Chester County Medicine is a publication of the Chester County Medical Society (CCMS). The Chester County Medical Society’s mission has evolved to represent and serve all physicians of Chester County and their patients in order to preserve the doctorpatient relationship, maintain safe and quality care, advance the practice of medicine and enhance the role of medicine and health care within the community, Chester County and Pennsylvania.
The opinions expressed in these pages are those of the individual authors and not necessarily those of the Chester County Medical Society. The ad material is for the information and consideration of the reader. It does not necessarily represent an endorsement or recommendation by the Chester County Medical Society.
OFall 2024 PRESIDENT’S MESSAGE
BY DAVID E. BOBMAN, MD PRESIDENT OFCHESTER COUNTY MEDICAL SOCIETY
n September 19, 2024 the annual Physician Recognition Dinner took place at Concord Country Club. Once again, this was an amazing affair enjoyed by everyone. Over 100 members and non-members were in attendance. Our Keynote Speaker was Kevin B Johnson, MD (the David L. Cohen Professor of Pediatrics, Biomedical Informatics, and Science Communication at the University of Pennsylvania), who spoke on the evolving use of artificial intelligence in the medical field. During this lecture, the room was silent as everyone, like myself, was wowed by the advancements which have already been made, and more to come. To name a few, medical chatbots providing follow up medical visits, assistance in diagnosis, and real time medical transcription of office visits. Artificial intelligence will only get better as it learns over time as forecast many years ago:
“Dave, I am capable of learning from my mistakes and improving my performance.” (2001: A Space Odyssey)
As in past years, we were joined in this event by a number of our local politicians with whom we were able to converse prior to and during the dinner. Also in the political arena, as the 2024 elections are upon us, the Chester County Medical Society will be hosting a political forum on October 17th attended by several of the candidates running for State Senate. During this event, we will be posing questions to learn more about their stances on issues related to health care in Pennsylvania. All Chester County physicians are invited and encouraged to attend, but as space is limited, we request people register through our web site. We expect this to be an insightful forum.
Fond Regards, David
What’s on your mind? Help us to learn more about emergent trends affecting your work!
Write to us at: OurCCMS@gmail.com
DVT 101 A COMPREHENSIVE GUIDE TO DEEP VEIN THROMBOSIS
BY DR. ABHI KASINADHUNI
Deep Vein Thrombosis (DVT) is a condition where a blood clot forms in a deep vein, most commonly in the legs. These clots alter the normal blood flow to the affected region, causing pain, swelling, and redness. DVT is a common condition and affects as many as 900,000 people each year in the U.S. alone (1) .
Occasionally, the clot may break off and travel through the bloodstream into the lungs, causing a blockage. This condition is called pulmonary embolism (PE). PE can result in reduced blood flow and oxygen levels in the lungs. Unfortunately, sudden death is the first symptom in about 25% of people who suffer from PE (2) .
As alarming as it may sound, DVT can be treated and managed with the right lifestyle choices and medications. In this article, we’ll explore every aspect of DVT, what causes it, the common risk factors, how to prevent it, the hallmark signs and symptoms, and finally, how to treat and manage it.
The Science Behind DVT: Understanding The Basics
DVT occurs when a blood clot or a gel-like clump of blood forms in a deep vein and causes hindrance in the normal blood
flow to the vessels. Typically, DVT occurs in the legs but it can also develop in the arms or pelvis. Veins are responsible for returning oxygenpoor blood from the body back to the heart, from there it gets transported to your lungs for reoxygenation. When a clot forms in one of these vessels, it can cause a partial or complete blockage of the blood flow. DVT becomes dangerous when the clot is large enough to block the blood flow in a major vein such as the veins in your lower legs or thighs (3) .
If left untreated, the clot may break off, which can then travel to more important sites such as your lungs, causing pulmonary embolism. Understanding how deep vein thrombosis develops can be crucial for recognizing its symptoms and getting medical help at the earliest sign.
DVT Or Something Else: Spotting The Differences
DVT may be confused with other medical conditions that affect the blood vessels, such as superficial vein thrombosis or varicose veins. To an untrained eye, these conditions may look similar, leading to a misdiagnosis. It is important to seek help from your healthcare professional.
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• Superficial Vein Thrombosis. It affects veins closer to the skin’s surface and it is not a lifethreatening condition. Unlike DVT, clots in superficial veins rarely lead to severe complications (4) .
• Varicose veins. These are swollen, twisted veins visible just under the skin (5). Although varicose veins can cause discomfort, they do not typically result in the formation of potentially life-threatening clots like the ones in DVT. Varicose veins typically present as a coiled or twisted mass of veins in the skin of the lower legs as compared to DVT which does not exhibit these symptoms.
• Peripheral Artery Disease (PAD). It is characterized by the narrowing of arteries and reduced blood flow. PAD causes pain due to reduced blood flow whereas DVT causes pain due to the presence of a blood clot in a vein(6).
Are You At Risk Of Developing DVT?
Deep vein thrombosis is a multifaceted condition with several risk factors that contribute to its development. Understanding and identifying these risk factors is absolutely crucial in preventing and managing the symptoms before they get out of hand. Let’s take a look at some of the common risk factors of DVT.
• Age is a major factor. Individuals over 60 are at a higher risk of developing clots and DVT.
• Prolonged immobility, such as sitting during long flights or car rides, can also slow down the blood flow, eventually increasing the risk of clots.
• Obesity puts extra pressure on veins, compressing them which can lead to stasis of blood.
• Smoking affects your blood
circulation and its ability to clot. The nicotine causes the platelets to clump together which increases the risk of clot formation.
• Medications, such as hormone replacement therapy (HRT) and birth control pills, can increase the likelihood of blood clots.
• Orthopedic surgery on the hips or legs is another high-risk situation, as patients are often immobile for extended periods.
Does DVT Run In Families?
Yes, both acquired and genetic factors can increase your risk of DVT. For instance, mutations in Factor V Leiden increase the risk of abnormal blood clotting. Similarly, mutations in the prothrombin gene can lead to higher levels of a protein that helps in clot formation (7)
Simply put, if there’s a history of DVT or PE in your family, you might be at an increased risk of getting DVT. However, it is important to remember that these mutations do not directly cause DVT, but only increase the risk. Especially, when combined with other factors like prolonged immobility or surgery.
DVT And Lifestyle: Choices That Matter
Like other chronic health conditions, the risk of DVT depends on your diet, exercise, and other lifestyle choices. Let’s break them down:
• Smoking increases the tendency of blood to clot. It damages the lining of blood vessels, altering the balance of clotting factors.
• A sedentary lifestyle, with little physical activity, leads to slower blood circulation which makes clot formation easier. On the other hand, regular physical activity helps maintain healthy blood flow, thus reducing the risk of clotting.
• Poor Diet, high in unhealthy fats and low in fiber, can also contribute
to obesity – a common risk factor for DVT. On the other hand, staying hydrated and maintaining a balanced diet rich in fruits, vegetables, and lean proteins can promote healthy circulation.
Silent And Serious –The Signs And Symptoms Of DVT
DVT is often asymptomatic and doesn’t show any noticeable signs or symptoms. However, when it does, here’s what they look like:
• Swelling, usually in one leg, is one of the hallmark symptoms of DVT. It can range from mild to severe, depending on the size and location of the clot.
• Pain or tenderness in the affected leg, especially when standing or walking. This pain might feel like a cramp or soreness which is why it can easily be confused with muscle strain.
• Redness or a warm sensation in the affected area. However, it is important to rule out the other causes of redness and warmth (3)
I Have DVT Symptoms But Not The DVT
DVT symptoms can easily be confused with other, less serious conditions. For example, muscle strains also cause pain and swelling, but they usually resolve with rest and do not cause redness or warmth. DVT, on the other hand, causes a constant ache whereas muscle injuries often worsen with their movements.
Infections such as cellulitis can also mimic DVT by causing redness and tenderness. Unlike DVT, they are accompanied by fever and other systemic signs of disease.
How is The Diagnosis Made?
The diagnosis of DVT is based on your medical history, your family history,
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physical exam, and the results of imaging tests.
Medical History and Physical Examination
Your medical history and a thorough physical examination is the first step in diagnosing DVT. Your doctor might ask you about the signs and symptoms of DVT, any recent travel history, surgery, or immobility for an extended period of time.
For the physical examination, your doctor may check for warmth, tenderness, and differences in leg circumference. If a clot is suspected based on these findings, they may order further tests to confirm the diagnosis. This will also help your doctor rule out other health conditions.
Imaging Tests
If your doctor suspects DVT, they may typically refer you for imaging tests to confirm their diagnosis. The most common
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test is a Doppler ultrasound, which uses sound waves to create images of the veins and check for clots (8). It is a noninvasive, and painless procedure that is highly specific for diagnosing blood clots.
If the ultrasound is not effective or if the clot is suspected in a difficult-to-see location, other imaging tests, like a CT scan or MRI, are recommended. These more advanced tests provide a clearer and more detailed view of the blood vessels.
D-Dimer Blood Test
A D-Dimer test is performed when DVT is suspected. This blood test measures the levels of a substance that’s released when a blood clot breaks down. Elevated D-Dimer levels suggest that there may be a clot in the body. However, this test is not specific to DVT. Levels of D-Dimer may be raised in other conditions, such as infections or inflammation.
Potential Complications Of DVT
DVT itself is not life-threatening; it’s the aftermath that follows. For instance, when the clot breaks off and gets lodged in the lungs, it can lead to sudden death if not managed promptly. Besides chronic pain and swelling, here are some of the more serious complications of DVT:
Pulmonary Embolism (PE)
Pulmonary embolism is a common and potentially fatal complication of DVT. Symptoms of PE include sudden shortness of breath, sharp chest pain, rapid heart rate, and coughing.
If you experience one or more of the above-mentioned symptoms, it’s advised that you seek immediate medical attention. Without a prompt medical intervention, PE can lead to heart failure and eventually death (9)
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Post-Thrombotic Syndrome (PTS)
Sometimes people can develop long-term complications such as postthrombotic syndrome (PTS) even after the resolution of the blood clot.
PTS develops due to the damage to the veins by the clot. Blood starts to pool at the blocked part of the vessel, increasing the pressure and permanently damaging the vein.
Symptoms of PTS can include chronic pain, fatigue, pulling, swelling, and changes in skin color or texture in the affected leg (10). In severe cases, it can lead to leg ulcers that are quite difficult to heal. Furthermore, PTS makes it difficult to walk or stand for long durations, which seriously affects a patient’s quality of life.
Treatment for PTS includes wearing compression stockings, keeping the affected leg elevated, and engaging in physical therapy to improve blood circulation.
Treatment Of DVT –An Overview Of Options
The treatment strategies for DVT are focused on managing the symptoms and complications as well as keeping the clot from growing any further.
1. Blood Thinners or Anticoagulants
Blood thinning medications or anticoagulants are the first choice of treatment for DVT. They are crucial in preventing the existing clot from growing and reducing the risk of new clot formation. They do not dissolve the existing clot but they provide the body with enough time to naturally break it down.
Warfarin is a widely used prescription anticoagulant. However, newer alternatives like apixaban (11), rivaroxaban, and dabigatran are becoming more common because of their safety and less need for monitoring.
2. Thrombolytics: Clot-Busting Drugs
When the clot is large or it is at risk of causing a pulmonary embolism, thrombolytics are the go-to option (12) The term thrombolytic literally translates to clot-breaking. They work by dissolving the clot directly. Thrombolytic drugs are typically administered through a catheter placed directly into the clot or through an intravenous (IV) line. However, due to their high risk of causing severe bleeding, thrombolytics are usually reserved for lifethreatening situations only.
Stay One Step Ahead –Tips To Prevent DVT
As clichéd as it may sound, prevention is always better than cure. DVT may be a serious concern when it comes to the complications but it’s preventable. You can take one step at a time to minimize the effect of acquired and environmental risk factors such as obesity, sedentary lifestyle, and smoking.
Lifestyle Changes
Small, consistent lifestyle changes can reduce the risk of DVT more than you can imagine. Here’s what you can do:
1. Maintain a healthy weight
2. Quit or cut down on the number of cigarettes you smoke per day
4. Maintain a healthy diet that is rich in antioxidants and omega-3 fatty acids
5. Keep yourself hydrated Stay On The Move
Physical activity is essential for preventing DVT, especially for individuals who are at risk due to prolonged periods of inactivity. This includes those who sit for long periods at work or during travel.
Being physically active does not mean that you must perform strenuous exercises; even the simplest exercises would do. Simple activities like walking, stretching, or even moving your legs and feet while sitting can help maintain circulation.
Assessing Risk In High-risk Situations
Certain conditions can increase the risk of DVT. For example, both orthopedic surgeries and long-distance travel can increase the chances of clot formation.
Orthopedic procedures such as hip or knee replacement are some of the riskiest surgeries in terms of DVT formation. In these high-risk scenarios, doctors often recommend preventive measures to lower the chances of DVT.
These can include the use of anticoagulants, compression stockings, and regular movement. Before surgery, patients undergo a risk assessment to determine the need for preventative treatments. Deep Vein Thrombosis
It is important to know that patients on blood thinners require continuous monitoring to adjust dosages and prevent potential side effects, such as excessive bleeding.
3. Participate in regular physical activity such as walking, cycling, or swimming
DVT Risks In Special Populations
Pregnant Women
Pregnancy significantly increases women’s risk of developing DVT. Hormonal changes during pregnancy cause the blood to clot more easily. To top it off, the growing uterus can compress veins in the pelvis and legs, which in turn slows down the blood flow.
Women with a family history of DVT or other clotting disorders are at an even higher risk. Doctors often recommend compression stockings and frequent movement to reduce this risk. Women who are at higher risk of developing DVT are kept on low-dose anticoagulants during pregnancy and the postpartum period.
Cancer Patients
Cancer patients, especially the ones who are receiving chemotherapy sessions, are at risk of DVT. Chemotherapy and some types of cancer themselves increase the tendency of blood to clot. Furthermore, cancer treatments can sometimes cause immobility which is another risk factor for a blood clot.
Post Surgery Patients
Knee surgery or hip replacement can be a major risk factor for DVT. Major surgeries are followed by a downtime and the patient is often immobilized during this period which can cause stasis of blood and eventually DVT.
For this reason, many post-operative patients are administered blood thinners to prevent clot formation. Furthermore, compression stockings or devices that intermittently inflate and deflate are often used to maintain blood flow in the legs.
DVT And Travel: Managing DVT On The Go
Prolonged traveling, especially by air, significantly increases the risk of DVT. The limited movement inside a plane combined with changes in the cabin pressure make it ideal for your blood to pool in the lower
limbs and form clots. This risk is even more heightened for people who have other DVT risk factors, such as obesity, smoking, or a history of clots.
This is one of the reasons why it is encouraged for you to walk during long flights to maintain your blood circulation and prevent stasis.
Tips for Safe Travel
Here are some tips to travel safely if you’re planning a trip that requires you to sit down for a prolonged period:
• Hydration is the key – stay hydrated at all times.
• Avoid alcohol and caffeine since they can lead to dehydration.
• Move around regularly when on the plane. Five minutes of walking is recommended for every hour of immobilization.
• When traveling by car, make regular stops to walk around a bit.
Once someone has been diagnosed with DVT, the treatment must be continued even at home. Keeping the affected leg elevated can help reduce swelling, as it promotes blood flow away from the lower body.
Next, it is extremely important to follow medical advice regarding the use of medications. There is no one-size-fits-all approach. Some individuals may be advised to limit their physical activity for a time, whereas others may need to stay active to prevent further complications.
For pain management, over-the-counter painkillers are the best option. However, it is always best to discuss it with your doctor first.
Compression Stockings Or Socks
Compression stockings are an essential part of DVT management, especially for individuals who are at risk for postthrombotic syndrome (PTS). These special elastic stockings apply pressure to the legs. The increased pressure helps to improve the blood flow and reduces swelling in the affected limb.
Compression stockings are recommended for long-term use, especially in those individuals who have had DVT previously or are at high risk of recurrence.
Regular Follow-ups and Monitoring
DVT is not a condition that can be managed with a one-time treatment. It requires ongoing monitoring and followup care. You should make regular visits to your healthcare professional to ensure that the clot is resolving as expected. These checkups may involve imaging tests, such as ultrasounds, to evaluate the clot.
In some cases, long-term use of blood thinners may be necessary to prevent recurrence.
Final Thoughts On DVT
DVT is a serious yet preventable condition, and awareness is the first step toward prevention. It is key to understand the symptoms, risk factors, and knowing when to seek medical attention.
DVT may have severe complications, such as pulmonary embolism, however, prompt management and treatment can reduce these risks. There are many ways to lower your risk of DVT whether it’s making lifestyle changes, staying active during long periods of inactivity, or taking preventive measures during high-risk situations like surgery.
By staying informed with up-to-date information, you can protect yourself and your loved ones from DVT and its lifethreatening complications.
Michael Battista
BY BRUCE A. COLLEY, DO
Some years ago, we featured a local student artist from Downingtown West High School. So, when I received an invitation to Downingtown East High School’s yearly student craft art show, I was excited to attend with the idea of perhaps finding another local young student artist to feature in our journal. The show was held at East High School’s auditorium. I was admiring one exhibit after the other. There were graphics, ceramics, photography, and stunning examples of furniture made in the wood shop by aspiring cabinet makers. In one area of the gym was a row of displays in which individual student artists featured a variety of their personal art forms. One display caught the attention of my wife and me, and we both remarked that we should feature this student in the journal. Then, wondering how to contact this student artist, we were about to wander off to find the principal. But just then a tall, very excited young man standing behind us said to a friend “Oh it’s a blue ribbon!” and so the judge’s opinion reflected our thoughts as it declared, “Best of Show.” And as luck would have it, we met Mike Battista, a senior at Downingtown East High School. Soon after the show I was lucky to meet up with Mike at his home to learn more about his art journey.
Mike described his inclination to doodle, and at age 12 was sketching pictures. At age 14 he became fascinated with movie props and special effects. He remembers going to the movies and watching TV, of course to enjoy the show, but found himself analyzing and criticizing the costumes, makeup and gadgets used on the set. Mike would then try to reproduce them at home. When he got to high school, he took advantage of the wide variety of art and shop classes offered at Downingtown West High School. I must give a personal shout out to the district’s commitment to the fine and manual arts.
Mike, as you will see, has a varied array of art forms. Sketching, painting with watercolor and acrylics, woodblock prints, models, digital art and photography. During the hour I spent with him I learned, to my surprise, that he will attend West Chester University in September, not as an art major, but as a physics major. “I like math and to learn how things work.” he explained. Our conversations drifted to various academic topics and at one point Mike was discussing the controversies related to quantum mechanics and The Big Bang. I gave my best erudite head nods, hoping to convince him that I understood. I suspect he knew I did not and being a gracious young man, he returned to the topic at hand. Please take a few minutes to enjoy Mike’s wide range of fine art and craft art.
Tribute to Andy Warhol
Quantum Mario pen & ink
Artist Statement for Michael Battista
As an artist, my passion for art knows no bounds. Creating and appreciating art are integral parts of my life, fueling my creativity and bringing me immense joy. Working with wood and clay is a deeply fulfilling experience for me, as these materials allow me to bring my artistic visions to life in tangible forms. The earthy warmth of wood and the malleability of clay inspire me to explore the boundless possibilities of artistic expression. Through my art, I aim to evoke emotions, provoke thoughts, and connect with others on a profound level. Each piece I create is a labor of love, infused with my dedication to craftsmanship and my unwavering love for the artistic process. Art is not just what I do; it is who I am, and I am endlessly grateful for the ability to create and share my passion with the world.
Charcol Anatomy
Set Design Medley
Musings of the Fiendish Orthopaedic
The Die... Exercise in pot metal casting from concept to pour
Integrating an Ancestral Medical Past with Modern Medicine
How does the term Wellness allow us to understand our well-being? How does it move us to define and select lifestyle choices that sustain our health? In this article, we examine the pillars that define wellness and influence our optimal health. We hope that this exploration enhances your thinking about new opportunities for selfcare and allows you to explore those areas with your patients, as well.
The concept of wellness can be found throughout our rich cultural history. Health systems specific to our historical timeline, aimed to balance the mind, body, health, and the spirit, form a holistic vantage point. Ayurveda Indian medicine, Chinese traditional medicine, and that of the ancient Greeks and Romans, not only focused on addressing disease but focused on prevention. Integrated into their thinking was attention to lifestyles that included the areas of nutrition, physical activity, sleep, moderate behavior, ethical behavior, development of positive thoughts, and mindfulness practices like meditation, Tia Chi, and yoga.
If we traveled back to Aristotle’s time, 383BC, implications in writings about wellness were prevalent and defined by words like eudaimonia, which related to happiness, well-being, and a flourishing temperament.
The 21st century offers us the ability to integrate these wellness pillars alongside the great advances in medicine and research. But with these advances, what place is there for the concept of wellness from our ancestral, founding fathers of modern medicine?
The Global Wellness Institute (GWI) defines wellness as, “The active pursuit of activities, choices, and lifestyles that lead to a state of holistic health.” They go on to suggest that this definition is not a “passive or static state.” They suggest that wellness is quite the opposite, an active state with choices and intentions that lead to premeditated actions that drive desired states of health and well-being. They also suggest that wellness is linked to holistic health which integrates a continuum of practices, working in “harmony” with medicine.
Dr. Peter Attia, MD, an oncological surgeon, and founder of Early Medicine (earlymedicine.com), explores in his book, OUTLIVE; The Science and Art of Longevity, the critical need to redefine wellness. He invites us to relook at a new model that incorporates healthy lifestyles, as not only part of a wellness model but as a preventative tenant and deterrent to illness. He asks that we integrate active lifestyles choices and intentions as suggested by the GWI, and explores how new perspectives can address the paradigm shift in what contributes to longevity, healthy aging, and our overall health and well-being.
Throughout all 411pages of his book Dr. Attia emphasizes that exercise and movement are by far, “the most potent longevity drug, which preserves our cognitive and physical function.” He goes on to share that we don’t exercise enough and warns the reader that, “exercising the wrong way can do as much damage as good.” He also significantly addresses the area of emotional well-being by sharing, “…. that I have learned the hard way, striving for physical health and longevity is meaningless if we ignore our emotional health.”
Physician Wellness and Your Journey
Finally, the letter you’ve been waiting for arrives: acceptance into medical school. All your hard work, countless hours of studying, sleepless nights, and sacrifices of time with friends and family have culminated in this moment. Your relentless determination to achieve this singular goal has paid off. Now, the real journey begins. Medical school introduces an entirely new set of challenges: years of study, residencies, sleepless nights, and financial commitments.
Everyone’s motivation for entering the healthcare profession is unique, with one similar nucleus, the desire to make a difference and help orchestrate people towards better health. Whatever your reason, it fueled you through tough times and led you to this point in your career or retirement.
Why Physicians are Highly Susceptible to Stress
Physicians are integral to our communities, serving as the frontline defense against illness and injury. That is a huge undertaking and responsibility. However, their roles can come with significant stress to their physical and emotional well-being.
Stress Factors
• The healthcare system presents numerous challenges from reimbursement to administrative challenges.
• Many physicians start their careers with mountains of debt from medical school, adding pressure to earn and repay loans.
• Physicians often face the frustration of being unable to help patients to the fullest extent due to restrictions imposed by insurance companies, hurdles that limit their ability to provide optimal care, further contributing to their stress.
• Large patient caseloads.
• Bearing witness to patient struggles and constant exposure to suffering and death can take a heavy toll on a physician’s mental health. Compassion fatigue, a condition characterized by emotional and physical exhaustion, is a common issue among healthcare providers.
And let’s not forget about the 2020 global pandemic that added an unprecedented environmental stressor, exacerbating the strain on physicians through increased workloads, the ongoing threat of reinfection, the emotional burden of treating critically ill patients, and insufficient staffing and resources.
Movement and Its Value to Health &Well-Being as a Stress Reducer
“Our nature lies in movement,” as Blaise Pascal writes.
In addressing stress, one powerful yet often overlooked tool is movement, as substantiated by the cultural history of medicine. Current research shows that movement changes both the physicality of the body and its internal chemistry, along with recalibrating our emotional wellbeing.
Physical activity plays a crucial role in maintaining and improving health. Engaging in regular movement not only enhances physical well-being but also serves as a vital stress reducer. Regular exercise improves cardiovascular health, boosts immune function, and helps manage weight. Additionally, physical activity stimulates the production of endorphins, the body’s natural mood lifters, which can reduce the perception of pain and improve mental health.
In the context of stress reduction, movement is particularly beneficial. It helps regulate the body’s stress hormones, such as cortisol, and promotes relaxation. Exercise also provides a healthy outlet for frustration and anxiety, offering a mental break from daily pressures. For physicians, incorporating regular physical activity into their routines can be an effective strategy to mitigate the high levels of stress they face.
Practical Strategies for Incorporating Movement into a Busy Schedule
For physicians, finding time for regular physical activity can be challenging due to their demanding schedules. However, there are practical strategies to incorporate movement into daily routines:
• Short, Intense Workouts: Highintensity interval training (HIIT) workouts can be completed in a short amount of time and offer significant health benefits.
• Active Breaks: Taking short breaks during the day to stretch, walk, or do light exercises can help reduce stress and improve focus.
• Integrating Movement into Daily Activities: Walking or biking to work, taking the stairs instead of the elevator,
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and doing household chores can add to your daily physical activity.
• Group Activities: Joining a sports team or exercise class can provide social support and make physical activity more enjoyable.
• Mind-Body Practices: Yoga, tai chi, and meditation can help reduce stress and improve overall well-being.
Overcoming Burnout: A Holistic Approach
What is burnout?
Burnout typically happens when we experience too much emotional, physical, and or mental fatigue for too long. How can it be overcome?
With the process of integrating wellness options and selecting areas that help the body to reboot, lifestyle habits in the areas of movement, sleep, and other selfcare choices are a good starting point.
Helping You Figure Out What Works For You.
Addressing burnout requires a holistic approach that encompasses physical, emotional, and mental well-being. In addition to regular physical activity, physicians can benefit from the following strategies:
• Mindfulness and Meditation: Practicing mindfulness and meditation can help reduce stress, improve focus, and enhance emotional resilience.
• Adequate Sleep: Prioritizing sleep is crucial for physical and mental health. Establishing a regular sleep schedule and creating a restful sleep environment can improve sleep quality.
• Healthy Diet: Eating a balanced diet rich in fruits, vegetables, lean proteins, and whole grains can support overall health and energy levels.
• Professional Support: Seeking support from colleagues, mentors, or mental health professionals can provide valuable insights and coping strategies.
• Work-Life Balance: Setting
boundaries between work and personal life, taking regular breaks, and making time for hobbies and interests can help prevent burnout.
As the healthcare community navigates the ongoing challenges of a strained system and the lasting impacts of the pandemic, prioritizing movement and physical activity can be a crucial step toward sustaining the well-being of physicians and their clients.
By recognizing and addressing the significant stressors they endure, we can support their health and, in turn, ensure they continue to provide the best care for their patients.
Conclusion: The Path to Overcoming Burnout
Overcoming burnout is a journey that requires self-awareness, commitment, and a willingness to make changes. Gifting ourselves the daily ‘pause’ to think about our wellness needs is a crucial first step. By incorporating regular physical activity, adopting healthy lifestyle habits, and seeking support when needed, physicians can redefine their sense of purpose and well-being.
Remember, taking care of yourself is not a luxury but a necessity. By prioritizing your health and well-being, you will feel better as you can continue to make a positive impact on your patients and the community. Together, we can create a supportive environment that acknowledges the challenges physicians face and provides the resources needed to thrive in their career.
Future Thoughts on Movement as Medicine
In concluding, we asked Dr. Jason Elvin, DPT, VP of Clinical Services with Kinetic Movement Reimagined, to summarize his thoughts about burnout and wellness as related to movement. Dr. Elvin, where do you see movement medicine headed?
Up until recently movement medicine, otherwise known as Physical Therapy or Physiotherapy, was allocated for those
with orthopedic injuries or movement trauma. Research and its conclusive findings have revealed the significant benefits of a “movement prescription” that addresses our daily lifestyles and movement routines. As experts in the field, we are now overseeing and developing programs for the community, businesses, alumni clients, and individualized client groups. Our expanded focus addresses movement lifestyles, and programs that address agility, flexibility, and strength, and also allow us to ‘be moved’ by workshops that increase our emotional wellbeing such as our new series, The Nature of Movement.
What message would you like to share with our physician community, addressing situational stress or burnout?
With the various stress factors spoken about earlier in this article, I wish to share with physicians the following ‘ask,’ that they gift themselves at least three times a week a renewed commitment, focusing on their movement health. “No one will take care of your body other than you,” Dr. Elvin states, and it is up to each of us to manage one of the most important aspects of our health, that of movement. “Research has shown that the biggest indicator of future health is your body’s ability to move.”
Dr. Elvin recalls one of his favorite quotes from a professor at Temple: “If all of the benefits of exercise could be put in one pill it would be the most prescribed medication in the world.”
We welcome your questions and comments as we pave the way to expand thinking about movement health, with the ultimate goal of integrating medicine and wellness concepts that bring value to mindbody health.
Contributors:
Leadership Team @ Kinetic Movement Reimagined (includes Kinetic PT)
Dr. Jason Elvin, DPT VP of Clinical Services (c)908-319-6636
Dr. Jared Bonacquisti, DPT
Clinical Director, Chester Springs and Eagleview
Sheri Gardner, MS Director of Integrative Alliance
SageLife Uses Cutting Edge Tool to Help Team Members, Loved Ones Understand Dementia
The Virtual Dementia Tour gives participants the experience of living with dementia to build empathy
Repetition. Pacing. Hoarding. Wandering. Agitation. Rummaging. Withdrawal. Freezing up. Confusion. Frustration. These are just a few of the confusing behaviors that people with dementia may exhibit, causing anxiety and impatience in their loved ones.
“Everything that a person with dementia does has a reason,” explains Nicole Armstrong, BSW, CDP, a Wellness Navigator/Social Worker at SageLife. “It may not make sense from the outside, but from the point of view of the person pacing or hoarding or wandering, it’s completely logical.”
SageLife, which owns several senior living communities in Pennsylvania, including Plush Mills in Wallingford, Daylesford Crossing in Paoli, Echo Lake in Malvern, and The 501 at Mattison Estate in Ambler, is helping families better understand what their loved ones are going through by offering Second Wind Dreams’ Virtual Dementia Tour.
“The program utilizes tools to alter your senses as a facilitator guides you through normal everyday tasks in a homelike setting,” says Armstrong. “It’s scientifically proven to be the closest simulation of what it’s like to have mid- to late-stage dementia. We don’t want to ruin this powerful experience by explaining too much about it beforehand, but what I can say is that after experiencing the eight-minute tour, participants have a much deeper understanding of the immense challenges that people with dementia face as they navigate the world. It’s much more than a condition affecting memory. Dementia alters all of your senses and changes how you perceive everything.”
Gerontologist and Clinical Psychologist P.K. Beville, Ph.D., created and perfected the tour as a way to build empathy, sensitivity, and awareness in individuals caring for people with dementia. More than 3 million people in 20 countries have taken the tour.
“As you take the tour, you are observed, and when you’re done, the facilitator will debrief you and tell you what they saw,” says Armstrong. “It’s very common for participants to realize that they were displaying some of the same seemingly nonsensical behaviors that they had seen in people with dementia. Normally decisive people freeze up. They may ask the same question over and over, or rummage repeatedly in a box looking for something that isn’t there. Kind and friendly people may become very angry. It’s very eye-opening and really helps participants gain patience and empathy. It also helps them let go of the idea that they have to control or modify or stop behaviors that are harmless. It’s OK if a person with dementia repeats themselves. It’s OK if they pace.”
Virtual Dementia Tour training at SageLife
SageLife’s Connections memory care embraces the Positive Approach® to Care, a philosophy pioneered by the globally respected dementia care expert, Teepa Snow. This innovative program focuses on accentuating the retained skills of each resident, coupled with personalized support to enhance their overall well-being.
SageLife is now making the Virtual Dementia Tour a mandatory experience for all new team members, from nurses and aides, to concierges, housekeepers, drivers, and food and beverage staff.
“It’s a very powerful tool for building empathy and deepening understanding,” says SageLife Regional Director of Health & Wellness Beth Anne Maas, BSN, MHA. “As a nurse with over 40 years of experience working with people with dementia and hundreds of hours of specialty training, I didn’t think it was necessary for me to experience it personally. But I’m so glad I did. Even though I knew what was coming, it still taught me things. At one point, I was startled by a loud noise, and I had the epiphany that I had inadvertently been that loud noise in the past. I am a very friendly, peppy person, and it helped me realize that my enthusiasm could actually be startling to someone with dementia. By experiencing the changes in sensory perception firsthand, it reinforced the importance of maintaining a calm environment and approaching people from the front where they can see me before they hear me.”
Eventually, every SageLife team member will experience the Virtual Dementia Tour as part of ongoing training. “Our residents don’t just interact with nurses and aides,” explains Maas. “It’s important that every single associate they meet is coming from a place of empathy for the challenges they are currently experiencing. We understand that each of our residents is a unique person with their own histories and preferences, and that they are absolutely deserving of respect, patience, and dignity at all times. The Virtual Dementia Tour is really helping take our positive approach to memory care to the next level.”
For more information, contact Heather Kato at hkato@sagelife.com.
To contact SageLife about a Virtual Dementia Tour, visit https://www.sagelife.com/contact-us/.
To learn more about memory care at SageLife, visit https://www.sagelife.com/living-options/memory-care/.
Medical Waste
Regulated healthcare waste services are becoming a pain point for independently owned facilities as well as larger health systems in our area. From sustainability goals, incinerator capacity issues, increased fees, industry consolidation and scheduling challenges, the regulated waste industry is changing rapidly. Whether your facility is dealing with any of these challenges or other obstacles, it is crucial to understand industry basics and know that you have options for your company.
A contracted vendor may provide disposable or reusable containers for your various waste streams. Once full, the containers are picked up on a scheduled or as needed basis (yes, you are allowed to utilize On Call/As Needed services). The waste is tracked via shipping papers (sometimes referred to as manifests) from the point of generation to the treatment site. The two primary treatment methods to render infectious waste non-infectious are incineration and autoclaving. An autoclave utilizes steam and pressure to rid the waste of pathogens. Certain waste streams must be incinerated while most infectious waste can be autoclaved. Pennsylvania has regulations that require you to segregate your waste streams at the point of generation to ensure they are treated properly. This means labeling containers appropriately with Pathological,
Chemotherapy or Non-Hazardous Pharmaceutical so these materials can be treated at an incinerator. After the treatment process is completed, the remaining treated material is considered a non-infectious special waste and will end up at a permitted final disposal site. The ash from a medical waste incinerator can be sent to a landfill or recycled, and the treated waste from an autoclave will be sent to a solid waste landfill or a waste to energy incinerator. The healthcare facility will receive copies of their fully signed shipping papers/manifests from the processing facility once the waste has been treated.
Sustainability is crucial for our environment and personal health. Our clients prefer to eliminate the amount of waste and plastics entering our local landfills. Unfortunately, the healthcare industry requires the use of a lot of single use disposable items. Everything from PPE, syringes and medical supplies are used once to prevent the spread of disease among patients and staff. Even with these unique challenges, there are still options to improve your waste footprint. For large quantity generators, the best option is to implement a reusable container program. You can eliminate purchasing large single use disposal sharps containers and utilize reusable containers provided by your medical waste vendor. This should also reduce your costs by eliminating the
need to purchase new containers. For smaller offices, it can be even more of a challenge. Without the volume, the cost of a reusable container program may not make sense. If you must use disposable sharps containers, try to ensure you are utilizing the right size container to reduce the need to purchase an excess of small containers. If you have the space, maybe opt for an 18-gallon disposable sharps container rather than 2- or 3-gallon containers. This allows you to be efficient with your vendor pickups while reducing the number of single use containers you need to buy.
There are also sustainability opportunities when disposing of your medical waste. There is currently a large push for waste to energy incineration rather than landfilling treated medical waste. However, this comes at an additional cost. There is only one medical waste incinerator in the Northeast region and with low supply and high demand, the price point for incineration is higher than autoclaving (steam treating) medical waste. There are ways to perform both. Currently, our company autoclaves the waste we transport and then sends that treated waste to a solid waste incinerator at a much more cost-efficient price than going directly to a medical waste incinerator. This has become a major benefit to a lot of our clients who are conscious about becoming a zero-landfill
facility. Sustainable disposal options are more expensive but still a valuable option for all size healthcare facilities.
A more prominent challenge for our local healthcare facilities is finding support for questions about unique waste streams, adding additional services, invoice corrections, etc. Our regulated waste industry is in the process of going through major market changes. From hazardous material incinerator backlogs to massive company acquisitions, it can be a challenge for our clients to understand the most important thing to remember in our market – they have options! The feedback we consistently hear from clients at association meetings, networking events and fundraisers is “We never knew there were other options for our medical waste services.” As a familyowned and local company, I am proud to say that there are many options for your medical waste disposal services that include companies just like ours. The challenge is picking the right company that fits your needs. We may not be the perfect fit for your team, but you never
know until you meet with multiple vendors.
John Khalifa, Stacey Yantis (CRNP), Dr. Stephen Belfiglio, Dr. Valerie McAuley, Dr. Michael McGuire, Elizabeth Facciolo (CRNP), Sarah Smith (CRNP), Dr. Lauren Kummer, Dr. Susan Leath, Dr. David Lewis, Carrie Karhnak-Glasby (CRNP), Suzannah Maynard (CRNP), Dr. Mariele Briones, Dr. Christopher Bruno, Dr. Neema Chokshi, Dr. Matthew Kane, Dr. Arti Patel, Debbie Preble (CRNP), Dr. Douglas Atlas, Dr. Qurratulain Baig, Dr. Katherine Chin, Dr. Mica Kane, Dr. Heather Lockner, Dr. Jean Stretton, Dr. Jane Sunoo, Dr. Susan Kohli, Dr. Monika Kumanova, Dr. Marianne Nikas, Dr. Drew Rowan, Dr. Gene Uhler, Dr. Alpa Vadher, Erin Lender, (CRNP), Denise Meli (CRNP), Dr. Brian Boucher, Dr. Charles Catania, Dr. John Hornick, Dr. Sissy John, Dr. Sony John, Dr. George Limpert, Dr. Karen Squire, Dr. Madeline Wood, Andrea Leffet (CRNP), Anita Snyder (CRNP), Sue Villarini (CRNP), Dr. Vitasta Bamezai, Dr. Harmony Bonnes, Dr. Francis Brennan, Dr. Victoria Brosius, Dr. Eric DiCicco, Dr. Laurie Gallagher, Dr. Neeraja Peri, Dr. Jessica Schleusner, Dr. Rannette Schurtz, Dr. Eric Yeh, Laurie Taylor (CRNP)
You also need to feel comfortable with your vendor’s business. The easiest way to ensure you are hiring a legitimate company is to ask for a Certificate of Insurance, copies of their state permits, copy of treatment site permits and 3-5 client references. Any pushback from your vendor for these simple items could be an immediate red flag. These are normal requests from government agencies, large institutions and even small healthcare practices that want to ensure their vendor is engaging in proper business operations. Second, you need to understand how the company handles emergency requests, services, changes to pickups, or anything else that could arise in your next 5-10 years of business. This could be as simple as an additional pickup during flu season, adding additional locations because you acquired practices or adding more frequent services due to growth. You want to know your vendor is close enough to respond quickly and flexible
enough to adjust your services when you need them the most. Calling client references is a great way to find out how they handle all sorts of situations as well as understanding their response time. Finally, you want to ensure the contract they want you to sign is fair for all parties. Contracts with early termination fees, long terms (3-5 years) and automatic renewals with price increases each year are not beneficial to your longterm success. You always have the option to negotiate any contract terms you wish. If the vendor wants your business, they will adapt to your needs. If they feel you are not worth accommodating, then you will know right away.
As a local vendor in our community, I want to see our healthcare facilities grow and succeed. Our goal is to provide you with high quality, customer-oriented medical waste solutions that are safe, efficient and responsive. If you pick the right partner, it will be easier than you ever imagined!
L to R:
Dr. Maria DeMario, Dr. I. Dennis Holgado, Dr. Nicholas Kalman, Dr.
