Damar Hamlin could be released from a Buffalo hospital in the next day or two | CNN



CNN
 — 

A week after suffering a cardiac arrest while playing the Cincinnati Bengals, doctors are hoping Buffalo Bills safety Damar Hamlin is healthy enough to be released from a Buffalo hospital within 24 to 48 hours, Michael Hughes, senior vice president and chief administrative officer at Kaleida Health, told CNN on Tuesday.

Doctors are finishing tests and are identifying possible causes of the event, including whether there were any pre-existing conditions that played a role in Hamlin’s January 2 cardiac arrest.

“Hamlin is going through a series of testing and evaluation today,” Kaleida Health said in a statement Tuesday. The Buffalo General Medical Center team will also “potentially treat any pathology that may be found, as well as plan for his recovery, discharge and rehabilitation.”

Hamlin himself updated his fans Tuesday afternoon.

“Not home quite just yet,” Hamlin tweeted. “Still doing & passing a bunch of test. Special thank-you to Buffalo General it’s been nothing but love since arrival! Keep me in y’all prayers please!”

Hamlin was transferred from a Cincinnati hospital to the Buffalo hospital on Monday after doctors determined his critical condition had improved to good or fair – surpassing expectations.

“We felt that it was safe and proper to help get him back to the greater Buffalo area,” Dr. Timothy Pritts, chief of surgery at the University of Cincinnati Medical Center, said Monday.

Hamlin’s parents flew from Cincinnati back home to Pittsburgh but then flew to Buffalo. They were en route Tuesday from the Buffalo Bills’ practice facility and were expected to arrive at the hospital to see Hamlin soon.

Hamlin, a second-year NFL player, has been regaining strength over the past several days after his sudden collapse after a tackle against the Bengals in Cincinnati.

“He’s certainly on what we consider a very normal to even accelerated trajectory from the life-threatening event that he underwent,” Pritts said, “but he’s making great progress.”

Normal recovery from a cardiac arrest can be measured in weeks to months, Pritts explained. But Hamlin has been beating that timeline at each stage and is neurologically intact.

Still, Pritts said it’s too early to say when Hamlin could get back to normal life or what caused his heart to stop, saying more testing is needed.

Hamlin was sedated and on a ventilator for days after his cardiac arrest. On Friday morning, the breathing tube was removed, and Hamlin began walking with some help by that afternoon, his doctors said Monday.

The safety’s condition was upgraded Monday because his organ systems were stable and he no longer needed intensive nursing or respiratory therapy, doctors said.

“He walks normally,” said Dr. William Knight, a neurovascular critical care expert who treated Hamlin at UC Health. “He is admittedly a little weak. I don’t think that’s of any real surprise after what he went through, just regaining his strength. And that’s part of his recovery process.”

Hamlin’s release Monday meant he could return to Buffalo, which prompted even more encouragement and eagerness for some of his teammates to see him again.

“Super excited that he’s back in Buffalo and what a job that the team of docs and the medical team did out in Cincinnati, and now he’s in great care here in Buffalo. We’re happy to have him back,” Buffalo Bills head coach Sean McDermott told reporters Monday.

After seeing him Monday, McDermott said Hamlin was “tired” but seemed happy. “Happy to be back in Buffalo and around a familiar area to him. I know he’s taking it just one step at a time.”

The coach also said his team has grown since Hamlin was injured, saying such experiences nurture growth.

“We will all have grown as people, and as men in this case,” McDermott said, noting there’s a plan in place for the players and staff to visit Hamlin “at the proper time.”

“Having him nearby will give us more comfort” and inspire the team as it prepares for the postseason, McDermott said.

Although Hamlin was not with the team when they played Sunday against the New England Patriots, his support was definitely felt.

When his team scored a touchdown, Hamlin set off alarms in the ICU, Pritts said.

“When the opening kickoff was run back, he jumped up and down and got out of his chair and set – I think – every alarm off in the ICU in the process, but he was fine, it was just an appropriate reaction to a very exciting play. He very much enjoyed it,” Pritts said.

Hamlin was “beyond excited” Sunday and felt “very supported by the outpouring of love from across the league, especially from the Buffalo area. We’ve learned this week that the Bills mafia is a very real thing,” Pritts added.

The immediate medical response to Hamlin’s collapse helped save his life, and the Buffalo Bills are now encouraging people to learn how to administer CPR.

Assistant athletic trainer Denny Kellington is credited with performing CPR when Hamlin lost his pulse on the field and needed to be revived through resuscitation and defibrillation.

The medical response was part of an emergency action plan that “involves team, independent medical and athletic training staff, equipment and security personnel, and is reviewed prior to every game,” a Monday statement from the Bills read.

The team pledged support for resources including CPR certifications, automated external defibrillator units and guidance developing cardiac emergency response plans within the Buffalo community, according to the statement.

“We encourage all our fans to continue showing your support and take the next step by obtaining CPR certification,” the Bills said.

Clarification: This story has been updated to clarify Hughes’ remarks about Hamlin’s injury and recovery.



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What older Americans need to know before undergoing major surgery | CNN



KHN
 — 

Larry McMahon is weighing whether to undergo a major surgery. Over the past five years, his back pain has intensified. Physical therapy, muscle relaxants, and injections aren’t offering relief.

“It’s a pain that leaves me hardly able to do anything,” he said.

Should McMahon, an 80-year-old retired Virginia state trooper who now lives in Southport, North Carolina, try spinal fusion surgery, a procedure that can take up to six hours? (Eight years ago, he had a lumbar laminectomy, another arduous back surgery.)

“Will I recover in six months — or in a couple of years? Is it safe for a man of my age with various health issues to be put to sleep for a long period of time?” McMahon asked, relaying some of his concerns to me in a phone conversation.

Older adults contemplating major surgery often aren’t sure whether to proceed. In many cases, surgery can be lifesaving or improve a senior’s quality of life. But advanced age puts people at greater risk of unwanted outcomes, including difficulty with daily activities, extended hospitalizations, problems moving around, and the loss of independence.

I wrote in November about a new study that shed light on some risks seniors face when having invasive procedures. But readers wanted to know more. How does one determine if potential benefits from major surgery are worth the risks? And what questions should older adults ask as they try to figure this out? I asked several experts for their recommendations. Here’s some of what they suggested.

Ask your surgeon, “How is this surgery going to make things better for me?” said Dr. Margaret “Gretchen” Schwarze, an associate professor of surgery at the University of Wisconsin School of Medicine and Public Health. Will it extend your life by removing a fast-growing tumor? Will your quality of life improve by making it easier to walk? Will it prevent you from becoming disabled, akin to a hip replacement?

If your surgeon says, “We need to remove this growth or clear this blockage,” ask what impact that will have on your daily life. Just because an abnormality such as a hernia has been found doesn’t mean it has to be addressed, especially if you don’t have bothersome symptoms and the procedure comes with complications, said Drs. Robert Becher and Thomas Gill of Yale University, authors of that recent paper on major surgery in older adults.

Schwarze, a vascular surgeon, often cares for patients with abdominal aortic aneurysms, an enlargement in a major blood vessel that can be life-threatening if it bursts.

Here’s how she describes a “best case” surgical scenario for that condition: “Surgery will be about four to five hours. When it’s over, you’ll be in the ICU with a breathing tube overnight for a day or two. Then, you’ll be in the hospital for another week or so. Afterwards, you’ll probably have to go to rehab to get your strength back, but I think you can get back home in three to four weeks, and it’ll probably take you two to three months to feel like you did before surgery.”

Among other things people might ask their surgeon, according to a patient brochure Schwarze’s team has created: What will my daily life look like right after surgery? Three months later? One year later? Will I need help, and for how long? Will tubes or drains be inserted?

A “worst case” scenario might look like this, according to Schwarze: “You have surgery, and you go to the ICU, and you have serious complications. You have a heart attack. Three weeks after surgery, you’re still in the ICU with a breathing tube, and you’ve lost most of your strength, and there’s no chance of ever getting home again. Or, the surgery didn’t work, and still you’ve gone through all this.”

“People often think I’ll just die on the operating table if things go wrong,” said Dr. Emily Finlayson, director of the UCSF Center for Surgery in Older Adults in San Francisco. “But we’re very good at rescuing people, and we can keep you alive for a long time. The reality is, there can be a lot of pain and suffering and interventions like feeding tubes and ventilators if things don’t go the way we hope.”

Once your surgeon has walked you through various scenarios, ask, “Do I really need to have this surgery, in your opinion?” and “What outcomes do you think are most likely for me?” Finlayson advised. Research suggests that older adults who are frail, have cognitive impairment, or other serious conditions such as heart disease have worse experiences with major surgery. Also, seniors in their 80s and 90s are at higher risk of things going wrong.

“It’s important to have family or friends in the room for these conversations with high-risk patients,” Finlayson said. Many seniors have some level of cognitive difficulties and may need assistance working through complex decisions.

Make sure your physician tells you what the nonsurgical options are, Finlayson said. Older men with prostate cancer, for instance, might want to consider “watchful waiting” — ongoing monitoring of their symptoms — rather than risk invasive surgery. Women in their 80s who develop a small breast cancer may opt to leave it alone if removing it poses a risk, given other health factors.

Because of McMahon’s age and underlying medical issues (a 2021 knee replacement that hasn’t healed, arthritis, high blood pressure), his neurosurgeon suggested he explore other interventions, including more injections and physical therapy, before surgery. “He told me, ‘I make my money from surgery, but that’s a last resort,” McMahon said.

“Preparing for surgery is really vital for older adults: If patients do a few things that doctors recommend — stop smoking, lose weight, walk more, eat better — they can decrease the likelihood of complications and the number of days spent in the hospital,” said Dr. Sandhya Lagoo-Deenadayalan, a codirector in Duke University Medical Center’s Perioperative Optimization of Senior Health (POSH) program.

When older patients are recommended to POSH, they receive a comprehensive evaluation of their medications, nutritional status, mobility, preexisting conditions, ability to perform daily activities, and support at home. They leave with a “to-do” list of recommended actions, usually starting several weeks before surgery.

If your hospital doesn’t have a program of this kind, ask your physician, “How can I get my body and mind ready” before having surgery, Finlayson said. Also ask: “How can I prepare my home in advance to anticipate what I’ll need during recovery?”

There are three levels to consider: What will recovery in the hospital entail? Will you be transferred to a facility for rehabilitation? And what will recovery be like at home?

Ask how long you’re likely to stay in the hospital. Will you have pain, or aftereffects from the anesthesia? Preserving cognition is a concern, and you might want to ask your anesthesiologist what you can do to maintain cognitive functioning following surgery. If you go to a rehab center, you’ll want to know what kind of therapy you’ll need and whether you can expect to return to your baseline level of functioning.

During the Covid-19 pandemic, “a lot of older adults have opted to go home instead of to rehab, and it’s really important to make sure they have appropriate support,” said Dr. Rachelle Bernacki, director of care transformation and postoperative services at the Center for Geriatric Surgery at Brigham and Women’s Hospital in Boston.

For some older adults, a loss of independence after surgery may be permanent. Be sure to inquire what your options are should that occur.

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Making the case for an underappreciated but full-of-flavor ingredient | CNN

Editor’s Note: Sign up for CNN’s Eat, But Better: Mediterranean Style. Our eight-part guide shows you a delicious expert-backed eating lifestyle that will boost your health for life.



CNN
 — 

Among foods that spark a strong reaction, anchovies are at the top of the food chain.

Whether they’re adored or abhorred, it’s difficult to find someone who doesn’t have a strong opinion about these small silvery swimmers.

Food writer Alison Roman wants the haters to think differently. Anchovies are more versatile than most people think and deserve to be approached with an open mind, according to Roman.

She might be biased — anchovies are one of her all-time favorite foods — but she has a strategy to change cooks’ minds.

“They’re more of a condiment than an ingredient,” Roman said. “To cook with them, you don’t need to eat them whole.” She incorporates anchovies into many of her dishes in the same way that she would add garlic, herbs or other flavorful aromatics. “Most of the time when I’m eating (anchovies), I can’t even see them.”

Even if you think your taste buds will rebel if you try an anchovy, your brain and heart will be happier if you do. “Anchovies are a small but mighty fish,” said Michelle Dudash, registered dietitian, nutritionist and author of “The Low-Carb Mediterranean Cookbook.”

“They’re packed with the omega-3 fatty acids DHA and EPA, which are important for brain, cardiovascular and skin health,” she added. Anchovies are on par with salmon and tuna as one of the fish with the highest amounts of omega-3s per serving, and are a good source of protein, niacin and vitamin B12.

Following Roman’s lead of using anchovies as one of many elements in a dish instead of as the spotlight ingredient, cooks who want to incorporate anchovies into meals “can start small,” Roman suggested. “They don’t have to dump a whole jar into their salad.”

Here are three ways Roman likes to introduce anchovies to the wary but curious. Ready to change your “anchoview”? Read on.

Move over, ranch dressing — there’s another dip in town. Bagna cauda, the Italian dipping sauce made from anchovies, garlic, butter and olive oil, is traditionally served with crudités as an appetizer.

Roman loves using bagna cauda as a vehicle to introduce unsuspecting dinner guests to anchovies because it hits the taste trifecta of “salty, buttery, garlicky” flavors. “It’s mostly about garlic and vegetables,” Roman said. In addition to the traditional accompaniment of raw, crunchy vegetables, she likes to include steamed artichoke hearts and tender cooked potato slices.

Bagna cauda is also an answer to the ever-present question about anchovies: What about the bones? “They are so tiny, they mostly all melt” and dissolve into the dish when heat is applied, Roman said. “They’re not going to choke you.”

“High-quality anchovies shouldn’t have many bones,” she added, and they should not be noticeable like they would be in larger fish, such as a salmon fillet. If you happen to see many bones in your anchovies, “spring for a more expensive tin,” Roman said.

If the presence of whole anchovies resting atop a bed of romaine in a Caesar salad has been historically too much to handle, Roman’s Caesar-adjacent salad will be a refreshing revelation.

Roman likes to pair bitter greens from the chicory family, such as radicchio, with a dressing that can stand up to their strong flavors. “I put anchovies in my salads all the time,” she said, but when hidden in the dressing, they add body and nuance without overpowering any of the other ingredients with which they’re paired.

Anchovies in a dressing can add body and nuance to a salad without overpowering other ingredients.

Her preferred dressing blends finely chopped anchovies and capers with lemon, whole grain or Dijon mustard, and good quality olive oil. “It’s anchovy-heavy but more about the mustard and the garlic,” Roman explained, which she finds “meatier and saltier and more interesting” than the usual Caesar dressing.

Finally, the same strategy of dissolving the umami flavors of anchovies in a sauce comes into play when making a rich and comforting pasta. Based on the Venetian dish bigoli in salsa, in which long strands of thick bigoli pasta are tossed with slow-simmered onions and anchovies, Roman’s version can be used with any long, thin pasta.

Pasta alla puttanesca features garlic, olives, capers, tomatoes and anchovies.

Roman adds whole anchovies and chopped dried chili pepper to a skillet of sliced onions, garlic and fennel caramelized in olive oil. The whole fillets might look intimidating, but as with the bagna cauda, the anchovies melt and dissolve as the sauce simmers, leaving only a rich and meaty undertone. Finishing the dish with freshly squeezed lemon juice and parsley brightens up the intense sauce.

A free-form pasta sauce such as this lets you adjust the flavor balance based on what you like best. If you love lemon, squeeze more on. If fennel isn’t your favorite, use more onions instead. If you like it spicy? Amp it up with more chili pepper. “Gauge your own personal preferences,” Roman recommended.

When choosing a tin or jar of anchovies, Roman said to make sure the anchovies are oil-packed, salt-cured anchovy fillets, not brined, pickled or whole anchovies. The former is the most common style of jarred or canned anchovies on the market, but it always pays to double-check the label.

Second, “always try a bunch of brands. They really are all different,” Roman said. Though the ingredients in each container should be the same — anchovies, salt and olive oil — the fillets will vary in saltiness, taste and texture. “Ortiz and Cento are available nationally,” she said, and many other brands are available in brick-and-mortar and online specialty food stores.

One note on the salt-curing: “The only downside of anchovies is the sodium,” Dudash noted, since they are packed in salt during the curing process. “If you are concerned about your sodium intake or if you simply prefer less salty food, briefly rinse the anchovies and pat dry with a paper towel” before using them.

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Home delivery of medications can help improve access, especially when time is tight | CNN



CNN
 — 

Covid-19 hospitalizations are on the rise in the United States, with more than 34,000 new admissions last week, but millions of vaccines and doses of antiviral treatments that could help prevent severe outcomes from the virus remain unused.

Research has found that many who could benefit most from the Covid-19 medication Paxlovid – including the elderly and Black and Hispanic people, groups that have disproportionately had the most severe illness – are less likely to take it.

As the supply of Paxlovid has grown, efforts have been made to improve timely, equitable access to the treatment.

“The driving distance to the nearest site or the geographic accessibility of the places where Paxlovid is being offered doesn’t seem to be the primary driver of why these populations are not getting the treatments they need,” said Dr. Rohan Khazanchi, a resident at Harvard Medical School and health equity consultant for the New York City health department.

Transportation is one significant barrier to health care access for many people, experts say, but creating equitable outcomes will involve a much more comprehensive approach.

In response to the White House’s call for pharmacies to help make this winter a healthier one for Americans, Walgreens launched a program Thursday in partnership with DoorDash and Uber Health that offers free home delivery of Paxlovid for those with a prescription. The initiative is meant to increase access to Covid-19 treatment, particularly for those in socially vulnerable or medically underserved communities.

Millions of Americans get prescriptions through the mail, a service that research has shown is used more frequently among seniors, adults with poor health and others who are also at high risk of severe outcomes for Covid-19.

But Paxlovid is most effective when taken within five days of symptoms starting, making timely treatment a critical piece of the puzzle and traditional mail-order delivery too slow.

Walgreens also plans to expand the service to include HIV treatment – in line with the Biden administration’s goals to accelerate efforts to end the HIV/AIDS epidemic in the US.

As with Paxlovid, early uptake is key with HIV treatment. And people who miss doses of HIV treatment risk developing drug resistance, making it crucial that they stick with the prescription.

“There are places across the patient journey that would divert a patient from being able to get treated and back to feeling better. But that’s where our teams have been working on really understanding that patient journey and then offering and identifying solutions to help address that,” said Rina Shah, vice president of pharmacy strategy at Walgreens.

Rite Aid adopted a prescription delivery program during the Covid-19 pandemic through a partnership with ScriptDrop. Service fees are currently waived for all eligible prescriptions, which excludes controlled substances and refrigerated medications but includes Paxlovid.

CVS also has one- or two-day delivery in most locations and on-demand delivery at some, which is provided free to people enrolled in the membership program.

In March, the Biden administration launched a federal Test-to-Treat initiative that streamlined access to Paxlovid for people who had Covid-19, with testing and prescribing all happening in one visit. In May, the program was broadened to specifically reach more vulnerable communities.

Khazanchi was author of a study published last month that found that Black and Hispanic people were more likely to live closer to Test-to-Treat sites than White people. But despite the physical proximity, these groups were less likely to get outpatient Covid-19 therapeutics – even though they’re at elevated risk of infection and severe disease.

Even if someone has a car or another way to get to the doctor’s office, pharmacy or other Test-to-Treat location, they’re often challenged by the time required to make that trip, said Dr. Rachel Werner, executive director of the University of Pennsylvania’s Leonard Davis Institute of Health Economics.

“It’s a combination of things that prevent access to care,” said Werner, whose research has focused on health equity. “Often, people have to take time off of work to do that, and they don’t always have paid sick leave. Everyone’s lives are complicated, and sometimes it’s hard to balance competing priorities.”

According to a report from health analytics company IQVIA, 9% of all new prescriptions in 2019 were “abandoned” at pharmacies, representing a gap in physician-recommended care that was not received by the patient. But home delivery programs that have expanded throughout the Covid-19 pandemic may help.

“I think it may be important to think about other medications or conditions where the time to treatment really matters. And those may be the ones that I think would be ripe for this kind of home-based delivery system,” Werner said. “These are urgent things that people might otherwise show up to an urgent clinic or ER for and instead could just get a medication.”

With the expansion of things like telehealth and options for home care, experts say, the Covid-19 pandemic helped widen the picture of what health care can look like.

“For far too long, we’ve been bound by the idea that health care is something that occurs within the four walls of a hospital or clinic,” Werner said. “What the Covid pandemic really did, which is important, is it made people realize that health care should be accessible where and when people need it, and it doesn’t have to be delivered in the physical structure of a health care setting.”

Experts say that while it’s critical to break down barriers in terms of access to medication, it’s important to also address the issue of trust.

In the research about accessibility to Test-to-Treat sites, Khazanchi and his co-authors suggested that programs should leverage trusted community stakeholders like local health-care providers for in-person outreach and other “low-tech, high-touch” methods to ensure equitable use.

Dr. Kedar Mate, president and CEO of the Institute for Healthcare Improvement and assistant professor at Weill Cornell Medical College, thinks about it in terms of supply and demand.

“Getting treatments to people who need them is principally an issue around access and ensuring that the supply goes to where the people are,” he said. “There’s a different problem, though, on the demand side. Are patients willing or interested to get tested and then get treated if they are found to be positive? That has everything to do with a totally different set of challenges which have to do with trust, information, disinformation, misinformation and belief in the health system overall.”

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