Healthy communities 2015 composite esub by Ulster Publishing

Healthy Hudson Valley AUGUST 6, 2015 • ULSTER PUBLISHING • HEALTHYHV.COM

Healthy Communities

It's all about relationships

Between patients and practitioners, hospitals and practices, insurers and industry, what really keeps us healthy.

6, 2015 2 | August Healthy Communities

Getting to the heart of healthcare Elisabeth Henry recounts the lessons learned from a slowarriving family emergency

t was 1975. Lily Tomlin, backed by Howard Shore’s All Nurse Band, sang “St. James Infirmary” on Saturday Night Live. Oh, the arch, transvestite humor. Lily Tomlin’s deadpan, wry gaze as she lounges cat-like on the piano. Hilarious. Unforgettable. I remember the catchy chorus of the tune: Heart, heart, heart Got your Pappy Heart, heart, heart Your Mammy, too Heart, heart, heart Got your baby And heart, heart, heart … is gonna get you! I sang it that night after the show as I hailed cabs to go clubbing, and would hum it decades later through all the permutations of my life. It cheered me, and why not? My childhood in a fiercely fit, athletic family and my lifelong love of slapstick made me open to the logic that a heart attack was comic fare. There was nothing deadly in it. In fact, heart attacks, to me, were a form of slapstick. (See Krusty the Clown’s heart attack on the air, in The Simpsons, circa 1986.) Hearts just didn’t stop beating, did they? Could they? Just like that? One night last November my husband and I were watching It Happened One Night on TCM.

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were wearing eau de ammonia. Crackling noises come from his chest, like Twinkies in a package trying to be born, alien-style, through his sternum. He stops coughing and smiles at me weakly. Stunned and shaken, I resort to scold-mode. I inform him that he is going to the doctor, and

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Our contributors ... Lynne Crockett is a professor and writing program administrator at SUNY Sullivan who writes a monthly column for the Shawangunk Journal. She has published her creative nonfiction in literary anthologies and journals. Jen Holz raises sheep, chickens and kids in the Catskills and was a longtime columnist for The Phoenicia Times. Recent transplant to the area Amanda Howard, now on the hunt for the perfect pancake, is overwhelmed by the region’s pizza options. She worries she knows way too much trivia about Buffy the Vampire Slayer. Harry Matthews lives on an old farm on the Kaaterskill Creek outside Palenville with his partner Catherine and their three cats. He can most often be found in the woods building things, gardening, or plucking his tenor guitar on the porch of his cabin by the creek. Annie Nocenti makes films and comics, has taught film in Kingston and Haiti, lives by the Esopus Creek, and is the sprout of a doctor-father

and mother-pharmacist with a big mortar-andpestle collection. Her work can be found at www. annienocenti.com. Hugh Reynolds has been a political columnist covering Ulster County characters and activities for more than a generation now. A staff columnist for Ulster Publishing, he occasionally needs dental care. The images in his story were by Phyllis McCabe. Paul Smart, a writer and editor for Ulster Publishing, has edited a number of regional weekly and biweekly newspapers. He lives in Greene County. Violet Snow, a journalist, author and frequent Ulster Publishing presence, specializes in history, genealogy, suspense fiction and nature, and also expresses herself through photography, video and music. This issue’s cover is of Dr. Mario Catalano, an Ulster County resident who started his dental practice in Catskill in the 1970s. His story can be found inside. The photo is by Catskill-based photographer Fawn Potash.

soon. Like. Now. But he wouldn’t ... so fast forward a few uneventful days. The very excellent PA Allie suspects pneumonia, but just to be on the safe side orders a stress test. He resents her, but more me. Days later, we sit in a huge sitting area, akin to an airport lounge, or rather God’s Waiting Room. Everyone looks old. Even those who look youthful enough to be insulted by my last comment, have trouble getting out of chairs, or hearing the receptionist scream out a name, and have no interest in that luscious snapper-shrimp-mussels dish just created on TV on the ubiquitous food channel. My husband yawns as he reads The Wall Street Journal. As I study the room, I am both dismayed and fascinated. What the hell is happening? Has the whole world been fumigated with geezer spray? Everybody looks dusty. I recall that New Year’s Eve scene in Zardoz. It gets worse. The receptionist screams out my husband’s name. Twice. He rises, pats my head, and strolls wordlessly towards the scrubs-clad aide beckoning to him like Hermes at the swinging door. Twenty minutes later the receptionist screams my name, and I am ushered into another waiting room. This time, it’s a single. My husband is holding a plastic sculpture of a heart. He tosses it in his hand and places it back in its holder. A man/boy comes in, fit and tan and really young. I think that he may be a college student, interning here until the pool opens and his paying gig as a lifeguard begins. Nope. He’s the specialist. “Sir, I see a shadow on this test. I have made an appointment for you to have a cardiac catheterization,” he said quietly, respectfully. “The dye?” My husband motions with his hand as if to give himself a needle in the arm. “Yes, the dye, but we go through the leg … There’ll be plenty of time to talk that over with the specialist who does that.” “Okay, when do you want me to go?” My husband looks at me and shrugs, as if to say, whaddya gonna do? “Friday,” says Dr. Suntan. “Friday. Like … this Friday?” My husband is incredulous. I am rather pleased at how efficiently this office runs. n Friday I was taken aback by how very much this catheterization seemed so like a serious procedure. I had had imagined it might be like having cataract surgery, where you sit in what look like hair-salon recliners (there is a long, long row of hair-salon recliners, filled with people wearing shower caps) while technicians of various methods of expertise step up and down the rows, readying everyone for the quick ride into the room with the laser beams. Zap! You’re out! But no. My husband was given a hospital gown, a bed with a curtain, and the new doctor (this one looked just like the sound engineers I knew in Manhattan) gave us the drill. It sounded just like a drill, like he had given it 20 times that day already. It relaxed me. This was no big deal. He sent me out the door with a little plastic mouse that shuddered to tell me when to meet the doctor to confer after the procedure. Panera Bread has the very same little plastic things to tell you when your lunch is up.

I found a seat, some terrible, dog-eared magazines, and settled in. I pawed through my purse for the oatmeal cookies I had bought at the fundraiser in the hallway. My little plastic thing rattled on the empty seat beside me. I hurried to the conference room. Was there a mistake? Was he allergic to the dye? Had he misbehaved? The doctor came in, now flushed. “Your husband’s arteries are so clogged I cannot do the test.” He searched my face. “I have made an appointment to see the surgeon. Later today.” That Monday I left my husband at the big doors in the Cardiac Wing at 5 a.m. He had forbidden me from telling any of our children, since they are busy and far away. My choice was either to defy him and cause a cardiac event or face the wrath of my kids. No matter how big they are, they are still my kids and their wrath doesn’t scare me. But I prayed I wouldn’t face their feelings of betrayal and heartbreak alone. The nurse told me I might be able to see him some time after surgery was completed, around five or six that night. I drove the hour and a half home to feed my livestock. After 12 hours of surgery I was allowed to see him. He had had a quintuple bypass. Quintuple? How could that be? Did he have extra hearts? The nurse was sweet, but deflected all questions to the not-present doctor. My unconscious husband lay surrounded by a horseshoe-shaped array of machines, connected to him by tubes to every part of his body. In hindsight, the scene resembled so many where Captain Kirk and Mr. Spock try to determine just which wounded alien life form had been retrieved after the most recent war on that hostile planet. At the time I was disoriented. Luckily, in his mouth was

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a large tube, quite like a Cuban stogie, propped jauntily out the side, W.C. Fields style. I hoped he was dreaming he was winning at poker. I kissed his shoulder, and his lips moved a little. Very little. Then it was time to go. ecovery in the hospital was brought with the usual challenges. Usual for us, anyway. The Gypsy roommate (a real Gypsy) hated everyone except my husband. He would leave the door open while he sat on the toilet so he could talk to my husband. The orderly dropped my husband en route from critical care to regular care, thus dislodging my husband’s oxygen tube, leading to many breathless moments. Lucky orderly. My husband saved that story for home. Had I known, Albany would be missing one orderly. The family of his next roommate was so rowdy they were not allowed in en masse, so if I went in to the hallway, those who didn’t make the cut surrounded me with questions. Finally we were home. We told the children when they came home for Thanksgiving. Remember the wrath I mentioned? The girls cried. My son was ashen. The girls hissed their fury at me out of their daddy’s earshot but sent me flowers the next week. My son expressed nothing, but later that spring he quit his college football team. “If ever I have to take care of you and daddy, I can’t get my brains knocked out playing a game,” he told me on Skype. He was adamant. The scars are impressive. There is a thick, long one running down the center of his chest, and three sizeable ones placed strategically below. Those are for the drains. A gash and bullet holes. Knowing that they were earned in a life-saving procedure does not dull the impact of this sight, or erase the knowledge that he was cut open with effort, drained of all his blood while a vein was removed from his leg and used to make new veins to his heart. The old clogged ones are still there, as are the little, filament-like volunteer veins that kept him alive when the main rigging closed up. They inserted drains into the whole works, stitched him up, pumped the blood back into him, and revived him. All this was done to him. All this changed life for us forever. I will not speak for him about what it’s like to go from crawling beneath buildings in Manhattan to design underpinnings that will keep the buildings up for another 100 years to life as it is now. He is not able to fully articulate that yet. I will tell you that the children are more solicitous. They speak about making room for us at their homes. My son is not sorry about his choices. Maybe we will downsize: sell horses, sell land. Oh, sure, it’s sad. There was a time when all we had was a Jeep and a small, cheap apartment. For all we know, he was all clogged up then. But he’s fixed now. And gas is getting cheaper. We want to find a restaurant near the ocean that makes that snapper-mussels-shrimp dish, and oh, yes, with couscous and kale and raisins on the side.

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6, 2015 4 | August Healthy Communities

What my 97-year-old doctor knows Paul Smart talks with his dermatologist, who started practicing just before D-Day

fter years of unheeded prescriptions, I finally found a dermatologist this spring. Dr. Irving Milberg is 97 years old, practicing out of his home compound near the old Granit Resort between Accord and Kerhonkson. He’s accomplished, astute, and full of the sort of vast experience that translates into deep knowledge of his field, general healthcare issues, and the myriad ways in which our world has shifted over his lifetime. “They tell me that when I was a kid I would bring clothes to anyone I knew who got a cold,” this gentle man said softly, the sound of the waterfalls over which his home and office perch in the background. “I was always looking to help others feel better.” Milberg grew up in Brooklyn, born in Williamsburg and raised in Flatbush. His father had come over at the age of 18 from Romania, his mother at six from a place that had been Russian at times, Polish at other times, depending on the most recent war. He attended Erasmus Hall High School. He recalled that one of his classmates at the Brooklyn school, Ira Grossel, would later claim fame as the actor Jeff Chandler. Milberg went to Johns Hopkins University and in 1943 got his medical degree from the State University of New York Downstate Medical Center College of Medicine. He interned at SUNY Health Science Center at Brooklyn before joining the war effort and practicing medicine for the first time in England on the eve of D-Day. “I was a jock and won nine letters while in college,” he recalled. “I gained some acclaim as a baseball pitcher and was even offered a position with the New York Giants. Back in the day I got to know some great players, people like Rogers Hornsby and Lefty Groves ...”

ilberg decided to specialize on dermatology after he developed a rash on his hand during his sophomore year in med school. “Everyone said I should use starch and water to cure it and I asked why,” he said. “They didn’t

PHOTO BY PAUL SMART

Dr. Irving Milberg, seen here in his home ofﬁce in the Rondout Valley, laments the day when the health insurance industry stepped into the doctor-patient relationship. know. I went to one of my teachers and asked if I could have a lab to work within. He gave me one and I started to explore how colloids have a big effect on skin, especially in terms of inflammation. And it turned out to be a perfect specialty for me, involving lots of surgery, lots of psychology, and a constant chance for me to use my brains.” Assigned to a general hospital in England during the war, Dr. Milberg found that his dermatological specialty translated into a focus on the treatment of the various venereal diseases rampant in the military. He remembered, in particular, what happened after the army tried a pre-D-Day invasion of the French coastal city of Dieppe the year before his arrival. He said he treated hundreds of cases incurred during the two days the Allies spent before retreating. “After the war my wife and I moved to Fort Dix in New Jersey, after which I set up a practice in

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Brooklyn and eventually moved to Manhattan, where I moved my practice after becoming affiliated with NYU and other hospitals,” Milberg continued. “I kept offices on East 78th Street for decades even after moving to Westchester, and then back to Manhattan following my divorce.” He started working full-time for Beth Israel Hospital. In the early 1960s he opened a private practice in Ulster County. “I’ve got four kids, five grandchildren and three great-grand kids,” he said with a smile. “I pioneered the conjunction of dermatology and psychology after going back to get a degree in the latter,” he said. “Over the years I headed all the leading associations in my field.”

ow has medicine shifted over his 72 years of practice? “Few people had insurance when I started, and for years afterwards. People paid what they could. Your practice was based on the good relationship doctors had with their patients,” he explained. “If the guy was poor you didn’t charge him. Each patient was a person you got to know, and the same principles applied to doctors’ and patients’ relationships with hospitals. Now every decision involves what seems to be thousands of people.” Financial scandals in the 1980s uncovered the need for the insurance industry to “bolster its basics.” “Certain people recognize a good business when they see one,” he explained. “There were times when grants would pay for medical research, but then the market for new patents grew bigger and bigger. New medicines helped everyone a great deal, but they also shifted the way money works with medicine.”

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August 6, 2015 Healthy Communities In his own specialty, dermatology, Dr. Milberg said he’s noticed a shift away from old afflictions such as tumors and venereal diseases to the effect of food additions and the effects of chemicals and pollution on the skin. Cancers have grown more complex, but also more treatable. But, he added, people have become more apt to self-diagnose, and many have lost the sense of loyalty they had to their doctors in the past. “People’s use of the Internet can be terrible,” he said. He himself does use it, and does voluminous reading to keep up with all things in his specialty, medicine in general, and what’s needed to stay current with the psychological elements of his patient base. “There’s a lot of misinformation around,” he said, “as bad if not worse than when we had to deal with what people’s grandmothers had told them.” Milberg told a succession of anecdotes about “grandmother knowledge” back in the day, often involving treating grandma. How would the nonagenarian dermatologist summarize his views on medicine today? What words of advise and concern did he have? “Of all the civilized nations we have the worst system there is. The fact that medicine got to be a business saddens me to no end,” he said. “I think the Affordable Care Act is a good step in the right direction but it saddens me that we can’t muster the political will to do what’s really needed and move on to universal healthcare.” Dr. Milberg laments how careful doctors have become about the amounts of time they spend with patients, at the suggestion of insurers. That breaks the doctor/patient bond at the center of all medicine, in his view. He tells other anecdotes. Following a recent personal health scare he found himself having to use his experience to get to actually see a doctor while in a local hospital. While practicing in hospitals, he’s been reprimanded for spending too much time with a patient, or suggesting therapy against the will of an insurer. “This shouldn’t be a business,” Dr. Milberg said. “It was a calling.” What has he leanred, personally, over the decades he’s been practicing? “I’ve learned a lot about people; I’ve learned a lot about myself,” he answered. “And I finally left Beth Israel when this person I took to calling ‘the Armani lady’ started reprimanding all the veteran doctors for spending too much time with their patients, saying we should max that relationship out at 15 minutes... I started seeing more and more instances where computers were diagnosing, and not diagnosing correctly.” Will he retire anytime soon? Dr. Milberg smiled, looked out at the forest surrounding his office as a car pulled up. His next patients in a day full of them. “As long as my eyes are working, my hands are working, and my brain is working, why should I retire? he replied. He goes over how my own complaints have disappeared overthe months. Then suggests I take to wearing a cravat “ala Fred Astaire.” Because it’ll be good for both my fair skin... and my outlook on life. “I just can’t see waiting around,” he said. “What I know, what I do, still has value.”

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6, 2015 6 | August Healthy Communities

Becoming more than what one's parents wanted Amanda Howard writes about her ﬁance's residency, and his love for his career as a doctor

t different times throughout childhood, I wanted to be: a teacher, an oceanographer, a stay-at-home mom (‘cause mine was the best), a starship captain, and the next Stephen King. None of those things have happened. The thought of people who pick something at a young age, continue to want it, and then make it happen boggles my mind. In my informal poll of six doctors, more than half knew they wanted to be physicians from childhood. Eleven years old seems the magic number. How does a future physician go about achieving that goal? I was surprised at some of the answers. The quickest path is to get good grades, major in one of the sciences, go to medical school, get a residency in your preferred field, and then pass the state boards at the end of the residency. But that’s a pretty massive oversimplification. The quickest path still takes many years. There are other options. You can get a degree in agronomy and change your mind later, and as long as you do well on the Medical College Admission Test (MCAT), you still have a shot at getting into medical school. It’s not only about the hard science; it’s also about personality, suitability, ability to interact with patients. Several of my informal polling subjects went into research after college before deciding they wanted to be more involved in the medical field. One, a biochemistry major in college, decided to be a doctor during his junior year. He decided his

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The route to a medical practice is long. After med school, internships and residencies, most doctors ﬁnd they end up respecting what they do more than they did when they started. research job was “too quiet and antisocial,” adding, “Instead of test-tube babies, I’m working with real babies.” Another got his master’s in physiology and took a year break before starting med school. Yet an-

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other majored in medical technology in college, intending to be a veterinarian, before deciding that “human life is more important.” My fiancé is in his third year of residency. His med-school trajectory was a little different. He did not actually choose his path. Like many of us, as an undergrad he had been unsure of his future. His parents stepped in and decided he would be a doctor, and off to medical school he went. After a rocky beginning, he now couldn’t imagine having done anything else. Typically, med school consists of two years of basic sciences classes such as anatomy, pharmacology and biochemistry, and then two years of clinical science rotations. A rotation, a bite-sized hands-on class in different specialties, is designed to help students choose their path. Rotations can be all in one place, or scattered throughout hos-

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August 6, 2015 Healthy Communities pitals and organizations that have partnerships with the medical school. For example, my fiancé did a six-week psychiatry rotation in Nebraska, a two-month obstetrics rotation in Brooklyn, and a family medicine rotation in Kingston. The last eventually led to his residency here. After a fledgling physician has narrowed it down to one or two specialties, it’s time for interviews. Lots of research goes into choosing which programs to apply for, and the med student is responsible for paying for flights, hotels, etc. to those interviews Then comes, to this outsider’s opinion, the weirdest part of the med-school process, the match. The hospitals and medical programs rate all the students they interviewed. Just like a dating website, if the student and the program rate each other the same, they are matched, and that’s where the new doctor’s residency will be. The strangest part of the match is that it only happens once a year. If I apply for an accounting position, or to be a web designer, or a coffee-shop barista, and I don’t get the job, I can try again next week. If a medical student doesn’t match, he or she has to wait another whole year, filling in the time with additional classes, research jobs, or whatever else is available, before trying the process again

the following spring. It’s an intense undertaking, and the stress levels are astounding. After surviving the ringer that is Match Day, the real work starts. Residencies vary by specialty. My fiancé is in family medicine, so he’s here for three years. A surgery residency is five years, with more added on if the surgeon wants to specialize further. Most programs are three years, with options to continue with fellowships. Throughout the residency, the doctor learns not only about patient care, but about communicating with patients and the family, pharmacology, time management, and all the other things that go into making a doctor. Doctors must pass three cumulative tests to get to the next step, plus board licensing exams at the end. These exams cost thousands of dollars, and they’re on top of the hundreds of thousands of dollars in med-school student loans. The hours are legendarily long, the work is intense, and each year of residency adds more responsibility (i.e., teaching first-year students, running a solo case). I asked my fiancé what his favorite and least favorite parts of medical school were. He said his favorite was the variety of his rotations: traveling to different places, seeing how differently each hospital ran their programs, learning new things

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in new environments. His least favorite part, he said, For two years, he lived out of a suitcase, finding rooms and apartments to rent for a month or two at a time. Signing a one-year lease in Kingston was a shock, but now it’s home. If you’re thinking medical school might be for you, make sure you’re adaptive, patient (no pun intended), good at science, able to make quick decisions on little sleep, willing to take on some serious debt, and dedicated. The road is long. When you get to text your loved ones in the middle of the night and say you just saved a baby’s life, though, it’s all worth it.

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6, 2015 8 | August Healthy Communities

Dentistry has evolved Hugh Reynolds describes what Dr. Mario Catalano built in Catskill

rom the halls of Buffalo dental school to the shores of Tripoli. From Fishkill to Kingston to Catskill, to Mike Tyson’s gold teeth and a photoop with President Gerry Ford, it’s been a half-century odyssey for Greene County dentist Mario Catalano. Catalano, a Town of Ulster resident and former chairman of the Ulster County Republican Committee, and his partners Howard Leifer and Tom Bruno, operate one of the larger dental practices in the region. It all began in 1969 in a two-room office above the Main Street headquarters of the Catskill Daily Mail. Catalano, a Brooklyn native who grew up in Long Island, was majoring in history and government at the University of Buffalo when one of his fraternity brothers, a dental student, got him interested in dentistry. The atypical “man with a plan,” Catalano had structured his college studies so that by his junior year he could pursue a career in medicine, dentistry, law or business. “I was fascinated by the [dental-school] curriculum,” Catalano said. Upon graduation, he was accepted into the university’s school of dentistry

on full scholarship. During the summer between schools Catalano and his first wife were married. He also enrolled in Navy ROTC after starting dental school and was commissioned a lieutenant when he graduated. The couple had two children while Catalano was studying dentistry, a third about five years later. . A two-year hitch in the Navy dental corps took him to Marine Corps Camp LeJeune in North Carolina and on a six-month cruise to the Mediterranean with the Second Marine Division. “I learned a lot about dentistry in the Navy,” he said. Shortly before his discharge in 1969, Catalano and his wife Maryann, who was from Rochester, began making plans to establish a private practice. “We thought about North Carolina, but decided we wanted to come back to New York,” he said. A fellow officer, Walter Flynn, recommended

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the Hudson Valley. “I had never been here, but he said it was a beautiful area, close to New York City, and there was lots of opportunities for a young dentist,” Catalano said. Flynn eventually opened a practice in Red Hook and later worked with Catalano. “We started from the bottom [of the Hudson Valley) and worked our way up from Fishkill to Catskill,” Catalano joked. The man with a plan learned the business side of a business from his father, who owned an awning company in New York. “My father was a craftsman and a hard worker, but business was not his strong suit,” Catalano said. “I learned a lot working with him during summers in college. I learned from his mistakes, too.” Catalano’s dental plan was at the time somewhat radical. “When I entered practice there were very few dental groups,” he said. “Most dentists were single practioners, or if they practiced with another dentist it was father-son. For reasons of serving the most patients and efficiencies of scale, I was committed to a group practice from the beginning.”

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ot everyone immediately bought into Catalano’s vision. But the Catskill Savings Bank granted a $53,000 mortgage in 1971 to build a 3400-square foot building on the edge of the village on Boulevard Avenue. . Leifer, fresh out of the Air Force, joined the practice in 1975. Bruno, an Athens native and a patient, in 1990. The practice employs two other full-time dentists. The Catalano family originally settled in Woodstock, moved to Hurley, and then established residence in Hillside Acres in Kingston. Why not Greene County? “To tell you the truth, I find the (25-mile) morning drive very comforting,” he said. “I can think about the patients I will see that day and be ready to go when I get there. It’s a very relaxing ride home. I can clear my head. I don’t bring anything home with me.” And yet he’s close enough for emergencies. “We will never leave a patient in pain or distress if there is any way we can help it,” he said. A keen interest in politics and civic affairs and a growing family kept Catalano busy away from the office. He was an Ulster County legislator for a term in 1980-81 and county Republican chairman for two years a generation later. Chairman of the Greene County Cancer Society and a Jaycees founder, he “joined everything” when he first ar-

rived in Greene County. “There was no advertising in those days,” he explained. “You grew your practice with quality care and references and by going out and meeting people.” The teenage Tyson was briefly a patient during his training years in Catskill under Cus D’Amato in the early 1980s. “He was so broad he barely fit in the chair,” Catalano said. The dentist recalled the future heavyweight champion as a soft-spoken polite young man. Another heavyweight champion factored in Catalano’s decision to locate in this area. “My wife and I were looking at an office space in a new medical building on Albany Avenue at the corner of North Manor when a gentleman pulled up and asked me for directions to Montgomery Ward [then on North Front Street a few blocks away]. I had never been to Kingston before so I couldn’t help him. After he left, I ran back to the car and said to my wife, ‘Wow. That was Floyd Patterson! My hero.’ I figured if Floyd Patterson lived around here (in New Paltz) this must be pretty cool place.” Catalano was unable to consummate the deal for the Albany Avenue site and wound up in Catskill.

atalano believes the future of his profession is in good hands. “The kids coming into dental school (more than half of them women) are just brilliant,” he said. “I’m not

| 9

sure I could get into school these days.” But the profession has evolved, much like medical practice. If Catalano was a forerunner in establishing a group practice decades ago, the trend now, he says, is toward mega-groups, employing dozens, if not scores of dentists at large sites. “Wall Street has discovered there’s money to be made in buying up and consolidating dental practices,” he said. “Why settle for two percent on a treasury bill when you can clear 15 percent in a dental conglomerate?” The country’s largest dental group, headquartered in Chicago, operates almost 700 offices and is expanding, Catalano said. “We’re constantly approached,” he said. Catalano allowed there are advantages to the dentists. “We’re free of all the paperwork and administration. We can better practice dentistry and tend to our patients.” Approaching his 50th year in practice, Catalano, 73, says he has no plans to retire, though he’s cut his work schedule to about 20 hours a week. “I have been blessed,” he said. “I thoroughly enjoy what I do, the interaction with patients and staff, the good work we do. I can’t imagine doing anything else.” Catalano and his wife Ann (Guerin) live in the town of Ulster with their college-aged sons, Andrew and Nicholas.. Full disclosure: Mario Catalano is author Hugh Reynolds’ dentist.

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6, 2015 10 | August Healthy Communities

What health insurance means to us Harry Matthews describes the mandated route to new maturity

he life of an artist, seemingly glamorous to some from the outside, is rarely easy and rarely glamorous. Due to the choices I’ve made I’ve often found myself broke, hustling for work, living in cold spaces, and eating a lot of rice and beans. I’ve spent almost my entire adult life without health insurance of any kind. Having been born in England, a country that offers of its citizens free healthcare, I reasoned that if I were ever to come down with a catastrophic illness I could go back, sign on, and receive whatever treatment I might need. Despite plentiful self-inflicted abuse over the years (addiction, smoking, crazed lovers), I’ve remained relatively healthy so far. But how long could this last? I’ve just lately come to the blinding realization that not only am I not getting any younger, but I’m actually getting older! By older I mean that I’ve

reached that eye-opening time in life when you’re finally no longer under the youthful illusion that your body can withstand anything you throw at it, when a rambunctious night out inflicts hurts for days after, and when your back goes out for a week after you bend over to pick up the garbage. I’ve been lucky so far with my health. But now, as I approach 50, what were once little annoyances seem to loom over me like encircling carrion birds. Enter Obamacare. Like many others, I had followed our president’s efforts to make healthcare affordable to the masses with a decent amount of skepticism, not really believing that it would ever become a reality. When it did come, still in my youthful procrastination, I put off signing up for it. I would do it next year. Tax time came. I had to pay a penalty for my laziness. So I made a few half-hearted attempts to enroll via the website marketplace. I found myself stymied by the craze-inducing maze-like structure of its design (“What do you mean my Social Security number is wrong!” I yelled at the state healthsite). Fortunately, a friend told me about a free service that offered a trained “navigator” to help me get

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through the enrollment process. Dubious, I called the number. Within minutes I had scheduled an appointment for that very evening. My doubt that this could ever work for me hung firm. A few hours later I was sitting in a stuffy office of Catholic Charities in Catskill with a charming woman from the Columbia County Community Healthcare Consortium who blazed through the website like a kid with his favorite video game. I answered her questions, and she darted around the site, dodging this and leaping over that. After a little more than a half-hour, she looked over at me and whispered conspiratorially. “Keep your fingers crossed.” With a practiced air of drama, she raised her right index finger and then slowly dropped it onto the “Enter” key. Calculating …. Calculating …. Ding! All of a sudden I had health insurance.

strange feeling came over me that now, after 48 years and somewhat against my will, with literally the click of a button, I had grown up and become an adult. It felt weird. I thanked her profusely and hurried out of the office. As I drove home the world seemed different. Not that it had changed, but I had. I remember thinking that if I had a car accident now at least I wouldn’t have to sell the house and move to Cuba. It wasn’t that I started driving any more recklessly than normal, but the thought was comforting. As I neared the house, I passed a couple of guys in their twenties hiking down to our nearby waterfall and wondered whether they had health insurance. Too young and irresponsible, I thought with my newly misplaced sense of status. Over the next month, while I waited for the insurance to kick in, I identified a doctor and began

August 6, 2015 Healthy Communities

PHOTO BY WIKICOMMONS

Once you've found the insurance, in many cases with the help of a navigator, the next step is to ﬁnd the right doctor. listing in my head all the things I would discuss with him when we finally met. Coincidentally, around this time I started having a number of strange and troubling symptoms which, due to a deer tick I had pulled off one night, I self-diagnosed as Lyme disease. As I was still a few weeks away from being able to see a doctor without having to shell out hundreds of dollars, I persuaded a friend to hook me up with some doxycycline that he had gotten from his doctor-father. Some of the symptoms disappeared. Others continued. What I was sure had been Lyme now seemed more ominous and less tactile. I started wondering whether I was finally feeling my age. It was as if my new-found adulthood had unwittingly aged me, relegating my longstanding youthful health to the past where it belonged. Damn, I thought, I knew there was a catch!

he hours and days seemed to pass interminably until my first doctor’s visit. While I waited I continued my mental lists of health complaints (something I had never done in my pre-insurance life), continued feeling lousy, and started wondering whether after all these years I was now turning into a hypochondriac. Two days before my appointment the clinic called to say they had to reschedule. So now the wait, and the anxiety, was pushed back yet another week. A week later I was finally in the office. The doctor poked and prodded me, ran a battery of tests, ordered blood work, and eventually told me that I was in fairly decent health. He assured me that I would die, but it probably wasn’t going to be any

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he would probably have been called even more of a God-hating socialist by yahoos like the increasingly insane Donald Trump than he already has been called. I think all he wants is see our country catch up with most of the rest of the world. In this country we take things in the small measures that allow them to work, realistically and with baby steps. Though we may not be able to change broken things overnight, we equally can’t fix a broken bone just by hoping. Just like I am learning to take my medicine and look after myself as I should, our oft-brokenseeming country is learning that it benefits from looking after its own and keeping them in good health without impoverishing them. Though the monthly nut I pay my provider hurts each time I do it, I’m sure an untreated broken leg or a heart attack would hurt a lot more.

time soon. He told me I needed to quit smoking (I know, I know), get more cardiovascular exercise (damn you!), and lay off the salt. Walking out of the clinic, I felt a responsibility for something I had blissfully ignored for as long as I could remember: my health. Over the past months I’ve found myself being more careful with my diet, more aware of how I’m feeling, and more concerned about how what I might do would adversely affect my wellbeing. When the blood work came back, it showed that I had high cholesterol, but was otherwise mostly healthy. I’ve recently started taking an anti-smoking medication with the plan that I will again soon be smoke-free. I’ve restarted taking long morning walks with my partner, and we’ve also gotten back into juicing and herbal supplements. With insurance the $300 prescription cost nothing. The co-pay at the doctor’s office was negligible. Prior to my getting insurance, anytime that I had had a medical issue I had relied on the increasingly rare option of someone like Dr. Wayne Longmore (who, despite his negative notoriety, I thought a great and caring doctor), who ran the now closed walk-in clinic in Woodstock. Without low-cost clinics like Dr. Wayne’s, I worry that those people who can’t afford health insurance would have little recourse but to do what I had done, ignore their health. Though far from perfect, the Affordable Care Act has been startlingly successful. More people are now insured than ever before in this country’s history. I mean, come on. I, of all people, have health insurance. It still kind of astounds me. Like many Americans do, I believe that healthcare is a right and should be free for all. Had Barack Obama achieved such a momentous feat,

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Compassionate communication Jen Holz knows people travel far for the right veterinarian

ix years ago, Rebeccaâ&#x20AC;&#x2122;s dog Tess was degenerating before her eyes. Only four years old, sheâ&#x20AC;&#x2122;d lost her appetite. Her gait had stiffened, and sheâ&#x20AC;&#x2122;d slowed unexplainably. Her vet diagnosed Lyme disease and prescribed medications. Time passed with no improvement. The doctor increased her meds. Tess kept deteriorating. Her coat grew dull. She gained weight, and she became lethargic. One day, Rebecca took Tess for a walk and found her paws had left a blood trail on the sidewalk behind her. It was at that moment Rebecca realized â&#x20AC;&#x153;the pain Tess must have been feeling â&#x20AC;&#x201C;â&#x20AC;&#x201C; how much she was struggling just to lift her legs.â&#x20AC;?Â Â Friends urged Rebecca to try a new vet. She did, driving the hour and a half to Ancramdale to see Dr. Tina Aiken. â&#x20AC;&#x153;The very first thing she did was test Tessâ&#x20AC;&#x2122; thyroid,â&#x20AC;? she said. She had an inkling

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Veterinarian student Kortney, from Syracuse University, has spent the summer learning the various forms of caring her career path requires. that her immune system had been compromised by Lyme and affected her thyroid. It had. Tess is now on a prescription for Levothyroxine. That is a far cry from the plethora of meds she had been on. She is also on a raw-foods diet of local beef and pureed vegetables, which is cheaper than dog food, natural and local. Tess has

lost more than ten pounds and is back to being â&#x20AC;&#x153;her cheerful, chipper self.â&#x20AC;? Rebecca swears, â&#x20AC;&#x153;Dr. Tina saved Tessâ&#x20AC;&#x2122; life.â&#x20AC;?Â Rebecca now lives in the city, with weekends in the country, where she still drives Tess to see Dr. Tina. Mark Rosenberg is a busy man. He smiles as

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Dr. Marc Rosenberg of Hurley Vet performs surgery at his ofďŹ ce. The dachshund is recovering nicely. he enters the room for our interview, quickly apologizing that he just scheduled an emergency surgery. I follow him down the hall, swept along with his cadre of assistants. The patient is a petite dachshund whoâ&#x20AC;&#x2122;s swallowed several pins. The procedure must be done quickly, and Dr. R has already transitioned into focus as we slip away. Further down the hall, we meet a cheerful pig on an aquatic treadmill. He trots along, buoyed by water, while his happy pig heart pumps aerobically. Aqua therapy is an effective treatment for a range of problems, including rehabilitation, arthritis, and obesity. Does it work? We meet Max, a lumbering Labrador who hasÂ lost over 50 pounds with the aqua tread. He is one of several rescues that Hurley Vet cares for. Later I ask Dr. R to talk about his philosophy and advice.Â What drives client loyalty? â&#x20AC;&#x153;Good patient care, good communication with the owners, and being available when needed.â&#x20AC;? He runs quite a complex business. His practice,

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Hurley Vet, offers Â â&#x20AC;&#x153;office visits six days a week with multiple veterinarians rotating through these days, surgeries/dental cleanings, ambulatory farm/house calls, and diagnostics, including an in-house laboratory, digital radiology, stateof-the art ultrasound,â&#x20AC;? and a â&#x20AC;&#x153;wellness center that includes an underwater treadmill and therapeutic laser.â&#x20AC;? Â Â Dr. R urges preventative care especially â&#x20AC;&#x153;nutrition, exercise, vaccination protocols, and early intervention when disease is present.â&#x20AC;? He also has high hopes for pet insurance. Eileen Jefferson runs a house-call practice that providesÂ â&#x20AC;&#x153;proactive care, honing in on diet, lifestyle, and early diagnostic screensâ&#x20AC;? in Kingston, Stone Ridge, Rosendale, and the Rondout Valley.Â Dr. J says house callsÂ â&#x20AC;&#x153;allow for more time and more personalized care.â&#x20AC;? She finds most cases can be resolved at home with less expense. â&#x20AC;&#x153;Clinical experience and a good physical exam can tell a lot for little cost,â&#x20AC;? she says. Dr. J is a vet with a mission. She writes extensively about veterinary ethics, adoption and animal welfare. Her advice? Understand genetic predisposition for ailments and treat proactively. Choose grainfree wet food for cats and forego buffet-style feeding. Vaccinate wisely. Choose a vet who â&#x20AC;&#x153;performs a thorough physical exam, is attentive to your questions, and respectful of your animalâ&#x20AC;&#x2122;s emotions.â&#x20AC;? What are her most common services? Itâ&#x20AC;&#x2122;s hard to generalize, but she notes that â&#x20AC;&#x153;geriatric care seems to be most in demand.â&#x20AC;? Janis Jackman at the Ulster County SPCA agrees.Â â&#x20AC;&#x153;As people get older, so do their pets.â&#x20AC;?Â Â It is often this population that finds its way into shelters after aging owners can no longer afford care. The SPCA offers substantially discounted vet care at its in-house clinic, as well as a walk-in vaccine clinic on Wednesdays from noon to 2 p.m.

| 13

â&#x20AC;&#x153;Pricing should correspond to the economy, and the economy is poor right now.â&#x20AC;? Jackman said. She emphasizes the importance of vaccinations, â&#x20AC;&#x153;Parvo [for example] is a harsh and contagious disease that can be prevented with a distemper vaccine .â&#x20AC;Ś We want everyone to have access to affordable services.â&#x20AC;?Â Does she have a favorite vet? Â â&#x20AC;&#x153;I love Dr. [Konstantine] Barsky, heâ&#x20AC;&#x2122;s so generous with his time here at the clinic.â&#x20AC;? She finds him â&#x20AC;&#x153;kind, understanding, gentle, helpful.â&#x20AC;? Also of Hurley Vet, Dr. B shuttles some of the rescues back to HV for fostering.Â I ask Kortney, a pre-vet student at Syracuse, what drives client loyalty. â&#x20AC;&#x153;Compassion,â&#x20AC;? she answers.Â Compassion and communications rule.Â Lack of compassionate communication was the most common complaint I heard people make about their least favorite vets. The word â&#x20AC;&#x153;sterileâ&#x20AC;? was used. A young woman from Woodstock tells her emotional story. â&#x20AC;&#x153;I just fell apart,â&#x20AC;? she says, â&#x20AC;&#x153;my dog was dying, I was on the floor, crying, and he sat with me, and said, â&#x20AC;&#x2DC;Itâ&#x20AC;&#x2122;s okay to fall apart.â&#x20AC;&#x2122; I felt so supported.â&#x20AC;? Her vet is David Gunzburg, another Hurley vet. â&#x20AC;&#x153;I wouldnâ&#x20AC;&#x2122;t go anywhere else,â&#x20AC;? she says, â&#x20AC;&#x153;and he has that cool Australian accent.â&#x20AC;? We expect a lot from our vets beyond skill. We scrutinize their personalities, philosophies, and pro-bono work. You probably donâ&#x20AC;&#x2122;t know your doctorâ&#x20AC;&#x2122;s political views or how he gets to work, but clients know Eileen Jefferson advocates for animal welfare and Mark Rosenberg rides a Harley.Â Smart vets are re-inventing their practices with ethics and affordability in mind. We expect a lot, and we usually get it, because the vets who inspire client loyalty deliver.

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6, 2015 14 | August Healthy Communities

A well-planned death Most of Lynne Crockett's peers are drawing their aging parents close to home

n 1989 my parents moved into their retirement house, a beautiful post-and-beam structure in a rural area between Woodstock and Saugerties. My husband Donald and I built our home on the same property, a quarter-mile down the driveway. My parents always tried to plan ahead, and the plan this time was for us to be nearby as they aged. As is usual with life’s plans, theirs changed. After the blizzard of 1993 they sold their home and headed south, to the land of their winter vacations: Sunset Beach, North Carolina. In Sunset Beach my dad golfed year round and my mum walked the beach with her dogs. They also had an active social life with other snowbird retirees. My parents moved south they were in their seventies, healthy and active. In the late 1990s my father discovered that he had an aggressive form of prostate cancer. Because the cancer had spread, dad was treated with surgery and then radiation. During this time my father was exhausted. My mother was responsible for his care. Still up in Saugerties, I worried about both of them. In 2004 my parents decided to return to the frozen north, though they intended to spend their winters down south. My father was not enthusiastic about the move, but my mother wanted to be near family. This final move (and it was final) made my life easier. I saw them regularly and was able to help, when the time came, with shopping, driving and healthcare appointments. My mother also was relieved to have my assistance as my dad went through chemotherapy and hospitalizations for related health problems. My parents’ and my experiences are not unique. People in their seventies and eighties, if they live far from family, generally move nearer as their health deteriorates. In fact, while writing this article I questioned several friends about whether they knew anyone whose parents remained distant from family during their final years: the answer was no. These moves are significant as they symbolize a loss of independence. My friend’s mother, for instance, left her home, life and friends in New York, where she had lived her entire life, to be near her daughter in Texas. She died a few years later.

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As we age, our ﬁrst inclination may be to stay where we are. But reality dictates that it is often best to move closer to where our caretakers live. Her daughter, who had lived a fairly independent life prior to her mother’s move, suddenly found herself in the role of caregiver. Although relinquishing one’s previous way of life is difficult, being near family provides greater control for everyone during the time of declining health. In January 2010 my parents were preparing to leave for their annual southern sojourn when my mother died suddenly, most likely of heart failure. This also was according to plan — her plan. She always said that she didn’t want to deal with hospitals, nursing homes or fuss. When the EMTs arrived they asked if my mother had a DNR (donot-resuscitate order). She did. I could tell it was difficult for my father, but the decision had been made by my mother. Had she been resuscitated and disabled from a stroke, she would have been furious with us for not following her wishes. The DNR took the decision out of our hands and eliminated some of our stress in a painful situation. Prior to my mother’s death and my father’s decline, dad showed me (more than once) where the paperwork (like his will and DNR) was kept. He completed a healthcare proxy form (a medical power of attorney) designating me as his proxy, the person who could make healthcare decisions for him if he were unable to. He discussed his estate and finances with me regularly. I was in denial, but he ignored my attempts to avoid the topic and forced me to listen. As his health deteriorated, I had no time or emotional energy to consider the legal aspects of losing my parents — and because he had done it all earlier, I didn’t need to. Dad died at home in November 2010.

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After having experienced a tough two years he had been determined never again to be hospitalized. His doctor, however, was not interested in dad’s desires; she wanted us to hospitalize him — and then made it difficult for me to set up Hospice care because Hospice requires a doctor’s approval. Had dad remained in Sunset Beach without an agent (healthcare proxy — me) his doctor probably would have had the final word. Due to the clear communication of his wishes, he avoided hospitalization and died as he desired, at home, with his family. Because he had planned ahead he remained in control of his final days. Not everyone can care for family at home, either because of lengthy or difficult illnesses (like Alzheimer’s) or because they are not compatible with their family. The cost of long-term care in professional facilities is prohibitive and may lead to bankruptcy. If the estate is in a trust, however, it can be protected. Physician-assisted death (PAD) is now legal in five states, but not in New York. Both my parents were in favor of physician-assisted death. Discussions about these and other endof-life issues within a family before one needs to make immediate decisions are important. Following my parents’ deaths I found it difficult to make any decisions, even one as simple as whether to throw out my mother’s last shopping list. However, in retrospect, I am glad that my mother had the death she had desired — quick, with no fuss. I am glad that I helped my father to die at home, comfortably, where he wanted to be. And I am thankful that he had the foresight to plan for the inevitable, simplifying my life so I was not responsible for making choices that I may later have regretted.

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August 6, 2015 Healthy Communities

| 15

A tale of two doctors Annie Nocenti, like many, ﬁnds herself poised between differing views of modern healthcare

When he was done, her foot looked normal again. Swelling gone. Her entire calf was blue. Spidery colors traveled up her thigh. She may have limped into the hut, but she walked out to great cheering. A sprain that normally would have needed weeks or months in a cast to heal had been sort-of healed in a few minutes. I wouldn’t recommend you try this at home. I imagine we were lucky this was just a sprain and not a fracture or worse. But the incident did change how I felt about medicine.

hen I was 18 years old I hiked with a friend up a volcano in Guatemala. A freak wind kicked back and sent fiery volcanic smoke our way. We ran down the mountain ahead of the ash. My friend fell near the bottom, and her foot swelled to the size of a melon ball. Far from a hospital, we flagged down a bus headed for a bigger town. She used me as a crutch, hopping on one foot, in pain. On the bus, I chatted in my broken Spann the decades that folish with the guy in the seat next to us. He lowed that adventure, I understood our predicament and talked experienced all kinds of to the bus driver about making a special healthcare. When I had stop. The note written in Spanish that he staff writing jobs, I enjoyed handed me told us to get off the bus and “real” insurance. During my show the note to anyone we met. We got freelance years, I had “cataoff, facing what seemed to be a dirt road strophic” insurance: very to nowhere. There was no one to hand the cheap, but it only kicked in note to. when medical bills reached My crippled friend leaned on me and we bankrupting heights. limp-hopped down a long, dusty path. Was During those years, I frethis was some kind of trick, a naive trap quented a walk-in clinic with for a gringo? Eventually we hobbled into a father-son doctor team. a village of Mayans (the indigenous people Both the Young Doc and the of Guatemala) living in slatted wood huts Elder Doc had patients in surrounded by crops and chickens. The and out in a flash. Their style adults stared at us cautiously. was speedy efficiency: check Children, with their open curiosity, can the vitals, shine the scopebe icebreakers and envoys in these situalight into ears and eyes and tions. A young boy stepped up and read down the throat. Test the the note, which said (I think): “These are ticker, take the pulse, weight, my friends. Help them, please.” height, and boom, done. The youngster led us circuitously deeper Even with a packed lobby of into the village, and finally stopped before patients there was never a PHOTO BY ANNIE NOCENTI a hut with nothing in it but an old Volk- The daughter of a doctor and pharmacist, the author owns an inherited collection of long wait. swagen car seat, tipped back so that it re- classic mortar and pestles, an age-old tool for the making of effective medicines. These were what I came sembled a doctor’s examining chair. to think of as “short-talking” no electricity nor TVs.) A man with a saxophone A man of medicine (or so we assumed) beckdoctors. Both father and son used the same desk. began to play outside the hut. It seemed we were oned us to enter, and sat my friend in the car seat. The colorful knickknacks never changed, nor the now the focus of an impromptu party, I imagined He began to crush herbs and powders in a woodfamily photos, kitsch calendar and orange Gaa “silly gringos in the hut” party. en mortar with a stone pestle. He made a white nesha, the elephant-headed deity statue of wisAs the man of medicine ground the stone viscous goop and smeared it all over my friend’s dom. You could sign up to see either doctor. As against my friend’s green-leaf foot, I watched foot and ankle. He wrapped her foot in wide, flat they shared the same last name, not even the gold the swelling in her ankle go down. The black and green leaves. By now it truly looked like a fat green nameplate on the desk changed. blue slowly moved up her calf, the colors moving melon. He picked up a stone and began grinding it There was one big difference between them. in tree-branch patterns up her leg. He seemed to into her leaf-wrapped foot. She screamed. The Younger Doctor opened a script pad and be jumpstarting or speeding up a healing process, Rows of wide eyes filled the long, thin cracks bescribbled away. The Elder didn’t, except for the ocpressing on the swelling of the sprain through tween the wood slats of the hut. The village kids casional penicillin for strep throat. If you couldn’t whatever magic goop was inside the herbal wrap. watched and giggled, as though we were a funny sleep, you were depressed, your tummy hurt, or TV show brought into their village (a village with

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6, 2015 16 | August Healthy Communities you wanted some of mommy’s little anxiety helpers, you signed up for the Younger Doc. The Elder was more careful. He once explained to me that the meds his son prescribed so freely — anti-depressants for teens, sleeping pills for elders, ADD drugs for kids, valium for the stressed — were for problems he didn’t consider problems. One time I stopped by the clinic because I had a flare-up of gum disease, for which the Younger Doc had once prescribed antibiotics. This time Elder Doc was in, and told me there was no need for pills. “You need bone strength,” he said. “Eat more orange food. Mangoes, carrots, papayas, tangerines, butternut squash. Just go into a grocery store

and buy orange things.” “Cheese doodles?” I joked. “Cantaloupe, sweet potatoes, apricots,” he continued, ignoring my comment. I bought orange foods, which are rich in beta carotene. The gum disease faded away. Last year my minimal catastrophic insurance was gobbled up by The Affordable Care Act. I was offered free basic care at a new clinic. My first visit was to a long-talker, a “healthcare specialist” who long-talked about yoga, acupuncture, integrated medicine and nutrition. Then the real doctor, fresh-faced and right out of med school, came in and added in his favorite daily exercise routine.

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He reminded me of something the actor Burt Reynolds once said, of working with a very young director: “I got socks older than him.” This young doctor wanted to do a slew of bloodwork, but after long-talking for an hour still hadn’t drawn blood. When I asked why, he explained that this was just the first “doctor-patient relationship talk.” I’d need another appointment before we moved on to actual care. This holistic approach may have been great, but I sure miss the short-talkers. Before going to an actual doctor these days, I check in with Dr. Google. Since patients come in loaded with dubious information. Dr. Google seems to both please and annoy real doctors. I always surf-consult before spending money on a doctor, just in what ails me can be solved with orange foods. As I learned long ago, some things can be healed with a leaf wrap, a rock, and some magic goop.

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