Can texting new parents to report their blood pressure help address maternal mortality? These doctors think so

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Sarah Gantz | The Philadelphia Inquirer (TNS)

PHILADELPHIA — Two Penn Medicine physicians had an unorthodox idea for reducing the number of patients who develop dangerously high blood pressure in the weeks after giving birth: Stop asking them to come into the doctor’s office for blood pressure screenings.

Dangerously high blood pressure, is a leading cause of maternal death and hospital-readmission after birth, and is often preventable with routine screening. But many new parents are too overwhelmed in the first days of their baby’s life to get themselves to extra medical appointments.

Physicians Sindhu Srinivas and Adi Hirshberg decided to instead send patients home with blood pressure cuffs and instructions for how to report their readings by text message twice daily for 10 days.

Ten years later, the results are so impressive, Penn has made it standard practice across its eight hospitals. The program, called Heart Safe Motherhood, has been nationally recognized with awards from the American Heart Association and American Hospital Association, among others. And now, it’s being used at other Philadelphia hospitals, including Thomas Jefferson University Hospital and Jefferson Einstein Philadelphia Hospital.

More than 18,000 Penn patients have participated since the program launched in 2014. It’s credited with nearly eliminating the rate at which postpartum patients are readmitted for blood pressure complications within a week of giving birth, and closed a racial disparity gap that left many more Black patients at risk of severe complications.

The reason: More patients are following through on blood pressure screening after childbirth. Fewer wind up back in the hospital because doctors are able to spot danger signs and intervene sooner.

“We’re empowering the patient,” said Hirshberg, the director of obstetrical services at Hospital of the University of Pennsylvania. “We couldn’t do it without the monitors, but an important part of the program is the education of why we’re doing it.”

Shortly after Victoria Batista’s son was born, she developed a splitting headache, her vision was blurry, and she tripped walking through her home in Philadelphia. She attributed it all to being exhausted after a 67-hour labor that ended in a C-section, and the stress of caring for a newborn, her first.

“All these signs were pointing to having an issue, but I kept glossing over them,” said Batista, 32. “And then I got a notification: Check your blood pressure.”

She had so much going on she didn’t want to bother, but knew that her phone would just keep buzzing until she responded.

Batista punched in the numbers: 220/110, blood pressure so critically high she was at risk of a stroke. Within 10 minutes, someone at Penn called, telling her she needed to get to the hospital immediately.

“Had it not been for that program, for them harassing me about it — almost — I could have died,” she said.

Addressing maternal death disparities

The program is an emerging solution to sobering statistics that show Black Americans remain more than twice as likely to die during pregnancy or childbirth, or in the following months, according to the Centers for Disease Control and Prevention. The disparity persisted despite a national decline in maternal mortality rates in 2022.

Handing out blood pressure cuffs alone won’t solve a national maternal mortality crisis. But the Heart Safe Motherhood program has reduced readmissions for blood pressure complications among Penn’s postpartum patients from 5% to 1%.

Philadelphia institutions say the Heart Safe Motherhood program has also helped them understand how to better connect with patients and potentially make inroads addressing other deadly postpartum complications.

Jefferson launched the program in late 2021, and Einstein’s Philadelphia campus followed in spring 2022.

Response from patients and providers has been overwhelmingly positive, said Anneliese Gualtieri, the patient safety and performance improvement coordinator for obstetrics and gynecology at Einstein.

“You’re actually partnering with the patient in their care, which is something that patients like — to be part of their own solution,” she said.

Catching symptoms early

Jasmine Hudson, a nurse practitioner at Penn’s diabetes center, gave birth to her second child at Penn in May 2023. She credits the Heart Safe Motherhood program for saving her life days later.

Hudson took home the blood pressure cuff nurses offered and diligently responded to the text prompts with her blood pressure reading.

An automated algorithm analyzes the blood pressure readings patients send in and flags abnormal results to doctors.

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The program texts back to let patients know their reading is good, or to ask them to test again in a few hours if it’s elevated. When a patient doesn’t respond to the prompt, the program texts a reminder.

And when someone’s reading is too high, patients receive a text with the hospital phone number and instructions about who to ask for.

Hudson didn’t think much about it when a reading came back slightly elevated one morning. She felt tired, and her husband said she seemed a little irritable — but she reasoned: What new mom isn’t?

“As moms, we’re so used to caring for our families and caring for others. We come second or third or fourth,” she said.

But after a second elevated reading, the automated program urged her to go to the hospital, where she stayed for three days.

Hudson went home with blood pressure medication and, more than a year later, is doing well.

Postpartum care at home

Hudson is among some 18,000 Penn patients who have participated in Heart Safe Motherhood. The program has about 50 patients on any given day.

Staff focus on patients at risk for hypertension or preeclampsia, for instance, people with elevated test results during pregnancy or immediately after birth, or a history of high blood pressure during a past pregnancy.

Between 30% and 40% of Penn’s maternity patients qualify and are sent home with blood pressure cuffs and instructions for reporting their readings, said Srinivas, the vice chair for quality and safety for obstetrics and gynecology at Penn. The health system covers the cost of the device, about $30, for patients who can’t get reimbursement from their insurer.

Prior to launching the Heart Safe Motherhood program, Penn would ask at-risk patients to come back in the days after giving birth to have their blood pressure checked. Many never showed. Others had a normal reading at their appointment, only to have their blood pressure begin rising after returning home again.

Black women were at greater risk than white women — they were less likely to come for a follow-up blood pressure check and more likely to be readmitted to the hospital.

Too often, Srinivas would see a new mother go home in good health, only to return days later with life-threateningly high blood pressure.

“How did we not know this was going to happen?” Srinivas would ask herself.

Now, she doesn’t have to worry as often. About 90% of patients in the Heart Safe Motherhood program follow up on requested screenings, a compliance rate that’s the same for Black and white patients.

Providers say the program addresses a few key hurdles to managing blood pressure postpartum: Parents don’t have to self-identify subtle, common symptoms, and they don’t have to leave their home.

“Access to care is one of the biggest issues,” said Ryan Brannon, an OBGYN and director for quality and safety in obstetrics at Thomas Jefferson University Hospital. “Heart Safe Motherhood was something that enabled us to get access to a larger population.”

Next steps for reducing maternal deaths

Despite the program’s success, there’s more work to be done.

“While home blood pressure monitoring is great, we have to have a system in place that then will be able to make a difference for those elevated blood pressures,” said Laura Hart, a co-director of Temple’s cardio-obstetrics program. “It’s a multilayer process.”

For instance, people who develop hypertension or preeclampsia during pregnancy are at greater risk for heart problems later in life.

Temple Health has not adopted Heart Safe Motherhood, but providers have spent hours talking to doulas, patients, and other community health leaders about the symptoms of high blood pressure and where to turn for help, said Estefania Oliveros, who is also co-director of the cardio-obstetrics program.

At Jefferson’s hospitals, Brannon and Gualtieri want to expand the Heart Safe Motherhood program to include more languages, such as Russian and Mandarin.

The program currently communicates with patients in either English or Spanish.

Penn doctors are testing what other maternal health complications, such as postpartum depression, they can improve with the program’s monitoring approach.

And because of Heart Safe Motherhood’s success, the system now hands out blood pressure cuffs to at-risk patients during pregnancy, to begin tracking potential blood pressure complications even earlier.

©2024 The Philadelphia Inquirer, LLC. Visit at inquirer.com. Distributed by Tribune Content Agency, LLC.

‘An exciting time:’ Breakthroughs coming to treat and prevent hair loss

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Are young people losing their hair earlier than past generations?

New research shows anxiety and poor diet may be a factor in the early onset of hair loss in millennials and 20-somethings.

At the same time, men and women older than 50 are experiencing hair loss and hair thinning, either due to genetics, hormone changes or the aging process.

Together, these have triggered a skyrocketing demand for therapies and drugs to prevent and treat hair loss. So far, the FDA has approved only topical minoxidil and finasteride as pharmacological treatments. No other drug has been FDA-approved for the most common form of hair loss in almost 30 years. But that soon may change.

A least a half dozen medications and cell-based therapies are advancing in clinical trials, and Florida dermatologists see hope on the horizon.

“It’s an exciting time,” said Dr. Joshua Berlin, a Boynton Beach dermatologist who treats patients for hair loss. “We are seeing a resurgence of companies looking at solutions for this condition. Although it’s nothing life-threatening, it affects a significant part of the population, and it’s upsetting for them.”

Berlin said the increased advertising for hair loss products has created more awareness — and interest in solutions. “I am definitely seeing more people coming to my office specifically for hair loss.”

Dr. Brett King, an associate professor of dermatology at Yale School of Medicine, specializes in hair loss. He is jazzed about the advancements and attention on the most common form of hair loss called androgenetic alopecia, also known as female and male pattern hair loss. He recently discovered something for his patients that is working.

King is getting great results by prescribing oral minoxidil, a well-known hair-loss treatment drug typically applied to the scalp. Minoxidil is the active ingredient in Rogaine, a lotion or foam that is rubbed on the scalp, and is now generic. It has not been approved by the Food and Drug Administration for oral use for hair loss. However, a rising number of hair-loss dermatologists recently have been giving the low-dose pills to patients, and like King, they report success.

“Oral minoxidil is so much better for many reasons,” he said. “Topical only works where you put it, while oral treats all the parts of your scalp.”

Two new medications approved in the last year and a half also show results in people who have alopecia areata, an autoimmune condition that attacks hair follicles and causes hair loss. Alopecia areata is the second most common type of hair loss. The medications allow users to regrow their hair again.

“Now hair loss is something that when someone walks into a dermatology office, the doctor doesn’t just throw up their hands and say ‘I don’t know, go get Rogaine,’” King said. “Now we have new treatments for the two most common forms of hair loss.”

Those advancements are just the start, he believes.

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Some drugs in clinical trials show promise for the early stages of hair loss and hair shedding, while others exhibit the potential to stimulate existing hair folicles and create new hair growth. In addition, progress also is coming unintentionally in some cases as medications intended for other health conditions are repurposed as hair growth stimulators. Another field of research and development is cell-based therapies that stimulate hair growth by injecting stem cells into the scalp.

“I think in the next decade we will see the new development of medicines that truly grow hair … medicines that do not just do a reasonably good job, but doing a great job of treating severe hair loss at younger and younger ages,” King said.

Biotech researchers believe that people with hair loss will turn to convenient, direct-to-consumer, treatments — pills, lotions, injections — they can use in their homes.

Of course, hair transplants remain popular, too.

Berlin says the best way to know the right choice is to see a dermatologist. They can examine your scalp and order blood work to check for possible underlying causes.

If a nutrient deficiency is an issue, taking specific supplements may remedy the situation. Berlin is a fan of a biotin as well as a nutritional supplement called Nutrafol — a blend of vitamins, minerals, and botanical ingredients. One study found Nutrafol decreases hair shedding in women before during and after menopause. “They work to some degree, no question,” he said.

“Hair loss is a condition where we have had nothing new for many years and all of a sudden there are breakthroughs,” he said. “The goal is more novel threatments, and I know many people would like see that.”

Sourh Florida Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.

5 ways to practice financial self-care

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By Kimberly Palmer | NerdWallet

The investing information provided on this page is for educational purposes only. NerdWallet, Inc. does not offer advisory or brokerage services, nor does it recommend or advise investors to buy or sell particular stocks, securities or other investments.

The term “self-care” might conjure images of relaxing bubble baths or massages. But true self-care encompasses your finances, too.

“Self-care is about taking care of yourself so you can look better, feel better and be prepared for the future,” says Stacy Miller, a certified financial planner and founder of BayView Financial Planning in Tampa, Florida. “Financial self-care is an aspect of that. You’re giving your bank accounts a facial.”

Money experts say financial self-care starts with looking at your current money practices, then continues toward developing a solid plan for the future. And just like a skincare routine, everyone’s approach looks a little different.

Reflect on your past

Taking time to consider your “money story,” or how you grew up thinking about money, can be a good place to start, says Lindsey Konchar, a financial therapist in Minnesota. “Were your parents open about it? Were you taught anything about money?” she suggests asking yourself.

From there, you can try to shift the way you talk to yourself about money, such as by moving from an attitude of “I am bad with money” to “I am learning about money and am excited to be on this new financial self-care journey,” Konchar adds.

Mykail James, a financial educator in Washington, D.C., known to her social media followers as “the Boujie Budgeter,” says cultivating a sense of gratitude can also be beneficial. “Affirmations can help overcome negative thought patterns,” she says. She suggests ones such as, “I deserve the money I receive for work” or “I am worthy of being financially secure.”

(Kimberly Palmer shares how she practices financial self-care.)

Let your goals inform your habits

James likes to pick a few specific goals to focus on at any one time and then brainstorm about how to achieve them. For example, she likes to scroll through million-dollar home listings posted online and then calculate how much she would need to earn to be able to afford one. “That kind of thought experiment helps me formulate my goals,” she says.

Taking tangible steps toward your goals helps reduce stress and worry, says Robert Stromberg, a CFP and founder of Mountain River Financial in Abington, Pennsylvania. Since goals vary so much by person, those steps also differ, but they often start with a close review of your overall financial picture, including current spending and saving behavior.

Track spending

Budgeting apps can assist with that kind of financial review, says Maggie Klokkenga, a CFP and financial planner at Abundo Wealth in Morton, Illinois. “The first step is to just track your expenses. It’s like stepping on the scale. No one wants to look at it, but then you can become aware of your numbers,” she says.

Getting “financially naked” in that way can inspire some shifts in your spending to better align with your goals, she adds. Using apps that automatically sort your spending into different categories and flag subscriptions or unusually high amounts can also help.

“When people are aware of their numbers and start to take action with intention, they feel more in control,” Klokkenga says.

Ramp up savings

Stromberg notes that “the vast majority of clients I work with are under-saving.” He suggests prioritizing an emergency fund, which ideally holds three to six months’ worth of expenses, as well as saving for any known large expenses, such as a new car.

Being aggressive about savings “gives people a tremendous amount of comfort,” he says, because you know you are prepared for different scenarios. Keeping the money in a high-yield savings account insured by the Federal Deposit Insurance Corp. allows it to continue to grow until you need it.

Save what you can, even if it’s less than the recommended amount, James recommends. “Saving a little money is better than no money, so start wherever you are, and you can always grow it over time,” she says.

Automating your savings so a certain amount is transferred from your checking account or paycheck into your high-yield savings account each month can reduce stress, Konchar says. Anything you can do to reduce the mental load of managing your money allows you to spend that mental energy on other things, she says.

Take advantage of employee benefits

Contributing money to an employer-sponsored retirement plan like a 401(k); funding tax-advantaged flexible spending accounts for health care and child care expenses; and signing up for any other employee benefits like disability and life insurance can also contribute to your overall financial self-care, says Kevin Keller, CEO at CFP Board, a financial planner association.

“Consumers can enjoy life today and feel more comfortable, knowing they are on track to achieve their life goals,” he says.

Any good self-care routine also involves smaller daily pleasures, too, which is why James suggests giving yourself some kind of reward, such as a leisurely walk or an ice cream, after working on your finances. “Positive reinforcement gets people to continue to do something good,” she says.

Kimberly Palmer writes for NerdWallet. Email: kpalmer@nerdwallet.com. Twitter: @kimberlypalmer.

Olympic Games: The happy place that helped St. Paul gymnast Suni Lee find peace

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St. Paul gymnast Suni Lee pulls up to Midwest Gymnastics in Little Canada shortly after 4 p.m. It’s a hot summer day in early July, and the 2024 Summer Olympics in Paris are quickly approaching.

She makes casual conversation with a couple of coaches on the mat as the local gym quickly starts to fill in around her. She puts the finishing touches on her warmup when a group of little kids rush in to give her a hug before their practice. She smiles and wraps her arms around them before heading to the balance beam to work on her routine.

The scene doesn’t make sense on the surface. You’ve got Lee working to perfect a tumbling pass under the watchful eye of longtime coaches Jess Graba and Ali Lim, then less than 50 feet away are a handful of 6-, 7-, and 8-year-olds learning the basics of the sport. The whiplash is jarring for an outsider.

Not to Lee. The chaos inside Midwest Gymnastics has never bothered her. She has been working out there since she was a kid herself and has always found beauty in being able to blend in.

“This is her happy place,” Graba said. “She’s just another kid when she walks in here. She doesn’t have to worry about anything else. It’s like home for her.”

That feeling has been instrumental for Lee over the past few years.

The journey to qualify for another Olympics hasn’t been easy. Not only has she had to figure out how to handle fame at a young age after winning the gold medal in the all-around competition at the 2020 Summer Olympics in Tokyo, she also has had to navigate an incurable kidney disease that nearly ended her career.

All the while Midwest Gymnastics has served as a safe space where she can go whenever things get overwhelming.

“I think it’s been a saving grace for all of us,” Lim said. “We can come in here and leave the rest of the stuff outside.”

The culmination will come this weekend in Paris for Lee with Olympic qualifications starting at 4:40 a.m. CST Sunday. local time. If things go according to plan, Lee will be competing in the team final and the all-around final next week. Frankly, no matter what happens, Lee can take pride in the fact that she made it back.

“I’ve learned that I’m a lot stronger than I think,” she said. “I’m capable of anything if I put my mind to it.”

How it helped her handle fame

Nothing was the same for Lee after winning the gold medal in 2020.

Everybody wanted a piece of her in the immediate aftermath.

She returned home to St. Paul and was greeted with a parade in her honor. She traversed the country on a media tour that featured countless public appearances as well as a trip to the Met Gala in Manhattan. She competed as a contestant on “Dancing With The Stars” alongside other celebrities.

“There were a lot of things on her plate,” Graba said. “You can’t prepare an 18-year-old for that.”

She handled it with grace every step of the way, and continued to do so once she got to Auburn University. As much as she enjoyed parts of her college experience, there were certain aspects that made it difficult for Lee to settle in and feel completely comfortable.

In an interview with Sports Illustrated, Lee highlighted some of the challenges, like how she had to opt for virtual classes because she couldn’t walk to class without a security detail. She added that her teammates at Auburn weren’t the nicest to her because of her stature.

She started to feel like an outcast. It was a far cry from her experience at Midwest Gymnastics back home where she felt love from everybody around her.

“The way she handled everything was so impressive to watch,” Lim said. “She’s just been so poised through it all.”

How it helped her navigate illness

After announcing on social media that she planned to leave Auburn to focus on qualifying for the Olympics, Lee was diagnosed with an incurable kidney disease that ultimately forced her to move back home sooner than expected. She stopped training completely while doctors tried to get things under control.

Forget the Olympics. She just wanted to be healthy.

“That was scary,” Graba said. “We had no idea what was going on.”

As she slowly started to learn more about it, Lee returned to Midwest Gymnastics, as a way to clear her head more than anything else. It wasn’t about training for the Olympics at that point. It was simply about feeling like herself, even if only for a few moments at a time.

“She can just come here and go about her business,” said Puner Koy, who coached her at Midwest Gymnastics when she was young. “That’s really important because she’s constantly under a microscope with everything else she has going on in her life.”

Eventually, Lee felt herself getting stronger, and she let herself start thinking about the Olympics. She talked to Graba and Lim, and they came up with a plan.

“It was a really hard transition for all of us after I got sick,” Lee said. “Just having to work through all of that, they almost had to relearn how to coach me.”

There were ups and downs as soon as they started training with a purpose. Sometimes she would wake up and her energy levels were so low that she could barely get out of bed. Sometimes she would wake up and her hands would be so swollen she couldn’t grip the uneven bars.

Whenever she was at Midwest Gymnastics, though, Lee was thrilled to be working toward something again.

“I’m so glad that I never gave up,” she said. “There were so many times where I thought about quitting.”

The hard work paid off last month at the Olympic Trials at Target Center in Minneapolis. After completing a ridiculous routine on the uneven bars, Lee had a pretty good idea that she had done enough to make the U.S. team. It became official a couple of hours later, and Lee burst into tears on the mat.

“The further away we get from it, the more we’ll realize how big of a deal it was,” Graba said. “It was relief more than anything in the moment. It was like a weight lifted off our shoulders. Now at least whatever happens it’s going to be happening at the Olympics.”

How it helped her appreciate success

Fittingly, after qualifying for the Olympics, Lee found herself back on the mat at Midwest Gymnastics. Never mind that she had accomplished her goal. There was still work to be done.

“There’s more in the tank,” Lee said. “I’m never going to be satisfied.”

Maybe the coolest part about seeing Lee in her element is observing the way some of the little kids perceive her. As much as she might exists as a celebrity when they watch her compete on television, she exists as a peer whenever they are in the gym together.

“She’s just Suni in their eyes,” said Eric Kangas, who coaches at Midwest Gymnastics. “She just so happens to be an Olympic champion.”

That doesn’t mean there aren’t hilarious moments along the way, like earlier this year when Lee literally had to avoid a little kid while practicing her mount onto the balance beam.

“I was joking with her,” said Tony Maras, who got his start at Midwest Gymnastics, then went on to compete collegiately for Nebraska. “If she can train with a little kid running across the mat, she can go out there and compete at the Olympics, no problem.”

Asked about her goals heading into the Olympics, Lee said she would like to win a team gold medal more than anything else. She added that individually she would like to be competitive in the all-around final and that she also wants a gold medal on balance beam.

You can bet her family at Midwest Gymnastics will be following along every step of the way.

“We are so incredibly proud of her,” Lim said. “I would not want to do this with anybody else.”

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