The Best and Worst States for Infertility

Fertility report card scores states on insurance coverage for IVF, fertility specialists, and support groups.

If you’re struggling to get pregnant, the best states to live in are Connecticut, Illinois, Maryland, Massachusetts, and New Jersey.

That’s according to a “fertility report card” from RESOLVE: The National Infertility Association, which assessed each state based on whether they offer insurance coverage for in vitro fertilization (IVF), the number of fertility specialists in each state, and the prevalence of infertility support groups.

So what are the worst states for couples struggling to get pregnant? RESOLVE says it’s Alaska, New Hampshire, and Wyoming, which all were graded an “F.”

“For the second year in a row, we are working to highlight state-by-state disparities between access to support resources and fertility treatment, in an effort to motivate people to take action to improve their state’s fertility friendliness,” said Barbara Collura, President/CEO of RESOLVE. Insurance coverage is one of the biggest hurdles for IVF, with some states not providing insurance due to IVF not being a life or death issue, and for ethical reasons.

See a snapshot below, or view the full interactive here:

map of 2014 Fertility Scorecard  copy

Food

Kraft Recalls Hot Dogs That Are Actually Cheese Dogs

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Man Standing Next to Automobile Shaped Like a Hotdog Sickles Photo-Reporting Service—www.jupiterimages.com

Beware a wiener in cheese dog clothing

Call it a classic mix-up.

Kraft is recalling 96,000 pounds of Oscar Mayer Classic Wieners that are actually Classic Cheese Dogs in the wrong packaging, the U.S. Department of Agriculture announced Sunday.

The product labels are incorrect and don’t reflect ingredients like milk, which is an allergen for many people, according to a statement posted on the USDA website. The recall specifically applies to 16-oz packages of “Oscar Mayer Classic Wieners Made with Turkey & Chicken, Pork Added” and cases of ““Classic Cheese Dogs Made with Turkey & Chicken, Pork Added, and Pasteurized Cheese Product.”

The mix-up was discovered by a consumer who notified Kraft on April 18, and Kraft notified the FDA’s Food Safety and Inspection Service (FSIS.) Neither the company nor FSIS has received any reports of illnesses caused by the mistake.

medicine

Study: Children Given Codeine in ER Despite Risks

Too many kids are getting codeine in emergency rooms, say the authors of a new study, which estimates that at least half-a-million children receive prescriptions each year

The painkiller codeine is prescribed to kids in at least half-a-million emergency room visits, a new study suggests, despite recommendations in place to limit its use among children.

Only 3% of children’s ER trips in 2010 resulted in a codeine prescription, but with kids making 25 million ER visits each year, authors of the study say too many children are getting the opiate, the Associated Press reports.

The study, published Monday in Pediatrics, analyzed national data from 2000 to 2010 on emergency room visits by children between the ages of 3 to 17. The study’s authors say the annual number of visits that led to codeine prescriptions ranged from approximately 560,000 to 877,000, though the frequency of codeine treatment slightly declined during the study.

A pediatric drug expert told the AP that codeine use has likely declined further since the study ended after last year’s strict warning from the Food and Drug Administration about the drug’s risks and possible complications.

[AP]

Africa

Ebola Virus Claims 61 Lives in Guinea

A scientist separates plasma cells to isolate any Ebola RNA in order to test for the virus at the European Mobile Laboratory in Gueckedou, Guinea, on April 3, 2014 Misha Hussain—Reuters

The West African country of Guinea has seen 109 confirmed cases of the Ebola virus, of which 61 have been fatal, according to local health officials and the World Health Organization

Sixty-one people have died from the Ebola virus in Guinea since January, said the West African nation’s Ministry of Health on Saturday. There have been 109 confirmed cases of the virulent disease in the entire country.

“The biological analysis can be achieved henceforth quickly,” said Dr. Sakoba Keita, the Guinean health official leading attempts to combat the infection, which can have a fatality rate of up to 90%.

First discovered in 1976 in two simultaneous outbreaks in the Democratic Republic of Congo and Sudan, the Ebola virus was named after the Ebola River near where the former outbreak was discovered. There is still no cure for the disease, which is spread through bodily fluids and the handling of infected corpses.

5 Ways to Make Sure Your Doctor is Listening to You

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Read this before you step foot in a doctor's office.

Using checklists in medical care sounds like common sense. We’ve all heard the stories of the man who had the wrong leg operated on and the woman who had a sponge left in her belly. Checklists are routine in other professions as well, and we know they can prevent hospital infections and surgical error. But could there be a downside to checklist medical care? Consider these two examples:

Scenario 1:

You come into the ER after you dove to catch a softball. You’re pretty sure you have a bruised rib, but because you said the magic words of “chest pain,” you’re suddenly whisked away to get blood drawn, an EKG and a chest X-ray. You’re told this is all part of the “chest pain protocol.” But did you really need all of those tests done?

Scenario 2:

You tell your doctor you’re tired and feeling run down. Your doctor does routine blood work, again following a checklist of things to look for: anemia, thyroid problems, and so forth. Everything is “normal.” The checklist is complete, so your doctor assures you that you’re OK—even though you know you’re not.

MORE: 7 Lies We Tell at Doctor’s Appointments

In my work as an emergency physician, I know that checklists can be helpful. They ensure complex procedures are done thoroughly and provide an extra assurance for safety. But they can also result in a “cookbook” approach, where you get the same recipe of tests and medications as everyone else. Unfortunately, this can result in expensive and unnecessary care, and even misdiagnoses or harm.

Here are five tips to make sure you get the best, personalized care every time you see a doctor:

1. Insist on telling your story. Studies have shown that 80 percent of all diagnoses can be made based on just the story of your illness. Doctors have limited time to listen to your story, but you must make sure they understand why you’re there. Don’t just say that you have chest pain—explain when it started, what you were doing, and how it felt. Write down key elements. Practice until you can tell it in 30 seconds or less. Then tell your story to your doctor the moment you see her to make sure she focuses on your individualized story.

More: 5 Questions To Ask Before Being Tested

2. Give open-ended responses to close-ended questions. If you suspect that the doctor is going through a checklist of yes/no questions, try to get her to focus on you by adding personal elements to your answers. If you’re asked, “when did you start feeling so tired?” don’t just say “two weeks ago.” Add that you’re normally very energetic and run five miles a day, but for the last two weeks, you can barely get out of bed to work (if that’s the case). These answers help provide context to who you are.

3. Ask about your diagnosis before you consent to tests. If you’re told you need to get blood drawn, ask why. Sometimes, that’s enough to stop the “cookbook” from taking over. Every test should be done for a specific reason, not just because it’s what’s done in this protocol, but because it helps focus the diagnosis. Also ask about what to do if the tests are negative. Just because they’re negative doesn’t mean there isn’t anything wrong, so what would be your next steps?

MORE: Are Female Doctors Better Than Male Ones?

4. Inquire about treatment options. In very few situations is there only one test that could work or one protocol that must be followed. If your doctor says you need to do this one set of tests, ask what your other options are. Often, watchful waiting is a perfectly acceptable alternative. Discussing options helps remind your doctor to tailor the treatment to you.

5. Let your doctor know that you want to be a partner in your decision-making. If you still think that your doctor is following a recipe rather than individualizing care, ask her to explain her thought process to you. Say that you respect her expertise, and you want to learn what it is that she is thinking. Your doctor may be so busy or so used to checklists that your request can help her refocus on you and your individual needs.

MORE: The Mistake Your Doctor Might Be Making

This article was written by Leana Wen and originally appeared on Womenshealthmag.com.

Why I’m Running the Boston Marathon Again

Fortier, who ran the Boston Marathon in 2013, will compete again this year. Image courtesy of Dave Fortier.

Massachusetts resident Dave Fortier, who was injured near the finish line, is setting out to reclaim what was taken from him last year.

I never considered myself a runner, but five years ago my best friend Brad called to tell me he had cancer. Brad was always the fit one, and I decided running could be a way for me to support him and raise money for his cause, the Dana-Farber Marathon Challenge, which benefits the Dana-Farber Cancer Institute in Boston. Before I knew it, I had signed up for my first marathon: the 2013 Boston Marathon.

The evening before the race my family walked down Boylston Street to scope out where they should stand during the marathon. We decided the area by the finish line would be too packed, and so they chose an area further back. When we passed the medical tent, my 14-year-old daughter said to me, “Dad, I hope you don’t end up here.”

The marathon was tough, but when I reached the 20-mile mark, I remember thinking to myself, this is it. My body was tired, but I was genuinely having a great time. I thought about Brad as I pushed through the last few miles–he was undergoing chemo at the time. I came up to the street where my family was, and I was rejuvenated when I saw them yelling and waving. When I turned onto Boylston Street, I was hugging the left side of the road like my training plan had advised. I started waving to the people cheering on the sidelines. I even stopped to thank a soldier for his service. I could see the arches over the finish line only 10 yards away and I was overwhelmed with excitement.

Then, suddenly, everything changed.

There was a huge flash to my left, right where I was waving to fans only a moment before. I felt the bang, and immediately grabbed my head in pain. My foot was hit with shrapnel, and an older man in orange (you may recognize him from footage of the explosion) collapsed in front of me.

I saw and felt the second blast, but I could barely hear it. I looked down and realized my foot was in a pool of blood, and I limped to the very medical tent my daughter didn’t want me to go.

Lying in the hospital bed later that day, I felt my phone buzz. It was a text from the Boston Athletic Association: “Congratulations on your time, you finished the Boston Marathon!”

Recovery was not easy, but I started trying to jog a bit in late May. I still have hearing loss in my left ear and I can feel the injuries in my foot, but by that summer I was running without much pain. Running is how I support Brad, so I was determined to continue. Since its inception 25 years ago, the Dana-Farber Marathon Challenge has raised more than $61 million for cancer research. I’m one of more than 700 runners on the team this year raising money. I even ran the New York City Marathon in November.

I decided I also needed to start taking care of my emotional self to better understand my physical and hearing related issues, and I joined a support group for people injured in the bombing. I realized when I met them for the first time that these were the very same people I was waving to at the finish. We understand each other’s pain. We saw and felt the same things, we were within feet of each other when it all happened.

In the late fall it was announced that everyone injured in the bombings received two entries into this year’s marathon. Many of the people within my support group dealing with similar injuries were ecstatic. This was the marathon where we could take back our hearing, take back that chunk from our leg, take back our ability to walk. It wasn’t a tough decision to sign up for the second time. We’ve created a running group called 4.15 Strong, and 28 of us will be running the Boston Marathon. We’re a rag-tag group of runners. Some of us are limping, some walking, some running.

I’m constantly thinking about what it will be like to run that route again. I’ve made myself return to Boylston Street many times so that it won’t be as emotional on race day. It’s already set up just like it was last year. This year, I’ll be at the finish line to make sure all 28 of us make it across. We are taking back what was taken away from us last year as runners and spectators….and we’re running for those that can’t.

You hear a lot about “Boston Strong,” resilience, and recovery. I’ve seen what that means. I’ve witnessed people learn how to walk again with one leg, or learn how to walk with two new legs. People just don’t give up, we adapt and we persevere.

Dave Fortier lives outside of Boston in Newburyport, Massachusetts, where he owns a process and network optimization company. He lives with his wife and two daughters. You can visit his marathon fundraising page here.

Saudi Arabia

Saudi Arabia Confirms 20 New Cases of Deadly MERS Virus

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Saudi medical staff leave the emergency department at a hospital in the center of Riyadh on April 8, 2014 Fayez Nureldine—AFP/Getty Images

About 49 people have been infected in the past six days by the incurable Middle East Respiratory Syndrome virus, which has claimed 76 lives in Saudi Arabia. The country's Health Minister said he did not know the cause of the sudden rise in cases

Saudi Arabia’s Health Ministry this weekend confirmed 20 new cases of the deadly Middle East Respiratory Syndrome, or MERS. All told, the MERS virus has infected 244 people in Saudi Arabia, with 49 confirmed cases in the past six days alone.

Of the 244 infected people in total, 76 have died, Reuters reports. MERS has no known cure and kills approximately a third of the people it infects.

Saudi Arabia’s Health Minister Abdullah al-Rabia said on Sunday he did not know the cause of the sudden rise in cases. He said there was no current need for extra precautionary measures like travel restrictions.

Authorities say the disease, which scientists have linked to camels and is similar to the SARS virus, does not spread easily from person to person and could die out on its own. However, some experts have warned that the virus could mutate, allowing for easier human-to-human transmission.

[Reuters]

This Dancing Poop Will Teach India’s Poor How To Use The Toilet

Latest campaign raises awareness about a health crisis in a country of over 1.2 billion people

+ READ ARTICLE

This video about an army of evil, dancing turds is no joke. It’s part of a targeted campaign by UNICEF that addresses one of India’s biggest public health problems – the widespread practice of public defecation.

The series of videos, online games and public announcement which began late in 2013 reveal some startling facts. About 620 million people in India defecate in the open, and only half the population uses toilets. The leading causes of malnutrition, which affects 48 percent of children in India, are from diarrhea and worms associated with microbial contamination of drinking water.

The ‘Poo2Loo’ campaign may seem a bit silly but it’s sparked a conversation in India about a health crisis in a country of over 1.2 billion people.

diet

USDA Grants Help Schools Serve Healthier Lunches

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About $25 million in new grants will go toward improvements like slicers for fruits and vegetables and better storage for fresh food. The USDA says it will proportionally split the funds among state agencies

The USDA announced on Friday that it is awarding $25 million in grants for schools in need of kitchen equipment to cook up healthier food.

The Pew Charitable Trusts and the Robert Wood Johnson Foundation recently released a report showing that 88% of school districts need at least one piece of kitchen equipment and 50% need infrastructure changes in order to provide healthier meals. For instance, some schools lack storage space for fresh food and proper slicers and choppers for cutting up fruits and vegetables. (Currently, around 90% of schools say they are meeting the requirements for school lunches, which set rules for calories and availability of foods like fruits, vegetables, whole grains and low-fat milk.)

“We know that there is still a significant unmet need for kitchen equipment in schools, and outdated equipment can make it more difficult to prepare healthy meals,” said Agriculture Secretary Tom Vilsack in a statement. “With these grants, schools will be able to get the tools they need to make the healthy choice the easy choice for America’s youngsters.”

The USDA says it will proportionally split the funds among state agencies, and within the states, districts will be awarded various sums, with the majority going to the schools in the highest needs where at least 50% or more of the students attending are on a free or reduced-cost meal plan.

Nutrition

How to Quit Sugar for a Year

Sourcebooks - ©Sourcebooks, 2014

One woman's quest to eliminate the sweet stuff, and how she felt when she came out the other side.

“It just made so much sense to me,” says author Eve O. Schaub after watching a YouTube video called “Sugar: A Bitter Truth,” a lecture by Dr. Robert Lustig, a professor at the University of California, San Francisco (UCSF). It prompted her to embark on a yearlong quest to put her family on a sugar diet, cutting out everything from table sugar to any food product with added sugar. It was no easy task; they discovered that meant eliminating anything from brownies to cold cuts. In her new book, Year of No Sugar, Schuab documents how they managed their not-so-sweet year. TIME asked the author about her journey, and tips for how to curb one’s sugar consumption.

This interview has been edited and condensed.

What inspired you to take this on?
I’ve always been interested in food from a very young age, and I like to cook and bake. I’ve also been interested in how food correlates with how we feel, and our health. I was a vegetarian for two decades, so I have been on some other food-related paths. I was really ready to hear the message when I watched the YouTube video. Something about it really clicked. Everywhere I went after that, I felt like I suddenly had sugar vision and I saw what everyone didn’t see. I thought, ah hah, what if we stopped eating sugar entirely, and what if we tried to do it for a year?

How long did it take you to go grocery shopping?
It used to take me about 45 minutes to do a normal shopping trip, and this one took me an hour and a half. I should have brought my magnifying glass and my dictionary. I was reading and reading and astounded by how much I didn’t know. It made me mad, because food shouldn’t be this hard. I was stubborn about reading every last ingredient because I wanted to make sure we were following our own parameters. But once I did that recon, it was done. I knew what we could buy and what was off-limits.

Any tips for navigating the grocery store. Any surprising items to avoid?
Going straight to produce is great. Not everyone wants to make their own crackers, for example. There are some things that are really hard–I wouldn’t say you can never find a no sugar version—but it can be very hard. And they are things that are not sweet, so they’re unexpected. For example, bread is a big one, especially the sandwich breads. My family went to the bread aisle and came up with 250 some different varieties of bread, and we could only find a variety from one manufacturer that did not contain added sugar. But there are plenty of other unusual food products with sugar. I found sugar in sausages, tortellini, tortillas, mayonnaise, ketchup, cold cuts. I ultimately came to the conclusion that there is almost nothing they will not try to put sugar in.

Is it possible to dine out on this diet?
It is—we did. First, we found out which places were making their own food. We were astonished to find that some restaurants did not necessarily know what was in their own food. We learned how to ask questions. Once we got to the point that we knew what restaurants made their own sauces and dressings and knew what was in it, we would go back again and again. They got to know us and would ask how it was going.

Was it hard to travel?
You have to plan snacks ahead. At every convenience store, you’re lucky if you can find a banana. They will try to have healthy snacks. They will have things like yogurt, granola bars, and power bars. But sadly they often as much sugar as a candy bar, up to 25 grams of sugar.

Was dessert ever a possibility?
Just because we weren’t having sugar didn’t mean we weren’t having dessert. I did a lot of experimenting with old favorite recipes of mine. I would alter things I always made, like cookies and bars, with things like bananas and dates. We made banana ice cream, which we loved.

Your family ended up using dextrose often. Can you explain what that is?
It’s not fructose. I found the question of dextrose confusing. I asked Dr. Robert Lustig, and he was very kind in replying and letting me know that dextrose was glucose, so for our fructose-free purposes, it was perfectly fine. It’s about one-third the sweetness of table sugar, and it’s made of corn. Right now, as far as I know, you can only get it by mail order.

How did you survive the holidays?
The holidays can be especially challenging and there is this sense that we need sugar to celebrate. We need to mark the occasion with something even more crazy special and sweet than we are already having in our every day lives. It can be very difficult to navigate that delicately because you don’t want that person to come away feeling rejected because you didn’t eat their meal. We would let it be known that this is something that we would be doing, and ask if there was anything we could bring. That way we have at least one thing we can eat. Once you do the research, you know where it is. You know it’s going to be in the ham because if the glaze, it’s going to be any potato salad and coleslaw. We knew that when we went to aunt Carol’s house, the safe thing for us would be the mac and cheese.

How do you get kids on board?
My kids were the most excited when they were actively participating. They would love making banana ice cream themselves. Kids get so excited about food and where it comes from and watching food cook, and I think that’s the key to getting kids to care about food and love the taste of fresh, healthy, and homemade food.

What can people expect from cutting their sugar consumption?
Not eating sugar affects everyone in different ways. None of us really lost weight, but we were not looking to. The kids didn’t seem to be noticeably calmer, but hyperactivity wasn’t something we were trying to address either. I, in particular, had more energy, and that is something I have struggled with for as long as I can remember. On a regular basis I would crash and feel like I had a total lack of energy. When I do not eat sugar, I have plenty of energy. We felt healthier and it seemed to me that we did not get sick as much or for as long. My daughters missed 10 to 15 days of school the year before, and in the year of no sugar they missed two to three. That seems like better health.

Is this easier for someone who likes to cook?
I think it helps a lot if you like to cook. If I had trouble buying bread, I knew I would enjoy making it at home, if I could find the time. But you don’t have to love to cook to take in less sugar. There are lots of ways we can cut of sugar consumption and feel better. For instance, cut out drinking sugar. Have a sparkling water instead of a soda. For people who say they don’t have time, I wish we could place more emphasis on food as being important and worthy of our time. Perhaps we don’t have a lot of time, but making your own tomato sauce takes about 20 minutes.

Do you still avoid sugar?
After we finished our year, everyone expected us to go on a sugar binge to make up for lost time. We found that we had really lost a lot of our craving for super sweet foods. It was a little rocky at first because we had no rules. It had been hard on no sugar, but it had been clear. Over time we came to a middle ground, which I call “high level sugar avoiders.” I refuse to buy things that have sugar in them as an added ingredient, especially if it’s something that’s not sweet, doesn’t need it, and no one knows it’s there. We will have a sugary sweet once in a great while. I’d say 99 times out of 100 we are not having sugar, but for a special occasion we will have something. It will be small, and it will be special.

Do you recommend other people try this?
They don’t have to because I did it for them! The best advice I can give is to be aware and be judicious. Being aware means reading ingredients and asking questions. Being judicious means making sure you don’t get on that sugar escalator so you don’t have a little today, then more tomorrow, then more after that.

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