Ulster Publishing’s
Healthy Hudson Valley Magazine M i In gluten we trust? 2014-15
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Reefer Rx Obamacare: Year One
Mountain bikes Rotator cuff injuries
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• May 1, 2014
Healthy Hudson Valley
After the deadline Obamacare tips prior to the 2015 enrollment Mike Townshend o get the most of out the federal Affordable Care Act, you’re going to need to spend time busting out the calculator, doing math and researching your options. You’ll require attention to detail. You’ll need to familiarize yourself with jargon like “out-of-pocket maximum,” “high deductible,” “health savings account,” “qualifying life event,” “premium” and “formulary.” It isn’t easy. But it’s worth it. When I did the math, I decided to opt out my employer-based health insurance as a way to save money. I learned a lot since then – the hard way. Other people than myself have managed to jump the enrollment hurdles. According to a mid-April count from the White House, 8 million Americans had enrolled
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through the Affordable Care Act’s health-insurance marketplaces. Some 28 percent of enrollees were between the ages of 18 and 34, and 35 percent of enrollees are under the age of 35. Here are some of the tips I discovered along the enrollment route. 1) Double-check everything Your employer likely offers a range of plans – platinum, gold and silver on down to bronze. The ACA (aka Obamacare) allows you to ditch coverage through your employer if the lowest-cost bronze plan they offer costs more than 9.5 percent of your total W-2 wages. Base your comparative calculations of the lowest bronze plan to get the right info. Forget the costlier plans they offer for now. Multiply your W-2 wages for the year (all of them if you have multiple jobs) by that
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May 1, 2014 • 3
Healthy Hudson Valley
LAUREN THOMAS
John Jeffreys, Healthcare Reform Specialist at Ulster Insurance Services hosts a recent seminar regarding the Affordable Care Act. 9.5 percent. Here’s an example: Let’s say you’re single, making $30,000 a year. Poverty, if you are single, was set at $11,670 per year by the feds for 2014. That means you’re making about 257 percent of Federal Poverty Level (FPL). Take that $30,000 and multiply it by 9.5 percent. If that bronze plan costs more than $2,850 per year – $237.50 per month or $59.37 per week – you can explore the exchange. This isn’t the case for everyone, but healthcare in New York State is expensive and employers can’t always help as much as Uncle Sam might. So it’s worth investigating if you fall below 400 percent of the FPL. You could get a tax credit on the exchange. Take a look at the poverty guidelines for 2015 when they come out. Dig out your W-2, get your “9.5” and match it what your employer’s worst annual bronze-plan costs.
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If it looks like you might be in the ballpark, go and see what the state’s tax-credit estimator says. It’s online at www.healthbenefitexchange.ny.gov/calculator.
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• May 1, 2014
Healthy Hudson Valley
MAKOplasty. IF YOU CAN’T RUN TO THIS SEMINAR, YOU MAY NEED IT MORE THAN YOU THINK.
Don’t let bad knees or painful hips keep you from learning about the cutting-edge technology of MAKOplasty® and how it’s changing the face of orthopedic surgery with smaller incisions and quicker recovery times. Come find out if MAKOplasty partial knee resurfacing or MAKOplasty total hip replacement is right for your medical needs. This free informational seminar is presented by Vassar Brothers Medical Center, the only hospital to have this technology from Yonkers to the Canadian border. For reservations or for more information, call (845) 483-6088.
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Healthy Hudson Valley
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• May 1, 2014
Healthy Hudson Valley
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Family size will alter your Federal Poverty Level math. For instance, the FPL for a four-person household was $23,850 this year. So 400 percent of that is $95,400. Depending on how the math shakes out, you could pay less on the exchange than your employer’s most modest bronze plan. 2) Block out some phone time As anyone who tried to sign up on New York State of Health can tell you, sometimes the experience required a waiting game. Before I understood how the exchange worked for my situation, I had three big questions I needed a human being to answer. It took four calls – each with about an hour of wait time – to get those questions answered.
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• May 1, 2014
Healthy Hudson Valley
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One of those times, a state exchange worker answered. Because of supposedly poor cell-phone reception on my end, they hung up on me. If you have questions, block out time to wait on hold. Use a landline to avoid reception issues. Most of the glitches are ironed out by now, and hopefully when open enrollment starts in November for this next year it will play out better. However, grab something to read and the old-school corded phone just in case. 3) Life-altering changes can help you Sometimes lost in the unending drumbeat of the ACA’s March 31 open-enrollment deadline was the “qualifying life event� exemption. What does it mean? Here’s an example: Tony, who has diabetes, gets medical insurance through his job at Acme Corp. But Acme’s products can’t compete and aren’t selling. Corporate downsizing occurs and Tony loses his job – and access to insurance. It used to be Tony that had to get COBRA or nothing at all. Now Tony can sign up on the exchange today – regardless of March 31 having long gone by. Other big events, such as moving to a new state, having a kid, experiencing a change in family income, getting married or divorced, allow you to sign up despite your missing the deadline. If for some reason you didn’t sign up but still want to – and something major happened in your life – check whether the exemptions that qualify as a “life event� apply to you.
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Healthy Hudson Valley
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• May 1, 2014
Healthy Hudson Valley
Finding the best deal How do you buy health insurance on the exchange? Frances Marion Platt
T
he overall strategy is to keep as many dollars in your pocket as possible.” That was the bottom line of the free “How to Buy Health Insurance,” a recent seminar offered at Ulster Savings Bank in New Paltz by John Jeffreys, ChHC, RHU, of the bank’s subsidiary Ulster Insurance Services. Though Jeffreys mainly cut his teeth pitching health-
“
insurance plans to small-business owners, the game has changed since passage of the Affordable Care Act (ACA). He now bills himself as a “health care reform specialist.” Part of his message, to be sure, was the advantages of using a trained broker like himself to help find the best deal in signing up for individual health-insurance coverage (it doesn’t cost you anything; the insurer pays the broker fee). But most of his 90-minute seminar, consisting of a PowerPoint presentation and questionand-answer session, was aimed at demystifying the
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Healthy Hudson Valley
complexities of the new law, New York State’s new health exchange, and the types of individual health-insurance products now available. There are about 20,000 pages of information attached to the new legislation, Jeffreys said, and it’s not necessary for the average person to wade though it all. In New York State, not that much has really changed, compared to many other states, he said. Prior to the passage of ACA, he said, federal law allowed insurers to “charge different[ly] for a man or a woman … for young versus old … for someone who’s sick versus not sick. All that’s thrown out. Everybody pays exactly the same rate in their rating region.” But in New York, he noted, “We’ve been doing that for years.”
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May 1, 2014 • 11
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Communing with One and All: Making All Well with Love’s Body of Light, with Joe Loizzo & Mary Reilly Nichols May 9-11 R&R Weekend Getaway Packages Offered most weekends during the retreat season For a schedule of Cleansing, Hiking and Healing weekends, Visit www.menla.org
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• May 1, 2014
Healthy Hudson Valley
Even the new prohibition against denying coverage of preexisting conditions – “one of the big tenets of health care reform� – won’t make a radical difference, he said, since New York insurers had already dropped the discriminatory practice some time ago even though it was still technically legal. What has really changed in this state are the number of choices available and the cost to individual buyers. “A true individual market has been formed. It used to be ridiculously expensive: $1,200 [per month] minimum to buy a single plan with a high deductible,� he said.
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Capping the maximum deductible for individuals at around $4,000 has “cut the rates almost in half.� The maximum individual out-of-pocket expense under the new plans, after premiums and deductibles, is $6,350 annually. Getting seriously ill or having an accident shouldn’t mean financial ruin any more. Sweetening the pot considerably is the fact that, if your income is low enough and if you apply for coverage through New York State’s new online health exchange, “you can actually get tax credits to make it more affordable.� If your family income falls between 138 and 400 percent of the Federal Poverty Level (anything lower than 138 percent gets you Medicaid coverage), you qualify for something called the Advance Premium Tax Credit. A percentage of your premium gets taken off the top, with the federal government paying the insurance company directly to the tune of the amount of the tax deduction for which you would have qualified (presuming your income level stays about the same as in 2013). Then there’s the Individual Shared Responsibility Tax Credit, which is available if your family income is between 100 and 250 percent of the FPL and you opt
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Healthy Hudson Valley
for a standard silver-level plan. Depending on how the plan is structured, it reduces your cost by bringing down the deductible, the co-pay, the level of coinsurance and/ or the maximum out-of-pocket expense. This may all sound enticing, but many potential consumers of individual health-insurance plans under the new system – including some of the audience at the Ulster Savings seminar – seem to be finding the expanded array of choices a little bewildering. Comparing the available plans can seem like apples and oranges – and cherries and pears and pineapples – especially if your employers have always picked a plan for you in the past
May 1, 2014 • 13
on a take-it-or-leave-it basis. This is where working with a broker can be of real help, said Jeffreys. He dedicated a large portion of his presentation to defining terminology and providing general guidance. To pick the right plan, he said, you need to assess your own family’s health situation and your financial situation. Consider which doctors are important and whether you’re including people who previously would not qualify for health insurance because of a preexisting condition. For example, it makes little sense to save money on premiums by opting for a plan with high fees
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• May 1, 2014
Healthy Hudson Valley
DERMATOLOGY CRAIG AUSTIN M.D. Ph P
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for important diagnostic procedures if you’ll avoid such tests and thus risk late diagnosis of some serious – and far more costly – illness. The available plans range in cost from bronze, providing a minimum of 60 percent coverage of health expenses, to platinum, covering 90 percent. There are many different ways to slice and dice cost savings. “The mixes are a little more complicated than they used to be,” Jeffreys admitted. From one plan to the next, higher deductibles may mean lower premiums or co-pays. Free office visits to your general practitioner may be counterbalanced by higher costs for specialists or prescription drugs. “Look at your overall risk strategy,” he said. “Do you want to take more risk, or do you want the insurance company to take more risk?” He advised that the applicant look at the health exchange as a store, and to the greatest extent possible remove emotion from the decisionmaking process: “Some of it is just math,” Jeffreys said. Minimizing your overall dollars out-of-pocket – taking into account the potential costs of an accident or major illness that isn’t fully covered – is the big-picture goal to keep in mind. Some seminar participants who already had health coverage through work were worried that their employers, having fewer than 50 staff members and thus not legally required to insure them, might dump them onto “Obamacare.” Jeffreys advised them to sit tight and educate them-
May 1, 2014 • 15
Healthy Hudson Valley
selves as best as possible about their options in the meantime. Though the open enrollment period for the kickoff of ACA won’t reopen until November, losing existing coverage fits the definition of a “qualifying event” that would enable one to apply outside the official time window. If you didn’t sign up for individual health insurance by March 31, you may end up having to pay a fine. But, in the meantime, a broker can still help you make a decision for future coverage. You don’t have to be an Ulster Savings Bank customer to consult John Jeffreys; he can be reached at 338-6000, extension 3956, or via e-mail at jjeffreys@ ulstersavings.com.
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• May 1, 2014
Healthy Hudson Valley
Changing the system Some of the things to expect from implementation of the Affordable Care Act Lynn Woods xpect to pay a fine if you are uninsured and didn’t sign up for health insurance by March 31, the deadline set under the Patient Protection and Affordable Care Act. On next year’s income-tax form you will be required to note whether you signed up for insurance. The fine will be based on the amount of declared 2014 income. New York State, which has set up its own health-plan marketplace, will allow people who missed the deadline to sign up
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for health insurance some time starting in November. Given that it’s past the deadline, that’s the most timely information gleaned from a recent meeting at the Boiceville Inn designed to provide last-minute information to the public on signing up for health insurance. However, other details of the new health care system were covered at the meeting, which was sponsored by Ulster County Legislature chairman John Parete in partnership with The Institute for Family Health. IFH representatives were on hand to provide information and answer questions. How much will you pay if you missed the deadline? For the first year of no insurance, 1 percent of your income. As noted earlier, that’s based on your income-tax filing. The amount increases to 2 percent after the second year of no insurance and subsequently increases to 2.5 percent in subsequent years. “There are exemptions due to hardship, or you can appeal it,” said Andrea Brown-Briggs, clinical director of care management for the IFH. If you signed up for health insurance after March 15, coverage starts May 1, as opposed to April 1 for earlier enrollees. Brown-Briggs recounted some benefits of the new law. Its goal is to ensuring everyone, including people who previously would not qualify for health insurance because of a pre-existing condition, has access to af-
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• May 1, 2014
Healthy Hudson Valley
fordable health care. The bill increases the number of medical providers so that patients will no longer be held hostage to having a limited number of providers. It provides for an increase of coverage for preventive care, such as colon cancer screenings and flu shots. And coverage is available for a care counselor available to people suffering from multiple illnesses. “The goal is better health care and better outcomes for everyone with lower costs,” Brown-Briggs said. She noted that the individual mandate requires every one of the nation’s uninsured to sign up for insurance, or pay that aforementioned fine if they remain uninsured after the March 31 for more than three months. By going to the New York State website, www.nystateofhealth. ny.gov, or calling 855-355-5777, people can compare private health-insurance plans along with federally funded Medicaid and Child Health Plus, available to those with low incomes. People whose incomes were above Medicaid levels but met another threshold – 400 percent or less of the Federal Poverty limit, which amounts to $94,200 for a family of four in 2014 and $45,900 for an individual – qualified for a federal subsidy to reduce the cost of a private plan. All health insurance plans are required to provide 10 listed health benefits, including ambulatory services to and from the hospital, hospitalization, treatment for mental-health and substance abuse, emergency services, dental and vision care for children, and maternity services. In this state, there are 12 to 14 health insurance plans to choose from, tiered to offer different premium amounts for varying levels of coverage, including at one extreme high...your answer for extremely natural skin and hair care products, freshly handmade in small batches in the Hudson Valley of New York State SOAPS • LOTIONS CREAMS • SALVES SCRUBS • BATH SOAKS ESSENTIAL OILS
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deductible catastrophic plans designed for young healthy adults. The maximum out-of-pocket cost is $6,350 for an individual plan and $12,700 for a family plan. The choice of qualifying doctors and hospitals as well as type of medications covered is greater under the new system, said Brown-Briggs. Besides the question of affordability, other variables affecting what plan people sign up for are the amount of medical care they require as well as the type of medications. “A big component [of what plan you select] is your medications,” she said. A new element of the plans is what’s called a Health Home, which refers to a care management provider, said Melissa Martinez, program director at Family Practice Center of New Paltz, which belongs to IFH. The provision is modeled after what’s offered under Medicaid and the managed-care programs of policies offered by Wellcare, Fidelity and other major healthinsurance providers, she said. The goal is to increase access and quality of care based on a virtual network for providers at lower cost, she said, noting that currently health care costs are exceptionally high for people with chronic illnesses. People who have two or more chronic conditions or one chronic condition but are at risk of another, or have mentalhealth issues, qualify for the provision, which pays for a counselor to coordinate their care and services, such as transportation to a doctor. Family Practice Center of New Paltz is one of the regional organizations that provide care management services. In addition, some Medicare and Medicare/Medicaid patients will receive a letter enabling them to opt in to
ULSTER GASTROENTEROLOGY Dr. Reham El-Shaer is pleased to inform you that she is starting her own gastroenterology practice. Dr. El-Shaer is a highly respected Board certified Gastroenterologist dedicated to the prevention, diagnosis, treatment and management of digestive disease. Ulster Gastroenterology offers the cutting edge and coordinated top quality care of patients. Dr. El-Shaer is looking forward to caring for her patients with any digestive issues they might have and she is willing to take care of young patients at least 14 years old and above. Our staff will always be available to help you with any questions.
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May 1, 2014 • 19
Healthy Hudson Valley
participation in an Accountable Care Organization, a group of health care providers, such as the Institute for Family Health, which is partnering with two other health care organizations for its ACO. The ACO will ensure you are receiving proper care and can afford it. If care is lacking, the ACO will find a provider for you. Such coordination of care is provided without cost to those qualifying patients who opt in, though they must use the providers in the system. They must also opt in for data-sharing, which is subject to privacy restrictions. “Fee-for-service is the way the system works right now,” Martinez said. “Health care costs are so high because every provider is different. With health care reform, instead of paying for each service you pay for the quality of the service.”
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Healthy Hudson Valley
Spinnin’ ’round Get the most from your mountain bike Ashley Drewes
I
t doesn’t matter who you are, there’s probably a right mountain bike for you. How do you shop for a cutting-edge new bike? How will you maintain or repair it? We talked to area bike-shop owners to discover everything you should know before you hit the trails.
Tune-ups According to Sam Burr, store manager at Windham Mountain Outfitters in Windham, riders should take their bike for a tune-up as soon as they unearth it from the garage for the season. It’s especially important to have your bike worked on by a professional, he said. “Bicycles are a machine – bottom line,” he said. “While
the basics of bicycle are simple, to keep your bicycle operating at its maximum capabilities and safely, a skilled mechanic is irreplaceable. One can watch all the YouTube videos they want. Nothing can replace the experience and knowledge of your local shop’s mechanics. If you value your time, money and safety, take your bicycle to a shop.” Burr said the kind of care a bike needs after disuse depends on the condition of the bike when it was stored. “If a bike has been left outside or has been ridden hard and neglected, then the maintenance and repairs can be extensive. If the bike has been used, but maintained, and also built properly in the first place, then usually pumping the tires up to recommended tire pressure – and maybe a little chain lubrication – and off you go.” Christian Favata, owner of Table Rock Tours & Bicycles
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Healthy Hudson Valley
May 1, 2014 • 21
LAUREN THOMAS
New Paltz resident and massage therapist Dale Montelione Grust sits beside her moutain bike. According to bike experts, tune-ups are a key ritual each year.
in Rosendale, agreed. He said it was always a good idea to bring your bike to a proper shop for a spring tune-up. Checking the tires and tubes (if your bike has them) and making sure the chain is clean, rust-free and well-lubricated are vitally important. It’s always important to check your brakes and make sure there is air in the suspension.
“If you value your time, money and safety, take your bicycle to a shop.” – Sam Burr
What to buy? If it seems like your bike needs more than a tune-up, it may be time for a replacement. What should you look for when shopping for a new bike? What kind of riding you want to do matters. “If you’re looking for something to cruise the rail-trail, it’s going to be different than venturing off into the Catskills doing really gnarly kind a stuff,” Favata said. Test-ride different options, find out what feels best for you. There’s nothing worse than getting stuck with an uncomfortable bike. Burr said shoppers should know how much they want to spend. Luckily, he said, “pretty much all the major manufacturers are making great bikes for any wallet.” Burr believes that buying local instead of at a big-box retailer is important. “No matter how cheap the bike, if it is assembled and tuned out of the box by a skilled
and trained person, that bicycle will perform and ride much better than that built by someone that just knows how to turn a wrench,” he said.
Wheels and hybrids Favata said that 27.5-inch diameter wheels are hot this year. Traditional mountain bikes used to come with 26-inch wheels. Then the “29ers” – bikes with 29-inch wheels – made their debut. “These bikes are more efficient, maintain speed better, have better traction and are better for climbing and rolling over stuff,” Favata said. However, the
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Healthy Hudson Valley
larger wheel can be cumbersome, especially downhill. The 27.5-inch diameters that have grown in popularity recently may provide the best of both worlds. Favata said these dual suspension bikes are more of a “fun bike,” and because of that the industry has begun mass-producing bikes with mid-size wheels for mainstream bicycle lineups. Burr said he personally rides a 26-inch wheeled, full-suspension Trek Remedy with 150mm (6 inch) of travel front and rear. But he’s gearing up to purchase a new 27.5-inch wheel model Trek Remedy with 140mm (5.5 inch) travel front and rear. According to Burr, what the larger size wheels lack in handling they make up for in speed. “Twice now I have been beat in XC races [cross-
country] by less skilled and possibly less fit riders on board 29-inch wheeled mountain bikes,” Burr admitted. Initially, Burr was reluctant to switch. “I am a 26-inch wheel holdout! I have ridden 29er mountain bikes, and they are not as nimble and flickable as my 26er. But the industry is more or less forcing the wheel-size revolution. “The three major bicycle manufacturers [Giant, Trek, Specialized] are not really offering high-end 26er mountain bikes. Pretty much depending on intended use or mountain-bike discipline they are offering either a 27.5-inch or the 29.” There is also a new kind of bicycle called a fitness hybrid or flatbar road bike. Burr said the new type is great to ride around town, commute to work or ride for fitness – while still being comfortable and light. It’s like a road bike and mountain bike had a baby – the best of both worlds. “You have the 700c (29-inch) wheel of a road bike, but not the narrow tire,” explained Burr. “Usually, these bikes are specced with tires that are one-inch to 1.25-inch-wide tires. So, they are reasonably stable and still roll smooth and fast. You also have a more lightweight frame, like a road bike. Then you have the more comfortable handlebars and upright
Although buzz is growing about electric mountain bikes, don’t expect to see them in most local stores anytime soon. Serious riders frown on them.
Warren Buffett on local newspapers... “Newspapers continue to reign supreme, however, in the delivery of local news. If you want to know what’s going on in your town – whether the news is about the mayor or taxes or high school football – there is no substitute for a local newspaper that is doing its job. A reader’s eyes may glaze over after they take in a couple of paragraphs about Canadian tariffs or political developments in Pakistan; a story about the reader himself or his neighbors will be read to the end. Wherever there is a pervasive sense of community, a paper that serves the special informational needs of that community will remain indispensable to a significant portion of its residents.”
Warren Buffett is investing in local newspapers. Shouldn’t you be doing that, too?
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Healthy Hudson Valley
geometry of a mountain bike plus durable mountainbike components like derailleurs, brakes and gears.” Burr said these new bikes accounted for about 40 percent of Windham Mountain Outfitters’ sales last summer.
What about electric bikes? Electric mountain bikes are another trend. Though some serious riders have sworn them off, they can make a world of difference for a casual rider or a bike commuter looking for a little boost. “They are amazing machines,” Burr said. “They have regenerative motors, which allow them to charge the battery packs just in normal use. Also, the amount of power that these motors can output is pretty impressive. A lot of models have governors on the motors to keep the speeds down. There is great potential in these machines especially as more and more people look for alternative means of transportation.” Despite growing buzz about electric mountain bikes,
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don’t expect to see them in most local stores any time soon. Sean Gramling from Kingston Cyclery said the bikes are just starting to take off, and likely won’t even be available to many retailers until mid-summer. Mike Newman, owner of the Bicycle Depot in New Paltz, said he’s opposed to the electric models and doesn’t plan on ever carrying them. For retailers, the issue isn’t availability or a personal stance, but a lack of demand. Burr said his store could order the new e-bikes through the main brand they carry, Trek, but that “there is not too much need for them in our regional market.” “Electric bikes are fun,” Favata said, “but I don’t see them in the next year or so taking off around here. There’s not a market for that type thing around here. It’s more for urban settings where commuting is big.” “People who get bikes are riding to ride,” Favata added. “They don’t want that motor on their bike.” The new e-bikes are also pretty expensive – around $4,000 to $5,000 each. Urgent Medical Care, Adults and Children Family Practice Holistic & Traditional Options
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HealthAlliance Hospital: Broadway Campus
Emergency Services
photo © john halpren
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PHOTO © JOHN HALPREN
he Department of Emergency Services has worked diligently throughout the past year to improve the patient experience and satisfaction with emergency care. Updates included changes to triage and the registration process as well as establishing an “autism-friendly” program. The team is making every effort to accommodate the needs of all patients and ensure a high-quality, timely and efficient visit at the Emergency Department.
“Autism-Friendly” Program New Bedside Triage Model Hypothermic Resuscitation Cardiac Care Stroke Care Trauma Team Response Made possible from the generous donations of the HealthAlliance Foundation www.FoundationUpdate.org
“AUTISM-FRIENDLY” PROGRAM
As of December, 2013, the HealthAlliance Hospital: Broadway Campus Emergency Department implemented an “autismfriendly” program. The program was established to provide patients with Autism Spectrum Disorder (ASD) with a more comfortable experience when visiting the Emergency Department. Patients with ASD react and communicate differently, requiring a special approach to creating a safe and supportive environment— especially in emergency situations. In an effort to recognize this need, HealthAlliance initiated special training for medical providers, nursing staff and other key hospital personnel. Additionally, the Emergency Department now possesses a sensory box to aid in relaxation and two iPads to help with communication between doctors and patients with ASD. Already several patients and their families have benefited from the new program. NEW BEDSIDE TRIAGE MODEL
The HealthAlliance Hospital: Broadway Campus will implement a bedside triage model on April 1, 2014. With this new process, patients enter the ED, are identified and banded, and brought directly to
a bed in the ED where triage is performed. To facilitate this model, Registered Nurses working in the ED have undergone re-education in Emergency Severity Index Training. Additionally, the staffing matrix has been changed to accommodate the new process. The Bedside Triage Model will help prevent delays and get patients to a doctor sooner. With this new process, Emergency Department leadership hopes to improve the patient experience, quality and safety; and reduce the number of patients that leave the ED without being seen. A new “autism-friendly” program was developed to treat ASD patients in a safe, supportive way.
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HYPOTHERMIC RESUSCITATION
The HealthAlliance Emergency Department continues to utilize a very special protocol for men and women who have suffered from cardiac arrest and loss of consciousness. Once the patient’s cardiac rhythm is re-established, the team works to cool the patient to 32 degrees Celsius (89.6 degrees Fahrenheit) to decrease the metabolism of the brain. This cooling has been demonstrated to decrease brain tissue death associated with lack of oxygen during the cardiac arrest and to provide an opportunity for recovery of neurological function. We have had dramatic recoveries of patients who have successfully returned to the community to lead happy and productive lives after this therapy.
CARDIAC CARE
HealthAlliance Hospital: Broadway Campus is on the front line of emergent cardiac care in evaluating chest pain and treating acute myocardial infarction (‘heart attack’). The team of skilled Emergency Physicians, Registered Nurses and staff work closely with the regional EMS Paramedics with the goal of pre-identification of chest pain and heart attack victims prior to arrival. The LIFENET System has been put in place to effectively transmit 12-lead EKG reports from the field to the hospital digitally. In the ED, the team can review the EKG and determine if the patient is indeed having a major cardiac event. Upon arrival, the patient is rapidly assessed. If the patient is suffering from a life-threatening clot in the coronary arteries, our physicians can choose to use TNKase (Tenecteplase) to dissolve the clot, similar to the process of treating ischemic stroke. Once stabilized, the patient can be transported to area medical centers for interventional cardiac catheterization. STROKE CARE
As the accredited Stroke Center for Ulster County, HealthAlliance Hospital: Broadway Campus provides expert care in the emergent recognition, evaluation and treatment of stroke symptoms. Our team of Board Certified Emergency Physicians, along with our specially trained Registered Nurses, work to render lifesaving and “brainsaving” critical care to patients who are suffering from strokes. For patients who are suffering from an ischemic stroke caused by a blood clot, we utilize the special medication t-PA (Tissue Plasminogen Activator) to dissolve the offending clot
and restore vital oxygen-rich blood flow to the brain. This gives the patient a chance for recovery from the acute stroke and an eventual successful return to our community. The work of the multidisciplinary Stroke Team in saving lives is nothing short of extraordinary. TRAUMA TEAM RESPONSE
Trauma Team Response was developed for a specific purpose: to deliver highly effective, time-critical, lifesaving evaluation and care for victims of trauma. Trauma is a serious disease process in our region—Ulster County has one of the highest rates of traumatic motor vehicle death per population when compared to other counties in the Hudson Valley region. With major Level I trauma centers more than an hour away by ground transport, the EMS system relies heavily on the helicopter medevac system. While HealthAlliance Hospital: Broadway Campus is not a Trauma Center, paramedics will transport serious trauma victims to our Emergency Department when poor weather conditions prevent the use of the regional helicopter medevac system, or when the trauma occurs within minutes of the hospital. In cases of serious trauma, paramedics will pre-notify the ED to activate the Trauma Team. This team activation is vigorous, with personnel involvement from the ED, Respiratory, Radiology, Surgery, Lab and Blood Bank. The goal is stabilization and disposition of the traumatically injured patient in less than 30 minutes. In trauma, every moment is critical in stopping hemorrhage
The HealthAlliance Hospital: Broadway Campus Emergency Center Trama Team Response (above) was developed to stabilize traumatically injured patients within 30 minutes. With the closest Level 1 center an hour away, the Center’s need to be prepared is critical.
processes and restoring precious blood perfusion of the vital organs. To ensure preparedness and proper response, Emergency Department Physicians and Associate Providers undergo recurrent training in Advanced Trauma Life Support. The Registered Nurses complete advanced training in adult and pediatric Trauma Care through the Trauma Nurse Core Curriculum and Emergency Nurse Pediatric Course promulgated by the Emergency Nurse Association. From child to adult, motor vehicle crashes to burns, falls to gunshots, the Trauma Team has made a profound difference in the lives of traumatically injured patients. Our team stands ready to respond in a second’s notice 24/7, 365 days a year to guarantee the highest dedication to lifesaving care for our community. ■
The HealthAlliance Hospital: Broadway Campus Emergency Center Registration group, responsible for keeping all the moving parts moving smoothly and supporting patients, Emergency Center staff, physicians, and making arrangements for the next phase of care.
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Wafting in Medical marijuana makes progress in New York Jesse J. Smith ack in January, Gov. Andrew Cuomo broke New York State’s decade-long stalemate over medical marijuana by announcing that he’d dusted off a never-implemented 1980 law allowing up to 20 hospitals to prescribe the plant to seriously ill patients. Since then, the governor’s office has remained silent while the state health department drafts regulations to guide the program. Meanwhile, various plans to go beyond the governor’s proposal have been gaining adherents in the state legislature. The announcement that New York would soon join the list of 20 states and the District of Columbia allowing the use of marijuana for medical purposes has re-ignited a debate over a plant that – despite strong evidence that it provides some medical benefits to cancer, AIDS, multiple sclerosis patients and people with other serious illnesses – remains on the federal government’s list of banned substances that have no legitimate medical use, such as heroin and cocaine. Evidence of cannabis’ use as medicine dates back about 3,000 years. It was introduced into Western medicine in the 1840s by a British surgeon working in India. Since then, numerous small-scale studies have suggested a range of medical benefits associated with cannabis and various synthetic and natural compounds known as cannabinoids. The evidence for marijuana’s medical benefits is strongest in its role in treating nausea and vomiting associated with chemotherapy. According to a report from the National Cancer Institute, a study of 30 randomized studies found that THC (the active ingredient in marijuana) extracts outperformed traditional anti-nausea drugs and helped patients gain weight. Other studies have shown cannabinoids’ efficacy in relieving pain and reducing anxiety and sleeplessness in cancer and AIDS sufferers. The National Cancer Institute paper endorses the use of cannabinoids – already in use in prescription antiemetics like Marinol – while hedging due to a lack of
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research on the medical value of smoked or otherwise ingested cannabis. Other studies have shown cannabis to provide beneficial effects to people suffering from ailments ranging from MS to post-traumatic stress disorder.
A legislative turnaround Marijuana’s status as a Schedule I narcotic – designated by the feds as having no legitimate medical purpose – has made it difficult to conduct the kind of large-scale, long-term studies needed to form a medical consensus. In November, the American Medical Associated reiterated its opposition to the full on legalization of marijuana, calling the plant “a dangerous drug.” But when it comes to the use of cannabis for medicinal purposes, the physicians’ group takes a more nuanced approach. A 2001 report by the AMA’s Council on Science and Public Health noted that shortterm studies showed promise for the use of cannabis in for the treatment of neuropathic pain and other ailments. The report noted that the plant’s status as a Schedule I narcotic had made it difficult to develop clinical protocols for its use in medical settings. “The patchwork of state-based systems that have been established for medical marijuana is woefully inadequate in establishing even rudimentary safeguards that normally would be applied to the clinical use of psychoactive substances,” it reads. The report recommends a government review of marijuana’s status as a Schedule I drug. Moving marijuana into the “controlled substance” class of drugs – which includes patently dangerous but medically accepted substances like hydrocodone and Valium – would open the door to wider-ranging research as and use of marijuana as prescribed by doctors nationwide. On the federal level, there’s been little progress in taking marijuana off the Schedule I narcotics list. But that hasn’t stopped 20 states and the District of Columbia from implementing medical marijuana protocols (Washington and Colorado took a step further
Marijuana’s status as a Schedule I narcotic – designated by the feds as having no legitimate medical purpose – has made it difficult to study.
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LAUREN THOMAS
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approving legalization of recreational pot last year). In the Northeast, New Jersey, Connecticut, Maine, New Hampshire, Vermont and Rhode Island all have legalized medical marijuana to varying degrees. In New York, meanwhile, the Democrat-controlled state Assembly has passed a bill allowing the use of marijuana for certain ailments each year for nearly a decade. The measure has invariably died without a floor vote in the Republican-controlled Senate. Assemblyman Kevin Cahill, one of the bill’s original sponsors, blames Republican inaction on the influence of Conservative Party chairman Mike Long, who has made opposition to marijuana legalization a litmus test for Republicans seeking the endorsement of the small but politically important third party. But, earlier this year, Long backed off that stance, saying that while the party continues to oppose medical marijuana it was no longer a deal-breaker for Conservative support. Combined with Cuomo’s proposal for a narrowly construed medical marijuana system, that change in position could provide the impetus a reform measure needs to clear the Senate and become law. Several Republican state senators have indicated their support for such an initiative.
“I think that what Cuomo was doing was saying, OK, I’m opening the door a crack, now it’s up to [state lawmakers] to see how far you want to take it,” Cahill said.
Unsanctioned approval While the medical establishment and New York politicians have been slow to officially embrace medical marijuana, a thriving underground of patients, marijuana growers, weed-friendly patient advocates and healthcare providers aren’t waiting around for the law. Back in 2009, local marijuana grower and activist Joe Barton lamented the bust of his Hurley pot farm by publicly declaring that cops were depriving cancer patients of his high-quality product. One Hudson Valley healthcare worker who often deals with the terminally ill said that marijuana use by the very sick was an everyday, if unsanctioned, occurrence in her workplace. “We’re not allowed to condone or push people towards [medical] marijuana,” said the employee, who asked to remain anonymous because of the topic’s sensitivity. “But we’ve had patients who straight-up smoked. You’d smell the marijuana down the hall and just pretend you didn’t smell it.” The employee said she’d seen firsthand the efficacy of marijuana in relieving pain, especially among those whose lingering ailments had left them largely resistant even to high doses of traditional pain medications like morphine. The marijuana, she said, most often comes into the facility in the form of baked goods or other “edibles.” Other times, patients employ vaporizers that deliver the THC without the smoke. Oftentimes she said elderly patients, who may be unfamiliar with or disapproving of marijuana, try it after conversations with their children or grandchildren. The employee said that she’d seen patients’ appetites and mood improve dramatically with marijuana use. She estimated that about three-quarters of her colleagues, including doctors, believed that marijuana had a role in medicine. That number, she noted, included older, more conservative healthcare workers who generally disapprove of recreational drug use. “Once you see it work, it changes how you think about it,” she said. “I have co-workers who think it should be legal for medical use who would never, ever want their children or grandchildren smoking it for recreational use.”
Studies have shown cannabinoids’ efficacy in relieving pain and reducing anxiety and sleeplessness in cancer and AIDS sufferers
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Opponents of medical marijuana see these attitudes as a smokescreen for full legalization. They point to the examples of states like California, where a broadly constructed medical pot law made it a relatively simple thing for virtually anyone to obtain a prescription (often from a physician employed by a marijuana dispensary). In Washington State and Colorado, medical marijuana laws opened the door to voter referenda that made the two states the first in the nation to legalize marijuana for recreational use. Many legalization advocates don’t shy from the medical marijuana as stalking-horse-for-legalization argument. National Organization to Reform Marijuana Laws Capital Region (NORML) executive director Kevin Jones regard “medical marijuana” as a meaningless phrase akin to “medical tomatoes.”
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“Calling it medical doesn’t change the plant,” Jones said. “But once we get patients taken care of, we can get past the toxicity theory and the addiction theories, which are false, and move on to legalization.” Jones said that while 30 to 40 percent of New Yorkers favor outright legalization of marijuana and 80 percent favor its medical use. New York politicians don’t hear often enough from people who want to change the laws, Jones said. He believed a tipping point would occur when people realized that 70 years of prohibition and a four-decade-old War on Drugs had done little to prevent those who want to smoke marijuana from doing so while costing taxpayers billions. “I smoke every day, because I can get [marijuana] every day,” Jones said. “It’s not the smokers who are getting screwed. It’s the taxpayers.”
A GUIDE TO A CHILD’S DEVELOPMENT • By the end of 1 year old (12 months), many children: ° use simple gestures (waving “bye-bye”) ° say “dada” and “mama” ° imitate actions in their play (clap when you clap) • By the end of 1-1/2 years (18 months), many children: ° do simple pretend play (“talk” on a toy phone) ° use several single words unprompted • By the end of 2 years (24 months), many children: ° use 2- to 4-word phrases ° follow simple instructions ° point to object or picture when named • By the end of 3 years (36 months), many children: ° use 4- to 5-word sentences ° be understood by unfamiliar listeners, although there may be sound errors ° play make-believe with dolls, animals, and people (“feed” a teddy bear) • By the end of 4 years (48 months), many children: ° use 5- to 6-word sentences ° be easily understood when speaking ° follow 3-step commands (“Get dressed. Comb your hair, & wash your face.”)
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Behind the fad What’s so good about gluten-free? Jennifer Brizzi
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wenty-nine percent of us either have given up gluten deliberately or are trying to, according to the market research company The NPD Group. That’s over onequarter of the U.S. population. What’s wrong with this stuff, the gluey substance in some grains that is created when two proteins – glutenin and gliadin – bind and give dough texture, stretch and risability? Many restaurants, stores, bakeries and sandwich shops are now offering gluten-free options for this burgeoning section of the population, which feels that life is better without gluten. “I think it’s TV marketing, the doctor shows, the health blogs,” said Liz Malgieri, a registered dietitian, of Village Apothecary in Woodstock. “People are being exposed to a marketing force feed, bombarded with images. They’re being told gluten is bad, that it’s the devil.” Malgieri recently offered wellness programs on this topic at both of Village Apothecary’s stores in Saugerties and Woodstock. Best-selling books like Wheat Belly: Lose the Wheat,
tigue, arthritis or bone or joint pain, and can lead to more serious issues like malnutrition, anemia, osteoporosis, liver disease and intestinal cancer. “It’s growing so fast,” said Malgieri, “because more people are aware of it now … It’s the most undiagnosed disease, although doctors are getting better at diagnosing it. “Symptoms can come and go. Someone can keel over in pain one day from it and be fine the next week. And everyone’s different.” People with celiac disease need to avoid gluten in all forms, including rye, barley and bulgur. They have to know how to find it lurking in unexpected places, from salad dressings to soy sauce to processed cheese, even some yogurt, candies and cosmetics. “It takes less than 1/8 teaspoon of flour to trigger a gluten response,” Malgieri said. Celiacs can consume oats that are confirmed to be uncontaminated with gluten, as well as millet, corn, rice, quinoa, buckwheat, amaranth and teff, plus flours made from legumes, nuts and coconuts. A larger group of us – about 6 percent or so – experience non-celiac gluten sensitivity, and may have problems with the skin, joints, sinuses and digestive system, and sometimes irritable bowel, headache, fatigue and depression. One of the most common allergies in children is a wheat allergy, which they usually outgrow, although some adults do remain allergic. People consuming gluten in a natural or organically grown, non-genetically modified form tend to have fewer gluten or wheat sensitivity issues. And why we suddenly have mass reactions to a grain we’ve been eating for eons is a subject of debate as well, with many plausible theories. These medical problems are more easily diagnosed now than they used to be, when people would suffer for years and not know what was wrong with them. But if you’re tired, overweight, sluggish or have bad skin, you may want to join the ranks of the gluten-free and try giving it up to see if that helps. You’ll be in plenty of company.
“If you’re worried about an intolerance to gluten, you have to give it up completely, not just part-time.” – Liz Malgieri, dietitian
Lose the Weight, and Find Your Path Back to Health by William Davis, MD (Rodale, 2011) and Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar – Your Brain’s Silent Killers by David Perlmutter, MD (Little, Brown and Company, 2013) tout the ills of consuming gluten in wheat, barley and rye, or even grains in any form at all. Many followers are now avoiding all grains, including many who are on the trendy Paleo diet that’s based on that of our ancient hunter-gather ancestors. Paleo is high-protein and low-carb and bans salt, sugar, legumes, dairy, potatoes and all grains. owever, the very serious celiac disease affects at least 1 percent of the population. This genetic disorder is an immune-response reaction to gluten, which harms and inflames the small intestine. Consuming the smallest amount of gluten can cause symptoms such as digestive disturbances, fa-
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MARTIN LABAR
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Healthy Hudson Valley
“A
part from the well-known role of wheat gluten in celiac disease, there is scant evidence for more general threats to health by wheat consumption (other than over-consumption of calories),” said Peter Olin, co-founder of ultimateglutenfree.com. He’s a Ph.D., plus a food safety and nutrition advocate. “Wheat feeds over a billion people, and provides 20 percent of calories consumed. It is protein-rich, cheap and versatile … A large part of wheat consumption is not a ‘lifestyle choice,’ but a necessity … Is there truly a threat to health (at least in the prosperous, over-fed West), or does the demonization of wheat simply feed another fad for people who want to lose weight, and want an external bogeyman to blame, rather taking responsibility for their own health?” Since gluten-free flours are often refined ones, giving
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up gluten means you may risk deficiencies in important vitamins, minerals and nutrients like iron, calcium, thiamine, riboflavin, vitamin B12, niacin, folate, phosphorus, zinc and fiber. So it’s a great idea to have your diet guided by a dietitian, and if you suspect celiac disease or gluten sensitivity, by a physician as well. Key, too, is following a very healthy well-balanced diet based on fruits, vegetables and complete proteins. Just because crafty bakers can now make gluten-free cookies and cakes with a delicious taste and texture doesn’t give you free reign to base your diet on those. “What I tell people is that it’s healthy to eliminate processed, packaged foods,” Malgieri said. “Because those gluten-free substitute baked goods sometimes don’t taste good, missing textural components that the gluten gives them, the manufacturers compensate by adding more sugar, more fat, more salt, or some flours that are more refined. So it’s pure junk food. “It’s fine to have some,” she added, “but better to eat real food: more vegetables, fruits, beans, healthy meats. Feed your body what it was to meant to eat, what it wants. “People will say, ‘this is great, I have more energy, I lost weight’,” she said, “but that’s probably not the lack of gluten, it’s the healthier diet. “I’m not against people going gluten-free,” said Malgieri. “It’s worth a shot. But some people go about it the wrong way. What drives me the battiest is when they don’t do it 100 percent. If you’re worried about an intolerance to gluten, you have to give it up completely, not just part-time. If you want to try it, you should.
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Healthy Hudson Valley
Just get rid of the junk food, and give it at least twelve weeks of being 100 percent gluten-free.”
P
roblems from obesity to sluggishness that are now being blamed on gluten – at the suggestion of the popular media – may have other causes: a more sedentary lifestyle, heavily sweetened beverages, more processed, refined foods, preservatives and other chemicals. Foods take turns in the spotlight, worshipped as a superfood, full of nutrients, like goji berries or chia seeds, or demonized as the cause of all dietary ills. In the 1970s that was sugar, followed by saturated fat, then carbs. Right now it’s gluten or grains in general. What will it be tomorrow? While celiac disease, gluten intolerance and wheat allergies are very real, well over half of us can eat grains
A Patient-Centered Pharmacy
May 1, 2014 • 33
and enjoy their many health benefits. We just have to make sure they are good ones, e.g. whole grains organically grown and non-GMO whenever possible. If giving up gluten makes you feel better, go for it. But if not, you may be able to lose weight and improve your health with a sound, varied diet based on whole natural foods.
On the web: http://ultimateglutenfree.com/ http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/gluten-free-diet/ art-20048530 http://www.npd.com/perspectives/food-for-thought/ gluten-free-2012.html
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Healthy Hudson Valley
Eat a bug Cricket tacos and the future of food Quinn O’Callaghan here are so many crickets on this taco. Something like 70, I’d guess at first glance. I’m in Toloache in the Upper East Side of Manhattan. a nice little tapas place with an expensive menu, on which is the chapulines taco – “chapulines” being Spanish for crickets. The bartender stares at me as I stare at my lunch of dry-roasted bugs. He tries to lighten the mood by giving me a short history of cricket-eating. “You know, crickets were a big part of the Mayan diet,” he says. I poke at a dead cricket that normally I wouldn’t even be willing to touch. “Oh. Good for them,” I respond. The future of food points in a few key directions in terms of sustainability and nutrition. Hydroponics, a subset of hydroculture that is a method of growing plants
T
using mineral nutrient solutions in water without soil, is a buzzword in progressive horticulture. These folks are convinced that the future of agriculture lies in literal towers of produce. Lab-grown meat, too – the kind that is literally cow, pig, chicken, etc. tissue grown from petri dishes, culture tubes and Bunsen burners – may, in time, eliminate farm waste and concerns about animal cruelty. And then there’s bugs. Eating insects is the future of nutrition. It’s already established around the world. People have been eating crickets and grasshoppers in Mexico for millennia. The consumption of a leaf-cutter ant is commonplace in parts of South America. People in Thailand eat all kind of bugs with snacking regularity. Though there are innumerable positives to making insects an integral part of a diet, eating bugs just has never caught on here, outside of a few haute-cuisine outposts. Blame it on the general squeamishness of the American public. As one of those squeamish Americans, I am wary of this taco. Frankly, I thought there might have been more ceremony to it, more layered flavors . You know, the way that veggie burgers are often doped up with loads of fixings to distract from the strange consistency of the patty. Nope. This is just two generous scoopfuls of dry-roasted,
“By all means, eating insects is the future of nutrition. It’s already established around the world: people have been eating crickets and grasshoppers in Mexico for millennia.”
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MOOKIE FORCELLA
cilantro-and-lime-flavored crickets deposited on two otherwise lovely tortillas, with a dollop of guacamole and some onions on top to distract. The bartender glances at me as I hoist it into the air. I think he can tell that I’m not fond of the visual of dozens of dead bugs falling out of either end of my lunch. But at least he seems amused. The woman sitting next to me looks very concerned
as I’m about to take my first bite. I feel as though I’m in a circus act, about to willfully ingest poison. Lady, you’re going to have to get used to it. Even the United Nations is on board, pushing the act of eating insects – known as entomophagy – to the gastronomical forefront. According to an extensive report published in 2013 by the Food and Agriculture Organization (FAO), a UN agency dedicated to countering international
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• May 1, 2014
Healthy Hudson Valley
famine, the promotion of entomophagy is a must if we are to ensure that the growing global population remains fed. There are already strains on the food industry. According to the FAO, rearing insects for food is incredibly cost-effective, and could help alleviate hunger in Third-World countries if properly promoted. The FAO makes a solid argument for the nutritional value of insects in comparison to beef. A section of the report called “Beef versus insects: An example of the mealworm,” clarifies how 100 mg of mealworms beats or comes close to beating 100 mg of beef in several key nutritional categories, including protein, fat and many key acids. The only downside is that you’d have to really get into eating mealworms. Lawrence Forcella, a self-employed entomologist (bug scientist), has no beef with eating insects. He’s had plenty. In fact, this summer he lit up a few cicadas, which were in no short supply, and dug in. “We oven-roasted them,” Forcella explained. “With a little salt, they were delicious. We covered them in olive oil and put them in the oven until they got crispy.” You want to get them just as they emerge from their larval
stage, he said, because they’re going to be soft, having just molted. “You won’t have that crunchy exoskeleton to deal with. I would say that it’s kind of nutty.” There may not be many options for edible bugs in the Hudson Valley, but I suppose that depends on how brave you are. Forcella says that cicadas are definitely the go-to culinary experience among insects around these parts. Grasshoppers, too, are a viable option for Hudson Valley entomophagists. “Insects are cheap and abundant,” Forcella said. “If it takes an acre of land to raise a cow, on that one acre of land you could raise a lot more insects. That’s really what it is. It’s about the amount of resources that could be invested into producing a pound of beef versus the amount of resources that go into producing a pound of insects. You spend far less resources creating that.” Toloache must be making a killing on this taco. It runs me $15. Doing this was a calculated risk for me. Otherwise, I would have had to order grasshoppers, in bulk, and prepare them for consumption at my house. The taste was not so bad, even close to good. The
Even the United Nations is on board with pushing the act of eating insects — known as entomophagy — to the gastronomical forefront."
Sit back & relax
We love the web. It’s fast. It’s free. It connects us to people and information from around the world.
It feels good to cut the cord. To immerse yourself in a good book or article, to hold it in your hands.
But it’s not perfect. Some sites collect personal data, putting you at risk of identify theft. Leaning forward, staring at a screen causes headaches. E-mail and chat are constant interuptions. Our minds weren’t made for this.
We’re there for you on the web, but that’s just the tip of the iceberg. For the best coverage of your community, with the best reading experience, subscribe today to the print edition of any Ulster Publishing newspaper at subscribe@ulsterpublishing.com or www.hudsonvalleytimes.com.
May 1, 2014 • 37
Healthy Hudson Valley
crickets themselves were inoffensive. They’re not meaty or foreign, they’re just dozens of little crunch bombs that have taken on the zest of the citrus in which they were cooked. I tried not to look down at the plate too much. By the time I finished my second taco, there were spare crickets littered everywhere across the plate. I decided not to offend the sensibilities of the poor woman next
to me out by picking up the spare bugs and nibbling on them while watching the Liga MX game playing on the TV over the bar. I could potentially see eating bugs again in the future. Hell, I’d be able to say that I ate them before they were cool. On the train ride home, I pull a whole cricket leg out of my teeth.
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I pledge to read the printed word It’s a movement that’s catching on. It’s not hard to see why. Studies show readers retain more when they read on paper compared to a screen. And in a world bent on speeding us up, it’s nice to sit back and relax with the paper. That’s why ulster publishing—while exploring the web—remains committed to our newspapers, which are printed sustainably on recycled paper when possible. r e a d t h e p r i n t e d w o r d. o r g
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Impaired mobility Rotator cuff injuries afflict athletes, Average Joes Sharyn Flanagan
W
hen you watch professional athletes compete, it becomes obvious that the pursuit of their passion can take its toll. Elite athletes aren’t the only ones who suffer from overextending their bodies, however. You too can be sidelined by repetitive movements. A fairly common cause of pain and disability among adults, rotator cuff injuries occur most frequently from repeated overhead movements. Baseball pitchers fre-
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quently get it easily, and it can come from a painter’s or carpenter’s work movements. According to the American Academy of Orthopedic Surgeons, roughly two million U.S. residents go to their doctors because of a rotator cuff problem each year. For those who don’t already know, the rotator cuff is a network of muscles and tendons, keeping the ball on your upper arm bone snugly within the shoulder socket. Rotator cuff injuries cause a range of symptoms: from a dull ache in the shoulder to outright pain and the inability to perform simple tasks. Initially, the pain
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May 1, 2014 • 39
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• May 1, 2014
Healthy Hudson Valley
may be mild and occur only with certain movements of the arm. But over time pain may be present even when one is resting or at night – especially when lying on the affected shoulder. Though the risk of rotator cuff injury increases with age, the malady can occur in children, too, particularly those involved in sports like swimming. Dr. David Ness, a chiropractor in New Paltz who specializes in treating athletes, said that he has successfully treated a number of children with rotator cuff injuries post-surgery. Ness said he sees this type of injury in those who play baseball, volleyball, racquetball or tennis – even swimmers or weightlifters who try to do too much weight. “And if you’re not used to doing overhead weight and
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Healthy Hudson Valley
you don’t have good posture or good form,” he said, “that’s another way you can get injured.” Overuse causes the injuries most often, Ness said. But rotator cuff injuries can result from trauma, too. They can occur from falling and dislocating a shoulder or becoming injured in football or skiing. If your doctor feels you may have a rotator cuff tear, an ultrasound or an MRI might be suggested. Severe rotator cuff injuries involving complete tears of the muscle or tendon require surgical repair, Ness said.
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any patients respond well to more conservative treatments. It’s possible to recover from a less severe rotator cuff injury with physical therapy exercises which improve flexibility and strength of the muscles surrounding the shoulder joint.
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• May 1, 2014
Healthy Hudson Valley
“I specialize in a technique called Active Release Techniques [ART], which is what we use to treat rotator cuff injuries in our office,” Ness said. “It’s a patented state-of-the-art treatment for muscle, ligament, tendon and joint injuries, performed by chiropractors, physical therapists and other people who do body work.” Patients can be treated post-surgery as well. ART is a form of deep-tissue work related to the myofascial release work done by a massage therapist. The myofascial tissues – the tough membranes that wrap, connect and support muscles – are manipulated with focused manual pressure and stretching, loosening up restricted movement. The ART work consists of a series of patented movements – over 700 protocols now for all the different muscles, according to Ness – that break up and remove scar tissue from deep within and between muscles, tendons, ligaments and nerves. Ness identifies the scar with his thumb or fingers, and starting with the patient’s muscle shortened, he applies tension while the patient moves the body part to lengthen the structure. This breaks up the scar tissue, restoring normal movement and relieving pain.
T
he chiropractor who invented the ART system was working with triathletes when he developed
the techniques, Ness said. “He had an engineering background, and was an Ironman. Now ART is at every Ironman event in the world as a treatment pre-race and post-race.” Ironman triathlons consist of a 2.4-mile swim, a 112mile bicycle ride and a 26.2-mile marathon run, in that order and done without a break. Traditional chiropractic work is not done to fix a rotator cuff injury. But chiropractic has expanded its realm. “Today’s chiropractors are more than just spine doctors,” Ness said. “A lot of us treat different parts not related to the spine.” Since the shoulder and spine are so intimately related, it’s best to treat both. “In our office, we would do a combination of treatment for the thoracic spine, which the shoulder and scapula sit on, which could include manipulation, then the ART soft-tissue treatment would be done on all the muscles of the upper extremity.” This is followed by the patient doing strengthening exercises and stretching. Ness says that one of the advantages of the ART system is that one typically gets results in four to six treatments. “It’s effective and long-lasting. There’s no ongoing care needed. They come in for their prescribed four to six treatments and then they go out and recover,” he said.
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Healthy Hudson Valley
“If they keep their posture good, and stretch and do their exercises, most of the time it doesn’t come back.” An annual ART certification process is customery. Ness also serves as the official chiropractor and ART provider for the Hudson Valley Triathlon Club and the Vassar College athletic department, where he works in the sports medicine department with the athletic trainers and the ancillary doctors. Physical therapists,
an orthopedic surgeon and a podiatrist are also available. “We keep the athletes in the game or get them back in the game,” said ness, who is in his fourth year of service at Vassar. For more information, contact Dr. David Ness at 2551200 or email npsportsdoc@gmail.com.
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• May 1, 2014
Healthy Hudson Valley
Looming pox Shingles vaccine may benefit 60-somethings Jennifer Brizzi erck commercials urge us to get the shingles vaccine, with horror stories of excruciatingly painful, maddeningly itchy rashes from the disease also known as herpes zoster (no relation to genital herpes). Reminders that the virus is probably laying in wait in most of our bodies reinforce the fear. But will the vaccine help prevent this all-toocommon affliction and is it worth its high price? Shingles is caused by the virus varicella, or VZV, the same one as chicken pox. Approved by the Food and Drug Administration in 2006, the vaccine is a live form
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of the virus. It is 14 times stronger than the chicken pox vaccine now routinely administered to most children. Shingles is rare in the young and your risk goes up the older you get, higher in immunocompromised or other weakened people. You have to have had chicken pox first, which 99 percent of us have had. The chicken pox virus lies dormant for decades – in a nerve of your trunk, leg or face. Then if at some point your immune system weakens, whether from old age, drugs or disease, the virus may come back to life many years later in the form of that horrendous rash. First though preceding the rash, is a prodrome in the form of an unbearable tingling itch or sharp, burning unexplained pain on just one side of your face or body. You may experience
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Healthy Hudson Valley
lead to corneal ulcers, conjunctivitis or even vision loss. Generally after a week or two of the rash, the blisters scab over and the rash is completely gone by a few weeks later. However about one person in five continues to have lingering complications in the form of post-herpetic neuralgia,
headache, malaise, sensitivity to light or perhaps fever and chills. Then, in most cases, three to five days later, pustulating blisters develop at the site. The pain is so great it affects sleep, mood and general quality of life. One-tenth to one-quarter of shingles sufferers have eye involvement, which can
In older people, chicken pox may come back to life many years later in the form of a horrendous rash called shingles.
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ivers, mountains, hills, valleys, streams, lakes, forests, historic hamlets and friendly villages with so much to do in each. That’s the Hudson Valley, an attraction for all. Talk to the tourists, boaters, day trippers and families — folks of all ages and interests. Tell them what you can offer for their vacation enjoyment. t Restaurants
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WOODSTOCK TIMES
alm@nac 12
Pete and Peggy
section inside!
TIMES
Healthy Hudson Valley OCTOBER 25, 2012
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ULSTER PUBLISHING
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HEALTHYHV.COM
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VOL. 12, NO. 43
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$1.00
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THURSDAY, OCTOBER 25, 2012
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A miscellany of Hudson Valley art, entertainment and adventure | Ca l e n d a r & C l a s s i f i e d s | I s s u e 4 8 | No v. 2 9 — D e c . 6
Hugh Reynolds:
Amayor’s farewell
Working Families boost Gallo
Hillside Manor bash for Hizzoner
All-natural remedies bring real help
INSIDE
alm m@n nac arts & entertainment guide, calendar, classifieds, real estate
NEWS > 6
COUNTY BEAT > 19
No fake
NEWPALTZX.COM
90 Miles to present “I Remember Mama”
An Angeloch sky Beloved artist passes on
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KINGSTON TIMES
Coming to terms
Gallo 697, Clement 691 (so far). Polacco 228, Turco-Levin 207.
LLOYD:
Mountainside Woods debate
THURSDAY, SEPTEMBER 22, 2011 VOLUME 6; ISSUE 38 ULSTER PUBLISHING, INC. WWW.KINGSTONX.COM
Page 9
Lloyd voters to decide on term limit extensions for town supervisor, clerk & highway superintendent
by Lisa Childers
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by Erin Quinn
O Robert Angeloch drawing in Monhegan, in this John Kleinhans photo.
n Friday, March 18, 2011, on the morning of the full Super Moon, legendary artist and co-
Continued on Page 9
art gallery and art school, and the fervent admiration of generations of devoted art students. To his personal credit, he leaves a lasting legacy of art, beauty and a sustaining example, having led a life of purpose with unwavering determination and accomplishment. Born on April 8, 1922 in Richmond Hill, New York, Angeloch served in the US Air Corps and Army during World War II where he was a pilot,
studied to be an engineer and ended up in medical school. He studied at The Art Students League of New York from 1946-1951, where he first began painting with Yasuo Kuniyoshi and printmaking with Martin Lewis. He spent the summer of 1947 learning the craft of making woodcuts with Fiske Boyd and it was that summer that Angeloch first studied nature working out of doors. For this reason he recently Continued on Page 13
he Phoenicia Library was gutted by fire in the early morning hours of Saturday, March 19. Within three days, plans were already in place to open a temporary library on Saturday, March 26, in the building recently vacated by Maverick Family Health, across from the Phoenicia post office. “It’ll be a bare-bones operation,” cautioned library director Tracy Priest. “We’re restoring minimal services, but we want to open our doors. People can return library books and pick up books they’ve ordered from interlibrary loan. From the Mid-Hudson Library System, we’re borrowing a computer and components we need to check books in and out. We’ll open at 10 a.m., and Letter Friends, the early literacy program, will happen at its normal time, 11 a.m. We’re looking eventually to have a small lending library, which may be on the honor system, since all our bar codes were destroyed in the fire.” Writing classes and other programs scheduled for later in the spring will be held as planned. It looks like at least a couple of computers will be donated for use by patrons. The blaze was reported to have come from an electri-
cal fire, which started in the back of the building. “We don’t have a full report on the extent of the damage,” said Priest, who visited the building after the fire with the insurance adjuster and Town of Shandaken supervisor Rob Stanley. “The adjuster said there has to be a second claims adjustment because it’s considered a major loss. We don’t think any books or materials will be salvageable. But because of the location of the fishing collection, we may be able to clean some of that and save it.” The Jerry Bartlett Memorial Angling Collection includes more than 500 fishing and nature books, plus an exhibit of fishing rods, lures, fly tying gear, and photographs. “The books are a mess,” said Priest. “Everything is fused together and melted. What’s in the front of the building has been damaged by smoke and water, but everything there is like we left it. Then you cross a line towards the back, and everything is black. There’s a hole of the ceiling of the children’s room, and you can look right up into my office upstairs. Everything from my desk is on the floor Continued on Page 7
LAUREN THOMAS
Pictured is the cast of 90 Miles off Broadway's upcoming production of "I Remember Mama". Top row, left to right: Dushka Ramic as Aunt Jenny, Wendy Rudder as Aunt Sigrid, Zane Sullivan as Nils, Joel Feldstein as Papa, Wayne Kreuscher as Uncle Chris, Julia Cohen as Katrin, Ken Thompson as Mr. Thorkelson and Sherry Kitay as Aunt Trina. Bottom row left to right: Chloe Gold as Dagmar, Kim Lupinacci as Mama and Carly Feldstein as Christina.
N VIOLET SNOW
Blaze of pages Phoenicia Library goes up in smoke by Violet Snow
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ALMANAC WEEKLY
Healthy Body & Mind
Warm core Soapstone-aided massage technique relieves the pain
NEWS OF NEW PALTZ, GARDINER, HIGHLAND & BEYOND
ULSTER PUBLISHING
Super’s proposal Onteora board hears of cuts, tax rates, layoffs
he latest Onteora Central School District 2011-2012 budget proposal does not include massive layoffs as might be seen in other districts, but does feature the elimination of six teacher positions and reductions to part-time of another five, among job cuts in many sectors. The cuts are seen as a reaction to declining enrollment, but also contribute to a total plan that increases spending by only 0.87 percent, that would translate, based on revenue figures, to a 3.9 percent levy increase. At the Tuesday, March 22 board of education meeting at Woodstock Elementary, school officials presented The Superintendent’s Recommended Budget to trustees that includes an increase in spending to a total of $50,477,497. If the board adopts the budget at its April 5 session, voters will be asked to vote on the budget on May 17. If voters reject the budget proposal, a contingency (or austerity) budget could be put in place that would eliminate $121,785 from the equipment budget line, as mandated by the
INETY MILES OFF Broadway will present “I Remember Mama” at the New Paltz Reformed Church on Nov. 2, Nov. 3, Nov. 9 and Nov. 10 at 7:30 p.m. and Nov. 11 at 2 p.m. The play will also be performed at the First United Methodist Church in Highland on Nov. 17 at 7:30 p.m. The story shows how Mama,
with the help of her husband and her Uncle Chris, brings up the children in a modest San Francisco home during the early years of the century. Mama, with sweetness and capability, sees her children through childhood, managing to educate them and to see one of her daughters begin a career as a writer. Mama’s sisters and uncle furnish a rich
background for a great deal of comedy and a little incidental tragedy. Tickets are $15 for general admission, $8 for students on opening night only, $12 for seniors/students and advanced sales and $10 for members/groups. For additional information, e-mail email@ninetymilesoffbroadway.com or call 256-9657.
N TUESDAY, NOV. 6, not only will residents vote on numerous contended races -- most notably being who shall become the president of the US -- but there will also be a plethora of local votes cast for federal, state, county and municipal political leaders. In the Town of Lloyd, the only local referendum on the ballot is for voters to decide whether or not the town clerk, town highway superintendent and town supervisor should have their two-year terms extended to four years. These are all separate referenda, as suggested by Lloyd supervisor Paul Hansut, who said that he wants to give “voters a chance to weigh in on each and every position, and not lump them all together, as many towns have done in the past.” The idea behind the four-year term, according to Hansut, is to give those elected to office “enough time to get familiar with the nuts and bolts of the job, Continued on page 12
The big read One Book/One New Paltz to read & discuss The Submission by Erin Quinn
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Pictured are some of the members of the One Book/One New Paltz committee (left to right): Jacqueline Andrews, Linda Welles, Maryann Fallek, John Giralico, Shelley Sherman and Myra Sorin.
Phoenicia Library after the fire.
HAT WOULD HAPPEN if the selected architect for a 9/11 memorial at Ground Zero turned out to be a Muslim-American? How would people react to the news, particularly those families who lost loved ones in the terrorist attack? There are no easy answers to the questions raised by award-winning author Amy Waldman in her debut novel The Submission, chosen as this
PANCAKE HOLLOW SHOOTING PAG E 9
year’s One Book/One New Paltz readers’ selection. In Library Journal, Sally Bissell remarks that this book is an “insightful, courageous, heartbreaking work that should be read, discussed, then read again.” This is exactly what One Book/ One New Paltz will attempt to do as it embarks on its seventh year of a communitywide reading program filled with events, reading groups, panels and featured authors and actors. One Book is a Continued on page 12
A cut above
Esopus papercutting artist extraordinaire Jenny Lee Fowler
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hen Jenny Lee Fowler moved from Oregon in 1997, she decided to mark each snowfall that first winter in the East by cutting a snowflake out of paper. Being a person who makes things by hand, it seemed like a fun thing to do. Then, like the icy flakes that drift lazily on the wind before becoming a full-fledged storm, the act of cutting paper snowflakes took on a momentum of its own as Fowler became fascinated with the folk tradition of papercutting. One day, her father-in-law asked her if she’d ever done a portrait, like the silhouettes created by folk artists. Her interest piqued, Fowler dared herself to cut 100 portraits of people. Beginning with friends and family, she later moved on to cutting portraits of strangers, who would sit for her at the campus center at Bard, where Fowler worked. “I practiced a lot and found that I totally loved it,” says Fowler. “It kind of surprised me because I’d thought of silhouette portraits as these kind of ‘stuffy’ things, and then I realized that they were really cross-sections of people at a moment in time. I started to see them as more dynamic.” Fowler came across a passage in which one of the early papercutters called silhouette portraits “a moment’s monument,” a description that she finds particularly apt. “They really do capture a little moment, and even the same person can have a different portrait the next day,” Fowler explains. Artful papercutting is now Fowler’s niche, and the Continued on page 13
Beauty of the beat PHOTOS BY PHYLLIS MCCABE
K
INGSTON’S CORNELL PARK HOSTED THE ANNUAL DRUM BOOGIE FESTIVAL LAST SATURDAY, where dozens gathered to get their drum on. At left, Hethe Brenhill of the Mandara ensemble, dances in the sun. At right, a member of the Percussion Orchestra of Kingston (POOK) gets in the rhythm. For more pics, see page 10.
THEATER ON A TRAIN ‘Dutchman’ uses Trolley Museum’s subway car as unusual stage for play exploring sensitive topic of interracial relations. Page 16
TEEN SCENE “The Den” to open in Midtown, giving youths a place to dance, gather and do something positive. Page 8
FIGHTING FOR MIDTOWN Challengers in Ward 4 Common Council race say incumbent isn’t doing enough to help Kingston’s poorest neighborhoods get their fair share. Page 2
fall home improvement special section
BIG ‘O’ Organizers say second annual O-Positive fest will more art, tunes, awareness and health care to Kingston’s creative community. Page 14
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• May 1, 2014
Healthy Hudson Valley
with continuing pain even after the rash has healed. This is more likely to occur the older the person is, is and likely to be worse with advancing age. “Almost one out of three people in America will develop shingles during their lifetime and the risk increases as you get older,” said Benjamin N. Haynes, senior press officer in the Centers for Disease Control and Prevention’s (CDC) Infectious Disease Team. “Anyone 60 years of age or older should get the shingles vaccine,” he added, “regardless of whether they recall having had chickenpox or not. Studies show that more than 99 percent of Americans ages 40 and older have had chickenpox, even if they don’t remember getting the disease.” Among people who live to age 85, half will get the disease at some point in their lives. Although the vaccine is approved for ages 50 to 59 as well, the CDC recommendation is only for 60 and older. Although 1 million shingles cases are reported each year in this country, shingles itself is not a contagious disease, and cannot be passed from person to person.
However the blisters are contagious as there is varicella in them, which could give an exposed person chicken pox but not shingles directly. lthough the CDC recommends the vaccine for everyone over 60, only 14 percent to 16 percent of people in that population get it. Some are vegetarian and object to the pork and beef products in the vaccine. Some are allergic to the gelatin. Some are skeptical that it will work at all. Many are kept away by the considerable cost of the vaccine. Another issue is a history of supply problems – said to be better now – or doctors who don’t want to have it in stock because of the high cost and worry that it will expire before they use it up. People who are advised not to get the vaccine include those with weakened immune systems from leukemia, lymphoma or HIV/AIDS, and those receiving immune-suppressing drugs like steroids or chemotherapy. The vaccine has a 51 percent prevention rate. When it
A
Shingles itself is not a contagious disease. However the blisters are contagious and could give an exposed person chicken pox.
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doesn’t work to keep shingles at bay, it at least reduces its severity of the symptoms. It also may reduce the risk of postherpetic neuralgia by 67 percent. The effectiveness may not be permanent, however. Although studies are ongoing the vaccine has been around such a short time that we’re still not sure. Preliminary findings indicate that it may last six to 10 years or more and then stop working. The high cost of the vaccine may keep some people away – just under $200 at the least expensive establishments, and well over that in most. An additional fee for the administration of the vaccine often comes along with it as well. One possible reason for the high cost is that there is no generic version available and Merck is the only manufacturer. “I can’t speak to the cost,” said Haynes. Not all private insurances cover the shot, and when they do there is usually a co-pay, or they only cover the vaccine for specific age ranges, such as over 60. Medicare Part D plans cover it although sometimes there is a hefty co-pay, or you have to pay for it and wait to get reimbursed. Medicaid sometimes pays for it. Merck, who manufactures the vaccine, has a plan called the Patient Assistance Program that dispenses vaccines for free to low-income U.S. citizens without health insurance.
May 1, 2014 • 47
ment of Health said they only offer vaccines for flu and pneumonia, but not shingles currently. “We refer people to their primary care physician,” a spokeswoman said. Someone for whom cost is a factor should seek help from the Department of Social Services, she added. After the vaccine the patient may get a headache, and near the vaccination site (the upper arm) the skin may be tender, red and itchy, or have a chicken pox-like rash. So should you get it? Maybe. “The shingles vaccine was recommended by the Advisory Committee on Immunization Practices (ACIP) in 2006 to reduce the risk of shingles and its associated pain in people age 60 years and older,” said Haynes, “as they are more like to get shingles, experience severe pain from the disease and have nerve damage.”
he Dutchess County Department of Health offers it at its Adult Immunization and Screening Clinics. The Ulster County Depart-
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Healthy Hudson Valley
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