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Thursday, 9 June 2016

Princess Health and June 9th, 2016 Observing And Analyzing. Princessiccia

Princess Health and June 9th, 2016 Observing And Analyzing. Princessiccia

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June 9th, 2016 Observing And Analyzing

A good friend of mine joked, with a smile, "I can't stand you, Mr. I'm Not Trying To Lose Weight!! I'd kill for 3.2 pounds." 

Yesterday's maintenance weigh-in was truly unexpected. I haven't handled my schedule very well. Instead of me managing it, I've allowed it to manhandle me. My point is, too little sleep and a big bunch of missed workouts, should have translated to a slight gain. It didn't. And I'm not complaining AT ALL. I'm just observing and analyzing. 

I can see where this whole I'm not trying to lose weight thing can possibly read annoying to anyone starting out or in the middle of intense struggle along the way. But before you yell, "shut-up Sean, Mr. I'm Not Trying To Lose Weight," at your computer or device screen, consider--I've been at all points along this road. And some of those places, I hung out for quite some time. 

What this is really proving to me is how the metabolism can effectively be transformed. If you told me I'd be eating 2300 calories per day and somehow, still losing weight, I would have never believed you. I was convinced my metabolism was stuck on super slow. It might have been for a very long time. But clearly, it's different now. I'm blessed and very grateful. But my bigger point is this: There's hope for anyone who believes they're forever in a down position with their metabolism.

I'm not a nutrition expert, obviously. But I think the gradual evolution of my food plan is chiefly responsible for this quicker metabolism.

I eat a lot of, what I call, "one ingredient foods" or "foods without a nutrition label." As in, an egg is an egg, an apple is an apple, natural peanut butter is simply peanuts, an avocado is an avocado, you get the idea. Granted, I certainly eat some processed stuff--but for the most part, it's very simple things. The abstinence from refined sugar for over two years, I truly believe--has contributed in a major way.

My opinion, based on what I've learned from others and the analysis of everything, on the whole--is this: The body recognizes and processes these things I'm eating easier and much faster. I'm not throwing it many heavily processed curve balls or refined sugar--I'm also getting more than enough water every day...and so, the metabolism works more efficiently. 

So what now? Do I add more calories? When I commit to a more structured weight training program (longtime readers, even though I might deserve it--please refrain from bursting out in laughter), I'll need to add a fairly good amount of calories, I'm sure. Even just a more consistent combination of cardio/strength training will require more calories, I'm certain.

If we study this from the right perspective, it offers a tremendous amount of hope for yet another wonderful part of our individual transformations along the way. Perhaps right around the corner for some--maybe further down the road for others. But, it's possible. 

Once again I wasn't able to blog late afternoon instead of last thing at night. That plan is clearly a work in progress.

Isn't everything a work in progress? 

Today, I maintained the integrity of my calorie budget. I remained abstinent from refined sugar. I met my #watergoal and I exercised well with nearly two hours of walking around my location broadcast this evening. I'm dropping in bed at a fairly reasonable hour.

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Thank you for reading and your continued support,
Strength,
Sean
Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

Princess Health and Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system. Princessiccia

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As the administration of Gov. Matt Bevin works toward dismantling Kynect, the state's health insurance exchange, health advocates say they worry that the transition is going too quickly to be smooth, risking a loss of coverage for some Kentuckians.

Kentucky Voices for Health, a coalition of groups supporting health-care reform, said June 9 that the administration needs to "keep, hire and train adequate staff," make eligibility decisions quickly, "dedicate enough resources to educate the public on how to enroll," publish its plan and allow time for comment, and "create an online dashboard to measure how well the system is functioning."

The group also wants the administration to extend the transition period, saying that no state has made such a transition so quickly.

�To be successful, we need to take our time and make absolutely sure we�re protecting consumers from gaps in coverage," KVH Executive Director Emily Beauregard said. "By . . . taking more time to complete the transition, Kentucky can keep more of its people covered with access to essential care."

Whitney Allen, coordinator of community development and outreach for the Kentucky Primary Care Association, said in the KVH news release, �These recommendations are key to fostering a culture of continuous improvement focused on the consumer experience.�

Keeping a campaign promise, Bevin decided to shift Kentuckians enrolling in private, federally subsidized health insurance via Kynect to the federal exchange, www.healthcare.gov, and Medicaid recipients to Benefind, the state's new one-stop website for state benefits, by Nov. 1.

This new model for subsidized insurance is a federally supported but state-based marketplace, in which the federal government will handle consumers' eligibility appeals but the state will handle insurance-company grievances and still review insurance plans. The federal government will certify the plans but it will "strongly rely" on state recommendations, Health Secretary Vickie Glisson said in March. Consumer grievances will be handled by a state-federal partnership.

Kentucky Voices for Health said it wants "to ensure that any enrollment system that will replace Kynect works as well or better to ensure all Kentuckians have access to coverage without interruption or barriers."

Bevin's office replied to the KVH release with this statement: "Throughout the process, we have updated stakeholders and listened to their feedback. We appreciate the continued interest, input and cooperation of advocates as they are an important component of our communications and outreach strategy during the transition from Kynect to healthcare.gov. We are pleased to report that Kentucky has met all milestones and deliverables, some ahead of schedule, that were established by the [federal] team in order to proceed with the transition to healthcare.gov."
KVH continued to emphasize the importance of Kynectors, a blanket term used for those who help Kentuckians apply for and enroll in coverage. The state has about 600 Kynectors, but their fate is uncertain.

�Research indicates that Kentucky consumers find insurance overwhelming and confusing, and value the face-to-face assistance they have received to navigate the system,� Dr. Susan Buchino of the Commonwealth Institute of Kentucky, said in the KVH release. The institute, part of the University of Louisville School of Public Health and Information Sciences, calls itself a "transdisciplinary collaborative for population health improvement, policy and analytics."

KVH said the Bevin administration recently agreed to its request to have a diverse, multi-stakeholder advisory committee like the one that helped create Kynect.

The group said its recommendations came from Kynectors and health advocates, "many of whom have hands-on experience with enrollment and consumer assistance." Click here for the full report.

Forbes magazine contributor Josh Archambault wrote June 7 that Bevin is right to end Kynect because it serves mainly as a funnel to the Medicaid program and is funded by a fee on all health-insurance policies sold in Kentucky.

At least part of the fee will remain in place to help pay transition costs, fund the Kentucky Health Information Exchange and cover remaining claims to the high-risk insurance pool for which the fee was originally established. It was transformed into Kynect funding by an executive order from then-Gov. Steve Beshear.

"Kynect�s website will actually be active until the end of 2017, as the site also services small-business plans which have no set open-enrollment season," Archambault notes.
Princess Health and A Serious Challenge to the 2012 Low-carbohydrate "Metabolic Advantage" Study. Princessiccia

Princess Health and A Serious Challenge to the 2012 Low-carbohydrate "Metabolic Advantage" Study. Princessiccia

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Warning: this post will be a bit more wonkish than usual, because I need to get detailed to make my points. To read a summary, skip to the end.

In 2012, David Ludwig's group published an interesting RCT that suggested a substantial "metabolic advantage" resulting from a high-protein, very-low-carbohydrate diet (VLC) (1). In other words, this diet led to a higher energy expenditure relative to a normal-protein, low-fat diet (LF) over a one month period (a low-glycemic-load, normal-protein diet was in the middle and not significantly different from the other two). Resting energy expenditure (REE) was slightly but significantly higher on the VLC diet, and total energy expenditure (TEE) was elevated by a whopping 300+ kcal/day! I covered the study at the time, describing it as "fascinating" and "groundbreaking", and calling for the study to be replicated so we can be more confident in its unexpected result (2).

This finding has been used by Ludwig, Gary Taubes, and others to support the carbohydrate-insulin hypothesis of obesity, although there is no evidence that the effect was mediated by insulin, and also no evidence that it was mediated by reduced carbohydrate rather than increased protein (3).

Since I published that post, my confidence in the finding-- and particularly the common interpretation of it that reducing carbohydrate intake to a very low level increases REE and TEE-- has gradually been eroding. This is partially because other studies have generally reported that the carbohydrate:fat ratio of the diet has little or no effect on REE, TEE, or fat storage (4, 5, 6, 7, 8, 9, 10).

Read more �

Princess Health and Nonprofit says most of the 52 Kentucky hospitals it grades on patient safety got Bs and Cs, and KentuckyOne got five Ds. Princessiccia

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Kentucky Health News

A nonprofit group that rates hospitals recently doled out its hospital safety scores and found that most Kentucky hospitals scored a 'B' or 'C' in overall patient safety, and that five of the six Kentucky hospitals that got Ds are owned by the same hospital system.

The Leapfrog Group, a non-profit organization that rates hospitals, evaluated more than 2,500 hospitals nationwide, including 52 in Kentucky. Most of Kentucky's hospitals were not rated because rural critical-access hospitals don�t have to report their quality measures.

It found that 21.2 percent (11) of Kentucky's hospitals got As, which was much lower than the national average of 31 percent, while 11.5 percent (6) got Ds, more than the national average of 6.3 percent. Additionally, 23 percent (12) got Bs and 44 percent (23) got Cs.

"Once again Kentucky had fewer 'A'-rated hospitals than the national median and more hospitals rated near the bottom with increasing numbers of 'D's. More troublesome is the observation that five of the six hospitals receiving a 'D' are in the same hospital system," Dr. Peter Hasselbacher, emeritus professor of medicine at the University of Louisville, wrote in an op-ed for the Kentucky Health Policy Institute blog.

Except Lake Cumberland Regional Hospital, the Kentucky hospitals that got a D are owned or operated by KentuckyOne Health: Jewish Hospital, Sts. Mary and Elizabeth Hospital and University Hospital in Louisville; and St. Joseph Hospital and St. Joseph East in Lexington.

Richardson
Staffing cuts at the U of L Hospital have made it �unsafe� for seriously ill and injured patients, Dr. J. David Richardson, vice chair of surgery and president of the American College of Surgeons, told the university's top health officials in an email on June 7. He said the public hospital has �never been worse in the 34 years that I have been heavily involved with it,� reports Andrew Wolfson of The Courier-Journal.

"In an interview, Richardson said the problems are so great that the only solution is to 'unwind' the 2013 agreement in which the state turned over day-to-day management of the hospital to Catholic Health Initiatives," Wolfson reports. He said the letter understated the problems, which are making it impossible to conduct academic research at the hospital.

The two University of Kentucky hospitals got Cs from The Leapfrog Report. Pikeville Medical Center is the only Kentucky hospital evaluated that has had straight As since 2013, when the study began. Click here for Kentucky's Hospital Safety Scores.

KentuckyOne Health issued a statement saying University "is an excellent hospital with a dedicated and talented team of professionals that is staffed to meet the patient�s needs. Our focus has always been on quality, safety and patient experience."

On Sunday, June 12, KentuckyOne and the university ran a full-page ad in The Courier-Journal saying they are "committed to ensuring safe and effective patient care" and "Safety and quality are our top priorities." They said they take Richardson's concerns "seriously, and we are committed to reviewing and addressing the issues noted."

In 2012, when management of most of the hospital was given to KentuckyOne, "Officials said it would pump $1.4 billion into U of L health operations over 20 years. But the company has had financial troubles ever since, and in February 2014 announced it was laying off 500 employees in Kentucky," Wolfson notes.

The Leapfrog Group's analysis was developed under the guidance of the nation's leading patient safety experts and the scores were based on 30 measures of publicly available hospital safety data. The ratings are issued twice a year, for errors, injuries, accidents and infections. The report is peer-reviewed and published in the Journal of Patient Safety.

Hasselbacher noted legislation in Congress that would protect some hospitals from Medicare payment cuts if they serve more than average numbers of indigent and poor people.

"Care must be taken that this initiative, lobbied heavily by hospital organizations and their partners in academic medicine, is not interpreted to imply that is it acceptable to provide medical care of lower quality to poor people or in teaching hospitals," he wrote. "The fact that this protection is being considered at all is a tacit admission that our current methods of measuring quality and safety are flawed."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Princess Health and Salmonella outbreak in 35 states linked to live poultry; 21 cases reported in Kentucky; here are some tips to avoid infection . Princessiccia

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U.S. Centers for Disease Control and Prevention photo
Poultry specialists from the University of Kentucky are urging Kentuckians who raise chickens or ducks to take extra precautions against salmonella infection, since 21 cases have been reported in the state.

�Any contact with live poultry puts you at risk for salmonella infection,� Jacqueline Jacob, UK poultry extension project manager for the College of Agriculture, Food and Environment, said in a news release. �Salmonella germs can be in the birds� droppings and on their bodies and also on their cages, coops, hay, plants and the soil where they live and roam.�

Salmonella is a bacteria that makes people sick. Symptoms usually develop 12 to 72 hours after exposure and include diarrhea, fever and abdominal cramps. The illness usually lasts four to seven days. Children under 5, adults older than 65 and those with weakened immune systems are at the greatest risk of being severely affected.

These infections are part of a seven-state salmonella outbreak that have all been linked to contact with life poultry from multiple hatcheries. Jacob cautioned that any chicken can carry salmonella, even if it looks clean and healthy.

So far, more than 300 people have been infected, with more than one-fourth of those children aged 5 or younger, according to the federal Centers for Disease Control and Prevention.

�Many of the cases in the current outbreak are linked to backyard flocks, so we want to remind folks of simple things they can do to protect themselves," Jacob said.

Tips to avoid infection:
  • Wash hands thoroughly with soap and water immediately after touching live poultry or anything in the area where they live.
  • Do not let live poultry inside the house, or around areas where food or drink is located.
  • Do not let children younger than 5 handle or touch live poultry without supervision.
  • Adults should supervise the handwashing of young children.
  • Keep poultry away from your nose, mouth and eyes.
  • Wash your hands with sanitizer that has a 99 percent or higher bacteria kill rate after handling poultry at shows and fairs.
�It�s also a good practice to be careful when you wash equipment or eggs in the kitchen sink,� Jacob said. �You don�t want to cross contaminate food. Always use a good disinfectant to clean up in the kitchen when you�re finished.�

Click here for more advice from the CDC for backyard flock owners.

Wednesday, 8 June 2016

Princess Health and June 8th, 2016 Big Weigh-In. Princessiccia

Princess Health and June 8th, 2016 Big Weigh-In. Princessiccia

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June 8th, 2016 Big Weigh-In

I'm doing an "almost Tweets only" tonight. It was weigh day.
photo 203.8 weigh day_zpsf6lzm8jf.jpg
Monthly Maintenance Weigh-In: 3.2 pound loss since May 4th's weigh-in. 203.8 represents an all-time adult low (actually since 10 years old). It brings my overall weight loss to 301.2 pounds- having lost 59.6% of my previous 505 pounds. ?#?blessed? & ?#?grateful?

I wasn't able to post my blog late afternoon. And I completely obliterated my planned bedtime. I'm not going to dwell on this at all. At least not tonight. I worked this evening, a little later than I planned. Had a late dinner, too. Long day. I'm looking forward to a break from this schedule. I'll be taking one very soon.

I maintained the integrity of my calorie budget. I remained abstinent from refined sugar and I exceeded my water budget by thirty-two ounces.

I'll write more tomorrow about this weigh-in. I certainly wasn't expecting a 3.2 pound loss. I feel really well.

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Thank you for reading and your continued support,
Strength,
Sean

Princess Health and Official praises needle exchanges and medication-assisted treatment for addiction: 'Treatment works. Recovery is possible.' . Princessiccia

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Scott Hesseltine
Scott Hesseltine, the new vice-president of addiction services at Louisville's Seven Counties Services, talked on Kentucky Educational Television about needle exchanges and a new model of addiction treatment that combines medication assisted treatment with an abstinence-based model of care.

"We are in the midst of a tragic public-health crisis and it's claiming the lives of our citizens at astronomical rates," he said, noting that more than 1,000 people die from drug overdoses in Kentucky each year and that the state has the highest rate of hepatitis C in the nation.

Seven Counties Services provides behavioral-health services, primarily for people on Medicaid, in Jefferson County and six neighboring counties: Henry, Oldham, Trimble, Spencer, Shelby and Bullitt.

The interview on "Connections with Renee Shaw" was part of KET's "Inside Opioid Addiction" initiative, which is funded in part by a grant from the Foundation for a Healthy Kentucky. It aired in June.

Hesseltine, who came to Seven Counties Services from the Hazelden Betty Ford Foundation, a nationally recognized drug and alcohol treatment center, commended Kentucky's "forward thinking" in passing an anti-heroin bill last year.

Among other things, the bill allows needle exchanges to decrease the spread of infectious diseases, like hepatitis C and HIV, that are commonly spread by drug users sharing needles. They require both local approval and funding and have met with some resistance because many think they condone or perpetuate drug use.

Asked about that, Hesseltine said research shows that needle exchanges do what they are meant to do -- reduce the incidence of infectious disease among intravenous drug users.

He noted that Justice Secretary John Tilley, who was instrumental in passing the heroin bill as a state representative, said at a recent community forum in Corbin that research found that addicts who are involved in needle exchange programs are five times more likely to enter treatment.

"And we know treatment works and recovery is possible, so any avenue to slow the spread of disease and to help more people find the solution in recovery is a positive thing," he said.

Another point of contention among some lawmakers is that some of the state's needle-exchange programs don't adhere to a needle-for-needle exchange, which they say was the intent of the law,but instead provide as many needles as the addict needs for a week.

Hesseltine said the needs-based model decreases needle sharing and thus disease, so "Needs-based is more appropriate; it is more evidence based."

Hesseltine told Shaw that while working at Hazelden, he was part of an initiative that completely "altered the way we provided care." The new program, called COR-12, combines medication-assisted treatment with the 12-step abstinence model, which had been the only accepted recovery treatment program at Hazelden.

Hesseltine brought the new model with him to Seven Counties Services and said he likes to call it "medicated assisted recovery." He said "It has to be done appropriately so we are helping to stabilize someone from their biological symptoms of addiction so they can then engage in the recovery process."

Hesseltine told Shaw that addiction isn't curable, but is treatable.

"I would say it is a chronic disease that can be put into remission with structure, support, accountability and behavioral interventions," he said. "Curable? No, but like diabetes -- not curable, but certainly manageable."

Shaw asked if any addict is beyond reach. "Only someone who is not alive," Hesseltine replied. "Treatment works. Recovery is possible." He said that is why access to naloxone, the overdose-reversal drug branded as Narcan, is so important.

Asked what policy changes he would like to see, Hesseltine listed increased funding for drug treatment, "high level" models of care that shift addiction services to local communities, and repeal of the Medicaid rule that doesn't allow any reimbursement for mental-health and substance-use-disorder residential treatment facilities with more than 16 beds.

With treatment, Hesseltine said, "People can go from a pitiful and incomprehensible demoralization, a state where they have no hope to one of having hope, to being a productive member of society and to really regaining a place where they feel good about themselves and they are leading a life full of joy and freedom."
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