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progress Women and Children’s Services 2008

The Sandwich Generation

Caregivers Stuck in the Middle

Battling Childhood Obesity

Tips for Healthier Kids and Families

www.PoconoMedicalCenter.org

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Women and Children First At one time, this quaint phrase acknowledged that women and children needed extra protection. In this issue of Progress we’re putting women and children first—with a twist. At Pocono Medical Center, we have a long tradition of providing quality care for the women and children of our community. The stories on these pages help illustrate that commitment.

Caring for our children means caring for our future, and at PMC we’re working hard to ensure our kids enjoy vibrant, healthy lives. To this end, the dedicated staff at the Clementine Abeloff Community Health Center provides quality healthcare to our community’s most vulnerable children, the un- and underinsured.

In our story on the Donna L. Hodge Memorial Dental Center, you’ll meet one of the newest additions to our caring staff. We also tackle one of our society’s most critical health care issues—childhood obesity. Helping

children cope with asthma is the focus of our partnership with Upward Bound Asthma Camp, an institution that celebrated its nineteenth year this summer. In addition, families struggling with diabetes and Attention Deficit Hyperactivity Disorder (ADHD) will find useful information in these pages.

Women in our community face equally compelling health issues.

We’re addressing one of these, breast cancer, by offering new digital mammography servies. From heart disease, to pain management to hot topics like perimenopause and the so-called “Sandwich Generation� of caregivers, we offer tips to women who are struggling with these challenges in today’s fastpaced world.

I hope that you enjoy reading about the exciting ways we’re putting women and children first.

Thanks to your help, we will continue to do so in the future.

Kathleen E. Kuck Interim President & CEO Pocono Medical Center

Digital Mammography Offers Clarity New service at PMC

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Thanks to increasing awareness combined with early detection methods, breast cancer is no longer the somber diagnosis it once was. A key to early detection is a regular annual mammogram, an X-ray image of the breast tissue.

Used for more than three decades, this critical diagnostic tool just got more effective with the introduction of digital mammography. PMC joins a short list of less than ten percent of mammography units in the country providing this new service, which offers a significant improvement in breast cancer diagnosis and prevention for many women.

Compared to conventional film, digital mammography has a number of advantages. Film mammography works like traditional photographs, however images created directly on film remain static. In contrast, digital images are more dynamic, making them easier to manipulate and interpret. Digital mammography also offers instant, electronic imaging that can be easily stored and transmitted. While the cost is higher, the radiation doses are significantly smaller than traditional film mammography.

All women can benefit from the new technology, but

women with some specific factors are the best candidates for digital mammograms. A trial conducted by the American Cancer Society comparing the two technologies concluded that women with very dense breast tissue and women under 50 or pre- or perimenopausal women would benefit from digital mammography instead of film mammography.

Digital mammography also offers the advantages of speed and comfort. Less compression as well as the machine’s contour make the process more comfortable. The detailed images are developed within seconds.

This year, Pocono Medical Center was awarded a three-year accreditation for its digital mammography services by the American College of Radiology (ACR).

The prestigious ACR accreditation is presented to facilities that demonstrate high practice standards. “We are proud to provide the finest technology for the detection of breast cancer,� said Kathleen E. Kuck. “As one of the few digital mammography systems in the area, PMC offers a great service to women in our community.�

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HEALTHNOTES Urgent Relief for a Going Problem New Surgical Treatments for Urinary Incontinence Urinary incontinence—the involuntary leakage of urine—is a growing women’s health problem. More than 13 million women in the U.S. will have urinary incontinence at some point in their lives.

Urinary incontinence (UI) among women is so prevalent that gynecologists are now making UI screening a part of a woman’s annual gynecological exam. The most common type of UI is stress incontinence, which is characterized by sudden urinary leakage in response to everyday activities like laughing and running. Physical changes like childbirth and menopause cause stress incontinence, which can weaken the pelvic muscles and decrease urethral resistance. The second type of UI, urge incontinence, produces sudden, uncontrollable, and frequent needs to urinate.

Urge incontinence is not necessarily linked to pelvic damage, physical change, or age.

Urge incontinence can be treated medically without surgery. UI medication enables the bladder to contract normally. Patients may also perform Kegel exercises to help strengthen the pelvic area. Eating a healthy diet, decreasing caffeine intake, exercising regularly, and avoiding smoking as well as bladder training (learning to hold one’s bladder according to a set schedule) can also help.

The most successful forms of treating stress incontinence (SUI) are surgical methods to support the urethra. Both the physician’s preference and the patient’s diagnosis determines the type of stress incontinence surgery a patient undergoes. Like any procedure, certain patients will benefit more from one type of surgery than another.

Whatever the treatment or diagnosis, urinary incontinence, which has been touted as a “growing going problem� for women, is one disorder that is not going away any time soon. Nevertheless, treatment for incontinence has seen radical improvements over the years, and patients suffering from UI should rest assured that finding relief is now more possible than ever.

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Curbing Behavioral Issues without Drugs Managing ADHD “Kids today� is the common refrain when viewing a child acting up in a public place. Some kids have serious behavioral issues, and parents and teachers frustrated with negative behavior are often at a loss on how to address them. For decades, many have turned to medications as a way to manage an uncontrollable child, often diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). But everything old is new again, and parents, teachers, and healthcare professionals alike are increasingly embracing behavior modification therapy instead of meds.

ADHD is a behavioral condition in which individuals, typically children, have difficulty paying attention and controlling their behavior.

While medication is recommended for most patients, there are some non-pharmacological techniques that can be useful to control this condition.

To address ADHD, it is essential for parents to train themselves in behavior modification techniques. Through consistency and the use of rewards and consequences, the child learns the outcome of good or unacceptable behavior.

Parents should also consult a behavioral therapist who teaches social skills and offers tips on how to read other people’s social clues. These are concepts that the child with ADHD lacks and needs to be taught.

Solid structure at home will also help. Set specific goals, and maintain a daily schedule and task list. Provide logical, organized placement of the child’s schoolwork, toys, and clothes. Other tips include rewarding positive behavior, and implementing calm but effective discipline techniques such as timeouts or removing children from stressful situations. Keep distractions to a minimum and set reachable goals.

Parenting classes, support groups, or therapy sessions that teach effective parenting skills for children with ADHD, provide opportunities to connect with other parents and perhaps obtain a referral for a qualified specialist in ADHD.

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Cooking for the Diabetic Family Healthy Meal Tips All of us should eat healthy meals low in fat, salt, and refined sugars and rich in fruits, vegetables, whole grains, and lean meats, but the nutritional needs of diabetics are more complicated. Diabetes is serious, but it’s possible to live a happy, healthy life and still enjoy delicious foods by following a few guidelines.

There are two types of diabetes. In Type I, what used to be called Juvenile Diabetes, children don’t produce insulin, and they need to receive insulin either subcutaneously through shots or a pump. In Type II, which is more common, patients either don’t produce enough insulin or their bodies ignore it. Insulin is critical to your body. It converts food, notably sugars and starches into energy.

Medication and exercise can help control diabetes, but perhaps one of the biggest challenges diabetics face is planning meals. A few steps can help calm your fears and fill your plate with healthy, delicious foods. “There are a lot of myths that diabetics can’t eat cake or drink alcohol,� says Dr. Vincent Francesangeli of Pocono Internal Medicine Specialists. “While diabetics cannot go overboard with these foods, moderation and balance is the key. Healthy eating is an important way to manage blood glucose levels.�

Meal plans are a great way to monitor and control your diet and avoid overeating and indulging, which contributes to Type II diabetes. Patients with diabetes should work with their doctor and dietician to come up with an ideal meal plan. They should read labels, note calorie, fat, and sodium content, and monitor their glucose levels when trying out new foods or recipes.

The American Diabetes Association offers some helpful guidelines. For example, The Food Guide Pyramid groups foods according to carbohydrate and protein content, and offers suggested servings. The Rate Your Plate method is another quick guide for diabetics in which they divide their plates into one quarter grains, one quarter proteins, and the remaining half of vegetables such as broccoli or leafy greens. “There are a number of cookbooks with meal plans and recipes and a host of resources both here at PMC and in the general community for our diabetic patients looking for nutritional guidelines,� advises Dr. Francesangeli.

Kids Breathe Easier Upward Bound Asthma Camp For the last 19 years, local children with asthma have been gathering for a weekend of fun and education at Pocono Medical Center’s Upward Bound Asthma Camp. The three-day camp is held at Stony Acres the third week of June for seven to thirteen year olds with asthma. “This camp is designed to help asthmatic kids have fun,� says Dr. Rajesh Bhagat, specialist in allergies and immunology. “We want to enhance their knowledge of asthma and their confidence in managing this condition.�

Campers enjoy the usual fare of crafts, hiking, team games, and evening talent shows, but there are numerous educational and health-related activities, as well. A core group of doctors, nurses, respiratory therapists, and other special volunteers provide expert staffing and advice. “This camp is unique due to the one-on-one consultation we have with each child, where we go over their medications and their particular situation,� says Dr. Bhagat. “We check their ability to use inhalers, measure their breathing capacity, and teach kids how to be responsible in self-managing their asthma.�

Parents are also involved in the activities. Camp concludes with a mock game show. The fun presentation style motivates kids and parents to learn more about asthma.

Capacity at the camp is 48 children. Kids stay in comfortable, single-sex cabins with showers and bathroom facilities. They enjoy freshly prepared, healthy meals and snacks, with special effort made to accommodate food allergies. Perhaps most attractive, the camp fee is $10 for the entire weekend. “Dedicated volunteers and donations make this camp possible,� says Dr. Bhagat. “We simply could not help so many children and families learn to manage their asthma without continuous financial and personnel support.�

Next year marks the 20 th anniversary of Upward Bound Asthma Camp. To support the camp, contact Janett Raughley at 570-476-3523.

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All Smiles Stroudsburg Native Joins Team at Valerie M. Hodge Memorial Dental Center

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servicing at-risk communities in Bethlehem and Easton. “I was dropped into a Winnebago caring for three to 18 year olds,� she says, “and I loved it.�

Working with kids, Dr. Guy has learned the importance of creating positive early dental experiences to lay the groundwork for a lifetime of dental care. She takes extra measures to be sure children don’t develop a dental phobia later in life. “My goal is to provide compassionate, quality dental care and treat people the same way I’d want to be treated,� she says. “I always think that could be my child or family member in the chair.�

Since joining the team at the Dental Center, Dr. Guy has continued to hone her skills in providing quality dental care to kids and families in the community. Over the years, she’s seen how the area’s healthcare needs have changed.

Named in honor of Dr. Valerie M. Hodge, a tireless supporter of PMC, the Center provides critical dental care to our most vulnerable and important constituency—children.

This service makes it possible for all local children to have access to the same, high quality healthcare, regardless of their background or their family’s financial status. The Center offers preventative, restorative, and some surgical dental procedures including extractions under local anesthesia, and composite and silver fillings. In an emergency, the staff strives to see the child on the same day or within the week. “Access to care everywhere is the goal, but there are very few

providers who accept state-based insurance and medical assistance patients,� she says. “This is the only health center of its kind in Monroe County. Growing up in this area, I’m sensitive to the distances families must travel to get care here and what an important role we serve.�

She adds, “I’m very proud to be a part of this team.�

The Hodge Dental Center also functions as an auxiliary screen for other health issues. Sometimes patients may present with a symptom they consider is dental but which warrants further medical attention.

In these cases, help is close at hand. “We’re in the same building as the pediatric practice and steps from the hospital, so there are many chances for cross-consultations,� she says.

In particular, Dr. Guy’s mission is to raise the dental I.Q. of the general public and impress upon them the connection between dental health and general well being. Healthy teeth are important for eating, which can affect proper nutrition and growth. Dental pain can interfere with concentration and sleep, impacting learning and daily activities. Poor oral health can affect our smiles and facial shape, which can impact us psychologically. “There is a false perception that dentistry is a fringe medical service,� she says. “But there are a lot of connections between oral and general health. Unfortunately, for many people, it’s only when they are in pain that they understand how important it is to maintain dental health. We’d like to change that.�

“I always think that it could be my child or family member in the chair.� Jessica Guy, DMD, PMC Physician Associates: Valerie M. Hodge Memorial Dental Center, with a young patient.

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espite her relative youth, Dr. Jessica Guy recalls a Stroudsburg that no longer exists.

As a child, she roamed the region’s open fields and woods, returning at sundown after her adventures.

But childhood in the Poconos, like its wild places, has changed. Today, homes have replaced trees and now these homes are filled with families and their kids, many of whom “Dr. J� treats as the newest dentist at the Valerie M. Hodge Memorial Dental Center at the Clementine Abeloff Community Health Center.

This Stroudsburg native’s roots with Pocono Medical Center run deep. Her mother was a nurse at Pocono Medical Center (PMC) and is currently a member of the Nurse Family Partnership team. Her son was born at PMC and is a patient at the Abeloff Center. “I’m deeply invested in the PMC family,� she acknowledges.

After graduating from Temple University School of Dentistry in Philadelphia, Dr. Guy worked in private practice in Mount Pocono.

Here she discovered her love for treating children. As a new mom and one of the few women dentists in the area, she received frequent referrals for kids. “There are a lot of general dentists who don’t have the patience or the time for kids,� she says. “But I like working with them.�

While she enjoyed private practice, she wanted to give something back, a desire that led her to community dentistry. As part of The Lehigh Valley Health System, she practiced dentistry aboard a mobile home

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wouldn’t wish this pain on my worst enemy,� says Nelly as she eases herself onto the examining table. For Nelly, an otherwise healthy woman in the prime of her life, the pain in her right hip arrived mysteriously five years ago. Its source escapes her, though she remembers a hard fall in her twenties. “It’s excruciating,� she winces. Her painful hip interferes with housework, makes it difficult to stand, walk, and even sleep. The incessant pain has brought her to the care of Dr. David M. Richlin, an anesthesiologist at Pocono Medical Center who specializes in pain management. “Pain is a subjective experience, but it has significant emotional, behavioral, psychological, and financial implications,� says Dr. Richlin “By the time patients come to me, they’ve seen many healthcare providers.

They’re overwhelmed, and their suf-

fering is amplified by frustration and past treatment failure.�

Pain management is a relatively uncommon application of anesthesiology. Only ten percent of all anesthesiologists are involved to any significant degree in pain management. The best practioners integrate multiple safe treatments synergistically. These may include oral and topical medications, and nerve blocks that stop the transmission of pain nerves to the brain. Oral anti-depressants are also commonly employed, both to treat all-to-common coexisting depression and as a sleep aid. Cognitive behavioral therapy, exercise, rehabilitation, sleep therapy, relaxation training distraction, and even Complimentary Alternative Medicine (CAM) such as yoga, meditation, and tai chi may be used. “Most pain patients haven’t received a proper diagnosis,� says Dr. Richlin.

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“Before you can treat an illness, you have to identify and define it. By defining and describing the problem, we can organize and integrate effective strategies for management control.�

He adds, “Since pain often creates a dysfunctional and unproductive lifestyle, it’s critical to get patients back to work.�

Dr. Richlin has honed his skills over a career spanning three decades. He employs what is called the Biopsychosocial Paradigm, which treats the whole person, not just the symptoms or condition. This methodology assesses the interaction of biological, psychological, and social factors when addressing the illness.

The primary tools in his toolbox include a complete and accurate patient assessment and a multi-modal approach. He begins with a comprehensive patient questionnaire, interview, and evaluation. A focused

physical exam follows. Like an archeologist, he gathers the fragments of his patients’ medical histories and stories from their lives. Each event or treatment is examined and analyzed as pieces to solve the puzzle of pain.

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Women are somewhat more likely to be referred for pain management than men, and there are certain syndromes or conditions with significantly higher incidences among females. Fibromyalgia, a pain syndrome marked by excruciating aches throughout the body, lingering fatigue, and extreme sensitivity to touch at tender points in the body, affects an estimated six percent of the population, primarily women.

While there is currently no cure for fibromyalgia, with appropriate treatment and patient education, many patients can manage their pain and improve their quality of life. “I have patients who are in real distress that is attributed to fibromyalgia,� says Dr. Jonathan Goldner, a specialist in internal, critical care, and geriatric medicine at Pocono Internal Medicine Specialists. “Through innovative drug combina-

tions and lifestyle changes, we’re achieving better symptom control and functional outcomes.�

.JHSBJOF 3FMJFG Women are three times more likely than men to suffer from migraine headaches. Migraines can last several hours and are marked by extreme, debilitating head pain, as well as nausea and light sensitivity. Characteristically, they are one-sided. Women who are overextended, juggling family and career may be more susceptible.

Migraines are also associated with fluctuations in estrogen that occur during menstrual cycles. In fact, some women who have suffered migraines often find relief after menopause. “One of the first things migraine patients need to do is get enough rest,� says Dr. Richlin. “Tricyclic antidepressants can help foster sleep and have a direct effect in reducing the incidence and severity of the headaches. Migraine sufferers need to modify their lifestyle as well as use prophylactic and interventional strategies. Using a multi-modal treatment approach, it’s possible to markedly decrease headache occurrence.�

He advises using prophylactics such

as beta-blockers and calcium channel blockers. As an interventional strategy, utilizing migraine specific triptans taken at the onset of a migraine has proven effective in the majority of subjects in randomized control trials.

For Nelly, some of the mystery was removed from her pain by naming it—trochanteric bursitis—an inflammation or irritation of the bursae on

“Since pain often creates a dysfunctional and unproductive lifestyle, it’s critical to get patients back to work,� says Dr. Richlin the lateral hip. But it is the first stop on a road that, for many patients, can be fraught with frustrating detours.

An injection of a local anesthetic and a long acting steroid massaged into the area followed by ice applications offered immediate and sustained relief.

As she leaves the hospital, she is cautiously optimistic, her face no longer chiseled with pain. Like many pain patients, she’s taking the first steps back to a normal life.

David M. Richlin, MD, Anesthesiologist at PMC (left) Jonathan A. Goldner, DO, FCCP, Pocono Internal Medicine Specialists (right).

Women are three times more likely than men to suffer from migraines (far left).

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Cheryl Hamilton, MD, FACOG, PMC Physician Associates: Obstetrics and Gynecology, encourages women to discuss all of the options to treat perimenopause.

Embracing Change 8PNFO BOE %PDUPST 8FJHI 1FSJNFOPQBVTF 0QUJPOT or women, change is a fact of life. From changing fashions and hairstyles, to navigating trends in careers or parenting, women are used to change. Throughout a woman’s life— adolescence, adulthood, and pregnancy—women’s bodies are dynamic. Perimenopause is one of the more significant life changes. “Peri means around, so perimenopause is the prelude to the change in life,� explains Dr. Cheryl Hamilton, PMC Physician Associates: Obstetrics and Gynecology. “Menopause is the cessation of ovarian function. It occurs when women have no menses for six months or greater.�

Women are born with a finite number of eggs in their ovaries. As they get older, the health and number of the eggs and the amount of estrogen and progestrogen released by the ovaries lessens. This is when perimenopause sets in.

-PX *NQBDU .FOPQBVTF Most women experience perimenopause about four years before menopause, which usually occurs when they reach 51, however every woman is on her own calendar.

Some women start to notice changes in their late thirties, but by their forties, they begin to have perimenopausal symptoms.

While they are similar to menopause, the symptoms of perimenopause are more muted. As women enter this phase of their lives, they may have power surges (also known as hot flashes), lowered sex drive, and discomfort during sex due to vaginal dryness. They may also experience heightened pre-menstrual symptoms, menses irregularities, mood swings, and irritability. Some

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women also have problems with frequent urination or other urinary control issues.

Treatment varies and can include conventional hormone therapy (HT), changes in lifestyle as well as holistic and natural remedies. “Patients should discuss all of the options with their doctor to make informed decisions. At PMC, we tailor treatment programs around our patients wants and needs,� explains Dr. Hamilton.

/BUVSF T 8BZ More than 60 percent of Dr. Hamilton’s patients opt for natural remedies and lifestyle changes.

Ingredients derived from plants or roots that contain phytoestrogens, naturally occurring female hormones, help combat symptoms.

Natural remedies such as black cohash, flax seed oil, evening primrose oil, soy, and tofu are often embraced as an alternative to HT. Many women also find acupuncture, yoga, or meditation helpful. “Based on clinical studies, the jury is still out on the effectiveness of non-traditional holistic treatment forms versus hormone therapy, but some patients embrace these natural supplements and find relief.� explains Dr. Hamilton.

She adds, “Regular exercise is healthy at any age. Exercise lowers the incidence of depression by releasing serotonin, helps with weight control, and improves circulation, which can help moderate power surges.�

Hormone therapy is also a common treatment. Low dose birth control pills are often prescribed, particularly for patients suffering from menstrual irregularities in

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tandem with irritability. In addition, women have shown a favorable reaction to anti-depressants as a way to combat mood swings.

3BJTJOH UIF $VSUBJO PO "DU ** Despite these changes, perimenopause, isn’t the end of the reproductive life for many women.

Pregnancy is possible as long as women still have a period. As current trends illustrate, women are still fertile and many continue to have children into their mid and late forties. However, fertility drops dramatically. “While there are a lot of physical changes, it’s important to note the psychological component of perimenopause,� says Dr. Hamilton. “The change of life is a reminder of the aging process. In a youthoriented culture, this can be very disorienting for women, particularly if they are facing challenging life events such as the death of a loved one, divorce, or career difficulties due to ageism.�

For this reason, Dr. Hamilton recommends a healthy support system and a well-balanced lifestyle. She encourages patients to seek out other women who are experiencing some of the challenges of perimenopause, whether through informal get togethers or in a more structured setting such as a support group. “This time of life can be a wakeup call,� explains Dr. Hamilton, “but it is also a time of prioritizing and reflection. Based on the choices women make through exercise, diet, and either hormone therapy or natural remedies, the second half of women’s lives can be rich, fulfilling, and healthy.�

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ometimes when I think about all the things a woman does, I’m amazed,� says Maria Zane.

She speaks from experience. In the prime of her life, Maria finds herself caring for elderly parents while raising a child and juggling a demanding job. She’s not alone. Approximately 20 percent of women her age are part of “The Sandwich Generation,� stuck in the middle of two demanding age groups. Women pulled in several directions like Maria do so at the risk of safeguarding their own health. “People are living longer,� explains Dr. Vincent Francesangeli, of Pocono Internal Medical Specialists. “The high cost of nursing homes and elder care forces many families to care for their parents, often while there are still children to raise.�

#BMBODJOH "DU “It’s pretty intense sometimes,� concedes Maria. She has been the primary caregiver for her father who has had two significant surgeries, as well as her elderly mother. Balancing a career, taking care of her son, and making time for her husband has been a challenge. “My husband is a saint,� she says. “I think it’s toughest on him.�

According to current estimates, nearly 15 million adults are caring for relatives providing free care worth about $257 billion per year. Traditionally, women have been society’s caregivers, but it’s a role that does not always mesh with the realities of today’s world.

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$BVUJPO UP UIF $BSFHJWFS “It’s common for caregivers, most of whom are women, to put the needs of their loved ones first,� says Dr. Robert Morrow, Chief of Psychiatry, Pocono Medical Center. “This can have consequences on their mental and physical health. For single mothers, caregiving can have a devastating economic impact, as well.�

Caregivers face significantly higher health risks than the rest of the population. They are more at risk for depression and addiction disorders such as alcoholism, as well as other stress related diseases including heart disease. The rise in risks directly corresponds to their rise in age. The Caregiver Health Effects Study conducted in 1999 provided sobering insight into the physical and mental effects of caregiving, notably on elder caregivers. In the study, caregiver mortality rates were 63 percent higher than the general population.

Maria has experienced this stress firsthand. A typical day may include driving her parents to the doctor, helping with her son’s homework, and preparing meals. Often she wedges in these activities around a demanding job. She believes the pressure may have physically manifested in Temporomandibular Joint and Muscle Disorder (TMJD) pain in her jaw or mouth. TMJD is often traced to teeth clenching or stress.

5BLF B 4BGFUZ #SFBL For a break, Maria grabs dinner with a friend or takes a trip to the family’s beach house. Though she

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usually “squeezes in� these activities, the change of scenery and company actually provide important health benefits. This is exactly the sort of “therapeutic selfishness� Dr. Morrow prescribes. “When I see elderly patients, I spend as much time if not more with their caregivers,� says Dr. Morrow. “Addressing the caregivers’ stress will ultimately benefit the patient.�

Adds Dr. Morrow, “Caretakers need to be given permission to care of themselves. Otherwise they’re no use to anybody.�

For now, Maria is thankful for the small things. Her parents are “in good shape.� Her husband and son are patient and understanding. When she compares her straits to a friend facing a more critical caretaking situation, she acknowledges, “She has no life. It makes you think about what lies ahead.�

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(ltop to bottom) Vincent Francesangeli, Jr., MD , Pocono Internal Medical Specialists Robert Morrow, MD, Chief of Psychiatiry, PMC

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HPV

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early half of the U.S. population, both men and women, either have been or will be affected by this virus. Yet most never know it.

More than 130 versions of the virus exist, and of these, approximately 40 are sexually transmitted. Human Papillomavirus, better known as HPV, is the most common sexually transmitted infection causing genital warts, cervical cancer, and other HPV related cancers. But now a new

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vaccine for young women may help stem its spread. “People may carry an HPV virus without experiencing any symptoms and unknowingly infect others,� says Dr. Aparna Tamaskar of PMC Physician Associates in Brodheadsville.

Like many viruses, it’s possible to contract HPV and successfully fight it with no adverse effects. It may simply disappear after a month or a year. In a more threatening scenario, HPV can linger before presenting in both

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high and low risk forms, manifesting in either an embarrassing nuisance or a life-threatening condition.

HPV is spread by direct skinto-skin contact including sexual intercourse, oral sex, anal sex, or any other modality involving hand to genital contact. It is very unlikely that HPV is transmitted from touching objects such as a toilet seat. The risk of infection increases with the number of sexual partners, and patients who have other sexually transmitted

More than 40 percent of sexually active young women have HPV. A new vaccine may be an effective preventative measure against the virus (left). (left to right) Aparna Tamaskar, MD, PMC Physician Associates: Family Medicine, Brodheadsville Christopher B. Lynch, DO, FAAP, Pocono Pediatric Associates.

diseases such as chlamydia, gonorrhea, HIV, hepatitis, or syphilis are more susceptible to HPV. “Another troubling characteristic of HPV is that condoms do not completely protect against infection,� says Dr. Tamaskar.

The virus is most commonly associated with genital warts, with HPV types 6 and 11 causing an estimated 90 percent of the cases. A common indicator of the presence of low risk forms of the virus, warts may appear anywhere in the genital area alone or in groups, assuming a variety of shapes. The warts have a cauliflower-like surface and can range from a few millimeters to several centimeters. Though they

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The vaccine may be an effective preventative measure against HPV, but it is no substitute for regular gynecological visits and health screenings. are the most common manifestations of HPV, only one per cent of sexually active adults are estimated to have genital warts. Treatment can include chemical solutions, and genital warts may or may not go away in time. “Normally, the body’s immune system combats HPV, but if not,

genital warts appear on the skin and mucous membranes of the genital region,� explains Dr. Tamaskar. “Warts are unsightly and pesky, but, in general, they won’t become cancerous.�

Garnering more attention are higher risk HPV virus types 16,18, 31, 33, and 35, which have been linked to an estimated 70 percent of cervical cancer cases. Females infected with these viruses run the risk of developing abnormal cells along the lining of the cervix. These could lead to precancerous or cancerous cells. Though not as common, HPV may also cause cancer of other genital areas.

According to the Centers for Disease Control, an estimated 20 million people are currently infected with HPV, with more than six million joining their ranks each year. More than 40 percent of sexually active young women have the virus. But while HPV is prevalent, testing is problematic and not very useful for young women.

The new 2006 consensus guidelines of the ASCCP (American Society of Colposcopy and Cervical Pathology) recommend HPV screenings for women upon reaching 21 years of age, or for those who have been sexually active for more than three years.

Dr. Christopher Lynch of Pocono Pediatric Associates advises sexual abstinence, monogamous relationships, delayed sexual debut, and minimizing the number of sex partners as the best ways to reduce the risk of HPV. “A new vaccine, Gardasil™, shows

great promise in controlling the spread of HPV, reducing the cost, morbidity, and mortality associated with cervical cancer,� he says. “We recommend that girls are vaccinated from ages 9 through 26 to protect against an HPV infection.�

He adds, “Patients, however, should always check with their doctor to determine if the vaccine is right for them.�

Gardasil™ is used to prevent infection with HPV virus types 6, 11, 16, and 18. It is administered via injection to the patient three times over a period of six months. While many older women have expressed an interest in the vaccine, it is most effective when given before the patient comes into contact with any HPV virus.

The vaccine may be an effective preventative measure against HPV, but it is no substitute for regular gynecological visits and health screenings. It’s also important to note that an abnormal pap smear is not a contraindication to the vaccine. “Gardasil™ may not fully protect all girls and women and does not prevent all types of cervical cancer,â€? cautions Dr. Tamaskar. “Women of all ages should remember that the vaccine should not replace your yearly pap smear.â€?

She adds, “But this vaccine is an important measure to help control the spread of HPV, the cause of cervical cancers as well as genital warts. It offers real relief to women in combating this virus.�

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Women’s Heart Health &YFSDJTF %JFU 4UJMM UIF #FTU .FEJDJOF

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hey are sobering statistics that can break your heart. One in two women will die of heart disease.

Three out of four women have more than three risks for heart disease. As the leading cause of death for American women, heart disease claimed nearly half a million lives in 2003 alone. Strokes took an additional 100,000. Stated simply, the numbers are high. And they are rising. “Heart disease among women is an epidemic. The tragedy is that this is a preventable disease,� says Dr. Anne T. Cahill, cardiothoracic surgeon at Pocono Medical Center’s ESSA Heart and Vascular Institute (HVI).

About a century ago, most women

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died from infections, complications from pregnancy, and childbirth. Today heart disease, stroke, and cancer are the leading killers. Of the three, heart disease and stroke take the most lives, and every year the risk factors for developing these diseases increase.

Despite these statistics, the clichĂŠd view of the middle-aged man struck down with a heart attack persists. “In fact, heart disease strikes more women, some in their thirties.â€? says Dr. Patricia Rylko, Board certified in cardiovascular diseases.

This increase is attributed, in part, to the rise in obesity. In the last 30 years, obesity rates for women have increased 300 percent. Today, nearly

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three out of four women are obese.

3FXBSET PG ,OPXJOH :PVS 3JTL To beat this preventable disease, women should know their risk factors.

Smoking is the number one preventable risk factor for heart disease. Additional risk factors such as aging and family history are uncontrollable, but high cholesterol, diabetes, high blood pressure, obesity, stress, and lack of exercise can almost all be managed through changes in behavior.

Rarely do these risk factors exist alone. Often they are links in a chain that lead to heart disease. Lack of exercise causes obesity. Obesity can cause diabetes, high cholesterol, and

(left to right) Anne T. Cahill, MD, PMC Physician Associates: Cardiothoracic Surgery Patricia Rylko, MD, FACC, Cardiologist.

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high blood pressure. Stress can exacerbate any of these issues. “Heart disease is multi-factorial,� says Dr. Rylko. “Modify as many things as you can. If you smoke, quit.

Exercise, change your diet, develop stress-reduction techniques. Patients need to look at the whole picture.�

Adds Dr. Cahill, “Knowing your risk factors is the key to prevention, since two thirds of women who have a heart attack have no symptoms.�

In addition to lifestyle changes, women should know their numbers for cholesterol, blood pressure, and blood sugar. They can then compare these numbers to their baseline statistics, which were ideally taken in their teens.

For cholesterol, aim for an LDL of 130 or less and an HDL of 50. Blood pressure numbers greater than 120 over 80 should be evaluated. Blood sugar glucose level should be less than 103.

Cardiovascular disease also increases exponentially in postmenopausal

women. For this reason, women should be re-screened and evaluated after menopause and consult with their physicians about hormone therapy.

While medications can be used to treat high blood pressure and high cholesterol, both doctors agree that changing behavior is the best medicine.

Exercise combined with a healthy diet is critical to heart health. The rate of exercise is directly proportional to lowering risk factors and should include cardiac work to raise heart rate as well as strength exercises. Exercise regulates metabolism, increases bone density, and helps relieve stress.

Briskly walking a minimum of 30 minutes per day, five days a week, can offer significant health benefits. And the 30 minutes can be broken into increments. “A diet of sensible portions low in fats, sugars, and high in fruits, vegetables, and other whole foods can save lives,� says Dr. Cahill.

“I encourage my patients to keep track of everything they eat,� adds Dr. Rylko. “The results can be surprising.�

To help prevent heart disease, PMC is working to empower and educate women and promote women’s heart wellness. The Women’s Health Advisory Forum brings together PMC physicians, community leaders, and other stakeholders to address women’s heart disease. The Heart and Vascular Institute covers all aspects of cardiovascular health from wellness to intervention. But both doctors stress the importance of prevention. “We encourage women to consult their primary care physicians. Have a health screen, complete with blood tests and risk profile,� says Dr. Rylko. “There is a tragic lack of awareness and lack of treatment of heart disease. By taking charge of their lives, women can beat this preventable disease,� adds Dr. Cahill.

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Battling Childhood Obesity " )FBWZ -PBE GPS 'VUVSF (FOFSBUJPOT

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igh blood pressure, elevated cholesterol, Type II diabetes, depression, trouble sleeping, muscular and skeletal issues‌this laundry list of ailments usually strikes the elderly. But increasingly, our kids are suffering from these medical issues. They are the afflictions of children who are obese and overweight. A new report in the New England Journal of Medicine argues that for the first time in two centuries our children will have a shorter life span than the previous generation because of obesity. “Obesity is the most important public health issue in the United States,â€? says Dr. Jose Bordas, pediatrician at PMC Physician Associates: Pediatrics at the Clementine Abeloff Center. “For a long time it was overlooked, accepted, or even taboo to talk about with families who presented with weight issues.â€?

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(above) Jose Bordas, MD, FAAP, PMC Physician Associates: Pediatrics Causes of childhood obsesity include increased time in front of televisions and video games (left), as well as diet (facing page).

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In the 1960s and 70s the number of obese children in the U.S. hovered at five percent. In recent years, that statistic has skyrocketed to 25 percent of our country’s children. According to the Centers for Disease Control, in the past three decades childhood obesity has more than doubled for preschool children aged two to five years and adolescents between 12 and 19. More food for thought?

The rate has more than tripled for children aged six to eleven. “Because of these statistics, it’s now essential in every pediatric visit to measure Body Mass Index (BMI),� says Dr. Bordas.

A recent heartening study in the Journal of the American Medical Association suggests that the rate of childhood obesity may be leveling off, but there is still cause for alarm. Healthcare

Sidebar: Tips for parents and kids Eat sensible portions of fruits, vegetables, whole grain cereals and breads, lean meats and low or no-fat dairy products. Avoid processed foods and sugary treats. Substitute water for soft drinks. Bake, broil, or steam foods. At restaurants, eat half of your meal and get a “doggie bag� for the rest.

Kids (and parents) should be active for at least 60 minutes a day. Moderately paced exercise that burns calories and builds young bodies includes running games like tag, swimming, soccer, jump rope, street hockey, or Frisbee football.

Incorporate physical activity into your family’s routine. Walk or bike to a nearby park to play games. Take stairs whenever possible. When visiting the mall or supermarket, park far away.

Limit TV or computer time to a maximum of two hours per day.

Develop new exercise and eating habits. Stick to it until it becomes routine.

professionals agree, an alarming number of children in this country have significantly excess body fat. The reasons for this epidemic are as varied as a fast food menu.

Overly processed, nutritionally empty fast food is often cited as the leading culprit. A recent article in Pediatrics magazine states that one third of American children between the ages of 4 to 19 eat fast food‌every day. In addition to being high in fats, sugars, and sodium, fast food is typically served in larger portions.

But obesity can’t be blamed on super sizing alone. While food portions have grown, kids

struggle with weight because of changes in their activities.

The reduction of physical education programs, the prevalence of television, internet time, and video games all contribute. “In today’s society, kids simply don’t move as much,� says Dr. Bordas. “They don’t play outside without adult supervision like they used to. Kids in suburbia spend a lot more time in front of the TV or video games or on their computers.�

Dr. Bordas recommends focusing on healthy eating habits and making behavioral changes that benefit the whole family, especially if both parents and

children are struggling with weight issues. Exercise and physical activity are critical in beating obesity. Possibilities can range from bike rides to games of football or soccer.

The important thing is to keep it fun and keep kids moving. “Next time you come home from work, instead of reaching for the TV remote, get outside and play with your son and daughter,� says Dr. Bordas. “It’s a great way for mom and dad to reduce work stress and spend time with the kids.�

Families and children struggling with weight issues can find help and resources through Pocono Medical Center. They

include glucose testing, a proper lipid profile, thyroid and liver function testing, testing for sleep apnea, orthopedic issues, addressing gastroenterology issues such as gallstones and early cirrhosis of the liver, as well as mental health referrals for children suffering from related depression disorders. “Parents should consult with their pediatrician and a nutritionist. They can advise on food issues like meal plans and portion control,� says Dr. Bordas.

He adds, “Changes in behavior and nutrition can add up to a healthier lifestyle that’s beneficial to both parents and kids.�

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Pocono Health Foundation Board of Directors William B. Cramer, Esq. Chairman $SBNFS 4XFU[ .D.BOVT 1$ William A. Viechnicki, D.D.S., A.B.O. Vice Chairman 7JFDIOJDLJ BOE ,JMBSFTLJ 0SUIPEPOUJDT

A Message from Pocono Health Foundation All of us at the Pocono Health Foundation are united by the universal desire to keep our families healthy. At Pocono Medical Center, children’s and women’s healthcare has always been a priority. The growing number of exceptional pediatric and family practices throughout our area speaks to our commitment to quality care for the women and children in our community. The vision of our donors has enabled PHF to experience record-breaking growth and monumental strides toward preventing illness, promoting wellness, and restoring health for women, children, and all members of our community. I encourage you to join us and make a gift to the Foundation. Please visit us on the web at www.poconohealthfoundation.org or simply call us at 570-476-3305. Thanks to your support, we can continue to offer quality healthcare close to home.

William B. Cramer, Esq. $IBJSNBO 1PDPOP )FBMUI 'PVOEBUJPO #PBSE PG %JSFDUPST

Rosemary Driebe Olofsson Treasurer 1PDPOP 1SPEVDF $PNQBOZ Paul Schuchman Secretary 0EE -PU 0VUMFUT Anne T. Cahill, MD 1.$ 1IZTJDJBO "TTPDJBUFT $BSEJPUIPSBDJD 4VSHFSZ Joan M. Duckloe 4ZLFT BOE "TTPDJBUFT Charles M. Hannig 4QSFBE &BHMF "TTPDJBUFT Donald M. Headings, Jr. $)6* &OUFSQSJTFT Donna L. Hodge, Ph.D. &BTU 4USPVETCVSH 6OJWFSTJUZ Ann Negvesky "VYJMJBSZ PG UIF 1PDPOP .FEJDBM $FOUFS Donna Zlocki .D%POBMET 3FTUBVSBOUT

To learn more about how you can support Pocono Medical Center or make a gift, please visit www.poconohealthfoundation.org or call us at 570-476-3530

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206 East Brown Street East Stroudsburg, PA 18301 570-421-4000 www.poconohealthsystem.org

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