Gv igh 98 oct13 by In Good Health: Rochester's Healthcare Newspaper

in good October 2013 • Issue 98

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Rochester–Genesee Valley Healthcare Newspaper

Infertility Rates Continue to Decline

Pets With CANCER

Obamacare: Game On…

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

2 New Versions of Flu Vaccine Coming Find out why there are two versions this year Meet Your Doctor Eva Pressman is going where women have never gone before at URMC OB-GYN department

Once Considered Legally Blind, Teen Is Starting to Drive Thanks to Treatment by Local Doctors Dan Krenzer was diagnosed with an inflammatory eye disease called uveitis, which causes inflammation, cataract and glaucoma. In the third grade, the disease hit hard. He began learning Braille because the disease degraded his vision. Legally blind, he could only see shapes and colors. Find out his trajectory until today when he is ready to drive Page 17 October 2013 •

Developing Cutting-edge Medical Devices Local program puts teams of graduate biomedical engineering students next to surgeons as they treat their patients. The goal is spur the development of new medical devices that meet clinicians’ and patients’ needs Page Page 10 18

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

or the first time, there will be a vaccine that protects against four strains of the flu virus. Until now, flu vaccines have only protected against three forms of the virus. Each year, scientists choose what they believe will be the three most common forms of the flu to spread during the winter months, and they incorporate them into the annual vaccine. This year’s new vaccine containing four varieties has those three flu forms and an additional version of the virus. “The real need for the vaccine with four flu viruses comes if that additional virus begins to circulate,” says Clark Kebodeaux, assistant professor of pharmacy practice at St. Louis College of Pharmacy. “At this early point, it’s not certain what types of flu will cause the most illnesses.” Vaccines will be available through two forms of injections and a nasal spray. “If parents want to ensure that their children receive the new style of vaccine, ask for a nasal spray instead of an injection,” Kebodeaux says. “The four strain vaccine is available by injection as well, but some injections only

include the three strain vaccine. Going forward after this year, we’ll know if the additional protection is necessary.” Adults with egg allergies have a new option as well. An egg-free version of the vaccine is available, but it is only for adults aged 18 to 49. Kebodeaux adds that older adults, and those with chronic conditions like diabetes and asthma, need to receive an injection as soon as the vaccines arrive. The high-dose version of the vaccine for older adults protects against three versions of the flu virus. “I encourage everyone to get any version of the flu vaccine,” Kebodeaux says. “There will be plenty for everyone.”

Inpatient Dialysis

Dialysis is now available to inpatients at Thompson Hospital. Patients hospitalized for other conditions who need dialysis on a regular basis can receive treatments while recovering at F.F. Thompson Hospital. Additionally, consultations for both inpatients and outpatients dealing with kidney disease are available with a referral from your doctor. Please ask your primary care physician for details.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

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CALENDAR of

HEALTH EVENTS A

Oct. 1

‘Steppin’ Out’ event to beneﬁt cancer patients The 13th Annual Steppin’ Out for Friends with Cancer will be held at 6 p.m., Tuesday, Oct. 1, at Clifton Springs Hospital, 2 Coulter Road, Clifton Springs. Proceeds from the walk benefit cancer patients who are receiving care on the campus of Clifton Springs Hospital & Clinic. New this year: you can either walk or Zumba! The 2-mile walk travels through the picturesque Victorian village of Clifton Springs and the Zumba will be lead by certified Zumba instructors. Registration is at 5:30 p.m. in the Clifton Springs Hospital main lobby. Proceeds from the walk, will benefit income-eligible patients being treated for any type of cancer. Registration forms may be picked up at Clifton Springs Hospital Main Lobby, Finger Lakes Hematology & Oncology, Finger Lakes Radiation Oncology Center, or on the Web at CliftonSpringsHospital.org. For more information, contact the Clifton Springs Hospital Foundation Office at foundation@cshosp.com or 315-4620120.

Oct. 1 – Nov. 19

Grief support program offered in Clifton Springs For the spiritual care department of Clifton Springs Hospital, grieving after the loss of a loved one is a healthy

and normal process made easier by the company of others. The department will present a series intended to make the grief journey an easier one to travel. Led by Chaplain Gail Conners, the program consists of eight weekly sessions each Tuesday from Oct. 1 through Nov. 19. Participants may choose either a morning session at 9:30 a.m. or an evening session at 7 p.m. The program will be held in the hospital chapel, on the second floor of the main lobby. There is no cost for this program. Reservations are required by calling Chaplain Conners at 315-462-0142.

Oct. 8, 15, and 22

Workshop: ‘Survive and Thrive on Your Own’ Do you live alone? Is it a challenge for you? “Living Alone: How to Survive and Thrive on Your Own,” is a three-part workshop offered for women who want to gain the know-how to forge a meaningful and enriching life on their own. You’ll discover how to think differently about living alone and learn practical strategies to overcome loneliness and other emotional pitfalls, rediscover your true self, and socialize in a couples’ world. The workshop takes place from 7– 9 pm at House Content Bed & Breakfast in Mendon on three consecutive Tuesdays: Oct. 8, 15, and 22.The workshop fee of $125 includes a Living Alone manual, empowerment exercises, and lots of helpful resources. To register, contact Gwenn Voelckers at 585-624-7887 or email gvoelckers@rochester.rr.com.

Letters

to the Editor

The need to protect our kids from tobacco industry marketing Did you know that schools with higher rates of student smoking tend to be surrounded by a large number of tobacco retailers in the neighborhoods where the schools are located? Take a look around the areas closest to those schools. What are your kids seeing and noticing on their way to school or close to the school they attend? In New York state, more than 50 percent of tobacco retailers happen to be located within 1,000 feet of an elementary or secondary school, which means most kids cannot avoid passing tobacco marketing to and from the schools they attend. In addition, if your child is shopping in those convenience stores, they are being bombarded with colorful, enticing and very attractive tobacco advertising at the checkout — and behind the counter, most commonly referred to as “power walls.” We know that tobacco marketing is a cause of youth smoking and the Page 4

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SUNY Buffalo Study Sees Increased Menthol Cigarette Use Among Young People

Surgeon General has reported that tobacco advertising is more prevalent inside tobacco retailers located near schools. First, consider taking a tour of your local retailer to educate yourself and then contact your elected officials about the need to protect our kids from tobacco industry marketing! We want all students to be focused and successful this academic year! To learn how to get involved, visit www.SeenEnoughTobacco.org. For more information about what you can do to increase awareness about tobacco advertising and its influence on our local youth, call the Tobacco Action Coalition of the Finger Lakes at www. smokefreefingerlakes.com (585-6661401). Helen A. Dunlap Project coordinator. Tobacco Action Coalition of the Finger Lakes. She can be reached at 585-666-1401.

new study on mentholated cigarette use in the U.S. finds an increase in menthol cigarette smoking among young adults and concludes that efforts to reduce smoking likely are being thwarted by the sale and marketing of mentholated cigarettes, including emerging varieties of established youth brands. “Our findings indicate that youth are heavy consumers of mentholated cigarettes, and that overall menthol cigarette smoking has either remained constant or increased in all three age groups we studied, while non-menthol smoking has decreased,” says lead researcher Gary Giovino, professor and chairman of the University at Buffalo Department of Community Health and Health Behaviors. Giovino, one of the world’s leading tobacco surveillance researchers, estimated menthol and non-menthol cigarette use during 2004-10 using annual data on nearly 390,000 persons 12 years old and older who took part in the National Surveys on Drug Use and Health. The data included more than 84,000 smokers. The results, which were published online in the international journal, Tobacco Control showed that: • Among cigarette smokers, menthol cigarette use was more common among 12-17 year olds (56.7 percent) and 18-25 year olds (45 percent) than among older persons (range 30.5 percent to 32.9 percent). • Menthol use was associated with being younger, female, and of nonwhite race or ethnicity. • Among all adolescents, the percent who smoked non-menthol cigarettes decreased from 2004-10, while menthol smoking rates remained constant. • Among all young adults, the percent who smoked non-menthol

cigarettes also declined, while menthol smoking rates increased. • The use of Camel menthol and Marlboro menthol increased among adolescent and young adult smokers, particularly non-Hispanic whites, during the study period. “The study results should inform the FDA regarding the potential public health impact of a menthol ban,” Giovino says. “The FDA is considering banning menthol cigarettes, or other regulatory options,” he says. “This research provides an important view of the trends and patterns of menthol use in the nation as a whole. The FDA will consider these findings and findings from multiple other studies as it goes forward.” Giovino is particularly alarmed that the findings show youth are heavy consumers of mentholated cigarettes and the use of menthols is specifically associated with being younger, female and of non-white ethnicity. “This finding indicates that mentholated cigarettes are a ‘starter product’ for kids in part because menthol makes it easier to inhale for beginners,” says Giovino. “Simply stated, menthol sweetens the poison, making it easier to smoke. Young people often think menthol cigarettes are safer, in part because they feel less harsh. “When I was growing up, one of my older friends said he didn’t think that menthol cigarette smoking was that dangerous because he was told that they were good for you if you got a cold,” says Giovino. “It turns out that Kool was advertising that way for a long time but was stopped from doing so by the Federal Trade Commission (FTC) around 1955. “This ‘urban legend’ has persisted.”

More college scholarships for those with intellectual disabilities

en more local individuals with disabilities will be able to pursue a college education, thanks to scholarships funded by Excellus BlueCross BlueShield. Individuals served by Lifetime Assistance, Inc. of Chili who have Down syndrome, autism and other intellectual disabilities will be able to pursue a two-year achievement award certificate program at Monroe Community College (MCC). The program is designed specifically for students recruited through Lifetime Assistance. Students will audit classes, complete internships, participate in social clubs and work with peer mentors. “Individuals with disabilities want the chance for a career, and businesses benefit when they hire a workforce that’s inclusive of all backgrounds and abilities,” said Joseph Searles, corporate director of diversity and inclusion, Excellus BCBS. “The scholarships help to ensure that our community’s future workforce is trained, inclusive and diverse.” Students with disabilities are less than half as likely as their peers to have

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

attended college in the two years after high school, according to a U.S. Education Department report. Those with disabilities aged 21 to 64 were also not as likely to be employed compared to their non-disabled counterparts, according to a report by the U.S. Census Bureau. One student bucking that trend is Richard VanGee of Rochester, who is visually impaired and has a mild intellectual disability. With help from Lifetime Assistance, he enrolled in spring 2012 in the program at MCC. He audited classes in history, music and disability education, participated in several social activities and completed internships at local radio stations, Hochstein School of Music and Dance and The Association for the Blind and Visually Impaired (ABVI). When he completes the program in December, he will seek full-time employment in the community. “I highly recommend this program to anyone who is interested in broadening their horizons,” Richard said. “I think it is a good program. I like it a lot. Everyone really likes what they do, so come check it out.”

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

.S. hospitals have made major progress in adopting electronic health records systems over the past three years, according to a new report. The number of hospitals with a basic electronic health records (EHRs) system tripled from 2010 to 2012, with more than four of every 10 hospitals now equipped with the new health information technology, according to a July report by the Robert Wood Johnson Foundation. “Given the size of our country, that’s amazing progress in a very short time period,” said report co-author Ashish Jha, an associate professor with the Harvard School of Public Health. However, there is much more work to be done, the report indicates. These systems may have been adopted, but hospitals have not yet figured out how to use the new technology to improve patient safety and reduce health care costs. For example, the study found that 42 percent of hospitals now meet federal standards for collecting electronic health data, but only 5 percent also meet federal standards

for exchanging that data with other providers to allow widespread physician access to a patient’s records. “The news here is mostly good, but we shouldn’t declare victory yet,” Jha said. “In other industries it takes about 10 years after technology is adopted to see real efficiencies. My hope is we’ll see that more quickly in health care. We don’t have 10 years to waste.” Researchers believe that three factors have combined to drive adoption of electronic health records — society’s increasing reliance on information technology, new federal funding to support purchase of EHR systems, and future penalties under the Affordable Care Act that will be assessed against providers who will not use EHRs. “It’s the right incentives at the right time,” Jha said. “Doctors and hospitals have been thinking about buying electronic health records [systems] for some time. This is where our society is moving. But the finances have been a challenge. The federal incentives have been very well targeted. They were well designed to help push hospitals and doctors to adopt EHRs.”

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Electronic Health Records Slow the Rise of Healthcare Costs

se of electronic health records can reduce the costs of outpatient care by roughly 3 percent, compared to relying on traditional paper records. That’s according to a new study from the University of Michigan that examined more than four years of healthcare cost data in nine communities. The “outpatient care” category in the study included the costs of doctor’s visits as well as services typically ordered during those visits in laboratory, pharmacy

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

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In Good Health is published 12 times a year by Local News, Inc. © 2013 by Local News, Inc. All rights reserved. 106 Cobblestone Court Dr., Suite 121 – P.O. Box 525, Victor NY 14564. • Phone: 585-421-8109 • Email: Editor@GVhealthnews.com Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo • Writers and Contributing Writers: Jim Miller, Deborah J. Sergeant, Gwenn Voelckers, Anne Palumbo, Ernst Lamothe Jr., Mike Costanza, Maggie Fiala • Advertising: Donna Kimbrell, Amber Dwyer Layout & Design: Chris Crocker Ofﬁcer Manager: Laura Beckwith No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

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Meet

Your Doctor

By Lou Sorendo

Dr. Eva K. Pressman In a field once dominated by men, this physician has risen to head her department Q. What drew you to practice obstetrics and gynecology, and to specialize in maternal and fetal health? A. My initial interest in OB-GYN is really that the field allowed me to combine both medical and surgical care of patients, which is different than many fields of medicine. It turns out that it is only half the patients, because its only women, but I was willing to give up the other half of the population to be able to do both medical care and surgical care. The surgery includes not only cesarian sections, but hysterectomies, the removal of ovaries, and other surgical procedures involving the female reproductive organs. Q. Maternal fetal medicine focuses on high-risk mothers and fetuses during pregnancy. Why did you specialize in that area? A. My interest…was that the conditions that I would be following and treating would be more complicated, but more interesting. I get to care for women who go into pregnancy with underlying medical problems — high blood pressure, diabetes, heart disease, lupus, sickle cell disease — the list goes on and on. I get to help them though those conditions over the course of a pregnancy, which sometime requires additional care and treatment. Q. Do you see more diabetes and other complications among your pregnant patients these days? A. The incidence of hypertension and diabetes has both gone up over the last few decades. Some of it is related to the increase in obesity, and some of it is related to the fact that the average age of childbearing has increased over those decades. The average age is now 29 years old. It used to be below 25. Those conditions are more common as we get older. Q. At one time, OB-GYN was a male-dominated field. You finished your residency in 1988, and became chairwoman of obstetrics and gynecology at the University of Rochester on Sept. 1. Has the gender makeup of the field changed in the intervening years? A. The balance of male-female providers has changed over time. Of the physicians training in OB-GYN, the vast majority of them are female. That was not the case a generation ago. I don’t know exactly when the switch happened. Q. Any idea why the change occurred? A. I don’t know why more female providers are going into obstetrics and gynecology. I think there Page 6

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are many patients that seek out female OB-GYN providers, so I think that has probably played a role in it. Q. Did it play a role in your decision to enter the field? A. I don’t think so. When I started training, it was still more males going into OB-GYN than females. It was just what I wanted to do. Q. What challenges does your field face today? A. I think the challenges for OBGYN as a specialty are continuing to move the knowledge base forward. We are, luckily, in an era where including women in research, as well as including pregnant women in research, is much more common. There were many, many years when all of the research done to move medicine forward excluded not only women in many studies, but specifically excluded pregnant women. That made taking care of pregnant women when they became ill very difficult, because we had not evidence upon which to base our clinical positions.

Q. Why were women, and specifically pregnant women, excluded from research studies? A. There was a worry about doing something experimental that could harm the fetus. There was also a worry that patients who would start a research study when they were not pregnant could become pregnant during the course of the research study. Such patients might not give interpretable data, or something that you were doing as part of the research study could cause harm to an unknown pregnancy. Those are realistic concerns, but can be addressed in most studies. Q. How has the general view of such research changed? A. We’ve sort of come to the realization that by not studying women, and specifically not studying pregnant women, we have actually done much more harm to mothers and babies, because we don’t know how to effectively treat them in many circumstances. Probably the primary example was the H1N1 flu, where pregnant women were much, much more severely affected by the disease, and to not know the best way to treat them put them at great risk. Q. Has the increase in OB-GYN research changed the field? A. Yes. We actually have a much better evidence-based approach to delivering clinical care than we used to. We like to treat patients based on the evidence that’s been obtained in welldesigned studies. It’s not always possible to do that, because each patient is different and each situation is different, but I think that we’re able to do it much more of the time than we used to. Q. How have technological advances helped shape treatment? A. Technology’s not the answer to everything, but certainly ultrasound technology has opened up a whole new world for us. Being able to see the fetus more closely while its still in utero has allowed us to diagnose and sometimes treat conditions that we weren’t able to do before. There are also fetal treatments, both surgical and medical, that we are able to do that can correct issues before the baby is born. The one that’s actually been around for some time is to give a fetus a blood transfusion in the course of a pregnancy. It was originally designed for RH disease, where the mother’s blood type and the baby’s blood type are not compatible. The mother’s antibodies destroy the baby’s red blood cells, making the baby sick. It can

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

also be used for viral infections or other situations where the baby becomes sick, as well. Q. What challenges does the obstetrics and gynecology department face? A. Health care is going through some transitions. There is the distinct possibility that the way that we are paid for the care we deliver will change significantly over the next generation. The idea is that we won’t get paid for the services we provide but by the lives that we cover. It came up for the first time early in my training, with the idea that managed care was going to completely change the way we deliver medical care. It didn’t then, but it might now. Q. Are you referring to the idea that physicians would be paid for the results they bring about—in essence, for helping their patients get better? A. That is the ideal, but it’s a little hard to see how that will be actualized. I think the metrics of who gets better are a little vague at this point in time. I do think that that is my goal as a physician, to help patients get better and to minimize the bad outcomes for both the mother and the fetus. In theory, that sounds like the perfect system. In practice, I’m not sure how that will come to pass. Q. How might you respond to such changes, should they came to pass? A. My philosophy on delivering care is you deliver the best possible care that you can in the circumstances in which you find yourself, and worry less about whether it will be paid for or not. If you do the right thing for the patient—and the pregnancy in my case—then the outcomes will be better and it will cost society less in the long run. I didn’t go into this because of the salary attached. I went into it because I enjoy what I do. Q. On Oct. 1, uninsured Americans can begin enrolling in health insurance plans through the health insurance exchanges that were set up under Obamacare. Could that present a challenge for your department, as more OB-GYN patients appear at your door? A. I think we live in a state and in a county where pregnant women have pretty good access to care, at least during the course of the pregnancy, whether they’re insured or not. I don’t see our patient volume changing from that regard. We may be able to help more gynecology patients who had more limited resources before they were able to get into exchanges.

Lifelines: Current Positions: Chairwoman of Obstetrics and Gynecology, The James R. Woods Professor, Professor of Obstetrics and Gynecology in Maternal Fetal Medicine, Director of Maternal Fetal Medicine and Director of the MFM Fellowship training program at the University of Rochester. Education: OB-GYN residency training, fellowship in Maternal Fetal Medicine at Johns Hopkins University, Baltimore, MD; medical degree, Duke University School of Medicine, Durham, NC; Undergraduate degree, Brown University, Providence, RI. Personal: Married, with three children. Enjoys traveling, swimming, downhill skiing, walking and reading ﬁction.

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

pproximately four million cats and dogs develop cancer annually in the U.S., according to the National Veterinary Cancer Registry. The organization also estimates that more than half of all pets that live more than a decade will develop some form of cancer. With treatment, cats and dogs can survive cancer. But as with humans, early diagnosis and prompt treatment make a big difference. Unfortunately, pets often stoically hide symptoms while their cancer grows and it takes an astute owner to recognize something’s wrong. With the hundreds of types of cancers that can afflict pets, there’s no hard-and-fast list of symptoms to look for. Owners should have a vet check their pets for any strange lumps and bumps, change in eating or elimination habits, or unusual behavior. “At a visit like this, we take down

the pet’s history, do a physical, and may order lab tests like a complete blood count,” said Rodger Kuntz, a veterinarian at Chili Animal Care. Deciding what to do after a cancer diagnosis depends upon many factors, including the likelihood of recovery and the family’s finances. “A single mom with four kids puts feeding her kids as the top priority,” Kuntz said. “An older couple with no children at home will go to the ends of the earth to save their pet. It’s something people have to discuss with their vet.” Animals with a non-metastasized lump often respond well to surgical removal of the lump. Of course, as with humans, the animal’s health and age and the type of cancer also play a role in surviving. “The technology is there to do a lot for pets with cancer,” Kuntz said.

The distribution of In Good Health — Rochester-Genesee Valley’s Healthcare Newspaper has recently been audited by the Circulation Veriﬁcation Council.

Here are some of the results

100,000 Readers � Reliable Circulation. Nearly 100% of copies are picked up by readers vs. the national average of 75%.

� Readership. Each issue is read by 3.05 people vs. the national average of 1.8.

� High Retention. Nearly 50 percent of readers keep an issue of In Good Health for a month or more.

� Positive Results. The average for positive ad results in our publication is 51%. The national average for positive ad results is 74%, largely due to manufacturer’s coupons

� Ideal Readership. Over half of In Good Health readers are female. Over half of readers lives in households with incomes of over $75,000.

Health In Good

Mailing Address: P.O. Box 525 • Victor, NY 14564 Phone: 585-421-8109 Web: GVhealthnews.com Email: Editor@GVhealthnews.com

Rochester-Genesee Valley Healthcare Newspaper

More Pets Suffering from Cancer Needed in Research

he inclusion of veterinary species in clinical trials plays a key role in advancing the diagnosis, treatment and prevention of cancer for all species,” said Alexis DeLee representing The National Veterinary Cancer Registry. “The pharmaceutical industry is starting to invest more in animal cancer research. But in order to accelerate the adoption of clinical trials, we need pets — in large numbers — to participate. The National Veterinary Cancer Registry wants to identify these pets and make them available to participate in trials as they emerge around the country.” The National Veterinary Cancer Registry offers 10 reasons why cancer research for pets is important to both pets and humans: 1. Animal cancer is naturally obtained or spontaneously developed, as opposed to experimentally induced, as is the case with lab mice. 2. In many cases, pets develop the same types of cancers as their human caregivers do. 3. Animal tumors are similar to human tumors in terms of size and cell kinetics. Dogs and cats also possess similar physiology and metabolism characteristics to humans, which enables us to com-

pare treatments such as surgery, radiation and chemotherapy. 4. Most pets are large enough for high resolution imaging studies, as well as surgical intervention. 5. Dogs and cats have intact immune systems as opposed to many rodent model systems, enabling immunologic treatment approaches to be explored. 6. Most animal cancers progress at a faster rate their human counterparts, permitting more rapid outcome determinations, such as time to metastasis, local recurrence and survival. 7. Animal trials are more economical to perform than human trials. 8. Because fewer “gold standard” treatments exist in veterinary medicine, it is ethically acceptable to attempt new forms of therapy – rather than to wait until all “known” treatments have failed. 9. Dogs and cats live long enough to determine the potential late effects of treatment. 10. And the recent elucidation of the cancer genome and its resemblance to the human genome provides unparalleled opportunities to study comparative oncology from a genetic perspective.

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Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Growing Through Loss: Lessons Learned

n the past five years, I lost my father, my dog Lillie, a dear friend to a rare cancer, and then my brother Mark, who left this world far too soon at age 60. I was barely recovering from one loss, when another would make an unwelcome entrance. I’m still trying to make sense of it all. Just as living with a spouse doesn’t guarantee “happily ever after,” living alone doesn’t guarantee safe shelter from life’s losses and heartaches. Loss comes with living. It’s inevitable and sometimes predictable. And not all loss is bad. That’s what I’ve come to know. Whether a loss is caused by death, the end of a relationship or other life circumstances, most of us struggle to comprehend and cope with the emotions that result. That certainly was the case for me after my divorce. The breakup of my marriage was the first major loss in my life, and my recovery was slow and painful. It was also transforming. Loss became my “teacher” and I learned profound life lessons about grief, self-compassion, and ultimately, acceptance. If you are in the throes of loss, perhaps some of my reflections below will help ease the burden of your grief.

While there’s no best way to manage loss, I’ve discovered some things along the way that may help you feel a sense of renewal and hope. Loss is as personal as it is profound. Fortunately, in my times of loss, I have had my family, friends, and therapist here to remind me that each of us is unique and each of us manages loss and grief in our own, individual ways. I was not urged to “move on” or “find closure.” I appreciated everyone who simply let me be me, on my timetable — to cry or not, to return to work or not, or to enjoy an evening out, when I was ready for company and in need of a good, hard laugh. Loss can inspire honest expression. As a young adult, being emotive was not my style. Stoic is probably how most people viewed me (including myself). But, as my losses grew, so did my need and desire to express my true feelings. And now, I wouldn’t have it any other way. My losses have inspired me to be more real, more

KIDS Corner Is My Child’s Toy Toxic? Read the Label

here are thousands of children’s toy manufacturers around the world. Toys can be made of metal, plastic, paint, fabric and many other components, but are they really safe for your children? KidsChemicalSafety.org has compiled information from scientific experts to help parents make sense of information they are hearing about toys and chemicals. The website recently published an essay on exposure to chemicals in toys, what it means for children’s health and ways that parents can minimize the risk to their children, and an essay on physical hazards with toys and the types of prevention and first aid needed to address these hazards. “Parents can protect their child from chemicals in toys by choosing appropriate toys designed for their child’s age and paying attention to warnings on the labels,” said physician Rick Reiss, an expert on exposure assessment who authored the “Chemical Risks in Children’s Toys?” essay for KidsChemiPage 8

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calSafety.org. “The most important thing a parent can do is to assure that very young children do not have access to toys that are not intended for their age.” For example, Reiss noted, some toy jewelry contains levels of lead and cadmium. While these toys may be safe if they are only touched (lead and cadmium don’t easily penetrate human skin), they may not be safe if mouthed, since lead and cadmium dissolve in saliva and then get swallowed. The most important thing a parent can do, according to KidsChemicalSafety.org, is often the simplest thing: read the label. A quality toy company that is in compliance with international regulations will carefully develop label warnings intended to provide parents with information to minimize risk. The most important information is usually the recommended age range. This recommendation is based on knowledge of typical behaviors of children of different ages.

spontaneous, and more authentic. I wouldn’t change that for anything. Loss can facilitate self-awareness. This was especially true for me, in terms of getting in touch with myself and some unfinished issues and unresolved feelings. When I thought about what I wished had been different or what I would have liked more of in a relationship, my losses helped me clarify my preferences and priorities. Anger about not being truly seen nor heard told me that I highly value relationships where respect is demonstrated. It is a “must have” attribute for me, going forward. Loss welcomes a good listener (and some forgiveness). Understandably, people often don’t know what to say to a friend or loved one who has experienced a loss. When unwanted advice or careless remarks came my way, I tried my best to forgive those whose intentions were good, but whose words hurt. Mostly, I appreciated those who sat with me, listening with dignity and

compassion. Loss can sometimes use a change of scenery. I have always believed that the mind and body are connected. When the clouds roll in and sadness visits, I seek out what restores my faith and renews my energy. For me, that means spending time in nature. Turning off my phone and going for a long walk in a beautiful, peaceful place helps me regain my perspective. I’m reminded that “spring” will return. Life is good. Loss reminds us about what really matters. My mother, who has shared many of my losses, doesn’t hesitate for a moment when asked what is important to her: “Family,” she says unequivocally. I couldn’t agree more. Grief and loss can teach us so much. For me, clarity about what matters has been one of the most valuable lessons. If you are struggling with loss and feelings of isolation, I encourage you to draw loved ones close. Whether it be a friend, a family member, counselor, or pastor, reach out and ask for help and support. Know that feeling better is within all of our grasp, as long as we pay attention, keep our hearts and minds open, and have the courage to explore and share our feelings. We are not alone. Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon. For information about the fall workshop, see the events calendar in this issue, call 585 624-7887, or email gvoelckers@rochester.rr.com.

Young People Now at Higher Risk for Stroke

ifteen percent of the most common type of strokes occur in adolescents and young adults, and more young people are showing risk factors for such strokes, according to a report in the journal Neurology. Neurologist Jose Biller of Loyola University Medical Center is a co-author of the report, a consensus statement developed by the American Academy of Neurology. Between 532,000 and 852,000 persons aged 18 to 44 in the United States have had a stroke. U.S. hospital discharges for stroke among persons aged 15 to 44 increased 23 to 53 percent between 1995–1996 and 2007– 2008, depending on age and gender of the group. “The impact of strokes in this age group is devastating to the adolescent or young adult, their families and society,” Biller said. Biller is a member of an expert panel the American Academy of Neurology convened to develop a consensus report on the recognition, evaluation and management of ischemic stroke in young adults and adolescents. About 85 percent of all strokes are

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

ischemic, meaning they are caused by blockages that block blood flow to the brain. And more young people have risk factors for ischemic strokes. Those risks include high blood pressure, diabetes, obesity, abnormal cholesterol levels, congenital heart disease and smoking. Strokes in young people have a disproportionally large economic impact, because they can disable patients before their most productive years. And while coping with the shock of having a stroke, “younger survivors may be dealing with relationships, careers and raising children — issues that require additional awareness and resources,” the consensus report said. The authors said more emphasis is needed on teaching about stroke in young people and its risk factors and warning signs in school, at the work place and in primary care physicians’ offices and the media. Given the increasing physical, emotional and financial burden strokes cause in young people, “there will need to be greater research into reducing this burden.”

Obamacare: Game On…

Are Monroe County’s Physicians Ready for Obamacare? A Q&A with Monroe County Medical Society President James Fetten

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bamacare, President Barack Obama’s signature health insurance reform legislation, could swell the ranks of the insured by an estimated 29 million Americans. On Oct. 1, health insurance exchanges that New York and many other states have set up to help the uninsured select their health care plans will open their doors. Given that as much as 20 percent of Monroe County’s adults lacked health insurance in 2011, is the local medical community ready for the potentially large number of new patients that Obamacare could bring to local hospitals, clinics and doctors’ offices? Monroe County Medical Society President James Fetten, a physician himself, spoke to In Good Health about Obamacare and the readiness of local physicians for the changes the health care reform measure could bring. For more information about Obamacare — officially The Patient Protection and Affordable Care Act — or about enrolling in a medical plan, go to obamacarefacts.com/obamacarebill. php. Q. How do local physicians view Obamacare? A. I think there’s a lot of unknowns with what’s going to unfold. Doctors are taking a wait-and-see attitude, and they’re not jumping into this with both feet. In general terms, we sort of know what’s being asked of the health care system: to provide quality care at a lower cost, and to have hospitals associate with practicing physicians, and aim toward improved health of the population and, ultimately, less health care. More people being covered by health insurance is unquestionably a

Questions About the New Law? New York state has set up a website to help residents sign up for health insurance plans and answer questions about those plans. • Go to: nystateofhealth. ny.gov. • For additional information, call 1-855-355-5777 toll-free. • Customer service hours of operation are currently Monday to Friday, 8 a.m. – 5 p.m. • Starting Oct. 1, the hours will expand to Monday to Friday, 8 a.m. – 8 p.m., and Saturday, 9 a.m. – 1 p.m.

good thing. Q. Millions — and possibly tens of millions — of Americans are expected to sign up for health insurance in the coming year. Are Monroe County’s physicians and medical systems ready for additional patients? A. Just because more people are covered by insurance doesn’t necessarily mean there will be more ill patients coming into the health care system. There may be, but it’s not a direct relationship. Two hundred thousand more people are covered in Rochester doesn’t mean there are going to be 200,000 more doctors visits. It means more citizens with health insurance, which will help to hopefully keep people healthier by being able to seek out medical care sooner when they need it. If they need it — if medical illness should befall someone — then hopefully, they will not have financial ruin as a result of that illness. Q. Could Obamacare actually result in less strain on medical systems? A. The change that Obamacare is seeking to bring is making primary care more at the front and center of delivering health care, and rewarding services that are not currently reimbursed — like preventive care and sitting down for discussions [with patients regarding care]. The way things are set up now with the fee-forservice system, there is literally not enough time these days for a primary care physician to provide those types of services. They’re being asked to do more and more preventive care and other services that are not currently reimbursed. That can’t continue. The reason that primary care is waning currently is the fee-for-service system, and the poor reimbursement for the work that they [primary care physicians] do. If the reimbursement system changes in some fundamental way — where doctors won’t need to depend on fee-for-service or visits to obtain reimbursement — then a new strategy could be developed where care could be provided in a different context. The goal could be to keep people healthy, to require less doctor’s visits, and to try to focus on some lifestyle issues that can lead to diseases, and perhaps even decrease the incidence of some chronic diseases. Seventy-five percent of health

care spending is on managing chronic diseases — diabetes, high blood pressure, congestive heart failure. Q. Could this shift in reimbursement — and treatment — happen under Obamacare? A. I don’t know if the reimbursement scheme in and of itself will catalyze that change. But I think that Obamacare, or The Affordable Care Act, is a step in the right direction. Q. From the way you’ve spoken about U.S. health care, we appear to be playing catch-up. Is that your view? A. Many other countries do things differently, and have universal coverage and have systems that work for them. Here, we’re sort of trying to reinvent the wheel, and not taking examples from other countries that have wrestled with this and figured it out. We’re basically the last industrialized nation on earth that does not have universal coverage. Wrestling with that fundamental moral question has taken us longer than every other industrialized nation.

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Page 9

New UR Center Helps Students Develop Cutting-edge Medical Devices CMTI takes biomedical devices from concept to prototype By Mike Costanza

rin Keegan has enjoyed building things since she was a child playing with blocks. Now, the 21-year-old hopes to build the kinds of devices that could help physicians treat their patients. “I like providing things for clinicians to use,” Keegan said. “That’s why I’m interested in medical devices.” Keegan is in the first crop of graduate students to enter the University of Rochester’s Center for Medical Technology and Innovation (CMTI). Developed through the collaboration of two of the university’s schools, the Hajim School of Engineering and Applied Sciences and the School of Medicine and Dentistry, CMTI puts teams of graduate biomedical engineering students next to surgeons as they treat their patients. The partnership was created to spur the development of new medical devices that meet clinicians’ and patients’ needs, and can be profitably manufactured and sold. Keegan and eight other students began their studies in July. CMTI might be said to have shown Chandra its value before it technically opened its doors. Two students who were enrolled in pilot programs that led to the center’s creation produced new types of catheters for use in vascular surgery—surgery of the veins and arteries. The university has applied for patents on the catheters. Those who complete the yearlong program will emerge with master’s degrees in biomedical engineering, and the chance to enter a growing field. According to the US Bureau of Labor Statistics, the field has an above average employment outlook through 2020. Physician Ankur Chandra, CMTI’s clinical director, conceived the idea of bringing clinicians and budding biomedical engineers together in operating rooms about two years ago. “If you look at any major successful medical device, almost all of them were conceived by clinicians, and then they were developed and perfected by engineers,” he said. A long road runs from the conception of a device to the development of a usable product. Someone must design the device, build a prototype, and test it. Then, a company must be found that is willing to develop, manufacture and market the finished product. Unfortunately, biomedical engineers generally do not have the clinical knowledge needed to see the need for a new medical device. CMTI executive director, physician Greg Gdowski, visited a Chicago company that makes Page 10

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products that are used in colorectal surgery—surgery of the lower part of the gastrointestinal tract. “They rarely ever hire an engineer who’s ever seen colorectal surgery,” Gdowski said. Without such direct clinical contact, a biomedical engineer might not even know of the need for a new type of medical equipment. Clinicians, on the other hand, often know what is needed to treat patients more effectively, but generally lack the time and expertise needed to design such devices and help bring them to market. CMTI brings the two sides together. The center’s six full-time and two part-time graduate students initially split into three teams. When reached last August, each team was in the midst of shadowing a vascular, orthopedic or colorectal surgeon for two months as the clinician treated patients. While observing and interacting with a surgeon in and out of operating rooms, each team sought to determine whether new devices were needed to treat patients more easily or efficiently. “We task them with finding, essentially, 100 needs each over the summer, things that they could do in the clinic that would make things better,” Gdowski said. “A few of the groups have found as many as 180.” After they’d completed their observations, each student was to select a single clinical problem to attack. In August, two CMTI students appeared to be well on the path to focusing upon important problems. Spencer Klubben, who was Gdowski shadowing a colorectal surgeon, watched as nurses counted and recounted surgical sponges during operations. The common practice is intended to prevent the sponges from being left inside patients, necessitating another operation. Searching for a better way to deal with the problem, Klubben wondered whether sponges could be developed that would not harm the body if left behind. “Is it possible for that device to stay in there, or degrade?” he said. While observing patients who were awaiting heart transplants, Keegan noticed that sticky bandages sometimes took off patches of skin when being removed. “The only thing that we heard from patients is that the band aid hurt when it came off,” she said. The observation led Keegan to consider trying to develop a band aid that doesn’t damage a patient’s skin when it’s removed. Chandra asserted that such devic-

Physician Greg Gdowski, (background) executive director of the University of Rochester’s Center for Medical Technology and Innovation, explains the functions of a medical device to graduate biomedical engineering students Muhammad Musleh (left) and Erin Keegan. After working closely with local surgeons, Musleh, Keegan and other CMTI students plan to use the knowledge they’ve gained to develop new medical devices that meet clinicians’ and patients’ needs. es, though they might seem relatively simple, could be of greater benefit to medicine in the long run than more complicated ones. “There’s an inverse relationship between the complexity of the device and the number of people you can potentially help with the device,” he explained. Once they’d focused upon specific clinical problems, the students were to design devices that would solve those problems. If all goes as planned, by the end of the program they will have prototype devices that are intended to solve those problems ready to be presented to biomedical equipment manufacturers. At the time he spoke to In Good Health, Gdowski was looking for local or national biomedical companies that

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

would be willing to work with CMTI’s students during the development process. He said that the collaboration could give the students greater understanding of product development and marketing from the industry’s point of view, and help bring new devices to market. Chandra said the combination of clinicians from the University of Rochester Medical Center and biomedical engineers could yield a great many new medical devices—and startup companies to develop them—in the years to come. “I think the floodgates haven’t even opened yet in terms of the potential ideas that come from here,” he asserted.

SmartBites

By Anne Palumbo

The skinny on healthy eating

Helpful tips

Crazy for Wild Rice

Like most rice, uncooked wild rice will keep a long time in a dry, airtight container. Cooked, drained and tightly covered wild rice can be stored in the fridge for up to a week, and in the freezer for up to 6 months. Rinse well before you cook to remove unwanted particles.

ow that my meat consumption has all but dwindled to a few times a week, I’m always looking for alternative protein sources. If the protein source also packs a nutritious punch and is low in calories — hooray times three! Wild rice, a whole grain that is actually the seed of marsh grass native to the Great Lakes area, is my newest find. Slightly higher in protein that many other whole grains, one cup of wild rice delivers about 7 grams of protein (an egg has 6). Although it’s not a complete protein, it can easily be combined with beans or cheese to create a protein that contains all the essential amino acids necessary to build and replenish body tissues. Unlike white rice, which has been stripped of vital nutrients during processing, wild rice boasts a respectable amount of cholesterol-lowering fiber, mood-boosting B vitamins, zinc and manganese. While zinc is good for wound healing, manganese is good for bones and energy production.

host of chronic, age-related diseases. Finally, wild rice is gluten-free, a boon for those who have a hard time digesting this particular protein substance.

Wild Rice with Wild Mushrooms Adapted from Bon Appetit Serves 6-8

But like brown rice and most other whole grains, wild rice is low in fat, cholesterol, sodium and calories (only 160 per cup). Looking to lose weight? According to a study published in the American Journal of Clinical Nutrition, women who consistently eat whole grains weigh less than those who don’t. On the antioxidant front, wild rice is a fierce competitor. In fact, scientists at the University of Manitoba found that the antioxidant activity of wild rice was 30 times greater than that of the white-rice control. Not bad for swaying marsh grass! Antioxidants gobble up free radicals, which have been implicated in a

1 ½ cups canned low-salt chicken broth ½ ounce dried porcini mushrooms 1 cup wild rice, rinsed under cold water ½ teaspoon salt 2 bay leaves 2 tablespoons olive oil 1 cup chopped onion 1 cup chopped carrots 3 garlic cloves, minced ¾ teaspoon dried marjoram ½ teaspoon dried thyme 1 ½ cups sliced white mushrooms I cup dried cranberries (optional) ½ cup shredded Parmesan cheese (optional)

soaking liquid. Slice porcini into bitesize pieces. In medium saucepan, bring 3 cups of water to boil. Add rice, salt and bay leaves. Cover tightly and simmer 50-60 minutes. Drain; discard bay leaves. (Porcini and rice can be prepared 1 day ahead. Cover porcini, soaking liquid and rice separately and refrigerate.) Heat olive oil in large soup pot over medium heat. Add onion, carrot, garlic, marjoram, thyme and porcini and sauté 5 minutes. Add white mushrooms; sauté until tender, about 7 minutes more. Add cooked rice and 1 cup of reserved porcini soaking liquid to pot. Simmer until almost all the liquid is absorbed but mixture is still moist, about 10 minutes. Season with salt and pepper. Gently mix in cranberries. Sprinkle with Parmesan cheese.

Bring broth to boil in small saucepan. Remove from heat; add porcini mushrooms and let stand until soft, about 30 minutes. Drain, reserving

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

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Page 11

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

woman who delivered via cesarian section years ago would never consider the chance of a future vaginal delivery; however, it’s become much more commonplace for women to have a vaginal birth after cesarian (VBAC). Limiting a woman’s options for subsequent deliveries after a C-section arose from a study publicized in 1997 in an article in the “New England Journal of Medicine.” Amy Haas, a certified childbirth educator for 18 years who serves as the education chairwoman for Rochester Area Birth Network, said that the study indicated that moms whose labor is induced have an exponentially increased risk of uterine rupture, “the big fear of VBAC moms,” Hass said. “When the journal was published, the study was misinterpreted by the editor that moms should not have VBACs. What we learned is to not induce with prostaglandin.” In subsequent years, many studies have indicated that VBAC is a viable option for the majority of healthy, lowrisk mothers. Though the medical community’s stance has generally shifted in acceptance of VBAC, protocol regard-

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ing VBAC “made it nearly impossible for most facilities to offer it through the set-up requirements,” Haas said. For example, the number of staff members required to attend a VBAC may exceed what a small hospital can offer. Considering the disadvantages of C-section, it’s easy to see why many women generally prefer vaginal delivery. Though a common procedure, C-section is still a major abdominal surgery and carries with it all the risks of surgery such as blood clots, blood loss and infection. “Then you’ll have a newborn to care for,” Gaila Harriff, a registered nurse and a DONA-certified birth doula serving the Rochester area. “Csection does save lives. But when it becomes a misused option, that’s what we don’t want.” Though some women request cesarian for the delivery of some or all of their children to avoid the birth pains of vaginal delivery, the post-delivery recovery is longer. But women who want to avoid C-section now have a greater chance their birth plans will pan out. Harriff said that it depends upon the caregiver.

“A lot of doctors say you can do this, but during labor, they can pull the carpet out from under you,” she warned. “Look at their rate of C-section. As a doula, I work on a birth plan with the mom and dad. That plan is important to discuss with the care provider. Find out the reasons for a previous C-section.” For example, a woman whose first delivery was an uneventful vaginal delivery and whose second was a C-section because of a breech birth is likely a good candidate for VBAC. Harriff said that one of the reasons some obstetricians still hold to the notion of “once cesarian, always cesarian” is that “liability drives a lot of health care today.” The patient’s and baby’s health, mom’s weight and ethnicity, the reasons for the previous C-section, and other factors play a role in VBAC success. “One of the biggest barriers is the availability of a hospital that does that,” said Loralei Thornburg, OB-GYN with University of Rochester Medical Center. “In our region, there is a limited number of hospitals that do VBAC. You may need to look to transfer care

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

to a different hospital.” Most practices hold a position one way or the other. If the mom’s regular OB-GYN is unable to attend the birth, the back-up should hold the same VBAC stance, but “it’s good to ask,” Thornburg said. Among the biggest dangers of VBAC to the mother is uterine rupture; however, the risk is less than 1 percent. “There are risks and benefits to both,” Thornburg said. “The majority of women who choose to have a VBAC or C-section are content with their decision. Odds are in your favor either way. Women tend to think in anecdotal stories, such a friend had similar circumstances and think they’ll have the same experience. There is a small chance of complications either way. “When you talk about successful VBAC, one with no complications is safest for mom and baby,” Thornburg added. “An elective, repeat C-section, is second safest option. The least safe choice is emergency delivery at 3 a.m. after a failed VBAC. If we knew which women would be in group 3, we’d move them into group 2 but we don’t know.”

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

nfertility rates among U.S. women have fallen, but more women who eventually do get pregnant are having problems conceiving or carrying a child to term, a new report suggests. Between 1982 and 2010, the percentage of married women aged 15 to 44 who were infertile — meaning they did not become pregnant after a year of unprotected sex with the same partner — declined from 8.5 percent to 6 percent, according to the report from the Centers for Disease Control and Prevention. That translates to about 1 million fewer infertile women in this age group in 2010 than in 1982. Looking at only the oldest women included in the report (women aged 35 to 44), researchers also found their infertility rate decreased over the study period, from 44 percent in 1982 to 27 percent in the years between 2006 and 2010. Contrary to a public perception that infertility is increasing, “in truth, the data don’t support that infertility is on the rise,” said study researcher Anjani Chandra, a demographer at the CDC’s National Center for Health Statistics. However, the percentage of married women who experienced difficulties becoming pregnant or carrying a pregnancy to term — medically known as impaired fecundity — increased slightly over the study period, from 11 percent in 1982 to 12 percent in the years between 2006 and 2010. Rates of impaired fecundity peaked in 2002, at 15 percent.

Among all women (not just those who are married) the percentage with impaired fecundity increased from 8.4 percent in 1982 to 11 percent in the years between 2006 and 2010. Women are more likely to experience difficulties becoming pregnant as they get older. In recent years, 11 percent of married women aged 15 to 24 had difficulty becoming pregnant, compared with 47 percent of those aged 40 to 44. Chandra said more women are now having children at older ages, which increases the risk of fertility problems and fertility loss. But the availability of fertility treatments may, in part, counteract this trend, so that on the whole, infertility rates have not changed much. Use of fertility services may also lower the percentage of women who fit the definition of infertility used in the study, Chandra said. Women who experience problems becoming pregnant today may seek medical services quickly, and become pregnant before the 12-month period that would be needed to classify them as infertile, Chandra said. It’s important to note that not all women in the study who were classified as infertile may have wanted to have a child. About 40 percent of childless women with fertility problems did not intend to have a child in the future, the study found. The report was published Aug. 14 by the CDC’s National Center for Health Statistics.

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Page 13

Women’s issues No Amount of Alcohol, Drugs Safe During Pregnancy By Deborah Jeanne Sergeant

he CDC states that 40,000 babies are born annually with fetal alcohol syndrome, caused by moms drinking alcohol while pregnant. FAS can cause long-term, debilitating problems for babies. Babies can experience a wide variety of immediate and lasting consequences arising from their mother’s consumption of alcohol while pregnant. These include fetal alcohol syndrome, alcohol-related birth defects, and alcohol-related neuro-developmental disorders. “Fetal alcohol syndrome is characterized by poor fetal or infant growth, central nervous system abnormalities, and characteristic facial features,” said physician Neil Seligman, assistant Seligman professor in the department of obstetrics and gynecology at University of Rochester Medical Center. The abnormal features include a narrow eye opening, no vertical indentation between the upper lip and nose, and a thin junction between the lip

and adjacent skin. Babies of imbibing moms can have small heads, abnormal brain development, behavioral abnormalities, impaired memory, learning, reasoning, attention, and concentration, problems with vision or hearing, and seizures. Other bodily organs and functions may also be impaired such as the kidneys, heart, and bones. “Alcohol exposure is the leading preventable cause of mental retardation,” Seligman said. “Adults with FAS are at increased risk for mental illness such are drug and alcohol dependence and depression.” Seligman said that the most commonly abused drugs during pregnancy are opiates/heroin, cocaine, benzodiazepines, and amphetamines. “In general these drugs can cause birth defects, obstetrical complications, neonatal drug withdrawal, and longterm neuro-developmental abnormalities,” Seligman said. “Cocaine is associated with an increased risk of birth defects affecting the genitourinary tract, heart, brain, and bones whereas amphetamine abuse has been linked to congenital heart disease and cleft lip,” he added. Drug abuse can also complicate birth, cause pre-term birth and stillbirth. Since drugs pass through the placenta to the baby, most experience

withdrawal. Children may experience problems with learning, vision, speech, and behavior. The March of Dimes has begun several initiatives for eliminating alcohol and drug use during pregnancy. “No level of alcohol or drug use is safe,” said Dorothy Dreyer, associate director of program services for the March of Dimes, Genesee Valley/ Finger Lakes Division, which serves several counties throughout Upstate New York. The organization has developed educational brochures geared towards consumers and works with healthcare professionals to continue to educate patients. “I think moms continue to drink because they have a friend who drank or smoked and had a preemie who was fine, so they think they can do it too,” Dreyer said. “They don’t understand the importance of not drinking during pregnancy.” The problem has become large enough that some healthcare organizations are contemplating universal drug testing for their pregnant patients. Universal testing may help some moms quit; however, it also poses a quandary: will it drive moms who imbibe and use drugs away from prenatal care altogether?

“They may not get prenatal care, which isn’t as important as cleaning up, but prenatal care can help identify problems with the pregnancy,” Dreyer said. Seligman blames, in part, the difficulty some women face in obtaining treatment for alcohol and drug dependency. “For individuals who abuse heroin or other opiates, the waiting list to enter a methadone treatment program may be a year or longer,” Seligman said. He also said that since about half of pregnancies are unplanned, sexually active women need to use dependable contraception. Any woman who may become pregnant should avoid alcohol and illicit drug use and talk with her doctor about any prescription and over-the-counter drugs she takes.

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

ome parents may shy away from talking to their daughters about puberty, but Loyola University Health System obstetrician and gynecologist Akua Afriyie-Gray, stresses the importance of sitting down with your tween when the time comes. “Most girls enter puberty without much education on the topic,” AfriyieGray said. “Parents should be proactive about talking to their daughter about puberty, so that she knows what to expect when her body begins to change.” Afriyie-Gray offers the following tips on how to talk with your tween about puberty: Be prepared. Have your talk ready to go when the time comes. Pay attention to your daughter. Be aware that your daughter may not come to you when she begins experiencing changes in her body. Look out for these changes and let her know what to expect. Puberty typically starts around age 8 or 9 with hair development under the arms and in the Page 14

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pubic area. Breast development usually occurs next at age 9 or 10 followed by menstruation, which begins on average at age 12. Puberty typically takes three to four years to complete. Inquire about other girls. Ask your daughter if her friends have started shaving, wearing a bra or menstruating. This takes the focus off of your child and it may be a good opening for discussion about your daughter’s body and the changes she may be experiencing. Take a positive approach. Let your daughter know that puberty is a natural process, which all girls experience. Stress that there is no need for her to be embarrassed, but be sensitive to what your daughter is ready to discuss. Dispel myths. Answer any questions and correct any misconceptions your daughter may have about puberty. Talk to your daughter about hygiene. Let her know what products are available for menstruation and that she can continue

with her normal activities when she has her period. Let her know about fertility. Stress to your daughter that menstruation signals that she can become pregnant. Turn to an expert. If you do not feel comfortable talking with your daughter about puberty, schedule an appointment for her to see a pediatrician or a gynecologist who specializes in treating children and adolescents.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

Women’s issues Post-partum Depression Much Worse Than ‘Baby Blues’ By Deborah Jeanne Sergeant

he birth of a baby is usually a happy time for a family; however, for some women, post-partum depression (PPD) brings a dark cloud over the event. More than “baby blues,” which affects most new mothers and resolves within a week or so, PPD can last much longer and interferes with a woman’s ability to care for herself and her family. Kimmie Garner, co-coordinator with Postpartum Resource Center of New York, said that about one in eight women experience post-partum depression. “That is probably a lot lower than what it actually is because of women not coming forward to report it,” Garner said. “It’s very stigmatized. Women feel Poleshuck like they should be happy. It’s all about preparing for the birth, but afterwards, women can feel very alone as it’s been built up to be this big, exciting period of their lives.” Ellen Poleshuck, an associate professor in both psychiatry and OB/GYN for Finger Lakes Health, said that women and their families need to watch for “depressed mood or loss of interest to do things, most of the day nearly every day for two weeks or

more, accompanied by other symptoms such as insomnia, changes in appetite, low self-esteem, extreme fatigue, difficulty concentrating, changes in activity level, and thoughts of death or dying. PPD typically occurs within four weeks of childbirth.” Certain factors can raise the risk of PPD, such as a physically stressful pregnancy, little support during pregnancy, history of depression or anxiety disorders, and unknown biological causes. Area health practitioners are working to help more women recognize and treat PPD. Michelle Telga, nurse practitioner in women’s health at Unity Health system, said that their care providers screen for signs of PPD during post-partum calls and office visits. “I believe many women are familiar with the signs, especially over the last few years with it being in the media with famous actresses having that problem,” Telga said. After reporting they are experiencing PPD symptoms, the next step is visiting with their care provider, which can include a phone consultation. Most providers use a questionnaire to evaluate their post-partum patient’s symptoms and then discuss any treatment options. This can include psychotherapy and medication. “Many women do feel guilt over it, though it’s a biochemical problem,”

Telga said. “Just like a diagnosis of diabetes isn’t something you should feel guilty about, you shouldn’t feel guilty about post-partum depression. This is something these women can’t help.” Most health insurance covers treatment for depression, thanks to the 2008 Mental Health Parity and Addiction Equity Act, which requires coverage to extend to depression treatment just as it does for biomedical health care. “Protection of coverage for mental health care is anticipated to be maintained under the Affordable Care Act,”

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o reduce risk of post-partum depression, Kimmie Garner, co-coordinator with Postpartum Resource Center of New York, recommends the following tips: • “Have a strong support system, especially if you have a history of depression. • “Be open with your care provider and family if you’re prone to depression. • “Have a post-partum doula, especially helpful if you don’t have a partner or support system. A doula comes in and does laundry, child care of other children, and helps with baby care. • “Reach out and talk with other women such as at new mother support groups. It shows there are many women experiencing this around the country and around the world. • “Communicate about it to your faith community. Bringing food and checking in on new mothers takes the pressure off her. • “Just like having a birth plan is important, having a post-partum plan in place can be really important for people who are predisposed to depression. It is a huge life change and has a lot of stressors.”

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Poleshuck said. “Despite these laws, expensive co-pays and deductibles can interfere with women’s ability to obtain the treatment they need.” If cost inhibits a woman’s ability to seek care for PPD, Poleshuck encourages them to seek clinics which offer free or subsidized services. OB-GYNs also offer leads on local resources. Anyone considering harming herself or others should immediately seek emergency help by dialing 911 or checking in at their nearest emergency room.

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Having Pain During Intercourse? By Zoe Fackelman

en and women can have pain while having sexual intercourse in the perineum — crotch area — as result of hip, low back and pelvis region muscle, nerve or boney alignment conditions. Dyspareunia, the medical term for pain related to sexual intercourse is more commonly seen in women. About 20-50 percent of women will have pain with penetration or thrusting of the penis. The pain is described as aching, sharp, burning, stabbing or tingling and is often felt at the opening of the vagina, deep in the vagina, lower abdomen, groin, hip or low back. The list of reasons why you may have pain with intercourse is a long one, so seeing a physical therapist specifically trained to evaluate and treat this condition is extremely important. Depending on the findings during

Highland Now Offers Scarless Gynecologic Surgery

ighland Hospital recently became the first hospital in the region to offer virtually scarless gynecologic surgery with the use of single-site instrumentation on one of its two daVinci surgical robots. Gynecologic surgeons Oona Lim and Coral Surgeon in August performed the region’s first single-site robotic hysterectomy, leaving only an incision of 2.5 cm (less than an inch) inside the woman’s navel. The Single-Site technique is more advanced than traditional four-incision robotic procedures used to date. It has received FDA approval for benign gynecologic procedures as well as cholecystectomy (gall bladder) surgery. On Aug. 12, Highland’s chief of surgery, Joseph Johnson, performed the

1 in 5 Women Don’t Believe Their Brest Cancer Risk

espite taking a tailored risk assessment tool that factors in family history and personal habits, nearly 20 percent of women did not believe their breast cancer risk, according to a new study from the University of Michigan Comprehensive Cancer Center. Most of the women who didn’t believe their risk numbers said they did not feel it took into account their family history of cancer or their personal Page 16

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your examination, your treatment may consist of correcting any muscle, nerve or boney alignment conditions, pelvic floor rehabilitation and instruction on how to be sexually active and avoid pain. You may now realize how common this problem is and there is no need to feel embarrassed about getting the help you deserve to feel wholesome in the bedroom. Zoe Fackelman is a physical therapist and the owner of Lake Country Physical Therapy and Sportscare, PC in Canandaigua. For more information, visit www. lakecountrypt.com or send her an email at zoe@lakecountrypt.com.

hospital’s first single-site gallbladder surgery. Only a few programs nationwide are using single-site technology for gynecology cases, according to the hospital. “This is an exciting addition to the capabilities that robotic surgery gives to surgeons and their patients,” says Lim. “With robotic surgery, we’re able to make smaller incisions so there’s less blood loss during surgery and fewer complications. Patients go home the next day. They require less pain medication and their recovery time is better, so they can return to work and to their lives much faster.” “The single-site approach takes the many benefits of robotic surgery a step further by reducing the number of incisions from four to one,” adds physician Surgeon. “This is much more than a cosmetic improvement for the patient. The more incisions you have, the more post-operative pain the patient can experience. The location of incisions also is a factor; incisions that are lateral, on the side of the body, tend to cause more pain than those that are medial (in the center of the abdomen). So using the navel as the port of entry reduces the likelihood of pain and improves the patient’s recovery.”

health habits. The tool did ask relevant questions about the individual’s family and personal history. “If people don’t believe their risk numbers, it does not allow them to make informed medical decisions,” says senior study author Angela Fagerlin, associate professor of internal medicine at the University of Michigan Medical School and a research scientist at the VA Ann Arbor Center for Clinical Management Research. “Women who believe their risk is not high might skip chemoprevention strategies that could significantly reduce their risk. And women who think their risk should be higher could potentially undergo treatments that might not be medically appropriate, which can have long-term ramifications,” she adds. The findings, published in Patient Education and Counseling.

What They Want You to Know:

Lactation Consultants and Counselors

By Deborah Jeanne Sergeant

actation consultants and counselors work with families who choose breastfeeding. Some offer their services independently and others work from an organization such as a hospital to provide support and information for nursing mothers. Organizations such as the International Lactation Consultant Association provide training and certification for consultants. • “Most people don’t have complications with breastfeeding but we offer support. If something is more advanced than what we can help with, we refer people. • “We do home visits, as opposed to hospital-based lactation support. When someone can come to your home and offers support, it makes a big difference. I can take the time to help. If the baby is sleeping, I can stay and wait until he wakes up for a feeding. I can see where you’re breastfeeding. I can see if you’re having problems with your sofa. A consultation at the hospital is important, but a delivery room isn’t your space. • “Lactation counselors charge less than consultants but you can get as much support. They don’t have as much clinical perspective, but can still offer lots of support. Ellen Derby, certified lactation counselor in Pultneyville serving Ontario County • “I see mothers prenatally and post-partum with educating about breastfeeding. • “Breastfeeding classes can educate mothers to help them make an informed decision about breastfeeding. We want to get her started on a positive note. • “Every mother should be seen by a lactation consultant in the hospital and after they go home. • “You need a lot of training and education to become certified. It includes 90 credit hours of lactation-specific education. In addition, you have to have a nursing background, or some people have a dietitian background or take courses geared towards child development, psychology or sociology. You have to have 1,000 clinical hours of shadowing a consultant and pass a board exam. You have to take continuing education classes. • “Breastfeeding is an individual choice between a mom and a baby. It’s a choice we encourage for many, many

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

reasons: health, psychology, and future health benefits, both for mom and baby. • “The numbers are growing of women who are breastfeeding but we do not have the support we need in this society. Going back to work is very difficult. We see those breastfeeding rates dropping when women go back to work. It’s something women struggle with to get the time they need. • “Breastfeeding in public still makes some people uncomfortable. It’s not about what people think, but how a mother is feeding her baby. Dianne Cassidy, international board certified lactation consultant and owner of Dianne Cassidy Consulting, Rochester • “When people hear the words ‘lactation consultant’ I feel they envision physically helping place a breast in the baby’s mouth. Often, I do not even touch a mother during the breastfeeding process. • “So many things contribute to the success of a mother’s ability to breastfeed. Some of the support systems that have been available to mother in the past are no longer present. • “Generations of women helped the new mother establish good breastfeeding patterns, routines and practices that led to a robust milk supply and infant growth. Families were present to help with the running of the home, while the new mother rested and fed her baby. • “Other misconceptions about breastfeeding include pain, sagging breasts, exhaustion, spoiling babies and more. All of these are far from the truth when it comes to breastfeeding with proper support, education and experience.” Donna Barrows, register nurse and board certified lactation consultant with Advanced Nurse Lactation Certificate and owner of Little Darlings, Inc. in Rochester Deborah Jeanne Sergeant is a writer with In Good Health. “What Your Doctor Wants You to Know” is an ongoing column that appears monthly to give our area’s healthcare professionals an opportunity to share how patients can improve their care by helping their providers and by helping themselves.

Once Blind, Henrietta Teen Learns to Drive

Are these conditions preventing you from seeing ? Are you frustrated and ready to do something about it?

After multiple eye surgeries at URMC to help restore his vision, 16-year-old is now driving

Telescopic and Prismatic glasses will help with simple tasks and can give better vision and more independence.

By Maggie Fiala

n the first grade, Dan Krenzer’s eyes wouldn’t stop crossing on picture day. Dan’s parents expected to purchase glasses to solve the problem since their three daughters were nearsighted. “We went to the eye doctor. My parents thought it was going be a simple appointment, but it took a few hours because they noticed something was wrong with my eyes,” Krenzer said. Dan was diagnosed with an inflammatory eye disease called uveitis, which causes inflammation, cataract and glaucoma. In the third grade, the disease hit hard. He began learning Braille because the disease degraded his vision. Legally blind, he could only see shapes and colors. He had to use an eye patch and walk with a guided cane. The disease caused serious complications-cataracts, glaucoma, and retinal and corneal problems. He has had five surgeries to repair damage to his retinas, remove cataracts in both eyes and implant devices to reduce pressure from glaucoma. Today, Dan’s outlook is much better. The 16-year-old got a learners permit in April with the OK of his doctors at the Flaum Eye Institute and Golisano Children’s Hospital. A team of doctors have been managing Dan’s care for the past decade. They have improved and stabilized his vision to 20/25. Dan still wears glasses and takes medication, but is in the driver’s seat. Dan is now focused on the future. He began his junior year at Rush-Henrietta High School and hopes to pursue astronomy in college and as a career. In his spare time, he is learning to drive on his own. He admits he needs a lot more practice, but hopes to get his license in the spring of next year. “It was always in the back of mind, ‘what if I couldn’t drive,’ so I was a little nervous about that, but the doctors reassured me I would be able to,” Krenzer said.

What is Uveitis

Uveitis is swelling and irritation of the uvea, the middle layer of the eye. Uveitis can be caused by autoimmune disorders such as rheumatoid arthritis or ankylosing spondylitis infection, or exposure to toxins. In many cases, the cause is unknown. It affects about 280,000 people and causes 15 percent of blindness in

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the United States each year. While the disease is rare in children, it can be associated with systemic inflammatory diseases, according to the National Eye Institute. There is no cure for the disease. The trick is to control disease symptoms with surgery and the right balance of medication, said Yousuf Khalifa, a uveitis and corneal specialist at the Flaum Eye Institute. Khalifa became involved in Dan Krenzer’s treatment three years ago. Dan was experiencing flare ups of inflammation after surgery. His doctors wanted to put him on a medication regimen that would control the inflammation and would prevent a secondary cataract, more glaucoma, or more swelling in his retina. Khalifa recommended a new medication called Remicade, which treats autoimmune disorders. The FDA has not approved Remicade to treat eye inflammation; however, its standard practice across the United States to use it for uveitis, Khalifa said. The medication made a huge difference in stabilizing his vision. “Without this he wouldn’t have done well,” Khalifa said. “As long as he is followed closely and the inflammation stays under control, he has a very good prognosis.” Dan receives Remicade IV infusions every six to eight weeks. He may go off the medication eventually, but not in the near future, Khalifa says.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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ER Visits Common After Seniors’ Surgery, Study Finds

The Social Ask Security Ofﬁce

At some hospitals one in four patients returns for emergency care following colon operation

fter common surgeries, nearly one in five older Americans ends up in the emergency department within a month of being discharged from the hospital, according to a new study. The University of Michigan Medical School researchers also found wide variation among hospitals in the rates of older patients who needed emergency department care after having surgery on their hearts, hips, backs, colons and major blood vessels. Rates were as much as four times higher in some hospitals than in others. “There was a lot of variation depending on what the surgery was for,” study lead author Keith Kocher, an emergency physician and assistant professor in the department of emergency medicine, said in a university news release. For example, rates of ER visits after colon surgery ranged from one in four patients at some hospitals to one in 14 patients at others. The researchers analyzed data from nearly 2.4 million Medicare patients who had at least one of six common operations over a three-year period. More than 4 percent of them had two or more emergency department visits within one month after leaving the hospital. The study team also found that more than half of the patients who required emergency care were readmit-

ted to the hospital directly from the ER, according to the study published in the September issue of the journal Health Affairs. The six types of surgery included in the study were: angioplasty or other minimally invasive heart procedures; coronary artery bypass; hip fracture repair; back surgery; elective abdominal aortic aneurysm repair; and removal of part of the colon to treat problems such as colon cancer. The most common issues that brought patients to the emergency department were cardiovascular and respiratory conditions, infections, complications with the site of their surgery or procedure incision, and abdominal or gastrointestinal problems. “We went into this expecting some variation, but were surprised at how much we found,” Kocher said. “That means this is probably a finding health providers and systems can act on to improve their rates, to ensure coordination of care and that patients can access timely care for problems that develop after they are discharged before having to come to the emergency department.” If further research supports it, postsurgical emergency department visits could be added to other measures such as infection rates in assessing and grading hospitals on their quality of care, according to the study authors.

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If You Can’t Work Due to a Disability, Social Security Can Help

f you are disabled and you’re no longer able to work, you should learn how Social Security can help you. Disability is something most people do not like to think about; however, the unfortunate reality is this: the chances that you will become disabled are probably far greater than you realize. Studies show that a 20-year-old worker has a more than one in four chance of becoming disabled before reaching retirement age. Social Security pays benefits to people with disabilities through the Social Security disability insurance program, which is financed by Social Security taxes. If you qualify, you can receive a monthly disability benefit from Social Security for as long as your disability keeps you from working. The amount of your benefit is based on your average lifetime earnings. Potential Medicare coverage is dependent on several factors and usually starts after you receive disability cash benefits for 24 months. When you work and pay Social Security taxes, you earn credits. The number of credits you need to qualify for disability benefits depends on your age, and some of the work must be recent. For example, if you become disabled after age 31, you need to have worked at least a total of 10 years, including five of those having been worked within the past 10 years. But if you become disabled before age 24, you need only one and a half years of work in the past three years. If you have a disability that keeps you from working, the time to get

Q&A Q: Can I delay my retirement benefits and receive benefits as a spouse only? How does that affect me? A: It depends on your age. If you are full retirement age or older when you first apply, and your spouse is receiving Social Security benefits, you can choose to apply and receive benefits on just your spouse’s Social Security record. This way, you could delay applying for benefits on your own record in order to receive delayed retirement credits. If you are full retirement age or older, and have already applied for retirement benefits, you can request to have payments suspended. If you qualify for a spouse’s benefit, you can receive those payments and earn delayed retirement credits on your own record. By applying only for benefits as a spouse, you may receive a higher retirement benefit on your own record later based on the effect of delayed retirement credits. You can earn delayed retirement credits up to age 70

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

started with your application is now. That’s because it takes time to determine whether you qualify for benefits. It usually takes about three to five months for a medical decision from the state agency that evaluates your condition. If your application is approved, your first Social Security disability payment will be made for the sixth full month after the date we determine that your disability began. Given the time it can take, it’s in your best interest to do everything you can to speed up the process. The best first step is for you to read our online publication, “Disability Benefits,” at www.socialsecurity.gov/pubs. It will tell you all about the process, including the information you will need to apply for benefits. Then, take advantage of our online disability starter kits. You will find them on our disability website at www. socialsecurity.gov/disability. From that page, simply select the option to apply for benefits online, and on that page you will find the disability starter kits. There is one kit for children and one for adults. Each kit is available in both English and Spanish. The starter kits help you begin the process by providing information about the specific documents and the information that we will request from you. Take a look at the disability starter kit now at www.socialsecurity.gov/disability. Once you complete the online disability starter kit and you’re ready to apply, the most convenient way to do that is also online. Just go to the same disability website at www.socialsecurity.gov/disability.

as long as you do not collect your own benefits. Since the rules vary depending on the situation, you may want to talk to a Social Security representative about the options available to you. To learn more, visit www.socialsecurity. gov or call us at 1-800-772-1213 (TTY 1-800-325-0778). Q: My daughter just joined a nonprofit charity and is helping victims of natural disasters. She gets a salary. We were wondering if she has to pay Social Security tax. A: Yes, people who work for nonprofits and who receive a salary must pay Social Security tax just like everyone else. It is commendable that she is helping people in need. But the fact is that she is also a wage-earner. Those wages and the Social Security tax she pays on them will offer her financial relief in the future, when it comes time to apply for Social Security. So she is really helping herself, too. For more information, visit our electronic publication, “How You Earn Credits” at www. socialsecurity.gov/pubs.

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Health Exchange Shopping Tips for Uninsured Boomers and Early Retirees Dear Savvy Senior, At age 62, I will be retiring at the end of the year and plan to enroll in Obamacare until my Medicare kicks in. Can you offer me any advice on choosing a plan? Almost Retired Dear Almost, The new health insurance exchanges — also known as Obamacare — that begin in 2014 will have a significant impact on millions of Americans who need health insurance, especially preMedicare retirees and uninsured baby boomers who often have a difficult time finding affordable coverage. To help ensure you get the best health insurance coverage that fits your needs, here are some things you should know. Health Exchange Overview

Starting Oct. 1, you will be able to shop for health insurance policies, and enroll in one directly through your state’s health insurance marketplace website, over the phone, via mail or in person at a designated center. The coverage will go into effect on Jan. 1, 2014. You can also be reassured to know that federal law prohibits marketplace insurers from denying you coverage or charging you higher rates if you have a pre-existing health condition. But they are permitted to set premiums up to three times higher for applicants over the age of 50, and smokers may be charged up to 50 percent more than nonsmokers. To help make coverage affordable, sliding scale tax-credits will be available if you earn less than 400 percent of the poverty level — that’s $45,960 for a single person and $62,040 for couples. These tax-credit subsidies will provide immediate savings off your monthly premiums. See the Kaiser Family Foundation online calculator (kff. org/interactive/subsidy-calculator) for a premium estimate. Every state will have a marketplace, but each state can choose how it will operate. Seventeen states, including New York, and the District of Columbia will run their own state-based marketplace, seven states will partner with the federal government, and 26 states will offer federal marketplaces.

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

Policy Choices

To make shopping and comparing a little easier, the health plans will be divided into four different levels — bronze, silver, gold and platinum. The bronze plan will have the lowest monthly premiums but the highest outof-pocket costs when you need care, while the platinum plans will have the highest premiums with the lowest outof-pocket costs. You will also have a variety of health insurance companies to select from. To help you evaluate insurers, the nonprofit National Committee for Quality Assurance offers online “report cards” at ncqa.org that can help you narrow your choices. Because most plans will be managed-care policies such as HMOs or PPOs that require you to get your care within a network of providers, you’ll want to make sure that the doctors and hospitals you typically use are covered in the plans you’re considering. The new marketplace plans are expected to offer fewer choices of health-care providers, and who’s included may vary quite a bit. You also need to find out what happens if you want to use a doctor or hospital outside a plan’s network. Will you have to get a referral or pay more to get these services, or will it even be covered at all? Also check the plan’s formulary, which is the list of prescription drugs they cover, to be sure all the medications you take are covered without excessive co-pays or requirements that you try less expensive drugs first.

Get Help

If you need some help with all this, the Marketplace Help Center offers a toll-free helpline at 800-318-2596. Or, if you’d rather get face-to-face assistance, there will be designated centers set up with trained and certified navigators, counselors and application assistors to help you, along with insurance agents and brokers. To find help in your area, call the marketplace Help Center after Oct. 1 for a referral. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.savvysenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book. October 2013 •

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In the workshop led by Gwenn Voelckers — a woman who’s “been there” — you’ll learn practical strategies to overcome loneliness and other emotional pitfalls, rediscover your true self, and socialize in a couples’ world. $125 fee includes empowerment exercises and many helpful resources. For more information, call (585) 624-7887 or email gvoelckers@rochester.rr.com IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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H ealth News Sleep Insights expands practice into Newark Sleep Insights Medical Services, PLLC, a Rochester-based medicine specialty practice, is expanding its network of clinic sites and sleep center testing facilities into Newark. The new location will be in the Quality Inn at 125 N. Main Street, Newark. “We recognized there was an unmet need in this geographical area,” said physician Jacob Dominik, medical director at Sleep Insights in Newark. “Many patients come to the Penfield site from Newark and the surrounding communities; by expanding our consulting and overnight sleep testing services, we are able to minimize patients’ drive time and make it more convenient for them.” Sleep Insights is an integrated sleep medicine provider offering consultative, diagnostic testing, and sleep therapy services. Diagnostic testing includes overnight or daytime testing in a sleep lab facility or home sleep testing for certain appropriate patients. “Our clinical approach as sleep specialists is to combine our clinical skills with the most advanced diagnostic technology available to arrive at the correct diagnosis and plan of treatment for our patients,” said physician Ken Plotkin, medical director and CEO of Sleep Insights. “Our patients come to us with insomnia, daytime sleepiness, fatigue, narcolepsy, sleep apnea, restless legs syndrome—anything that affects their ability to sleep or function the next day. Our focus is on helping each patient as soon as we can, the best we can.”

Mercy Flight raises $240,000 for night vision goggles Mercy Flight Central has completed its Light Up the Night fundraising drive and raised a record $240,000 from local businesses, charitable foundations and hundreds of individual donors. The campaign sought to raise funds to purchase night vision goggles, which cost approximately $11,000 per pair. These goggles are a lightweight binocular mounted to the flight crew’s helmet and powered by a low-voltage battery pack. This technology enables the pilot and crew to see objects that might not be seen readily by the naked eye. This can mean the difference between life and death when safety is critical. “Night vision goggles have been a major priority to Mercy Flight Central as these devices improve the safety and response time of each mission,” said Neil Snedeker, president and chief executive officer. “We are deeply appreciative of the support we’ve enjoyed from across New York state in raising money to help us fund these critically needed tools.” Major donors included Constellation Brands, Elf Foundation, Rochester General Health Systems, University Page 20

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of Rochester Medical Center, Davenport Hatch Foundation, Bethesda Foundation, The William G. McGowan Charitable Fund and numerous other companies and charitable foundations.

Jane Shukitis appointed to the Council for Elders Jane Shukitis, vice president of Unity Aging and Community Services, was recently appointed to the Monroe County Council for Elders by County Executive Maggie Brooks. The council advises and makes recommendations to the director of the office for the aging concerning matters relating to the senior citizens of Shukitis Monroe County. The Monroe County Council for Elders is an integral part of the effort to provide quality services to senior citizens in this area. Shukitis lives in Spencerport.

Highland Hospital welcomes new physician Physician Elizabeth Loomis recently joined Highland Family Medicine, part of Highland Hospital. She will be on call at Highland for both Highland Family Maternity and general inpatient medicine. Loomis’ special interests include obstetrics, HIV and addiction medicine. She recently completed a fellowship in faculty development at Lancaster General Loomis Family and Community Medicine in Lancaster, Pa. She completed her residency at Lancaster General FCM, serving as chief resident from 2011-12. Loomis earned her bachelor’s degree at the University of Rochester, majoring in neuroscience with minors in both brain and cognitive science and theater. Before entering medical school at the University of Rochester School of Medicine and Dentistry, Loomis served with the Peace Corps for two years as an education volunteer in Chimoio, Mozambique. Originally from Rushville, Loomis lives in Rochester.

New physicians join Rochester General Hospital Rochester General Hospital recently welcomed four new physicians • Galina Radunsky, who has a Doctor of Osteopathic Medicine degree (DO), specializes in pediatrics. She attended Midwestern University; Chicago College of Osteopathic Medi-

cine, Downers Grove, Ill., and completed her residency at the University of Rochester Medical Center: Golisano Children’s Hospital. She lives in Rochester • Jennifer Tibbens-Scalzo, a medical doctor (MD), specializes in family mediRadunsky cine. She will practice at Rochester General Hospital and NewarkWayne Community. Tibbens-Scalzo, attended SUNY Upstate Medical School in Syracuse and completed her residency at St. Joseph’s Hospital, also in Syracuse. She lives in Webster. Michaelides • Joy Michaelides, a medical doctor (MD), specializes in urological surgery. Michaelides attended the University of Rochester Medical School and completed her residency at the University of Rochester School of Medicine. She lives in Rochester. • Brian Day, Day who has a Doctor of Osteopathic Medicine degree (DO), specializes geriatrics. Day attended Philadelphia College of Osteopathic Medicine in Philadelphia and completed his fellowship at the University of Rochester School of Medicine and Dentistry, Monroe Community Hospital in Rochester. He lives in Rochester.

Unity Health System has new physicians Two physicians recently joined Unity Health System. • Paul A. Patrick, a Rochester resident, will practice at Unity’s emergency center. He earned his Doctor of Medicine degree from the University of Rochester School of Medicine and Dentistry. He completed his residency in emergency medicine at Strong Memorial Hospital. Patrick Patrick is a member of the American College of Emergency Physicians. • Yana Levin, who lives in Pittsford, will practice at Unity’s intensive care unit. She earned her Doctor of Medicine degree from Mt. Sinai Medical School of New York University and Levin completed her resi-

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

dency in internal medicine and a fellowship in pulmonary and critical care medicine at the University of Rochester Medical Center. Levin is board certified in internal, pulmonary and critical care medicine. She is a member of the American College of Chest Physician and the American Thoracic Society.

Thompson Hospital adds to pulmonary services Thompson Health and the University of Rochester Medical Center are collaborating to provide pulmonary and critical care services to patients, families and care teams at Thompson Hospital. On Aug. 5, URMC pulmonologists began treating Thompson inpatients who have issues related to the lungs and respiratory system. Previously, many of the patients with these issues had to travel to other hospitals in order to receive pulmonary services during their hospitalizations. In addition, pulmonary and critical care consultations from URMC are more readily available to Thompson professionals now. The new services are a result of Thompson’s 2012 affiliation with URMC. Physician Carlos R. Ortiz, who serves as Thompson’s senior vice president of medical services, said with pulmonologists on-site on a regular basis, more bronchoscopies are expected to be performed at Thompson now. A bronchoscopy is an outpatient diagnostic procedure involving a thin fiber optic tube. “This enhancement of services is a natural step in the affiliation and the evolution of improving local, in-hospital services, and it will benefit the community by allowing us to locally manage some of the more complicated medical cases,” DOrtiz says.

Gift to beneﬁt fracture care, orthopedic research Hansjörg Wyss, a Swiss entrepreneur and philanthropist, has given $2 million to the University of Rochester to support clinical and research work related to geriatric fracture care being led by physician Stephen I. Kates in the department of orthopedics and the Center for Musculoskeletal Research (CMSR). Wyss’ gift establishes the Hansjörg Wyss Professorship in orthopaedic surgery, which will support Kates’ activities related to developing and disseminating a program for the treatment of fractures in geriatric patients. These activities are expected to include research work at the geriatric fracture center at Highland Hospital, and national and international lecturing. This gift will aid Kates’ efforts to expand and disseminate the Geriatric Fracture Center’s model of health care and improve the treatment of fractures in geriatric patients. It also will enhance the work of Kates and the CMSR focusing on geriatric fracture investigation.

Vitamins

H ealth News

Synthetic vs. Natural

Deaf Scientists to Train in Rochester

Experts explain the difference and suggest what’s better By Deborah Jeanne Sergeant

Peter Hauser chats with graduate students Gloria Wink of Rochester (left) and Gina DeNaples of Greensboro, N.C. (right). Photo by Mark Benjamin, RIT/NTID.

$2.1M award will help train deaf and hard-ofhearing people pursuing graduate degrees in biomedical or behavioral science The nation’s first educational program specifically tailored to deaf and hard-of-hearing people pursuing graduate degrees in biomedical or behavioral science began Sept. 1 in Rochester. The National Institute for General Medical Sciences, part of the National Institutes of Health, awarded the $2.1 million grant to the University of Rochester Medical Center’s Clinical & Translational Science Institute (CTSI) and Rochester Institute of Technology’s National Technical Institute for the Deaf, Center on Access Technology. The objective is to build a model program that integrates activities at each university to improve the experience of deaf and hard-of-hearing students seeking advanced degrees. Called the “Rochester Bridges to the Doctorate,” the program will facilitate a transition from master’s degree programs offered at the various colleges at RIT to Ph.D. programs at UR. “Deaf and hard-of-hearing students are woefully underrepresented among Ph.D. candidates in the sciences, and this landmark training program aims to bridge the gaps — in communication, mentoring, and across languages and cultures – to address the critical shortage,” said physician Thomas A. Pearson, principal investigator for UR, senior associate dean for clinical research, director of UR’s National Center for Deaf Health Research (NCDHR), and CTSI director.

“Until now, deaf people interested in science faced a glass ceiling at the master’s degree level,” Pearson said. “We’ve already received scores of inquiries from interested students, and we believe we’re addressing a huge, unmet need.” “This is an amazing opportunity for aspiring deaf scholars who have long been under-served and underrecognized,” said Peter C. Hauser, principal investigator for RIT, director of the Deaf Studies Laboratory at NTID and Science Mentorship Leader for the NSF Science of Learning Center on Visual Language and Visual Learning (VL2). “We applaud NIH for recognizing the deaf population as a minority group and awarding this grant to broaden the participation of deaf and hard-ofhearing individuals in biomedical and behavioral sciences.” The five-year grant will offer many new opportunities. Mentoring faculty will hold special seminars and skill-building workshops on topics like grant-writing and responsible conduct of research and will provide tutoring, counseling, graduate assistantships and a summerin-residence program. The program will also help prepare research faculty and their labs to work with deaf and hard-of-hearing students. Researchers will track graduate degree completion and other careerdevelopment outcomes among deaf and hard-of-hearing students in the program, compared to students not enrolled in the program. Two graduate students will enroll in the first year, with three students per year in each of the following four years. The goal in the initial five years is to provide a total of 14 students with the knowledge and skills required for a successful career in the biomedical and behavioral sciences.

he Centers for Disease Control reports that about half of Americans take vitamin supplements. Ensuring that the vitamin supplement itself does what it claims can be tricky. Supplements are not regulated by the Food and Drug Administration (FDA) in the same way that medication is. The FDA ensures supplements are safe, but efficacy is a different matter. One of the biggest differences among types of supplements is synthetically-derived or naturally-derived supplements. Some experts are clearly naturalsupplement supporters, like Robert Clement, who served on the American Academy of Nutrition board from 1992 to 1999 and now sells Shaklee supplements from his home in Rochester. “Human cells are not designed to take in synthetic substances,” Clement said. “Many supplements are synthetic. Most vitamins are processed with high heat and chemicals, which destroy the nutrients. ‘Natural’ ones can be labeled that being only 15 percent natural and the rest synthetic. It’s legal by government standards.” It’s important to not only check the label to make sure supplements contain 100 percent of one’s daily needs, but also that it’s 100 percent natural, according to Clement. “Know about the integrity of the company to know if it is a good supplement,” Clement said. “Most don’t do enough testing for purity and potency.” Marge Pickering-Picone, owner of Professional Nutrition Services in Webster, is a certified nutrition consultant and has been in the business 30 years. “There are some things that you can use that are synthetic that may help you,” she said. “They get the blood work to change, like vitamin C or E and they do work in some cases. But it doesn’t repair in the same way natural ones do.” She prefers natural supplements “because they promote other fuels in your body to perform more adequately. You get more things that align with your system with you use natural ones.” Marusia Marrapese, wellness consultant at Lori’s Natural Foods Center in Rochester, has 30 years of industry experience. She encourages people looking for good-quality supplements to research whether or not the manufacturer uses genetically-modified organisms, known as GMOs, in its source material. She’s also wary of supplements processed with petroleum-based chemicals. “People don’t look at where the source is grown,” she said. “These diff are important because we don’t have any transparency in food laws.”

October 2013 •

“When you take low quality supplements, it might be more taxing on your body to process inert ingredients than deliver the nutrients to you,” Marrapese said. She believes the best types of supplement are those made from whole foods, such as MegaFood, New Chapter and Garden of Life, which dry whole, raw, organic foods to use in their supplements. Like Marrapese, Beth Smythe, registered dietitian and representative of the New York State Dietetic Association, thinks that the best way to get vitamins and minerals is from nutrientrich foods. “Talk to your healthcare provider-registered dietitian, doctor or pharmacist--before taking any dietary supplement,” Smythe said. “Natural supplements don’t always mean ‘safe.’ Safety depends on the chemical makeup, how it works in the body, how it’s prepared, and the dose used. This safety issue is the same for natural or synthetic.” Even though taking supplements sounds like a natural way to improve health, they can interfere with prescription medication and that’s why it’s important to discuss any possible contraindications.

Checking Supplements and Vitamins Check out these sites recommended by Beth Smythe, registered dietitian and representative of the New York State Dietetic Association:

• U.S. Pharmacopeia www.usp.org • Consumer Lab www.consumerlab.com • NSF International www.nsf.org “These independent organizations offer quality testing and allow products that pass these tests to display their seals of approval,” Smythe said. “However these seals do not prove that a product is safe or effective.”

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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National Neurologist Shortage Not Affecting Finger Lakers Providers By Deborah Jeanne Sergeant

n April study published in Neurology, the official journal of the American Academy of Neurology, stated that the US will be grossly under supplied with neurologists by 2025. “The estimated active supply of 16,366 neurologists in 2012 is projected to increase to 18,060 by 2025,” read the study. “Long wait times for patients to see a neurologist, difficulty hiring new neurologists, and large numbers of neurologists who do not accept new Medicaid patients are consistent with a current national shortfall of neurologists.” The study estimates the 11 percent shortfall in 2012 will increase to a 19 percent shortfall by 2025. Researchers concluded, “In the ab-

sence of efforts to increase the number of neurology professionals and retain the existing workforce, current national and geographic shortfalls of neurologists are likely to worsen, exacerbating long wait times and reducing access to care for Medicaid beneficiaries. Current geographic differences in adequacy of supply likely will persist into the future.” Part of the reason for a shortage of neurologists is the rapidly growing number of baby boomers who will need neurological care as they age for health issues such as stroke, Parkinson’s and Alzheimer’s, along with the decrease in medical students specializing in neurology. Locally, we may have less to worry about. A shortage of neurologists isn’t a

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concern of physician Jason S. Feinberg, internal medicine, hospital medicine, and vice president medical affairs and chief medical officer for Finger Lakes Health. He said that the six neurologists in this area work independently with privileges at the FF Thompson, Clifton Springs Hospital, Newark-Wayne, and Geneva General. “We’ve been successful in recruiting people into our practices,” Feinberg said. He thinks the amenities of the region helped attract physicians Phil Vitticore, Justin Rymanowski, Robert Knapp, William Kingston, Ziad Rifai and Eugene Tolomeo. “It’s a great area to live in and work,” Feinberg said. “They’re close to care centers in Rochester that have more specialized neurologic services. If you’re recruiting and a young doctor, you need to have the volume of patients to serve.” The doctors also cover for each other so they’re not on call every night. “That is a very successful recruitment strategy, instead of working separately,” Feinberg said. “Their lifestyle is much better.” Finger Lakes Health and sur-

rounding health organizations also proactively recruit replacements for the area’s neurologists before anyone retires. “There’s a nice hand-off and introduction period so patients can get transitioned better,” Feinberg said. Another reason the neurologists in Feinberg our area offer such good coverage and service is their willingness to travel to local facilities to meet patients’ needs. “Going to where the patients are is nicer rather than having the patients go to them,” Feinberg said. “You see a lot of groups that have one camp, but if you’re on the western side of the county, you may decide you will travel the same distance into Rochester or if you’re on the eastern side, you’d have to go to Syracuse. I don’t think they’d be successful if they were all in one place. I’ve got to hand it to them: that’s what’s made them successful.”

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Happy 26th Birthday! Now, Get Your Own Insurance Young adults may be eligible for financial help when purchasing coverage

f your bicycle crashes and you break a leg, you could face more than $7,000 in medical bills if you’re an uninsured young adult in Upstate New York, according to a new infographic by Excellus BlueCross BlueShield. Or, suffer a concussion during a soccer game, and you could face about $3,000 in medical costs. “More than 280,000 New York state adults will turn 26 in 2014, and many of them will no longer be eligible for coverage through their parent’s health plan,” said physician Jamie Kerr, vice president, chief medical officer for utilization management, Excellus BCBS. “Young adults will likely weigh the pros and cons of obtaining health coverage and decide whether to go without coverage or purchase insurance to protect themselves from unexpected medical bills,” she said. Starting in 2014, almost everyone will be required to have health coverage. Individuals could obtain coverage through an employer, government program or college plan, for example, or through the New York health benefit exchange, ‘NY State of Health.’ Adults who forgo coverage will face paying a penalty. Young adults may be eligible for financial help when purchasing coverage. In 2014, a young New Yorker with an average income of about $32,000 would qualify in Upstate New York for about $400 to $2,500 annually in tax credits. “We know that thousands of young adults in Upstate New York annually face unexpected health problems, whether they sprain their ankle, hurt their back or develop a severe case of bronchitis,” Kerr said. “But young adults may go without health insurance because they don’t believe they’ll get hurt or sick and need coverage.” The Excellus BCBS infographic covers the types of medical costs that uninsured young adults in upstate New York may face. The infographic also details possible benefits of obtaining coverage, including no cost for preventive services such as regular checkups, a $600 gym reimbursement and prescription drug coverage. Go to excellusbcbs.com/factsheets to view a printable PDF of the infographic, or go to brand.excellusbcbs.com/infographics/turning26.php to view a mobile-friendly version.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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YOU ARE OUR FUTURE Why are healthcare professionals attracted to Visiting Nurse Service of Rochester & Monroe County, Inc.? Competitive compensation and beneﬁts programs, cutting-edge technology, on-going training and development, and a wealth of competent professionals working together as a team to provide the best care possible — these are just a few of the things that set us a part. Learn more about why we’re a vibrant and exciting place to work.

IT Help Desk/Support

The employee will be a member of the agency’s IT Help Desk team and be primarily responsible for providing information systems and end-user support. Key responsibilities installation, maintenance, repair, and support of MS Ofﬁce products and other desktop applications, telecommunications (cell, smart and desktop phones), hardware and peripherals for in-house and remote users. The employee will also participate in training new users during orientation and after hours, on-call support as well as regularly scheduled after hours maintenance windows.

Minimum qualiﬁcations include:

Rehab Team Manager $10,000.00 Sign On Bonus

Providing direct supervision to assigned visiting staff in collaboration with the Clinical Manager. Responsible for the coordination of patient services to ensure the delivery of high quality, cost effective care according to policies and procedures of the agency, while maintaining patient/family centered care.

Qualiﬁcations

• NYS licensed Physical Therapist, Occupational Therapist or Speech Language Therapist required. • Associates or 3 year Diploma program required, Baccalaureate degree preferred. • Required 1-2 years home care experience. • Expertise in case management of high risk populations, and expertise in case • Management with the ability to incorporate new ideas and concepts into clinical practice. • Excellent working knowledge of regulatory standards and reimbursement issues in-home care.

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• B.S. in Computer Science, Information Systems, or related degree. Network + Certification and Windows Certification will be accepted in place of a degree. • Extensive knowledge of MS Access. • Extensive knowledge of PC hardware configuration, memory management, modems, Windows XP/7/2003/2008, MS Office and other windows based software. • Exp. In database design and VMware helpful. • Three years’ experience in providing printer, personal computer hardware and software support, including troubleshooting and repair.

Care Transition Coach

Acts as facilitator of interdisciplinary collaboration and care continuity across care settings, coaching patients and their caregivers to play an active an informed role in the patients care plan execution.

Qualiﬁcations

• NYS Licensed RN, LMSW or Other allied health professional. • Minimum of 1- 2 years in the home care, health care or community based organization. • Strong education/teaching background. • Strong communications skills. • Experience in managing complex problems and developing creative solutions.

Physical Therapist

$10,000.00 Sign On Bonus “VNS is looking for a full-time experienced physical therapist that enjoys the ﬂexibility and challenges provided by community health. Interested individuals must be able to utilize current best practices to provide physical therapy in the home. We seek individuals who enjoy the ﬂexibility and challenges of community health are able to treat a wide variety of diagnoses including patients with joint replacements.” If you’re licensed to work in New York State and have a minimum of oneyear exp. in a hospital inpatient setting and are interested in the opportunity and challenge of providing rehabilitation therapy to patients in their own home environments, we’d like to talk to you.

Additional Clinical Opportunities in the Following Areas: • RN West Team Med Surg/Acute Care • RN Hospice NOC • RN Cardiac Team • RN Livingston County • RN Palliative Care

Qualiﬁcations:

NYS Licensed RN with minimum of one-year experience as a clinical nurse in a hospital or home care environment. OR BSN and a minimum of 6 months experience in hospital or homecare.

Apply today at www.vnsnet.com and join a team dedicated to patient and family centered care at home.

Qualiﬁed candidates please send resume to:

S. Pugsley, Human Resources 2180 Empire Blvd., Webster, NY 14580 Fax: 585-787-8369 / spugsley@vnsnet.com VNS values diversity and encourages minorities to apply. E.O.E.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2013

“We would like to thank our dedicated Employees for their commitment to quality and for choosing to work at VNS.”