Cny igh 187 july15 by In Good Health: CNY's Healthcare Newspaper

in good Wish Granted Three-year-old Grace Ratley of Canastota’s wish to go to Disney World was recently granted by Make-A-Wish Central New York.

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July • Issue 187

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CNY’s Healthcare Newspaper

‘July Effect’ Real Phenomenon or Myth?

Don’t skip the lips and other spots, local experts say

The ‘July Effect’ is the belief that medical care received in teaching hospitals during the month of July bears a higher risk of complications because it’s when many experienced medical providers go on vacation and when new physicians begin their residencies. There is even a study about that — and tons of criticism of the study

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Breast Care Partners New collaboration among local professionals to provide the most effective and beneficial treatment for breast cancer n Related: New blood test may predict breast cancer Prostate Cancer Chairman of urology department at SUNY Upstate talks about when men should worry about the disease Page 11

‘100 Deadliest Days for Teens’

Upstate Medical University’s Trauma Center is offering easy tips for teen drivers during what the AAA Foundation for Traffic Safety deemed the “100 Deadliest Days for Teens.” Page 14

Swiss chard ranks ahead of kale, the Kim Kardashian of leafy greens. Why the impressive ranking? See SmartBite inside.

Treadmills: Tread With Care How dangerous can using a treadmill be? Just ask Sen. Harry Reid of Nevada, who was recently injured while using the equipment. Studies show in 2014 alone emergency departments across the country reported 24,400 injuries associated with treadmills. We talk to local experts about it Page 9

Meet Your Doctor Padma Ram, M.D., strikes out on her own — opens first urgent care center in Oswego. “I totally believe in private practice,” she says Page 6 July 2015 •

Bionic Page 8 Pancreas Offers New Hope for Type 1 Diabetics

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Millions More Long-Term Care Workers Needed by 2030: Study Biggest need is in home and personal care aides, expert says

t least 2.5 million more long-term care workers will be needed to look after older Americans by 2030, a new study shows. This demand will remain even if there is a major shift from institutional care to home care, according to the researchers. “Even if 20 percent of elderly patients move out of nursing homes into home health care, which would be a huge change, the projected increase in demand for long-term care workers would only drop from 79 percent to 74 percent,” study author Joanne Spetz, a professor at the Institute for Health Policy Studies at the University of California, San Francisco, said in a university news release. “Filling these jobs will be a big challenge under any scenario,” she noted. Spetz is also associate director for research strategy at the Center for the Health Professions. Policy makers and educators need to “redouble” their efforts to recruit, train and maintain long-term care

workers, the researchers said. They noted that 20 percent of Americans will be aged 65 or older by 2030. Nineteen million adults will require long-term care by 2050. That number was just 8 million in 2000, the researchers added. Over the next 15 years, the biggest increases in demand will be for counselors, community and social workers, and home health and personal care aides, the researchers predicted.

“In terms of sheer numbers, the greatest need is going to be for home health and personal care aides, with well over 1 million additional jobs by 2030,” Spetz said. “The challenge is that these are currently very low-paid, high-turnover, entry-level positions. A lot of people in these jobs are living in poverty while working full time. We have to figure out how to make them sustainable,” she added.

Underage Drinking Down in Past Decade

nderage drinking in the United States is declining. But alcohol remains the most widely used substance of abuse among American children, federal researchers reported in June. The rate of current drinking (within the last month) among youngsters aged 12 to 20 fell from 29 percent in 2002 to 23 percent in 2013. Plus, the rate of current binge drinking in this age group declined from 19 percent to 14 percent during that time period. Binge drinking is defined as having five or more drinks on the same occasion. However, more American teens use alcohol (23 percent) than tobacco (17 percent) or illicit drugs (14 percent), according to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) report. The report is based on data from an annual, national survey of 67,500 Americans aged 12 and older. “When parents communicate clear expectations and they are supported by community efforts to prevent underage drinking, we can make a difference,” Frances Harding, director of SAMHSA’s Center for Substance Abuse Prevention, said in an agency news release. “However, there are still 8.7 million current, underage drinkers and 5.4 million current, underage binge drinkers. This poses a serious risk not only to their health and to their future, but to the safety and well-being of others. We must do everything we can to prevent underage drinking and get treatment for young people who need it,” Harding added.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

Americans May Be Wasting More Food Than They Think New survey on wasted food finds efforts to reduce individual waste should focus on financial costs

ost Americans are aware that food waste is a problem, are concerned about it, and say they work to reduce their own waste, but nearly three quarters believe that they waste less food than the na-

Health

tional average, new research suggests. The findings, from the Johns Hopkins Center for a Livable Future (CLF)

at the Johns Hopkins Bloomberg School of Public Health, are significant given that 31 to 40 percent of the American food supply goes to waste, primarily in homes, stores and restaurants. The top foods wasted, by weight, are fruits and vegetables, due in part to their perishability and bulk. Food waste costs Americans $161.6 billion annually. A report on the research was published June 10 in the journalPLOS ONE. “Americans perceive themselves as wasting very little food, but in reality, we are wasting substantial quantities,” says study leader Roni Neff of Bloomberg School’s Department of Environmental Health Sciences. “It happens throughout the food chain, including both a lot of waste by consumers, and a lot on our behalf, when businesses think we won’t buy imperfect food. The root causes are complex.” When listing reasons why they toss food out before eating it, consumers gave the top reasons as food safety concerns and a desire to eat only the freshest food.

in good

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Place your help wanted ad with In Good Health to get the qualified employee you are looking for. Call 342-1182 for more info.

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EMPLOYMENT

“I Believe in Touching Lives” Nurse Aide Training Program Coordinator/Instructor This position supervises all aspects of the NATP, reports to the Director of Staff Education and is responsible for the day-to-day operations of the training program. Strong verbal, written, computer and leadership skills required. FT, Monday-Friday. Current NYS RN License and two years related experience working in a nursing home and able to demonstrate competency to teach adult learners as evidenced and documented by at least one of the following: Completion of a professionally recognized course in teaching adult learners or NYS Education Department teacher certification; two years of experience teaching nursing or nursing related programs to adults in an academic setting approved by the State Education Department or other recognized accrediting body; two years of experience teaching nurse aides in a residential health care facility.

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GENTIVA, the nation’s leading provider of Home Healthcare, is hiring for exciting career opportunities in Cayuga, Onondaga and Oswego counties.

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AUBURN AND LIVERPOOL NY 2 Yrs. prior certified home care exp., BSN and clinical management exp. Sign on Bonus available for qualified candidates hired by August 1, 2015.

Rehabilitation/Mental Health Counselor Provides rehabilitation and mental health counseling services to in-patients and out-patients. Primarily works with adult patients with brain injuries, but may also work with other adult patients with mental health issues. Must have a Masters Degree in Rehabilitation Counseling or Mental Health Counseling. Must be a Certified Rehabilitation Counselor (CRC) or Licensed Mental Health Counselor (LMHC). Prefer minimum of 2 years experience as a Rehabilitation Counselor or LMHC. Must be a Certified Rehabilitation Counselor (CRC) or Licensed Mental Health Counselor (LMHC). Prefer a minimum of 2 years experience as a Rehabilitation Counselor or LMHC. Prior experience working with persons with brain injury preferred. PT, weekdays, 20 hrs/week

Positions also available for

Registered Nurses, Physical Therapy Assistants and Occupational Therapy Assistants. For more information 315-457-0184 or email Lynda.fox@gentiva.com Apply online at www.gentiva.com/careers

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July 21

Make-A-Wish holds event in Seminar in Cayuga County Chittenango to address Medicare issues Make-A-Wish Central New York will present the second annual Walk On The Wild Side, honoring the Heitkamp Family. This family-friendly event takes place from 5:30 – 8:30 p.m., Friday, July 17 at the Wild Animal Park on Lakeport Road in Chittenango. With a wide range of domestic and exotic animals from all over the world, the park is a great place for adventure, learning and family fun, according to the organization. Tickets are $25 for adults and $20 for children ages 3-12; children 2 years of age or under are free. Admission includes zoo admission, shows and demonstrations, a welcome backpack with goodies, dinner for ages 3-plus, a Safari game card with prize drawings, and so much more. To reserve your tickets or for more information, call 315-475-WISH or visit cny.wish.org.

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If you are turning 65 soon and are overwhelmed with Medicare options, you’re invited to attend a complimentary, unbiased monthly class sponsored by the Cayuga County Office for the Aging. It will take place from 5:30 – 7:30 p.m., Tuesday, July 21, in the basement training room of the Cayuga County Office Building in Auburn. The two-hour class will discuss how to determine whether the plan you are considering will give you peace of mind or potential headaches. You’ll learn about how Part D drug plans work and whether EPIC co-pay assistance is an option for you. If your income is limited, officials will provide information about programs to help pay for your insurance coverage, as well as a listing of the free and low cost preventive care under Medicare. Seating is limited, so registration is required. For more information or to register, please call the Cayuga County Office for the Aging at 315-253-1226, or visit our website at www.cayugacounty. us/aging under the News & Activities section.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

The ‘July Effect’ — Real Phenomenon or Myth A study states that medical errors increase 10 percent in teaching hospitals during the month of July as a result of new doctors coming into the profession. Experts offer a criticism of the study By Deborah Jeanne Sergeant

hen something goes wrong in a medical scenario, patients and loved ones want answers. It’s only natural to examine what went wrong to find something or someone to blame. In part, we want to understand why this happened so it can never devastate someone else’s life. Understanding also helps us gain closure about trauma. The July Effect is the belief that medical care received in teaching hospitals during the month of July bears a higher risk of complications because it’s when many experienced medical providers go on vacation and when new physicians begin their residencies. A study published in 2010 in Journal of General Internal Medicine stated that medical errors increased 10 percent in teaching hospitals, but not other hospitals, during the month of July. The data spanned from 1979 to 2006. Critics of the study assert that the time span goes back to decades predating technology that helps today’s medical personnel cross-check patient care plans. The earlier data would skew the statistics and current-day hospital processes help reduce errors.

Medical malpractice attorneys certainly see numerous examples of how different factors can add up to a serious and even fatal complication; however, Jeff DeFrancisco, attorney with DeFrancisco & Falgiatano Law Firm, said, “I’ve heard of the July effect, but I haven’t seen any evidence to truth behind it.” The firm operates several offices in Central New York, including Syracuse. Trisha Torrey, a patient advocate, writer and speaker, is very familiar with the July Effect. “I think it was a key reason for my own misdiagnosis, the impetus for my career as a patient advocacy and empowerment consultant,” Torrey said. “I do not think it’s overblown at all. If you are sick, or need surgery, and your life is in the balance, do you want beginners taking care of you?” More than a decade ago, Torrey was misdiagnosed with a rare form of cancer called subcutaneous panniculitis-like t-cell lymphoma (SPTL). Her ordeal began in July when two labs independently affirmed she was desperately sick. In her own research, she learned that even with treatment,

patients with SPTL die within years. She didn’t feel sick and her oncologist’s blood work and CT scan returned negative for lymphoma, yet he urged her to get chemotherapy or she would be dead within months. By conducting her own research and connecting with a specialist who gave her a correct diagnosis, Torrey spared herself needless chemotherapy (which, if she actually had SPTL, would not have been as an effective treatment as radiation). A biopsy confirmed she had never had cancer, but panniculitis, an inflammation of fat cells, which self-resolved. Torrey endured tremendous emotional stress and financial loss from July through September that year during her ordeal. This spring, she advised a family member facing surgery in a few months to schedule it before June 30 and, if that weren’t possible, to delay until mid-August “when the people who know what they are doing are more likely to be back at work,” Torrey said. While anyone scheduled for elective surgery won’t likely be surprised

by a new face on the day of surgery, those caring for the patient may very well be new members of the medical team, especially in a teaching hospital. If you’re nervous about an upcoming hospital stay, discuss with your providers the possibility of scheduling for a different month if thoughts of the July Effect concern you.

Not a factor

Though anecdotally some patients refer to the “July Effect”, it “has never been a factor in medical malpractice cases to my knowledge,” said Margaret E. Somerset, attorney specializing in health care with Underberg & Kessler LLP in Canandaigua. “But that doesn’t mean it can’t happen.” Somerset pointed out that courts rely upon relevant evidence on the day of a particular incident for medical malpractice suits, and the “July Effect” would not contribute significantly enough to become a factor in a case.

Healthcare in a Minute By George W. Chapman Women as family “CMO” Fifty-nine percent of women say they make the healthcare decisions for their families, according to a survey of more than 9,000 people conducted by a NYC-based think tank. This jumps to 94 percent when women work and have kids under 18. However, 62 percent of these family “chief medical officers” say they lack time to research and understand healthy habits; 50 percent reported they lacked the confidence to make the right choices for healthcare; and 35 percent actually distrust their providers. The results of this survey are not new. The industry has to do a much better job of educating and engaging the family “CMO,” especially as reimbursement shifts to pay for performance and outcome. Impact of penalties on hospitals uncertain Since 2008, Medicare has penalized hospitals for preventable or avoidable injuries like patient falls, pressure sores and infections. (Hospitals are fined 1.5 percent of their Medicare payments for failure to report.) Unfortunately, there haven’t been random follow up surveys to determine if there is a cause and effect. Are there fewer avoidable incidents as a result of the penalties? If hospitals focus on reducing these particular incidents, does it come at the cost of an increase in other types of avoidable injuries? The good news for Medicare members is that preventable hospitalizations have dropped 11 percent since 2013. The reduction can be attributed to a lot of factors, including penalties for hospital readmissions

within 30 days of initial discharge, Medicare simply not paying for certain admissions anymore and better outpatient management. Drug costs unsustainable According to a study sponsored by Express Scripts, ever increasing specialty drug costs will bankrupt our healthcare system. About 576,000 of us spent more on drugs last year than the median household income (about $52,000). That number is up 63 percent over 2013. 140,000 of the 576,000 spent over $100,000. While 98 percent of these costs were borne by insurance, they are ultimately passed on to all of us in higher premiums. Specialty drugs to treat hepatitis C and cancer are primarily responsible for the drastic increases. This is not just a USA problem. Global costs for cancer drugs exceeded $100 billion last year. The AMA and the Pharmaceutical Research and Manufacturers of America are recommending that an insurer’s summary of benefits and coverage (SBC) provide more detail about what drugs are covered so consumers can make informed decisions. If this does happen, however, there must be an independent authority looking out for insurers who purposely “dump” expensive specialty drugs from their formularies, or significantly reduce coverage, in an effort to steer away at-risk-consumers who require expensive drugs. No single insurance company could survive if it had to assume all the risk for all consumers who needed an expensive specialty drug. The playing field has to be kept level.

Less choice is not worse care Insurance plans that limit consumers to specific physicians and hospitals are nothing new. These “narrow” networks are easier to manage and control and can keep costs down. Like the staff model HMOs of old, burgeoning hospital systems and accountable care organizations will ultimately control both costs and quality by offering finite provider choices for care. The question has always been does the quality of care provided by 50 cardiologists, for example, differ from that provided by 200 cardiologists? According to a study published in Health Affairs, the average quality of care in narrow/restricted networks is actually higher than that of open-ended unrestricted commercial networks. This is not surprising because there is far better communication, cooperation and familiarity among a finite or narrower panel of providers. Premiums for 2016 Depending on your plan, most NYS insurers are once again requesting double digit rate increases for 2016. The NYS Insurance Department rarely approves the full request. Commercial insurers traditionally cite increased utilization and higher drug costs as the culprits for the rate increases. Meanwhile, by comparison, Medicare premiums (for the oldest of Americans) have remained virtually unchanged the last four years at about $105 a month for Physician Part B coverage. The nation’s seven largest insurers (Aetna, Anthem, Cigna, Health Care Services Corp, Humana, Kaiser Permanente, United) July 2015 •

added 5.6 million members with profit margins over 4 percent. Health insurance stocks hit an all-time high earlier this year. Costliest conditions While the list is pretty much unchanged over the last ten years, costs, in 2012 dollars, have risen substantially. According to the Agency for Healthcare Research and Quality: heart conditions lead the way at $101 billion; trauma was second at $93 billion; at third was cancer, which increased 48 percent over the last decade to $88 billion; in fourth place is asthma at $76 billion; mental health treatments came in fifth at $84 billion. New York State Healthcare Forum Got a question concerning healthcare? Check out “Ask the Oracle” at www.Newyorkhealthcareforum.com. The site is designed to help consumers navigate the often confusing and frustrating healthcare system. It is free and anonymous. Your email address is kept in strictest confidence and is not used for any other purpose than to respond to your question.

GEORGE W. CHAPMAN is a health consultant who operates GW Chapman Consulting in Upstate New York. To reach him, email gwc@gwchapmanconsulting.com.

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Good News Snacking on Peanuts May Extend Your Life

eople who regularly eat peanuts may live longer, a new study from the Netherlands finds. But before you get too excited, peanut butter doesn’t count. In the study, people who ate at least a third of an ounce (10 grams) of peanuts or other nuts daily were 23 percent less likely to die over a 10-year period than people who didn’t eat nuts. The biggest reductions in deaths among the nut-lovers were for deaths from respiratory diseases, neurodegenerative diseases and diabetes, followed by cancer and cardiovascular diseases, the researchers said. The benefit of eating nuts topped out at 15 grams daily, which is about half a handful, and eating more than that did not bring further decreases in people’s risk of dying during the study, Piet van den Brandt, a co-author of the study and professor of epidemiology at Maastricht University, said in a statement. But “it was remarkable that substantially lower mortality was already observed” at this level of consumption, he said. Eating peanut butter, however, despite its high content of peanuts, was not associated with a lower mortality risk. Peanut butter’s salt and vegetable oils, which contain trans fatty acids, may supersede the protective nutrition in the peanuts themselves, the researchers said.

Bad News Exercising Mind and Body May Not Protect Against Alzheimer’s

ome studies have linked doing brainy puzzles and physical exercise with a decreased risk of developing Alzheimer’s disease, or with staving off the cognitive decline associated with the disease. But now, new research suggests otherwise. The latest study on the topic found that staying physically and mentally fit may help healthy people ward off the normal mental decline that comes with aging, but it doesn’t affect the underlying causes of Alzheimer’s disease. In people with Alzheimer’s, the brain contains abnormal, fuzzy, cloudlike clusters of fragments of a protein called beta-amyloid that surround nerve cells and block their signals. This leads the person’s brain function — and, in particular, memory — to deteriorate. In the new study, researchers looked at beta-amyloid and other markers of Alzheimer’s, to see if the levels of these markers in people’s brains responded to physical and mental exercises. The results indicate that exercising “may possibly be separate from any protection against the markers of Alzheimer’s disease in the brain,” study author Keith A. Johnson, co-director of the Massachusetts Alzheimer’s Disease Research Center at Harvard Medical School, said in a statement.

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Meet

Your Doctor

By Chris Motola

Padma Ram, M.D. Physician strikes out on her own — opens first urgent care center in Oswego. “I totally believe in private practice,” she says Q: How did you come to your current position as medical director of Lake Ontario Prompt Medical Care? A: I’m a board-certified internist. I came to Oswego in January of 1995 and began working in the emergency room. Within two years I received an invitation to join Oswego Medical Consultants, which I did. I worked with them for three years and then decided to start my own practice. I started in a small office in Oswego Hospital and moved to a location near SUNY Oswego. Because I’m a primary care physician and I was getting older, I decided I needed a permanent place. We got this building, 300 State Route 10, with the help of the college, the Industrial Development Agency and Operation Oswego County. Now we’re in a center with lots of room. One of my staff suggested starting an urgent care. So we investigated and now we have our internal medicine private practice. We also have prompt care. It’s like a walk-in clinic, urgent care. St. Joseph’s imaging is there. We’re working with Oswego Hospital to try to figure out what we can provide to the community. Q: Is Lake Ontario Prompt Care a subsidiary of Oswego Health? A: No. I totally believe in private practice. I actually switched over to electronic health records in 2003, so we ended up being ahead of some of the changes in the health care law, which helped us stay private. My patients who have been with me 10 to 15 years have been very supportive. My staff has been very supportive. I want to see what I can do to give back and provide to the community. So we are going to stay

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

private, but at the same time, we want to cooperate with our community hospital. Q: What are some of the challenges of starting an urgent care center? A: There are different levels of urgent care. The challenges are usually related to cost. Fortunately, we got an IDA loan to help with equipment costs. Finding providers is also a major issue. We’re a four-exam-room urgent care. We have two nurse practitioners and one physician assistant. I’ve just hired a third nurse practitioner. She’s going to start in a month or two. But we need a physician. Currently we are open Monday through Friday 8 a.m. - 6 p.m. We’re open Saturdays until 2 p.m. I’m always here while we’re open. Q: Ideally, what hours would you like to offer? A: Ideally, I’d like to be open from 7 a.m. – 11 p.m. When we started, we tried to do 7 a.m. – 7 p.m., but it was too much to cover with our current staff. Q: You have a

background in administration from working as the director of the local medical Staffkings. Has that helped you track down potential staff? A: Yes, but Staffkings was mostly for staffing nurses and home care aids for patients with chronic illnesses. Q: What challenges and opportunities has the Affordable Care Act produced for practices like yours? A: The opportunities come from more patients having access. It has increased the number of patients we get. For primary care, I think it’s a big benefit. Some of the patients are upset about the big deductibles they have, but I think even then they seem to be settling down. I know there are a lot complaints about it, but I think it’s been good. I think it’ll be better in a few years when it’s been tweaked to the needs of the patients. Q: What kinds of patients do you usually see in urgent care? A: During the flu season we had a lot of patients with respiratory complaints and pneumonia. This year, the flu vaccine wasn’t as effective, so many patients that received the vaccine still came down with the flu. Some of them were so sick that we had to hydrate them. Q: You’ve been in Oswego awhile now, what are the challenges of providing care in a fairly remote, rural area? A: It’s one of the state’s lowest-ranking areas on health indices. The population is more spread out. Also, smoking is a big problem. It’s the habits. We have quite a bit of lung cancer. It’s difficult with smoking. We can’t really lecture them. We have to start at the school level. We see a lot of respiratory problems in winter. I think smoking plays a role. Wood stoves play a role. Q: Wood stoves? That’s one I don’t usually hear. A: People with asthma or COPD? It’s not good for them. Q: Since urgent care tends to be more geared toward acute complaints, are you able to do much preventive care? A: A lot of them come in when they’re sick, or because they don’t have a primary care physician. So we start the process there and, quite often, our office will take over for them as a primary care provider. We’ll also provide care for seasonal workers who are here only part of the year.

Lifelines Name: Padma Ram, M.D. Position: Private practice/ founder of Lake Ontario Prompt Care Medical Care Hometown: Ooti, India Education: Coimbatore Medical College at Madras University (India) St. John’s Episcopal Hospital (Far Rockaway, NY) Affiliations: Oswego Health Organizations: American Medical Association, Medical Society of New York Family: Three children Hobbies: Pets (dogs and cats), walks

GUEST COLUMNIST

New York Needs More Doctors, Better Policies to Encourage More Med Students to Stay By Assemblyman Will Barclay

ccess to quality healthcare is a necessary component for a thriving community and we are fortunate to have great healthcare facilities and providers in Central New York. That being said, our healthcare system is under stress because we continue to face shortages of healthcare professionals in New York state — particularly in rural areas. These shortages are particularly acute for primary care doctors and nurses but extend to specialty practices and other healthcare providers. The need for more doctors was confirmed by a recent report by the Healthcare Association of New York State, which found that New York needs 942 additional doctors, most (615 of them) in Upstate. The report goes on to say that there are four factors contributing to the shortage of primary care physicians: • the current primary care physician workforce is aging and therefore retiring; • fewer medical residents are choosing to go into primary care; • high medical school debt is forcing residents toward specialties that typically pay more than primary care; and • many doctors do not want to practice in rural, underserved areas of the state. In order to help alleviate this problem, a number of proposals have been put forward including, among other things, increasing funding for the Doctors Across New York program and the use of more telemedicine services. Over the past year, I have crafted legislation that also will help address our doctor shortage. My legislation, which was drafted with the assistance of Dr. Ron Uva, a leader in obstetrics and gynecology, who formerly practiced in Oswego, would provide funding to establish 50 additional residencies at hospitals in New York state. The legislation then requires those who fill and complete these residency positions to commit to practicing in an underserved area of New York state for a minimum of five years. The effect of this legislation, if enacted, is threefold. • One, it will increase the number of residency positions. All physicians must complete three or more years of residency training after receiving their medical degree. Unfortunately, due to a number of reasons, the number of residency positions in New York state and across the country is much lower than the number of students receiving their medical degrees. Accordingly, a large number of medical school graduates are unable to get the necessary training to become licensed, practicing doctors. My legislation, in a small way, attempts to address this issue. • Second, the doctors completing these residencies will be required to practice in an underserved area of New York state for a minimum of five years.

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This, like the state’s Doctors Across New York program, is meant to get doctors into rural, underserved areas. Quite simply, in exchange for the state paying for these residency positions, those doctors who benefit from the residency positions will need to provide their services to areas most in need in New York state and not simply leave the state as, unfortunately, so many NYS medical school graduates are now doing. • Third, it is a hope that by requiring these doctors to complete five years of service in a medically underserved area, they will build a practice in these areas and therefore be more inclined to stay. It is not enough to simply get doctors to practice in underserved areas for a limited duration. We want them to stay, build a practice in these areas, and become a part of the community. I understand that this legislation alone will not solve our doctor shortage and that it does not address the shortages for other healthcare providers such as nurses. However, it is a good and relatively inexpensive way to start addressing the issue and perhaps can provide the model for a larger, more encompassing program. If you have any questions or comments on this or any other state issue, or if you would like to be added to my mailing list or receive my newsletter, please contact my office. My office can be reached by mail at 200 North Second Street, Fulton, New York 13069, by e-mail at barclaw@ assembly.state.ny.us or by calling (315) 598-5185. You can also friend me, Assemblyman Barclay, on Facebook.

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Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Less can be more for those who live alone

ess is more. We’ve all heard that expression. But can less really be more when you live alone? For me, the answer is a resounding “Yes!” Here’s what I’ve discovered: When I’m pining for what I don’t or can’t have — when all I want is more, more, more — I lose my center. I get overwhelmed. In those times, I need to remind myself that less is often more, and that moderation and balance are good rules to live by. If you’ve fallen victim to the allure of “more, more, more” as I have on occasion, you may want to hop aboard my less-is-more bandwagon. Here’s what I plan to do less of this summer. Care to join me? Spend less. Have you been on a spending spree lately? I was, just last month, and now I am paying the price, literally. I just couldn’t stay away from the garden centers! For the rest of the year, I resolve to reduce my spending. How? By creating and sticking to a budget, of course, but also by following some good advice I got from a friend a few years ago. She suggested I stay out of stores (even the garden centers). Sounds obvious, right? Well, it didn’t occur to me at the time, but it works. So does throwing out direct-mail catalogs without cracking their covers.

Waste less. Wasting less goes handin-hand with spending less. I’ve been on this personal crusade for a while now, and it’s paying off. I use up what I have before I buy any replacements. No exceptions. Just this spring, I purchased some earth-friendly, lavender-infused dryer sheets. I thought it would be the “green” thing to do. I’m sorry to report that they didn’t do a very good job, but I used up the sheets anyway. I then gave myself a big high-five for doing my part to minimize waste. Eat less. It’s picnic time! Did you overdo it this weekend? Jeans a little snug? Welcome to my world. Rather than go on some fad or overly restrictive diet, I resolve to regain my waistline by cutting calories, not by cutting out major food groups. I am determined to exercise more, eat only when I’m hungry, and focus on portion control. Granted, it’s easier said than done, but I’m on a mission to get it right this summer. Are you with me? Drink less. One glass of wine, and I’m relaxed and happy. Two glasses, and I’m ready to call it a night at 8:30

p.m. (Hey, what do you expect at my age?) Besides draining me of my energy and motivation, alcohol also weakens my resolve to avoid that second helping of potato salad. If I have more than one drink, my new pledge to “eat less” bites the dust. When it comes to drinking, “twice as much ain’t twice as good,” by any standard. Let’s raise a glass to drinking less in 2015! Socialize less. Yes, socialize less — especially if your pace is frantic in an effort to avoid that dreaded “alone time.” When you slow down, you become more mindful of yourself and the things around you. This will help you appreciate what you have and make better choices. Ease into it, if you need to. It can take time, patience and practice to find comfort in your own company. Complain and blame less. Try this: For one hour, do not complain about anything or blame anyone for your troubles. If you’ve fallen silent, take heed. While chronic complaining can be a hard habit to break, I believe there is an antidote: You can choose to take responsibility for your life. When you

complain, you are declaring helplessness. When you decide to do something about what bothers you, you are declaring strength and you are taking responsibility. I have a little sign above my desk that reads, “In the face of adversity, don’t complain, just work harder.” It reminds me that I am in charge of my destiny and that complaining and blaming others will get me nowhere. Care less. That’s right. Care less about what others think of you. Care less about what your ex is up to. Care less what your kids think of your new haircut. Or what your mother thinks of how you live your life. Sure, we all need to be sensitive to other’s thoughts and feelings, but if we care too much about other’s opinions, we risk losing our own sense of self. What’s important is what you think and what you want for your life. On your own, there’s no better time to express your own independence, your own sense of style, and your own point of view. Caring less will empower you. Wanting less, doing less, and consuming less instead of more, more, more has untold benefits. It can improve your health, your relationships, and even our planet. If constantly wanting “twice as much” is sending you to your knees, I encourage you to stay down there for a moment and to say a little prayer for moderation in all things. I’m confident that better health and happiness will be your reward, nothing less. Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon, NY. For information about upcoming workshops or to invite Gwenn to speak, call 585-6247887 or email: gvoelckers@rochester.rr.com.

Bionic Pancreas Offers New Hope for Type 1 Diabetics New technology being developed at Boston University; other research, including pancreatic cell transplantation, also brings hope By Deborah Jeanne Sergeant

ew and emerging technology is helping Type 1 diabetics more easily manage their condition. About 3 million Americans have Type 1 diabetes, accounting for about 5 percent of people who have diabetes, according to the American Diabetes Association. Unlike Type 2 diabetes, in which the body doesn’t use insulin effectively and diet and exercise can help Heider mitigate the effects of the disease, those with Type 1 diabetes have a poorly functioning pancreas. It produces too little or no insulin, the hormone that converts sugar and starch into energy for the body’s use. Since it is usually diagnosed in childhood, it has been called “juvenile diabetes” though Type 1 diabetes is incurable. Using insulin injections or

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automatic pumps and constant blood sugar monitoring can help diabetics manage the condition. But these methods are laborious and especially difficult for children to handle. New discoveries may change that. Researchers at Boston University are working with the American Diabetes Association on a bionic pancreas. “It’s so exciting for people who have Type 1 diabetes,” said Travis Heider, executive director for the Upstate New York region of the American Diabetes Association. Based on a closed-loop system, the device administers insulin and micro-bursts of glucagon as its sensors realize the body’s need. The “smart” technology learns the user’s eating habits and activity patterns so it can supply insulin and glucagon accurately. The equipment interfaces with a smartphone. “No more are the days of literally counting all the carbs,” Heider said. The device is proving so successful

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

that diabetics involved with its initial testing did not want to give them up. “It was so life-changing for them, to have a taste of what it’s like to not live with diabetes,” Heider said. The anticipated date for FDA approval is 2017.

Other advances

This and other developments excite physician Ruth S. Weinstock, chief of endocrinology, diabetes and metabolism and medical director of clinical research at Joslin Diabetes Center at Upstate Medical University. For example, the continuous glucose monitoring (CGM) device uses a sensor under the skin to send and receive information wirelessly to a device the size of a cell phone. “They’re working on an app,” Weinstock said. “Many with Type 1 diabetes don’t have symptoms to warn them [about blood sugar levels]. With CGM devices, you can set an alarm if the blood sugar is too low or too high.

“Also, there’s a pump where if the alarm goes off, the person gets an infusion automatically. You get the right combination without having to prick your finger or give injections.” Technological advances include inhaled insulin sold under the name Afrezza. “This cannot be used by smokers or people with chronic lung disease,” said nurse Sharon Carroll, certified diabetes educator at St. Joseph’s Hospital Health Center. “The short-acting insulin is inhaled before a meal, so it must be used in conjunction with a basal, long acting insulin.” It includes a shelf-stable insulin pen, so diabetics can inject insulin on the go. “The patient is able to dial in the dose which promotes accuracy and compliance,” Carroll said. Longer-lasting insulin concentrations reduce the number of injections necessary.

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By Deborah Jeanne Sergeant

any people enjoy the convenience of working out on a treadmill at home or at a gym. Regardless of the weather, you can still get a great workout and stay fit. But treadmills also present a few hazards for the unwary and they were in the news recently because of two highly reported incidents. Sen. Harry Reid of Nevada was injured while exercising on a treadmill, as was CEO of Web survey company Survey Monkey, David Goldberg, husband of Sheryl Sandberg of Facebook. Goldberg died of head injury after reportedly falling from a treadmill, though heart arrhythmia played a role in his untimely death. In a New York Times blog in early May, writer Sabrina Tavernise writes that there were just 30 reported deaths related to use of treadmills from 2003 to 2012, based on information from the United States Consumer Product Safety Commission—an average of about three a year—but the number of injuries is far higher. However, according to the blogger, in 2014 emergency rooms treated 24,400 injuries associated with treadmills nationwide. In all, 62,700 injuries were reported for all exercise equipment — a category that includes swimming pools, weights, golf clubs, and trampolines. Treadmills caused the single largest number of injuries, according to the blogger. Falling while on a treadmill can cause serious injuries because the automatic belt continues to rotate while the runner is down. A fall can also cause the user to hit the head on the hardware and suffer severe injuries. Though treadmills provide an opportunity to run regardless of weather, anyone interested in purchasing a treadmill should know how to use it safely. The most important step is selecting the right treadmill for you. Consider how many people will be using the treadmill and how they will use it. One that can’t bear enough weight can malfunction and cause injury. Two walkers may use a model with a smaller, shorter deck and smaller motor, as opposed to a family couple

training for a half marathon and teens that run track to withstand that type of usage. Check the warranty to make sure you can receive service on the equipment to both prevent problems and make any needed repairs. Wayne Venditti, manager Syracuse Fitness Store, sells and services treadmills. He feels that professional set-up and maintenance is essential to safe — and long-lasting — operation. “Anything we sell, we deliver,” he said. “We don’t let the customer set them up. We service the problems, too.” When average consumers set up treadmills, they make mistakes such as not leveling the machine or not noticing the belt has shifted. The machine must be placed five to six inches from a wall at the rear of the unit in case of a fall. It should also plug directly into a wall without the cord getting pinched under the machine, otherwise the cord can become worn and the electrical cord can short out. Dawnmarie Raymond, owner of Go Figure Gym in Camillus, tells people to not stand on the belt when it’s first turned on, but to always keep the feet off to the sides. “They need to put the safety release on their clothes,” Raymond said. “When you have that on and if you fall, it stops the treadmill so you don’t have to worry about the treadmill hitting you. “You can hold onto the sides until you’re comfortable. And don’t go faster than you can handle.” John Francis, owner of Workouts B’ville in Baldwinsville (formerly known as Riverside Fitness Center), advises people new to treadmills to adjust either the pace or the grade once they feel comfortable, but not both at the same time. “Once you’re used to it, then you can do programs on the treadmill, like hill training, sprints and interval training,” Francis said. “Be careful and wear a good running shoe.” Slick-soled shoes may present a slipping hazard. It’s also smart to make sure the shoe offers good arch support.

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My Turn

By Eva Briggs

1,000,000,000,000 That’s 1 trillion and that’s the number of microbes in our bodies

art of what makes biology so interesting is studying other creatures and their interactions in the natural world. Most of us think in terms of ecosystems made of the big things we can easily see — whether it’s a local forest, an African jungle, a Pacific coast rainforest or a coral reef. But the microbes harbored in and on the human body are organized into their own ecosystems. The average human body is made up 10 trillion human cells but hosts 100 trillion microbes. (One trillion is 1,000,000,000,000 or one million million!) One important microbiome (bacterial ecosystem) exists inside our intestinal tract. In fact, over half the dry weight of your feces comes from bacteria. There may be as many as 1,000 species of bacteria in your gut, though a mere 30-40 species account for 99 percent of the total. There are also a smattering of fungi and protozoa. These tiny organisms are essential to proper functioning of our digestive system. They aid in breaking down nutrients into constituents that we can absorb. They produce certain vitamins

such as vitamin K and biotin. They help prevent disease-causing organisms from gaining a foothold in the gut. It turns out that even among normal healthy people, there are several distinct gut ecosystems or enterotypes — just like there are different blood types. But we don’t know a lot about what causes these different enterotypes — genetics? Environment? Or do they arise from chance bacterial colonization early in life? It’s too early too know, but perhaps someday knowing a person’s gut ecotype will be clinically useful in choosing the best diet or drug. There is also some fascinating research suggesting that intestinal bacteria may influence behavior. The research was done in mice. One study looked at mice who had chronic colitis and anxiety-like behavior. Feeding a probiotic bacterium —“Bifidobacterium longum” — changed the mouse behavior to a much less anxious pattern. Other studies confirmed that altering a mouse’s intestinal bacteria — with antibiotics or by transplanting intestinal

microbes from one individual to another — altered anxiety-related behaviors. These behaviors involved activity level and willingness to explore open spaces. Since mice can’t tell us if they’re feeling anxious, researchers assume the more active, inquisitive mice were less anxious. How could this work? There are several theories. One is that the bacteria are sending signals to the brain via the vagus nerve. In some studies altering the gut bacteria only changed the behavior of mice whose vagus nerves were intact. Cut the nerve, and the effect disappeared. Another theory is that bacteria produce neurotransmitters — chemi-

cals involved in brain signaling — such as serotonin and brain-derived neurotrophic factor (BDNF). After all, many widely used antidepressant medicines act by affecting serotonin. It seems that altering the intestinal flora affects behavior more in young developing mice. So perhaps this research won’t translate into a way to change behavior in adult humans. Even more intriguing, it leads one to wonder about whether the overuse of antibiotics could change brain development in babies and children? We do know that sometimes antibiotics can kill the good normal gut bacteria and allow bad bacteria to flourish. An especially bad bug is called “Clostridium dificile” or “C. diff” for short. When “C. diff” gains a foothold, it causes diarrhea that can be debilitating and hard to treat. It’s nice to know that you are never alone, that you will always have the company of trillions of tiny microorganisms to keep you company. Eva Briggs is a medical doctor who works at two urgent care centers (Central Square and Fulton) operated by Oswego Health.

I am Jerry Stanard.

Jerry Stanard is counting his blessings these days. After experiencing his second severe headache in two days, his wife, Barb, decided he needed medical care at the Fulton Urgent Care Center. It’s very likely that trip saved his life. It was just 20 minutes after testing that Jerry learned he was experiencing a life-threatening brain hemorrhage. He was transferred immediately to a higher level of care. www.oswegohealth.org

“The level and promptness of care at the Fulton Urgent Care Center is allowing me to tell my story,” Jerry said. I am Jerry Stanard. This is my story.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

SmartBites

By Anne Palumbo

The skinny on healthy eating

Swiss Chard Packs a Nutritional Wallop

ome produce just gets all the press. Kale — the Kim Kardashian of leafy greens — is one such vegetable. Sure, it’s loaded with benefits; and, yes, it’s a vitamin K and calcium hotshot; but it’s not the only nutritious green out there. Its humble cousin, Swiss chard, is also packed to the max with health benefits. A recent report published by the Centers for Disease Control that ranked 47 “powerhouse fruits and vegetables,” in fact, placed Swiss chard above kale. Why the impressive ranking? In a word, Swiss chard is an antioxidant superstar. Research has demonstrated that chard contains a rare and diverse variety of antioxidants that help reduce both inflammation and oxidative stress. Because chronic inflammation, especially when coupled with damaging free-radical stress, has been shown to increase our risk of obesity, Type 2 diabetes, high blood pressure, heart disease, certain cancers and several forms of arthritis, Swiss chard and its huge entourage of antioxidants seem primed for the limelight. Swiss chard has been called a “diabetic’s best friend”— for numerous

and unique reasons. One, multiple animal studies have shown that one of chard’s premiere antioxidants helps to steady blood sugar, especially following a meal. Two, chard’s good amount of fiber and protein also help stabilize blood sugar levels, since they help regulate the speed of digestion and keep food moving at the right pace through our system. Three, promising research has demonstrated that chard may help pancreatic cells — the cells responsible for the production of insulin — regenerate. And four, repeated studies on animals have revealed that chard may protect the liver from diabetic damage. Calling chard a “bone’s best friend” would not be out of the question either. Like other leafy greens, Swiss chard is loaded with vitamin K, with one cooked cup providing 700 percent of our daily needs. Vitamin K,

which helps blood clot properly, is a key ingredient in maintaining strong, healthy bones. And although chard does contain bone-healthy calcium, it also contains oxalates, which can bind up calcium and make it unavailable to the body. Since oxalic acid is broken down in cooking and doesn’t interfere with the absorption of calcium present in other foods, many nutritionists recommend that we cook our chard and also combine it with calcium-rich foods, like cheese, that can be easily absorbed. Last but not least, this low-calorie vegetable is a super source of vitamin A, delivering 200 percent of our daily needs in one cooked cup. This workhorse vitamin is needed for normal bone growth, healthy skin, eyesight and proper tooth development. Helpful tips: When buying Swiss chard, look for firm leaves that are vivid green, not wilted, and unblemished. Stems may be white, yellow or red, with no noticeable flavor differences between the colors. Do not wash Swiss chard before storing. Place it in a plastic storage bag, squeeze out as much air as possible, and store it in the refrigerator for up to five days.

chopped 1 tablespoon olive oil ½ teaspoon salt ¼ teaspoon black pepper 1/3 cup water ¼ cup dried cranberries (or currants) Lemon zest from 1 lemon 1 tablespoon (or more) fresh lemon juice ½ cup toasted slivered almonds 1/3 cup crumbled feta cheese Cut stems and center ribs from chard, discarding any tough parts near base, then cut stems and ribs crosswise into ¾-inch-thick slices. Coarsely chop leaves. Cook garlic in oil in large heavy pot over moderately low heat, stirring occasionally, until pale golden, about 2 minutes. Add chard stems and ribs, salt and pepper; cook, stirring occasionally, about 4 minutes. Add chard leaves and water; stir well, then increase heat to medium and cook, covered, stirring occasionally, until leaves are tender, about 5 minutes. Remove from heat and stir in cranberries, lemon zest, lemon juice, toasted almonds, and feta cheese. Makes about 4 servings.

Braised Swiss Chard with Dried Cranberries and Feta Adapted from Gourmet 1 bunch Swiss Chard 2 large garlic cloves, finely

Anne Palumbo is a lifestyle columnist, food guru, and seasoned cook, who has perfected the art of preparing nutritious, calorie-conscious dishes. She is hungry for your questions and comments about SmartBites, so be in touch with Anne at avpalumbo@aol.com.

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Women’s issues False Breast Cancer Alarm Has Negative Impact on Health T he psychological strain of being told that you may have breast cancer may be severe, even if it turns out later to be a false alarm. This is the finding of new research from the University of Copenhagen, which has just been published in the scientific journal Annals of Family Medicine. Researchers call for improving screening accuracy, thus reducing the number of false-positive mammograms. “Our new study shows that facing a potential breast cancer diagnosis has a negative effect. So far, we have

believed that women who only had to undergo physical examinations or additional mammography would feel mentally better than women who had to undergo biopsy or surgery. It now turns out that there is no difference between having to undergo a physical examination or surgery. Being told that you may have cancer is what affects, stresses and worries you,” says Bruno Heleno from the Research Unit for General Practice, University of Copenhagen. “We must do everything we can to

reduce the number of false-positive mammograms. We must also be better at informing women that there may be psychological consequences associated with a mammography screening, and that many women receive false positives. For each woman who dies of breast cancer, there are 200 women who receive a false positive, says John Brodersen, associate research professor at the research unit for general practice, University of Copenhagen.

Menopause & Complementary Medicine More women turning to alternative medicine for menopause without medical guidance

he use of complementary and alternative medicine (CAM) is increasing for the treatment of menopausal symptoms but often without the guidance of a clinician. That’s according to a new study reported online in June in Menopause, the journal of the North American Menopause Society (NAMS). As a result, the authors suggest that healthcare providers — in particular family medicine practitioners — need to be more aware of the various CAM therapies and take a more active role in guiding patients through their options to more safely and effectively coordinate their care.

Ongoing fear of the potential risks of hormone therapy is cited as a primary reason for the growing use of CAM among menopausal women (including pre-, peri- and postmenopausal) in recent decades, according to the study. CAM is a general term for healthcare practices and products not associated with the conventional medical profession. Some of the more commonly accessed CAM practitioner groups include massage therapists, naturopaths/ herbalists, chiropractors/osteopaths, and acupuncturists. The more popular self-prescribed CAM supplements/ activities include vitamins/minerals, yoga/meditation, herbal medicines,

Strong Bones After 50? Women May Not Need Next Test Until 65 Fracture risk was very low for younger postmenopausal women with no osteoporosis, study found

postmenopausal woman who is 50 and still shows “normal” readings on her bone density test may not need her next such test for 10 or even 15 years, a new study finds. However, researchers led by physician Margaret Gourlay of the University of North Carolina at Chapel Hill stressed that younger women who do show signs of bone loss are at high risk for a major fracture, and do require regular testing. The study involved almost 4,100 postmenopausal American women between the ages of 50 and 64 who took part in the ongoing Women’s Health

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Initiative study. All of the women had undergone a bone mineral density test to assess their risk for fractures and osteoporosis. The women were not taking hormones, calcium or vitamin D supplements. They also had never had a broken bone, the team said. The results: Among women whose tests showed no signs of osteoporosis, it took nearly 13 years for just 1 percent of the youngest women, and almost eight years for 1 percent of the oldest women, to suffer a spinal fracture or broken hip. It also took roughly 12 years for

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

3 percent of the younger women and nearly nine years for 3 percent of the older women without osteoporosis to sustain a spinal fracture or break a hip, wrist or arm, Gourlay’s team said. The researchers believe that — barring significant health issues — younger postmenopausal women with no sign of osteoporosis do not need a repeat bone mineral density test for 10 to 15 years. The study was funded by the U.S. National Institutes of Health and published in the June issue of Menopause.

aromatherapy oils and/or Chinese medicines. “There is still much to be learned in the CAM arena and women need to understand that just because something appears natural does not necessarily mean it is without risk, especially for certain populations,’ says NAMS Medical Director Wulf Utian, a physician. “In the meantime, this study does a good job of alerting clinicians to the growing interest in CAM alternatives and of the critical role of health providers in helping educate patients on the potential risks and benefits of all options.”

Breast Care Partners Emphasizes Team Approach New collaboration involves breast-health professionals in CNY working to provide the most effective and beneficial treatment for breast cancer By Hannah McNamara

ne in eight women in the United States will be diagnosed with breast cancer in her lifetime and it’s the second-leading cause of death among females. Breast Care Partners, a new collaboration of breast-health professionals in Central New York, are working to provide the community the most effective and beneficial treatment for breast cancer. This new model of breast care is a collaborative approach called “multidisciplinary care” and has proven to be the most effective way to beat breast cancer, according to its proponents. Under the multidisciplinary approach, each patient is evaluated with a team of numerous breast-care professionals. The team is experienced in the evaluation of breast abnormalities in order to develop the best possible treatment options for each individual patient. “It’s becoming the new model of cancer care and it’s a real partnership,” said Kara Kort, a surgeon at St. Josephs Medical Center in Syracuse. Since every woman has different circumstances and health concerns, the health care providers within this collaborative Schu unit understand how important it is to make sure every patient has her own tailored breast care treatment plan. William Schu, a surgeon at Crouse Hospital, and John Gullo, an oncologist at Hematology-Oncology Associates of CNY, first discussed the concept of Breast Care Partners about two years ago. “I was motivated to start this program because I felt we take care of breast cancer patients and breast health in general, but we don’t have an organized care system,” Schu said. For the past two years, Breast Care Partners has focused on gathering all of the best breast care physicians from local health care centers such as Hematology Oncology Associates of CNY, CNY Surgical Physicians, Crouse Hospital, Crouse Radiology Associates, St. Joseph’s Physicians Surgical Services, St. Joseph’s Medical Center and St. Joseph’s Imaging Associates. Although they are separated by location, together they are committed to changing the lives of women in the community.

Cream of the crop

“I recognize we have excellent physicians in the city who provide top level care for patients and I just wanted to bring them all together,” Schu said. “The final product will be a multi-disciplinary breast care system that will offer a connectedness between all levels of breast health specialists and navigation between all of the processes, so it will be carried out smoothly for patients even though we’re not in

one building,” said Schu. At Breast Care Partners, a team is commonly made up of a primary care physician, a breast surgeon, a breast care nurse, medical and radiation oncologists, as well as a nurse navigator, which is a unique aspect to the multidisciplinary system. Nurse navigators guide patients through the system in order to better help them understand processes and outcomes. “The nurse navigator really gets the process moving forward and they are very well thought of by patients because they are the first person to connect with them,“ Schu said. “They are really the glue to the process of moving the patients through the care.” In Breast Care Partners, there are two nurse navigators. One navigator is located at each of the hospitals involved in the collaboration. In cases where a patient is referred from their primary care doctor or gynecologist for abnormal imaging, then a practice navigator picks up the baton and moves forward with the patient and their breast care treatment. “There are so many steps through the process and they are all different procedures that the patient has no experience with,” said Katie Tindall, a certified nurse navigator at Crouse Hospital. “I can make sure the next step is already taken care of and they

don’t have a wait time that can cause any anxiety.”

More efficient process

“As a practitioner, if I have the nurse navigator engaged in the process, it’s a much more fluid process,” Schu said. “Patients connect with them and they are available to the patients at all times through the process for moral support, questions or scheduling.” Patients are offered direct access to nurse navigators and are able to call them at any time with questions, which is important to make sure their experience runs smoothly, Tindall stated. “Our overall job is to evaluate the patient, consult and discuss the patients amongst ourselves and the multidisciplinary team and come up with a consensus for care,” Schu said. “Since we’re situated in a broader region and not just in one place, we straddle the whole community so there’s a lot of avenues into this system that aren’t just going to one place, so that’s the beauty of it.” Breast Care Partners also offers a handful of patient support groups for women in the breast care program. These include programs for caregivers, children learning to adjust, online coping classes and patient mentor programs. The practitioners recognize that although support groups may not be for everyone, it’s vital that they offer

the connections for support groups in order for patients to warm up to the idea of them. “There are a lot of other psychosocial needs that women have going through this and I think that’s where the support groups come in,” Kort said. “Physicians do a great job of taking care of what they know best, but there are a lot of other components to health care and things like support groups are very vital in the whole process.” Breast Care Partners are in the stage of finalizing the process and hope to have all the credentials for a multidisciplinary breast care system by the end of this year. “My long-term goal for Breast Care Partners is to create a system of care that’s credentialed in that all players are practicing cutting-edge medicine,” Schu said. “In terms of expanding our role or our geographical presence, I’m hoping that over time there will be more recognition of this system of care.”

Can a Blood Test Predict You’ll Get Cancer? Possibility of predicting breast cancer through metabolic blood profile could add yet another weapon in the fight against breast cancer By Deborah Jeanne Sergeant

iagnosing and treating breast cancer early offers the best chances of beating it. A new test developed by researchers at the University of Copenhagen may be able to predict a woman’s likelihood of developing breast cancer before it’s even present. Though still in the experimental stage, the possibility of predicting breast cancer through a comprehensive metabolic panel of blood tests could add yet another weapon in the fight against breast cancer. Mammography is about 75 percent accurate, but can only detect cancer already present. “I am very interested in any tools being developed to enhance our prediction of a woman’s risk of breast cancer over the immediate time period as well as over her lifetime, and strongly advocate early detection,” said physician Gloria Morris with Hematology-Oncology Associates of Central New York. Morris hopes that research on the blood panel will continue using a larger group and that the subjects will be studied over a longer period of time. The test is purported to show an increased risk with 80 percent accuracy.

That can arm women and their physicians with the knowledge they need to mitigate the patients’ risk with the other screening tools and treatment options available. “If you had something like that test that’s completely accurate, it would be akin to the breast cancer gene,” said physician Kara C. Kort of St. Joseph’s Physicians. Kort added that “it would be great if we could better predict who was going to get breast cancer because then we could focus screening more closely on those individuals. Then you have to say to yourself, ‘What do you do with those people?’” She compared that group with women who have BRCA1 or BRCA2 gene mutation that indicates a much greater likelihood of developing breast cancer. Theoretically, women whose blood test is positive for high breast cancer likelihood would face similar follow-up choices. Typically, women genetically predisposed to breast cancer can choose from among a few options, including more frequent screening using MRI. Insurance usually covers the more July 2015 •

expensive screening for women with the mutated gene. They could also take drugs such as tamoxifen, which has been shown to prevent breast cancer but bears negative side effects. Double mastectomy, the last, most radical approach, leaves up to a 5 percent chance of developing breast cancer since it’s difficult to remove all the breast tissue. Though the blood test’s 80 percent accuracy seems impressive, 20 percent of women could receive a false negative. Especially women with additional risk factors, such as family history of breast cancer, should continue to remain vigilant with the screening regimen their doctors recommend. Since 87 percent of breast cancer occurs in women with no family health history, every woman should stick with the screening her physician recommends. At present, most medical professionals agree that annual, baseline mammograms should begin at age 40, unless factors such as family medical history of breast cancer, which sets the baseline at 10 years younger than when the relative received a breast cancer diagnosis.

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Women’s issues Urinary Tract Infections Harder to Treat By Deborah Jeanne Sergeant

rinary tract infections (UTIs) have become harder for physicians to treat. New strains of bacteria resistant to antibiotics have developed, making the infections more difficult for doctors to treat, especially in populations of immuno-suppressed women. These include diabetics, cancer patients receiving chemotherapy and people receiving immunosuppressant drugs such as for rheumatoid arthritis and fibromyalgia. Jason Donovan, physician assistant with Vitalize Medical in Rochester, treats clients from Buffalo to Syracuse. He said the problem has caused physicians to up the ante and perform intramuscular injections and IV therapy to treat and beat these infections. In addition to those who are immuno-suppressed, “the aging population as a whole is experiencing this,” Donovan said. “There’s a lot more aged women developing these infections.” Part of the reason this has become a problem is that physicians have been

too eager to appease patients who demand antibiotics for treating viral infections or minor bacterial infections that should self-resolve. This causes bacteria to develop stronger strains. As a result, it’s harder to treat UTIs because the bacteria resist treatment from antibiotics. Changes in estrogen levels, such as during young adulthood and after menopause, is when many women get UTIs the most. The changes in hormone level can lower the level of good bacteria and allow the bad bacteria to multiply. Some post-menopausal women receive relief from applying vaginal estrogen cream, which helps improve the pH level so the good bacteria can thrive; however, some of its contraindications include women with a personal or family history of breast cancer. Fortunately, women have other options. Laurel Sterling, registered dietitian and integrative dietitian and wellness educator at Natur-Tyme in

KIDS Corner ‘100 Deadliest Days for Teens’ Upstate Medical University’s Trauma Center offers tips to keep teen drivers safe

he Let’s Not Meet By Accident program of Upstate Medical University’s Trauma Center is offering easy tips for teen drivers during what the AAA Foundation for Traffic Safety deemed the “100 Deadliest Days for Teens.” Upstate’s tips include how teen passengers can also help teen drivers stay focused on the road as well as tips for parents. “Despite progress in car safety

regulations and new technology, motor vehicle accidents remain the leading cause of death for drivers ages 15 to 19,” said Kim Nasby, Upstate Trauma Center’s injury prevention coordinator and Let’s Not Meet By Accident instructor. “We at Upstate want to ensure that teens, their parents and the other drivers are properly prepared for the coming months, as well as encourage everyone to start practicing safe habits every day. ”

Page 14 • IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

Syracuse, recommends drinking juiced celery and parsley and also hibiscus tea. Supplements D-mannose and cranberry extract can also support urinary tract health. Drinking cranberry juice may seem a good option; however, most cranberry juice is sweetened with sugar or a highly sweet juice such as apple juice. “[Include] no sugars in diet,” Sterling advises women with chronic UTIs. “Alkalize [the] diet.” Sugar, for example, is acidic, and that helps bad bacteria to flourish. “[Take] probiotics, especially lactobacillus reuteri and lactobacillus rhamnosus,” she added. Probiotic supplements help re-establish the good bacteria and diminish bad bacteria. All of these supplements are available over the counter at most health food stores and some pharmacies. While most yogurt contains probiotics, avoid the sweetened kind and go with

Tips for teen drivers and their teen passengers

The most common distractions for teen drivers include cell phone use and texting, driving under influence of alcohol/drugs, talking with passengers, and the car radio. Avoid distractions by: • Turning your cell phone off while driving. If not possible, put the phone on safe mode or download one of the many apps that prevents phone use while driving. Some apps offer settings that automatically reply to text messages. Also, teen passengers can hold the teen driver’s phone and respond to calls or texts for them. If the cell phone must be used by the driver, pull off the road at a safe distance and use the phone. • Having a back-up plan to avoid driving, or driving with someone under the influence of alcohol or drugs. Underage drinking and/or drug use while driving is illegal, dangerous and is proven to be deadly. Teen passengers should refuse to ride in a car with a teen driver who is under the influence. Remember, parents or other caregivers would much prefer a phone call for a pick-up than a teen driving under the inflence of drugs. • Limiting your vehicle to one passenger, if possible. Also, there is plenty of time to socialize after the ride, so teen passengers should reduce conversation and movement while on the road with teen drivers. Also, respect the teen driver and do not encourage negative behavior, such as speeding. • Finding your preferred radio station or playlist before you start the car and sticking with it until you reach

plain yogurt instead. Donovan added that careful hygiene can also help, such as wiping from front to back after urination and keeping the area clean and dry throughout the day. In general, eating right, getting enough rest, exercising and treating any other health issues should help women resist UTIs.

your destination. Keep music at a low level and save the dancing for home. • Reviewing maps and directions before leaving for an unfamiliar destination. GPSs should be placed in appropriate places that do not obstruct the driver’s view. If a GPS or map needs to be consulted, pull over at a safe distance. Teen drivers and teen passengers should also prepare for travel by checking the weather each day. • Keeping sunglasses in the car. The sun may also be an outside distraction for teen drivers. When buying sunglasses teens should opt for sunglasses labeled ‘UV 40’ or polarized lenses, to reduce glare from reflective surfaces like glass or polished metal. Remember, all drivers, not only teens, should signal when changing lanes, wear a seatbelt, turn on headlights at night and during bad weather and always obey the speed limit. It takes only seconds to lose control of the car so don’t feel pressured by the flow of traffic to speed. Maintain a larger buffer zone with faster speeds. Let’s Not Meet By Accident is a free interactive injury prevention program designed by Trauma Services at Upstate to enlighten young drivers about the harsh realities of bad decision making behind the wheel. The program is offered once a month for up to 150 students from various schools throughout Central New York. The program services more than 40 area high schools. For more information, contact Let’s Not Meet By Accident: 315-464-4779. Submitted by Upstate Medical University’s Trauma Center.

Parenting By Melissa Stefanec melissa@cnyhealth.com

Advice on Giving Advice A dvice. It’s the one thing every parent has more than enough of, besides crumbs and laundry. Everyone wants to give it, and a lot of people don’t want to hear it or take it. Parenting advice is everywhere. It’s gushing out the mouths of [sometimes] well-meaning family and friends. The Internet is fraught with it. Every time you turn on the TV or open your browser, there is some sort of parenting or child-rearing guidance waiting to accost you. Sometimes parents go looking for it, and other times we are slapped upside the head with it. So that’s why, when I started writing about parenting, I was a little worried. I was adding my voice to the constant thrum that many parents try so hard to tune out. I decided to do it anyway, and I haven’t looked back. My daughter is turning 4 years old. For those of you keeping track, that means I have written more than 50 parenting columns. Every month, I try to make my voice heard among the masses by spouting off about topics I think other parents will find interesting. Over the last four and a half years, I made some allies and some enemies when doling out my parenting advice. It can be challenging to stay respectful, passionate, humorous and engaging. Some columns reflect that struggle better than others (I recognize that is not an achievement). However, I think I am getting better at giving advice. So, ad nauseam, here is my advice on giving advice because, let’s face it, most parents love giving advice, but hate listening to it. It’s very easy to alienate someone with advice. Giving advice is an art form, and although I am a work in progress, I want to share what I have learned thus far. Always be respectful (even when you are very angry) Sometimes I get fired up about a parenting topic. Sometimes, someone emails me (or my publisher) when he or she is all fired up about a topic. My best piece of advice, regarding advice, is to never give advice or feedback when you are fired up. If you simply have to put your words on paper, do so. Just make sure that paper or email sits idle for 24 hours. Do not drop it in the mailbox or hit send. We are never our most reasonable or kind when we are worked up about something. Wait until you can be respectful before you advise. Share what you did, not what another should do. No one likes to be treated like a bad puppy and chastised and ordered around. People don’t want dictation when they are looking for input. When I give advice, I try to say what I do, not what I think others should do. Who

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I am to try to tell every parent how to live his or her life? I figure sharing what works for me is more useful then telling people what to do, and hopefully my advice is better received as a result. Reconcile the fact that not everyone will agree with you, and that’s peachy. If I always tried to please everyone, I would go insane. That’s true in life and true in advice. I know my columns are going to rub some people the wrong way, and other times I am sure I have made some people angry. You can’t give advice without angering someone every once in awhile. Just stay respectful and stay cool and keep on keeping on. Play devil’s advocate with yourself and accept you will give bad advice. I don’t pretend to have all of the answers. When giving advice, I always try to be empathetic. I try coming at a situation from the opposite viewpoint. It helps to keep me humble. I think that’s the best way to avoid alienating people. Sometimes I hit a home run, and other times I don’t. We all have to learn to live with that when it comes to ourselves. Don’t be pompous or haughty. No one likes a know-it-all. No one wants to be condescended to. No one wants to feel as though he or she is incompetent or an idiot. Arrogance has a way of doing all of these things, so I try to keep it out of my advice and life. Understand there is often more than one answer. Just because something works for me, doesn’t mean it’s going to work for someone else. Every child is different and there is not a blanket approach or perfect formula for getting this parenting job done. Parenting is a very personal endeavor, and there are many paths one can take to arrive at the same destination. Encourage people to take those other paths. The world will be a better place for it. If you hurt someone’s feelings when offering advice, apologize to him or her. You can stick to your guns and still be sympathetic. Issuing a simple “I’m sorry” never killed anyone. When you are passionate about a topic, it can be easy to alienate, offend or criticize, and often times this is completely unintentional. Make amends anyway. We all want the same courtesy when the shoe is on the other foot. So there you have it, my advice on giving advice. You can email melissa@ cnyhealth.com with your advice for advice givers (or with prototypes for that fruit-snack dispensing kitten I am still in the market for).

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SummerSafety Sunscreen: Don’t Skip the Lips and Other Spots By Deborah Jeanne Sergeant

ummertime is sun time. Many people take a few moments to apply sunscreen to save themselves from a nasty burn and future skin damage, but some don’t apply it everywhere they should. “Anything open and exposed needs to have sunscreen, like tops of your feet, earlobes, back of the neck,” said Martha Ryan, senior director community engagement for the American Cancer Society for Upstate New York. Many people miss these areas or feel uncomfortable Farah applying sunscreen there, though they should do so. “Wear a hat to protect your head,” Ryan said. “Its visor can shade your ears, face, and the back of your neck.

Wrap-around sunglasses can protect your eyes.” Since it’s difficult to keep sunscreen out of the eyes, she advises wearing wrap-around sunglasses to protect them. Make sure they are UV-rated. Sport sunscreen tends to run less and resist stinging the eyes when its user sweats. Sunscreen should be broad-spectrum, protecting against UVA and UVB rays and bear a 30 SPF rating or higher. Re-apply every four hours or after each time you towel off. Joyce Farah, a dermatologist with Farah Dermatology and Cosmetics in Syracuse, said that to protect the part, or, for those with thin or short hair, the entire scalp, a hat makes it easy. “Hair gives you a five SPF,” Farah said. “Since you can’t put sunscreen on a full head of hair, you should wear a hat.” Another often forgotten area is right under your nose. “Most people don’t put anything on their lips, but a few lip balms have

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

sunscreen in them,” Farah said. “Lip gloss is actually not a good thing to put on the lips because it intensifies the UV exposure.” Lipstick typically does not contain SPF, so check labels. Many makeup manufacturers are getting sun-smart to protect their users. Some foundation primer, liquid foundation and powder also offer varying levels of SPF; however, those containing titanium dioxide or zinc oxide offer the best protection. “Another area people forget is their hands,” Farah said. “Particularly if you’re going on a road trip, your hands are on the wheel and the windshield isn’t protective.” Reapply sunscreen to your hands as you’re out and about. Beware of gaps such as at the lower back between the hem of your shirt and the waistband of your shorts if you’re bending down to garden. “Another area often missed is the top of the feet and toes,” Farah said. “People put sunscreen down their legs,

but forget their feet. We see the tan line or burn line on their feet when they come in wearing sandals.” A day at the beach isn’t so much fun for your skin. While reapplying sunscreen after toweling and every two hours helps protect exposed skin, exposing less skin makes it easy. Many surfer-style rash guard shirts come with SPF technology as part of the fabric to help beachgoers stay protected. They also come in crew neck and long-sleeved styles. Outdoors clothing companies have also begun selling garments with SPF as a selling point. A plain, white T-shirt offers only about 7 SPF when dry and 3 when wet. In general, the darker the color and the tighter and thicker the fabric’s weave, the better protection it offers, unless it’s a high-tech fabric made to offer high SPF.

Wanted: Nurses to Work at Hospice CNY Hospice coping with nursing shortage By Matthew Liptak

ertain positions in healthcare require intangibles such as having a thick skin and tender heart. “The challenges are that you are dealing with death and dying on a daily basis,” veteran registered nurse Lois Maughan of Hospice of Central New York said. “When you go into nursing you know that you’re going to lose some of your patients. In hospice, you know that you’re going to lose all if not most.” The lack of supply of hospice nurses is evident in the region. The Hospice of Central New York has been looking to fill two RN case management po- Running the Hospice of Central New York: from left, sitions since last year. Clinical Educator Lois Maughan, CEO Cindy Chandler, Maughan recently Corporate Compliance Officer Jackie Fields. became hospice’s clinical that I can make and the difference that educator. She has been a nurse for 33 I can make,” Maughan said. “And the years and worked at the hospice for 13 autonomy that hospice nurses have.” of those. She’s one of a dozen full-time There are also other benefits. Hoscase-managing RNs who work for hospice nurses start out with three weeks pice. There is also a pool of nurses that of paid vacation and can earn up to five is available to work on-call. weeks after 12 years of service. They The organization serves 130 patients a day and about 1,000 a year, said also can get four personal days and five holidays off. Sick days can be accrued the hospice’s CEO, Cindy Chandler. Each case manager has 10 to 14 patients too. Nurses are reimbursed for their he or she serves at one time. They may business expenses and after three years visit two to four of these terminally ill receive an annual retention bonus. patients a day. Hospice of Central New York also Jackie Fields, the hospice’s coroffers health and dental insurance, life porate compliance officer, said the insurance and a tax-sheltered retireposition requires attention to detail, ment plan. flexibility and communication and Although they work autonomously, organizational skills. hospice nurses aren’t really on their “I think challenges are the documentation,” she said. “There’s always a own. Hospice nurses don’t do shift challenge in any nursing role. There’s a work, but have regular schedules with the vast majority of weekends off. Onlot of documentation that’s required.” call nurses can fill in when a case-manShe also agrees that nursing dying aging RN has off. There is a social patients can be stressful. A third of worker and chaplain to help too. hospice patients typically die within That support from coworkers is seven days of receiving hospice help, another reason Maughan likes her job. Fields said. “Hospice is the most supportive But there are ample rewards in hosworking environment of any that I’ve pice nursing too. ever worked because of the character of “I always viewed it as an honthe staff and nature of our work,” she or to walk into the patient’s home,” Maughan said. “You’re kind of walking said. “We know it’s tough, so we have to be there to take care of each other.” into the patient’s home turf and you Chandler admitted the pay is ususee what’s important to them — their ally a little lower than what hospitals families and belongings. Just being able to make that personal connection I can offer nurses, but said the positions offers nurses a chance to work more found to be exceedingly rewarding.” closely with patients and families than Making a difference other places do. A hospice nurse is not Maughan remembered a particular someone who just gives meds and a litpatient who said something that kept tle bit of care and moves on to the next her on the job instead of leaving the patient, she noted. position. She asked the man how he “It’s really a lot about what most of was feeling as death drew closer. He us went to nursing school for,” Chantold her, because of her work, he didn’t dler said. “We went to school to be feel like he was getting sicker. His pain able to be supportive, nurturing and and symptoms were under control and caring to another human being. Here he was at ease with the future. Her our expectation is that the nurse spends nursing skills were making a critical the time with the patient and the family difference in the man’s life. and does all that holistic care.” She stayed on at hospice. To find out more about the avail“I wouldn’t do any type of nursable positions or hospice care, call ing now other than hospice nursing Hospice of Central New York at 315because of that personal connection 634-1100.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

Letter to the Editor When Should You Start a Conversation About Prostate Cancer? Not at 35, says SUNY Upstate urologist

hank you for the opportunity to write this letter to the editor as a follow-up to the June 15 article in the men’s section of In Good Health. I presently serve as professor and chairman of the department of urology at SUNY Upstate Medical University and director of the prostate cancer program at the Upstate Cancer Center. After having completed a fellowship in urologic oncology at the National Cancer Institute of the National Institute of Health — and prior to accepting the position here in Syracuse — I stayed at the National Cancer Institute and practiced urologic oncology, teaching numerous students, fellows and residents. I read the article by Deborah Jeanne Sergeant titled “Turning 35 Means Guys Should Start a Conversation About Prostate Screenings” with Bratslavsky much concern. It was interesting to learn about the opinion of Darryl Mitteldorf, a licensed social worker and chairman of the NY State Prostate Cancer Coalition in New York City. According to the article, the reader may learn that “starting the conversation at age 35 captures the men who would benefit from PSA testing earlier. It’s a simple message.” It may have appeared as a simple message. As a urologic oncologist, I also believe in prostate cancer screening and I also support the role of a conversation with our patients about prostate cancer and the potential benefits of screening. Nevertheless, as a professor at a medical college and someone who embraces knowledge obtained from the evidence rather than from personal opinion, I felt compelled to write this letter. While PSA screening is controversial, its benefits are reflected in the largest-to-date screening study of over 150,000 men demonstrating the ability of PSA testing to decrease the number of men dying from prostate cancer. We have also observed a considerable 30-percent decrease in prostate cancer deaths in the U.S. since the introduction of PSA testing in this country. Therefore, evidence does support PSA screening in today’s “evidence-based medicine.” It is also important to recognize that while PSA screening prevents some men from dying from prostate cancer, it also generates much anxiety and often leads to over-diagnoses (diagnosing men with cancer who may have never been diagnosed otherwise

or may have never been threatened by this disease). Additionally, PSA value may be influenced by several non-cancerous conditions. Yet, “abnormal” PSA results may become the cause of much anxiety, lead to unnecessary biopsies, and eventually potentially unnecessary treatments. The best available literature today supports PSA testing for men aged 55-70, and is further supported by the guidelines of the American Urological Society. Certain men at increased risk for prostate cancer such as those with family history of prostate cancer, those of African American descent or those with a family history of breast or ovarian cancer may benefit from an earlier discussion with their physician and potentially earlier screening age. Nevertheless, no literature supports “early” prostate cancer screening, and especially at the age of 35. I do realize that starting a conversation about prostate cancer screening does not mean that the PSA test is automatically performed. However, my concern is that a proportion of men may either not receive adequate counsel about the drawbacks of PSA screening or automatically accept an idea of “early screening” desiring their PSA drawn starting at the age of 35. This may create an enormous emotional and financial cost to a huge segment of young men, and our healthcare as a whole. Just like many other decisions in medicine, the decision to screen is a complex task and cannot be used in a “one size fits all” approach. Additionally, for many, treatment of prostate cancer has become a business rather than an opportunity to practice medicine, and many men may experience unnecessary side effects from potential treatment of prostate cancer diagnosed “too early.” At Upstate we take pride in our ability to use available literature, guidelines, newest technology and academic state of mind to guide men with their decision about prostate cancer screening and treatment. We continue to remain cognizant that screening is not without issues. We would not suggest screening men with a conversation of prostate cancer at such a young age because of the risk factors. Screening too early may become a serious issue for our young men and be harmful. I suggest that we follow the rule of “do no harm first.” Gennady Bratslavsky, MD Professor and chairman, Department of Urology and director, Prostate Cancer Program, SUNY Upstate Medical University. He can be reached at bratslag@upstate.edu.

By Jim Miller

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Golden Years Don’t miss the next edition of In Good Health

Dear Savvy Senior, What tips can you recommend to help senior pet owners with their veterinary bills? I have two cats and a dog that are family to me, but their vet bills have become unaffordable. Fix Income Frankie Dear Frankie, The high cost of veterinary care has become a problem for millions of pet owners today, but it can be especially difficult for seniors living on a fixed income. Routine medical care can cost hundreds of dollars, while urgent/ specialized treatments and procedures can run into the thousands. But, it is possible to reduce your pet care costs without sacrificing their health. Here are some tips that can help you save. Shop around: If you’re not attached to a particular veterinarian, call some different vet clinics in your area and compare costs. When you call, get price quotes on basic services like annual exams and vaccinations, as well as bigger-ticket items, like to repair a broken leg, so you can compare. Also, check to see if you live near a veterinary medical school (see aavmc.org for a listing). Many schools provide lowcost care provided by students who are overseen by their professors. Ask your vet for help: To help make your vet bills more manageable, see if your vet’s office accepts monthly payments so you don’t have to pay the entire cost up front. Also, find out if your vet offers discounts to senior citizens or reduces fees for annual checkups if you bring in multiple pets. Search for low-cost care: Many municipal and nonprofit animal shelters offer free or low-cost spaying and neutering programs and vaccinations, and some work with local vets who are willing to provide care at reduced prices for low-income and senior pet owners. Call your local shelter or humane society to find out what’s available in

your area. Look for financial assistance: There are a number of state and national organizations that provide financial assistance to pet owners in need. To locate these programs, the U.S. Humane Society provides a listing on their website that you can access at humanesociety.org/petfinancialaid. Buy cheaper medicine: Medicine purchased at the vet’s office is usually much more expensive than you can get from a regular pharmacy or online. Instead, get a prescription from your vet (ask for generic) so you can shop for the best price. Most pharmacies such as Walgreens, CVS, Walmart, Kmart, Rite Aid and Target fill prescriptions for pets inexpensively, so long as that same drug is also prescribed to humans. And, many pharmacies offer pet discount savings programs too. You can also save by shopping online at one of the Veterinary-Verified Internet Pharmacy Practice Sites accredited by the National Association of Boards of Pharmacy, like 1-800-PetMeds (1800petmeds.com), Drs. Foster & Smith (drsfostersmith.com), KV Supply (kvsupply.com), and PetCareRx (petcarerx.com). Consider pet insurance: If you can afford it, pet insurance is another option worth looking into. You can get a basic policy for under $10 per month, and some insurers provide discounts for insuring multiple pets. See petinsurancereview.com to compare policies. Membership discount plans like Pet Assure (petassure.com) are another way to save, but you’ll need to use a vet in their network. Look for other ways to save: In addition to cutting your veterinary bills, you can also save on pet food and other supplies depending on where you shop. Target, Walmart, Costco and the dollar stores typically offer much lower prices than supermarkets and specialty retailers like Petco and PetSmart. You can also save on treats and toys at sites like coupaw.com and doggyloot.com.

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Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.savvysenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book. July 2015 •

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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The Social Ask Security Office Provided Deborah Banikowski, Social Security OfficeSocial Security Office

Supporting Our Youth, Protecting Our Future

ocial Security serves a person for who live in households with low life — from birth, to death, and income and limited resources if they even beyond, by helping to care meet our strict definition of disabilifor surviving dependents. When a ty. You can find more information on parent becomes disabled or dies, Social eligibility requirements by visiting our Security benefits help to stabilize the website at www.socialsecurity.gov. family’s financial future in an othThis year marks the 25th annivererwise turbulent time. And, we pay sary of the Americans with Disabilities benefits to adults and children. Act (ADA) of 1990. The ADA ensures In July, the world celebrates equal opportunity for and World Youth Day. Social Security equal treatment of people with is no stranger to helping children disabilities at school, in work in need. Every year, about 4.4 places, in commercial facilities, million children receive monthly and through the services availbenefits because one or both of able from state and local govtheir parents are disabled, retired ernment agencies. The ADA or deceased. Those benefits help requires that government with their day-to-day needs. agencies communicate with In addition, Social Security Americans who have disabilprovides vital income for disities in the way that fits their abled children, including peoneeds. This legislation shows Banikowski ple disabled since childhood, our nation’s commitment to through our Social Security Disability all people, despite their physical and Insurance (SSDI) program and our Sup- mental disabilities. plemental Security Income (SSI) proSince the ADA’s inception, Social gram. To qualify for children’s benefits Security has been and continues to be under the SSDI program, the applicant at the forefront, providing accommomust be the child of a parent entitled dations for disabled beneficiaries and to benefits and meet Social Security’s employees. It’s a natural part of who strict definition of disability. He or she we are as an agency. must have a physical or mental conIf you think your child may qualify dition, or a combination of disabling for children’s benefits, you can apply conditions, that seriously limits his or by calling Social Security toll-free at her daily activities and is expected to 1-800-772-1213 (TTY 1-800-325-0778) or last for at least 12 months or result in by visiting your local Social Security ofdeath. fice. You can also read our publication, The SSI program provides payBenefits for Children, at www.socialsements to blind or disabled children curity.gov/pubs.

Q&A

Q: I’m 17 and eager to start my first summer job, but my mother misplaced my Social Security card. How can I get another? A: If you know your Social Security number, you may not need to obtain a replacement card to obtain employment. However, if a prospective employer requests it, in most cases you only need to provide your Social Security number, and you don’t actually need a replacement card. But if you do need the card, you can get a replacement Social Security card by following the steps below. There is no charge for a Social Security card, but you are limited to three per calendar year and 10 replacement cards during your lifetime. You will need to: • Show the required documents. We need to see different documents depending on your citizenship and the type of card you are requesting. Go to www.socialsecurity.gov/ ssnumber to find out what documents you will have to show. • Fill out and print an “Application for a Social Security Card;” and • Take or mail your application and original or certified copies of the original documents to your local Social Page 20

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Security office. For more information, read our pamphlet, “Your Social Security Number and Card” at www.socialsecurity. gov/pubs. Q: Why should I sign up for a Social Security online account? A: my Social Security gives you a personal online account you can securely use to check your Social Security information and do business with us. With a my Social Security account you can: • Keep track of your earnings and verify them every year; • Get an estimate of your future benefits if you are still working; • Get a letter with proof of your benefits if you currently receive them; and • Manage your benefits: • Change your address or telephone number; • Start or change your direct deposit; • Get a replacement Medicare card; and • Get a replacement SSA-1099 or SSA-1042S for tax season. • To find all of the services available and set up an account, go to www. socialsecurity.gov/myaccount.

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

Most physicians who recently graduated from St. Joseph’s family medicine residency program will remain in the area. From left, first row, Sylvia Lee, Dr. Jennifer Gayagoy, James Tucker (program director), Kim Nguyen and Carlos Dator. Second row, from left, are Karishma Circelli, Karla Martinez-Dulmer, Welena Qazizada, Amber Sarwar and Andrea Finocchiaro. Third row, from left, are Gurpreet Rakhra, Andrew Richardson and Zaki Badawy.

Most of St. Joseph’s Residency Grads Stay in Syracuse St. Joseph’s Hospital Health Center announced that most of 12 graduates from St. Joseph’s family medicine residency program will remain in New York state: three will be joining programs and practices in Syracuse, three more will stay in the greater Central New York region, and another one will remain in the state. From the residency program’s general practice for dentistry, two of the five graduates will remain local and two more have accepted positions in New York State. “Our residents have access to many different ambulatory, inpatient, clinical and other patient care experiences at institutions throughout the community, including specialized programs in sports medicine and nursing homes,”

said physician James B. Tucker, director of St. Joseph’s Family Medicine residency program. “It is our intention to connect our residents to all of the opportunities available here, so that graduates of our program continue to deliver a higher level of care to our community.” St. Joseph’s residency program has graduated more than 500 physicians. Over 80 percent of the family medicine graduates practice in New York state. The program is one of the oldest family medicine residency programs in the country and the second largest in the country. More information about the program is available at www.sjhsyr. org/family-medicine-residency.

Upstate Medical University offers  minimally invasive alternative to traditional salivary gland surgery Upstate University Hospital is the only hospital in New York state, outside of Rochester and New York City, to offer salivary endoscopy or sialendoscopy, a minimally invasive alternative to open salivary gland surgery. The FDA-approved endoscopic procedure allows the surgeon to simultaneously detect, diagnose and treat inflammatory and obstructive disorders of the salivary ductal system without having to remove the salivary gland. Sialolithiasis, or salivary stones (calculi), is the most common disorder treated with this technique. Other Marzouk disorders that can benefit from sialendoscopy include stenosis, radioactive iodine-induced sialoadenitis, and recurrent juvenile parotitis. Mark F. Marzouk is one of a few surgeons in New York, and the only physician in Central New York, who is trained in sialedenoscopy. Marzouk

is the chief of the division of head and neck surgery at Upstate’s department of otolaryngology with specialty in minimally invasive salivary endoscopy, transoral robotic surgery and minimally invasive thyroid and parathyroid surgery. According to Marzouk, sialendoscopy is a simple, safe and a less-invasive alternative to traditional treatment which requires removal of the salivary gland made through an incision in the neck, after which time the patient is required to remain hospitalized overnight. “Undergoing the sialendoscopy procedure is highly beneficial to patients in that normal function of their salivary gland is maintained,” said Marzouk. He adds that there are other benefits as well. “Our ability to visualize and treat the specific cause of the inflammation or obstruction allows us to save the salivary gland, leaving the patient with no external scars and at a no risk of facial nerve injury, as opposed to open surgery” he said. “Other benefits include less recovery time, same-day discharge, and the resumption of normal activity the next day.”

H ealth News Crouse has new VP for medical affairs Crouse Hospital has named physician Mickey Lebowitz as vice president of medical affairs and clinical quality. A highly regarded board-certified internist and endocrinologist who has been on the list of Best Doctors in America, Lebowitz joined Crouse in 2010 as senior medical quality director. Providing oversight, mentoring and performance assessment of all physicians and practitioners, Lebowitz will work closely with the quality improvement division on patient safety and process improvement initiatives Lebowitz and will partner with physician leaders to help lead system-wide efforts for clinical quality, safety and cost of clinical care. He also oversees infection control, care coordination, physician quality and medical affairs. Lebowitz served as a hospitalist at the Veteran’s Administration Hospital in Syracuse, where he received the resident teaching award. He’s been in private practice, and was a member of Internist Associates of CNY and then the founder and director of the Crouse Diabetes and Endocrine Center. In 2009, he released his first book, “Losing My Patience: Why I Quit the Medical Game.” Lebowitz earned his medical degree from SUNY Upstate, which is also where he completed his internal medicine training, chief residency and endocrine and diabetes fellowship. He resides in Dewitt.

St. Joseph’s Physicians has new chief operating officer St. Joseph’s Physicians has appointed Julianne Duffy Himes as chief operating officer. In her new role, Duffy is responsible for day-to-day operations for the practice’s 10 locations serving the Syracuse community. As director of clinical operations, Duffy was responsible for overseeing clinical operations for St. Joseph’s Physicians. She also served in a leadership role as SJLinked’s Director of Ambulatory EMR Implementation. “Julianne brings both clinical acumen and a great working knowledge of practice operations to the posiDuffy tion,” said Frederick Letourneau, senior vice president for St. Joseph’s Physician Enterprise. “Having worked closely with our medical staff and managers, her transition

to this role will be seamless as the practice continues to meet the needs of our patients.” Prior to joining St. Joseph’s, Duffy worked as a physician assistant in emergency medicine for Crouse Hospital in Syracuse, as well as a physician assistant in general surgery for St. Joseph’s Hospital Health Center. Duffy was an adjunct instructor in the department of physician assistant studies at Le Moyne College in Syracuse from May 2011 to August 2013. A graduate of Le Moyne College, Duffy earned a Bachelor of Science degree in biology and a Master of Science degree in physician assistant studies. She is licensed in New York state, and certified by the National Commission on Certification of Physician Assistants. Duffy plans to continue practicing as a physician assistant.

Loretto names new general counsel Holly Hoehner has joined Loretto as vice president and general counsel in charge of legal. Hoehner will also serve as corporate compliance officer for Loretto. Prior to accepting this position, Hoehner was a partner with Hiscock & Barclay in the business services and health care and human services practice groups. Her practice has focused on business transactions and contracts, as well as ethics and corporate compliance matters, especially in the area of health care fraud and abuse. Prior to joining Hiscock & Barclay, Hoehner Hoehner was assistant general counsel of Taro Pharmaceuticals in Hawthorne, NY, where she designed, developed and implemented Taro’s compliance program and served as chair of the compliance committee. Hoehner grew up in Central New York and is active in the community. She has served on the board and the governance committee of MedTech Association. Hoehner is a pro bono volunteer for the Say Yes to Education program and past participant on the executive leadership committee of the Go Red For Women campaign of the American Heart Association. Hoehner graduated from Columbia Law School (J.D.) and received her undergraduate degree from Cornell University. Hoehner, and her husband, Thomas, have two sons and live in Fayetteville.

Community hires new family nurse practitioner Christina Riggall, a board certified family nurse practitioner, has been hired at the Hamilton Family Health Center, operated by Community Memorial Hospital.

Riggall, who studied at Morrisville State College and the SUNY Institute of Technology, received her Masters of Science Family Nurse Practitioner degree in 2014. Her previous experience includes work at the Oneida Healthcare Center Extended Care Facility, Mollen ImRiggall munization Clinics, Crouse Community Center, Upstate University Hospital and the Oneida Indian Nation Health Services. She began seeing patients in midMay. “Christina Riggall has a strong background in family practice,” said Dawn Sampson, practice manager for the four CMH Family Health Centers located in Hamilton, Morrisville, Munnsville and Waterville. “She will be an integral part of our primary care team and we are pleased to welcome her. Family practice medicine is a high priority for Community Memorial Hospital.”

Champions for Life in Auburn has new director The board of directors at Champions for Life in Auburn announced the hiring of the organization’s new executive director, Melissa Gravius. Gravius was born and raised in Auburn and lives in Camillus, with her husband Brandon, an accountant, and son, Alexander, a sophomore at Bishop Ludden Junior-Senior High School. Formerly a mental health professional working with dually diagnosed adults, and an attorney specialGravius izing in family and matrimonial law, Gravius has worked at Catholic Charities in Syracuse since 2009. In her spare time, Gravious volunteers for a Volunteer Lawyer’s Project as a member of the Vera House legal clinic. In 2014, she was awarded a 2014 “40 Under Forty” award, recognizing her civic contributions to Central New York. Champions for Life is a recreation and sports center focused on inspiring body, mind and spirit by promoting Christian virtue. Champions has two campuses; an indoor facility and educational center on Grant Avenue Road and a 160 acre outdoor park with a respite home on North Road.

DeThomas joins Auburn Orthopaedic Specialists Physician Ronald S. DeThomas has recently joined Auburn Orthopaedic July 2015 •

Specialists (AOS). He is board certified in orthopedic surgery and is an active member in the American Academy of Orthopaedic Surgeons. His undergraduate studies were done at Columbia University and he received his medical degree from Albany DeThomas Medical College. As a general orthopedic surgeon, DeThomas specializes in joint replacement, fracture repair surgery, arthroscopy and carpal tunnel procedures.

St. Joseph’s Hospital welcomes new hospitalist Physician Anita Gofran has recently joined St. Joseph’s Hospital Health Center as hospitalist. Gofran earned her Doctor of Medicine in 2001 from Howard University in Washington, D.C. and her Bachelor of Arts from Columbia University in New York. She completed her internal medicine residency and renal fellowship at Montefiore Medical Center at the Albert Einstein College of Medicine. As a hospitalist, Gofran’s primary role will be to focus on the general medical care of hospitalized patients and to maintain open Gofran lines of communication with primary care physicians and specialists ensuring a continuum of care for patients. Prior to joining St. Joseph’s, Gofran spent eight years in private practice as a nephrologist where she worked with patients on diagnoses of kidney disorders and developed treatment plans. She has been published twice for her research in the field of nephrology and presented to the New York Society of Nephrology in 2007. “We are very pleased to welcome Dr. Gofran to our hospitalist group. She brings excellent experience in the fields of internal medicine and nephrology,” says physician Sandra Sulik, vice president for medical affairs. “St. Joseph’s physicians like Dr. Gofran support our patients’ needs and enhance our integrated network of care.” Gofran is a member of the American Society of Nephrology, and holds Board Certification in Internal Medicine and Nephrology.

online @ cnyhealth.com

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H ealth News Wish Granted

Three-year-old Grace Ratley loves all things Minnie Mouse. When asked what her one true wish would be, Grace didn’t hesitate. She wanted to go to Disney World to meet Minnie in person. Grace has severe combined immunodeficiency — SCID. For one week, she and her parents traveled to Orlando, to experience a week of Disney magic. While in Orlando, Grace and her family stayed at Give Kids the World, a resort tailored to children with special needs. Grace met her favorite princesses and spent some time with her beloved Minnie Mouse. Make-A-Wish Central New York, Inc. is a nonprofit, tax-exempt organization dedicated to granting the special wishes of children between the ages of 2 ½ and 18 who are living with life-threatening medical conditions. Since its inception in 1985, MakeA-Wish has granted more than 1,500 wishes. It has received financial support of individuals and businesses throughout its 15-county region, including Cayuga, Madison, Oneida,

Walking for Epilepsy in Central New York

Three-year-old Grace Ratley of Canastota is all smiles in her pink Minnie Mouse ears. Onondaga and Oswego. For more information about MakeA-Wish, visit cny.wish.org or call 315475-WISH (9474).

JCC’s Honors Supporters at Annual Meeting & Gala

The 5th Annual Salt City Walk Raises Epilepsy Awareness and Funds in Syracuse, NY Syracuse, NY –Epilepsy-Pralid, Inc. (EPI), the local affiliate of the Epilepsy Foundation of America, will hold the 5th Annual Salt City Walk on July 11th at Long Branch Park, Syracuse from 9am to 11am. To register, go to www.epiny.org. The family-fun event includes inflatable skee ball, balloon twisting, Otto the Orange, a DJ, and more. All money raised supports epilepsy services in Central New York. More than 300 supporters joined together for last year’s Walk. Team Gabby has been a part of the event since its inception. Christine DiOrio, team captain, shares why the Salt City Walk has become an annual tradition for her family and friends. “Gabby was diagnosed five years ago with benign rolandic epilepsy. Now, at the age of 10, she is excited to participate in her 5th Salt City Walk. Gabby had her second seizure one week before the first Walk. Over 50 family and friends signed up to participate and had raised a sizable donation within a week,” DiOrio recalled. “I was so happy and so humbled by the support system we had that day and by the friendly, caring and excited staff at EPI, that I am sure I spent most of the day with happy tears in my eyes.”

For Rachel Kelly, this year’s Walk will be her first. Rachel was recently diagnosed with epilepsy as an adult and is facing some of the challenges that can accompany seizures, such as the inability to drive. “I've experienced ‘episodes’ since 2009 that went misdiagnosed as panic attacks, fainting episodes, or dehydration, until January 2015, when I had a seizure in my sleep, awakening my husband. It is scary for us, but we are learning to adjust.” One in 26 people in the United States will develop epilepsy at some point in their lifetime. Kelly feels fortunate, in a way, because her seizures are mild, and largely controlled by medication. “I want to be a part of the solution. I know how hard it is for me to feel ‘normal.’ I can't imagine what that's like for a child, or a family raising a child, or adults who have lived with this their whole lives,” Kelly said. Salt City Walk enables EPI to provide education, financial support, and other services to those experiencing epilepsy in Central New York. “We hope that one day Gabby will be seizure free, but, in the meantime, she is happy to be a normal kid who helps support a great cause,” DiOrio added. If you would like to find out more or register, go to www.epiny.org.

Happy 103 Birthday

The Teen Funders of the Jewish Community Foundation of Central New York in attendance at the JCC’s Annual Meeting & Gala pose for a photo with their Kovod Award along with Nancy Belkowitz (far left). The Sam Pomeranz Jewish Community Center of Syracuse welcomed a packed house of supporters for its 152nd Annual Meeting & Gala on Sunday, June 7, at Owera Vineyards in Cazenovia. Over 215 people celebrated with the JCC as it honored a select group of local men and women for their many years of selfless giving to the center and to the local community. “The show of support for this year’s honorees was outstanding,” said JCC of Syracuse Executive Director Marci Erlebacher. “The service that our award recipients have provided is truly remarkable. We can all learn a lot from their unselfish acts, and we are all

better off because of their kindness.” A total of six awards were presented this year. All of the honorees received a plaque and will have their names displayed at the JCC for their respective awards. The first award given, the Kovod Award, which signifies honor and importance, was presented to the • Teen Funders of the Jewish Community Foundation of Central New York (Kovod Award); • Herbert (Hecky) Alpert, Michael Moss and George Wladis (JCC’s Hall of Fame Award); • Debbie Goldwein and Nancy Kasow. (Kovod Gadol Award).

Coming in the August edition of In Good Health Page 22

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The Manor at Seneca Hill in Oswego hosted a special party May 29 to celebrate the 103rd birthday of resident Anna Kielb. Kielb is a Fulton native, who at one time worked at the woolen mill located

on West First Street in the city. A photo taken when Kielb was a young adult can be seen on the table. Pictured with Kielb are two of her nieces, Jean LeRoy and Penny McCann, who took part in the celebration.

featuring Golden Years

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

Hematology-Oncology Associates Receives Oncology Medical Home Status It is the first and only cancer practice in the state to achieve this status Hematology-Oncology Associates of Central New York (HOA) has further defined itself as one of the most recognized cancer practices in the nation for quality and a commitment to patient-centered cancer care. In May, the practice received full accreditation status from the Commission on Cancer as an Oncology Medical Home (OMH). There were 10 practices in the U.S. seeking this recognition; HOA is one of several that received this prestigious designation, making it the first and only cancer practice in the state to achieve this status. This accreditation program is the result of a collaborative effort with a steering committee of cancer care organizations, advocacy organizations, insurers, the Community Oncology Alliance (COA), and the Commission on Cancer (CoC). The OMH model promotes standards and quality-centric processes that provide a coordinated, efficient, patient-focused system for delivering quality care. These enhanced standards include objective, reportable, continuously measured criteria that demonstrate improvement. COA developed the Oncology Medical Home program to address the twin needs of quality care and payment reform to decrease the cost of cancer care for patients and the healthcare system. To achieve this status, HOA, in addition to compliance with all quality standards and measures, had to undergo an on-site inspection and evaluation of their practice. “Comprehensive OMH criteria

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for evaluation and patient-centered care standards were developed,” said physician Anthony Scalzo, president of HOA. “Accreditation formalizes the processes and standardizes the measurement criteria for an OMH practice and will enable a meaningful reduction in costs to patients and the healthcare system. OMH practices represent the future of cancer care delivery in this country.” “We have chosen the OMH practice model as a way to deliver continuously improving care to our patients while controlling the cost of care,” said Maryann Roefaro, CEO of HOA. “Not only do we believe that our patients’ care will benefit now, this model represents the best opportunity for future care and savings. The implementation process came with an incredible amount of effort, commitment and additional expense to our practice. In times of decreasing reimbursement, this says a great deal about the quality and nature of our physicians.” Hematology-Oncology Associates was established in 1982. It is certified by the American Society for Clinical Oncology for quality (QOPI Certification). It is the only cancer practice with that designation in Central New York, as well as the Certified OMH designation.Visit www.hoacny.com for more information.

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Learning and Performing Excellence

GOLDEN YEARS SPECIAL Special August 2015 Issue of In Good Health— CNY’s Healthcare Newspaper

Crouse Hospital was well represented at the Eight Annual CNY BEST awards dinner June 11, sponsored by the CNY Chapter of the Association for Talent Development. Crouse was nominated in two categories and took home the top honor in the Learning and Performance Individual/Team category. Registered nurses Tara Box and Michael Allain were recognized for their efforts to develop a comprehen-

sive training and staff development program for clinicians and support staff to support the hospital’s neuroscience institute initiative. Crouse’s Chief Quality Officer Derrick Suehs was the evening’s keynote presenter. Suehs spoke about organizational transformation and shared how Crouse’s mission, vision and values contribute to the overall success of the hospital.

Some of the feature stories in this coming issue: • Dietary changes every senior should make • Aging & sex: do they go together? • Silver Sneakers: profile of the local program • Software developed by local nurse helps assess seniors’ health • Savvy Senior and more

Reach nearly 100,000 readers in the region Call 342-1182 for more information about readership and rates. We design your ad at no charge. See us at cnyhealth.com July 2015 •

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& Aquatic Centers Offering physical therapy services for: • Orthopedic Injuries • Women’s Health (Camillus) • Aquatic Therapy (Camillus) • Sports Injuries • Neck and Back Pain • Total Joint Care • Diabetic Peripheral Neuropathy

Accepting • Worker’s compensation • Medicare • and most insurances

2 Convenient Locations 5700 West Genesee Street Entrance F in Medical Center West Camillus, NY 13031 468-1050 601 South Main Street North Syracuse, NY 13212 Next to Papa John’s 452-5580 Page 24

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2015

The results you want, the care you deserve.