The Sentinel: Health

Got hives? Here is what we know you are itching to learn about Chronic Urticaria

Urticaria is a rash causing round, swollen areas on the skin. It can be tender, itchy and/or painful. People with light skin may see red, raised bumps or welts.

BPT - If you've had hives, you know how challenging they can be. But you may not know that there is more than one type of hives, or urticaria, and that treatments are available. A brief episode of hives is a nuisance, but when symptoms persist for weeks, months or years, it can take a physical and psychological toll.

What is urticaria?

Urticaria is a rash causing round, swollen areas on the skin. It can be tender, itchy and/or painful. People with light skin may see red, raised bumps or welts. In people of color, hives may match the color of surrounding skin or appear slightly lighter or darker. They may appear all over your body or in one area.

Urticaria occurs when chemical compounds involved in the body's inflammatory and immune responses are released. One of these chemicals is histamine, which is released by mast cells and basophils. When this release happens in the skin's outer layers, it results in hives.

Most hives resolve quickly, but they can become chronic. Acute urticaria refers to hives lasting one day to six weeks. Chronic urticaria means the hives have lasted for six weeks or longer. For many people, the cause is unknown.

Chronic urticaria eventually goes away by itself.

Chronic urticaria is a rare condition that occurs in only 23 out of 10,000 people, though the actual number may be higher, since many people do not report or recognize the symptoms. Chronic urticaria is most common in adults aged 40-59. More women than men are affected, and more Black Americans and other ethnic groups are affected. There are two types:

Chronic idiopathic urticaria (also called chronic spontaneous urticaria) is not triggered by external factors. In many cases, the cause could be an autoimmune condition, another systemic disease like cancer, or unknown.
Chronic inducible urticaria is caused by certain environmental and physical factors.

Identifying urticaria triggers

Common triggers include:

Allergens, including certain foods
Exposure to heat/cold
Tight clothing
Insect stings and bites
Infections and viruses
Medications such as antibiotics and NSAIDs
Diseases including asthma, celiac disease, diabetes, lupus, rheumatoid arthritis, thyroid disease, vasculitis and vitiligo
Stress

Diagnosis and treatment

The cause of your chronic urticaria may be hard to identify. It's best to see a specialist such as a board-certified allergist or dermatologist for diagnosis and treatment.

Your doctor may perform allergy tests, lab tests or a skin biopsy to rule out other conditions that involve or resemble hives. You can help by keeping a diary that tracks your symptoms.

Chronic urticaria eventually goes away by itself. Management focuses on the most appropriate treatment to control symptoms, usually starting with the first line of treatment: a long-lasting antihistamine.

Antihistamines block production of histamine to reduce or eliminate hives and ease itch and swelling. Ask your doctor for a non-sedating antihistamine.

Topical itch creams may provide mild relief for hives that do not cover the entire body.

Corticosteroids: Topical corticosteroids reduce inflammation, irritation and itching. By reducing inflammation, they also promote healing. For a severe hives flare-up, a short course of oral corticosteroids (prednisone) can help reduce inflammation and itching. These medications can cause serious side effects, especially if taken long-term. It's important to follow your doctor's instructions when taking oral corticosteroids.

Advanced treatments

It's important to work closely with your doctor if your hives don't respond to treatment. If antihistamines alone do not help, your doctor may recommend combining them with other medications, including leukotriene modifiers or H2 blockers. New advanced treatments are available, and more are in clinical trials or undergoing FDA review.

Biologics: Omalizumab is a biologic medication used to treat chronic urticaria when antihistamines haven't worked. Two more biologics are in development as chronic urticaria treatments: dupilumab is in FDA review and briquilimab is in clinical trials. Biologics work by targeting cells and interrupting the inflammatory process. This stops or reduces symptoms. Biologics are injectable medications typically given once per month.

Cyclosporine: This is an oral medication that calms the immune system to prevent hives from occurring. It can be taken along with antihistamines. Since cyclosporine is an immunosuppressive, it can decrease the body's ability to fight infections. Talk with your doctor about side effects and the benefits vs. risks of taking this medication.

Bruton's tyrosine kinase (BTK) inhibitor: Remibrutinib is an oral medication in clinical trials. It works by blocking the activation of mast cells and basophils. These cells release histamine and other inflammatory mediators that cause hives, swelling and itching. By blocking this process, remibrutinib can reduce or eliminate symptoms.

Hives and mental health

It's important not to blame yourself for your hives. If you're feeling anxiety, depression or embarrassment about your skin condition, talk with your healthcare provider or a mental health specialist. Support groups for people with urticaria also let you share experiences and know you are not alone.

Don't let chronic urticaria impact your quality of life. Talk to your doctor. Check out the Chronic Urticaria Toolkit at ChronicHives.info.

Microplastics and our water: What families should know

StatePoint Media - Statistics show if that if you’re not filtering your water the right way, your family is likely consuming microplastics.

An overwhelming 94% of U.S. tap water is contaminated with fragments of plastic pollution called microplastics, and bottled water does not fare much better —microplastics are found in 93% of 11 popular water bottle brands around the world.

Microplastics found in drinking water are not just an environmental hazard — mounting evidence indicates that they are also a potential human health hazard.

When it comes to your family’s health and well-being, don’t take chances.

So what can you do to help make your drinking water safer? Investing in the right water filter is a great start. Be sure to choose one that meets internationally-recognized testing standards and is backed by independent testing. For example, all of LifeStraw’s water filters feature a membrane technology capable of filtering out microplastics and a host of other contaminants, such as bacteria and parasites.

To ensure your family has higher-quality water wherever you go, tackle the problem with this two-pronged approach:

At home: Supply your household with safer water using the LifeStraw Home High-Capacity Dispenser. In addition to microplastics, this sleek, 35-cup dispenser also removes bacteria and parasites, and reduces lead, mercury and chemicals, including PFAS, as well as chlorine, herbicides, pesticides, dirt, sand and cloudiness, while retaining essential minerals.

On the go: Access healthier water when you are at school, work or out and about using the LifeStraw Go Series Water Filter Tumbler. This insulated, travel-sized stainless steel water filter improves taste and protects against contaminants, including microplastics.

To learn more about safe drinking water, as well as efforts being made to improve drinking water around the world, visit lifestraw.com/blogs.

When it comes to your family’s health and well-being, don’t take chances. Simple steps can vastly improve your water supply and reduce your consumption of harmful pollutants.

Op-Ed |
New study reveals obesity ages individuals by 27 years

Findings highlight wide-ranging health impacts and alarming cost implications

by Patty Starr
President and CEO, Health Action Council

Newly released claims data from more than 220,000 people reveal the latest evidence on the role obesity plays in health and health care costs, underpinning the need for supportive measures and interventions.

The new study, which analyzed Health Action Council (HAC) members with health plans administered by UnitedHealthcare, found that people with obesity cost their employers 2.3 times more than those without the condition and paid 66% more out-of-pocket ($662) per year than their peers without obesity. Notably, Millennials with obesity incurred over 8% higher per member per month (PMPM) costs than Baby Boomers without obesity who were 27 years older, due to the increased likelihood of chronic condition diagnoses.

Multifaceted health consequences

Comorbidities such as diabetes, hypertension, high cholesterol, and musculoskeletal issues were major cost drivers. The more comorbidities a person with obesity experienced, the higher their costs became. Obesity significantly increased the risk of various cancers, including breast, colon, rectum, and upper stomach cancers, and increased the risks for anxiety, substance use disorders, and depression.

Obesity among women of childbearing age

The report highlighted a 19-percentage-point rise in obesity rates between Gen Z women (9%) and Millennial women (28%), the largest generation in today’s workforce. This was particularly concerning due to the heightened maternal mortality risks and mental health issues associated with obesity.

The ripple effect on children

Children of parents with obesity are generally twice as likely to develop the condition themselves, but this risk tripled for children of HAC members if at least one parent had obesity. These children were also 44% more likely to experience depression, 39% more likely to have ADHD, and had higher rates of developmental disorders, asthma and diabetes.

Whole person weight management solutions

Effective strategies will require more than GLP-1s, which are unlikely to meaningfully impact obesity rates due to their high costs and low compliance rates. Consistent with the Food and Drug Administration’s label, these medications should be used in tandem with a life-style modification program for the treatment of obesity.

Strategies for employers

Following are a few steps employers can take to build a healthier workplace culture.

Understand your population. Analyze claims to determine the percentage of your workforce and dependents impacted by obesity. Identify prevalence, most impacted groups, as well as other health risks and social drivers of health.
Foster a healthy environment. Encourage a positive relationship with food, activity, and stress management by offering classes on exercise, nutrition, and mindfulness and providing non-processed foods at meetings, events, and in common areas. Encourage daily physical activity, less screen time, and quality sleep.
Offer comprehensive health solutions. Implement wellness solutions that integrate whole-person health by providing access to virtual providers such as network dietitians, digital health tools like mental health apps, and wearable technologies such as continuous glucose monitors.

About the author ~

Patty Starr, CEO of Health Action Council

Patty Starr is President and CEO of Health Action Council and is responsible for driving the strategic direction of the organization--build stronger, healthier communities where business can thrive.

Bird Flu spreads to cats, concern for human infections heighten

So far, 43 types of mammals have tested positive for bird flu in the U.S.

(Urbana) - A growing number of cases of H5N1 avian influenza, commonly known as bird flu, have been detected in domestic cats across the United States, raising concerns about its potential transmission to humans. Veterinary experts and public health officials are warning pet owners to be vigilant as the virus spreads across multiple states and is linked to contaminated food sources.

Dr. Leyi Wang, a virologist and professor of veterinary medicine at the University of Illinois Urbana-Champaign, recently confirmed the presence of H5N1 in a cat at the university’s Veterinary Diagnostic Laboratory. The U.S. Department of Agriculture (USDA) has reported 130 cases of bird flu in domestic cats, spanning 23 states, including Illinois. Since 2022, 126 domestic cats have been infected, with around half of those cases occurring in 2024. Many cats were exposed through contaminated food or raw milk.

Lethality and Transmission Risk

"Bird flu H5N1 infections in cats are usually serious and life-threatening, with a high mortality rate. Infected cats show severe clinical signs such as lethargy, fever, loss of appetite, difficulty breathing, discharge from the eyes and nose, and neurological issues like tremors, seizures, incoordination or blindness," Wang explains. "Domestic cats are companion animals and have close contact with humans, potentially transmitting viruses to owners. A previous report revealed a cat-to-human transmission of influenza A virus, so H5N1 transmission might be possible as well."

Infections have been reported most often after prolonged and unprotected exposure to an infected animal.

Although no confirmed cases of cat-to-human transmission of H5N1 have been recorded in the current outbreak, Wang and other experts warn that as the virus circulates in mammals, the risk of mutation increases. "Previously, H5N1 had limited infection in mammals. However, the new H5N1 involved in outbreaks since 2022 mutated and acquired the capability to infect different mammal species including domestic and wild cats. So far, 43 types of mammals have tested positive for bird flu in the U.S., with domestic cats being the highest number," Wang says.

Pathways of Infection

The Centers for Disease Control and Prevention (CDC) states that people can be infected with avian influenza viruses through contact with infected wild, stray, feral, or domestic animals. Infections have been reported most often after prolonged and unprotected exposure to an infected animal. The CDC has previously documented avian influenza transmission from mammals to humans in the U.S., including a case involving a cat in New York City in 2016 and a cow in 2024.

The virus has been detected in poultry and cattle, allowing it to enter the raw food supply. Concerns over food contamination led the U.S. Food and Drug Administration (FDA) to recall Savage Cat Food Large Chicken Boxes (84 ounces) and Small Chicken Boxes (21 ounces) due to the potential presence of H5N1. These products, with a “better if used by” date of November 15, 2026, were distributed in multiple states, including Arizona, California, Colorado, Maryland, New York, and Pennsylvania.

Pet owners who have fed their cats the recalled products should watch for symptoms of bird flu, including fever, lethargy, loss of appetite, reddened or inflamed eyes, nasal and eye discharge, difficulty breathing, and neurological signs such as tremors, seizures, or blindness. If a cat exhibits these symptoms, immediate veterinary attention is advised.

Public Health Concerns

Public health experts fear that as H5N1 spreads among mammals, the likelihood of a pandemic increases. The New York Times recently reported that domestic cats could serve as a critical pathway for the virus to evolve and potentially become more transmissible to humans. If the virus mutates or swaps genes with another flu virus, it could pose a greater threat to human populations.

"If you work with animals, wash your hands well after interacting with poultry, livestock or animals outside the household. I also would suggest changing clothing and shoes after interacting with animals or birds with unknown health status, before interacting with your own pets," Wang advised.

Prevention and Protection

With no available vaccine or antiviral treatment for H5N1 in cats, prevention is key. Experts recommend keeping cats indoors to limit exposure to infected birds and wildlife. Pet owners should also avoid feeding raw meat or raw milk to their pets and ensure they do not come into contact with potentially contaminated food sources.

Wang stresses the importance of vigilance among pet owners. "Cat owners should contact their veterinarians if they are concerned their pet has contracted bird flu. Tell the veterinarian if your pet has been exposed to raw meat, raw milk, backyard birds or wild waterfowl. Unfortunately, only supportive care is available for cats with bird flu, and no antiviral drugs are yet available."

Beyond pet care, experts urge the public to remain cautious when handling animals and animal products. Personal protective equipment (PPE) is recommended for veterinarians and those working closely with animals at risk of infection.

Allergy season is just around the corner; some tips that might help you be less miserable

Photo: PEXELS/Edward Jenner

by Tim Ditman
OSF Healthcare

DANVILLE - Spring allergies will be here soon. If you’re suffering from a runny or congested nose, watery or itchy eyes or sneezing, it’s tempting to grab the first medicine that catches your eye at the pharmacy or rifle through the bathroom drawer for some pills you’re hanging on to.

Not so fast, says Maddy Draper, APRN, a health care provider at OSF OnCall. She says it’s important to know what to take and when in order to avoid side effects that can be serious.

Photo provided

Maddy Draper, APRN

What to take

Draper says an antihistamine like Astepro, Zyrtec, Allegra or Benadryl is a typical first line of defense.

“There are also decongestants for severe nasal congestion or sinus pain and pressure,” Draper adds. Sudafed is a well-known decongestant.

If a more severe case brings symptoms like face swelling or wheezing, Draper says treatment could be a steroid like Flonase or prednisone.

For more chronic (in other words, long term) allergy cases, the U.S. Food and Drug Administration says a provider may recommend immunotherapy to build up a tolerance. This could be an injection or a tablet under the tongue.

Misuse

It may not seem like over the counter allergy medications are ripe for misuse, but it can happen.

Draper says antihistamines, especially Benadryl, can make you drowsy. If you take too much or take it at the wrong time, you could, for example, find yourself sleepy behind the wheel. Or your attentiveness at work or school could suffer.

On the flip side, Draper says Sudafed can make you jittery, irritable or cause heart palpitations (the feeling of an irregular heartbeat). This could be a big issue, she says, for people with a heart condition.

“We want to avoid nasal sprays for people with nasal trauma. Things like a deviated septum or nasal sores,” Draper adds. “Putting something up the nose could cause further tissue damage.”

Draper says to take medication as directed by your provider. Or if it’s over the counter, follow the label instructions. She says these medications typically take a couple days to start working. So don’t be tempted to take an extra dose if you’re not seeing relief right away.

Think of the children! (and seniors)

Children and seniors may be more impacted by the side effects of allergy medications. An older adult who takes Benadryl, for example, may be drowsy to the point that they fall and suffer a serious injury.

So, Draper says providers will typically start with an antihistamine that doesn’t make you super drowsy. She says Zyrtec is approved for ages six months and up, and that’s often where providers will start.

“Any antihistamine label is going to tell you to consult your provider for use under the age of two,” Draper says. “So you’ll need to be seen by a provider or your pediatrician.” This could be a virtual visit or a message to your provider in your patient portal.

Plan ahead

Draper says knowing your allergy triggers and acting accordingly is key to avoiding unpleasant symptoms. For example, you know grass clippings will cause an allergic reaction, but you have no choice but to mow the lawn.

“Primary care providers and allergists typically recommend starting the medication prior to exposure,” Draper explains. “If you know you’re going to be outside on that windy, dry day to mow, start the antihistamine a couple days prior so it can fully take effect.”

If you can’t get a handle on a known allergy, or if you have unexpected allergy symptoms, Draper says it’s never a bad idea to go to an urgent care.

Or if you find yourself looking for an over the counter medication option: “Just ask the pharmacist,” Draper suggests. “They’ll give you recommendations.

“There’s usually a specific aisle for allergies,” she adds. “Find the right antihistamine. Flonase is another big one we see people use.”

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Strength training can help women live longer, healthier lives

by Paul Arco
OSF Healthcare

ROCKFORD - It’s no great surprise to read that men and women both benefit from working out.

But women may receive greater benefits from regular exercise than men, according to a study published in the Journal of the American College of Cardiology.

Photo provided

Mary O’Meara
OSF Cardiovascular Institute

The study centered on the importance of exercise as a way to avoid dying prematurely. The researchers studied data from 400,000 people and found that women who exercised were 24% less likely to die early from any cause. Men who exercised, however, were 15% less likely to die early.

The study also revealed that the women who exercise had a 36% lower risk of dying from a cardiovascular event, compared to men at 14%. That’s important because women have twice the risk of dying from a heart attack than a man.

Mary O’Meara is a nurse practitioner with OSF HealthCare. She says society still views heart attacks more as a man’s disease. That’s simply not true.

“Usually, a male is feeling this really bad chest pressure, chest pain going in the left arm into the jaw, very pale. Women, very often, will just complain of fatigue, nausea or heartburn. ‘I feel wiped out. I just can't walk across the room. I need to sit down,’” explains O’Meara. “Unfortunately, that can be a sign of a heart attack in a female, and it gets missed quite often.”

While any movement is good, O’Meara stresses the importance of women incorporating strength and/or resistance training, such as lifting weights. Frequency and the amount of weight depend on the person and their situation.

Photo: MovePrivateFitness/Pixabay

“For a long time, women were encouraged to do more aerobics-calisthenics. We were always thought of as the weaker sex, I guess you can say, and we weren't really encouraged to do any weight bearing exercise,” says O’Meara. “A lot of research has come back that states that women should be focusing on weight bearing exercises for several different reasons.”

Strength training can also help women as menopause becomes an issue. According to O’Meara, hormones start changing between the ages of 40 and 50 – a time when women start losing muscle and see an increase in body fat. Strength training can help with that change, along with other health issues.

“We found that weight bearing exercise can reduce our risk of dementia and Alzheimer's, and also reduce our risk of osteoporosis, which is a big one,” says O’Meara.

O’Meara also has a nutrition tip for her patients. Protein, she says, is important for women to prevent muscle loss, especially during menopause. O’Meara recommends 30 milligrams of protein before and 15 milligrams after a workout, to help rebuild muscle that has been naturally broken-down during exercise.

Additionally, O'Meara is a proponent of healthy fats. She encourages patients to incorporate grape seed oils, olive oils, fish oils, flax seed oils, nuts and avocados into their diets. Her philosophy is that good fats battle bad fats, and good fats protect our heart.

O’Meara stresses that it's never too late for women to start exercising. Even a short walk or work around the home, for instance, can go a long way to a healthier future.

“You read many testimonials from people who were couch potatoes and never exercised,” she says. “And then, they go into these exercises and do wonderful things that have really made a difference.”

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5 tips to help you battle the bugs this cold and flu season

BPT - Cold and flu season typically runs from October to May, but with summer colds, COVID outbreaks, RSV and allergies, it's a pretty safe bet that you and your family may be dealing with a variety of symptoms of one kind or another, no matter the season.

Given this year-round battle against illness, the ever-rising costs of medications can put a strain on your wallet and cause confusion as to how best to guard against all of those various bugs out there.

"It's vital for families to get reliable information on how to prevent illnesses, especially during cold and flu season when many bugs are at their worst, and what to do if they do come down with something," said Preeti Parikh, Executive Medical Director at GoodRx, the leading prescription savings platform in the U.S. "This includes information about how to get the best price on any medications they need."

That's where GoodRx comes in. It is an online platform that does double duty. GoodRx can save you up to 80% off retail prices of medications, plus it offers trusted information on the myriad health conditions that families deal with. GoodRx's articles, written by a team of doctors, pharmacists, health economists and public health experts, provide you with authoritative and trustworthy answers to your most pressing health questions so you can make better decisions for your family's health.

When it comes to navigating cold and flu season, Dr. Parikh offers the following tips to prevent illness and manage treatment if you do become sick.

Get vaccinated. Everyone should get their flu shot and COVID booster by the end of October, and these shots can be done at the same time. It’s the most important thing you can do to prevent illness, not only for yourself, but for vulnerable people in your community, such as children, the elderly and people with chronic conditions.
Older Americans should investigate the RSV vaccine. All Americans aged 75 and older should receive one dose of the RSV vaccine. Adults aged 60 to 74 with serious chronic conditions, pregnant women, and young babies may also need to get vaccinated. Work with your healthcare provider to determine if the vaccine is best for you.
Wash your hands. Everyone should practice good disease prevention! Wash your hands, avoid touching your face, and sneeze or cough into your elbow.
Protect others. If you're sick, stay home. Don't go to the office or out shopping or dining. If you must go out, wear a mask to help avoid passing those bugs around.
If you do become sick, GoodRx can help you save on treatments, including antibiotics that can treat your infection, cold medications to help with symptoms, and antivirals, which can shorten the duration or alleviate the symptoms of your illness. On average, GoodRx users save $34 on cold and flu treatment medications.

So, how do the savings work? It's actually very easy. Just go to GoodRx.com or the mobile app and type in the name of the medications you have been prescribed. You'll get a listing of local pharmacies and their prices. Choose the lowest one, and a coupon will pop up. Bring your phone with you to the pharmacy and show the coupon to your pharmacist to get the lowest possible price on your medications.

To arm yourself with information about how to battle the bugs, and ways to save at the pharmacy, visit G oodRx.com/go/fluseason.

hMPV: It has been around for a while and most of us don't have to really worry

Photo: Juliia Abramova/PEXELS

Infants and toddlers are at the greatest risk of suffering from an hMPV infection, a seasonal virus in the news identified more than two decades ago. While generally harsh the first time, symptoms are usually mild with subsequent reinfections.

(SNS) - A recent outbreak of hMPV in China in the current news cycle around the world because the China government is taking the rapid spread seriously, taking a preventive stance, asking citizens to wash their hands frequently, masking up, and pushing early testing.

Is there a reason to worry?

According to the Journal of the American Medical Association (JAMA), "In adults of all ages, HMPV is a common infection, and, although often asymptomatic, it can result in serious infection that requires hospitalization."

Exactly who is at high risk of suffering from complications

Young Children: Infants and toddlers are especially vulnerable to serious respiratory conditions, such as bronchiolitis and pneumonia.
Older Adults: Individuals aged 65 or above, as well as those with chronic health concerns such as asthma or COPD, are more likely to have complications.
Pregnant Women: HMPV during pregnancy can result in respiratory issues, which may endanger both the mother and infants' health.
Immunocompromised Individuals: Those with weakened immune systems, whether due to medical conditions or treatments like chemotherapy, are at a higher risk of experiencing severe symptoms.

What is hMPV?

hMPV was first discovered in 2001 by scientists from the Netherlands in a group of children where tests for other known respiratory viruses were negative. It is in the same category of viral infections as the Pneumoviridae family and respiratory syncytial virus, or RSV.

It is believed the virus originated in birds before adapting to infect humans. Genetic studies indicate it likely circulated among humans for decades before it was identified by scientists.

According to the CDC, hMPV is a virus that can cause upper and lower respiratory infections. Because we spend more time indoors during colder months, hMPV is more likely to circulate during the winter and spring months when other similar diseases, such as RSV and the flu, are prevalent.

The American Lung Association says that hMPV is most commonly spread from person to person through close contact with someone who is infected. Shaking hands, hugging or kissing as well as coming in contact with viral material from coughing and sneezing or touching objects such as toys or doorknobs are the usual methods of infection.

Resembling other respiratory illnesses, diagnosis and treatment can be assessed via three methods. There is a PCR test, much like the now standard COVID-19 test, available for doctors. The hMPV is a molecular test that detects the virus' genetic material with high accuracy and is regarded as the gold standard for diagnosis. Doctors can also use a Rapid Antigen Test. While providing faster results, they are less sensitive in detecting the virus compared to PCR tests.

The final method is the more evasive Bronchoscopy, which looks for changes in the lung tissue. A bronchoscopy is a standard procedure that allows a doctor to examine the inside of the lungs, trachea, and bronchi using a thin, lighted tube called a bronchoscope. The procedure is commonly used to diagnose and treat a variety of lung conditions.

hMPV usually causes symptoms similar to the common cold that lasts roughly 2-5 days and goes away. Most children who get infected with hMPV are age 5 or younger. According to Cleveland Clinic, you can get HMPV again, but symptoms are usually mild after your first infection. Severe symptoms and complications affect a small number of children (5-16%) who may develop a lower respiratory tract infection such as pneumonia. The majority of the infections occurred in children under the age of 14,

Once infected, patients will develop varying levels of immunity to subsequent exposures according to Cleveland Clinic. "You can get HMPV again, but symptoms are usually mild after your first infection."

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Health insurers limit coverage of prosthetic limbs, question their medical necessity

by Michelle Andrews

KHN - When Michael Adams was researching health insurance options in 2023, he had one very specific requirement: coverage for prosthetic limbs.

Adams, 51, lost his right leg to cancer 40 years ago, and he has worn out more legs than he can count. He picked a gold plan on the Colorado health insurance marketplace that covered prosthetics, including microprocessor-controlled knees like the one he has used for many years. That function adds stability and helps prevent falls.

Prosthetic coverage by private health plans varies tremendously. Even though coverage for basic prostheses may be included in a plan, many insurance companies will cap payouts for devices and impose restrictions on the types of devices approved.

Photo: ThisisEngineering/Unsplash

But when his leg needed replacing last January after about five years of everyday use, his new marketplace health plan wouldn’t authorize it. The roughly $50,000 leg with the electronically controlled knee wasn’t medically necessary, the insurer said, even though Colorado law leaves that determination up to the patient’s doctor, and his has prescribed a version of that leg for many years, starting when he had employer-sponsored coverage.

“The electronic prosthetic knee is life-changing,” said Adams, who lives in Lafayette, Colorado, with his wife and two kids. Without it, “it would be like going back to having a wooden leg like I did when I was a kid.” The microprocessor in the knee responds to different surfaces and inclines, stiffening up if it detects movement that indicates its user is falling.

People who need surgery to replace a joint typically don’t encounter similar coverage roadblocks. In 2021, 1.5 million knee or hip joint replacements were performed in United States hospitals and hospital-owned ambulatory facilities, according to the federal Agency for Healthcare Research and Quality, or AHRQ. The median price for a total hip or knee replacement without complications at top orthopedic hospitals was just over $68,000 in 2020, according to one analysis, though health plans often negotiate lower rates.

To people in the amputee community, the coverage disparity amounts to discrimination.

Fewer than half of people with limb loss have been prescribed a prosthesis

“Insurance covers a knee replacement if it’s covered with skin, but if it’s covered with plastic, it’s not going to cover it,” said Jeffrey Cain, a family physician and former chair of the board of the Amputee Coalition, an advocacy group. Cain wears two prosthetic legs, having lost his after an airplane accident nearly 30 years ago.

AHIP, a trade group for health plans, said health plans generally provide coverage when the prosthetic is determined to be medically necessary, such as to replace a body part or function for walking and day-to-day activity. In practice, though, prosthetic coverage by private health plans varies tremendously, said Ashlie White, chief strategy and programs officer at the Amputee Coalition. Even though coverage for basic prostheses may be included in a plan, “often insurance companies will put caps on the devices and restrictions on the types of devices approved,” White said.

An estimated 2.3 million people are living with limb loss in the U.S., according to an analysis by Avalere, a health care consulting company. That number is expected to as much as double in coming years as people age and a growing number lose limbs to diabetes, trauma, and other medical problems.

Fewer than half of people with limb loss have been prescribed a prosthesis, according to a report by the AHRQ. Plans may deny coverage for prosthetic limbs by claiming they aren’t medically necessary or are experimental devices, even though microprocessor-controlled knees like Adams’ have been in use for decades.

Cain was instrumental in getting passed a 2000 Colorado law that requires insurers to cover prosthetic arms and legs at parity with Medicare, which requires coverage with a 20% coinsurance payment. Since that measure was enacted, about half of states have passed “insurance fairness” laws that require prosthetic coverage on par with other covered medical services in a plan or laws that require coverage of prostheses that enable people to do sports. But these laws apply only to plans regulated by the state. Over half of people with private coverage are in plans not governed by state law.

The Medicare program’s 80% coverage of prosthetic limbs mirrors its coverage for other services. Still, an October report by the Government Accountability Office found that only 30% of beneficiaries who lost a limb in 2016 received a prosthesis in the following three years.

Cost is a factor for many people.

“No matter your coverage, most people have to pay something on that device,” White said. As a result, “many people will be on a payment plan for their device,” she said. Some may take out loans.

Working with her doctor, she has appealed the decision to her insurer and been denied three times.

The federal Consumer Financial Protection Bureau has proposed a rule that would prohibit lenders from repossessing medical devices such as wheelchairs and prosthetic limbs if people can’t repay their loans.

“It is a replacement limb,” said White, whose organization has heard of several cases in which lenders have repossessed wheelchairs or prostheses. Repossession is “literally a punishment to the individual.”

Adams ultimately owed a coinsurance payment of about $4,000 for his new leg, which reflected his portion of the insurer’s negotiated rate for the knee and foot portion of the leg but did not include the costly part that fits around his stump, which didn’t need replacing. The insurer approved the prosthetic leg on appeal, claiming it had made an administrative error, Adams said.

“We’re fortunate that we’re able to afford that 20%,” said Adams, who is a self-employed leadership consultant.

Leah Kaplan doesn’t have that financial flexibility. Born without a left hand, she did not have a prosthetic limb until a few years ago.

Growing up, “I didn’t want more reasons to be stared at,” said Kaplan, 32, of her decision not to use a prosthesis. A few years ago, the cycling enthusiast got a prosthetic hand specially designed for use with her bike. That device was covered under the health plan she has through her county government job in Spokane, Washington, helping developmentally disabled people transition from school to work.

But when she tried to get approval for a prosthetic hand to use for everyday activities, her health plan turned her down. The myoelectric hand she requested would respond to electrical impulses in her arm that would move the hand to perform certain actions. Without insurance coverage, the hand would cost her just over $46,000, which she said she can’t afford.

Working with her doctor, she has appealed the decision to her insurer and been denied three times. Kaplan said she’s still not sure exactly what the rationale is, except that the insurer has questioned the medical necessity of the prosthetic hand. The next step is to file an appeal with an independent review organization certified by the state insurance commissioner’s office.

A prosthetic hand is not a luxury device, Kaplan said. The prosthetic clinic has ordered the hand and made the customized socket that will fit around the end of her arm. But until insurance coverage is sorted out, she can’t use it.

At this point she feels defeated. “I’ve been waiting for this for so long,” Kaplan said.

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

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This article first appeared on KFF Health News and is republished here under a Creative Commons license.

Exposing misconceptions about infant nutrition for new moms

by Tim Ditman
OSF Healthcare

Photo: Jonathan Borba/PEXELS

DANVILLE - Bringing a new baby home raises the focus on their and mom’s well-being. Toward the top of the list: what and how the child is being fed.

Whether you choose to breastfeed or use formula, misconceptions about infant nutrition are everywhere. Xandra Anderson, a certified lactation consultant at OSF HealthCare, cuts through the noise.

Do I need to change what I put in my body while breastfeeding? This covers a lot of ground, from a mom’s diet to whether she should abstain from alcohol, caffeine, tobacco and medication.

Breastfeeding moms generally don't need to change their diet. Drinking a caffeine-heavy drink before breastfeeding may keep your baby awake longer than normal. After drinking alcohol, wait a few hours to nurse.
Moms can also generally stay on medication while breastfeeding. Talk to your health care provider if you have questions or if you have a medical procedure.
If you smoke, do so after breastfeeding. Then wait a few hours to nurse again.
Have breast milk you can't use in feeding? Use it on baby acne or in their bathwater.

Do I need to change what I put in my body while breastfeeding? This covers a lot of ground, from a mom’s diet to whether she should abstain from alcohol, caffeine, tobacco and medication.

Diet:

Healthy eating is always good. But Anderson says new moms generally don’t have to change their diet for breastfeeding. If your diet is heavy on certain things (like garlic or dairy) and you notice your baby is extra fussy, you can try changing your meals. A provider may also want to test your baby for allergies.

Alcohol and caffeine:

Drink these in moderation and with precise timing, Anderson says.

“Babies are very sensitive to caffeine. If you have a cup of coffee and nurse right away, the baby is going to be awake for a lot longer than normal,” Anderson explained.

“That doesn’t mean you have to not drink coffee. Just maybe not add three shots of espresso to your morning coffee,” she adds with a smirk.

For alcohol, Anderson says the drink will filter out of your breastmilk like it filters out of your blood. So after having a couple of alcoholic drinks, wait two to three hours before breastfeeding or pumping.

“The breastmilk isn’t ruined. You just need to give it time,” Anderson says.

But here’s a lifehack if mom feels full of breast milk and wants to pump right after having a drink: Go ahead and pump, and use the milk on your baby’s acne or in their bathwater. Just keep it away from their mouth.

“It’s antimicrobial. It’s antibacterial. It’s moisturizing,” Anderson says, singing the praises of breast milk. “Our babies are in the most perfect environment in the womb. Once they’re born, their world is cold, dark and dry. They can get dry skin, acne or cradle cap [greasy or flaky spots on the scalp]. Breast milk is a great way to prevent or heal those things.”

Medication and other health care issues:

Anderson says most medication is safe to use while breastfeeding. In fact, it’s important to stay the course – for example, with mental health medication – so you can be the best mom possible. Talk with your health care provider if you have questions.

If you have a medical procedure, also get advice from a professional. For example, Anderson says if you get a hepatobiliary iminodiacetic acid (HIDA) scan for a gallbladder concern, you’ll be radioactive for around 24 hours. Don’t breastfeed during that time. Or if your breasts feel full and you have to pump, dump the milk down the drain.

Tobacco:

Anderson admits it’s tough to kick the habit. But she reminds moms: infants are very sensitive to nicotine. It can disrupt the child’s sleep and feeding and even interfere with organ development. Secondhand smoke can increase the risk of a respiratory infection and sudden infant death syndrome (SIDS).

If you’re smoking with a new baby at home, do so after breastfeeding, then wait two to three hours before nursing again. Wear one jacket while smoking so you don’t get an odor or residue on a lot of your clothes or the baby.