the lining of the gastrointestinal tract, Surampudi says, so carbohydrates like sugar are not a bad thing in your supplements — they’re actually preferred.

Even so, it’s a delicate balance. A supplement with too much sugar may work against your aim to be healthier.

“The body stores excess sugar for energy later, and that’s stored as fat,” Surampudi says. “And if you drink too much [sugary fluids], that can lead to health complications.”

While sugar and sodium help fuel hydration, those with diabetes or high blood pressure should be careful with hydration supplements, paying attention to their sugar or salt intake.

“Use it with caution and discuss with your healthcare provider,” Surampudi says.

Do we need them?

Hydration supplements aren’t unsafe for most people to take daily if the sugar content is moderate — but they’re often not necessary, says Dr. Christopher Duggan, editor of the American Journal of Clinical Nutrition and a Harvard Medical School professor.

Most adults and children don’t meet daily hydration recommendations, he says, which is currently 13 eight-ounce cups of fluid for healthy men and nine for healthy women, according to the National Academy of Medicine. (Note this recommendation includes all fluids, not just water. And we tend to get 20% of our water intake from food.)

“So if adding a light flavoring gets them to drink more water, that’s probably not a terrible thing,” Duggan said. “But if the expense is high, it’s ultimately not worthwhile. Because unless you’re participating in vigorous exercise or your GI tract doesn’t work normally, water alone is probably an adequate hydration.”

Some hydration supplements even contain ingredients that are not hydrating when consumed in large quantities, such as caffeine. Though caffeine is a diuretic, consuming up to 400 mg of it daily can actually help with hydration, according to the Academy of Nutrition and Dietetics’ King. Other flavored powders contain various B vitamins, which may cause problems in excess.

“B6, if you consume too much of it because you’re getting it elsewhere, there’s a risk for some people of neuropathy, which means damage to the peripheral nerves (which are outside of the brain and spinal cord), and which can cause numbness and tingling, among other things,” Surampudi said.

Surampudi recommends consuming hydration supplements only in moments when your body is especially challenged.

“If there’s a situation where you’re fluid down, or in a high altitude or in an extremely hot climate, that’s where these things can be helpful,” she said.

How 8 top hydration supplement brands perform

So take your hydration boosters with a healthy dose of skepticism. Here’s an analysis of eight hydration supplements — the good, the bad and the meh — according to L.A.-based dietitian Katie Chapmon.

Liquid I.V.’s Hydration Multiplier. “I would not have someone choose this to use every day because the added sugar is really too much — it’s the first and second listed ingredients. The other thing is: They boast, on their website, that the hydration multiplier has ‘3x the electrolytes of the leading sports drink.’ And that may be wonderful for someone who is doing very high-impact sports or who would require serious electrolytes replacement, but it’s not for the average person. Electrolytes balance out our cells, but if we have too much it throws off that balance and our cells can actually become oversaturated; it can make it harder for that cell to work and to get hydrated. This is why a more moderate amount of electrolytes may be a better option for athletes and heavy sweaters.”

Nuun Sport Hydration. “This one has a lower amount of added sugar. It might be for someone who wants to flavor their water — which, alone, would help increase fluid intake and therefore their hydration. It has electrolytes — your sodium, magnesium, potassium, chloride — but I would not have someone use this from a serious athletic standpoint because athletes need to not only replenish electrolytes lost but also sugars lost through expelling energy through exercise. Would it help hydrate cells? Sure, a little bit. But most people will end up drinking this because they like the flavors — and a lot of people like Nuun’s flavors.”

Cure Hydrating Electrolyte Drink Mix. “I like this one as a water flavoring — out of all of them, it was one of my favorites for that. But it’s not a true electrolyte blend. It includes sodium and Himalayan salt. But there’s no chloride and magnesium. This would not be a recommendation for gym-goers or athletes as it doesn’t contain any sugars, which are needed for adequate electrolyte and energy replenishment. It’s just a water flavoring because it contains lower amounts of sodium and potassium than other hydration alternatives. The ingredients are straightforward and clean — it has no added sugar, which is great — but it’s not in the same boat as an electrolyte product, even though it’s advertised as that.”

MIO Strawberry Watermelon Liquid Water Enhancer and MIO Sport Electrolytes + B Vitamins. “Out of all of these, MIO is probably one of my least favorites. The first is just a water flavoring, but all these additives — like sucrose acetate and Red 40 — they’re not good for you. Red 40 is a synthetic food dye. It’s considered safe, but a lot of people can have allergies causing headaches. It’s safe but not as good as Cure, which uses a natural additive like beet powder for color. Mio Sport uses Blue 1 for coloring, also a synthetic dye. It does contain B vitamins — B3, B6 and B12 — but not the complete B complex of eight B vitamins. It’s also not as strong of an electrolyte blend. Like Cure, it is missing your chloride and magnesium.”

Ultima Replenisher, Broad Spectrum Electrolyte Mix. “This one is OK from a standpoint that it’s going to flavor water and has the electrolytes that we’re looking for, like potassium, sodium, magnesium and chloride. But they’re relatively low amounts, containing one-sixth the amount of sodium in Nuun and Orgain; therefore, it is not for serious athletes.”

LMNT Zero-Sugar Electrolytes, Raw Unflavored. “This is a clean, straightforward brand and zero calories — just your electrolytes. It isn’t flavored, though, so would not be an adequate water flavoring product. It would be good for a smoothie boost or if someone is on an elimination diet. But you’d need to add in a carbohydrate source, like fruit, for this to be more hydrating. It would have to be a whole lemon squeezed in. Or, if doing a smoothie, add a quarter cup of frozen berries to help absorb the electrolytes and help hydration.”

Water Boy Hydration Electrolyte Drink Mix for Weekend Recovery. “I was nervous about the high sodium content here. Sodium is the first ingredient and it’s almost 50% of your daily value. Compared to the other electrolytes — potassium, magnesium and chloride — the sodium is very high and the others are low. It’s a really odd balance. But it has zero sugar and it has only 1 gram of carbohydrates, which, from the ingredient list, I’m assuming is coming from a natural flavor or potentially the vegetable juice. But it’s not enough carbohydrates to balance out the high sodium content. This product is marketed as a ‘hangover’ cure because alcohol dehydrates the body; dehydration is a major contributor to hangover symptoms. Rehydrating the body using alkaline salt neutralizes the acid from alcohol and dehydration; however, this product would benefit from a better balance of all electrolytes, not just high amounts of sodium.”

Orgain Hydro Boost, Rapid Hydration Drink Mix. “I like this one for athletes. Sugar is the first ingredient, but for athletes that would help absorb the electrolytes. And it would also replenish glucose storage in the muscles. And I like the balance of sodium and chloride here too. There’s also potassium. It’s missing magnesium, but because the sodium and chloride are so well balanced it outweighs that. There’s also no synthetic flavoring. It’s all things like organic lemon juice and organic monk fruit. It’s not for everyday use because of the high sugar content, but great for athletes for specific use like a long-intense bike training, high energy, intermittent workouts or an event, like a sports game.”

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©2024 Los Angeles Times. Visit latimes.com. Distributed by Tribune Content Agency, LLC.

The study led by a group of Swedish researchers and published Sunday in the Journal of the American Medial Association, found that a test  based on measuring certain proteins in the brain had about a 90% accuracy rate in diagnosing Alzheimer’s in those with cognitive symptoms. By comparison, primary care doctors and specialists had a 61% and 73% accuracy rate in diagnosing the disease, the study found.

Currently, the disease can be definitively diagnosed only by more expensive and invasive tools such as PET scans and spinal taps. The neurodegenerative disease afflicts more than 6 million Americans, and Baltimore and Maryland have been found to have some of the nation’s highest rates of prevalence.

The blood test in the study and others of its ilk are only available in research trials at the moment. Getting one to the market and available in a primary care physician’s office would represent “incredible progress,” said Corinne Pettigrew, an assistant professor of neurology at the Johns Hopkins University School of Medicine who was not involved in the study.

“This would allow patients to review options for treatments, learn about what to expect of the disease and plan for the future,” said Pettigrew, who leads outreach, recruitment and engagement for the Hopkins Alzheimer’s Disease Research Center.

She said the test also would be important for ruling out Alzheimer’s as the reason for a patient’s cognitive impairment, allowing doctors to seek and treat the actual cause.

The study involved 1,213 people in Sweden whose average age was 74 and who were being evaluated because of cognitive symptoms. According to the paper, Alzheimer’s is often misdiagnosed by primary care physicians and even specialists because of a lack of or limited access to diagnostic tools. That prevents patients from starting treatments for those with early Alzheimer’s, which require test results confirming the disease, the study said.

“The higher diagnostic accuracy of the blood test indicates that it could be suitable for implementation in primary care, but future studies need to examine its effect on clinical care,” according to the study, which was led by Dr. Sebastian Palmqvist, of Lund University in Sweden. “In addition to improving diagnostic accuracy, a positive test result could further support the initiation of widely available treatments.”

Ilene Rosenthal, program director at the Greater Maryland chapter of the Alzheimer’s Association, called the study findings “extremely exciting” for advocates such as her organization who have pushed for more research to understand and treat the devastating disease.

“When you have 90% accuracy,” she said, “that’s very impressive.”

Rosenthal envisions a time when a blood test for Alzheimer’s will be as common and widely available as those that test for cholesterol.

“This should become a normal part of a physical or a wellness visit,” she said.

Alzheimer’s still has no cure, but there are treatments that can ease its symptoms and change its progression if started early enough. That makes the development of a test vital, and it will incentivize patients and doctors to use them, Rosenthal said.

“The real urgency right now is the availability of new treatments. But these treatments are only going to work in the early stages,” she said. “It’s so much better to know than to not know.”

It turns out there might be a scientific reason behind women needing extra “beauty sleep.” Studies show, on average, women require about 11 minutes more sleep per night than men do. Although this difference might seem small, it can have significant implications for overall health and well-being.

Research is limited, but the reasoning points to hormones, according to the Sleep Foundation. Women experience a roller coaster of hormonal changes throughout their lives — from menstruation to pregnancy and menopause. Each of these stages can disrupt sleep patterns. Women are also 40% more likely than men to suffer from insomnia.

“When it comes to physiology, women’s hormones have a huge role to play in sleep,” Dr. Aileen Alexander, a women’s health and sleep expert, told Glamour magazine. “Overall, this means women are suggested to have a greater need for sleep and are more likely to indulge in daytime naps.”

Beyond biological factors, societal expectations and responsibilities also contribute to women’s sleep needs. Research has shown women often shoulder the majority of household and caregiving duties, leading to increased fatigue and stress, according to Glamour. “Women are typically the ones who get up through the night to support children or, in some cases, elderly parents,” Alexander said. These added pressures may require more sleep to recover and maintain optimal cognitive function.

However, individual sleep needs can vary from person to person, regardless of sex. Factors such as age, lifestyle and overall health all contribute to a person’s optimal sleep duration.

“While we need more research to understand the gender gap between men and women’s sleep requirements and cycles, the consequences of not getting enough sleep are well evidenced and can have a huge impact on both men and women,” Alexander said.

To get the proper rest you need, experts recommend adults sleep between seven and nine hours a night. If you still find yourself not getting enough rest, talk to your doctor.

©2024 The Atlanta Journal-Constitution. Visit at ajc.com. Distributed by Tribune Content Agency, LLC.

True, you could’ve said the same thing 20 years ago and 40 years ago. But the gains made against cancer during the first two decades of the 21st century are so profound – and so unexpected given other trends that should be leading to more cancer deaths, not fewer – that some experts are talking again about the idea that cancer could be cured.

The Centers for Disease Control issued a report in June that crunched a range of U.S. cancer statistics collected during the first two decades of this century. The data track how roughly two dozen types of cancer played out in hundreds of locales, and they measure disease outcomes for all Americans based on gender, age and race.

It’s a complex study, but the bottom line is simple:

Cancer isn’t as lethal as it used to be.

In fact, the report’s key finding is that the U.S. cancer death rate was about a third (29.2%) lower in 2022 than it was in 1999.

“I don’t know if I’d have had the same outcome if I’d been diagnosed 20 years earlier, or even six months earlier,” said Tasha Champion, an Apple Valley resident who was diagnosed with an aggressive form of breast cancer in 2016, a day before she turned 36.

“I can’t say if cancer treatment, overall, has changed. I wasn’t involved in it before. But I’m glad to be where I am now, which I’m positive is because of the treatment I got at the time,” she said.

“A lot more people, like me, seem to be winning.”

Like much of the CDC report, the death rate, which strips away population growth, is a number that tells a very human story. At the turn of the century, cancer was killing 200.7 out of every 100,000 Americans, but by 2022 the number was down to 142. In a city the size of Burbank (population 104,000) that translates to about 60 lives saved per year. In a nation the size of the United States, population 333 million, that translates to about 3 million lives saved since 2000.

The agency also looked at the geography of cancer, tracking trends by state, county and even congressional district. In California, cancer deaths are running about 10% lower than the national average and the state’s gains in cancer mortality since 2000 match the gains made nationally.

County-level cancer numbers in the report cover only a five-year window ending in 2022, so it’s tough to track long-term trends. But, locally, those numbers also paint a mostly upbeat picture. People living in Los Angeles, Orange and Riverside counties are all less likely than other Americans to die of cancer, and the cancer death rate in San Bernardino County is within the margin of error for matching the national average.

All of which isn’t to suggest the story of cancer in America is only about numbers.

Oncologists and other experts and even some patients, like Champion, say every gain against cancer has involved some combination of human tenacity and intelligence and imagination. That formula, they add, can be applied to everyone from lab-bound researchers to patients volunteering for clinical trials.

And just as cancer isn’t a single disease (but is, instead, a constellation of diseases in which the bad actor cells tend to behave in a similar fashion) experts note there’s no single reason why the fight against cancer is going well.

For that, they point to changes and advances and trends that range from the obvious to the obscure.

The anti-smoking campaigns of the 1980s and ’90s are paying off in fewer cancer deaths in the 2000s. And while the Human Genome Project, which launched in the 1990s, didn’t lead to a cancer cure, as was once suggested, it did spin off other research that translated into DNA- and RNA-based ways to detect and treat many common types of cancer.

Even new laws – hikes in tobacco and alcohol taxes and municipal codes that limit the use of tobacco in public places – have led to fewer cancer deaths.

“We are finally seeing results from all the years of research and investment, and from patients participating in (cancer) research,” said Dr. Ed Kim, an oncologist who works as physician-in-chief and senior vice president for City of Hope Orange County, a branch of the Duarte-based cancer research center.

Kim, like others who’ve been working in cancer research and treatment since the 1990s, described a series of changes – some profound, some subtle – that have hit his profession over the past two decades.

Some drugs once used only for patients with advanced cancers have been deemed safe and effective for more people, boosting survivor rates. Biomarker testing – a genetic-based science that can help link specific treatments to specific cancers – has improved mortality numbers even though its widespread use is fairly new. Even some procedures that have been around for decades – surgical removal, for instance – are being used in new ways.

Overall, Kim described an evolving world in which cancer treatment is shifting from something akin to a broad, impersonal war – the blunt use of chemicals and weapons against mysteriously raging cancer cells – into something more like a series of criminal investigations, with genetics and other evidence used to solve individual cases of cancer.

“It’s a new era,” he said.

Odds in your favor

Not every number in the CDC’s report is uplifting.

For example, even though the national cancer death rate has dropped steadily since 2000, the total number of cancer deaths has not, rising by about 10.5% during the period tracked by the CDC, slower than the 18.5% growth in population in that period. In 2022, about 609,000 Americans died of cancer, making it the nation’s No. 2 killer, just behind heart disease. (The CDC also notes that cancer data from 2020 through 2022 was less reliable because the pandemic prompted some people to delay cancer screenings, and the surge in COVID-19 deaths may have masked some possible cancer deaths. In 2020 and ’21, COVID-19 was the No. 3 killer in the country, behind heart disease and cancer.)

That uptick in the raw death count is partly about age and obesity. Since 2000, America’s median age has jumped about 10%, to 38.8 years. Also, during that time, the percentage of American adults who are considered obese has jumped from about 31% to 42%. Because cancer is more lethal for older people, and often more common for people struggling with their weight, those factors have offset some of the gains made by technologies and treatments and healthier behavior.

Another factor in cancer’s stubborn lethality is equity.

People with no health insurance still die a lot more frequently of cancer than do the people with insurance. And the CDC numbers reveal shocking differences in cancer death rates based on race, gender and geography; a Black man living in Mississippi is three times more likely to die of cancer than an Asian woman in California.

Also, during the period tracked by the CDC, a few cancers (liver, uterine, pancreatic) appear to have become more lethal, not less. And huge gains made in prostate cancer death rates from the mid-1990s through the early 2000s – a result of the emergence of prostate-specific antigen (PSA) testing – appear to have leveled off since about 2012.

And, critically, while the nation’s cancer death rate has fallen, the rate at which new cancers are diagnosed has been close to flat, declining just 4.7% between 2000 and 2019. That suggests gains in cancer treatment are having a bigger impact than the gains in cancer prevention.

Still, the report tells a story of broad, long-term improvement. Cancer death rates have dropped – and survivorship has gone up – in every U.S. state and territory during the period studied. What’s more, the pace of improvement appears to be accelerating; from 2015 through 2019 cancer death rates in the United States fell by about 2% a year, doubling the pace of improvements made during the late 1990s.

Oncologists say all those changes have led to a simple, fundamental shift in the way they – and their patients – view cancer.

“You’re more likely to survive cancer, today, than you are to die from it,” Kim said.

“That wasn’t always true.”

Tasha and Kathie and tech

One of the numbers pulled from the CDC report is 3 million.

That’s roughly how many more Americans are living today because of lower cancer death during the past two decades, according to estimates by the CDC, the American Cancer Society and others.

No single technology or discovery is responsible for that.

But at least two women, Champion and Kathie Simpson of Mission Viejo, can point to a single advancement –- the arrival of oncotype testing for breast cancer, in 2004 – as a key reason why they’re around to share their cancer stories and confident about their futures.

The so-called “onco test” tracks 21 genes, and it can help predict a patient’s odds of developing breast cancer or the odds of breast cancer returning.

For Champion, the onco test was part of a broader story about her family history and her own future. She said her mother, who survived breast cancer in the late 1990s, was found in 2015 to carry the BRHC gene, a discovery that meant Champion and her two sisters might be at much higher risk than average of developing breast cancer. Champion soon took a similar test and was told she had an 87% chance of developing breast cancer, odds similar to what doctors gave to one of her sisters.

From there, Champion, a mother of four, opted to undergo a double mastectomy as a way to stave off any future breast cancer. But during that procedure, doctors found and removed a cancerous tumor, something that hadn’t been detected during a mammogram Champion had taken just six months earlier.

Discovery of the tumor – which Champion said was deemed “triple negative,” meaning it was more likely to be lethal – led to three rounds of intense chemotherapy, a lot of prayer and many late-night phone calls with her sister, who was living through a similar experience.

“People really questioned that surgery,” Champion said. “We were accused of not having enough faith, or of wanting a free implant job.”

But she said the subsequent cancer diagnosis was “more motivation than vindication,” and that the experience had the unexpected side effect of making her more confident.

“The decision reinforced my faith, in God and in myself,” she said. “I’d heard that little voice tell me to get the surgery and I listened to it.

“I have tried to continue doing that ever since.”

For Simpson, 48, who survived a 2021 breast cancer diagnosis, the onco test has produced a personalized report with a number – 19 – printed in large, bold type. The number reflects several factors in her genetic makeup and her current medical status that, combined, predicts she’s 94% likely to never experience a breast cancer recurrence.

The report, the detailed forecast, and the lumpectomy Simpson underwent with no follow-up chemo, were not widely available to breast cancer patients as recently as 15 years ago.

“For me, being a worrier, not a warrior, I don’t know what I would have done without that number,” Simpson said. “Ninety-four percent is a good number.”

Like Champion, Simpson – armed with a positive cancer forecast and a new, “don’t sweat the small stuff” mindset – is more confident today than she was before cancer. Last year, she and a partner quit their long-running jobs to start a new business (Keepsakes by KJ) selling souvenirs from around the world.

“The hardest thing in my life was telling my daughter, who was 16 at the time, ‘I have cancer,’” Simpson said.

“After that, everything is easy.”

Cancer for the cure?

Cancer might be the most well-funded issue in American life.

Politics, religion, even many other diseases can be divisive in some way. But raising money for cancer research and cures and prevention has been an ongoing part of American life since 1971, when then-President Richard Nixon signed the National Cancer Act.

Nixon’s idea was to use the space race template to focus the government on curing cancer. He even used the words “war on cancer” during the signing ceremony.

That effort didn’t quite pan out, but the mindset has carried on. Every president since Nixon has offered at least lip service to curing cancer. And cancer research, through the National Institutes of Health and other federal agencies, as well as the money generated by hugely profitable cancer drugs, has laid the foundation for many of the gains that are now bearing fruit.

It’s also why so many people, including Simpson, Champion and fellow cancer survivors Steve Bell of San Clemente and Michelle Rand of Hermosa Beach, spend at least some of their post-cancer lives promoting Relay for Life a series of walking/running events held in cities around the world that raise money for the American Cancer Society.

Rand, who in 2022 was diagnosed with an operable form of lung cancer – a version of the disease that wasn’t common even a decade ago, before improvements in surgical procedures and advances in lung cancer gene therapies – said the Hermosa Beach events she helps run have raised $4.1 million over the past 22 years.

She was raising money many years before she had cancer and says she plans to stay involved for many years to come.

“I’ve lost many friends to cancer over the years. But I’ve got a lot of friends who’ve lived, too. Now, that’s me.”

“I’m alive,” she added. “That’s my bottom line.”

Bell, who survived a 1997 bout with colon cancer, has spent most of his adult life helping that cause. The former manager for fitness and health programs in the city of Mission Viejo eventually became a full-time ambassador for the Relay for Life cause. That role has taken him to events around the country, as well as in Denmark, Gibraltar and Australia, among other places.

“Down there they call it bowel cancer,” Bell said, referencing the version of cancer he vanquished.

The fundraising, he said, is crucial.

“Of course, it matters,” he said. “There’s still so much to do.”

For Dr. Stephen Gruber, who directs the Center for Precision Medicine at City of Hope in Duarte, there’s just one thing on the to-do list: cure cancer.

“I use the word ‘cure’ as often as I can,” Gruber said.

“That’s because it’s true and appropriate. Many cancers are curable. We don’t use the word when we don’t have evidence, but the fact is that we are curing many more cancers than we used to. We’re not afraid of the word because we’ve made enough advances, and we’re in a situation of knowing the genomic profile of tumors that give us the power to use medication in very specific ways that, yes, lead to cures.”

“The future is bright,” Gruber added. “I’m incredibly optimistic.”

Cooper’s office said Monday that the Centers for Medicare and Medicaid Services late last week approved the plan submitted by the state Department of Health and Human Services.

Cooper and health department leaders have described the plan as a first-of-its-kind proposal in the country to give hospitals a new financial carrot to cancel debt they hold on low- and middle-income patients and to help residents avoid it. The effort also received praise Monday from Vice President Kamala Harris, the likely Democratic presidential nominee.

Cooper’s administration has estimated the plan has the potential to help 2 million low- and middle-income people in the state get rid of $4 billion in debt. Cooper has said hospitals wouldn’t recoup most of this money anyway.

“This debt relief program is another step toward improving the health and well-being of North Carolinians while supporting financial sustainability of our hospitals,” state Health and Human Services Secretary Kody Kinsley said in a release.

The proposal, which DHHS will now work to carry out, focuses on enhanced Medicaid reimbursement payments that acute-care, rural or university-connected hospitals can receive through what’s called Healthcare Access and Stabilization Program.

The General Assembly approved this program last year along with provisions sought by Cooper for years that expanded Medicaid coverage in the state to working adults who couldn’t otherwise qualify for conventional Medicaid.

Any of the roughly 100 hospitals participating in the program are now poised to receive even higher levels of reimbursement if they voluntarily do away with patients’ medical debt going back to early 2014 on current Medicaid enrollees — and on non-enrollees who make below certain incomes or whose debt exceeds 5% of their annual income.

Going forward, the hospitals also would have to help low- and middle-income patients — for example, those in a family of four making no more than $93,600 — by providing deep discounts on medical bills. The hospitals would have to enroll people automatically in charity care programs, agree not to sell their debt to collectors or tell credit reporting agencies about unpaid bills. Interest rates on medical debt also would be capped.

When Cooper unveiled the proposal July 1, the North Carolina Healthcare Association — which lobbies for nonprofit and for-profit hospitals, said the group and its members needed more time to review the proposal and awaited the response from the federal government.

Speaking last week at a roundtable discussion in Winston-Salem about the effort, Cooper said hospitals have “reacted somewhat negatively” to the effort. But many hospitals have engaged with us and and given us advice on how to write the procedures in order to help them if they decided to adopt this,” Cooper added.

State officials have said debt relief for individuals under the program would likely occur in 2025 and 2026. Cooper’s term ends in January, so the program’s future could depend on who wins the November gubernatorial election.

Other state and local governments have tapped into federal American Rescue Plan funds to help purchase and cancel residents’ debt for pennies on the dollar.

The vice president’s news release supporting North Carolina’s effort didn’t specifically mention Cooper, who is considered a potential running mate for Harris this fall. Harris highlighted efforts with President Joe Biden to forgive over $650 million in medical debt and to eliminate even more.

“Last month, I issued a call to states, cities, and hospitals across our nation to join us in forgiving medical debt,” she said. “I applaud North Carolina for setting an example that other states can follow.”

Iowa’s Republican leaders have been seeking the law for years and gained momentum after the U.S. Supreme Court overturned Roe v. Wade in 2022. The Iowa Supreme Court also issued a ruling that year saying there was no constitutional right to abortion in the state.

“There is no right more sacred than life,” Republican Gov. Kim Reynolds said in June. “I’m glad that the Iowa Supreme Court has upheld the will of the people of Iowa.”

Now, across the country, four states ban abortions after about six weeks of pregnancy, and 14 states have near-total bans at all stages of pregnancy.

The law in Iowa and other restrictions across the country will be a focus of the 2024 election, with Republicans celebrating their successes and Democrats criticizing them as an attack on women’s rights. Vice President Kamala Harris, who stands to become the Democratic presidential nominee, has said reproductive rights are at stake this November.

The Harris campaign released a video Monday to draw attention to the issue as Iowa’s law becomes enforceable.

“What we need to do is vote,” she said. “When I am President of the United States, I will sign into law the protections for reproductive freedom.”

Iowa’s abortion providers have been fighting the new law but still preparing for it, shoring up abortion access in neighboring states and drawing on the lessons learned where bans went into effect more swiftly.

They have said they will continue to operate in Iowa in compliance with the new law, but Sarah Traxler, Planned Parenthood North Central States’ chief medical officer, called it a “devastating and dark” moment in state history.

The Iowa law was passed by the Republican-controlled Legislature in a special session last year, but a legal challenge was immediately filed by the American Civil Liberties Union of Iowa, Planned Parenthood North Central States and the Emma Goldman Clinic. The law was in effect for just a few days before a district judge temporarily blocked it, a decision Gov. Kim Reynolds appealed to the state’s high court.

The Iowa Supreme Court’s 4-3 ruling in June reiterated that there is no constitutional right to an abortion in the state and ordered the hold be lifted. A district court judge last week said the hold would be lifted Monday morning.

Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, called it a “historic day for Iowa.”

The law prohibits abortions after cardiac activity can be detected, which is roughly at six weeks. There are limited exceptions in cases of rape, incest, fetal abnormality or when the life of the mother is in danger. Previously, abortion in Iowa was legal up to 20 weeks of pregnancy.

The state’s medical board defined standards of practice for adhering to the law earlier this year, though the rules do not outline disciplinary action or how the board would determine noncompliance.

Three abortion clinics in two Iowa cities offer in-person abortion procedures and will continue to do so before cardiac activity is detected, according to representatives from Planned Parenthood and Emma Goldman.

A law based on cardiac activity is “tricky,” said Traxler, of Planned Parenthood. Since six weeks is approximate, “we don’t necessarily have plans to cut people off at a certain gestational age,” she said.

For over a year, the region’s Planned Parenthood also has been making investments within and outside of Iowa to prepare for the restrictions. Like in other regions, it has dedicated staff to work the phones, helping people find appointments, connect with other providers, arrange travel plans or financial assistance.

It also is remodeling its center in Omaha, Nebraska, just over the state line and newly offers medication abortion in Mankato, Minnesota, about an hour’s drive from Iowa.

But providers fear the drastic change in access will exacerbate health inequalities for Iowa’s women of color and residents from low-income households.

Across the country, the status of abortion has changed constantly since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, with trigger laws immediately going into effect, states passing new restrictions or expansions of access and court battles putting those on hold.

In states with restrictions, the main abortion options are getting pills via telehealth or underground networks and traveling, vastly driving up demand in states with more access.

Nieces Nataleigh Goodwin, 6, and Emileigh Griffith, 2, loved him back, especially when he took them outside to draw with sidewalk chalk or to search for worms.

“That’s me and Emileigh and Aunt Ashleigh and Uncle Zack,” Nataleigh said, showing off a picture she drew while Ashleigh Blankenship spoke about the historic donation of her brother’s heart. “I miss him very much.”

Pate, who died July 9, made just the third HIV-positive-to-HIV-positive heart donation in the U.S. this month at Sentara Norfolk General Hospital, Sentara spokesperson Dale Gauding said.

Blankenship knew her 29-year-old brother, who lived with her in Portsmouth for most of the past two years, was an organ donor, but she and Pate’s two other sisters, Taylor Goodwin and Madison Tye, were stunned to learn the donation was possible a decade after he was diagnosed with HIV.

“I know my brother would have wanted that,” she said. “I feel like the HOPE Act needs more recognition.”

The HIV Organ Policy Equity Act, passed in 2013, established a research program that made liver and kidney transplants legal for people with HIV. In May 2020, the act was expanded to include all organs, and the first HIV-positive heart transplant took place in 2022.

This was the first HIV-positive organ donation for Sentara Health, Gauding confirmed, and for Virginia Beach-based LifeNet Health, the federally designated organ management organization for most of Virginia, said Douglas Wilson, its executive vice president. Pate’s organs were transported to recipients out of state.

As of Dec. 31, 2023, 377 HIV-positive kidney donations and 93 HIV-positive liver donations had taken place, according to UNOS, the United Network for Organ Sharing, which manages the United States’ organ transplant system.

The HOPE Act allows for living organ donations, but so far, only three have taken place. The second was a kidney donation in 2019 by Karl Neumann, a transplant registered nurse at Sentara Norfolk.

“Working in the profession for 20-some years at that point, I always wanted to be a donor, but once I was HIV-positive it was illegal for me to do that until the HOPE Act passed,” Neumann said Friday.

There are a few reasons donations remain rare, Neumann said, including the limited number of centers that can transplant HIV-positive organs and the comparatively small group of eligible donors.

Recipients of HIV-positive organs can only get their transplants at the roughly 35 centers that participate in the HOPE Act research study, Neumann said, and other transplant centers may refuse to accommodate HIV-positive patients even if they are receiving HIV-negative organs. Generally, donations can happen from anywhere.

Neumann’s donation took place at Duke University Hospital in North Carolina because Norfolk General is not part of the study, but his team in Norfolk works with HIV-positive patients, including a few who have received HIV-negative kidney transplants.

More complicated infection protocols are part of why so few transplant centers work with HIV-positive patients, but Neumann said he feels the persistent stigma surrounding HIV also contributes to the limited numbers.

“People live very normal lives with HIV at this point, but there’s still a social stigma,” Neumann said. “My doctors hated it when I said that I would rather have HIV than diabetes — but I think it’s easier to manage.”

Improvements in medication have helped make living donation possible without risk to the donor, Neumann said. The health, future health and rights of the donor are the most important factors in the process.

In the past, HIV medication sometimes caused kidney or liver failure, he said, but now, organ damage in most patients is caused by other health problems.

“If HIV directly related to needing a kidney or liver or something in the future, they would never even have proposed living donation,” Neumann said. “I always tell potential living donors that you’re getting the best health screening that you’re ever going to get.”

One of the biggest reasons donations remain rare, though, is the lack of awareness that they’re possible.

“I give a lot of gratitude to any of these people who have donated their organs and signed up ahead and registered, but also to those donor families — his family who is sharing his story,” Neumann said, referring to Pate.

Blankenship said her brother, who died as the result of a suicide attempt after battling mental illness for most of his life, was obsessed with his health, following strict routines and rules for everything from his diet to skincare. Even through the tumultuous times since their mother’s death in 2021, he kept up with managing HIV.

“He always thought he was unhealthy,” she said. “And look what happened. He was able to save lives.”

Have a health care or science story, question or concern? Contact Katrina Dix, 757-222-5155, katrina.dix@virginiamedia.com

OSKALOOSA, Iowa — Rural regions like the one surrounding this southern Iowa town used to have a lot more babies, and many more places to give birth to them.

At least 41 Iowa hospitals have shuttered their labor and delivery units since 2000. Those facilities, representing about a third of all Iowa hospitals, are located mostly in rural areas where birth numbers have plummeted. In some Iowa counties, annual numbers of births have fallen by three-quarters since the height of the baby boom in the 1950s and ’60s, when many rural hospitals were built or expanded, state and federal records show.

Similar trends are playing out nationwide, as hospitals struggle to maintain staff and facilities to safely handle dwindling numbers of births. More than half of rural U.S. hospitals now lack the service.

“People just aren’t having as many kids,” said Addie Comegys, who lives in southern Iowa and has regularly traveled 45 minutes each way for prenatal checkups at Oskaloosa’s hospital this summer. Her mother had six children, starting in the 1980s, when big families didn’t seem so rare.

“Now, if you have three kids, people are like, ‘Oh my gosh, are you ever going to stop?’” said Comegys, 29, who is expecting her second child in late August.

These days, many Americans choose to have small families or no children at all. Modern birth control methods help make such decisions stick. The trend is amplified in small towns when young adults move away, taking any childbearing potential with them.

Hospital leaders who close obstetrics units often cite declining birth numbers, along with staffing challenges and financial losses. The closures can be a particular challenge for pregnant women who lack the reliable transportation and flexible schedules needed to travel long distances for prenatal care and birthing services.

The baby boom peaked in 1957, when about 4.3 million children were born in the United States. The annual number of births dropped below 3.7 million by 2022, even though the overall U.S. population nearly doubled over that same period.

West Virginia has seen the steepest decline in births, a 62% drop in those 65 years, according to federal data. Iowa’s births dropped 43% over that period. Of the state’s 99 counties, just four — all urban or suburban — recorded more births.

Births have increased in only 13 states since 1957. Most of them, such as Arizona, California, Florida, and Nevada, are places that have attracted waves of newcomers from other states and countries. But even those states have had obstetrics units close in rural areas.

In Iowa, Oskaloosa’s hospital has bucked the trend and kept its labor and delivery unit open, partly by pulling in patients from 14 other counties. Last year, the hospital even managed the rare feat of recruiting two obstetrician-gynecologists to expand its services.

The publicly owned hospital, called Mahaska Health, expects to deliver 250 babies this year, up from about 160 in previous years, CEO Kevin DeRonde said.

“It’s an essential service, and we needed to keep it going and grow it,” DeRonde said.

Many of the U.S. hospitals that are now dropping obstetrics units were built or expanded in the mid-1900s, when America went on a rural-hospital building spree, thanks to federal funding from the Hill-Burton Act.

“It was an amazing program,” said Brock Slabach, chief operations officer for the National Rural Health Association. “Basically, if you were a county that wanted a hospital, they gave you the money.”

Slabach said that in addition to declining birth numbers, obstetrics units are experiencing a drop in occupancy because most patients go home after a night or two. In the past, patients typically spent several days in the hospital after giving birth.

Dwindling caseloads can raise safety concerns for obstetrics units.

A study published in JAMA in 2023 found that women were more likely to suffer serious complications if they gave birth in rural hospitals that handled 110 or fewer births a year. The authors said they didn’t support closing low-volume units, because that could lead more women to have complications related to traveling for care. Instead, they recommended improving training and coordination among rural health providers.

Stephanie Radke, a University of Iowa obstetrics and gynecology professor who studies access to birthing services, said it is almost inevitable that when rural birth numbers plunge, some obstetrics units will close. “We talk about that as a bad event, but we don’t really talk about why it happens,” she said.

Radke said maintaining a set number of obstetrics units is less important than ensuring good care for pregnant women and their babies. It’s difficult to maintain quality of care when the staff doesn’t consistently practice deliveries, she said, but it is hard to define that line. “What is realistic?” she said. “I don’t think a unit should be open that only delivers 50 babies a year.”

In some cases, she said, hospitals near each other have consolidated obstetrics units, pooling their resources into one program that has enough staffers and handles sufficient cases. “You’re not always really creating a care desert when that happens,” she said.

The decline in births has accelerated in many areas in recent years. Kenneth Johnson, a sociology professor and demographer at the University of New Hampshire, said it is understandable that many rural hospitals have closed obstetrics units. “I’m actually surprised some of them have lasted as long as they have,” he said.

Johnson said rural areas that have seen the steepest population declines tend to be far from cities and lack recreational attractions, such as mountains or large bodies of water. Some have avoided population losses by attracting immigrant workers, who tend to have larger families in the first generation or two after they move to the U.S., he said.

Katy Kozhimannil, a University of Minnesota health policy professor who studies rural issues, said declining birth numbers and obstetric unit closures can create a vicious cycle. Fewer babies being born in a region can lead a birthing unit to shutter. Then the loss of such a unit can discourage young people from moving to the area, driving birth numbers even lower.

In many regions, people with private insurance, flexible schedules, and reliable transportation choose to travel to larger hospitals for their prenatal care and to give birth, Kozhimannil said. That leaves rural hospitals with a larger proportion of patients on Medicaid, a public program that pays about half what private insurance pays for the same services, she said.

Iowa ranks near the bottom of all states for obstetrician-gynecologists per capita. But Oskaloosa’s hospital hit the jackpot last year, when it recruited Taylar Swartz and Garth Summers, a married couple who both recently finished their obstetrics training. Swartz grew up in the area, and she wanted to return to serve women there.

She hopes the number of obstetrics units will level off after the wave of closures. “It’s not even just for delivery, but we need access just to women’s health care in general,” she said. “I would love to see women’s health care be at the forefront of our government’s mind.”

Swartz noted that the state has only one obstetrics training program, which is at the University of Iowa. She said she and her husband plan to help spark interest in rural obstetrics by hosting University of Iowa residency rotations at the Oskaloosa hospital.

Comegys, a patient of Swartz’s, could have chosen a hospital birthing center closer to her home, but she wasn’t confident in its quality. Other hospitals in her region had shuttered their obstetrics units. She is grateful to have a flexible job, a reliable car, and a supportive family, so she can travel to Oskaloosa for checkups and to give birth there. She knows many other women are not so lucky, and she worries other obstetrics units are at risk.

“It’s sad, but I could see more closing,” she said.

(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

PHILADELPHIA — Two Penn Medicine physicians had an unorthodox idea for reducing the number of patients who develop dangerously high blood pressure in the weeks after giving birth: Stop asking them to come into the doctor’s office for blood pressure screenings.

Dangerously high blood pressure, is a leading cause of maternal death and hospital-readmission after birth, and is often preventable with routine screening. But many new parents are too overwhelmed in the first days of their baby’s life to get themselves to extra medical appointments.

Physicians Sindhu Srinivas and Adi Hirshberg decided to instead send patients home with blood pressure cuffs and instructions for how to report their readings by text message twice daily for 10 days.

Ten years later, the results are so impressive, Penn has made it standard practice across its eight hospitals. The program, called Heart Safe Motherhood, has been nationally recognized with awards from the American Heart Association and American Hospital Association, among others. And now, it’s being used at other Philadelphia hospitals, including Thomas Jefferson University Hospital and Jefferson Einstein Philadelphia Hospital.

More than 18,000 Penn patients have participated since the program launched in 2014. It’s credited with nearly eliminating the rate at which postpartum patients are readmitted for blood pressure complications within a week of giving birth, and closed a racial disparity gap that left many more Black patients at risk of severe complications.

The reason: More patients are following through on blood pressure screening after childbirth. Fewer wind up back in the hospital because doctors are able to spot danger signs and intervene sooner.

“We’re empowering the patient,” said Hirshberg, the director of obstetrical services at Hospital of the University of Pennsylvania. “We couldn’t do it without the monitors, but an important part of the program is the education of why we’re doing it.”

Shortly after Victoria Batista’s son was born, she developed a splitting headache, her vision was blurry, and she tripped walking through her home in Philadelphia. She attributed it all to being exhausted after a 67-hour labor that ended in a C-section, and the stress of caring for a newborn, her first.

“All these signs were pointing to having an issue, but I kept glossing over them,” said Batista, 32. “And then I got a notification: Check your blood pressure.”

She had so much going on she didn’t want to bother, but knew that her phone would just keep buzzing until she responded.

Batista punched in the numbers: 220/110, blood pressure so critically high she was at risk of a stroke. Within 10 minutes, someone at Penn called, telling her she needed to get to the hospital immediately.

“Had it not been for that program, for them harassing me about it — almost — I could have died,” she said.

Addressing maternal death disparities

The program is an emerging solution to sobering statistics that show Black Americans remain more than twice as likely to die during pregnancy or childbirth, or in the following months, according to the Centers for Disease Control and Prevention. The disparity persisted despite a national decline in maternal mortality rates in 2022.

Handing out blood pressure cuffs alone won’t solve a national maternal mortality crisis. But the Heart Safe Motherhood program has reduced readmissions for blood pressure complications among Penn’s postpartum patients from 5% to 1%.

Philadelphia institutions say the Heart Safe Motherhood program has also helped them understand how to better connect with patients and potentially make inroads addressing other deadly postpartum complications.

Jefferson launched the program in late 2021, and Einstein’s Philadelphia campus followed in spring 2022.

Response from patients and providers has been overwhelmingly positive, said Anneliese Gualtieri, the patient safety and performance improvement coordinator for obstetrics and gynecology at Einstein.

“You’re actually partnering with the patient in their care, which is something that patients like — to be part of their own solution,” she said.

Catching symptoms early

Jasmine Hudson, a nurse practitioner at Penn’s diabetes center, gave birth to her second child at Penn in May 2023. She credits the Heart Safe Motherhood program for saving her life days later.

Hudson took home the blood pressure cuff nurses offered and diligently responded to the text prompts with her blood pressure reading.

An automated algorithm analyzes the blood pressure readings patients send in and flags abnormal results to doctors.

The program texts back to let patients know their reading is good, or to ask them to test again in a few hours if it’s elevated. When a patient doesn’t respond to the prompt, the program texts a reminder.

And when someone’s reading is too high, patients receive a text with the hospital phone number and instructions about who to ask for.

Hudson didn’t think much about it when a reading came back slightly elevated one morning. She felt tired, and her husband said she seemed a little irritable — but she reasoned: What new mom isn’t?

“As moms, we’re so used to caring for our families and caring for others. We come second or third or fourth,” she said.

But after a second elevated reading, the automated program urged her to go to the hospital, where she stayed for three days.

Hudson went home with blood pressure medication and, more than a year later, is doing well.

Postpartum care at home

Hudson is among some 18,000 Penn patients who have participated in Heart Safe Motherhood. The program has about 50 patients on any given day.

Staff focus on patients at risk for hypertension or preeclampsia, for instance, people with elevated test results during pregnancy or immediately after birth, or a history of high blood pressure during a past pregnancy.

Between 30% and 40% of Penn’s maternity patients qualify and are sent home with blood pressure cuffs and instructions for reporting their readings, said Srinivas, the vice chair for quality and safety for obstetrics and gynecology at Penn. The health system covers the cost of the device, about $30, for patients who can’t get reimbursement from their insurer.

Prior to launching the Heart Safe Motherhood program, Penn would ask at-risk patients to come back in the days after giving birth to have their blood pressure checked. Many never showed. Others had a normal reading at their appointment, only to have their blood pressure begin rising after returning home again.

Black women were at greater risk than white women — they were less likely to come for a follow-up blood pressure check and more likely to be readmitted to the hospital.

Too often, Srinivas would see a new mother go home in good health, only to return days later with life-threateningly high blood pressure.

“How did we not know this was going to happen?” Srinivas would ask herself.

Now, she doesn’t have to worry as often. About 90% of patients in the Heart Safe Motherhood program follow up on requested screenings, a compliance rate that’s the same for Black and white patients.

Providers say the program addresses a few key hurdles to managing blood pressure postpartum: Parents don’t have to self-identify subtle, common symptoms, and they don’t have to leave their home.

“Access to care is one of the biggest issues,” said Ryan Brannon, an OBGYN and director for quality and safety in obstetrics at Thomas Jefferson University Hospital. “Heart Safe Motherhood was something that enabled us to get access to a larger population.”

Next steps for reducing maternal deaths

Despite the program’s success, there’s more work to be done.

“While home blood pressure monitoring is great, we have to have a system in place that then will be able to make a difference for those elevated blood pressures,” said Laura Hart, a co-director of Temple’s cardio-obstetrics program. “It’s a multilayer process.”

For instance, people who develop hypertension or preeclampsia during pregnancy are at greater risk for heart problems later in life.

Temple Health has not adopted Heart Safe Motherhood, but providers have spent hours talking to doulas, patients, and other community health leaders about the symptoms of high blood pressure and where to turn for help, said Estefania Oliveros, who is also co-director of the cardio-obstetrics program.

At Jefferson’s hospitals, Brannon and Gualtieri want to expand the Heart Safe Motherhood program to include more languages, such as Russian and Mandarin.

The program currently communicates with patients in either English or Spanish.

Penn doctors are testing what other maternal health complications, such as postpartum depression, they can improve with the program’s monitoring approach.

And because of Heart Safe Motherhood’s success, the system now hands out blood pressure cuffs to at-risk patients during pregnancy, to begin tracking potential blood pressure complications even earlier.

©2024 The Philadelphia Inquirer, LLC. Visit at inquirer.com. Distributed by Tribune Content Agency, LLC.