@ COLORECTAL CANCER BY THE NUMBERS
55 to 84 The age range in which most MEN AND WOMEN ARE DIAGNOSED with colorectal cancer.
1.3 million+ The estimated number of people in the U.S. living with COLORECTAL CANCER.
FALL 2017
It’s a test you don’t want to miss WHY YOU SHOULD BE SCREENED FOR COLORECTAL CANCER Screening for colorectal cancer gives you the rare opportunity to undergo a test that can actually prevent cancer. “Colorectal screening tests can detect colon polyps at an early stage, before they develop into colon cancer, and in many instances can prevent colon cancer entirely,” says Mark S. Codella, MD, a gastroenterologist at Nazareth Hospital. Precancerous polyps of the colon
can be removed during a colonoscopy, preventing further progression to an advanced cancer. Whichever colorectal screening test you choose, you should have it when you turn 50. African Americans should be screened at age 45, while other high-risk patients may require even earlier screening. Talk with your doctor — Continued on page 2
IN THIS ISSUE
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TALKING AND WALKING A new therapy program helps Parkinson’s patients
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DEALING WITH PAIN Getting the help you need
NEED A PRIMARY CARE PHYSICIAN? We can help you find one. Call 1.866.NAZARETH (1.866.629.2738).
It’s a test you don’t want to miss — Continued from front page about which of these common tests is right for you and how often you should be tested: Colonoscopy. Dr. Codella calls this test “the gold standard” because it is the best test for finding and removing polyps from the entire colon. Its main downside is the prep work you must do to empty your bowel before the test, though the prep is a lot easier now than in the past. Flexible sigmoidoscopy. Although similar to a colonoscopy, this test can only examine the inside of the lower colon, which means it could miss polyps on the right side of the colon. You still have to do the bowel prep work, and if a polyp or cancer is found, you’ll need a full colonoscopy. FIT test. This test detects blood in your stool, a possible sign of cancer. You can do the test at home. You place a tiny amount of stool in a vial or on a card using a small stick or probe, and you mail the sample to our lab. If results are positive, you’ll need a colonoscopy.
LEARN MORE Read about the many cancer services at Nazareth Hospital. Go to mercyhealth.org/ cancer.
Give a warm welcome to Dr. Dhar Sunil Dhar, MD, an interventional cardiologist, regularly adds years to people’s lives. And he might do the same for you now that he’s joined the cardiac team at Nazareth Hospital as Medical Director of the Cath Lab. Dr. Dhar came to us from Bluefield Regional Medical Center in West Virginia. “Nazareth’s excellent reputation and deep community roots brought me here,” he says.
Highly trained and skilled Dr. Dhar is fellowship trained in three different heart-related specialties: interventional cardiology, advanced heart failure and heart transplant, and cardiovascular disease. In our state-of-the-art cath lab, he uses catheters (thin tubes) and tiny tools and incisions to treat heart and blood vessel problems. He also opens blocked leg arteries—helping patients avoid amputation—and repairs painful varicose veins. But perhaps Dr. Dhar’s most impressive feat in the cath lab is emergency angioplasty for a heart attack. He uses a tiny balloon to open the blocked artery that triggered the attack. But rather than inserting the balloon through a blood vessel in the groin—the standard technique—he inserts it though one
in the wrist. That’s something only a small number of doctors in the U.S. can do. This radial approach speeds recovery and reduces the risk of complications, he says. Performing procedures in the cath lab is not the only thing Dr. Dhar does to help patients with heart problems. He also specializes in the medical management of: •• Heart failure •• Clogged arteries •• Irregular heartbeats •• Heart disease risk factors, such as high blood pressure and unhealthy cholesterol levels Dr. Dhar considers himself as much an educator as a surgeon. “I am committed to helping every patient fully understand their condition and how best to improve it,” he says.
24/7 CARE Learn more about heart care at Nazareth and Mercy Health System at mercyhealth.org/ heart.
Call today to get your mammogram Mammograms save lives. And at Nazareth Hospital we offer 3-D mammography, which helps catch more breast cancers at an early stage, when they’re often easier to treat.
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Mammograms are available •• Monday through Friday from 7:30 a.m. – 4:00 p.m. •• Every other Thursday from 7:30 a.m. – 7:30 p.m. •• Every other Saturday from 8:00 a.m. – noon. To schedule a mammogram, call 215.335.6400.
It’s personal MANY PEOPLE HAVE A STRONG BOND WITH THEIR PRIMARY CARE PHYSICIAN It may be easy to go to an urgent care center or a retail health clinic when we’re feeling sick. But neither one can replace the more personalized care we get from a primary care physician (PCP). That’s the conclusion of a study conducted earlier this year by the Harris Poll on behalf of Mercy Health System of Southeastern Pennsylvania. The survey asked more than 1,700 U.S. adults about their relationship with their PCP and if they had recently been treated someplace other than their doctor’s office— such as an urgent care center—for a health problem. Among the survey results: 6 in 10 (59 percent) of the respondents ✓ Nearly believed their PCPs care about them. half (49 percent) believed their PCP knows ✓ Nearly them personally. out of four respondents (75 percent) knew the ✓ Three name of their PCP. In contrast, very few knew the name of a care provider who most recently treated them at a retail health clinic (15 percent), urgent care center (12 percent) or free clinic (8 percent).
Although the study respondents did value their time with their PCP, many would go to an urgent care center if, for instance, it was too much hassle to make an appointment with their PCP or if their actual PCP wasn’t always available when they came in for an appointment. “We did the study because we wanted to enhance our understanding of the dynamics that affect interactions between patients and their PCPs,” says William J. Strimel, DO, President, Mercy Physician Network. “Urgent care centers and retail health clinics provide needed care for minor health problems in the evening or on the weekends, when it’s not possible to see a PCP. But they aren’t a substitute for the type of continuous medical care that a PCP provides. In other words, having a personal connection with your PCP matters.”
Only 36%
75% of patients
OF PATIENTS say they followed up with their primary care doctor after their most recent urgent care center visit.
65% of patients
assume their doctors receive updates on their urgent care visit automatically.
NEED A DOC? Find your Mercy doctor by calling 1.877.GO MERCY.
RX RX
know the name of their primary care doctor.
Physician Date Physician Date
12%
of patients know the name of the urgent care center medical professional who most recently treated them.
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23
30
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SCHEDULING ISSUES with their primary care office would cause two-thirds of patients to seek services elsewhere.
This study was conducted online by Harris Poll on behalf of Mercy Health System of Southeastern Pennsylvania in February 2017 among 1,735 U.S. adults ages 18 and older who have a primary care physician, whom we describe as patients. mercyhealth.org
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Speak LOUD and walk BIG SPECIALIZED THERAPY PROGRAM HELPS PATIENTS WITH PARKINSON’S COMMUNICATE AND MOVE BETTER
Allison Temple, MA, CCC-SLP, listened carefully to her patient as he expressed his frustration of not being understood. The device he used to search the internet by voice—one of those popular personal assistants with names like Siri and Alexa— couldn’t comprehend his requests. The reason? Parkinson’s disease (PD) had reduced his voice to a low volume. That’s not uncommon for people with PD. Now, a speech and physical therapy program at Nazareth Hospital Center for Physical Therapy, Rehab and Balance is helping people just like Allison’s patient cope. It’s called the Lee Silverman Voice Treatment (LSVT) LOUD and BIG.
‘Smoother communication’ Having a low voice volume means others may not understand you—at home or at places like the grocery store. That can be both frustrating and socially isolating, says Allison, who is a speech therapist with the LOUD part of the LSVT program. “Many patients with PD say they feel like they’re losing out, especially in group conversations,” she says. That’s where LSVT LOUD comes in. Outpatient speech therapy involves special voice exercises that retrain the brain and help people with PD speak more loudly and clearly. “Our goal is to improve their ability to be understood by family and friends and other people in their environment,” Allison says. In addition to improving voices, LOUD may help other PD-related problems—namely, impaired swallowing or a “masked” facial expression. “After being in the LOUD part of the program, people with PD say they’re more easily understood,” Allison says. “And their family members are excited that they can understand their loved ones and don’t have to ask them to repeat things. It’s just easier, smoother communication for everyone.”
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CHECK IT OUT Learn more about our stateof-the-art Center for Physical Therapy, Rehabilitation and Balance at mercyhealth.org/ therapy/outpatient or call 215.335.3954. For example, Heather might have a patient practice stepping and reaching up for an object. “We’ll have them step as big and as far as they possibly can and reach as high and as far out as they possibly can,” she says.
Moving in a big way The other part of LSVT is BIG. It involves physical therapy designed to address movement impairments. “When someone has PD, their movements may become very small,” says Heather Wilkinson, DPT, PT, a physical therapist with the BIG part of the program. “They may walk with a shuffling gait. And oftentimes it’s hard for them to start a movement.” BIG therapy might be thought of as resetting the brain’s sensory system.
“It’s almost like retraining your brain to understand what a more effective movement would feel and look like,” says Alex Taratuski, DPT, PT, who is also a physical therapist with the BIG part of the program. Working with a physical therapist, BIG participants perform everyday movements—with a big difference: “We have people move with very large movements,” Heather says. “And we have them do it over and over again.”
It takes commitment BIG and LOUD each involve a total of 16 sessions over four weeks. And there is homework. Patients are encouraged to practice certain phrases or movements as they go about their day. “Studies show it improves patients’ quality of life,” Alex says. “They feel more confident. And once you’re more confident, you’re willing to get out and do things.”
5 facts about Parkinson’s disease 1 Parkinson’s disease (PD) is a disorder of the nervous system that affects normal movements. It involves the loss of nerve cells that produce a brain chemical called dopamine.
2 The risk of PD increases with age—the average age of onset is 60, and the chances of developing the disease go up significantly after that. But an early-onset form of Parkinson’s can strike people under the age of 50.
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Scientists still aren’t sure what causes PD. As with many diseases, genes and some things in the environment may contribute.
The main signs and symptoms of PD are shaking (known as tremor); muscle stiffness; slow movements; and difficulty with walking, talking or balance. PD signs and symptoms typically begin on one side of the body and eventually affect both sides.
PD has no cure, and the signs and symptoms get worse over time. But treatment, such as with a drug called levodopa, can help people manage the disease.
Sources: National Institute of Neurological Disorders and Stroke; Parkinson’s Disease Foundation
mercyhealth.org
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The right help for persistent pain You’re in lingering pain— maybe from a bum knee, a sore back or a hip with arthritis. And you want one thing: to feel like yourself again. Your doctor wants that too. Even so, he or she may advise against taking a prescription opioid drug like oxycodone. Yes, these drugs can help with some types of pain, such as cancer pain, in the short term. “But they also come with serious risks, including addiction,” warns Ruth Martynowicz, Vice President of Operations at Mercy Home Health. That’s why your doctor may suggest other ways, besides taking an opioid, to ease your pain. For example, pain relievers such as acetaminophen (brand name Tylenol) or ibuprofen (brand name Advil) might help. So might steroid shots, physical therapy or exercise. If your doctor does prescribe an opioid drug, you should: Be frank. Tell your doctor if you’ve misused—or have been addicted to— alcohol or other drugs. If so, taking opioids could be very risky for you.
Speak up. Tell your doctor about all the medicines you take. Some aren’t safe to use with opioids. Take the opioid exactly as prescribed. Don’t take an extra or higher dose, even if you still hurt. Talk to your doctor instead. And
don’t drink alcohol while you’re on an opioid. Keep others safe too. Never share an opioid with friends or family. And keep the drug out of the sight— and reach—of curious kids. You might even store the opioid in a lockbox.
Prescription opioid drugs come with serious risks.
Don’t risk the flu—get your shot
WE CAN HELP Interested in the services Mercy Home Health provides? Call 1.888.690.2551 or visit mercyhomehealth.org.
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You want to stay healthy and feel good. And one way to do that, especially this time of year, is to get a flu shot. Some people develop serious complications from the flu, like pneumonia, and need to be hospitalized. Older adults are at especially high risk for flu complications, such as death. So are those with chronic health problems, like diabetes or heart or lung disease. Those are some key
reasons why nearly everyone 6 months and older should get a flu vaccine every year. “Getting an annual flu shot is the best way to help avoid getting very sick and infecting others who are more vulnerable,” says Donna Raziano, MD, Chief Medical Officer of Mercy Home Health. Why do you need a new shot each year? Because the viruses it prevents can change from one flu season to the next. Also,
the immunity depends on the strains of active influenza virus that year. It’s true that sometimes you can still get the flu even if you’ve had a flu shot. “But chances are, you won’t get as sick if you’ve been vaccinated,” says Dr. Raziano. “That’s why the vaccine is still your best defense against the flu.” Flu season can last for many months. So it’s not too late to get a flu shot if you haven’t done so yet. Talk to your doctor.
So nice to see you! VIDEO CALLS GIVE TELEHEALTH NURSES A CLEARER PICTURE OF HEALTH “Let me see what your ankles look like today.” That’s a request a nurse might make to a patient enrolled in the Telehealth Monitoring program at Mercy Home Health. And it’s a request that’s now possible because many patients on telemonitoring will have the use of a tablet for video conferencing. As part of the telehealth program, patients with heart failure, chronic obstructive pulmonary disease (COPD) or other serious diseases send blood pressure readings, daily weight and blood-oxygen levels over the phone from their home. Nurses from Mercy Home Health see this data on a screen, and they call the patient if anything needs prompt attention. And now many patients can see the nurse who responds because they have tablet computers that can make a video call.
“We see them, and they see us,” says Jayne Green, Regional Director of Operations at Mercy Home Health. “Being able to look at a patient helps us have a better idea of how they’re feeling.” For instance, a nurse can see if a patient is short of breath or if their ankles are swollen. Those might be signs of a change in the patient’s health. But the tech upgrade helps patients in more ways than one. Video makes a nurse’s call more personal, which many patients enjoy. “It’s nice that you get to put a face to the voice,” Green says.
ON-SCREEN HELP To learn more about the Telehealth Monitoring program, call 1.888.690.2551. Or visit mercyhomehealth.org.
THE A1C TEST
Your blood sugar report card Do you have any idea how well your diabetes is being controlled? You can have a very clear picture if you are getting regular A1C tests every 3 to 6 months. “This simple blood test lets you and your doctor know what your blood glucose level has averaged over the previous two to three months,” says Donna Raziano, MD, Chief Medical Officer for Mercy Home Health. Having a high A1C result means your blood sugar was not well-controlled during that time. “The higher your A1C result, the greater your chance of developing irreversible diabetic complications, such as eye disease, kidney disease or nerve damage,” says Dr. Raziano. A person without diabetes has an A1C level of less than 5.7 percent. For people with diabetes, a good goal may be keeping their A1C less than 7 percent. It is very important to have A1C tests and to not rely solely on the blood sugar testing you do at home. Those tests show your blood sugar level at a particular moment in time, but they don’t provide the overall picture that an A1C test does. It is a good idea to occasionally check your blood sugars at different times of the day, such as before dinner and bedtime, and not just exclusively when you are fasting in the morning. You should get an A1C test minimally at least twice a year. Your doctor may recommend you get it more often if your blood sugar levels are not well-controlled or your treatment plan changes. mercyhealth.org
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What men need to know AND
Prostate cancer usually grows slowly—and most men with the disease won’t die from it. Even so, before the year ends, it’s expected to claim roughly 28,000 lives nationwide. Richard H. Charney, MD, a urologist at Nazareth Hospital, answers three crucial questions about detecting and treating prostate cancer. The prostatespecific antigen (PSA) test for finding prostate cancer is controversial. Why? Answer: It can be a lifesaver for some men by detecting cancer that needs to be treated. But it can also detect cancer that would never cause
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MEN: NEED A UROLOGIST? We can help you find one. Call 1.866.NAZARETH (1.866.629.2738).
problems. This means some men might have unnecessary biopsies or treatments. What’s your opinion about PSA testing? Answer: Like most urologists, I advise men to talk to their doctors about the pros and cons of testing and then make a decision that makes sense to them. But if you have a family history of prostate cancer—for example, if your father or a brother developed it—the test is in your best interest. In that case, you should get regular PSA tests and digital rectal exams starting at age 40.
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What should men know about treatment for prostate cancer? Answer: Treatment— such as radiation therapy or surgery—is often highly successful, especially when cancer hasn’t spread beyond the prostate gland. But since prostate cancer often grows so slowly, some men may not need treatment, just close monitoring. That’s particularly true for older men and those with serious health problems. There’s no one-size-fitsall approach to treatment. If you learn you have prostate cancer, you need to carefully consider all your options with your doctor.
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Getting to know you
Richard H. Charney, MD
Name: Richard H. Charney, MD Specialty: Board certified in urology Medical school: Jefferson Medical College Internship and residency: York General Hospital, Abington Memorial Hospital and Albert Einstein Medical Center
MORE @ MERCY is published as a community service for the friends and patrons of Mercy Health System. Information in MORE @ MERCY comes from a wide range of medical experts. If you have any concerns or questions about specific content that may affect your health, please contact your healthcare provider. Models may be used in photos and illustrations. If you would like to stop receiving this publication, please email IAtMercy@mercyhealth.org. 2017 © Coffey Communications, Inc. All rights reserved.