Igh cny 166 oct13

in good October 2013 • Issue 166

Infertility Rates Continue to Decline

Pets With CANCER

It’s estimated that four million cats and dogs develop cancer in the U.S. every year. Find out what to do when cancer happens

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CNY’s Healthcare Newspaper

Obamacare: Game On… Page 9

‘Divorce is horrible’

So says Ellen Jones, who directs DivorceCare, a program that exists to help those going through divorce Page 13

Page 14

2 New Versions of Flu Vaccine Coming

Big Push for Suicide Prevention in Central New York

Find out why there are two versions this year Meet Your Doctor Robert Cooney of Upstate talks about his new position as presidentelect of the Shock Society

Crouse Nursing School: 100 Years Preparing Nurses The Crouse-Irving Training School for nurses, now Crouse College of Nursing, accepted its first class of nursing students, seen here, in 1913.

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Debra Graham, the CNY area director of the American Foundation for Suicide Prevention, became affiliated with the organization through her own tragedy. She lost her 17-year-old son to suicide.

Her nonprofit is now promoting several events in CNY to prevent suicide.

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Congratulations to our physicians and staff who have earned recognition for excellence in providing quality and cost-efficient care.

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www.sjhsyr.org � Follow us on Facebook and Twitter: stjosephshealth Blue Distinction® Centers (BDC) met overall quality measures for patient safety and outcomes, developed with input from the medical community. Blue Distinction® Centers+ (BDC+) also met cost measures that address consumers’ need for affordable healthcare. Individual outcomes may vary. National criteria is displayed on www.bcbs.com. A Local Blue Plan may require additional criteria for facilities located in its own service area. For details on Local Blue Plan Criteria, a provider’s in-network status, or your own policy’s coverage, contact your Local Blue Plan. Each hospital’s Cost Index is calculated with data from its Local Blue Plan. Hospitals in CA, ID, NY, PA, and WA may lie in two Local Blue Plans’ areas, resulting in two Cost Index figures; and their own Local Blue Plans decide whether one or both Cost Index figures must meet BDC+ national criteria. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for damages or non-covered charges resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

Two New Versions of the Flu Vaccine Arriving Soon First time two types of vaccines are offered

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or the first time, there will be a vaccine that protects against four strains of the flu virus. Until now, flu vaccines have only protected against three forms of the virus.

Each year, scientists choose what they believe will be the three most common forms of the flu to spread during the winter months, and they incorporate them into the annual vaccine. This year’s new vaccine containing four varieties has those three flu forms and an additional version of the virus.

“The real need for the vaccine with four flu viruses comes if that additional virus begins to circulate,” says Clark Kebodeaux, assistant professor of pharmacy practice at St. Louis College of Pharmacy. “At this early point, it’s not certain what types of flu will cause the most illnesses.”

Vaccines will be available through two forms of injections and a nasal spray.

“If parents want to ensure that their children receive the new style of vaccine, ask for a nasal spray instead of an injection,” Kebodeaux says. “The four strain vaccine is available by injection as well, but some injections only include the three strain vaccine. Going

forward after this year, we’ll know if the additional protection is necessary.”

Adults with egg allergies have a new option as well. An egg-free version of the vaccine is available, but it is only for adults aged 18 to 49.

Kebodeaux adds that older adults, and those with chronic conditions like diabetes and asthma, need to receive an injection as soon as the vaccines arrive. The high-dose version of the vaccine for older adults protects against three versions of the flu virus.

“I encourage everyone to get any version of the flu vaccine,” Kebodeaux says. “There will be plenty for everyone.”

Smoking Cessation Experts Weigh in on E-Cigarette E-cigarettes not yet proven safe; potential gateway to tobacco for youth

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ith the third and largest of the U.S. tobacco companies planning an e-cigarette product launch this fall, this next frontier for “Big Tobacco” provides renewed presence in a declining marketplace. It’s also a potential gateway to new smokers, particularly among teens and in emerging/foreign markets, according to behavioral scientists at The University of Texas MD Anderson Cancer Center.

E-cigarettes are battery-powered devices that provide inhaled doses of nicotine vapors and flavorings. The Centers for Disease Control and Prevention estimates that about 6 percent of adults have tried e-cigarettes, a number that has nearly doubled since 2010. Absent of tobacco, e-cigarettes have been promoted as a possible aid in getting

people to stop smoking and thereby reducing their lung cancer risk.

However, MD Anderson cancer prevention experts caution that more research is needed to understand the potential role of e-cigarettes in smoking cessation.

“Independent studies must rigorously investigate e-cigarettes, as there’s considerable potential benefit in these products if they’re regulated and their safety is ensured,” says Paul Cinciripini, MD Anderson’s director of the tobacco treatment program. “But promoting the e-cigarettes already on the shelves as ‘safe’ is misleading and, if looked at as a harmless alternative to cigarettes, could potentially lead to a new generation of smokers more likely to become tobacco dependent.”

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IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Pastor Mary Drake will share the story of her experience with an 18month-long depression and how she was healed from it. The Oct. 5 event — titled “From Darkness to the Light: Program on Depression” — is a free presentation offered by Live More Ministries and hosted by the Henderson United Methodist Church at 8871 state Route 178, Henderson, Jefferson County. Drake, who has been a pastor of the Mannsville and Lorraine United Methodist congregations for the past 11 years, is celebrating 20 years as a Methodist pastor and her struggle with depression occurred during that time.

The pastor now uses her experience with depression to help others. For more information, call 315-767-2058, email sallyj@twcny.rr.com or visit livemoreministries.blogspot.com.

Crouse NICU to host graduates reunion

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Oct. 6

Orthopedic Surgery Total Hips, Knees Acute Fractures Sports Injuries Carpal Tunnel Trigger Fingers

Oswego Health Services Center 140 West Sixth, St., Suite 220, Oswego, NY 13126

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Oct. 5

IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

dinner will be served both nights from 5–7 p.m. in the hospital cafeteria. Take outs are available.

Oct. 12, 19

Suicide prevention group holds events in the area See story on page 12

Oct. 15, 22, 29

Library to host Alzheimer’s for Caregivers program Maxwell Memorial Library in Camillus will present a three-part series titled “Living with Alzheimer’s for Caregivers—Middle Stage.” The program is designed to provide caregivers with the knowledge, tools and strategies needed to cope with a diagnosis of Alzheimer’s or related dementia. The program will take place from 5:30–7 p.m. on Tuesdays, Oct. 12, 22 and 29 at the library, 14 Genesee St. Free. Registration is recommended; sign up at www.maxwellmemoriallibrary.org or call the library at 672-3661.

On Sunday, Oct. 6, Crouse Hospital’s Women’s and Infants Services will host “Celebrating Heroes,” a reunion event that will bring together Crouse physicians and staff, parents and NICU “graduates” for an afternoon of remembrance and celebration. This 34th NICU Graduates Reunion will be held from 1–3 p.m. in the Marley Education Center, 765 Irving Ave. Free parking will be available in the Marley and Crouse Hospital garages. “We are so pleased to welcome back the babies and their families to celebrate these heroes. This is a wonderful opportunity for the NICU babies to reunite with those who cared for them,” says Barbara Miller Stahl, director of women’s and infants services. The family-friendly environment will include face painting, entertainment and refreshments for all. Email jenniesullivan@crouse.org if you plan to attend the event.

Oct. 25

Oct. 9, 10

Dan Cummings to host Hope For Bereaved dinner

Oswego Health Auxiliary holds bazaar event A bit of local history will be available at the Oswego Health Auxiliary’s annual bazaar to be held from 9 a.m.

– 7 p.m. Oct. 9 and 10 in the lobby of Oswego Hospital. During the bazaar, tickets to win the American Girl Doll, Caroline Abbott, will be available.

Caroline is one of American Girl Doll’s historic characters and her story takes place during the War of 1812. While the story centers on Caroline growing up in nearby Sackets Harbor, local residents know that at least one battle during this war was fought in Oswego Harbor. The two-day bazaar, which is open to the community, will also feature home-baked goods, crafts and themed gift baskets. A complete turkey

Fayetteville center to hold wine and cheese party The Fayetteville Senior Center will present its 10th Annual Wine, Cheese & Confections with silent auction from 6–9 p.m. on Friday, Oct. 25, at $20 per person. The center is located at 584 E. Genesee St., Fayetteville. Members of the center and the community will gather to enjoy New York state wines and juices, exotic cheeses, delicious coffees, teas and cocoa from Starbucks, and a variety of hors d’oeuvres, chocolates and desserts. There will be a silent auction with a variety of items and entertainment. Call 315-637-9025 for more information.

Nov. 1

News anchor Dan Cummings of WSYR TV channel 9 will host a dinner to celebrate a milestone for Hope for Bereaved, a nonprofit community organization dedicated to providing hope, support and services for the bereaved.

The event is celebrating 35 years of the organization and will also honor Therese Schoeneck, its founder and executive director. The celebration is a major fundraiser for the organization.

Funds help expand Hope’s outreach and services for grieving children, teens and their families. Students from Christian Brothers Academy are creating a mosaic bench to be raffled that night. Music will be provided by the Adventures. The dinner will take place Nov. 1 at OnCenter Grand Ballroom.

For more information, call 475-9675.

REPORT U.S. Hospitals Triple Use of Electronic Health Records System allows for significant savings and sharing of latest information on patients’ conditions

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.S. hospitals have made major progress in adopting electronic health records systems over the past three years, according to a new report.

The number of hospitals with a basic electronic health records (EHRs) system tripled from 2010 to 2012, with more than four of every 10 hospitals now equipped with the new health information technology, according to a July report by the Robert Wood Johnson Foundation.

“Given the size of our country, that’s amazing progress in a very short time period,” said report co-author Ashish Jha, an associate professor with the Harvard School of Public Health.

However, there is much more work to be done, the report indicates. These systems may have been adopted, but hospitals have not yet figured out how to use the new technology to improve patient safety and reduce health care costs.

For example, the study found that 42 percent of hospitals now meet federal standards for collecting electronic health data, but only 5 percent also meet federal standards

for exchanging that data with other providers to allow widespread physician access to a patient’s records.

“The news here is mostly good, but we shouldn’t declare victory yet,” Jha said. “In other industries it takes about 10 years after technology is adopted to see real efficiencies. My hope is we’ll see that more quickly in health care. We don’t have 10 years to waste.”

Researchers believe that three factors have combined to drive adoption of electronic health records — society’s increasing reliance on information technology, new federal funding to support purchase of EHR systems, and future penalties under the Affordable Care Act that will be assessed against providers who will not use EHRs. “It’s the right incentives at the right time,” Jha said. “Doctors and hospitals have been thinking about buying electronic health records [systems] for some time. This is where our society is moving. But the finances have been a challenge. The federal incentives have been very well targeted. They were well designed to help push hospitals and doctors to adopt EHRs.”

Electronic Health Records Slow the Rise of Healthcare Costs

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se of electronic health records can reduce the costs of outpatient care by roughly 3 percent, compared to relying on traditional paper records.

That’s according to a new study from the University of Michigan that examined more than four years of healthcare cost data in nine communities. The “outpatient care” category in the study included the costs of doctor’s visits as well as services typically ordered during those visits in laboratory, pharmacy

and radiology.

The study is groundbreaking in its breadth. It compares the healthcare costs of 179,000 patients in three Massachusetts communities that widely adopted electronic health records and six control communities that did not. The findings support the prevailing but sometimes criticized assumption that computerizing medical histories can lead to lower healthcare expenses.

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In Good Health is published 12 times a year by Local News, Inc. © 2013 by Local News, Inc. All rights reserved. Mailing Address: P.O. Box 276, Oswego, NY 13126. • Phone: 315-342-1182 • Fax: 315-342-7776.

Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo Contributing Writers: Jim Miller, Eva Briggs, M.D., Gwenn Voelckers, Deborah Banikowski, Deborah Sergeant, Anne Palumbo, Melissa Stefanec, Matthew Liptak, Molly Martindale Advertising: Jasmine Maldonado, Marsha K. Preston • Design: Chris Crocker • Office Manager: Laura J. Beckwith 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.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Page 5

Meet

Your Doctor

By Lou Sorendo

Dr. Robert Cooney Chairman of Upstate’s department of surgery talks about life in a trauma center and about his new position as president-elect of the Shock Society

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obert Cooney, chairman of the department of surgery at Upstate, in June took office as presidentelect of the Shock Society. During his one-year term, he will lead the society’s efforts to improve the care of victims of trauma, shock and sepsis. The society’s mission is to promote clinically relevant research and the dissemination of knowledge into the basic biology of trauma, shock and sepsis.

Q: What falls under the category of “trauma” in medicine?

A: It might be helpful to talk briefly about trauma as a public health problem. Trauma is the number one cause of death and disability for young Americans under the age of 40. It takes many forms: accidental injuries from driving, different kinds of physical activities, sometimes penetrating trauma from gang violence. Many people don’t realize, it’s also the fifth leading cause of death in the elderly. It’s obviously different in terms of the injury dynamics; falls are more common in that population. Car accidents would be number two. The risk of death or dying is exacerbated by the associated medical problems with that group, effects from certain medications like anticoagulants or even just the frailty that comes with old age.

failure, etc. So as an organization, the goal is to improve the care of patients with trauma, shock or sepsis. So our mission includes research as well as the dissemination of knowledge and the application of that knowledge.

Q: As chairman of the department of surgery at SUNY Upstate, do you see a lot of trauma patients?

A: Yes, I’m an active member of the trauma team here. I usually spend one week a month on the trauma service. I take calls and respond to the trauma bay. In addition to those direct involvements, we’ve begun a pro-

Q: Is that the kind of awareness you’re trying to build with the Shock Society?

A: Absolutely. From a clinical career point of view, I’ve been actively involved in caring for these patients throughout my career as an academic trauma surgeon. There’s a certain amount of adrenaline associated with taking care of critically ill patients. You have to be able to think quickly. Most trauma centers are located at academic medical centers. They represent one of the important missions of academic medical centers in health care.

Earlier in my career, I started looking at some of the problems these patients had clinically that were difficult or problematic. We developed a research to investigate the underlying mechanisms of these problems, the hope being that we could translate these findings into clinical solutions. The Shock Society is a premiere thought leader in the science and study of many of the problems that trauma patients suffer: shock, resuscitation, organ Page 6

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

cess of transforming trauma care here at Upstate to a much higher standard of care than was previously required by the New York State Department of Health.

Q: Do you think the public has reasonable expectations about what can be done for them if they’re injured?

A: That’s a tough question. I’m not sure many people understand the difference between a trauma center and an emergency room. There really are some big differences between them. While an emergency room is open 24 hours a day, seven days a week, the ability to bring very significant resources to bear for a critically injured patient is much different than that of a trauma center.

At a trauma center, there’s an operating room and staff ready to provide rapid surgical intervention at any time, so there’s a large cost associated with that.

If there’s an emergency going on in the operating room, we’d call another team in so there is, literally, someone waiting there if an injured person came in the door. We have all kinds of specialists, not only trauma surgeons, but orthopedic specialists, neurosurgical specialists, plastic surgeons, pediatric surgeons, etc. immediately available in case we need their expertise for patients with complicated injuries. So trauma centers are really complex, resource-intensive centers that can bring significant expertise bear on an injured patient at a moment’s notice. For example, when someone is on trauma call here at Upstate, we can be at a patient’s bedside in less than 15 minutes.

Q: What kind of support staff is involved?

A: It’s not

just surgeons. It includes nursing care, laboratory resources, blood bank and radiology. Our ability to have X-rays interpreted, interventional radiology in the care of our patients represents a huge multidisciplinary effort.

Q: How well covered is Upstate New York for trauma care?

A: There are different levels of trauma centers: level one is the highest, level three is the lowest. As far as level one centers: Albany has one, Upstate is a level one trauma center, Rochester has one. So they’re geographically distributed. You’d find level two centers in places like Binghamton and Utica.

They’re able to handle most things, but the sickest of patients would be stabilized and then shipped on. I think one of the challenges Upstate New York faces in systems-based trauma delivery is geographic, its rural nature and the extremes of climate we have that make transport difficult at certain times of the year.

Q: What can be done to mitigate that? Is that something the Shock Society looks into?

A: The Shock Society is really a research organization. So if there were a new medication that improves outcomes in patients that need massive transfusions, they would be involved in the laboratory testing of that. The state Department of Health is the governing body that is involved in distribution and designation of trauma centers in New York.

Q: How did you, personally, become interested in trauma medicine/ surgery?

A: There were multiple factors. Part of it was that it was a relatively new specialty at the time. I had a number of mentors who I admired who influenced my decision. It’s a high-adrenaline activity. I don’t know if you ever watch the show M.A.S.H., but there’s something exciting about a bunch of casualties coming in to be cared for.

Being in a civilian trauma center is not the same as being in a military trauma center, but I was in the Army Reserves for 10 years and worked in a trauma center in San Antonio.

Lifelines Name: Robert Cooney, M.D. Position: Chairman of the Surgery Department, SUNY Upstate Medical University Recent awards: Received a Distinguished Academic Achievement Award from the Medical Alumni Association of the University of Vermont at its “Celebrating Achievements—Legends & Leaders” event. The award recognizes Cooney for his outstanding scientific and academic achievements.

Hometown: Portland, Me., area Education: University of Vermont (medical), University of Massachusetts (residency), University of North Carolina (fellowship) Affiliations: SUNY Upstate Medical University, Crouse Hospital, Community General Organizations: American Association for the Surgery of Trauma, Society of Critical Care in Medicine, the Shock Society, Society of University Surgeons Family: Married to Lorrie Cooney, two daughters Hobbies: Skiing, golf, reading

When Pets Get a Cancer Diagnosis It’s estimated that four million cats and dogs develop cancer in the U.S. every year

By Deborah Jeanne Sergeant

A

pproximately four million cats and dogs develop cancer annually in the US, according to the National Veterinary Cancer Registry.

The organization also estimates that more than half of all pets that live more than a decade will develop some form of cancer.

With treatment, cats and dogs can survive cancer.

But as with humans, early diagnosis and prompt treatment make a big difference. Unfortunately, pets often stoically hide symptoms while their cancer grows and it takes an astute owner to recognize something’s wrong.

With the hundreds of types of cancers that can afflict pets, there’s no hard-and-fast list of symptoms to look for. Owners should have a vet check their pets for any strange lumps and bumps, change in eating or elimination habits, or unusual behavior. Sometimes, the signs are not obvious.

“Cats are stoic,” said Eve Ryan, veterinarian with Beaver Lake Animal Hospital in Baldwinsville. “I’ve had them all my life and my experience tells me that we see lots of painful and chronic medical conditions and [cats] don’t show it.”

Dogs can manifest symptoms that are little more obvious, such as despondency for a normally exuberant dog, whimpering, limping, refusing food or vomiting. Cat owners may dismiss

vomiting as a hairball, unlike dogs.

“Dogs are more dependent on people so people are quicker to notice [their health problems],” Ryan said.

An exam for a pet would include a physical, health history discussion with the owner, and possibly blood tests to see what the problem is. The vet may also order imagery to get a better look if there’s a lump.

Deciding what to do after a cancer diagnosis depends upon many factors, including the likelihood of recovery and the family’s finances.

“Veterinarians, first and foremost, concern themselves with the comfort and wellbeing of the pet and the relationship that pet has with the family,” Ryan said. “There should be a two-way dialogue when cancer is suspected as to what can and should be done about it to help the pet and family.”

Animals with a non-metastasized lump often respond well to surgical removal of the lump. Treatment with drugs may also be an option. Of course, as with humans, the animal’s health and age and the type of cancer also play a role in surviving.

“There are many, many options available,” Ryan said. “A cancer diagnosis is not necessarily the end.”

But if no treatment would help, the vet can ease a pet’s suffering with pain management.

More Pets Suffering from Cancer Needed in Research

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he National Veterinary Cancer Registry offers 10 reasons why cancer research for pets is important to both pets and humans: 1. Animal cancer is naturally obtained or spontaneously developed, as opposed to experimentally induced, as is the case with lab mice.

2. In many cases, pets develop the same types of cancers as their human caregivers do.

3. Animal tumors are similar to human tumors in terms of size and cell kinetics. Dogs and cats also possess similar physiology and metabolism characteristics to humans, which enables us to compare treatments such as surgery, radiation and chemotherapy.

4. Most pets are large enough for high resolution imaging studies, as well as surgical intervention.

5. Dogs and cats have intact immune systems as opposed to many rodent model systems,

enabling immunologic treatment approaches to be explored.

6. Most animal cancers progress at a faster rate their human counterparts, permitting more rapid outcome determinations, such as time to metastasis, local recurrence and survival.

7. Animal trials are more economical to perform than human trials.

8. Because fewer “gold standard” treatments exist in veterinary medicine, it is ethically acceptable to attempt new forms of therapy — rather than to wait until all “known” treatments have failed.

9. Dogs and cats live long enough to determine the potential late effects of treatment.

10. The recent elucidation of the cancer genome and its resemblance to the human genome provides unparalleled opportunities to study comparative oncology from a genetic perspective.

T

he Learning Disabilities Association of CNY provides Educational Consulting to families with children who have learning disabilities, ADHD or struggle with learning. Call for assistance in helping children, 315-432-0665 or visit our website www.LDACNY.org LEARNING DISABILITIES ASSOCIATION OF CENTRAL NEW YORK

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IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Page 7

Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Growing Through Loss: Lessons Learned

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n the past five years, I lost my father, my dog Lillie, a dear friend to a rare cancer, and then my brother Mark, who left this world far too soon at age 60. I was barely recovering from one loss, when another would make an unwelcome entrance.

I’m still trying to make sense of it all.

Just as living with a spouse doesn’t guarantee “happily ever after,” living alone doesn’t guarantee safe shelter from life’s losses and heartaches. Loss comes with living. It’s inevitable and sometimes predictable. And not all loss is bad. That’s what I’ve come to know.

Whether a loss is caused by death, the end of a relationship or other life circumstances, most of us struggle to comprehend and cope with the emotions that result. That certainly was the case for me after my divorce.

The breakup of my marriage was the first major loss in my life, and my recovery was slow and painful. It was also transforming. Loss became my “teacher” and I learned profound life lessons about grief, self-compassion, and ultimately, acceptance.

If you are in the throes of loss, perhaps some of my reflections below will help ease the burden of your grief.

While there’s no best way to manage loss, I’ve discovered some things along the way that may help you feel a sense of renewal and hope.

Loss is as personal as it is profound. Fortunately, in my times of loss, I have had my family, friends, and therapist here to remind me that each of us is unique and each of us manages loss and grief in our own, individual ways.

I was not urged to “move on” or “find closure.” I appreciated everyone who simply let me be me, on my timetable — to cry or not, to return to work or not, or to enjoy an evening out, when I was ready for company and in need of a good, hard laugh.

Loss can inspire honest expression.

As a young adult, being emotive was not my style. Stoic is probably how most people viewed me (including myself). But, as my losses grew, so did my need and desire to express my true feelings. And now, I wouldn’t have it any other way. My losses have inspired me to be more real, more

KIDS Corner Is My Child’s Toy Toxic?

Read the Label

T

here are thousands of children’s toy manufacturers around the world. Toys can be made of metal, plastic, paint, fabric and many other components, but are they really safe for your children?

KidsChemicalSafety.org has compiled information from scientific experts to help parents make sense of information they are hearing about toys and chemicals. The website recently published an essay on exposure to chemicals in toys, what it means for children’s health and ways that parents can minimize the risk to their children, and an essay on physical hazards with toys and the types of prevention and first aid needed to address these hazards.

“Parents can protect their child from chemicals in toys by choosing appropriate toys designed for their child’s age and paying attention to warnings on the labels,” said physician Rick Reiss, an expert on exposure assessment who authored the “Chemical Risks in Children’s Toys?” essay for KidsChemiPage 8

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calSafety.org. “The most important thing a parent can do is to assure that very young children do not have access to toys that are not intended for their age.”

For example, Reiss noted, some toy jewelry contains levels of lead and cadmium. While these toys may be safe if they are only touched (lead and cadmium don’t easily penetrate human skin), they may not be safe if mouthed, since lead and cadmium dissolve in saliva and then get swallowed.

The most important thing a parent can do, according to KidsChemicalSafety.org, is often the simplest thing: read the label. A quality toy company that is in compliance with international regulations will carefully develop label warnings intended to provide parents with information to minimize risk. The most important information is usually the recommended age range. This recommendation is based on knowledge of typical behaviors of children of different ages.

IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

spontaneous, and more authentic. I wouldn’t change that for anything.

Loss can facilitate self-awareness.

This was especially true for me, in terms of getting in touch with myself and some unfinished issues and unresolved feelings. When I thought about what I wished had been different or what I would have liked more of in a relationship, my losses helped me clarify my preferences and priorities.

Anger about not being truly seen nor heard told me that I highly value relationships where respect is demonstrated. It is a “must have” attribute for me, going forward.

Loss welcomes a good listener (and some forgiveness). Understandably, people often don’t know what to say to a friend or loved one who has experienced a loss. When unwanted advice or careless remarks came my way, I tried my best to forgive those whose intentions were good, but whose words hurt. Mostly, I appreciated those who sat with me, listening with dignity and

compassion.

Loss can sometimes use a change of scenery. I have always believed that the mind and body are connected. When the clouds roll in and sadness visits, I seek out what restores my faith and renews my energy. For me, that means spending time in nature. Turning off my phone and going for a long walk in a beautiful, peaceful place helps me regain my perspective. I’m reminded that “spring” will return. Life is good.

Loss reminds us about what really matters. My mother, who has shared many of my losses, doesn’t hesitate for a moment when asked what is important to her: “Family,” she says unequivocally. I couldn’t agree more. Grief and loss can teach us so much. For me, clarity about what matters has been one of the most valuable lessons.

If you are struggling with loss and feelings of isolation, I encourage you to draw loved ones close. Whether it be a friend, a family member, counselor, or pastor, reach out and ask for help and support. Know that feeling better is within all of our grasp, as long as we pay attention, keep our hearts and minds open, and have the courage to explore and share our feelings. We are not alone.

Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon. For information about the fall workshop, see the events calendar in this issue, call 585 624-7887, or email gvoelckers@rochester.rr.com.

Young People Now at Higher Risk for Stroke

F

ifteen percent of the most common type of strokes occur in adolescents and young adults, and more young people are showing risk factors for such strokes, according to a report in the journal Neurology.

Neurologist Jose Biller of Loyola University Medical Center is a co-author of the report, a consensus statement developed by the American Academy of Neurology.

Between 532,000 and 852,000 persons aged 18 to 44 in the United States have had a stroke. U.S. hospital discharges for stroke among persons aged 15 to 44 increased 23 to 53 percent between 1995–1996 and 2007– 2008, depending on age and gender of the group.

“The impact of strokes in this age group is devastating to the adolescent or young adult, their families and society,” Biller said.

Biller is a member of an expert panel the American Academy of Neurology convened to develop a consensus report on the recognition, evaluation and management of ischemic stroke in young adults and adolescents.

About 85 percent of all strokes are

ischemic, meaning they are caused by blockages that block blood flow to the brain. And more young people have risk factors for ischemic strokes. Those risks include high blood pressure, diabetes, obesity, abnormal cholesterol levels, congenital heart disease and smoking.

Strokes in young people have a disproportionally large economic impact, because they can disable patients before their most productive years. And while coping with the shock of having a stroke, “younger survivors may be dealing with relationships, careers and raising children — issues that require additional awareness and resources,” the consensus report said.

The authors said more emphasis is needed on teaching about stroke in young people and its risk factors and warning signs in school, at the work place and in primary care physicians’ offices and the media. Given the increasing physical, emotional and financial burden strokes cause in young people, “there will need to be greater research into reducing this burden.”

Obamacare: Game On…

Physician, Emergency Medical/ Clinical Investigator

Navigating New York’s new insurance marketplace

By Matthew Liptak

E

nrollment for low-cost health insurance through the health benefit exchange (www.healthbenefitexchange.ny.gov) begins Oct. 1.

New York’s new insurance marketplace, a result of the federal Affordable Care Act, will include trained personnel, known as navigators and in-person assistors, who will be ready to help those who find the enrollment process challenging.

Sara Wall Bollinger is the executive director for health planning of the Central New York Health Systems Agency.

The agency helps direct HealtheConnections Health Planning, an organization serving Onondaga County that has been given state grants in exchange for supplying navigators.

“Basically the navigator’s job is to determine what’s the best match with your family situation and your earnings or other money that you have and then match you with the subsidy or assistance program that’s going to be the best with you,” Bollinger said. “Then if you need more help they can actually help you fill out the form to apply. The forms will be online and there’ll also be a telephone hotline with people who can assist you with the online completion of the form. There’s a little bit of ID required that people just have to plug in their numbers.”

People will have to make an appointment if they want to get help from a navigator. HealtheConnections expects to have four people filling the role of navigator working at four local partner agencies. Those agencies are the Northside Urban Partnership, Salvation Army, South Side Innovation Center and Benefit Specialists of NY. Bollinger said she expects about 3,000 people to take advantage of the services initially. She believes they will be prepared to anticipate the volume due to the agency’s experience with other programs.

“There will be a scheduling issue,” she said. “I think for our navigators here in Onondaga County we’re going to have a telephone scheduler so that person will plug you into the next convenient time for you. If you have to come after work, maybe it wouldn’t be that same day. It might be three or four days later before an after work time slot was available but if you’re pretty flexible you should be able to get in right away.”

Most individuals who go to the New York State of Health website to choose a health insurance plan are not expected to need assistance. They are likely going to be able to work their way through the website unaided. But if they do need help, along with the navigator program, representatives at the New York State of Health Call Center are available Monday through Friday 8 a.m. to 5 p.m. to help guide

individuals. The call center number is 855-355-5777.

“It’s a marketplace,” Bollinger said. “What people say is it’s similar to Expedia. It will be a website. Multiple insurance carriers will have their products and if they provide service in your region you’ll be able to see what their products are. They’ll be broken into five levels according to how expensive they are and also how much they cover which are called bronze, silver, gold and platinum. If you’re a young person (30 or younger) you can get a fifth version that’s called catastrophic coverage.”

Bollinger said New York state’s new insurance marketplace is worth the effort consumers may need to put into it. She called it a great deal.

It’s easy to see the potential benefits New York State of Health. Those with an income of between 100 percent and 400 percent of the poverty level ($23,550 to $94,200 for a family of four in 2013) may be eligible for a premium tax credit that lowers the cost of health plans listed on the exchange website.

The cost of their health plan’s insurance premium, for those receiving this credit, will not exceed 9.5 percent of income. The exact amount of the credit is based on actual household income as reported in the income tax return.

Cost sharing reductions may also be available for those whose income is at 250 percent or less than the poverty level. These are provided to reduce out-of-pocket expenses.

Those who are at even lower levels of income may be eligible for Medicaid or the Children’s Health Insurance Program.

Those who want to may seek health insurance through providers offering plans outside the online marketplace. There is no requirement to use it, but the tax credit is only available to those purchasing qualified plans through the New York State of Health website.

The hope of the creators of the new system is that it will help drive down health insurance costs. The Congressional Budget Office estimates that when the Affordable Care Act is fully phased in the tax credit alone will help 20 million Americans afford health insurance.

Come 2014, those who choose not to get health coverage, be it in or outside the new marketplace, may be forced to pay a penalty fee. That penalty comes out to 1 percent of your yearly income or $95 per person, whichever is higher.

For those who are interested in getting insurance through the New York State of Health website, Bollinger advises taking time to consider the options. The initial open enrollment period runs from Oct. 1, 2013 to March 31 of next year.

“Take a little bit of time to look it over before making a decision,” she said. “Go and check out the site and then go back another day to actually enroll so you have a chance to get a feel for all the different choices that are in there.”

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Who to Call for More Information

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ach county of Central New York has different organizations contracted by the government to provide navigators. Navigators offer in-person assistance to those seeking low-cost health care insurance through the new New York State Health Benefit Exchange online.

For those requiring less personal attention both a national and New York State call center are available to answer questions and offer guidance.

Contact information is provided below.

• NATIONAL MARKETPLACE TOLL-FREE CALL CENTER Open 24 hours / 365 days a year Phone: 1-800-318-2596, TTY 1-855-889-4325 Organizations Providing Navigators and In-Person Assisters • CAYUGA COUNTY Cayuga/Seneca Community Action Agency Inc. 315-255-1703 • OSWEGO COUNTY Oswego County Opportunities Inc. 315-598-4717 • MADISON COUNTY Mowhawk Valley Perinatal Network 315-732-4657

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IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Are Area Physicians Ready for Obamacare?

A Q&A with Onondaga County Medical Society president

By Molly Martindale

O

bamacare, President Barack Obama’s signature health insurance reform legislation, could swell the ranks of the insured by an estimated 29 million Americans. On Oct. 1, health insurance exchanges that New York and many other states have set up to help the uninsured select their health care plans will open their doors.

Is the local medical community ready for the potentially large number of new patients that The Patient Protection and Affordable Care Act could bring to local hospitals, clinics and doctors’ offices?

Onondaga County Medical Society President Ramsay Farah, a physician with a specialty in dermatology, spoke to In Good Health about Obamacare and the readiness of local physicians for the changes the health care reform measure could bring.

Q.: What should local physicians be aware of as a result of the opening of health insurance exchanges on Oct. 1?

A.: The thing about Obamacare is that this is the most momentous shift in the way that medicine is going to be dispensed and practiced since the introduction of Medicare in the 1960s.

Just like there were many unforeseen consequences that no one could have dreamed of with Medicare, I think in the future we’ll look back and we’ll say the same thing about Obamacare.

We’re not exactly sure what will actually happen when the exchanges open. Honestly, it’s a little bit of a waitand-see approach. For example, one of the issues to consider with primary care practices is that they already have booked appointments and they’re full.

In Onondaga County, it’s sometimes problematic to get access into primary care, in addition to specialty care.

A lot of physicians are already full, so when they take on exchange patients there are potential issues that arise. For a lot of these exchange patients, the rates may offer lower reimbursements to physicians.

Physicians won’t have the ability to control the number of exchange patients that they see. These risks may turn out to be manageable but it’s too early to tell. Many questions still need to be answered and we really won’t know until the exchanges actually start.

Q.: Millions — and possibly tens of millions — of Americans are expected to sign up for health insurance in the coming year. Are Onondaga County’s physicians and medical systems ready for additional patients? If not, what must be done to prepare for it?

A.: One of the issues facing Ameri-

More about Obamacare?

For more information about Obamacare or about enrolling in a medical plan, go to www.obamacarefacts.com/obamacarebill. php.

IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

can medicine is the shortage of physicians. If you look at studies, virtually all of them will echo the same conclusion that there’s a shortage not just of specialists but primary care physicians as well. Even without Obamacare coming into the picture, the fact that the baby boomers are growing older, and are requiring more medical care is already affecting the medical world.

Something like 10,000 new patients enter Medicare everyday. That’s a huge volume. When you add Obamacare to that demographic, combined with the shortage of physicians, the addition of 30 or 40 million new patients may or may not break the system.

Physicians can prepare for this with labor force multiplication. Perhaps, where appropriate, they can incorporate physician extenders who work under supervision from physicians. We can also try to leverage technology. There already is a big push for electronic medical records, and even though they have their limitations when used appropriately, they can be a force multiplier.

Q.: Who is most affected by the provisions for 2014 under Obamacare?

How are they affected?

A.: The exchanges with Obamacare are expected to be a magnet for uninsured people with lower incomes.

Exchanges will really be the only place for them to qualify for new, federalsubsidized health insurance.

With the exchanges, it’s limited to individual families or companies with fewer than 50 employees. Those types of individuals currently cap at lower health insurance costs, which are insured by larger groups that can bargain for lower costs. I think that principally that they will be affected the most. However, I do believe it’s good that these underprivileged individuals will have access to good healthcare.

Q.: How will Obamacare affect the fee-for-service system?

A.: You could argue both ways for the feefor-service model. On the one hand, you could argue that the future for medicine and doctors are going to be part of large groups, like hospitals, exchanges or physician practices, so the fee for service model may become obsolete.

On the other hand, you could argue that in certain situations the fee-for-service could be offered as an alternative or become an economic niche.

When you buy health insurance on the exchanges, there are different tiers of health insurance that you can buy. The

lower tiers of insurance don’t necessarily cover a lot of things and there will be a significant out-of-pocket cost for those individuals with that lower tier of insurance. The fee-for-service system may either become obsolete or it may survive in small, isolated islands.

Q.: Will Obamacare place more focus on preventive care?

A.: I think that inevitably it will.

The focus is to get people insured so that they can see their doctor and stop using the emergency room as their source of primary care. From a doctor’s point of view, going to the emergency room involves reacting to a problem and that’s always more expensive than trying to prevent a problem.

I think if people have greater access to medicine, especially primary care, they will get the preventive care that they need. They won’t be using the emergency room as a last resort. They’ll actually be using the primary care as a first resort.

Q.: How will physicians benefit from the implementation of Obamacare? What aspect of it is the most significant for them?

A.: It’s really not clear yet how physicians will benefit. I think that if you step back and look at the broader picture, Obamacare is going to increase demand. Physicians will be in short supply and economically when demand outweighs supply, that can often be of benefit to the supplier. Potentially, doctors will be fine because they will have an influx of new patients. The problem can be though, that since there are so many pressures to cut costs, reimbursements are going to be cut with the exchanges.

At the same time that expenses are going up, what may wind up happening for physicians is that they may be asked to do a lot more with a lot less.

Q.: What is your personal view about Obamacare? What aspects of it do you favor or oppose?

A.: The aspect I favor about Obamacare is this was a genuine attempt to get universal healthcare and I do applaud that attempt. However, I don’t feel that this was the right way to go about doing it because I think that it does empower the insurance companies.

I think when we empower those health insurance companies, patients and physicians have a lot less leverage to change things that might need to be changed. I admire the effort to get universal healthcare but not the mechanics of how it’s being achieved.

Ramsay Farah

About HealtheConnections HealtheConnections, the Regional Health Information Organization (RHIO) of Central New York is a non-profit organization that is bringing patient medical records together electronically, safely and securely, to assist with better patient care. HealtheConnections is one of 11 RHIOs that comprise the State Health Information Network in New York State (SHIN-NY). We provide for the secure exchange of electronic health information making patient information available to authorized caregivers—where it’s needed, when it’s needed—so providers of care have a more complete picture of a patient’s health and can provide the best possible care.

HealtheConnections has connected hospitals, diagnostic centers, and several large practices that contribute patient medical information to the Health Information Exchange (HIE). These healthcare providers are not only contributing data, but are also accessing patients regional medical records to assist in patient care, along with hundreds of other primary care providers and specialists. Instant access to patient data is accessible through HealtheConnections Patient Lookup. The data includes patient demographics, lab results, radiology reports and images, medications, allergies, problem lists, transcribed reports and other data for over 1.3 million patients.

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Better information means better care. HealtheConnections offers valuable member services, including Patient Lookup, Results Delivery, Secure Messaging (Direct), CCD Exchange, My Results, and My Alerts. Many providers have already joined and are immediately seeing the benefits. We want you to benefit, too.

For more information about HealtheConnections services,, visit our website at www.healtheconnections.org or contact our Provider Engagement Services Team at 315-671-2241 x330.

109 South Warren Street ● State Tower Building, Suite 500 ● Syracuse, NY 13202 315.671.2241 ● www.healtheconnections.org Connecting You to Better Care Octobeer 2013 •

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Page 11

Liverpool, Chittenango Host Anti-Suicide Walks

By Matthew Liptak

I

n 2010 data supplied by The Centers for Disease Control and Prevention showed that 38,364 Americans died by suicide — or one person every 13.7 minutes. This October people from around Central New York are coming together to help stomp out this epidemic and remember those lost.

Two “Out of the Darkness” walks will take place this month, one at 11:30 a.m. at Long Branch Park in Liverpool on Oct. 12 and one at noon. at Jim Marshall Farms in Chittenango on Oct. 19.

This year organizers hope the walk in Liverpool alone will raise $50,000 toward preventing suicide. They say an average of 800 people have attended past events in Liverpool.

“A big percentage of our funding comes from fundraisers,” said Debra Graham, the Central New York area director of the American Foundation for Suicide Prevention (AFSP), which is sponsoring the walk. “Our signature fundraiser is our ‘Out of the Darkness’ walks which will be taking place across the country again this year.”

Ninety percent of those who commit suicide suffer from depression or some other form of mental illness, Graham said. The AFSP strives to reduce suicide deaths throughout the country by research and education but also offers comfort, reaching out to those who have survived the loss of a loved one.

One of the programs provided is the training of support group leaders who serve survivors. There are also healing conferences for survivors each year and grants are provided by the AFSP to scientists researching the causes of suicide and its prevention.

“Out of the Darkness” walks take place in several cities across the nation. In Central New York, two events are scheduled, one in Chittenango and one in Liverpool. Past events in Liverpool (photo) have attracted about 800 people.

Disseminating information on suicide prevention is a high priority for the organization. The “Out of the Darkness” walks are one way to raise awareness of the suicide epidemic.

Smaller efforts are being undertaken to get the word out too.

The AFSP provides films to both high school and college students and faculty on recognizing depression.

Graham emphasized that, like all the AFSP’s efforts, the films meet evidencebased and best practice standards. The organization also advocates for policies and legislation that prevent suicide.

It does have some limitations though. It doesn’t offer counseling.

“We’re not a service provider so

Head of Local Group Lost 17-year-old Son to Suicide

D

ebra Graham, the Central New York area director of the American Foundation for Suicide Prevention (AFSP), became affiliated with the organization through her own tragedy.

“I lost my youngest son Josh to suicide when he was just 17 and I came upon the AFSP about a year after he died and got involved as a volunteer,” she said.

“It really helped take a very tragic experience and turn it into something positive by helping others who had also lost a loved one and by working with those who may be having thoughts of suicide to encourage them to get help. It’s been very helpful in my healing process and likewise for other survivors that Graham I have met throughout the last ten years while working with AFSP.” So what should someone do if they know someone who is having thoughts about committing suicide?

“Encourage them to get help,” Graham, said. “Offer to accompany them.

Don’t leave them alone. Connect them to a resource that will be able to help them through this crisis.”

Those who are having thoughts of suicide can call 1-800-273-8255, the national lifeline number. All calls are conPage 12

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

we don’t do any type of counseling but just by raising the awareness, reducing the stigmas, we promote help-seeking behaviors at our events so that those who are having thoughts of suicide know that it’s not a weakness...that treatment works and we encourage that,” she said.

fidential and anonymous and the line is available around the clock every day of the week. There is a special veteranonly line available to at the number for those who have been in the service.

Those seeking advice about somebody they know who may be considering suicide are encouraged to call too.

Graham believes each of us can make a difference in preventing suicide —not only can, but should.

“I think everyone of us has an obligation to talk about it more because the more we talk about it the more we’re going to help reduce those stigmas,” she said. “If you were unaware that maybe you had a friend that was having suicidal thoughts and you were someone who weren’t afraid to talk about it that may be what would save that person’s life because they know you’re someone they can talk to. We’re not ashamed to talk about cancer or heart disease so why should we be ashamed or embarrassed to talk about [it] if we have a mental illness?”

For more information on the American Foundation for Suicide Prevention visit www.AFSP.org. For more information on the Out of the Darkness Walks go to www.outofthedarkness.org.

DivorceCare Offers Light in the Darkness of Divorce

Program in North Syracuse helps those going through a divorce

By Matthew Liptak “Divorce is horrible.”

So says the director of the DivorceCare program at North Syracuse Baptist Church, Ellen Jones.

Jones knows from personal experience the pain of divorce. She went through one in the 90s and didn’t seek help until a long time later when a coworker persuaded her to go to the DivorceCare program at the North Syracuse Baptist Church.

“I blew it off for a good year or two and I finally went,” she said. “I have not left North Syracuse Baptist Church since.” Jones now runs the DivorceCare program at the church.

“DivorceCare was actually something that was put together by a man who had gone through a divorce maybe 20 years ago,” she said.

“It’s been updated and it’s actually a national package that you can buy the videos and then you have a workbook and people can sign up to host it.

North Syracuse Baptist is a host for this DivorceCare package.”

The program runs 14 weeks and tries to cover most major aspects of dealing with the aftermath of the end of a marriage. Seminars and support meetings take place from 6:30 to 8:30 p.m. each Tuesday. All issues discussed

among members are considered confidential.

The classes began Sept 10, but those interested are encouraged to check out a class at any point in the series until it concludes in the beginning of December. Another series will begin March 11 of next year.

“Each week is a different one,” she said. “There’s a brochure that lists the weekly topic. The very first one talks about ‘What’s Happening to Me?’ the whole hurricane, ‘How did this happen and what am I supposed to do with it?’

Then the second week would be about the road to healing, how to start taking some steps to figuring it out.”

Following are classes on anger, depression, loneliness, scriptural interpretation of divorce, financial survival, new relationships, how kids are affected, sexuality and being single, forgiveness and reconciliation.

“It helped me tremendously,” said Marla Dursharm who went to the series after she filed for divorce after 35 years of marriage. “It gave a voice to my feelings and pain. I was with others that, although all of our situations were different, the commonality of pain at the tearing apart of a marriage was the same. We cried just as much for each

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other as you would for your own situation. You had people listening to you that understood and could relate. They could offer strategies to help you cope or just the comfort of saying I understand.”

People are encouraged to participate but also free to take a pass.

Graduates from past series of DivorceCare are encouraged to drop by, especially for the advice they might have to offer those who are just starting their journey. Thirty- to 40-minute videos played during the class also offer help.

“Each week it’s a real person’s story,” Jones said. “It’s somebody that’s really come through it, has something to offer and hopefully help them not make some of the bad decisions that these other people have made.”

About 20 people usually attend DivorceCare, Jones said. The church also sponsors a similar program for those dealing with grief and will be starting another class structured similarly centering on the challenges of being a single parent starting next March. There is no cost to attend

DivorceCare, only the price of a $15 workbook that can be reduced if the person attending is financially challenged. Free child care is also available during DivorceCare classes.

“The good thing about this program is that we have a group of people that have all gone through divorce, all our leaders are people who know the pain of divorce and recovered and healed from it which is one of the things—you’re looking more forward to your future than you are to your past,” Jones said.

For more information on the North Syracuse Baptist Church’s DivorceCare program call 315-458-0271 or to find another DivorceCare class in your area go to DivorceCare.org.

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Page 13

Women’s issues VBAC More Widely Accepted Among OB/GYNs Vaginal delivery after C-section becomes more common

By Deborah Jeanne Sergeant

A

woman who delivered via cesarian section years ago would never consider the chance of a future vaginal delivery; however, it’s become much more commonplace for women to have a vaginal birth after cesarian (VBAC).

Sarah Oakley co-leads ICAN of Syracuse, a national VBAC support and education organization. She said that as new research is published, the popularity of VBAC increases and decreases.

“In this area, it’s fairly limited and across the country only 57 percent of women who want VBAC can find a supportive provider.”

She said that in the late 90s VBAC peaked; however as more women sought VBAC, those who were induced had worse outcomes. The blame was erroneously place on VBAC and not the labor induction.

In subsequent years, many studies have indicated that VBAC is a viable option for the majority of healthy, lowrisk mothers. Though the medical community’s stance has generally shifted in acceptance of VBAC, protocol regard-

ing VBAC, “it became impracticable for hospitals to offer it and people began to be scared of it,” Oakley said.

Hospitals could not effectively staff VBAC births with the extra personnel required, especially smaller ones, so most shied away from VBAC as an option.

In 2010, the Conference at National Institute of Health looked at the safety and results from VBAC and trial of labor (TOLAC), a “wait-and-see” approach for moms with previous C-sections, and “called on organizations to facilitate access,” said Heather Shannon, nurse practitioner with Upstate Midwifery Program. The organization “determined that liability concerns impact willingness of physicians and hospitals to offer TOLAC.” Since then, the number of facilities offering TOLAC and VBAC has increased.

“Restrictive guidelines should not force women to forgo VBAC,” Oakley said. “Slowly, it’s becoming more accepted over the past three years.

There’s more information and research

out there. More women are asking for it. But, I think that there’s still a long way to go with only 8 percent of women who want to go with VBAC being able to do so.”

Considering the disadvantages of C-section, it’s easy to see why many women generally prefer vaginal delivery.

Though a common procedure, C-section is still a major abdominal surgery and carries with it all the risks of surgery such as blood clots, blood loss and infection. A TOLAC followed by a caesarean carries risk including: maternal hemorrhage, infection operative injury, blood clot, hysterectomy, death and uterine rupture.

Though some women request cesarian for the delivery of some or all of their children to avoid the birth pains of vaginal delivery, the post-delivery recovering is longer. The 60 to 80 percent of women with a successful VBAC avoid major abdominal surgery, experience lower rates of hemorrhage, reduce the risk of bowel or bladder injury, and other potential complications of C-sec-

tion. But women who want to avoid Csection now have a greater chance their birth plans will pan out. Oakley said that it depends upon the caregiver.

“In general, an OB-GYN group is pro- or anti-VBAC,” she said. “But it does pay to ask each provider. If they’re not all pro-VBAC, it’s not a good option.”

Each woman’s circumstances and birth history also make a difference.

For example, a woman whose first delivery was an uneventful vaginal delivery and whose second was a C-section because of a breech birth is likely a good candidate for VBAC. The patient’s and baby’s health, mom’s weight and ethnicity, the reasons for the previous C-section, and other factors play a role in VBAC success.

“Should a woman choose VBAC for her next delivery, she will need to seek out a provider and a hospital that offers this service,” Shannon said.

“Once established, she will be evaluated as to whether she is a candidate for a VBAC. She will then be educated on the risks, benefits and alternatives of VBAC, which will allow her to make a well informed decision whether this is the best option for her and her baby.”

Among the biggest dangers of VBAC to the mother is uterine rupture; however, the risk is less than one percent.

Checking Risks

Moms, want to estimate your chances of successful VBAC? Try this calculator and discuss it with your OB/GYN: mfmu.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth.html

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

Women’s issues US Infertility Rates Drop Over Last 3 Decades

I

nfertility rates among U.S. women have fallen, but more women who eventually do get pregnant are having problems conceiving or carrying a child to term, a new report suggests.

Between 1982 and 2010, the percentage of married women aged 15 to 44 who were infertile — meaning they did not become pregnant after a year of unprotected sex with the same partner — declined from 8.5 percent to 6 percent, according to the report from the Centers for Disease Control and Prevention. That translates to about 1 million fewer infertile women in this age group in 2010 than in 1982.

Looking at only the oldest women included in the report (women aged 35 to 44), researchers also found their infertility rate decreased over the study period, from 44 percent in 1982 to 27 percent in the years between 2006 and 2010.

Contrary to a public perception that infertility is increasing, “in truth, the data don’t support that infertility is on the rise,” said study researcher Anjani Chandra, a demographer at the CDC’s National Center for Health Statistics.

However, the percentage of married women who experienced difficulties becoming pregnant or carrying a pregnancy to term — medically known as impaired fecundity — increased slightly over the study period, from 11 percent in 1982 to 12 percent in the years between 2006 and 2010. Rates of impaired fecundity peaked in 2002, at 15 percent.

Among all women (not just those who are married) the percentage with impaired fecundity increased from 8.4 percent in 1982 to 11 percent in the years between 2006 and 2010.

Women are more likely to experience difficulties becoming pregnant as they get older. In recent years, 11 percent of married women aged 15 to 24 had difficulty becoming pregnant, compared with 47 percent of those aged 40 to 44.

Chandra said more women are now having children at older ages, which increases the risk of fertility problems and fertility loss. But the availability of fertility treatments may, in part, counteract this trend, so that on the whole, infertility rates have not changed much.

Use of fertility services may also lower the percentage of women who fit the definition of infertility used in the study, Chandra said. Women who experience problems becoming pregnant today may seek medical services quickly, and become pregnant before the 12-month period that would be needed to classify them as infertile, Chandra said.

It’s important to note that not all women in the study who were classified as infertile may have wanted to have a child. About 40 percent of childless women with fertility problems did not intend to have a child in the future, the study found.

The report was published Aug. 14 by the CDC’s National Center for Health Statistics.

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Page 15

Women’s issues No Amount of Alcohol or Drugs Safe During Pregnancy

By Deborah Jeanne Sergeant

T

he CDC states that 40,000 babies are born annually with fetal alcohol syndrome, caused by moms drinking alcohol while pregnant. FAS can cause long-term, debilitating problems for babies.

Babies can experience a wide variety of immediate and lasting consequences arising from their mother’s consumption of alcohol while pregnant.

These include fetal alcohol syndrome, alcohol-related birth defects, and alcoholrelated neuro-developmental disorders.

Heather Shannon, nurse practitioner and director of Upstate Midwifery Shannon Program, said the typical effects on the baby include “brain and neural development problems, growth deficiency, stature, structural changes, microcephaly, prematurity, low birth weight.”

Babies also experience abnormal features that include a narrow eye opening, no vertical indentation between the upper lip and nose, and a thin junction between the lip and adjacent skin.

Bodily organs and functions may

also be impaired such as the kidneys, heart, and bones.

The problem is both widespread and financially costly as well.

“One hundred neonates are born each day in the US with alcohol-related impairment,” Shannon said.

The estimated costs in the life of a baby exposed to alcohol adds up to $4 billion annually and $1.4 million in lifetime for each individual exposed.

Drug exposure also can cause lasting impairments depending upon the drug.

Shannon said that drug use by expectant mothers can cause problems, including neonatal withdrawal, low birth rate, facial anomalies, mental and social problems, and poor physical development.

Despite the well-known effects, Shannon thinks that many women continue to use alcohol and abuse drugs during pregnancy for many reasons.

The March of Dimes has begun several initiatives for eliminating alcohol and drug use during pregnancy.

“No level of alcohol or drug use is safe,” said Dorothy Dreyer, associate director of program services for the March of Dimes, Genesee Valley/ Finger Lakes Division, which serves several counties throughout Upstate New York.

The organization has developed educational brochures geared toward consumers and works with healthcare professionals to continue to educate patients.

“I think moms continue to drink because they have a friend who drank or smoked and had a preemie who was fine, so they think they can do it too,” Dreyer said. “They don’t understand the importance of not drinking during pregnancy.”

The problem has become large enough that some healthcare organizations are contemplating universal drug testing for their pregnant patients. Universal testing may help some moms quit; however, it also poses a quandary: will it drive moms who imbibe and use drugs away from prenatal care altogether?

“They may not get prenatal care, which isn’t as important as cleaning up, but prenatal care can help identify problems with the pregnancy,” Dreyer said.

Since about half of pregnancies are unplanned, sexually active women need to use dependable contraception. Any woman who may become pregnant should avoid alcohol and illicit drug use and talk with her doctor about any prescription and over-the-counter drugs she takes.

How to Talk to Your Daughter About Puberty Open communication is crucial in discussing physical changes, menstruation

S

ome parents may shy away from talking to their daughters about puberty, but Loyola University Health System obstetrician and gynecologist Akua Afriyie-Gray, stresses the importance of sitting down with your tween when the time comes.

“Most girls enter puberty without much education on the topic,” AfriyieGray said. “Parents should be proactive about talking to their daughter about puberty, so that she knows what to expect when her body begins to change.”

Afriyie-Gray offers the following tips on how to talk with your tween about puberty: Be prepared. Have your talk ready to go when the time comes.

Pay attention to your daughter. Be aware that your daughter may not come to you when she begins experiencing changes in her body. Look out for these changes and let her know what to expect. Puberty typically starts around age 8 or 9 with hair development under the arms and in the Page 16

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pubic area. Breast development usually occurs next at age 9 or 10 followed by menstruation, which begins on average at age 12. Puberty typically takes three to four years to complete.

Inquire about other girls. Ask your daughter if her friends have started shaving, wearing a bra or menstruating. This takes the focus off of your child and it may be a good opening for discussion about your daughter’s body and the changes she may be experiencing.

Take a positive approach. Let your daughter know that puberty is a natural process, which all girls experience. Stress that there is no need for her to be embarrassed, but be sensitive to what your daughter is ready to discuss.

Dispel myths. Answer any questions and correct any misconceptions your daughter may have about puberty.

Talk to your daughter about hygiene. Let her know what products are available for menstruation and that she can continue

IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

with her normal activities when she has her period.

Let her know about fertility.

Stress to your daughter that menstruation signals that she can become pregnant.

Turn to an expert. If you do not feel comfortable talking with your daughter about puberty, schedule an appointment for her to see a pediatrician or a gynecologist who specializes in treating children and adolescents.

Women’s issues Post-partum Depression Much Worse Than ‘Baby Blues’ One in eight women experience condition

By Deborah Jeanne Sergeant

T

he birth of a baby is usually a happy time for a family; however, for some women, post-partum depression (PPD) brings a dark cloud over the event.

More than “baby blues,” which affects most new mothers and resolves within a week or so, PPD can last much longer and interferes with a woman’s ability to care for herself and her family.

Kimmie Garner, co-coordinator with Postpartum Resource Center of New York, said that about one in eight women experience post-partum depression.

“That is probably a lot lower than what it actually is because of women not coming forward to report it,” Garner said. “It’s very stigmatized.

Women feel like they should be happy.

Garner It’s all about preparing for the birth, but afterwards, women can feel very alone as it’s been built up to be this big, exciting period of their lives.”

As stated above, many new mothers experiences an emotional letdown after birthing; however, PPD is much more extreme and longBrown lasting.

James Brown, OB-GYN at St. Joseph’s Hospital, said PPD manifests with sadness, depression and anxiety.

“Despair enters into the picture, even over the regular, daily, normal functions and tasks. It usually lasts for much longer than a couple weeks and usually counseling or support, along with medications, may be required,” Brown said. “Without treatment, PPD may actually worsen to a very severe form called post-partum psychosis, which, luckily, is not frequently seen.”

Certain factors can raise the risk of PPD, such as a physically stressful pregnancy, little support during pregnancy, history of depression or anxiety disorders, stressful life events and unknown biological causes.

Area health practitioners are working to help more women recognize and treat PPD. For example, moms who deliver at St. Joseph’s receive a phone call from staff after delivery once they have arrived at home.

“Unfortunately, this is not a standard,” Brown said. “There is a [PPD] questionnaire that can be used, but it is cumbersome and long. We have modified this and have patients complete at the post-partum visit. It would be great if this was part of all post-partum visits, but currently it is not.”

Since most practices schedule patients’ first follow-up visit six weeks postpartum, they may be severely depressed by then.

Treatment options can include counseling and medication.

But some women Loi don’t want to even seek help.

“Patients are sometimes reluctant to disclose their symptoms to family members or their doctor for fear of being labeled as either mentally ill or as an incompetent mother,” said Allison Loi, obstetrician with Upstate University Hospital Community Campus.

“These factors may lead to a delay in a patient disclosing her symptoms to her physician or a delay in diagnosis of a more serious condition.”

Most health insurance covers treatment for depression, thanks to the 2008 Mental Health Parity and Addiction Equity Act, which requires coverage to extend to depression treatment just as it does for biomedical health care.

If cost inhibits a woman’s ability to seek care for PPD, Loi encourages them to seek clinics that offer free or

subsidized services or support groups such as Postpartum Support International (www.postpartum.net, 1-800944-4PPD) to connect to PPD experts, crisis hotlines, support groups and local events.

Reducing the Risks of Developing PPD

To reduce risk of post-partum depression, follow suggestions offered by local experts • “Have a strong support system, especially if you have a history of depression.

• “Be open with your care provider and family if you’re prone to depression.

• “Have a post-partum doula, which is especially helpful if you don’t have a partner or support system. A doula comes in and does laundry, child care of other children, and helps with baby care.

• “Reach out and talk with other women such as at new mother support groups. It shows there are many women experiencing this around the country and around the world.

Octobeer 2013 •

• “Communicate about it to your faith community. Bringing food and checking in on new mothers takes the pressure off her.

• “Just like having a birth plan is important, having a post-partum plan in place can be really important for people who are predisposed to depression. It is a huge life change and has a lot of stressors.”

Kimmie Garner, co-coordinator with Postpartum Resource Center of New York.

• “Get as much rest as possible.

Sleep when the baby is sleeping.

• “Take care of yourself. Try to shower, get dressed and get out of the house on a daily basis.

• “If symptoms do not improve with the above interventions, or if you or a family member is concerned about your symptoms, contact your doctor right away.”

Allison Loi, obstetrician with Upstate University Hospital Community Campus.

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Page 17

Parenting

By Melissa Stefanec melissa@cnyhealth.com

A Less Judgmental Mama

A

s a parent, one thing you can’t help but notice is the amount parents judge each other. No two families raise their children in exactly the same way. My husband and I are raising our child in the way we think is best, but it’s sheer arrogance to think we are actually the best at this whole parenting thing.

Most children grow into functional adults. So why do we criticize our fellow parents’ choices? Why do we act haughty about our own achievements, all while ignoring our mistakes and shaking our heads in disapproval at others? Some of us may do it more than others, but we all do it at some point.

Our reasoning isn’t solid. We want reassurance and support, but we are going about getting it the wrong way. We need to stop the constant judgment and foster an environment of acceptance.

So this month I am going to come clean. Here is a list of things I disapprove of when it comes to parenting.

I know my disapproval is foolish, arrogant and needless. I need to get over it. I hope by putting my biggest dislikes out there, I will open my eyes and encourage others to do the same. No one with a clear head can argue that this world needs more intolerance. So in the spirit of tolerance, here is what I am going to work on when it comes to judgment.

Judgment 1 – Co-sleeping

Most pediatricians recommend not doing this, and I am very afraid of sudden infant death syndrome (SIDS).

One of my cousins recently lost a baby to SIDS. In my experience, parents who co-sleep have kids who have sleep problems. Their children seem to wait longer to sleep through the night or never want to sleep on their own.

Why judging is ridiculous? Pediatricians recommend stuff I disagree with all the time. Your pediatrician may know best in most cases, but he or she is not a god. You have to use your own best judgment regarding any child-rearing advice. You may have to weigh the advice from your pediatrician a little heavier than advice from great aunt Martha or Jenny McCarthy, but no one has all the right answers.

There are people all over the world who slept in the same bed as their parents and turned out to be perfectly healthy adults.

Judgment 2 – Formula decisions

Breast is best. We all know that. I think if you can breastfeed, you should, even if it’s just for a short while. It’s a lot of work, but it’s worth it.

Why judging is ridiculous. It is a lot of work. It’s a tiring, overwhelming and disheartening amount work. It’s even more daunting when you have to go back to work full-time after only a few weeks with your newborn child.

Some employers aren’t terribly understanding about pumping at work.

People don’t breastfeed because it’s Page 18

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

so incredibly hard. How can I judge someone for making more time in her life to take care of her family? There are children all over the world who were raised on mostly on formula, including this writer. Formula isn’t going to kill anyone.

Judgment 3 – Corporal Punishment

Hitting your kids is ineffective and damaging.

Why judging is ridiculous. I am only human. I cannot bring myself to say that judging this is ridiculous. I swear on a stack of dirty dishes that I will work on the other items in this article.

Judgment 4 – Letting your kids watch too much television

According to Neilson research conducted in 2009, children aged 2 to 5 spend an average of 32 hours per week watching television. That’s a lot of television. The television is rarely on in our house. The American Academy of Pediatrics doesn’t recommend television for children under 2. I would rather my daughter spent the majority of her time engaged in other activities.

Why judging is ridiculous. I’m living in lala land with this one. My daughter watches television at daycare (though nowhere near 32 hours). Kids watch television all the time. I don’t think anyone would advocate 32 hours of television a week for children, but a little television isn’t going to destroy my daughter’s IQ. Now that she’s over 2, I need to practice what I preach and recognize that most things are safe in moderation.

Judgment 5 – Parents who feed their kids garbage food

We all know there’s an obesity crisis in the U.S. A lot of healthcare professionals attribute much of this to our diets and sedentary lifestyles. Kids should eat food that is actually made of food, not processed ingredients and creepy chemicals.

Why judging is ridiculous. If you feed your children, I shouldn’t judge you. People eat unhealthy diets for a variety of reasons. Although I may not want that for myself or for my family, I shouldn’t look down my nose at other people. No one died from eating a hotdog. If you are keeping your kids fed, clothed, safe, sheltered and loved, who am I to judge?

So there you have it. Five (really four) ways I am going to be a less judgmental mama. I encourage others to take a look at how they judge other parents and try to tone it down a bit.

Offering love and support will help families grow long before judgment will. Let’s work together and raise a generation.

What They Want You to Know:

Lactation Consultants and Counselors

By Deborah Jeanne Sergeant

L

actation consultants and counselors work with families who choose breastfeeding. Some offer their services independently and others work from an organization such as a hospital to provide support and information for nursing mothers.

Organizations such as the International Lactation Consultant Association provide training and certification for consultants.

• “Breastfeeding encourages a unique bond between mother and baby and that both are healthier for having done it.

• “Breastfeeding decreases a mother’s chance of getting breast cancer and passes on antibodies to the baby that no immunization can provide.

• “In today’s economy it can save so much money. [The mother] does not need to purchase formula or bottles, [has] fewer sick visits, and fewer sick days.

• “Breastfeeding can sometimes be a little harder in the beginning as mom and baby are learning how it works but if they stick with it, it is the easiest thing ever.

• “Education about what to expect can help a new mother anticipate the difficulties and have coping mechanisms in place before they occur and possibly prevent them from escalating. A new mother with support at home will be much more successful.”

Kathy Distin is a nurse and an internationally board-certified lactation consultant, Oswego Health.

• “Mothers sustain life when they nurse their babies. A basic, simple concept, but one that is not applauded enough. The milk a mother makes for her baby is patented specifically for the new life that she has helped create. As much care and time our bodies invest to ‘grow’ a baby during pregnancy, the same is true for the care and time a mother’s body takes to produce milk specifically for that baby once it’s born. It is liquid gold.

• “Mothers need to trust their instincts: getting assistance from a

lactation consultant does not mean that anyone [mom or baby] is doing anything wrong. Babies initially function via instinct [hunger] and reflex [sucking]. Helping new mothers to trust their instincts as to the feeding cues of their newborn helps the two of them to get off to a healthy start together.

• “Successful breastfeeding usually always traces back to the latch. Lactation consultants will assist a mother to latch her baby in the most comfortable manner possible, taking in many factors. When the latch is correct, mom is happy, and baby is able to obtain more milk when nursing.

• “When it isn’t easy, or doesn’t feel natural, lactation consultants provide support, guidance and alternatives to assist mothers in obtaining their breast milk in a manner which allows them to give it back to their baby. We are a society that is ever evolving, with many demands placed on new mothers. Lactation consultants are there to assist mothers in making it the easiest transition as possible as they nourish their newborn.

• “Formula will never be breast milk. Formula companies spend a lot of money trying to replicate breast milk.

Despite their marketing and advertising to tout their product, the elephant in the room is that breast milk is trying to be copied for a reason. It’s the most perfect food on Earth for your baby.”

Michele Dwyer, registered nurse and international board certified lactation consultant, St. Joseph’s Hospital.

Deborah Jeanne Sergeant is a writer with In Good Health. “What Your Doctor Wants You to Know” is an ongoing column that appears monthly to give our area’s healthcare professionals an opportunity to share how patients can improve their care by helping their providers and by helping themselves.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Page 19

My Turn

Nurses and Volunteers Promote the Future of Nursing

By Eva Briggs

Organoids: A Big Step in the of Study of the Brain

W

hen my son was little, he was a huge fan of Teenage Mutant Ninja Turtles. One of the show’s more bizarre characters was the evil Krang, who was essentially a brain living in, and issuing orders from, a jar.

Although scientists can’t yet harvest a human (or other species) brain and keep it functioning in a lab, they have come one step closer by growing small clusters of organized neural tissue they’ve dubbed organoids.

These organoids are only 3 millimeters in diameter, the size of an apple seed. But they represent an exciting tool for scientists wishing to study how the human brain develops and what may go wrong in disorders of brain development.

Organoid production begins with embryonic stem cells. These undifferentiated precursor cells have the capacity to develop into various types of cells. The default state for embryonic stem cells seems to be to form nerve tissue. But in typical culture, while cells form, they generally have no structure or organization.

Scientists in Vienna decided to seek ways to culture nerve cells that were more mature and organized.

They learned that other scientists had produced “mini-guts” by coaxing stem cells to form intestinal cells when grown on a gelatinous protein substance called Matrigel. This method encouraged cells to proliferate in three dimensions rather than as a flat sheet.

By encouraging stem cells to form neural tissue while suspended in the Matrigel, scientists succeeded in producing larger, more complex clusters.

An important factor limiting the clusters’ growth was access to oxygen and nutrients.

In an actual developing organism, blood vessels grow within developing tissue to deliver the required oxygen and nutrients. The artificial neural cell clusters lack blood vessels. So the scientists placed them into a device that

slowly rotated and shook the growing tissue, delivering more oxygen and nutrients to foster larger growth.

After several weeks, the scientists were amazed to find the level of organization present in these tiny organoids. There were areas whose structure and differentiation resemble specific brain tissues: the choroid plexus that manufactures cerebrospinal fluid, the outermost brain layer known as cerebral cortex, and the retinal nerve tissue located in the back of our eyes.

Even with the agitation techniques, without blood vessels the organoids cease growing after a few months, the central layers die, and no new tissues continue to form. Remember it takes the human brain nine months plus at least 18 years to fully develop. But the organoids can stay alive indefinitely.

The oldest ones are about one year old.

These organoids are probably not large or complex enough to provide useful information about complex conditions like autism or schizophrenia.

But scientists have begun studies on at least one brain disorder, a genetic form of microcephaly, a condition where the brain stops growing before it’s fully developed.

Scientists are a long way from making a fully-functioning brain in a jar, but it’s exciting to se how modern techniques allow ever more complex models for basic research.

Eva Briggs is a medical doctor who works at two urgent care centers (Central Square and Fulton) operated by Oswego Health.

A group of volunteers with the Future of Nursing booth marched in the parade each day during the New York State Fair in Syracuse to raise awareness of educational and job opportunities for nursing students.Shown are: Barbara Orekondy, Albany; Deb Wolff, Albany; Lynn Kersey, Syracuse; Carolyn McAuliffe, Syracuse; Meghan Shaw, Auburn; andBarbara Boden, Albany.

Nurses make up 52 percent of all the licensed healthcare professionals in New York state. This group, with an average age of 50, consists of nurse practitioners, registered nurses, and licensed practical nurses.

“These statistics pose a challenge as well as an opportunity for the nursing profession,” said Carolyn Christie-McAuliffe, associate professor at Keuka College, and Debra A. Wolff, project coordinator at Future of Nursing, NYS Action Coalition, Foundation of NYS Nurses in Guilderland, near Albany.

They are particularly concerned that impending retirements of older nurses will create a void in the number of practitioners.

This was the primary reason 86 Keuka College RN completion students and volunteers manned the Future of Nursing booth at the New York State Fair this year.

In 2008, in an effort to assess and transform the nursing profession, the Robert Wood Johnson Foundation commissioned the Institute of Medicine to produce a report that made recommendations for nursing in the next decade. The report examined nursing practice across all settings, including hospitals, schools, homes, health clinics, long-term care facilities, military posts and community and

public health centers. The report also reviewed the roles nurses assume, as well as their varius levels of education.

“The Future of Nursing: Leading Change, Advancing Health” report concluded that high quality, patientcentered health care will require a transformation of the health care delivery system. The report also noted nurses are in a unique position to accept responsibility for leading this transformation.

New York state was designated as one of five initial pilot regional action coalitions to advance the Future of Nursing: Campaign for Action, based those recommendations from the Robert Wood Johnson Foundation report and the AARP Foundation.

The campaign starts with the recruitment of intelligent, compassionate individuals into the nursing profession. Another way to ensure safe, quality patient care will be to support nurses who want to continue their education, whether be it an associate’s, bachelor’s, master’s or doctoral degree.

Future of Nursing is a nonpartisan organization based in the capital district. For more information, contact Debra Wolff, project coordinator, at 518456-7858, ext 31 or go to www. futureofnursing.org.

By Patricia J. Malin

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Crouse College of Nursing Celebrates 100 Years

By Matthew Liptak

O

rganizers for the special homecoming of the Crouse College of Nursing hope for upwards of 200 people to attend 100th anniversary events at the Crowne Plaza Hotel in Syracuse the weekend of Oct. 18.

“It’s a tremendous milestone to be able to celebrate the fact that we’ve been educating nurses with a view to excellence for 100 years,” said college director Pat Zawko. “It’s truly remarkable that we have consistently done that and been a high-performing institution for all of those years.”

Participants may include those who have graduated today to those who exited the college back in the 1940s. Since 1913 Crouse has graduated close to 5,000 nurses.

The events planned for the homecoming will run over three days. Friday organizers will welcome guests to the event during a reception. Saturday will feature a luncheon honoring 50year graduates A large gala, including dinner and dancing, will follow in the evening. Individuals who have supported the college over the years will be honored.

“At that gala we will have on display artifacts from the college over the past 100 years,” Zawko said. “They actually have a time capsule that was buried and was opened. We have the artifacts from that time capsule. We have contracted with a costumer who is making three nursing uniforms modeled after the early 1900s, the 1930s and the 1950s and they will be on display and modeled throughout the evening so we can look at how the dress has changed.”

Trips to Destiny USA and spa packages will fill the gap between the luncheon and gala. Sunday will see the end of events with alumnists being able to tour facilities in both the hospital and college. They can see how Crouse has changed since they were once studying there.

“We’re certainly hoping for a good turn out from the alumni,” said alumni

Nursing students at Crouse learn at the Nursing Arts lab here in 1952.

The Crouse-Irving Training School for nurses, accepted its first class of nursing students, seen here, in 1913.

association president Joan Green.

“That would be wonderful to honor the school because it has such a great reputation.”

Changed profile

Crouse students gather together to relax in their living quarters here in 1943.

Nursing has changed over the years, Zawko said. Where once they were handmaidens to the doctors, nurses today are acting autonomously, managing health care and taking a lead in research. Rather than just treat illnesses they are emphasizing ways to prevent them.

“Nursing is not just a science of knowing what happens with the human body and how we treat things, but nursing is an art,” Zawko said.

“It is truly the ministering of one soul October 2013 •

to another. It is nurses who are at the bedside, who are in the homes, who are in the community, who are giving the day-to-day care of our population.

“The population trusts nurses.

They know that we are there to help.

Maybe because we take the time to look at the whole person, not just the physical. We’re concerned about the psychological, the spiritual, the emotional — all aspects of someone, the holistic approach. We can do that better than anyone as nurses.”

For more information on the Crouse College of Nursing 100th anniversary go to http://www.crouse. org/nursing/century-of-excellence/.

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Page 21

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

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That’s because it takes time to deterf you are disabled and you’re no mine whether you qualify for benefits. longer able to work, you should It usually takes about three to five learn how Social Security can help months for a medical decision from you. the state agency that evaluates your Disability is something most condition. If your application people do not like to think about; is approved, your first Social however, the unfortunate reality Security disability payment is this: the chances that you will will be made for the sixth become disabled are probably far full month after the date we greater than you realize. Studies determine that your disability show that a 20-year-old worker began. has a more than one in four Given the time it can take, chance of becoming disabled it’s in your best interest to do before reaching retirement age. everything you can to speed Social Security pays benup the process. The best first efits to people with disabilities step is for you to read our through the Social Security disonline publication, “Disabilability insurance program, which Banikowski ity Benefits,” at www.socialsecurity. is financed by Social Security taxes. If gov/pubs. It will tell you all about the you qualify, you can receive a monthly process, including the information you disability benefit from Social Security will need to apply for benefits. for as long as your disability keeps Then, take advantage of our online you from working. The amount of disability starter kits. You will find your benefit is based on your average them on our disability website at www. lifetime earnings. Potential Medicare socialsecurity.gov/disability. From that coverage is dependent on several factors and usually starts after you receive page, simply select the option to apply for benefits online, and on that page disability cash benefits for 24 months. you will find the disability starter kits.

When you work and pay Social There is one kit for children and one Security taxes, you earn credits. The for adults. Each kit is available in both number of credits you need to qualify English and Spanish. The starter kits for disability benefits depends on your help you begin the process by providage, and some of the work must be ing information about the specific recent. For example, if you become documents and the information that we disabled after age 31, you need to have will request from you. worked at least a total of 10 years, Take a look at the disability starter including five of those having been kit now at www.socialsecurity.gov/disworked within the past 10 years. But ability. if you become disabled before age 24, Once you complete the online disyou need only one and a half years of ability starter kit and you’re ready to work in the past three years. apply, the most convenient way to do If you have a disability that keeps that is also online. Just go to the same you from working, the time to get disability website at www.socialsecustarted with your application is now. rity.gov/disability.

Q&A

Q: Can I delay my retirement benefits and receive benefits as a spouse only? How does that affect me?

A: It depends on your age. If you are full retirement age or older when you first apply, and your spouse is receiving Social Security benefits, you can choose to apply and receive benefits on just your spouse’s Social Security record. This way, you could delay applying for benefits on your own record in order to receive delayed retirement credits. If you are full retirement age or older, and have already applied for retirement benefits, you can request to have payments suspended.

If you qualify for a spouse’s benefit, you can receive those payments and earn delayed retirement credits on your own record. By applying only for benefits as a spouse, you may receive a higher retirement benefit on your own record later based on the effect of delayed retirement credits. You can earn delayed retirement credits up to age 70

as long as you do not collect your own benefits. Since the rules vary depending on the situation, you may want to talk to a Social Security representative about the options available to you. To learn more, visit www.socialsecurity. gov or call us at 1-800-772-1213 (TTY 1-800-325-0778).

Q: My daughter just joined a nonprofit charity and is helping victims of natural disasters. She gets a salary.

We were wondering if she has to pay Social Security tax.

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Health Exchange Shopping Tips for Uninsured Boomers and Early Retirees Dear Savvy Senior, At age 62, I will be retiring at the end of the year and plan to enroll in Obamacare until my Medicare kicks in. Can you offer me any advice on choosing a plan?

Almost Retired Dear Almost, The new health insurance exchanges — also known as Obamacare — that begin in 2014 will have a significant impact on millions of Americans who need health insurance, especially preMedicare retirees and uninsured baby boomers who often have a difficult time finding affordable coverage.

To help ensure you get the best health insurance coverage that fits your needs, here are some things you should know.

Health Exchange Overview

Starting Oct. 1, you will be able to shop for health insurance policies, and enroll in one directly through your state’s health insurance marketplace website, over the phone, via mail or in person at a designated center. The coverage will go into effect on Jan. 1, 2014.

You can also be reassured to know that federal law prohibits marketplace insurers from denying you coverage or charging you higher rates if you have a pre-existing health condition. But they are permitted to set premiums up to three times higher for applicants over the age of 50, and smokers may be charged up to 50 percent more than nonsmokers.

To help make coverage affordable, sliding scale tax-credits will be available if you earn less than 400 percent of the poverty level — that’s $45,960 for a single person and $62,040 for couples.

These tax-credit subsidies will provide immediate savings off your monthly premiums. See the Kaiser Family Foundation online calculator (kff. org/interactive/subsidy-calculator) for a premium estimate.

Every state will have a marketplace, but each state can choose how it will operate. Seventeen states, including New York, and the District of Columbia will run their own state-based marketplace, seven states will partner with the federal government, and 26 states will offer federal marketplaces.

The differences between federal and state programs will be subtle. You will be able to access your state’s marketplace at Healthcare.gov.

Policy Choices

To make shopping and comparing a little easier, the health plans will be divided into four different levels — bronze, silver, gold and platinum.

The bronze plan will have the lowest monthly premiums but the highest outof-pocket costs when you need care, while the platinum plans will have the highest premiums with the lowest outof-pocket costs.

You will also have a variety of health insurance companies to select from. To help you evaluate insurers, the nonprofit National Committee for Quality Assurance offers online “report cards” at ncqa.org that can help you narrow your choices.

Because most plans will be managed-care policies such as HMOs or PPOs that require you to get your care within a network of providers, you’ll want to make sure that the doctors and hospitals you typically use are covered in the plans you’re considering. The new marketplace plans are expected to offer fewer choices of health-care providers, and who’s included may vary quite a bit.

You also need to find out what happens if you want to use a doctor or hospital outside a plan’s network. Will you have to get a referral or pay more to get these services, or will it even be covered at all?

Also check the plan’s formulary, which is the list of prescription drugs they cover, to be sure all the medications you take are covered without excessive co-pays or requirements that you try less expensive drugs first.

Get Help

If you need some help with all this, the Marketplace Help Center offers a toll-free helpline at 800-318-2596. Or, if you’d rather get face-to-face assistance, there will be designated centers set up with trained and certified navigators, counselors and application assistors to help you, along with insurance agents and brokers. To find help in your area, call the marketplace Help Center after Oct. 1 for a referral.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Page 23

Clinical Investigator/ Clinical Assistant Professor Clinical Assistant Professor at the Research Foundation of State University of New York (multiple locations in Syracuse, NY). Perform clinical care in the area of Plastic and Reconstructive Surgery. Provide care to patients with burn and/or hand injuries. Be available to oversee/supervise complex wound care provided by the General Surgery faculty and Stoma/Wound Care nursing team. Re-establish the Breast Reconstruction Microsurgical Tissue Flap program. Offer clear and effective instruction to students in the College of Medicine and Graduate Studies. Requires: M.D. or foreign equivalent; Completion of Medical Residency in Surgery; Completion of Fellowship in Plastic and Reconstructive Surgery; Board Eligibility or Certification in General Surgery; Eligibility for License/ Permit to practice medicine in the State of New York.

To apply please send CV to: Stacy Mehlek, Faculty Affairs & Faculty Development, The Research Foundation of SUNY at Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210.

The Research Foundation of SUNY at Upstate Medical University is an AA/EO employer engaging excellence through diversity. Women and minorities are encouraged to apply.

Clinical Assistant Professor Clinical Assistant Professor at SUNY Upstate Medical University (multiple locations in Syracuse, NY).

Perform clinical care in the area of oncologic urology, minimally invasive, robotic surgery, stone disease and IN GOOD HEALTH general urology including provision of primary care DISPLAY AD and consultant responsibilities for private patients and those patients being followed in the public clinics of October the urology department.

Size: 2.5 x 3.375 Offer clear and effective instruction within area of Cost: to students $169.42 expertise in the College of Medicine and Graduate Studies and serve as a preceptor/mentor for house staff.

Requirements: 1) M.D. or Foreign Equivalent. 2) Completion of Medical Residency in Urology. 3) Completion of Fellowships in Endourology and Minimally Invasive Urology. 4) Board Eligibility or Certification in Urology. Will accept foreign equivalent certification. 5) Eligibility for License to practice medicine in the State of New York.

Please send CV to: Stacy Mehlek, Faculty Affairs & Faculty Development, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY 13210.

SUNY Upstate Medical University is an AA/EO employer engaging excellence through diversity.

Women and minorities are encouraged to apply.

UPSTATE IS HIRING Upstate i� hiring�experienced RNs �� our�ICUs��������� ������������������������� Also hiring ��������������������������������� ����������������������������� ����������������������������������������������� We offer excellent state salary and benefits.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

H ealth News IN GOOD HEALTH DISPLAY AD October Size: 2.5 x 3.375 Cost: $169.42

Physician appointed to Oneida Healthcare board Physician Janice Eastman Bach has been appointed to the Oneida Healthcare board of trustees.

Bach has practiced at Child Health Associates since 2003 and serves on the Oneida Healthcare pediatric medicine medical staff.

A native of Oneida, she graduated from Wright State University School of Medicine in Dayton, Ohio, and completed her pediatric residency at SUNY Upstate Medical University in Syracuse.

She is a member of the American Academy of Pediatrics and the American Society of Addiction Medicine.

Bach has been instrumental in the implementation of the hospital’s Meditech system, which has enBach abled the introduction of electronic records.

“In her role as co-chair of the physician advisors group, Dr. Bach works to assure that the hospital’s electronic medical record is developed in partnership with area physicians,” said Oneida Healthcare CEO Gene Morreale. “We’re delighted and fortunate to have her serving on our governing board.”

ClearPath Diagnostics now offers dermatopathology ClearPath Diagnostics, an independent, physician-owned tissue and cytopathology practice, recently introduced dermatopathology to its service offerings. Physician Harleen Sidhu will be ClearPath’s director of dermatopaIn Good Health – 3/8 page V thology. completing herand residency in –After 5 x 10.25 (black white) anatomic pathology at Brown University/Rhode Island Hospital, Sidhu received fellowship training at Mount Sinai School of Medicine in New York.

She is a board-certified dermatopathologist and has published extensively in this area.

“I am passionate about the diagnosis of skin disease and was fellowship trained at one of the busiest and most diverse dermatopathology programs in the country,” said Sidhu. “I am excited about being part of ClearPath Diagnostics, Sidhu providing high-quality dermatopathology services, and continuing to build upon our pathology group’s exceptional reputation of innovation and expertise.”

Sidhu will be available and accessible for consultation and case discussion. When needed, Sidhu will secure second opinions from the department

of dermatopathology at Mount Sinai School of Medicine.

“We are thrilled to bring both dermatopathology and a highly respected, much-published professional like Dr. Sidhu to ClearPath,” said Jack Finn, CEO of ClearPath Diagnostics. “Dr. Sidhu’s vast knowledge in dermatopathology, in-depth expertise, commitment to consulting with referring physicians, and connection to Mount Sinai enhances the value we offer to the practices we serve throughout the northeast.”

St. Joe’s has new director of nursing recruitment St. Joseph’s Hospital Health Center has appointed Mary Jo Vona director of nursing talent acquisition and retention. In this role she is responsible for nursing recruitment and retention for the St. Joseph’s system.

Specializing in nurse recruitment and retention, performance improvement and coaching, Vona has 28 years of experience within critical care nursing and nursing recruitment.

She has helped create leadership development programs and has been instrumental in delivering orgaVona nizationally-aligned recruitment strategies in her role as manager of nursing recruitment and retention, a position she has held at St. Joseph’s since 2007.

A graduate of the St. Joseph’s College of Nursing, Vona holds a Bachelor of Science degree in nursing from Le Moyne College where she graduated cum laude. She is scheduled to complete a Master of Science in nursing administration from Le Moyne College in December.

A member of the National Association for Health Care Recruiters, Vona is a certified health care recruiter. She also is a Six Sigma Green Belt. She resides in Camillus.

Dosa named professor of child health policy Physician Nienke Dosa has been named as the inaugural Upstate Foundation Professor of Child Health Policy at Upstate Medical University / Upstate Golisano Children’s Hospital. She also has been named a senior fellow at the Burton Blatt Institute at Syracuse University.

Dosa is a nationally recognized specialist in child development, whose focus is in the Dosa area of community or-

Crouse Hospital College of Nursing Appoints New Director

An Assisted Living Community

Pat Schmidt-Zawko has been appointed director of the Crouse Hospital College of Nursing.

Zawko is filling the position vacated when the college’s former leader, Ann Sedore, was named chief nursing officer of the hospital in March of this year.

“Dr. Zawko will be a strong support as Crouse Hospital continues to strive for nursing and institutional excellence,” said Sedore.

“Her nursing background, educational Zawko experience, professional leadership and knowledge of our community will serve her and the college well.”

Zawko, who resides in Rome, most recently served as associate clinical professor of nursing and

Quality Care Services since 1974

ganization for the care and transition of children with developmental disorders, such as cerebral palsy and spina bifida.

Dosa has been a member of the Upstate faculty since 2002, and has served as associate professor of pediatrics since 2008. She earned her undergraduate degree from Yale University, and obtained her medical degree from Upstate and her Master of Public Health degree from the University of Rochester. She received additional training in pediatrics and developmental disabilities from both institutions.

In her new position, Dosa will further her research in the organization of health care services to children and young adults with developmental disabilities and in the development of inclusive fitness programs for these individuals. Dosa is a widely soughtafter speaker internationally on such issues. Additionally, Dosa will continue as the medical director of the spina bifida clinic at the children’s hospital, caring for these children and for those with cerebral palsy.

“Dr. Dosa is widely appreciated as a caring and compassionate advocate for persons with disabilities,” said Thomas Welch, Upstate professor and chairman of the department of pediatrics and medical director of Upstate Golisano Children’s Hospital.

“We believe that this new position, and the support which comes with it, will enable her to impact individuals well beyond our region.”

The Upstate Foundation Professor of Child Health Policy at Upstate Medical University/Upstate Golisano Children’s Hospital was established through contributions to the capital campaign for the Upstate Golisano Children’s Hospital.

Betsy Hartnett honored during Syracuse event Betsy Hartnett was honored at Crouse Health Foundation’s 37th annual Tribute Evening Sept. 27 at the Nicholas J. Pirro Convention Center, The Oncenter. She was recognized for her significant contributions to the greater Syracuse community.

Hartnett’s extensive involvement with Crouse as past chairwoman of the Crouse Hospital board of directors and the Crouse Health Foundation board

director of online learning at Upstate Medical University. She has been a member of numerous committees throughout the community, and has received multiple commendations, including having been nominated for the SUNY Chancellor’s Award for excellence in teaching.

She holds a doctorate in educational leadership, curriculum and instruction from University of Phoenix and a master’s degree in nursing administration from SUNY IT at Utica Rome. Zawko is a former board member of St. Elizabeth’s School of Nursing and of the nursing honor society Sigma Theta Tau’s Iota Delta Chapter, for which she had served as faculty adviser.

Zawko is assuming the director position during the college’s 100th anniversary year, and will preside over the festivities during the college’s first-ever Homecoming Weekend Oct. 18-20. of trustees was highlighted, as well as her active leadership with Syracuse Stage, the Foundation of the Roman Catholic Diocese of Syracuse, Catholic Charities, the Central New York Community Foundation and other community organizations. A highly-reHartnett garded attorney and CPA partner with Mackenzie Hughes, LLP, Hartnett’s leadership with local and state professional associations was applauded.

Tribute Evening 2013 featured an extended reception, gourmet dinner, tribute presentation, and entertainment

by The Silk Band. Net Tribute Evening 2013 proceeds will be used to support the work of Crouse Health Foundation, including purchasing special equipment, underwriting new initiatives, and funding educational programs and scholarships.

Rural Metro announces promotions Rural Metro Corporation, an emergency and non-emergency interfacility ambulance transportation company, recently announced the following promotions.

• Paul Voutsinas, an advanced emergency medical technician paramedic (AEMT-paramedic), has been promoted to training supervisor.

Voutsinas joined Rural/Metro in 1995 and has served as an emergency medical technician, senior paramedic, field training officer and most recently, quality assurance coordinator. Voutsinas was recently honored as the 2013 Central New York EMS Regional Council Instructor of the Year. He is a NYS certified instructor coordinator, certified lab instructor, and trainer for a variety of other coursework, including the American Heart Association. Voutsinas is an active volunteer firefighter with North Syracuse Fire Department, and completed his paramedic training at SUNY Upstate.

• Eric Kehoe, also an AEMT-paramedic, has been promoted to the position of operations supervisor. Kehoe joined Rural/Metro in 2006 and has

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served as an assistant supervisor since 2012, as well as a senior paramedic and field training officer in both Syracuse and Auburn. With 19 years of career experience in EMS, Kehoe previously served as the director of operations for Four Town Ambulance, and also as a paramedic with Bangs Ambulance. Kehoe is also an active volunteer firefighter with Sempronious VFD, and resides in Moravia.

Tully Hill has new director of quality improvement Mary Beth Welch recently joined Tully Hill Chemical Dependency Treatment Center as its new director of quality improvement.

Welch is a graduate of LeMoyne College with a bachelor’s degree in accounting and a master’s in business administration.

She completed the credentialed alcohol and substance abuse counseling (CASAC) training program at Onondaga Community College.

Welch is a certified International Standards Organization (ISO) auditor and has more than 15 years of operational leadership in quality, customer service, sales support and accounting/ finance.

Certified midwife joins Oswego practice, hospital Certified nurse midwife Lindsay Lachant has joined the staff of Oswego Hospital’s maternity center and the local practice, Oswego County OB-GYN. Lachant holds a master’s degree in nurse-midwifery from Frontier Nursing University, Hyden, Ky. Prior to earning her master’s degree, she was employed Lachant for eight years as a labor and delivery registered nurse at Southwestern Vermont Medical Center, in Bennington, Vt. In addition, she possesses a bachelor’s degree in nursing from Southern Vermont College.

Along with being certified as a midwife, she is a Lamaze certified childbirth educator, is certified by the International Board of Lactation Consultants, and holds various levels of cardiac pulmonary resuscitation (CPR) training and certification.

Lachant, her husband, and their two young daughters have relocated to Oswego. “We like living in a smaller community where you can get to know people and have the opportunity to be active in the community,” she said.

Oswego Hospital Holds Yearly Drill Oswego Hospital staff members practiced for a disaster they hope will never occur.

Some 40 hospital employees wore protective suits as they hosed down victims exposed to a hazardous substance in a special tent who were then triaged outside the hospital’s emergency entrance on Sept. 19. It was all a part of the healthcare facility’s annual decontamination drill.

The drill’s fictitious scenario involved a truck that overturns during a busy Oswego farmers’ market, which is carrying dry potash, or potassium hydroxide. As a result of the accident, those at the event experience tearing, pain, impaired vision, nausea and breathing difficulties.

Under the drill, rather than wait for emergency services personnel to respond to the scene, the frightened, anxious and sickened individuals decide to immediately report directly to Oswego Hospital.

Playing the role of the victims were students from Oswego County BOCES New Vision Allied Health and Government and Law Programs.

Coordinating the drill was Paul Vandish, Oswego Health director of quality and risk management. Participating in the drill were more than 40 staff members from numerous hospital departments.

Observing the drill were members of the Oswego City Fire Department, NYS Department of Health, Oswego County Emergency Management office, Oswego County Fire Coordinator’s office and the Oswego County Health Department.

Outstanding Employees

ONONDAGA HILL 5000 W Seneca Tpke Syracuse, NY 13215

WEEKENDS

10am– 2pm sosbones.com

IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013

Oswego County Opportunities (OCO) recently honored Elizabeth Liberti (second from left) and Robin France (second from right) of OCO’s education services with the Outstanding Employee Award. Nominated by fellow employees, they were recognized for their commitment, resourcefulness, and dedication to OCO and those they serve. Presenting the awards are OCO Deputy Executive Director Sarah Irland (left), director of OCO education services, Beth Kazel (center), and OCO Executive Director Diane Cooper-Currier, far right.

In the fight against breast cancer, knowledge is a powerful tool.

At MDR, we’re highly familiar with the latest advancements in breast health technology and diagnostics. But the most important tool is a simple one – knowledge. Understanding your risk factors is key to prevention and early detection of breast cancer and other health issues. As a provider of advanced diagnostics, including breast MRI, with more than 25 years of experience caring for patients, MDR is here to help. Talk to your doctor or contact us today for more information or a free risk assessment. It could be the most important learning experience you’ll ever have.

E. SYR. - BRITTONFIELD (Open Scanner) FAYETTEVILLE* FULTON (Open Scanner)

AUBURN BALDWINSVILLE CAMILLUS

SYRACUSE-CROUSE P.O.B. * SYRACUSE-ST. JOSEPH’S HOSPITAL* *MRI BREAST IMAGING CENTER

LIVERPOOL ONONDAGA SYRACUSE-CROUSE HOSPITAL

For scheduling, call 315-454-4810, or for our St. Joseph’s Hospital location, call 315-423-6833.

Visit www.mdrcny.com for a free personal breast cancer risk assessment.

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JOIN US! LILLY PATRICK

LACEY LEE

JULI BOEHEIM

THE WOMEN’S HEALTH NETWORK

INVITES YOU TO TAKE CHARGE OF YOUR HEALTH

MELANIE LITTLEJOHN

AMINY AUDI

Sign up to receive: � Alerts to Upstate health education events � Access

to support groups and seminars

� Small group Q&A sessions with doctors and

other care providers

� The first opportunity to attend special events

throughout the year � Nurse-guided access to services and providers � Call or sign up on line–it’s free!

HAVE A HEALTH-RELATED QUESTION NOW?

Call our Upstate Women’s Health Network Nurse at

315-464-2756 or 855-890-UWHN (8946)

www.upstate.edu/women Octobeer 2013 •

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • October 2013