Better Health - July 2019

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Better Health D

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DEMENTIA: tips for newly diagnosed , D2 HEALTHY WEIGHT: starting with school lunch, D3 BACK-TO-SCHOOL: ice breakers for nervous students, D4

| SUNDAY, JULY 21, 2019

“A child cannot learn until they are emotionally safe and feel that they are in a place that they are seen and known.”

- Dr. John O’Reilly is chief of the division of general pediatrics at Baystate Medical Center

Back-to-School

physicals mean more than vaccine shots at this clinic

By Anne-Gerard Flynn

Special to The Republican

Dr. John O’Reilly is chief of the division of general pediatrics at Baystate Medical Center, and Dr. Shauna Ejtehadi, a pediatrician and resident in that division.

They enjoy their aspect of family medicine for the involvement it brings in the lives of the young and helping them and their parents address issues this time of year like vaping, marijuana use and even what resources are available when the lack of the National School Lunch Program in summer results in food insecurity.

Ejtehadi likes her specialty for the “continuity I get with my patients.”

“When I am in the nursery I get to see them right after they are born, I get to see all the family in the room and when the siblings see the child for the first time and the funny things that they say and then to see them at the newborn visit, at the two-week visit, at the four-week visit and so forth,” said Ejtehadi who sees patients with O’Reilly at Baystate’s High Street Health Center.

“We get to see them and really build a connection with them and watch them grow. I can come into the exam room and say, ‘Who is this kid? You have grown so much since last time. It is so incredible to see that and be a part of their lives.”

Summer is an especially rewarding time for O’Reilly at High Street where back-to-school physicals number in the thousands and every year include some of his long-time patients who are college bound.

“When you do this for generations this time of year means the continuity of seeing the 18 year olds going off to college and remembering them when they were little,” O’Reilly said.

“I remember when fourth grade was hard for this one and look where he is now. You will have years and years of seeing a family.

The I-took-care-of-mom-whenshe-was-little kind of thing.”

It is this seasoned perspective that prompts O’Reilly to add that the back-to-school physical is “more than shots” to meet school vaccination requirements.

“This isn’t a factory line in the sense of ‘turn your head, cough and here is the paper,’” said O’Reilly of the back-to-school physical that in the commonwealth is required before the first school entry and at intervals of every three to four years thereafter. In Springfield, this

is kindergarten and grades 4, 7 and 10.

“There is a lot more to going to school now besides knowing your colors. There is the social-emotional. Pediatricians learn kids’ temperaments and strengths. They partner with the families to problem solve and they partner with the schools.

I know my patient over there is a little high strung and he reacts in certain ways. How do we help Johnny be ready for going to school and how do we plan with the teacher?”

Mid-summer, O’Reilly advises, is a good time for parents to schedule the back-to-school as well as sports physical, which can be done together if both are needed, before the August rush and to complete school medical forms that may have been handed out in May and “ended up at the bottom of the bills.”

He encourages younger children unsettled about going to school to do what he calls “social stories” with a parent that then can be read in preparation and reflect that first day of class as well as shared with the teacher.

“It means Mom takes pictures that show here we are at the breakfast table, here we are in the car, here is the playground to prepare the child so the child is ready and

so the teacher knows that child.

Knowing the kid is really important because there is a fit question,” O’Reilly said.

“A child cannot learn until they are emotionally safe and feel that they are in a place that they are seen and known. If they feel threatened, they shut down. What we do as pediatricians knowing the child, knowing the family, and working with the school can create a space in which that child can learn.”He added, “We need to maximize their medical care in order for them to learn and we have to maximize all the other things as well.”

“Come August we are going to be reading that book about going to school, we are going to be writing stories,” O’Reilly said.

“We are going to be writing notes to the teacher. We will be doing whatever to engage that child’s brain to go into school and we want the child engaged in that process to the level that kid can be.”

There are questionnaires completed prior to the visit that relate to behavioral health as well as medical concerns, and usually discussed with early adolescents and teens toward the end of the visit without the parent in the room.

This talk with the patient is part

of a process that begins early, O’Reilly said.

“We start these questionnaires when the baby is born that address what is your child’s temperament like, how easy is it to take your kid outside. When kids get a little older, we ask how is their sleep, their stress. It is a pediatric symptom check list,” O’Reilly said.

“Once kids start to articulate sometimes they will answer these questionnaires easier than to tell their parents.”He added, “Ideally we want to treat the parent involved and at a young age help that child to grow independently and take some ownership of their health.”

“As kids get older, we say we are going to talk to both of you and then mom you are going to step outside and I am going to do the private area exam,” O’Reilly said.

“You set up the expectation with the parent. OK, we are going to have you go. You don’t say,’ I am going to talk to your child about drugs now. Can you leave?’”

He added that pediatricians see a child “a lot and get to know their families within that relationship.”

“Families start to recognize trying to help that child grow physically and for that child to have their health care independence as well,”

Dr. John O’Reilly, chief of the division of general pediatrics at Baystate Medical Center, and Dr. Shauna Ejtehadi, a pediatrician and resident in that division, see patients at Baystate’s High Street Health Center.

(ANNE-GERARD FLYNN PHOTO)

O’Reilly said.

“The child with the food allergy is going to have to say, ‘I can’t eat that peanut cookie there because I own my health.’ You want to build that foundation early on.”

Topics O’Reilly addresses with parents include how young a child should have a cell phone.

“An eighth grader might need it for safety and keeping in communication, but below that it can be just a distraction,” O’Reilly said.

“I would have that conversation about when is your child in that situation where it is really important for their safety that you are able to communicate with them. It might mean they only need it on these days. It is thinking about the phone as a safety and communication tool rather than a babysitter. So, individualize it to your child as to where you go.”

O’Reilly said some parents do not realize how early children today face situations that could get them addicted to substances like nicotine or know how to discuss the health risks of electronic cigarettes with their popular flavorings.

O’Reilly does a lot of education around behavioral issues like smoking e-cigarettes that are considered tobacco products and sales restricted in Massachusetts to 21 and older by posing scenarios to the child.

“There is a fair amount of vaping and it has gone younger and younger so we as pediatricians can start preparing even the kid in middle school by asking what would happen if you walk into the bathroom and kids are vaping and they want you to vape,” O’Reilly said.

“This is happening and sometimes you do it but do you know anyone who smokes? The child might say, ‘Oh, yeah, my dad.’ Has he been able to quit? ‘No. He is miserable.’ That is the entry point to that discussion,” O’Reilly said.

“We also work with the families and say it is really surprising what your kids will see in middle school and what they will be exposed to.

When they come home, I want to create a space between you and your child in which you are judgement free and reaction free and if your kid comes home and says that, boy, everyone is vaping that you don’t jump on him. You let them know that you can have those conversations and you will treat them like an adult.

SEE SCHOOL, PAGE D4

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D2 | SUNDAY, JULY 21, 2019

THE REPUBLICAN | MASSLIVE.COM

MAKING IT

easier to see a doctor Steps to

Dementia Care

By Allison Litera

Special to The Republican

When it comes to dementia, the statistics are pretty staggering. More than 47 million people are living with dementia worldwide, with 5.8 million people in the U.S. living with Alzheimer’s.

(Alzheimer’s is the leading cause of dementia.) Of these 5.8 million, 200,000 are younger than the age of 65.

Common causes of dementia in those younger than 65 are traumatic brain injury, HIV, Parkinson’s disease, or Huntington’s disease, to name a few.

When someone gets the news that they or a loved one are diagnosed with dementia, it can be quite scary. They’ll feel burdened with questions like “What if they forget who I am?” or “What if I forget my loved ones?” Instead of focusing on these kinds of questions, one must remember that they are not alone.

It’s important to develop a support system from the day of the diagnosis. Newly diagnosed patients should consider bringing a family member or trusted adult to accompany them at the doctor to help better understand the situation.

“Upon diagnosis, it is also important to ask your doctor if they are a specialist or a gerontologist,” says Amber Ribadeneyra, RN, ICP, CDP, Hospice Clinical Manager at Overlook VNA & Hospice Services in West Springfield.

“From there, you can be referred to the appropriate medical help.” Ribadeneyra has been a nurse for 19 years and has worked in several different settings including a locked dementia facility and hospice. She is also a Certi-

fied Dementia Practitioner as well as an Infection Control Preventionist. As a part of Overlook VNA & Hospice Services in West Springfield, Ribadeneyra is doing her part to ease the strain of dementia and help patients and their families cope with the disease. Overlook offers services such as emotional and bereavement counseling support, pain management and integrated therapies to ease stress. Based out of Charlton, MA, Overlook Visiting Nurse Association & Hospice Services is a non-profit organization and part of the Masonic Health System of Massachusetts, which has a long history of community service. The hospice services at Overlook VNA were added to the West Springfield office in December 2018.

“I see patients diagnosed with dementia on a regular basis,” continues Ribadeneyra. “From those with Parkinson’s disease and Lewy body dementia to people with Alzheimer’s, it is important to meet the person where they are in their disease process.

They don’t want to be forgotten or to be a burden. Reassurance and inclusion are so important. Many times, when I visit people with dementia, their family is grieving the mental loss of their loved one, which can upset the person with dementia. Being an outside ‘friend’ is a relief for family and the patient. I don’t ask questions; I just listen and give my full attention, which I find is so comforting.” She agrees that there is a stigma attached to dementia.

“A misconception is people with dementia just lose their mind and are dangerous,” she explains. “I’ve cared for a variety of cases, including an early onset demented lady who was a black belt in judo, and she was so nice! She went to the police department herself when she realized something was wrong.”

- Dr. Kevin Snow

Holyoke Medical Group Walk-In Care makes quality healthcare more convenient than ever.

Ribadeneyra offers additional tips to deal with newly diagnosed dementia: • Ask the doctor to explain what dementia is, how it can affect someone, and what behaviors can be expected.

Chicopee recently gained a convenient new healthcare option that increases the accessibility of quality medical services in the area.

Offering same-day treatment for routine illnesses such as sore throat and fever, as well as physicals for work, school and sports, Holyoke Medical Group Walk-In Care is open late on weeknights and for six hours on Saturdays.

In an increasingly complex medical world, the team at the walk-in clinic understands that having a primary care provider who knows your health history is key.

“I’ll often call other providers outside of the Holyoke Medical Group if something needs to be addressed, in addition to the electronic medical records that are sent over after we see a patient,” says Medical Director Kevin Snow, MD. Anne Coffey, Office Manager at the walk-in clinic, also prioritizes this type of communication. “We try to work with community providers to get referrals so services will be covered for patients coming in. We also make sure there’s continuity of care between community providers and their walk-in patients.”

So how do you know when to go where for care?

This guide explains which choice—your primary care provider, a walk-in clinic or the Emergency Department—works best for specific medical situations.

• If the diagnosis is confirmed to be dementia, ask what type. Depending on the type of dementia, a treatment plan can be individualized to the dementia.

• Don’t be afraid to ask for a second opinion.

• Ask questions and take notes during your appointments/check-ins. Physicians are human too!

• Ask for additional testing. The change in mental status could be because of an undetected infectious process or medication.

• Ask about prognosis and available medications.

• Designate a Health Care Proxy (HCP) and Power of Attorney (POA).

• Contact the Alzheimer’s Association for support and additional education.

Ribadeneyra is pleased to make an impact in peoples’ lives and looks forward to continue doing so.

“The most rewarding part of my job is meeting people and knowing I have helped,” she concludes. “I get to meet incredible people with awesome stories. I’ve met a man whose mother was a passenger on the Lusitania, someone who was one of the first people to portray Smokey the Bear, and even an opera singer who sang in Europe during World War II! The stories from everyone are precious.

It truly is a privilege for me to help people.”

CHOOSE PRIMARY CARE Patients should try to get a same-day appointment with their primary care physician, if possible, for non-emergency situations, including minor illness and flu-like symptoms. If an appointment isn’t available, then care through the walk-in clinic is a good option.

In addition, explains Dr.

To learn more about Overlook VNA & Hospice, please call 800-990-7642 or visit www.overlook-mass.org

Amber Ribadeneyra, RN, ICP, CDP

is the Hospice Clinical Manager at Overlook VNA & Hospice Services in West Springfield, MA

Snow, “Patients should seek care from their primary care physician for chronic issues when symptoms have been building for a while, or when they’re being managed for a condition that requires medication.”

OPT FOR WALK-IN CARE The National Center for Health Statistics found that 48 percent of patients went to the emergency room because their doctor’s office was not open, and they didn’t know there was another option for care. This is where walk-in clinics can help. They’re best for conditions that are not chronic—issues that are out of the mainstream of a patient’s health. “Conditions like bronchitis, sprains, strains, fractures, cuts that need suturing and abscesses are all examples of things we treat frequently in the walk-in clinic,” says Dr. Snow. “If possible, we always want patients to check with their primary care physicians first in any non-emergent situation.”

The purpose of the walk-in clinic is to provide same-day care for minor acute medical issues that can’t be addressed by a patient’s primary care physician at the time care is needed.

Conditions that can be treated at the walk-in clinic include: • Allergies • Acute asthma attacks • Back, knee or joint pain • Cough/cold • Diarrhea • Ear infection • Fever without a rash • Headaches • Insect Bites • Minor burns • Nausea • Pink eye • Rash or skin irritations • School Physicals • Sore throat • Sports Physicals • Vomiting • Work Physicals SEEK EMERGENCY CARE Dr. Snow emphasizes that there are times when a trip to the Emergency Department (ED) is warranted, and even if someone shows up to the walk-in clinic, they’ll be referred to the ED if neces-

sary. “Any heart condition will be sent to the hospital; severe pain, chest pain, rapid heart rate and anyone with a known cardiac condition should go to the ED,” he says.

Other symptoms that should be addressed in the ED: • Change in mental status • Choking • Chest pain • Coughing or vomiting blood • Fever with a rash • Head or spinal injury • Loss of consciousness • Major trauma or burn • Risk of poisoning • Seizures • Slurred speech • Stroke symptoms • Sudden dizziness, weakness or change in vision “Our walk-in patients have access to the full complement of services available at Holyoke Medical Center,” says Coffey. “We’re available and willing to work with our community providers to offer backup when they’re not able to see their patients. We keep primary care providers apprised of the situation and help direct follow-up care.”

Dr. Snow enjoys his work at the walk-in clinic. “It’s really great to have things like X-ray available right away, so I can make a diagnosis and have it confirmed by a radiologist within a short amount of time.”

HOLYOKE MEDICAL GROUP WALK-IN CARE The clinic is located at 1962 Memorial Drive in Chicopee and sees patients age 12 and over. Most insurances are accepted. Patients do not need to be part of the Holyoke Medical Group to seek care at the walk-in clinic.

WALK-IN HOURS: Monday–Friday 8 a.m. to 7 p.m., and Saturday 9 a.m. to 3 p.m.

LAB HOURS: Monday–Friday 6:00 a.m. to 3:30 p.m., and Saturday 6:30 a.m. to 3 p.m.

X-RAY SERVICES: Available during Walk-In Care hours.

For questions regarding the HMG Walk-In Care, call 413.535.4995.

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SUNDAY, JULY 21, 2019 | D3

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THE REPUBLICAN | MASSLIVE.COM

Healthy weight starting with

school lunch Although there are a variety of theories behind the growing obesity problem plaguing North American adults and children, the most consistent findings point to caloric intake as the culprit. Here’s a simple equation to get to the root of the problem: Calories eaten > calories spent = weight gain.

According to National Health Examination Surveys, adult obesity trends in the United States between 1976 and 2014 indicate the percentage of the adult population classified as obese has roughly doubled to more than 38 percent in the last three decades. Children may be learning eating habits from their parents, potentially contributing to rising obesity rates in children as well. Recent findings from the Centers for Disease Control and Prevention indicate one in five school-aged children and young people in the United States is obese. In Canada, the Public Health Agency says roughly one in seven children is obese.

Teaching children healthy

eating habits starts at home and can extend to what students are given to eat while at school. The Center for Science in the Public Interest says schools across the country are working hard to improve school nutrition.

Here’s how parents and school districts can help make school lunches more nutritious and delicious and lower in calories.

· Control snack intake.

The U.S. Department of Agriculture says that more than one-fourth of kids’ daily caloric intake comes from

snacking. Choosing smarter snacks may help reduce overeating. Good snacks can include grain products that contain 50 percent or more whole grains by weight; snacks in which the primary ingredient is a fruit, a vegetable, dairy product, or lean protein; snacks that are a combination food that contain at least a ¼ cup of fruits or vegetables; and foods that contain no more than 200 calories.

· Read nutritional information.

When selecting foods for

school lunches, parents should read the nutritional information to make sure they know exactly what they are feeding their children.

Select foods that are low in saturated fats and cholesterol and high in fiber and nutrientrich fruits, vegetables, grains, and legumes.

· Go with water.

Rethinking beverage choices can help control kids’ caloric intake. Many people don’t realize just how many calories beverages add to their daily intake. Even a six-ounce, 100-percent apple

juice can include as many as 96 calories. Sodas and other soft drinks pack a hefty caloric punch. Water, seltzer and unsweetened iced tea are healthy beverage options. If milk is the go-to beverage, choose a reduced-fat version.

· Introduce new foods.

Children can be notoriously picky eaters, but with patience and perseverance, parents can introduce new, healthy foods at lunchtime.

Yogurt, hummus and salsa are healthy and can add flavor to vegetables and fruit.

When making sandwiches,

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WHEN I LOST THE WEIGHT,

I GAINED MY LIFE BACK.

”

- Raul

Raul Collazo had struggled with his weight all his life.

As a young father, Raul made the decision to finally make his health and future a priority. “I remember playing with my son and always being winded – I did not want to feel that way anymore. He deserves more from me.”

After thoughtful research and conversations with his family, Raul began his bariatric surgery journey by attending an educational session where he learned about the surgery options available at Baystate

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exchange refined breads for whole-grain varieties. Choose lean protein sources, and go heavy on vegetables and fruits for natural fiber, which will create feelings of satiety.

· Read the school menu.

Let children indulge in ordering from the school menu when healthy options are featured. Urge them to try something unexpected, rather than sticking to chicken nuggets or pizza days.

Healthy eating habits begin in childhood and can be initiated with school lunch

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THE REPUBLICAN | MASSLIVE.COM

Artwork in the pediatric waiting room at Baystate’s High Street Health Center. (ANNE-GERARD FLYNN PHOTO)

School

O’Reilly said another topic might be, “What are you going to say if a boy comes up to CONTINUED FROM PAGE D1 you and says this, how do you You start this anticipatosay no, what is your plan?’” ry stuff before it is going to “The same way we give happen and then you use their vaccines so if children get life experience where OK, I exposed to a disease, they see how people get hooked won’t get sick, we have conand we don’t want you to do versations that are vaccinatthat. We don’t want you to get ing them against these risky hooked.” behaviors,” O’Reilly said.

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“And you are also saying, this is so good that you are not doing this. So, you are helping to model, you are helping to praise, you are helping to protect.”

In Massachusetts,sexually active minors of childbearing age may access family planning services.

Ejtehadi said in her confidential talks with patients the “most questions I have are about sex, condom usage and misconceptions they have about oral sex not being considered sex.”

“They think it is totally different,” Ejtehadi said.

“They ask about birth control options and most of them don’t know they can come see us if needed without their parents’ permission.”She also said she has to be specific about marijuana, which is now legal for people 21 years and older in the commonwealth.

“If you ask are you doing drugs, they will say no because they think we are asking about illegal drugs,” Ejtehadi said.

“We have to specify are you using marijuana and to really provide education that in the growing brain marijuana harms it even more and we don’t know the outcomes of it.”

With alcohol, Ejtehadi said she will ask “if they know someone who always has to have a drink and surprisingly, they often say yes.”

“I will then talk about how dangerous it can be and that kids don’t do smart things when they are drinking,” she said.

O’Reilly said parents should get a child’s sleep cycle geared to back-to-school hours starting in mid-August with an hour or two change of time, especially for teens whose summer schedule may mean being up until 2 a.m.

He encourages parents of younger children to integrate activities like reading, counting and drawing into their daily routine during summer as well some kind of exercise that can be in the form of a break for a YouTube video of Zumba.

Ejtehadi reminds parents

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that for any child with learning difficulties that the parent has “to submit in writing that you want your child to be evaluated for individualized educational planning.”

Ejtehadi grew up in rural Colorado, majored in psychology at Colorado State University in Fort Collins and worked as an EMT before going to medical school at Western University of Health Sciences in Lebanon, Oregon.

She was drawn in part to Baystate’s residency program as her mother, the former Denise Riendeau, is a 1983 graduate of what was the hospital’s nursing school.

Springfield has been rated as one of the worst metropolitan areas for allergies and asthma. Air quality and aging housing stock with mold and cockroaches are ongoing factors with the Big E among the seasonal triggers for inner city kids, Ejtehadi noted, “who have not been exposed to cows, horses, pigs.”

“We get the family on board to understand the triggers and what to do when things get bad and to continue to give the medications even when the child does not have symptoms,” she said.

Although vaccinations against certain diseases are required for school entry except when medically contraindicated or a parent seeks a religious exemption, how this is enforced is left to school districts.

Ejtehadi said when she has a parent who will not immunize a child as required the practice has the parent sign a form that says, “I understand the risk I am putting my child in by not immunizing them. I am signing responsibility for that.”

“We continue to talk about it at every visit because that is how important we think it is,” Ejtehadi said. She talks to parents during the back-toschool physical about getting “all the prescriptions you are supposed to get and that the school has the medication and the instructions for the medication.”

She also stresses that “kids under 12 should not be left home alone when parents are working and parents need to be pro-active about signing kids up for sports or after-school programs, orchestrating rides or transfers, meals.” O’Reilly tells parents to run through safety scenarios with children who walk or bike to school.

“We don’t rush through the back-to-school physical,” O’Reilly said.

“Hopefully we get the child and parent in and do a good job and address all the issues - medical, behavioral, academic - that can make that child within that family within that school the best student they can be and we will have this relationship of putting the pieces of their social needs together so when I have them come back to check their asthma I can say by the way how are things and do I need to write a note to his teachers.”

He added, “It is that longitudinal connection that makes the difference.”

“It is about where are they, what should we be doing,” he said.

Back-to-school

ice breakers to ease first day fears

using a smartphone image Parents and template. This selfie illuseducators can tration will give the class key facts about each student sometimes and present an interesting, creative and enjoyable way underestimate for students to get to know children’s anxiety one another. over the dawn of word search a new school year. Student Word searches are enter-

Many students feel nervous when wondering if their teachers will be nice or if they will make new friends. These worries may be compounded by the return to routine and the end of an enjoyable period of rest and relaxation.

In 2015, CNN polled campers at a summer day camp outside New York City. The campers were elementary school students who were asked about what they were most nervous about for the return to school. Homework, tests, competition, greater expectations, grades, and making new friends topped the list of fears.

To help students transition to the classroom with fewer worries, teachers and parents may want to initiate ice breakers and other stress-reducing interactions. Here are some ideas.

Buddy up

Many schools will give out classroom assignments a few days before the first day of school. Parents can investigate who is in their child’s homeroom and initiate contact with the parents of one or more of those students. Collectively, parents can make a buddy plan for students to arrive to school together and enter the classroom as a team.

Coordinate clothing colors or have students wear another unifying symbol. This may allay fears and make the first day of school more fun.

School selfie

Students can craft “school selfies” on a piece of paper

taining and educational tools that can be put to use in the classroom. Parents or teachers can create word searches featuring the first names of all the students in the class.

Children often enjoy searching for their own names, and then they can help others, opening up lines of communication.

Word searches also can be customized for any subject.

Therefore, if student names aren’t desired, the theme can be classroom items or school terms.

Personal introductions

Students may worry about teachers mispronouncing their names or using a full name instead of a nickname.

Rather than a traditional roll call, teachers can encourage students to introduce themselves to classmates, using their preferential name and including a brief synopsis of their interests and what makes them unique.

Teachers also can initiate other ice-breakers by giving students a sheet with various questions, which students then have to complete by asking around among the other students. For example, “Who has a pet fish?” or “Find someone who has blue eyes.”

The first day of school can be difficult for some children.

Fun activities and some extra effort from parents and teachers can make the return to the classroom less stressful.