Health & Fitness (205)
CINCINNATI (AP) -- The Cincinnati surgeon who wrote the book on saving choking victims through his namesake Heimlich maneuver has now penned a new book: his memoir.
Dr. Henry Heimlich's views on how the maneuver should be used and on other innovations he has created or proposed have put him at odds with some in the health field. But he hopes his recently published memoir will preserve the technique that has cleared obstructions from windpipes of choking victims around the world for four decades and made his name a household word.
"I know the maneuver saves lives, and I want it to be used and remembered," the 94-year-old retired chest surgeon told The Associated Press this month. "I felt I had to have it down in print so the public will have the correct information."
Much of his autobiography - "Heimlich's Maneuvers: My Seventy Years of Lifesaving Innovation" - focuses on the maneuver, which involves thrusts to the abdomen that apply upward pressure on the diaphragm to create an air flow forcing food or other objects out of the windpipe.
Heimlich says thousands of deaths reported annually from choking prompted him in 1972 to seek a solution. Over the next two years, leading a team of researchers at Jewish Hospital in Cincinnati, he successfully tested the technique by putting a tube with a balloon at one end down an anesthetized dog's airway until it choked. He then used the maneuver to force the dog to expel the obstruction.
"By 1974, I knew I needed to get the maneuver to the public as soon as possible to save lives," he said.
He appeared on radio and television shows including "Good Morning America" and "Tonight Show Starring Johnny Carson" and started hearing from people who had used the maneuver or been saved by it.
The maneuver made headlines again this month. Clint Eastwood was attending a golf event in Monterey, Calif., when the 83-year-old actor saw the tournament director choking on a piece of cheese and successfully performed the technique.
"The best thing about it is that it allows anyone to save a life," Heimlich said.
Anne Jutt of Mason, a Cincinnati suburb, said Heimlich will always be a hero to her family. She used the maneuver last spring when her 6-year-old son was choking on a cherry tomato.
"I was scared of hurting him, but he was starting to get limp," she said. "I put everything I had into it, and the tomato flew out like a bullet."
Heimlich says the maneuver is very effective when used correctly, but he does not approve of American Red Cross guidelines calling for back blows followed by abdominal thrusts in choking cases that don't involve infants or unconscious victims. Red Cross officials say evidence shows using multiple methods can be more effective, but Heimlich says blows can drive obstructions deeper into a windpipe. The American Heart Association backs abdominal thrusts.
Neither organization supports Heimlich's view that using the maneuver to remove water from the lungs could save drowning victims. They recommend CPR.
"There is no evidence that abdominal thrusts are effective for drowning victims," said Dr. Robert Neumar, chairman of the Emergency Cardiovascular Care Committee of the American Heart Association.
Heimlich points with pride to some of his other innovations, such as a chest drain valve credited by some with saving soldiers and civilians during the Vietnam War. But he has drawn sharp criticism for his theory that injecting patients with a curable form of malaria could trigger immunity in patients with the HIV virus that causes AIDS. Medical experts have said injecting patients with malaria would be dangerous and have criticized Heimlich for conducting studies involving malariotherapy on HIV patients in China.
Heimlich mostly brushes off criticism about his work.
"I'll be the first to admit that a number of my ideas are controversial and in some ways unorthodox," Heimlich said. "But I have enough guts to know that when I am right, it will come about as the thing to do, even if others do the wrong thing for a time."
Heimlich now lives in an assisted-living facility but responds to emails and letters about his work and makes guest appearances with the Heimlich Heroes program. The program designed to teach young people how to use the Heimlich maneuver allows him to still pursue his passion for saving lives.
"And I'm not done yet," he said with a grin.
Smokers of electronic cigarettes will have to go outdoors like smokers of traditional tobacco products at one St. Louis area college campus. The Belleville News Democrat reports SIU-Edwardsville has banned electronic cigarettes indoors.
Campus officials told the paper that they felt the need to set a policy on E-cigarettes, since its the state's indoor smoking ban doesn't address them. Electronic cigarettes deliver nicotine via water vapor instead of smoke from burning tobacco. University officials say there's not enough data on the safety of the water vapors to non-smokers nearby.
Under SIUE's new policy, E-cigarettes may only be used outdoors, at least 15 feet away from an entrance.
POINT PLEASANT, N.J. (AP) -- On an icy night last month, a man entered a grocery store here, walked past the displays of cake mix and paper towels, and went into the bathroom, where he injected himself with heroin.
Hours later, the man was found dead in the bathroom with a needle still in his arm, authorities said. They believe the man was one of more than 80 across the country who have died in recent weeks after injecting heroin laced with fentanyl, a powerful synthetic opiate.
As the number of people who use, and fatally overdose on, heroin has skyrocketed in recent years, authorities are seeing the return of an alarming development: heroin that, often unbeknownst to the user, is spiked with fentanyl.
Fentanyl is a narcotic that is typically administered to people in chronic pain, including end-stage cancer patients. It is also used as an anesthetic. It is considered 80 times more powerful than morphine and can kill by inhibiting breathing.
"The dealers push this as being a super high, which it is, but it's also lethal," said Ellen Unterwald, director of the Center for Substance Abuse Research at the Temple University School of Medicine. Users typically don't know how much fentanyl is mixed in, and she said just a small amount can be fatal because the drug is so potent.
"A very small amount can exert a very significant effect," said Eric Strain, director of the Center for Substance Abuse Treatment and Research at Johns Hopkins University.
In Maryland, at least 37 people have died from the combined drugs, according to the Maryland Department of Health and Mental Hygiene, and in western Pennsylvania, authorities said they caused 22 deaths in recent weeks. In Rhode Island, 25 people have died from the laced heroin, and in Vermont state police have warned that pure fentanyl is being sold as heroin.
After Philip Seymour Hoffman was found dead with a syringe in his arm this month, investigators in New York tested the heroin found in his apartment for fentanyl, but found that it did not include the additive.
With more and more addicts turning to heroin because crackdowns on powerful prescription opiate painkillers have made them more expensive and inaccessible, there is concern that more people may be exposed to fentanyl-laced heroin during this wave than in previous ones, including in 2006 when hundreds of people from Chicago to Philadelphia died after injecting the drugs.
Last month the Drug Enforcement Administration put out a bulletin warning local authorities of what it dubbed "killer heroin," a mixture that was up to half fentanyl. It urged first responders to "exercise extreme caution" when coming into contact with any heroin because Fentanyl can be absorbed through the skin. It is unclear where the fentanyl is coming from. It is typically only distributed in hospitals. It can be administered in the form of a patch, a drip or a lollipop, which patients in pain suck on.
Heroin dealers put so-called stamps on the bags that hold their product, allowing users to delineate between different batches. Oftentimes they are product logos. Authorities said bags bearing the stamps "Bud Light," "Theraflu" and "Income Tax" have tested positive for fentanyl.
"A lot of those people thought that Bud Light was really hot, it's really good stuff, it sends you over the edge," said Ocean County, N.J. Prosecutor Joseph Coronato. "It's a marketing tool, almost."
Ocean County has been besieged by heroin and prescription drug overdoses in the past two years; in 2012 there were 53 overdoses in the county that hugs the Jersey Shore and last year there were 112.
"The demand is so high. That's the problem that's out there," Coronato said.
T.J. Smith, a spokesman for the police in Anne Arundel County, Md., said there have been four cases within the last year of heroin found with fentanyl in it, which he called an "unusually high number" in the county. Smith said heroin - both pure and laced with fentanyl - is driving a major increase in property crime. He said the drug has undergone a major change in the past year, with more potentially fatal doses found with fentanyl.
"It's a different heroin now," Smith said. "You can't use that same amount of heroin that you used a year ago because now it has a fentanyl kick in it."
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BRUSSELS (AP) -- Belgium, one of the very few countries where euthanasia is legal, is expected to take the unprecedented step this week of abolishing age restrictions on who can ask to be put to death - extending the right to children.
The legislation appears to have wide support in the largely liberal country. But it has also aroused intense opposition from foes - including a list of pediatricians - and everyday people who have staged noisy street protests, fearing that vulnerable children will be talked into making a final, irreversible choice.
Backers like Dr. Gerland van Berlaer, a prominent Brussels pediatrician, believe it is the merciful thing to do. The law will be specific enough that it will only apply to the handful of teenage boys and girls who are in advanced stages of cancer or other terminal illnesses and suffering unbearable pain, he said.
Under current law, they must let nature take its course or wait until they turn 18 and can ask to be euthanized.
"We are talking about children that are really at the end of their life. It's not that they have months or years to go. Their life will end anyway," said Van Berlaer, chief of clinic in the pediatric critical care unit of University Hospital Brussels. "The question they ask us is: `Don't make me go in a terrible, horrifying way, let me go now while I am still a human being and while I still have my dignity.'"
The Netherlands already allows euthanasia for children as young as 12, providing their families agree.
The Belgian Senate voted 50-17 on Dec. 12 to amend the country's 2002 law on euthanasia so that it would apply to minors, but only under certain additional conditions. Those include parental consent and a requirement that any minor desiring euthanasia demonstrate a "capacity for discernment" to a psychiatrist and psychologist.
The House of Representatives, the other chamber of Parliament, is scheduled to debate on Wednesday whether to agree to the changes, and vote on them Thursday. Passage is widely expected.
King Philippe, Belgium's constitutional head of state, must sign the legislation for it to go into effect. So far, the 53-year-old monarch and father of four has not taken a public position, but spokesman Pierre De Bauw said that is not unusual. "We never give any comment on any piece of legislation being discussed in Parliament," De Bauw said Tuesday.
Though one opinion poll found 75 percent of Belgians in favor, there has been a vocal opposition.
"We are opening a door that nobody will be able to close," Andre Leonard, the archbishop of Mechelen-Brussels and chairman of the Episcopal Conference of Belgium, told The Associated Press. "There is a risk of very serious consequences in the long term for society and the meaning we give to life, death and the freedom of human beings."
Etienne Dujardin, 29, a notary employee and father, has been among those staging protests as the debate in the House of Representatives nears. He doesn't believe safeguards proposed under the new law are watertight enough to protect youngsters who may be incapacitated by disease.
"If you take three psychiatrists, one of them will end up approving (euthanasia)," Dujardin said. "In the name of promoting freedom for children, we're letting someone else decide."
This week, an "open letter" carrying the names of 160 Belgian pediatricians was issued to argue against the new law, claiming there is no urgent need for it and that modern medicine is capable of soothing the pain of even the sickest children.
The doctors also said there was no objective way of providing that children possess the "discernment" to know what euthanasia means.
Van Berlaer, 45, was not one of the signatories. Very sick children who are surrounded by other ill and dying people are not like other youngsters, and mature quickly-too quickly, he said. They may look on as friends or neighbors in their ward die because they can no longer breathe or swallow, and come to realize what lies ahead for them.
In such cases, Van Berlaer said, a child may want to say goodbye to classmates and family, and ask if he or she can stop living.
"The thing is that it is an ultimate act of humanity and even love for the patients, minors in this case, that we at least listen to this question and think about why they would ask such a difficult thing," Van Berlaer said. "And it will never be easy, even if the law changes now, things won't be easier."
By his estimate, only a handful of Belgian children, all in the teenage years, would be able each year to make use of the lifting of age restrictions. "If there is still a possible medical treatment, they will not be allowed to ask for euthanasia," the Brussels pediatrician said.
The discernment clause, he said, should bar the law from applying to young children.
Dr. Marc Van Hoey, a general practitioner who is president of the Right to Die Association in the region of Flanders, also is in favor of the legislation. Euthanasia, he said, sometimes becomes the kindest and most caring option.
"I've seen quite a lot of persons dying in - how do you say in proper English - agony?" said Van Hoey. "If you see somebody who died in pain, you see his face completely with a kind of expression where you see the pain on the face.
"I never saw that when I gave someone euthanasia he or she asked for," the doctor said.
Besides Belgium, the only other countries to have legalized euthanasia are two of its neighbors, the Netherlands and Luxembourg, said Kenneth Chambaere, a sociologist and member of the End-of-Life Care research group at the Free University Brussels and University of Ghent.
In the Netherlands, children between 12 and 15 may be euthanized with parents' permission, while those who are 16 or 17 must notify their parents beforehand. Luxembourg limits the practice to legal adults 18 and older.
WASHINGTON (AP) -- Big retail stores, hotels, restaurants and other companies with lots of low-wage and part-time workers are among the main beneficiaries of the Obama administration's latest tweak to health care rules.
Companies with 100 or more workers will be able to avoid the biggest of two potential employer penalties in the Affordable Care Act by offering coverage to 70 percent of their full-timers.
That target is considerably easier to hit than the administration's previous requirement of 95 percent, but the wiggle room is only good for next year.
"It will be very helpful to employers," said Bill O'Malley, a tax expert with McGladrey, a consulting firm focused on medium-size businesses. "This gives them a bit of a transition period to begin expanding coverage on a gradual basis. There would be some cost savings to employers who otherwise were nowhere near meeting the standard for 2015."
It means that big companies, not only medium-sized firms, can benefit from the new employer coverage rules that the Treasury Department announced Monday. Under those rules, companies with 50 to 99 workers were given an extra year, until 2016, to comply with the health care law's requirement to offer coverage.
"I think it's pretty significant because the vast majority of the workforce is in large firms," said Larry Levitt, a health insurance expert with the nonpartisan Kaiser Family Foundation. "It affects a much bigger swath of the economy."
President Barack Obama's health care law requires companies with 50 or more employees working 30 or more hours a week to offer them suitable coverage or pay fines.
The so-called employer mandate was written into the law as a guardrail to discourage employers from shifting workers into taxpayer-subsidized coverage. Small businesses with fewer than 50 workers are exempt. And more than 90 percent of the larger firms already offer health care.
But even if it directly impacts a relatively small share of companies, the mandate still represents a major new government requirement on businesses. At a time when the economy remains weak, implementation has been fraught with political overtones. The requirement was originally supposed to take effect in 2014, but last summer the White House delayed it for a year. Then came this week's additional delay for medium-size companies.
Treasury officials say the lower coverage standard for bigger companies should help employers struggling with the health care law's definition of a full-time worker as someone who averages 30 hours a week. Many firms have traditionally set a 35-hour week as the threshold for offering health care benefits.
To determine if an employer is subject to the mandate, the government doesn't actually count full-time workers. It uses a complicated formula that also averages part-timers' hours and converts them to the equivalent of full-time workers.
The next step is to determine how many workers averaging 30 or more weekly hours are being offered coverage.
Say a franchise owner with two dozen fast-food restaurants in a state is already providing coverage to 50 percent of its workers averaging 30 hours. A 70 percent threshold would be less onerous than expanding the offer to 95 percent of employees.
The Treasury Department says it works out to an easier path for companies already on the way.
Mark Holloway, a benefits expert with the Lockton consulting company, says that will help some companies avoid what he calls the law's "nuclear penalty," a $2,000-per-employee fine levied across a company's entire workforce, after adjustments.
But it would still leave in place a second, lesser penalty if workers at the company obtain subsidized insurance under the law.
"I would say it's good news, but it's not a panacea for companies," said Holloway.
"I think people have realized the law is here to stay and we are going to have to live with it," he added. "This is fairly good transition relief that pushed some things off, but employers are still going to have to figure out how to navigate this stuff."
High tech glasses developed at Washington University School of Medicine in St. Louis may help surgeons visualize cancer cells, which could help reduce the number of surgeries need to eradicate the disease in many patients.
The glasses are so new they have yet to be named.
They're designed to make it easier for surgeons to distinguish cancer cells from healthy cells, by making the cancer cells appear blue. Highlighting the diseased cells will help to ensure that no stray tumor cells are left behind during surgery.
The glasses were used during surgery for the first time Monday. Breast surgeon Dr. Julie Margenthaler performed the operation at BJC's Siteman Cancer Center. She says more development and testing will be done, but the potential benefits to patients is encouraging.