Health Watch - Fall 2017

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FALL 2017

IMAGE MAGAZINE’S

lifestyle, fitness & nutrition

Embrace a healthy lifestyle at every age FALL 2017

THE REGION’S RESOURCE FOR HEALTH CARE

FAMILY HEALTH IS COMMUNITY

HEALTH

CONTENTS 10 Word on Health News, tips, and information for your well-being

16 The Vermont Family Based Approach at Mt. Ascutney Hospital 22 Enhance Health 28 The APD Multi-Specialty Clinic 34 Springfield Medical Care Systems 36 ClearChoiceMD 40 Cioffredi & Associates Physical Therapy

15 HEALTH SOURCE

TRENDS

42 Therapy Works

27 What Is a Nurse Practitioner?

44 A Holistic and Integrated Approach

32 What Is Telehealth?

46 Helping the Body Heal Itself

43 Home Safety Checklist 54 Manual or Power Toothbrush?

49 What’s New in Dentistry?

64 The Better to See You With

62 Hill Opticians

72 10 Skin Care Tips

66 White River Family Eyecare

91 Build a Better Smoothie

68 Appletree Opticians

96 Water Exercise

70 Better Hearing for Life

108 10 Ways to Keep Your Mind Sharp

74 Strong House Spa

117 The 12 Benefits of Tai Chi for Seniors

80 AboutFace

120 Tips for Aging Eyes

82 Save Your Skin

47 BE YOUR BEST

84 Building Better Diets for the Long Haul 87 Food for Good Health at Lou’s 88 Healthy to Go 92 Where Does Your Food Come From?

94 Bring Balance to Your Life 98 Creating a New Social Circle 106 Be Prepared for the Future 110 Comprehensive Wealth Management 112 The Jack Byrne Center for Palliative & Hospice Care 118 A Holistic Approach to Finding the Best Investment Strategy 124 Delivering Professional Care in the Comfort of Your Home

97 ART OF AGING

128 Advertisers Index

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health watch IMAGE MAGAZINE’S

EDITOR’S NOTE

FALL 2017

lifestyle, fitness & nutrition

Here’s to Your

Good Health!

P HOTO BY I A N R AYM O N D

W

elcome to the first annual issue of Health Watch, a magazine dedicated to bringing

you the latest developments in every aspect of health care. Most of us work hard every day to replace our old habits with new behaviors in an attempt to be healthier. In the quest to live a healthy lifestyle, we do

what we know we’re supposed to—we have annual physical exams, keep an eye on our blood pressure and cholesterol numbers to maintain acceptable levels, exercise more, and try to eat a nutritious diet.

Within these pages, you’ll discover valuable advice from many local health care providers. You’ll learn about expansions and new programs at area hospitals and clinics, and we’re sharing expert advice from local physical therapists, dentists, optometrists, and skin care specialists. We’ve also sought out the best tips from nutritionists on healthy snacking, nutrition for children, and the positive impact of locally grown foods. Lastly, we’re exploring health care options as we age. You’ll learn about several options for aging well in addition to assisted living facilities,

Mountain View Publishing, LLC 135 Lyme Road Hanover, NH 03755 (603) 643-1830

www.uppervalleyimage.com Publishers

Bob Frisch Cheryl Frisch Executive Editor

Deborah Thompson Associate Editor

Kristy Erickson Copy Editor

Elaine Ambrose Creative Director/Design

Ellen Klempner-Béguin Advertising Design

Hutchens Media, LLC Web Design

Locable

Inbound Marketing Manager

Erin Frisch

Advertising

Bob Frisch

visiting nurses, end-of-life care, and even financial planning.

When all is said and done, I have an overwhelming feeling of relief and gratitude for the range of excellent, experienced professionals we have access to in the Upper Valley. The staff and I also appreciate their participation in contributing their time and expertise to Health Watch. These dedicated professionals are here when we need them, keeping us and our families well. Enjoy!

Deborah Thompson Executive Editor dthompson@mountainviewpublishing.com

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2017

KEEP US POSTED: Health Watch magazine wants to hear from readers. Correspondence may be addressed to: Letters to the Editor, Health Watch 135 Lyme Road, Hanover, NH 03755. Or email us at: dthompson@mount ainviewpublishing.com. Advertising inquiries may be made by email to rcfrisch1@comcast. net. Health Watch is published annually by Mountain View Publishing, LLC© 2017. All rights reserved. Reproduction in whole or part is strictly prohibited. Health Watch magazine accepts no responsibility for unsolicited manuscripts, artwork, or photographs.

word on health NEWS, TIPS, AND INFORMATION FOR YOUR WELL-BEING

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PERCENT OF FACIAL AGING IS DUE TO SUN EXPOSURE

SUNSCREEN EXPLAINED

Your skin is exposed to the sun’s harmful UV rays every time you go outside, even on cloudy days and in the winter. Use a daily moisturizer with UV protection.

PROMOTE DIGESTIVE HEALTH

ANTIAGING TIPS:

1.

Choose sun protection

2.

Remember to apply

that has an SPF of 30 or

sunscreen to all exposed

higher and provides broad-

skin, including the neck,

spectrum coverage from

face, ears, and hands.

Just 15 minutes of yoga can help relieve bloating and ease stomach discomfort.

UVA and UVB rays.

FOODS THAT FIGHT FAT Alongside a regular fi tness regimen, a few key foods can help kick-start weight loss.

Yoga’s

SURPRISING BENEFITS EGGS

CAYENNE PEPPER

SALMON

The amino acids in egg whites help build lean muscle, which may help rev metabolism.

Daily consumption of the compounds in cayenne pepper speeds up abdominal fat loss by boosting the body’s ability to convert food into energy.

Protein builds muscle, and salmon is one of the healthiest sources of lean protein. It’s also rich in omega-3 fats, which aid weight loss.

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Yoga not only increases flexibility and builds strength but also helps prevent joint and cartilage breakdown, keeps bones strong, supports heart health, improves balance, and may even boost immunity.

FACTS & FIGURES

VITAMIN D

WALK, DON’T RUN? People who engage in equivalent

researcher noted that “you would

amounts of running and walking can

need to walk for about twice as long”

gain the same degree of benefits

to gain the same benefits as running.

when it comes to blood pressure, cho-

That’s because runners are likely to

lesterol, diabetes, and heart disease.

cover more ground, potentially lead-

The National Runners’ Health Study

ing to more health benefits. However,

with 33,000 participants and the

walking may be a more sustainable

National Walkers’ Health Study with

activity for a majority of people,

15,000 were compared. The lead

especially older Americans.

Vitamin D is a fat-soluble vitamin that the body produces in response to sunlight. It helps build strong bones; supports the health of the immune system, brain, and nervous system; regulates insulin levels; supports the cardiovascular system; and more.

Some reports suggest that up to

50%

of adults and children worldwide are vitamin D deficient.

HOW MUCH DO WE NEED? The Recommended Dietary Allowance (RDA) for vitamin D is 600 IU daily for people ages 1 through 70.

COLD & FLU RELIEF Elderberry Tea Drinking elderberry tea may help soothe cold and flu symptoms, including fever, headache, fatigue, sore throat, and coughing. Look for elderberry tea at your local natural market, and drink it daily for three days for maximum benefits.

TOP 3 SOURCES Sensible sun exposure: Experts recommend sun exposure on bare skin for 5 to 10 minutes 2 to 3 times per week to allow the body to produce sufficient vitamin D. Food: Salmon, tuna, and fortified milk and orange juice are dietary sources of vitamin D. Supplements: Look for vitamin D as part of a daily multivitamin as well as in cod liver oil and individual supplements. Opt for vitamin D3 (cholecalciferol), which is the highly absorbable form the body makes when exposed to sunlight.

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word on health WELLNESS

HEAD TO TOE According to the Mayo Clinic, massage can be a powerful tool for encouraging wellness.

Studies have found that massage may be helpful for anxiety, digestive disorders, headaches, insomnia, sports injuries, and soft tissue strains. It may also ease symptoms of depression and lower levels of the stress hormone cortisol.

Consider geriatric massage.

Techniques can help enhance blood circulation, combat depression, improve balance and flexibility, reduce the pain of arthritis, increase joint mobility, improve posture, and encourage overall well-being. Always check with your physician before receiving any type of treatment.

TAKE A BLOOD PRESSURE BREAK Reduce blood pressure with these natural, painless practices If you’ve been diagnosed with high blood pressure, the right foods and a healthy lifestyle go a long way toward lowering your numbers and keeping them down. In addition to achieving a healthy weight, exercising regularly, limiting alcohol, and eating a diet rich in whole grains, fruits, vegetables, and low-fat dairy, the following tips may also support your blood pressure.

• Spend Time with Your Pet According to the American Heart Association, owning a pet, particularly a dog, is linked with a reduced risk of heart disease. Dog owners are more likely to exercise, have a better cholesterol profile, have lower blood pressure, and be less vulnerable to the effects of stress.

• Eat Berries Anthocyanins, the bioactive compounds in blueberries, have been found to offer protection against hypertension. In one study, those who ate blueberries at least once a week reduced their risk of developing the condition by 10 percent.

• Have a Good Laugh Research finds that having a good laugh could lower your blood pressure, perhaps as much as eliminating salt from your diet or losing 10 pounds.

• Try Meditation Adding to the conventional methods of tackling hypertension and high blood pressure, consider a newer technique called mindfulness-based stress reduction. MBSR can be incorporated in your daily lifestyle along with physical activity and weight management to reduce the effects of high blood pressure.

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WHEN THE FOOTING GETS TRICKY We know we should exercise daily—no matter what. But when roads and sidewalks in Northern New England start to look like skating rinks, beware! A fall can result in an injury that sidelines you until spring. This winter, invest in a pair of traction devices to pull on over boots or shoes. They come in different styles, and one company, Yaktrax, has various models for more or less traction based on your planned activities. To avoid having to pull them on and off every time you head out, have a “dedicated” pair of boots that you leave your traction gear on all winter.

DON’T BE SAD Pump Some Iron

Seasonal affective disorder, or SAD, begins in late

If you’re new to the gym, new to strength training, or just find yourself surrounded by muscle heads, don’t be intimidated! It’s worth your while to move away from the treadmill and into the weight area a few days a week. Strength training helps build muscle and burn fat, and it protects against osteoporosis. To increase strength, opt for heavier weights and fewer repetitions.

To build endurance, go for more repetitions with lighter weights. And stick with it! After a few months you’ll see about a 20 to 40 percent improvement in strength.

fall as the hours of daylight wane, making some people lethargic and moody, and sometimes disrupting normal sleep patterns. Baseball cap or visor light phototherapy technologies help dispel the gloom for many. These portable, lightweight options fight symptoms by mimicking natural sunlight. While more research is needed to determine whether they’re as effective as sitting in front of a light box, they remain an option for busy people affected by SAD.

www.feelbrightlight.com

www.northernlighttechnologies.com

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HEALTH SOURCE HOSPITALS, URGENT CARE, CLINICS, PHYSICAL THERAPY

It is health that is real wealth and not pieces of gold and silver. —Mahatma Gandhi www.uppervalleyimage.com •

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Dr. Kathleen Geagan, MAHHC pediatrician, with the Bania family.

She examines Kaleigh while father Craig and sister Kenzie look on. Photo

by Tom McNeill.

E m p owe

ring

ices o h c y h t l a ke h e a m o t s e i l fami

The Vermont Family Based Approach at

Mt. Ascutney Hospital

T

he Pediatrics Department of Mt. Ascutney Hospital and its Ottauquechee Health Center has embarked on a program focusing not only on the well-being of children but also on the emotional and physical health of the entire family.

Dr. James Hudziak of the Vermont Center for Children, Youth, and Families at the University of Vermont created the Vermont Family Based Approach (VFBA) as a unique evidence-based method to improve health and well-being by focusing on the family as the unit of health.

Exploring ways to better strengthen families and guide good choices starting at an early age, and with support from John and Laurie Chester of Woodstock and the Canaday Family Charitable Trust, Mt. Ascutney began working with UVM last August. Courtney

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Above: Courtney McKaig, MAHHC Family Wellness Coach, with Corinna Brown and her children. Photo by Lynn Bohannon.

Right: Dr. Mary Bender, MAHHC pediatrician, with Steven Sheldon and his son Martin. Photo by Tom McNeill.

. as the unit of health ily m fa e th n o ng si well-being by focu Improve health and

Courtney works with the family and not just the child. “It’s important for them to recognize that time invested in their own well-being is an investment in their child. . . .”

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McKaig, a behavior specialist embedded with the Pediatric Department in both the Windsor and Woodstock locations, was trained as a Family Wellness Coach.

She partnered with other members of the community, including an early education coordinator, a school nurse, school principal, the community care coordinator at Mt. Ascutney, the lead RN in Pediatrics, and a mental health counselor. “I had a team of people who are involved with families in the community join and learn about the approach so we could work collaboratively,” Courtney says.

Identifying Strengths and Challenges At the 15-month well child pediatric checkup, families are introduced to the program.

Then, at the 18-month well child checkup, “That’s when we add a visit with a Family Wellness Coach to begin discussing the wellness domains and an assessment to determine how the family is functioning,” Courtney says. The coach helps identify the family’s strengths and challenges and helps them establish wellness goals. Then a plan is developed based on each family’s unique situation.

As a coach, Courtney works with the

th.

family and not just the child. “It’s important for them to recognize that time invested in their own well-being is an investment in their child. Then I listen and hear from them where their family is at and their concerns, and I try to tease out strengths and capitalize on what’s going well.

From that I can offer suggestions on where they might go.

You can see in their bodies there’s a sense of relief. ‘We can do this.’ Everyone’s schedule is different, so you meet them where they’re at and determine what works for them.”

Regular visits are scheduled every six months, at 24 months, 30 months, and 36 months, addressing the parent–child interaction and “building fluency in parents to attend to the positive social behavior they see in their children,” Courtney says.

Simple, Reasonable, and Achievable “The beauty of what Courtney does is she makes it simple, achievable, and then she links it to the science and lets them know they are doing something important,” says Jill Lord, RN and Director of Community Health at Mt. Ascutney.

“They don’t go away with a complicated plan they won’t follow. It’s a reasonable plan that comes from them after they explain their lives and what their struggles and goals are. It’s powerful.”

The Vermont Family Based Approach identified eight domains—exercise, nutrition, reading, sleep, mindfulness/ stress management, music, parenting, and community involvement—for their impact on wellness. Courtney says, “What’s great about the model is it allows you to hone in on achievable small steps that are known to improve wellness, which is what the eight health domains of this model can do.”

Courtney encourages reading together, for example, as a family activity rather than making the kids read on their own all the time. Parents are often so concerned about ensuring that their children read well that it can become a chore. Reading together can be a fun, bonding experience, she says. “It’s a brain builder and a relationship enhancer. It also encourages community involvement,” she adds, “such as a trip to the library.”

According to Dr. Hudziak, who created the Vermont Based Family Approach, all health is tied to emotional behavioral health. “You need to have your own emotional behavioral health in check in order to address some of the physical health issues,” Courtney says. “The beauty of this model is that we know that physical exercise can improve mood,

“The approach allows for discussions around just being. . . . This offers an opportunity to encourage families to be together and be a family and have gratitude for each other’s presence. That is empowering for families.”

According to Dr. Hudziak, who created the Vermont Based Family Approach, all health is tied to emotional behavioral health.

4 million children have a serious mental disorder

21% (1 in 5 children) have a disorder that causes at least minimal impairment

50% of all lifetime mental disorders start by the age of 14

50% of teens with mental illness drop out of high school Suicide is the 3rd leading cause of death in youth Statistics taken from The Vermont Family Based Approach YouTube video.

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ified the t n e id h c a e d A p p ro s a B ellness. y w il n m o a t F c t a n p o The Verm or their im f s le u d o 8m following

5

Mindfulness/ stress management

1

Exercise

2 Nutrition

3

Reading

4

Sleep

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7

Parenting

and it can improve attention. If children with ADHD are struggling, for example, we know that vigorous exercise can help improve their cognitive flexibility, their attention, and their mood. These domains are tied to improvements in emotional and behavioral health.” In terms of parent management, goals might include establishing consistent, predictable routines, providing positive attention, and understanding that it’s the behavior at issue and not the child.

6

Music

8

Community involvement

A Powerful Beginning Jill says she hears from families who express relief and gratitude “for being understood and for receiving concrete, practical help that can actually make a big difference in their life. It’s attainable.

We’ve yearned to be able to support that most critical unit in our lives—our families—instead of complaining about the dismal struggles of families. Having a practical, positive way to impact and support families is so wonderful and natural. It’s logical, and it’s a powerful beginning for what can happen. We feel privileged to be able to provide this positive, useful, practical, and powerful approach.”

Courtney says, “The approach allows for discussions around just being. So often I find families are trying to push their children to achieve, and there’s so much pressure in society to constantly teach your child something that, sometimes, just being and acknowledging and appreciating your child gets overlooked. This offers an opportunity to encourage families to be together and be a family and have gratitude for each other’s presence.

That is empowering for families.”  Mt. Ascutney Hospital and Health Center 289 County Road Windsor, VT (802) 674-6711 www.mtascutneyhospital.org www.uppervalleyimage.com •

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A NEW APPROACH TO HEALTH CARE

ENHANCE HEALTH

BY KATHERINE P. COX PHOTOS BY JIM MAUCHLY/MOUNTAIN GRAPHICS

People want to open it up to overall wellness and tackle all aspects of their life and health. —Dr. Dominic Candido, cofounder of Enhance Health 22 i m a g e h e a l t h w a t c h •

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T

here’s a shift in how people think about their health, says Dr. Dominic Candido, cofounder of Enhance Health in Lebanon.

“People want to open it up to overall wellness and tackle all aspects of their life and health,” he says. To that end, he and Dr. Cathleen Beaver launched Enhance Health last winter believing that psychological and physical health go hand in hand.

Dr. Candido, a clinical psychologist who founded Hanover Psychiatry for Dartmouth Geisel School of Medicine nine years ago, brings years of extensive experience in behavioral and cognitive therapy to Enhance Health. He has partnered with Dr. Beaver, formerly a primary care physician at Dartmouth-Hitchcock Medical Center, who for the past four years was on the development and medical team at the Dartmouth-Hitchcock Weight and Wellness Center, to provide a new model of health care in the region.

A Menu of Offerings Enhance Health provides what the two doctors call a menu of offerings of thorough physical and mental health evaluations, classes and workshops, and yoga. They offer ongoing primary care and psychological care. Four basic packages, based on medical history and physical and psychological consultation, include Lifestyle Wellness, a personalized plan that focuses on nutrition and healthy lifestyle behaviors; Professional’s Health, an in-depth plan that includes more extensive testing; Nutrition, personalized guidance emphasizing healthy eating habits; and Women’s Health, centered on women’s health issues. Assessments include medical history; nutrition analysis; lifestyle; physical, cardiopulmonary, and psychological fitness; and even genetic testing.

At Enhance Health, access is guaranteed. “Can I see my doctor and how soon?” is an issue people face in regard to access to their doctors,

Cofounders Cathleen Beaver, MD, and Dominic Candido, PhD.

“80% of chronic disease is preventable if people live healthy lifestyles. . . . We want to focus on positive pieces of psychology to improve people’s health.” www.uppervalleyimage.com •

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THE TEAM

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HOSPITALS

Dr. Candido says. “People being shut out for weeks and weeks—that’s not going to happen here.”

Aligning medicine and psychology under one roof allows Dr. Candido and Dr. Beaver to address and treat ailments and diseases, which Dr. Beaver says are driven by behaviors. She explains, “Eighty percent of chronic disease is preventable if people live healthy lifestyles. The question is what is getting in the way, and that’s where we feel psychology plays a big role. What makes us choose what we do? We want to focus on positive pieces of psychology to improve people’s health.”

Putting Patients at the Center The Enhance Health office was carefully designed around the philosophy of seamless, integrated care, with easy-to-access services in one place and a serene environment as envisioned by Dr. Candido. It’s not your typical doctor’s office—it’s bright and open, with clean lines and views to the woods outside.

“I wanted the space to reflect what our philosophy is—a clean palette on which a patient can paint his or her own life.” Dr. Candido said he was looking for “a tension in elements, a resolution of the dissonance between disparate elements that leads toward satisfaction; the stone (dark gray Vermont slate) against the carpet, the white against the splashes of color (art on the walls)— hopefully all these elements of dissonance resolve in a satisfactory way.”

In designing the space, Dr. Candido says he considered how the built environment is experienced, from the view of the woods out the window as you enter, contrasted with the modern décor of the furniture, to the solidity of the large, slate reception desk.

On one side of the offices is the psychological side, with five rooms sparingly decorated with furniture in mid century style and large windows

Dominic Candido, PhD; Teresa Candido, LICSW; Karriebeth Davis, practice manager; Cathleen Beaver, MD; Christina Tangredi, APRN; and Evan Bick, PsyD.

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WHAT IS CONCIERGE MEDICINE?

PHOTOS COURTESY OF YANKEE BARN HOMES

At Enhance Health, Drs. Dominic Candido and Cathleen Beaver are launching a new model of personalized health care in the Upper Valley, which they are calling Helthyly, a membership-based approach that will provide personalized medical and psychological attention. They are promoting it as “All the care you want, 24 hours a day, every day.”

In addition to the care already provided at Enhance Health, “This is a service for people who are looking for a more comprehensive package,” Dr. Beaver says. It’s for people looking for easy and accessible care, “those who want their health care to fit into their life and schedule rather than vice-versa.”

Two levels of annual membership include the basic membership, which provides patients with a wellness evaluation, a 60-minute consultation with a psychologist, a medical assessment, and a personalized action health plan. “Essentially, I will be their private doctor, and they have access to me for whatever care they need, 24 hours a day,” Dr. Beaver says.

“If they have urgent issues, we can see them right away. They will have access to text me if they need to.”

Access to all that’s offered at Enhance Health, including classes, workshops, and yoga, is included. A higher level, the premium package, provides unlimited access to a psychologist as well as personalized physical fitness and nutrition guidance.

“All the care you want, 24 hours a day, every day.”

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Top: Medical exam room.

Inset: Nurse practitioner Christina Tangredi.

looking out to the woods beyond. On the medical side, there’s an exam room, which also has an expansive view to the woods, that is sophisticated and uncluttered, with a soft, heated exam table. “I wanted to make it as comfortable as possible with the focus on the patient,” Dr. Beaver says.

The windows are mirrored on the outside to ensure maximum privacy.

A nutrition consultation room and a testing room for cardiopulmonary and metabolic evaluations complete the medical side.

“People are excited about what we’re doing and the chance to experience

health care in a different way,” says Dr. Candido. “The feedback we get from our patients is that they really love the atmosphere, how they can receive everything in one place, how easy it is to access our complementary services.”

“We’re looking to reinvent health care and offer something new to the Upper Valley,” Dr. Beaver says. “We want to create a new model of health care that puts patients at the center.”  Enhance Health 67 Etna Road, Suite 350 Lebanon, NH (603) 448-0055 enhancehealth.org

HEALTH CARE HOSPITALS TODAY

BY HEALTH WATCH STAFF

What is a

Nurse Practitioner?

KEEPING UP TO DATE WITH ADVANCES IN MEDICINE A nurse practitioner (NP) is a registered nurse (RN) with advanced training in diagnosing and treating illness. NPs prescribe medications, treat illnesses, and administer physical exams. They tend to focus on prevention, wellness, and education. NPs often work in conjunction with a doctor, or they may work independently.

These professionals typically need at least a master’s degree to practice, and a doctor of nursing practice (DNP) is quickly becoming the preferred level of preparation in this field. NPs provide primary, acute, and specialty health care services to diverse populations.

Many NPs work in primary and acute care settings including Adult health

Geriatric health

Family health

Women’s health/ midwifery

Pediatric health Neonatal care School/college health

Psychiatric/mental health

Nurse practitioners may also work in a variety of specialties, including the fields of allergy and immunology, cardiac care, dermatology, endocrinology, emergency department care, hospice, gastroenterology, neurology, orthopedics, surgery, urology, and more.

According to the American Association of Nurse Practitioners, patients under the care of NPs report greater satisfaction, fewer unnecessary ED visits, fewer hospital readmissions, and fewer preventable hospitalizations compared to patients under the care of doctors. Furthermore, NPs may be a more cost-effective alternative to doctors, due in large part to their lower educational costs.

Fourteen years after the first nurse practitioner program was established in 1965 at the University of Colorado and five years after the American Nurses Association established a separate council for NPs, their ranks had exceeded 15,000 by 1979. Today there are more than 205,000 NPs licensed in the United States.  Sources: www.npcentral.net, www.nursepractitionerschools.com

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The APD Multi-Specialty Clinic OUTPATIENT CLINIC AT ALICE PECK DAY MEMORIAL HOSPITAL TO OPEN THIS FALL

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HOSPITALS

HEALTH CARE CLINIC

BY HEALTH WATCH STAFF

A ONE-STOP HEALTH CARE DESTINATION, the Alice Peck Day (APD) Memorial Hospital Multi-Specialty Clinic is on track to open its doors this fall. The space caters to patients who prefer convenience when arranging their visits with health care providers and health services.

The new structure is a two-story, 44,000square-foot building and is known as the APD Multi-Specialty Clinic. It is located conveniently on the campus of Alice Peck Day Memorial Hospital in Lebanon, New Hampshire.

The APD Multi-Specialty Clinic will house most of the hospital’s outpatient departments, including Family Practice, Geriatrics, Internal Medicine, Pediatrics, and Orthopaedics. It will also include Cardiopulmonary, General Surgery, Pain Management, Physiatry, Plastic and Reconstructive Surgery, Podiatry, Sleep Health, Occupational Health, Urology, and Women’s Care.

In addition, it will include outpatient Phlebotomy and Radiology, as well as rehabilitative services such as physical therapy and occupational therapy.

Other services such as x-ray and labs will also be available at the Multi-Specialty Clinic.

“This is all about making it simple to coordinate patient care,” says Dr. Dale Vidal, the executive director of the Multi-Specialty Clinic. “Instead of asking patients to go from building to building, we now offer nearly everything they need for their outpatient care in a single location that is welcoming and friendly.”

All of the services will be supported with continuous quality improvement and information management. The Multi-Specialty Clinic will include more than 50 providers and more than 150 staff.

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Right: Dr. Len Rudolf, Dr. John Houde, Dr. Diane Riley, and Dr. Ivan Tomek of the APD Orthopaedics team will be welcoming patients in the new outpatient clinic.

Below: Internal medicine provider Dr. Sari Galanes and pediatrician Dr. Doug Williamson will also be welcoming patients at the clinic.

Opposite: Providers from the Robert A. Mesropian Center for Community Care, Women’s Care Center, and the Sleep Clinic will soon call the Multi-Specialty Clinic their home.

“This is all about making it simple to coordinate patient care.”

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HEALTH CARE CLINIC

“We think providers and patients will be very excited to be in this building,” says Dr. Sue Mooney, the president and CEO of APD. “It’s big enough to bring all of these providers and services together under one roof, but also small enough to feel like a town square where neighbors and friends gather.”

E4H (Environments for Health Architecture) of Williston, Vermont, served as the architect for the Multi-Specialty Clinic. Built on time and under budget by DEW Construction Corporation, the project had an estimated cost of $13 million. The Monadnock Economic De-

velopment Corporation (MEDC) is the developer of the project, and APD has entered into a long-term lease obligation with the MEDC. Since 1932, Alice Peck Day Memorial Hospital has been the community hospital of the Upper Valley, delivering high-quality health care in a friendly environment where patients come first.

Today APD sees patients from communities throughout New Hampshire and Vermont, and annually has over 100,000 patient encounters.

Long known for providing highly personalized care, APD also offers a

wide range of specialized services that include Orthopaedic Surgery, Neurosurgery, Pain Management, Primary and Family Care, Senior Care, and Women’s Care. APD became an affiliate of Dartmouth-Hitchcock Health in 2016 and is committed to creating a sustainable health system to improve the lives of the people and communities it serves for generations to come.  Alice Peck Day Memorial Hospital Multi-Specialty Clinic 9 Alice Peck Day Drive Lebanon, NH (603) 448-3122 www.alicepeckday.org

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KEEPING UP WITH TECHNOLOGY

BY HEALTH WATCH STAFF

what is telehealth?

DISCOVER THE LATEST TOOLS HEALTH CARE PROFESSIONALS ARE USING TO IMPROVE CARE Telehealth is the use of electronic information and telecommunication technologies to support long-distance health care, patient and professional health-related education, public health, and health administration.

Technologies include videoconferencing, the Internet, streaming media, and wireless communications. Telehealth is not a specifi c service but a collection of methods for enhancing health care and education delivery.

Hospitals are pursuing telehealth as a way to expand access to care, make it more convenient for patients, create new effi ciencies, improve care coordination, prevent readmissions, better monitor and treat at-risk populations, and expand population health programs.

“Telemedicine” is a term that is still used sometimes when referring to clinical diagnosis and monitoring that is delivered by technology. However, the term “telehealth” is now more commonly used, as it describes the wide range of diagnostic and management capabilities, education, and other related health care fi elds. These include but are not at all limited to: Dentistry Counseling Physical and occupational therapy Home health Chronic disease monitoring and management Disaster management Consumer and professional education 

Î

Telehealth is not a specific service but a collection of methods for enhancing health care and education delivery.

A teledoctor checks a patient’s blood pressure virtually.

76% 90% BY 2018

of US hospitals and health systems either have in place or expect to implement a consumer telehealth program by 2018, according to Hospitals & Health Networks magazine.

of LARGE COMPANIES

will offer a telemedicine benefit.

Source: First Stop Health

Top Three Goals for Hospitals/Health Systems Planning to Introduce Telehealth by 2018 Improve care/ access

53%

Better care coordination/ integration

41%

More efficiencies in care delivery

41% 0%

10%

20%

30%

40%

50%

60%

70%

Source: Hospital & Health Systems 2016 Consumer Telehealth Benchmark Survey

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2017

Unique Integrated Care for Rural Communities SPRINGFIELD MEDICAL CARE SYSTEMS WITH ITS SOLID HISTORY OF COMMUNITYBASED HEALTH CARE, Springfield Medical Care Systems lives up to its guiding principle, “where people come first.” In fact, its unique structure of integrated care puts its nine primary care centers in the six towns of Springfield, Bellows Falls, Chester, Ludlow, Londonderry, and Charlestown, New Hampshire, front and center, above Springfield Hospital, which is a subsidiary.

“Through our corporate reorganization as a federally qualified health center, we became early adapters in the transformation of health care services. We believe we are well positioned to move to the next level of providing value and improving population health,” says Timothy Ford, Chief Executive Officer of Springfield Medical Care Systems.

“We are unique in that we include a critical access hospital, which also includes The Windham 34 i m a g e h e a l t h w a t c h •

2017

Center inpatient psychiatric facility, as a subsidiary to a community health center network,” says Anna Smith, Chief of Marketing and Corporate Communications. “Our goal is improving access to high-quality health care in our rural communities, understanding what the needs are, and working to meet those needs.” Services include a full range of primary care, women’s health, pediatrics, dental, vision, mental health, and substance abuse counseling.

To underscore its commitment to improving quality and access, Springfield participates in the Vermont Blueprint for Health, an initiative to move the state toward a model of primary health care that focuses on wellness rather than acute care, thereby controlling health care costs. Medicaid, Medicare, Blue Cross-Blue Shield of Vermont, MVP, and Cigna all participate in the program.

Much of today’s health care system reimburses through a fee-for-service model, says Tom Dough-

HOSPITALS

HOSPITALS

BY KATHERINE P. COX

“We believe we are well positioned to move to the next level of providing value and improving population health,” says Timothy Ford, Chief Executive Officer of Springfield Medical Care Systems.

erty, Blueprint’s project manager for Springfield. The Blueprint model is wellness focused, with physicians and staff working with patients to keep them out of the hospital.

“It provides funding for community services, such as transportation, helping someone find food or housing, educational outreach, or helping them get signed up for needed social services,” Anna says. “All these services support a healthier lifestyle.”

Should patients require specialty care, including surgery or orthopaedics, or inpatient hospital care, Springfield Hospital is part of the continuum of care and part

of the Federally Qualified Health Center network that keeps them close to home.

Community hospitals serve a vital role in rural communities where patients can remain near their families, friends, and support systems, and their care can continue to be coordinated with their primary care clinician who knows them well.

“We have a 24/7 Emergency Department, a critical service in a rural community. Lab and x-ray services available locally are also important for quality of care and reducing barriers to those for whom transportation is an issue,” Anna says. “Providing care that is conveniently accessible with costs

From far left: Springfield Medical Care Systems shares corporate offices with Springfield Hospital. Timothy Ford, Chief Executive Officer, Springfield Medical Care Systems; Cecil Beehler, II, MD, Chief Medical Officer; and Bob DeMarco, RN, MA, BSN, Chief of Quality, Chief Information Officer. Gianina Kennedy, FNP-C, visits with a young patient at Chester Health Center.

Photo by Cameron Paquette.

as low as possible provides value to the community.”

If patients need a higher level of care that requires them to go to a tertiary care hospital, “We’re here for their aftercare with local providers and care coordinators that they know. We have a strong support system to help connect patients with local services they might need, including financial assistance.”  Springfield Medical Care Systems 25 Ridgewood Road Springfield, VT (802) 885-2151 springfieldmed.org www.uppervalleyimage.com •

35

ClearChoiceMD founder and CEO Marcus J. Hampers, MD MBA.

NO APPOINTMENTS — JUST WALK IN 36 i m a g e h e a l t h w a t c h •

2017

HOSPITALS

CLINICS

BY MARCUS HAMPERS, MD, CEO AND FOUNDER OF ClearChoiceMD PHOTOS BY JIM MAUCHLY/ MOUNTAIN GRAPHICS

understanding Urgent Care AN INTEGRAL PART OF AN INCREASINGLY COMPLICATED HEALTH CARE LANDSCAPE

AT THE CORE OF ALL HEALTH CARE REFORM INITIATIVES is a desire to improve access for all, to decrease costs, and to improve quality. For a hospital, this can be a seemingly impossible nut to crack when it is expected to provide comprehensive care, with all of its accompanying advanced and expensive services.

While there is ongoing and spirited debate regarding the impact that the Affordable Care Act (ACA) has had on the average American, what is becoming clear is that we must now be cost-conscious consumers of our own health care. The ACA has forced many of us to select high-deductible plans, and as a result, we seek the most value from our health care dollars without having to compromise on quality.

Times have changed dramatically from the days when health insurance covered everything, and patients rarely asked, “What’s this going to cost me?” The demand for health care was previously inelastic, or in other words, its cost did not affect the demand. This is the opposite of what normally happens to demand for goods or services when prices rise. A market in which consumers had no incentive to control costs because a third party was footing the bill proved to be unsustainable.

The ED Dilemma In the course of practicing emergency medicine for 20 years, I have personally witnessed emergency department (ED) overcrowding

and how such overcrowding can cause an entire hospital to cease normal functioning as resources are diverted to the ED. Patient flow throughout the hospital becomes obstructed, and sadly, some of the sickest patients may not be seen as quickly as they should.

Through no fault of their own, patients who do not have a true emergency are coming to the ED because they either do not have a primary care provider (PCP), or if they do, that person is inaccessible or unable to provide the required treatment in a medical office, for example, x-rays or stitches.

Unfortunately, the US is suffering from a shortage of primary care physicians, and there is little hope that this will change anytime soon.

Young new doctors today are often saddled with a daunting amount of debt, and consequently, they are understandably selecting specialties that pay two or three times what a primary care physician earns.

The costs associated with unnecessary emergency department visits are staggering, and collectively as a society, we all bear the expense. Typically, an ED visit will cost about ten times what the same diagnosis and treatment in an urgent care center would be. In addition to the cost associated with an unnecessary ED visit, otherwise healthy people who go to the hospital ED unnecessarily place themselves at risk for contracting dangerous drug-resistant super-bacterial infections.

www.uppervalleyimage.com •

37

CLINICS ClearChoiceMD offers on-site digital x-rays at a fraction of the cost of other facilities.

Millennials are choosing urgent care over primary care Last year, a survey by FAIR Health found that millennials were being drawn into urgent care because of its convenience. The study found that millennials (ages 18 to 34) and younger Gen Xers (ages 35 to 44) were more likely to rely on urgent care clinics, while consumers age 45 and older were more likely to depend on primary care.

Source: www.ajmc.com/newsroom/5facts-about-urgent-care-clinics

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2017

A Better Choice Urgent care is the treatment of choice for non-life-threatening illnesses and injuries in people of all ages. It is not a substitute for primary care, but it does safely satisfy many of the needs of adult and pediatric patients who visit emergency departments unnecessarily. Urgent care is not intended to replace the ongoing relationship that a person has with his or her primary care provider (PCP); rather, it is intended to treat episodic illness and injury in a timely manner.

While many PCPs will often attempt to carve out time in their busy daily schedules to “add on” patients who call with an acute problem, this can be inconvenient for both the patient and provider.

True primary care is focused on health maintenance and the treatment and prevention of chronic health problems like diabetes, emphysema, cancer, and high blood pressure.

Many physicians, myself included, believe that the time a PCP spends with patients counseling them about an existing illness or the prevention of one is invaluable and will result in a better and longer life for the patient. Indeed, many PCPs in the communities we serve have directed their patients who call seeking

a same-day appointment to our urgent care centers when they were either too busy or it was after hours. By doing so, the PCP has more time to spend with scheduled patients.

The relationship between the PCP and the urgent care center works well when information from the urgent care visit, including any x-ray or laboratory result, is shared electronically with the PCP in nearly real time. While some critics of urgent care may argue that it “disrupts” the continuity of care, that has not been our experience if local PCPs have confidence in the quality of the care being provided at the urgent care center and that information is shared in a timely manner.

Urgent care is now an integral part of our increasingly complicated health care landscape because it improves access and quality and decreases costs. Its value to us as cost-conscious consumers of health care will continue despite an uncertain fate for the Affordable Care Act.  Marcus J. Hampers, MD Chief Executive Officer ClearChoiceMD 74 Pleasant Street, Suite 204 New London, NH (603) 526-4635 info@ccmdcenters.com

PHYSICAL THERAPY

BY BILL CIOFFREDI, PT

Health care

EVOLUTION

CIOFFREDI & ASSOCIATES PHYSICAL THERAPY As the population ages, we’re faced with more knee, hip, and shoulder surgeries and replacements, as well as back pain and other muscular and joint problems. We asked Bill Cioffredi, PT, founder of Cioffredi & Associates, The Institute for Health & Human Performance, to discuss the challenges and describe the treatments offered by his physical therapy business.

Are we using our bodies in ways that can lead to pain or injury?

In the bodywork and exercises that we use in our work, I often feel we are simply undoing what people have done to themselves. Most of our clients didn’t have an accident.

Rather, they developed a painful condition gradually, often 40 i m a g e h e a l t h w a t c h •

2017

without a known reason. Postural pain, as well as joint and muscle pain, are frequently the result of unknowingly tensing or activating muscles that don’t need to be working or are working too much for the demand. Herniated discs, sciatica, arthritis pain, and rotator cuff problems are all examples that are influenced by this issue.

To a large degree, our work in helping people to restore pain-free movement involves freeing up stiff tissues in joints.

But then we need to teach people how to “relax” their muscles.

“Release” may be a better term, as we want our clients to release the excessive tension and muscle activation—not have muscles go totally soft. “Good posture” is not a held position; it is free of excessive tension. We are often involved in teaching

HOSPITALS

Left: Medically based personal training provides a safe way to advance a client with a total hip replacement beyond the fundamental rehab returns of physical therapy, while remaining connected to the clinician.

According to the Arthritis Foundation, exercise is considered the most effective nondrug treatment for reducing pain and improving movement in osteoarthritis.

Physical therapists can work with you to develop a customized, safe, and effective strengthening and conditioning program.

treatment of craniofacial pain including temporomandibular joint dysfunction (TMD) of the jaw (TMJ).

people to release their excessive muscle tension and “get out of their own way.” It can be learned.

Are there specific parts of the body that you primarily treat?

The spine is the base from which all of the extremities move.

We believe that to be able to effectively treat pain in the joints, muscles, and nerves (neural musculoskeletal pain), one must be able to provide excellent treatment of spinal conditions.

From there, we address all the remaining joints of the body; we do not leave out selected bits and parts to go untreated or undertreated. We are also experts in the design and management of custom foot orthotics, hand rehabilitation, and the

What is unique to the Cioffredi & Associates physical therapy program?

It is common for people to utilize a number of separate providers to address component parts of their pain and rehabilitation.

One provider may only be addressing joint mobility; another is responsible for addressing soft-tissue mobility. The third provider is the particular movement or activity specialist. Our approach brings all those benefits together.

Each of our clinicians is required to be competent to evaluate the condition and understand the primary sources of pain and to address each of them in an order of magnitude. Relief is achieved by mobilizing and manipulating joints and soft tissues that are restricted through manual techniques, use of instrument assistance, or solid filament needle techniques, and finally through addressing appropriate postures and movement patterns for that individual. In short, our intention is to provide a comprehensive approach to restoring pain-free movement.  Cioffredi & Associates 112 Etna Road Lebanon, NH (603) 643-7788 cioffredi.com www.uppervalleyimage.com •

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PHYSICAL THERAPY

BY HEALTH WATCH STAFF

Helping you achieve

optimal movement THERAPY WORKS Therapy Works Inc. has served the Kearsarge/Lake Sunapee Area for the past 25 years, providing expert care for clients of all ages needing physical therapy services.

“We have successfully rehabilitated a 90-year-old patient who needed to get back to his tennis game, a 16-year-old soccer player needing to get back to tournament play in top condition, and a

42 i m a g e h e a l t h w a t c h •

6-year-old who required help after a fall from a swing,” says Beth W. Swanson, PT, DPT, OCS. “We offer treatment in all areas of physical therapy, including sports-related injuries, work-related injuries, neck and back pain, jaw pain, and postsurgical care. We can also work with you to help you with your wellness and fitness goals.”

Beth explains that physical therapists

provide services that develop, maintain, and/or restore an individual’s maximum movement and functional ability, helping at any stage of life when movement and function are limited by aging, injury, disease, or disorder.  Therapy Works 75 Newport Road, Unit 4 New London, NH (603) 526-2781 www.therapyworkspts.com

2017

“This is all about making it easier for patients to coordinate their care.”

HEALTH CARE HOSPITALS TODAY COURTESY OF CIOFFREDI & ASSOCIATES, THE INSTITUTE FOR HEALTH & HUMAN PERFORMANCE

Home Safety

checklist

REMOVE HAZARDS IN YOUR HOME TO PREVENT FALLS

Once you’ve been discharged from the hospital or a rehabilitation facility, ask a friend or a family member to make sure your home is safe. If you’re using a walker, a cane, or crutches, the last thing you need is an obstacle in your path.

FLOORS Remove throw rugs or secure them with nonslip backing or double-sided tape.

Keep floors clear of unnecessary objects including books, magazines, tools, shoes, furniture, and so forth.

STAIRS Place brightly colored tape or color on the edges of steps to clearly identify them.

Consider nonslip treads on bare-wood steps.

Ensure that railings are present and secure.

KITCHEN Place items you use more often on lower shelves to avoid reaching.

Do not stand on chairs or boxes to reach overhead. Use step stools instead.

BEDROOM Install night-lights to avoid walking in the dark.

After lying or sitting for long periods, pause before moving to a standing position.

FOOTWEAR Avoid wearing socks on hard floors. Wear slippers with a nonskid surface instead.

Ensure that footwear is low-heeled and has rubber nonskid soles.

Keep a telephone and flashlight within reach of your bed in case of emergency.

Wear protective footwear at all times if you have decreased sensation or diabetes.

BATHROOM Use a shower chair, raised toilet seat, grab bars, and a removable showerhead to ensure safety and mobility.

PERSONAL SAFETY Consider wearing a safety alarm or carrying a cellular phone in your pocket to use in an emergency such as a fall.

Place nonskid adhesives or mats on tub and shower floors to prevent slipping.

Use a cane or walking stick to compensate for decreased sensation.

Install liquid soap dispensers to avoid having to reach for a dropped bar of soap.

Avoid distractions and doing more than one thing at a time while you’re involved in actions that can challenge balance; for example, don’t talk while descending stairs.

www.uppervalleyimage.com •

43

PHYSICAL THERAPY

BY MARK AIKEN

a holistic and integrated SCHMIDT PHYSICAL THERAPY

A visit to Chris Schmidt won’t be the same as a visit to many other therapists. First, you will notice right away that he has an accent. He comes from the Netherlands— and this fact could underpin a number of the differences between Chris and other local therapists. “Physical therapy in the Netherlands is probably more specialized and more hands-on,” Chris explains. Dutch therapists, he says, might be more inclined to use traction techniques, mobilizations, and massage to treat patients compared to their American counterparts.

Consistent with this description, Chris holds several specialized certifications, notably his COMT (Certified in Orthopedic Manual Therapy) and CAFS (Certification in Applied Functional Science), among others. His toolbox also includes dry needling, yoga, and—always—careful attention to the individual needs of each patient. “We are a small practice with a highly individualized approach,” he says.

What exactly does he mean by small? The practice has two physical therapists (Chris and Diane Tensen), two assistants, and a massage therapist. They maintain office hours in Lebanon and Claremont, and he also works out of European Face and Body Studio in Hanover. What does Chris enjoy about being a physical therapist? “I like helping people, interacting with people, and solving problems relating to physical limitations,” he says.

Chris has practiced physical therapy for 35 years, and he takes an integrative and holistic approach. For example, if a patient is trying to return to sports or work, Chris doesn’t just look at the patient’s physical ailment.

“We also try to diagnose potential problem areas that activities related to that sport or job might present,” he says. Whatever the ailment, Chris’s aim is to take a bigpicture approach and to figure out the best treatment for each individual.  Schmidt Physical Therapy Chris Schmidt, PT, COMT, CAFS 3 Dunning Street Claremont, NH (603) 542-9200

44 i m a g e h e a l t h w a t c h •

10 West Park Street Citizens Bank Building Suite #101 Lebanon, NH (603) 448-2005 schmidtphysicaltherapy.com 2017

approach

SERVICES INCLUDE Orthopedic Manual Physical Therapy Spine Rehabilitation Vestibular Rehabilitation Medical Exercise Therapy Work and Sports-Specific Rehabilitation (golf-specific physical therapy and other sports) Home Exercise Protocols Post-Surgical Rehabilitation Dry Needling Myofascial Pain Syndromes Temporomandibular Joint (TMJ) and Craniomandibular Dysfunction

TIPS FOR AVOIDING INJURY 1.

Maintain a healthy and active lifestyle.

2. Notice when you have a problem, and reflect on what its root might be (for example, hip pain could be the result of foot pain that altered your gait).

3. Consider prevention and early intervention to avoid significant injury.

4. Use common sense. “Condition your body slowly over time,” says Chris.

5. Ask yourself: If I do this, could I hurt myself?

European Face and Body Studio 70 Main Street Hanover, NH (603) 277-9075

HOLISTIC MEDICINE

BY SUSAN NYE

Helping the Body

Heal Itself

TREATING THE WHOLE PATIENT, NOT JUST THE SYMPTOMS

Dr. Randy Schaetzke, DC, DIBAK

As baby boomers age, we start hearing more and more about alternative and adjunctive medical practices. But homeopathy, holistic health, and chiropractic are hardly new concepts. If you are looking for answers beyond traditional Western medicine, Dr. Randy Schaetzke is someone you should meet.

A trained chiropractor, Dr. Schaetzke moved to Vermont almost 25 years ago. At the time, he decided to call his practice Wholistic Health Services of Vermont. Dr Schaetzke explains, “I had the idea to put a ‘W’ in front of holistic since whole means in its entirety.”

He continues, “With wholistic health, we look for the why behind symptoms. This wholistic approach to health is more than a simple diet change or taking a few herbs or vitamins.”

Dr. Schaetzke summarizes his approach to health care as, “Treating the person who has symptoms instead of treating the symptoms that have attacked a person.” He looks at the total patient from a structural, chemical, and emotional perspective. Instead of prescribing a medicine to work on a particular symptom

or group of symptoms, Dr. Schaetzke works with his patients to understand their individual health concerns and needs.

Dr. Schaetzke notes, “Since I am a chiropractor, many people come to me thinking they have a structural problem, for instance, chronic headaches or a bad back. Unfortunately, sometimes fixing the structure doesn’t fix the problem, and the pain returns.” That’s when the wholistic approach comes into play. “By looking at the whole patient and considering dietary issues, possible chemical imbalance, and emotional concerns as well as structural troubles, we can get to the root or roots of the problem,” says Dr. Shaetzke.

“We may discover that those headaches are not caused by too much time in front of the computer but a food allergy. By identifying and then fixing the underlying cause, the body can heal itself.”  Dr. Randy Schaetzke, DC, DIBAK 6985 Woodstock Road Quechee, VT (802) 296-6030 www.doctorrandy.com

CHIROPRACTIC ADJUSTMENT

INCORRECT POSTURE

CORRECT POSTURE

Chronic headaches and back and joint pain are common reasons to visit a chiropractor. Chiropractic care has a long-standing history, and anthropological evidence suggests that ancient Egyptians, Greeks, and Chinese performed spinal manipulations to relieve pain. Manipulations are designed to improve com-

46 i m a g e h e a l t h w a t c h •

munication between the central nervous system and other organs and tissues. To appreciate this complexity, you need to understand that every joint, tendon, ligament, and muscle has nerve endings. These nerve endings send signals to the brain via the spinal cord with every movement. Your brain then processes

the signal and sends out a response.

A problem or pain occurs when abnormal signals are sent to the brain. Chiropractors adjust or mobilize the spine and other joints to restore proper alignment and communication between the nervous system and the body’s tissues. For example, by manipulating the

knee, hip, and spine, a chiropractor can improve knee function and reduce the pain caused by degenerative joint disease or osteoarthritis. In addition, a chiropractor such as Dr. Shaetzke will offer advice on diet and exercise to further improve functionality, reduce inflammation, and ease pain.

2017

“This is all about making it easier for patients to coordinate their care.”

BE YOUR BEST DENTAL CARE, EYE CARE, SKIN CARE, HEARING, NUTRITION, EXERCISE

To keep the body in good health is a duty . . . otherwise we shall not be able to keep our mind strong and clear. —Buddha www.uppervalleyimage.com •

47

BY HEALTH WATCH STAFF

J

ust as new discoveries and technologies are revolutionizing medical treatment, similar advances are taking place in the field of dentistry.

Apprehensive patients will be happy to learn that needles to deliver novocaine to numb an area of the mouth may soon be a thing of the past. Dentists may use a small electric current instead to administer the anesthetic, saving time, money, and unnecessary patient anxiety.

Uneasy patients may also discover they may not have to endure the dental drill for tooth decay much longer. Air abrasion allows for the precise removal of decay, preserving healthy tooth structure without the use of a local anesthetic.

UPPER VALLEY PROFESSIONALS ARE KEEPING UP WITH INNOVATIONS FOR PATIENT CARE AND COMFORT

WHAT’S NEW IN

DENTISTRY? www.uppervalleyimage.com •

49

WHAT’S NEW Air abrasion is a drill-less technique that is being used by some dentists to remove early, small areas of tooth decay and to perform other procedures.

Toby P. Kravitz, DDS

An optical scanner can map a tooth and create a 3D model of it.

Roger A. Phillips, DMD, FICOI

Natalia Streltsov, DMD

PORCELAIN VENEERS A dental veneer is a shell or layer of tooth-colored porcelain or composite that is placed over the facial surfaces of your teeth to correct worn tooth enamel, uneven tooth alignment or spacing, discoloration, and chips or cracks.

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Your local dentist may also be using computer-assisted design and manufacture (CAD/CAM) in the office to complete tooth restorations in one visit. These can include inlays, porcelain veneers, crowns, and bridges. Straight out of science fiction movies is the use of lasers, which may offer a suture-free option for the treatment of benign tumors, cold sores, crown lengthening, decay removal, dental fillings, and more.

Need a new crown? Don’t be surprised if your dentist uses an optical scanner to map the tooth and create a 3D model of it. Do you want even more good news? Porcelain veneers are getting thinner, which means preserving more of the original tooth, and bonding and filling materials as well as dental implants are all improving. Visit an Upper Valley dental professional soon to preserve or create your beautiful smile while helping promote good health.

Getting Down to Basics From his office in Norwich, Vermont, Toby P. Kravitz, DDS, remarks, “I don’t know how, when, or why the mouth was dropped from the rest of the body with regard to health care. Obviously, that was a big mistake. We know that optimal health cannot happen without a healthy mouth. In fact, dental disease adversely affects overall systemic health and has implications for diabetes, heart disease, and stroke.”

Dr. Kravitz continues, “We believe in comprehensive dentistry.

You can’t effectively treat just one tooth. The teeth and gums and the jaw joint all need to work in harmony. We look at the big picture and formulate a plan that will help get and keep our patients healthy. The

intention is that, once this plan has been achieved, patients will need just regular hygiene visits to maintain oral health.”

Natalia Streltsov, DMD, of Summer Court Dental in Hanover agrees, saying, “We consider the total well-being of each patient, knowing that oral health influences overall health. Dentists are an important part of your complete health care team. Before a patient undergoes open heart surgery, for example, the surgeon will send them for a dental exam. An oral abscess or other problem can cause complications.” Similarly, patients who have had a knee or hip replacement need to take prophylactic antibiotics before a dental cleaning to avoid infection in the surgical area from the release of bacteria.

Take It from the Pros “With many new advances in dentistry today, including superior whitening agents, 3D printing of crowns and various prosthetics, and titanium dental implants to replace missing teeth—just to name a few—one thing that hasn’t changed is the importance of good home care and daily brushing and flossing,” says Roger A. Phillips, DMD, from his office in Hanover.

According to Dr. Phillips, superior oral health is beneficial for overall health and provides a positive level of selfconfidence. Poor oral health has been proven to have a direct link to potential heart and cardiovascular conditions.

Obesity and poor overall health that can lead to diabetes often result in poor gum tissue health and can affect the stability of your teeth.

Cosmetic and implant dentistry are particularly interesting and rewarding for Dr. Phillips. He loves the challenge of restoring and improving patients’ smiles and the functionality of their teeth. “Besides providing comprehensive general dentistry,” Dr. Phillips continues, “we also deliver complete dental implant treatment using 3D imagery to aid in placing the dental implant in the exact proper www.uppervalleyimage.com •

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“Many patients don’t realize that their problems with chewing, jaw pain, TMJ, headaches, earaches, and even tooth fracture can be caused by bruxism, which is grinding of the teeth during sleep. Being fitted with a mouth guard usually solves the problem,” says Dr. Streltsov.

Several Upper Valley dentists, including Dr. Phillips and Dr. Streltsov, are providers of Invisalign, a new technology which moves and straightens your teeth without using traditional wires and brackets.

“Patients find that their ability to properly clean and brush their teeth during treatment is much easier compared to traditional orthodontic treatment,” says Roger A. Phillips, DMD.

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position in the jaw. Our team also provides state-of-the-art ceramics for cosmetic veneers, which are thin layers of ceramic that are placed on anterior teeth to change the shape, length, and color. Ceramic veneers are often life changing for those individuals who have always wanted to improve their smile.”

In regard to high-tech equipment, Dr. Kravitz says, “In certain cases, I may use an intraoral camera, which allows us to view clear, precise images of your mouth, teeth, and gums in order to accurately make a diagnosis. With clear, defined, enlarged images, you see details that may be missed by standard mirror examinations. Patients are usually amazed to see their teeth and gums up close.

I may also use laser dentistry for select soft-tissue procedures. For soft-tissue surgical procedures, the laser eliminates the need for suturing, and healing is much faster.”

Dr. Streltsov adds, “From whitening and cosmetic dentistry—bonding, crowns, porcelain veneers, and dentures—to oral surgery and orthodontics, we work with our clients to ensure they have healthy, beautiful smiles.”

Keeping It Comfortable Dr. Phillips says, “New to our practice is anesthesiologist Dr. Adrienne Williams of Anesthesia Consultants of the Upper Valley (ACUV). She provides IV sedation so patients can be put to sleep for wisdom tooth extractions, multiple dental implant placement, and complex restorative treatment.”

ACUV was founded in 2016 by anesthesiologist Adrienne Williams, MD. This service allows patients who need sedation to receive the care they need in an office-based setting, avoiding having to go to a hospital setting or travel to more urban areas where office-based anesthesia more commonly exists.

“I am passionate about bringing individualized, safe, and compassionate care to patients in the office setting, while allowing health practitioners to care for their patients in the often calmer, more private and peaceful setting of their own offices,” says Dr. Williams. “Whether for dental procedures, podiatry, plastic surgery, urology, reproductive medicine, or any other procedure, I am eager to help practitioners help their patients.

I want to make things compassionate and easy for everyone involved.”  Toby P. Kravitz, DDS 303 US Route 5 South Norwich, VT (802) 649-2630 www.norwichvtdentist.com Roger A. Phillips, DMD, FICOI Upper Valley Esthetic Dentistry 31 South Park Street Hanover, NH (603) 643-3190 www.drrogerphillips.com Natalia Streltsov, DMD Summer Court Dental 1 Summer Court Hanover, NH (603) 643-8998 summercourtdental.com Adrienne Williams, MD Anesthesia Consultants of the Upper Valley, PLLC ACUV.nh.vt@gmail.com www.anesthesia-consultants-nh-vt.com

DENTAL CARE

BY HEALTH WATCH STAFF

manual or power toothbrush?

CHOOSE YOUR WEAPON AGAINST PLAQUE AND TOOTH DECAY

What kind of toothbrush do you prefer, manual or electric?

Researchers report that both clean debris and plaque equally well, but if you suffer with arthritis or another condition that limits your range of motion, you’ll probably do a better job of cleaning your teeth using a powered toothbrush.

When you shop for a brush, look for a head that fits easily into your mouth to access all surfaces of your teeth. While larger heads are available, they may not be able to reach the teeth at the back of your mouth or the sides of

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your teeth. Choose soft bristles with rounded tips to protect your gums, roots, and tooth enamel, all of which can be damaged by brushing too hard with medium or hard bristles.

No matter which option you choose, brush twice a day for at least two minutes each time. If your toothbrush is comfortable and you enjoying using it, you’re more apt to brush for the recommended amount of time, so choose whichever you like best, and ask your dentist what he or she recommends.  Source: WebMD.com

RATINGS WARS How do you know which is the best rechargeable or batterypowered toothbrush to buy? The experts at review.com checked the latest research from the American Dental Association as well as independent organizations. They also studied customer reviews from consumer and manufacturers’ websites. Last but not least, they brushed their own teeth with the top models.

Here are the highest rated brushes for 2017: Oral-B Black 7000 with SmartGuide Oral-B ProfessionalCare SmartSeries 5000 with SmartGuide Philips Sonicare DiamondClean Oral-B ProfessionalCare 1000 Philips Sonicare FlexCare Platinum Philips Sonicare Essence Oral-B Deep Sweep 5000 with SmartGuide Source: www.reviews.com www.reviews.com

TURN OFF THE WATER WHEN YOU BRUSH! Did you know that we waste up to four gallons of drinking water every time we brush?

DENTISTS

BY HEALTH WATCH STAFF

What’s new in Orthodontics?

TRENDS AND INNOVATIONS

The fastest growing segment is Invisalign teen for 12-to-19-yearold patients.

“Now I can offer Invisalign to 80 percent of my adult patients.

Some are octogenarians.”

Donald J. Neely, DMD, MSD Hanover Orthodontics 7 Allen Street, Suite 300 Hanover, NH (603) 643-1200 www.drneely.com

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Like all medical technologies, the materials and methods for orthodontic treatments are constantly evolving. Anyone requiring braces 20 years ago would have been subjected to large, silver brackets and wires reminiscent of James Bond’s nemesis known as Jaws in The Spy Who Loved Me. Many of us have the school pictures immortalizing our agony as we tried to figure out how to smile without showing our “metal mouth.”

In ninth grade, I—personally and painfully—earned the devastating nickname “Iron Maiden.” But thanks to progress and innovation, dental professionals are now able to deliver better results and greater comfort for their patients. By staying current with the latest technologies, orthodontic specialists are better equipped to help guide their patients in choosing the latest, most appropriate treatment options available to achieve their desired result.

“Invisalign clear aligners have eclipsed bonded metal braces as the appliance of choice for straightening teeth,” says Donald J. Neely, DMD, MSD, of Hanover Orthodontics.

“Now I can offer Invisalign to 80 percent of my adult patients. Some are octogenarians.

Many never had braces or thought they were too old. Others stopped wearing their retainers and their teeth have moved. Teeth can be moved at any age if the mouth is healthy,” Dr. Neely explains. Initial consultations are complimentary and include a panoramic x-ray. A referral is not necessary.

The fastest growing segment is Invisalign teen for 12-to-19-year-old patients. Conventional bonded braces are still used for early interceptive treatment at age seven, for certain types of bite problems, and to perform special

tasks as an adjunct to Invisalign treatment.

You can even make a fashion statement with 24-karat gold braces, Dr. Neely adds.

The Invisalign system has a steep learning curve, Dr. Neely says, and it takes an orthodontic specialist to get the most from the appliance. Facial appearance and the position of the lips in relation to the teeth when smiling and speaking are critical to creating an excellent result. “In a growing patient, the individual direction of growth further complicates the planning,” says Dr. Neely.

“We have excellent software for simulating the results of various treatment options. This improvement in communication helps the patient choose his or her treatment and helps the orthodontist produce more pleasing and predictable results.”

Aligntech, the inventor of Invisalign, is a laboratory; their technicians will do only what they are specifically instructed to do and no more—and sometimes even less because real teeth don’t move according to computer algorithms, Dr. Neely explains. The orthodontist’s prescription must anticipate these exceptions and adjust individual tooth movements accordingly. The orthodontist must have a clear vision of the desired result from the very beginning. A quality result depends on open communication and attention to detail.

According to Dr. Neely, “The orthodontist’s aesthetic judgment is just as important as his or her clinical skills and experience. My job is to design an individualized, customized treatment plan to fulfill the patient’s goals and address their concerns.” Friendly, sympathetic staff members at his office treat each person who comes in as they would a member of their own family. 

2017

“This is all about making it easier for patients to coordinate their care.”

DENTAL CARE

BY HEALTH WATCH STAFF

your child’s Pediatric Dentist PLAN THE FIRST VISIT BETWEEN 12 AND 18 MONTHS OF AGE Make your child’s first visit to the dentist enjoyable and positive in a child-friendly environment filled with compassion and care.

“We strive to build a relationship with your child and establish a long-term home for your child’s oral health care needs,” says Steve Rayes at Just Kids Pediatric Dentistry, which has offices in Lebanon, New Hampshire, and Norwich, Vermont.

“Your pediatric dentist prefers to see your child within the first six months of the eruption of the first primary tooth,” Dr. Rayes explains. “This most often will be a lower-front baby tooth, and the average eruption will occur at 6 months, placing the first visit between 12 and 18 months of age.”

What Is a Pediatric Dentist?

A general dentist attends a four-year doctorate program to attain his or her degree. “A pediatric dentist completes an additional two-year certificate or three-year master’s program of specialized training after dental school and is dedicated to

Brushing Tips for Your Child Dr. Rayes recommends the following guidelines: 1. Starting at birth, clean your child’s gums with a soft cloth and water.

2. As soon as your child’s teeth erupt, brush them with a softbristled toothbrush.

3. Children 0 to 36 months should have their teeth brushed with a rice-sized amount of fluoridated toothpaste.

4. Children from 36 to 60 months of age should have their teeth brushed with a pea-sized amount of toothpaste.

5. Be sure to use an ADAaccepted fluoride toothpaste.

6. Parents should brush children’s teeth until they are old enough to do a good job on their own.

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the oral health of children from infancy through the teenage years,” Dr. Rayes explains. In addition, the curriculum covers childhood growth and development and behavior management and includes advanced procedures with the assistance of sedation and general anesthesia in an outpatient or hospital setting.

Why Are Primary Teeth Important?

Primary teeth, or baby teeth, are important for three reasons, according to Dr. Rayes: For proper chewing and eating, to provide space for the permanent teeth and guide them into the correct position, and to permit normal development of the bones and muscles of the jaw.

Primary teeth also affect the development of speech and add to an attractive appearance, says Dr. Rayes. While the front four teeth last until 6 to 8 years of age, other teeth (such as cuspids and molars) aren’t replaced until age 10 to 13. 

TIP: Sippy cups should be discontinued by the first birthday. If your child uses a sippy cup throughout the day, fill it with water only, except at mealtimes. By filling the sippy cup with liquids that contain sugar (including milk and fruit juice) and allowing a child to drink from it throughout the day, the child’s teeth are being soaked in cavitycausing sugar that the bacteria subsequently break down into acid. This may lead to early childhood cavities.

Just Kids Pediatric Dentistry 303 Route 5 S, Unit 2 Norwich, VT (802) 649-5210 206 Heater Road Lebanon, NH (802) 649-5210 www.justkidspediatricdental.com

DENTAL CARE

On average, one in four preschoolers in the United States has already had a cavity, and that number grows to 55 percent by the time they’re old enough for kindergarten.

BY HEALTH WATCH STAFF

bright smiles for the Younger Set THAT’S THE SPECIALTY AT UPPER VALLEY PEDIATRIC DENTISTRY The West Lebanon location of Upper Valley Pediatric Dentistry is a bright and happy dental practice geared toward caring for the dental health of children from 1 to 18 years old in the Upper Valley and beyond. The practice offers comprehensive dental care including cleanings, fluoride treatments, sealants, fillings, extractions, space maintainers, nitrous oxide, and hospital access.

“Our goal is to help children maintain good oral health throughout their entire lives by helping them establish good habits when they are young,” says Eileen Saunders, DMD. “We always welcome new patients to our practice. We kept children in mind when we designed our office, which has a fun atmosphere and a TV in every room.”

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Dr. Saunders recommends brushing at least twice a day and flossing daily. “You should brush and floss your child’s teeth until he or she is old enough to do this unassisted,” she says. “This helps prevent tooth decay, periodontal disease, and other oral health issues, as do over-thecounter fluoride toothpastes and mouth rinses, which we recommend in addition to in-office fluoride treatments within 6 months of the eruption of the first tooth to age 18.” Fluoride helps protect young teeth by making them more resistant to the buildup of decay-causing plaque and sugars. It can also speed remineralization and disrupt acid erosion in teeth.

Eating a balanced diet and limiting sugary snacks are also important for good oral health, she adds. “When you can, have

your child drink a glass of water after meals,” Dr. Saunders suggests. “This can help wash away sugars from foods and drinks. If something your child drinks contains acids, such as sodas, have them wait 30 minutes before brushing. This will allow their saliva time to neutralize the acids and protect their teeth.”

Besides caring for patients at her office, Dr. Saunders is also proud to be on staff at Alice Peck Day Memorial Hospital and Dartmouth Hospital Medical Center to provide dental care in the hospital setting when needed.  Upper Valley Pediatric Dentistry 30 Airport Road, Suite 7 West Lebanon, NH (603) 790-8130 uvpediatricdentistry.com

EYE CARE

BY VIRGINIA MUSANTE

HILL OPTICIANS

Caring for

Upper Valley eyes since 1947 Eyes are amazing components of our bodies. We use them all the time in so many ways. It’s easy to take them for granted—and critically important not to.

We tend to think about eye care when our glasses seem to be less effective, but it’s something that deserves our attention every day. Regular exams, at a minimum, are critical. It’s easy to believe that all is well because many eye diseases don’t have any warning signs or symptoms.

Some of these can result in blindness, but many can be resolved if caught early. Based on your eye health and your age, exams might be necessary only every couple of years, depending on your optometrist’s or your ophthalmologist’s recommendation. But regular exams are always important.

Daily care is crucial too, such as protecting your eyes from the sun. UV rays have an impact on eyes and can lead to problems including cataracts and macular degeneration. Eyeglasses should always provide UV protection. Polycarbonate lenses automatically include such protection. Lenses made from glass, less common these days, do not.

Sunglasses are, of course, one way to protect your eyes. Transition lenses are another option; these lenses darken automatically in response to sunlight. Polarized lenses provide great UV protection. And low-tech solutions work too, such as wearing a wide-brimmed hat. Whichever you choose, protecting your eyes from the sun is important for all ages, even for children. 

SERVICES The friendly staff at Hill Opticians offers a range of eye care services.

Basic eye exams and exams for contact lenses may include: Visual acuity and refraction to determine the extent of refractive error (nearsightedness, farsightedness, astigmatism), as well as the proper prescription for glasses and contact lenses.

Binocular vision to determine how well the two eyes work together.

Examination of the retina, the blood vessels of the retina, and the optic nerve head using an ophthalmoscope to help detect signs of diabetes, high blood pressure, certain types of stroke, and autoimmune diseases such as rheumatoid arthritis, multiple sclerosis, and lupus.

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Examination of the eyelids, cornea, iris, and lens.

Pupil dilation to look at the internal structures of the eye.

Hill offers in-house grinding of lenses to fill your prescription and fit your frames. No more waiting for your lenses to be sent out and ground off-site.

And of course, Hill Opticians carries a wide range of eyeglass frames in several brands for men, women, and children, as well as a selection of contact lenses. Lens prescriptions can include tinting, UV protection, and Transitions and progressive lenses.

What’s New in Contacts For comfort, some new lenses have a wetting agent embedded in the lens material. And the 1-Day Acuvue Moist Multifocal blocks about 82 percent of UVA and 97 percent of UVB rays. (But sunglasses are still required for complete UV protection outdoors, since the contact lens doesn’t cover the entire eye.) www.allaboutvision.com

2017

“This is all about making it easier for patients to coordinate their care.”

Taking care of your eyes is important. Preventive care such as regular exams and UV protection is easy to do and can allow your eyes to be their best for years to come. —Virginia Musante, Hill Opticians

Hill Opticians 53 South Main Street Hanover, NH (603) 643-2400 www.hillopticians.com

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EYE CARE

the better to

see you with

FRAMES ARE NOT WHAT THEY USE TO BE, 1

2

3

4

6 64 i m a g e h e a l t h w a t c h •

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1

1. SHANGHAI

BY ETNIA BARCELONA hillopticians.com

5

2. ISERE BY MODO hillopticians.com 3. RIO GRANDE BY ECO hillopticians.com 4. DEREK LAM’S CLARA FRAME BY MODO hillopticians.com 5. ECO’S JORDAN FRAME hillopticians.com 6. DOLABANY EYEWEAR’S ADRIANE hillopticians.com

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7. ROUND FLECK CLIP-ON www.rayban.com 8. RIVBOS RBK002 Rubber Flexible Kids’ Polarized Sunglasses for Babies and Children Ages 3—10

www.amazon.com

7

8

The most common vision disorders in children are refractive errors such as myopia, hyperopia, and astigmatism.

Do kids need sunglasses?

Kids need sunglasses just as much as their parents do. And children with blue eyes are at greater risk for UV damage than their brown-eyed peers, according to YourSightMatters.com. www.uppervalleyimage.com •

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EYE CARE

BY HEALTH WATCH STAFF

VITAMIN D, OMEGA-3 FATTY ACIDS

WHITE RIVER FAMILY EYECARE

Eat Well to See Well Besides offering a range of services from eye examinations to eyeglasses and contact lenses, optometrist Dr. Eugene Bernal says that to ensure eye health, we need to eat a healthy diet. Here he explains.

It seems that every day we are getting more advice as to what we should be eating and not eating to keep ourselves healthy. Nutritional science and research have come a long way, and our access to quality foods has increased tremendously in the past decade. Eating healthy is good for your whole body—but let’s focus on specific foods that will keep your eyes in top shape— hopefully at least until you’re done with them.

We’ve all heard that carrots are good for the eyes, but there are many important vitamins, minerals, and other nutrients that have been shown to be essential for good vision and may protect your eyes from sight-robbing conditions and diseases such as cataracts, macular degeneration, glaucoma, night blindness, and tear deficiency.

The following is a list of the most important vitamins and nutrients for healthy eyes along with their sources: Beta-carotene: carrots, sweet potatoes, spinach, kale, butternut squash Flavonoids: tea, red wine, citrus fruits, blueberries, cherries, legumes, soy products Lutein and zeaxanthin: spinach, kale, turnip and collard greens, squash, broccoli, peas, avocados Omega-3 fatty acids: cold-water fish (salmon, tuna, herring), flaxseeds, walnuts Selenium: seafood, Brazil nuts, enriched noodles, brown rice Vitamin A: beef, chicken liver, eggs, butter, milk Vitamin C: sweet peppers (red or green), kale, strawberries, broccoli, oranges, cantaloupe Vitamin D: salmon, sardines, mackerel, milk, orange juice fortified with vitamin D Vitamin E: almonds, sunflower seeds, hazelnuts Zinc: oysters, beef, Dungeness crab, turkey (dark meat)

BETA-CAROTENE, LUTEIN, ZEAXANTHIN, VITAMIN C

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“This is all about making it easier for patients to coordinate their care.”

VITAMIN C

VITAMIN A

SELENIUM

In general, it’s best to obtain most nutrients through a healthy diet, which should include at least two servings of fish per week and plenty of colorful fruits and vegetables.

Since not everyone is able to follow these recommendations, your family doctor might suggest a multivitamin to supplement your diet. Your eye doctor may also recommend specific vitamins or supplements for vision if you have signs or risk factors for certain eye conditions or diseases. So, eat well and see well. 

FLAVONOIDS

VITAMIN E

ZINC

White River Family Eyecare 587 Hartford Avenue White River Junction, VT (802) 295-4887 Hanover Eyecare Lyme Road, Suite 201 Hanover, NH (603) 643-2410 www.whiteriverfamilyeyecare.com www.uppervalleyimage.com •

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EYE CARE

BY HEALTH WATCH STAFF

Protect Your Vision APPLETREE OPTICIANS IN NEW LONDON MAKES IT EASY If you’re looking for an optometrist in the New London area, you’re in luck. Dr. Donna Reed purchased Appletree Opticians in 2007 from Dr. Wesley Nichols, who had been seeing patients in this same location for more than 30 years. “Working in a small town, you have the privilege of caring for patients, pediatric to geriatric, and providing them with comprehensive eye care. We have patients that had come in as children to see Dr. Nichols and are now bringing their children to me for eye care,” says Dr. Reed, who has worked in New Hampshire for 15 years—previously in Lebanon—and practiced in London, England, before coming to the area.

Serving the Community Regarding the day-to-day operation of the office, Dr. Reed remarks, “I’m lucky to have an experienced, friendly staff. My office manager has been with me for nine years, and we have a couple of part-time staff that are equally dedicated. Our full-time licensed optician has been with the practice since before I took over, and we have a full-service lab on-site. We have an optical department in our practice, so we’re able to offer prescription and nonprescription glasses, sunglasses, fashion frames, sports eyewear, safety wear, contact lenses, and repairs.”

Elaborating on contact lenses, Dr. Reed adds, “Currently, the most popular choice is daily disposable contact lenses—wear them once

The most effective way to maintain your vision is through regular eye exams, a healthy lifestyle, and eye protection.

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and discard. They’re great for traveling, sports, convenience, and comfort.

Contacts come in a range of colors, and bifocal contact lenses are also available.”

Comprehensive routine eye exams are important for everyone, not only for vision but also to determine the health of the eye and related systemic issues such as diabetes and hypertension. Equally important in an annual exam is evaluation for ocular conditions such as cataracts, macular degeneration, and dry eye. The practice is also privileged to have access to ophthalmology for surgical cases locally.

Dr. Reed has a word of advice for parents of young children coming for their first eye exam. “It always helps if they come in after a nap. I try to make the exam as comfortable as possible—not insisting drops have to be instilled the same day or focusing on one task too long. We want the child to enjoy the experience and want to come back.”

What About LASIK? LASIK (laser-assisted in situ keratomileusis) is a popular elective laser eye surgery to correct myopia, hyperopia, and astigmatism. Dr. Reed works closely with two reputable laser clinics: Laservue, located in Montreal, Canada, and Clear Advantage Vision Center in Portsmouth, New Hampshire. To determine if a patient is a good candidate for the surgery, a pre-op LASIK evaluation is done in Dr. Reed’s office. The information is then sent to the LASIK center for evaluation and determination of suitability.

Last but not least, “Customer service is a high priority for us,” Dr. Reed states.

“We try our best to be timely, friendly, and knowledgeable.”  Appletree Opticians Dr. Donna Reed 197 Main Street New London, NH (603) 526-4043 drdonnareed.com www.uppervalleyimage.com •

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HEARING

BY HEALTH WATCH STAFF

better hearing

for life

Did you know that hearing loss is the third most common physical condition in America after arthritis and heart disease?

Untreated hearing loss is a quality of life issue, particularly as people age.

“At Powerhouse Hearing Center, we believe that to hear better is to live better. It begins with one customer, one conversation, one relationship at a time,” says Cindy Edmondson of the Powerhouse Hearing Center in Lebanon. “You hear with your brain, not your ears,” she continues. “Studies show that individuals with hearing loss experience a 30 to 40 percent accelerated rate of cognitive decline. This decrease in brain stimulation may contribute to brain atrophy. The greater the rate of hearing loss, the faster the decline of memory and thinking.” Isolation, loneliness, depression, anxiety, and falls are all linked to hearing impairment.

It can affect relationships and overall quality of life.

According to Frank Lin, MD, at Johns Hopkins and the National Institute on Aging, today’s new and exciting wireless high-tech hearing instruments provide automatic adjustment to speech recognition, direction, immersion in the environment, and most important, reduction and separation of background and ambient noise from conversational speech.

“Today’s advanced hearing instruments are discreet, open, and invisible,” Cindy states. “Starkey’s most advanced hearing instruments come in every size, shape, and color. They can be as simple as putting them in and having them adjust automatically to the environment, or as sophisticated as using an app that can make adjustments to specifi c environments through GPS. The phone recognizes geographically where you are and adjusts to the ‘geotagged’ location setting itself!”

Cindy says, “Hearing loss is often viewed as an inevitable part of aging, but it does not need to be.”  Powerhouse Hearing Center 23 PowerHouse Mall 8 Glen Road West Lebanon, NH (603) 298-9775 www.powerhousehearingcenter.com

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Halo2 iQ Made-for-iPhone Accessories

Features on new hearing aids allow you to stream calls from your iPhone directly to your hearing aids using Bluetooth 4.0 wireless technology. You can stream phone calls, music, and more, directly from your iPhone to your hearing aids.

SKIN CARE

10 skin care tips

BY HEALTH WATCH STAFF

EASY STEPS TO A GLOWING COMPLEXION 1. Always wear sunglasses with UV protection, not only to protect your eyes but also to avoid squinting, which causes crow’s-feet.

2. Get enough sleep. Your body and your skin need time to regenerate after busy days.

3. Eat a Mediterranean diet filled with fresh vegetables, fruit, fish, and olive oil for plenty of omega 3s and antioxidants, which give skin a healthy glow.

4. Moisturize as soon as you step out of the bath or shower to lock moisture in.

5. Take special care with the delicate skin around your eyes. Dab on moisturizing creams; never pull or stretch the skin.

6. Exfoliate once a week to get rid of dead skin cells that can dull your complexion.

7. Eat carrots and tomatoes. They contain lycopene and beta-carotene to repair skin cells and help protect skin from sun damage.

9. Choose green tea, vitamin C, and CoQ10 for healthy antioxidants, known to help prevent aging.

10. Indulge in berries. They’re packed with antioxidants, and they also help with the body’s production of collagen. 

8. Exercise regularly. It increases blood flow for a healthy glow.

Personalized Skin Care If you’re searching for a wide variety of pampering services, look no farther than European Face and Body Studio in Hanover, where Annemarie Schmidt offers more than 19 different choices for facials, 8 massages, and several body treatments. She specializes in facials, particularly antiaging treatments. Trained and schooled in the Netherlands, where she and her husband are from, Annemarie has 37 years of experience providing rejuvenating, natural skin care.

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Annemarie Schmidt.

Photo by Lynn Bohannon.

“Everyone wants to shave off 25 years,” she says. “The right facial can shave off 10 years. It’s not an illusion.

It’s how you treat your skin.” The extensive menu of options includes High Skin Refining that firms, tones, and lifts the skin; SeaCreation, which uses natural products found in the ocean; Pure 02, which incorporates oxygen and water to smooth, brighten, and hydrate the skin; and Cellular Renewal, which uses a glycolic and lactic acid peel to eliminate dead skin cells and stimulate cell renewal. Other treatments are available that boost collagen to plump the skin, as well as a detoxification facial, a calming treatment that helps balance sensitive skin, and microdermabrasion and ultrasonic treatments.

Regarding her antiaging facials, Annemarie says, “I go the natural way.

I try to prevent aging. We work with clients to clear the skin and make it radiant. I also educate clients about how to prevent aging skin.” Proper use of the right products, hydration, and sun protection are foremost for maintaining healthy skin, she notes.

“We combine aesthetics with wellness,” she adds. Gentle massage of the face, neck, and shoulders is a part of every 50-minute facial. “Touch is very important,” Annemarie adds. European Face and Body Studio Annemarie Schmidt 70 Main Street Hanover, NH (603) 277-9075 www.europeanfaceandbodystudio.com www.uppervalleyimage.com •

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BY LAUREN SEIDMAN PHOTOS BY LYNN BOHANNON

SELF-CARE

is HEALTH CARE STRONG HOUSE SPA

“The health care system is broken,” Sheila says, “and the answer is wellness.

Practice self-care and wellness to prevent disease.” www.uppervalleyimage.com •

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When Sheila Armen and Shelly Yusko opened Strong House Spa in Quechee, Vermont, 25 years ago, they introduced a green, organic wellness facility with a mission to provide relaxation, balance, and health through prevention to Upper Valley residents and visitors.

Shelly Yusko, BS, LMT, is an expert in structural integration and treating soft tissue injuries as well as treating patients with chronic illnesses like MS and Parkinson’s and repetitive stress conditions. Today, they are broadening that mission by incorporating Eastern and Western medicine into an array of new services and features that promote the spa’s guiding principle: self-care is health care.

“The health care system is broken,” Sheila says, “and the answer is wellness. Practice self-care and wellness to prevent disease.” Self-care offerings at 76 i m a g e h e a l t h w a t c h •

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Strong House have always included therapeutic massage, facials and water body treatments, wet sauna and low-heat infrared sauna, manicures and pedicures, and the use of organic skin care products and organic signature essential oils blended in-house, as well as, since 1999, yoga and other fitness-related classes.

Focusing on Total Wellness Now, with a sharpened focus on total wellness— from stress relief to management of chronic pain and treatment of sports injuries—Strong House

PAMPER YOURSELF

HOSPITALS

Relax and unwind with any of the services offered at Strong House Spa. Choose from an array of massages, facials, saunas, water body therapies (seaweed wrap and mud and salt treatments), SPF makeup application, hair removal, manicures and pedicures, and several other specialties.

also offers personal training in a fully equipped gym, acupuncture, guided meditation walks on forest trails, and health counseling.

Personal trainer Karlen Thyne joined Strong House in June 2016. A fitness professional with over 15 years’ experience, Karlen became a trainer “to help people live longer, be active, and feel good.” The wheelchair-accessible gym is located in an airy building a few feet away from the main facility. Karlen gives his clients personalized attention, developing 12-week programs for them based on their

needs, level of fitness, and goals. He teaches them how to exercise using not only gym equipment but also their body weight alone, which allows them to keep up their workout routine at home.

Dedicated to helping everyone achieve balance through a healthier lifestyle, Karlen has a roster of clients that includes cancer patients, athletes healing from injury, and people who have never engaged in any type of physical activity.

Mason Stabler was studying biology at

Left: You can find organic products for the skin and body by Jurlique, a bio-dynamic farm in Australia known for its iconic rose collection. The spa also carries a full range of self-care products designed to keep you healthy between appointments.

Above: The spa has two saunas, a high-heat wet sauna and a lowheat Infrared sauna for superior detoxification.

www.uppervalleyimage.com •

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Below, from left: Holistic wellness is dependent on differentiating the root of any imbalance, whether it be physical or emotional, and addressing it through appropriate treatment modalities and lifestyle changes. Acupuncturist Mason Stabler and personal trainer Karlen Thyne both practice under this

philosophy to provide their clients with the most effective individualized care.

Shelly Yusko performs Mu Xing therapy using hot bamboo sticks that prepare the muscles for deep tissue bodywork.

The spa also uses hot shells, hot stones, and wet heat packs to assist with relaxation.

Strong House “is a wellness center where people can get everything done in one place with the attention they want and need.”

COMMON CONDITIONS TREATED BY ACUPUNCTURE Musculoskeletal and Neurological Pain (Acute and Chronic) Stress, Depression, Anxiety, PTSD Gastrointestinal and Digestive Disorders HEENT (Headaches and Ear, Eye, Nose, and Throat Conditions) Post-Stroke Conditions Trauma/Surgery Recovery Cold and Flu Menstrual Disorders/Irregularity Immune System Support Regulating Chronic Disease

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Kenyon College when he “fell in love with the philosophy of treating the human body naturally,” and he has been the acupuncturist at Strong House since March 2017.

He treats a wide range of symptoms—back and joint pain, headaches, neuropathy, digestive issues, infertility, depression, and anxiety—using the traditional needles along with cupping, herbal medicine, and moxibustion, a type of heat therapy.

A Holistic Health Approach Like Karlen, Mason works closely with his clients to discover the root of their conditions and treat the entire system. He appreciates the broad scope of Strong House as “a medical clinic along with a spa,” offering “a great mix of modalities for the sick and injured.” Karlen agrees, saying Strong House “is a wellness center where people can get everything done in one place with the attention they want and need.”

Some people, especially those who spend a lot of time in front of a computer, want and need to decompress in nature, which is why Sheila built trails for forest bathing. Combining guided meditation with Nordic walking, forest bathing gives people an opportunity to reconnect with the outdoors, and with themselves. And

soon, a medical doctor will be on-site to assist clients suffering from Lyme disease and other chronic illnesses, as well as those struggling with stress or pain.

Many of Strong House’s clients have been coming to the spa since it opened, receiving treatments during pregnancies, illnesses, menopause, and injuries.

After 25 years of helping people achieve wellness through self-care, Sheila can say with conviction, “We’ve got your back—through life.”  Strong House Spa 694 Main Street Quechee, VT (802) 295-1718 stronghousespa.com www.uppervalleyimage.com •

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SKIN CARE

BY HEALTH WATCH STAFF

Looking Great over 50 SIMPLE STEPS TO YOUTHFUL SKIN As we age, most of us are concerned about how to maintain a youthful appearance. We asked Susan Sorensen of AboutFace Skin Therapy in Lebanon to share some expert advice for both women and men.

“Using professional, pH-balanced skin care products is one of the best and easiest ways to achieve healthy skin,” says Susan.

“Combined with regular monthly visits to your aesthetician, who can determine the best course of treatment for you through a custom skin analysis and consultation, as well as diligent use of a broad-spectrum SPF 50 sunscreen, over-50 skin can look healthy, radiant, and younger.”

Susan explains that professional skin care products are formulated with quality ingredients to ensure maximum efficacy and are a better value than drugstore or cosmetic-counter brands, which are often recommended by a salesperson rather than a licensed aesthetician with an in-depth knowledge of the skin, product ingredients, and results-oriented treatment methods.

Monthly treatment can result in a more even skin tone, smoother texture, and an overall radiance achieved through intentional treatment protocols designed to optimize both the health and appearance of the skin.

AboutFace Skin Therapy Susan Sorensen 37 Bank Street Lebanon, NH (603) 448-5800 www.aboutfacesusan.com

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Susan recommends Dermalogica skin care products, which can help minimize skin-aging triggers and encourage collagen production. }

WHY IS SUNSCREEN IMPORTANT? The consistent and daily use of broad-spectrum sunscreen (SPF 50) is vital to protect the skin from the aging and burning effects of the sun. The sun’s rays penetrate clouds and can cause sunburn. Just check out the ski slopes in the winter months! Even on rainy days, sunscreen is important, as incidental sun exposure can lead to a skin cancer diagnosis. Higher value, more expensive SPF protection does not provide any additional protection.

DESCRIBE A TYPICAL DAILY HOME REGIMEN Recommended home care is simple and should take no longer than five minutes, morning and evening. Cleansing, prescribed exfoliation, use of a moisturizer, eye cream, and SPF are elements of a basic routine that anyone can follow.

Like brushing and flossing, consistent home care will result in better health, an improved appearance, and compliments from friends and strangers on the beauty of your skin! | Pharmaceutical skin care products from GlyMed Plus, which are available only through skin care professionals, fight the effects of aging, acne, sun damage, pigmentation, and other skin conditions.

WHAT ARE WE DOING WRONG? One of the most common skin care mistakes women make is overexfoliation, which results in red, irritated skin and a compromised lipid barrier, leading in turn to dryness and dehydration. As we age, it is not necessary to exfoliate daily, since the skin thins with age and is more susceptible to damage caused by aggressive scrubbing or overuse of products containing fruit kernels or nutshells that will abrade the skin.

Another mistake many women make is not removing makeup and/ or washing the face at night. While at rest, the body regenerates itself, and the skin-cell renewal process is stimulated to produce new cells.

Treating the skin at night allows the body to synthesize product ingredients and helps you wake up with a fresher face ready for another round of daytime treatment.

2017

“This is all about making it easier for patients to coordinate their care.”

CAN WE AVOID GETTING WRINKLES?

WHAT ABOUT SKIN CARE FOR MEN?

While no one is completely immune to the onset of wrinkles (which are actually a combination of the aging process and DNA damage), a few important steps can be taken to delay the onset of fine lines and wrinkles and smooth the appearance of those fine lines and wrinkles when they do start to appear.

First, heed your licensed skin care professional’s advice. Second, invest in professional skin care products and use them as prescribed. Third, commit to regular monthly treatment to enhance the results of your consistent homecare regimen. Fourth, consider advanced treatments to provide a faster result. Facials alone will help, but to obtain a lasting effect on the skin, discuss a series of advanced treatments with your licensed skin care professional. Fifth, limit sun exposure and use SPF 50 diligently.

Additionally, a healthy diet, exercise, and the generous consumption of water and food containing water lead to a healthier complexion.

Skin care for men should be simple and consist of a pH-balanced cleanser, exfoliating product, a post-shave moisturizer to help maintain the body’s natural moisture factor, and an SPF. Male skin also requires regular professional treatment using protocols designed specifically for thicker skin that result in healthier skin. 

DRINK MORE WATER!

All types of skin need water to maintain pH and balance. A lack of hydration can result in dry, tight, flaky skin that is less resilient and more prone to wrinkling. In addition to drinking lots of water, apply a hydrating moisturizer within two minutes of leaving the bath or shower when skin is still porous, allowing for better absorption.

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SKIN CARE

BY HEALTH WATCH STAFF

save your skin

PERAZA DERMATOLOGY PROVIDES EXPERT CARE TO YOUR BIGGEST ORGAN Your skin is the first thing that many people notice about you, yet we do not always take appropriate steps to protect it. We asked Upper Valley dermatologist Dr. José Peraza for some tips and suggestions.

Protect Your Skin “Sun exposure is the main cause of premature aging,” Dr. Peraza says. “From the earliest age, use sunscreen liberally and you can prevent most aging from the sun.”

He tells all his patients to apply chemicalfree SPF 30 sunscreen to block the UVA and UVB rays that cause the most damage to our skin. “These are best, especially for outdoor activities like golf or tennis. When you perspire, you don’t want a cream with chemicals running into your eyes.” He cites EltaMD, Vanicream, and Neutrogena as reliable brands. Modern sunscreens are convenient and effective, and they need to be applied every two to three hours, especially after swimming, even if the product is labeled as waterproof.

While most people know that sunscreen is important, not everyone considers clothing as a critical tool in skin care. “Protective clothing is even more important than wearing sunscreen,” Dr. Peraza says. “Be sure to wear a wide-brimmed hat to protect the nape of your neck.” He notes that reflective surfaces like sand or snow can increase the sun’s intensity and recommends UPF clothing in these environments, particularly for children.

Also important for skin health is regular skin cancer screening. “I’m seeing an epidemic of skin cancer right now, so skin cancer checks should be a part of health maintenance, particularly after age 50,” Dr. Peraza says. Modern dermatology provides many different treatment options, from topical medications to x-ray therapy and surgery.

Reverse the Damage If your skin is showing the effects of decades outdoors, there are ways to reverse the damage. (See sidebar.) Sun exposure harms connective tissue and the underlying structure of the skin. “Products can help replenish connective tissue, so moisturize regularly,” he states. “Niacinamide, a B vitamin, can protect against DNA damage, and several minimally invasive procedures are available to help improve skin’s appearance.” Lastly, Dr. Peraza notes that it is never too late to develop good sun protection habits. “Make sunscreen, protective clothing, and regular medical checkups a part of your life all year-round,” he says. “Your skin will thank you.”

Dr. Peraza practices at Peraza Dermatology Group offices in Claremont, Lebanon, New London, and Windsor.  Peraza Dermatology Group 367 Route 120, Suite A1 Lebanon, NH (603) 542-6455 perazaderm.com

“Sun exposure is the main cause of premature aging,” Dr. Peraza says.

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Apply chemical-free SPF 30 sunscreen to block the UVA and UVB rays that cause the most damage to our skin.

A FEW SKIN-REJUVENATING TREATMENTS Fillers: used for loss of volume and to fill wrinkles.

Intense Pulsed Light: visible light is used to effectively and safely improve the appearances of brown sunspots, facial redness, texture, and visible signs of sun damage and aging.

Micro-needling: also called collagen induction therapy, this uses fine needles to puncture the skin and create a controlled skin injury in order to rejuvenate skin.

Thread lifting: helps to elevate sagging brows, cheeks, and jowls. Due to the design of the delicate thread filaments used in the procedure, the surrounding tissues act to hold tiny sutures under the skin in place without visible scars.

NUTRITION

BY AMY TULLER, RD, LD, CDE

Building better

diets for the long haul

CHILDREN WILL LOVE EATING HEALTHY WITH THESE EASY TIPS “How can I get my kids to eat better?” It’s a question I’m asked often, and as a parent, it is a challenge I live with as well. As parents, we all want our children to grow up healthy. It’s important to remember that healthy eating is a family affair. It is equally important for all members of the family to be eating nutritious foods.

Therefore, the best way to start getting your children to eat better is to evaluate your own diet. Keeping healthy food choices in the house and not buying as many high-calorie, low-nutrient foods is a good start.

It’s much harder to make healthy food choices when there are “junk food” choices available instead. Most adults have a hard time avoiding these temptations, so we can’t expect our kids to either.

For a review of how to build a healthy diet, a good resource is the USDA website www.choosemyplate. org, which recommends that our plates be half full of fruits and vegetables at each meal. The other half should have a protein source such as fish, lean meat, eggs, or soy, and a grain, preferably a whole grain.

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Here are a few things to remember when you’re trying to improve your child’s dietary habits.

Remember that kids can have finicky tastes. It may take up to 15 tries of a new food before a child will accept it, so keep offering! And offer foods that are not your favorites so that your child has an opportunity to enjoy a wide variety of healthy foods. Try offering the same food prepared in different ways; your child is more likely to discover a way he or she enjoys it.

Be prepared before the “hungries” hit! Cut up fruits and vegetables and put them out before mealtimes when kids are hungry. Serve with olive oil and vinegar dip or homemade ranch dip, hummus, or nut butters. Most of us are more inclined to eat these foods if they are prepared and set in front of us.

2017

“This is all about making it easier for patients to coordinate their care.”

Get your kids involved in meal planning, shopping, and meal preparation at an age-appropriate level. Have them choose some of their favorite nutritious foods and talk about how they would like to cook them. Look through cookbooks or online for ideas for different ways to prepare them.

Aim for at least five servings of fruits and vegetables each day.

Include vegetables and fruits in breakfasts, lunches, dinners, and snacks.

For packed school lunches, plan the menu for a week at a time with your children and ask for their input. Ask them to use the ChooseMyPlate template to design their own healthy lunches, and develop the family’s grocery shopping list together.

Present foods prepared different ways, raw when appropriate as well as cooked, and steamed, poached, grilled, sautéed, or roasted.

Try serving foods in a wrap, alone, or with a sauce. This provides variety and exposes children to many different flavors.

Snacks are an important part of a child’s diet. They provide calories, protein, vitamins, and minerals for growing bodies when nutritional needs might not be met by meals. Look at snacks as “mini meals” and include a healthy protein source, such as yogurt (a lower-sugar variety, not the kind with cookies and candy on top), nut butter, fish, meat, eggs, cheese, beans, or soy, as well as using snack time as an opportunity for your child to consume more fruits or whole grains for energy.

Plan a garden for next spring.

Even if it’s just a small container garden or a few herb or tomato plants, kids who are involved in growing their own food tend to be more open to eating a variety of fruits and vegetables.

Helpful resources for meal planning and recipes can be found at www.choosemyplate.gov, www.oldwayspt.org, www.kidseatright.org, and www.5aday.org.

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Try to avoid processed foods as much as possible, and opt for homemade whole foods instead. Foods in their natural state are usually healthier than those that come from a box, bag, or can. Plan meals and snacks ahead so you have nutritious options handy when you need them. For example, the grilled chicken you have for dinner can become chicken salad in celery logs for tomorrow’s snack if you cook extra.

You might also be able to prepare some foods in the evening to use for the next day’s meals if you know you will be short on time.

Avoid sugary drinks such as sodas, punch, sweetened teas, and lemonade.

Offer unflavored milk or water with a slice of lemon, lime, or orange in it, or home-brewed flavored but not sweetened iced teas. Whole fruits are a better choice for most kids than fruit juices, as they contain the fruit’s beneficial fiber and less natural sugar. Once kids get into the sugar habit, it can be hard to break. Make gradual changes to include less sugary foods and drinks, and kids will get used to a different taste.

Helping your children build a healthy diet is not a black or white proposition.

There are occasions when we eat “fun foods” that are not as nutritious, but if we can teach our children healthy eating habits when they are young, they are more likely to continue those habits and have a better chance of avoiding chronic diseases in adulthood.

We tend to lead very busy lives today and feel like we don’t have time for a lot of cooking. But making good nutrition a priority for the whole family is a great investment in everyone’s health now and for the future.  Amy Tuller, RD, LD, CDE 303 US Route 5 South, Unit 5 Norwich, VT (802) 649-1444 www.amytuller.com

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NUTRITION

BY PATTIE FRIED, CO-OWNER OF LOU’S RESTAURANT & BAKERY

Lou’s Restaurant & Bakery 30 South Main Street Hanover, NH (603) 643-3321 www.lousrestaurant.com

Food for Good Health at Lou’s CUSTOMERS ARE LOOKING FOR NUTRITIOUS OPTIONS Breakfast trends have changed in recent years, and as a restaurant in a college town, we need to pay attention to emerging food trends. Fortunately, we are blessed with a population of customers who value locally sourced, whole foods that are not only good for you but also delicious and satisfying. Menu changes have to be carefully considered, and we need to maintain a balance between traditional hearty food and nutrient-filled “superfoods.”

Smoothie bowls are going strong, along with bone broth soups and alternative options for sugar in baked goods.

Our smoothie bowl is filled with acai berries mixed in local Greek yogurt and topped with fresh fruit, chia seeds, and organic local honey. Acai berries are considered a superfood that’s loaded with antioxidants, and they have an earthy, raspberry, dark chocolate flavor. These bowls are delicious, gorgeous, and good for you. They are especially popular with Dartmouth students and tourists.

People are looking for options that don’t include refined white sugar. Muffins are an easy grab-and-go item but are not considered a healthy breakfast option. Toby spent months working on a recipe for a “healthier alternative to a muffin.” He came up with a moist and delicious, glutenfree breakfast cookie that’s loaded with flaxseeds, nuts,

berries, agave nectar, coconut, and spices. Right now, the bakery is researching alternative sweeteners, including agave, monk fruit, and honey.

Another trend that has long been considered a great healer is bone broth. About three years ago, we started making bone broth chicken soup using bones from free-range, organic, all-natural chickens; we call it “soul soup.” The extended cooking process breaks down the bones, creating a soothing, highly nutritious broth. Who doesn’t want a healthy gut, great skin, and strong bones? Broth has always been considered great for healing. It’s not uncommon for us to deliver our bone broth soup to Dartmouth students who are feeling under the weather, often at the request of their concerned moms. 

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NUTRITION

BY HANNAH BRILLING, RD, NUTRITION SPECIALIST AT THE CO-OP FOOD STORE

EATING WELL CAN BE EASY—AND TASTY

healthy to go

Whether you’re headed to school, on a road trip, or to your desk, selecting nutritious foods to eat on the go can be a challenge. Here are a few suggestions for stepping up your fruit and veggie game.

ing!

st add dress

veggies—ju Quinoa and

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Pack and Peel For snacks, consider a two-container approach: cucumbers, cherry tomatoes, peppers, broccoli, cauliflower, and carrots packed in one, and hummus, salad dressing, or Greek yogurt dip in another.

For salads with staying power, add protein, whole grains, and nuts or seeds. Plan to cook extra meat or fish, tofu, or quinoa for dinner and use a portion to top greens for lunch the following day. A half-dozen hard-boiled eggs can last the week or choose rinsed canned chickpeas or beans for variety. Need more ideas? Check out food52.com, thefirstmess.com, halfbakedharvest. com, and deliciouslyella.com.

Keep hard-boiled eggs on hand, a great go-to snack!

Gluten-free flatbread wit h roasted ch cauliflower, ickpeas, and avocado spread.

urt.

bles and yog

Raw vegeta

Embrace large fruits. These can be economical and offer a change from bananas. Choose one evening a week to prep. For example, if you like cantaloupe, start by washing the outside peel, then make one slice for a flat surface on the cutting board. Peel (carefully) with a knife before cutting up the remainder of the fruit. Portion into containers for stress-free weekday mornings. Add peanut butter or yogurt for dipping, and you’ll balance out sugar with fat and protein.

Co-op tip: Eat in season! Apples, squash, pumpkin, beets, carrots, and potatoes are fresh and local into the colder months.

Nuts and Dried Fruits A small handful of nuts can be great for healthy and satisfying snacking. Dried fruit—unlike its processed counterparts, fruit snacks and fruit juices—contains the fiber, antioxidants, and nutrients of fresh fruit. The natural sugars are concentrated, though, so consume in moderation and eat the fresh versions when possible.

Co-op tip: Consider organic and fair-trade nuts, which may contain fewer toxins and will support sustainable farming and livable wages.

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Vegetarian cole slaw and chickpea sandwich.

Inspired Sandwiches Roasted veggies can lay the foundation for a tasty, meatless lunch. Start with whole-grain bread and add pesto, sundried tomatoes, garlic aioli, or any little bits of sauce you’ve got in the fridge. Layer on cheese, sliced veggies, and hummus.

For easy planning, make extra veggies for dinner and use the leftovers for lunch.

Co-op tip: Based on research regarding processed meats and colon cancer risk, aim for two slices or fewer of deli meat, bacon, and sausage per day. Substitute with chicken, tuna, egg salad, or vegetables to reduce your intake.  Co-op Food Stores coopfoodstore.coop 45 South Park Street Hanover, NH (603) 643-2667 12 Centerra Parkway Lebanon, NH (603) 643-4889 209 Maple Street White River Junction, VT (802) 295-3400 Co-op Market 43 Lyme Road Hanover, NH (603) 643-2725

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NUTRITION

Build a better smoothie

AN EASY WAY TO INCREASE YOUR FRUIT AND VEGGIE SERVINGS Mango Carrot Ginger Smoothie Makes 2 servings, about 1N cup per serving Prep time: 10 minutes This smoothie is packed with vitamin C, vitamin A, and carotenoid compounds found in yellow-orange fruits and vegetables, which have been linked to disease protection.

1 mango, peeled and sliced into chunks K orange, peeled and quartered 1 large carrot, sliced into large chunks 1K cups soy milk, plain 1 (1-inch) piece of fresh ginger, peeled 6 ice cubes

Place all ingredients in the container of a blender and process until smooth. Pour into two glasses. Enjoy!

Per Serving: 200 calories, 4 g total fat (0 g saturated fat), 36 g carbohydrates, 7 g protein, 4 g dietary fiber, 120 mg sodium

Smoothies have benefits beyond good taste; they can help you increase the number of fruits and vegetables in your diet. It can be a challenge to meet your vegetable requirement of about 2½ to 3 cups a day for adults and your fruit requirement of about 1½ to 2 cups a day for adults, so packing a few servings into your glass is a good start. And unlike juices, smoothies use the whole fruit or vegetable, so you’re getting all that fiber plus vitamins, minerals, and phytochemical goodness. 

Here are a few tips for building a better smoothie:  Fill at least one-third of your blender with vegetables such as carrots, peppers, cucumbers, greens, and celery.  Add unsweetened fresh, canned, or frozen fruit—oranges, bananas, berries, mangoes, peaches—to add natural sweetness and nutrients.  Skip added sugars such as honey, table sugar, or agave. The fruit serves as all the sweetener you need.  Add fortifi ed soy or dairy milk to increase protein as well as calcium and vitamin D.  Add a pinch of spice, such as ginger, to further increase fl avor and anti-infl ammatory compounds.

Courtesy of the American Institute for Cancer Research, www.aicr.org

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NUTRITION

BY CHRIS JACOBSON, UPPER VALLEY FOOD CO-OP

Where Does Your Food Come From?

BUYING LOCALLY GROWN FOOD HELPS THE COMMUNITY Many people are looking for ways to step up their game when it comes to healthier living, but what does that mean? It means being mindful of what you’re eating, where it comes from, and how it has been cultivated. Healthier living also indicates responsible purchasing from sources and growers who treat their employees well and steward the land responsibly. All of these affect individuals and communities.

And a resilient and robust community tends to support a thriving economy and healthy people.

The Upper Valley Food Co-op can help out in several areas—most directly with your focus on food. We have a keen eye for the food web and supporting conscientious shopping. One big reason folks come to UVFC is to enjoy our impeccable organic produce, sourced locally whenever possible. Our bulk section offers many packagefree, protein-dense options for fiber-friendly and meat-reduced diets. Much of our meat selection comes from locally sourced and vetted farms that treat their animals well and utilize pasture over permanent enclosures.

We also seek Fair Trade and pesticide-free options that sustain both the consumer and the provider, and we have a massive medley of vitamins and supplements to help people maintain the ideals their practitioners recommend. In short, we’re a good match for healthy living with knowledgeable staff eager to help you find solutions.

The “big red apple co-op” in downtown White River Junction offers education about your food too: sourcing, growing, cooking, and food preservation, along with a multitude of topics to help our community better understand our bodies, minds, and the connections between them. We are not purists by any stretch, but we actively practice harm reduction by improving product options to make it easier for consumers to make healthier choices when it comes to food and treading lighter on the planet.  Upper Valley Food Co-op 193 North Main Street White River Junction, VT (802) 295-5804 www.uppervalleyfood.coop

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“This is all about making it easier for patients to coordinate their care.”

October is National Co-op Month, a time to celebrate co-ops everywhere for all the good they bring to our communities locally and globally. www.uwcc.wisc.edu

Did You Know?

According to Yes! Magazine, US food co-ops spend more revenue locally, recycle more materials, buy more products locally and more organic produce, and create more jobs than conventional supermarkets. www.geo.coop

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EXERCISE

BY HEALTH WATCH STAFF PHOTOS BY CPERRY PHOTOGRAPHY

Bring Balance to Your Life DISCOVER NEW STRENGTH AND FLEXIBILITY AT BISCUIT HILL PILATES

Since its inception, Pilates has enjoyed a reputation as a fitness modality that not only supports strength and flexibility but also promotes proper alignment by focusing on correct joint mechanics and mobility.

Exercises can be modified to make an exercise easier or more challenging, depending on the individual’s needs and ability. Biscuit Hill Pilates Studio in Woodstock carries on this tradition with the collaboration of its seasoned Pilates and physical therapy staff.

“Our sessions are individualized,” says owner Deanna Busch, “and unless you are attending a mat class, we work with no more than two clients at a time. We work with all populations, ranging from healthy athletes to people with hip and knee replacements, neck and shoulder injuries, back issues, and foot and ankle problems.”

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Clockwise from top left: Deanna Busch; Rebecca Nash, DPT; and Kelly Kane. Missing from the picture is Lucy Dunne. The studio. A semi-private Reformer lesson. “Walking” on the CoreAlign.

Opposite: Correcting alignment on the ladder barrel.

A few well-designed movements, properly performed in a balanced sequence, are worth hours of doing sloppy calisthenics or forced contortion. — Joseph Pilates

Unlike conventional weight training, which tends to build short, bulky muscles, Pilates focuses on building long, lean muscles that enable us to gain more flexibility. “We work from the inside out,” Deanna explains. “One of our main objectives is to develop the strong, deep abdominal and spinal stabilizing muscles—the core. From this strong core, more correct and fluid movement can be achieved.”

Whole body integration is the goal to work toward, according to Deanna.

“We work to strengthen the weak muscles and balance the entire body.

Pilates can help retrain your body to move in a safer, more efficient way.

The quality of movements during a session is more important than the quantity of repetitions. Proper breathing is essential and helps you execute a movement with the most power and efficiency.”  Biscuit Hill Pilates Studio 512 East Woodstock Road Woodstock, VT (802) 457-4525 biscuithillpilates.com www.uppervalleyimage.com •

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BY HEALTH WATCH STAFF

Dive In! IMPROVE FITNESS AND MEET NEW FRIENDS Upper Valley Aquatic Center offers many health, wellness, and fitness programs, including free childcare and classes for members and the Poolside Café with healthy food options, according to Communications Director Lisa Vallejo Sorensen.

Below is a sampling: Member Wellness Screenings: Cholesterol, glucose, and Tanitascale reading to measure blood pressure, weight, BMI, body composition, and metabolic age.

Nutrition Consultation FREE Senior Fridays 9–11am Land and aquatic exercise classes including mind/body offerings like yoga, Pilates, and meditation Balance Programs: Tai Ji Quan for Better Balance Walk with Ease: Arthritis Foundation program to reduce pain and increase health Well & Fit at UVAC: Exercise for those with a doctor’s referral PALS for Life, PALS for Life Bridge Program, and Cancer-Free Living: Small group training program for breast cancer survivors 60/60 Physical Therapy: Transition program NeuroKinetic Therapy for chronic pain or acute injuries BE Fit Physical Therapy now has an office at the UVAC.

Upper Valley Aquatic Center 100 Arboretum Lane White River Junction, VT uvacswim.org

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Exercising in water reduces the weight of your body by up to 90%.

Exercising in water is a fun and effective way to meet your fitness needs, and it offers the opportunity to exercise in a group and meet new friends. Performing an hour of water aerobics burns more calories than spending an hour doing more strenuous activities, including downhill skiing, according to the Mayo Clinic.

Exercising in water reduces the weight of your body by up to 90 percent, which makes taking to the pool a great option, especially if you are overweight or have arthritis. Another consideration is that more-strenuous sports are known to subject muscles and joints to wear and tear. Exercising in water provides a significant amount of resistance, which can build and tone your muscles without putting excessive stress on your joints.

Performing water aerobics can also improve flexibility. Because the water supports so much of your weight, it is easier to stretch muscles and move your joints through a greater range of motion. Be aware, however, that the resistance in water exercise is not enough to reduce the risk of osteoporosis, so you’ll need to add some weight training to your routine. Low-impact activities such as walking, gardening, and housecleaning can help keep your bones strong.  Source: Do Water Aerobics Really Give You a Good Workout? by John Kim, Spa Health Club, 9/07/12.

2017

“This is all about making it easier for patients to coordinate their care.”

ART OF AGING SENIOR CARE, ASSISTED LIVING, VISITING NURSES, FINANCIAL WELL-BEING

Aging is not lost youth but a new stage of opportunity and strength.

—Betty Friedan

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BY SUSAN NYE

CREATING ¢ A NEW ∫ SOCIAL CIRCLE DISCOVERING VALUABLE LIFE LESSONS

F

rom the time we are born, we are part of a social circle. It starts with our family and evolves to include school and then work and eventually a family of our own. With age, too many people face a shrinking circle. While grandchildren fill seniors with delight, all too often they live far away or are too busy for regular visits. Perhaps a spouse has passed away, in addition to lifelong friends and relatives. Senior living provides more than peace of mind that the walk will be shoveled or the leaves raked; it draws residents into a new social circle.

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Age has no reality except in the physical world. The essence of a human being is resistant to the passage of time. Our inner lives are eternal, which is to say that our spirits remain as youthful and vigorous as when we were in full bloom. . . .

— Gabriel García Márquez, Love in the Time of Cholera

From top left: Jack and June Liberman recreate a scene from On Golden Pond for the Summercrest calendar. Marylynne Bowers (center) and sisters enjoy the annual Summercrest Friends and Family BBQ. Summercrest residents laughing and “Singing in the Rain.” Photos courtesy of Summercrest.

From top right: Neil Atkins relaxes on one of Woodcrest’s many porches with house dog Winston. Resident Betty Williams arranges fresh flowers each week for the dining room tables. Photos courtesy of Woodcrest Village. www.uppervalleyimage.com •

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Summercrest Senior Living Set in a quiet, residential neighborhood, Summercrest sits at the crest of the hill on Summer Street in Newport, New Hampshire. The organization provides three programs for older adults: independent living, assisted living, and memory care. There are 36 apartments in the independent and assisted living section and 18 in the memory care unit.

Built about 20 years ago, Summercrest was designed with the services it provides in mind.

There are no retrofits or workarounds. The corridors are wide to accommodate wheelchairs and walkers. The rooms in the memory care unit are fireproof to support a defend-in-place strategy. Instead of evacuating, residents can remain safe and secure in their rooms. This capability is important for residents with dementia or Alzheimer’s, who may wander off in the confusion or suffer from limited mobility.

Locally owned and operated, Summercrest’s owners, management, and staff are committed to providing a secure and nurturing home for seniors.

Leigh Stocker has been the marketing director at Summercrest for five years. During that time, she has learned much about elder care and the elderly. Leigh admits, “I was a little nervous when I first walked in.” However, one of the residents immediately put her at ease. “Muriel drew me in and opened my eyes to her vast knowledge, wealth of information, and wisdom. She told me stories and provided answers to things I didn’t even think to ask.”

In an age when we are all in a hurry and much too busy, the residents at Summercrest pass on the valuable lessons of slowing down and being present. When asked what is the best thing about growing older, Mary Gardner from Keene says, “In a place like Summercrest, it’s the care I’ve received.

I don’t call it service; I call it care.” Betty Clarke from Croydon was happy to share a valuable lesson as well. She advises, “Surround yourself with happy people.” Carol Rollins of Newport adds, “Every day, tell someone you love them.”

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HOSPITALS Betty Clarke from Croydon was happy to share a valuable lesson as well. She advises, “Surround yourself with happy people.” Carol Rollins of Newport adds, “Every day, tell someone you love them.”

Clockwise from top left: Summercrest during spring. The warm and welcoming dining room.

Summercrest living room where residents can gather to socialize.

Solarium and library.

A spacious bedroom in a one-bedroom apartment. Residents like to read or gather to play games in the solarium and library.

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Woodcrest Village From the beginning, the Brenner family has made it their mission to provide assisted and supportive living services in a safe and secure homelike setting. The Brenners opened Woodcrest House in 1988. The original 12-room residence was built in 1820 and is listed on the National Registrar of Historic Landmarks. Today, Bethany Brenner runs Woodcrest Village. It has expanded to cover three floors.

There are 32 traditional assisted living apartments and 12 memory care rooms.

Located right on Main Street in New London, New Hampshire, Woodcrest is at the center of everything. Easy walking distance to the town green provides access to summer concerts, the annual Winter Carnival, and other fun activities. Close proximity to shops, restaurants, and churches allows many residents to stay active and maintain their independence. A visible part of the community, Woodcrest residents are frequently out and about. It’s wonderful to see them taking a walk up and down Main Street or watching the world go by from a bench on the green.

In addition to Woodcrest’s easy access to local activities, the Brenners invite families and the community in. There is an active calendar of events, and many are open to the public. About five years ago, the Brenners teamed up with 102 i m a g e h e a l t h w a t c h •

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Adventures in Learning to bring a series of lectures to Woodcrest residents and the community at large. There are also concerts throughout the year and in the summertime, Saturday Night at the Movies, showing both recent releases and classic films.

Seeing the growing need, Woodcrest has started a Memory Café. Family caregivers and those suffering from memory loss gather once a month. “Our goal is to create a safe, no-judgment zone,” says Bethany. As dementia progresses, it can become increasingly difficult for someone to follow a conversation and stay engaged. Individuals begin to lose the ability to use common social filters at home or in public, often causing caregivers to become isolated.

Bethany says, “At the Memory Café, families come to realize that everyone in the group is in the same boat.

Spouses and adult children may socialize, have fun, and gather helpful information. The venue offers a supportive, comfortable atmosphere without concern of ‘social appropriateness.’”

It is a relief for caregivers to realize that they are not the only ones coping with these medical and social issues.

Bethany says, “We are happy that we can provide this service to the community.” She adds, “There’s great comfort in just knowing you are not alone.” 

Clockwise from left: The main living room offers residents a place to gather for conversation and relaxation in front of the cozy fireplace. Residents enjoy three meals a day featuring a selection of homelike entrées professionally prepared

by Woodcrest’s skilled chefs. Woodcrest’s salon offers barber and beauty services for residents. The side porch is the place where residents enjoy morning sunshine, fresh air, bird watching, and views of their seasonal window boxes. Woodcrest’s country kitchen offers freshly made coffee, fresh pastries, the daily newspaper, and socializing.

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TYPICAL ASSISTED LIVING SERVICES Not to be confused with a nursing home, assisted living facilities do not offer full nursing care. Most provide the following services: Assistance with daily living activities and personal care as needed Health services and medication administration Central dining programs offering three meals a day Housekeeping and maintenance Laundry services Educational and recreational activities Exercise programs Wellness programs Social services Access to religious services and activities Transportation arrangements Emergency call systems in both private and common areas 24-hour security

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PHOTO COURTE

SY OF WOODCR

EST VILLAGE

Most assisted living facilities offer a dedicated area for Alzheimer’s and dementia care.

These facilities are designed to protect the residents from wandering and agitation.

Specially trained staff work to improve the quality of life for memory-impaired residents.

In addition, most assisted living facilities have the capability to work with home health care groups to provide skilled nursing care and hospice services.

FINANCIAL WELL-BEING

BY MIKE MORIN

WHERE LONG-TERM CARE HAPPENS

51%

Home health care

31%

Nursing home

18%

Assisted living or adult day care

A person at age 65 has a

70% chance of needing some type of long-term care during retirement. But long-term care doesn’t necessarily mean a nursing home.

HELP WITH MAKING INFORMED DECISIONS We asked Tim Guaraldi what important points we need to be aware of when it comes to our insurance needs, at any time of life but especially as we age.

You have been an active member of many community organizations. How does this help you understand your clients’ insurance needs?

Our agency was established in 1969 by my father from zero policies, after my mother passed away suddenly from a brief illness. This got him started in life insurance sales and consequently has been a big part of our agency’s growth.

Personally, I have been past president of the Lebanon Lions Club for a couple of terms and a member of NAIFA (National Association of Insurance and Financial Advisors) for the local chapter for several years until it was folded into the Manchester, New Hampshire, chapter. I am currently a member of the Lebanon Riverside Rotary. I have also been a board member of the former Upper Valley Community Credit Union and a member of Business Networking International. Being active in the area allows me to see the needs of our particular community from all aspects: business owners, workers, retirees, and nonprofits and social agencies. One of my favorite activities is helping out with the LISTEN dinners in White River Junction.

What types of financial services do you offer, especially for people looking toward retirement and estate planning?

We can provide LTC (long-term care) planning, retirement planning, and financial planning. We partner with other professionals from the local area or out of the area. Each client is different and may have different wants and needs—and some clients don’t have any idea. A lot of what we do is educate our clients so they can make informed decisions. LTC in particular is an area that is increasingly missed in the retirement planning process. The clients who get it are the ones who have had to take care of an elderly parent or spouse. It is exhausting to the caregivers, many times on top of their existing jobs. We work with clients to help them understand the importance of having a longterm care policy in place to help with the care and expenses that go along with taking care of a senior parent or spouse. LTC can be an important part of a well-planned retirement.

How can families use life insurance as a tool for planning financial security?

Life insurance is an important part of any family’s financial security plan, from paying off the mortgage or other long- or short-term debt, extending living-expense coverage and covering the cost of college, to planning for final

Guaraldi Agency 21 Bank Street Lebanon, NH (603) 448-3250 www.guaraldi.com

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“This is all about making it easier for patients to coordinate their care.”

38%

of people who enter a nursing home fully recover or stabilize and are released. expenses (funeral) and creating a trust for special-needs children. All these can be protected by purchasing life insurance. It just takes planning, and that’s the hard part for most families—finding the time to sit down and make a plan.

For those approaching or in the retirement phase of life, explain 401(k) rollovers with an eye toward tax-deferred strategies.

Everyone has a different risk tolerance when it comes to investing, especially when you are going into your retirement years. Did I save enough to last through my retirement? Have I been too conservative with investments? What should I do with my 401k, 403b, simple IRA, Roth IRA, or traditional IRA? My job is to help you work through those fears and ease you into your retirement. It is also to be honest with you and advise you when you may not have enough to retire and may have to continue to work full or part time. What are your plans and do they fit with your financial situation?  www.uppervalleyimage.com •

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ART OF AGING

BY HEALTH WATCH STAFF

10 ways

to keep your mind sharp Your mind doesn’t have to slow down as you age. Use these proven methods to retain and boost mental acuity.

3. Enjoy a cuppa Sip more tea. Green and black teas have been shown to prevent memory loss, while peppermint stimulates the brain.

Lemon balm is said to help us retrieve stored information.

1. Exercise your brain Medicine found that seniors who participated in brain-

4. Socialize

stimulating activities more than once a week over a

People who maintain relationships with

20-year period reduced their risk of dementia by 63

family and friends live 20 percent longer

percent. Check out several games on the AARP web-

and are more likely to retain memory,

site at stayingsharp.aarp.org or brainteasers, riddles,

language, and abstract thinking skills.

A study published in the New England Journal of

games, and more at braingle.com.

2. Try something new

5. Eat a healthy diet

Devote at least 15 minutes a day

Foods rich in antioxidants—berries, dark leafy greens, grapes,

to learning something new. Learn

broccoli, beets, and tomatoes—prevent cholesterol from

a few phrases in French, take up

clogging your arteries and keep your brain in good working

an instrument, or try an out-of-

order. Eating fish containing

the-ordinary recipe.

omega-3 fatty acids (salmon, tuna, and cod) once a week may slow cognitive decline by 10 percent a year, according to research at Rush University Medical Center in Chicago.

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9. Play catch 6. Both sides now Exercise your brain with activities that use both the left (memory and logic) and right (visual memory) sides to

Practice throwing and catching with a partner or play table tennis; these activities help hand-eye coordination and visual and tactile response.

puzzles or play Chinese checkers or

10. Try aromatherapy

Scrabble.

Did you know that certain scents can

boost mental agility. Solve crossword

make you more productive and can act to stimulate the brain? Lemon oil,

7. Switch it up

peppermint oil, and lavender oil all have beneficial properties. 

Increase mental agility by switching hands, which can increase brain circuits. If you’re right-handed, brush your teeth or jot down a note with your left hand, and vice versa. Walking backward also stimulates the brain.

8. Stay active Studies show that aerobic exercise increases brain volume and white matter (which aids connectivity between brain cells) more than stretching and toning exercises do.

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FINANCIAL WELL-BEING

BY MIKE MORIN

Comprehensive Wealth Management CONSIDER YOUR FINANCIAL HEALTH AND THAT OF YOUR LOVED ONES A wealth management plan should be the road map to your secure financial future. Too often, people think of their wealth management plan only in terms of an investment portfolio.

A comprehensive plan is designed to achieve a wide range of specific financial goals and objectives. An effective approach will define where you are starting from, where you are going, and how you will get there.

Dennis Mitchell, CFP® Managing Director at Ledyard Financial Advisors Ledyard Bank 2 Maple Street Hanover, NH (603) 643-0044 www.ledyardbank.com Other locations in Concord Lebanon Lyme New London Norwich, VT West Lebanon

The following are areas to consider when making this critical decision: 1. Choose an advisor who uses a comprehensive approach and who provides effective communication.

2. Have a clear understanding of the fees you are paying.

There are two basic methods of paying an advisor: a fee based on a percentage of your portfolio value, often called an “assets under management” fee, or fees and commissions paid on a per-transaction basis.

Financial planning is an ongoing process, not a one-time event. It is prudent and necessary to have periodic reviews of your plan, understanding that changes in goals may require adjustments or amendments to that plan. 

The 13 areas below may be included in the development of a comprehensive wealth management strategy. Choose your financial advisor carefully.

Investments

Create an appropriate investment plan to meet income needs while preserving and building wealth.

Business succession Create the right transition plans for your business.

Review the adequacy and costs of coverage to ensure that you and your family are properly protected.

This step is often referred to as risk management.

Durable power of attorney Identify the appropriate designee to make financial and medical decisions on your behalf in the event you are unable.

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Retirement plans and IRAs

Insurance

Focus on election, distribution, and beneficiary decisions to ensure that you maximize your benefits.

Taxes

Financial planning

Banking

Proactive tax management is important.

Become familiar with strategies that can minimize tax liabilities.

Optimize use of credit and banking resources to simplify cash management, leverage assets, and preserve established wealth.

Determine cash flow and plan now to meet future needs.

Family gifting

Charitable gifting

Titling of assets

Executor/ trustee

Review gifting strategies to your children and/or family during your lifetime.

Explore appropriate tax-advantaged charitable gifting strategies.

Review to ensure that the manner in which your assets are titled reflects your intentions.

Consider your selection of a family member and/or corporate representative to carry out your estate plans.

Distribution of wealth Be aware of strategies to maximize the distribution of wealth at the time of your death.

2017

“This is all about making it easier for patients to coordinate their care.”

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HOSPITALS

BY NANCY FONTAINE

THE JACK BYRNE CENTER FOR PALLIATIVE & HOSPICE CARE

Making each day as good as it can be for patients and their loved ones There are often misconceptions about what palliative or hospice care means.

Hospice, which shares the same word root as hospitality and hospital, is about care, comfort, and compassion for those nearing the end of their lives. www.uppervalleyimage.com •

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Our local hospice agencies have created a wonderful network of support for these people and their families. Sometimes more severe symptoms can’t be managed at home, though, and patients must be readmitted to acute care hospitals, which are great at providing care but are not very much like home.

For people living with serious illnesses, palliative and hospice care can make a vast difference in the quality of their lives. Although historically associated with the end of life, this type of care is a part of comprehensive treatment for more and more people earlier in the course of illness, when the management of symptoms associated with treatments as well as diseases; support for the psychological, social, and spiritual aspects of illness; and thoughtful planning to ensure that care plans are aligned with patients’ and families’ values are paramount.

Toward the end of the course of an illness when disease-specific treatments are no longer effective or have become too burdensome, hospice care can provide these same supports in a patient’s home.

“Most people say they want to spend the end of life in their own homes,” says Dr. Kathryn B. Kirkland, Section Chief and Director of Palliative Medicine at Dartmouth-Hitchcock and the Dorothy and John J. Byrne, Jr., Distinguished Chair in Palliative Medicine at Dartmouth’s Geisel School of Medicine, “and our local hospice agencies have created a wonderful network of support for these people and their families. Sometimes more severe symptoms can’t be managed at home, though, and patients must be readmitted to acute care hospitals, which are great at providing care but are not very much like home. We haven’t had a facility that provided both access to specialized intensive inpatient symptom management and a home-like environment.”

Enter the Jack Byrne Center for Palliative & Hospice Care, now under construction as the newest addition to the Dartmouth-Hitchcock campus, designed to fill this gap for people in the Upper Valley. Scheduled to open in December, the 12-bed facility will combine interdisciplinary patient- and family-centered care with opportunities for teaching, training, and research

— Kathryn B. Kirkland, MD, Director of Palliative Medicine, Dartmouth-Hitchcock

Patients’ rooms are bigger than typical hospital rooms to allow family members to stay overnight comfortably. Other homey touches include a balcony off each room big enough to accommodate a hospital bed and panels that cover medical equipment so it is not always in view.

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HOSPITALS

for health care providers. It was made possible by a $10 million gift from the Jack and Dorothy Byrne Foundation in 2014, along with another $7 million in donations and commitments from community members around the region. Going forward, philanthropy will continue to play an important role in supporting programs for patients and families served by the center.

The Jack Byrne Center, as it is called, is built to feel warm and welcoming from the moment people walk in the front door into a great room dominated by a big fireplace and the good smells from a busy family kitchen. Patients’ rooms are bigger than typical hospital rooms to allow family members to stay overnight comfortably. Other homey touches include a balcony off each room big enough to accommodate a hospital bed and panels that cover medical equipment so it is not always in view.

Currently, Dartmouth-Hitchcock is working in partnership with local hospice agencies to create plans of care that will allow for smooth transitions for home hospice patients who need to spend time in the center and create collaborative care plans that reflect ongoing

An artist’s rendition of the Jack Byrne Center for Palliative & Hospice Care, located on the Dartmouth-Hitchcock Medical Center campus in Lebanon and scheduled to open to patients in December.

80%

More than of patients with chronic diseases say they want to avoid hospitalization and intensive care at the end of life.

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The Jack Byrne Center is designed to serve not only patients but also their family members and caregivers. There are spaces in the building where families and community members can feel at home and where educational programs will be offered to help build the skills and knowledge necessary to care for loved ones.

“We hope to use the center to help get symptoms to a point where they can again be managed at home.”

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involvement of the hospice team already overseeing care. “Our philosophies are very much the same: to make each day as good as it can be in the face of serious illness,” Dr. Kirkland explains. “The center will give us another tool to be able to do this.”

Dr. Kirkland emphasizes that one of the goals of the Jack Byrne Center will be to get hospice patients who want to spend their final days at home back home. “We hope to use the center to help get symptoms to a point where they can again be managed at home,” she says.

The Jack Byrne Center is designed to serve not only patients but also their family members and caregivers. There are spaces in the building where families and community members can feel at home and where educational programs will be offered to help build the skills and knowledge necessary to care for loved ones. The center will serve as a learning lab to study how to deliver the best possible care and how best to build capacity among other health care teams and learners in the region.

The Jack Byrne Center will be one of

the sites—in addition to inpatient units, outpatient areas, and the intensive care unit (ICU)—where Dartmouth-Hitchcock palliative care residents, fellows, and students can rotate to get hands-on experience with this patient population.

Dr. Kirkland says, “The Jack Byrne Center holds great promise. It is exciting to be able to build on the work of earlier palliative and hospice care leaders, such as Dr. Ira Byock, with the support and generosity of the Byrne family. It’s a real privilege to bring that vision to life.”

An open house celebration for the Jack Byrne Center is planned for November 5 and will be open to the public with selfguided tours, offering community members the opportunity to see the center before it officially opens for patients, families, and caregivers in December.  The Jack Byrne Center for Palliative & Hospice Care 154 Hitchcock Loop Road Lebanon, NH (603) 650-5402 www.dartmouth-hitchcock.org/ palliative_care.html

ART OF AGING

BY HEALTH WATCH STAFF

˜ e 12Benefits of Tai Chi for seniors

The benefi ts of tai chi for seniors are many. If you’re looking for a low-impact, relaxing form of exercise that requires only about 20 minutes a day and rewards your efforts, this is for you. Tai chi is an internal Chinese martial art, in the sense that it focuses on mental and spiritual aspects integrated into movement. This meditative form of exercise consists of a series of 19 movements using slow-moving, circular forms.

12 11

10

Promotes faster recovery from stroke and heart attack

Improves symptoms of Alzheimer’s, multiple sclerosis, and Parkinson’s disease

Improves balance and stability by strengthening ankles and knees

2

Promotes deep breathing

Reduces bone loss in menopausal women

Enhances mental capacity and concentration

4

Accumulates energy rather than depleting it by releasing endorphins

7

Relieves physical effects of stress

3

9

8

1

Improves lower body and leg strength

Promotes mind and body integration through mental Reduces imagery blood

5

Helps with arthritis pain

pressure

6

Many senior care facilities and community centers are offering tai chi classes (some free of charge) because of its extensive health benefits. It doesn’t require any special equipment, and many seniors find it an easy activity and a peaceful environment where they can meet others with common interests. Your local library may have demonstration DVDs you can use if you can’t find a class.  Source: insideeldercare.com

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FINANCIAL WELL-BEING

BY MIKE MORIN

JMH Wealth Management A HOLISTIC APPROACH TO FINDING THE BEST INVESTMENT STRATEGY

Jeffrey M. Harris CFA, AIF, CPWA JMH Wealth Management 45 Lyme Road, Suite 307 Hanover, NH (603) 643-8899 www.jmhwealth.com

My fiduciary obligation is to always act in your best interest. Period. I signed up for the Accredited Investment Fiduciary (AIF) program as soon as I heard about it, and I received my AIF designation in March 2005. The AIF program is built around 24 prudent practices, and it’s an important guide on how to define our relationship.

Over the past year, the Department of Labor expanded advisors’ fiduciary obligations to include all retirement investment accounts, which translates into greater transparency.

“We create an investment strategy, not one of those boilerplate ‘financial plans’ for clients.”

To manage your money and help you achieve your goals, I must have a complete understanding of your financial life and the risks you face. To gain that understanding, I use a holistic approach that involves gathering and analyzing information related to your estate plan, tax situation, risk or insurance needs, educational funding, and retirement planning. I want

you to share as much information as possible with me, and through a number of meetings, together we identify the best investment strategy for you. And then we go about implementing it.

No single person can be an expert in all the diverse areas that affect your financial life, so it’s imperative to work cooperatively with your other existing legal, tax, and insurance advisors. In fact, I will rely on their expertise as questions and issues arise. If you don’t have an existing relationship, document, or solution in place, I am able to refer you to a relevant professional.

Gauging risk tolerance is very difficult, partly because it changes over time and is asymmetric. For example, most of us embrace risk in rising markets but dislike it in falling markets. I assess your risk tolerance two ways: subjectively and objectively. The subjective evaluation is the review of all the information described above, including your existing investment holdings. Your current investment holdings are always informative, as they implicitly give me a sense of your risk tolerance because of the risk embedded in them. Our

meetings and discussions of all the financial data and investment holdings round out the subjective analysis.

The objective assessment is the scoring of three risk questionnaires that I will ask you to complete and return to me. The scoring from the risk questionnaires results in an asset allocation target that is then compared to your current asset allocation and portfolio holdings. I look for inconsistencies and contradictions between the subjective and objective data that can shed more light on your risk tolerance. We’ll review and ultimately agree upon specific risk level and asset allocation targets.

Life changes for everyone and every family, and that means reviewing your investment strategy regularly. I strongly suggest that you try to tune out the daily market commentary and headlines, which are simply noise, and keep your focus on your long-term objectives. Despite wars, depressions, recessions, social upheaval, and punishing periods of inflation, the financial markets have rewarded long-term investors. 

Life changes for everyone and every family, and that means reviewing your investment strategy regularly.

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“This is all about making it easier for patients to coordinate their care.”

ART OF AGING

10 TIPS FOR HEALTHY VISION Following the steps below may help prevent or slow the progression of macular degeneration:

BY HEALTH WATCH STAFF

aging eyes AS WE GET OLDER, TAKING CARE OF OUR VISION IS MORE IMPORTANT THAN EVER The risk of eye disease increases with age, yet many older adults are failing to schedule regular appointments for checkups. According to the American Academy of Ophthalmology, one in six Americans age 65 and older has a vision problem that can’t be corrected with glasses or contact lenses.

Aging is a process that brings about many opportunities and changes, from milestones such as becoming a grandparent or going back to school to simple lifestyle changes, like starting a new exercise program. While vision loss and blindness are not a normal part of aging, some vision changes such as losing focus, having trouble distinguishing between colors such as blue and black, and needing more light to see well are common. These changes can often be corrected with contact lenses or glasses and improved lighting.

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1. Eat lots of dark green, leafy vegetables.

2. Take a balanced multivitamin and mineral supplement.

3. Eat fish or take a fish oil supplement.

4. Consume fruit and nuts every day.

5. Avoid refined carbohydrates.

6. Control your blood pressure and cholesterol levels.

7. Exercise regularly and maintain a healthy weight.

8. When outdoors, wear sunglasses to block UV light.

9. Don’t smoke.

10. Have regular eye exams.

23.7

million American adults age 18 and older reported experiencing vision loss, according to the report for the 2015 National Health Interview Survey.

As they age, people are also at higher risk for vision loss from certain eye diseases and conditions, including the following: • Age-related macular degeneration (AMD), which gradually destroys the macula (the part of the eye that provides sharp, central vision) • Cataracts, a clouding of the lens in the eye • Diabetic retinopathy, a complication of diabetes continued on page 122

What age-related macular degeneration (AMD) looks like AMD is the leading cause of vision loss in the aging population and the leading cause of blindness among Caucasians. According to the National Eye Institute, AMD affects more than 14 percent of white Americans age 80 and older.

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While cataracts are rarely dangerous, after a number of years they will likely affect vision.

By age 65, over

90% of people have a cataract and half of the people between the ages of 75 and 85 have lost some vision due to a cataract.

Source: www.visionproblemsus.org

that damages blood vessels in the retina (the light-sensitive tissue at the back of the eye) • Glaucoma, a group of diseases that can cause fluid and pressure to build up in the eye and damage the optic nerve • Low vision, a visual impairment that interferes with the ability to perform everyday activities and cannot be corrected by regular glasses, contact lenses, medication, or surgery • Dry eye, a condition that occurs when the eye does not produce tears properly or when tears evaporate too quickly.

Pay attention to your eye health to make sure your eyes are healthy and you are seeing your best, and schedule an appointment with a local eye care professional if you’re due for an examination, usually every one to two years.  Sources: American Academy of Ophthalmology, aao.org. Department of Health and Human Services, National Institutes of Health, National Eye Institute, nei.nih.gov.

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ART OF AGING

BY SUSAN NYE

Delivering Professional Care in the

Comfort of Your Home HOME CARE AND VISITING NURSE SERVICES Visiting nurses date back to the 1880s, when free medical services were provided to New York’s poorest residents. By the early 1900s, visiting nurse agencies had spread throughout the Northeast. Providing quality health care in rural areas can be particularly challenging, and visiting nurses provide critical services in the Upper Valley and Sunapee regions.

The area is fortunate to have a number of not-for-profit and for-profit home health care agencies and visiting nurse associations. Each one is a separate and distinct organization.

Patients have the right to choose the group that best suits their needs. Everyone is urged to be proactive and investigate the options before an urgent situation develops.

Founded in 1970, Lake Sunapee Region VNA & Hospice (LSRVNA) is a nonprofit home health care agency with nearly 200 staff and more than 90 volunteers. Each year, this dedicated team drives more than 600,000 miles to cover Grafton, Merrimack, and Sullivan counties. While seniors are their largest patient population, LSRVNA covers all ages from newborns to the elderly.

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AMERICA IS EXPERIENCING A DRAMATIC SHIFT IN DEMOGRAPHICS, AND IN 2019, PEOPLE OLDER THAN 65 YEARS WILL OUTNUMBER THOSE YOUNGER THAN 5.

Source: journals.sagepub.com

Typical Visiting Nurse and Home Care Options Home Health Care is an array of skilled medical services delivered by registered nurses; licensed nursing assistants; physical, occupational, and speech therapists; and staff specialists. These specialties include wound care, medication management, pediatrics, IV therapy, social work, and more.

Personal Private Care offers a menu of nonmedical services that assist with activities of daily living to help keep individuals safe, secure, and independent at home. Services include meal preparation, light housekeeping, laundry, errands, shopping, companionship, and more.

Hospice Care is provided at the end of life, generally when a person’s life expectancy is six months or less. An exceptional team of nurses, aides, therapists, spiritual care providers, social workers, and volunteers helps patients and their families understand and cope with the complex physical and emotional issues faced at the end of life.

Community Wellness is provided through a variety of free and low-cost events, programs, and activities. These include but are not limited to support groups, bereavement programs, health fairs, health clinics, community education, foot care, flu vaccinations, and respite programs. www.uppervalleyimage.com •

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ART OF AGING

VNH is passionate about helping people—it’s the reason we’re here. The relationship we have with each client is rooted in respect—for the families whose homes we are privileged to enter, for the communities we are honored to serve, and for all the lives we touch (and that touch us).

— Jeanne McLaughlin, VNH President & CEO

Jim Culhane, the organization’s president and CEO, sums up their mission: “From doctors and nurses to LNAs and housekeeping, our dedicated staff is committed to helping patients remain in their homes.” To meet this goal, the organization provides services for a variety of needs.

Jim continues, “Our patients could be recovering from an accident or surgery or managing an illness. LSRVNA services help people stay safe at home as they recover or age.”

The organization’s hospice care is well-known and esteemed in the area.

Karen Krumenaker of Claremont has tremendous respect for the caregivers who helped both her father and her family. She says, “Lake Sunapee Region VNA 126 i m a g e h e a l t h w a t c h •

& Hospice was my saving grace when my father was dying.” Like most family members, Karen was overwhelmed with questions. “The nurse was very patient and gave me the strength I would need for the coming days. Words can’t describe how grateful my entire family is for the love, support, and genuine care they showed us. Thanks to LSRVNA, my dad was able to be home for his final days.”

The LSRVNA staff typically goes above and beyond to meet their patients’ and families’ expectations. Karen remembers fondly the plaque and book they gave her father, a World War II and Korean War veteran. She says, “This amazing group of professionals is astonishing. They will always be in my heart.”

2017

“This is all about making it easier for patients to coordinate their care.”

The Visiting Nurse and Hospice for Vermont and New Hampshire (VNH) has its roots in the early days of the home nursing movement. From its founding as a small agency in 1907 in Windsor, VNH has grown through expansion and merger to support 160 towns in Vermont and New Hampshire.

Throughout its long history, VNH staff have made and kept their promise to patients to come home to excellent care. Each year, they provide services to more than 6,000 people. They log thousands of miles making more than 150,000 home visits. VNH health care professionals and staff provide care and services for people of all ages and in all stages of life.

While VNH remains a separate entity with its own finances and corporate structure, the agency became an affiliate of Dartmouth-Hitchcock Health in the summer of 2016. This partnership has been a win–win. VNH’s close relationship with Dartmouth-Hitchcock Medical Center (DHMC) creates a world-class continuum of care and has improved patients’ transitions from hospital to home.

The partnership expands DHMC’s portfolio of services and provides VNH with easy access to additional resources.

Having this extensive range of services can be particularly important for the chronically ill, as well as anyone with limited access to hospital care. Together they share a goal of providing seamless health care for their patients.  Lake Sunapee Region VNA & Hospice 107 Newport Road New London, NH (603) 526-4077 lakesunapeevna.com Visiting Nurse and Hospice for Vermont and New Hampshire 88 Prospect Street White River Junction, VT (888) 300-8853 vnhcare.org www.uppervalleyimage.com •

127

ADVERTISERS INDEX

AboutFace Skin Therapy 73

Good Neighbor Health Clinics 95

Quail Hollow 122

Alice Peck Day Memorial Hospital 33

Guaraldi Agency 105

Amy Tuller Dietician 86

Hanover Eyecare 9

Randy Schaetzke Wholistic Health Services 45

Anesthesia Consultants of the Upper Valley 51

Hanover Terrace Health Center 127

Roger Phillips, DMD 48

Annemarie Schmidt European Face and Body Studio Back cover

Hill Opticians 1

Springfield Medical Centers Inside front cover

JMH Wealth Management 119

Sugar River Bank 90

Appletree Opticians 69

Just Kids Pediatric Dentistry 59

Sugar River Kitchens, Bath & Flooring 107

Baker Orthodontics 5

Keene Medical Products 127

Summer Court Dental 53

Biscuit Hill Pilates 95

Lake Sunapee Region VNA & Hospice 123

Summercrest Senior Living 122

Cioffredi & Associates Physical Therapy 39

Ledyard National Bank 111

The Strong House Spa 74

ClearChoiceMD 14

Lou’s Restaurant 90

Therapy Works 42

Co-op Food Stores 83

Mascoma Dental Associates 51

Toby Kravitz, DDS 55

Counseling Associates 21

Mertens House 104

Upper Valley Food Co-op 86

Dartmouth-Hitchcock Dermatology 79

Mountain Valley Treatment Center 107

Upper Valley Pediatric Dentistry 61

Dartmouth-Hitchcock Medical Center 4

Mt. Ascutney Hospital Inside back cover

Donald Neely, DMD 57

Neal Wallace Dental 2

Visiting Nurses for Vermont & New Hampshire 126

Enhance Health 7

Orange Blossom Wellness 79

Eyeglass Outlet 69

Peraza Dermatology Group 3

Gifford Health Care/Morgan Orchards 109

Powerhouse Hearing Center 71

White River Family Eyecare 9 Wooodcrest Village 121

For more information about print and online advertising opportunities, contact Bob Frisch at (603) 643-1830 or email rcfrisch1@comcast.net.

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