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Oregon Health Plan Pays For Puberty Suppression

Some states now cover the cost of medical treatment for people who are transgender. Oregon is one of them. But, since January, Oregon is going one step further.

It now pays for drugs that suppress puberty in children who think they might want to change their gender - if they're on the Oregon Health Plan.

An upcoming story will look into the medical pros and cons of the therapy. But first, here's a look at how a 13-year-old and her family came to the tough decision to suppress puberty.

Michael was born biologically male 13 years ago in the community of Grand Ronde.

Michael's Mom, Dee, remembers bringing three dresses home for three cousins when Michael -- who now goes by Michaela -- was about six.

"When she saw those dresses, her eyes just lit up. And she said, 'who are those for?' I'll never forget it. And I said, 'well, these are for the girls. Do you like them?' And she said, 'yeah.' So I said, 'well do you want to try any of them on? If any of them fit you, do you want to wear them?' And she said, 'yeah.'"

"She just twirled and twirled in that dress it was so wonderful," Dee says.  "And that's when I knew. At that point. I'm not wrong here."

To protect her privacy, OPB has agreed not to use the real names of Michaela or her mother.

When Michaela turned seven, the family went on a trip to California where she wore dresses and went out in public as a girl.

"She had the best week of her life up to that point," her Mom says.  "And she was so open and had just so much fun."  But there were problems. "She wouldn't wear her pink and purple to school anymore, like she used to," Dee explains. "She was starting to get teased, which was way too hard for me to take."

"I don't really remember any of that," says Michaela crying, "...other than some of [what] Ray's friends did." Ray is her older brother.

The family decided to move to Portland so Michaela could attend a school where people only knew her as a girl.

"Any boy who wants to look like a girl can just grow your hair long and put some mascara on, put a dress on and they'll look very female," says Doctor Karin Selva. She is Michaela's pediatric endocrinologist at Randall Children's Hospital in Portland. "But as soon as puberty hits, that's when the body pretty much turns on someone who is transgender." So for Michaela that would mean growing an Adam's apple, facial hair and a heavy male body structure.

Dutch researchers, in a study published in the journal, Pediatrics, found that puberty suppression gave transgender youth, "the opportunity to develop into well-functioning young adults."

So last year, when Michaela started to experience the first signs of puberty, Dr. Selva started puberty suppression injections.

Michaela's family has private health insurance. But for someone on the Oregon Health Plan, the hospital says Lupron  - the puberty suppression drug - costs about $7,500 for three months.

Dr. Selva says now they need to discuss how long to keep Michaela on the suppression drugs and whether she wants to start taking the female hormone, estrogen. "Some people are ready and want the cross hormones yesterday, and they're 12. Well, we're not going to do that. That's a little young for our comfort level."

"But around 14, 15, we'll discuss with the parents and patient and talk about long term," she continues. "Because once you start cross hormone therapy, that is the permanent changes that can affect fertility and there are some things we do not know about long-term outcome for prolonged hormone exposure." As Dr. Selva tells Michaela, the important thing is that she can develop as she wants to develop, and in a way that doesn't attract unwanted attention. "No one in your school knows? Right? Does anyone know? No one has to know." The state estimates that about 175 people will use some kind of transgender treatment under the Oregon Health Plan this year, but it doesn't have figures on how many of those people might be seeking puberty suppression.

 Look for a story, Wednesday, on the pros and cons of puberty suppression therapy.

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What Fat Grizzlies Can Teach Us About Obese Humans

Grizzly bears pile on the fat every autumn. But in their obese state through hibernation, they don’t appear to suffer health consequences like overweight humans do. Scientists in eastern Washington are trying to figure out why. A new study involving those bears may yield insights into possible therapies for human obesity and diabetes.Michael Werner: Plump. Pudgy. Portly. Call them what you will, but for grizzlies, being fat is being happy.Heiko Jansen, Associate Professor, Washington State University: They’re sort of OCD eaters in the fall. They will consume so much of that that they're putting on nearly 10 pounds a day. If you translate that to pizzas, it’s about 16 large pepperoni pizzas a day.Werner: For humans, this kind of weight gain could cause some serious health problems like heart disease, stroke and type 2 diabetes. But grizzlies have trouble surviving without it.Jansen:  All their focus is on, is eating. It’s just born out of necessity. If they don’t have enough fat, they won’t survive hibernation. Brutal lesson to learn, if you’re a bear.

Werner: Grizzly bears can easily double their body fat in the lead up to hibernation. Some of the brown behemoths here at Washington State University's Bear Center will reach more than 700 pounds!Wild bears developed the ability to hibernate as a way to survive winter, when food is scarce. The fat they store up over the summer and fall fuels them through their six to seven month slumber.And during that time, their bodies change in surprising and incredible ways.Joy Erlenbach, WSU Bear Center Manager: They don’t eat or drink or urinate or defecate during the hibernating season. The bear’s metabolism decreases drastically. Their heart rate drops from somewhere around 60 beats per minute to much lower, maybe around 10 beats per minute.

Werner:  But perhaps the most remarkable adaptation during hibernation is that the bears become diabetic, or something that looks a lot like it. Their bodies become resisitant to insulin, a hormone that regulates blood sugar.Jansen: What we see in bears looks very similar to what happens in diabetic humans. The big difference, though, the bears transition into and out of that state every year. So they exhibit a reversible, if you want to call it, diabetic state. Which is not something that’s very easy to do for humans.Werner: Heiko Jansen studies seasonal changes in grizzlies, with help from the biotech giant Amgen, he is trying to solve the mystery of how the bears make this switch. The answer could one day lead to a treatment for human diabetes.But to study this phenomenon you need access to hibernating bears, and the WSU bear center is the only place in the world where captive grizzlies hibernate.

Jansen: We know so little about bear physiology that every time we generate a hypothesis, it’s almost invariably rejected because we just know so little. And despite our best efforts, the questions we ask are almost always answered in a very different way than we expected.Werner: Many of these bears were nuisance animals rescued from the wild. And studying a wild 700-pound grizzly is no picnic.Jansen: The bears are not something you can mess with. Even trained bears will rear their ugly heads at time, unpredictably. So we have to work with them in a protected environment and very, very carefully.Erlenbach: The bear center has worked to train bears because, if we can work with trained bears, we can avoid the need to anesthetize them to do simple procedures like blood draws and echocardiograms.Erlenbach: We feed the bears honey when we’re doing voluntary blood draws because they like it and it’s a way to reward them for working with us and it’s also a way to keep their mouth occupied. As soon as we start feeding them honey, we can ask them to sit, and we can ask them to lay down, and then we can ask them to stick out their foot and then they’ll stick their foot out through one of the slats in the crate and we’ll be able to do a voluntary blood draw that way.

Werner:  But not every bear is so accommodating. Some have to be tranquilized.Erlenbach:  We’ll load up a darting pistol with the drug that we’ll use to anesthetize the animal, and we’ll use that to inject the drug into the animal, and then a few minutes later, the bear will basically fall asleep.Werner:  Researchers can then draw blood and take tissue samples. The key to understanding how beras switch in and out of a diabetic state may lie in the bear's fat cells. Here in Jansen's lab they're growing grizzly fat cells, hoping to get an up-close look at the mechanism that allows grizzlies to go from being diabetic to non-diabetic, and back again.

Jansen: Our hypothesis is that it’s occurring at the fat cell, so we wanted to work with those cells directly. Somewhere within that cellular molecular machinery is a mechanism that can explain this switch. I think ultimately the hope of everyone is that we would be able to treat diabetes. Of course we all realize that it’s a very long shot and we’re working with exotic species that have mechanisms that we don’t fully understand, but insulin seems to do similar things in the bear that it does to people, and thereby understanding those mechanisms could allow diabetics to overcome their disease.Jansen: Studying the bears has forced us to rethink so many things not only about our biology but their biology. We’re understanding and learning more every day.Werner: As long as food is involved, the bears at the center are happy to help.This was first reported for the KCTS9 program, IN Close, which airs throughout Western and Central Washington Thursdays at 7 p.m.

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Oregon Health Policy Board Wants To Stop Personal Belief Vaccination Exemptions

The Oregon Health Policy board met Tuesday to try to reduce the state's vaccination exemption rate, which is the highest in the nation.

Over the last decade, Oregon's vaccine exemption rate for kindergartners has risen to seven percent.

In some schools it's as high as 70 percent.

Most of those exemptions are given because of a parent's personal beliefs. Mississippi and West Virginia don't allow that kind of exemption and more than 99 percent of their kids are vaccinated.

Oregon Health Sciences University president Joe Robertson sits on the Oregon Health Policy Board, and says something needs to be done. "The trends are alarming. When you're not vaccinated, you are a clear and present danger to others," he said. "These are potentially lethal diseases."

There's a bill in the legislature to end Oregon's policy of allowing personal belief exemptions.

The Oregon Heath Authority's new policy is that exemptions should only be allowed for medical reasons.

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OSU Study Finds Treadmill Desks Won't Help Employees Drop Pounds

Since recent studies have surfaced about the detriments of sitting all day at a desk, the modern day office has hatched all sorts of ideas to help out employees, like standing desks, telecommuting and treadmill desks. But as it turns out, walking while working is just another fad.

A new study out of Oregon State University found that while treadmill desks can help overweight or obese employees, the increase of activity only has limited results, and in the end, it doesn't help workers get their daily dose of exercise.

John Schuna, an assistant professor of exercise and sports science at OSU, determined that employees could increase the daily steps by 1,000 with the treadmill desk, but none experienced any significant weight loss or changes in their body mass index during the 12-week experiment.

"Treadmill desks aren't an effective replacement for regular exercise, and the benefits of the desks may not justify the cost and other challenges that come with implementing them," said Schuna in a statement.

The experiment included 40 participants with half using treadmill desks. Treadmill desk users walked about 1.8 miles an hour, so that they could still focus on their tasks. Researchers concluded increasing daily steps don't replace the benefits of moderate to vigorous exercise.

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Multnomah County Considers Banning Sales Of E-Cigarettes To Kids

Multnomah County held a public hearing Thursday, on banning the sale of e-cigarettes and other vaping products to kids.

E-cigarette use among 11th graders in Multnomah County almost tripled over three years.

Use started at less than 2 percent in 2011 and got to 5.2 percent by 2013. But the rate of growth is what worries health officials.

Sixteen-year-old Natalie Conte told the hearing that vaping at her school is becoming increasingly common.

"I have friends who believe that vape pens are healthy or safe," she said. "Whenever I try to give them information about e-cigarettes, what they truly contain, they turn me down, they push me away."

David Glen of Fatboy Vapors in Gresham said he agrees kids shouldn't be allowed to use e-cigarettes. But he asked the county to allow vaping in certain places.

"I'm talking about the vape shops that are specifically trying to help people get off of cigarettes," he said. "They need to be able to sample these."

The county is also considering licensing tobacco and vaping systems - but only if the legislature doesn't create a statewide system this session.

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Portland VA To Add 200 Medical Staffers

The Portland Veterans Administration will receive nearly $34 million dollars to increase staffing at its facilities around Oregon and Southwest Washington.

The Portland VA will use the funds to hire an additional 200 medical personnel.

Daniel Herrigstad, a spokesman with the agency, said the money comes with strict guidelines.

“It’s specifically earmarked toward hiring direct patient care staff to improve the access for veterans for primary care, mental health and specialty care services," he said.

The positions are especially helpful because the Portland VA is the fastest growing facility of its kind in the country, Herrigstad said.

“The average rate of growth for new veterans coming into a facility nationwide is below two percent, I believe it’s about 1.7 percent, so we’re over three times the growth rate," he said.

The federal funds are part of the Choice Act, which President Obama signed into law last August.

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Oregon Doctors Wait For Feds To Allow New Meningococcal Vaccine

Following several high-profile cases of meningococcal disease in Oregon, local doctors are waiting to see if the federal government will permit a new vaccine.

The rate of meningococcal disease has been dropping over the last two decades, but the illness can be fatal.

There is a vaccine. But it doesn't protect against the Serogroup B strain -- the one responsible for about 60 percent of cases in Oregon.

Dr. Paul Cieslak with Oregon's Immunization Program says the Centers for Disease Control and Prevention is looking at a new vaccine for that strain. "Rest assured that the CDC knows all about Oregon's outbreak," he said. 

"Since 1994 we've been working real closely with them and whenever they think of meningococcal disease, they think of Oregon and our particular problem with Serogroup B. So they're really all over it."The CDC's immunization committee meets next month to decide whether to permit the new vaccine.

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New Oregon Health Plan Enrollees Skew Younger And Healthier

The hundreds of thousands of Oregonians who signed up for Medicaid under the Affordable Care Act last year, are younger and healthier than expected -- according to a new study out of the state.

The age and health of new Oregon Health Plan enrollees is important, because on average a population is more expensive to care for if it's older and sicker.

But Lori Coyner with the Oregon Health Authority says the 380,000 Oregonians who were added to Medicaid last year, tended to be young and healthy.

"The biggest jump has been in the age 19 to 35 and then 35 to people in their 50s," said Coyner. "They do not have, it appears, a lot of what's called 'pent-up demand,' meaning that they are very sick and they haven't seen a doctor."

Other parts of the report show Oregon's Coordinated Care Organizations continue to see a decrease in ER visits and fewer hospital re-admissions. That has helped the bottom line, keeping the average cost of care below what it was 2011.

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140,000 Oregonians Signed Up For Health Insurance So Far

So far more than 140,000 Oregonians have signed up for individual insurance during this open enrollment season.

"We've been really happy with how the open enrollment period as been going for 2015," said Aaron Patnode, the executive Director of Cover Oregon.

"And the numbers that the carriers are reporting are actually right on track with where we expect to be from our enrollment projection standpoint for 2015."

Most are enrolling via the federal website, healthcare.gov. It took over from the failed Cover Oregon website. But three of every seven customers have gone directly to the insurer's website. People included in the Medicaid expansion of the Affordable Care Act, get coverage through the Oregon Health Plan.

The state says so far about 990,000 people are enrolled.

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Oregon Starts Insurance For Transgender Medical Procedures

This January, the Oregon Health Plan starts covering the cost of reassignment surgery for transgender people.  It also helps cover the cost of hormone therapy and puberty suppression.

Some politicians question the use of tax payer money, but people in the transgender community call it ground breaking.

When Alexis Paige was born 26 years ago, as far as doctors and family were concerned, she was a boy. But by 11, she began to grow breasts and wanted to be a girl, making school very difficult.

"It kind of culminated in an instance in which I was actually pressed against a wall by someone who groped my breast to see if they were real and wanted to check if I was actually a male or female," she said.

By 16 her hips began to spread. She says she always felt different -- as if she wasn't in the right body -- and it drove her to try suicide.

"I was riding my bicycle when I noticed a car coming, just in that moment, I decided I'd purposely ride out in front of it and I was hoping that it would kill me," she said.

By last year, Paige went through therapy and saw a doctor who prescribed estrogen.

"Suddenly for the first time I had energy, I wasn't feeling sad all the time," she said.  "I actually stopped getting sick. I stopped feeling sore. This was who I was supposed to be."

At that time, Paige had a job and insurance to cover medical expenses. But then she lost that job and was terrified she'd have to end the therapy.

She says knowing that the Oregon Health Plan will now cover her hormones if she losses her job again, is invaluable.

"I know there will be some people who will question that and question whether that's right or it's wrong," she said.

"There's people who argue back and forth about whether it's innate to be trans or it's psychological. And the thing is, so what? I mean, you don't look at someone with cancer and go, 'Oh your cancer wasn't caused by a genetic reason, it was environmental, so we're not going to treat you.'"

Oregon joins California, Massachusetts, Washington D.C. and Vermont as jurisdictions where Medicaid covers medical treatments for gender dysphoria.

By looking at medical billing data, the state estimates at least 175 people will use the new coverage this year.

But there are those who question its validity and expense.

"To a large degree I think the jury is still out on these procedures and whether or not they're legitimate," said Roseburg Republican, state Senator Jeff Kruse. 

He's on the Legislature's Senate Committee on Health Care and Human Services. He says the gender reassignment medical procedures are "elective" and "dubious at best."

Oregon's Health Evidence Review Commission decided to look into coverage for gender dysphoria last year -- after a psychiatrist pointed out that the state had lumped it with conditions like pedophilia.

"People with gender dysphoria that did not receive treatment had a much higher rate of hospitalizations or ER visits or doctor visits for depression and anxiety," said commission director, Dr. Ariel Smits.

"And they had a pretty significantly high suicide attempt rate -- some studies found about 30 percent.  But folks when they received the treatment that they felt was adequate for their gender dysphoria, had an almost normal rate of depression and anxiety compared to the general population."

Their suicide rate also dropped significantly.

But what about the cost?

"It may cost somewhere in the $100,000 to $200,000 range although these numbers are very vague," said Smits. 

"There's also the possibility that it'll be less, or even cost savings, because hopefully these folks will no longer be going to the ER or being hospitalized for their severe depression or suicide attempts."

While the coverage begins this month, Basic Rights Oregon says it may take the state a while to line up services.

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