IGH - WNY 72 October 2020 by In Good Health: WNY's Healthcare Newspaper

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BFOHEALTH.COM

OCTOBER 2020 • ISSUE 72

Defeating Cancer

Breast Cancer Awareness Month INSIDE n Is breast cancer the leading cause of cancer death in women? (It’s not) n 10 things young women should know about breast cancer n Latest news in cutting-edge gene targeting and testing n The history of the pink ribbon

Starts on page 10

Amy & Mike

SIMPLY SMILING MAY BOOST YOUR OUTLOOK

Effort from the Lesakowski’s family has raised over $5 million for cancer research and support

Things You Need to Know About Depression

Story on p. 10

Americans Now More Likely to Get COVID-19 Vaccine: Poll

Brussel sprouts America’s most-hated vegetable doesn’t deserve the bad rap P. 13

SHIFT WORK

Another health risk for workers in healthcare and other fields P. 5

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Healthcare in a Minute By George W. Chapman

Presidential Candidates’ Misleading Messages About Drug Prices

lections are just around the corner and political ads, national and local, are rife with claims that their candidate is confronting drug manufacturers regarding their outrageous pricing. I wrote about this early this year, but I think it’s worth repeating as we are bombarded with these misleading claims by candidates. It is well documented that we pay more for drugs and use more of them per capita than most if not all other countries. We spent about $345 billion or over $1,000 per capita on drugs last year. In countries with a single payer or universal healthcare model, the government uses its massive purchasing power to negotiate prices with drug manufacturers. But not the USA. We squander our purchasing power when it comes to drugs. The Centers for Medicare & Medicaid Services (CMS) covers 60 million people on Medicare and 70 million people on Medicaid for a staggering 130 million people or roughly 40% of the U.S. population. By comparison, Canada negotiates drug prices, paying far less than we do, with a purchasing power of a relatively paltry 30 million people. So why doesn’t CMS use its huge purchasing power to at least negotiate drug prices? Simply: because of the powerful drug lobby. It is the No. 1 lobby on the Hill by far, spending $4 billion over the last 20 Page 2

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years and employing almost 1,300 drug lobbyists. That’s 2.4 lobbyists per congressperson. (How are they not tripping over each other as they enter and exit congressional offices?) The ubiquitous drug lobby has succeeded in quashing this “no brainer” negotiating issue, which would save us literally billions in drug costs, by contributing heavily to campaigns. While drug prices are allowed to escalate untethered, CMS clamps down on physicians and hospitals by unilaterally setting their reimbursement. Take it or leave it. CMS seeks “input” from physician and hospital lobbyists, but still establishes their fees in advance every year. The drug manufacturers attribute their high prices and healthy profits to: research and development, the cost of going through FDA approval, getting drugs to market and potential lawsuits. All those points may be valid, but if CMS is not going to set drug prices like it does for providers, can’t they at a minimum negotiate prices? The U.S. government and consequently U.S. consumers are paying anywhere from four to 120 times the price paid by other countries, no questions asked. A lot of congressman continue to parrot the drug lobby mantra that controlling drug prices will lead to less innovation and fewer new drugs entering the market. No one is begrudging drug manufacturers a fair profit.

Congressman Tom Reed (R-NY) said, “You are putting too much weight in the hands of the government dictating price.” What? Where is this when it comes to physicians and hospitals? CMS should be the 800-pound gorilla at the negotiation table when it comes to drug prices. Campaigns are expensive so most candidates are more than willing to accept drug company donations and look the other way. Instead of a bill with some real teeth that would simply and broadly allow CMS to negotiate prices for all drugs and save us billions, a bipartisan bill from Congress, (the 2019 Elijah Cummings bill), feebly suggests allowing CMS to use its substantial purchasing power to negotiate a pithy 25 (yes, 25) drug prices. The bill then suggests allowing CMS to negotiate 35 (yes, 35) drug prices — by 2033. That means, 13 years from now. This bill remains buried on Senate Leader Mitch McConnell’s desk as he has yet to present it to the Senate for a vote. Despite the unanimous consensus that drugs cost way too much, you can thank the drug lobby and a beholden Congress for nothing being done about it and a lot of misleading lip service.

COVID-19 Price Gouging

This is a summary of an article by ProPublica, a nonprofit newsroom that investigates fraud and abuses of power. Zach Sussman was employed as an emergency physician for a free-standing, for-profit chain of emergency facilities called Physicians

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2020

Premier ERs. The chain is not affiliated with any hospitals. Being a good employee, he went to one of the Physicians Premier emergency facilities for a COVID-19 test and was told by his employer he would be held harmless for any copays. He was shocked to discover his employer billed his insurance company for close to $11,000 for a 30 minute visit. About $2,000 was for the professional and physician component of the visit and about $9,000 was for the ER facility component. For perspective, Medicare pays about $42 for COVID-19 antibody testing. He was astonished to see that his insurance company, Golden Rule, which is a subsidiary of insurance giant UnitedHealthcare, paid 100% of the $11,000. Because Physicians Premier ERs did not participate in his insurance, they were not beholden to any predetermined or pre-negotiated rates. Consequently, Physicians Premier ERs jacked up its charges and hoped for the best. Coding experts called the $11,000 bill totally obscene and fraudulent. Commercial insurers do audits for fraud but not nearly enough so cases like this can fall through the cracks. Sussman did not want to be associated with this kind of price gouging and resigned from the ER company. Physicians Premier did not respond to ProPublica for comment.

George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.

Green Living

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Americans Now More Likely to Get COVID-19 Vaccine: Poll

ust over 54% of Americans now say they would get a COVID-19 vaccine in the first 12 months after it’s introduced, a significant increase from 42% in July, a new WebMD poll finds. However, only 27% of the 1,000 readers who participated in the survey said they’d get a vaccine within the first three months after it becomes available, which is just slightly higher than 26% who said so in the July poll. In the new survey, 12.5% of respondents said they wouldn’t get a vaccine at all, and 21.4% said they’re unsure. For any COVID-19 vaccine to be approved by the U.S. Food and Drug Administration, it has to prevent or reduce the severity of infection in at least 50% of people who receive it. But only 8.8% of survey participants said they consider that 50% standard effective, with 65.2%

saying a vaccine should be 75% to 99% effective to be approved by the FDA, WebMD reported. Only 25.6% of respondents said they would get a vaccine that was 50% effective, 35.5% said they wouldn’t get the vaccine, 25.6% said maybe and 13.3% said they weren’t sure. “We already know that people are worried about getting a COVID vaccine, and understanding how well the vaccine works could be another hurdle for patients,” said physician John Whyte, chief medical officer of WebMD. “Public health officials face a tough challenge explaining to consumers what this vaccine can and can’t do.” There are more than 170 potential COVID-19 vaccines being developed worldwide, with 142 in preclinical evaluations and 31 in clinical trial, according to WebMD.

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Dr. Mark Cavaretta Joins

Dr. Mark Cavaretta MD, FACS, FASMBS

Polio Eradicated in Africa: WHO An effort that began in 1996 has led to the eradication of polio in Africa, according to the World Health Organization. The campaign by governments and nonprofits delivered nearly 9 billion polio vaccines, WHO Director-General Tedros Adhanom Ghebreyesus said in a livestreamed event recently.

“The end of wild polio in Africa is a great day,” said Tedros, who chairs the polio oversight board. “Your success is the success of the world. None of us could have done this alone.” There is no treatment or cure for polio, but vaccination can prevent infection with the once common virus, according to him.

Over a decade of General and Bariatric Surgery experience in WNY About 2,000 bariatric procedures performed Fellowship Trained in Bariatric and Advanced Laparoscopic Surgery Board Certified by the American Board of Surgery Fellow of the American College of Surgeons Fellow of the American Society for Metabolic and Bariatric Surgery

- Accepting New Patients -

Trinitymedicalwny.org | (716)893-0333 2625 Harlem Rd, Cheektowaga

October 2020 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Meet

Your Doctor

By Chris Motola

Mark Cavaretta, M.D. Surgeon discusses the ‘obesity pandemic’ and explains why bariatric surgery is the most effective treatment for obesity (he has performed more than 2,000 of those surgeries) Q: You’ve recently joined Trinity Medical WNY. What attracted you to the group? A: The group here are all fellowship-trained in bariatric and minimally invasive surgery. They just have an excellent program. They also have the Da Vinci robot, which is probably the wave of the future for bariatric surgery. Q: Why should a patient consider bariatric surgery? A: Only 1% of patients eligible for bariatric surgery have it annually. Yet, bariatric surgery is the most effective treatment for obesity, in conjunction with proper diet, exercise and behavioral changes. Gut hormone changes after bariatric surgery are a main reason for its effectiveness. Gut hormones that normally act as appetite stimulants tend to decrease after bariatric surgery, reducing hunger and promoting weight loss. Gut hormones that control blood sugars tend to change in favor of better blood sugar control, resulting in improvement of diabetes. There are other gut hormones changes that have their own specific beneficial effects. Non-surgical treatments for obesity gener-

ally do not produce these favorable hormone changes. Bariatric surgery also relies on restriction and malabsorption mechanisms to achieve benefits. Q: Bariatric surgery has been around for a while now. What do the long-term effects of it look like? A: We think of obesity as a chronic disease, so it needs to be evaluated and treated lifelong. There’s some risk of weight regain. In fact, a little bit of weight regain is considered normal. Abnormal weight regain can happen in up to 10% to 20% of patients. In those situations they need to be reevaluated from a dietary and physical activity standpoint. They may even need another surgery. Q: Have there been any recent advances in bariatric surgery technique? A: This may prove to be the decade of robotic minimally in-

vasive bariatric surgery. Only 8% of surgeons performed robotic general surgery in 2012. That figure has soared to 35% in 2018 and this percentage should continue to rise. I recommend that patients interested in bariatric surgery should look for a center that has robotics. The surgery does not have to be done robotically, but a bariatric surgery program with robotics is a good sign that the practice is advanced and up to date with the most skilled surgeons. Q: Has bariatric surgery gotten safer over the past couple of decades? A: Now is the best and safest time in history for patients to have bariatric surgery. Almost every bariatric surgeon these days is fellowship trained. That means an entire extra year of training was devoted to mastering bariatric and other minimally invasive surgeries. Also, most bariatric surgery centers are now Accredited Centers of Excellence through MBSAQIP [Metabolic and Bariatric Surgery Quality Improvement Program]. An expert in the field does a site visit at the hospital and office, and a chart review of recent cases. This expert ensures that the program is meeting the safety and quality guidelines set forth by the quality improvement program. Programs must be re-accredited every three years. With fellowship training and program accreditation, safety has come a long way. It is common for many bariatric centers of excellence to report major complication rates below 1%. A recent study in the “Journal of Diabetes, Obesity, and Metabolism” looked at over 66,000 diabetic patients undergoing several major types of laparoscopic operations. The laparoscopic gastric bypass had a lower complication rate than hysterectomy, appendectomy, gallbladder, colon resection, and other commonly performed surgeries. Q: How has the coronavirus pandemic affected bariatric surgery? A: As we focus on the coronavirus pandemic, let us not forget about the other pandemic that has been plaguing us much longer and now affects more than one-third of adults in the U.S. — obesity. When the coronavirus hit, elective surgical procedures, including bariatric surgery, were canceled. In response, ASMBS [American Society for Metabolic and Bariatric Surgery] reevaluated how bariatric surgery should be categorized. Given the lifesaving benefits bariatric surgery can have, ASMBS now categorizes bariatric surgery as “medically necessary time sensitive surgery” or “medically necessary non-emergent surgery” and rejects the “elective” category in which bariatric surgery has traditionally been placed. This new terminology will hopefully change how prospective patients, the health care community, our health care system, and society as a whole view bariatric surgery. Perhaps this will get us closer to beating the obesity pandemic. Q: Besides weight loss does bariatric surgery have any other benefits? A: Yes — metabolic benefits — and these benefits are sometimes more important than the weight loss. Improvement or resolution is often achieved with diabetes, hyper-

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2020

tension, hyperlipidemia and obstructive sleep apnea. The surgery often leads to quality of life improvements such as better mobility, improved sleep, less shortness of breath, relief of back and joint pain and ultimately improved longevity. All new patients go through a comprehensive program at a center of excellence that stresses patient education and evaluation and optimization of diet, exercise, and behavior that continues even after the surgery, so patients get the most benefit from the surgery. Q: What are the qualifications for bariatric surgery? A. The basic criteria for bariatric surgery have remained the same for several decades. A BMI of at least 40 or a BMI of at least 35 with a comorbidity such as diabetes, hypertension, hyperlipidemia or sleep apnea. Q: What are the most common bariatric procedures? A: All cases these days are done minimally invasively — either laparoscopically or robotically. The sleeve gastrectomy is suitable for most patients. It is the most common weight loss surgery in the world. The gastric bypass is an excellent option for patients with difficult to control diabetes or GERD. Revisional bariatric surgery is now the third most common type of bariatric surgery performed. A sleeve gastrectomy can be converted to a gastric bypass or a BPD [biliopancreatic diversion with duodenal switch]. A lap band can be removed and then converted to anything — a sleeve, a bypass or a BPD. Reflux symptoms [heartburn] and weight gain are two common reasons why revisions are done. The biliopancreatic diversion with duodenal switch is a good option but done less often. Q: Do you see bariatric surgery ever fitting into more of a preventive care model for obesity? A: It’s a big risk benefit analysis. It’s been decided by the American Society for Metabolic and Bariatric Surgery that if your BMI is below 35, the benefits probably don’t outweigh the risks. It can be looked at as preventive for comorbidities like diabetes, high blood pressure, high cholesterol, sleep apnea. We sometimes see improvement or even complete resolution of those issues with bariatric surgery and a good chance of them never acquiring them if they don’t already have them.

Lifelines Name: Mark Cavaretta, M.D. Position: General and bariatric surgeon at Trinity Medical, WNY Group, affiliated with Sisters of Charity Hospital and Mount Saint Mary’s Hospital Qualifications: Board-certified general surgeon and fellowship-trained in minimally invasive bariatric and foregut surgery. Interests: Robotic surgery, endoscopy, and a wide range of emergency and elective general surgery cases. Hometown: Orchard Park Affiliations: Trinity Medical Center Organizations: American College of Surgeons; American Society for Metabolic and Bariatric Surgery; Society of Robotic Surgery; Obesity Medicine Association Hobbies: Hockey, chess

Things You Should Know About Depression By Ernst Lamothe Jr.

epression is a topic that is hard for many to understand, difficult for sufferers to cope with and often something challenging to talk about. Whether it’s because of the various misconceptions or the complexity of the subject, too often depression gets misdiagnosed or ignored. Making matters worse, 2020 has offered a consistent plate of unpredictability, tragedy and anxiety that has led to an increase in reported depression cases. “Depression is one of the most treatable illnesses, but if left untreated, it could have fatal or debilitating consequences,” said physician Steven L Dubovsky, professor and chairman of the department of psychiatry at University at Buffalo. “It is essential to recognize when you start feeling symptoms because 10% of men and 20–25% of women report feeling at least one episode of depression in their life. It is something that is more common than people realize.” Watch the symptoms 1. Although depression symptoms

may vary in intensity or frequency, there are a few warning signs of which people should be aware. A person may feel sadness, tearfulness, emptiness or hopelessness. There are times with angry outbursts, irritability or frustration, even over small matters. When depression hits, there is a loss of interest or pleasure in

most or all normal activities, sleep disturbances, including insomnia or sleeping too much, ` and reduced appetite and weight loss or increased cravings for food and weight gain. There can be feelings of worthlessness or guilt, fixating on past failures or self-blame. “When you are feeling a loss of joy in activities you love, a significant decrease or increase of sleeping pattern and the same for weight, these are some symptoms you should look at as an early warning,” said Dubovsky. “People also report just an overall feeling of irritability and anxiety which causes some to pull away from people which can cause a cycle of more depressed behavior because you are detaching yourself from life.” Don’t subscribe to the 2. myths There is still a stigma about peo-

ple expressing their inner thoughts about their depression. Some people will simply call it the blues or dismiss it as something that can easily be solved with a nap or vacation. However, it goes deeper than that. And because of the layers associated with depression and the backlash from family and friends, sometimes people decide to keep that part of their lives to themselves. “There are some that believe depression just goes away by itself and all you have to do is tough it out. If it was something that went away that easy then people wouldn’t be

dealing with depression,” said Dubovsky. “This is something that you don’t want to wait a long time before taking action.” Talk to a professional 3. Exposure to and living through traumatic events has the

strong potential to shape a person’s belief, knock us off our equilibrium and rock a person to their core at a fundamental level. That is why reaching out to a psychological expert is important. “Being depressed is not a sign of weakness. Actually, admitting you have an issue is a show of strength,” Dubovsky said. “You shouldn’t have the attitude of I’m just going to grin and bear it. You should be proactive because admitting it is a sign that something is wrong and you are trying to fix it so you don’t affect your life or the lives around you.” Medication can work 4. Antidepressants are a popular treatment choice for depres-

sion. Although antidepressants may not cure depression, they can reduce symptoms. “Antidepressants have been known to work and can make a person’s quality of life better,” said Dubovsky. “Sometimes there are situations when taking it consistently is needed because you have those who stop taking antidepressants and they are surprised that some of the symptoms come back. It is no different

Shift work: Not Good For Your Health By Eva Briggs, MD

ou probably read a lot about the health risk to essential workers of potential exposure to COVID-19 during the current pandemic. Another health risk for essential workers in healthcare, police, firefighting, food service, transportation and similar occupations is shift work. Shiftwork is defined as any work that takes place outside of the traditional 9 to 5 workday, such as evening, night, early morning, or rotating shifts. About 15% of workers are affected by shift work. Potential adverse effects of shift work are due to a combination of lifestyle and biology. Lifestyle effects include less time to exercise regularly. Shift workers might eat at odd times and be more likely to eat an unhealthy diet. Shift workers are more prone to feeling isolated, because their jobs may hinder interactions with family and friends.

Shiftwork also clashes with most people’s natural internal clock, the circadian rhythm, which is linked to natural daylight and darkness. This tells us to be awake when it is light and to sleep when it is dark. When the natural sleep-wake cycle is disrupted, it alters the natural release of hormones and chemicals in your body. Shiftwork adversely affects the cardiovascular system. It changes the level of cholesterol, leading to an increase in arterial disease such as heart attacks. It increases insulin resistance, raising the risk of diabetes. Other effects include elevated blood pressure and obesity. Sleep alterations include trouble falling asleep and trouble staying asleep. Excessive sleepiness or drowsiness develops during times when individuals need to stay alert, such as driving home after work. Night shift workers enroute to home are much more likely to be involved in a drowsy-led driving ac-

cident or near accident than daytime shift workers.

What can be done? The problem isn’t going to go away because many professions require shift work. But there are measures workers can take to combat the effect. The most important is to prioritize adequate sleep, seven to eight hours per night for most people. Some ways to accomplish this start with minimizing light exposure during sleep times. Use room darkening curtains or shades. Try to keep the same schedule. If your shifts change, try to schedule your sleep times to include at least four of the same hours each night. Adhere to the same schedule even on weekends and days off. Ask other household members to help maintain the quiet and dark, such as by wearing headphones and avoiding noisy activities like vacuuming while you’re trying to sleep. Put a “Do Not Disturb” sign on your front door so that delivery people and friends will not ring the doorbell or knock. Experts also recommend working no more than five eight-hour night shifts or four 12-hour night shifts in a row.

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Physician Steven L Dubovsky is professor and chairman of the department of psychiatry at University at Buffalo. than a diabetic deciding not to take their insulin or someone diagnosed with epilepsy not taking their seizure medication. While you can’t solve everything with a pill, for some it is quite helpful.” Avoid drinking 5. Sometimes in deciding what’s worse the pain or the hang-

over, people opt to avoid the former. But mental health experts say one of the worse things you can do is try to drink away depression. “Even drinking one or two drinks per week can keep you depressed so my best advice is to avoid drinking completely when you are depressed,” said Dubovsky. “The problem is more severe than a drink can fix.” I know from experience that’s not always achievable. After a string of night shifts, try to be off 48 hours. Avoid long commutes, if possible. Be aware that prolonged shifts and excessive overtime contribute to the adverse effects of shift work. Rotating shifts are also particularly problematic. Plan to nap before the night shift, which can approve your alertness. Can medicines help? Caffeine is more effective than placebo in reducing errors and improving performance for night shift workers. Frequent small doses seem to work best. Be aware that for some people caffeine too close to bedtime can interfere with sleep. So, you may need to restrict it to the first half of the shift. If all else fails, after appropriate changes to your sleep environment and schedule, prescription medicines such as modafinil (Provigil) and armodafinil (Nuvigil) can combat excessive sleepiness and promote alertness. Eva Briggs is a medical doctor who works at two urgent care centers in the Syracuse region.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Asking for Help: Don’t be Frightened by October Chores

appy October, dear readers! I love this time of year with all its fabulous autumn colors, cooler weather and cozy fall fashions. October is all about a change: a change of season, a change in priorities and a change in perspective. I don’t know about you, but I always need some help when confronted with all the chores and changes this time of year presents. I need help with raking leaves, stowing hoses, putting away lawn furniture, cleaning gutters and downspouts, etc. I may even need some “emergency” pet-sitting, if I choose to take off and enjoy a leaf-peeping weekend in Vermont. We all need a helping hand from time to time. Giving and receiving help from my friends and family has proven to be a wonderful way for me to deepen relationships and strengthen bonds. It’s another one of the many “life lessons” I’ve learned while on my own — that asking for help brings blessings, not burdens. If asking for help is difficult or awkward for you, know that you are not alone. Many people — and, regrettably, many of those who may need it most — find it hard to reach out and ask for help in times of need. There are many reasons, but my

experience tells me that lots of women and men who live alone avoid asking for help because they fear being seen as weak or vulnerable. I know that after my divorce I was reluctant to ask for help. I wanted to show the world that I was perfectly fine, thank you. When I really could have used some help, I avoided asking anybody for anything, determined to muscle through on my own. It led to isolation and pointless hardships. Not asking for assistance kept me distant from friends and family. I denied myself (and them) the chance to connect on a genuine and meaningful level. Looking back, it’s clear to me that my healing and personal growth were compromised as a result. I encourage you to let go of any excuses not to ask for help. Instead, be true to yourself and to those who love and want to support you. Below are some words of encouragement and a few tips to help you help yourself: n Be honest. What keeps you from asking for help? Could it be pride? Do you think you’ll be seen as incapable or weak? Are you concerned about being a bother? Or, would asking for help force you to acknowledge that, indeed, you need it?

Take a moment and reflect on what keeps you from asking for assistance. n Redefine what it means to be strong. Everyone needs support every once in a while, and seeking help is not a weakness. In fact, the strongest people are often those who have the courage to admit they need help and reach out. I’ve always admired this quality in others. Real strength is knowing your personal limitations and having the confidence to recruit assistance when you need it. n Have a little faith. Believe that people truly want to help. Just turn the tables, and think about how you’d respond if a friend, family member or co-worker asked for a helping hand. Chances are you wouldn’t hesitate. You might even feel slighted if not asked, especially if someone you cared about was having real difficulty. Know that others, too, want to be there for their friends and family (and you!) when in need. n Take a chance. When you choose to be vulnerable and ask for help, you are opening yourself up and exposing your authentic self. While it may feel risky, when you are “real” like this, you have an amazing opportunity to cultivate deeper bonds with others. It can be a positive, life- and relationship-changing experience, but only if you are willing to take a chance and make your needs known. n Make the ask. As a first step, put some thought into where you could really use some support and then ask for help with one specific item. It could be something as simple as asking a neighbor for help raking leaves to something as important as requesting a recommendation for a financial adviser. If finding just the right words is

hard to come by, you might start out by saying, “You know, I’m not very comfortable asking for favors, but I wonder if you might be able to help me with something?” n Express your gratitude. You know this, of course. A heartfelt thank you in person or in writing will be warmly received by the person whose help you have accepted. No need to go overboard. Remember, people often want to help others and don’t expect to be compensated for doing a good deed. n Offer help in return. Because giving can be as gratifying as receiving, you’ll want to make it known that you, too, are available to return the favor. We all have gifts, we all have needs, and we all can be of great assistance to one another. Look around, and you’ll find plenty of opportunities to help those who have helped you during your time of need. Asking for help becomes easier with practice. Just as I did, you’ll soon discover the benefits that lie in the aftermath of the ask — benefits that include stronger relationships with existing friends and family members, as well as the prospect of making new connections with others. The rewards inherent in accepting help and expressing your gratitude are many and go both ways. So, take it from me: Life can be better, just for the asking.

what is happening in the broader communities,” Goza said in an AAP news release. “A disproportionate number of cases are reported in Black and Hispanic children, and in places where there is high poverty. We must work harder to address societal inequities that contribute to these disparities,” she added. Physician Sean O’Leary is vice chairman of the academy’s committee on infectious diseases. “This rapid rise in positive cases occurred over the summer, and as the weather cools, we know people will spend

more time indoors,” he said. “The goal is to get children back into schools for in-person learning, but in many communities, this is not possible as the virus spreads unchecked,” O’Leary added. With flu season approaching, it›s important to «take this seriously and implement the public health measures we know can help,» he said. That includes wearing masks, avoiding large crowds, maintaining social distance and getting a flu shot. “These measures will help protect everyone, including children,” O’Leary said.

Gwenn Voelckers is the founder and facilitator of Alone and Content, empowerment workshops for women, and author of “Alone and Content,” a collection of inspiring essays for those who live alone. For information about her workshops, to purchase her book, or invite her to speak, visit www. aloneandcontent.com

s d i K Corner

Over Half a Million U.S. Kids Already Infected With COVID-19

ore than 500,000 U.S. children had been diagnosed with COVID-19 as of early September, with a sizable uptick seen within weeks, a new report reveals. There were 70,630 new child cases reported between Aug. 20 and Sept. 3. That brought the total to 513,415 cases — a 16% increase over two weeks, according to state-bystate data compiled by the American Academy of Pediatrics (AAP) and the Children›s Hospital Association. “These numbers are a chilling reminder of why we need to take this virus seriously,” said AAP president, Page 6

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physician Sara Goza. As of Sept. 3, children accounted for nearly 10% of all reported COVID-19 cases in the United States since the start of the pandemic, according to the latest weekly report from the two organizations. The findings highlight the need to redouble efforts to curb the spread of the new coronavirus, the experts said. The virus has surged in Southern, Western and Midwestern states during the summer, they pointed out. “While much remains unknown about COVID-19, we do know that the spread among children reflects

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2020

Cancer

Amy and Mike Lesakowski, back right, with Roswell Park Comprehensive Cancer Center President and CEO Candace S. Johnson and beneficiaries of the funds the event raises for cancer research and treatment. Photo by Bill Wippert, courtesy of 11 Day Power Play.

Cancer is a Family Affair for Survivor Amy Lesakowski Through the 11 Day Power Play, family has raised over $5 million for cancer research and support By Jana Eisenberg

f you’re like many Buffalonians who are passionate local hockey fans, you’ve probably heard of the 11 Day Power Play. The unique annual fundraising event, co-founded by Mike and Amy Lesakowski, started in 2017, raising money for Roswell Park Comprehensive Cancer Center and other organizations. Amy Lesakowski is a breast cancer survivor; in 2008, at only 35 years of age, she was diagnosed. Her treatment at Roswell, which involved then-new immunotherapy drugs and participation in a clinical trial, was successful. Grateful for Amy’s survival, and also to honor Mike’s mother, who died in 2016 from lung cancer, the Lesakowskis, an avowed “hockey family,” came up with the 11 Day Power Play, which finds hundreds of volunteer players from ages 11 to 80 in a marathon sponsored game of hockey. The majority of the funds raised (over $1 million each year; as of this year, it’s $5.2 million) are donated to Roswell. It normally takes place in July, so that more players can take part; this year, because of the pandemic, the 2020 event happened in late August. Amy Lesakowski spoke with In Good Health about her own extremely positive attitude 10-plus years post-cancer, how she advises others with any cancer diagnosis, and find-

ing opportunity where others might see challenges. Question.: What do you say to people who are newly diagnosed? Amy Lesakowski: I encourage them to get a second opinion. It’s scary when you first get your diagnosis, so take your time and get a second opinion. I also encourage them to go full steam ahead with treatment; don’t look for what you did wrong in the past. A cancer diagnosis gives you a chance to look at your body differently and take care of yourself. When you are younger, cancer can be more aggressive; it’s helpful for cancer patients to see me doing well. There’s a lot of hope, and there have also been a lot of advancements in treatment. Q.: How do you think about the possibility of relapse/reoccurrence? A.: It’s true that cancer survivors have a fear of the unknown, but for the most part, once I hit the five-year mark, I stopped worrying. There’s no sense or use in it. I have so many more years. I try to live life to the fullest. It’s important to take care of yourself and focus on the positive. The most difficult thing is moving past that fear. Q.: Has COVID changed anything for you?

A.:Going through significant change like this makes us stronger. Our reaction to the pandemic is similar to when I got my cancer diagnosis; we have to get through it and we are not going to stop living, but we’ll do it as safely as we can. This year, because we didn’t have live spectators at our event, we partnered with Uplifter Video to livestream additional content. We focused on 19 different cancers, raising awareness about treatment and symptoms. That was new for us, and I’m very proud. It was a blessing that we could spend time interviewing doctors at Roswell Park and the team captains; we actually reached more people than ever, while showing the story’s human side. (Visit the 11 Day Power Play YouTube channel for the videos.)

to fight the cancer, and have fewer side effects than standard chemo treatment. We also support Roswell’s clinical trials and wellness programs. It’s very important — for both patients and their families — to treat the whole person. I sit on Roswell’s Scientific Advisory Committee, which awards grants to Roswell doctors. That helps us know where our funds are going. We also give a portion of the funds to Camp Good Days, Make a Wish Western New York, and the Oishei Children’s Hospital. When a person has cancer, it’s important to support the whole family. When I was going through treatment, I didn’t know I could send my kids to camp — I thought it was for kids with cancer.

Q.: Why is it important to you and your family to do awareness- and fundraising? A.:During my three years of treatment, I had the advantage of being on a clinical trial and receiving a recently approved immunotherapy drug. Sadly, the type of cancer my mother-in-law had did not have a trial or new drugs. “All cancers matter” to the 11 Day Power Play. We want to make sure that patients can get the best treatments. We primarily support research into immunotherapy treatments; they use your own body

Q.: Why do you think 11 Day Power Play has been so successful? A.:It’s a true community event, we have men and women, young and old participating. And it just keeps getting bigger. The first year we had 40 players and this year, we would have had thousands, if it weren’t for the shutdown. We’re really “Buffalo proud” — we love emphasizing that the event started here. We’ve got big plans, and we’re moving fast and furious in the fight against cancer. It’s something to be proud of in our city.

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Cancer

ing of the skin • A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out) • Skin redness, soreness, rash • Swelling • Nipple discharge (could be a watery, milky, or yellow fluid, or blood) Normal breast tissue may be lumpy, which is why it is important to know how your breasts normally feel. Most lumps are not cancer. Many women choose to perform breast self-exams so they will know if a new lump appears or an existing lump changes size. However, breast self-exams are not a substitute for mammograms. These changes may not necessarily indicate that you have breast cancer, but they could and should be evaluated.

Persistent and Speak 4.Be Up

Be your own health advocate and make sure you mention any breast changes or lumps to your doctor. Some patient concerns are dismissed because they are “too young” to have breast cancer. If you think you feel something, seek answers. Don’t be afraid to get a second opinion and more information.

Breast Cancer in Women Under 40: 10 Things You 5. Need to Know

Find The Right Doctor

ach year, nearly 13,000 women under age 40 will be diagnosed with breast cancer, making up about 7% of all breast cancer cases, and 40% of all cancers of women in this age group. Throughout her lifetime, a woman has a one in eight risk of developing breast cancer. No matter what your age you need to be aware of risk factors. In many cases of breast cancer early diagnosis is the key to survival.

What is Breast Cancer? Breast cancer is the most common cancer in American women, and it is the second most common cause of cancer deaths in women. (Lung cancer still kills almost 4 times as many women each year as breast cancer.) Breast cancer occurs rarely in men as well. There are about 230,000 new cases of breast cancer diagnosed in women the U.S. each year, and about 2,300 new cases diagnosed in men. To understand breast cancer, it’s important to learn the anatomy of the breast. Most of the breast is comprised of fatty (adipose) tissue, and within that are ligaments, connective tissue, lymph vessels and nodes, and blood vessels. In a female breast there are 12-20 sections within it called lobes, each made up of smaller lobules that produce milk. The lobes and lobules are connected by ducts, which carry the milk to the nipple. The most common type of breast cancer is cancer of the ducts, called ductal carcinoma that accounts for just over 80% of all breast cancers. Cancer of the lobes (lobular carcinoma) makes up just over 10% of cases. The rest of the breast cancers have characteristics of both ductal and lobular carcinomas, or have unknown origins. Page 8

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1.Know Your Breasts

While women under 40 only make up about 7% of all diagnosed breast cancer cases, breast cancer is a leading cause of death among young women age 15-34. It is important to know your breasts. Know how they feel, and have your doctor teach you how to do a proper breast self-exam, if you choose, to help you notice when there are changes that need to be examined by a doctor.

2.Know The Risk Factors

Younger women may have a higher risk for developing breast cancer with the following risk factors: • Certain inherited genetic mutations for breast cancer (BRC A1 or BRCA2) • A personal history of breast cancer before age 40 • Two or more first-degree relatives (mother, sister, daughter) with breast cancer diagnosed at an early age • High-dose radiation to the chest • Early onset of menstrual periods (before age 12) • First full-term pregnancy when you are over 30 years old • Dense breasts • Heavy alcohol consumption • Obesity • Sedentary lifestyle • High intake of red meat and poor diet • Race (Caucasian women have a higher risk) • Personal history of endometrium, ovary, or colon cancer • Recent oral contraceptive use

3.Breast Changes to Watch Watch for changes to your breasts, and if you notice any of the following, see your doctor: • A lump in or near your breast or under your arm • Changes in the size or shape of your breast • Dimpling, puckering, or bulg-

If you are diagnosed with breast cancer, it’s important to find the right medical team to work with you. It may be tempting to stick with your first doctor, but it’s always a good idea to get a second opinion and make sure you are seeing the right specialists for your type of cancer. You may see several different types of oncologists (cancer specialists), including medical, surgical, and radiation oncologists. The medical specialists you see should be well versed on all the new treatments and approaches including genetics and neoadjuvant therapy (chemotherapy before surgery). Make sure your doctors know the National Comprehensive Cancer Network (NCCN) treatment guidelines which determine treatment based on stage of the disease and prognostic factors of the tumor that are considered the gold standard. You may also want a caremanager or caseworker to help you on your journey.

Your Medical His6.Know tory

It is important to know your family history and share it with your doctor. Women with a first-degree relative (mother, sister, daughter) with breast cancer have nearly twice the risk of being diagnosed with breast cancer as a woman who has no family history. Tell your doctor which family member(s) had breast cancer or other breast diseases, and how old they were when diagnosed.

7.Seek a Second Opinion

Most doctors will suggest getting a second opinion, and even if they do not, it is always a good idea. Most insurance will cover it. It’s important to seek a specialist in breast cancer who is up to date on the latest treatments and can help you make the best decisions on how to proceed. You may discuss your diagnosis with another pathologist who can review your breast tissue slides and confirm a diagnosis, or another medical oncologist, surgical oncologist, or radiation oncologist to determine the

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2020

best treatment choices.

It’s OK to Ask 8.Know Questions

Ask questions! You should be an active participant in your care. Your medical team should explain to you any medical terms you do not understand, explain your treatment choices, possible side effects, and expected outcome. Ask for references to additional specialists you can talk to so you can learn more about your breast cancer. If you have not yet been diagnosed with breast cancer but are at high risk, ask your doctors about testing and any preventive measures you can take. Also don’t be afraid to ask family and friends for support. Seek support groups with other people who are going through what you are, or who have gone through it. Bring a close friend or family member to your appointments to both take notes, or record your visit, and to encourage you to request clarification if anything is unclear. Express your feelings and concerns.

9.Do Some Research

If you are diagnosed with breast cancer, learn about your specific diagnosis. Understand what terms such as stage and grade mean, and how they impact your treatment options. Helpful resources include BreastCancer.org and NCCN.org — guideline on breast cancer written for patients

Network With Other 10.Young Women

It can feel isolating to be diagnosed with breast cancer at a younger age, but there is support available and it can be helpful to connect with other women your age who are going through what you are, or who have beat breast cancer. You can start by asking your doctor about any local support groups. In addition, you can find support groups by searching online. Some resources to find support groups include: • The National Cancer Institute’s Cancer Information Service (1-800-4-CANCER; 1-800-422-6237) • Local chapters of the American Cancer Society • Local chapters of Susan G. Komen for the Cure Source: Onhealth.com, operated by WebMD LLC, part of the WebMD Consumer Network.

Breast Cancer Prevention for Young Women If you are a young woman there are some risk factors for breast cancer you can avoid. • Don’t smoke • Exercise regularly • Eat a healthy diet, with an emphasis on plant foods • Limit consumption of red meats and processed meats • Maintain a healthy weight • Limit or avoid alcohol consumption • If possible, avoid shift work, especially at night Changing your lifestyle and habits may not completely prevent you from getting cancer but it can lower your risk, especially if you have some unavoidable risk factors already such as a genetic history.

Cancer

Is There a Link Between Hair Dyes and Cancer?

illions of people color their own hair, even though some of the chemicals in permanent hair dyes are considered possible carcinogens. So, is home hair coloring safe? According to a new study, the answer is a qualified yes. After tracking cancer risk among more than 117,000 U.S. women for 36 years, the investigators found that personal use of permanent hair dyes was not associated with any increase in the risk of developing bladder, brain, colon, kidney, lung, blood or immune system cancer. Nor were these dyes linked to an uptick in most skin or breast cancers. “We observed no positive association between personal permanent hair dye use and risk of most cancers or cancer-related mortality,” said study lead author Yin Zhang, a physician and research fellow in medicine with Brigham and Women’s Hospital, Harvard Medical School and the Dana-Farber Cancer Institute, in Boston. But permanent dye use was linked to a slightly increased risk for basal cell carcinoma (skin cancer), ovarian cancer and some forms of breast cancer. In addition, an increased risk for Hodgkin lymphoma was observed, but only among women whose hair

was naturally dark. The research team said it remained unclear as to why, but speculated that it could be that darker dyes have higher concentrations of problematic chemicals. The findings were published online Sept. 2 in the BMJ. The study team noted that somewhere between 50% and 80% of American and European women aged 40 and up color their hair. One in 10 men do the same. According to the American Cancer Society (ACS), hair dyes are regulated as cosmetics by the U.S. Food and Drug Administration. But the FDA places much of the safety burden on manufacturers. Permanent dyes account for roughly 80% of all dyes used in the United States and Europe, the study noted, and an even higher percentage in Asia. Why? Because “if you use permanent hair dyes, the color changes will last until the hair is replaced by new growth, which will be much longer than that of semi-permanent dyes, [which] last for five to 10 washings, or temporary dyes, [which last] one to two washings,” Zhang said. The problem? Permanent hair dyes are “the most aggressive” type on the market, said Zhang, and the kind “that has posed the greatest potential concern about cancer risk.”

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Amy & Mike

SIMPLY SMILING MAY BOOST YOUR OUTLOOK

Effort from the Lesakowski’s family has raised over $5 million for cancer research and support

Things You Need to Know About Depression

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Cancer

Physician Joyce Ohm works at Roswell Park Comprehensive Cancer Center. “If a patient has many family members with cancer, it may make sense to do additional genetic testing.”

Laura K. Fisher, right, talks to a patient at Windsong, which offers radiology, genetic counseling, vein care and breast care in Williamsville. Fisher is a certified genetic counselor and director of genetic counseling at Windsong.

Family History Plays a Role in Cancer Risk In addition to predicting risk of cancer, genes can also make a difference in treating cancer By Deborah Jeanne Sergeant

any factors play into why cancer develops, both known and unknown. For some people, family history plays a role, yet only 5% to 10% of cancers are caused by inherited gene mutations, according to the American Cancer Society. Other health factors, such as obesity, diet, exercise and stress management make a difference as do environmental influences, including radiation, certain chemicals, tobacco use and smog exposure. The American Cancer Society recommends exploring genetic testing for people who have a strong family history of certain types of cancer, those already diagnosed with cancer (especially if it appears an inherited mutation could have caused it), and people whose family members have a known inherited gene mutation. Laura K. Fisher echoed that recommendation. She is a certified genetic counselor and director of genetic counseling at Windsong, which offers radiology, genetic counseling, vein care and breast care in Williamsville. “It’s based on their personal or family history,” Fisher said. “An individual who is diagnosed with a cancer at a young age like breast or colon at 45 or younger is a good candidate for genetic testing.” She added that other examples include those with three or more relatives with the same type of cancer, Ashkenazi Jewish ancestry, or family history of a rare cancer, such as male breast cancer or ovarian cancer. People with these risk factors should talk with their care provider or schedule a consultation with a certified genetic counselor. Most specialists do not require a referral. A lack of a gene mutation does Page 10

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not mean cancer cannot occur. “We often talk with women on knowing their history and knowing their genetics, but a family history doesn’t preclude you from having breast cancer,” said Andrea Moran, executive director of the Upstate New York Affiliate of Susan G. Komen Breast Cancer Foundation. “They may say, ‘No one ever had it in my family history’ or ‘It doesn’t show up in my genetic testing,’ but that doesn’t mean you should take your eye off regular screening, at home breast care and mammograms.” Moran encourages people to “know your normal” when it comes to their own bodies. Whether it is the breasts or other areas of the body, “if you see something abnormal, that should prompt a call to a provider,” Moran said. For those who undergo genetic testing, it is important to understand how a mutated cancer risk gene, such as BRCA1, BRCA2 or Chek2 for breast cancer, can affect health in other ways. “There are types that are linked to multiple types of cancer,” said physician Joyce Ohm, with Roswell Park Comprehensive Cancer Center. “If a patient has many family members with cancer, it may make sense to do additional genetic testing.” Ohm encourages people with cancer gene mutations to remain vigilant about their health and to ask their providers about other screenings and preemptive measures they may need. Most insurance companies cover genetic testing for people with enough risk factors. The testing can reveal if they carry genes that raise their lifetime risk of cancer or if waitand-see is a reasonable approach.

While preemptive surgery is not easy, it virtually eliminates the risk of ever needing cancer treatments for that type of cancer. Patients are essentially consenting to surgery now to avoid the great likelihood of surgery plus chemotherapy or radiation later. People with genetic predisposition to certain types of cancer must also determine how preemptive surgery would affect other areas of life. A young adult who had not yet had children may want to delay surgery that would affect fertility, for example, compared with someone who has already had a family. Instead of paying for frequent rounds of imagery, insurance companies are usually more ready to pay for preemptive surgery and reconstruction for patients with high risk cancer gene mutations. Ohm said that many more gene mutations have been identified than even several years ago. For people who have undergone genetic testing several years ago, “it’s worth talking with their physicians.” In addition to predicting risk of cancer, genes can also make a difference in treating cancer. Diagnosed patients have treatment “based on their tumor type and that guides therapy,” Ohm said. “It will help guide prognosis and treatment choices and understand the severity and type of the cancer they had.” Ohm added that years ago, all breast cancer was lumped into once category, but now physicians distinguish among different types, based in part by genetic testing. Albert Rizzo, MD, chief medical officer with the American Lung Association, said that in the past five to 10 years, “there are at least 20 new drugs targeting mutations.”

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2020

The treatment is most effective if begun with an early diagnosis. “It’s probably more relevant in lung cancer because that’s where the genetic markers have been identified,” Rizzo added. “It’s part of the discussion when you talk with an oncologist. One question is, ‘Will my treatment change if we do genetic testing?’ They may give good reasons as to why they don’t want to do genetic testing. It may depend on the stage of the cancer or comorbidity of the patient.”

Cancer at a Glance • This year alone, breast cancer is estimated to be diagnosed in more than 252,000 women. • Of those 252,000 women, an estimated 12,600 to 25,200 have a BRCA mutation. • If you have a BRCA1 mutation, you have an estimated 72% chance of developing breast cancer by age 80. If you have a BRCA2 mutation, you have an estimated 69% chance of developing breast cancer by age 80. • 100% of patients with ovarian cancer and pancreatic cancers should consider genetic testing. • One in 10 breast cancers have hereditary causes • One in six patients with prostate cancer have a germline variant (gene variation) • One in five patients with pancreatic cancer have a germline variant. Source: BeBRCAware.com and www.invitae.com.

Cancer

The History of the Pink Ribbon By Deborah Jeanne Sergeant

n addition to the orange, gold and red foliage colors, you’re likely seeing a lot of pink this time of year as October is Breast Cancer Awareness Month. Most people realize that a looped pink ribbon represents breast cancer awareness; however, many do not know about the origin of the campaign. Ancient texts relate that ribbons used in décor have traditionally symbolized longing for those absent during wartime. The 1973 song, “Tie a Yellow Ribbon Round the Old Oak Tree” (Irwin Levine, L. Russell Brown), echoes the sentiment of a ribbon symbolizing support and welcome for a loved one at war. According to www.pinkribbon. org, Charlotte Hayley, a breast cancer patient in California, thought the ribbon was appropriate to symbolize the fight against breast cancer. In 1991, she started distributing peach ribbons with a handbill urging more funding for breast cancer. Hayley handed them out at grocery stores and sent them to public figures such as former first ladies and Dear Abby. Self magazine editor Alexandra Penney adapted the symbol by shifting the color to pink. In 1991, the Susan G. Komen Breast Cancer Foundation established the pink ribbon as a national symbol for breast cancer awareness by distributing one to every participant in the organization’s NYC Race for the Cure. Though Hayley died at age 91 in 2014, her grassroots effort demonstrated that everyday people could make a difference. That is the mindset behind organizations like Komen, which was founded by Nancy G. Brinker in 1982 to fulfill a promise to her sister, Susan G. Komen as Komen was dying from breast cancer. Brinker said she would do everything she could to eradicate breast cancer. A sister’s promise has grown into an

internationally recognized organization. Andrea Moran, executive director of the Upstate New York affiliate, said that the grassroots beginnings of Komen “is one of our strengths, and that we focus only on breast cancer. “We also take a 360-degree approach. It’s not just research or patient care or advocacy. Because we’re grassroots, a lot of what we achieve is community-led and integrated into the landscape of small towns and communities.” The organization is shifting in 2020 and 2021 to consolidate local affiliates under a national organization based in Dallas. “We’ll be able to engage even if there’s not an affiliate where they live,” Moran said. “We will continue to have a presence in Upstate New York.”

Local grassroot groups Rob Jones, executive director of Breast Cancer Network of WNY, Inc. in Depew, said his nonprofit “supports women with breast cancer through all stages of survivorship.” One example is the TLC Tote, which the organization gives to newly diagnosed women. It contains information on resources and personal comfort items. Windsong Radiology funds the totes. Jones added that Breast Cancer Network hands out about 200 totes annually, but there are about 1,400 new cases in the Buffalo area each year. About 300-400 people are members. “We’d like to get those totes out to more people; they’re quite helpful,” Jones said. The network also offers five support groups in Depew, including programming on survivorship and restorative health. Most of that is online because of the pandemic, but Jones said the support groups “hav-

Anne Kist directs Luminina Corp, dba Hope Chest in Getzville. en’t lost a beat. People really depend on them.” He said that the local aspect of everything the organization does makes the network stand out. “We are a small, grassroots volunteer organization,” Jones said. “We don’t raise money to send out of town; everything is for Western New York individuals. All of our support is local.” The only exception is a small grant from New York state. “It’s important because there are so many people who need the support and services,” Jones said. “Anyone who’s gone through breast cancer joins the sisterhood that it creates. There’s a bond. We present an opportunity for them to socialize and network with each other.” The Breast Cancer Network of WNY also supports research grants distributed by Breast Cancer Coalition of Rochester, which gives to Western New York research organizations. Anne Kist directs Luminina Corp, dba Hope Chest in Getzville. Along with breast cancer support, the group has offered free fitness programs, nutritional classes and, in the summer months, dragon boat racing for 20 years. “We’re all in the same boat — pun intended,” Kist said. “We don’t sit around in a circle discussing our cancer. If someone needs support, we’re here to support them. Some have gone through survivorship in different ways than others. We link up those who have had certain procedures done so they can talk about

“We’re all in the same boat — pun intended,” says Anne Kist, who heads Hope Chest in Getzville. Her group has offered free fitness programs, nutritional classes and, in the summer months, dragon boat racing for 20 years. October 2020 •

issues that might come up. Pretty much, we’re not trying to survive but thrive.” Though most of its programming is virtual, Hope Chest has continued supporting its 200 members through the pandemic, though Kist said they miss hugging. “We’re a big hugging group,” she added. The nonprofit receives funding from donors. “We try to empower our teammates to be better physically, mentally and emotionally,” Krist said. This fall, Windsong Breast Care in Williamsville founded Windsong Cares Foundation, a board-operated charity that provides financial support for preventive cancer screening, cancer research and patient care. Funding from fundraisers and grants supports Windsong Cares. Though not the only kind of cancer included, breast cancer is the foundation’s main focus, according to board member Gina Fedele. This includes mammography and other screening. “There are a number of people who are uninsured and under-insured,” Fedele said. “This makes sure they have access.” For genetic testing, individuals must meet requirement for insurance coverage, such as family history. Windsong Cares can help people who do not have adequate coverage. For patients requiring treatment, the cost can push and exceed $100,000. Even with insurance, co-pays and deductibles can be difficult for some patients to afford, especially considering the likelihood of lost work time during their illness. The foundation provides financial support to other breast cancer organizations, including Breast Cancer Network. The organization provides “access to education and cancer prevention are key to reducing mortality to cancer. Our vision is to transform our community into a healthier region with creative thinking, and prevention initiatives funded by our generous donors. “More Than Strong,” the foundation’s first fundraiser, is Oct. 17 with a basket raffle and barbecued chicken sale.

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Colleen Conner Ziegler visits Wyoming’s Grand Teton National Park after she received a diagnosis of lung cancer five years ago, even though she never smoked in her life. She now is an advocate for more lung cancer research funding.

Lung Cancer Kills More Women Than Any Other Cancer Lung cancer — not breast cancer as some may think — is the leading cause of cancer death for women By Deborah Jeanne Sergeant

ore women die of lung cancer than colon and breast cancer combined. Twentyfive percent of all cancer deaths are from lung cancer. According to the American Lung Association, 15% of people diagnosed with the disease have never smoked. Among nonsmokers, women are three times as likely to have lung cancer. One of them is Colleen Ziegler, who lives in Rochester. She has never smoked but was diagnosed five years ago with stage 4 lung cancer. “A lot of people are not aware of the impact that lung cancer [has]. It is the leading cause of cancer death,” said Ziegler, a patient at Massachusetts General Hospital in Boston. “Four hundred and thirty-three [people] a day die from lung cancer.” Breast cancer research has helped reduce death rates among patients through proven prevention programs and treatments. Ziegler said that acquisition of research dollars is driven by awareness. Twenty years ago, she survived breast cancer. She believes that lung cancer is not as “popular” of a cancer because of lack of awareness. “One of the challenges with lung cancer is there appears to be a stigma associated with it,” Ziegler said. “A lot has to do with the perception that tobacco use is the only cause. Lung cancer receives only 6% of federal funding available for cancer research.” Page 12

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Ziegler said that currently, the federal government designates $14 million to lung cancer research, compared with $90 million to prostate cancer and $150 to breast cancer. Because of discrepancies like these, she usually travels to Washington, DC, annually to advocate for lung cancer research funding. Ziegler said oftentimes, representatives say they did not realize that lung cancer leads in cancer deaths — nor why lung cancer research has so few dollars allocated to it. As to why women are three times as likely to have lung cancer as men, Ziegler said that researchers do not know. She was diagnosed at age 58, but knows women diagnosed in their 20s who have never smoked and lived healthy lifestyles. “People think it’s only a 70-yearold guy who smoked his whole life,” Ziegler said.

Reasons unclear Musa Saeed, pulmonologist and assistant professor at UB Jacobs School of Medicine and pulmonologist at Roswell Park Comprehensive Cancer Center, said that it is unclear as to why women are more prone to lung cancer. “There’s speculation on hormonal influences,” Saeed said. “There’s no concrete evidence to suggest that yet. HPV can also be related to lung

cancer but it’s not validated; it’s speculated.” He added that especially when caught early, women respond better to treatment to lung cancer than men, even though they’re more likely to have lung cancer. “We’ve made advances in targeted immune therapy,” Saeed said. “We can make a regimen that goes directly to that type of tumor. It can work more effectively for longer life and a better cure rate.” Ziegler said very few treatments are available for lung cancer patients. She is currently enrolled in a clinical trial for alectinib, daily oral pills providing targeted therapy that “mutes” the cancer, though it won’t destroy it. Ziegler thinks that eventually, the cancer will outsmart her treatment and mutate into a different type of lung cancer or another cancer that won’t respond to treatment. In the meantime, she travels to Boston every two months for a check-up and deal with side effects like fatigue, muscle pain, edema, weight gain, cataracts and shortness of breath — all of which she says are manageable compared with cancer. Five years ago, she was told she had three to six months to live. “My lung tumors have significantly decreased due to the target therapy,” she said. “Overall, I feel very lucky. It’s a matter of perspective and how you choose to look at what your life is like.”

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2020

She thinks that few people with lung cancer have as long to live because most lung cancers are discovered by the time they’re at stage 4. She said she was sick 15 months before she received a diagnosis. Ziegler said that many do not get screened for lung cancer because for insurance to cover it, the person must have numerous risk factors. Among those who qualify, only 5% seek screening. Physician Albert Rizzo, chief medical officer with the American Lung Association, believes that many women are not aware of “how significant lung cancer is for their health,” he said. While Rizzo acknowledged that many current cancer cases are attributable to the tobacco use of the 1980s and 1990s, “there seems to be a number of young women who are nonsmokers who are diagnosed with lung cancer.” In these cases, the cancer is more treatable, but only if caught early. Unfortunately, few seek screening unless they have smoking history. Even if money were no impediment, screening everyone is not a good idea. “If you screen too widely, you find things that don’t need to be found and put people through needless procedures,” Rizzo said. “You want to screen people who benefit the most.” The recommendations are mostly based upon smoking history. That does not help those who have lung cancer for non-tobacco causes. Rizzo said that environmental or occupational exposure are not included as risk factors. About 7 million to 8 million Americans are eligible for screening, but only 5% follow through. “It’s another mission messages: assess yourself for being at high risk and talk with your physician about being screened,” Rizzo said. “If you’re screened, you’re more likely to have it diagnosed it while it’s early. If it’s at stage 3 or 4, the survivability drops off significantly.” He thinks that hormones may affect why non-smoking women have three times the rate of lung cancer as non-smoking men. “There are genetic studies that it occurs more in Asian women than non-Asian women,” Rizzo added. “Is it due to the size of the lungs? It may have to do with anatomy.”

Lung Cancer at a Glance • This year 228,820 Americans will be diagnosed with lung cancer. • Lung cancer is the leading cause of cancer death in the US. • Lung cancer claims more lives annually than either colorectal, pancreatic, breast or prostate. • Nearly 20% of men and women diagnosed with lung cancer are never smokers. Source: GO2 Foundation for Lung Cancer:

SmartBites

The skinny on healthy eating

Why Brussels Sprouts Deserve a Shout-Out

America’s most-hated vegetable doesn’t deserve the bad rap

taunchly refused by many and accused of smelling like old socks when boiled, America’s most-hated vegetable doesn’t deserve the bad rap. Replete with flavor when properly prepared, Brussels sprouts pack an astonishing array of nutritional benefits. Plus, these unsung heroes are affordable, in season now, and last over a week in your fridge (a true bonus when grocery shopping is the last thing you want to do). Nicely low in both calories and carbs, Brussels sprouts are exceptionally high in vitamins K and C. One cooked cup of these tiny green globes packs over 250% of the minimum daily target for vitamin K and over 150% of the minimum vitamin C target. Vitamin K plays an important role in blood clotting, bone health and possible protection against osteoporosis, while vitamin

C supports collagen production, iron absorption, wound healing and immunity. Like its cruciferous cousins — cabbage, kale, cauliflower and broccoli — Brussels sprouts are rich

in fiber, boasting nearly 4 grams per cooked cup. A valuable but often overlooked nutrient, fiber promotes regularity, helps regulate blood sugar levels and may reduce the risk of heart disease and diabetes. Brussels sprouts teem with multiple disease-thwarting compounds — phytochemicals, antioxidants, anti-inflammatories — that help deactivate potentially damaging chemicals or shuttle them out of the body more quickly. Though more research is needed, some studies have suggested that the compounds found in Brussels sprouts may help decrease the risk of cancer, suppress inflammation, lower cholesterol and promote heart health. A final shout-out: Brussels sprouts can help prevent ulcers. The sulfur compounds in this cruciferous gem are known to reduce ulcer risk by squelching the overgrowth of H. pylori, a type of bacteria linked to stomach sores.

Shredded Brussels Sprout Salad with Toasted Pecans Serves 4-6

For the vinaigrette: 1 lemon juiced, about ¼ cup 1 tablespoon honey 1 tablespoon Dijon mustard 1 tablespoon minced shallot 1 garlic clove, minced ½ teaspoon salt ¼ teaspoon coarse black pepper 2 tablespoons extra virgin olive oil

Helpful tips

Steaming and boiling Brussels sprouts can make them mushy and stinky—not a good combo. Instead, give them the treatment they deserve by shredding them in a salad or roasting them at a high oven temperature, which creates crispness and a sweet, nutty flavor. Select tight, firm sprouts with healthy green leaves. Smaller sprouts run sweeter. Refrigerate unwashed and uncut in a sealed plastic bag for up to 10 days. In a small bowl, whisk together the vinaigrette ingredients until well combined. Set aside. Wash the Brussels sprouts and removed any damaged outer leaves. Cut the sprouts in half lengthwise. Place cut side down and thinly slice crosswise to create shreds. Discard the tough root end and separate the shreds with your fingers. You may also use a mandolin or food processor to create shreds. In a large bowl, combine sprouts, chopped pear or apple, cranberries, pecans, and gorgonzola crumbles. Add vinaigrette, toss to coat, serve.

Anne Palumbo is a lifestyle colum-

For the salad: 1 pound Brussels sprouts, shredded 1 pear or apple, chopped ½ cup dried cranberries ½ cup chopped pecans, toasted ½ cup gorgonzola cheese crumbles

nist, food guru, and seasoned cook, who has perfected the art of preparing nutritious, calorie-conscious dishes. She is hungry for your questions and comments about SmartBites, so be in touch with Anne at avpalumbo@aol.com.

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 13

‘More than 50% of Americans now meet the clinical definition for an anxiety disorder or depression. We are experiencing a global crisis. And we are also experiencing collective trauma, the loss of loved ones, the loss of employment, the racial reckoning of generations of systemic racism.’

Simply Smiling May Boost Your Outlook

miling can trick your mind into being more positive, according to a new study. Researchers at the University of South Australia found that the simple act of moving your facial muscles into a smile can make you view the world more positively. “When your muscles say you’re happy, you’re more likely to see the world around you in a positive way,” said lead researcher Fernando Marmolejo-Ramos, a human and artificial cognition expert at the university. He and his colleagues studied how people interpret various images of facial and bodily expressions that range from happy to sad, based on whether or not they were smiling themselves. The study involved 256 volunteers from Japan, Poland, Spain and Sweden. Participants were asked to hold a pen between their teeth, an act that forces facial muscles to replicate the motions of a smile. They were then shown images of facial expressions that ranged from frowning to smiling, and videos of a person walking in different positions, ranging from “sad walking” to “happy walking.” The participants viewed each image or video with and without a pen in their teeth, and then evaluated if the evoked emotion was “happy” or “sad.” The researchers observed that the participants were more likely to view a broader range of the images and videos as “happy” when smiling themselves. “In our research, we found that when you forcefully practice smiling, it stimulates the amygdala — the emotional center of the brain — which releases neurotransmitters to encourage an emotionally positive state,” Marmolejo-Ramos said in a university news release. The results suggest that everyone, and particularly those suffering from mental health issues like anxiety and depression, may benefit from the simple act of smiling. “For mental health, this has interesting implications. If we can trick the brain into perceiving stimuli as ‘happy,’ then we can potentially use this mechanism to help boost mental health,” Marmolejo-Ramos said. “A ‘fake it till you make it’ approach could have more credit than we expect.” The study was published recently in the journal Experimental Psychology.

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Q A &

with Melinda C. DuBois

“Our work is more important than ever,” says new executive director at Mental Health Advocates of WNY

By Michael J. Billoni

elinda C. DuBois began as executive director of the Mental Health Advocates of WNY (MHA) Sept. 1, following Ken Houseknecht’s retirement after nine years in the position. DuBois, who came to the MHA from Planned Parenthood of Central and Western New York, brings 25 years of experience managing multidisciplinary health and human service organizations. The MHA was founded in 1962, has a $2 million operating budget and serves more than 25,000 individuals annually with 25 full time and over 20 part time staff and volunteers. Q: What are your goals and vision for MHA as you begin as its executive director? A. As I learn more about this wonderful agency that has been in existence for over 50 years, it seems clear that our work is more important than ever. My goals and vision include increasing the number of lives we impact by providing assistance in navigating the mental health system, referrals to clinics and mental health professionals, workshops, support groups and community education training. We are in the schools, in the hospitals, and in the courts providing support and guidance for our community members who are challenged with living with mental illness. I

would like to raise awareness and expand our focus on prevention, early detection, and wellness. It’s incredible that we provide emotional skill building for preschoolers. When we start talking early about emotional well-being and the fact that we will all struggle at times, we decrease the stigma associated with mental health needs, and create space for getting help. Ultimately, when our community members think about mental health, I want them to immediately think about Mental Health Advocates. Who should I call when I am not sure what the answers are? Call us. We will listen with compassion, and we will help find the right resources. Q: How concerned are you and your peers in the mental health field about government funding cuts towards mental health programs? A. Although MHA is currently in a strong financial position, it is amazing to me that we are talking about funding cuts at this time. We all agree these are unprecedented times. Prior to this COVID-19 pandemic, we would say that one in five Americans experience a mental illness in any given year and more than half will go untreated. A recent study by the National Institutes of Health states that more than 50%

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2020

of Americans now meet the clinical definition for an anxiety disorder or depression. We are experiencing a global crisis. And we are also experiencing collective trauma, the loss of loved ones, the loss of employment, the racial reckoning of generations of systemic racism. Now more than ever, funding should be increased for the vital services we provide. How, as a society, can we turn our backs on the basic needs of our struggling friends and families? We need an increase in funding, not cuts. Q: What is your background in the mental health field and what are your strengths as a team leader? A. I received my master’s in social work and started my career as a mental health counselor. Throughout my career, I have stayed connected to the mental health field through my involvement on boards such as Crisis Services and Horizon Health, and through my work on a college campus leading the health and counseling center. My strengths as a team leader include a strong drive to help my team excel and grow, with compassion and love, with mutual respect, and accountability. I am right there with my team. We do this work together. Q: Talk about the MHA’s new office space environment and how it will benefit local community members. A. The WNY Human Services Collaborative, located at 1021 Broadway, will provide a wide range of health and human services to vulnerable and marginalized individuals and families living in or near the city of Buffalo, through the development of a co-located, multi-service entity. Our goal is to improve the functioning of organizations and systems through development and implementation of innovative programming specifically designed to improve the health and well-being of participants Q: What do you see for the future of Mental Health Advocates? A. I see us growing, expanding our youth and family advocate services to more hospitals and behavioral health providers, and being an important resource for our community. As we, as a society, decrease stigma, normalize mental health treatment, and recognize the impact of childhood and generational trauma on our fellow citizens, the work of the MHA will be even more vital and necessary. Editor’s note: Anyone experiencing a mental health issue for the first time, call 716-886-1242 and for more information, visit www.mhawny.org.

Death by Suicide Increasing Suicide rates are up 35% since 1999. Local experts say effects of coronavirus may push numbers even higher By Deborah Jeanne Sergeant

he most recent numbers from the Centers for Disease Control and Prevention indicate that 48,344 people died by suicide in 2018, an increase from the previous year’s number, 47,173. Although that represents only two-tenths of 1%, it continues the trend of the past two decades, up by 35% since 1999. “Untreated depression is the No. 1 reason for suicide,” said Mark O’Brien, licensed clinical social worker and commissioner of the Erie County Department of Mental Health. “Depression can be internal without any external causes. It can be genetic, inherited. It can also have external factors precipitating depression and a combination of the two.” He added that high stress levels also contribute to the trend, including financial struggles, working and educating at home and worries about the virus. There are also social isolation issues, which may lead to higher increases of suicide in 2020.

“There are three overlapping factors: thwarted belongingness, ‘I am alone.’” O’Brien said. “Perceived as a burden, ‘I am a burden,’ and capability for suicide, ‘I am not afraid to die.’ Where those overlap, that is where the great danger for suicide exists.” Celia Spacone, Ph.D., with Suicide Prevention Coalition of Erie County, said that the demographic with the highest risk is men from age 24 to 59. They represent 65% of suicides. Although women attempt death by suicide at a higher rate, men die at a “much higher rate,” Spacone said. One of the reasons is that men tend to use firearms — the most likely lethal attempt means — and they generally feel more stigmatized about treating mental health issues. Though the numbers have remained steady in Erie County in the past two years, Spacone isn’t sure how the pandemic will affect the rates locally. Erin Ruston, licensed mental health counselor with Buffalo Med-

Suicide Prevention. Yes, There Is an App for That By Deborah Jeanne Sergeant

hone apps can help with items frivolous to serious. Apps that address mental health issues may prove helpful tools in preventing death by suicide. Naturally, a phone app is only as helpful as the user makes it. Like any other tool, if it is not used, it is not helpful, so people reluctant to use their smartphones will not benefit from these apps as much as someone who consistently turns to a smartphone for help. “If someone is comfortable with that type of technology, it can be an adjunct to therapy,” said Celia Spacone, Ph.D., with Suicide Prevention Coalition of Erie County. “There are safety plans that can be done on

an app. You can carry it with you all the time. It can be a way of taking control and staying safe.” One app example is Virtual Hope Box, a virtual safety plan. It stores the contact information of people can call, music and photos that help them feel grounded, and other aspects of their safety plan. Most people always have their cellphones with them, making it the ideal means of keeping their safety plan on hand; however, “some want a sheet of paper,” Spacone said. It is important to seek mental healthcare from professionals. Phone apps cannot replace this care; however, apps can help support and reinforce the work done in therapy.

ical Group in Williamsville, calls the effects of the pandemic on suicide rates “the perfect storm,” including increased stress and anxiety, isolation and lack of regular coping strategies and routines. “You have 42 million who are unemployed, worried, scared and angry,” Ruston said. “They’re worried about their finances, loved ones who have passed away or who aren’t accessible.” Many people contemplating suicide exhibit common signs. O’Brien, the commissioner of the Erie County Department of Mental Health, said signs include increase in irritability; changes in eating and sleeping habits; increase in emotional turmoil; increase substance abuse; comments about despair or fatalistic comments; the inability to experience pleasure; and morbid or shame-based preoccupation with the past.

“The more someone is able to verbalize something, the better,” O’Brien said. “There’s the principle that we were given two ears and one mouth. Listen. Hope and connectedness are the best antidote for suicide. Hear what the person is saying and what they’re not saying.” Of course, assisting the individual connect with a therapist or with emergency medical personnel (as needed) is important; however, for some people, connecting with a friend may be a helpful first step. “You will never give someone the idea of killing themselves if they’re not already thinking about it,” O’Brien said. “You can ask ‘Are you planning on killing yourself?’ Sometimes, they’ll say they are. Sometimes they’ll say no. If you ask and they share it with you, you may be the first one they share it with.” Spacone encourages those concerned to not try to solve the person’s problems or minimize them. “If you do suspect someone is considering suicide, say, ‘I’ve noticed you’re down lately and you are saying some things that are troubling. You’re not checking in with people. Are you having thoughts of taking your life?’ If it’s true, it more often than not opens a line of communication,” Spacone said. Trying to point out all the person has to feel grateful for or shaming the person minimizes the pain that feels very intense. “People need to be heard,” said Shawn Marie Cichowski, life coach and owner of Western New York Life Coaching. “Say, ‘Tell me more.’ Definitely listen and pick up on the cue.” Instead of remaining passive, she encourages worried friends and family to err on the side of caution. “Say ‘I’m concerned.’ Listen within your scope of practice. Encourage them to get the right support. Keep that space and listen.”

Seeking Help

Helping those struggling should start with listening.

Veterans can use the resources at www.veteranscrisisline.net. General resources are at the National Suicide Prevention Lifeline website, suicidepreventionlifeline.org or by calling 800-273-8255. Crisis Services’ 24-hour number is 716834-3131.

Apps can also provide a means to supplement the care the patient receives between sessions. That daily or as-needed maintenance may enhance the therapist’s work. “The gold standard for safety planning is the SAMHSA Suicide Safe app,” Spacone said. But apps that encourage healthful coping methods — like eating right, exercising and practicing mindfulness, gratitude and meditating — may also prove helpful. Spacone said that self-care can contribute to good mental health. Mark O’Brien, licensed clinical social worker and commissioner of the Erie County Department of Mental Health, said that the safety planning apps may be helpful in that users can record what helps them feel better, “like social supports, listening to music, doing artwork and exercise,” he said. “What are resources to turn to like mental health providers and support groups?” Apps can also help users become more self-aware as to how they are feeling and how to verbalize their

pain so others can better understand. He also thinks that apps that encourage exercise can be helpful. “Exercise is hard to do when you’re depressed but it releases endorphins and serotonin,” O’Brien said. He also thinks that apps can help people stay on a schedule and break up their goals into manageable chunks. “Setting smaller goals and priorities can have an impact with your life,” O’Brien said. Since reaching for smart phone apps is a strategy many employ now, it makes sense to use apps as another tool for promoting good mental health. “People’s phones are so easily accessible right now,” said Erin Ruston, license mental health counselor at Buffalo Medical Group in Williamsville. “There’s Head Space and the Calm app and breathing apps and meditation. There are some that if you are feeling suicidal, you fill out your mood for the day and the results go to your care provider.

Listening can play role

October 2020 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 15

like. For more information on Create Space Buffalo, visit createspacebuffalo.com.

Paul Cartone: “We’re programmed at a young age not to cope with our feelings, and that’s why we distract ourselves.”

Mental Health Matters Year-Round

Suicide Awareness Month was celebrated last month, but experts say concern with suicide and mental health should always be on the forefront By Jenna Schifferle

few years ago, I received the news that one of my classmates from high school

died. After a years-long battle with depression, he chose to end his life in his 20s with so many years left unlived. A million thoughts ran through my head when I learned the news. Though I had never been close to him, I wondered if I could have done more to prevent his suicide or, at very least, make him feel less alone.

A Wide-Spread Crisis Sadly, this story is not unique. An estimated 1.4 million suicide attempts occurred in 2018, according to the Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report. As a result of those suicide attempts, more than 48,000 Americans lost their lives. These figures only scratch the surface of a greater mental health crisis that has seen 17.3 million adults in the United States experiencing at least one major depressive episode, according to the 2017 National Survey of Drug Use and Health. As a nation, we observed Suicide Awareness Month in September. Efforts to talk about suicide and mental health, however, should continue year-round. These conversations are instrumental in fostering a deeper understanding of mental health and bringing visibility to issues that are commonly stigmatized. From there, we can begin to break down barriers that make people feel alone and isolated.

The Pandemic’s Impact The pandemic has made conversations about mental health even more pressing. People are losing their jobs as companies are downsizing and small businesses are closing their doors. Families are going months without seeing each other, and even when reunited, they have to navigate safety precautions and social distancing. Uncertainty underlies many people’s daily lives, leaving anxiety and stress that can be detrimental to mental health. Below, several experts weigh in on the pandemic’s impact on mental health and offer advice on how Page 16

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to recognize our own struggles and support loved ones who are also struggling.

Katie Mullaney: Art can make a difference

Alissa DeFini: “A lot of times, support can just be listening in a nonjudgmental way.”

Katie Mullaney, a licensed creative arts therapist in Buffalo, agrees that the pandemic has triggered people who already struggle with mental health issues. Even people who haven’t been previously diagnosis with a mental health condition have found themselves feeling more depressed or anxious as a result of social isolation and uncertainty. This is where art can make a difference. Mullaney runs a studio called Create Space Buffalo where people can take individual or group therapy sessions. In those sessions, participants practice mindfulness techniques and use art to navigate their experiences. Art can be a useful medium to help people process what’s going on in our world, she says. “As humans, we create pictures in our mind of memories. Kids grow up processing things through their art. They draw pictures of who they want to be. They draw pictures of their family. They draw pictures of their friends. That’s all part of processing their experiences. As we grow older, we stop doing that.” By creating art, Mullaney says people access a part of their brain that’s connected to emotions and trauma. This allows them to work through issues differently than they would verbally. “Art brings up things you might not have otherwise been aware of. It brings out a part of your story that you may not have known was there.” Beyond art, Mullaney recommends three tips for improving mental health during the pandemic: reach out to a source that feels safe, even if it’s through phone or video call; create structure every day and include self-care as a regular practice; and find a way to process things for yourself, whatever that may look

Alissa DeFini, a licensed mental health counselor in Tonawanda, points out that widespread job uncertainty, transitions to remote work or back to in-office work, and the changing landscape of education are just three of the factors people have been navigating during the pandemic. Add those factors to the general sense of anxiety people feel about COVID-19 and the impact of seeing loved ones fall ill, and people’s mental health is suffering, DeFini said. These situational factors have exacerbated pre-existing mental health concerns. To overcome the stress and anxiety that affects mental health, DeFini recommends a mix of mindfulness-based and cognitive-based techniques. Mindfulness focuses on centering ourselves in the now rather than living in the past or the future, while cognitive-based techniques focus on challenging negative thoughts using critical questions. For instance, is this thought based on feeling, fact, or simple habit? As for supporting loved ones who are struggling, DeFini recommends being present and lending an open ear. “A lot of times, support can just be listening in a nonjudgmental way.” Above all, DeFini wants people to know that the anxiety and fear brought about by the pandemic are to be expected given the circumstances. For that reason, it’s important for people to maintain a healthy diet, exercise, improve their social support system and get a good night’s sleep. “There are a lot of folks struggling with this, and it’s normal to feel anxious during this time. You are not alone.”

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2020

When it comes to the pandemic, most of us have heard the expression “the new normal.” For Paul Cartone, a psychotherapist and life and sports coach in Amherst, the new normal is temporary like many things in life. A year or two from now, fears about work, money, school, and illness will look much different. Despite this assurance, Cartone said that these fears can be overwhelming in the moment. As a counselor, his job is to ground people in reality and help them understand the logical. This requires a change in perspective. “We’re programmed at a young age not to cope with our feelings, and that’s why we distract ourselves.” Our emotions and the way we process them are deeply rooted at the cellular level, Cartone says. Often, this takes us to a place of fear and irrational thinking. To counteract it, we have to deal with how we’re feeling, which starts with recognizing that we’re not OK. From there, we should identify the feeling and name the emotion. Once we do, we can allow ourselves to feel it. If it’s within our control to change it, we can; otherwise, we have no choice but to let it go. Only then should we turn to distractions like exercise or television. Of course, sometimes it’s the ones we love who are struggling. In that case, Cartone recommends reaching out to the one we’re worried about and being there when they’re ready to talk. Beyond that, the most important thing we can do is learn the signs that someone might be struggling or contemplating suicide: • Withdrawal • Irritability or aggression • Sleeping too much or too little • Uncharacteristic behavior • Talking about suicide or not wanting to live • Giving away possessions • Excessive alcohol or drug use “Sometimes people feel like talking about their mental health makes them a burden, but that’s not true. There’s always help out there, no matter what.” For more tips from Paul Cartone, visit his website at justbementallyfree.com.

Reach Out for Help If you or someone you love are struggling with depression, anxiety, substance abuse, or are contemplating suicide, reach out for support by calling Crisis Services of Western New York at 716-834-3131. You can also call the National Suicide Prevention Lifeline at 800-273-8255.

Experiencing Vision Loss? By Jim Miller

Should I Buy Long-Term Care Insurance?

Consider a Low Vision Evaluation. Macular Degeneration

Dear Savvy Senior,

Diabetic Retinopathy

My wife and I have thought about purchasing a long-term care insurance policy, but we hate the idea of paying expensive monthly premiums for a policy we may never use. Is there a good rule of thumb on who should or shouldn’t buy long-term care insurance?

Head Injury Stroke

Call today to schedule a Low Vision Evaluation.

Getting Old Dear Getting,

There are two key factors you need to consider that can help you determine if purchasing a long-term care (LTC) insurance policy is a smart decision for you and your wife. One factor is your financial situation and second is your health history. Currently, around 8 million Americans own a policy.

Who Needs LTC Insurance? As the cost of LTC — which includes nursing home, assisted living and in-home care — continues to rise, it’s important to know that most people pay for LTC either from personal savings or Medicaid when their savings is depleted, or through a LTC insurance policy. National median average costs for nursing home care today is around $92,000 per year, while assisted living averages around $50,000 per year. While national statistics show that about 70% of Americans 65 and older will need some kind of LTC, the fact is, many people don’t need to purchase a LTC insurance policy. The reasons stem from a range of factors, including the fact that relatively few people have enough wealth to protect to make purchasing a policy worthwhile. Seniors with limited financial resources who need LTC turn to Medicaid to pick up the tab after they run out of money. Another important factor is that most seniors who need LTC only need it for a short period of time, for example, when they’re recovering from surgery. For those people, Medicare covers in-home health care and nursing home stays of 100 days or less following a hospital stay of more than three consecutive days. So, who should consider buying a policy? LTC insurance policies make the most sense for people who can afford the monthly premiums, and who have assets of at least $150,000 to $200,000 or more that they want to protect, not counting their home and vehicles. Another factor to weigh is your personal health and family health history. The two most common reasons seniors need extended longterm care is because of dementia

or disability. And, almost half of all people who live in nursing homes are 85 years or older. So, what’s your family history for Alzheimer’s, stroke or some other disabling health condition, and do you have a family history of longevity? You also need to factor in gender too. Because women tend to live longer than men, they are at greater risk of needing extended LTC.

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Choosing LTC Insurance After evaluating your situation, if you’re leaning toward buying a LTC policy, be sure to do your homework. The cost of premiums can vary greatly ranging anywhere between $2,500 and $8,000 per year for a couple depending on your age, the insurer and the policy’s provisions. Also note that because of coronavirus, it may be more difficult to qualify for coverage now if you’re age 70 or older, in a high-risk group or have had a positive COVID-19 test. To find a policy, get a LTC insurance specialist who works with a variety of companies. See the American Association of Long-Term Care Insurance website (AALTCI.org) to locate one. Also shop insurers like Northwestern Mutual and New York Life, who work only with their own agents. Another option you may want to consider are hybrid policies that combine long-term care coverage with life-insurance benefits. These policies promise that if you don’t end up needing long-term care, your beneficiaries will receive a death benefit. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

Reach nearly 80,000 health- conscious readers in Western New York.

IN GOOD HEALTH

WNY’s premier healthcare information resource editor@bfohealth.com

Serving Western New York A monthly newspaper published by Local News, Inc. Distribution: 32,500 copies throughout more than 1,500 high-traffic locations in the region In Good Health is published 12 times a year by Local News, Inc. © 2020 by Local News, Inc. All rights reserved. 3380 Sheridan Dr., # 251 • P.O. Box 550, Amherst NY 14226 Phone: 716-332-0640 • Fax: 716-332-0779 • Email: editor@bfohealth.com Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo • Writers: Deborah J. Sergeant, Jim Miller, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Michael J. Billoni, Eva Briggs (MD), Jana Eisenberg, Jenna Schifferle Advertising: Anne Westcott, Amy Gagliano • Layout & Design: Dylon Clew-Thomas Office Manager: Nancy Niet No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

October 2020 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 17

NYS Smokers’ Quitline Launches Audio/Video Podcast Series: ‘New York Quitcast

Ask The Social

Security Office

From the Social Security District Office

Online episodes geared toward assisting healthcare professionals with cessation efforts and helping smokers/vapers quit tobacco-use

s part of its enhanced outreach efforts to both healthcare professionals and those who currently smoke or vape, the New York State Smokers’ Quitline (Quitline) launched “New York QuitCast,” an audio/video podcast series. Brief news stories in both video and traditional audio-only podcast form are available at the Quitline’s Online News Room and YouTube page. Ongoing episodes provide timely information to busy healthcare professionals on addressing tobacco cessation with their patients as well as guidance to smokers and vapers seeking to become tobacco-free. New York QuitCast’s inaugural episode on “COVID-19 and Smoking Cessation” featured expert recommendation from physician Daniel Croft, senior instructor of pulmonary and critical care medicine at University of Rochester Medical Center and a member of the Quitline’s Healthcare Professional Task Force. The series’ second episode focused on the Quitline’s Patient

Referral Program and ways healthcare professionals and organizations can enhance their onsite cessation interventions and collaborate with the Quitline to treat nicotine-dependent patients. The third and most recent episode of New York QuitCast highlights the Quitline’s ongoing nicotine gum promotion, which began in July. Throughout 2020 and while supplies last, smokers and vape-product users can receive up to three months of free nicotine gum by calling 1-866-NY-QUITS (1-866-697-8487) or visiting nysmokefree.com. The episode features a testimonial from Ellen W. in Long Island, who is celebrating nearly two years of smoke-free living thanks primarily to support from the Quitline and use of nicotine gum. The marketing and outreach team with Roswell Park Cessation Services will continue to develop episodes of New York QuitCast in response to timely issues related to treating nicotine dependence. Roswell Park Cessation Services administers the New York State Smokers’ Quitline from Roswell Park Comprehensive Cancer Center in Buffalo.

Breast Health Program at ECMC Recognized

rie County Medical Center (ECMC) Corporation’s breast health program was recently honored by America’s Essential Hospitals as a Top 10 submission nationally. The VITAL 2020 awards committee stated that this program was “receiving high marks and extensive consideration” for its Increasing breast health equity via primary care navigation program in the population health category. “We are appreciative to America’s Essential Hospitals for this recognition,” said ECMC President and CEO Thomas J, Quatroche Jr., Ph.D. “The results of this initiative to increase mammography screening highlight the dedication of ECMC’s primary care staff and Western New York Breast Health for their commitment to improving patient outcomes and access. Ultimately, this intiative has saved lives.” As of 2016, the breast cancer mortality rate in Erie County exceeded that of the state by 4.7%. With support from the American Cancer Society change grant program, ECMC examined barriers preventing women from getting mammograms. A survey of patients showed transportation to be the single largest barrier to obtaining health care. Further complicating matters, Western New York Breast Health previously Page 18

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only offered mammogram services through its mobile mammography coach and screening results were not automatically entered into patient records; instead, results were often mailed, called in, faxed, or otherwise electronically sent to the main health care campus. In October 2018, an ECMC Foundation and Western New York Brest Health initiative began to increase mammography screening in primary care clinics by monitoring provider ordering compliance, tracking contact attempts for all patient reminders and conducting training for all providers and staff on motivational interviewing. Further, transportation barriers were addressed through the mobile mammography coach and a collaboration with a local taxi service. As a result of the initiative, ECMC and Western New York Breast Health saw a nearly 12% increase in mammography screenings over a yearlong period, including four potential lives saved — four patients returned abnormal screenings and were later confirmed to have breast cancer. In addition, the project resulted in several important improvements to internal processes to meet patients’ needs. Information about ECMC breast health services and the mobile mammography unit is available at 716632-7465.

Learn Online With Social Security

ith more people learning online, we would like to highlight some of the digital resources we have for educators. Chances are a student will know someone who receives retirement or disability benefits. This could be a way to relate our many programs to a new audience. Showing young people that our programs help wounded warriors and children with disabilities can help them develop greater empathy and provide a path to inspired learning. We offer an educator’s toolkit teachers can use to engage students and educate them on our programs. The toolkit includes: • Lesson plans with objectives;

Q&A Q: My child, who gets Social Security, will be attending his last year of high school in the fall. He turns 19 in a few months. Do I need to fill out a form for his benefits to continue? A: Yes. You should receive a form, SSA-1372-BK, in the mail about three months before your son’s birthday. Your son needs to complete the form and take it to his school’s office for certification. Then, you need to return page two and the certified page three back to Social Security for processing. If you can’t find the form we mailed to you, you can find it online at: www.socialsecurity.gov/ forms/ssa-1372.pdf. Q: How can I get a copy of my Social Security Statement? A: You can get your personal Social Security Statement online by using your personal account. If you don’t yet have an account, you can easily create one. Your online statement gives you secure and convenient access to your earnings records. It also shows estimates for retirement, disability, and survivors benefits you and your family may be eligible for. To set up or use your account to get your online Social Security Statement, go to www.socialsecurity.gov/ myaccount. We also mail statements to workers age 60 and over who aren’t receiving Social Security benefits and do not yet have a my Social Security account. We mail the statements three months prior to your birthday. Q: How are my retirement benefits calculated? A: Your Social Security benefits are based on earnings averaged over

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2020

• Infographics and handouts for each lesson plan; • Links to Social Security web pages; • Talking points; and • Quiz questions and answers. You can access the toolkit at www.ssa.gov/thirdparty/educators. html. Parents are a child’s first educators. You can use our toolkit to introduce your child or grandchild to the importance of having a social safety net for hardworking Americans. We value and welcome the efforts all teachers make to educate America’s young people, and we want to help spark discussions with students about the benefits Social Security provides to millions of people. Please share our toolkit with your favorite educators today.

your lifetime. Your actual earnings are first adjusted or “indexed” to account for changes in average wages since the year the earnings were received. Then we calculate your average monthly indexed earnings during the 35 years in which you earned the most. We apply a formula to these earnings and arrive at your basic benefit. This is the amount you would receive at your full retirement age. You may be able to estimate your benefit by using our Retirement Estimator, which offers estimates based on your Social Security earnings. You can find the Retirement Estimator at www.socialsecurity. gov/estimator. Q: I get Social Security because of a disability. How often will my case be reviewed to determine if I’m still eligible? A: How often we review your medical condition depends on how severe it is and the likelihood it will improve. Your award notice tells you when you can expect your first review using the following terminology: • Medical improvement expected — If your condition is expected to improve within a specific time, your first review will be six to 18 months after you started getting disability benefits. • Medical improvement possible — If improvement in your medical condition is possible, your case will be reviewed about every three years. • Medical improvement not expected — If your medical condition is unlikely to improve, your case will be reviewed about once every five to seven years. For more information, visit www. socialsecurity.gov.

H ealth News ECMC earns ‘LGBTQ Health Care Equality Top Performer’ designation Erie County Medical Center (ECMC) Corporation recently announced it received the “LGBTQ Health Care Equality Top Performer” designation from the Human Rights Campaign Foundation (HRC). The designation was awarded in the 13th edition of HRC’s Healthcare Equality Index (HEI), released in September. A record 765 health care facilities actively participated in the HEI 2020 survey. Of those included in the HEI, 193 earned an “LGBTQ Health Care Equality Top Performer” designation. “We are extremely pleased to have achieved this designation as an LGBTQ Health Care Equality Top Performer,” said Cynthia Bass, director of diversity and Inclusion at ECMC. “Our goal advanced by our executive leadership team and supported throughout our entire organization is to lead the way in human rights and this recognition is a testament to our commitment in this regard.” In the 2020 report, 495 facilities earned HRC’s “LGBTQ Health Care Equality Leader” designation, receiving the maximum score in each section and earning an overall score of 100. Another 193 facilities earned the “Top Performer” designation for scoring from 80 to 95 points. With 90% of participating facilities scoring 80 points or more, health care facilities are demonstrating concretely that they are going beyond the basics when it comes to adopting policies and practices in LGBTQ care, according to a hospital news release.

The Mcguire Group, 1199SEIU and Trocaire College join forces on apprenticeship program Through a workforce development in long term care grant from New York state, The McGuire Group, 1199SEIU Upstate healthcare union and Trocaire College are collaborating on an apprenticeship program to help close skills gaps within the nursing workforce. Currently, 10 union-certified nursing assistants (CNA) working at McGuire have enrolled in the practical nursing program at Trocaire to pursue an advanced nursing degree. The U.S. Department of Labor’s Apprenticeships: Closing the Skills Gaps funding opportunity is also supporting the collaboration. The

purpose of the two-year program is to promote apprenticeships as a significant workforce solution in filling current middle- and high-skilled job vacancies and closing the skills gap between employer workforce needs and the skills of the current workforce. “The students’ range of experience varies from one year to greater than 18 years, and all have been tremendously engaged in the program,” said Dana Mata, nurse manager for The McGuire Group. “The apprenticeship curriculum includes coursework in a wide range of topics from regulatory, quality management and leadership training to application of clinical skills taught in their nursing program. The program also includes integrating McGuire policies and process already in place and continuing with the McGuire mission of providing quality care in all of our facilities.” In order to be eligible to participate in the apprenticeship program, the students had to have worked for at least one year at McGuire in addition to meeting academic thresholds. As part of the collaboration, Trocaire provides the practical nursing curriculum and support services. 1199SEIU facilitates testing used for screening, tutoring and processes all the tuition payments. In addition to employment, McGuire also provides the on-the job training (OJT). The students’ school hours and OJT substitute for their work hours. The students are also working at least one shift per week at their facility. “The students in the program had been away from school for a long time and were scared and overwhelmed. With classes going remote due to the pandemic, many also needed to learn new technologies,” said Jennifer Blickwedehl, Ph.D., associate dean for curriculum and instruction and program director, general studies, Trocaire College. “With all that, in addition to the stress COVID-19 added to their workload, they are all doing amazingly well and have been a wonderful addition to the classroom.” The students started classes spring 2020.

Grant to enable ECMC to provide fresh food to for HIV/AIDS patients Erie County Medical Center (ECMC) Corporation will receive a Ryan White HIV/AIDS Program grant award of $147,842, according to notification it received from the U.S. Department of Health and Human

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Services Health Resources and Services Administration (HRSA) The grant will fund a pilot program to be administered through The YOU Center for Wellness (formerly Immunodeficiency Services) at ECMC in partnership with the African-American Food Co-Op to provide fresh food for HIV/AIDS patients co-diagnosed with high blood pressure and diabetes. The grant program period extends from September through August 2021. “We are grateful to HRSA for this grant,” said ECMC President and CEO Thomas J, Quatroche Jr., Ph.D. “These funds will now enable ECMC’s YOU Center to build on its comprehensive approach to address social determinates of health, specifically the health needs of these specific HIV/AIDS patients. Through this grant and the partnership with the African-American Food Co-Op, ECMC can further expand on its efforts to promote health equity in our community.” Physician Jonathan Claus, medical director of The YOU Center for

Wellness, ECMC, said, “Despite a multitude of medical advancements related to treatment and prevention, chronic disease management among patients living with HIV/AIDS remains a major public health issue. The formidable combination of social determinants of health and behaviors that contribute to worsening health outcomes, have kept the puzzle of successful chronic disease management in a steady state of incompletion for this vulnerable population. Food insecurity, a common social determinant of health, coupled with an HIV/AIDS diagnosis, can have a tremendous impact on a patient’s ability to manage chronic diseases such as hypertension and diabetes. The Ryan White Part C Capacity award will afford ECMC and The YOU Center for Wellness the opportunity to provide self-management education, behavioral modification techniques and fresh fruit and vegetable deliveries to our patients living with uncontrolled chronic conditions and HIV/AIDS.”

BlueCross BlueShield Announces $2.1 Million in Relief for 150 Local Primary Care Providers

t a time when health care providers face significant challenges resulting from the COVID-19 pandemic, BlueCross BlueShield of Western New York recently announced it distributed $2.1 million in relief for nearly 150 local primary care provider (PCP) groups through its COVID-19 Provider Relief Program (PRP). This adds to the region’s leading health plan’s efforts to alleviate the impact of the pandemic on the local health care system. Other recent efforts include: • Accelerating quality incentive payments totaling more than $2 million. • Reimbursing providers at 100% for telehealth visits, which remain at no-cost share to fully insured and commercial BlueCross BlueShield members through the end of the year. BlueCross BlueShield is also finalizing plans on a new reimbursement program for doctors and nurse practitioners to help cover the cost of personal protective equipment (PPE) within their practices. PRP funds were recently dispersed to qualifying independent PCP practices who experienced a reduction in revenue compared to baseline metrics, among several other factors stemming from the pandemic. This included operational impacts, such as staffing, and costs incurred to improve telehealth capabilities. The local health plan also considered whether the provider continued to serve patients during the pandemic, including through telehealth, as part of the criteria. “The health of our community rises and falls with primary care.

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We’ve witnessed the impact that the dual health and economic crises has had on our providers as they shifted their practices to meet the health care needs of their patients, our members,” said physician Thomas E. Schenk, executive vice president, chief medical officer at BlueCross BlueShield of Western New York. “Aligned with our mission as a not-for-profit health plan rooted in the community for over 80 years, we continue to listen, respond and make every effort to support the health care providers our members rely on, especially at this time.” Family/general medicine, internal medicine, pediatrics and independent nurse practitioners, acting as a PCP practice, were among providers who received funding. In addition, as part of their ongoing efforts to support the community during the pandemic, BlueCross BlueShield donated $1 million to the WNY COVID-19 Response Fund to address the most critical and immediate community needs. The health plan also dedicated a team of health professionals to provide personal outreach and support to members during this time of uncertainty and has since connected with 25,000 members to offer wellness check-ins. These actions are in addition to funding 100% of the cost of more than 70,000 COVID-19 tests for their members in Western New York since April. Additional resources and information on BlueCross BlueShield’s response is available at www. bcbswny.com/coronavirus.

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ECMC’s state-of-the-art KeyBank Trauma and Emergency Department is now open.

Welcome to your new emergency department World-class care now has a world-class facility By listening to the needs of our patients and caregivers, the facility now matches the high-quality care we deliver to over 70,000 Western New Yorkers each year. We thank the entire community for their support and hundreds of donations to provide the very best technology and environment for our patients and their families.

Designed to treat more patients comfortably, the new Trauma and Emergency Department includes: • 57 spacious treatment rooms • Decreased wait times • 100% of RNs with specialized ER training • 100% attending doctors board-certified in ER medicine

• New imaging and lab spaces

The difference between healthcare and true care ECMC.edu

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