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Mom who lost son to opioid overdose shares heartbreaking photo

A Calgary mother wants the world to see the destructiveness of drugs.

As her son lay dying in a hospital bed from an overdose of fentanyl, a man-made opioid, Sherri Kent climbed into the bed to comfort him and held his hand. Kent posted a photo of the emotional moment on Facebook in hopes of warning others to stay away from the deadly drug.

>> See the Facebook post here

Her son, Michael, was just 22 years old. 

“I just want everyone to know that my son Michael overdosed on fentanyl,” she wrote in the Facebook post. "My son was not an addict he made a mistake that cost him his life. I just want to make everyone aware of the epidemic that’s goin (sic) on right now. It’s out of control and there is no way to protect our children from this other than to warn them of the dangers of drug use today.

>> Read more trending news

“I’ve lost my son to this horrible tragedy and want to make parents aware that it can happen to anyone … Please share this with your family and friends to help prevent another tragedy.”

In an interview with the CBC, Kent said her son met a man who offered him heroin while he was in the town of Kelowna – about 240 miles east of Vancouver. He didn’t initially take the man’s offer; however, Kent said the man tracked her son down the next day.

She said the man and her son went into a store bathroom to use the drug.

“The other man got all sketched out and messed up and left my son in the washroom,” Kent told the CBC. “About 20 minutes later, he was too scared to go back and check on my son … so he ran for the people who own the store to unlock the door, and that’s when they found him.

“He was already blue in the lips. By the time the ambulance got there, he was in cardiac arrest.”

The young man was rushed to the hospital and placed on life support. He died on March 21 when the life-support apparatus was turned off.

>> Watch the news report here

Woman’s reaction to sandals prompts severely swollen feet, ER visits

An unsuspecting woman was confined to a wheelchair and visited multiple hospitals when her ankles blistered and swelled uncomfortably and alarmingly.

>> Read more trending news

When Jessica Jones noticed a small, red spot on her ankle in February, she thought it was a spider bite. When she saw a doctor, he told her it was cellulitis, a common bacterial skin infection, WVUE reported. He gave her medicine and sent her home. 

But the next day, the spot on Jones’ ankle had grown, and it was inflamed and painful.

Jones visited a local emergency room, where doctors told her she had bullous pemphigoid, a rare skin condition that causes large, fluid-filled blisters. Again, she was given prescriptions for medication and sent home.

But the blisters continued to grow, causing Jones more pain.

“She essentially had, at the end of the day, second-degree burns,” dermatologist Robert Benson told WVUE.

Visits to two more hospitals left Jones with a diagnosis of a photosensitivity rash and lupus erthyrematosus. Each time she was given medication, but nothing eased Jones’ pain or reduced the swelling and blisters. Before long, Jones couldn’t walk and she was confined to a wheelchair.

“It scared me because I’m thinking, ‘What if they have to amputate my feet?’ That was going through my mind,” she told WVUE. “They’re telling me this is lupus, bullous impetigus, and I said, ‘This is getting worse.’ I said, ‘I’ve been on all these antibiotics, steroids, creams -- nothing’s working.”

Two weeks after her first doctor’s appointment, Jones called an ambulance and was taken to a third hospital. While at Oschner Hospital in New Orleans, a doctor asked a question that the others hadn’t. She asked if Jones had worn any new shoes recently. Jones said she had. 

“I noticed a couple of days after wearing them, the top(s) of my feet (were) getting sore, but I didn’t think anything of it. Shoes have always done that whenever I tighten the straps up on them,” Jones told WVUE. “The doctor said, ‘Where the strap is located on the shoe is exactly where your burns are.’ She says, ‘This is looking more like a chemical burn from leather more than bullous impetigus or lupus.’”

The doctor diagnosed her with contact dermatitis, a result of the severe allergic reaction Jones had to a material out of which the shoes were made.

Jones, who doesn’t blame the shoe manufacturer, said she may never wear leather again. 

“As soon as you see (your skin) with redness, blisters and irritation, don’t wait too long to get checked out,” Benson said.

Read more at WVUE.

This 10-Minute Core Workout Will Make You Feel Confident As Hell

By now you know that a strong core (the muscles that surround and support your spine) is essential to mastering nearly every exercise. But did you also know that core strength holds the key to killer confidence too? For proof, check out this quick 10-minute core workout. 

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The do-anywhere routine targets your core muscles from every angle, which will cinch in your waist like a corset and help you stand taller, sit straighter, and walk prouder thanks to extra support for your low back and spine. Which is to say: You'll be strutting into rooms like a boss in no time. This workout is the perfect finisher to your go-to cardio routine or a great option for busy days when you can't make it to the gym. Plus, there's a bonus AMRAP at the end to test your total-body strength and track your progress, so be sure to bookmark or pin this one. Getting in any movement—even if it's just 10 minutes—makes you feel accomplished and proud, so press play to get started. 

To recap: You don't need any equipment for this workout. An exercise mat is optional. 

Workout: Plank Crawl Superman Series Side Plank Thread the Needle (R/L) Reverse Plank (With Leg Raise) Circle Crunch Turtle Inchworm (With Push-Up Progression) Bear Bonus AMRAP

Looking for more short and effective at-home workouts? Grokker has thousands of routines, so you’ll never get bored. Bonus: For a limited time, Greatist readers get 40 percent off Grokker Premium (just $9 per month) and their first 14 days free. Sign up now!

Running Short On Time, Covered California And Insurers Seek Obamacare Answers From GOP

With a deadline looming, California’s health exchange and a major insurer pressed Republican leaders in Washington to clear up confusion over their commitment to key provisions of the Affordable Care Act.

Health insurers participating in the Covered California exchange for individuals and families must submit initial rates for 2018 on Monday. Peter Lee, the exchange’s executive director, warned in a conference call Thursday that rates could jump by more than 40 percent if the Trump administration and Republican-led Congress walk away from crucial elements of the health law.

In the meantime, House Republicans are looking to revive their Obamacare replacement bill and rally more support among moderate lawmakers in hopes of holding a vote soon.

In addition to Covered California, the chief executive of Molina Healthcare, a Long Beach-based insurer, implored Congress and the Trump administration on Thursday to act quickly to stabilize the exchange markets.

At issue are the continued federal funding of subsidies that reduce low-income consumers’ deductibles and copays and the enforcement of the individual mandate to purchase health coverage or pay a penalty.

Premiums in Covered California plans could increase by 42 percent, on average, if those subsidies aren’t funded and the mandate isn’t enforced, according to an analysis released Thursday by the exchange. Covered California has about 1.3 million customers.

Lee said it is imperative for leaders in Washington to clear up the uncertainty to avoid damaging insurance markets nationwide and hurting consumers. He said statements this week by the Trump administration that it would continue funding the cost-sharing subsidies haven’t specifically addressed whether that applies to all of 2017 or 2018.

“Health plans need to know now what are the rules of the road,” Lee said. “Insurers are considering their participation in the face of unprecedented uncertainty.”

Much of the debate this week in Washington has centered on House Republicans amending their Obamacare replacement bill, the American Health Care Act. But Lee said addressing the current market rules should be a priority ahead of crafting broader legislation.

Lee declined to comment on the latest legislative proposal from House Republicans, but he noted it still faces a long road ahead in Congress before it would win approval. “Health plans need to submit bids for today’s reality. Policymakers need to address that reality,” Lee said.

In a letter to House Speaker Paul Ryan and other congressional leaders, Molina Healthcare CEO J. Mario Molina said the cost-sharing reduction subsidies are essential for making coverage affordable for many consumers. Those subsidies cover out-of-pocket costs for exchange customers with incomes below 250 percent of the federal poverty level. They are separate from the tax credits that subsidize premium costs.

Without that federal funding, Molina wrote, “we will have no choice but to send a notice of default informing the government that we are dropping our contracts for their failure to pay premiums and seek to withdraw from the marketplace immediately.”

Molina said his company currently serves more than 1 million people through insurance exchanges in California and several other states. Molina had nearly 69,000 enrollees in Covered California as of December, state data show.

Anthem, California’s largest for-profit health insurer and a key player on exchanges nationally, issued a similar warning this week. During an earnings conference call on Wednesday, Anthem CEO Joseph Swedish said the insurer may exit some state exchanges or resubmit for higher rates if the fate of the cost-sharing subsidies isn’t resolved by early June.

Anthem has more than 310,000 customers in the California exchange, or nearly 25 percent of the market. Rival Blue Shield of California is the leader in state enrollment with 389,480, or 31 percent market share.

Republican leaders in Congress say they will address these concerns and move quickly to aid consumers by replacing the ACA with a plan that will reduce premiums and expand options for coverage.

The health law “is collapsing,” Ryan said at a news conference Thursday. “The American health care system in the individual market is in peril right now. We have a moral obligation to prevent people from getting hurt, to stop the damage from being continued.”

Many conservative Republicans oppose the Trump administration’s decision to continue to pay the cost-sharing subsidies, calling the subsidies unconstitutional because they lack congressional approval. House Republicans successfully sued to block the payments, but a judge put the ruling on hold while the Obama administration appealed the case. It’s not yet clear how President Donald Trump will handle that appeal.

Amid this political uncertainty, California Insurance Commissioner Dave Jones told insurers this week they could submit two sets of rate filings on Monday for their exchange business. One filing would reflect continued funding of cost-sharing subsidies and enforcement of the individual mandate. A separate filing could assume the opposite.

“In light of all the actions taken by the Trump administration and House leadership to undermine the ACA, I expect that health insurers will consider filing significant rate increases for 2018,” Jones wrote in a bulletin to insurers this week.

For 2017, rates in Covered California rose by 13.2 percent, on average, statewide. The state exchange is one of the few that actively negotiates rates with insurers. Premiums for the next year usually are announced in July.

The Best and Worst Breads You Can Eat, Ranked

Bread is like a modern-day curse word. When you're trying to clean up your eating habits, it's typically the first thing to go. But we love bread, so we did some dirty work to find out just how bad it is for you, really. Turns out, it can be part of a healthy diet. At least, if you opt for the right kind.

It sounds simple enough. Yet choosing the best bread isn’t always straightforward.  There are plenty of options to confuse us that sound wholesome. So which ones are actually good for you? From sprouted, to whole wheat and multigrain, to gluten-free and more, these are the ones we think are the best (and worst) choices you’ll find in the bread aisle.  

1. Sprouted Grain

If you've had Ezekiel bread, you've had the sprouted grain kind. It's definitely in the running for healthiest bread, but does it stand up to its reputation? Yes, it does. Sprouted grains convert some of their starch to protein, vitamins, and minerals, so breads made with them tend to be more nutrient dense than non-sprouted breads, including 100 percent whole wheat, explains registered dietician Isabel Smith. More protein and less starch fills you up more too. That’s not all. There’s a good chance that any sprouted bread you pick up will be made from more natural ingredients than the others—so you may not have to spend as much time deciphering the package label.

Per slice: 80 calories, 5g protein, 14g carbs, 1g fat, 4g fiber, 0g sugar

2. 100 Percent Whole Grain

Bread made with 100 percent whole grains (like whole wheat) falls behind sprouted grains, but it’s still a great choice, Smith says. Unlike breads made with only partly whole grain, these breads are free of refined grains or flour, so they’re still a good source of protein and fiber.

That’s not to say that all 100 percent whole-grain breads are created equal. Some have more added sweeteners than others, and they can still contain synthetic preservatives and stabilizers. Your best bet is to choose breads with less than 3 grams of sugar per slice and make sure the sugar comes from natural sources such as honey, molasses, or cane sugar, Smith says. Steer clear of those made with potassium bromate and azodicarbonamide (both are linked to the C-word), as well as high-fructose corn syrup and partially hydrogenated oils. Bleh.

Per slice: 81 calories, 4g protein, 14g carbs, 1g fat, 2g fiber, 1.5g sugar

3. Multigrain

Multigrain means that a bread is made with multiple types of grains (such as wheat, barley, and millet), but those grains don’t have to be whole. Usually, multigrain loaves are made mostly with refined grains, making them lower in fiber, protein, and nutrients than whole grain and sprouted breads, Smith says. But because they likely contain a little bit of whole grain, they’re still better than the Wonder Bread that used to fill your school lunches.

Per slice: 75 calories, 3g protein, 12g carbs, 1g fat, 2g fiber, 2g sugar

4. Gluten-free

Though they might sound healthy, most gluten-free breads are made with refined grains and heavy starches such as white rice flour and potato starch. Chemical composition and starch digestibility of different gluten-free breads. Segura ME, Rosell CM. Plant foods for human nutrition (Dordrecht, Netherlands), 2012, Feb.;66(3):1573-9104. They also tend to pack extra fat and sugar to improve the texture and flavor. So in general, they tend to be lower in protein, fiber, and nutrients, and higher in calories than some other types of bread, Smith says.

There are some exceptions. Breads made with lower-starch flours such as almond, coconut, and quinoa flour are better gluten-free options. “But they still tend to be fairly low in protein, fiber, and nutrients, so read the label,” says Smith. Bottom line, unless you have celiac disease and *definitely have to* avoid gluten, you might want to consider sprouted bread before falling for the gluten-free trend.

Per slice: 109 calories, 1g protein, 18g carbs, 3.5 g fat, 1g fiber, 3g sugar

5. Sourdough and Rye

Like white bread, both sourdough and rye are made with refined flour—so they don’t offer much in the way of protein, fiber, or nutrients. Rye’s one plus comes from caraway seeds. “They contain digestive benefits, antioxidant properties, and help to add a little bit of fiber,” Smith says. But the amount of caraway seeds in certain brands might not be enough to do you any good.

And because sourdough bread is made with white flour, it’s low in fiber and protein—and won’t keep you full for very long, says Smith. If you enjoy the flavor of sourdough and rye, go ahead and enjoy them occasionally but don't expect to get your health fix. There’s no definitive proof that they're better for you than white bread.

Per slice (rye): 83 calories, 2.5g protein, 15.5g carbs, 1g fat, 2g fiber, 1g sugarPer slice (sourdough): 116 calories, 0g protein, 21g carbs, 1.5g fat, 1g fiber, 2g sugar

The Bottom Line

Sprouted-grain or 100 percent whole-grain breads deliver the best nutritional bang for your buck. Check your labels before you purchase. Your best options are ones that deliver at least 3 to 5 grams of protein and fiber per slice, and no more than 3 grams of sugar per slice. Avoid any breads with potentially unsafe additives, sweeteners, preservatives, or fats. 

And let’s be honest: If you feel like jumping into a pillowy slice of white bread or a crusty white baguette once in a while, it's all good. But if you can’t imagine eating anything but a sandwich for lunch every day or can’t say no to your ritualistic avocado toast, then you might want to shoot for these better options.

The Healthiest Breads, Ranked, Because We'll Never Say No to Carbs

Bread is like a modern-day curse word. When you're trying to clean up your eating habits, it's typically the first thing to go. But we love bread, so we did some dirty work to find out just how bad it is for you, really. Turns out, it can be part of a healthy diet. At least, if you opt for the right kind.

It sounds simple enough. Yet choosing the best bread isn’t always straightforward.  There are plenty of options to confuse us that sound wholesome. So which ones are actually good for you? From sprouted, to whole wheat and multigrain, to gluten-free and more, these are the ones we think are the best (and worst) choices you’ll find in the bread aisle.  

1. Sprouted Grain

If you've had Ezekiel bread, you've had the sprouted grain kind. It's definitely in the running for healthiest bread, but does it stand up to its reputation? Yes, it does. Sprouted grains convert some of their starch to protein, vitamins, and minerals, so breads made with them tend to be more nutrient dense than non-sprouted breads, including 100 percent whole wheat, explains registered dietician Isabel Smith. More protein and less starch fills you up more too. That’s not all. There’s a good chance that any sprouted bread you pick up will be made from more natural ingredients than the others—so you may not have to spend as much time deciphering the package label.

Per slice: 80 calories, 5g protein, 14g carbs, 1g fat, 4g fiber, 0g sugar

2. 100 Percent Whole Grain

Bread made with 100 percent whole grains (like whole wheat) falls behind sprouted grains, but it’s still a great choice, Smith says. Unlike breads made with only partly whole grain, these breads are free of refined grains or flour, so they’re still a good source of protein and fiber.

That’s not to say that all 100 percent whole-grain breads are created equal. Some have more added sweeteners than others, and they can still contain synthetic preservatives and stabilizers. Your best bet is to choose breads with less than 3 grams of sugar per slice and make sure the sugar comes from natural sources such as honey, molasses, or cane sugar, Smith says. Steer clear of those made with potassium bromate and azodicarbonamide (both are linked to the C-word), as well as high-fructose corn syrup and partially hydrogenated oils. Bleh.

Per slice: 81 calories, 4g protein, 14g carbs, 1g fat, 2g fiber, 1.5g sugar

3. Multigrain

Multigrain means that a bread is made with multiple types of grains (such as wheat, barley, and millet), but those grains don’t have to be whole. Usually, multigrain loaves are made mostly with refined grains, making them lower in fiber, protein, and nutrients than whole grain and sprouted breads, Smith says. But because they likely contain a little bit of whole grain, they’re still better than the Wonder Bread that used to fill your school lunches.

Per slice: 75 calories, 3g protein, 12g carbs, 1g fat, 2g fiber, 2g sugar

4. Gluten-free

Though they might sound healthy, most gluten-free breads are made with refined grains and heavy starches such as white rice flour and potato starch. Chemical composition and starch digestibility of different gluten-free breads. Segura ME, Rosell CM. Plant foods for human nutrition (Dordrecht, Netherlands), 2012, Feb.;66(3):1573-9104. They also tend to pack extra fat and sugar to improve the texture and flavor. So in general, they tend to be lower in protein, fiber, and nutrients, and higher in calories than some other types of bread, Smith says.

There are some exceptions. Breads made with lower-starch flours such as almond, coconut, and quinoa flour are better gluten-free options. “But they still tend to be fairly low in protein, fiber, and nutrients, so read the label,” says Smith. Bottom line, unless you have celiac disease and *definitely have to* avoid gluten, you might want to consider sprouted bread before falling for the gluten-free trend.

Per slice: 109 calories, 1g protein, 18g carbs, 3.5 g fat, 1g fiber, 3g sugar

5. Sourdough and Rye

Like white bread, both sourdough and rye are made with refined flour—so they don’t offer much in the way of protein, fiber, or nutrients. Rye’s one plus comes from caraway seeds. “They contain digestive benefits, antioxidant properties, and help to add a little bit of fiber,” Smith says. But the amount of caraway seeds in certain brands might not be enough to do you any good.

And because sourdough bread is made with white flour, it’s low in fiber and protein—and won’t keep you full for very long, says Smith. If you enjoy the flavor of sourdough and rye, go ahead and enjoy them occasionally but don't expect to get your health fix. There’s no definitive proof that they're better for you than white bread.

Per slice (rye): 83 calories, 2.5g protein, 15.5g carbs, 1g fat, 2g fiber, 1g sugarPer slice (sourdough): 116 calories, 0g protein, 21g carbs, 1.5g fat, 1g fiber, 2g sugar

The Bottom Line

Sprouted-grain or 100 percent whole-grain breads deliver the best nutritional bang for your buck. Check your labels before you purchase. Your best options are ones that deliver at least 3 to 5 grams of protein and fiber per slice, and no more than 3 grams of sugar per slice. Avoid any breads with potentially unsafe additives, sweeteners, preservatives, or fats. 

And let’s be honest: If you feel like jumping into a pillowy slice of white bread or a crusty white baguette once in a while, it's all good. But if you can’t imagine eating anything but a sandwich for lunch every day or can’t say no to your ritualistic avocado toast, then you might want to shoot for these better options.

‘Center Of Excellence’ Designation Doesn’t Rule Out Complications Of Bariatric Surgery

Getting bariatric surgery at a “center of excellence” doesn’t mean that patients can be assured that they will avoid serious complications from the weight-loss procedure at the facility, according to a recent study.

Even though facilities that have been accredited as centers of excellence must all meet minimum standards, including performing at least 125 bariatric surgeries annually, the risk of serious problems varied widely among centers, the study found.

“To become accredited, there’s no measure of outcomes, it’s just a process list,” said Dr. Andrew Ibrahim, a research fellow at the University of Michigan Institute for Healthcare Policy and Innovation and the study’s lead author. In addition to minimum case volumes, accredited centers have to have special surgical equipment to handle overweight patients, such as bariatric operating tables and longer laparoscopic instruments.

Insurers typically restrict coverage of bariatric surgery to procedures performed at accredited facilities, however, and nearly 90 percent of bariatric surgeries are performed at a center of excellence.

Bariatric surgery is used to treat people who are severely obese and have not had success with other weight-loss programs. Surgeons use a variety of methods to make the stomach smaller so that less food can be consumed easily.

For this study, researchers analyzed claims data of more than 145,000 patients at 165 bariatric surgery centers of excellence in 12 states from 2010 to 2013. Nationally, the rate of serious complications following surgery — heart attack, kidney failure or blood transfusion, for example — varied widely among the centers, from 0.6 percent at the low end to 10.3 percent at the high end. The rate varied widely within states as well. Nearly 1 in 3 lower-performing hospitals had a higher-performing hospital in the same service area, the study found.

Bariatric surgery has come a long way from the early days when some low-volume centers experienced 30-day mortality rates approaching 10 percent, according to Ibrahim. In this study, 72 patients died in the hospital following surgery — a rate of less than 1 percent among study participants.

However, while accreditation has had an effect on quality and safety, “at the moment, just going to a center that is accredited does not ensure uniform high-quality care for a patient,” Ibrahim said.

The degree of technical skill of the surgeon performing the procedure may affect post-operative outcomes, the study found, as may the degree to which centers follow accepted best practices for bariatric patient care. Neither of those variables is captured in this study.

The organization that accredits bariatric surgery hospitals collects data from hospitals about serious complications, but the data aren’t publicly available, according to the study. So there’s no way for patients to use the data to learn which bariatric center of excellence in their area has the lowest serious complication rates. “Not yet,” Ibrahim said.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Try This At Home: Program Brings Drug Addiction Treatment To Patients

[audio mp3="https://kaiserhealthnews.files.wordpress.com/2017/04/20170417_atc_home-based_drug_treatment_program_costs_less_and_works.mp3"][/audio]Can’t see the audio player? Click here to download.

Hannah Berkowitz is 20 years old. When she was a senior in high school, her life flew off the rails.

She was abusing drugs. She was suicidal. She moved into a therapeutic boarding school to get sober, but she could stay sober only while she was on campus during the week.

“I’d come home and try to stay sober really hard — really, really hard,” said Berkowitz, who had trouble staying away from old friends and bad habits. “Sometimes I’d make it through the weekend, and sometimes I just couldn’t make it. It was white-knuckling it, just holding on.”

The transition back home always triggered a relapse for Berkowitz.

“I thought it was just my fault and there was no hope,” she said.

But Berkowitz did have luck. She had private health insurance and lived in Connecticut, where a startup company, Aware Recovery Care, had begun treating clients in the very environment where Hannah struggled to stay sober: her home.

A Chronic Disease Approach

Treating addiction is a growing business, and some treatments, especially inpatient care, can run tens of thousands of dollars. For many people, the help is only temporary. The National Institutes of Health estimates that 40 to 60 percent of people addicted to drugs relapse. But there is a way to help some people pay less for better results, said Matt Eacott, vice president of Aware Recovery Care.

“Ninety-nine percent of the industry really treats addiction as an acute problem — like a rash on your arm that you rub lotion on and you’re done,” he said.

Rather than a bad rash, Aware treats addiction as a chronic illness that doesn’t disappear just because symptoms are under control — a cost-effective way of treating addiction, Eacott said.

Aware comes into clients’ homes and connects them with a nurse, a primary care doctor, a therapist, peer support, 12-step meetings and a case manager. Clients hooked on opioids can get medication-assisted treatment. They can also submit to urine screening and GPS tracking, if that helps them stick with the program.

Hannah’s mother, Lois Berkowitz, said the program is intense at first. But as Hannah built coping skills, the supports faded into the background.

“It’s not like they’re doing the work for the addict,” said Lois Berkowitz. “They’re just basically taking them by the hand and saying, ‘Here are the places you need to go that will help you. And I’m going to go with you to start so it doesn’t feel that uncomfortable. And then we’re going to let you fly.'”

Before they fly, Aware clients have a pretty long runway. The treatment lasts a full year.

The Numbers

Aware has now expanded from its base in Connecticut into New Hampshire. The program is expensive: $38,000 a year. As of now, it’s available only to private-pay clients and people insured through Anthem health insurance in New Hampshire and Connecticut.

Anthem became the first insurer to pay Aware, because the treatment is based on hard science that’s yielding solid results for clients, said Dr. Steven Korn, Anthem’s behavioral health medical director. Science and results are rare in addiction treatment, he said.

“There are old, old notions that have hung pretty tough,” said Korn. “When I was young, when I was in training and as soon as substance abuse was mentioned, the response of physicians was, ‘Well, go to AA. That’s not our problem. We don’t treat that.'”

For a year of treatment, Anthem said, it’s paying Aware about the same as the cost of a month or two of inpatient treatment. Anthem also says 72 percent of Aware clients are either sober at the end of one year or still in active treatment.

That’s about twice the sobriety rate of people who check in to a facility for a month and then get no follow-up care, said Dr. Stuart Gitlow, past president of the American Society of Addiction Medicine.

Treating addiction at home makes sense because it’s the exact place where people learned their bad habits, Gitlow said.

“It’s all based on this concept that addiction is not about the substance use but is about what led to the substance use in the first place. And you can’t really get there without getting to know the patient,” he added.

Aware said it’s in negotiations with four more major insurers. It aims to have a couple of hundred clients in New Hampshire by the end of the year.

This story is part of a partnership that includes NHPR, NPR and Kaiser Health News.

California Proposes Stringent Cap On Toxic Chemical In Drinking Water

California regulators are proposing a strict limit on a toxic man-made chemical that has contaminated water supplies throughout the state, particularly in its vast agricultural heartland.

California would be only the second state, after Hawaii, to establish a threshold for the former pesticide ingredient and industrial solvent known as TCP (1,2,3-trichloropropane) in drinking water. The chemical compound, identified in California as a human carcinogen, is no longer in wide use but has leached over the years into many wells and reservoirs.

The problem extends well beyond California and Hawaii, environmental advocates say, but the chemical is not regulated by the federal government. Citing federal data, the Environmental Working Group, a Washington, D.C.-based advocacy organization, says the chemical also has been detected in water supplies of a dozen other states, including New York, Pennsylvania and New Jersey, as well as Puerto Rico.

Once TCP gets into the groundwater, it “persists for centuries,” according to the EWG’s April report.

The California State Water Resources Control Board’s proposal would set the maximum allowable amount of TCP in public tap water at five parts per trillion — the lowest level that existing filtration systems can reliably detect and far lower than Hawaii’s.

It “is a top priority for the state water board,” said board spokesman Andrew DiLuccia.

TCP taints water systems serving nearly a million people from Sacramento to San Diego, according to the state water board. The compound is present at levels above the proposed limit in 562 wells, reservoirs and other sources belonging to 94 public water systems, according to 2016 data. Those numbers do not include private wells.

In California, the contamination exists in many urban areas, including in Los Angeles, San Bernardino and San Mateo counties. Though the source in those more populated regions is not known, the pollution is believed to come from industrial and hazardous waste sites.

“Los Angeles has quite a bit of contamination,” said Andria Ventura, toxics program manager for the environmental advocacy group Clean Water Action. “It’s hard for water providers to pinpoint where it came from.”

But California’s most serious and widespread TCP contamination is in the agricultural counties of the Central Valley, where the chemical was an ingredient in soil fumigants sold by the Shell Oil and Dow Chemical companies from at least the 1950s into the 1980s.

During that period, farmers who grew potatoes, sugar beets and other vegetables used the fumigants to kill tiny, soil-dwelling worms called nematodes. Dozens of municipalities and public water suppliers across the state have filed lawsuits against Shell and Dow, alleging that the companies knew — or should have known — that the TCP in their soil-fumigating pesticides would migrate into groundwater and pose a serious health hazard.

Shell and Dow have denied wrongdoing. Shell quit selling its product, known as D-D, in the mid-1980s. About the same time, Dow opted to reformulate its fumigant, known as Telone, after which TCP declined to “generally undetectable” levels, according to company spokesman Jarrod Erpelding. He declined to comment further, citing pending litigation.

Shell sent an email response: “The former Shell agricultural product, last manufactured more than 30 years ago, contained trace amounts of 1,2,3 trichloropropane (TCP). It was used to control microscopic worms that attacked crops causing millions of dollars a year of crop loss for farmers, and was approved for use by the U.S. government and the State of California.”

Environmental advocates say the adoption of a regulatory limit for TCP is a crucial step to help cash-strapped, rural water districts pay for the cleanup of their drinking water.

“It allows the districts when they go into court to be very specific and say to the judge, ‘We’re going to need exactly this amount of money to purchase this kind of system to meet the state standards,’” said Bill Walker, managing editor at the Environmental Working Group and co-author of its report on the role of Shell and Dow in California’s TCP drinking water problem.

“It doesn’t guarantee they’ll win,” he said, “but it increases their leverage.”

At a public hearing on April 19, water board members heard testimony and received written comments on the proposed limit. Now the board is reviewing the input it received and will likely vote on the plan by summer, DiLuccia said.

The regulation would require water utilities to test their supplies for TCP and remove it from any public drinking water source that exceeded the threshold, starting in 2018.

The proposed limit is more stringent than Hawaii’s because it is as close as California could get to meeting its stated “public health goal” for TCP set in 2009, officials say.

Though it is difficult to know how long the California cleanup might take, the cost of TCP testing and subsequent cleanup could reach nearly $500 million over 20 years, according to one water board estimate.

TCP contamination “disproportionately impacts poor communities and communities of color,” said Jenny Rempel, of Community Water Center, a Visalia, Calif.-based advocacy group. “This is a problem where the cost should not be borne by taxpayers.”

Todd E. Robins, a San Francisco attorney who is representing more than two dozen of the water suppliers that are suing Shell and Dow, argues that the companies included TCP in their worm-killing pesticides to get rid of the compound without having to pay for proper disposal. It was a byproduct of unrelated manufacturing processes and, according to the suits, played no role in killing the plant-damaging worms.

“The TCP that we find today in groundwater is the result of past use of soil fumigants that contained TCP as an unnecessary ingredient,” Robins said. “Instead of paying for disposal costs, they started getting farmers to pay for them.”

“The saddest part of the story,” Robins added, “is that the … actual active ingredient breaks down in the soil after a matter of days and has rarely been detected in anyone’s groundwater.”

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One of the lawsuits filed by Robins, on behalf of the Del Rey Community Service District in Fresno County, says the companies knew they could remove or reduce the amount of TCP in their pesticides without compromising its effectiveness but failed to do so.

The complaint calls TCP a “hazardous waste” — a byproduct created in the manufacturing of a different chemical, allyl chloride, that Shell and Dow used to make plastics and other commercial products.

An internal Shell memo uncovered in Robins’ litigation cites $3.2 million in savings from “cost avoidance for disposal” related to the allyl chloride operations. The memo is dated Jan. 20, 1983 — a year before the company stopped producing the TCP-laced pesticide.

In addition to the pending cases, which also name distributors and marketers as defendants, Robins said he has settled eight cases against both Shell and Dow since 2010. He said he cannot disclose the amounts because of confidentiality agreements.

Last December, in a case tried by a different lawyer, a Fresno Superior Court jury awarded the city of Clovis $22 million against Shell to clean up its TCP-tainted drinking water.

In 2010, in a case brought by the city of Redlands, Shell won. The company argued that a nearby aerospace plant was the source of the toxin. Moreover, the wells in question were used for irrigation, and the jury didn’t believe they’d ever be used for drinking water.

As the lawsuits proceed, some California residents do what they can to protest the toxic chemicals in their water supply. Bartolo Chavez, 57, took time off his job in a juice packing house to testify at the recent hearing in Sacramento.

“We talk about the contaminants and the danger,” said Chavez, who has lived for 21 years in the Central Valley town of Arvin, Calif. “And [that] we’re exposed.”

He said he gets tokens from the water district to get free filtered water — not just because of TCP but because of other contaminants as well, such as arsenic and chromium-6.

“But the tokens aren’t enough,” Chavez said, speaking through a Spanish-language interpreter. “So in addition, we buy bottled water at Costco.”

Chavez and his wife, a hotel worker, pay about $50 a month for that water — a price they say they can ill afford. But leaving Arvin isn’t an option either, Chavez said.

“I have thought about moving, but it’s not so easy to find work in other places, especially when you’re older,” he said. “Our house is almost paid off, and to move would be to start over again, so it’s almost impossible.”

California Healthline Managing Editor Bernard Wolfson contributed to this report.  This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Best and Worst Salad Toppings

A few years back I typed up a list of New Year’s resolutions on a small piece of cardstock, laminated it, and put it in my wallet. On that list was the resolution to eat a salad every day, simply because eating salad always made me feel like I was doing something good for myself. After all, salad provides several vitamins and can fill you up while reducing your caloric intake. What could be healthier than a big, fresh salad? Unfortunately, many things, as I later found out. Salads can run the gamut of healthiness, depending on what is in them. Although that big bowl of greens may be packed full of antioxidants and fiber, it can also be laden with fat, cholesterol, and sodium—not to mention an overabundance of calories. Some restaurant salads can even contain more calories than a cheeseburger! Luckily, like most things in life, a salad is the outcome of several small decisions. To make sure you don't sabotage your healthy diet unintentionally, choose wisely the next time you order a salad from a restaurant or visit the salad bar. When dining out, don't be afraid to ask questions, make special requests (extra veggies, dressing on the side, light cheese) and ask about substitutions (like grilled chicken for breaded). Most restaurants will be happy to accommodate you as long as their kitchen is stocked with the ingredients you want. Here’s how to choose wisely next time you're making a salad at home or choosing one from a menu. Lettuce The foundation of most salads, lettuce adds substance, crunch, water, and fiber for very few calories—only about 10 per cup. But if you want all that and vitamins, too, toss out the iceberg and toss in the romaine, mixed baby greens and spinach. While iceberg lettuce is lower in nutrients (and still makes a decent choice if it's the only thing available), these other greens are rich in vitamins A, C and K, manganese, and folate. Protein Adding protein, such as lean meat, tofu, eggs or beans, will help bulk up your salad and keep you full longer. Unfortunately, many protein toppings are deep-fried, breaded and greasy, which adds unnecessary calories plus cholesterol, sodium and fat to your salad. Skimp on fattier toppings such as bacon and fried (breaded) chicken strips, and go for lean proteins instead. Grilled chicken, canned beans of all kinds, chickpeas, tofu, hardboiled eggs (especially whites), or water-packed tuna are leaner choices. Nuts and seeds are popular in salads, too, and while they’re a healthy source of good fats and some protein, they’re not exactly low-cal. If you choose to add them, watch your portions (1/2 ounce contains more than 80 calories). Cheese Restaurants know that people love cheese, so they tend to pile on multiple servings of it on their salads. It might be tasty, but it sends the calorie counts sky high! While cheese is a nutritious food that adds flavor, calcium, and protein to a salad, enjoy it in moderation due to its high fat content. Just a half-cup of cheddar cheese (the amount on many large restaurant salads) contains 18 grams of fat and 225 calories. To keep calories in check, use a single serving of cheese (approximately 2 tablespoons). Choose low-fat varieties as much as possible to save on saturated fat and calories. A smaller amount of a stronger-flavored cheese, such as Brie, feta, chevre, gorgonzola, sharp cheddar or bleu cheese will go a long way in helping you cut down on your portions. Pile on the Veggies Vegetables like bell peppers, grated carrots, sugar snap peas, and tomatoes provide flavor, fiber, and vitamins for few calories. Grated carrots, for example, have only 45 calories in a whole cup, and there are only about 20 calories in an entire red bell pepper. When building your best salad, use as many veggies as possible for extra filling power—and a nice crunch! Practice moderation when it comes to starchy vegetable toppings like corn and potatoes, which are higher in calories. And remember to go for a variety of colors to ensure you're getting several different nutrients and antioxidants in your salad bowl. Don't Forget the Fruit Don't leave fruit on the sidelines! Fresh, canned and dried fruits add a sweetness that can help temper the slightly bitter taste of greens and veggies. They also provide color and texture (not to mention nutrition) to your salad bowl. Chopped apples, pears, grapes, or mandarin oranges (canned in juice—not syrup—and drained) are excellent salad toppers. Chewy dried fruits (cranberries, raisins) work well, too, but they are also high in calories (so only use a sprinkle!). Avocados (and the guacamole made from them) are creamy and nutritious thanks to their heart-healthy fats, but they're also a concentrated sources of calories. Keep your use of avocado to a minimum if you're watching your weight. Crunchy Toppings Sesame sticks, crispy noodles and croutons are salty and crunchy but conceal lot of hidden fat. Better options include water chestnuts, apple slivers, a small serving of nuts, crumbled whole-grain crackers, and homemade croutons. To make your own low-fat croutons, just slice a large clove of garlic and rub it over both sides of a piece of whole-grain bread. Cut the bread into cubes and then brown it in the toaster or conventional oven. Dressing A very healthy salad could go very wrong with one too many shakes of oil or dressing. The main issue with dressing is its fat and sodium content—and the fact that people have trouble controlling their portions. Two tablespoons is an appropriate serving of dressing, but most restaurants serve much more than that, whether mixed in to your salad or served on the side. Those calories add up fast. When dining out, always ask for dressing on the side and dip your fork into the dressing before picking up your bite of salad. Caesar, ranch and other cream-based dressings (when not specified as low-fat) are calorie bombs worth avoiding. Look for dressings specified as "low-fat" that contain no more than 60 calories per serving. You can also add flavor for minimal calories by using salsa, vinegar or lemon juice. Salad may be the symbol of healthy eating, but not every salad is healthful—or diet-friendly. The healthfulness of your next salad depends on the simple choices you make when topping or dressing it. Perhaps my greatest discovery about salads was that because you can customize them so easily, you could make a huge main-course salad for a very small amount of calories. Pile in the lettuce and veggies, add a moderate amount of lean protein, sprinkling some cheese and a little something crunchy and measure a portion-controlled side of dressing, and you’ve got a dinner that won’t leave you feeling hungry.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1388

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