Ulster Publishing’s
Healthy Hudson Valley Magazine M i 2017-18
Where it’s at...
Experiencing Medicaid, Child Health Plus, Medicare and ACA navigators Moving on to a specialty hospital Ultramarathons, dental insurance and communicating with pets
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• May 4, 2017
Healthy Hudson Valley
Ulster Publishing Co.
What’s going to happen? Troubled times for healthcare choices By Paul Smart
T
he first time I got insurance was way back when it used to come with a job. I hardly used it. Then for years I didn’t have any until my then-girlfriend made it a prerequisite for marriage. I had to go begging to the various places I was freelancing for to find an employer willing to let me access their insurance plan. I had to work more to cover the cost of the insurance out of my paycheck, with enough left over for taxes. Eventually my wife found a real job with fewer hours than we were working freelance. It also had real benefits, including various forms of top-notch insurance. By then I had let my own hard-earned insurance lapse
PAM GESKIE
info@bluedeer.org | 845-586-3225 1155 County Route 6 | P.O. Box 905 Margaretville, New York 12455
Think Pink Locally
Seven-month old Sara Grace Geskie is the daughter of Jeff and Laura Geskie of Ulster County and granddaughter of Pam Geskie. When thinking about healthcare, it’s always a good start to think about the future.
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so I could go on her policy. Everything was hunky-dory until her job evaporated, and with it our insurance. Enter the Affordable Care Act. Losing the job didn’t mean we got kicked to the curb immediately. There was a grace period during which our coverage would continue as it was. That meant a flurry of doctor’s visits, along with a mouthful of new fillings, root-canal excavations, and even a post-and-crown. On the New York State of Health website my wife was given the name of a local navigator who would help her fill out paperwork and put in an application for
May 4, 2017 • 3
a healthcare subsidy. Since her job loss qualified as a catastrophic event of some sort, we didn’t have to wait for an open-enrollment period. And I could go along for the ride, since my own income had dropped from the previous year. The new public insurance has been great. Our card is from MVP. It doesn’t quite ring bells like SNAP supposedly does, but it’s accepted easily by everyone I see, making my prescriptions pretty much free. Our co-pays are just about non-existent, and even some of the dental care is cheap, though only if it involves the
Table of contents What’s going to happen?
To insure or not to insure?
Troubled times for healthcare choices by Paul Smart................................................................... 2
Extracting the truth about dental plans by Harry Matthews ..................................................... 28
How to survive the health marketplace
The age of the ultramarathon
Tips for getting the best insurance coverage by Lissa Harris................................................................. 6
Taking care of the kids
Long-distance running has its benefits and its challenges by Violet Snow .............................................................. 32
The saving grace of Child Health Plus by Lisa Childers ............................................................. 12
Bionic knee
Considering one’s prime Health in my Medicare years by Elisabeth Henry ......... 16
The story of my long recovery from surgery by Gail Beverly ............................................................. 38
Travel medicine?
Mental postcards
More specialists are getting based right here by Jodi LaMarco ..........................................................20
Animal communications involve several levels of meditation by Cindy Brody .........................................42
YOUR SMILE IS IN GOOD HANDS Please welcome
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• May 4, 2017
Healthy Hudson Valley
front of the mouth, where missing teeth might hurt in a job interview. I have to admit that being on Medicaid has scared me. I feel this sense of foreboding, like something may be wrong. What if our navigator made a mistake? Worse, what if the whole system shifts under us, or something happens in Washington or Albany that pushes rates up to where it’s best for us not to be insured again? Do I hold on to whatever illnesses I’m harboring until I qualify for Medicare, which hopefully will still be around when I need it? One persistent basic question kept coming up as we put together this edition of Healthy Hudson Valley. What’s going to happen? There’s a great deal of uncertainty, with widely varying opinions about what’s happening. Nothing is definitive.
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The discussion has been changing as fast as Tweets allow. The key thing we keep hearing is that there are several deadlines this summer for insurers to set rates and make coverage changes. We have been trying to paint a picture of what is working now and what needs help from a series of personal accounts we’ve been assembling. The current push to change things by undoing the systems we have is being resisted. The outcome is uncertain. Policy takes serious discussion, and sometimes a willingness to reach compromise. We need to take a look at what is, rather than just what we believe. In an atmosphere of extreme political polarization, that’s more necessary than ever. Stay healthy! It’s the most affordable option.
Healthy Hudson Valley Magazine 2017-2018 An Ulster Publishing publication Editorial WRITERS: G. Beverly, Cindy Brody, Lisa Childers, Lissa Harris, Elisabeth Henry, Jodi LaMarco, Harry Matthews, Paul Smart, Violet Snow PHOTOGRAPHERS: Pam Geskie, Dion Ogust, Violet Snow and various public-domain artists. EDITOR: Paul Smart LAYOUT BY Joe Morgan This issue’s cover is designed from a public-domain photograph. Ulster Publishing PUBLISHER:
Geddy Sveikauskas ADVERTISING DIRECTOR: Genia Wickwire DISPLAY ADS: Lynn Coraza, Pam Courselle, Pamela Geskie, Elizabeth Jackson, Ralph Longendyke, Sue Rogers, Linda Saccoman PRODUCTION MANAGER: Joe Morgan PRODUCTION: Diane Congello-Brandes, Josh Gilligan, Rick Holland CLASSIFIED ADS: Amy Murphy, Tobi Watson CIRCULATION: Dominic Labate Healthy Hudson Valley Magazine is one of four Healthy Hudson Valley supplements Ulster Publishing puts out each year. It is distributed in the company’s four weekly newspapers and separately at select locations, reaching an estimated readership of over 50,000. Its website is www.hudsonvalleyone.com. For more info on upcoming special sections, including how to place an ad, call 845-334-8200, fax 845-334-8202 or email: info@ulsterpublishing.com.
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Healthy Hudson Valley
Where modern medicine meets compassionate care. At Northern Dutchess Hospital, better care is happening close to home. We offer spacious private rooms big enough for you and your family, as well as an expanded emergency department for greater comfort. Plus, our state-of-the-art operating suites are equipped to handle the latest surgical techniques. Discover the modern hospital that puts patients first. Learn more at healthquest.org/NDH
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• May 4, 2017
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PUBLIC DOMAIN PHOTO
Health fairs have become the big events that job fairs were a few years ago. They’re great places to get a sense of what’s being offered in a region, insurance-wise, as well as information about free clinics in progressive areas like the Hudson Valley.
How to survive the health marketplace Tips for getting the best insurance coverage By Lissa Harris t’s a cold, rainy Friday afternoon, and the woman on the other end of the line has clearly had a long day working the phones at the New York State health insurance marketplace. She mumbles at top speed through her scripted interrogation. When she gets to the part asking if I have access to any kind of health insurance through my employer, I stifle a laugh. It’s funny. I know that plenty of people have this magical thing
I
called employer-sponsored health insurance. About 49 percent of the U.S. population, in fact — a fortunate demographic that includes my mom, my doctor and my congressman. It’s another world, though, and not the one I live in. I’ve been self-employed for so long that the idea of a company putting up cash money for me to go to the doctor sounds like something out of a utopian sci-fi novel. For many of my working friends, too — small business owners, writers and hustlers of the modern-day gig economy — health insurance and healthcare have long
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Share our Gracious Lifestyle Welcoming, Authentic & Diverse We are an integral part of the close knit Woodstock, Kingston and Saugerties communities. From our front porch we enjoy the hustle and bustle of the farmer’s market, historical society concerts or a passing parade. Ivy Lodge is an open and accepting community made stronger and more magnificent for having embraced differences among its members.
Apartment Living All of our modern, handicapped accessible apartments have private showers. Housekeeping, linen and laundry service are included.
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Enhanced Programming Special license that allows residents to age in place Nurses are on site seven days a week, and our highly skilled staff has training and experience with accommodating, in a respectful and caring manner, the changes associated with advanced aging.
Our owner-operator, Joan Hyde, PhD is a professor of Gerontology and an internationally recognized researcher and published authority on assisted living and best practice care for people with cognitive impairment.
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• May 4, 2017
Healthy Hudson Valley Hours: Mon.-Fri. 9-6 • Sat. 9-4
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been something to scrape together, or to do without. People in my situation — working, and earning too much to qualify for most forms of government assistance, but without access to an employer plan — have been notoriously underinsured for a long time. Our ranks are growing. According to a January report from the Treasury Department, the number of people reporting self-employment income rose more than 30 percent between 2001 and 2014. Getting more workers outside the realm of “regular” employment insured is just one of the quixotic goals of the Affordable Care Act, also known as Obamacare. The U.S. healthcare system is fiendishly complicated. In a constantly changing landscape, it’s tough even to figure out exactly what effects the law is having on healthcare in America. But as the numbers come in, it seems the ACA is making a dent. Self-employed workers are buying marketplace plans at three times the rate of regular wage-earners, according to that Treasury report. On a broader level, the percentage of Americans who are uninsured has dropped precipitously since the ACA’s major provisions went into effect. The law may be imperfect, but it is working. Let’s not sugarcoat it: Marketplace plans aren’t great. Insurance on the individual market was expensive before Obamacare, and it still is, although subsidies do help ease the pain. If you’re used to sharing the cost of health insurance with your employer, the pricetags for plans on the New York State of Health will come as a rude shock. Deductibles for the more affordable plans are high, and “gold” or “platinum” plans that cover the
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May 4, 2017 • 9
lion’s share of medical expenses come with expensive premiums. More troublingly, several state insurance exchanges have hit unexpected turbulence in getting off the ground. In 2015, the nonprofit Health Republic, one of the more popular insurers on the New York State marketplace, shut down abruptly after accumulating tens of millions of dollars in losses, leaving hundreds of thousands of enrollees (including yours truly) scrambling to get new insurance coverage mid-year. With some factions in federal government actively seeking to kneecap the ACA’s marketplaces for political purposes, there may be more unforeseen woes ahead. For all its myriad flaws and aggravations, Obamacare has brought health coverage within reach for many – and given consumers new options they’re loath to give up. With Congress poised in March on the precipice
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of a failed effort to repeal the ACA, the nation’s capital heard it loud and clear: the roar of millions of registered voters realizing all at once that, as messed-up as the health insurance landscape is, it could be worse. On that happy note: If you’re planning on shopping for coverage through New York State of Health, here are three basic tips for getting the most out of it.
Plan ahead Your best bet for getting coverage for the upcoming year is to shop for coverage during the open enrollment period. For 2018 plans, that’s November 1 through December 15 (that’s six weeks less than the time applicants had last year, thanks to new regulations from the Trump administration that cut the enrollment period in half ). If you have recently had a major life event like the loss of job-based insurance, the birth of a child, a marriage or divorce, you’ll be able to sign up for a marketplace plan anytime through special enrollment. If you’re not sure whether you qualify for special enrollment, contact the marketplace and ask.
Be patient Applying for insurance through the marketplace takes time, whether you’re filling out the application online, over the phone or with help from a broker. Set aside a chunk of time to deal with the process. If you have irregular paychecks and tax returns that vary wildly from year to year, you’ll have to be especially scrupulous in calculating your income – mistakes made
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during your application could cost you next year at tax time. Claiming a subsidy will save you on premiums in the short term, but if your income proves to be higher than you expected you’ll have to pay it back with your federal tax filing. If your household income puts you in the realm of Medicaid eligibility, you should be prepared to produce proof of your income: pay stubs, tax returns, business records or letters from employers.
Find help Got a question? Call the New York State Health Exchange. Its phone bank is sometimes prone to long wait times and inexplicable connection problems, but you can get real, live, knowledgeable human beings on the phone who can be invaluable in helping you through the application process. You can also find free help in your community. On the website of the New York State Health Exchange is an online list of “navigators.” Their job it is to provide free in-person help to applicants signing up for marketplace plans. Navigators often schedule appointment hours at local libraries, clinics and other community centers. Check the online list to find one near you. I confess that I dread having to wrangle with the New York marketplace. It’s byzantine, it’s tedious, it’s a mess of red tape. I have to wade into it every time my income goes up or down. And they’ll have to pry it from my cold, dead hands – because as aggravating as it is, it beats the hell out of having no insurance at all.
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• May 4, 2017
Healthy Hudson Valley
Ulster Publishing Co.
Taking care of the kids The saving grace of Child Health Plus By Lisa Childers
W
hen the financial world took a downturn, we lost our health insurance obtained through employment. I knew nothing about health insurance, thinking I could just call up any company, similar to buying insurance for a car, and ask, “What can you sell me and what does it cost?” That is what I did, and encountered dismay on the other end of the line from several insurance agencies.
I learned that it doesn’t work that way. There is workrelated Cobra offered for six months if you can afford it. When the financial world takes a turn for the worst, however, who can afford $1200 a month (if lucky) for family insurance? My husband and I did without. The one gem I did find was that my son would be covered through Child Health Plus (CHP), the New York State health insurance program for children under the age of 19. When I told the office people at my son’s pediatrician that we had lost our insurance, they pointed me to a representative. My son was ten at the
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Healthy Hudson Valley
May 4, 2017 • 13
PAUL SMART
With New York’s Child Health Plus, going to the doctor to treat colds, flu and other ailments has lost its stigma. The result is a healthier crop of young New Yorkers with better attitudes towards healthy living. time, and it was a relief knowing he would be covered at an affordable price. During this time, I was trying to obtain my own health insurance through private means. The end result opened into a nightmare of eligibility refusals for various reasons. Eventually I found health insurance through the Arts Society of Kingston just for myself because we
could not afford it for two. My husband, the healthier person, went without. My insurance cost nearly $400 a month and had a deductible of $3500 and no prescription coverage. Because I had lagged between insurance companies, any pre-existing condition would not be treated until I paid into the insurance for a year. Jumping through
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federal mandate hoops of fire was required it. optional. Over the years my By the way, any son had medical therapy care due to hiccups along the the stress of trying way that needed to find insurance special attention. was not covered. We never had a Sorry. problem with reCHP provides a fusal to treatment. subsidy by using I spoke to other yearly or monthly parents who used gross income. BeCHP and their cause we are freeexperiences were lance, we sometimes similar. The only had zero premiums concern I came and sometimes we across was a waitdid not qualify for ing period for a the subsidy. The new mother with monthly premium individual insurwithout the subsidy ance to get her was under $200. If child enrolled in you are at four times CHP. It appears the poverty level, the state fixed this you do not qualify. so it would roll There are premium over. My advice to caps on the subsidy a new mom about if you have multo give birth is to tiple children. If you make sure you don’t qualify for the have your insursubsidy, however, ance ducks lined it’s full premium for up. Make calls, each child. That can be informed, and get pricey. have peace of mind There are no that this stuff has out-of-pocket exPUBLIC DOMAIN PHOTO been taken care of. penses. Everything, Out of the Clinton administration’s push for a national CHP is now and that includes healthcare system 25 years ago came basic coverage for folded into the Afdental, vision, and kids, with mandated dental plans in most places, including fordable Care Act prescription, is New York. It’s taken huge burdens off young families. (ACA). Nothing covered. Well care, has changed about it, except sign-up can be online or emergency care, surgical, hospice, substance abuse, through an “enroller,” according to its website (health. mental health are all covered. CHP provided coverage ny.gov). Before the ACA, I would use an enroller befor mental health and substance abuse even before a
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cause the Internet was not an option. Over the years my enroller and I met at Barnes and Noble over books and coffee, my house for tea, or a diner for lunch. I think we met in an office once because my enroller needed to make copies. It was always a pleasant experience. You can also go to the New York Marketplace (nystateofhealth.ny.gov), put in your income, and see whether your children qualify. A sign in blue may tell you to call a number. I did a quick check by using one child with an income ranging from $50,000-to$70,000 and was flagged as possibly eligible for Child Health Plus. The New York State children’s health program, begun around 1990, was so successful it became a template for the National Children’s Health Insurance Program Neil Schneider
May 4, 2017 • 15
(CHIP) passed in 1997. Senator Edward Kennedy (D) was the sponsor and senator Orrin Hatch (R) the cosponsor. Hillary Clinton pushed the CHIP program, securing $24 billion in the Senate instead of the $16 billion approved by the House. The bill allows matching federal-state funds for children’s health care and targets families not eligible for Medicaid but unable to afford regular insurance. Under the ACA, the program was to expanded to more insurance companies. Currently, CDPHP, Fidelis, Hudson Health, United Healthcare and Wellcare carry CHP. With the future of the ACA in question it’s heartening to know CHP is under a separate piece of legislation. It appears to have its own strong legs. At least our children will be taken care of.
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Considering one’s prime Health in my Medicare years
COURTESY OF ELISABETH HENRY
In addition to her work as a writer, the author has become a recognizable face on television and online advertisements extolling the virtues of an active older life, as well as the state’s many programs for seniors. Just don’t call her a senior citizen. by Elisabeth Henry
“
Y
ou love SOUTH Park?” This question, mouthed by an incredulous and suspicious high-school sophomore during an ill-fated foray into “teaching English,” struck me as an accusation, a clue that uncovered an unsavory truth about me, the geezer in question. That I could mouth to myself the lyrics to Biggy Smalls proved hilarious to the students observing me, the substitute teacher with headphones, marking
papers in an empty classroom. Apparently we are prescribed by generation. Open border, yes, please! Gay marriage, of course. Inter-racial marriage? Where have you been? But do not challenge the clothes age barrier. (Please see: 20 Trends You are Too Old to Wear. Spoiler alert. Discard the Daisy Dukes, the big, chunky bangle bracelets, the tube tops. I’m lookin’ at you, Caitlyn Jenner.) It would seem the safest route is to make oneself as unnoticeable as possible, which is a step beyond irrelevant, since to appear to try to be relevant is to try
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Ulster Publishing Co.
We Know Kids. Get to Know Us. David Fenner, MD
Wendy Bacon, MD
Rhinebeck Office
John Sieverding, MD
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• May 4, 2017
Healthy Hudson Valley
Ulster Publishing Co.
to appear. Ew. Health care is an issue where we, the irrelevant, seem to be especially problematic. Saint Mother Theresa may be gone, but her legacy does not permit us to be wheeled out to the curb on dollies when we are too weak to get to the john ourselves. That will never do. But what will? One of my sons-in-law unwisely mentioned that the problem is the baby boomers. Too many. Too needy. You may be too young (of course you are) to remember the bit where the villain says, “Slowly I turn….” wherein he turns. It is ominous. Then he says, “Step by step…” as he moves, seething, towards his helpless victim. This is how the scene played in my kitchen, except my husband was wielding a chunk of firewood. And he was silent, until he said “Just give me everything I paid. In cash. I’ll take that deal.” And then he put the wood on the fire and went to the living room to watch Kirk Douglas as Ragnar scream “Odin!” in that Technicolor swashbuckler, The Vikings. It’s not just innocent hipsters who are stumped as to what to do with the bent and beleaguered. Despite millions upon millions spent on the Affordable Care Act: its website, its implementation and its poorly educated navigators, one can still find oneself marooned on the tundra of the uninsured. (I’m lookin’ at you, FDR!) I did lose my health care. I could not see my doctor. I could not afford the plan that was identical to my old plan. I lost all insurance and gave up horses for a while. he hell with it. It’s behind me now. I qualified for Medicare, which was so easy compared to the mountains of paperwork, endless consults, and miles and miles logged on my car traveling to this or that agency trying to remedy my former predicament. It seems I qualified simply because I just didn’t die. I am grateful for it, not just for my personal needs, but for so many friends punished by the passage of time. When I see Eddie, I see the man who loads log trucks with 60-foot lengths of felled ash trees, but now he has three stents in his heart and admits to some measure of fear. When I see Judith, I see a woman so prized for her horsemanship that one stable owner offered her a
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The combination of Social Security and Medicare started to solve major problems that once faced America’s seniors, as well as relieving the financial burdens on communities that struggled to care for their elders. Now new frontiers await as our population ages, including the benefits of active grandparenting and great-grandparenting. princely sum just to do saddle work with horses right before a show. Now she can barely walk. She refused psychotropic drugs for her “anxiety.” “Sure,
Dr. Jonathan Sumber, Podiatrist We make your feet feel young again!
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I’m anxious,” she looked a me with a wan smile, “You’re anxious when you’re dying.” In India, there is a tradition wherein widows live together in communities, caring for each other as they age. In the Bruderhof communities, many people attend to the needs of the elderly, so no one person or group grows tired or numb from the effort. While it may seem that the tasks of caring for the elderly mirror the tasks of caring for the very young, the plight is actually very different. The reasons why are too numerous and tedious to mention. Ah, but I’m not circling that booby trap yet. wish I knew how to reveal the secrets hidden in Medicare. I’ll bet there is a form to fill out for that jowl lift. There should be, now that “reproductive health” is as remote, for most of us, as “docking one’s tail. Or ears.” In the meantime, I try to be healthy. My one remaining vice is black coffee pressed from good beans in a spotlessly clean French Press. But the young ones are getting to me, even though I cannot completely disguise my nausea when they describe what kambucha is. Someday I will stock the larder with spirulina, kelp, and E3Live, just because I love young people so much. I sometimes work in those domains of youth, theater and the film industry. There I find the best ones. They are bright, and happy to tell me about books and plays and films and spirulina — all the things I have missed because I am usually forbidden to cross the age barrier because my escorts, my children, now live far away. These youngsters forgive me. They give me a pass.
I
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They are hopeful, honest, lively and kind. They make me resolve never to be a burden. I even have a plan. When I know it’s time, and the weather report cooperates, I will take a bottle of Royal Salute whiskey, several blankets, a favorite book, glasses and my bundled self to a comfortable, sheltered seat — preferably in the forest — and wait for the blizzard, during which I will drink and read my way to the purgatory where I will find my beloved but not-quitegood-enough-for-heaven friends. But I am certainly not circling that trap, either. I am instead buoyed by a recent interview shown online. The subject is the Yazidi women, who have been raped and beaten and sold as slaves. They escaped their torturers and formed militias. “Surely,” said the panel moderator to the journalist, “there is a way to survive, to heal, without engaging in battle?” “Oh, yes,” replied the journalist. “But the agencies which set up hospitals and so forth do not provide psychological counseling for healing.” “They say they heal themselves when they first hold their weapon,” the film-maker adds quietly. “Yes. They do,” repeats the journalist. So I too will not merely pray to heal, bemoan the futility of fate or whine for attention. I will dare to speak truth to power with a twinkle in my eye, listen to whatever music I choose, and keep my edges nicely sharpened and defined. I will not go gently into that good night. Unless some handsome young man asks me to slow-dance to “I Only Have Eyes for You.” I’m lookin’ at you, Prince Harry.
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• May 4, 2017
Healthy Hudson Valley
Ulster Publishing Co.
PHOTO RENDERING COURTESY OF CHAZEN COMPANIES
Vassar Brothers Medical Center in Poughkeepsie has been growing fast in recent years, centering Health Quest’s network of regional hospitals.
Travel medicine? More specialists are getting based right here By Jodi LaMarco
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here’s a long-held belief in the Hudson Valley that patients seeking high-quality medical care need to go to New York City. But now the picture’s getting more complex. Local hospitals are clustering into networks offering more specialized services both in-house and through other providers. Some top downstate hospitals have entered the Hudson Valley marketplace, and their presence will continue to grow. There are also new and different patterns of specialty care, often connected to the availability of new technology.
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“Health Quest’s three hospitals [in Rhinebeck, Poughkeepsie and Carmel] and affiliate providers offer a number of specialty services, including oncology, cardiology, orthopedics and minimally invasive surgeries, that are comparable and, in some cases, exceed the care received in New York City hospitals,” claimed public and community affairs manager Marcela Rojas Rojas. “Vassar Brothers Medical Center, the flagship hospital for Health Quest, was one of 844 hospitals to receive an “A” in the 2016 Leapfrog Hospital Safety Grades, ranking among the safest hospitals in the United States." Hospital network websites offer a host of recommendations and awards from myriad entities. Which ones matter most? Where does the PR separate from meaningful levels of accomplishment? Dr. Steven Frisch, who coordinates delivery systems at Albany Medical Center, noted that his network's goal was to standardize the level of care patients receive at all its hospitals. “Columbia Memorial has a hospital in Hudson. It’s a more limited scope than Albany Medical Center, but we’re doing a lot of joint programming with them,” he said. Rather than offering every possible service at all its facilities, Albany now focuses its effort where it will have the most impact. “For those things that require teams of physicians and lots of expensive equipment, I think there’s a tendency
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towards the centralization of services,” Frisch added. Early last year, Westchester Medical Center’s health network expanded to include Kingston-based Health Alliance of the Hudson Valley. "We struggled for years to recruit and retain specialists. Finding the right people and keeping them here proved very difficult," noted HealthAlliance of the Hudson Valley president and CEO David Scarpino of the region's big affiliations of recent years. "Now, with our 14 months of affiliation to Westchester Medical, we can leverage their recruiting power and share resources
May 4, 2017 • 21
with other hospitals in a way we couldn't before. It's the best of both worlds, keeping things local while also raising the quality of our community's healthcare." The sharing, Scarpino continued, has allowed Kingston's hospitals to work in tandem with Poughkeepsie's Mid-Hudson Hospital. New surgeons have been added, and what can't be handled locally can be accessed at Westchester's Valhalla campus, by helicopter if needed. At Health Quest, Rojas said, the partnership among the three hospitals has been helping each facility find
Caremount doctor gets award
C
aremount Medical, the multi-specialty medical group with facilities in KIngston, Rhinebeck, Poughkeepsie and several sites in Putnam and Westchester counties — recently saw one of its specialists, Dr. Diana L. Silverman, get an “Under 40” award from the Dutchess County Regional Chamber of Commerce. Silverman is a breast surgical oncologist who specializes in all types of diseases of the breast, both benign and malignant. She is an expert in skin-sparing mastectomies, an advanced surgical technique where the breast tissue is removed through a very small incision, after which immediate reconstruction can be performed by a plastic surgeon.
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• May 4, 2017
Healthy Hudson Valley
Ulster Publishing Co.
COURTESY OF HEALTHALLIANCE
David Scarpino at HealthAlliance sees only benefits from affiliation with the Westchester Medical Center. its strength. “We are working together and finetuning what each hospital’s specialty is,” she noted. She cited the same sort of consolidation raison d'etre noted by Dr. Frisch. “We don’t do heart surgery in Putnam, but we provide other cardiac services,” she said. For an advanced cardiac procedure, patients are instead referred to the group’s Vassar location. Were the current systems considering ways to share services and specialties on a regional basis? Though several were exploring that concept, HealthAlliance's Scarpino said, such things aren’t presently possible. Until it is, he said, "We look at how we can close the gaps in our own systems. On a regional basis, for example, I think we all need more physicians working in obstetrics, neonatology and urology." Dr. Frisch said Albany Med does sometimes refer patients to hospitals outside its network, but only when it comes to a few specific services. “If you said
to me, ‘Compare your scope to any of the major New York City programs,’ the only things we’re missing are that we don’t have a burn center and we don’t have a limb re-implantation program any more,” Frisch explained. “Those are the only two kinds of patients that we send out.” Regional hospitals are still fighting to keep locals local, and aren’t always eager to talk about network shortcomings. One smaller network politely declined to discuss the holes in its palette of offerings.
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he more people utilize specialists within the new systems, Scarpino said, the more old attitudes about the primacy of urban hospitals start to fade. "If they need high-level care we can get them to it," he said. "We've now got the best of both worlds here." Frisch similarly expressed confidence in Albany Med’s ability to deliver top-notch care. “I know people tend to
Real healthcare deadlines
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hen will the big changes be occurring? Talk of a new repeal-and-replace law keep wobbling along in Congress. What’s with the rush, besides pride? In the preface to its February 15 market stabilization rule, the federal Department of Health and Human Services announced that it would be revising its 2017 calendar for 2018 insurance plans and rates from early May to June 21. The Centers for Medicare and Medicaid Services will send insurers a notice as to corrections
they need to make in their applications by August 2 rather than by the earlier date of June 13. A final notice of rates will go out to insurers on September 15, and open enrollment for the national exchanges are set to open November 1. Insurers in some states, not including New York, have been dropping out of marketplaces based on profitability measures, including the numbers of those utilizing Medicare, Medicaid and Child Health Plus systems.
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May 4, 2017 • 23
Healthy Hudson Valley
COURTESY OF MIDHUDSON REGIONAL HOSPITAL
When he returned to his native Hudson Valley to head vascular surgery at MidHudson Regional Hospital in Poughkeepsie, Dr. Joseph Fulton, MD, FAC, and assistant professor of surgery at New York Medical College, helped bring his downstate experience to his patients. think of the big New York City programs. We actually have the same range of pediatric cardiac services that you would find in New York City, with state-monitored
outcomes that are typically number one or number two in the state,” he said. The region’s hospital systems are not shy in touting
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• May 4, 2017
Healthy Hudson Valley
Ulster Publishing Co.
ADVANCING SURGICAL CARE. HERE.
Leading specialists closer to home — that’s WMCHealth Physicians at Lake Katrine. With eight highly respected surgeons in six unique areas of expertise, we’re expanding our ability to care for you. As members of the Westchester Medical Center Health Network, your surgery can be performed at the location that is most convenient for you — HealthAlliance Hospitals or MidHudson Regional Hospital. It’s just another way we’re Advancing Care. Here.
WMCHealth.org/LakeKatrine
BREAST | GENERAL | NEUROLOGICAL | ONCOLOGIC | THORACIC | VASCULAR
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May 4, 2017 • 25
Healthy Hudson Valley
LEADING G SPECIALISTS SPECIALIST TS CLOSER C TO HOME. BREAST SURGERY
GENERAL SURGERY
Zoe Weinstein, MD Breast Surgeon
Michael Moscowitz, MD General Surgeon
Michael Cho, MD, FACS Neurosurgeon
Mark Watts, MD, FAANS Neurosurgeon
Dr. Weinstein is the Medical Director of the Fern Feldman Anolick Breast Center with over 20 years of experience as a board certified surgeon. She is proficient in advanced breast surgical procedures, and also performs minimally invasive breast biopsies under ultrasound and stereotactic guidance. For appointments, call 845.383.1759.
A Kingston native, Dr. Moscowitz is a highly skilled and dedicated surgeon, experienced in both traditional open surgery and innovative, minimally invasive techniques. He focuses on procedures relating to the abdomen and its contents, as well as hernias and diseases involving the skin. For appointments, call 845.383.1759.
Dr. Cho has been practicing neurosurgery for nearly 20 years. He specializes in both cranial and spinal surgery with a particular expertise in complex spinal surgery, and has a unique proficiency in repairing traumatic injuries to the spinal column and spinal cord. For appointments, call 845.483.5305.
An accomplished neurosurgeon with over 25 years of experience, Dr. Watts is proficient in c aring for the brain and spine and has a special clinical interest in neurological disease in the elderly, brain tumors, hydrocephalus, and conditions associated with the cervical spine. For appointments, call 845.483.5305.
ONCOLOGIC SURGERY
THORACIC SURGERY
NEUROSURGERY
VASCULAR SURGERY
NEUROSURGERY
VASCULAR SURGERY
Eric Dong, MD, FACS Surgical Oncologist
Tracey Weigel, MD Chief, Thoracic Surgery
Joseph Fulton, MD, FACS Chief, Vascular Surgery
John Kwon, MD, RPVI Vascular Surgeon
A fellowship-trained surgical oncologist, Dr. Dong focuses on the treatment of gastrointestinal cancer, including colon, esophageal, gastric, liver and pancreatic cancer. He’s also actively involved in the management of patients with endocrine disorders, and a leader in palliative care. For appointments, call 845.483.5741.
A national leader in thoracic surgery, Dr. Weigel has extensive clinical and research expertise in both minimally invasive and robotic-assisted surgical treatment of thoracic malignancies and benign conditions. Her clinical research has focused on developing innovative surgical techniques to treat lung and esophageal cancer. For appointments, call 914.493.8793.
A nationally recognized vascular surgeon, educator, and researcher, Dr. Fulton completes complex surgical and endovascular procedures on the most delicate structures in the body, treating a wide spectrum of peripheral vascular conditions, including carotid artery disease, peripheral arterial disease, and aortic aneurysms. For appointments, call 845.483.5934.
Dr. Kwon specializes in utilizing minimally invasive endovascular technology to perform vascular repairs and reconstructions. He has a unique clinical interest in complex endovascular vein treatments, thoracic outlet syndrome, and reducing wound complications following vascular surgery. For appointments, call 845.483.5934.
WMCHealth.org/LakeKatrine
1561 Ulster Avenue, 2nd Floor, Lake Katrine, NY 12449 • 845.383.1759 Westchester Medical Center Health Network includes: WESTCHESTER MEDICAL CENTER I MARIA FARERI CHILDREN’S HOSPITAL I BEHAVIORAL HEALTH CENTER MIDHUDSON REGIONAL HOSPITAL I GOOD SAMARITAN HOSPITAL I BON SECOURS COMMUNITY HOSPITAL I ST. ANTHONY COMMUNITY HOSPITAL HEALTHALLIANCE HOSPITAL: BROADWAY CAMPUS I HEALTHALLIANCE HOSPITAL: MARY’S AVENUE CAMPUS I MARGARETVILLE HOSPITAL
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• May 4, 2017
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Ulster Publishing Co.
COURTESY OF ALBANY MEDICAL CENTER
Albany Medical Center, affiliated with one of the nation’s oldest medical colleges, has been able to attract specialists in a growing variety of fields. the plusses of staying local. “The advantage our system has to medical centers in the city are our deep roots in the communities we serve and, most importantly, the convenience and accessibility we provide,” Rojas said of the Health Quest system. “Patients and their families can stay close to home and be assured they will receive compassionate, top-notch care.” “We’re also an upstate culture,” Frisch of Albany Med said. “I think the people who work here are comfortable
for upstate folks.” Being part of a local culture can mean greater responsiveness and willingness to innovate on the part of healthcare systems. Everyone is looking at two main characteristics in the Hudson Valley, Scarpino said, an aging population and "underlying behavioral health conditions that have resulted in an epidemic of addiction issues.” More psychiatrists are needed, he said. Until that gap
Are shoeless homes healthier?
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hat’s the story with taking shoes off in homes? According to a flurry of new stories on the practice, which is commonplace in much of the world, shoes carry piles of microorganisms, including sometimes dangerous bacteria, into homes. That can mean trouble for those more susceptible to germs, such as the very young or seniors. The stories all reference a recent University of Houston study that examined the prevalence of a specific bacterium, Clostridium difficile (C. diff ) that is responsible for nearly a half-million annual infections in the U.S., according to the Centers for Disease Control and Prevention. In their research scientists found that 26.4% of shoe soles tested positive for C. Diff, about three times the number found on the surfaces of bathrooms and kitchens. Other studies have similarly found increased amounts of other bacteria, including E. coli, tracked into homes on shoes, even when they’ve been wiped repeatedly on a welcome mat. As for worries about people’s bare feet or socks, it turns out the outside of a shoe is much dirtier than anything on the inside.
PUBLIC DOMAIN PHOTO
Whether left outside or inside one’s door, shoes shed when entering a home mean leaving troves of germs and bacteria as well.
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Ulster Publishing Co.
can be filled, Westchester Medical has been pushing the idea of telemedicine, which it has found has works well with younger populations who've grown up raised on computers and smartphones. he consolidation of America’s 4862 community hospitals is continuing. For the last several years, the number of mergers has been about 100 annually. According to the American Hospital Association, most of the 27 hospital transactions in the first quarter of 2017 were for not-for-profit health systems merging with in-state counterparts. No matter what the circumstances, the partnership principals usually say much the same thing. Here’s one from a Wisconsin merger last summer, chosen more or less at random: “By more closely aligning our two organizations, our leaders can increase access to care
May 4, 2017 • 27
for patients and further build a smart, efficient delivery system that optimizes the best of both organizations and cares for patients where and when they need care.”
Where do Hudson Valley families turn when touched by autism?
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• May 4, 2017
Healthy Hudson Valley
Ulster Publishing Co.
To insure or not to insure? Extracting the truth about dental plans
PUBLIC DOMAIN PHOTO
Dental insurance is good at covering basic cleanings and cavities.
by Harry Matthews hen I was a young buck living in the city a long time ago with no health insurance let alone a dental plan, I woke up one morning with an excruciating pain emanating from a certain tooth in my mouth. Though I had always done my best to take care of my teeth I don’t think I had been to see a dentist since I was 15 years old and still living at home. As I hadn’t had any emergency-like need to see a dentist, it didn’t occur to me to have regular check-ups. Ah, the sublime foolishness of youthful bravado.
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In my neighborhood in Brooklyn there were a number of dental offices to choose from, though, like the neighborhood itself, some looked as though they had seen better days. Where was a young cranky-feelinghead-exploding-with-pain-young-upstart going to go? I popped a few Advil and called a close friend who had just had a tooth pulled to ask his advice. Where had he gotten it done. Thankfully, I did as he told me before I did anything that needed what is known as a dental discount plan. He had paid $99 for his plan, and then got the tooth done for free from a very friendly dentist four blocks away. I took down the name and number of the plan and 20
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Healthy Hudson Valley
minutes later had a plan of my own. Four hours after that, I was leaving said dentist’s office with a numb face, a script for some stronger painkillers, and a freshly done root canal that would have cost me $350 but that I only had to pay $50 for. And to think that that morning I had never even heard of a dental discount plan. ears later, with the body starts showing signs of wear and tear (a friend said to me recently that when you hit 50 the warranty is up and things just start breaking down), the teeth are going to need
Y
May 4, 2017 • 29
some attention from time to time. Some out there have been lucky enough to have steady jobs that offer dental plans as part of their HMOs, while others might live near a dental college that offers steeply discounted services. Then there are those of us who pay for their health insurance out of pocket, and having a dental plan is an option that is not always easily affordable. I’m not complaining, I make my bed every morning and sleep in it every night. I accept the choices I’ve made in life. If I choose to have or not to have a dental
Feeding a better beard
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hat’s the relationship between food and beards? Recent articles have started coming out in the nation’s main daily newspapers, debunking the use of multivitamins to boost beard growth. Instead, all have been saying, try a diet rich in proteins and fiber. Food recommendations we’ve seen include spinach, pumpkin seeds, cinnamon, bell peppers, sweet potatoes and carrots, lean meats, tuna, sardines, and salmon, brazil nuts, orange juice, raisins, eggs and beef. What, no craft ales or ciders? Not if you’re building testosterone and dihydrotestosterone (DHT), the basic tools for beard growth.
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What makes for a healthy beard? The right foods, medical and beard professionals are saying, include not just craft beers in Brooklyn-like settings.
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• May 4, 2017
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WIKICOMMONS
Dental work is an afterthought to many American health plans. It’s covered for kids and those who have entered the Medicare or Medicaid worlds. plan is something I can live with. That said, I am a big fan of Obamacare. Before the
enactment of the ACA I could not have afforded to have any health insurance, and luckily I didn’t have any ma-
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jor medical issues. Today I have been insured for over three years, and thankfully so as I’ve had some small yet serious enough occurrences to have a primary-care physician to look out for me. Despite the benefits, there are certain drawbacks to the ACA and the healthcare marketplace here in New York State. First, my health insurance has changed each year for no apparent reason, each time for seemingly better coverage for less money. Bu this did not turn out to be entirely true. Last year I was offered a new plan that for a little extra included both dental and vision. So I jumped at it. It wasn’t until I had an old filling fall out and needed to find a network provider that I understood why it was so inexpensive. When searching the insurance company’s website the only dentist I could find turned out to be 20 miles away, which didn’t bother me, but when I showed up at the address, literally across the tracks in a slightly rundown part of town, the office looked so fly-by-night that I seriously considered skipping the appointment and paying out of pocket at a more trustworthy establishment. I chose to keep the appointment and unfortunately my fears were not unfounded. The work they did all fell out within the month. Stubbornly, I went back two more times, only to have the same result happen. y insurance plan changed again this year. I opted for one with larger medical-provider coverage so I could have more choice when it came to pri-
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May 4, 2017 • 31
mary-care doctors but no dental plan. Dentist-wise I was back to square one. I have still yet to decide which direction I will take. In researching this article on the internet I found loads of dental-insurance options as well as dental discount plans that both had their pluses and minuses. HMOs often use what is called “managed care” that by and large seem to have the most limited options when it comes to choosing a dentist. Conversely, a dental indemnity plan, or “fee for service,” as it is known, make the insured pay slightly more out of pocket but offer a much wider choice when it comes to picking your dentist. Both types of plans cover basic dental healthcare such as cleanings, X-rays, and sealants. Basic procedures which might include treatment for gum disease, extractions, fillings and root canals often come with deductibles, co-pays and co-insurance determining the patient’s out-of-pocket expenses. Dental plans through your job can cost anywhere from $20 to $50 per month, while paying for your own plan can set you back $300 to $400 a year. Dental discount plans are slightly cheaper but may have higher co-pays. If you don’t have insurance but know a dentist you like, ask them what insurance they accept or whether they participate in a discount plan. You may also research discount and insurance plans, their provider networks, costs, co-pays, and general coverage. Find out what might work best for you and your needs. And don’t forget to floss. A healthy tooth is a happy tooth!
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The age of the ultramarathon Long-distance running has its benefits and its challenges By Violet Snow
A
t the age of 59, after believing for my whole life that I was not the kind of person who would ever run a mile and three-quarters without stopping, I took up running. That distance, my personal best, is paltry compared to the 50 miles runners will cover in Manitou’s Revenge, the Catskill Mountains ultramarathon on June 17 and 18. And yet the principle is the same — our potential to achieve the seemingly impossible. I live in Phoenicia, where endurance-sports enthusiasts gather for kayak races on Esopus Creek whitewater, cycling competitions up and down the cloves, triathlons on nearby mountains, and long-distance runs. But the
ultramarathon may be the toughest of all these sports. It takes a contestant anywhere from eleven to 24 hours to complete what the Manitou website calls “a grueling, gnarly, nasty course with approximately 15,000 feet of climbing, much of it rocky and precipitous... To make matters worse, the course gets progressively more difficult as you go along! And to top it all off, the average runner will have to tackle this hardest terrain in the dark.” Sounds like fun, right? Christopher Fey, who lives in the High Peaks of the Adirondacks, completed the course in 15 hours in 2014, and is looking forward to beating that time this year. His friend Jan Wellford, who set the course record of 10 hours and 51 minutes in 2014, will also be returning to tackle Manitou.
VIOLET SNOW
Ultramarathons, such as the one our author writes about passing through Phoenicia, are rugged affairs, not quite the spectator sport some may wish they could become.
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Aside from the rush of accomplishment already noted, what motivates runners to subject themselves to such a punishing challenge? “It’s not really a race as much as an event,” said Fey. “I’ve done competitive bike racing, which is pretty cutthroat. On the trails there’s more of a festival atmosphere, people supporting each other. It’s a community of people who enjoy being outside, being on the trails, pushing themselves hard for whatever reason.” Yes, but what reason? Some participants do have a competitive spirit. “They like to move fast,” Fey explained. “Others have an addictive personality. There are a lot of ultra runners who have had other addiction issues, and they’re substituting one addiction for another. For me, it’s just having a goal, having something to train for.”
Fey switched from cycling to running when his children were born. Although he no longer had time to train on a bike, he could push a jogging stroller. Now that the kids are four and six years old, he can run on his own twice a day, choosing among early morning, lunch break, and after work. He describes himself as a teacher who works extensively with ninth graders who are at risk of dropping out. “No wonder I run so much,” he explained. The 2014 Manitou was the first 50-miler Fey had ever run, a big step up from the 30-mile races to which he had been accustomed. In the past two years, he’s done two 100-milers. He used to go mountain climbing in Alaska and has met a lot of mountaineers who became ultra runners. “Mountain climbing is perfect training,” he said. “I have two kids, so I can’t just go climbing in
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crazy-dangerous places. In a marathon, I’m not going to get injured.”
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Fey, 39, trains 30 miles a week in the winter, building up to about 60 miles a week leading into an ultramarathon. His practice miles are “mostly slow, very hilly miles on trails.” He also does strength training for his legs in the off season. The Adirondacks give him plenty of chances to train on rugged terrain — and yet, he’s impressed by the Catskills. “It’s a stunningly beautiful race, and I like the cool little towns.”
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he course begins near Windham up in Greene County and follows parts of the Long Path, a 357mile hiking trail that extends from the George Washington Bridge to Altamont in the Albany area. Runners scale Blackhead Mountain and Stoppel Point as they head toward the North/South Lake area near Tannersville. Climbing and descending Indian Head,
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Twin and Sugarloaf mountains, they reach Mink Hollow. Then it’s on to Plateau Mountain, Silver Hollow Notch, and Edgewood and Carl mountains. Coming down Tremper Mountain, contestants emerge onto Plank Road, which leads them to the finish line in front of Phoenicia’s parish hall. Many of the uphills require hiking or climbing rather than running. “Uphill tires you out,� said Fey, “but downhill beats your legs up. I use lightweight trekking poles, so I can put weight on my arms going downhill and on terrain with a lot of rocks and roots, where you have to take long steps or jump down. There’s tons of that in this race. If you’re a road runner only, you’d fall down quite a bit. You have to train on that type of terrain to stay upright.� Ultras require careful attention to factors that road
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or you can get sick,” said Fey. Because of the remote location of the course, support stations are often two to three hours apart, so it’s important for the participants
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to know how much food and water to carry. The eight or nine stations on the Manitou are provisioned with liquids, glucose gel packs, soup, peanut
Kingston telemedicine expands
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Telemedicine allows specialists to work with patients throughout the region when the patients can’t make the trip to the hospital. Seen here is one of the new telemedicine centers at Westchester Medical Center in Valhalla.
S
tate-of-the-art telemedicine technology linking HealthAlliance Hospital with the specialized Westchester Medical Center Health Network telehealth operations center in Valhalla is now up and running, a recent press release from the regional hospital system noted. The idea is to provide “personalized care from advanced WMCHealth specialists without having to travel to visit them.” It’s all started with “telestroke” medicine, to be followed
by telepsychiatry, teletrauma and teleICU services. The new programs connect all HealthAlliance hospitals with WMCHealth’s eHealth operations center, which is staffed by medical specialists utilizing 20 multimedia stations to monitor patients in real time, with vital signs, medications, blood test results, X-rays and other pertinent information from bedside monitors getting sent to the eHealth control center through high-speed data lines.
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butter and jelly. At each one, Fey grabs some nourishment and stocks up on food and Gatorade for the next few hours. Sometimes he cleans his feet with alcohol pads and changes his double-thickness merino wool socks to prevent blisters. After a stop of one to five minutes, he’s off again. A wrong turn in the woods can send a runner temporarily off-course, and weather can be daunting. In 2015, early-evening thunderstorms meant near-darkness at 8 p.m., plus bumps and bruises from navigating slippery rocks in the dark. All applicants are screened to make sure they have the experience to handle the course. Even so, almost a quarter of the participants drop out before the end. Last year 94 runners were accepted into the event. Of the 72 who finished, nine were women. In 2013, notes the
May 4, 2017 • 37
website, “The top five across the line were the youngest in the field, and yet we had four finishers in their sixties! Also an interesting note, no women dropped from the race.” “A lot is psychological,” Fey observed, “having the confidence that you can do it. At first you don’t even believe you can do it. You don’t realize what you’re capable of.” That’s exactly why the ultra fascinates me. Not that I’m going to go out and start training for a 50-miler. But just knowing it’s humanly possible to cover 50 mountainous miles in under 24 hours — the very concept expands my understanding of what we can do if we set our minds to it. For more information, see http://www.manitousrevengeultra.com.
Green seniors do better
A
new British study has found that urban green spaces have a tendency to boost older people’s mental well-being. The study out of the University of York tracked a group of people 65 and older who wore portable devices that recorded their brain activity as they walked in both busy and green urban locations. The participants experienced changes in levels of excitement, engagement and even frustration as they
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moved between busy and green areas, and showed markedly better benefits from being in green spaces, preferring them because they were calming and quieter, according to the study. While not groundbreaking news for the Hudson Valley, the study is being pegged for policy discussion regarding more effective senior care. The study was published in the International Journal of Environmental Research and Public Health.
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Ulster Publishing Co.
Bionic knee WIKICOMMONS
The knee, like all human joints, may look like the simplest of things, and yet its tied to all, as the old ditty goes. Surgery on any joint’s replacement involves a much more complex recovery than many suspect.
The story of my long recovery from surgery By Gail Beverly
W
hen it became clear that I’d have some time unencumbered by a day job last spring, I decided to go ahead with a knee surgery I’d been putting off. It
was encouraging to read about new techniques, such as makoplasty, one of a class of new robotic techniques that allow replacement of just one or two knee compartments rather than an entire knee. MAKOplasty has a registered trademark. Why replace an entire joint when you can just fix the
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broken part? Made sense to me. Vassar Hospital, it turns out, is the only place between Putnam County and Albany that offers the procedure. I was wary about going to a hospital. Further research pointed me to Dr. Frank Lombardo of Orthopedic Associates of Dutchess County, an expert in the new procedure. I made an appointment. Because only one component of my bad knee was destroyed and the other two were in good shape, I was a great candidate for the new single-compartment replacement surgery. Dr. Lombardo told me, though, that for my type of operation makoplasty was not necessarily the best option. He assured me he could do an even better procedure by hand. He had done hundreds of these procedures successfully, he told me, and it could be done on an outpatient basis in the surgery center associated with his medical practice. After more research on the surgery center and the practice, I decided to go with the non-hospital outpatient option. Although the makoplasty articles highlight patients who experience “little pain” and are out for “only two weeks” from work, I can now tell you that there are actually four sources of major pain during the knee replacement process. These are: 1) Trying to get an estimate of how much you’ll need to save up for the co-payment part of the surgery bill (getting an estimate from your insurance company, involving a “code,” is a classic Catch-22). 2) Scheduling the surgery. One might be forgiven for thinking that a physician’s practice and an associated
May 4, 2017 • 39
surgery center owned by the same people would coordinate their scheduling. But no. 3) The no-joke recovery and requisite physical therapy of about seven or eight weeks also hurts a lot. But it’s worth it, with physical therapy the ticket if practiced more than three times a week. In the early days, many of my efforts looked an awful lot like that great scene in Kill Bill I where Beatrix Kiddo has escaped from the hospital and hauled her half-paralyzed self into her now-dead rapist’s awful yellow Pussy Wagon, where she spends hours willing her big toe to move. 4) Paying for the surgery. It’s expensive. Ouch. had the operation. I was in and out of the surgery center in six hours. And then I was bionic, cleared to go out into the world walking once again like a normal person instead of one with a perpetual limp about two months after my surgery. I had yet to experience the most surprising part of the recovery journey, the part that no one talked about. No one. What happens during the surgery is that all your tendons, ligaments, muscles and vessels get pushed out of the way so that the doctors can get to the parts of the knee that are to be replaced. This takes unencumbered space, and you can imagine that they can’t have any pesky, stringy things in the way. Really, you wouldn’t ask your car mechanic to replace a fuel pump or an alternator with a bunch of string and tinsel and little green twigs in the way.
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But my knee told me very clearly afterwards that they weren’t where they needed to be yet. They hurt inside the joint. Something in my knee would snap when I bent it. Sometimes something would get stuck, and the pain would cause me to limp all over again. I didn’t panic over this. It felt sort of like the kind of pain that I’d experienced before with my neck slipping out of place or my back going bad for a few days. It’s not fun. You just deal with it. If I kept moving and sleeping and do range of motion exercises, I figured something would eventually happen to put the irritated joint back into place. I’d feel magically better. I resolved to find exercises that would help the ligaments and tendons find their right place again. What amazed me was how critical getting through this undisclosed-to-me phase in recovery is to being able to benefit from the surgery. Just as with the surgery, your physical-therapy regimen is not going to get you where you want to be if you can’t exit the post-physical therapy phase of recovery. You can “graduate” from
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physical therapy and still be in pain the rest of your life if you don’t deal successfully with healing after your physical therapy. This involves two aspects, getting the innards of your joint in their right place again and training your body to put equal weight on both legs when walking, to even your stride, and to keep fully bending the repaired knee when you are walking. What I didn’t anticipate was what this was doing to the rest of my body, which had been compensating for my bad knee for several decades. The change in my stride threw my hips and back out, as they were not used to the new balance in my step and posture. Fortunately, being an unduly healthy and fairly active person. I was able to overcome the issues described above through daily exercise and perseverance. How would patients less healthy, mobile and optimistic than I deal with their physical state during this phase of recovery? Does the 70-or-80-year-old patient suffer through the surgical pain and then the months of physical therapy
Mental health plays second fiddle
A
new analysis of data from the Centers for Disease Control and Prevention’s national health interview survey shows that serious psychological distress, or SPD — defined as severe sadness and depressive symptoms that interfere with a person’s physical wellbeing — is rising in America, especially its more rural portions, That’s partly due to attitudes towards mentalhealth help. Researchers from NYU’s Langone Medical Center analyzed almost a decade’s worth of data and found that estimated 3.4 percent of the nation’s adult population suffers from a serious
mental-health issue. Lack of access to professional help because either of insurance policies that don’t cover such things or that they live where such help is minimal has left 9.5 percent of people without help. The problem is worsening as self-medication increases, causing its own problems. The underlying problem, report authors say, is that mental health still plays second fiddle to physical health when it comes to checkups. And all such conditions are still stigmatized.
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only to be left with a joint that is permanently painful because the tendons never find their place again? How do they train their bodies to readjust to a changed stride and balance. Do they wind up with persistent hip and back pain because of having their knees fixed? Who is there to help them deal with the post-physical-training recovery phase? ’ll share the exercises that I found to be helpful in getting my knee, hips and spine back into balance. Everything in its place. I do these exercises lying across a bed on my back, so that my feet hang over one side. I do knee bends with my head flat or supported by a medium pillow, arms at the sides, palms down, hands under hips. I lift my legs up at a 90-degree angle to my chest and then bend at the knee, right and left separately, as much as I can. I do 50 knee bends every morning to get my knee going. I do leg raises from the same starting position, at a 90-degree angle from my chest (the bottom of my foot is parallel to the ceiling), lowering my leg slowly to the bed. I do 50 of these. I do prone knee curls, bending my knees and bringing my feet as close to my hips as I can. I do 20 every morning, sometimes standing up. I do at least 30 double leg lifts without a pillow supporting my head because I want to ensure that I don’t strain my neck. I also do double leg-lift/knee-bend combinations in groups of ten, 15 and 20 depending
I
May 4, 2017 • 41
on how I’m feeling. I undertake regular reclining hamstring stretches, bringing both my knees to the chest at my sides and holding for 20 or 30 seconds to feel a nice stretch. I undertake foot circles to ensure that my knee’s tendons and ligaments are in the place they want to be. For all these exercises, there’s a really important admonition: Remember to breathe! It will help develop body awareness, flow and mindfulness as you remind yourself to inhale and exhale fully. Don’t hold it in. My hope in documenting this experience is that other folks going through a knee replacement will better understand the challenge of the post-physical-therapy phase of their recovery. Perhaps the exercise regime that helped me will also help others to snap all those stringy inner parts into the right place where they want to be.
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Mental postcards Animal communications involve several levels of meditation
PUBLIC DOMAIN PHOTO
Canine communication comes in many forms. The key to a good relationship with one’s dog, our Woodstock-based author notes, comes down to listening with more than one’s ears. By Cindy Brody
O
ur relationships with our dogs are very deep. Our dogs are always watching us, and they are affected by our moods and fears. I’m an animal communicator. I help
to resolve all kinds of problems. Separation anxiety around vacations is one of my favorite subjects. When we travel, we can’t always take our furry best friends with us. But no one needs to suffer. We can ease their stress by making sure they will be connected to us while we are away. We can send them
Rhinebeck weight-loss surgery To help people break the cycle of weight gain and improve their quality of life, Healthquest’s Northern Dutchess Hospital recently launched a weight-loss surgery program that offers minimally invasive gastric bypass, sleeve and band surgeries. The surgeries change the anatomy of the digestive system to decrease hun-
ger, absorb fewer calories, and burn fat more quickly. A complimentary dinner seminar about the new program, “When Diets Don’t Work: A Look at Weight Loss Surgery,” will be held at 5:30 p.m. Tuesday, May 9, at Frank Guido’s Little Italy in Kingston. Call 554-1734 to reserve a seat.
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ELISABETH HENRY
Some dogs make the best babysitters, while many babies make the best dog listeners. something I call “mental postcards.” Annabelle, a rat terrier, used to literally go nuts when her human mom, Fran, would go on vacation. She would refuse to eat and she would pull the hair out over her lower back. Depression would move in like a dark cloud. Fran decided stay-at-home vacations were all she could manage. Then she was invited to go on the trip of a lifetime, traveling through India for three weeks. Annabelle and I chatted. She told me that Fran was her life, and that she couldn’t bear the thought of being separated from her. This is classic separation anxiety. I looked into her eyes and told her about the plans that Fran was making for her in her absence. She would get to stay at home with one of her favorite people. They
would play ball. They would sleep together. There would be special treats. I told her that Fran was going to be so happy to go and have a great time, and that she knew that Annabelle would have just as much fun at home. I could feel her energy shifting. The anxiety was lifting. Annabelle was relaxing. Next I gave Fran the instructions for mental postcards. Every time she got excited about the trip she should share her feelings with Annabelle. As the trip date neared, Annabelle showed no signs of stress. When it was time to go Fran simply said goodbye, and off she went on her dream-come-true trip. She was gone for three weeks, and sent Annabelle mental postcards every day. When she returned home,
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ELISABETH HENRY
The literature is filled with the health benefits our pets bring us. Animals help limit human stress and provide both perspective and companionship. she found Annabelle had had a great time and, though very happy to see her, was quite self-contained. During Fran’s absence, she had eaten every meal and had never touched her fur.
A
mental postcard can also be sent in the form of a prayer, a meditation, or just a kind thought. Blind studies performed in hospitals have shown that people who are prayed for heal more quickly and with fewer complications than those who are not. Imagery work is very powerful, and all animals are amazing receivers of this type of energy work. I speak with ani-
mals all over the country by using these skills. I also send healing energy to animals that are sick or hurt. No matter how far away they are, they receive energy, and it helps them get better. Many people will tell me that they hide their suitcases until the morning before they leave on vacation. This can really stress some dogs out. Nobody likes these kinds of surprises. You need to prepare your dog. Start telling him or her a couple of weeks before your trip. Let him know whether he is staying home or if he will be with friends. Remind him of how much fun he had the last time at Aunt Jill’s.
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If he’s going to a kennel, take him for a visit. If you get strong feelings that he doesn’t like a particular kennel, try a couple more. Choose the one about which he gives you the best vibes. Making him a part of the decision will make everyone feel better. There are a lot of people who pet-sit for a living. More and more people prefer to leave their animals at home, and when you don’t
Wayne W. St. Hill
May 4, 2017 • 45
have a family member to come and stay with your dog pet-sitters are a great option. If you have a dog that is socialized, you can find a boarding kennel that shares your philosophy of dog care. Make sure you visit this kennel with your dog a couple of times, so he’ll be familiar with it. Once you find the perfect fit, you can tell him he’s going to camp.
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Make sure you bring him a couple of things from home that won’t be missed if they get lost or chewed up. I suggest an old t-shirt that has your scent; they make a great comfort blanket.
H
ere’s how we send mental postcards in the form of meditation: Find a quiet spot to sit, and then close your eyes and tune into your own breathing for a few minutes. This will help to get you more in the moment. You can start by thinking about your dog.
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Imagine his face and simply send him your love. You can also send your thoughts in the form of snapshots. “Hey, Rex, I’m on the beach and I’m having a really good time. I’ll be home in a couple if days.” Tell him you’re having a great time. If you feel a stress that doesn’t go away, call your dogsitter and check in. It will help to alleviate stress for both of you. If you spend your vacation worrying about your dog, that is the mental postcard he will receive. When you’re good, your dog is good.
Which seniors get scammed?
N
o, it’s not just poor judgment or financial acumen. A new study by Cornell University’s Laboratory of Brain and Cognition has found that a pair of major differences in the brain may help distinguish which seniors are at risk of falling prey to financial scams. Such scams have been found to affect about five percent of older adults after age 60. The study evaluated older adults who had been robbed by family members or neighbors, or scammed online or by phone, and then compared that group to peers who’d been exposed to a potentially exploitative scheme but recognized and avoided it. More anger and hostility in those who’d been scammed proved the only behavioral difference that emerged between the groups. The brain images were more telling: Exploited seniors showed more shrinkage and less connectivity in
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two key areas of the brain. The anterior insula, which signals when something significant is happening, was significantly reduced in the exploited group of seniors, which suggests their brains weren’t signaling that they faced a risky situation. And the medial prefrontal cortex, which helps read social cues such as people’s intentions, also showed more shrinkage and fewer neural connections in this area. Researchers found the networks of both affected brain regions were more connected to each other, suggesting that the combination of effects might leave those seniors more vulnerable to scams. The study was published March 28 in the Journals of Gerontology. More studies are now being started to expand on the findings, possibly establishing means for better predicting who’s susceptible to scams.
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You can also think of some image with personal meaning for you. It can be a memory of a tender moment with your dog, or you can send him a mental picture of him surrounded by a glowing red heart. It comes from your heart and from your love. It is really pretty simple. There is no right or wrong way to do this. He will feel your love and caring from long distance, and it will be calming and connecting for him.
Health Quest launches GetFitHV
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May 4, 2017 • 47
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eginning Saturday, May 13, Health Quest is kicking off a new GetFitHV.com website that offers fitness tips, healthy recipes and a fitness contest with entries at more than 80 check-in Get Fit workout locations. There will be raffles for prizes ranging from local gym memberships and sporting goods store gift cards to an Apple Watch grand prize. There is no cost to take the Get Fit challenge. To celebrate the spring challenge, Health Quest is hosting a Get Fit kickoff party from 10 a.m. to 1 p.m. Saturday, May 13 at Upper Landing Park, 83 N. Water St., Poughkeepsie. To take the challenge and learn more about the kickoff, sign up at www.getfithv.com.
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IN EMERGENCY CARE, IT’S ABOUT EXPERIENCE. OURS AND YOURS. Another way we’re investing in you. At HealthAlliance Hospital: Broadway Campus, a member of the Westchester Medical Center Health Network (WMCHealth), it’s all about experience. We’re board-certified in emergency medicine, nationally recognized for our stroke care and we use the latest in telemedicine to give our patients access to the region’s leading specialists. Our patients tell us we make their experience exceptional by treating them with the utmost respect and clearly communicating about every step of their care. The Emergency Department at HealthAlliance Hospital: Broadway Campus. Another way we’re Advancing Care. Here.
hahv.org Westchester Medical Center Health Network includes: WESTCHESTER MEDICAL CENTER I MARIA FARERI CHILDREN’S HOSPITAL I BEHAVIORAL HEALTH CENTER MIDHUDSON REGIONAL HOSPITAL I GOOD SAMARITAN HOSPITAL I BON SECOURS COMMUNITY HOSPITAL ST. ANTHONY COMMUNITY HOSPITAL I HEALTHALLIANCE HOSPITAL: BROADWAY CAMPUS HEALTHALLIANCE HOSPITAL: MARY’S AVENUE CAMPUS I MARGARETVILLE HOSPITAL