Rochester InGoodHealth by In Good Health: Rochester's Healthcare Newspaper

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Rochester–Genesee Valley Healthcare Newspaper

April 2011 • Issue 68

Farewell to Lucy “The decision to euthanize Lucy, my best friend of 15 years, was quite possibly the hardest decision I’ve had to make in my life”

Fighting Infant Mortality

FREE

Rochester General Now Has Busiest ER in Upstate

The ER at Rochester General Hospital has more than 100,000 visits in 2010 making it the busiest ER in Upstate New York. Story on page 9

Infant mortality among African Americans in Rochester — 17 per 1,000 live births — is more than three times higher than the state average for all races. Perinatal Network of Monroe County wants to change that

Meet Your Doctor:

Unity’s Paul Maurer L I V I N G A LO N E

Living Alone: The Power of Anticipation

All You Need for Healthy Cooking Top chefs suggest best utensils to have at home

Couple recalls arduous adoption process Partners credit their success to Children Awaiting Parents, a local nonprofit organization

Women’s Health April 2011 •

• Several Factors Behind Caesarian Section Spike • Post-Partum Depression • Everything Doulas Want You to Know • What’s More Deadly to Women: Cancer? Heart Disease? Diabetes? Alzheimer’s?

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 1

Finger Lakes Radiology joins the ﬁght against breast cancer Your local Open-bore MRI provider now offers MRI imaging of the breast. Along with a state-of-theart and patient friendly MRI scanner, Finger Lakes Radiology has acquired an advanced image analysis software solution, SpectraLook®, to assist their radiologists in detecting breast cancer. Talk to your doctor to see if a breast MRI is right for you.

196 North Street Geneva, NY 14456 (315) 787-5399 www.ﬁngerlakesradiology.com

Dedicated to Providing Quality Woman’s Healthcare Obstetrical Care Includes High Risk Complete Gynecologic Care Pediatric / Adolescent Gynecology Urogynecology and Pelvic Reconstructive Surgery Urinary Incontience Evaluation and Treatment Advanced Laparoscopic and Hysteroscopic Surgery Robotic Gynecologic Surgery Family Planning Infertility Evaluation and Treatment Menopause Management OB /GYN Ultrasound 3D and 4D Bone Density testing – DXA Scan Fitness and Nutrition Aesthetic Treatments & Hair Removal Page 2

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011

Jeroo K. Bharucha, MD Wendy M. Dwyer, MD Marc H. Eigg, MD Donald J. Gabel, MD Marc S. Greenstein, DO Michelle M. Herron, MD Judith E. Kerpelman, MD, CCD Edward B. Ogden, MD Colleen A. Raymond, MD Derek J. tenHoopen, MD Sandra Moore, WHNP Beverly Shaheen, WHNP Mary Frachioni, WHNP

Prescription drug costs to treat MS rise 126 percent Excellus study shows cost of brand-name prescription meds in Upstate jumps 93 percent in six years. Some, like drugs to treat multiple sclerosis, jumped 126 percent

he average cost of brand-name prescription drugs in Upstate New York rose 93 percent (a total of $93.46) between 2004 and 2010 and 11 percent ($19.19) from 2009 to 2010, according to a report issued in March by Excellus BlueCross BlueShield. By contrast, generic prescription drug costs on average increased by less than $1 in the 2004 to 2010 time period. “Although brand-name drug costs have added millions to Upstate New Yorkers’ health care costs, the good news is that brand-name drugs now represent a smaller share of all prescriptions written in Upstate New York,” says Dr. Frank Dubeck, chief medical officer for Medical Policy, Excellus BlueCross BlueShield. Brand-name drugs as a percent of all prescriptions written by physicians in Upstate New York fell from 48.1 percent in 2005 to 28.4 percent in 2010. During that same time period, the share of generic medicines among total prescriptions written rose from 51.9 percent to 71.6 percent. The Excellus BlueCross BlueShield report zeroes in on cost increases for commonly used brand-name drugs that significantly affect prescription drug spending in Upstate New York. It notes that from 2005 to 2010, a 30-day supply of Actos, Advair, Lipitor and Singulair each recorded more than a 30 percent five-year increase in average wholesale price, and the average wholesale price of Nexium increased 27.5 percent over five years. Brand-name prescription drugs that have posted among the greatest increases in average wholesale price for a 30-day supply over the past five years include Acthar Gel (more than a 2,000 percent increase), Copaxone (131 percent increase), Entocort EC (119 percent increase), Xeloda (88 percent increase), Tracleer (77 percent increase) and Gleevec (71.5 percent increase). “Specialty drugs constitute an entire prescription drug category that has seen a marked increase in the number of different drugs prescribed, along with hefty cost hikes,” continues Dubeck. Specialty drugs generally are categorized as high-cost, self-administered drugs that are injected, taken orally or inhaled to treat conditions such as multiple sclerosis, hepatitis and cancer. From 2003 to 2010, the number of unique prescription specialty drugs that cost $500 or more per month increased 109 percent, while the number of individual specialty drugs that cost $2,000 or more per month increased 242 percent. Within the specialty drug category, the Excellus BlueCross BlueShield report identifies escalating costs among prescriptions used to treat multiple sclerosis. The five-year period from 2005 to 2010 saw a $20,600 (or 126.4 percent) increase in per-person, mean

annual prescription drug costs, which totaled about $37,000 in 2010. A closer look at the specialty prescription drugs used to treat multiple sclerosis appears in a simultaneously issued report, The Facts About The Rising Cost of Prescription Drugs to Treat Multiple Sclerosis in Upstate New York. Assuming that 7,000 of the 13,000 people who have multiple sclerosis in Upstate New York take prescription medications to treat their illness, the drug cost increases for multiple sclerosis treatments alone have added an additional $144 million to annual health care spending across Upstate New York since 2005. Added together, the drugs taken to treat multiple sclerosis cost Upstate New Yorkers $258 million in 2010. The average wholesale price for one patient to have a year’s worth of Avonex is $40,650 (an increase of 79 percent from 2006); 52 weeks of Copaxone costs $47,200 (up 112 percent from 2006). “Although none of the specialty multiple sclerosis drugs provides a cure, people who have multiple sclerosis depend on these drugs to manage their disease and treat their symptoms,” points out Dubeck. “Patients must continue taking the drugs for years to get the intended benefit. Those who have multiple sclerosis have no choice but to pay more for the same medications they’ve taken for years.” While six drugs have dominated the prescription drug category for multiple sclerosis, two new prescription drugs, Ampyra and Gilenya, were approved for use by the Food and Drug Administration in 2010. The average wholesale price of Ampyra is about $16,000 per year, which could be added to the prescription drug regimen that multiple sclerosis patients already take. The average wholesale price of Gilenya is expected to be more than $57,000. If Gilenya is substituted for the commonly used Avonex or Copaxone, Gilenya’s higher cost would add $10,000 to $15,000 a year to treatment costs. Two to three other oral drugs await FDA approval in 2011. “Clearly, the affordability of multiple sclerosis drugs is being challenged by inordinate price increases set by prescription drug manufacturers over the past five years,” comments Joel Owerbach, vice president and chief pharmacy officer, Excellus BlueCross BlueShield. “As a pharmacist, I’m concerned about the prospect of drug therapy for multiple sclerosis patients becoming unaffordable. It’s a concern I share with other, similarly high-priced prescription drugs,” he notes. � See related article — “Generics continue to make inroads, offer savings” — on page 22. April 2011 •

AAIR Research Center 300 Meridian Centre, Suite 305, Rochester, NY 14618 Phone: (585) 442-1980 Email: research@aair.info

Clifton Springs

Hospital & Clinic

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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CALENDAR of

Adult Smoking Rate Hits Plateau Percentage of New York state high school students who reported smoking goes up

avorable trends that showed declining Upstate New York adult smoking rates are leveling off, while the percentage of high school smokers statewide is on the rise, according to a new report issued by Excellus BlueCross BlueShield. “This is a disturbing set of findings because of its implications for the future,” says Dr. Robert J. Holzhauer, vice president and chief medical officer, Excellus BCBS. “Smoking is associated with at least 30 percent of total cancer deaths, nine of 10 lung cancer deaths and a host of other illnesses and complications that could be prevented by a single action. “I can’t even begin to describe the frustration that physicians feel when more patients report smoking,” Holzhauer continues. “Lives are shortened unnecessarily, and billions of dollars are spent to treat illnesses caused by this deadly habit. Those dollars could be better used to treat less preventable conditions.” According to the Excellus BCBS report, the Upstate New York adult smoking rate is 3 percentage points higher than that of adult smokers statewide and nationally. Following a decline from 25.5 percent in 2003 to 21.6 percent in 2004, smoking rates in Upstate New York hit a relative plateau between 2005 and 2009. From 2008 to 2009, Upstate New York adult smoking prevalence rose from 19.4 percent to 21.3 percent. Variations in adult smoking rates among Upstate regions are modest, ranging from about 20 percent in the Finger Lakes and Western New York regions to 24.3 percent in the Southern Tier. About 22 percent of those in Central New York and the Utica/Rome and North Country region are current smokers. In setting its goal for 2020, Healthy People, an initiative sponsored by the Centers for Disease Control and Prevention that tracks progress toward national health improvement objectives, retained the goal (unmet for 2010) of reducing adult smoking rates to 12 percent. “Clearly, we still have a lot of work to do to reach the Healthy People 2020 goal,” says Holzhauer. Experts say that focusing smoking prevention on youth is critical because nearly all first-time tobacco use occurs before high school graduation. Youth who start smoking are likely to continue the habit into adulthood. Smoking rates among New York state adults peak in the 18- to 24-year-old age group at 28.7 percent. See video — Go to www.youtube.com/excellusbcbs to view a video on how Upstate New York smokers are quitting the habit. Page 4

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HEALTH EVENTS

April 2

Anger management for kids offered in Rochester The Mental Health Association in Rochester and the Better Days Ahead Family Support Network will present “TemperTamer,” an eight week anger management program for elementary school children and their caregivers or parents. This program teaches children how to respond when they are angry so they do not get into trouble by hurting people or destroying things. This program is limited to children in first through fourth grades. The children will be grouped by grade level. It will take place from 10–11:30 a.m. at Mental Health Association, 320 N. Goodman St., ste. 202 on April 2, 9, 16 and 30, May 7, 14, 21 and June 4. For more information and to register please call 325-3145 ext 137.

April 5

HLAA discusses hearing devices, tinnitus research The Hearing Loss Association/ Rochester (HLAA) chapter will meet at 11 a.m. and 7 p.m. Tuesday, April 5, at St. Paul’s Episcopal Church, East Avenue at Westminster Road across from George Eastman House. The 11 a.m. program, “Assistive Devices to Warn and Help You” presented by Kristen Nolan, a senior clinical audiologist at Rochester Hearing and Speech Center, will discuss how people with hearing loss can take advantage of new technology — gadgets, gizmos, devices — to augment hearing aids and cochlear implants to partially overcome disability and cope better in a noisy world. At 7 p.m. program the discussion will focus on causes and possible treatment for ringing, buzzing, roaringand phantom noise in your head even without a noise stimulus. It will be presented by Edward Lobarinas, a clinical audiologist and assistant research professor at the Center for Hearing and Deafness at SUNY Buffalo whose research focuses on tinnitus and its treatment. His talk will highlight recent findings about drug therapies for tinnitus and the relation of tinnitus to brain changes and hearing loss. All programs are audiolooped. Those needing a sign language interpreter should contact Linda Siple at 475 6712. For more information visit www. hlaa-rochester-ny.org or telephone 2667890.

April 7

Prostate cancer group to meet in Canandaigua The Man-to-Man Prostate Cancer Support Group will meet from 6 to 8 p.m., Thursday, April 7, in the Community Room, Ferris Hills at West Lake, Canandaigua. The group, in partnership with the American Cancer Society, provides patient education and support. Brad Stanton, a prostate

cancer survivor, facilitates the group. All cancer patients, their families and those interested in learning more about prostate cancer are welcome. There is no charge for this program. Call 3946303 for more information.

April 8–10

Upstate LGBTQ Conference held in Rochester The 2011 Pride and Joy Families Weekend Conference will be held April 8–10 in Rochester. The conference will bring together lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals, families and allies for three days of learning and socializing at the RIT Inn and Conference Center. Highlights will include more than 15 adult educational workshops, an ImageOut Film Festival screening room and a teen panel in which kids with LGBTQ parents speak out, among other activities. As with the three previous Pride and Joy Conferences, held in Ithaca in 2001, Binghamton in 2005, and Utica in 2009, families are expected to gather from all over Upstate New York and beyond. Examples of adult workshop topics include legal and policy protections, estate planning, gender in our families, LGBT at school, gay and lesbian grandparents, rural living, gay dads, adoption and foster care, parenting teens, social dancing, and building an LGBTQ-inclusive family library. To register for the 2011 Pride and Joy Families Weekend Conference and the pre-Conference training day, visit PrideAndJoyConference.org, or call (607) 724-4308.

May 15

Golf event to raise funds for Clifton Springs Hospital The event will take place at 1 p.m. Sunday, May 15, at Clifton Springs Country Club. View and order the newest summer golf fashions from Nike and Kate Lord at 20 percent off suggested retail and enjoy an elegant lunch while supporting the work of the Clifton Springs Hospital Auxiliary. Tickets are $25 per person and are available April 1 at the hospital’s main lobby information desk (2 Coulter Road, Clifton Springs) or at Clifton Springs Country Club. A portion of all apparel and ticket sales benefits the Clifton Springs Hospital Auxiliary.

April 19

Celiac support group to meet in Rochester The Rochester Celiac Support Group will meet at 7 p.m. Tuesday, April 19, in the Social Hall at St. Anne Church, 1600 Mount Hope Ave. in Rochester. All are welcome. Newcomer orientation starts at 6:30 p.m. Youth group ages 10 to 17 meets same time as the meeting. Celiac disease is an autoimmune disorder in which the immune system reacts to gluten, a protein found

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011

in wheat, rye, and barley. The autoimmune response causes damage to the lining of the small intestine resulting in the body’s inability to absorb needed nutrients. Untreated, celiac disease results in a variety of debilitating symptoms including osteoporosis and an increased chance of intestinal lymphoma. For more information visit www. rochesterceliacs.org or call 861-4065.

April 30

Rochester celebrates World T’ai Chi & QiGong Day Each year people across the world celebrate World T’ai Chi & QiGong Day to promote a healthier, peaceful world. It offers personal, social and world health throughout many cultures. Beginning at 10 a.m. in each time zone, participants celebrate by simultaneously performing different forms of T’ai Chi to promote peace, harmony, and well-being to people everywhere. The Rochester T’ai Chi Ch’uan Center will host its 11th annual local celebration of the worldwide health event. Local participation in World T’ai Chi & QiGong Day takes place at 10 a.m., April 30, at Brighton’s High School, 1150 Winton Rd. South. The Ching-fen Lee dancers will perform traditional Chinese dance and Brighton Town Supervisor Sandra Frankel will be a guest speaker. For more information contact Brian Bruning, instructor for the Rochester T’ai Chi Ch’uan Center, at 461-0130 or visit www.rtccc.com

April 30

Event to raise awareness for pancreatic cancer To raise awareness of pancreatic cancer, the Luau for Lustgarten Foundation based in Bethpage, Long Island, is organizing a fundraising campaign in Rochester to help fund research to find a cure for the disease. With food, music, auctions, raffles and other activities, the 2nd Annual Luau for Lustgarten Fundraiser will take place April 30 at the RIT Inn & Conference Center. Last year nearly 300 attendees helped raise nearly $12,000 for the foundation. According to the organization, pancreatic cancer is considered the most deadly of cancers: it’s the fourth leading cause of cancer deaths in the United States with only a 5 percent survival rate. “Too many families are finding out too late just how terrible this disease is as it silently attacks its victims,” said Mary Ellen Smith speaking for the foundation. For more information, call 225-3088 or send an e-mail to luauforlustgarten@yahoo.com.

May 1

Program to discuss vegan, vegetarian food The Rochester Area Vegetarian Society (RAVS) is inviting the public to attend a program to learn more about vegan and vegetarian food. Titled “Q&A: Your Nutrition Questions Answered,” the program will be presented by Bob LeRoy, nutrition advisor to the North American Vegetarian Society. It will take place at 5:30 p.m. Sunday, May 1 at Buckland Lodge, 1341 Westfall Road in Brighton. A vegan potluck dinner will be served at 7. Participants are asked to bring a dish (with enough to serve a crowd), a serving utensil; and a place setting for your own dinner. The cost is $3. For more information, call 234-8750.

Local Expert: Number of Diabetics Could Reach 50 Percent in the U.S. By Mike Costanza

he Centers for Disease Control and Prevention has just released new data regarding diabetes in the U.S., and the news isn’t good. “We’re seeing the numbers for type 2 diabetes increase at a very alarming rate,” says Arlene Wilson, associate director for community initiatives for the American Diabetes Association of Upstate New York. If that trend continues, Wilson says, as many as 50 percent of Americans could have type 2 diabetes within 30 years. Because people who suffer from diabetes are at increased risk of developing conditions that include glaucoma, heart disease and stroke, the trend could have a staggering effect on millions, and on society as a whole. “We’re really at the cusp of being the first generation whose children Wilson won’t outlive them,” Wilson says. Though modern medicine describes two forms of diabetes—types 1 and 2—the two are very different, Wilson says. In type 1 diabetes, the body does not produce insulin, the hormone it needs to convert sugars, starches, and other foods into the energy it needs to function. “The body has certain cells that produce insulin, and the body actually starts to attack those insulin-producing cells,” Wilson explained. In most cases, those who suffer from type 1 diabetes have inherited risk factors for the disease from both parents. Only about 5 percent of those who suffer from diabetes have this form of the disease, according to the American Diabetes Association. Insulin therapy and other treatments can help them remain in good health. Type 2 diabetes, the most common form of the disease, is when the body either doesn’t make enough insulin to be able to process foods normally, or the cells of the body do not make proper use of insulin. While this form of the disease has a genetic basis as well, those who are overweight or obese are at greater risk for developing it.

“The percentage of body fat has risen to the point that it impacts the ability to produce insulin and utilize insulin,” Wilson says. Unfortunately, obesity is growing in the U.S., driven upward by a combination of poor diet and sedentary lifestyles. Wilson suggests several steps to reduce the risk of developing type 2 diabetes. To begin with, check for a family history of the disease. Those who find evidence of it should begin getting tested for the disease at the age of 45, or earlier, she says. Then, begin switching to a healthier diet, and working to reduce or control weight. For example, instead of buying processed foods rife with fat and salt to consume at the end of a long day, bring home prepackaged salads or other healthy foods to use as the basis for meals. “Get a salad, get some meat or fish to throw on top of the salad, and that could be dinner,” she says. Can’t obtain fresh vegetables easily? Wilson suggests that you try frozen, and stay away from white flour, pasta, and rice, in favor of whole or multi-grain foods. For some, the dietary change might require adopting a different view of food itself. “We need to develop a relationship where we see food as fuel for our bodies, and not as a reward, not as a prize, and not as an indicator of success, wealth or fortune,” Wilson says. At the same time, use simple measures to incorporate exercise into your day. For example, instead of sitting down and reaching for the remote after dinner, wash and fold a load of laundry, or take a walk. “It’s an activity that helps to offset the calories that the person just ate,” Wilson says. For additional information, turn to the CDC’s 2011 National Diabetes Fact Sheet at www.cdc.gov/Features/ DiabetesFactSheet, or to the American Diabetes Association at www.diabetes. org/diabetes-basics.

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In Good Health is published 12 times a year by Local News, Inc. © 2011 by Local News, Inc. All rights reserved. 106 Cobblestone Court Dr., Suite 121 – P.O. Box 525, Victor NY 14564. • Phone:(585) 421-8109 • E-mail: Editor@GVhealthnews.com Editor & Publisher: Wagner Dotto Associate Editor: Lou Sorendo Writer: Mike Costanza Contributing Writers: Dr. Eva Briggs, Jim Miller, Deborah J. Sergeant, Gwenn Voelckers, Anne Palumbo, Karen Boughton Siegelman, Dean Lichterman Advertising: Marsha K. Preston, Laura Vannah 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.

April 2011 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Meet

Your Doctor

By Mike Costanza

Dr. Paul Maurer How losing a bus after a shift at St. Ann’s Home led neurosurgeon to a long career in medicine Q. I understand you came to medicine by a kind of roundabout way. A. The only reason I’m in medicine is because the bus, the Rochester transit system, was not working well one day. My summer job at St. Ann’s Home had ended—I had a job washing dishes. I went out to wait for the bus, and wait for the bus, and wait for the bus, and the bus never came. I thought, “I’ve got to get another job. I guess I’ll go to the hospital—it’s right across the street.” I just wandered across the street to Rochester General Hospital, which at the time was Northside [Hospital]. They said, “We don’t have any dishwashing jobs, but we do need somebody to clean the operating room floors.” So, I became a cleaner in the operating room at the hospital. When I wasn’t cleaning the rooms, I could watch. When you’re 16 years old, to watch them open somebody’s head, and put it back together, and clean the room, and see the person wake up, you think, “Wow that is amazing.” As I became interested in anatomy in medical school, I thought, “This is what I want to do.” My father was a high school teacher, and my mom stayed home and raised us. It would’ve never occurred to me to do this any more than to be a furnace guy. If the bus had come, who knows what I’d be doing. Q. You probably could have specialized in any one of a number of fields. Why did you enter neurosurgery? A.I always was quite sure that I wanted to be a surgeon. I enjoyed neuroanatomy in medical school, and became fascinated with the nervous system as a physiologic entity. It’s beautiful anatomically; it’s beautiful physiologically. Really it is the essence of what makes you human. I do the vast breadth of neurosurgery, but my particular interest is several-fold—cervical spinal surgery, lumber spinal surgery, and brain aneurysms. Q. How do you mean, “the essence of what makes you human?” It’s what separates humans from all other living structures and creatures—what really makes you human. Your ability to interact, your ability to communicate verbally, your ability to have amazing depth of emotion in every direction—that’s a unique feature of humans. It’s the development of the brain and the nervous system that gives us that.

harm. That is the emotional hazard of being in this job. Every decision in medicine, no matter your specialty, can cause irreparable harm. Q. That seems as if it could be a bit, well, daunting. Are you drawn to that kind of challenge? A. People select a career, both in life and within their field, because of personality designs. There is a personality profile that selects this field, to some degree. It is a person who seeks out complexity, and maybe even to some degree seeks out a very highgrade, maybe even high-risk, challenge. The helicopter pilots I met in the Army during the war, they’re not laid back, reserved people—that’s not who selects those jobs. You probably see a certain kind of person in journalism—a certain similarity—the same as in neurosurgery. Q. Have those challenges become easier to approach with experience? A. I’ve become very comfortable with the surgery because I’ve done many, many thousands of surgeries. But interestingly, I find the emotional impact of the problems worse, not easier, which is not what I would have expected.

emotion about what these people have and what they experience that I do now. When you have children, you watch them grow up, you diaper them, you watch them learn to ride a bike, and you watch them graduate from high school. Now, when I have somebody that has a horrible problem, either an operative problem or the disease itself, you feel much more of the human impact, because you’ve raised a human. What journalism probably is to you now is different from what you thought it would be—maybe in a good way. Q. Given those influences, what keeps you coming in to the operating room, day after day? A.The victories that we have, which are by far the majority. Ninety percent of what I do is with a disease that is either treatable in a pretty reasonable success rate, or in many cases even curable. We have 10-12 percent that unfortunately involve a disease that is not something that in 2011 we have the answer for. For the tragic, unfortunate and sad events, which are burdensome, there are always 15 or 20 beautiful results. Q. How has neurosurgery changed over the decades since you first took up the scalpel? A. Much of the advance of medicine is the advance of diagnostics. Even in 1960, when we were kids, there was no CAT scan. If you hit your head or you had bad headaches, there was no way to investigate that in any real sense. It was all guesswork, and the complication rates were catastrophic. That changed dramatically with the advent of the CAT scanner in the late 1970’s, which then facilitated the neurosurgeon knowing where to go, what to do, what are we dealing with. What had once been difficult to identify, difficult to study, now, in a very rapid fashion, was ushered into a different era of success. Those successes have continued with the MRI, and so on so forth.

Q. How do you mean? A.When you’re in your twenties—I certainly didn’t have the full depth of

Q. For the layperson, neurosurgery appears to carry challenges that other types of medicine may lack. Is that true? A. It is true that with the nervous system, being as delicate and as unforgiving as it is, small errors both in judgment and technique can lead to cataclysmic, long term, even permanent Page 6

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011

Q. Have surgical techniques changed as well? A. Absolutely, mostly with the use of the microscope and magnification. Every surgery that I do, I wear what are called “surgical loupes.” They are telescopic lenses on glasses that magnify everything about

four times. For the [more demanding] brain operations, we use the microscope, which goes even higher—eight or 10-power magnification. To look at an aneurysm with the naked eye, it’s a tiny little blister on a blood vessel, and it’s hard to see. All of a sudden, this five-millimeter aneurysm now was like a 50-millimeter aneurysm. The tools of the trade evolved with it—to microinstruments. We can now manipulate structures safely that we never could do before, Most of my waking day, every day, is spent looking at life and humanity through a four-power magnification telescope—it’s pretty strange. That always draws jokes about the rest of my life, which is at normal view. Q. You joined the US Army and went on active duty at a time when many physicians were building their practices and paying off their student loans. Then, you volunteered for service in the Persian Gulf War. Why take a job with Uncle Sam? A. I have always loved military history. If I wasn’t in medicine, I’m sure I would have gone into the military. I was at Walter Reed [Army Medical Center] in Washington DC, and the Gulf War began. I’d been in the Army as an active neurosurgeon for four or four-and-a-half years at that point. I’d watched the news the first few years after Kuwait was invaded, and I thought “It’s really wrong that all these young brave men are potentially going to be harmed, and this is what I’ve been trained to do, and it’s what I should do.” Two days later, I was on a plane. Q. You were awarded the Bronze Star? A. It was “for leadership in a combat theater,” I think is the phrase on the award. I don’t know that I deserved it more than anyone. It’s one of the things I’m proudest of. Of all things on my wall that’s on the top, that’s above my medical degree.

Lifelines Practice: Paul Maurer, MD, at Unity Neurosurgery, 2655 Ridgeway Avenue, Suite 460, Rochester. Administrative positions: Chief of neurosurgery, Unity Hospital; chairman of Unity Neurosurgery, and surgical director of the spine center at Unity Hospital. Academic positions: Clinical professor, department of neurosurgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave., Rochester. Education: MD, University of Rochester School of Medicine and Dentistry; BA, biology, University of Rochester. Residencies: general surgery and neurosurgery, University of Rochester School of Medicine and Dentistry. Military service: U.S. Army, 1986-1991. Chief of Neurosurgery, 86th Evacuation Hospital, King Khalid Military Complex, Kingdom of Saudi Arabia. Also stationed at Walter Reed Army Medical Center, Washington, DC, and Letterman Army Medical Center, San Francisco, Cal. Decorations: Bronze Star, presented for leadership in a combat theater. Personal: 57 years old; two grown children and one grandchild; enjoys reading military histories, particularly those about World War II.

Couple recalls arduous adoption process They credit their success to the work of Children Awaiting Parents (CAP), a nonprofit that helps find permanent homes for kids By Mike Costanza

fter 11 years together, Jaime Burgos and his partner were ready to adopt a child. “The only link missing from our family was that one,” Burgos says. Children Awaiting Parents, (CAP) helped the couple find the little boy that completed the Burgos family. Since 1972, the nonprofit has helped thousands of children and parents come together to form loving, permanent families. “We serve children and families all across the country,” says Mark Soule, executive director of CAP. Soule has a personal connection to CAP. His parents, Peggy and David Soule, formed the nonprofit just after they’d adopted him as an infant. “They said, ‘You know, there’s all these other kids out there that nobody showed us,’” he says. CAP focuses its energies on children who have special needs, Soule says, though the term has a different meaning in adoption circles than when it is used in the classroom. While some in foster care suffer from emotional, mental or physical disabilities, others are “special” only because they are the kinds of children for whom it is difficult to find homes. In this context, older children, those in sibling groups that should be placed together, and those who are members of minority groups all have special needs. “Statistically, we find that more families are interested in adopting Caucasian children,” says Kathryn Young, an adoption social worker with Catholic Family Center. CAP helps find permanent homes for the kids it serves, though it does not arrange adoptions. Instead, the nonprofit facilitates adoptions primarily by connecting prospective parents to kids who are ready for homes. Only kids who are legally free for adoption and living in foster care make it onto the nonprofit’s rolls. The agency fills its rolls via a nationwide network of connections to public and private foster care and adoption agencies. Locally, it recruits primarily from children who are under the care of the Monroe County department of human services. Caseworkers regularly call the agency about children who are appropriate for CAP’s services, Soule says. Once contacted by a caseworker, the agency obtains a good quality photo of that child and basic information about him or her, and places both on its website. Those seeking to open their lives to a child can look the listings over, and then contact the nonprofit for more information. CAP then performs a brief initial screening, and passes on contact information for the agency that is caring for the child involved if appropriate, Soule says. That initial connection is only part of the complex, lengthy adoption pro-

cess, Soule says. All prospective adoptive parents in the US must pass a “home study” before bringing a child home. During the study, trained professionals determine whether the parents, the other family members in the home, and the home itself form an environment conducive to the optimal development of the child. As part of the home study, prospective parents also have to complete the Model Approach to Partnerships in Parenting/Group Preparation and Selection (MAPP/GPS) Pre-Certification Training Program. The MAPP program covers the information and skills necessary for successful foster or adoptive parenting. CAP provides MAPP training, and refers prospective parents to other local nonprofits for home studies, Soule says.

Jaime Burgos (left) and his partner Matthew Reynell with their adopted son, James, with the help from Children Awaiting Parents.

Anti-gay prejudice

Burgos, a longtime friend of Soule’s family, knew of CAP’s work. In 2006, he and his partner, Matthew Reynell, contacted the agency for assistance with the adoption process. They completed their home study and all the other elements of the approval process about a year later, and began looking for a child to whom they could open their Greece home. They made countless telephone calls over the next year-and-a-half. “You can search for a child from all 50 states if you have a completed home study,” Reynell says. Most caseworkers did not even bother to call back. Though Reynell says much of that might have occurred because the caseworkers involved were overworked, the same-sex couple also encountered anti-gay prejudice. “Arkansas was the state where the woman was frantically flipping through the law book to read me the law verbatim that homosexuals cannot adopt children,” Reynell says. Closer to home, the couple searched through lists of local children seeking adoption, and attended functions that brought prospective adoptive parents and children seeking homes together. One of the more unusual was a “matching party” in a Buffalo gymnasium that was organized like a carnival. Families that had completed home studies occupied different stands. “Children free for adoption would go from stand-to-stand to spend five minutes with the parents, not knowing they were with parents searching for kids for adoption,” Reynell says. Reynell was at an adoption conference in November 2008 when he spied a picture of an 8-year-old boy named James who was staying at the Crestwood Children’s Center, a residential facility run by the Hillside Family of Agencies. The couple contacted Hillside regarding the young boy, did not receive a reply, and contacted CAP, Reynell

Academy Award winner and producer Hilary Swank and producer Molly Smith co-hosted a fundraiser for CAP in Los Angeles. Mark Soule, CAP’s director, in a photo with actress Swank. Photos courtesy of John Shearer with Wire Image. says. Though James was not listed on the nonprofit’s rolls, CAP’s staff stepped right in to help the couple get through to the appropriate caseworker at Hillside. “This is where CAP is unique,” Reynell says. “They will help you, they will answer questions, they will point you in the right direction.” Within 48 hours, Crestwood called with an offer to allow the couple to read James’ inch-thick file. They met with James’ clinician in December, who allowed them a look into his room. Burgos says that sight of the room, which was largely bare of toys and the other evidence of a loving family, left him in tears. Without knowing that he’d even meet James, Burgos bought blankets, toys, sheets and other presents for the boy. When he and Reynell related the story to their co-workers, they chipped in to buy such items for the other kids in James’ unit.

April 2011 •

“We had stockings for every child,” Reynell says. On New Year’s Eve, they met James for the first time. “He jumps on my lap and puts his arm on my arm, and goes, ‘Are you my forever daddy?’” Burgos says, with a catch in his voice. As they wended their way through the adoption process, the couple spent more and more time with James, until Crestwood allowed them to move him into their home. On Oct. 30, 2009, an Erie County court—James is from Buffalo—gave him two “forever daddies,” and a new name, “James Burgos-Reynell. As joyous as that event was, Reynell and Burgos agree that all has not been smooth sailing since that day. James suffers from fetal alcohol spectrum and post-traumatic stress disorder, which manifest themselves through poor impulse control, deficient long-term memory, and other symptoms. “James is definitely a one-child household who needs a lot of attention,” Reynell says. Still, with careful attention to his needs at home and the assistance of specialists, James has made what Reynell calls a “360-degree turnaround,” since he came to the couple’s home. Asked how he felt about his new home, James gave two thumbs up. “It feels good, because I know that this family loves me more than my old family,” he says. As of January, about 550 children were on CAP’s rolls. The organization, with its staff of eight employees, depends on donations for its budget, just under $500,000. It received a boost in Tinseltown in February, when 2S Films, the production company formed by two-time Academy Award winner and producer Hilary Swank and producer Molly Smith, co-hosted a fundraiser for CAP in Los Angeles. James was one of the guests.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

•

Page 7

Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Living Alone: The Power of Anticipation It’s been a long and especially cold winter, but hope is on the horizon. “Such is the state of life, that none are happy but by the anticipation of change.” Samuel Johnson

little anticipation can go a long way. There’s nothing like the promise of a “light at the end of the tunnel” to help you endure a really rough patch. And, having something to look forward to can help you through even the longest, loneliest night. As spring approaches, I can feel the anticipation in the air. I’m eagerly awaiting the early arrival of crocus and daffodils. And I can’t wait for the butter-yellow forsythia to burst into color. The garlic in my vegetable garden is already poking through the frosty soil and my mouth is watering for luscious homegrown tomatoes. It’s been a long and especially cold winter, but hope is on the horizon. I’m looking forward to the change of season and my anticipation is fueling all kinds of ideas and energy. Anticipation is not the same as just waiting for something to happen. It’s

not just letting time pass. I’ve discovered that intentional anticipation can be incredibly powerful and moving. It can spur us into action, awaken a long-lost passion, and bring about great joy. I’m a believer that anticipation itself can transform a possibility into a reality, and so I build it into my daily routines. In doing so, I have made living alone more of an adventure than a carefully planned existence. I encourage you to join me and incorporate a little expectancy and suspense into your world. Below are a few strategies that have worked for me. Perhaps they’ll work for you, too! • Fill your future with fun. It could be concert tickets, a vacation, dinner with friends or a new class. I have tickets to see k.d. Lang in June. Whenever the winter doldrums set in, I put on her latest CD and imagine the good time I’m going to have with my friend Terry. He loves her voice, too! I enjoy being uplifted by the antici-

KIDS Corner Are Our Kids Oversnacked?

ids aren’t the only ones who smile when the words “snack time” are heard. We are obsessed with snacking. Aisle after aisle in the grocery store is filled with sweet, salty, savory and, yes, even healthy snacks. Do we live in an oversnacked society? Is this fixation adding to the dangerous level of childhood obesity and playing a role in the growing number of poorly nourished kids in our country?“Despite the increase in weight of our children, there are still critical nutrient gaps,” said Gina Bucciferro, registered dietitian and pediatric nutrition expert at Loyola University Medical Center. “Snacks can either make or break the nutritional quality of a kid’s daily intake.” Page 8

•

Research has shown that 88 percent of U.S. children do not meet the recommended daily intake for fruit and 92 percent do not meet the same for vegetables. Though obesity is a major concern for kids with poor nutrition, there are other health risks as well. These include heart disease, depression, high blood pressure, tooth decay, anemia, osteoporosis and diabetes. According to Bucciferro, snacks are a great way to bridge the nutritional gap. Parents need to be aware of what is being served and when it takes place to help keep snack time a good time.

When to snack

1. After physical activity. In addition to needing high-quality energy for

pation of her performance and a fun night out with a dear friend. • Plan ahead and look forward to holidays. Memorial Day is coming up. Consider hosting a small get-together at your place. This “official start of summer” offers a great opportunity to bring people together for some good food and fun, in honor of veterans and soldiers both overseas and here at home. Why not embrace the holiday, make plans, and look forward to sharing this national day of remembrance with friends and family? • Order something from a catalog or online store. I make good use of this simple strategy, perhaps more than I should (smile)! But I like looking forward to a package waiting for me on my front porch. I enjoy anticipating the arrival of a good book in the mail, or a new blouse or home accessory. It makes coming home alone a little more fun and interesting.

growth and development, children involved in sports and other physical activities need to replace the extra energy they are burning. Whole grains, fruits, vegetables and low-fat dairy can provide the carbohydrates needed to replenish little athletes without added sugar and fat. Fluids also are important in making sure active kids stay hydrated. According to the American Dietetic Association, school-age children need to drink six 8-ounce cups of water per day and another 8 ounces for every half-hour of strenuous activity. A sports drink is only necessary for activities lasting longer than 60 minutes. 2. Scheduled between-meal times. Children do have increased nutritional needs, so providing snacks between meals can help them stay focused and healthy. The goal should be to offer as much nutrition as possible without providing excessive sugar, fat and calories. Fruits, vegetables and low-fat dairy are an easy way to meet this goal. These types of foods, eaten two to three hours before a meal will not spoil an appetite, whereas high-fat foods might.

When not to snack

1. As a reward. Our relationship with food is formed at a very young age. When food is provided as a reward an unhealthy relationship with food can be formed. Rewarding chil-

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011

• Join Facebook, LinkedIn or an online dating service. Make it possible for people to find you and for you to reach out to others. You might be surprised by what you discover — a new friend, an old heart throb, a childhood buddy or an unexpected opportunity to socialize. Who knows what might arrive in your inbox?! The anticipation of a “hello” or “wink” can turn a dreary day into one filled with surprises. • Schedule a “day off” just for you. I do this throughout the year. Monday is my preferred day off. I pick a Monday about four weeks out and look forward to filling it with activities I love. I choose Mondays because when the weekend is over, it’s not over for me! My special day is still out there ahead of me, yet to be experienced and enjoyed. • Plant a seed for the future, literally. For Valentine’s Day, my niece Erin gave me a little pot and “starter” seeds for a miniature rose bush. It sits on the sunny ledge above my sink, and I just love tending it and waiting for its tiny tips to make their appearance. Consider growing a few plants from seed to harvest. It’s such a simple joy, and a reminder of the profound power of anticipating future positive events. I anticipate good things ahead for all of you who adopt some of these strategies. And I invite you to share your experience with me. E-mail me at the address below and I’ll look forward to hearing from you! Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon, New York. For information about her workshops or to invite Gwenn to speak, call her at (585) 624-7887 or e-mail gvoelckers@rochester. rr.com.

dren with playtime or fun, educational activities can form much better habits than indulging in high-fat, high-sugar fare. Also, providing these types of foods after an accomplishment can lead the child to place a higher value on low-nutrition food items. Also, don’t treat these foods as forbidden. Encourage everything in moderation. 2. To cure boredom. Starting a habit of eating when bored can become a slippery slope. If you notice your child requesting snacks at off-times, make sure to assess the situation. If your child’s normal meal times have been thrown off due to a hectic schedule or if they’ve had increased activity, provide them with a small, low-calorie snack such as fruit and low-fat yogurt or veggies and light ranch dip. However, if it’s been a typical day and you notice your child is just antsy, provide a fun activity instead. Depending on your child’s age coloring and other activity books can be a good option for minimal supervision while not encouraging increased television time. “Snack time can be beneficial for kids. Just make sure kids are snacking at the right time and that snack items are closing the nutrient gaps, not worsening a child’s nutrient deficit which be detrimental to a child’s health,” said Bucciferro.

Rochester General Hospital Has the Busiest ER in has more than 100,000 visits in 2010, the Upstate Hospital highest number in its history By Amy Cavalier

hey’ve undergone extensive renovations on their emergency departments over the past two years. A new adult emergency department opened Oct. 7, 2009, followed by a new pediatric emergency department on Dec. 7, 2010, and just a week later, a new psychiatric department was unveiled. A brand new observation unit, for patients who need to stay in the hospital less than 23 hours, will be complete by October this year. If you look beyond the new waiting rooms, emergency departments and equipment though, you’ll find a much bigger change lies beneath the surface. Last year, Rochester General’s emergency department saw more than 100,000 patients, making it the busiest in Upstate New York, and among the Top 10 in the state, according to Dr. Keith Grams, the hospital’s chief of emergency services. This is the highest number of visits in the hospital’s history. Part of that can be credited to the new facilities, Grams said. A large part of it is due, however, to a change that the hospital staff made in December 2010 which has turned the traditional model of emergency department care on its head. Grams came to Rochester General in September 2010 from Strong Memorial Hospital, where he served as medical director. The medical director of the emergency department, Bryant Gargano, was also relatively new. It didn’t take long for them to see the system just wasn’t working. “We would regularly see four-tosix-hour waits under the prior traditional model,” said Grams. “Thirty to 45 patients waiting in the emergency room at 11 o’clock at night was common place.” The new leadership team enlisted the help of staff and planned to eliminate or at least reduce the wait time people were experiencing in Rochester General’s emergency department. “We recognized that the traditional way to approach patient care had a lot of non-value added steps of waste we could eliminate to make things better for patients and staff,” he said. The new ED system is a patientcare centered approach, Grams said. If a patient comes in vertical, they stay vertical, rather than being forced to lay in a bed waiting for care. A patient who comes into the emergency department walking, or in other words with a minor medical emergency, is brought into a room where they get to see a health care provider, a nurse and a patient care technician all at the same time, and then the initial work-up can begin. “That way, folks that come in with a minor complaint that don’t need much work can be discharged immediately,” said Grams. Patients that need more extensive care, such as an X-ray or blood work

age “door to doctor” time for a patient at RGH’s emergency department was 90 to 110 minutes. The percentage of people who would leave before being seen was 4.8 percent in 2009. The national average is 4.1 percent, according to Grams. Frustration levels were high under the old system, Grams said. Patients were frustrated, which made staff frustrated, which turned into a downward spiral of continued frustration and dissatisfaction. Nurse manager at RGH, Shari McDonald, had only been at the hospital for one month when the changes went into effect. She was part of the team that helped develop the plan. Before the changes went into affect, McDonald said, employee morale was very low. Members of the staff at Rochester General Hospital celebrated in December 2010 their “Imagine walking down 100,000 patient in the emergency department. the corridor and seeing 100 people,” she said. “When a nurse walks in and sees that, you know already you’re not going to have a good day, and that’s why �� it was important to move those people out of the waiting room. Administration �� said they supported us 100 �� percent and they wanted �� the best for our patients.” �� With new leadership, �� new facilities and a new �� patient care system, Grams �� said staff worked hard as �� a team to adjust to a lot of �� changes in a short amount �� of time. �� “The biggest obstacle �� really was changing how �� the emergency department �� team viewed the patient �� flow and approach to pa�� tient care, because we were �� very invested in that tradi�� tional model,” said Grams. “Everybody said it need to �� change, but there’s always �� Sources: 2011 CNY Healthcare Guide, Rochester General Hospital and individual hospitals. that apprehension of doing (1) Estimate number of visits in 2010; (2) Figures from 2009 it, so it was an underlying cultural change in how we are placed back in the waiting room to approach patient care.” build those private rooms and increase watch some television, and then they McDonald said Grams has helped area for staff. About 8 to 10 percent are called back in when the results are nurses think beyond patient care to see of emergency department patients ready. Those who might need an IV or the big picture. are still handled at the triage, where CAT scan are sent to a different area, “Nurses aren’t taught about busithey can be immediately cared for and with reclining chairs and more treatness, we’re taught about caring and discharged. ment capabilities. Patients in need of compassion,” she said. “Dr. Grams Under the old model of care, a immediate care are placed in a bed. helped the nursing division understand patient entering the emergency de“We were just tripping over one that when a patient leaves without partment would come in, register and another in the old emergency departcare, that means they’re in harm’s way, wait. Next, they’d see a nurse in triage, ment,” Grams said. “Individual treatand it’s a financial loss to the hospital, then wait. Then they’d get called into ment area was significantly increased which means we could lose employees, a room for more waiting. Tests might in the upgrades. Our goal was to be which affects patient care.” be run, and then another wait for the able to get everybody in a private The proof that it’s working is in results. Then finally, the patient would room.” the numbers. Under the new system, be treated and released or admitted, With double the amount of square which meant another potentially long Continued on the next page footage, Grams said, they were able to wait. On average, Grams said, the aver-

Number of Visits to Emergency Departments in 2010 at Select Upstate New York Hospitals

April 2011 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

•

Page 9

UCVA U Outside the B. Thomas Golisano Emergency Pavilion at Rochester General

Rochester General Hospital Has the Busiest ER in Upstate Continued from previous page the average door to doctor wait time is road faster, where they get good ser29 to 30 minutes. The national average vice and they get treated with respect, is 51 minutes. And the length of stay they’ll come back to that,” he said. for emergency room patients is on a “Patients can pick where they want gradual decline as well. to go, but the EMS can influence the “The proof is the patients keep patient. We are just now starting to see coming back and we had a record patients from primary care physicians breaking month in January,” McDonald that we weren’t seeing before. It’s just said. the simple word of mouth by patients McDonald and staff...they’ll said all staff get tell their friends together for daily Wait Time at and family which huddles to discuss spreads by wildRGH’s Emergency what went right fire.” Department and what went Before, Grams wrong that day. said, he might get That gives everytwo positive notes Then... one a sense of owna month, now the • Average door to doctor time: 90 to 110 ership, which has notes come in a minutes. boosted employee manilla envelope, • About 4.8 percent of patients would morale. and there are eight Customer satto 10 a month. leave the emergency department without isfaction has also Last year, being seen in 2009 changed drastiRGH’s Emer• Patient satisfaction, as measured by cally. According gency Department national survey company Press-Ganey, to Grams, patient treated 100,833 satisfaction at was in the single digits. patients, up over RGH, as measured 8 percent from by national survey the previous year. Now... company Press Grams said other • Average door to doctor time is 29 to 30 Ganey, has been in hospitals in the the 90th percentile minutes. area have taken two of the past 12 notice of the new • About 1.5 percent of patients leave months. That’s up system at Rocheswithout being seen. from the single digter General. • Patient satisfaction has been in the 90th its previously. The “The fun part changes in speed of percentile two of the last 12 months. is, the better we service at Rochesare, the better ter General’s emereveryone else will gency department has also resulted in try to be,” he said. “Our ultimate goal more ambulance traffic coming into the is when somebody wants to figure out hospital. how to get it right, that they’re picking “If emergency services find a up the phone and calling Rochester hospital that can get them back on the General Hospital.”

CVA is a privately-owned cardiology practice that serves the Greater Rochester, Finger Lakes and Southern Tier areas. It has 15 board-certified cardiologists, seven nurse practitioners, three physician assistants, a support staff of more than 100 professionals working in four locations: Brighton, Greece, Geneseo, and Dansville. “Our mission is to provide the best cardiac care to our patients by utilizing the latest medical information and state-of-the-art techniques in a pleasant and friendly environment” said Daniel J. Williford, physician with the practice. UCVA offers comprehensive cardiac care ranging from expert consultation, stress testing, echocardiography, nuclear imaging, arrhythmia detection and treatment, blood pressure monitoring, pacemaker and defibrillator management, and vascular studies including lower extremity and carotid artery ultrasounds. UCVA is also the exclusive provider of enhanced external counterpulsation (EECP) in the Greater Rochester area. This non-invasive treatment has been shown to significantly relieve symptoms in patients with refractory angina. For patients who require care beyond general cardiology, UCVA has cardiologists that specialize in electrophysiology and coronary interventions. “Cardiac electrophysiologists have additional training in the management of heart rhythm disturbances” said Sarah Taylor, eElectrophysiologist with UCVA. “We employ sophisticated techniques to diagnose and treat arrhythmias, including ablation therapy to eliminate electrical pathways in the heart that cause arrhythmias and implantation of pacemakers and defibrillators.” Interventional cardiologists are trained to perform coronary angiograms and correct coronary blockages with angioplasty and stenting. What makes UCVA different from other cardiology practices? “Everyone was very pleasant, professional and explained things to me in a very clear and concise manner that I understood,” said one patient. “Very favorably impressed with efficiency and coordination of all the people

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involved in the test procedure,” said another patient. With a closer look we found an abundance of more than satisfied patients who said they would or have highly recommended UCVA to others. One couple even said, “We happen to be Miller UCVA’s biggest fans! We happily make the drive from Lockport [Buffalo area] because we know that UCVA is second to none. We have never been disappointed; in fact their competent and compassionate care exceeds our expectations.” Williford summarized what patients can expect on a visit to UCVA: “We provide the complete range of cardiac services.” “We are available Williford in four different outpatient locations and see patients at local hospitals, including Highland Hospital, Rochester General Hospital, Strong Memorial Hospital and Unity Hospital at Park Ridge.” “Our cardiologists are all board certified with a wealth of experience.” “We are dedicated to treating each patient as an individual in a caring and respectful manner.” “We will communicate your information to your primary care physician and other physicians in a timely manner to keep them abreast of your condition.” In April 2011, UCVA the practice will launch a new website — www. ucva.com — which will include online bill payment, prescription refill, appointment requests, patient education, and much more. “We hope this service provides added convenience and accessibility for our patients. Our goal is: “Helping You to a Healthy Heart.” Check us out on Facebook under “UCVA,” said Christine Miller, RN, RHIT, MPA, chief administrative officer at UCVA.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011

SmartBites

By Anne Palumbo

The skinny on healthy eating

A Delicious Ticket to Soy: Edamame

ention the word “soy” and many people tune out, saying it’s too hippie-dippie, too bland, too full of unknowns. Their mind leaps to tofu (a.k.a. soybean curd) and their tongue retracts in agony just thinking about the mushy glop coming down the pike. While I can’t relate — because I have mastered some truly delicious tofu-based recipes — I do understand. Thankfully, there’s another way to incorporate soy into our diets, a way that involves a sweet, nutty-tasting bean called edamame (pronounced eduh-MAH-may). Known as the “green soybean,” because it’s harvested when the plants are still young, edamame has achieved superfood status in many circles. No surprise there. Edamame is a nutritional powerhouse in my book. Low in fat, sodium and cholesterol, this wonder bean is high in fiber and super high in protein, boasting 10 grams per half cup. That’s a lot of healthy protein for only 120 calories. What’s more, unlike the protein in any other legume, edamame’s protein is complete, meaning it has all nine essential amino acids. Translation: Comparable to animal protein, this bean’s protein doesn’t need to be combined with any other food to reap the benefits of this workhorse nutrient. More good news: Edamame brims with folate, a vitamin essential for the development of healthy fetuses, as well as for the production of serotonin. Me? I’m more interested in edamame’s high concentration of manganese, a mineral vital for good bones and healthy brains. I don’t know about other women in middle age, but my creaky bones

and scatty brain need all the help they can get these days. Lastly — and why I’m so sweet on soy — edamame is uniquely rich in isoflavones, a phytochemical associated with many of the health benefits that soy has shown in clinical studies: reduced risk of heart disease, lower cholesterol, stronger bones, and reduced risk of some forms of cancer.

½ teaspoon honey ¼ teaspoon coarse black pepper ½ teaspoon salt ½ teaspoon red pepper flakes (optional) Microwave edamame for 4 minutes; stir and set aside. Make pasta according to directions. While pasta is cooking, whisk together dressing ingredients in small bowl and set aside. In large frying pan, sauté garlic and ginger in sesame oil on medium heat for about 2 minutes. Add julienned red pepper and edamame and sauté 4 to 5 minutes more. Turn heat to low. Drain pasta and place in medium bowl. Add dressing and mix thoroughly. Serve pasta topped with warm edamame mixture. Garnish with toasted sesame seeds and scallions.

Helpful tips

In many supermarkets, you can find two types of edamame in the frozen vegetable section: shelled or with the pods. Look in the health-food section if you can’t easily find them. Both are already cooked and ready to be thawed and eaten. Since you can’t eat the pod (and the extraction of the bean can be a bit slippery), I prefer cooking with and eating shelled edamame.

Sesame Edamame with Whole Wheat Pasta 8 oz. whole wheat linguine 12 oz. frozen shelled edamame 3 cloves garlic, minced 1 tablespoon fresh ginger, minced 1 red pepper, julienned 2 teaspoons sesame oil Garnish: Toasted sesame seeds and sliced scallions Dressing 1 tablespoon sesame oil 1 tablespoon soy sauce 1 tablespoon rice vinegar

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Local chefs: What you need in the kitchen for healthy home cooking By Sheila Livadas

ome cooks need basic kitchenware, ordinary pantry items and a full spice rack to prepare healthy meals, local chefs say. Certain cooking techniques also help wring excess fat and calories from meals. Trying new foods often spurs home cooks to lighten up meals, local chefs add. “You’ve never had cardamom? Well, check it out,” says Marie Lovenheim, a nutritionist and chef who manages Little Green Café & Juice Bar at Pilates Plus in Brighton. Equipping a kitchen for Matthew Cole, executive healthy cookchef and director of ing doesn’t dining services at need to cost Rivers Run Active Adult much, local Community in Henrietta, chefs note. recommends that healthA $15 citrus conscious home cooks zester called a Microplane, own an indoor grill.

for instance, is a particularly useful, says Rosita Caridi-Miller, chef and owner at Mendon-based Cibi Deliziosi. Most home cooks don’t need an extensive cutlery collection either, since a chef’s knife, paring knife and slicing knife handle nearly every job, she says. Lovenheim, who teaches consumer nutrition at Monroe Community College, recommends that home cooks own a blender, a stockpot and a wok or a heavy skillet. She also is a fan of a mortar and pestle for breaking down whole spices. An indoor grill tops chef Matthew Cole’s list for essential home cooking equipment. “I always tell [people] that if you can’t grill your vegetables, you can invest in a steamer,” says Cole, who is executive chef and director of dining services at Rivers Run Active Adult Community in Henrietta. A standard double boiler also works for steaming, he says. Basic staples in the home pantry can make healthy cooking less daunting, says Michael Flint, executive chef at Wegmans Food Markets Inc.’s Pittsford store. He always has olive oil on hand at home for various purposes, including making vinaigrettes. Home cooks who prefer fresh herbs over their dried counterparts can grow them indoors in flowerpots during the

fall and winter, Flint says. Most dried herbs will serve home cooks well if they can’t grow their own, with the exception of garlic powder, which makes Flint cringe. Home cooks should strive to have a light hand with salt, Caridi-Miller of Cibi Deliziosi says.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011

“If there’s recipe that calls for a tablespoon of salt in cooking or a teaspoon of salt in cooking, I’ll start out with half of that,” says Caridi-Miller, whose business is open by reservation for catering, cooking classes, parties and events. “You need a little bit of salt to season the food and bring out the

flavors while it’s cooking, but you don’t usually need a ton of it.” Because kosher salt dissolves quickly on the tongue, “you can actually use less of it and still get that full-flavor impact,” adds Caridi-Miller. She also uses Hawaiian sea salt because of its lower sodium content. For those who need to avoid salt, Caridi-Miller suggests turning to black pepper for flavor. When it comes to convenience foods, Little Green Café’s Lovenheim does cook with canned beans. She also uses orange juice concentrate and orange marmalade to make vinaigrettes. Cooking techniques clearly matter when striving to put healthy meals on the table. When pan-searing fish, for instance, Flint recommends measuring the needed oil instead of eyeballing it so that extra fat and calories don’t creep up in the final product. Steaming salmon, cod, haddock or even chicken in a broth seasoned Marie Lovenheim, a nutritionist and chef who with fresh herbs often helps home manages Little Green Café & Juice Bar at Pilates cooks slash their fat consumption, Plus in Brighton, recommends that home cooks Flint adds. own a blender, a stockpot and a wok or a heavy Cole of Rivers Run says poaching can be helpful to health- skillet. conscious home cooks, but that Rochester Public Market and area farmmethod will deplete some foods’ nutri- ers markets offer the chance for home tional value, he says. cooks to redouble their commitment Preparing a few dinners in advance to healthy eating, Lovenheim says. and storing them in the refrigerator She suggests shopping with a friend helps make healthy cooking less stress- and splitting the cost of large shares of ful, Cole says. fruits and vegetables. “It’s all about preparation,” says Healthy cooking can even have Cole, who would whip up several an immediate impact on grocery bills, days’ worth of dinners and snacks at especially when the focus shifts away once when he was training as a bodyfrom meat consumption. builder. “There’s nothing wrong with rice Locally grown food available at the and beans,” Lovenheim says.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 13

A Farewell To Lucy The decision to euthanize Lucy, my best friend of 15 years, was quite possibly the hardest decision I’ve had to make in my life By Amy Cavalier

n Friday, Feb. 25, I put my dog Lucy to sleep. We’ve been through a lot together. I adopted her when I was 18 years old and she practically raised me as much as I raised her. Together we played, we grew up, we learned, we celebrated, we loved and we mourned. Coming to the decision to euthanize Lucy, my best friend of 15 years, was quite possibly the hardest decision I’ve had to make in my life up until this point. Everyone told me, “you’ll know when its time” or “the dog will tell you when its time.” Let me tell you, it wasn’t that easy. Lucy didn’t make it easy. The old girl put up quite a fight. She had plenty of spirit left in her, but her legs just couldn’t keep up. According to her vet, David Hancock of Perinton Vet Clinic, Lucy suf-

Amy Cavalier with her dog Lucy. “ I know Lucy will always be with me, but she was ready to go and I think I was finally ready to let her go.”

fered from a compression of the spinal cord, which is producing a failure of nerve communication from her brain to her back legs. “She no longer knows where her back legs are, and has difficulty putting them in the right spot, but

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that particular problem isn’t painful, it doesn’t hurt,” Hancock told me a few months before I came to the decision. “If she couldn’t walk or move, now we’d have a major issue, but just because she stumbles doesn’t mean she

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hat’s the No. 1 disease killing American women? It’s not breast cancer. It’s heart disease. It’s also more deadly for women than men. “In general, men have greater risk of heart attacks than women, and have them earlier in life,” said Amit Chitre, regional vice-president communications and marketing for the American Heart Association Rochester. “But heart disease kills more women than men each year.” Surprised? Many women experiencing heart attack do not even realize that they are having one and for that reason and others, “women are more likely to die when having a heart attack compared to men,” said Dr. Christine Tompkins, assistant professor of cardiology and electrophysiology at University of Rochester Medical Center. The classic signs of heart attack—chest discomfort, discomfort in other areas of the torso, shortness of breath disproportionate to activity level, Tompkins and breaking out in a cold sweat — are not always present when women have heart attacks. “There are undoubtedly gender differences in the presentation, diagnosis and treatment of women,” Tompkins said. Some women may have the same signs, a few of the same signs or none of the signs that men have. Women may present with indigestion, nausea or vomiting, tingling in an arm or jaw or neck pain. Busy women may ignore these symptoms or dismiss them as something less serious. They aren’t the only ones to overlook heart attack as a possibility. “Health care providers often consider other diagnoses and thus referrals for diagnostic testing is delayed,” Tompkins said. Though Chitre is not aware of studies or statistics on this scenario, feedback from female heart attack survivors shows many “were often told it was indigestion or any number of things other than heart attack,” he said. The diagnostic testing for patients with chest pain works differently for women, too. An acute heart attack appears differently for women than men on an electrocardiogram. Treadmill tests used to detect coronary artery disease “are less sensitive and have lower diagnostic accuracy in women than men,” Tompkins said. “Imaging helps improve this accuracy, but also tend to generate more false positives in women due to physical differences.

Women’s smaller heart size and greater breast tissue can interfere. In addition to delayed treatment, the physical differences between men and women may make treatment less effective with women. “For years, we assumed women would respond to therapies similar to men,” Tompkins said, “however, studies now suggest that this may not be the case. Rather, women tend to have less favorable outcomes and higher mortality rates following coronary interventions.” She added that women’s smallersized heart arteries may be partially to blame, but complications “occur more frequently in women following interventions—both cardiac catheterizations and bypass procedures—for reasons that are not fully understood.” Of course as with any medical emergency, promptly seeking medical attention is paramount to a good outcome. Any woman exhibiting the signs of heart attack should call 911 immediately. It is unsafe to drive while experiencing a heart attack and emergency personnel have equipment with them that can help. “Too often people make the mistake of calling their family physician who needs paging or call a relative or drive themselves to the doctor,” Chitre said. “If you think it’s serious, please call 911.” After calling 911, don’t engage in activity or anything stressful. Chew a 325 mg. “adult” aspirin to help break up any clots in the bloodstream. (Chewing it will help it reach the bloodstream faster than swallowing.) If no clots are present, taking an aspirin won’t be harmful. Chitre recommends waiting near the unlocked front entrance and sending someone outside to flag down the ambulance if needed. “Have your medications handy if you take any,” he added. “That can save a lot of time and in some cases save a life.” The American Heart Association shared the following statistics on cardiovascular disease (CVD), the underlying reason people have heart attacks: • More than one in three female adults has some form of CVD. • Since 1984, the number of CVD deaths for females has exceeded those for males. • In 2006, CVD was the cause of death in 432,709 females. Females represent 52.1 percent of deaths from CVD. • In the United States in 2006, all cardiovascular diseases combined claimed the lives of 432,709 females while all forms of cancer combined to kill 269,819 females. Breast cancer claimed the lives of 40,821 females; lung cancer claimed 69,385.

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Page 15

Women’s issues Why More Women Are Opting for C-sections By Deborah Jeanne Sergeant

ight years ago, Christy Muscato of Rochester began laboring at home with her first child early in the morning. Around 8:30 a.m., she and her husband arrived at the hospital. The initial examination revealed that her baby was presenting frank breech, meaning the baby’s buttocks, not her head, was positioned to emerge first. “Breech, especially on the prime delivery—first baby—is almost 100 percent sent for a C-section,” Muscato said. “The concern is that the largest

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part of the baby at this point, the head, will not fit through the pelvis.” Usually, once the head delivers, the rest of the body comes out easily. Because the water had broken and she had already begun laboring, the Csection was the only option. Although Muscato’s C-section caused no complications, she remembers feeling disappointment about her birth experience. Several people saw and held her baby before she could. In most vaginal births, the baby is handed directly to the mother. Muscato’s daughter was laid on a table with a large pole blocking her line of vision so she could not even see her baby. “She didn’t come with me back to my room and I had to wait for over a half an hour to finally see and hold her,” Muscato recalled. “I really missed those initial moments with my baby. Emotionally, I will never get back those first moments my baby was in the world. I will never be the first person she saw or felt or heard. That is hard.” Some experts agree that the mother-baby bond is enhanced with immediate contact after birth. In cases like Muscato’s, medical professionals opt for a C-section to avoid injury to mother and baby; however, some argue that in cases of breech presentation, trying earlier interventions to turn the baby into a better position may help. Approximately one-third of deliveries are C-sections, a jump from only a decade ago, according to Dr. Vanessa Junor at Lakeside Health in Brockport. “Some of it has to do with

the increased prevalence of obesity in our population,” she said. “Studies show that 29 percent of women of reproductive age have a body mass index (BMI) greater than 30 and 8 percent have a BMI greater than 40.” Carrying extra pounds can complicate pregnancy and necessitate a C-section. “There is a higher risk of diabetes and delivery of a largefor- gestational-age infant as a whole, the labors can be longer and studies show an increase risk of Caesarean delivery,” Junor said. She also listed fetal intolerance to labor and umbiliMuscato cal cord prolapse as reasons some women need emergency C-sections. Loralei Thornburg, ob/gyn with specialty in maternal fetal medicine at the University of Rochester Medical Center, added that the rise in multiple births and older moms has also increased the number of C-sections. “These increase the risk of complications which increases the C-section rate,” she said. She added that patients’ increased familiarity with C-sections have helped increase the rate, and “medical liability has led physicians to do more C-sections than in the past.” The increasing number of artificial labor inductions also contributes to the rise in C-sections. “Artificially beginning labor before the women’s body and baby are ready to be in labor is a very slippery slope,” Muscato said. “It is the beginning of the cascade of interventions that have a very high probability of ending in a C-section. There are medical reasons for an induction, but make an informed decision with your care practitioners.” Kathleen Mugnolo, certified doula with DONA International and referral coordinator for The Doula Cooperative of Rochester, believes that a variety of factors of giving birth in a hospital setting can sometimes snowball and contribute to the likelihood of a C-section. “Women aren’t allowed to eat and it wears away her reserves,” she said. “When she’s tired, and has no reserves, her uterus isn’t able to function the way it should. They resort to pitocin, which adds more pain. I don’t think medical professionals are malicious, but aren’t trained for problem solving. They’re trained for crisis. They need to find ways to work around it.” She advises women to stay home as long as possible so they can stay relaxed, comfortable and eat as needed. In some cases, however, pre-

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011

planned C-sections are medically necessary. Women with active herpes infection or HIV with a high viral load are C-section candidates.

Vaginal birth after C-section

Often moms and doctors are nervous about a vaginal birth after a previous C-section because the tissues have been compromised because of the surgery. Although vaginal birth after C-section is possible and many women do fine, attempting a vaginal birth depends upon the doctor’s recommendations and the mother’s preference. Although it’s rare, some women request a C-section for a number of reasons, “as long as the fetus is mature based on criteria,” Junor said. “Only one to three percent of all Caesarean deliveries are performed for this reason in the US.” Some women who request a C-section do so because they live far away enough from a medical facility that they fear not “making it” in time for the baby’s delivery. Others want to plan the date of the birth or harbor fears about vaginal delivery. “They fear pelvic organ prolapse and incontinence, pain or tearing vaginally, or they say, ‘Everyone in my family has had a C-section’ so they do not want to have a trial of labor,” Junor said. Studies have not Junor proven that a C-section reduces the long-term risk of incontinence. Melissa Carman, DONA-trained birth doula and certified as a lactation educator counselor from University of California San Diego, said, “There are some women who are too posh to push and want to schedule a C-section. I think a lot will pick 11/11/11.” Carman founded Mothers to Be and More in Newark. Junor discusses with patients disadvantages to C-sections such as longer recovery time, increased morbidity compared to vaginal delivery, such as fever, wound hematoma or infection, DVT (deep vein thrombosis), and repeat surgery with future pregnancies and its consequences. “Some people say they want a C-section because they don’t want pain,” Thornburg said. “You trade one for the other. The anesthesia will take away pain during delivery, but vaginal delivery gives a faster recovery than a C-section. Women who have a lot of obligations need to think about how long a Caesarean will put them out of commission in completing those obligations.” Recovery time can take as long as

eight weeks if they have complications and can be as short as four weeks with a vaginal delivery; however, it varies woman to woman. “It’s major abdominal surgery that takes a long time to recover,” Mugnolo said. “It may seem easier but it’s not.” Women who do not want a C-section should discuss and spell out their wishes before they go into the delivery room. Many women include this in their written labor plans. As a mother who has subsequently given birth vaginally, Muscato favors vaginal births. “I would take the vaginal birth any day,” she said. “Major abdominal surgery to a normal natural body experience? No contest. A C-section is not something to be taken lightly. As for an elected or scheduled C-section, there are many benefits to letting labor begin on its own. There are good resources out there to get any research that one might want to make that informed decision. “As for an unscheduled C-section, when the baby or mother is not in distress but labor just does not seem to be progressing, I would suggest they find out any and all possibilities to do progressing labor and trying them all. Then when they make the decision for the c-section, they will know they did all they could to avoid it.” Moms who have C-sections are usually advised to forgo a subsequent pregnancy for 18 months to allow time for the uterus to heal. Recently the American Congress of Obstetrics and Gynecology issued guidelines on attempting vaginal delivery after c-section (known as a VBAC, or Vaginal Birth After a C-section). Hospital personnel may not be able to offer the opportunity to try VBAC to women who don’t meet these requirements. “The success rate for the appropriate patient is 60 to 80 percent,” Junor said. “Such patients include one with previous successful VBAC, previous vaginal delivery, prior C-section for non vertex presentation like breech, and women with spontaneous onset of labor. This can be an acceptable alternative to elective repeat C-section.” Some of the concerns of VBAC include uterine rupture; however, the risk is 0.2 to 1.5 percent. “This risk is on the lower range if the patient is not induced,” Junor said. “VBAC can be a reasonable and safe choice for women with a prior low transverse scar, if the ACOG guidelines are followed appropriately.” With every c-section, additional scar tissue is formed, which can compromise the uterus, increasing the risk of abnormal presentation or the placenta implanting over the scar. “A woman planning a large family should think more about VBAC because when you get to high numbers of c-sections the risk increases,” Thornburg said. When Muscato gave birth to her second daughter vaginally, the experience “helped to take back and fill in some of the loss I felt from my oldest’s birth,” she said. As a DONA International certified doula, helping her clients through Csections and VBACs has in turn helped Muscato as well. “What I love most, is that those clients I have been with for their Csections are coming back around with their next child and having their own beautiful powerful VBACs and finding their own strength and release,” she said. Muscato also founded Beautiful Birth Choices, (www.beautifulbirthchoices.blogspot.com) to support mothers with their birth experiences.

Women’s issues Post-Partum Depression From baby blues to post-partum psychosis, the spectrum of emotional problems facing many new moms varies considerably By Deborah Jeanne Sergeant

fter their baby is born, many moms feel sad. Ranging from the common “baby blues,” which afflict about 80 percent of moms by some estimates, to less commonly experienced post-partum depression (PPD) to the rare post-partum psychosis (PPP), the spectrum of emotional problems facing many new moms varies considerably. Experts aren’t entirely sure what causes the phenomenon, “but we’re confident that there is no one single cause,” said Emma Robertson-Blackmore, assistant professor of psychiatry at the University of Rochester Department of Psychiatry. “PPD affects women from all racial, cultural and social backgrounds. Physical, hormonal, social, psychological and emotional factors may all play a part in triggering the illness.” It seems incongruent that new mothers should feel sad once the longawaited day finally has arrived; however, giving birth leaves mothers awash in fluctuating hormones, facing nearly overRobertsonwhelming challenges Blackmore and disappointment in their new life after months of building anticipation. “Some women appear to be biologically vulnerable to the massive changes in hormones that occur following childbirth, while for others experiencing stressful life events may play a bigger role in the development of illness,” Robertson-Blackmore said. Risk factors during pregnancy can help women realize what is happening beforehand so they can seek treatment early. Robertson-Blackmore listed: experiencing depression or anxiety during pregnancy, a family or personal history of prior depression, experiencing stressful life events and lack of social support, and possibly relationship difficulties, socioeconomic difficulties and low self-esteem. “It’s also important to note that some women will have none of the risk factors and will still become ill,” Robertson-Blackmore added. Melissa Carman, founder of Mothers to Be and More in Newark and a DONA International-trained birth doula, recalls that she experienced baby blues for three to four days after giving birth. “I cried for no reason and had to call my husband and ask him to come home,” she said. “Nothing was wrong;

I couldn’t stop crying. It’s no one’s fault. No one caused this. I honestly thought there’s no way I’d have baby blues or PPD because I’m totally in control of things and there I was bawling my eyes out for no particular reason. You have no control over it.” Carman, also a certified lactation educator counselor by the University of California San Diego, believes the birth experience itself may play a role in PPD, a factor she has observed as a doula who has aided in home births. “A woman feels more comfortable in her own home and environment and giving birth with the support she needs,” she said. “That’s not always the case in the hospital. I’ve seen many lovely hospital births, but I’ve seen women not very dilated and they start inducing labor.” For some women, medical intervention that they feel is unwarranted robs them of the birth experience they had idealized, whether or not the intervention was necessary or could have been avoided. For mothers of premature or sick babies, the early isolation from their infants can inhibit bonding with the baby and make the birth experience seem surreal because they do not have the usual experience of rooming with the baby and taking him home two days later. “You have an expectation of how you’d bond with your baby or how life would be afterwards, especially if you’re a first-time parent,” said Kathleen Mugnolo, certified doula with DONA and referral coordinator with The Doula Cooperative of Rochester. “You have no idea of how sleep exhausted you’ll be. That contributes to it.” In addition to awareness of PPD risks, moms should realize that they can help prevent it by breastfeeding their babies, seeking practical support for life post-delivery, and adjusting their expectations to the reality of life with a newborn. Breastfeeding aids in leveling out hormone levels and promotes mother/baby bonding. By accepting help as needed, new moms can get the rest they need and cope better with their recovery from birth. Realizing that they now have a new full-time job—caring for a newborn—helps moms understand that they are “getting something done.” They’re keeping baby safe and happy.

April 2011 •

Many women experiencing sadness after giving birth feel inhibited about seeking help because they fear appearing weak, unloving mothers, or like they have lost their minds. Highly publicized cases of mothers with PPP who harm their children can also dissuade sad moms from talking about their feelings. PPD isn’t a rare condition. About one in eight women will experience PPD. Fortunately, PPD and PPP are “highly treatable and most women recover fully,” Robertson-Blackmore said. The treatment provided depends on the severity of illness, symptoms, and the individual women experiencing them. Medication, talking with a counselor and support groups may be helpful. Women should also keep in mind that if they’ve experienced PPD or PPP, they have a 40 percent risk of another episode after a subsequent pregnancy and a 25 percent risk of depression unrelated to motherhood. “Subsequent episodes tend not to be as severe, as women and their families recognize the signs of illness and seek treatment more quickly,” Robertson-Blackmore said. “Also, the health provider knows what treatments have been effective in the past and so can begin them quickly.”

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 17

Women’s issues

Fighting Infant Mortality Infant mortality among African Americans in Rochester — 17 per 1,000 live births — is more than three times higher than the state average for all races. Perinatal Network of Monroe County wants to change that By Mike Costanza

ood health starts for a child long before it begins growing in the womb. “Mom’s health before she becomes pregnant is a critical determining factor in the ability that she has to have a healthy pregnancy and a healthy baby,” says Patricia Brantingham, executive director of the Perinatal Network of Monroe County. For about the past 13 years, the nonprofit has worked to improve the health of pregnant women and their babies. “We focus primarily on low-income women and women of color,” Brantingham says. “Those are the women who tend to have unhealthy pregnancies and unhealthy babies.” The organization also serves the needs of children from birth to the age of 2. Unfortunately, some of Monroe County’s children never reach even their first birthdays due to poor maternal health. Figures from the Perinatal Network indicate that 69 babies born here in 2009 did not Brantingham live beyond a year. That translates to an infant mortality rate of just over 7.8 babies per 1,000 live births. A deeper examination of the statistics reveals wide disparities among the county’s racial groups and geographic areas. When controlling for those factors, statisticians found that infant mortality among African Americans across the county rose to 14.8 per 1,000 live births, and to 17 per 1,000 live births among those who reside in Rochester. By comparison, infant mortality statewide was 5.5 per 1,000 live births for all races in 2007, the last year for which figures were available. Data from the U.S. Department of Health and Human Services indicates that disparities exist elsewhere, as well. Whereas the infant mortality rate among non-Hispanic whites was 5.8 per 1,000 in 2006, among Hispanics it ranged from 4.4 to 8.3 per 1,000, depending on the subgroup being examined. What accounts for these disparities? Research supports the view that their roots lie deep in the experiences Page 18

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of such minority groups, Brantingham says. “[It] is the accumulation of the impact of not just a lifetime, but generations of poor health, poor access to health care, [and] a toxic environment,” she says. Poor nutrition, smoking, the use of alcohol or illicit drugs, lack of healthy exercise, the presence of toxic substances, chronically high stress, lack of access to health care, and other factors can all can compound these long-term effects, further affecting a fetus. The cumulative effects emerge amongst African Americans and other minority groups in the form of higher numbers of premature births and children with low birth weights, which are associated with over 60 percent of infant mortality. “Those are the primary causes of death,” Brantingham says. The Perinatal Network has taken a two-pronged approach to the problem of infant mortality. In the first prong of its attack, the nonprofit partnered with two local health systems to create two Healthy Start Centers Blanchard in Rochester. Healthy Start, a program of the US Department of Health and Human Services, encourages communities to reduce infant mortality through providing adequate prenatal care to women in need, teaching those women how to maintain good health, giving them greater access to medical care, and taking other measures. The nonprofit partnered with the Rochester General Health System to create Comienzo Sano, the Healthy Start program based at RGHS’s Clinton Family Health Center. “We’re serving mostly Latina or refugee patients that typically have higher infant mortality rates,” says Anne-Marie Blanchard, a physician assistant for Comienzo Sano. The program serves about 2,000 women, in a part of the city beset by poverty, violence and other economic and social problems. “There is smoking over here, poor nutrition, really low education rates,”

The Perinatal Network has partnered with Rochester General Hospital and Unity Health System to curb infant mortality in the region Blanchard says. “We have the highest HIV rate; we have the highest STD rate.” Often, the program’s patients may cope with the stress of life through overeating, substance abuse or other unhealthy behaviors. Comienzo Sano uses a combination of prenatal care, education in the medical issues that could affect pregnancy and early child rearing, and the teaching and use of stress reduction techniques to help its patients bear healthy babies. Patients spend part of their time at the center in groups with Blanchard or other program staff, learning about that which they need to do to accomplish that end. “Part of the group time is spent on education about nutrition, about substance abuse, about birth control methods, etc.,” Blanchard says. The groups also give their members informal settings in which to discuss those issues to their satisfaction, such as the reason a behavioral change is necessary. “Always, there’s a different medical reason that they don’t understand,” Blanchard explained. The women can also learn stress reduction techniques— and even yoga—in their groups. Jennifer Betancourt, one of Blanchard’s patients, recently took her

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011

first yoga lesson. Betancourt does not speak English, but through an interpreter told In Good Health that she’d found the lesson “very relaxing.” The 24-year-old, who is pregnant with her fifth child, says that Comienzo Sano has helped her adopt more healthy dietary habits, learn how to hold a baby more safely and improve her knowledge of breastfeeding. Blanchard says that after her patients meet in groups, she meets with them singly in order to provide their prenatal care. The Clinton Family Health Center can provide some of the other medical care they may need. The Perinatal Network also partnered with the Unity Health System to help establish a second Healthy Start program in Rochester. Brantingham says that the Healthy Start Center, located on the health system’s Genesee Street campus, serves a mostly African American population. The Perinatal Network doesn’t limit itself to fostering direct action against infant mortality. It also coordinates the activities of other local organizations that are concerned with maternal health, and provides some of the technological support they need to do so.

What They Want You to Know:

Doulas

By Deborah Jeanne Sergeant

oulas assist pregnant women. As defined by DONA International (www.dona.org), a doula is “a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.” ■ “A lot of people don’t know what a doula is. A lot of times I say ‘a professional labor coach.’ ■ “A doula does not take the place of the partner or dad. ■ “For me, because I deal a lot with home births, it doesn’t mean I think every woman should have a home birth. It doesn’t mean I wouldn’t support a woman who doesn’t want a natural childbirth. ■ “I don’t think any woman should give birth in a hospital without a doula. Women don’t think when they’re in labor. They put their brain on a shelf. There’s a lot going on and at the height of transition, [medical personnel] offer an epidural, and if you wait another half hour, you’d be pushing your baby out. ■ “We’ve become a society where we’re afraid to give birth to our own babies and something terrible will happen. We totally have the power within us to give birth to our babies. We do have certain scenarios where we need medical intervention. By all means, I am totally grateful, but 80 percent of the time, women don’t need any intervention. ■ “A doula is emotionally attached, but differently. They’re not making decisions based on the fact that they love that person, unlike a father.

He makes decisions based upon the emotions, not what’s actually going on. A doula helps keep it real and constantly informs them on what it’s normal. ■ “Every situation is different, every mom is different. Moms seem to be very bonded with the doula because for centuries, women have taken care of other women.” Melissa Carman, DONA-trained birth doula and certified as a lactation educator counselor from University of California San Diego, founder of Mothers To Be and More in Newark ■ “Labor can be very powerful, overwhelming and downright scary. Doulas are a calming presence. We are experienced childbirth support. ■ “We don’t do anything medical. We are there to support the families we work with and help them to make the most informed choices available to them. ■ “Throughout the ages, in nearly all societies for which we have records, women have been helped and comforted in labor by other women. These women stayed throughout labor providing physical comfort, emotional reassurance, and information. Essentially, labor support is ‘mothering the mother.’ ■ “A doula is available to the parents with information about medical interventions, including risks and benefits, and allows them to make an informed decision. ■ “In order to have a positive birth experience, most women need continuous labor support. Although obstetrical nurses are experienced in dealing with a laboring woman’s emotional and physical needs, they can seldom guarantee the support they provide will

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last throughout the labor, especially in hospital settings where shift changes, coffee breaks, heavy paperwork and busy nights regularly occur. Some ob nurses handle up to six laboring couples at a time. Midwives may be able to offer more labor support, but they too have clinical duties to which they must attend. ■ “The father or partner may be better able to provide continuous support but has little actual experience in dealing with the forces of labor. Even fathers who have had intensive preparation are often surprised at the amount of work involved (more than enough for two people). Even more important, many fathers experience the birth as an emotional journey of their own and find it hard to be objective in such a situation.” Christine Muscato, certified doula with DONA, certified doula and natural childbirth instructor, certified natural health professional, naturopath and founder of Beautiful Birth Choices in Rochester ■ “A lot of people are uninformed and don’t know what a doula is and how valuable one can be. It’s proven that the presence of continuous support helps prevent intervention and expedites the birth process. ■ “In this day and age birth is something we have to learn about when we become pregnant. Once upon a time, we had sisterhood around us. We have to seek out ways to develop a community and a doula is a valuable part of that community. ■ “Financially, it’s hard for people nowadays to not consider the expense. A lot of doulas become trained as doulas because they firmly believe the support is crucial. Most doulas work on a sliding scale or, if they’re newer, gratis to get the experience. Seek out the support regardless of your financial situation. Those who do have the means should honor the hard work that goes into it.” Kathleen Mugnolo, certified doula with DONA, referral coordinator with The Doula Cooperative of 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.

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1 in 13 Older Adults Reported Some Form of Elder Abuse Lifespan groundbreaking study finds hidden elder abuse in New York state

ifespan of Greater Rochester Inc. recently released the summary report of a groundbreaking study of the prevalence of elder abuse in New York state. The study found that one in 13 older adults suffered some form of elder abuse in the year preceding the survey. The results also point to a dramatic gap between the rate of elder abuse reported by older residents in the survey and the number of cases referred to and served by formal elder abuse service systems. The major findings included: A total one-year incidence rate of 76 per 1,000 older residents of New York state for any form of elder abuse. Applying the incidence rate to the general population of older New Yorkers, an estimated 260,000 older adults in the state were the victims of at least one form of elder abuse in a one-year period in 2008 and 2009. However, the survey of documented cases identified just 11,432 victims in all service systems in New York state in 2008 — meaning for every known case, 24 were unknown. The highest one-year rate of elder abuse occurred for major financial exploitation (theft of money or property, using items without permission, impersonation to get access, forcing or misleading to get items such as money, bank cards, accounts, power of attorney) with a rate of 41 per 1,000 surveyed. The study also found that 141 out of 1,000 older New Yorkers have experienced an elder abuse event since turning age 60. The New York State Elder Abuse Prevalence Study was the result of a unique collaboration by research partners including Lifespan of Greater Rochester Inc., Cornell Weill Medical

College, Cornell University (Ithaca) and New York City Department for the Aging with Principal Investigators, Mark Lachs, MD, of Weill Cornell Medical College, and Jacquelin Berman, PhD, of New York City Department for the Aging. “I was present yesterday when 90-year-old Mickey Rooney testified before the U.S. Senate Select Committee on Aging about being financially exploited,” said Ann Marie Cook, president/CEO of Lifespan. He told the committee, “Life was unbearable. I felt trapped, scared and helpless. When I tried to speak up, I was told to shut up and was told that I didn’t know what I was talking about.” “If it can happen to Mickey Rooney, it can happen to anyone, and it does,” Cook said. “As Dr. Mark Lachs, our principal investigator, stated in his testimony before the same committee, ‘Elder abuse is the most hideous form of ageism imaginable.’” The study research, conducted over three years, included telephone interviews with a representative, statewide sample of residents aged 60 and older to estimate the prevalence and incidence of various forms of elder abuse in New York state among communitydwellers. Additionally, researchers surveyed adult protective services, law enforcement, prosecutors’ offices, victim services agencies, domestic violence programs, and aging services providers to learn the number of reported cases during a single calendar year (2008). The researchers compared rates of elder abuse in the two component studies, permitting a comparison of “known” to “hidden” cases, thereby determining an estimate of the rate of elder abuse underreporting in New York state.

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The Social Ask Security Ofﬁce Column provided by the local Social Security Office

Survivors Benefits Explained More than 6.4 million survivors receive benefits averaging $1,129 a month

he loss of a loved one can be painful. The death of a wage-earner upon whom a family depends also can be financially devastating. If you’re like most young or middle-aged workers, you probably think of Social Security only as a retirement program. But some of the Social Security taxes you pay go toward providing survivors insurance for workers and their families. Think of it as a life insurance policy you never knew you had — paid for by the same taxes that cover you for retirement or disability. When you die, certain members of your family may be eligible for survivors benefits. These include widows, widowers (and divorced widows and widowers), children, and even dependent parents. In many cases, there also is a one-time lump-sum payment of $255 that can be made to a surviving spouse or minor children who meet certain requirements. You may not think it will happen to you, but the stunning truth is that one in eight of today’s 20-year-olds will die before reaching their full retirement age of 67. In fact, 98 of every 100 children could get benefits if a working parent dies. More than 6.4 million survivors

Q&A Q: Do I need a Social Security card? I want to get a summer job and my dad can’t find my card. A: If you know your number, you probably don’t need to get a card. If you find out that you do need a replacement card, you can download and complete the application for a replacement at our Website. Then, take or mail the application to your local Social Security office with the required documentation. The Web address is www.socialsecurity.gov/ssnumber. If you do get a replacement card or find the original, you shouldn’t carry it with you. Keep it in a safe place with your other important papers. Q: Can I get a new Social Security number if someone has stolen my identity? A: We do not routinely assign a new number to someone whose identity has been stolen. Only as a last resort should you consider requesting a new Social Security number. Changing your number may adversely affect your ability to interact with Federal and State agencies, employers, and others. This is because your financial, medical, employment and other records will be under your former Social Security number. We cannot guarantee that a new number will solve your problem. To learn more about your Social Secu-

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011

receive benefits. The average survivors benefit is $1,129 a month. If you are a survivor, you should apply for survivors benefit right away. You can apply by telephone or at any Social Security office. Call us toll-free at 1-800-772-1213 (TTY: 1-800-325-0778). To help prepare you, here is the information we will need: • Proof of death — either from a funeral home or a death certificate; • Your Social Security number, as well as the deceased worker’s; • Your birth certificate; • Your marriage certificate, if you are a widow or widower; • Your divorce papers, if you are applying as a divorced widow or widower; • Dependent children’s Social Security numbers, if available, and birth certificates; • Deceased worker’s W-2 forms or Federal self-employment tax return for the most recent year; and • The name of your bank and your account number so your benefits can be deposited directly into your account. To learn more about survivors benefits, please read the online publication at www.socialsecurity.gov/ pubs/10084.html. Visit the Survivors page at www. socialsecurity.gov/pgm/survivors.htm.

rity card and number, read our online publication on the subject at www. socialsecurity.gov/pubs/10002.html. Q: I’m retiring early, at age 62, and I receive investment income from a rental property I own. Does investment income count as earnings? A: No. We count only the wages you earn from a job or your net profit if you’re self-employed. Non-work income such as annuities, investment income, interest, capital gains, and other government benefits are not counted and will not affect your Social Security benefits. Most pensions will not affect your benefits. However, your benefit may be affected by government pensions earned through work on which you did not pay Social Security tax. You can retire online at www.socialsecurity.gov. For more information, call us toll-free at 1-800-772-1213 (TTY 1-800-325-0778). Q: I was turned down for disability. Do I need a lawyer to appeal? A: You are fully entitled to hire an attorney if you wish to, but it is not necessary. In fact, you can file a Social Security appeal online without a lawyer. Our online appeal process is convenient and secure. Just go to www. socialsecurity.gov/disability/appeal. If you prefer, call us at 1-800-772-1213 (TTY 1-800-325-0778) to schedule an appointment to visit your local Social Security office to appeal.

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How to Keep Up With Your Medications Dear Savvy Senior, What devices can you recommend to help forgetful seniors keep up with their medications? My 76-year-old mother takes nine different prescription drugs and that doesn’t include all the vitamin supplements or overthe-counter medicines she takes. Any suggestions? Concerned Daughter Dear Concerned, The challenge of juggling medications can be a problem for anyone, especially seniors who take multiple drugs for various health conditions. Here are some different solutions that can help. Medication Helpers

Getting organized and being reminded are the two keys to helping your mom stay on top of her medication regimen. To help achieve this, there are a wide variety of inexpensive pill boxes, medication organizers, vibrating watches, beeping pill bottles and even dispensers that talk to you that can make all the difference. To find these types of products go to epill.com (800-549-0095) and forgettingthepill. com (877-367-4382) where you’ll find dozens of affordable options. If your mom needs a more comprehensive medication management system there are several good options here too. One of my favorites is the Maya from MedMinder (medminder.com, 888-633-6463), a computerized pill box that will beep and flash when it’s time to take her medication, and will call her if she forgets. It will even alert her if she takes the wrong pills. This device can also be set up to call, e-mail or text caregivers letting them know if your mom misses a dose, takes the wrong medication or misses a refill. The cost for Maya is $20 per month which covers rental and service fees. Some other good medication management systems worth a look at are TabSafe (tabsafe.com, 877-700-8600) and the Philips Medication Dispensing System (managemypills.com, 888-6323261), both of which will dispense her medicine on schedule, provide reminders and will notify caregivers if her pills aren’t taken. These systems run under $100 per month.

Reminding Services

Another option that can help your

mom keep on top of her meds is with a medication reminding service. These are services that will actually call, e-mail or text your mom reminders of when it’s time for her to take her medicine and when it’s time to refill her prescriptions. Some even offer extra reminders like doctor and dentist appointments, wake-up calls and more. Companies that offer such services include mymedschedule.com, which provides free medication reminders via text message or e-mail. Their website can also help you make easy-to-read medication schedules that you can print out for your mom to follow. Other similar companies worth a look are rememberitnow.com which also offers free text message and e-mail reminders and pillphone.com which charges around $4 per month. If, however, your mom doesn’t text or use a computer, OnTimeRx (ontimerx.com, 866-944-8966), Snoozester (snoozester.com) or Daily Pill Calls (dailypillcalls.com, 866-532-6855) may be the answer. With starting prices ranging between $4 and $10 per month, these services will call your mom on her home or cell phone (they can send text messages too) for all types of reminders including daily medications, monthly refills, doctor appointments and other events. Or, if you’re looking to keep closer tabs on your mom, services like Care Call Reassurance (call-reassurance.com, 602-265-5968) or CareCalls (parentcarecall.com, 888-275-3098) may be a better fit. In addition to the call reminders to your mom’s phone, these services can be set up to contact you or a designated caregiver if she fails to answer or acknowledge the call. Care Call Reassurance costs $15 per month if paid a year in advance, and CareCalls costs $39 per month plus a one-time activation fee of $99.

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Savvy Tip:

If you have questions or concerns about the medications your mom is taking, gather up all her pill bottles (including all prescription drugs, overthe-counter medications, vitamins, minerals, and herbal supplements) and take them to her primary physician or pharmacist for a drug review so he or she can look for any potential problems.

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. April 2011 •

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H ealth News Dr. Loretta C. Ford named to Women’s Hall of Fame Dr. Loretta C. Ford, founding dean of the University of Rochester School of Nursing, will be one of 11 American women inducted to the National Women’s Hall of Fame this fall. The induction ceremony will take place Sept. 30 and Oct. 1 in Seneca Falls, the birthplace of the American Women’s Rights Movement. Ford is an internationally renowned nurse leader who transformed the nursing profession and changed the delivery Ford of health care by cofounding the nurse practitioner model at the University of Colorado in 1965 with Henry Silver, a pediatrician. Today there are more than 140,000 nurse practitioners in the United States. In 1972, Ford became the founding dean of the University of Rochester School of Nursing, where she implemented the unification model of practice, education and research. During her tenure, the educational mission of the school of nursing also expanded beyond the bachelor’s and master’s degree programs to provide both doctoral and post-doctoral training. She retired in 1985, but continues to consult and lecture on the historical development of the role of nurse practitioners and on issues related to the advancement of nursing practice and health care policy. The National Women’s Hall of Fame is the nation’s oldest membership

organization recognizing the achievements of great American women. Inductees are selected every two years based on their lasting contributions to society through the arts, athletics, business, education, government, humanities, philanthropy and science. Founded in 1969, the National Women’s Hall of Fame has inducted 236 women since its inception. This year’s inductees join a notable group including Susan B. Anthony, Dr. Dorothy Haight, Maya Lin, Sandra Day O’Connor and Rosa Parks. For more information on all of this year’s inductees, visit www.greatwomen.org.

Roberts Wesleyan school recognized by NASP The National Association of School Psychologists (NASP), the governing body that provides standards and oversight for university-level degree programs in school psychology, has granted “full national recognition” to Roberts Wesleyan College’s graduate program in school psychology. This certification status, in place through Dec. 31, 2015, is awarded in recognition of the quality, relevance and comprehensiveness of the program in equipping students for the rigors of a career in the field of school psychology, according to NASP. Students who graduate from the program are eligible for the national certificate in school psychology (NCSP), a high professional distinction. “We’re very pleased to receive this determination from NASP’s program approval board,” said Cheryl Repass,

Guest Columnist

Generics continue to make inroads, offer savings By Joel Owerbach, Pharm.D.

he makers of high-cost brand name drugs continue to lose market share to lower cost generic versions and generic alternatives. According to a new Excellus BlueCross BlueShield Fact Sheet on cost trends of prescription drugs, generics now account for nearly 72 percent of all prescriptions written in upstate New York — up from about 52 percent five years ago. Some brand name drug manufacturers are aggressively looking for ways to save their spot in your medicine cabinet. Their strategy targets the electronic prescribing systems that more and more doctors are using to instantly send prescriptions from the exam room to the patient’s pharmacy. We’re encouraging, and physicians are embracing, e-prescribing technology because it can issue alerts about dosing, drug allergies, drug interactions and duplicate therapies. Errors Page 22

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tied to legibility and opportunities for fraud are virtually eliminated. E-prescribing software also can alert prescribers to money-saving opportunities with generic or other lowercost alternatives to high-priced brand name drugs. That’s why this technology has the attention of big drug companies. Legislation pending in Indiana, Kansas, Mississippi, Missouri, Nebraska, New Mexico, New Jersey, North Dakota, Oklahoma, Pennsylvania and South Dakota would prohibit e-prescribing software from showing doctors lowercost drug options, including generics and preferred brands; would prevent e-prescribing software from showing safety information; and would disallow lower-cost pharmacy options. According to industry Web site DrugstoreNews.com, one of the world’s largest drug makers, is behind e-prescribing restrictions within the Indiana legislation.

the college’s director of graduate psychology programs. “It confirms the quality of our graduate program in school psychology, and of the student candidates who complete it.” Repass added that NASP’s action also establishes the value of the program’s emphasis on clinical and therapeutic intervention. “NASP rated us strong in the clinical and therapeutic areas,” she noted. An official list of NASP-approved programs is published and posted online by the Association. Roberts Wesleyan anticipates a larger number of masters candidate applications as a result of the award and the added recognition it brings to the College.

St. Ann’s has new chief nursing executive St. Ann’s Community recently hired Michele A. Sinclair of Lancaster (Erie County) as the organization’s new chief nursing executive. Sinclair will oversee the day to day functions of the nursing departments in St. Ann’s Home and The Heritage, two skilled nursing communities on St. Ann’s Irondequoit campus, and will act as the director of nursing for St. Ann’s Home. “Michele is a highly motivated nursing professional who has extensive experience in leading Sinclair organizational change and building high-

If you read the article on Best Buy Drugs in the March 2011 issue of Consumer Reports, you’ll understand why. The Consumer Reports authors use Pfizer’s cholesterol-lowering statin Lipitor as an example of the opportunities to save with generics: They list a monthly supply of Lipitor (one 10-mg pill per day) at $112, compared to $4 for a monthly supply of CR Best Buy Drug generic alternative Lovastatin (one 20mg pill per day). We estimate the cost difference to be even greater since the current average wholesale price we see for Lipitor is $154 per month, compared to generic alternatives that range from $4 to $10 for a month’s supply. Excellus BCBS calculates that the increase in market share for generics over the past five years has reduced overall health care spending in Upstate New York by about $1 billion. Whether or not the state-by-state effort succeeds in placing limits on e-prescribing technology, ultimately health care consumers retain all the power. That is, as long as they remember to ask their doctor or pharmacist this simple question, “Is there a lower cost generic or over-the-counter alternative that’s right for me.” Joel Owerbach of Penﬁeld, is vice president and chief pharmacy ofﬁcer, Excellus BlueCross BlueShield.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011

performing teams. We are very much looking forward to the knowledge and expertise she brings to our organization. It is with great pleasure that I announce her selection and appointment,” said Michael McRae, senior vice president of operations/administrator of St. Ann’s Community. Sinclair is a certified nurse executive by the American Association of Nurse Executives and comes to St. Ann’s Community with 40 years of nursing experience. She previously worked as the vice president for clinical services in the long term care division of Catholic Health of Western New York, and was with the organization for eight years. During her time there she received a 2010 Healthcare Top 50 award from Business First in Western New York for her innovation, creativity and achievements in developing a cardiac program for transitional care patients with a diagnosis of Congestive Heart Failure that upon discharge significantly decreased the readmission rate to the hospital. Sinclair earned her Bachelor of Science in health care administration from St. Joseph’s College in Standish, Maine, and is a candidate to receive her Master of Science in nursing administration and leadership from the same school in 2012.

Alzheimer’s group honors educator Barbara Bruce The Alzheimer’s Association honored community leader Barbara Bruce at its first Celebrating Women & Successful Aging: Little Purple Dress Luncheon, a fundraiser designed to applaud women who have made significant and impact to successful aging and overall quality of life. The event was held March 3 at the Memorial Art Gallery. Coinciding with the release of national Alzheimer’s Association spokesperson Maria Shriver’s timely publication, The Shriver Report, the agency dedicated its newest fundraiser to inspirational women in the Rochester community who embody the true meaning and spirit of healthy living. The prestigious Debra J. Mayberry Inspiration Award was given to Barbara Bruce, an educator, public speaker, and successful aging facilitator who embraces and promotes best practices with regard to healthy living. “Barbara Bruce is truly an agent of positive change in the field of successful aging,” said David Midland, president/CEO of the Alzheimer’s Association, Rochester and Finger Lakes Region. “She has made a measurable difference in the lives of people in our community and we congratulate her on receiving this prestigious award.”

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A Farewell To Lucy

Continued from page 14

fall. She had difficulty getting up, but she was still going up and down small flights of stairs and getting under foot whenever I was cooking in the kitchen. She would practically tear my hand off when I would offer her a treat. She could still stand to eat and drink on her own for the most part, and she wasn’t having accidents in the house that often. For a while, I wasn’t convinced it was time, or that she was ready. I asked my vet for guidance on coming to the end of life decision. Hancock told me he measures a dog’s quality of life using three characteristics — attitude, appetite and activity. If a dog is unable to move, doesn’t have a good appetite, those are pretty good indicators they could be ready to be euthanized. Activity is another indicator. “Do they still seek attention, are they engaged in life, do they interact, or are they just apathetic,” said Hancock. “Those three things, individually and in combination, determine when its appropriate to allow a dog to go.” For a while, I wondered if I really would “just know,” as everyone led me to believe I would. My vet said it’s not uncommon for a patient to ask “is it time?” People want guidance. In the end though, Hancock told me, “I don’t make the decision for you, Amy, or for anyone else. That decision has to come from you and you have to be convinced it’s the right decision because it’s irreversible and I don’t want anyone second guessing that decision. These are things that have been our very good friends for a very long time and we all want to be making that decision appropriately.” Dr. Hancock said euthanizing pets is the hardest part of his job. “I’ve spent a lot of time crying with my clients,” he said. “It never gets easier.” I adopted Lucy in August 1995. Back then, her name was Sheba. Upon adopting her, I changed Sheba’s name to Lucy. I was 18 years old and fresh out of high school, about to enter my freshman year of college. Lucy was a 6-month-old mutt; 30 pounds of adorable, red spunk very much resembling a fox. It was not easy being a young college student raising a puppy, and many things were destroyed in the process. Despite all the trouble she caused, the two of us became inseparable. She was completely attached to me and could be trusted off a leash because she was so loyal she would never leave my side. Lucy loved to chase squirrels up trees, and I mean she literally could get

five feet up the tree and still stick the landing! She enjoyed being spoiled by “grandma,” loved blankets and soft fuzzy soccer balls, and was an all around easy-going, well socialized dog. She made many dog and cat friends in her day. Together we moved from place to place, and Lucy was there with me as I completed my degree and began my career. She was there through all my ups and downs, and sometimes she was the cause of them. It was late March of 2001 when Lucy was about 6 years old. For a few days, she’d been acting funny. Finally, I noticed that she was sluggish, to the point where she wouldn’t eat or drink anything. I rushed her to the vet’s office where I received some very grim news. Lucy had Auto Immune Hemolytic Anemia or, in other words, her immune system was attacking her red blood cells. Where most dogs have 37 to 57 percent red blood cells in their blood stream, Lucy’s were at 10 percent. Her platelet count was around 71,000. Normal levels are 200,000 to 500,000. “That’s on death’s doorstep,” said her former veterinarian Eric Ehrhardt, owner of Fruit Valley Veterinary Clinic in Oswego. In serious cases, the immune system will even also attack the bone marrow. For a week, Lucy stayed at the veterinarian’s office and showed no signs of improving. She had very little energy and could barely walk. “They don’t have the energy to spare for eating and walking,” Dr. Ehrhardt said of dogs with AIHA. “It’s totally exhausting. They’re basically in shock.” Lucy received a blood transfusion and stayed at the veterinarian’s office for five days, every one of which I would light a candle at night and pray that my dog would live to see old age. I wasn’t ready to lose this dog so young. I would visit Lucy several times a day, sneaking in some contraband turkey to tempt her taste buds. But still, her red blood cell count showed no signs of recovery. When Lucy was finally sent home on a Friday, the vets told me there was a good chance she would just pass away in her sleep, but they left the catheter in her paw just in case she seemed uncomfortable and needed to be put to sleep. Although she had no appetite, I was directed to try to give her five different medications twice

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a day. Three days later, on Monday, Lucy was still alive. I called the vet’s office and they told me to bring her in. A blood test showed her red blood cell count had risen to 17 percent. It seemed almost like a miracle. After at least $1,000 in vet bills, a lot of medications and months of rebuilding her strength, Lucy returned to her old self and every day since then has seemed like a gift. In her lifetime, Lucy has had several dental surgeries, she chewed at least a dozen pairs of shoes, she’s lived in two states and survived two dog attacks. Lucy spent a few weeks with one of my friends in Long Island one summer, and when I went to retrieve her, we took a detour to New York City where she got to see a concert in Central Park and ride the subway. This dog has lived more lives than any cats and better than many people. She’s lived the best life she could live. It was hard to make the decision this time around to pull the plug, but it’s a decision that’s been 15 years in the making. I knew the day would come. I even started a blog over a year ago, written from the perspective of Lucy, a dying dog reflecting on her life.

For more stories about the Amazing Tales of Lucy, visit theamazingtalesoﬂucy.blogspot.com

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Additional Locations: Clifton Springs • Greece

Reliability April 2011 •

In the end, the blog fizzled out. Just the day-to-day responsibilities of taking care of a geriatric dog took up any time I might have to blog. And after a while, it was just sad, because Lucy’s quality of life was just not there anymore. So I made the appointment to have her euthanized Friday, Feb. 25. wasn’t sure what this would be like, how I would handle losing my best friend. Of course, bringing Lucy to the vet for the last time was overwhelmingly sad. Taking her collar off her for the last time and feeling the warmth leave it was devastating. But at the same time, I feel like this is a celebration. The fact that I kept a dog alive and well for this many years is something I am proud of. I gave her the best life a dog could ask for. It will be hard without her. I’ll miss being able to bury my face in her fur when times are tough. I’ll miss her kisses, which never failed to make me smile through the hard times. Things are so quiet now that she’s gone, but it’s also nice to have some freedom. I know Lucy will always be with me, but she was ready to go and I think I was finally ready to let her go. Even though you’ll never be ready.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Gaining Insight Studies by Excellus help shed light on health care issues By Aaron Gifford

n the early 1990s, officials at BlueCross BlueShield wanted a better way to explain to its customers the connection between insurance premiums and health care costs. The company set up a corporate communications office and made plans to generate reports on what the true costs of health care really looked like— and what the public could do to keep the costs from constantly increasing. In the days before the World Wide Web, it was quite an ambitious undertaking. “There was a need for more conversation about personal habits and how it affected health insurance costs,” said Geoff Taylor, Excellus BlueCross BlueShield senior vice president of corporate communications. Taylor, who had worked as a news reporter for The Associated Press, was recruited for the initiative because the company wanted to produce materials that its customers could understand, free of scientific jargon and technical medical terms. “The main idea,” he said, “was to help people connect the dots.” As the Internet emerged, the reports evolved from a global approach designed to serve the entire customer base to a targeted approach for individuals. In 2003, the company began putting fact sheets on its website, with the topics ranging from cigarette smoking, to cancer screening, to insurance coverage for experimental treatments. A 2005 study published on costs savings for generic prescriptions made a huge splash in the insurance industry and with the media, as newspapers across the state published the Excellus report in its entirety. “It just got a ton of interest,” Taylor said.

Ad hoc approach

And yet, Excellus BlueCross BlueShield does not have a dedicated staff for these reports. Rather, it utilizes a team of writers and researchers that spends most of its time producing other types of materials for the company, and several in-house experts. That list includes chief pharmacy officer Joel Owerbach, who is considered a national expert on generic drugs, and Patricia Bomba, a geriatrician and national expert on end-of-life issues, Taylor said. “It’s entirely in-house people— even practicing surgeons contribute,” Taylor said. “And the writers work with them to make sure they speak plain English. They can’t use scientific terms or industry jargon.” All told, there are 49 different reports, surveys or fact sheets on Excellus’ website. The items are organized under 12 different general topics: AcPage 24

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cess and Health Coverage; Behaviors and Health Conditions; Costs—General; Dental Care; End of Life Care; Experimental Treatment and Clinical Trials; Health Measurements; Hospitals; Malpractice; Medical Advances; Prescription and Nonprescription Drugs. Taylor could not estimate an annual or total cost for producing the fact sheets and studies, saying there is no line item in the communications budget for that program. He also could not estimate how many employees work on a report in any given year. In fact, there is no formal schedule or plan for producing the fact sheets and the topics are not planned out way ahead of time, Taylor explained.

Backed by the facts

Employees keep an eye out for trends, and ideas for potential reports are discussed often, but the communications staff must be assured that the concepts, ideas and trends can be illustrated with reliable statistics and expert insight before anything is published. A typical fact sheet is 10 pages or less, and consists mostly of graphics, charts and comparison numbers for different regions of Upstate New York. All the data comes from reputable sources, Taylor said, such as the Centers for Disease Control and the state Department of Health. The final section of the fact sheet typically brings steps consumers can take to keep health care costs down and/or maintain a healthier lifestyle. A recent report on fall incidence and insurance costs for older adults, for example, said seniors can reduce the risk of fall by wearing sensible, properly fitting shoes and installing non-slip treads on wooden floors. Excellus officials said they know the fact sheets are well read, but it’s difficult to gauge whether these reports can be credited to customers making healthier and more economical decisions to help keep health care costs stagnant. Taylor did point out that generic prescription fill rates in Upstate New York grew faster than in any other region of the country after Excellus’ 2005 report. Liz Martin, Excellus vice president of communications in Syracuse, said the Compassion and Support health care website was inundated with hits after Excellus released its fact sheet on end of life care in 2008. The report noted that living wills and documents for health care proxies could be obtained from the site. “There has been a real up-tick in how many people were clicking on it for information,” she said. “There was

clearly a pent-up desire for people to get that information.”

Hot button topics

Moreover, the 2005 national media coverage of the debate surrounding the care of a Florida woman, (Terry Schiavo), who was in a vegetative state, prompted Excellus BlueCross BlueShield to engage in that topic with the community locally. “Patricia Bomba was involved in that as well,” Taylor said. “It’s not a pleasant topic, but we wanted to facilitate conversation between family members. It’s important to talk to your family about what your wishes are for end of life care.” The immediate future of the fact sheet initiative, Taylor said, is to update some of the reports for which the data has changed. A previous report on smoking, for example, showed that smoking rates were decreasing. The

latest round of regional statistics on smoking, however, no longer indicates a downward trend. “It’s somewhat discouraging,” Taylor said, “but we have an obligation to report the facts. The latest round of numbers hasn’t necessarily been moving in the right direction.” Martin stressed the role of the reports isn’t solely to encourage change or containing health care costs. That would be the case for the 2008 report on the leading causes of death in Upstate New York, which showed that heart disease and cancer were the No. 1 and No. 2 causes, respectively, of death in five regions of Upstate New York from 2003-2005. “Sometimes it’s just putting the information out there,” she said. “There’s not always a call to action. And it’s not always about the financial toll, but the human toll.”

Excellus findings Excellus BlueCross BlueShield has issued 49 reports and surveys in the last few years. Here are some of the findings: • Nearly 2 million New York state adults are informal caregivers • Close to 15,000 older Upstate NY adults are injured and hospitalized due to falls • An Excellus BlueCross BlueShield report finds that 127,000 upstate New York adults survived a stroke. • “New Report: Upstate Is Ripe with Opportunities to Save Lives, Time and Money with E-prescribing” • “Report: Upstate New Yorkers Unnecessarily Use the ER” • “Increase in Generic Fill Rate Saved Upstate New York $127 Million in 2009” • “Sexually Transmitted Diseases: The Silent Epidemic” To view other studies, fact sheet and surveys, go to excellusbcbs.com/factsheets.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • April 2011