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Why Opt for a Green Burial?

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As moms, we focus a lot on births, but death isn’t something we talk a lot about. It’s not like we share death stories over coffee like we do our birth stories. And we certainly don’t talk about whether we want a traditional vs. green burial at playdates!

I recently shared that this past year I’ve been able to witness and support loved ones through both birth and death, and I was awed by the beauty in both. I came away with a strong feeling that while we stop inhabiting our bodies one day, the real self always remains.

Death is something we should be prepared for, though, whether it’s for our loved ones or for us. As our families age, we might have to navigate our parents’ or other family members’ last wishes. We can (and should) plan for our deaths as a way to share our end-of-life wishes with our families. Since I use products and processes that are lower in toxic load and better for the environment and future generations, I’m excited about these more eco-friendly options.

What Is a Traditional Burial?

A conventional burial involves several steps. First, the body is embalmed with formaldehyde to help preserve it and slow decomposition. Then it’s placed in a wooden or metal casket. Funeral services are the services held to honor the deceased at places of worship or funeral homes. Often a gravesite service is held at the burial site where the body is buried in a metal or concrete vault or plastic liner in a burial plot in a cemetery. And lastly, the grave is marked with a headstone.

Why Is Traditional Burial Harmful?

In a traditional burial, most of the materials used are not biodegradable. From the caskets with metal handles to the headstones to the concrete vaults, these things will not break down any time in our children’s future.

The Journal of the National Cancer Institute conducted a survey of funeral industry workers’ health. They found that the worker’s exposure to the embalming fluid is toxic to their health. Those exposed to formaldehyde were more likely to get and die from leukemia and brain cancer the longer they worked in the industry.

In addition, in a 2022 report from Illness, Crisis, and Loss, they found that those same embalming chemicals also leach into the ground and can cause pollution. The leaching poses the biggest threat to marine life and possibly our drinking water. The Canadian Environmental Protection Act classifies formaldehyde as a highly toxic substance.

Traditional cemeteries also landscape their cemeteries, which involve fertilizers and pesticides. In addition, they use large amounts of water to keep the grounds looking green.

What Is a Green Burial?

Green burials are growing in popularity as people seek options that reflect the choices they’ve made to have a lower toxic, more natural life. The Green Burial Council, a nonprofit in the death care industry, defines a green burial as one that reduces environmental impact and works to conserve natural resources. It’s better for the environment by lessening the toxic load that traditional burials have. Green burials use non-toxic and biodegradable materials.

The benefits of a natural burial include:

  1. Less expensive – A traditional burial can cost between $7,000 and $12,000, including the funeral or memorial service. Green burials require fewer materials (caskets, embalming, etc.) and tend to be less expensive.
  2. Biodegradable products – Typical burial products are made from natural resources and aren’t biodegradable. With a natural burial, there isn’t a need for a casket made from exotic trees or metal. They also don’t use concrete burial vaults or plastic liners, which can take hundreds of years to decompose.
  3. Less toxic chemicals – Traditional burial chemicals are toxic to the environment and the workers who complete the work. In addition, traditional cemeteries often use pesticides and fertilizers to maintain their grounds, which increases pollution.
  4. Help promote land conservation – Traditional cemeteries don’t work to conserve or protect land and natural habitats. Natural burials often take place in areas that are carefully restored and maintained to preserve the natural areas where they occur.

Green Burial Options

Several green burial options are available depending on where you are and what your or your loved one’s wishes are. The costs of these options vary. While there are pros and cons to each, these are all more natural burial alternatives than the traditional burials we’re used to.

Cremation

The first and probably most known option is cremation. It’s been used since ancient Roman and Greek civilizations, and possibly starting even earlier, around 3000 BCE.

For cremation, you still need a combustible container that the body can be placed in while it’s heated to anywhere between 1,800 and 2,000 degrees. After cremation, the family is given about 4-6 pounds of ashes. 

You can spread these ashes in a memorial forest, where you can buy a tree as your loved one’s final resting place. Another option is to spread the ashes at their favorite location or even your backyard (just be sure to check local laws and regulations first!). Or you can store the ashes in an urn in your home, or even do something creative with them, like having the ashes turned into jewelry! It costs around $1,000 – $3,000 for the process (not including any memorial service).

This option is available in all states and is easily accessible. One negative of this option is the emissions that can be put off from the process. Although it’s not a high amount of carbon dioxide (about the amount of a long road trip), there are other emissions, including mercury. The emissions from cremation are still less than the impact of traditional burials.

Aquamation

A newer natural burial option is aquamation, or water cremation. This process was started in an effort to process animal carcasses into fertilizer. In 2005, it became an option in America for humans and is currently available in about 22 states.

Like cremation, aquamation processes the body into a powder similar to ashes. Unlike cremation, it uses water and potassium hydroxide to break the body down. The body is heated to about 320 degrees, and at the end, you receive the “ashes” that remain. The average cost of aquamation is $2,000 – $3,000.

This process is a great option as it uses less electricity and releases less emissions. This makes it a good alternative for anyone searching for a less toxic burial option. A con is that it isn’t available in all states yet.

Human Composting

This is one of the cleanest green burial options available. Currently, it’s only available in seven states in America (Washington, Colorado, Oregon, Vermont, California, New York, and Nevada). However, this new option is gaining popularity and is slowly becoming legal in other states.

Just like it sounds, the body is broken down into compost. Similar to the process you’d use to make compost for your garden, this option is good for those who want to have a more natural burial. The body is put into a vessel with natural materials that help it decompose (straw, wood, alfalfa) until microbes break the body down. 

This process can take 30-60 days. When it’s complete, the family is given a portion of the soil that they can use to spread or plant (just don’t use it in your vegetable garden). The cost of composting is about $2,500 – $5,000.

The one con for this option is that it’s the least available. But as other states adopt human composting, it’ll become more widely available.

Green Cemetery

Another new option in the burial offerings is green burial cemeteries. Green cemeteries aren’t available in every state. These are conventional cemeteries that use concrete vaults and traditional embalming but biodegradable containers.

In these resting places, there are no embalming or concrete vaults, and bodies are buried in a biodegradable casket or shroud. These cemeteries often offer more natural surroundings with native plants and even wildflowers. They allow nature to exist as it does in the wild, instead of traditional landscaping that uses fertilizers or pesticides. They can sometimes look and feel more like a nature preserve.

These natural burial grounds are often involved in land conservation and sustainability. Some are run by nonprofit groups that want to bring more natural practices to the funeral industry. The Green Burial Council offers certification for green burial practitioners, including green cemeteries, funeral homes, and product providers. Their website offers a list of certified natural cemeteries that meet their standards.

One con for this option is that there aren’t a lot of green cemeteries yet. Hopefully, that will change as the demand for more natural burial options continues to grow.

What Is a Green Funeral?

Traditional funerals are held at places of worship or funeral homes, often with a body present in a casket. With a green burial, there’s often no casket (in the case of aquamation or human composting and sometimes in cremation). Traditional funerals also often have lots of plastic flowers and a headstone at the burial site. Green funerals don’t have flowers or a headstone at the burial plot, if there is one. The footprint of the funeral is much less with a green funeral vs. a traditional funeral.

Green funerals could even include more creative options like a home service or a gathering of family and friends to share a meal. Or if you opt for cremation, a green funeral could involve a gathering at a special place where you want your ashes spread.

When Green Burial Might Not Be an Option

One hesitation you might have about green burials is if you want to view the body at the funeral or memorial service. Although traditional burials offer embalming to preserve the body, a green burial does not. But this doesn’t mean you can’t still have a viewing. You aren’t required by law to embalm a body, but many funeral homes will not allow a viewing without it. 

However, if the funeral home will allow it or you opt for a home viewing, you can keep the body preserved with dry ice or refrigeration for 2-3 days. It’s best to check with your local regulations if a viewing is an important part of your end-of-life wishes.

Another FAQ about green burial is what if the body has to be transported across state lines? If your loved one has died in another state, you can usually transport it to your home state for burial. A few states require you to have a body embalmed before crossing state lines. If you are required to embalm the body, you probably won’t be able to have a burial in a green cemetery or do human composting. You can still have the body cremated or processed with aquamation.

Why Planning for Death Is Important

You may wonder why this is important. It’s not an easy thing to think and talk about, especially when we’re considering our own death. But planning for the future is important, and that includes planning for death.

If you strive to live in a non-toxic, natural way and also want to help the environment for our children’s future, you can carry those preferences over to your death plans. This allows you to leave a legacy of a more natural life and death.

Planning for death is one of the best gifts you can give your loved ones because you take all the guesswork out of what you want to happen at a very emotional time. It makes it easy for them to simply follow your end-of-life wishes instead of having to guess what you’d like. It’s also a statement of how important a nontoxic life (and death) are to you and your family.

Another important thing you can do is have these conversations with your family and loved ones to see what their wishes might be for end-of-life. Then you don’t have to guess what’s important to them. Sharing these alternative options with them might help them realize that there are other healthier options to traditional burials.

Have you planned for your or a loved one’s death? What natural burial alternatives seem the most interesting to you?



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The Surge in Lyme Disease Reports

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Lyme disease stands as the most common vector-borne illness in the US, with 90% of cases originating from 15 jurisdictions characterized by high incidence rates across the Northeast, Mid-Atlantic, and Upper Midwest. The notable increase in Lyme disease cases reported in 2022 reflects changes in surveillance methodologies rather than an increase in the disease risk. A revised surveillance case definition has improved the uniformity of case reporting among jurisdictions. However, it also presents challenges in conducting comparisons with past data due to differences in methodologies.

With the implementation of the new surveillance case definition in 2022, there was a marked rise of 62,551 Lyme disease cases reported to the Centers for Disease Control and Prevention (CDC). This represents a 1.7-fold increase over the annual average of 37,118 cases noted during 2017–2019. The data reveal a significant surge in Lyme disease incidence among the older population, particularly in adults aged 65 years and older, where incidence rates have approximately doubled in comparison to the 2017–2019 timeframe.

“The number of reported Lyme disease cases in the United States increased 68.5% over the average reported during 2017–2019; in high-incidence jurisdictions, the number of cases increased 72.9%, whereas in low-incidence jurisdictions, the number of cases increased 10.0%,” according to the CDC. “The differential increase in incidence might reflect:

  • more frequent laboratory testing among older age groups.
  • proportionally more disseminated illness in older age groups
  • proportionally more positive laboratory test results related to previous exposure to Borrelia burgdorferi rather than a current illness.”1

3 Key Takeaways

  1. The introduction of a new surveillance case definition in 2022 led to a substantial 68.5% increase in Lyme disease reports compared to the 2017-2019 average.
  2. Data from 2022 reveals a significant increase in Lyme disease incidence among individuals aged 65 years and older, with rates approximately doubling from the previous years.
  3. The current Lyme disease surveillance system likely underestimates the true incidence due to its reliance on clinical symptoms and variable clinician reporting.

The 2022 revision of the surveillance case definition permits high-incidence jurisdictions to report cases of Lyme disease based purely on laboratory evidence, without the need for corroborating clinical information. This adjustment seeks to foster greater consistency in surveillance practices across different jurisdictions.

According to the CDC, “date of illness onset is rarely available in high-incidence jurisdictions given the reliance on laboratory-based reporting without case investigation to ascertain clinical information. Alternative dates related to laboratory testing or reporting still demonstrate summer seasonality, but are shifted 2 weeks later, reflecting the expected time lag required after symptom onset to mount a detectable immune response to B. burgdorferi.”1

This report highlights two significant limitations in Lyme disease surveillance. First, the current surveillance likely misses many cases, especially early-stage ones without sufficient laboratory evidence, due to reliance on clinical symptoms like the erythema migrans rash and the variability in clinician reporting. Overreporting can also occur from serologic tests detecting past infections, leading to the inclusion of cases not currently affected by Lyme disease. Second, the adoption of the more sensitive Modified Two-Tier Test (MTTT) serologic assays for Lyme disease in 2019 has the potential to increase detected cases but has been hindered by systemic challenges in test recognition, possibly underrepresenting true incidence rates in 2022.

The adoption of standardized codes by both commercial and clinical laboratories is essential for the accurate identification of individuals who have laboratory evidence of Lyme disease for surveillance objectives. Despite the increase in the number of reported cases compared to past years, the figures still fall short of the approximately 476,000 annual Lyme disease diagnoses projected in the United States, underscoring the urgent need for effective prevention strategies.

Prevention Strategies include being mindful of going outside of ticks in grassy or wooded areas. Protect yourself by treating gear with 0.5% permethrin and using EPA-approved insect repellents like DEET. Check for ticks on clothing and gear after being outdoors, use a dryer on high heat to kill ticks, and wash clothes in hot water. Shower and do a full body check for ticks within two hours of coming indoors to lower disease risk.2

References

  1. Centers for Disease Control and Prevention (CDC). Surveillance for lyme disease after implementation of a revised case definition-united states, 2022. Published on February 15, 2024. Accessed February 16, 2024. https://www.cdc.gov/mmwr/volumes/73/wr/mm7306a1.htm?s_cid=mm7306a1_w
  2. CDC. Preventing tick bites on people. Published September 30, 2019. Accessed February 16, 2024. https://www.cdc.gov/lyme/prev/on_people.html



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Hawaiian Style Slow Cooker Kalua Pulled Pork

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Tender slow cooker kalua pulled pork is salty, smokey melt-in-your-mouth perfection. Enjoy authentic Hawaiian luau pork flavor at home with this super simple 3 ingredient masterpiece.

You don’t need a luau to enjoy Hawaiian cuisine and this moist kalua pulled pork. Serve with a side of Hawaiian sweet rolls, Hawaiian macaroni salad, and this incredible grilled pineapple for a complete island experience!

Slow Cooker Kalua Pulled Pork

Slow cooker kalua pulled pork is the easier version of authentic kalua pork. Traditionally, kalua pork is cooked in the ground, but this slow cooker is a great modern day method! With only 3 ingredients this is one of the easiest meals to make! It cooks low and slow to achieve the most tender results. You won’t believe it when you taste this explosion of salty and smokey flavor. And it’s a perfect recipe to make for a crowd!

Also known as kalua pig or Luau pork, kalua pulled pork is a staple at Hawaiian luaus. They carry on the tradition of cooking a whole pig in an underground oven filled with hot stones. The pig is generously salted and wrapped in banana leaves then lowered into the ground to smoke all day. This slow cooker method also requires all day to cook. You’ll want to plan ahead because to get that divine tenderness you’ll want the pork to cook for at least 16 hours. For more delicate juicy pork recipes try my carnitas, this Mississippi pork, or my sweet pulled pork!

Kalua Pulled Pork Ingredients

It doesn’t get any easier than a 3 ingredient recipe. Especially when the result is as incredible as this kalua pulled pork. Although there are only 3 ingredients, using the right ingredients will ensure that authentic kalua pork flavor.

  • Pork Butt Roast: This cut of meat is also called a pork shoulder roast. You can get one with the bone or without.
  • Course Hawaiian Salt: Hawaiian salt is loaded with minerals and is traditionally important in this recipe. Look for this in your specialty stores like Cost Plus World Market, or Trader Joe’s. You can also order it from Amazon. Use any kind of course salt like Kosher or Himalayan salt if you can’t find Hawaiian salt.
  • Liquid Smoke: Available at any grocery store near the BBQ sauces. It adds the signature smokey flavor to the pork so don’t skip this ingredient!

Kalua Pulled Pork Recipe

This kalua pork recipe is perfect for feeding a crowd. Super simple to make, but you definitely need to plan ahead! Prepare the pork the night before and allow it to cook all night. It’s SO worth the wait!

  1. Place Pork in Slow Cooker: Spray the inside of the slow cooker with non-stick cooking spray. Place the pork in the slow cooker.
  2. Season With Salt/Add Liquid Smoke: Sprinkle the salt on top of the pork and generously rub the salt on the pork. Pour the liquid smoke on top of the salted pork.
  3. Cook: Cook on low for 16-20 hours. Yes, really that long! Turn the roast halfway through.
  4. Shred: Once fully cooked, remove the roast and shred it with two forks. Remove any fat pieces as you shred the pork and discard them. Add the shredded pork back to the slow cooker. The pork will absorb the juices and flavor from the bottom of the slow cooker!
  5. Enjoy: Enjoy the pulled pork over rice or served in a bun!
First photo of the pork roast in the slow cooker. Second photo of the salt sprinkling on the roast. Third photo of the liquid smoke pouring on the roast. Fourth photo of the roast prepped before it cooks.

Tips For the BEST Kalua Pulled Pork

This is a really hard recipe to mess up but here are some tips to make sure it stands out above the rest. It’s so incrediby easy and it turns out perfect every time.

  • Pork:  Pay attention to the size of your roast. If you get a roast larger than 6 pounds (8-12 pounds) you’ll want to increase both the salt and the liquid smoke. Too little can leave your pork tasteless. The amazing flavor comes from the salt and liquid smoke. For a larger roast increase the salt and liquid smoke by 1-2 teaspoons.
  • Rinse and Trim: Rinse and pat your roast dry to ensure the flavor “sticks” to it. Trim your roast of large chunks of fat, and place fat side up in the slow cooker, the fat will baste the rest of the roast as it cooks.
  • Pierce: Poke the roast with a fork all over before rubbing in the salt and liquid smoke to increase the flavor inside and out.
  • Liquid Smoke: It is recommended by some Islanders to use hickory liquid smoke for an authentic flavor, but mesquite is just as good. It’s mostly personal preference.
  • Time:  I know I’ve said it before, but truly the longer you can cook it the better. This will work if you start in the morning and let it cook all day. It may not be quite as tender, but will still taste amazing.

Top view of the shredded kalua pork in the slow cooker.

Storage and Ideas for Leftovers

Kalua pulled pork makes great leftovers! Use in your favorite Mexican dish such as quesadillas, tacos, burritos, or on top of nachos. You can also use leftovers to make pulled pork sandwiches or sliders. The possibilities are endless!

  • In the Refrigerator: Bring leftovers to room temperature and store in an airtight container with the juices. Store in the fridge for up to 5 days.
  • In the Freezer: Freeze leftovers in a freezer safe container or freezer Ziploc bag. Seal tightly and place in the freezer for up to 3 months.
  • To Reheat: Thaw frozen leftovers in the fridge over night. Reheat leftovers in the microwave or on the stovetop in its liquid. Make sure to reheat with the liquid because the pork might taste dry if you leave it out.

Top view of kalua pulled pork in a black bowl with rice and macaroni salad on the side. A fork is inside the bowl with teriyaki sauce and green onions garnished on top.

More Delicious Pork Recipes

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  • Spray the inside of the slow cooker with non-stick cooking spray. Place the pork in the slow cooker.

  • Sprinkle the salt on top of the pork and generously rub the salt on the pork. Pour the liquid smoke on top of the salted pork.

  • Cook on low for 16-20 hours. Turn the roast halfway through.

  • Once fully cooked, remove the roast and shred it with two forks. Remove any fat pieces as you shred the pork and discard them. Add the shredded pork back to the slow cooker. The pork will absorb the juices and flavor from the bottom of the slow cooker!

  • Enjoy the pulled pork over rice or served in a bun!

Updated on February 16, 2024
Originally Posted on May 22, 2013

Calories: 449kcalProtein: 76gFat: 14gSaturated Fat: 4gCholesterol: 214mgSodium: 2795mgPotassium: 1272mgCalcium: 19mgIron: 2mg

Nutrition information is automatically calculated, so should only be used as an approximation.





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File your taxes using Form 1095-A, Health Insurance Marketplace® Statement

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Published on March 9, 2023

The tax filing deadline is April 18, 2023. If anyone in your household had a Marketplace plan in 2022, use Form 1095-A, Health Insurance Marketplace® Statement to file your federal taxes. You’ll get this form from the Marketplace, not the IRS. Check your Form 1095-A to make sure your information is correct. Keep it with your other important tax information.

Check your online account for Form 1095-A

If you didn’t get your Form 1095-A in the mail, or you can’t find it, check your HealthCare.gov account:

  1. Log into your HealthCare.gov account.
  2. Under “Your Existing Applications,” select your 2022 application.
  3. Select “Tax Forms” from the menu on the left.
  4. Download all 1095-A forms shown on the screen.

How to “reconcile” using Form 1095-A

  • You’ll use the 1095-A form to “reconcile” — check if there’s any difference between the premium tax credit you got and the amount you qualify for on your taxes.
  • Before you start, check the form to make sure the information is right. If you filed your taxes with an incorrect form, you may need to file an amended tax return using the correct information.
  • If anything about your coverage or household is wrong, contact the Marketplace Call Center.



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Age-Friendly Health Care: A New Approach

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America’s senior population has grown by 34.2% in the last 10 years, and today about 54 million Americans are 65-plus.

If you’re in this group, you may take four or more medications, see as many as five doctors each year, and have at least one chronic health condition. You may also feel that your doctors and nurses often don’t listen to your preferences or fully include you in decisions about your own care.

According to a 2015 Journal of General Internal Medicine study of more than 16,000 older adults, one in five said they experienced age discrimination from their doctors or during hospital visits. Almost 6% of older adults said they faced age discrimination frequently, and their health worsened over the next 4 years.

“We must recognize that the way we manage the health care of elderly patients is not the same as how we manage 30- or 40-year-olds. We are not talking to our patients enough about what matters to them. We are getting better at managing their medications, but we don’t do as well at taking them off their medications. We don’t focus enough on their risk of falls,” says John Whyte, MD, WebMD’s chief medical officer.

Whyte recently played a key role in developing Age-Friendly Health Systems (AFHS), a new approach to care for older adults developed by the John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States. Doctors, nurses, and other health care providers who treat older people need to be better listeners, he says. “We need to ask what matters to our older patients. It’s a simple question, but it needs to be asked in an explicit way by each physician. We need to change how we approach treatment of our elderly patients.”

Could health care focus on your personal preferences and health goals as you age, not just what your doctor thinks is best for you or your test results? AFHS recommends that doctors and nurses plan care for older adults based on what they or their caregivers value most. Every medical visit or decision should cover the 4Ms, four building blocks of high-quality care:

  • What matters, so older adults set their personal lifestyle and health goals, and health care professionals plan their treatment with these goals in mind
  • Medications they take for any condition, including whether they need each drug and if any side effects interfere with doing what matters to them
  • Mobility, so they can move safely, function in their daily life, and do what matters to them
  • Mentation, to prevent or diagnose, treat, and manage memory loss, dementia, and/or depression

Many health care systems, such as the 1,200 CVS MinuteClinics, include the 4Ms in every appointment with an older adult, says John A. Hartford Foundation President Terry Fulmer, PhD. Your doctor or nurse may ask you about your personal goals, values, and preferences, but these questions can be hard for some older people to answer.

“If I say to an older patient, ‘What are your goals?’ They may say, ‘You’re the nurse, don’t you know?’” Some older people may think they need to defer to their doctor or nurse during care, and let them make all the decisions, Fulmer says.

“We need to make people comfortable with this question of what matters to you. Very often, it’s hard to get that conversation started. You might say, ‘I want to talk with you about my mobility, my mood, and my medications, all based on what matters to me.’ That’s a very robust conversation.”

How do doctors and nurses feel about an age-friendly approach to care when they treat older people?

Fulmer and Whyte are among the co-authors of a new study in the Journal of the American Geriatrics Society. The results show most primary care providers believe they should approach care for older patients differently and consider age when they make treatment decisions, but don’t always include the 4Ms in care.

The study is based on a survey of 1,684 primary health care providers randomly selected from the Medscape database during the fall of 2020. Responders included 575 doctors, 613 nurse practitioners (NPs), and 496 physician assistants (PAs).

They were asked for their opinions on age-friendly care or the 4Ms, and how they care for their older patients. While more than 90% of providers agreed that older patients “require a different approach to care than younger patients,” only 50% of doctors and PAs and 69% of NPs said they always consider a patient’s age in routine care. Only 36% of the surveyed doctors said they ask their older patients what matters to them.  

High-risk medications for older people include drugs that may cause harmful side effects or interact with other drugs, says Marcus R. Escobedo, vice president of communications at the John A. Hartford Foundation and a study co-author.

Many drugs to treat anxiety, insomnia, or pain can have side effects that lower an older person’s quality of life or are even unsafe for them, he says. Antipsychotic drugs often prescribed for older people with dementia can make them drowsy and increase the risk of falls, for example.

As we get older, our body and metabolism change, Escobedo says, so there may be medications that are not right for older adults that are too often still prescribed. “They may be taking too many medications overall. If you have lots of different providers, or if you go into the hospital, you may be prescribed medications. Then, you go home, and these drugs are not stopped.”

While 84% of doctors said they review older patients’ use of high-risk medications and screen for depression, only 78% said they take their patients off or lower their dose of high-risk meds or avoid using these drugs at all.

“If older adults do recognize possible side effects from their medications, are we listening to them? They may say something like, ‘I am just feeling off,’” Fulmer says. That’s why one of the 4Ms is to review your meds and see if any need to be changed. “We need to start that conversation about your medications with what matters to you.”

The AFHS framework urges doctors and nurses to ensure that older patients can move safely so they can do what matters to them. Your health care provider may prescribe physical therapy or exercises to help you stay mobile.

“One of the best ways to prevent falls is to encourage older people to do physical activity and just some movement. We help them build strength and balance. That will help you be more confident as you move,” Escobedo says.

The survey found that 73% of doctors, 82% of NPs, and 76% of PAs said they always screen older patients for limits on how well they can get around. However, only 56% of doctors, 61% of NPs, and 56% of PAs said they “ensure early, frequent, and safe mobility” when they treat older people.

Health care providers may screen older people for mobility problems, but they need to do more to help them move better and prevent falls, Fulmer says.

“My older patients and I often talk about pre-habilitation. That’s working to get strong before you have an event” like a fall that causes a fracture, she says. “People want control over their life. You can work with your physical therapist to get ahead of your challenges. We can say, ‘Let’s do some strength training. You can take charge of your mobility.’”

Mentation is another of the 4Ms. Only 60% of doctors, 70% of NPs, and 67% of PAs surveyed said they refer their older patients who test positive for cognitive impairment, or having some problems with memory or making decisions, for more tests and treatment for their symptoms.

Health care visits are often as little as 10 minutes long, so doctors and nurses need to ask older people how they feel and what activities they are able to do, like going to the movies, or if they can walk more than one block, Fulmer says.

The survey found that 43% of doctors, 37% of NPs, and 38% of PAs agreed that “it is up to the patient to tell me what their needs are.” Fulmer believes providers need to ask these questions and listen more carefully to their older patients’ responses.

“It’s a conversation: ‘What is front and center for you right now?’ We need to give older people a voice. Let them start this conversation,” she says. The survey’s results suggest that health care providers need more training in how to put older adults’ needs front and center in their care. 

Future generations will benefit from a more seamless health system where all your medications, health conditions, and, most importantly, personal goals and preferences are all in your chart, she says. “Good care for older adults is usually good care for everybody.”



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New Insights Into Hepatitis E Virus (HEV) Resistance

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This study from JHEP Reports investigates the development of genetic variants in HEV during treatment with sofosbuvir (SOF) and ribavirin (RBV) in patients with chronic infection. By analyzing these variants’ emergence and their resistance to the combined drug therapy both in vivo and through cell culture evaluations, the research focuses on the virus’s intra-host evolutionary dynamics. These dynamics are important for assessing current treatment efficacy and guiding the development of more effective next-generation antiviral therapies.

Combination treatment successfully lowered viral load towards the quantification limit but did not achieve sustained virological response during treatment. Variants like A1343V and G1634R, associated with SOF or RBV, emerged, with A1343V, alone or with G1634R, showing SOF resistance in concomitant in vitro treatment.

“We closely monitored HEV ribonucleic acid (RNA) levels in stool and blood during concurrent treatment to ensure that, if clearance is possible, all virus is removed,” investigators wrote. “This may also be an important monitoring procedure, as HEV often remains longer in stool, possibly indicating residual viral reservoirs. Thus, stool sequencing may increase the detection window and increase the sensitivity for the detection of minor variants. Indeed, at the end of treatment, both patients were able to clear HEV in plasma but not in stool samples.”1

3 Key Takeaways

  1. This study conducted by JHEP Reports focuses on understanding the emergence of HEV variants during treatment with SOF and RBV and their resistance to these treatments in cell culture.
  2. Researchers emphasized the importance of closely monitoring HEV RNA levels in both stool and blood to ensure comprehensive virus clearance, highlighting that HEV can persist longer in the stool.
  3. The study observed a weaker and delayed viral relapse in patients treated with a combination of SOF and RBV compared to those undergoing SOF monotherapy, suggesting that combination therapy may offer a strategic advantage in managing HEV infection.

The study involved 2 individuals with chronic HEV infection who had not responded to ribavirin therapy and subsequently received a combined treatment of sofosbuvir and ribavirin. To evaluate the treatment’s effectiveness, the investigators monitored liver enzyme levels and the presence of the virus in blood and fecal samples. They also examined the virus’s evolution using high-throughput sequencing targeted at the viral polymerase and evaluated the replication capability of resistance-associated variants using an HEV replicon system.

“As we have previously shown, highly diverse virus populations may already harbor resistance-associated variants at low frequency – such as the A1343V. RBV may thus promote virus heterogeneity which in turn promotes the emergence of variants,” investigators wrote. “However, it is interesting to note that viral relapse was weaker and delayed in these two patients, as indicated by viral loads near LOD throughout treatment, especially compared to SOF monotherapy, where viral relapse occurred between weeks 4 and 12 after treatment initiation.”1

The study’s limitation was its 2-patient sample size. Viral relapse in these patients was weaker and delayed, maintaining viral loads near the limit of detection throughout treatment, in contrast to the quicker relapse observed in cases of SOF monotherapy, which typically occurred between weeks 4 and 12. The study found evidence that HEV relapse during SOF monotherapy is associated with a specific mutation, A1343V, in the HEV polymerase finger domain. This mutation was found in a separate cohort of 8 out of 9 patients at the consensus level and was associated with a fivefold reduction in SOF susceptibility in vitro.

Administering high doses of both medications can negate the edge provided by variants associated with resistance. Given the limited number of studies currently available, future research should explore the impact of combined treatments and dosage levels, alongside tracking the diversity of HEV.

Reference

Gömer A, Dinkelborg K, Klöhn M, Steinmann E, Maasoumy B et al. Dynamic evolution of the sofosbuvir-associated variant A1343V in hev-infected patients under concomitant sofosbuvir-ribavirin treatment. JHEP Reports. Published January 2, 2024. Accessed February 15, 2024. doi: https://doi.org/10.1016/j.jhepr.2023.100989



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Birria Ramen Recipe | The Recipe Critic

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The crazy good combination you never knew you needed! Birria ramen features ultra-tender shredded chuck roast simmered to perfection with ramen noodles in a flavorful consommé soup base.

Need more birria in your life? Try these birria tacos next! They’re meaty, cheesy, and oh so delicious!

Shredded birria meat served with noodles and a rich broth.

Birria Ramen Recipe

Birria ramen has been popping up everywhere recently. And for good reason! It combines tender and juicy birria meat with ramen noodles and a flavorful red chile sauce.

I remember when I first tried birria ramen, I was a little unsure about the combination, but it ended up being so good! It’s a delicious Mexican twist on a classic comfort meal! You’ll be hooked once you try it for yourself.

Birria Ramen Ingredients

Okay bear with me, I know this is a pretty lengthy ingredient list. But you’ll be making the birria meat from scratch and you need to infuse it with all of those tasty flavors!

For the Beef:

  • Boneless Chuck Roast: The main source of protein, cut into bite-sized pieces for quicker cooking and soaking up the flavorful broth.
  • Salt & Pepper: Simple seasonings to enhance the natural flavor of the beef.
  • Olive OilUsed for searing the beef in!

Consommé/Sauce:

  • Dried Chiles: Guajillo and ancho chiles provide smoky and earthy depth to the birria ramen broth.
  • Onion & Tomato: Add sweetness, savory notes, and body to the sauce.
  • Garlic: Because everything is better with a kick of savory garlic flavor!
  • Spices: To season the broth for the birria ramen, I used a blend of pepper, cumin, coriander, oregano, smoked paprika, and kosher salt.
  • Apple Cider Vinegar: Adds a touch of acidity to balance the richness and brighten the flavors.
  • Beef Broth & Water: Form the base of the flavorful consommé.

Birria Ramen Toppings

In addition to the shredded birria meat and flavorful broth, here’s what I added to my ramen!

  • Ramen Noodles: I used dry instant ramen noodles, but you can also use fresh ramen noodles if you prefer!
  • Birria Ramen Toppings: Jalapeno for spice, cilantro for freshness, lime for acidity, and of course- some soft-boiled eggs.
Collage of the beef and broth being prepared for birria ramen.

How to Make Birria Ramen

Keep in mind that the birria meat needs about 4 hours to slow cook, so this isn’t the best recipe to make if you’re short on time. But the good news is, once you’ve cooked the beef, it’s easy to store in the fridge and use later for a quick meal!

  1. Season and Sear the Beef: Season the beef chunks with salt and pepper, heat the olive oil over medium high heat in a skillet. Sear the meat until it is browned on all sides but do not fully cook.
  2. Add to Crockpot: Add the seared meat to a crockpot.

Preparing the Broth

  1. Prepare Chiles: Cut the stems off of the dried chilies and discard the seeds by shaking them out of the pods.
  2. Toast: In a medium skillet, add the chiles, and cook for 1 minute on each side. Toast until fragrant and lightly toasted.
  3. Boil: Bring 1 cup of water to a boil and remove from the heat. Submerge the chiles in the water and soak for 15 minutes while you prepare the rest of the sauce.
  4. Cook Vegetables: To the same skillet, add the oil and onion and tomato. Sauté for 4-5 minutes, stirring occasionally, until charred and softened. Add the garlic cloves and sauté until fragrant for 2 more minutes.
  5. Blend: Transfer roasted vegetables to a blender. Strain the soaked chilies, and add them to the blender as well.
  6. Add Seasonings and Broth: Add the pepper, cumin, coriander, oregano, smoked paprika, salt, apple cider vinegar, and beef broth to the blender with the rest of the sauce ingredients and blend until smooth.
  7. Add to Crockpot: Pour the sauce and 3 cups of water into the crockpot with the beef. Cover and set the crockpot to high, cook for about 4 hours or until the beef is easily shredded.
  8. Shred: Remove the beef from the crockpot, shred it and then set it aside. Then add salt and pepper to taste.

Assembling the Ramen

  1. Cook Ramen and Eggs: Cook the ramen according to the package directions and soft boil the eggs.
  2. Add Broth and Beef: Pour about a cup of broth into a bowl, portion out some of the shredded beef into the bowl of broth.
  3. Finish With Noodles and Toppings: To the bowl add a portion of the cooked noodles, a soft boiled egg cut in half, some jalapeno, cilantro and lime wedges and enjoy! Birria ramen is best served hot and fresh.
Combining the beef and broth with ramen noodles.

Tips and Variations

  • Make it Spicier: Add a dash of sriracha or hot sauce to give your birria ramen more heat.
  • More Toppings: You can top this dish with any number of your favorite toppings! I recommend shredded purple cabbage, sliced radish, green onions, or diced red onion in addition to the toppings mentioned in the recipe.

Closeup of noodles topped with cilantro and a lime wedge.

How Long Does Leftover Birria Ramen Last?

Keep leftovers in the fridge in an airtight container for up to 4 days. If possible, store the birria beef, consommé, and noodles/toppings separately.

Picking up birria ramen noodles with chopsticks.

More Delicious Mexican-Inspired Recipes to Try

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For the beef

  • Season the beef chunks with salt and pepper, heat the olive oil over medium high heat in a skillet. Sear the meat until it is browned on all sides but do not fully cook.

  • Add the seared meat to a crockpot.

  • For the consume/sauce

  • Cut the stems off of the dried chilies and discard the seeds by shaking them out of the pods.

  • In a medium skillet, add the chiles, and cook for 1 minute on each side. Toast until fragrant and lightly toasted.

  • Bring 1 cup of water to a boil and remove from the heat. Submerge the chiles in the water and soak for 15 minutes while you prepare the rest of the sauce.

  • To the same skillet, add the oil and onion and tomato. Sauté for 4-5 minutes, stirring occasionally, until charred and softened. Add the garlic cloves and sauté until fragrant for 2 more minutes.

  • Transfer roasted vegetables to a blender. Strain the soaked chilies, and add them to the blender as well.

  • Add the pepper, cumin, coriander, oregano, smoked paprika, salt, apple cider vinegar, and beef broth to the blender with the rest of the sauce ingredients and blend until smooth.

  • Pour the sauce and 3 cups of water into the crockpot with the beef. Cover and set the crockpot to high, cook for about 4 hours or until the beef is easily shredded.

  • Remove the beef from the crockpot, shred it and set it aside. Add salt and pepper to taste.

Assemble the ramen

  • Cook the ramen according to the package directions and soft boil the eggs.

  • Pour about a cup of broth into a bowl, portion out some of the shredded beef into the bowl of broth.

  • To the bowl add a portion of the cooked noodles, a soft boiled egg cut in half, some jalapeno, cilantro and lime wedges and enjoy!

Calories: 606kcalCarbohydrates: 28gProtein: 49gFat: 35gSaturated Fat: 13gPolyunsaturated Fat: 4gMonounsaturated Fat: 19gTrans Fat: 2gCholesterol: 156mgSodium: 1613mgPotassium: 1515mgFiber: 11gSugar: 15gVitamin A: 9492IUVitamin C: 17mgCalcium: 103mgIron: 8mg

Nutrition information is automatically calculated, so should only be used as an approximation.





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Life changes? You may qualify for a Special Enrollment Period

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Published on March 23, 2023

Life change? You may qualify for a Special Enrollment Period

Open Enrollment for 2023 ended on January 15, 2023, but you may still be able to enroll in or change Marketplace coverage if you’ve had certain life events or income. Life events that may qualify include getting married, having a baby, moving, or losing health coverage. Get a full list of qualifying life changes.

Do I qualify for a Special Enrollment Period?

My income changed. Am I eligible for Medicaid or CHIP?



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After-Birth Sitz Bath Herbs DIY Recipe

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I’ve always thought that after labor, women should be able to look forward to a nice quiet vacation and recovery time. Instead, we get a precious baby and the lack of sleep that often accompanies them. This DIY sitz bath recipe is at least a little healing and pampering to look forward to during postpartum recovery.

Postpartum Sitz Bath

Herbs are wonderful for after birth and help speed recovery time. I’ve used my healing salve on both a c-section scar and a small tear (after the second day) to speed healing and they worked great. This sitz bath recipe uses an herbal infusion in a relaxing bath to ease soreness and speed recovery. You can also use it in a peri bottle or a cooled pad for extra comfort.

I used quite a variety of herbs here, but you don’t need all of them. Here’s what a sitz bath is and why they’re so great for new moms!

What is a Sitz Bath?

Sitz comes from the German word sitzen, meaning to sit. It’s a little soak for your bottom that brings targeted relief to the genital area. They can help ease pain, increase blood flow to the area, and speed healing. Sitz baths are recommended for:

  • Hemorrhoids
  • Anal fissures
  • Episiotomy stitches
  • Sore or damaged vulva and perineal area
  • Sore rectum or anal area

It’s perfect for after childbirth! Even if you didn’t tear during labor, the warm water and soothing herbs help reduce discomfort and swelling.

How to Take a Sitz Bath (Two Ways)

Drug stores sell sitz bath kits that fit into your toilet bowl. These consist of a shallow basin and sometimes a bag that feeds warm water into the sitz bath basin. You can also find a simple plastic sitz bath bowl without any bags or attachments. These are nice because they concentrate the soothing water just where you need it.

If you don’t have a sitz bath bowl, then the bathtub also works. It should be cleaned before each use though. You don’t want germs or old soap scum on your still healing bottom!

Here’s how to do a sitz bath step-by-step:

  1. If using a sitz bath, place the clean container under the toilet seat. Fill about 1/2 full with warm water or herbal tea and Epsom salt. Be sure the water temperature isn’t too hot to avoid burning.
  2. If using a bathtub, make sure the tub has just been cleaned and fill it with several inches of warm water. You want the water to cover your thighs when you sit in it. You’ll add your herbal tea and/or Epsom salts to the shallow bath.
  3. Soak your bottom in the warm water for 10-20 minutes, 1-4 times a day.
  4. Pat the area dry with a clean towel or let it air dry. Do not scrub the area.

What to Use in a Sitz Bath

Now that you know what a sitz bath is and how they work, what should you put in yours? There are a variety of herbs that are gentle and help heal the tender area (more on that below). You can also add a little baking soda and Epsom salts to your sitz bath to speed the healing process.

If you have hemorrhoids, then try dabbing a little witch hazel onto the rectum after your bath. There are also a few things that should not go in a sitz bath!

While I love essential oils, they do not disperse in water alone and they’re too harsh for the tender perineum area. Scented bath salts, bubble baths, and similar products should also be avoided.

The Herbs I Used

Herbs can be a great option for a DIY sitz bath, and you’ll notice I’ve used quite a few. You don’t have to use all of these for it to still be effective, so just use what you have.

  • Comfrey Leaf – This herb is a demulcent to soothe dry, irritated tissues. It also reduces swelling and bruises and is anti-inflammatory and antiseptic. It stimulates tissue repair and tones loose tissues.
  • Lavender Flowers – The scent helps ease tension and stress. Lavender is also antimicrobial, helps fight off infection, soothes itchiness and pain, speeds wound healing, and reduces swelling.
  • Plantain Leaf – Soothes inflammation and fights infection, mildly demulcent to soothe irritated tissues, soothes pain, burning, and itching, and stimulates collagen for faster wound healing.
  • Red Raspberry Leaf – Tightens loose tissues and reduces inflammation. Also very high in many nutrients.
  • Yarrow Flower – Eases inflammation, pain, and swelling. Staunches excessive bleeding, speeds wound healing, helps modulate blood flow, and is specifically used for hemorrhoids
  • Calendula Flowers – Soothes irritated tissues and is anti-inflammatory, antibacterial, antiviral, and antifungal. Soothes cuts, bruises, and abrasions. It’s astringent and a blood decongestant to help with hemorrhoids.
  • Shepherd’s Purse – Useful to reduce bruising and heavy bleeding. Used for wound healing and is anti-inflammatory.
  • Uva Ursi Leaf – An astringent that’s used for infections and inflammation in the lower urinary tract. Antibacterial and helps prevent UTIs.

Herbal Sitz Bath

This DIY sitz bath helps soothe tender, sore areas after childbirth. Also great for hemorrhoids and other uncomfortable areas!

Prep Time5 minutes

Total Time5 minutes

Yield: 3 cups

Author: Katie Wells

  • Mix herbs in a glass container or silicone bag. I used a large mason jar. The proportions don’t have to be exact.

  • Add 1 cup of herbs to 2 quarts of boiling water.

  • Remove water from heat and let sit for 20 minutes, covered.

  • Strain and add to a sitz bath and soak for 20 minutes. Both mom and baby can soak in the bathtub to speed cord and perineum healing.

You can use this blend in a small sitz bath or in the bathtub. Use 1/2 cup of herbs and 1 quart of water if using a small sitz bath container. 

More Ways to Use:

  • Brew with the above ratios and add to a Peri Bottle for use after going to the bathroom.
  • Pour some pre-brewed herbal mix onto pads and freeze for a pain-relieving ice pack.
  • Use a diluted mix around the baby’s cord stump for healing.

This also makes a wonderful addition to a new-mommy gift basket along with homemade natural baby care items and lotion bars for mom.

Have you ever used herbs post birth? Did they help you? Share below!



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Dole Initiates Voluntary Salad Recall

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The FDA announced that Dole Fresh Vegetables is recalling Dole-branded and private label salad kits, which were processed on the same line as a cheese that has been recalled by the manufacturer, Rizo-Lopez Foods, for the possible presence of Listeria monocytogenes.1

The recall is being issued due to possible cross-contamination of cheese contained in certain masterpacks and potentially contaminated with the bacteria.1

Just last week, The FDA announced that Rizo-López Foods (RLF) voluntarily recalled some of its specific dairy products, and that recall was associated with an ongoing, national listeria outbreak.2 According to information shared with the Centers for Disease Control and Prevention (CDC) and FDA, Rizo-López Foods may be the potential source of the outbreak.2

A listing of products subject to this recall include Dole, President’s Choice, and Marketside brands. The specific products, brand names, and lots are included in the table below. The product lot codes are located in the upper-right-hand corner of the package. Consumers who still have any of these products in their refrigerators or freezers are urged not to consume the product and to discard it immediately.

Table. Listing of recalled salad kits

Credit: FDA

Dole has said recalled salad items were distributed in the following states” AL, CA, CT, FL, GA, IN, KY, LA, MA, MD, MI, MN, MO, MS, NC, NV, NY, OH, PA, SC, TN, UT, VA, WA and WI. Additionally, these salads were distributed in Canada and include the following provinces: Alberta, British Columbia, New Brunswick, Ontario, and Quebec.

In an update provided yesterday from CDC and FDA, the number of people affected by the outbreak has remained the same. There have been 26 illnesses, 23 hospitalizations, and 2 deaths. To get a full, updated listing of the affected cheese products and brand names, consumers can go here.

Listeria in healthy people may have short-term symptoms such as a fever, headache, stiffness, and gastrointestinal discomfort, including diarrhea. However, in children, seniors, and people with weakened immune systems, this foodborne infection can be more severe and could be fatal in some cases. The infection can also cause miscarriages and stillbirths in pregnant women.2 For anyone who is suffering these symptoms after eating these products, they are recommended to contact a health care provider right away.


References

1. Dole Fresh Vegetables, Inc. Announces Voluntary Recall of Limited Number of Salad Kits Due to Possible Health Risk from Listeria Monocytogenes. FDA press statement. February 8, 2024. Accessed February 15, 2024.
https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/dole-fresh-vegetables-inc-announces-voluntary-recall-limited-number-salad-kits-due-possible-health

2. Rizo-López Foods, Inc. Voluntarily Recalls Dairy Products Because of Possible Health Risk. FDA press statement. February 6, 2024. Accessed February 7, 2024.
https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/rizo-lopez-foods-inc-voluntarily-recalls-dairy-products-because-possible-health-risk



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