By GILLIAN MOHNEY
An Indiana couple is celebrating an extra-special arrival with the birth of their identical triplet daughters.
Ashley and Matt Alexander of Greenfield, Indiana, were surprised weeks ago when they learned they were expecting three new additions to their family during a routine sonogram, according to ABC affiliate WRTV-TV in Indianapolis, Indiana.
"She was checking [Ashley] and right away there were twins, and she goes, 'Let me check for a third,'" Matt Alexander told WRTV-TV in an earlier interview. "I'm like, she's just joking. I said, 'You're joking,' and she said, 'No, we don't joke about this stuff.' So [Ashley] about came off the table."
The couple, who already have a son, had conceived the triplets naturally, so they were not expecting to see three heartbeats on the sonogram.
Ashley Alexander told WRTV-TV she has a plan to tell the girls apart.
"I'm painting their nails," she said. "One's going to be pink, one purple, and the other probably pale blue."
Dr. William Gilbert, the director of women's services for Sutter Health in Sacramento, California, said in an earlier interview with ABC News there was no definite rate for the number of identical triplets born every year.
"It's hard to calculate a conservative estimate," Gilbert said about the rate of naturally conceived identical triplets. "One in 70,000 - that would be on the low end. The high end is one in a million."
By Heather Stringer for Nurse.com
In 2010, the Institute of Medicine issued eight recommendations that dared to transform the nursing profession by 2020. This year marks the midway point for reaching the goals outlined in the report “The Future of Nursing: Leading Change, Advancing Health,” and statistics at halftime offer a glimpse into nursing’s progress so far.
Although the numbers in some areas have altered little in the first few years, infrastructure changes have been set in motion that will lead to more noticeable improvements in the data in the next several years, said Susan Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing. The RWJF partnered with the IOM to produce the report.
“I am a very impatient person and would like things to move faster, but we have to remember that we are changing social norms with these goals,” Hassmiller said. “We are trying, for example, to convince hospital leaders, nursing students and educational institutions that it is important for nurses to have a baccalaureate degree, and that takes time.”
Hassmiller is referring to Recommendation 4 of the report, which calls academic nurse leaders across all schools of nursing to work together to increase the proportion of nurses with a baccalaureate degree from 50% to 80% by 2020. The most recent data collected from the American Community Survey by the Future of Nursing: Campaign for Action found that the percentage of employed nurses with a bachelor’s degree or higher only climbed 2% between 2010 and 2013. However, Hassmiller suggested the percentage is likely to increase rapidly in coming years because nursing schools have increased capacity to accommodate more students. As a result, the number of nurses enrolled in RN-to-BSN programs skyrocketed between 2010 and 2014, from about 77,000 nurses in 2010 to 130,300 students in 2014, according to the American Association of Colleges of Nursing — a 69% increase.
Campaign for Action leaders also are optimistic about the profession’s ability to approach the 80% goal because nursing schools are beginning to experiment with new models of education, such as bringing BSN programs to community colleges.
Traditionally, students spend at least three years in a community college earning an associate’s degree to become an RN — at least a year for prerequisites and another two to complete the nursing program, Hassmiller said. These RNs may work for a few years before returning to school to earn a BSN — and some may not return at all, said Jenny Landen, MSN, RN, FNP-BC, dean of the School of Health, Math and Sciences at Santa Fe Community College in New Mexico. To avoid losing potential BSN students, leaders from New Mexico’s university and community colleges began meeting to discuss a new paradigm: students who were dually enrolled in a community college and a university BSN program.
The educators started by forming a common statewide baccalaureate curriculum that would be used by all community colleges and universities, Landen said. The educators also discussed how to pool resources, such as offering university courses online at local community colleges. “This opens the opportunity of earning a BSN to people who need to stay in their communities during school,” she said. “They may have family commitments locally, and they can take the baccalaureate degree courses at the community college tuition fee, which is much less expensive.”
Four community colleges in New Mexico have launched dual enrollment programs within the last year. At Santa Fe Community College, there are far more applicants than the program can hold, Landen said. Community colleges and universities in other parts of the country also are working together to create programs in which nursing students can be dually enrolled. In addition to nursing schools buying into the need for more BSN-prepared nurses, there also is evidence that employers are moving toward this new standard as well. According to a study released in February in the Journal of Nursing Administration, the percentage of institutions requiring a BSN when hiring new RNs jumped from 9% to 19% between 2011 and 2013.
So far, the national data related to Recommendation 5 — double the number of nurses with a doctorate by 2020 — suggests there have been minimal changes in the number of employed nurses with a doctorate, yet there has been a significant increase in the number of students pursuing this level of education. According to the JONA article, on average about 3.1% of employed nurses in all institutions had a doctorate in 2011. This rose to 3.6% in 2013. This percentage likely will increase in the coming years because of the proliferation of doctor of nursing practice programs since 2010. These programs are geared for advanced practice RNs who are interested in returning to the clinical setting after earning a doctoral degree. Between 2010 and 2013, the number of students enrolled in DNP programs doubled from just over 7,000 students to more than 14,600. There was a lesser increase in the number of students enrolled in PhD programs, up 12% from 4,600 to 5,100, according to the AACN.
“When the DNP degree became an option, it opened the opportunity of a higher level of education to the working nurse, not the researcher, and that was attractive to many nurses,” said Pat Polansky, MS, RN, director of program development and implementation at the Center to Champion Nursing in America. “Getting a research-based PhD takes longer and not every nurse can do that, so the DNP has become a wonderful option.”
Leaders at the Campaign for Action, however, acknowledge that it is important to find strategies to boost the number of PhD-prepared nurses because the profession needs those nurses in academia and other administrative, research or entrepreneurial roles where they are contributing to the solutions of a transformed healthcare system, Hassmiller said. To encourage more nurses to pursue the path of a PhD, in 2014 the RWJF launched the Future of Nursing Scholars Program, which awards $75,000 per scholar pursuing a PhD. This is matched with $50,000 by the student’s school, and the funds can be used over the course of three years.
In December, the nursing profession will have another opportunity to assess progress on the recommendations when the IOM releases findings from a study that is under way to assess the national impact of the Future of Nursing report. The changes happening in areas such as education are remarkable, Hassmiller said, and she is eagerly anticipating the results from the current IOM study.
“I would never modify the goals because you need something to strive for in order to affect change,” Hassmiller said. “I am extremely encouraged because we have never seen anything like this. For the first time in history, more than half of nurses have a bachelor’s degree, and it is going to keep climbing. The most challenging part has been the number of people that need to be influenced to make the business case as to why it is important, and it is finally happening.”
1) Remove scope-of-practice barriers.
2) Expand opportunities for nurses to lead and diffuse collaborative improvement efforts.
3) Implement nurse residency programs.
4) Increase the proportion of nurses with a baccalaureate degree to 80% by 2020.
5) Double the number of nurses with a doctorate by 2020.
6) Ensure that nurses engage in lifelong learning.
7) Prepare and enable nurses to lead change to advance health.
8) Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data.
© 2015 OnCourse Learning Corporation. All rights reserved.
There are many reasons women need cesareans. Sometimes the situation is truly life-threatening. But often the problem is that labor simply isn't progressing. That was the case for Valerie Echo Duckett, 35, who lives in Columbus, Ohio. After receiving an epidural for pain, Duckett's contractions stopped. By late evening she was told she'd need a C-section to deliver her son, Avery. Duckett says she has vague memories of being wheeled into the operating room, strapped down and shaking from cold.
"They were covering me up with warm blankets,"she says. "I kind of slept in and out of it." Her only memory of meeting her newborn son for the first time was from some pictures her husband took.
This is the experience many women have. The cesarean section is the most common surgery in America — about 1 in 3 babies is delivered this way. But for many women, being told they need a C-section is unpleasant news. Duckett says she felt like she missed out on a pivotal moment in her pregnancy.
"It took me a long time even to be able to say that I gave birth to Avery," she says. "I felt like I didn't earn the right to say I gave birth to him, like it was taken from me somehow, like I hadn't done what I was supposed to do."
Duckett's reaction to her C-section is unfortunately a common one, says Betsey Snow, head of Family and Child Services at Anne Arundel Medical Center, a community hospital in Annapolis, Md.
"I hear a lot of moms say, 'I'm disappointed I had to have a C-section.' A lot of women felt like they failed because they couldn't do a vaginal delivery," says Snow.
Now some hospitals are offering small but significant changes to the procedure to make it seem more like a birth than major surgery.
In a typical C-section, a closed curtain shields the sterile operating field. Mothers don't see the procedure and their babies are immediately whisked away for pediatric care — a separation that can last for close to half an hour. Kristen Caminiti, of Crofton, Md., knows this routine well. Her first two sons were born by traditional cesarean. She was happy with their births because, she says, it was all she knew. Then, just a few weeks into her third pregnancy, Caminiti, who is 33, saw a post on Facebook about family-centered cesarean techniques catching on in England.
"I clicked on the link and thought, 'I want that,' " she says.
The techniques are relatively easy and the main goals simple: Let moms see their babies being born if they want and put newborns immediately on the mother's chest for skin-to-skin contact. This helps stimulate bonding and breast feeding. Caminiti asked her obstetrician, Dr. Marcus Penn, if he'd allow her to have this kind of birth. He said yes.
When Caminiti told Penn what she wanted, his first thought was it wouldn't be that difficult to do. "I didn't see anything that would be terribly out of the norm," he says. "It would be different from the way we usually do it, but nothing terrible that anyone would say we shouldn't try that."
Family-centered cesareans are a relatively new idea in the U.S., and many doctors and hospitals have no experience with them. Penn and the staff at Anne Arundel Medical Center quickly realized the procedure would require some changes, including adding a nurse and bringing the neonatal team into the operating room.
And there were a bunch of little adjustments, such as moving the EKG monitors from their usual location on top of the mother's chest to her side. This allows the delivery team to place the newborn baby immediately on the mother's chest. In addition, Penn says, the mother's hands were not strapped down and the intravenous line was put in her nondominant hand so she could hold the baby.
At the beginning of October, Caminiti underwent her C-section. She was alert, her head was up and the drape lowered so she could watch the delivery of her son, Connor. Caminiti's husband, Matt, recorded the event. After Connor was out, with umbilical cord still attached, he was placed right on Caminiti's chest.
"It was the most amazing and grace-filled experience to finally have that moment of having my baby be placed on my chest," Caminiti says. "He was screaming and then I remember that when I started to talk to him he stopped. It was awesome."
And the baby stayed with her for the rest of the procedure.
Changes like this can make a big difference, says Dr. William Camann, the director of obstetric anesthesiology at Brigham and Women's Hospital in Boston and one of the pioneers of the procedure in the U.S. At Brigham and Women's, their version of the family-centered cesarean is called the gentle cesarean. Moms who opt for it can view the birth through a clear plastic drape, and immediate skin-to-skin contact follows.
Camann says the gentle C-section is not a replacement for a vaginal birth; it's just a way to improve the surgical experience. "No one is trying to advocate for C-sections. We really don't want to increase the cesarean rate, we just want to make it better for those who have to have it," he says.
So why has the procedure been slow to catch on? Hospitals aren't charging more for it — so cost doesn't seem to be a major factor. What's lacking are clinical studies. Without hard scientific data on outcomes and other concerns like infection control, many hospitals may be wary of changing their routines. Betsey Snow of Anne Arundel Medical Center says the family-centered C-section represents a cultural shift, and her hospital is helping break new ground by adopting it.
"It is the first time we have really done anything innovative or creative with changing the C-section procedure in years," she says.
Kristen Caminiti says her hope is that these innovations become routine. She says she'd like nothing more than to know that other women having C-sections are able to have the same amazing experience she had.
When it came time to have the baby, Shirita Corley was alone. Her mother was at the casino, her sister was not answering her cellphone, her boyfriend had disappeared months earlier, and her father she had not seen in years.
So she got in her green Chevy TrailBlazer and drove herself to the hospital.
“I feel so down,” she texted from her hospital bed. “I’m sick of these deadbeats. I’m sick of having to be so strong.”
The message went not to a friend or family member, but to a nurse, Beth Pletz. Ms. Pletz has counseled Ms. Corley at her home through the Nurse-Family Partnership, which helps poor, first-time mothers learn to be parents.
Such home visiting programs, paid for through the Affordable Care Act, are at the heart of a sweeping federal effort aimed at one of the nation’s most entrenched social problems: the persistently high rates of infant mortality. The programs have spread to some 800 cities and towns in recent years, and are testing whether successful small-scale efforts to improve children’s health by educating mothers can work on a broad national canvas.
Home visiting is an attempt to counter the damaging effects of poverty by changing habits and behaviors that have developed over generations. It gained popularity in the United States in the late 1800s when health workers like Dr. S. Josephine Baker and Lillian Wald helped poor mothers and their babies on the teeming, impoverished Lower East Side of Manhattan. At its best, the program gives poor women the confidence to take charge of their lives, a tall order that Ms. Pletz says can be achieved only if the visits are sustained. In her program, operated here by Le Bonheur Children’s Hospital, the visits continue for two years.
It is Ms. Pletz’s knack for listening and talking to women — about misbehaving men, broken cars, unreliable families — that forms the bones of her bond with them.
She zips around Memphis in her aging Toyota S.U.V. with a stethoscope dangling from the rearview mirror. Her cracked iPhone perpetually pings with texts from her 25 clients. Most of them are young, black, poor and single. Few had fathers in their lives as children, and their children are often repeating the same broken pattern.
“I was lost, going from house to house,” recalled Onie Hayslett, 22, who was homeless and pregnant when she first met Ms. Pletz two years ago. Her only shoes were slippers. “She brought me food. That’s not her job description, but she did it anyway. She really cares about what’s going on. I don’t have many people in my life like that.”
Infant mortality rates in the United States are about the same as those in Europe in the first month of life, a recent study found, but then become higher in the months after babies come home from the hospital — a period when abuse and neglect can set in. (The study adjusted for premature births, which are also higher in the United States partly because of poverty. They were kept out of the study, researchers said, because the policies to reduce them are different.)
In Memphis, where close to half of children live in poverty, according to census data, the infant mortality rate has long been among the country’s highest. Sleep deaths — in which babies suffocate because of too much soft bedding or because an adult rolls over onto them — accounted for a fifth of infant deaths in the state, according to a 2013 analysis of death certificates by the Tennessee Department of Health.
When Ms. Pletz recently visited Darrisha Onry, 21, she saw Ms. Onry’s week-old child, Cedveon, lying beside her on a dark blue couch. The room was warm, small and crowded with a large living room set, a glass table, porcelain statues of dogs and an oversize cage holding two tiny, napping puppies.
“Where is he sleeping?” Ms. Pletz asked.
Cedveon started to cry, and Ms. Onry walked out of the room to make his bottle.
“The safest place for him is alone by himself on his back in his crib,” Ms. Pletz said, scooping up Cedveon, who had launched into a full-throated squall.
A little later, Ms. Pletz said, "You know never to shake the baby, right?”
Ms. Onry nodded.
Ms. Pletz continued: “Nerves get shot and sometimes people lose their cool. If that happens, just put him on his back on a bed and close the door, and take a little rest away from him.”
The program is unusual because it is based on a series of clinical trials much like those used to test drugs. In the 1970s, a child development expert, Dr. David Olds, began sending nurses into the homes of poor mothers in Elmira, N.Y., and later into Memphis and Denver. The nurses taught mothers not to fall asleep on the couch with their infants, not to give them Coca-Cola, to pick them up when they cried and to praise them when they behaved. The outcomes were compared with those from a similar group of women who did not get the help.
The results were startling. Death rates in the visited families dropped not just for children, but for mothers, too, when compared with families who did not get the services. Child abuse and neglect declined by half. Mothers stayed in the work force longer, and their use of welfare, food stamps and Medicaid declined. Children of the most vulnerable mothers had higher grade-point averages and were less likely to be arrested than their counterparts.
The program caught the attention of President Obama, who cited it in his first presidential campaign. His administration funded the program on a national scale in 2010. So far, the home visits have reached more than 115,000 mothers and children. States apply for grants and are required to collect data on how the families fare on measures of health, education and economic self-sufficiency. Early results are expected this year.
“The big question is, can the principle of evidence be implemented in a large federal program?” said Jon Baron, president of the Coalition for Evidence-Based Policy, a nonprofit group in Washington whose aim is to increase government effectiveness in areas including education, poverty reduction and crime prevention. “And if so, will it actually improve health?”
Experts say federal standards are too loose and have allowed some groups with weak home visiting programs to participate, even if they show effects on only trivial outcomes that have no practical importance for a child’s life. Congress should fix the problem, Mr. Baron said, warning that the program in its current state is “a leaky bucket.”
“If left unchanged, essentially anyone will figure out how to qualify,” he said.
Its future is not assured. Funding for the home visiting initiative runs out as early as September for some states, and if Congress does not reauthorize it this month, programs may stop enrolling families and the $500 million the Obama administration has requested for 2016 will not be granted. Last week, its supporters urged Congress to extend it.
In Tennessee, where home visiting programs have bipartisan support, infant mortality is down by 14 percent since 2010, and sleep deaths dipped by 10 percent from 2012 to 2013. State officials credit a multitude of policies, including the home visits.
Ms. Pletz worries that she has helped only a handful of her clients truly improve their lives. But Ms. Corley, 28, the mother who drove herself to the hospital, said Ms. Pletz, who has been visiting her for two years, had made a difference. She “has been my counselor, my girlfriend, my nurse,” Ms. Corley said. Ms. Pletz helped her cope with the disappearances of her children’s fathers, taught her to recognize whooping cough and pushed her to set career goals, she said.
“She knows more about me than my own family does,” Ms. Corley said. “I feel like I’ve grown more wise. I feel stronger for sure.”
The morning after Ms. Corley gave birth, Ms. Pletz brought her breakfast: eggs, flapjacks and bacon. The new baby, Daniel, lay in a clear plastic crib next to Ms. Corley’s hospital bed, and the two women talked over his head like old friends.
“Can I pick him up?” Ms. Pletz asked.
Ms. Corley replied: “I think he’s waiting on it.”
Jonathan Winston Jones
The disconcerting news was the doctor had to Google the issue first to figure out the best medical advice.
"My provider just did a Web search to figure out what dose of hormones I should be on, and put me on the highest dose," Sallans said. That could have been a dangerous choice. "Starting too high of a dose too quickly can cause a lot of health problems, particularly to cardiovascular health."
Fortunately, Sallans didn't have any health complications.
But his experience left him with a mission. He volunteers to speak with medical institutions, as well as with businesses and colleges, to urge them to be more LGBT inclusive.
While a growing number of medical schools are teaching future doctors how to address health concerns that can be specific to the lesbian, gay, bisexual and transgender communities, studies show current doctors only get about five hours of training, if they get any at all.
For members of the LGBT community who live in more rural and conservative areas like Nebraska, the struggle to get good, or at least up-to-date, medical care may be even more difficult.
In general, legal protections and institutional supports for LGBT Nebraskans are already thin, spotty or nonexistent.
On March 2, the United States District Court struck down Nebraska's ban on marriage for same-sex couples, but that ruling is on appeal.
Without the legal institution of marriage, LGBT Nebraskans typically lack family health benefits, unless their employers provide them to same-sex partners.
A 2014 study from the Williams Institute at the University of California Los Angeles found that states without LGBT legal protections in place see lower rates of health insurance coverage for LGBT residents than states with protections.
That plays out in Nebraska.
A 2014 study from researchers at the University of Nebraska Omaha found that LGBT residents in the rural parts of the state have lower rates of health insurance coverage than their counterparts in urban areas.
Even when LGBT Nebraskans have health insurance, they struggle to find providers versed in lesbian, gay, bisexual and transgender heath care needs.
Research shows that LGBT individuals often experience health issues linked to being regular targets of discrimination or social stigma. Discrimination has been linked to higher rates of substance abuse, suicide and stress-related illnesses, which can include heart problems, obesity, eating disorders and cancer.
If the available doctors are not familiar with the increased rates of these issues, they may provide inadequate care.
Patients who find their doctors do not understand their issues may also delay treatment, often with bad health outcomes, said Jay Irwin, an assistant professor of sociology at the University of Nebraska-Omaha and a researcher in LGBT health.
Sometimes patients are turned away by providers who don't want to treat LGBT patients, particularly if there are no laws to prohibit such discrimination.
Irwin has completed studies that focus on the health care challenges of lesbians in rural areas and found that many people feel isolated and are afraid to come out -- or risk discrimination in the medical office.
Nebraska's sheer size doesn't help. Sixteenth largest in the nation by geography, members of its LGBT community often live far from large cities with significant LGBT populations and with teaching hospitals with staff members who have experience working with members of that community.
The Human Rights Campaign's 2014 Healthcare Equality Index named four Nebraska health care facilities, all in Omaha, as leaders in LGBT health care equality.
Omaha is on the state's eastern border with Iowa. LGBT residents in western Nebraska -- for instance, places like North Platte -- have to travel 270 miles in either direction, to Omaha or Denver, Colorado, to reach facilities designated as leaders by the Human Rights Campaign.
People who work within the health care system have seen some improvement when it comes to treating members of the LGBT community.
Jill Young is the client services manager at Nebraska AIDS Project's Scottsbluff, Nebraska, office in the western part of the state.
She recalled when she started working there in the late 1990s she saw medical staff refuse care to LGBT people with HIV/AIDS.
"We had nurses, for example, who said they wouldn't serve patients with HIV/AIDS," Young said. "But we've come a long way since then."
Young has seen more hospitals in the region adopting policies that are supportive of LGBT residents, including one that just started recognizing same-sex partners' wills as legal documents that will allow them access to their partners when they are being cared for in areas restricted to immediate family only.
But she said she still sees too many LGBT residents traveling great distances to get care and she still sees too many patients who don't seek medical care until it is too late.
"We still go to the hospital," she said, "and see people who are days away from dying."
Eric Yarwood, 44, has more experience than he would like with Nebraska's health care facilities.
He spent over 100 days last year at hospitals in Omaha for complications related to germ cell cancer.
He had nine rounds of chemotherapy, three stem cell transplants, his third surgery two weeks ago and five more days for followup last week.
For all but four of the days he was in the hospital, his partner, Aaron Persen, 36, was at his side every evening. "Aaron and I are a unit," Yarwood said. "I can count on my fingers the number of times he didn't come."
While the couple has found the overwhelming majority of physicians and medical staff to be "genuinely supportive" of their relationship, there still were a few instances when they felt uncomfortable and unaccepted, once with a physician and another time with a nurse.
"I'm not sure how often the medical staff works with gay couples or receives training on how to work with gay couples," Yarwood said.
Yarwood's prognosis is good, and the couple looks with optimism to a future of having more access to LGBT-inclusive health care facilities and a more inclusive state overall.
"Hopefully, by the time we get through the cancer and save a little money," Persen said, "Nebraska will follow most other states and allow our relationship to be legally recognized."
Liberia released its last Ebola patient, a 58-year old English teacher, from a treatment center in the capital Thursday, beginning its countdown to being Ebola-free.
"I am one of the happiest human beings today on earth because it was not easy going through this situation and coming out alive," Beatrice Yardolo said after her release.
She says she became infected while caring for a sick child.
"I was bathing her. I used to carry her from the bathroom alone because nobody wanted to take any risk. That is how I got in contact," she said.
Yardolo, a mother of five, said she had been admitted to the Chinese-run Ebola treatment center in Monrovia on Feb. 18.
"I am so overwhelmed because my family has been through a very difficult period from January to now. And to know that it's all coming to an end is a very delightful news. I'm so happy," Yardolo's son, Joel Yardolo, told reporters.
Tolbert Nyenswah, assistant health minister and head of the country's Ebola response, says there are no other confirmed cases of Ebola.
"For the past 13 days the entire Republic of Liberia has gone without a confirmed Ebola virus disease," Nyenswah told reporters. "This doesn't mean that Ebola is all over in Liberia."
After a 42-day countdown - two full incubation periods for the virus to cause an infection - the country can be declared Ebola-free. Officials are monitoring 102 people who have been in recent contact with an Ebola patient.
Since the epidemic started a year ago, Liberia has recorded 9,265 cases of Ebola, with 4,057 deaths. But the World Health Organization says there are almost certainly more cases than that. WHO says close to 24,000 cases have been recorded, and close to 10,000 deaths, in the entire West African epidemic.
-- The Associated Press and Reuters contributed to this story
It’s a battle they never thought they’d face, let alone at the same time.
Missy and Brooke Shatley, a mother and daughter from Prairie Farm, Wisconsin, both have cancer. They were diagnosed only 13 days apart.
“It’s that unbelief,” Missy, 38, told ABC News of her reaction when they learned the devastating news. “You feel numb like this can’t really be happening. This is happening to somebody else, it could never be you.”
Missy was diagnosed with stage 2 cervical cancer on December 26, the day after Christmas.
“I went in for my annual physical and that was the result of it,” she explained.
Then on January 8, Brooke, Missy and her husband Jason’s oldest child, was diagnosed with stage 3 ovarian cancer.
“Why us? Why?,” Missy asked. “Is it something in our water? Is it genetic? Why both of us in such a short time frame? The doctor said it’s not the water, it’s not the environment, it’s just a freak act of nature.”
Before Missy’s diagnosis, Brooke, 14, had been experiencing severe abdominal pain that went undiagnosed for several weeks.
“The doctors told us she had a baseball-sized hemorrhagic disc and it would go away on its own and we should just wait,” Missy explained. “We waited for a few weeks and thought, ‘This is ridiculous,’ and we sought a second opinion.”
The Shatley’s then took Brooke to see the same specialist that had just diagnosed her mom days earlier. The devastating news was that Brooke’s tumor was larger than they originally suspected and needed to be operated on immediately.
“It was a four-and-a-half hour surgery,” Missy recalled. “It was a football-sized tumor. It had intertwined in her abdomen. You couldn’t tell by looking at her belly, but it was football-sized.”
The brave mother-daughter duo began undergoing intense treatments at the same time in Marshfield, Wisconsin, about two hours from their home--understandably weighing heavily on husband and father Jason, a dairy farmer, who was traveling back and forth to take care of them while also tending to their other two children and maintaining their farm.
“It’s hard,” Missy said. “Just to even think, ‘That’s my wife and daughter,’ how does anybody deal with that? Plus we have two other kids at home so he’s trying to be a husband, father, keep up with the farm, he’s being pulled in so many directions, how do you even begin?”
This week has been better for the family, however. Both Missy and Brooke are back home, resting and enjoying their time, although possibly brief, out of the hospital.
Missy just completed her final round of radiation and chemotherapy on March 2. She now must wait eight to 12 weeks before they can tell how effective the treatment was on her cancer.
Brooke still has one more round of chemo to complete, tentatively scheduled to begin on March 9.
Although their simultaneous diagnosis has been difficult, Missy says, in a way, it’s been nice to have that newfound bond with her daughter.
“You don’t want to experience it with anybody, but if you have to, doing it as a mother-daughter is helpful,” she said. “You’re bonding over raw emotions. It’s definitely a connection that you form.”
On March 28 their community is holding a benefit for the resilient pair, which Missy says is just one of the generous things they’ve done to help throughout this process.
“Not in a million years could I imagine the outreach we’ve had,” she said. “The surrounding communities have been phenomenal. We have a dairy farm so we’ve had people volunteer to do chores, saw wood, make meals, provide transportation for the other kids when we need it--anything and everything they’ve offered up.”
Most importantly, she added, “Prayers, lots of prayers.”
It is vital that treatment for stroke is given as quickly as possible in order to minimize the amount of long-term damage that occurs. Unfortunately, a new study has suggested that one third of Americans would be unable to access a primary stroke center within 1 hour should they need to.
The study, published online in Neurology, was a population-level virtual trial simulating how long it would take for patients to access stroke care following changes to systems of treatment.
"Research has shown that specialized stroke care has the potential to reduce death and disability," says study author Dr. Michael T. Mullen. "Stroke is a time-critical disease. Each second after a stroke begins, brain cells die, so it is critically important that specialized stroke care be rapidly accessible to the population."
According to the authors, stroke is one of the leading causes of death and disability in the US, occurring when the flow of blood to a portion of the brain is blocked or an artery in the brain ruptures or leaks.
In 2012, the beginnings of a three-tiered regionalized system of care were implemented. This involved the designation of certain hospitals as primary stroke centers (PSCs) and comprehensive stroke centers (CSCs), with CSCs providing the highest level of care.
Dr. Mullen and his colleagues decided to create virtual models in order to estimate what percentage of the population would have access to a comprehensive stroke center after selectively converting a number of primary stroke centers to facilities providing a higher level of care.
"In this report, we demonstrate how mathematical optimization modeling can inform the strategic development of the US network of stroke centers by simulating the conversion of PSCs into CSCs," the authors write. "This allows for virtual trials of competing system configurations in order to design a system that maximizes population access to care."
Reduced access to specialized stroke care could worsen pre-existing disparities in health
Data from 2010 was utilized, at which point there were 811 PSCs and no CSCs in the US. The researchers converted up to 20 PSCs in each state into CSCs and calculated how long it would take local populations to access these treatment facilities by ambulance or plane in optimum conditions.
After converting the PSCs to CSCs, the researchers found that only 63% would live within a 1-hour drive of a CSC, with an additional 23% within a 1-hour flight of one.
"Even under optimal conditions, many people may not have rapid access to comprehensive stroke centers, and without oversight and population level planning, actual systems of care are likely to be substantially worse than these optimized models," says Dr. Mullen.
Levels of access to care also varied in different geographical areas. Worryingly, access to care was lowest in an area often referred to as the "Stroke Belt" - 11 states where stroke death rates are more than 10% higher than the national average, predominantly situated in the southeast of the US.
"Reduced access to specialized stroke care in these areas has the potential to worsen these disparities," says Dr. Mullen. "This emphasizes the need for oversight of developing systems of care."
The authors suggest the actual number of CSCs that will be established is likely to be much smaller than 20 per state, and that increasing the number of CSCs is not an ideal way to improve access for patients due to the high costs involved.
A number of limitations are acknowledged, such as using trauma data to calculate the amount of time taken to reach a hospital, and calculating population access to hospitals using where people live, rather than where strokes occur. However, the authors argue that the majority of strokes (over 70%) occur at home.
In a linked editorial, Dr. Adam G. Kelly and Dr. John Attia suggest that CSC status is likely to be determined more by financial motives, however, rather than a population health basis.
They write that timely accessibility of PSC services, either on-site or via telemedicine, should be the first priority in the organization of regional stroke care. Following this, "CSCs should be added in a coordinated, stepwise manner with regional needs - not hospital bottom lines - as the major determinant for new CSCs."
A nurse who contracted Ebola at the Dallas hospital where she worked plans to sue the hospital's parent company, Texas Health Resources, hoping to be a "voice for other nurses," her lawyer said today.
In the suit, which Nina Pham plans to file Monday, the 26-year-old nurse alleges that Texas Health Presbyterian Hospital didn't train the staff to treat Ebola and didn't give them proper protective gear, which left parts of their skin exposed, her lawyer Charla Aldous said.
"One of the most concerning things about the way [the hospital] handled this entire process is you've got a young lady who has this disease which she should not have. And if they properly trained her and given her the proper personal protective equipment to wear, she would not have gotten the disease," Aldous said.
Aldous said Pham hopes the suit will "help make sure that hospitals and big corporations properly train their nurses and healthcare providers."
"This is not something that Nina chose," Aldous said, but "She's hoping that through this lawsuit she can make it a change for the better for all nurses."
Pham is still coping with Ebola's after-effects, including nightmares and body aches, her lawyer said.
"She has not gone back to work yet and she is working on recovering," Aldous said. "I don't know if she'll ever be a nurse again."
Texas Health Resources spokesperson Wendell Watson said in a statement: "Nina Pham bravely served Texas Health Dallas during a most difficult time. We continue to support and wish the best for her, and we remain optimistic that constructive dialogue can resolve this matter."
Last fall, Pham cared for Liberian native Thomas Eric Duncan, who flew to the U.S. and was diagnosed with Ebola at Texas Health Presbyterian Hospital.
Pham took care of Duncan when he was especially contagious, and on Oct. 8, Duncan died from the virus.
Pham tested positive for Ebola on Oct. 11, marking the first Ebola transmission on U.S. soil.
On Oct. 16, Pham was transferred to the National Institutes of Health's hospital in Bethesda, Maryland. She was discharged on Oct. 24.
At the news conference announcing Pham's discharge, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the NIH, said she tested negative for Ebola five times, and that it wasn't clear which treatment saved her because they were all experimental.
"I want to first tell you what a great pleasure and in many respects, a privilege ... to have the opportunity to treat and care for and get to know such an extremely courageous and lovely person," Fauci said, adding that she represents the health care workers who "put themselves on the line."
Pham's dog, Bentley, was also quarantined for several weeks, over fears that he, too, would develop Ebola.
Each year more than 15,000 women under the age of 55 die of heart disease in the United States. And younger women are twice as likely to die after being hospitalized for a heart attack as men in the same age group.
It doesn't help that women tend to delay seeking emergency care for symptoms of a heart attack such as pain and dizziness, says Judith Lichtman, an associate professor of epidemiology at the Yale School of Public Health. "We've known that for a while," she says.
In a small study published Tuesday in Circulation: Cardiovascular Quality and Outcomes, Lichtman and her colleagues looked into why women delay getting help. The researchers conducted in-depth interviews with 30 women, ages 30 to 55, who had been hospitalized after a heart attack.
It turned out that many had trouble recognizing that they were having symptoms of a heart attack. "A lot of them talk about not really experiencing the Hollywood heart attack," Lichtman tells Shots.
A heart attack doesn't necessarily feel like a sudden painful episode that ends in collapse, she notes. And women are more likely than men to experience vague symptoms like nausea or pain down their arms.
"Women may experience a combination of things they don't always associate with a heart attack," Lichtman says. "Maybe we need to do a better job of explaining and describing to the public what a heart attack looks and feels like."
But even when women suspected that they were having a heart attack, many said they were hesitant to bring it up because they didn't want to look like hypochondriacs.
"We need to do a better job of empowering women to share their concerns and symptoms," Lichtman says.
And medical professionals may need to do a better job of listening, she adds. Several women reported that their doctors initially misdiagnosed the pain, assuming that the women were suffering from acid reflux or gas.
Doctors should pay special attention to women who have high blood pressure or cholesterol, as well as those with a family history of heart disease, Lichtman says.
This is just a preliminary study. Lichtman has already started working on a much larger study investigating why women have a higher risk of dying from heart disease than men.
But the findings aren't too surprising, says Dr. Nisha Parikh, a cardiologist at the University of California, San Francisco who wasn't involved in the research.
"I take care of young women who have heart disease, and this story is very common," she says.
Part of the issue is that most of the research on heart disease has focused on men, since the condition is more common among men. As a result, the diagnostic tools that doctors use to identify heart disease aren't always well suited for female patients.
Cardiologists are just beginning to rethink how to best recognize and treat heart attacks in women, Parikh notes.
Heart disease is the third leading cause of death for women ages 35 to 44, and it's the second leading cause of death for women 45 to 54, according to the Centers for Disease Control and Prevention. (Cancer is the No. 1 cause.)
"Historically we thought of heart disease as sort of a man's disease," Parikh says. "But that's not the case."
This study also highlights the importance of empowering women to speak up about their worries, says. Dr. Jennifer Tremmel, a cardiologist at Stanford University.
"It's interesting because the whole idea of female hysteria dates back to ancient times," Tremmel says. "This is an ongoing issue in the medical field, and we all have to empower women patients, so they know that they need to not be so worried about going to the hospital if they're afraid there's something wrong."