IGH - CNY-247 - July 20 by In Good Health: CNY's Healthcare Newspaper

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JULY 2020 • ISSUE 247

BEYOND COVID-19

Important health numbers you absolutely need to know about To maintain good health, it’s all in the numbers that measure key indicators of health. We talk to local experts who discuss what those numbers are and how we can get them to normal levels. P. 16

Crouse ER Doc: ‘The ER Is a Safe Place’ Richard Steinmann has been an ER doctor at Crouse for over 30 years: ‘We know how to be safe and we know how to keep our patients safe’

Special women’s health issue inside

Emotional Abuse: Women Are Often the Target Also inside

Gynecologist Maria Ciciarelli talks about caring for women who delivered babies during COVID-19 pandemic

PICKY EATERS For many kids, picky eating isn’t just a phase

n At 92, Janice Nelson, retired nursing school dean, embarking on a fundraising project to help Hospice of CNY n Q&A with Randi Bregman, the executive director at Vera House director

Little Raspberries Score Big on Many Fronts

P. 17

More Young Americans Abstaining From Sex

P. 2

More Young Americans Are Going Without Sex

ex, and lots of it, has long been the primary preoccupation of young adults, but more of them are now going months and years without any intimate encounters. New research shows that one of three men between the ages of 18 to 24 have not had any sex during the past year, putting to rest all the talk of the “hookup culture.” Men and women aged 25 to 34 in the United States also reported an increase in sexual inactivity and a decrease in sexual frequency during the past two decades, the researchers found. “In the age of Tinder, young people are actually having less sex, not more,” said Jean Twenge, a professor of psychology at San Diego State

University. Analyzing national survey data, researchers found that sexual inactivity increased from 19% to 31% among men 18 to 24 between 2000 and 2018. They defined sexual inactivity as no sex at all for a year or more. Among those aged 25 to 34, sexual inactivity doubled among men (7% to 14%) and nearly doubled among women (7% to 13%) during the same two decades, the researchers reported. Many who remain sexually active are having sex less often, the findings also showed. Fewer people are having sex at least weekly, particularly those with one sexual partner. The report was published online June 12 in JAMA Network Open.

“It is important to distinguish between a decrease in sexual frequency among those who are sexually active and an increase in those who do not have sex at all,” said lead researcher Peter Ueda, a physician-researcher at the Karolinska Institute in Sweden. “While the mean sexual frequency among those who were sexually active may reflect their priorities and preferences, sexual inactivity may reflect an absence of sexually intimate relationships, with substantially different implications for public health and society,” Ueda said. Technology and society appear to be colliding in a way that dramatically affects young adults’ interest in sex, said Twenge, who wrote an editorial accompanying the new study.

Even though kids are entering puberty earlier, they are taking longer to grow into adulthood, Twenge said. It’s not just about sex. These young adults also are taking longer to begin working, start dating, move out of their parents’ home, settle into a career, live with a partner, have kids or buy houses, Twenge said. The generation coming up after millennials, which Twenge calls “iGen,” aren’t even that motivated to hang out with friends, she said. “iGen does those things significantly less than previous generations did at the same age,” Twenge said, noting that young adults these days would rather check out social media, play video games or text their pals. “They’re choosing to spend their leisure time communicating using their phones instead of face-to-face,” Twenge continued. “When people aren’t face-to-face, they’re probably going to have less sex.” All told, young adults now might decide that bingeing Netflix or posting on Instagram is more enjoyable than seeking a sexual partner, Twenge said. “There are just more things to do at 10 p.m. than there used to be,” Twenge explained. Even when people are together, they’re allowing their smartphones to interfere with their chemistry, Twenge added. Many people on dates are guilty of “phubbing” -- pulling out their phone and snubbing the person they’re with, Twenge said. “What happens to face-to-face interactions when the phones come up? Not surprisingly, it just doesn’t go as well. It’s not as emotionally close,” Twenge said.

Here for CNY. As always. Faster Treatment = Better Outcomes People have been avoiding emergency rooms fearing they will be exposed to the COVID-19 virus.

Getting to the hospital quickly is critical for patients suffering heart attacks or strokes, when heart and brain cells can die by the minute. Other serious conditions — such as severe headache or stomach ache — can also cause long-lasting damage if treatment is delayed. Our regionally recognized emergency services, cardiac care and Comprehensive Stroke Center teams are here 24/7 to provide you and your family with rapid intervention and treatment for all medical emergencies.

Your Safety = Top Priority To keep you safe, we have put in place stringent safety and infection control measures in our Pomeroy Emergency Services Department and across our entire hospital and outpatient sites to prevent the spread of infection, including:

Screening patients, visitors and staff at entry points Requiring all patients, visitors and staff to wear a mask Isolating suspected COVID-19 patients in private rooms Rigorous deep cleaning/disinfecting of all surface areas

Don’t wait to go to the Emergency Department – Call 911 #TakeMeToCrouse Page 2

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

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Meet

Your Doctor

By Chris Motola

Maria Ciciarelli, M.D. Gynecologist affiliated with Crouse Hospital talks about caring for women who delivered babies during COVID-19 pandemic

Coronavirus May Be Seasonal After All

ere’s a glimmer of hope about the new coronavirus: New research finds it appears to follow a seasonal pattern that is similar to the flu. Scientists found that all cities/regions with large COVID-19 outbreaks have similar winter climates, with an average temperature of 41 to 52 degrees Fahrenheit, average humidity levels of 47% to 79%, and are located within a latitude band of 30 to 50 N. This includes Wuhan, China; South Korea; Japan; Iran; Northern Italy; Seattle; and northern California. The findings also suggest that U.S. mid-Atlantic states may be at risk, as well as New England, according to researchers at the Institute of Human Virology (IHV) at the University of Maryland School of Medicine (UMSOM) and the Global Virus Network (GVN). “Based on what we have documented so far, it appears that the virus has a harder time spreading between people in warmer, tropical climates,” said study leader Mohammad Sajadi, an associate professor of medicine at UMSOM, physician-scientist at IHV, and a member of GVN. The researchers used weather data from the previous few months, as well as typical weather patterns from last year, to predict community spread of COVID-19 within the next few weeks. The next step is to determine if weather and climate forecasts could make the predictions more reliable. Study co-author Anthony Amoroso said, “I think what is important is that this is a testable hypothesis.” Amoroso is an associate professor of medicine at UMSOM and chief of clinical care programs for IHV. “If it holds true, it could be very helpful for health system preparation, surveillance and containment efforts,” he added in an institute news release. The study was published online June 11 in JAMA Network Open.

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Q: I take it people are still having babies through the pandemic. A: I was sort of joking with someone the other day about how it didn’t stop women from having their babies. It did change how we do things in the office and in the hospital. For example, how many support people you can have in the delivery room, the protective equipment we have to wear which, for labor, really isn’t optimal. So it’s those kinds of things that have affected our day-today at the office and at the hospital. Q: How do you prepare prospective mothers to deal with it? A: It’s challenging. As we’ve progressed with this, the rules have changed, sometimes even daily. Just trying to keep them informed about what the hospital policy is, what to do at home. When can family come to visit the baby? When is it OK to be around the baby? We use a lot of different specialists, so we rely on the pediatricians to tell patients when they get home from the hospital to quarantine for at least 14 days, especially if they have elderly parents who would normally help them out. Getting

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

them mentally prepared during the visit is important. It’s hard whether you’re a new mom or a mom with kids at home, having someone come in to help is a big deal. I can’t imagine having to go home with a newborn and only having your husband to help. You need time to do things as simple as laundry, taking a shower. So I think as we’ve progressed through the pandemic it’s gotten a bit easier. Before we were saying don’t have anyone come around the baby for six weeks, now we’re saying around two weeks as long as nobody’s sick and they’re wearing masks. Q: COVID’s risk factors seem to generally increase with age. How much of a risk are infants? A: There’s definitely concern about infant exposure, but I haven’t seen much about babies getting really sick. I also haven’t had any COVID-positive moms. There’s always a risk of exposure to the babies though, especially if mom was exposed. Q: Has there been any research into transmission through parents? A: I’m not aware of any reports of transmission through the mom, and I haven’t seen any research or report on babies that have tested positive if mom tested positive. No defects that I’m aware of in babies.

Q: Do you expect an increased demand for obstetric services in the near future? A: I think it’ll have an impact as far there’re going to be more pregnancies after quarantine, if you ask me. People have been stuck inside with nothing better to do, so I think we’re probably going to have more babies. But I think it can go the other way with women who are afraid of being exposed and may skip their pap and pelvic exams. So it can go either way. Q: Has a backlog been building on the gynecological side? A: Up until recently, we were doing half days and only seeing obstetric patients and emergency visits. So we had all of our routine appointments back to reduce exposure to our staff and pregnant patients. So we have a very big backlog of routine stuff we’ll be catching up on over the next few months. We’re busy doing that. I think the vast majority of patients seem willing to come back, but do have some that are asking to push it back a bit longer because they’re still worried about exposure. Q: What brought you to Crouse? A: I grew up in Cicero, I graduated high school from CNS, went to college at Geneseo. I came back to CNY to Upstate Medical for medical school. The residency program at Upstate works out of Crouse, so I guess you can say I’m a lifer. Q: Do many of the younger trainees stay? A: Not very many, no, which is unfortunate for the area, because we’ve had a lot of OB-GYNs in the area recently retire. We see a lot come through for their training but then go back to wherever they came from or to other towns. I think in the last three or four years, we had one stay from the residency program and two come in through the Buffalo program, so I don’t see a lot staying. Q: Are you involved with fertility treatments? A: I do a lot of contraception, which is true of a lot of GYNs, but I also have a lot patients who I’ll start the infertility workup for. I’ll do ovulation induction and check the fallopian tubes and that kind of thing. I don’t do any of the advanced infertility treatments — I’ll refer them out for that. But the patients who just need a little bit of help, like the ones with polycystic ovarian syndrome, that’s something that I enjoy doing, and there are a reasonable number of women who can be helped without having to see a specialist.

Lifelines

Name: Maria Ciciarelli, M.D., FACOG Position: Gynecologist with CNY Women’s Healthcare, affiliated with Crouse Health Hometown: Cicero Education: SUNY Upstate Medical Affiliations: Crouse Hospital Organizations: Board-certified with American College of Obstetrics and Genecology, American College of Obstetrics and Gynecology (ACOG) Specialty: Contraception, adolescent medicine, infertility, skin injections Family: Husband; daughter 16; son 15 Hobbies: Gardening; hanging out by the pool; time with family

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IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Dreams Dashed

Finding your ‘happily ever after’ on your own

met Susan several years ago, when she attended one of my Alone and Content workshops. Below, she plaintively recalls the raw feelings she experienced following her divorce:

“I opted to end my unhappy marriage and initiate a divorce about three years ago. Since then, I’ve been on my own. It wasn’t easy back then. I was surprised to discover that many married friends no longer wanted to socialize with me, fearing I might be a threat and attract the interest of their husbands. Plus, I made my daughter the singular focus in my life, and lost contact with people. Over time, I developed the attitude that I had nothing to offer and slid into a minor depression. Finances were another issue. I had stayed home to take care of my daughter but, after my split, found it necessary to get a job to make ends meet.” Susan, like many divorced women and men, found herself bewildered and fearful of the future after her marriage ended. For many, the experience of having a marriage of many years unravel is not unlike becoming the victim of an unwelcome catastrophe.

No matter what, and even though more people are waiting longer to walk down the aisle, most still hold onto the dream of “happily ever after.” That dream is powerful. Letting go of it can seem next to impossible. I know it was for me. While getting and being divorced can feel overwhelming, most everyone presses on and, lo and behold, eventually experiences a change in attitude and perspective that ultimately enriches their lives and opens up possibilities — possibilities they couldn’t have imagined when they were in the throes of loss. Susan continued: “It’s taken me a long time to get it together. I went back to college and graduated with an advanced degree in nursing. It kept me busy, but now my daughter is preparing to leave for college. Life will be very different (and a lot quieter) without her here, so I am being proactive. I’m walking with friends (six feet apart) and I’m an active member of Meetup.com (now virtual), the social networking program that gives members safe ways to find and connect with others who share common interests — things such as hiking, reading, food, pets, pho-

tography, hobbies, etc. I also make a point of staying in touch with my colleagues at work, through email and Zoom meetings. And, I’m no longer waiting for an invitation; I’m initiating the contacts, which people appreciate. It feels good! Attending Gwenn’s workshop was the jump-start I needed to get moving. Listening to others made me realize that we were all struggling with similar issues. I no longer felt so alone and benefited from hearing how others have dealt with their challenges. When the workshop was over, I made several small, but meaningful changes at home. I now create a nice place-setting for dinner and put fresh flowers on my kitchen counter to welcome myself home. I cleaned up the clutter on my desk and am practicing meditation most mornings (it’s a work in progress). I am also planning a solo travel adventure abroad, when it’s safe to lift off. That’s a huge leap for me!” While few women and men consciously decide to live singly, more and more are finding themselves on their own in midlife. The good news? Like Susan, they are making healthy choices and finding joy on their own. While she acknowledges that there are trade-offs to being single, she has created a life that meets her needs and supports her new dreams:

Gwenn Voelckers is the founder and facilitator of Alone and Content, empowerment workshops for women, and author of “Alone and Content,” a collection of inspiring essays for those who live alone. For information about her workshops, to purchase her book, or invite her to speak, visit www. aloneandcontent.com

“It seems to be part of a child’s disposition.” Nor do the findings mean that parents cannot do anything about picky eating, she stressed. The study merely followed families to see what happened naturally — and did not test any intervention to change kids’ habits. What does seem clear is that mealtime ultimatums do not help. In this study, mothers of picky eaters reported more efforts to control what their child consumed — including limits on sugary, fatty foods. (When kids are high on the finicky scale, Pesch noted, they often stick to those types of foods.) Despite those battles, children’s fussiness held strong. In fact, coercion is probably

destined to fail, according to Nancy Zucker, director of the Duke Center for Eating Disorders at Duke University in Durham, N.C. Zucker, who wrote an editorial published with the study, pointed to one of its key findings. Based on mothers’ responses to a standard questionnaire, the pickiest eaters also tended to be emotionally reactive in general. And those kids will not respond well to dinner-table demands — “It won’t work,” Zucker said. “These children will just shut down.” She agreed that the findings suggest picky eating is a trait. “These kids may be more harm-avoidant,” Zucker said. “And when you think about it, eating is breaking a barrier — allowing something into your body. These children hold back when everyone else is running to the food.” So what can parents do? Zucker said that making meals a pleasant experience may at least brighten children’s moods around food. And that could, at some point, ease their boundaries. Including kids in shopping and meal preparation, Zucker said, is one way to make it more enjoyable for them. Pesch agreed, adding that simple exposure may help, too. That is, keep making varied meals for the family so that the picky eater gets used to the sights and smells. “But keep it low-pressure,” Pesch said. “Don’t try to force them to ‘clean their plates.’ “

For Many Kids, Picky Eating Isn’t Just a Phase, Study Finds

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limited culinary repertoire. Still, researchers saw bright spots in the findings, published May 26 in the journal Pediatrics. For one, there were no signs that picky eaters were underweight. And the fact that the fussiness seems to be a trait — and not a failure on the parents’ part — might bring some solace. “It can be very stressful for parents to deal with a picky eater,” noted senior researcher Megan Pesch, a pediatrician at the University of Michigan’s C.S. Mott Children’s Hospital in Ann Arbor. But if parents think they did something wrong to cause it, she added, these findings suggest otherwise. “It’s not your fault,” Pesch said.

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

On her own, Susan has fashioned a life that works well for her. You can, too. Being single can give you the time you need (and deserve!) to sustain a diverse and interesting network of friends, to go new places, to pursue your professional or personal aspirations, and to experience adventures yet to be imagined. My advice? Don’t close yourself off from people. It’s easy to stay home (especially these days), to dig a hole and furnish it — but that’s a big mistake. Be curious, Be courageous. Research things to do and show up. Go ... even if it means going alone. Who knows what you might discover on the corner of happy and delight?!

“After my divorce, I had this dreaded thought that I would be alone for the rest of my life. I identified with Whistler’s Mother, in her dowdy dress and dour expression. I now realize that just because I choose to live alone does not mean that I am alone: Fact is, I’m surrounded by family and friends who love me.

s d i K Corner

or parents hoping their “picky” eater will grow out of it, a new study may be unwelcome news. Researchers found that choosy 4-year-olds were still turning their noses up at many foods at age 9 — suggesting their finicky eating is more of a trait than a phase. The study, which followed over 300 children, found three patterns: The majority were consistently middle-of-the-road when it came to food fussiness — sometimes shunning unfamiliar cuisine, but remaining relatively open to trying new foods. A sizable minority (29%) consistently ate everything their parents offered up. Then there was the picky 14%. From age 4 to 9, they routinely refused new foods and maintained a

I am no longer frantically, desperately seeking a new relationship or the next big thing to ignite excitement in my life. I am content to spend time either at home alone or socializing safely with small groups of dear friends. I’ve even gone on a few ‘virtual’ dates. As I’ve come into my own, I now know that I am fully responsible for making positive changes in my life. That realization is empowering. I’m engaged with others and am having fun and feeling like my old self again for the first time in a very long time.”

Right Care. Right at home. EMERGENCY ROOM OR URGENT CARE? For illnesses or injuries that are not life-threatening but still need immediate medical care.

URGENT CARE. RIGHT AT HOME.

Crouse ER Doc: ‘The ER Is a Safe Place’

we know how to take care of patients and ourselves without putting anyone at unnecessary risk. We know how to use our PPE (personal protective equipment). We know about masks, the importance of hand washing, gloves, gowns, hoods and face shields. We know how to be safe and we know how to keep our patients safe. The take-home message? If you have an emergency, something scary and maybe even dangerous, you can go to your ER. We will take care of you and we will keep you safe. Don’t stay home and hope the chest pain goes away on its own. Don’t stay home and hope the stroke symptoms will be better after a nap. Lifesaving medical treatment is time sensitive — your chances of full recovery are vastly improved if you get early treatment. If you have something emergent, come to the ER. We’re here to help. And you will be safe.

Richard Steinmann, is the medical director of Crouse Hospital Pomeroy Emergency Services and has been working as an ER doctor for over 30 years.

Cuts or wounds that may require stitches z Sprains, strains or deep bruises z Mild to moderate asthma attacks z Ear infections z Upper respiratory infections z Coughs and congestion z Sore throats z Insect bites and rashes URGENT CARE

To avoid lines and check in online visit our website. Wait in the comfort of your home and we will send a text when it’s almost your turn. oswegohealth.org/urgent-care

EMERGENCY SERVICES. RIGHT AT HOME.

The unknown. The unexpected. It’s not really something we ever prepare for but when an emergency happens, Oswego Health is right at home. Oswego Hospital’s emergency services department is staffed 24 hours-a-day by board-certified physicians, nurse practitioners, physician assistants and nurses. Our highly-trained and experienced emergency medicine staff is ready to treat a range of emergent conditions quickly, safely and within minutes at our technology-advanced Emergency Department.

WHEN TO VISIT THE EMERGENCY DEPARTMENT z z

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WHEN TO VISIT URGENT CARE z

By Richard Steinmann, MD am an emergency medicine physician — an ER doc — and I have a message for you: It’s safe. Your ER is safe. For weeks — months, really — people were told to avoid hospitals. They were places where the COVID-19 virus lay in wait. Unless you were desperately ill, you were better off riding it out at home, rather than risking infection by seeking medical attention. And we did. We stayed home. And it turns out there was a cost to staying home. The price we’re paying for avoiding or delaying healthcare is that more of us have gotten sick from diseases that could be treated or cured with more timely care. COVID-19 doesn’t prevent people from having heart attacks and strokes, but it does make many of them afraid to get care — which can be lethal. The bottom line is that cancer patients need their therapies, asthmatics need help to breathe, septic patients need antibiotics and people with heart attacks need their arteries opened. Since the coronavirus pandemic hit, the number of patients visiting emergency rooms nationwide dropped by 40% to 50%. These statistics mirror what we have seen in Syracuse and across the region. Thankfully, more people are now getting the message that it is not good to delay emergency care. The good news is that the ER is safe. Hospitals in Central New York have not been overwhelmed. And,

When it comes to non-emergency injuries, illnesses, or symptoms, Oswego Health is right at home. Our convenient urgent care locations at the Fulton and Central Square Medical Centers are just minutes away, and our team of skilled professionals and board certified physicians are there when you need it.

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In Good Health is published 12 times a year by Local News, Inc. © 2020 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: Deborah Sergeant, Jim Miller, Gwenn Voelckers, Deborah Banikowski, George W. Chapman, Anne Palumbo, Melissa Stefanec, Chris Motola, Eva Briggs (M.D.), Ernst Lamothe Jr., Payne Horning, Richard Steinmann, MD, Kara Gemmell, Debra J. Groom • Advertising: Amy Gagliano, Cassandra Lawson Layout & Design: Dylon Clew-Thomas • Office Manager: Nancy Nitz No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

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Severe bleeding Difficulty breathing Chest pain or pressure Broken bones Trauma or injury to the head Sudden dizziness or difficulty seeing Severe abdominal pain Pregnancy related complications EMERGENCY DEPARTMENT

oswegohealth.org/emergency-services

When it’s Urgent we’re Right at home.

Remember, if you have a medical emergency, go to your nearest emergency room or call 911.

July 2020 •

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Page 7

Big Need for Blood Donations as Postponed Surgeries Resume

s U.S. hospitals resume procedures put on hold by the coronavirus outbreak, there’s an urgent need for blood and platelet donations, the American Red Cross says. Following a sharp decline in demand for blood products that began in early April, hospitals’ needs have recently spiked 30%. “Blood donors are essential to ensuring the continued health of their community by making sure hospitals have a readily available supply of blood products for patients,” said Chris Hrouda, president of the American Red Cross Biomedical Services. “Blood cannot be stockpiled like other medical supplies and must be constantly replenished.” Hrouda said the Red Cross is

grateful to the tens of thousands of donors who rolled up a sleeve to help early on. Though hospitals have resumed surgeries and treatments that were paused in response to COVID-19, many blood drives continue to be canceled as businesses and community groups remain closed, Hrouda said in a Red Cross news release. He said this has hampered the Red Cross’s ability to collect nearly 13,000 blood and more than 2,600 platelet donations needed at U.S. hospitals and transfusion centers. The Red Cross said it’s urgently seeking donors and hosts for blood drives to ensure blood products are readily available for patients. “During this crisis, we’re all in this together,” Hrouda said.

To make an appointment to donate, go to the American Red Cross website, use its donor app, call 800-RED-CROSS, or activate the blood scheduling skill for Alexa. Donors are asked to schedule an appointment before they arrive at a blood drive and must wear a face covering. Red Cross blood drives and donation centers follow strict safety and infection control measures. The news release said those steps

include checking temperatures of staff and donors; providing hand sanitizer and routinely disinfecting surfaces, equipment and areas that donors touch; keeping donors socially distanced; ensuring staff and donors wear face coverings and that staffers wear gloves and change them frequently; and using sterile collection sets and an aseptic scrub for every donation.

However, he believes the vaccine will not be a one and done solution and will most likely require boosters. Once a vaccine is approved for use, the question remains what will be its durability. It could be six months or a year or two. (It should be noted: Moderna is not the only bio tech firm developing a vaccine.) There has been much confusion over wearing masks. Fauci emphasized the three basics of mitigation are still the most effective at slowing the spread of the virus: frequent hand washing, social distancing and masks in public. The latter all the more important when inside. Meanwhile, in anticipation of a vaccine, the federal government has begun stockpiling 400 million syringes by December.

of elective surgeries and routine office visits have put most providers in dire financial straits. Most have resorted to furloughing or laying off staff as bottom lines flounder. In April, CMS issued guidelines for providers to open up again for normal business. Basically, “non-emergent, non-COVID care (NCC) should be offered to patients, as clinically appropriate, in localities or facilities that have the resources to provide such care, as well as the ability to quickly respond to a surge in COVID-19 cases, if necessary. Decisions should be consistent with federal, state and local orders, and CDC guidance and made in collaboration with state and local public health authorities. Careful planning is required to safely deliver in-person care to patients requiring NCC, and all aspects of care must be considered.” If you have been putting off care, you are encouraged to contact your provider and resume your treatment or address your health concerns.

Healthcare in a Minute

By George W. Chapman

Use of Telehealth Surges: From 10% in 2019 to 46% in April

o one could have predicted that a pandemic would be the catalyst or “black swan” event for telehealth. Up until the pandemic, telehealth was infrequently used. It was approximately 10% of a typical provider’s schedule in 2019. In April 2020, it had ballooned to 46%. Industry experts are predicting that telehealth could be $250 billion a year in spending post-pandemic. Both providers and consumers are adapting to the new reality. According to a recent consumer survey by McKinsey & Company, 75% of respondents are highly or moderately likely to use telehealth services. Seventy-five percent of respondents who recently received services via telehealth were satisfied. Up until the pandemic, providers were somewhat reluctant to incorporate telehealth into their business models, primarily due to poor reimbursement from insurers. Telehealth was used mostly to reach isolated, rural or homebound patients. Because of the pandemic, Medicare began to reimburse providers for a telehealth visit the same as an office visit. Most commercial carriers followed suit. The big question is whether or not Medicare will continue improved telehealth reimbursement beyond the pandemic. The longer this pandemic lasts, the further the horse is out of the barn. Medicare would certainly face a backlash from both providers and consumers who have adapted to this delivery of care option. Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma sounds like she is hedging her bets, though, when she said that while telehealth is getting us through this pandemic, it won’t replace the “gold standard” of in-person care.

AHA Addresses Systemic Racism

The pandemic has disproportionally impacted people of color. It has exposed the systemic racism in Page 8

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public health. Rick Pollack, CEO of the American Hospital Association, recently addressed the problem. “As places of healing, hospitals have an important role to play in the wellbeing of their communities. As we’ve seen in the pandemic, communities of color have been disproportionately affected, both in infection rates and economic impact. The AHA’s vision is of a society of healthy communities, where all individuals reach their highest potential for health … to achieve that vision, we must address racial, ethnic and cultural inequities, including those in health care, that are everyday realities for far too many individuals. While progress has been made, we have so much more work to do.”

COVID19 Vaccine

Dr. Tony Fauci is the nation’s leading expert on infectious disease. As director of the National Institute of Allergy and Infectious Diseases, or NIAID, Fauci is cautiously optimistic about the development of a vaccine by bio tech firm Moderna.

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

What We Know So Far

A recent article in the New York Times gave a summary. 1) We will be dealing with this pandemic for a long time. 2) Masks mitigate the spread. 3) Our public health infrastructure needs an update if not an overhaul. 4) The pandemic is hugely expensive: testing, treatment, PPE, lost wages, mitigation, etc. 5) We can’t count on herd immunity to protect us. 6) There are far more symptoms than expected or experienced. 7) We can worry less about surface transmission of the virus. It is mostly person to person. 8) We can worry less about a mutating virus. 9) Warm weather will not defeat the virus. Estimates of the cost of the virus to insurance companies, (commercial, Medicare Advantage and Medicaid) are modeled or based on infection rates. A population infection rate of 10% puts cost estimates around $30 billion while an infection rate of 60% could cause costs to skyrocket toward $500 billion.

Reopening Healthcare

The pandemic forced hospitals and physician offices to close to non-emergent care. The cancellation

CVS Testing NURO

If pizza can be delivered via drone or autonomous vehicle, why not drugs? CVS pharmacy is currently testing delivering prescriptions via autonomous vehicle “NURO” in a Houston suburb. NURO is a business that started in 2018 delivering groceries in Texas and Arizona. The company raised over $1 billion from investors. George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.

Syracuse Lab Studying Drug that May Prevent Coronavirus Spread in Senior Homes Loretto, Clarity Clinical Research team up to test new drug to prevent coronavirus among seniors By Payne Horning

larity Clinical Research, a research laboratory in East Syracuse, is one of only two sites in New York state now studying a drug which has shown some potential for inhibiting the spread of viruses, to see if it could contain coronavirus outbreaks at long-term care facilities. The drug at the center of the trial, Nitazoxinide, is something that Lisa Sonneborn with Clarity says their team is optimistic about. “One of the very interesting things about the treatment is that when they first evaluated it with regards to COVID-19, they were finding it was inhibiting the replication of the coronavirus in cell cultures — and not just COVID-19; it’s also inhibited replication of SARS and MERS and other coronaviruses, including influenza,” Sonneborn said. “It was that information that prompted the attempt to do this with participants in long-term care facilities because of those positive results that suggested it could be really beneficial.” For the study, Clarity is partnering with Loretto, a comprehensive continuing healthcare organization that provides services for older adults in Central New York. Willing participants at four of Loretto’s assisted living facilities in the region will be administered a drug twice a day for six weeks once one of

their fellow residents tests positive for COVID-19. Clarity researchers have a good idea of who will be a good candidate for the study thanks to all of the background information that’s available on nitazoxinide. The drug has been studied numerous times before and is an FDA-approved treatment used by an estimated 400 million people for acute viral respiratory illnesses. Loretto and Clarity have previously teamed up for other studies affecting older adults, focusing on diseases like Alzheimer’s and dementia. It was that partnership that Sonneborn said made this COVID-19 study possible. “One of the things that is very rare in clinical trials is to see the collaboration between a clinical research facility and something like a longterm care facility,” Sonneborn said. “That structure doesn’t often exist or doesn’t exist in abundance throughout the United States. So, what made us very unique was not only our previous collaborative relationship with Loretto, but the speed at which we were able to work together to adapt both our clinic and staff and their facilities and staff to make this happen.” With its easy transmission and high risk of mortality for older Americans and those with compromised immune systems, COVID-19 has

Lisa Sonneborn, a researcher at Clarity Clinical Research in East Syracuse, is working on a trial to test the efficacy the drug nitazoxinide. ravaged some of the nation’s nursing homes. Nearly half of Onondaga County’s deaths from the pandemic came from nursing home residents. Loretto Chief Marketing Officer Julie Sheedy said while the loss of life for their residents has been minimal compared to some of the other homes in the area, they were eager to sign up for this trial. “If we don’t have a vaccine, we need other ways to keep it out; something like this can be really beneficial to facilities to make sure they can keep control of the virus and keep it out of their facilities,” Sheedy said. “Anything we can do collectively for the community and our residents to protect them from this is really core

to our mission.” The team at Clarity hopes to enroll as many of Loretto’s residents who are medically able and willing to participate, but they first have to wait for someone at a facility to contract the virus. As for getting something to market, Sonneborn said the timeline in these studies varies greatly due to the many variables involved. However, she notes that this is the fastest the lab has ever started any clinical trial and she says they plan to do whatever they can to move the research forward as quickly as possible.

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Page 9

My Turn

By Eva Briggs

All About Food Allergies About one in every 20 children has a food allergy

ids aren’t born with the allergies. Not even if a parent has food allergies and regardless of what the mother ate during her pregnancy. The tendency to develop allergies may be inherited. But a specific allergy requires exposure to the offending agent to develop. Usually the sensitizing exposure involves eating the offending food. In some cases, the initial exposure is via the skin. Diagnosing food allergy begins with the history. Food allergy symptoms start soon after the food was eaten — in minutes to as long as four hours. Symptoms that occur the day after eating a food are not from an allergy to that food. The following foods are the culprit in the vast majority of cases: milk, eggs, tree nuts (walnuts, pecans, almonds), fish, shellfish or legumes (soy, peanuts). The food might be hidden in as an ingredient in a baked good or salad. Typical allergy symptoms are hives, trouble breathing, lightheadedness or vomiting. To confirm a suspicious history, allergists check skin tests or blood tests. It’s wise to test only for the suspected food and perhaps closely related foods. Complete food panel

tests are unnecessary and potentially misleading. Blood test levels may not correlate with the severity of an allergic reaction. Usually if a child has a certain type of reaction, subsequent reactions will be the same. But not always. Families need to prepare for unanticipated severe reactions. Start with avoidance. Read ingredient labels and menus carefully. Children with food allergies should have access to an epinephrine autoinjector, such as an EpiPen. Treat mild reactions with an antihistamine. Diphenhydramine (Benadryl) has been the mainstay, but cetirizine (Zyrtec) may be a better choice. It starts working as quickly as diphenhydramine, lasts longer, and causes less drowsiness. For severe allergic reactions, such as any respiratory symptoms, dizziness or vomiting more than once, administer epinephrine and go to the emergency room. The reason is that the allergic reaction might outlast the epinephrine and recur when epinephrine wears off. If that happens, the emergency room can provide further treatment. Epinephrine side effects include shakiness and rapid heartbeat. About 75% of egg or milk allergic

children tolerate them in baked goods. If uncertain, an allergist can challenge under observation in the office. If a child can safely eat milk or eggs cooked in food, they have more food choices. Most children allergic to eggs and milk outgrow these allergies during childhood. Doctors once thought children never outgrew peanut, tree nut or shellfish allergies. We’ve learned that as many as 20% of children do outgrow these allergies. An allergist will ask about accidental exposures and reactions during yearly follow-up visits. The allergist may then repeat the skin test. If there is no history of reaction and levels of the blood test have fallen, the doctor may perform a food challenge in the office.

Food reaction Certain fruits and vegetables cause mouth itching in some pollen-allergic people. This is called oral allergy syndrome or pollen food allergy syndrome. Substances in these fruits and vegetables cross-react with proteins found in the pollen. It does not progress to anything dangerous. Another food-related reaction is eosinophilic esophagitis (EOE). A type of white blood cells, eosinophils, inflames the esophagus. It starts at any age. Infants and toddlers experience difficulty feeding. School-age children vomit and have abdominal pain. Teenagers report trouble swallowing and food getting stuck. The diagnosis requires upper endoscopy, looking into the esophagus with a lighted tube, and obtaining biopsy samples. There is no easy test to determine which food is causing the problem. Treatment starts with an acid blocking medicine. Another

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treatment uses a thick formulation of oral steroids to coat the esophagus. Eliminating various foods and checking the response by repeating endoscopies is another option, but this might require six to 10 endoscopies. Another food reaction is food protein enteropathic syndrome. The onset is hours after the food is ingested with vomiting accompanied by lethargy. There is no specific test. Fortunately, most kids outgrow this. Ondansetron (Zofran) can help with vomiting. We used to think you could reduce the chance developing a food allergy by delaying common allergy-provoking foods in children at high risk. We’ve learned the opposite is true. Exposing children to peanut protein starting at age 4-6 months reduces the chance of developing peanut allergy. Of course, you can’t feed infants whole peanuts. But thinned peanut butter, or peanut containing products designed for children work fine. Eva Briggs is a medical doctor who works at two urgent care centers in the Syracuse region.

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Contact Tracers Key to New York’s Meet Your Provider Battle with COVID-19 Oswego Health PrimeCare Practice reminds you to schedule your annual preventive physical exam

e make appointments to see our doctor for many different reasons. While some of us only go to the doctor when we are experiencing a new problem or have concerns, your primary care physician can offer much more. One way to achieve good health is to get an annual physical. While some of us may not think of a yearly examination as being necessary, your physician can offer some valuable help during your visit that can assist you in preventing future health concerns, including: • identifying risk factors that could lead to future health problems and offer expert advice on how to manage them. • establishing baselines that will aid you and your doctor in making future healthcare decisions. • updating your vaccinations to prevent disease and its consequences such as missed work and future healthcare concerns. • reviewing and renewing medication prescriptions to ensure you are treating your medical problems the best way available.

Prevention Starts at Oswego Health Just because you are healthy right now, doesn’t mean you don’t need guidance on preventive healthcare measures. Every adult should have a primary care physician to monitor their health, answer questions, and offer preventative care services to keep them healthy through all stages of life. Don’t have a primary care physician? Contact Oswego Health PrimeCare as both Meaghan Primm, MD, and Andrew Rogall, MD, are accepting new patients in Fulton, 315-592-3930. Remember, the best medicine is preventive medicine.

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Contact tracers say in many ways, they are like old-fashioned detectives By Payne Horning

esearchers at Columbia University recently released a study indicating how effective measures to enforce social distancing and restrict individual contact have been in the United States’ battle with COVID-19. The analysis suggests that these steps reduced transmission rates and thus the overall death rate. In fact, the model used in the study showed that had the country’s leaders implemented these social distancing measures just one week earlier — on March 8 rather than March 15 — as many as 36,000 deaths could have been avoided, which is more than one-third of total deaths related to the virus in the U.S. to date. Key to the success of the social distancing initiative is a group known as contact tracers. Contact tracing is the practice of tracking down people who have either tested positive for the virus or those who have come into contact with someone who is infected. Like the roots of a plant, the contacts one person has can spread far and wide in the community. It’s the job of contact tracers to find out about each and every one of these interactions and contact those people so they can be told about their potential exposure to the virus, the need to get tested, and then advised to quarantine so as not to continue the spread of the virus. Contact tracers say in many ways, they are like old-fashioned detectives. “This really is an investigation,” said Wendy Kurlowicz, director of community environmental health at the Onondaga County Health Department. “It’s not just about gathering some information. It’s about thinking on your feet and asking the questions to make people really think honestly about where they’ve been and whom they have put at risk for exposure.” Once someone tests positive, contact tracers need to inquire about all of the contacts the individual has had within a time period that is based on the Centers for Disease Control and Prevention guidelines. Kurlowicz said usually, that means a few days before they started experiencing symptoms or were tested for the virus. This investigatory work requires patience according to Tina Bourgeois, a senior licensed practical nurse and communicable disease nurse at the Oswego County Health Department. “You can’t rush them,” Bourgeois said. “I always tell them take your time and think through this; let’s figure this out and protect everybody you’ve come in contact with — right down to the mailman.” That said, Bourgeois said it’s more of a conversation than an interrogation. Her colleague Jodi Martin, the supervising public health nurse for preventive services at the Oswego County Health Department, agrees. “You have to build a bond and a

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

Tina Bourgeois (seated), a senior LPN and communicable disease nurse at the Oswego County Health Department, and Jodi Martin, the supervising public health nurse for preventive services at the Oswego County Health Department. They both work as contact tracers in Oswego County. relationship in a short period of time or they will not be open with you,” Martin said. That begins and ends, she says, with displaying empathy. Sometimes, the contact tracer is the first person to inform the individual that their test for COVID-19 came back positive, which can evoke an emotional response. Martin says it’s their responsibility to not only console these people but also walk them through what happens next and what to do if they become seriously ill. It also means ensuring they feel supported by asking if they have the resources necessary to last them through the period of quarantine, which is supposed to be observed for 14 days. One time, Martin and her colleagues actually delivered toilet paper and aspirin to someone who lived alone. Bourgeois and Martin, who have spent years working in contact tracing for the Oswego County Health Department, say that COVID-19 is in some ways easier to investigate than other communicable diseases. Everyone is familiar with what the disease is, so there isn’t as much to teach as with other diseases, and the number of potential contacts per person are somewhat limited since most people have been quarantining since mid-March. But the sheer volume of people who have contracted the disease multiplied by the number of contacts each one has had is overwhelming county health departments across the country. Onondaga, Oswego, and other counties have had to pull employees from different divisions of their health departments just to help make these calls. As a result, many contact tracers like Kurlowicz are doing this for the first time ever.

“From nurses to the environmental health team to early intervention to public health coordinators — this is a completely different role and we jumped right into this,” Kurlowicz said. “It’s all hands on deck here.” Even more people will be joining the team in the coming months thanks to a new state initiative. New York Gov. Andrew Cuomo said the state plans to build an ‘army’ of contact tracers — anywhere from 6,40017,000 depending on the projected number of cases of COVID-19. The effort is being funded by former New York City Mayor Michael Bloomberg and the curriculum to train and certify individuals to become contact tracers is being developed by the Johns Hopkins University’s Bloomberg School of Public Health. Gov. Cuomo says ramping up the number of contact tracers is vital as the state attempts to end the statewide quarantine. Martin said she was skeptical at first about adding people who are not public health employees to the team of contact tracers. But she does not see another way for New York’s existing staff to stop the massive amount of known people who are positive or have come into contact with someone who is positive from inadvertently infecting others, which is key to reopening safely. In fact, she encourages people to apply because the work is so vital and fulfilling. “Sometimes, you don’t always see the benefit right there of a contact tracer, but there is a benefit,” Martin said. “You’re not going to see it because the whole purpose of that is to stop more cases, so even though sometimes you may feel like why am I doing this – they are doing a lot of good. It is rewarding.”

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xcellus BlueCross BlueShield expects to spend at least $162 million on its comprehensive response to the COVID-19 pandemic. The health plan is funneling more than $1 million worth of grants for testing supplies and personal protective equipment to Upstate New York hospitals and area health care workers. It is also working with regional business groups to help employers and their employees return to work. “No one has faced a public health crisis like COVID-19 in the almost 90 years that our health plan has provided coverage in Upstate New York,” said Christopher C. Booth, president and CEO of Excellus BlueCross BlueShield. “This crisis requires a strong and comprehensive response to assure our members are able to receive the care they need and to help assure the system will survive. The pandemic significantly impacted the economy, sickened tens of thousands of people and continues to threaten Upstate health care.” With the state’s stay-at-home order and the suspension of elective medical procedures, Excellus BCBS expanded access to telehealth, trained physician offices how to use it, and increased the reimbursement to providers for these services. This allowed many local provider practices to continue to see patients using remote technology and replace lost in-office revenue. That expanded coverage and the increased reimburse-

Stay Active: Supporting Your Body and Mental Health By Kara Gemmell

s all of our routines have been so greatly interrupted by the COVID-19 pandemic it’s easy to lose sight of the importance of staying physically active. Many of us may be tempted to fill our time with sedentary activities such as watching TV. However, older adults are at a great risk for falls, health decline and emotional fatigue when they are not able to regularly exercise. For you and your loved one, intentionally creating a daily routine around physical movement is vital for your body as well as your mind! Consider encouraging your loved one to do the following: • Get Up and Move! Set a timer in their apartment and make sure you get up and move around your space, go out on the porch, get a glass of water, challenge yourself to keep moving throughout the day. • Practice at-home Fitness. Across the Loretto communities, therapeutic recreation and therapy

ment associated will cost at least $80 million in 2020. The health plan will absorb a $12 million reduction in Medicaid rates from the state this year, rather than pass it on to providers. Restoring some Medicare fees for providers that had been cut at the federal level added an additional $6 million in cost this year. Excellus BCBS also took several steps to reduce the administrative burden on hospitals which increased costs for the plan. • Suspension of prior-authorization, reviews, clinical editing programs and claim filing requirements will cost $51 million; • Implementing the 20 percent increase in reimbursement for COVID-19 admissions required under a new federal law will cost $3 million this year. For members, Excellus BCBS absorbed the cost of member out-ofpocket expenses for the diagnosis and treatment of COVID-19, medically appropriate testing, as well as absorbing the member cost share for all telehealth visits. These steps are adding about $9 million in cost this year. The $162 million in unbudgeted spending is being funded through the health plan’s reserves. The comprehensive response is in addition to $192 million in cash advances the health plan had extended to most of the 70 Upstate hospitals in its network prior to the pandemic outbreak. staff are providing substitutes for group fitness. Resources such as printed workout routines, pre-recorded classes with familiar staff members available on the residents TVs or online classes are all readily available and can be completed safely in a resident’s apartment. • Practice Seated Stretching and Breathing Exercises. Stretching out our hands, feet, neck and shoulders can be a great physical relief as well as a simple way to focus on relaxation. Your loved one can practice breathing exercises such as closing their eyes and taking 10 deep breaths in through the nose and out through the mouth. These types of routines can even aide in falling asleep. • Get Outside and Take a Walk. Spending time outdoors is a great way to energize ourselves and engage in healthy movement while still being practicing good social distancing. With encouragement your loved one can make movement a priority in their day. As we all navigate this difficult time it’s important to remember that continued exercise cares for your mind, body and mood! Kara Gemmell is director of recreation at The Nottingham, an independent senior living facility in Syracuse, part of Loretto.

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Page 13

Dental Care

Early Orthodontics Can Shorten Treatment By Deborah Jeanne Sergeant

rthodontic braces may seem like a treatment for teens, but the American Association of Orthodontists recommends a screening — and possible treatment — to start by age 7. Instead of waiting for the permanent teeth to come in, orthodontists would rather treat children to prevent or minimize future issues. Tansy Schoonmaker, pediatric dentist and co-owner of Little Jaws Big Smiles in Dewitt, recommends patients for orthodontic screening around age 7 or 8. “The vast majority of children don’t come [to the dentist] early enough,” she said. “It’s based on seeing if the child has 6-year molars and if they have enough teeth in the front.” The “6-year molars” are children’s first permanent teeth. “If you wait until 14, sometimes things are missed like an extra tooth or a tooth stuck in a jaw,” Schoonmaker said. “If it is caught early, it may require only a small opening and a year or two of braces instead of three or four years. Prevention is key.” When a child is screened early, the orthodontist can tell if the molars are likely to cause crowing problems, or if it’s a wait-and-see case. “Things can be done that are

bone-related in the way bones grow, like a crossbite,” said Deb New, orthodontist at New Smiles Orthodontics in Rochester. “In order to correct this, we’d want to place an expander.” Early intervention can reduce the duration and possibly the need for braces later. Though there’s no guarantee a child will never need braces, “it makes a bigger problem into a smaller problem,” New said. Orthodontists monitor the bone and tooth development, spacing and placement and use appliances such as expanders in the mouth as needed to attain and keep the space children need for their permanent teeth. As more teeth come in, the treatment plan adjusts. “Teeth come in in different stages of growth and development,” New said. This is important for guidance and helping parents to choose when to choose the appropriate appliance.” But New added that an orthodontic screening doesn’t necessarily mean braces are needed. Most providers offer free evaluation screenings. Orthodontist Steven Hietanen, who practice at Orthodontists Associates of Western New York, said that he has treated between 3,400 and 4,000 children with expanders. Many of his referrals come from dentists.

Some parents bring in their children because they see crowding. Others are concerned about other functional issues. “Oral expansion can help with improvement with breathing dysfunction the child has,” Hietanen said as an example. Some children with breathing problem may have their adenoids removed as they may cause obstruction. Hietanen said that a 2019 study by the American Association of Orthodontists states that children who have breathing issues treated only with adenoidectomy experienced a 50% success rate compared with 95% success for those treated with adenoidectomy along with expansion. “The size and shape of the upper jaw can affect how the lower jaw will develop,” Hietanen said. He referenced a University of Michigan study which suggested that of children treated with an expansion at age 8, more than 90% show spontaneous correction of a class 2 overbite. “In the untreated control group, there’s a 6% spontaneous improve-

ment,” he said. Some children with speech issues also benefit from orthodontic intervention. It’s all about identifying children who could benefit from early intervention and using the treatment to improve their future growth and development instead of trying to fix a problem once it’s fully manifested. “If a child was born with hip dysplasia, they’d take that baby prior learning to walk and put him in a brace to straighten the hip out,” Hietanen said. “They wouldn’t wait until he was walking. Why would we do any different in dentistry?” Since their bones aren’t as mature at 8 as 14, the force exerted by the appliances isn’t as great. Some orthodontists use removable appliances for early treatment; others, including Hietanen, prefer fixed appliances to better ensure compliance. He said that younger children are often more eager to please their parents and take better care of their appliances.

Should You Worry If Baby Teeth Get Cavities? By Deborah Jeanne Sergeant

t may seem of little consequence if baby teeth get cavities since they’re just going to fall out to make room for permanent teeth. But orthodontists place a good deal of value on keeping a child’s original teeth healthy. “They’re just baby teeth” is something that Tansy Schoonmaker, pediatric dentist and co-owner of Little Jaws Big Smiles in Dewitt, hears “all day, every day,” she said. But she insists they are important, both in the present and in the future. “If you don’t keep those teeth healthy, those teeth can become filled with cavities and painful,” Schoonmaker said. “It can become a distraction from school.” Children with pain in their mouths may feel reluctant to chew as much. Schoonmaker said that oftentimes, children don’t mention dental pain because its onset is gradual. Their dental pain may lead to poor eating. “When we fix their teeth, the parents say, ‘I can’t believe how much they’re eating,’” she said. “Parents sometimes bring in children with abscesses and the children never

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complained. The children think it’s normal.” Baby teeth play an important role in a child’s oral development as well. Schoonmaker said that children who lose baby teeth too early are more likely to need braces and more likely to need a longer treatment with bracers later. “We want to maintain baby teeth,” said Deb New, orthodontist at New Smiles Orthodontics in Rochester. “As teeth grow, they go where there’s space. If they lose a baby tooth prematurely, it can cause teeth to move where there’s space.” It may not be the most ideal space. New calls baby teeth “space maintainers” because as a tiny tooth falls out, the neighboring baby teeth still in place help prevent the permanent tooth coming in from going askew. For some teeth, the baby teeth help provide an even bigger space for permanent teeth. “Second molars, one of the last baby teeth to erupt, are wider front to back than the permanent tooth that will grow in,” New offered as an example. “That’s why we like to maintain these teeth.”

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

Baby teeth lost too early can mean the tongue is in a different, unnatural position which can cause crowding. Proper oral hygiene can help children keep their baby teeth for as long as they’re needed. Leaving it up to the children is likely not the best strategy. New encourages parents to monitor brushing with fluoride toothpaste — at least twice daily — for two minutes each session. Daily flossing is also important, as it removes plaque before it has the chance to harden onto the teeth. The child’s dentist can provide help in teaching proper technique. As recommended, a fluoride

dental rinse can help improve oral health, especially for children who live in cities that don’t add fluoride to the drinking water. Children can be seen by their dentist as early as the first tooth to get acquainted, become accustomed to dental examinations and develop a relationship of trust with the dentist. Parents should also set a good example of keeping up with their own home care and scheduled dental visits. Dental cleanings and exams twice a year or more often if recommended can also prevent problems.

Things You Need to Know About Pediatric Dental Care

“You want to have kids avoid gummy bears, jelly beans and fruit roll ups,” says chairman of URMC’s division of pediatric dentistry By Ernst Lamothe Jr.

avities are one of the most common chronic childhood diseases in the United States. About one in five children aged 5 to 11 years have at least one untreated decayed tooth, while one in seven adolescents aged 12 to 19 years have at least one untreated decayed tooth, according to the Centers for Disease Control and Prevention. Often this occurs because tooth care was not as vigorously done during their younger stages of life. “The importance of oral health simply cannot be underestimated,” said dentist Sean McLaren, chairman of pediatric dentistry at University of Rochester Medical Center. McLaren offers five tips to early tooth care.

Early maintenance Many parents believe their role in their child’s oral care begins when beginnings of the first tooth start appearing. However, there is work to be done before. A few simple routines after the first feeding and before they go to sleep can help wash out food, sugar and any bacteria that begins when they eat solid foods. “You want to start practicing good oral care before the first tooth arrives. Use a wet washcloth and

clean around the gums two to three times a day so your baby can get used to brushing,” said McLaren, who is also a board-certified pediatric dentist. “Once the first tooth starts to erupt, usually six months in, is when you want to start introducing toothpaste.”

Fluoride use Fluoride varnish can prevent about 33% of cavities in baby’s teeth, according to the CDC. Children living in communities with fluoridated tap water have fewer cavities than children whose water does not contain fluoride. Fluoride in water is the most efficient way to prevent one of the most common childhood diseases; tooth decay. The American Dental Association estimated 51 million school hours and 164 million work hours are lost each year due to dental-related illness. Some fluoride is also naturally present in groundwater and the oceans. “Fluoride is often recognized as one of the top measures for tooth decay prevention,” said McLaren. “You should brush your child’s teeth twice a day with fluoride toothpaste. Fluoride in water is truly a public health benefit.”

Wear a mouthguard Without a mouth guard, there is potential for

a collision that could cause teeth to be broken, knocked out or chipped. Tooth protection may also aid in preventing immediate or future expensive dental care. “We see a lot of dental injuries with kids that play contact sports,” said McLaren. “You have people being elbowed in sports where there is constant action. You can either get a custom mouth guard or a generic one that protects your teeth.” McLaren adds that a mouthguard is useful for more than just your teeth. “A guard can protect your bottom jaw from colliding with your top jaw and lessen the force of the blow. That has been known to decrease concussions since the top jaw is not moving upward in the mouth and affecting the brain.”

Healthly diet Eating the wrong foods continues to be a risk factor for heart disease and stroke. But making incorrect choices with your diet also has a ripple effect with your oral health. “You want to make sure you are careful with sugar, sticky food and dried fruit because they stick to your teeth, cause tooth decay and cavities. You want to have kids avoid gummy bears, jelly beans and fruit roll ups,” added McLaren. “Stay away from juices with a lot of sugar or even

Dentist Sean McLaren is the chairman of pediatric dentistry at University of Rochester Medical Center. chocolate milk. You can’t go wrong with water.”

Visit your doctor and floss Regular visits to your dentist for teeth cleanings every six months can help early detection of potential problems. Experts want people to floss once a day when they are young and continue that into adulthood. It prevents food and other particles from being trapped within the barriers. Make sure to floss between and around each tooth. Gently hook the floss like a C around the tooth. Slide the floss up and down and around all tooth surfaces, even the hard-to-reach back molars. Avoid snapping the floss between teeth. “Visiting your dentist will also help you clear up any myths. My mom used to tell me she had soft teeth which is pretty rare for someone. Cavity is the main bacteria that erodes teeth,” said McLaren. “You can have some heredity problems when it comes to your teeth so you want to be aware of your family history.”

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July 2020 •

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Page 15

Numbers to Follow for Good Health

o maintain good health, it’s all in the numbers that measure key indicators of health. These include blood pressure, cholesterol, minutes of activity per week, sleep, weight, blood glucose (if diabetic) and waist size.

“Different people have different numbers as far as their goals are concerned,” said Joshua Usen, doctor of osteopathic medicine in Western New York. “These are things a person needs to talk individually with their physician to see if they’re at their own goal.” These numbers are important to lower risk of disease and mitigate the effects of any existing health conditions.

Blood Pressure

Physician Az Tahir, who practices holistic medicine in at High Point Wellness in Syracuse, said that blood pressure is one of the vital signs because it’s associated with stroke and heart attack. “When blood pressure goes up, it affects the circulation,” Tahir said. Blood pressure should be less than 120/80. “[High blood pressure] can be silent,” said physician Joan Newell, who practices at Port City Family Medicine in Oswego. “People don’t necessarily notice their blood pressure is elevated until they have an organ compromised. If we can control blood pressure, fewer people will have kidney disease,” she said as an example of health issues that arise from high blood pressure. That’s why periodically checking it is so important.

Weight

Most health care providers use the body mass index (BMI) to determine a patient’s ideal, healthy weight. “We’re seeing more patients with hypertension and obesity struggling,” Newell said. “Obesity

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By Deborah Jeanne Sergeant is a huge problem. Keeping weight within a healthy range and the BMI between 20 and 25 is ideal. At 30, it’s still overweight, but better than obese.” The body composition can make a difference. A very muscular body builder may have a higher BMI than a lighter but less fit person. For most people, less than 20 is underweight. Between 25 and 30 is overweight, over 30 is obese and over 40 is morbidly obese. BMI calculators are available online such as at www. nhlbi.nih.gov/health/educational/ lose_wt/BMI/bmicalc.htm. “This one is a sensitive topic, but it is estimated that 30% of the U.S. population is overweight or obese,” said physician Andrew Rogall, with Oswego Health Fulton PrimeCare. “That number has more than doubled in the last 30 years. Being overweight puts us at risk for developing diabetes, cancer, heart attack and stroke.”

Cholesterol and triglycerides

The LDL (“bad”) cholesterol should be under 160 and HDL (“good” cholesterol) between 40 and 90 and triglycerides under 150 for generally healthy people. But Newell said that the numbers can vary based upon an individual’s risk factors, including age, smoking status gender, diabetes and blood pressure. Many providers suggest beginning to check cholesterol for men at age 35 and women at 45 because men have more cardiovascular risk. But anyone with risk factors should start at about 20 years old if they’re overweight, smoke or have hypertension. Rogall said that controlling cholesterol can reduce the risk of heart disease and stroke.

A1C blood sugar test

“Your hemoglobin A1C is a number that is the average of what your blood sugar has been over the last three months,” Rogall said. “This is one of these most important numbers for diabetic patients as this is how we diagnose and monitor how effective

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

your treatment has been.” Pre-diabetes is identified between 5.5 and 6.6. Rogall sets a goal of 7.0 to 8.0 for diabetics. In general, the A1C is administered annually for those who have prediabetes; biennially for those with type 2 diabetes who don’t use insulin and have their blood sugar level within their target range; and quarterly for type 1 or type 2 diabetics.

7. 5.

Minutes of exercise per week

To maintain weight, a person needs 150 minutes of moderate exercise weekly or 75 minutes of vigorous exercise. “When you’re talking about what’s moderate, I look at heart rates,” said Michael Dlugosz, a physician in Western New York. To find the target heart rate, subtract your age from 220. Moderate intensity exercise should be between 64% and 76% of the target heart rate. Vigorous exercise should be between 77% and 93% of the target heart rate, according to the Centers for Disease Control and Prevention. “That’s when you’re maximally active,” Dlugosz said. “Everyone’s will be a little different based on age and physical fitness.”

Hours of sleep

Most experts agree that between seven to nine hours of nightly sleep are recommended, and more for children. “It helps emotionally and physically,” Dlugosz said. “The more sleep deprived you are, the more in a state of stress you are.”

Waist circumference

More than just for vanity, waist circumference can indicate weight gain that has been linked with cardiovascular disease. “If I see a person that has central obesity in the belly, that’s when I focus more on circumference and changes in inches,” Dlugosz said. By meeting all the above numeric goals for your health, “you will be well on your way to feeling and looking your best, while also lowering your risk for serious illnesses like heart disease and stroke,” Rogall said. “Ultimately there are many other numbers that have important implications for your overall health; however, if you keep these goals in mind and adjust your lifestyle to achieve, you will be well on your way to making lasting improvements to your health.”

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Little Raspberries Score Big on This! By Anne Palumbo

hen it comes to a food’s nutritive profile, unexpected discoveries (good or bad) intrigue me. Pale cauliflower high in vitamin C? Who knew? Fibrous celery low in fiber? Didn’t see that one. Rich avocados full of healthy fats? More toast, please! So you can only imagine my delight when I discovered that raspberries — sweet, little raspberries — rock with more fiber than any other fruit: 8 big grams per cup. Since we need between 25 to 30 grams of fiber a day, that’s about a third of our daily needs. A vital nutrient, fiber promotes regularity, lowers cholesterol levels, helps control blood sugar levels, and may even help us live longer by reducing the risk of dying from cardiovascular disease and many cancers. Another discovery? Luscious raspberries are surprisingly low in sugar: only 5 grams per cup (about a teaspoon of sugar). As a comparison, one medium apple has about 20 grams. Equally low in carbs, raspberries are an excellent choice for anyone who wants to minimize their overall sugar and carb intake. Raspberries, like most berries, are full of antioxidants — health-protective compounds that have been tied to lower rates of heart disease, cancer, diabetes, obesity and other chronic diseases. These same antioxidants also help toreduce inflammation, a known trigger of premature aging. On top of everything, a particular type of antioxidant found only in red berries is so strongly associated with brain health and delayed cognitive decline that weekly consumption of berries is highly recommended by many leading health organizations. On the vitamin front, raspberries dish up a healthy dose of vitamin C: about 50% of our daily needs in just one serving. Essential for the growth and repair of tissue body-wide, vitamin C helps to increase the production of infection-fighting white blood cells, which is why many of us turn to vitamin C during cold and flu season and are seeking it now. Those looking to lose or maintain weight will appreciate raspberries’ nutrition stats: only 64 calories per cup and no fat, cholesterol or sodium. What’s more, raspberries’

slow-digesting fiber helps us feel fuller longer, making us less inclined to reach for those tempting chips.

Helpful tips

Fresh raspberries are highly perishable; use as soon as possible after purchasing or picking to ensure the best flavor and appearance. Choose berries that are ripe, plump and firm. Wash gently and pat dry right before eating or cooking. If not using right away, refrigerate unwashed raspberries in a shallow, covered container on a paper towel for up to 3 days. Be sure to toss any spoiled or moldy berries so they will not contaminate the others.

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For Mental Health, the Impact from COVID-19 Is Far From Over Situation may worsen after economy reopens, says expert By Payne Horning

onths of isolation, rising unemployment and general uncertainty have taken a toll on the nation’s mental health. Forty-five percent of the people the Kaiser Family Foundation polled in a recent survey said the virus has negatively affected their mental health — 19% of whom said that it had a major impact — and crisis hotline services across the country have reported major volume increases since the start of the outbreak. Even as states like New York slowly reopen and people are finally able to gather together and return to some of their regular routines, mental health providers say the situation won’t necessarily get better. In fact, they are concerned that it could get worse. “My experience with mental health issues is people deal with the crisis at hand really well and it’s when things lighten up and seem to be going back to normal that people fall apart,” said Sherie Ramsgard, a psychiatric nurse practitioner and owner of Whole Mental Wellness clinic in Fayetteville. Ramsgard said the past few months of widespread quarantine have been a traumatic experience for many, not just those who struggle with anxiety and depression. As a

result, Ramsgard said, people in the coming months may start struggling with what is essentially post-traumatic stress syndrome (PTSD). “We disassociate with the things we can’t help right now and put it in a little box and we just try to get through with the things we can handle on a daily basis,” Ramsgard said. “But once things lighten up, we start having nightmares, we start having flashbacks, and all of the things we put in a little box starts seeping out because our body has to experience it.” That fallout from the pandemic could be severe. A recent study from Well Being Trust and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care found that “deaths of despair” — those related to drug or alcohol misuse and suicide — are on the rise. The study projected that as many as 75,000 lives could be lost in this way as a result of the trauma from the nationwide quarantine. Paul Joslyn, executive director of the Syracuse-based mental health provider AccessCNY, said the problem may be exacerbated by the fact that many providers may be unable to meet the coming increased need for treatment. The economic toll the virus has taken on the nation’s econ-

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

omy is depleting tax revenues that governments need to fund public and private services, including the work that nonprofits provide. New York officials say the state faces a $13-14 billion deficit for fiscal year 2020-2021. To stem the potential losses, Joslyn is joining Central New York Rep. John Katko, North Country Rep. Elise Stefanik, and others in calling on Congress to increase the funding the federal government allocates to mental health providers in New York and beyond. A group of national behavioral and mental health providers that includes the American Foundation for Suicide Prevention, the National Alliance on Mental Illness and the American Psychological Association recently sent a letter to Congress saying as much $38.5 billion may need to be allocated, which is the amount that the organizations expect they could lose in revenue over the next year due to the outbreak. The letter said without this robust investment, behavioral health organizations may not be able to keep their doors open, leaving tens of thousands without access to vital mental health and

addiction treatment and care. The federal government is also being asked to continue the expansion of access to telehealth services, which is medical treatment provided to patients remotely through technology like video-streaming services. Use of telehealth has skyrocketed during the quarantine, aided in part by regulations that have been eased and the fact that many insurance companies and Medicare are now covering more of these services. Joslyn said one of the silver linings from this outbreak is the increasing number of people who have embraced this kind of technology, which has the potential to broaden access to treatment in a more efficient and cost-effective manner. Moving forward, Ramsgard recommends that people capitalize on the coping skills they acquired during the pandemic. The statewide PAUSE forced many to get back to the “basics,” Ramsgard said, like paying more attention to sleep, exercise, diet and human connection. It’s important to stay focused on that short- and long-term. “Mindfulness, slowing down, being more with nature, not feeling like we have to be on that hamster wheel 24/7 and that we do have to stop sometimes and breathe and just take in the good around us and appreciate those flowers that are blooming and the sunshine,” Ramsgard said. “I think we get on autopilot so often and we just miss all of the small things in life — what’s that saying? You’re going to look back and realize that the small things were really the big things.” Joslyn agrees that staying in contact with others, through whatever medium, is key. Just talking about your struggles with someone else can be therapeutic, he says. To that end, the state established the New York State Emotional Support Hotline at 1-844-863-9314 where people can schedule a free appointment with a mental health professional. New Yorkers can also access additional mental health resources at headspace.com/ny. And locally, people can call the National Alliance on Mental Illness (NAMI) Syracuse chapter at 315-487-2085.

Women’s Health Want to Help? Anyone who would like to donate to the Hospice of Central New York and the Finger Lakes education fund should send a check to Hospice Foundation of Central

Janice Nelson is the first dean of the College of Nursing at Upstate Medical University. At 92, she is raising money for additional training of nurses who work at Hospice of Central New York and the Finger Lakes.

Retired Nursing School Dean Embarks on Fundraising to Help Nurses at Hospice of CNY At 92, Janice Nelson is raising money for nurses at Hospice of Central New York get further education By Debra J. Groom

anice Nelson believes education is the key to doing a great job and providing great care for patients. Nelson, 92, of the Fayetteville area, is a retired registered nurse with master’s and doctoral degrees in nursing, education and nursing administration. She founded and was the first dean of the College of Nursing at Upstate Medical University and she also expanded services at Upstate to include a separate bachelor’s in nursing and post master’s advanced master’s certificate nursing programs to train clinical nurse specialist and nurse practitioners, according to an Upstate Medical University newslet-

ter.

And even though she has been retired from nursing for about 20 years, she still wants to be sure nurses can obtain the education they need to do their jobs well. Recently, she decided to help raise money for Hospice of Central New York and the Finger Lakes, a Liverpool-based organization that provides end-of-life care for individuals and their families. She sent letters out to people she knows in the area asking for donations to hospice to help nurses and aides there get additional training. “I talked with Cindy Gallagher [hospice chief executive officer]

about helping build up the education benefit for nurses and LPNs and aides at hospice,” Nelson said. “I told her ‘you need a discretionary fund and I need a project.’” The fund, Nelson said, would reimburse nurses, licensed practical nurses and aides who go back to school for more training. She said the fund works a lot like programs at other businesses — the person takes his or her class, pays for it and then is reimbursed by the company fund if he or she obtains a passing grade. “Hospice often had to rely on fundraisers, but sometimes we don’t make enough or don’t have enough money for the education benefit,” Nelson said. “I took a chance and sent out 45 to 50 letters to people I knew.” The move paid off, so to speak. She raised a little more than $8,000 for the education fund. “I got $1,000 from two people, $750 from one and $500 from one,” she said. Her letter asked people to “please consider donating $100 or more.” Here is a quote from her letter: “Following review of policies and procedures of both agencies, the administrative team of the newly merged hospice has determined that a personnel policy addressing financial assistance for employees interested in educational advancement is in order. “In order to establish a much-needed discretionary fund for this purpose, I have volunteered to seek donations from the greater nursing community. This money would be used to establish an educational fund which, in turn, would provide the necessary finances to enable this policy to become a reality.” “I invite you to join me in this worthwhile project. After all, we all know that the more knowledgeable the staff, the higher the quality of care.” “We hope to start small, sending two people per semester to school,”

New York and the Finger Lakes, 990 Seventh North St., Liverpool, NY 13088. Be sure to put Education Fund in the memo line of the check.

Nelson said. “Janice Nelson has been a longtime support of hospice and she is always coming up with ways to help us out,” Hospice CEO Gallagher said. “It is always greatly appreciated.” Gallagher said the money raised will help her nursing staff move on with their education and “provide them a chance to grow and be better” at their jobs. She said providing the education benefit also will help hospice attract nurses to the nonprofit and increase its nursing staff numbers. Hospice of Central New York and the Finger Lakes serves Onondaga, Madison, Cayuga counties and parts of Oswego County and the Finger Lakes. Nelson has long advocated education and has proven it through her own life. A native of the Buffalo area, she studied in North Dakota and then went on to obtain a degree in education from Daemen College in Amherst, near Buffalo. She received her master’s with a concentration in nursing administration from Columbia University and her doctorate in nursing education also from Columbia. She began her working career as a first-grade teacher. But then an accident landed her in the hospital for four months and she decided to make a career shift and go into nursing. As a nursing administrator, she said she loved working with the nursing staff and helping them with their jobs. At Upstate, she helped increase the amount of scholarship money available for nurses to expand their training, much the same as she did at Hospice. She also served for 20 years on the board of the Visiting Nurses Association in Syracuse and is past president of its Nurses Educational Fund. Nelson said she is thrilled with the response of her hospice fundraiser and is thinking of trying the letter-writing campaign again. “Maybe it is time to send out more letters, she said.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Page 19

Women’s Health

Emotional Abuse: Women Are Often the Target By Deborah Jeanne Sergeant

ne in four women and one in seven men will be victims of at least one incident of severe physical violence by an intimate partner — not a stranger — in their lifetime, according to the Centers for Disease Control and Prevention. Many people do not realize that emotional abuse often precedes physical abuse. Emotional abuse is far different than a spat between partners. “We look at a continuum of violence as to different ways violence happens,” said Randi K. Bregman, licensed master social worker and executive director at Vera House in Syracuse. “It’s about power and control. It’s someone trying to use their power and control, like physical abuse, emotional abuse, sexual abuse, financial abuse. Physical wounds heal but the emotional wounds are much harder to heal. “All these years later, it’s hard to stop hearing the voice in your head that says you’re no good.” Bregman added that emotional abuse is just as damaging as physical abuse, especially considering the life-altering and long-lasting effects of the former. Emotional abuse is a repeated pattern of coercion and control using manipulation. Every person occasionally acts snappish or hurtful. Emotional abuse takes place when a partner gains dominance through consistent use of intimidation, bullying, cruelty, name-calling and humiliating. Gaslighting is yet another tactic. With gaslighting, the abuser contradicts the victim’s memory of the past to cause the victim to doubt the memory of past comments or events for the purpose of undermining confidence and others’ trust. (“You’re forgetful — as always” or “That’s crazy; it’s not what happened at all.” Or “You must have misheard me; that’s not what I said.”) Using gaslighting helps the abuser “rewrite” the past to gain the upper hand by downplaying their offenses, appearing as victims and presenting the true victim as a wrongdoer. Of course, few would be willingly to enter such a relationship. But the power and control come by small degrees. Geoff Hopkins, board-certified

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child psychiatrist at the outpatient child and adolescent clinic at St. Joseph’s Health, said that many people don’t even realize they’re victims of emotional abuse. “You might have excessive criticizing or negating everything you say or trying to humiliate you,” Hopkins said. “It could be signs of emotional abuse.” Either partner in a romantic relationship can be victimized — even in couples not living together. Size and emotional needs generally make women easier targets for abusive men. Abusers aren’t just anger prone, substance abusers or people with mental illness (although people with these issues can abuse, too). Abusers are often capable of maintaining a socially acceptable veneer of self-control when it matters. “Research shows that men who are abusive often lash out at their partners or spouses with the intent of enforcing what they believe to be their rights, but that they are generally able to keep from reacting in an abusive manner when individuals other than their wives or children do not meet their expectations,” states goodtherapy.com. “This behavior is rooted in logic, demonstrating rationalization that makes it less likely that battering behavior stems from a mental illness, although it may in some cases.” Hopkins said that emotional abuse is “a prime risk factor for eventually being a victim of intimate

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

partner violence. Identifying this is important for one’s own safety.” Initially, victims are treated very well. In fact, abusers sweep them off their feet in a whirlwind romance. It’s like a storybook. Victims feels so lucky and dazzled by how attentive and thoughtful the abusers are, lavishing with expensive gifts and flattery. It feels like the love of a lifetime. Abusers slowly begins to exert more and more control over victims and usually under the guise of “protecting” or “helping.” Abusers isolates victims from friends and relatives that would spot any problems or support victims’ considerations of leaving. Abusers do this by eroding the victims’ trust in others and even accusing them of wrongdoing to drive a wedge in any other relationships. If the emotional abuse begins to lose effectiveness in controlling the victim, that’s when physical violence usually begins. Simply leaving seems an easy solution; however, on average it takes several attempts to leave. Many victims feel as if it’s their life work to rescue the abuser, as if they are uniquely qualified to be the only one who really understands. They still love their partner and want it to work out. They may be financially dependent and have children together. They also fear escalated violence and stalking should they leave. At this point, victims are in the most danger. They need to build a network of people to help. That may

include repairing relationships that the abuser has damaged and seeking help with a trained counselor. Well-meaning friends who want to “patch things up” between them likely will make things worse. Abusers are very likely to retaliate against victims in this situation in private and since they cannot see anything they’ve done wrong, they will blame victims “causing problems” in the relationship. Many think that couple’s therapy will help, but abuse is not a marriage problem; it’s one-sided. Anger management classes won’t help either since anger doesn’t cause the problem. “One thing that’s really important is we don’t use our concern for the person to justify ways of acting to show control over the other person,” Bregman said. Telling victims what to do doesn’t empower them. Instead of diminishing them, Bregman advises sharing supportive statements, like “I’m here for you if you want to talk; I love and care about you.” Most of the time, leaving the relationship is the only option when abusers have a personality disorder. Among those who are chemical dependent, only those who are willing to complete rehabilitation have hope of stopping battering. Leaving is usually the only safe choice long-term, yet it’s also fraught with peril in the process.

Women’s Health tion of domestic and sexual violence and elder abuse with other forms of oppression, particularly racism. I think that in this time period, when we look at the way that white supremacy and racism are playing out in our community, and in our nation today, we know how directly connected that is to the experiences of trauma for many people we serve. Somebody might be coming to us because they experienced intimate partner violence or abuse, sexual abuse as a child, but today, if you’re a person of color, what they’re focusing on in their therapy is going to be the reality of living as a black or brown person in the world today and how that triggers other types of trauma.

Q A &

with Randi Bregman

Vera House director talks about the agency and its services amid the coronavirus pandemic By Mary Beth Roach

era House staff, which numbers approximately 90, provides help for victims of domestic violence, sexual assault and elder abuse. Approximately 6,000 calls come into its support line annually. Located on James Street in Syracuse, the agency serves primarily Onondaga County, but it conducts its shelters and education and prevention initiatives in many areas. Q: What are some of the programs that Vera House offers? A: We provide comprehensive services for victims of domestic violence, sexual assault and elder abuse. Those services include our 24-hour emergency shelter program at two confidential locations. We also provide advocacy services, and that’s really a broad range of services for people who may not need shelter but need assistance; an order of protection; working with law enforcement, if they choose to do that; and navigating the housing system. We have a therapeutic counseling program that provides individual, family and

group counseling to those primarily affected by sexual violence and child witnesses to domestic violence. We have a program for people with abusive behaviors. We also have an education and prevention program. Just recently, we added a web chat line for those who may have difficulty in making a phone call. We’re usually open from 8:30 a.m. to 11 p.m. seven days a week with someone available to chat. We also have legal services available for individuals. Q: Over the years, how has the program changed? A: I think our programs and services have always been evolving. I think we’ve really enhanced our understanding of trauma-informed practice. You understand a lot of people’s choices and responses may be based on what they’ve experienced. This allows you to appreciate behaviors that could be thought of as difficult as coming from trauma. In the last few years, we’ve done a lot of work looking at the intersec-

get people what they need with all the limitations we’ve been facing. Q: With regards to the shelters, how has the pandemic affected the services? A: Prior to the pandemic, families that came into our shelters would share a family space. We would typically put two unrelated people in a room, kind of like a dorm-room style. With COVID, we had to change that configuration. We’ve had to cut many of the communal experiences that people would typically have in a shelter. People would usually have a shared meal. They would do groups together in a living area. We haven’t been doing that. It’s affected our ability to serve in a way we’d like to serve but we know that it’s essential in order to keep people safe from COVID-19.

Q: Has the number of calls locally been on the increase during the pandemic? A: It’s hard to tell exactly what increase or decrease in calls means until we’re out the other side of this. Our call numbers overall, if you average them since the start of the pandemic, are probably pretty consistent with last year’s. I will say that all of the calls that are coming to us, or the vast majority of the calls that are coming to us, have very high intense need because of COVID. People are feeling trapped; don’t have options; the courts weren’t hearing most cases. We were trying to help people do that remotely, so they would come into our office and we would practice social distancing and get them on Skype and connect with the judge. We do know and expect that people who are trapped in their homes with someone who’s been abusive to them are going to find it difficult to call for help. You have to brainstorm how to

Q: It was announced recently that due to the coronavirus, Onondaga County is forced to make cuts to a number of local nonprofits, including Vera House. How will this impact your programs? A: The county cuts to Vera House at this point amount to about $30,000. The cuts affect our therapy services for children who have been sexually abused and our advocacy services for victims of domestic violence. In a time when the need is great, it is very hard to absorb these cuts. If there is no relief for state and local governments in the next federal stimulus package, and additional anticipated cuts occur, it will be very difficult for us to maintain our current level of services. For more information and help, call 315468-3260 or visit verahouse.org.

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Women’s Health

Charcoal Masks Cleanse, Tighten Skin By Deborah Jeanne Sergeant

ctivated charcoal masks have become a popular facial treatment, available at many spas in the area. Overall, they are pretty effective. “In general, charcoal masks work by removing the oils in the skin,” said Dan Bryan, board-certified dermatologist with Dermatology Consultants in East Syracuse. “A lot of people like to use them if they have very oily skin or prominent pores. The charcoal will Bryan suck up the oil and unclog the pores. After people finish using them, their skin feels very smooth and their pores aren’t clogged.” Those applying charcoal masks place a warm towel to the face to open pores. Next, they apply the charcoal mask to the skin with either clean fingertips or a brush, keeping care to avoid the eyes, eyebrows, mouth, hairline and inside the nose.

Once they’re done applying the mask, they allow it to dry for 10 to 15 minutes before removing it. Depending upon the type of mask used, they may peel it off and clean off any leftover bits with a wet washcloth or clean it off entirely with a wet washcloth. “The one caveat is to patients with eczema or who are prone to skin allergies or rosacea, many charcoal masks can aggravate the skin as they have plant oils and chemicals people can be allergic to,” Bryan said. “If you have a background like this, be careful.” People with oily areas such as the “T-zone” of the forehead, nose and chin, sometimes use a charcoal mask in only that area and a moisturizing mask on drier areas of the cheeks. Joyce Farah, dermatologist with Syracuse-based Farah Dermatology, said that activated charcoal is used in toxicology to remove excess oil. To obtain the desired outcome, “you have to know the source of the mask,” Farah said. “It matters where you buy the mask from. Look to a U.S. company, where there is a little more regulation. It’s better that buying online where you don’t know

where it’s coming from. These masks are usually sold in dermatology offices that are better regulated.” A charcoal mask may be used about once every couple of weeks for a deep cleaning; however, those with skin conditions such as sensitivity, atopic dermatitis, eczema, or broken skin should ask a doctor before using a charcoal mask. Because they tend to remove oil, charcoal masks are not recommended for dry skin. Oddly, many Farah people aren’t

accurate in understanding their skin’s issues. Farah said that seeking guidance from a dermatologist or aesthetician is a good course of action because they can help determine the client’s skincare needs. “Charcoal masks are fine if you are using the right product for your skin,” Farah said. For people with sensitive skin, she said it can lead to a blister-like reaction and long-term or even permanent discoloration. “If you’re applying a mask or any product and it’s painful, take it off,” she said. “You can put a little of it on the inside of your wrist or elbow for the required time to test it.”

Experts: Supplements Not a Replacement for Healthy Diet By Deborah Jeanne Sergeant

f you’re concerned about the nutrition in your diet, popping a daily multi-vitamin may seem an easy fix; however, it’s not all that easy. “Multivitamins are a great start but won’t cover all of what we need,” said Karen Fisk, wellness educator at Natur-Tyme in Syracuse. “They’re not the be-all, end-all. It is intended to supplement a healthy diet, not take the place of one.” Many common things affect women’s health, including hormones, age, malabsorption issues, dietary restrictions, chronic disease, pregnancy and lactation. These can make it challenging to take a onesize-fits-all multivitamin. But in general, most women miss out on a few different areas, such as adrenal support. “That can be a big complex [formula] with vitamin C, an herbal capsule or tea; I’m a great fan of tulsi,” Fisk said, describing a few examples of adrenal support supplements. Also known as holy basil, the herbal is said to help modulate how the body expends adrenal energy. Fisk added that it’s also vital to hormone production. “If we spend all our time making adrenaline, we aren’t making enough hormones,” she said. Another big miss is magnesium, which Fisk said is in part responsible for “hundreds of functions within the body.” The typical American diet also

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doesn’t include enough beneficial fat, found in fish, nuts and seeds. Fisk added that these are important for the production of hormones and balancing blood lipids. Rosemary Squires, registered dietitian with a master’s degree in nutrition science, operates a private practice in Central Square. She said that supplementing with omega-3 fatty acids can help make up for a lack of fish, nuts and seeds in the diet. “They support so Squires many things from overall inflammation to brain health,” Squires said. She added that many people lack fiber, which is important for digestion and supporting a healthy gut microbiome. “Having good bacteria helps with mental health, joint health, immune health — virtually everything,” Squires said. She thinks that iron is among the top deficiencies in women. Lacking iron can contribute to fatigue, since iron aids in oxygenating blood. It’s commonplace for people who eat little or no meat to lack iron, which is also found in many beans and leafy greens.

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

Taking one multi-vitamin or group of supplements for life isn’t as beneficial as reevaluating supplementation needs based upon age and state. Laurel Sterling, registered dietitian, nutritionist and educator with Carlson Laboratories in Canastota, recommends looking at what a woman needs at that time. “During the child-bearing years, beyond what is found in a multivitamin, extra folic acid and iron may be needed,” Sterling said. “Also, calcium, magnesium and vitamin D3 and K2 — as MK-7 — are beneficial for bone and heart health. These nutrients are especially needed during pregnancy for fetal bone development.” Sunlight stimulates the body to generate vitamin D, a pre-hormone Sterling that regulates many bodily functions, but in areas

like Upstate New York, limited exposure reduces stores of vitamin D. This is especially important as women age. “During the 40s, 50s and beyond, extra bone building is needed,” Sterling said, “and even more D3 and K2 may be needed along with extra minerals that work to build up the bone matrix. “During perimenopause, generally between 45 to 55, the hormones are really fluctuating. Omega-6 fatty acids such as evening primrose oil assist in nourishing dry skin, hair, and mucous membranes as well as aiding hormone balancing.” Sterling also recommends vitamin E for heart health, biotin for hair, skin and nail health and, as needed, additional minerals to support the function of the thyroid, blood sugar, joints or other specific needs. As with making any change in diet or health, it’s important to check with a healthcare provider before taking any dietary supplements to ensure proper dose and to avoid contraindications with existing medication.

IGH_cancerJuly_4.75x13.75.qxp_Layout 1 6/24/20 7:27 PM Page 1

Parenting By Melissa Stefanec

MelissaStefanec@yahoo.com

Dangerous Dances and Powerful Lessons

e are facing unprecedented crises. Between a global pandemic and global protests, 2020 is changing life as we know it. Most of us can agree that we aren’t comfortable with the way things are. There is a lot of anger and arguments. Things are coming to a head. We adults aren’t sure how to conduct ourselves.

Our dangerous dance

It’s a strange thing we adults do — we pretend to have it all figured out. This leads to anger and unproductive confrontations. If we admit we don’t have it all figured out (which, none of us do), we view it as a personal failure that needs to be concealed at all costs. We live in society where people pretend to be experts in everything at the risk of having their beliefs invalidated. It’s destructive and foolish. Yet, we all keep time to the dance.

Rekindling our passion for questions

People want answers. Definitive answers make us feel comfortable and safe. They give the illusion of security. Answers are our security blankets, but our figurative blankets don’t do us much good. They only make us feel better. They don’t change reality or do anything to effect change. Quick answers aren’t going to move us forward as a society. We need to get back our basics. We need to remember the art of the question. If you have children, you know precisely how comfortable children and young people are with asking “why” and “how.” They realize they don’t have all the answers. They ask a lot of questions to make sense of the world around them. They recognize that to grow, they have to seek knowledge. They have to ask others for input, facts and reflections. They take what they hear or read, analyze it and try to arrive at tomorrow a little smarter than yesterday. What makes us adults think we have outgrown this? What makes us think we can name call and will ignorance all the way to solutions? When did we decide it is acceptable to say to ourselves, “I’m done growing,” “everyone else is an idiot” and “as long as I’m doing OK, I don’t care about you?” When did we lose our ability to grow through inquisition?

Dangerous lessons

Our know-everything and learn-nothing narratives teach our children some powerful lessons. We’re teaching them there will come a time when they can stop learning. One day, when they are bigger and

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self-righteous enough, they can pretend to know everything and laugh at all the fools who know so little. That narrative makes me ill. It makes me frightened for the world we are perpetuating. It’s time for all of us adults to put some effort into growing up.

Putting the “grow” in “grown-up”

As a society, we have reached a point of reconciliation. Reconciliation is defined as “the restoration of friendly relations” or “the action of making one view or belief compatible with another.” Why are we so afraid to reconcile? Why are we afraid to exist in the complexities of reality? This nation has been built on the blood, marginalization and exploitation of some human beings. No one who has read a history book can argue that. Yet, we resist that reality because this nation was also built on democracy, justice and individual freedoms for some human beings. Both of these realities are true. One doesn’t invalidate the other. Yet, our inability to reconcile hard truths keeps as from asking the tough questions that allow us to keep growing. Our reluctance keeps us from asking things like, “is it true that I have worked hard for everything I have but also have privileges others were denied?” It keeps us from asking, “Can the same people who keep me safe also be a threat to me or those around me?” It keeps us from taking that hard look inside and asking, “Have I been complicit in a system that benefits me at another’s expense, even if I didn’t create the system and don’t actively work to maintain it?” It keeps us from asking, “Am I willing to take simple steps to keep others safe?” Most of all, it keeps us from asking the hardest question of all, “Why do I feel the way I do?”

Taking our own advice

If we took a step back and embraced what we teach our children, we adults might actually change the world for the better. Next time we start pumping out clichés like “never stop learning,” “be quiet and listen,” “no one has all the answers,” “follow the golden rule” or “be the change you want to see” we need to stop and ask ourselves: when the last time we honored any of that? We need to stop calling each other names, talking over each other and pretending we have it all figured out. If we ask ourselves why we stopped growing and what we are going to do to change that, the answers might turn the tides of history in the right direction. In fact, we might actually teach the next generation something worth learning.

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will be in tune to infection control practices,” Townsend said. “Every business is going to be in tune to how they operate in terms of their own preparedness for challenges that come up. Every business is going to be looking at ways to not only make customers feel like they’re having a high-quality experience but likewise the importance of feeling safe when having that experience.”

Lessons from COVID-19

We’re pretty good at helping out.

By Deborah Jeanne Sergeant

t’s been a tough several months. The COVID-19 pandemic has touched everyone in many different ways. Despite the losses and challenges, an event as far-reaching as a pandemic can unexpectedly teach us a few things. Here are some of the lessons, according to experts.

We need to improve hand hygiene.

“Hand hygiene is important, and to wash hands regularly: before eating, after you’ve been out and about in public and before you touch your face,” said physician Helen Jacoby, infectious disease specialist with St. Joseph’s Health in Syracuse. “Stay away from big social events, like a concert.” Whether it’s flu season or a pandemic, proper hand hygiene makes a huge difference in transmission. Jacoby credits handwashing, along with social distancing, as key to flattening the curve and helping prevent the worst outcome of infection spread from coming true. But handwashing must include lathering the hands with soap and scrubbing for 20 seconds before rinsing and drying.

Vaccines are important.

“We’re all hoping so much for a COVID vaccine,” Jacoby said. “This stresses the importance of vaccines for illnesses for which we do have vaccines. With the polio epidemic, all we wanted was a vaccine. Now we want one for the novel coronavirus. We need to get vaccinated so we don’t have unnecessary outbreaks for measles, pertussis and more. We’ve become accustomed to being protected from communicable illnesses and COVID has reminded us [of the importance of vaccines]. The only illness that’s been eliminated completely was small pox. But there are regular outbreaks of measles in communities where there’s low vaccinated.”

We need to stop presenteeism.

“Presenteeism” was coined to describe workers who show up at the job even though they’re sick. Instead of touting this as a good work ethic, employers need to create an environment where employees feel secure enough in their position that they can take time off for illness as needed. “Try to avoid exposing other people to your illness,” Jacoby said. “I wish every workplace had sick days available.” Not allowing employees to take time off is shortsighted. It actually costs employers more in the longrun, she said. Page 24

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We need to improve our immune systems.

The job of the immune system is to protect us from disease. Physician Az Tahir, who practices holistic medicine at High Point Wellness in Syracuse, said that supporting immune function can improve one’s chances of not becoming infected and, if that does happen, recovering better. “Some people’s immune systems are strong,” Tahir said. “How to build a strong immune system is about eating healthy foods, drinking clean water, having positive thoughts, loving yourself and others, getting enough rest, physical and intellectual exercise and getting enough rest.” Tahir added that vitamin supplementation may help support good health, such as zinc and vitamins C and D.

We need to be better prepared.

Numerous healthcare organizations were short on personal protective equipment (PPE), among other supplies and equipment. “Pandemics come again and again,” Tahir said. “We should be ready for these things. Everyone ignored it until it’s too late. I hope this is not forgotten and we get ready.” Kim Townsend, president and CEO of Loretto, thinks of the pandemic as an event that although unforeseen and unwanted, that can help healthcare providers see where the system falls short and become better adept at caring for patients in future events that are similar. “Our lesson coming out of this is that you can be committed to being highly prepared, but even if you’re committed to it you have to anticipate in a pandemic or some other natural disaster that despite your best efforts to be highly prepared, it can be extremely challenging,” Townsend said.

We need to seek accurate information.

YouTube videos, forwarded social media posts, anecdotal accounts and many other sources of information do not hold the same weight as peer-reviewed, double-blind studies upon which the information from reputable sources is based. “I encourage people to check with their local health department or a government website, like the New York State Department of Health rather than Facebook,” said physician Joan Newell, with Port City Family Medicine in Oswego. “The CDC has been slow to update and it’s been harder to navigate. And it’s not

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

state-specific. The different systems of healthcare are sharing resources like never before.”

We need to become more self-sufficient with food.

“We like the efficiency of going to the most efficient of producers, but as a country, we need to identify industries where we want some homegrown capacity,” said Townsend, the CEO at Loretto. “I think we’ve done that with our food supply chain. Food sufficiency is an area where we want to have some capacity.” Although not everyone can garden, anyone can maintain a good stock of food at home. Exacerbated by job loss, food access became an even bigger concern, especially in the light of food availability once people began hoarding food, and supply chains for dairy, meat, and other good became disrupted. Stocking up doesn’t necessarily mean dropping a few hundred dollars for food at once. Picking up a few extra items each shopping trip can quickly build up a supply. Stocking up on healthful, affordable foods with a long shelf life. It’s good to build up a supply such as this for any emergency that can limit food access such as job loss, blizzard or other event. These could include canned fish, frozen fruits and vegetables, canned low-sodium soup, frozen meat, whole grain pasta and brown rice.

We need to make lasting changes in procedures.

Many companies and individuals in New York have changed many of their daily routines to help prevent the spread of COVID-19. “Almost down to the person, New Yorkers stayed home for more than two months,” Townsend said. “That’s why we’ve seemingly come out of the other side from the peak: because of the sacrifice. It’s very inspiring the lengths to which people will go to keep themselves and others safe.” Whether sewing masks at home as individuals or pivoting as companies to make helpful products to fight COVID, many Americans found ways to participate.

Things didn’t go as badly as they could have.

Healthcare providers stayed upto-date enough to effectively advise their patients. “In so many ways, the systems work,” said Newell, the physician with Port City Family Medicine in Oswego. “The New York State Department of Health system worked. We’re all connected electronically through our prescriber IDs and state license. They can contact each person and they can send emails. You get a link and have to confirm you receive it and it’s tied to your license. I need that active so I can practice every day. They send updates on any changes. They can tailor that. Today I got an email that’s specific to the fact that I’m a provider in Oswego County.” She added that the Health Department’s flu update system was already in place, making it easier to plug in COVID-19 information. “We’re not done leaning,” Newell said. “This isn’t over. We still have more to learn.”

“In the future every business

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By Jim Miller

How to Make the Most of Your Telehealth Appointment Dear Savvy Senior, I manage a large doctor’s clinic that treats hundreds of seniors each month. We are moving to more telehealth visits to help keep our patients safe at home during the coronavirus pandemic, but this new way of seeing a doctor is befuddling to many of our elder patients. Can you write a column educating patients on how to prepare for a telehealth appointment? Regular Reader

Dear Reader, I’d be happy to help! To help keep patients safe and at home during the coronavirus crisis more and more doctors and other health care providers are turning to telehealth (a.k.a. telemedicine) appointments, which are remote e-visits using a digital communication device like a smartphone, tablet or computer. Although telehealth has been around for a few years now, recent updates to regulations and a surge in demand has made it the easiest way to get many different types of medical care. Most telehealth appointments today tend to be primary care or follow-up visits that can assess symptoms or check on people who have had a medical procedure. Telehealth also works well for some specialties like dermatology or mental health care (counseling/therapy) services.

What to Expect The first step is to call your doctor’s office to find out whether telemedicine visits are available and whether you will need to set up an account or install special software on your computer, phone or tablet. Until recently, doctors were required to conduct telehealth visits through platforms such as Doxy, Thera-Link or MyChart that were compliant with the Health Insurance Portability and Accountability Act — or HIPAA. But some of those requirements have been relaxed in the current crisis, so many providers are using popular apps such as FaceTime, Skype and Zoom to conduct visits. Once you know what technology

you will be using, get familiar with it. You don’t want to spend the first 10 minutes of your visit trying to figure out how to unmute the audio. For older patients that aren’t familiar or comfortable with technology, ask a relative or friend with a smartphone, tablet or laptop to assist you. Take the time to clarify the purpose of the televisit before it begins. Prioritize a written list of three or four issues you want to discuss with your doctor and make a list of the medicines you’re taking, along with the dosages. Also, have relevant medical devices or logs on hand, such as a penlight or smartphone flashlight for viewing a sore throat, a blood-pressure cuff and thermometer (or recent readings), blood-sugar logs if you’re diabetic or a food log if you have gastrointestinal problems. If you’ve received medical care at different places, such as an urgent care facility or another doctor’s office, have your latest medical records with you during the telemedicine visit. Wear loose clothing that will allow you to show your medical provider what is concerning you. The length of the appointment may depend on the problem. A routine visit could be very quick, while others, such as a physical-therapy appointment, may last as long as a session at a clinic. Waiting rooms are sometimes replaced by virtual waiting rooms. Before the visit ends, make sure you know the follow-up plan. Do you need to schedule an in-office visit, fill a prescription or get a referral to a specialist? Right now, Medicare and Medicaid are covering the cost of telehealth visits (see medicare.gov/coverage/ telehealth for details), and most private insurers are following suit. If, however, you don’t have a primary care physician or need urgent care, you can get help through virtual health care service like Doctor on Demand (doctorondemand.com) or TeleDoc (teladoc.com). These services currently do not accept original Medicare, but they may be covered by private insurers including some Medicare Advantage plans — be sure you check.

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Home Care by Seniors for Seniors There’s a huge difference in the kind of home care you can receive from someone who really understands what your life is like as a senior. The concerns you have. The need for independence. Someone who, like you, has a little living under his or her belt. Our loving, caring, compassionate seniors are there to help. We offer all the services you need to stay in your own home, living independently. • Transportation • Shopping • Doctor Appointments • Companion Care • Housekeeping services • Meal preparation/cooking • 24-Hour Care • and more Call us today. Like getting a little help from your friends.

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ns Applicatio g in now be accepted. The following services are included in your rent • Trash Collection • New Appliances • Bus for shopping/groceries • Heat, Electricity & Hot Water • Snow Removal & Lawn Care • Planned Activities • All repairs & maintenance

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Stoneleigh Apartments Stoneleigh Apartments 400 Lamb Ave, Canastota • 697-2847 400 Lamb Ave, Canastota • 697-2847

Where your neighbors are like family! InvitingInviting one bedroom apartments essential services one bedroom apartments close close totoessential services and stores, as well as emergency and health services for and stores, as well as emergency and health services for Seniors (over 62) or receiving SS with a permanent mobility Seniorsimpairment (over 62) or receiving SS with a guidelines permanent mobility within income Page 26

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impairment within income guidelines

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020

Qualifying for Supplemental Security Income With Social Security

e pay monthly Supplemental Security Income (SSI) to people with disabilities who have low income and few resources, and people who are age 65 or older without disabilities who meet the financial limits. Income is money you receive, such as wages, Social Security benefits and pensions. Income also includes things like food and shelter. The amount of income you can receive each month and still get SSI depends partly on where you live. Resources are things you own, including real estate, bank accounts, cash, stocks and bonds, which we count in deciding if you qualify for SSI. You may be able to get SSI if your resources are worth $2,000 or less. A couple may be able to get SSI if they have resources worth $3,000 or less. If you own property that you are trying to sell, you may be able to get SSI while trying to sell it.

Q&A

Q: How can I get proof of my benefits to apply for a loan? A: If you need proof you get Social Security benefits, Supplemental Security Income (SSI) and/or Medicare, you can request a benefit verification letter online through your personal “my Social Security” account at www.socialsecurity.gov/ myaccount. This letter is sometimes called a “budget letter,” a “benefits letter,” a “proof of income letter,” or a “proof of award letter.” You even can select the information you want included in your online benefit verification letter. Q: I’ve decided I want to retire. Now what do I do? A: The fastest and easiest way to apply for retirement benefits is to go to www.socialsecurity.gov/retireonline. Use our online application to apply for Social Security retirement or spouses benefits. To do so, you must: • Be at least 61 years and 9 months old; • Want to start your benefits in the next four months; and • Live in the United States or one of its commonwealths or territories. Q: Although I stopped working a few years ago, I had additional seasonal earnings after my retirement. Will my monthly Social Security retirement benefit increase?

We will not count economic impact payments, also known as coronavirus stimulus payments or CARES Act payments, as income for SSI. These payments will also not count as resources for 12 months. You can read more about qualifying for SSI at www.ssa.gov/pubs/EN-0511000.pdf. If you’re an adult with a disability intending to file for both SSI and Social Security Disability Insurance, you can apply online for both benefits at the same time if you: • Are between the ages of 18 and 65; • Have never been married; • Aren’t blind, • Are a U.S. citizen residing in one of the 50 states, District of Columbia, or the Northern Mariana Islands; and • Haven’t applied for or received SSI benefits in the past. We’re here for you. You can find more information at www.ssa.gov/ benefits.

A: Each year, we review the records for all working Social Security recipients to see if additional earnings may increase their monthly benefit amounts. If an increase is due, we calculate a new benefit amount and pay the increase retroactive to January following the year of earnings. You can learn more about how work affects your benefits by reading our publication, “How Work Affects Your Benefits”, at www.socialsecurity.gov/pubs. Q: I am receiving Supplemental Security Income (SSI). Can my children receive dependent’s benefits based on my benefits? A: No. SSI benefits are based on the needs of one individual and are paid only to the qualifying person. Disabled children are potentially eligible for SSI, but there are no spouse’s, dependent children’s, or survivors benefits payable as there are with Social Security benefits. For more information, see our publication, Supplemental Security Income (SSI), available online at www. socialsecurity.gov/pubs. Simply type the title of the publication in the publication search box at the top of the page. You also may want to read Understanding Supplemental Security Income (SSI), available at www.socialsecurity.gov/ssi/text-understanding-ssi.htm. For even more information, visit www.socialsecurity.gov.

H ealth News

Oswego Health welcomes new psychiatrist

Oswego Health welcomes experienced psychiatrist Nickolas Togias to its behavioral health services department. Togias has extensive experience working with adult and geriatric patients in both outpatient and inpatient settings in the Southern Tier where he spent most of his career as a staff psychiatrist for United Health Services Hospital, Greater Binghamton Health Center as well as Community Treatment & Recovery Center, to name a few. Togias earned his medical degree from St. George’s University Medical School in Grenada, West Indies. He completed a transitional year in internal medicine from Albert Einstein Medical Center in 2000, psychiatry residency from the University of Nevada-Reno in 2004, and a fellowship in geriatric psychiatry from Columbia University, New York Presbyterian Hospital/New York Psychiatric Institute in 2007. Togias is board-certified in both psychiatry and geriatric psychiatry

by the American Board of Psychiatry and Neurology. He also received a prestigious honor from the American Psychiatric Association in 2018 and was recognized as a Distinguished Fellow. A native Ontarian, born in Toronto, Togias was instantly excited about returning closer to his roots. “When Oswego Health contacted me about this opportunity, I was not only drawn to the community, but their vision for the new behavioral health services property. Providing mental health services in a rural community to the level that Oswego Health has and will, is truly remarkable,” he said.

and maintaining the highest standard of care year after year. “We are beyond proud to be considered a center of clinical excellence. We take great pride in the care and connection we have with patients,” said the Center for Wound Healing Medical Director, physician Carlos Dator Jr. In 2018, the Center for Wound Healing at Oswego Health was also recognized as a center of distinction.

The Center for Wound Healing at Oswego recognized

Registered nurse Kim Spurling, director of women’s services at Oswego Hospital, believes that con tinuing education is key to providing care for the community. Spurling graduated May 10 from American Sentinel University with her Bachelor of Science in Nursing degree. Spurling has worn many hats at Oswego Health — from quality management specialist to the director of women’s services at Oswego Hospital. She now oversees the department where

The Center for Wound Healing at Oswego Health is the recipient of the 2019 Healogics Robert A. Warriner, III Clinical Excellence Award. This is a prestigious honor by Healogics, the nation’s largest provider of advanced wound care services. The Center for Wound Healing team earned this honor by scoring in the top 10% of eligible centers on the clinical excellence measure, comprehensive healing rate weighted by wound mix. The award demonstrates the center’s continued and consistent commitment to being patient first

Kim Spurling, RN Earns Bachelor of Science in Nursing

July 2020 •

she and her siblings were born. “We could not be prouder of Kim for continuing her education and training,” stated Oswego Hospital Director of Nursing Melissa Purtell. “Her dedication and commitment to the field of nursing and patient care is truly remarkable and we are lucky to have her at Oswego Health”

Discover

Inlet, NY

We have been working hard and working together, planning and preparing, and as we each open our doors to welcome you.

We look forward to seeing you when you are ready!

Inlet Area Business Association

InletNY.com

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LIFE CHANGING MEDICINE, MOVING MEDICINE FORWARD

IN GOOD HEALTH – CNY’s Healthcare Newspaper • July 2020