Last year Martha Montalvo-Ariri underwent a routine hysterectomy to help treat painful uterine fibroids. During surgery, her doctor used a morcellator, a device that cuts the tissue into pieces so it can be removed through small incisions. Ten days after the procedure, Montalvo-Ariri was diagnosed with a rare and aggressive form of uterine cancer called leiomyosarcoma. Even more devastating, the rotating blade of the morcellator had scattered cancerous tissue fragments around her abdomen and pelvic area, accelerating the disease’s progression. Such cases have raised significant concerns over the use of power morcellation to remove a woman’s uterus or fibroids. In April, after reviewing new data, federal regulators urged doctors to stop using morcellators, because if cancer is present the device can spread malignant cells beyond the uterus and worsen a patient’s chance for long-term survival. Now medical providers are wrestling with a difficult decision: Should they offer a procedure that has proven benefits for the majority of patients but also carries a rare but deadly risk for a small number?
Randy Gutzke, a longtime IV drug user who says he struggles daily to stay sober, recently was offered a quick-results test for hepatitis C at a West Side community health center. ”It wouldn’t be shocking, just due to my lifestyle,” said Gutzke. But 20 minutes later, he learned he had tested negative. More than 1,500 people have been screened for hepatitis C since February 2013 at public health “field stations” run through the University of Illinois at Chicago’s Community Outreach Intervention Projects, thanks to a $150,000 grant funded through the Affordable Care Act. While the sweeping federal law is best known for expanding insurance coverage, its authors also hoped to improve health and cut costs by investing upfront in prevention, wellness and public health initiatives. At the COIP centers, that means giving away a $20 test in hopes of detecting infections that can lead to liver failure and expensive organ transplants if not treated.
From the sidewalk in front of her apartment in Cicero, Yolanda Foster can see long freight trains and an endless line of trucks rumbling day and night through the sprawling rail yard across the street. What she can’t see are the clouds of microscopic lung- and heart-damaging particles that drift into the low-income, largely Latino neighborhood overlooking one of the Chicago area’s freight terminals. New research from federal scientists has found that levels of diesel soot in residential areas near the BNSF Intermodal Facility frequently spike higher than the national average for urban areas. The study, the first of its kind in Chicago, sheds light on health hazards posed by freight yards that are concentrated in some of the area’s poorest communities.
By targeting the nation’s biggest sources of heat-trapping pollution, President Barack Obama is seeking to help forestall droughts, floods and other disasters that are projected to become more frequent, intense and expensive as the global climate changes. But federal rules requiring a dramatic cut in carbon dioxide emissions from coal- and gas-fired power plants also could have more immediate effects on public health in Chicago and scores of other U.S. cities with chronically dirty air. Though scientists say it will take years of international efforts to slow climate change, the administration’s plan to curb noxious pollution emitted by U.S. coal and gas plants could have a swift impact — particularly by reducing soot and smog-forming chemicals that trigger asthma attacks, cause heart damage and take years off lives.
Mimi Koberlein woke up one morning unable to smell the bacon her husband was frying for breakfast. Confused, she ran to the shower, grabbed her shampoo and inhaled deeply. Nothing. Two years later, Koberlein, 47, still can’t smell lemons, freshly cut grass, her three boys or any other fragrances of life. Diagnosed with anosmia, or smell loss, she has tried decongestants, nasal irrigation, oral steroids and acupuncture. But nothing has worked.
Fiona O’Connell is familiar with the working person’s health care nightmare — the one where you get too sick to work, and then you lose your job, and then you have no insurance to pay for the treatment you need. O’Connell lived that nightmare, and she’s still bitter and angry. But now she can talk about it in the past tense. As of Jan. 1, the cancer survivor has medical insurance under the Affordable Care Act.
Leaded gasoline is such a well-known scourge that automobile fuel made with the brain-damaging additive is still sold in only six countries: Afghanistan, Algeria, Iraq, Myanmar, North Korea and Yemen. Shifting to unleaded fuel in the U.S. — the last drop of leaded gas was sold here in 1995 — has paid huge dividends. The amount of lead churned into the air by cars and factories has declined by more than 90 percent since the 1970s. Average concentrations of the toxic metal in children have plummeted almost as dramatically. But one industry stubbornly remains a holdout in the decadeslong push for a lead-free America.
When Lori Witt began pursuing a tubal ligation at age 27, she said physicians refused to even discuss it with her, telling her she was too young and might change her mind about having children. For more than a year, Witt tried to get sterilized. Finally she went with her 28-year-old husband to a military medical clinic overseas, where Witt said he was given a vasectomy with few questions asked. Decades after sterilization became broadly available to women in the U.S., some still have trouble obtaining one of the safest and most effective forms of birth control. In interviews and on Internet forums, women report facing resistance and flat-out refusal from health care providers as they seek permanent contraception. Along the way, they encounter sexist and paternalistic attitudes, such as the assumption that all women desire children or that they’ll come to regret their decision.
Sherry Loveless can see the promise of managed care right through her bedroom door. Saddled with multiple disabilities, Loveless, 61, has been stuck in her Rockford bedroom for months because the doorway is too narrow for her wheelchair to squeeze through. When she moved into the house in December, firefighters carried her to the bed. But soon, thanks to a restructuring in Illinois’ Medicaid program, a renovation project is scheduled to widen the door and build a ramp that will allow her access to the outside.
Ellen Hanrahan, a 36-year-old mother of two, was done having children. To make sure, she had tiny metal coils implanted inside her fallopian tubes, a relatively new form of permanent birth control marketed under the brand name Essure. A year later, Hanrahan began feeling a familiar form of fatigue — one she’d experienced with her previous pregnancies. Incredulous, she took a home pregnancy test. And then another. “I panicked, called my husband and said, ‘We have a problem,’” said Hanrahan, who was, indeed, 10 weeks pregnant. A team of researchers estimated Monday that as many as 9.6 percent of women could become pregnant within 10 years of undergoing hysteroscopic sterilization, or Essure. That is nearly four times the estimated risk after a laparoscopic tubal ligation, the more traditional method. The study, published in the journal Contraception, is the first to compare the effectiveness of the two main choices offered to women who seek a permanent form of birth control. "Overall, sterilization is very effective; the absolute risk of pregnancy is low," said lead author Aileen Gariepy, an assistant professor in the department of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine. "But if … one method is not as effective, that definitely needs to be part of the decision-making process and not overlooked."