COMPLIMENTARY
VOL 2 / ISSUE 3
NEW HAMPSHIRE
WO M EN MAGAZINE celebrating the women of New Hampshire
THE HEALTH ISSUE HEALTHCARE TODAY: A CONVERSATION PG. 10
Susanna Fier, VP of Corporate Communications & Public Affairs Elliot Hospital/SolutionHealth
Inside: Dr. Kristen Wright, Reproductive Endocrinologist Boston IVF & Clinical Assistant Professor Geisel School of Medicine at Dartmouth College
Could My Child Have Asthma?
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IN THIS ISSUE
CONTENTS 05 Dr. Terri Vanderlinde: A Passion for Helping Women Dr. Terri Vanderlinde of My Friend’s Gynecologist & Sexual Medicine in Dover, New Hampshire has devoted her life to helping women. She began her career as a high school science teacher at an all girls’ school, and was surprised to find that she could not answer all of her students’ questions about reproductive health. “I felt that I was letting them down,” she recalls. 07 Lactation and Milk Bank Services Benefit All Babies During Childbirth Portsmouth Regional Hospital (PRH), in partnership with Mothers’ Milk Bank Northeast, wants to ensure that all women have access to breast milk for their babies. In addition to existing lactation services at PRH, their newly-opened milk depot is a community location where screened milk donors can drop off milk at the
14 Ask the Pediatric Surgeon: Dear Dr. Soukup, I hope you could settle an on-going discussion with my spouse. Do you think it’s okay to leave our 2-year-old alone in the pool briefly with a coast-guard approved floatie on?
09 Karen Cerato: A Holistic Approach to Healing: For Karen Cerato, OT/L, RMT, RYT, founder, manager and owner of NH Health & Wellness Center in Nashua, New Hampshire, healthcare is about treating the whole person. Her journey towards this philosophy began in the 1990s, when she started her medical career by training to be an occupational therapist. Some years later she became intrigued by Reiki, and was certified in that discipline. 08 Could My Child Have Asthma? According to the Centers for Disease Control and Prevention, there are currently 6.2 million U.S. children living with asthma. If your child has a cough that never goes away, wheezes or whistles when running, or can’t breathe well during colds, asthma could be the reason.
12 Do Your Research: There are a
number of ways you can evaluate a potential aesthetic provider. It starts in the waiting room of course, as you look at the appearance of the facility, the staff and the potential service provider, but there are other things you can do to help you make a sound decision.
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TOP DOCTORS AND COUNTING We’re proud of the 112 doctors from across the Dartmouth-Hitchcock Health System featured on this year’s New Hampshire Magazine’s Top Doctors list. Thank you for your expert knowledge and compassionate care, and for helping us have more top doctors than any other health system or hospital in New Hampshire.
Alice Peck Day Memorial Hospital, Cheshire Medical Center, Dartmouth-Hitchcock Medical Center, Mt. Ascutney Hospital and Health Center, New London Hospital, Visiting Nurse and Hospice for Vermont and New Hampshire, Dartmouth-Hitchcock practice sites at more than 24 locations throughout the region. dartmouth-hitchcock.org
Denise Aaron MD Stacey Abbis MD William Abdu MD MS Daniel Albert MD Bruce Andrus MD MS Bradley Arrick MD PhD Emily Baker MD Perry Ball MD James Bartels MD Richard Barth Jr. MD Joan Crane Barthold MD Barbara Bates MD John Batsis MD David Bauer MD Valerie Bell MD John-Erik Bell MD Elizabeth Bengtson MD Paul Bettinger MD William Bihrle III MD Brian Binczewski MD William Black MD Annika Brown MD Jack Bueno MD Christopher Burns MD Mark Carney MD Samuel Casella MD Mary Chamberlin MD M. Shane Chapman MD Jeffrey Cohen MD Phillip Collins MD Richard Comi MD James DeVries MD Todd Dombrowski MD MS Konstantin Dragnev MD Richard I. Enelow MD Elisabeth Erekson MD MPH David Finley MD Timothy Fisher MD MS Evelyn Fleming MD Naomi Gauthier MD Marc Gautier MD Jennifer Glatz MD Patricia Glowa MD Philip Goodney MD MS Stuart Gordon MD E. Ann Gormley MD Benoit Gosselin MD James Gray MD MS Sherry Guardiano DO Matthew Hand DO Jeffrey Harnsberger MD Cherie Holmes MD MSC Paul Holtzheimer MD Joseph Hou MD Kathyryn Hourdequin MD
John Jayne MD Scott Jaynes MD Barbara Jobst MD J. Gilliam Johnston II MD Julie Kim MD PhD Alan Kono MD Stacey Kopp MD Kevin Kwaku MD PhD William Laycock MD Gregory Leather MD Lisa Leinau MD Stephen Liu MD MPH Keith Loud MD MS Harold Manning MD Heather Marks MD M.T. Charisse Marquez MD Keith McAvoy MD Jock McCullough MD Kenneth Meehan MD John Moeschler MD Patrick Morhun MD Srikrishna Nagri MD Catherine Pipas MD Emil Pollak JR. MD Richard Powell MD Anthony Presutti MD Brian Remillard MD William Rigby MD Steven Ringer MD PhD Lara Ronan MD Kari Rosenkranz MD Richard Rothstein MD Nina Sand-Loud MD Andrew Schuman MD Gary Schwartz MD Keisuke Shirai MD MSC Corey Siegel MD MS Mark Silbey MD Nathan Simmons MD Lijun Song MD PhD Andrew Spector MD David Stone MD Arief Suriawinata MD Vijay Thadani MD PhD Andrew Trembley MD Vijaya Upadrasta MD Dale Vidal MD Adam Weinstein MD Wendy Wells MD Loyd West MD Brent White MD Jill Winslow MD Jan Wollack MD PhD Alicia Zbehlik MD
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NEW HAMPSHIRE WOMEN MAGAZINE
IN THIS ISSUE
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SPOTLIGHT COLUMN | NHWM
DR. TERRI VANDERLINDE: A PASSION FOR HELPING WOMEN Dr. Terri Vanderlinde of My Friend’s Gynecologist & Sexual Medicine in Dover, New Hampshire has devoted her life to helping women. She began her career as a high school science teacher at an all girls’ school, and was surprised to find that she could not answer all of her students’ questions about reproductive health. “I felt that I was letting them down,” she recalls. WORDS: Crystal Ward Kent
“
I realized that there was a tremendous
need for more education in this area.” Vanderlinde went back to school and became an obstetrician/gynecologist. After serving as a major in the U.S. Army Medical Corps, she entered private practice, joining a group of other physicians. However, she was soon dissatisfied with how modern medicine operates. “I never felt right giving my patients just 15 minutes of my time,” she states. “I am seeing them at their most vulnerable when they come in for exams; many have questions and concerns, and I was supposed to rush them out the door. It was not how I wanted to practice medicine, nor how I felt medicine should be practiced.” Vanderlinde set out on her own, and stopped practicing obstetrics, instead choosing to focus on sex counseling, along with gynecology. “I’m one of only five doctors in New England who do sex counseling,” she explains, “and one of only two in New Hampshire. I’m not a sex therapist; I’m a counselor, which means that I bring that medical background to the discussion. I help women of all ages with all types of sexual issues. There is a tremendous need for this type of service. Sex plays an important role in our lives and relationships, yet many women don’t know where to go to get these issues addressed.” Vanderlinde, who is board certified in obstetrics/gynecology, wanted to be sure that she could offer a wide range of treatments for her patients, so she also became educated in a range of alternative medicine therapies. “I prescribe traditional solutions such as surgery and medications, but also discuss vitamins, salves, herbal treatments and acupuncture. This way, I can suggest a variety of solutions for my patients, and they can choose what they feel most comfortable with.” The new path has proven rewarding, for both Vanderlinde’s patients and for her. “I am energized by my patients,” she says. “I
am so privileged to have their trust, in that they allow me to examine them and that they confide in me. I am humbled and honored to be entrusted with their care. Helping them resolve their issues and lead more fulfilling lives is rewarding beyond measure.” While Vanderlinde loves working with her patients, she admits to being frustrated by the status of healthcare and the limitations of insurance, which she feels often prevent patients from getting the care they truly need. “I’ve spent my life studying the needs of women, learning about their bodies and how to treat their ailments, yet my knowledge as a doctor is not acknowledged. When I say my patient needs this procedure or treatment, too often the insurances don’t provide coverage, so the patient cannot get the care that they need. We as doctors spend too much time fighting with the insurance carriers over things that should not be in question, and that’s time that could be better served treating our patients. Medical care should not require so much debate.” Vanderlinde is also passionate about physicians being able to return to a more personal level of healthcare, an approach that she feels is essential to a patient’s healing process. “Every patient deserves adequate time and the doctor’s undivided, personal attention,” she says. “This is why we practice medicine— so that we can heal people. To me, that means taking the time to look my patient in the eye, take their hand, maybe even give them a hug if they are especially stressed. In other words, we should be able to engage in those moments of human connection and compassion, and not just conduct a rapid-fire medical history. Our patients deserve to be heard and feel listened to. I’ve seen firsthand how important this is. To me, taking this time is as important as any medicine I can prescribe. I hope that one day, we will find our way back to this being the standard of care.”
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why does my morning sickness last all day?
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EXPERT BIRTHING INFO PROVIDED BY PORTSMOUTH REGIONAL HOSPITAL
Lactation and Milk Bank Services Help Benefit All Babies During Childbirth Mothers who wish to donate milk can review all of the guidelines on the milk bank website, http:// www.milkbankne.org/donate, then contact a Donor Intake Coordinator for screening at 617-5276263 x3 or donate@milkbankne.org.
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ost healthcare professionals encourage mothers to breastfeed their babies, but for some women breastfeeding does not come easily. Issues with milk production, latching, pumping, and other obstacles can make it difficult for many women to successfully breastfeed. Portsmouth Regional Hospital (PRH), in partnership with Mothers’ Milk Bank Northeast, wants to ensure that all women have access to breast milk for their babies. In addition to existing lactation services at PRH, their newly-opened milk depot is a community location where screened milk donors can drop off milk at the hospital for shipment to a milk bank.
Lactation Services Even before her baby is born, a woman can take advantage of free Breastfeeding Basics classes, designed to increase her confidence in breastfeeding. These classes are available to all pregnant women, whether they plan to deliver at PRH or not. Prenatal lactation services include breast assessments, comprehensive health and medication reviews, breastfeeding education, and the creation of a personalized breastfeeding plan. After the birth of her baby, Portsmouth Regional Hospital has additional lactation assistance available in the form of: •
Outpatient lactation visits
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3 employed certified lactation consultants (IBCLC) with more than 80 years of combined experience.
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A private room for breastfeeding mothers to pump or feed their babies.
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Breast pumps and supplies for sale.
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Free support for all breastfeeding mothers in a weekly New Moms Support Group, which meets every Wednesday at 10 a.m. for babies older than 6 months and at 1 p.m. for babies younger than 6 months.
Nora Fortin, RN, Director of Seacoast Family Care Services at Portsmouth Regional Hospital, shares why breastfeeding helps lay the foundation for a healthy childhood and how babies benefit from drinking human milk instead of formula. “Giving formula to newborns changes a baby’s gut and gets rid of good bacteria. By ensuring that all women have the option of giving their babies human milk, we also help ensure that babies are given the best chance to grow and thrive.”
Milk Bank Services But what happens when a mother is not able to produce enough breast milk for her baby? Mothers’ Milk Bank Northeast, (MMBNE) a nonprofit community milk bank accredited by the Human Milk Banking Association of North America (HMBANA), has the answer. Since 2011, MMBNE has been screening donors, pasteurizing milk, and dispensing to over 80 hospitals and to families throughout the Northeast. For babies born prematurely or with serious medical conditions breast milk, whether from the birth mother or a donor, helps provide the best nutrition to support their developmental needs. As Krystal Atkinson, Chief Nursing Officer with Portsmouth Regional Hospital says, “Human milk can be lifesaving for preterm infants. It is especially protective against a life-threatening condition called necrotizing enterocolitis (NEC), which affects 1 in 10 of the smallest preterm infants. Human breastmilk is estimated to lower the risk of this condition by 79%. It also lowers hospital costs by reducing costs for care and shortening hospital stays.”
infants in neonatal intensive care units (NICUs). In addition, an increasing number of community hospitals with regular and special care nurseries use donor milk when babies need a supplement to their mothers’ own milk. Portsmouth Regional Hospital is 1 of 11 hospitals in New Hampshire offering donor milk, and 1 of 4 with their own milk depot. “The presence of a milk depot signifies a deep commitment to the health and well-being of the most vulnerable members of the community—the fragile babies whose lives depend on safe, pasteurized donor milk,” says Ann Marie Lindquist, Director of Community Relations for Mothers’ Milk Bank Northeast. Throughout history, mothers have helped each other by nursing each other’s babies, and it was once common practice for wealthy families to hire wet nurses for their babies. Today, the milk bank is a modern way for mothers to continue helping other mothers and babies in need. The donation process is simple: •
Complete a 15-minute phone screening.
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Fill out forms.
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Get a blood test, paid for by MMBNE.
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Make arrangements for delivery of your breast milk at no cost to you.
Mothers who wish to donate milk can review all of the guidelines on the milk bank website, http://www.milkbankne.org/donate, then contact a Donor Intake Coordinator for screening at 617-527-6263 x3 or donate@ milkbankne.org. Approved donors can then drop off milk at the PRH milk depot by appointment, from Monday through Friday, 8 a.m. to 4 p.m., at Portsmouth Regional Hospital’s Lactation Office. Call 603433-4086 to schedule an appointment.
Donor milk is rapidly becoming the standard supplement to mothers’ milk for preterm
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ASTHMA:
COULD MY CHILD HAVE ASTHMA?
A
ccording to the Centers for Disease Control and Prevention, there are currently 6.2 million U.S. children living with asthma. If your child has a cough that never goes away, wheezes or whistles when running, or can’t breathe well during colds, asthma could be the reason. Asthma is a syndrome related to swelling (inflammation) inside bronchial tubes together with twitchiness of airway smooth muscle (bronchospasm). Asthma can limit your child’s activities because inflammation and bronchospasm can obstruct airflow and make running and playing difficult. In addition to a nagging cough or wheezing during the day, asthma symptoms can lead to restless nights from constant coughing. Asthma exacerbations (formerly called “asthma attacks”) can be severe. The sudden increase in inflammation and bronchospasm limits airflow, which can be a medical emergency. If your child ever has severe breathing difficulties, can’t speak, or has changes in color or level of alertness, call 911 and get to the hospital right away. Not all children have regular symptoms of asthma. Some kids only have coughing, wheezing, or trouble breathing with colds. The common cold (known as the human rhinovirus) is one of
Marcus Shaker, MD, MS, FAAAAI, FAAP
the most frequent causes of worsening asthma. Managing asthma The goal of management is to make sure you control asthma—not the other way around! Albuterol is an important “rescue” medicine because it treats bronchospasm and makes breathing easier. But albuterol doesn’t treat airway swelling or inflammation. Addressing long-term asthma inflammation requires allergy testing to identify triggers. Many patient benefit from prescribed anti-inflammatory asthma controller medications, which improve daily symptoms and reduce the risk of asthma exacerbations. Inhaled corticosteroids (ICS) are the most common asthma controller medications and reduce inflammation within two weeks to two months. Treating airway inflammation takes time, so it is important to continue using these medications even as asthma symptoms improve. In addition to ICS controller-type medicines, there are new strategies that target the inflammatory molecules that cause airway swelling and can be very effective in controlling asthma. Children with asthma should always get a flu shot, and avoid tobacco smoke and known allergen triggers.
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Asthma is often classified using the “Rule of Two.” This means if a child has wheezing, coughing and/ or shortness of breath more than two times per week, an asthma controller (like an ICS) would be worth trying for a few months. Your child would also meet the “Rule of Two” if they have a nighttime cough that wakes them up more than two times per month. If asthma meets the “Rule of Two” we call it persistent (vs intermittent) asthma, and if it’s persistent, an asthma controller is needed. Can your child outgrow asthma? Children without other allergy risk factors, who tend to wheeze only a few times with colds, and do not have daily symptoms apart from colds are more likely to outgrow asthma. Asthma is more stubborn in kids with eczema, food allergies, environmental allergies or family members with asthma. Work the plan Families should work closely with their providers to develop an asthma action plan, which uses a “trafficlight” system to manage asthma by identifying worsening symptoms and treatment changes. The “green light” indicates daily management, including ICS dosage recommendations. The
“yellow light” stands for the onset of cold symptoms, allergies, or wheezing and includes the use of a rescue treatment (like albuterol). The “red light” means an emergency requiring medical care. Emergency providers will administer corticosteroids to reduce airway swelling and bronchodilators like Albuterol. Because corticosteroids can take several hours to work, it’s better to seek emergency care as soon as possible. Clear symptoms of the red zone include hard and fast breathing, needing rescue Albuterol treatments more often than every four hours, “pulling for breaths” (muscles between their ribs show or their nostrils flare out) or difficulty speaking in complete sentences. If you are worried or the plan is not working, it is important to get help. The goal of asthma management is to make breathing easy—so kids can be kids. Most of the time, a few simple steps can effectively control symptoms—giving your child more valuable time spent in school, sports and activities, and play. Marcus Shaker, MD, MS, FAAAAI, FAAP, is a doctor in Allergy, Asthma, and Clinical Immunology at the Children’s Hospital at Dartmouth-Hitchcock (CHaD).
NHWM | SPOTLIGHT
KAREN CERATO: A HOLISTIC APPROACH TO HEALING nutritional coaching, Naturopathic medicine and more. Cerato added to those offerings by becoming certified in Lyme Magnetic Protocol, a therapy that is used to treat not only Lyme disease, but also other illnesses where chronic infection is the culprit. Since opening its doors, the Center has seen significant The NH Health & Wellness Center is a cohesive team of highly trained, growth. compassionate health care providers who are committed to offering our “I started clients and community the education, empowerment, and integrative the Center just three and a therapies needed to achieve optimal well-being for the whole person. half years ago with just four 60 Main Street, Nashua NH 03060 providers and we now have 603.402.9134 • www.nhhealthwellness.com 12,” she says. email — info@nhhealthwellness.com “I love my team—we are a very cohesive group who work Written by Crystal Ward “Yoga really awakened me together for the good of the Kent to the fact that our health has patient. Patients may see just one not just physical components, of us, or several of us, depending or Karen Cerato, OT/L, but also mental, emotional, and on what is the best fit for their RMT, RYT, founder, spiritual,” she explains. “Too care. At the Center, our goal is manager and owner often, we focus only on our to get at the root cause of the of NH Health & Wellness physical selves, but how we are illness. We don’t just prescribe Center in Nashua, New faring in other areas can greatly a pill; we look at everything that Hampshire, healthcare is impact how we feel and how might be triggering the illness. about treating the whole our bodies function. The more “We also believe that there person. Her journey towards I learned about this philosophy, can be successful partnerships this philosophy began in the the more I realized that I between traditional medicine 1990s, when she started her wanted to pursue healthcare and integrated medicine. I medical career by training to with this as the foundation.” think we have been successful be an occupational therapist. Cerato became so committed because many patients feel that Some years later she became that in 2016 she opened the with today’s healthcare, they fall intrigued by Reiki, and was NH Health & Wellness Center, through the cracks. If they don’t certified in that discipline. seeing it as a place where fit into a certain box, they don’t She began seeing clients and people could receive a variety get the answers they need. We teaching others, but it was of treatments in a centralized work to get those answers, no not until she got involved setting. The Center offers matter how long it takes.” in yoga that pursuing a various alternative medicine more holistic approach to Cerato finds the Center’s modalities, including Reiki, healthcare became the goal. work very rewarding, as do the acupuncture, massage therapy, LESLIE EISENBERG PHOTOGRAPHY
Compassionate Care, Excellent Results
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members of her team. “Seeing patients get their lives back— there is no greater reward. We recently had a teenage girl who had been completely disabled due to chronic Lyme Disease. She had no energy and was not getting better. After a round of treatments here, she was back running and working a part-time job. She was living like she was meant to live.” Cerato admits that her field is not without challenges. “One of the biggest challenges we face is that there is a lot of confusing information out there. People have so many sources of information, especially with the Internet, that it can be overwhelming. They often don’t know what to believe. We help them sort through all of this data and hopefully, find the best treatment for them.” Cerato is excited about the Center’s future, and their ability to help more people heal. “We want to be the ‘who’ that people are looking for,” she says. “We believe that it’s not so much about what the diagnosis is as it is about who is the right fit for providing treatment. With our team effort, we believe that we can be that right fit for those in need.” The NH Health & Wellness Center also brings a strong female component to healthcare—though it was not by design. “Somehow, we wound up with 11 of our 12 providers being women,” laughs Cerato. “It’s turned out to be a good thing, though. I think there is a lot of sensitivity in our practice, and a lot of intuition. I do believe that women have a stronger sense of intuition, and that we are more comfortable tapping into that. We all have professional training and decades of experience, but when you combine that with intuition, I think it leads to exceptional healthcare.”
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NHWM COVER WOMEN | HEALTH ISSUE
HEALTHCARE TODAY: A CONVERSATION
Healthcare continues to be a hot topic in New Hampshire and elsewhere. Whether it’s discussions about coverage and premiums, excitement about technological advances, or pondering a new treatment, healthcare is usually in the news—and part of our conversations. Written by Crystal Ward Kent & Photograpy provided by Elliot Health System & Boston IVF NH Women decided to get some expert perspective on today’s healthcare. We spoke with two women who work in different aspects of the field--one as a physician and the other in healthcare administration. Here are there thoughts:
Meet the Experts:
Dr. Kristen Wright, reproductive endocrinologist and Clinical Assistant Professor at Geisel School of Medicine/Dartmouth. Susanna Fier, Vice President of Corporate Communications and Public Affairs for Elliot Health System/SolutionHealth.
PHOTOGRAPHY BY: LINDSAY LEIGH PHOTOGRAPHY
Why do you do what you do? Dr. Kristen Wright: “I’ve been interested in medicine my entire life. I loved science, but knew that I also wanted to help people in a direct way, and that medicine would let me do that. I wound up focusing on women’s health issues, and specifically infertility, after taking a course in Women’s Studies while in college. I realized that I could empower women by helping them overcome infertility. A diagnosis of infertility is pretty devastating, and impacts a woman not just physically but emotionally.” Susanna Fier: “I began my career as a lawyer. However, my dad is a doctor and my mother was always very involved in philanthropy when I was growing up, so healthcare was a big part
Susanna Fier, V.P. Corporate Communications & Public Affairs at Elliot Health System/SolutionHealth of my life. When the opportunity presented itself for a job at Elliot Hospital to help them develop their Charitable Foundation, I was intrigued. I joined and then took over the Public Affairs and Marketing Department. I’ve never regretted moving into the field; I love working in healthcare; it’s been a good fit for my skills.”
What do you see as some of the challenges facing healthcare today? Dr. Wright: “I think it’s hard for doctors to find the time to do all of the things that are required today. We spend a great deal of time dealing with things that don’t relate directly to the patient or their recovery. We need to improve the way that we deliver
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Dr. Kristen Wright, reproductive endocrinologist Clinical Assistant Professor at Geisel School of Medicine/Dartmouth.
healthcare so that doctors can spend more time doing what they are trained to do, and patients get the full benefit of the doctor’s time.” Fier: “Being able to adapt to the ever-changing healthcare landscape will remain a challenge. However, I do see many of the changes as positive steps to adapt and keep pace with the challenges that lie ahead. More healthcare partnerships are forming as providers join together in an effort to provide more local comprehensive care. Recently, Elliot Hospital and its affiliates joined with Southern New Hampshire Health as SolutionHealth for that very reason. We believe we will be better together. With this change, a patient can be seen
in Manchester or Nashua, and thanks to our collaboration, many patients will not have to leave their community or leave the state to get the care that they need. “Let me give you two examples: Recently, we had a patient at Elliot who needed a procedure by a gastroenterologist specialist who was not at our hospital. Southern New Hampshire Medical Center had such as specialist, and because he is also credentialed at Elliot and part of SolutionHealth, he was willing to come to Elliot Hospital and provide the care the patient needed. We also had a mom with a pre-term baby who was delivering at Southern New Hampshire Medical Center; when complications arose, they transferred to the Elliot Hospital
neo-natal intensive care unit, and now mom and baby are doing well. These examples show that positioning ourselves together enables us to prepare for the needs of the community well into the future.”
What do you see as benefits when it comes to healthcare today? Dr. Wright: “Technology today has advanced at an incredible rate, especially in my field. We now see patients who have diseases or conditions that in the past would have been incurable, and now they can be treated. Genetic research is very promising. I’m excited to see the great strides that have been made in the treatment of infertility. Before, there was little that could be done, but now that’s not the case. All in all, it’s an exciting time to be in medicine.”
caring and respect. We’ve also connected with affiliated services to make sure that these patients are ultimately able to get back to work, back with their families, and back to being productive members of their communities. When there is an emerging need, I believe leaders in healthcare are working as quickly as possible to try to become part of the solution.”
What changes would you like to see in terms of today’s healthcare? Dr. Wright: I’d like to see the system become more streamlined. The insurance system needs to be more user-friendly. We also need to see more doctor-input when it comes to what insurances should cover. We are the ones with the expertise and the knowledge of what is the best course of treatment, but often, patients cannot pursue our recommendations
Women frequently make the healthcare decisions for their families, any advice for them? Dr. Wright: “Pick a provider that you are comfortable with. It’s important to have a good connection with your doctor, as that will allow you to develop a better relationship over time. If you are choosing a specialist for a procedure, make sure that the specialist has extensive experience with that procedure. “ Fier: “We know from surveys that most people choose their providers based on their insurance plans and doctor recommendations. However, I would suggest that people also take the time to visit the doctor’s or hospital’s websites and read the information there.
“I’d like to see the system become more streamlined.” Fier: “This may seem like an unusual choice, but electronic medical records (EMRs). Having a single EMR at Elliot has made a tremendous impact on patient care. Wherever Elliot patients go, whether they have tests, see a specialist or primary care provider, or transfer to another physician within our network—their complete medical record goes with them and is accessible to the Elliot care team. Soon, the single EMR will be available to patients from Southern New Hampshire Health as well, as part of our SolutionHealth strategy; it will allow us to better serve our communities and work effectively together across southern New Hampshire. “I also think that today’s healthcare has proven to be very flexible when it comes to meeting the demands of the communities it serves. One example is how healthcare has risen to meet the challenge of the opioid and behavioral health crisis. Numerous experts have come together to help people get the treatment they need and to make sure that those in crisis are treated with
because the treatment isn’t covered. We have also noticed that insurance coverage has not kept pace with the incredible advances in medicine. Insurances are sometimes recommending treatments that are outdated, rather than what is the new standard of care—and what is best for the patient and their recovery. It should also be easier for patients to see specialists, as a specialist can often put the patient on the path to healing.”
We really make an effort to include lots of valuable information on our sites, from where our doctors studied, their credentials and specialties, to a bit about their personal interests. In many cases, you will also see patient comments and testimonials available on the site. Websites such as ours can really be a tremendous resource for people looking to make a healthcare choice.”
Fier: “I’m not sure if this is a change that I personally want, but I know that my teenage son would definitely embrace it, and that’s seeing electronic medical visits become more commonplace. I think that they are the wave of the future. Many people still prefer an in-person visit, but I believe Millennials will want this technology. Electronic visits are in use now in remote places where people cannot get to providers, or when there is an emergency and an electronic consultation must take place. However, I think the next generation will see the electronic visit as another way for them to save time, receive care, and get on with their day.” nhwomenmagazine.com / VOL 2 ISSUE 3 / 11
MEDICAL SPA | SPECIAL SECTION
DO YOUR RESEARCH Written by Dr. Lisa Vuich, Owner of Renew Medi Spa
Dr. Lisa Vuich is a graduate of Tufts University (1988) and Tufts University School of Medicine (1992). She opened Renew MediSpa in 2006 and has worked steadily since then to ensure that Renew MediSpa remains at the cutting edge of the latest advancements in nonsurgical aesthetics. She is a nationally recognized injector, a member of numerous aesthetic organizations, a Key Opinion Leader for several aesthetic companies, and a Master Clinical instructor for Specialty Med Training. She is board certified by the American Academy of Aesthetic Medicine and regularly instructs physicians and other providers on injection technique, platelet-rich plasma therapies and other aesthetic procedures through the Renew MediSpa Training Institute.
T
he last few months have seen multiple arrests of medical providers in the field of aesthetics, in most cases for violation of regulations. In New Mexico, a medical spa was shut down after inspectors identified “practices … that could potentially spread blood borne infections.” At least a few people who had procedures at this spa may have been infected with HIV as a result. Another arrest in Texas involved a medical assistant who was injecting without a license, without direct supervision, and with injectable products illegally imported from other countries. Multiple arrests in Florida in the last 6 months have stemmed from unlicensed and unsupervised providers performing services such as botox, dermal filler, IV’s, and hormone injections that are not within their scope of practice and not performed under medical supervision. There are a number of ways you can evaluate a potential aesthetic provider. It starts in the waiting room of course, as you look at the appearance of the facility, the staff and the potential service provider, but there are other things you can do to help you make a sound decision. Here are my top 5 tips: 1.
Do some “homework”Review the information provided by the practice on their website. Who are the providers, and what are their credentials? How long have they been performing the services, and how much time do they devote to their aesthetic practice? A
provider who injects once a week for example, and spends the rest of their time involved in non-aesthetic work, is not likely to deliver the same level of service as one who devotes themselves to aesthetics full time. You may elect to go to a novice injector, but if so you should at least know that up front to factor it into your decision. 2.
3.
requirements. The director must also be readily available in case of complication or need for urgent evaluation. 4.
Check out their ReviewsAre there just a handful of reviews, or hundreds or thousands of reviews? A 5-star rating based on 5 reviews doesn’t tell me much. An occasional negative review is going to happen no matter how expert a practice is, but the preponderance of opinion should of course be very positive. Hundreds of overall positive reviews is good evidence that it is likely a seasoned, high quality practice. Know some basic regulations. In New Hampshire as in many states, an RN can inject botox and dermal filler or deliver an IV, but cannot “formulate the plan of care.” In other words, they cannot decide the treatment to be delivered and then do so without a Physician or Nurse Practitioner having been involved first. Contact with the medical supervisor can occur that day, even if via Skype or similar, or in the recent past in a consultation regarding the procedures. Having a medical director “listed on the website” does not meet regulatory
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5.
Ask to see before and after photos of the provider’s results. Aesthetics is an art, and the skill of the artist will be more likely to determine the outcome of your procedure than the product in the syringe. This is not an unreasonable or unusual request, and you should be shown their own results rather than stock images from the manufacturer. If you are unsure whether an image on a particular practice’s website is a stock image, go to images.google. com. There you can do a reverse image search- in other words you upload the image through the search bar and Google will find where that image occurs in cyberspace. Typical stock images will pull up thousands of hits with this query since so many doctor’s offices use these on their websites as before and after examples. “Just say No” to Groupon- Groupon is simply not the place to be hunting for “a deal” on medical grade
services. If you knew how their fees and pricing are structured you would understand why. Would you normally look for a doctor or surgeon on Groupon? Every week at Renew MediSpa we see new clients who have had a negative experience with these deals. In many cases it is just that they saw “no difference whatsoever” after their procedure, but in some it is unwanted side effects such as poorly placed dermal filler, which we then have to dissolve for them. So much for “a great deal.” This is an exciting time in the field of non-surgical aesthetic medicine. New technologies and devices are coming out on a regular basis, making it possible to achieve results that previously would have required a surgeon’s knife. It is important as a consumer that you stay well informed, and find a provider who will help guide your decisions with your best interests in mind, and with safety as a number one priority.
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MAULING
Elliot Hospital: Ask the Pediatric Surgeon
BOULDERS
Q.
Dear Dr. Soukup, I was hoping you could settle an ongoing discussion with my spouse. Do you think it is ok to leave our 2 year old alone in our pool briefly with a coast-guard approved floatie on? Thanks! Anne A.
Dear Anne,
Thank you so much for this question! I’ll use it as an opportunity to highlight water safety as we jump-start into summertime. This is a scary topic to think about, but so important to be aware of. Children, especially toddlers, are at the highest age risk for drowning. It is the #1 cause of death for children age 1-4 years. They are curious explorers and do not yet understand that water can be dangerous. Unsupervised access to water represents the biggest threat to toddlers (including bathtubs, pools, lakes and other sources of standing water), but more than 30-40% of drownings occur with adult supervision present. Drowning happens quickly and silently, and 10% occur with an adult watching it happen – not recognizing that the child is in danger! Drowning doesn’t look like it does in the movies. A drowning victim is usually vertical in the water, mouth bobbing at water level, head tilted back, eyes closed or covered by hair. They are not waving their arms, splashing, or calling for help. It is silent and rapid. For this reason, the American Academy of Pediatrics (AAP) recommends close constant, undivided attention to toddlers who are in or around water. Use “touch supervision,” staying within an arm’s reach of a toddler near or in the water. This
is particularly true at poolside parties where it may seem there are many adults around, but no one is actually paying attention. The AAP recommends assigning a “water watcher” to constantly keep eyes on the child, taking turns with another responsible adult periodically. Cellphones, books, and other distractions should be eliminated while on watch. Life jackets or coast-guard approved floatation devices should be used in natural bodies of water, particularly in rivers where the current can be strong. However, even these floatation devices should never take the place of direct supervision. Swimming lessons for children of all ages is also recommended as another layer of protection for water safety. Lastly, fences, safety gates, and door locks can prevent unintended access of a toddler to water. So have fun! Enjoy the summer! But keep these important recommendations in mind for our children’s safety. Thanks for your question! Dr. Soukup #askthepediatricsurgeon If you have medical questions for Dr. Soukup, please forward them to askthepediatricsurgeon@elliot-hs.org.
Elizabeth S. Soukup, M.D., M.M.Sc. Pediatric Surgeon
Dr. Soukup is a Pediatric Surgeon at the Elliot Hospital and has an interest in educating families about pediatric health and wellness. Her mission is to provide expert specialty care for children of all ages in New Hampshire – newborns through teenagers – striving to keep them close to their families and communities. If you would like more information, call 603-663-8393 for an appointment, or visit our website at http://elliothospital.org/website/pediatric-surgery.php. Check out her previous articles at #askthepediatricsurgeon. Dr. Soukup earned her Bachelor of Science from the Massachusetts Institute of Technology and her Doctor of Medicine from the University of Chicago Pritzker School of Medicine, where she received the Outstanding Achievement Award in Medicine, graduating first in her class. She completed her General Surgery training at the Massachusetts General Hospital and her fellowship in Pediatric Surgery at Children’s Hospital Boston. During her time in Boston, she also completed a Masters of Medical Sciences degree in clinical investigation
Please send your questions to: askthepediatricsurgeon@elliot-hs.org
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from Harvard Medical School. She was awarded Elliot Hospital’s “Physician of the year” for 2018. She is board-certified in both Pediatric Surgery and General Surgery. She has specialized training and experience in minimally invasive surgical treatment for babies, children and teenagers. Her practice includes all areas of general pediatric surgery, including common pediatric surgical problems as well as neonatal surgery, congenital anomalies, minimally invasive surgery, and complex thoracic surgical problems.
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