IGH WNY 48 October 18 by In Good Health: WNY's Healthcare Newspaper

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OCTOBER 2018 • ISSUE 48

Meet Your Doctor

WOMEN’S HEALTH

Physician Liise Kayler talks about the growing kidney transplant program at ECMC and how it’s poised to grow further

SPECIAL ISSUE

n Sports concussions: Much worse for women n WNY Doulas assists women during pregnancy n Vaginal rejuvenation: FDA cautions about procedure n How food can affect urinary tract infection

Laughter Yoga People of all ages and abilities gather weekly at Cleveland Hill Methodist Church in Buffalo to do mainly one thing: laugh. They are members of Many Ha Ha’s Laughter Yoga Club

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PLUS: Cancer Awareness Month. See stories starting on page 14

Horse Farm in Buffalo A therapeutic riding center facility just north of Delaware Park makes a difference in the lives of kids with special needs

That’s the annual average salary for certified registered nurse anesthetists (CRNA). The job growth within the career is projected at 31 percent, nearly twice that of registered nurses

Healthy Sleeping Director of the Sleep and Wellness Centers of WNY talks about healthy sleeping

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Acorn Squash Acorn squash, of all the winter squashes, has many of the most important vitamins we need. See SmartBites inside

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Handy Tool or Bacteria Haven? Tips on how to sanitize one of the filthiest spots in your home. Yes, the kitchen sponge.

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Obamacare Enrollee Numbers Aren’t Falling: Report H ealth insurance coverage rates have held steady in the United States, despite continued commotion over the future of the Affordable Care Act, a new government report shows. About 28.3 million Americans were uninsured during the first quarter of 2018 — not significantly different than 2017, and 20.3 million fewer than in 2010, before the health insurance reform law (often called Obamacare) was passed. “Things are relatively stable. During a time with a lot of uncertainty — there’s been a lot of political turmoil over what will or won’t happen with Obamacare — these gains we’ve made in reducing the number of uninsured have held pretty steady,” said health economist Ellen Meara. She is a professor with the Dartmouth Institute for Health Policy & Clinical Practice, and was not involved with the new report. About 8.3 million Americans now carry health insurance plans purchased through an Obamacare state-based marketplace, according to the U.S. Centers for Disease Control and Prevention’s National Center for

Health Statistics (NCHS). Millions more are covered under the Affordable Care Act’s expansion of Medicaid. In Medicaid expansion states, the percentage of uninsured adults has decreased from 18.4 percent in 2013 to 8.7 percent this year, the report found. But in states that haven’t expanded Medicaid, there’s been a slight uptick in the uninsured, from 17.5 percent in 2015 to 18.4 percent in early 2018. The NCHS report, “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-March 2018,” was published Aug. 29. Claire McAndrew is director of campaigns and partnership at Families USA, a health care consumer advocacy group. “People fare better in terms of access to coverage if their state has expanded Medicaid,” she said. “The fact that the poor and nearpoor still remain disproportionately uninsured really points to the need for states that have not yet expanded Medicaid to do so,” McAndrew

added. The numbers show that actions taken by President Donald Trump have not yet resulted in the undermining of Obamacare, McAndrew and Meara said. These actions include expanding the sale of cheap plans that can deny coverage to people with pre-existing conditions; cutbacks in funding to promote open enrollment and assist people in buying insurance; and reductions to cost-sharing payments to insurance companies, the experts said. “People want health insurance.

They’ve become accustomed to the consumer protections and financial assistance available to them,” McAndrew said. “Even though the Trump administration has been doing work to undermine health coverage, people still are fortunately getting coverage and care.” There are some troubling trends within the numbers, however. The percentage of adults with high-deductible health plans increased from 43.7 percent in 2017 to 47 percent this year, according to the report.

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

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1-716-846-7901 (TTY 711) 9 a.m. – 5 p.m. | Monday - Friday www.WellCareNow.com WellCare (HMO) is a Medicare Advantage organization with a Medicare contract. Enrollment in WellCare (HMO) depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments and restrictions may apply. Benefits, premiums and/or co-payments/ coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premium. Premiums, co-pays, coinsurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details. You may enroll in the plan only during specific times of the year unless you qualify for a Special Election Period (SEP) or Initial Coverage Election Period (ICEP). WellCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-877-374-4056 (TTY:711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-374-4056 (TTY:711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-877-374-4056 (TTY:711)。 Y0070_WCM_08135E CMS Accepted 10232017

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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FDA Gets Tough on Juul, Other E-Cigarette Makers

alling the use of electronic cigarettes a burgeoning epidemic among Teens, the U.S Food and Drug Administration recently announced a crackdown on the sale of Juuls and other flavored e-cigarette devices to minors. More than 1,200 warning letters and fines have been sent to retailers and five major e-cigarette manufacturers who illegally sold Juul devices, which look like computer flash drives, and other e-cigarette products to minors. The companies have 60 days to come up with plans to stop those sales or the FDA may consider a ban on the sale of all flavored e-cigarette products, the agency said. “The disturbing and accelerating trajectory we’re seeing in youth and the resulting path to addiction must end,” FDA Commissioner Scott Gottlieb said at a media briefing. “We’re seriously considering a policy change that would lead to the removal of these flavored products from the market.” Manufacturers of the five top-selling national e-cigarette brands have received FDA warning letters, he said. All of these brands — JUUL, Vuse, MarkTen, blu e-cigs, and Logic — made up the majority of products sold illegally to minors, the agency said. The retailers targeted by the FDA include 7-Eleven stores, Circle K convenience shops and Shell gas stations. In addition, the agency’s plan includes a series of actions to stop youth use of tobacco products, especially e-cigarettes. More than 2 million middle and high school students were regular users of e-cigarettes last year, according to the FDA. “Our youth tobacco prevention plan focuses on three key strategies,” Gottlieb said. “First, preventing youth access to tobacco products. Second, curbing the marketing of tobacco products aimed at youth. And finally, educating teens about the dangers of using any tobacco-related products.” Although Gottlieb believes that e-cigarettes can help some adults quit smoking traditional cigarettes, he is concerned that e-cigarettes pose health risks, including the possibility of releasing nicotine at higher levels than conventional cigarettes, and may lead to nicotine addiction in teens. Nicotine is not a benign chemical, Gottlieb said. The developing adolescent brain is particularly vulnerable to nicotine addiction, he noted. “The FDA will not tolerate a whole generation of young people becoming addicted to nicotine as a trade-off for enabling adults to have unfettered access to these same products,” he said.

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CALENDAR of

HEALTH EVENTS

Oct. 9

Dining Out for Life to benefit Evergreen Health

For the 16th consecutive year, Western New Yorkers can help raise funds to assist individuals and families in the community who are affected by HIV simply by enjoying a delicious breakfast, lunch or dinner on Tuesday, Oct. 9, as part of Dining Out For Life, a national fundraising event held annually in more than 60 participating cities. This year, 84 participating restaurants in Erie, Niagara, Orleans and Chautauqua counties will donate 25 percent (or more) of their proceeds on Oct. 9 as part of Dining Out For Life, Western New York’s largest HIV fundraiser. All money raised remains in Western New York and supports the comprehensive spectrum of HIV treatment and prevention services offered by Evergreen Health, a nonprofit organization providing HIV services since 1983. Over $1.2 million — all of which has remained in Western New York — has been raised over the life of this event. According to the New York State Department of Health, it is estimated that more than 2,000 individuals in Western New York are living with HIV. Evergreen provides these individuals and their families with a variety of HIV specialty care services throughout the region, including primary care, full-service pharmacy, nutrition support, housing and transportation assistance, and mental health services. Outreach services touch another 10,000 in our community. “Dining Out for Life is one of our key annual fundraising events, and we could not do it without our 150 dedicated ambassadors, generous business sponsorships and the more than 12,000 diners who participate in this event annually,” said Rob Baird, Director of Fundraising and Events at Evergreen Health. “Whereas we typically have close to 100 restaurants participating, this year we intentionally lowered the number to allow us to focus on the relationships we have developed with the generous restaurateurs who have supported us all these years and to allow us to better train our volunteer ambassadors who will be at each of the participating restaurants that night.” KeyBank is the event’s presenting sponsor — for the third consecutive year. It will match, dollar for dollar, money donated by diners the night of the event, up to $10,000. For more information about the event, as well as a full list of participating restaurants, visit www. DiningOutForLife.com/WNY.

Oct. 10

Mental Health America CEO to visit Buffalo

The Mental Health Advocates of Western New York (MHA) is inviting behavioral health leaders, elected officials and people interested on

the current state of mental health in America to engage in a conversation with Paul Gionfriddo, CEO and president of Mental Health America. The event, which is free of charge, will take place from 8:30 to 10 a.m., Oct. 10, at WNED/WBFO Studios, 140 Lower Terrace in Buffalo. Gionfriddo is focused on policy and how mental health officials can strategically make changes to improve outcomes. For more information about the event, call Mental Health Advocates at 716-886-1242.

Oct. 30

Program to focus on women’s pelvic health

Pelvic and uterine health are important issues for women, especially as they age. Often, however, women have more questions than answers when it comes to conditions such as pelvic organ prolapse, gynecologic cancer, incontinence, and fibroid tumors. Catholic Health is sponsoring a community dinner program, “Pelvic Health – What All Women Need to Know” on from 5:30 to 7:30 p.m., Oct. 30, at the Millennium Hotel, 2040 Walden Ave., Cheektowaga. Join women’s health specialist, physician Praba Jeyalingam and physical therapist Racquel Kurzweg, for dinner and an informative discussion about preventing, diagnosing and treating pelvic and uterine

conditions. Get all your questions answered while learning more about the latest surgical and non-surgical treatment options for various conditions, the benefits of pelvic floor rehabilitation therapy, and the advantages of robotic surgery versus traditional. Space is limited and reservations are required. For more information, call 716-447-6205 or visit chsbuffalo. org/events.

Oct. 3, 10, 17, 24

“Walktober” invites downtown employees to walk

The Wellness Institute of Greater Buffalo is partnering with Visit Buffalo Niagara to offer a series of free, guided, noontime wellness walks — beginning and ending at the Buffalo Niagara Visitor’s Center in downtown Buffalo Wednesdays in October. Institute Executive Director Phil Haberstro hopes to encourage the downtown community and its guests to support the U.S. Surgeon General’s “Call to Action” promoting walking/ rolling and walkable communities by participating in the free 30-minute mid-day walks. Walkers are invited to convene prior to the 12:10 p.m. walks at Buffalo Niagara Visitor Center located at the corner of Lafayette Square and Washington Street in downtown Buffalo. Each week’s route will explore a different corridor of the city center, highlighting historic sites and architectural treasures. The guided walks will also provide education on pedestrian safety in urban environments. Walks will start at 12:10 p.m. on the following Wednesdays: Oct. 3, 10, 17 and 24. For more information, call 716851-4052, email wellness@city-buffalo.org or visit www.CreatingHealthyCommunities.org.

Breast Cancer Network Has New Program for Metastatic Patients The Breast Cancer Network of WNY (BCN) has developed a new program to benefit women living with metastatic breast cancer. The Metastatic TLC Tote Program is a free informational resource packet that contains pamphlets, books, comfort items, sample products, and relevant information for patients in Western New York who have been diagnosed with metastatic breast cancer. This program also includes an ongoing membership to the Breast Cancer Network of WNY and access to all of its programs and services. The Metastatic TLC Tote Program furthers BCN’s commitment to women living with metastatic breast cancer, according to a news release issued by the group. In addition to the totes, BCN also offers support groups, maintains an online resource page, and donates annually to metastatic research. Metastatic breast cancer is a stage IV disease that causes over 40,000 deaths in the United States each year and it occurs when

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

breast cancer cells spread to other organs of the body, most commonly liver, lungs, bones, and brain. For further information on obtaining a Metastatic TLC Tote, contact Marcia Heaney, chairwoman of the advocacy committee at 688-9177 or email marciaheaney@ hotmail.com. For information about the programs and services of the Breast Cancer Network of WNY, call 7060060 or visit www.bcnwny.org.

Study: Users of E-Cigarette Pods Exposed to Nearly As Much Nicotine as Smokers

new study on use of electronic cigarettes among adolescents reports striking findings: that young users of newer “pod” e-cigarette devices are absorbing nicotine at levels approaching nicotine exposure from traditional combustible cigarettes. The research, a collaboration between scientists at Roswell Park Comprehensive Cancer Center and pediatricians from Stony Brook Children’s Hospital, also reveals that Juul

and similar products contain high concentrations of a modified, salt form of nicotine, which is more readily absorbed upon inhalation. The team’s data, published in the journal Tobacco Control, represent the first reported independent findings on nicotine exposure among youths who use pod systems, small e-cigarette devices that resemble USB flash drives. “Pods are compact, lightweight, ultraportable and easy to use incon-

spicuously,” the authors of the new study note. “Use of Juul and similar products among youth has parents, teachers and the lay public appropriately concerned.” The research team surveyed patients aged 12 to 21 who were seen at three Stony Brook Children’s Hospital outpatient clinics in Long Island, from April 2017 to April 2018. More than 500 participants completed a 60-question anonymous questionnaire about their use of e-cigarettes,

with more than half of them providing urine samples. “We analyzed the samples looking at three things,” says the paper’s first author, pharmacist Maciej Goniewicz, PhD, associate professor of oncology in the department of health behavior at Roswell Park. “We measured how much nicotine is in the various products participants reported using, how much nicotine is in the vapor and could potentially be inhaled, and the concentration of nicotine metabolites in the urine of the 22 adolescents who reported using Juul or another pod within the last week, so we could see how much of the nicotine actually gets to the body.” The team found that the nicotine concentrations in Juul and similar products ranged from 21.8 mg/mL to 56.2 mg/mL — significantly higher than what is seen with other e-cigarette technologies. “The levels of nicotine inhaled and absorbed by these pod users was alarmingly high,” noted co-author and study principal investigator Rachel Boykan, a pediatrician and faculty member with Stony Brook Children’s Hospital and Stony Brook University. “While we acknowledge that this was a small study and further research is needed, it’s critically important that users, parents, clinicians, public-health advocates and regulatory bodies be informed about how Juul and similar devices work and how they impact the body, as our results show that the risk for long-term product use and nicotine addiction is dangerously high.” The study, “High exposure to nicotine among adolescents who use Juul and other vape pod systems (‘pods’),” is available at tobaccocontrol.bmj.com.

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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9/20/18 10:38 AM

Meet

Your Doctor

By Chris Motola

Liise Kayler, M.D. Head of kidney transplant at ECMC to use animated videos to increase awareness of living donor transplantation option Q: Tell us about the $1.2 million grant ECMC received from the government and how it relates to kidney transplants. A: It’s to better inform people about the option of kidney transplantation from living donors. Basically there are a lot of people who are in need of kidney transplants. The waiting list is about 100,000 patients and there aren’t enough kidneys available from deceased donors. So the other option is to have a kidney from a living donor. A lot of people are able to find living donors who then come forward and donate. They don’t have to wait to receive their kidneys, the kidneys work right away and they can get back to their lives more quickly and go on to have a better quality of life and live longer. But some people have a hard time discussing kidney donation with friends and family, knowing the details about kidney donation and about approaching family. Q: Where are patients currently getting the information they do have? A: Even when family members consider it, there are things they’d like to know, but they’re not necessarily coming to the transplant center to ask about. They’re looking online, they’re finding out in any way they can. So my idea was to make animated videos that clearly depict the process of being evaluated as a living donor, undergoing the surgery, following up, and recovering from the surgery. The idea is to help both the donor and the recipient. Q: What made you decide to use animated videos? A: I can’t remember the exact time the idea came to me, but it’s been an irritation of mine when I hear patients say they don’t understand something despite the classes that we have that give that information. We talk to them a lot in our clinics. Yet they still don’t understand a lot of the information we give them. And there’s just not a lot more time that we can spend with them. There’s a lot of literature that suggests that, even when we do talk to them, we’re not talking to them in a language they can understand. Sometimes they believe they understand but don’t. Sometimes they know they don’t understand, but are afraid of saying it.

about making another person or team available, bringing in the family, meeting with the family. That’s just more talking. Meanwhile, the internet is this resource everyone’s using to learn things. People go to YouTube to figure out how to fix their car or their house. Why aren’t we using that to help patients understand healthcare? It seems obvious that this is probably a better route, yet few of us are actually doing it. There are centers that are pushing the envelope and doing more videos. Usually it’s a person talking. Some have some great diagrams. From the studies that have been done, it’s a pretty powerful way to educate people. I happen to have a bias toward animated videos. Q: What do you find most appealing or effective about them? A: I think they impart information the best. At first I was thinking about doing whiteboards and found some good ones online. Then I looked at the comments and found most of them were from nursing students and social workers. The people that were engaged were already trained and somewhat academic people. It’s going kind of fast. There’s a hand moving on the screen. It looks cool, but it might not be good enough to explain complex ideas to lay people. Over time, as I started to investigate what was out there, I found a few great animated videos on healthcare topics. And then I switched gears and realized that

was the direction I was going to go. At that point it was just about putting a team together to make that happen, which is actually kind of a hard thing for me because I’m good at being a surgeon and clinician, but writing a script, creating a video, im imagining how the video will look; we’re used to doing PowerPoints. Q: How was the learning curve? A: This is a whole new medium for me. We had to find an animator. We’ve gone through five so far and have now found one we’re really happy to work with. But it hasn’t been easy getting it all together. It’s also quite expensive. Making a brochure or PowerPoint is very cheap. So it’s not easy to find funding. So I started writing grants. The HRSA [U.S. Department of Health and Human Services] grant was actually the third one I wrote that got funded. I had written some pilot grants that were important because they let us get started, figure out what imagery worked and what didn’t. What concepts we were successfully able to describe and which ones we weren’t. So it helped to have that pilot data to get the HRSA grant. The HRSA grant is exciting because it’s a kind of validation of our idea. It’s great when local grant agencies are supportive of your idea, but you don’t feel like it’s that viable until a government agency supports your idea. We have a large group of patients coming in in the next couple months to look over early prototypes of our videos and help us develop them. It’s important to have their input, because it’s for them. We need to know what they like, what they dislike, what information is not there. A lot of it is describing their experience, so we need to know if patients who are considering going through the process are getting an accurate view of what the experience is like. Q: What are some of the misconceptions about kidney donating that you think the video needs to address most urgently? A: That’s hard for me to figure out a lot of the time and something the focus groups will be able to help with. I know a lot of people don’t realize they can give up a kidney and live normal, just-as-long lives as they would with two. I think a lot of people don’t think they’re eligible because they have minor medical problems or take medications. It’s better for people not to self-select out and come to us and do some light testing to see if they’re eligible. In terms of visiting the transplant center, I don’t think they have that many expectations, but it’s good for them to be prepared for that visit. In terms of the surgery, some

Q: That seems to be a problem for a lot of science-based fields. A: The other annoyance I have is that when someone brings up the idea of another intervention, it’s usually Page 6

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

In the News

ECMC’s Regional Center of Excellence for Transplantation and Kidney Care recently received a $1.2 million grant from the U.S. Department of Health and Human Services Health Resources and Services Administration to increase solid organ and tissue donation. The award will be dispersed over three years — $400,000 per year. A record 138 kidney transplants were successfully completed in 2017 at ECMC. To date this year, 90 kidney transplants (seven living donor; 83 deceased donor) have been performed at ECMC versus 71 kidney transplants (nine living donor; 62 deceased donor) through Aug. 1, 2017. ECMC officials expect the total number of transplants in 2018 will surpass the number from last year. of them think they’ll be hospitalized for a long time. You can be back to work as early as two weeks if you have a desk job. For others, it’s four to six weeks. They all seem to understand the benefits of donation. That’s it’s an elective procedure that can be done before the patient needs to be on dialysis, so the patient doesn’t have to experience dialysis. They understand it’s a better and longer lasting kidney. The other great thing about videos is that they can be shared by the patients and community themselves without the physician even being involved. Q: When do you expect to release the videos? A: It’s a three-year process. It’ll take a year to iteratively develop the videos. Another year to conduct the studies and formally test patients to see if the videos increase their knowledge and confidence in their knowledge. We’ll also be looking at if they share the videos.

Lifelines

Name: Liise Kayler, M.D. Position: Program director, Regional Center for Excellence for Transplantation and Kidney Care at ECMC; clinical professor at University at Buffalo; division chief, kidney and pancreas transplant program at ECMC Career: Was director of the kidney and pancreas transplant program at Montefiore Medical Center, practiced at the Thomas E. Starzl Transplant Institute in Pittsburgh as a clinical faculty member and later at Shands Hospital University of Florida as the director of the living kidney transplant program. Serves on the UNOS histocompatibility committee and is cochairwoman of the American Society of Transplant Surgeons bylaws committee Hometown: Oakland, Calif. Education: University of Nevada School of Medicine Affiliations: Erie County Medical Center; University at Buffalo Organizations: American Society of Transplant Surgeons; American College of Surgeons Family: Boyfriend, three cats Hobbies: Biking, wind sports.

STD Rates Continue to Climb in U.S. U.S. going through ‘steep and sustained’ spike in sexually transmitted diseases, experts say

ases of gonorrhea, syphilis and chlamydia all increased in 2017, making it the fourth straight year in which STD infections continued to expand. “The United States continues to have the highest STD rates in the industrialized world,” said David

Harvey, executive director of the National Coalition of STD Directors. “We are in the midst of an absolute STD public health crisis in this country. It’s a crisis that has been in the making for years.” Concerns are also mounting that gonorrhea could soon become

resistant to all current antibiotics, officials from the U.S. Centers for Disease Control said. More than 4 percent of gonorrhea samples now are resistant to azithromycin(Zithromax), one of two antibiotics now used to cure the bacterial infection, the CDC says. That’s up from 1 percent in 2013. “The finding adds to the complexities of gonorrhea treatment,” said physician Gail Bolan, director of the CDC’s Division of STD Prevention. “Our nation must plan for the future. Our nation urgently needs additional treatment options for gonorrhea.” CDC records show that in 2017: • Gonorrhea cases increased 67 percent, rising from 333,004 to 555,608 diagnoses. Infections among men nearly doubled, and cases among women increased for the third year in a row. • Syphilis diagnoses increased 76 percent, from 17,375 cases to 30,664 cases. Nearly seven in 10 infections occurred among men who are gay or bisexual. • Chlamydia remained the most common STD with more than 1.7 million cases diagnosed, up from around 1.6 million the year before. About 45 percent of cases were among young

women aged 15 to 24. “After decades of declining STDs, in recent years we’ve been sliding backwards,” Bolan said. These STDs are curable with antibiotics, yet most cases go undiagnosed and untreated, according to the CDC. If untreated, these diseases can affect a couple’s ability to get pregnant, cause ectopic pregnancy and stillbirth, promote chronic pain in the pelvis or abdomen, and increase a person’s risk of contracting or transmitting HIV, the CDC noted. Experts chalk rising STD rates up to several factors. There’s not enough screening for sexually transmitted diseases, particularly among young people who are most vulnerable, Harvey said. A lack of sex education also is contributing to the spread of STDs. Finally, the experts said that funding for public health response to STDs has diminished over the years. “The explosion in STDs comes on the heels of years of cutbacks in federal funding,” Harvey said. “Federal STD funding has seen a 40 percent decrease in purchasing power since 2003. That means state and local health departments are working with budgets that are effectively half what they were 15 years ago.”

Healthcare in a Minute By George W. Chapman

More NPs and PAs Assuming Role as Main Care Providers

he collective term “advanced practitioner” refers to nurse practitioners and physician assistants. They are assuming an increasing role in the provision of care every year. It is projected that they will account for two-thirds of the new providers (MDs included) added to the workforce over the next decade. (It should be noted that the number of physicians entering the workforce is somewhat limited by the number of residency positions available.) The number of NPs/

PAs per 100 MDs has been rapidly increasing since 2000 and will be 55/100 by 2030. The workforce projections for 2030 are about 1,076,000 MDs, 397,000 NPs and 184,000 PAs. The Association of American Medical Colleges continues to predict a shortage of 120,000 MDs by 2030. Many believe that is vastly overstated because the prediction doesn’t account/acknowledge the increase in the aforementioned advanced practitioners, technology, super drugs and artificial intelligence.

Genetic Testing

many employers who are increasingly taking matters into their own hands. More and more employers are contracting directly with narrow, high-performing provider networks to both shift and lower costs. Some companies are investing in primary care clinics and setting up preferred provider networks for their employees. Seventy percent of employers responding to a survey by the National Business Group believe a new entrant from outside the healthcare industry is necessary to really disrupt the unsustainable and unaffordable status quo protected by too many vested interests. Hospital Ratings Conundrum

A recent article in the Wall Street Journal points to a huge gender gap in genetic testing. By a 3 to 1 margin, more women were tested for inherited gene mutation (like cancer) than men. Genetic counselors also report having far more women than men as clients. Experts have speculated: women are very concerned about breast cancer and more in tune with their health; men have historically been less likely to seek medical care; and men are less likely to embrace the results of genetic testing. Employers Taking Charge On average, employers cover two-thirds of an employee’s health premium. The rising cost of care has become an existential threat to the future of many businesses. The well-publicized joint effort by Amazon, Chase and Berkshire Hathaway to redesign how care is delivered and paid for has actually detracted from what is already happening with

CMS established a “hospital compare” site so consumers can check a particular hospital’s ratings on measures such as mortality, safety, cost, timeliness of care, patient experience and readmissions. While this is all well and good, it begs the question: “What is one to do when a particular hospital rating is below

average and that is where my physician admits?” This is becoming more of a dilemma as consumer choices are being limited by employers contracting with narrower networks, increased government incentives for hospitals and physicians to develop alliances; more physicians becoming employees of hospital systems; and insurance plans favoring particular hospitals. Going “out of network” is rarely a good option because you will lose your physician — and out of network co-pays are intentionally prohibitive. The best advice is to discuss your concerns and trepidations about a hospital with your physician. The physician may have an alternative for you. All hospitals are very concerned about their ratings and will take your concerns (and especially a physician’s concerns) seriously. Med School Tuition-Free The medical school debt students carry averages $200,000. This on top of their college debt. The other cost to consider: physicians don’t start earning money until their late 20s due to four years of medical school plus at least three years of residency. Magnanimously, the NYU school of medicine will begin to cover the cost of tuition regardless of the student’s financial situation. NYU is the first and only top 10 ranked medical school to do so. Incoming students this year will have all their tuition paid for and existing students will have the remainder of their tuition covered. Physicians are still No. 1 when it comes to income. According to a recent report from Glassdoor, the median base salary for physicians is $196,000, about 4 percent higher than 2017. NPs and PAs averaged about $108,000. Controlling Drug Prices The federal government regulates and determines what it will pay

October 2018 •

for physician and hospital services delivered to Medicare and Medicaid patients, government employees, and veterans. Most commercial payers tend to follow their lead and closely mirror those fees. The drug lobby has been particularly effective in avoiding government regulation of their fees and most agree the government should avail itself of its purchasing power (Medicare, Medicaid, VA, etc.) and get price concessions from drug manufacturers. In an effort to do just that, control Medicare Part D drug prices, CMS would give Medicare Advantage plans more flexibility in determining what drugs are on their formularies. It is called “indication based formulary design” and, obviously, cost would be an indication and consideration. But provider and patient advocacy groups are not happy with the Administration’s efforts to get Part D drug costs under control, which would eventually help commercial plans. The AMA argues this is a detriment to patients by introducing unfair complexity to Medicare patients and gives more power to insurers to decide on treatment plans. There is special concern about limiting the formulary for cancer treatment. It should be noted that physicians and hospitals received $8.4 billion in payments from drug companies in 2017 for research, “related expenses” and ownership and investment interests held by physicians and immediate family members. 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.

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Page 7

Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

October Can Be a Perfect Time to Change It Up!

all is my favorite time of year. For me, it means all good things: relaxing in front of a cozy fire, making soup on Sunday afternoons, donning my well-worn leather jacket for long walks and turning my attention to all those inside projects I neglected over the summer. The colors, aromas and industriousness that come with the fall season really appeal to me. But this hasn’t always been the case. After my divorce, this time of year and all its romantic charm would leave me feeling melancholy. Nostalgia and wistfulness would creep in, and I just wanted to retreat into myself. For those who live alone, the month of October has some unique challenges. Not one to wallow in a “woe is me” state of mind, I began to develop and employ some strategies to rekindle my love of the fall season. It can be the perfect time to mix it up, get busy and take some risks. Below are elements of my annual fall “game plan.” Take a look and see if one or more of these suggestions might not add a little color to your

life pallet this fall: Tackle indoor projects. Fall is a great time to accomplish all those indoor projects that fell by the wayside in the warmer months. I have a long list and keep it right in front of me — a reminder that I have plenty to do. Idle time is not a friend at any time of year, but it can become downright unfriendly when the days grow shorter. Now is the time to keep busy: organize your storage space, do some touch-up painting, update your wardrobe, or redecorate a tired bedroom or bath. There’s nothing like feeling productive to beat the October blahs. Get up and get going. Staying active when there’s a chill in the air can be difficult. I can remember many a dreary morning when all I wanted to do was hit the snooze button, pull up the covers and stay in bed. As nice as sleeping in can be from time to time, I don’t recommend a steady diet of it. In my experience, there’s no better way to start your day than to wake early. In the peace and quiet, there is glorious time to read, think and breathe. I use this important time

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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. © 2018 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, Julie Halm, Catherine Miller, Ernst Lamothe Jr., Jenna Schifferle, Jana Eisenberg, Daniel Meyer Advertising: Anne Westcott, Amy Gagliano, Angela Rosa Layout & Design: Dylon Clew-Thomas • Office Assistant: Kimberley Tyler 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.

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to myself to plan my day, write and answer emails. As the day brightens, so does my mood and gratitude for the precious day before me. Enjoy the great outdoors. Sunshine, fresh air and even a light rain can be invigorating, especially if you’ve been cooped up all day. I’m grateful every day for Scout, my adorable springer spaniel, who needs to be walked twice a day. Do I feel like walking her all the time? No. Do I feel better after taking her out? Yes, without fail. Whether you have a dog to walk or not, make an effort to leave your house and get outdoors. It will help relieve feelings of isolation during this cooler month. Learn something new. Going back to school and fall go hand in hand. Who among us isn’t reminded of the excitement (OK, perhaps nervous excitement) associated with returning to school after the summer break. Each fall I like to identify some new skill or subject to master. Last year, it was flower arranging; this year I’m looking at various lecture series. Continuing education opportunities are abundant in the community. Check out offerings by colleges and universities, libraries, community centers, and arts and cultural institutions. You’ll also find workshop listings online and in local newspapers. Start your search today! Invite people in. Over the years, I’ve discovered a few simple and manageable ways to bring people into my world and into my home. One way is to organize a gathering around a TV show or streaming movie.

Years ago, I invited my single friends over to watch West Wing with me on Wednesday nights. I provided the soup and salad; they provided the good company, refreshments and an uplifting mid-week change of pace. Football games, your favorite weekly sitcomor drama, a recent release on Netflix — any of these can become reasons to gather together with friends. The benefits? You’ll hone your cooking skills (boy, do I now have some great soup recipes!) and you’ll connect with people. What better way to enjoy a nice fall evening? There are so many wonderful and meaningful ways to enjoy this season and to ward off the blues that can sometimes emerge during October. If you are feeling sluggish, lonely, or isolated, try a few of the strategies above. They have stood me in good stead and have reinvigorated my appreciation for change and the possibilities and personal growth that can come with it. With a little “elbow grease,” as my father would say, these strategies can work for you, too. Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive empowerment workshops for women held throughout the year in Mendon. To purchase her new book “Alone and Content” visit Amazon.com. For information about her upcoming workshops or to invite her to speak, visit aloneandcontent.com, call 585-624-7887, or email gvoelckers@ rochester.rr.com.

s d i K Corner

Picky Eating May Mask Larger Issues

any children are picky eaters, making every meal a challenge. But for some, the problem goes deeper than not liking vegetables or whole-wheat bread. According to a study in the journal Pediatrics, more than one in five kids between the ages of 2 and 6 are considered “selective eaters.” Most of them are moderately picky, but about 3 percent restrict their food intake so much that it turns the dinner table into a war zone. Of even greater consequence, over the course of the study, the researchers found that children with selective eating behaviors were nearly twice as likely to have symptoms of social anxiety, generalized anxiety and even depression than kids without issues surrounding food. There’s even a term for the condition — avoidant restrictive food intake disorder, or ARFID. In some cases, limited eating will

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

affect a child’s growth and overall health, as well as his or her relationship with Mom and Dad, with both sides feeling the stress. It helps for parents to understand that a child’s extreme reluctance to eat is likely not just stubbornness. Some kids have heightened sensory responses and may be disgusted by the smell or taste of some foods. Others may have developed a negative association with one food, leading to anxiety about trying any other new foods. If every meal is a tug of war, talk to your pediatrician. Because it’s not clear which kids will outgrow being picky eaters and which won’t, your child may benefit from specialized counseling. It will be important for the therapist to find out what’s causing the problem and for your child to feel comfortable with the therapist and understand that the goal is to help the situation.

& QA

with Anne McCaffrey

Former Lockport mayor now the CEO of Eastern Niagara Hospital

nne McCaffrey recently accepted the post of president and chief executive officer of Eastern Niagara Hospital in Lockport, leaving her position as mayor of that city to seize the opportunity. She is a lifelong resident of Lockport and spent 20 years in health care management before becoming involved in politics. Q: Tell me about your thought process when you were considering taking this position. A: When I heard about the opening, I was certainly very intrigued and curious to see what the position would entail. I’ve lived in Lockport my whole life. The more I got involved in the process of interviewing and gathering information, I really thought this could be interesting. The [pending] affiliation with Kaleida was a big part of this. The support of the Kaleida really made me all the more interested in pursuing the position. If you had told me a year ago I would have been doing this, I wouldn’t have believed it. It’s not something that I could have planned or prepared for, but it’s interesting because I think all of my experiences have led me to this.

Q: Was it a difficult decision to leave behind the role of mayor? A: A little bit. I’ve listened to our residents for the last six years that I’ve been in the city government on multiple topics and I can tell you that knowing that our community has a hospital that provides excellent care and is financially stable is a very important thing for people in our city. Because the hospital is so important, I thought that [residents] would be really understanding and really what I’ve gotten is overwhelming support. What I really got from people is that they’re excited for me to bring a lot of the strengths I had in turning the city around to the hospital. Q: That actually brings me to my next question. What are some of the lessons you’ve learned during your time as mayor that you think will be applicable to your new position? A: I think probably the biggest thing is knowing the community, knowing the people that live here, what they want, what services they need in the hospital and the community. I’ve lived here my whole life and we’ve raised our children here. We know so many people and living in Lockport is such an important part of my life. I can 65 make sure that the focus is to Turning New to Medicare ensure the strength of our hospital Questions Medicare in our about community. I would say that’s number one, and numbers two and Local Professional Sean Kelly three together are the leadership Call 716-603-6851and the trust I’ve built experience

in the community. There’s a lot of conversations that elected officials have with their constituents and I think my communications with our public on a regular basis were a really important thing. Q: What are some of your goals in your new position? A: In this part of Niagara County we have about 100,000 residents so it’s important we have access to services. We have emergency services, child and adolescent psychiatry, chemical dependency, and we know that those are some of the issues in our community. We’re putting the mental health and substance abuse needs of our community at the forefront. Also, having good surgery here in our community is so important. All of those services are so important. We also have an obstetrics unit, so we have a maternity ward. We certainly understand that for some of the bigger issues, people might have to travel to Buffalo to the biggest hospitals, but, you know, for some of that typical, more routine care, I think our public wants to get that in their home community and know that if they need to get there or their family is coming to visit them, it’s a short distance. It’s convenient and I think that’s a comfort to our residents. I’ve been looking a lot at our patient satisfaction responses. What’s different for me is being in a hospital setting, so I’m trying to spend as much time as I can in each department to see what the needs are. Q: How is it going so far? A: You know, the transition has been pretty smooth for me. I think there are a lot of similarities in my position as mayor and my position here. It’s leadership, staffing, budgets, understanding the community, looking at feedback and looking for opportunities for growth. Interview by Julie Halm.

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Page 9

Horse Therapy in the City A therapeutic riding center making a difference in the lives of kids with special needs — from a horse facility just north of Delaware Park By Catherine Miller

ucked just north of Delaware Park is a large property adorned with an English Tudor and gothic style building, whose interior is home to horses. Yes, horses. The five-acre facility inside the city houses horses that are teaching young would-be equestrians and special needs children the many benefits of horse riding. Set on land that was once part of the Pan-American Exhibition, the property at 950 Amherst St. is now home to the Buffalo Therapeutic Riding Center and the Buffalo Equestrian Center. Horses that previously called this property home once roamed Delaware Park with their riders in the early 1900’s. Now the nonprofit Buffalo Therapeutic Riding Center [BTRC] takes over the facilities on Mondays to provide horse riding experiences to special need students, as young as 6 years old. “It’s an amazing place,” said Susan Schoellkopf, BRTC’s executive director, who has been affiliated with

Horse Shows Scheduled Adults and teens interested in volunteering are invited to contact the organization to learn about the many volunteer experiences available at the facility.Visit www.thebtrc.org or send an email to becandbtrc@ aol.com. The site also allows for families to file an application for a special needs student who may benefit from the riding sessions

the riding center for more than 30 years, “We’ve changed a lot of lives here, for both the children and the horses.” Young people with learning disabilities, mental and emotional impairments, as well as developmentally challenged students join together at the riding center to enjoy an indoor ride on the large mammals. Horses are known to mirror the emotion of their rider, and children seem to pick up on the emotional connection quickly. Eye contact, physical communication of patting, hugging and riding the horse allow for students with social and communicative challenges to gain a strong sense of understanding with the animal, according to Schoellkopf. The bond between the student rider and horse grows with each session, allowing for positive psychological and social benefits and increased confidence, Schoellkopf said. The guided ride on the maned creatures offers physical benefits such as core strengthening, stretching and flexibility improvements, handeye coordination and improved movement dexterity and balance, according to Schoellkopf. The riders, aged 6 to 18, are limited to four students per half-hour session. Each rider has a volunteer and a teacher alongside them for the ride. The session is designed with the intention of aiding the student physically, mentally and emotionally. Parents say that on days that their children are going to the riding center, they are excited and can’t wait to get there. Lida Petrella’s son, Sammy has been attending the riding center since May. “Sammy is more focused, more

Jennifer Hemingway, an instructor with Buffalo Therapeutic Riding Center, helps 7-year-old Sammy ride one of the horses at the center.

Buffalo Therapeutic Riding Center offers horse riding on Mondays at 950 Amherst St. in Buffalo. Since 1998 the center has had about 500 children riding its horses. attentive,” said Petrella, who watches her son ride from the enclosed viewing area. “He definitely looks forward to coming here.” Many of the young riders have physical disabilities that impair their movement, and are often judged for those disabilities. That changes as they come into the riding facility. “The students relate easily to the horses,” said Schoellkopf, “The horses don’t judge them. They get up on that horse, and their disabilities disappear.” All of the instructors are Professional Association of Therapeutic Horsemanship

International (PATH)-trained and certified and the BTRC is premiere certified, meaning that the center has gone through a rigorous process to verify that each instructor meets strict criteria for CPR and first aid training as well as how to properly handle the horse and transition and guide the rider for the most beneficially session for each student. The horses themselves are donated, but they are costly to maintain. They need shelter, grooming and food. That’s why the center is constantly trying to raise money to fund scholarships and maintain the facility.

NYS Smokers’ Quitline Launches Enhanced Website Redesigned nysmokefree.com features updated healthcare provider resources, new logo, increased visuals and online newsroom

s part of its ongoing commitment to promote tobacco cessation efforts, the New York State Smokers’ Quitline (Quitline), headquartered at Roswell Park Comprehensive Cancer Center in Buffalo, launched a fully updated, redesigned and mobile-ready website at nysmokefree.com. Enhanced visuals, easier-to-read text and more intuitive navigation will help visitors quickly find the latest resources on tobacco cessation. Messages throughout the website also encourage tobacco users and healthcare providers to talk to one another for greater chances of quitsuccess. “Cigarette smoking causes Page 10

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approximately 28,000 deaths statewide each and every year. Countless New Yorkers have used the Quitline to help them quit smoking. Besides the support of our trained Quit Coaches at 1-866-NY-QUITS, it’s critical for the Quitline to offer an effective 24/7 online resource in the fight against tobacco,” said Andrew Hyland, Ph.D, chairman of health behavior at Roswell Park Comprehensive Cancer Center and director of the Quitline. “Our website at nysmokefree. com has an entirely new look, refreshed materials and added resources — which will greatly help both those looking to break nicotine addiction and healthcare

professionals who assist tobaccousing patients in the quest to achieve and maintain tobacco-free lives.” Visitors to nysmokefree.com will notice a new color scheme and a new logo, with the “Q” in ”Quitline” resembling a no-smoking sign. In addition, a new online newsroom will help members of the media and healthcare providers stay informed about the latest tobacco cessation news in New York State. Tobacco users will encounter positive messages about the quitprocess throughout the website, such as reframing thinking about slips and relapses as well as building confidence and knowledge prior to discussing quitting with a

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

healthcare provider. Nysmokefree. com also addresses timely topics such as e-cigarettes, the truth about filters, medication enrollment and healthcare benefits. Healthcare providers will find a special sub-section of nysmokefree. com geared toward helping them deliver quality tobacco dependence treatment to their patients, including step-by-step information on how to use the Quitline’s patient referral program. Links to peer-reviewed resources are available for topics such as prescribing stop-smoking medications, billing codes and healthcare system-wide solutions.

Things to Know About Sleep By Ernst Lamothe Jr.

good night’s sleep is sometimes referred to as one of the best free medicines a person can get. And too often the general public is suffering from a lack of it. “People should not underestimate the importance of good sleep,” said physician Eric Ten Brock, professor at the department of medicine in the Jacobs School of Medicine and Biomedical Sciences. “Good sleep is essential to functioning at your highest levels at every stage in life. There are people who say they only need four or five hours sleep a night to function and they are either lying, in the minority or don’t realize how they are not living up to their full effectiveness.” Brock offers six tips for attempting to reclaim that needed good sleep.

Keep a regular bedtime. Even though as adults we don’t always like routine, going to bed at the same time each day has significant benefits. Going to bed and waking up at the same time every day will actually help you sleep better at night. “Your sleeping cycle has a certain circadian rhythm where you often wake up at the same time during the night,” said Brock. “Your body also has a certain rhythm of when it wants to get up. Going to sleep at random times can completely cause your system to be out of sorts.”

Use the bed for sleep Sometimes sleep seems to be a secondary use for the bed. People read, eat, talk and play around on the phone or watch television. However, using it for its primary purpose can make an incredible difference in how you sleep. “Similar to going to bed at the same time, your body and mind responds to the rhythm of using the bed for sleep,” said Brock, who is also the medical director of the Sleep and Wellness Centers of Western New York. “Instead of checking your email or browsing through the internet, when you use your bed for sleep it helps you focus on getting good sleep.”

Go to bed when you are tired Seems simple enough. Yet it is one of public’s biggest mistakes and reasons why they struggle sleeping. Sometimes people go to bed early and figure sleep will just hit them or they do the opposite and push through and stay awake even when their bodies want to go to sleep. Both are mistakes. “People feel like just lying in bed will make them tired and that is not often the case. Or they say that even though they are tired they don’t feel like going to bed and they stay up,” said Brock. “You don’t necessarily need the one or two hour countdown in bed before going to bed and you don’t want to accidentally get that second wind because you stayed up past the time you were tired.”

Making the Most of Your Doctor’s Visit By Jim Miller

tudies have shown that patients who help their doctors by providing important health information and preparing themselves for appointments tend to get better care than patients who don’t. Here are some simple things we can all do to help maximize our next visit to the doctor. Before Appointments Gathering your health information and getting organized before your appointment are the key steps to ensuring a productive

meeting with your doctor. This is especially important if you’re seeing multiple doctors or are meeting with a new physician. Specifically, you need to: Get your test results — If you’re seeing a new doctor for the first time, make sure he or she has copies of your latest X-ray, MRI or any other test or lab results you’ve recently had, including reports from other doctors that you’ve seen. In most cases, you’ll need to do the leg work yourself which may only require a phone call to your previous doctor asking them to send it, or you may

Be careful with naps Even though they can be pleasant, taking a nap could be very disruptive to your sleeping cycle. If you’re sleep deprived or just looking for a way to relax, you might be thinking about taking a nap. Napping at the wrong time of day or for too long can backfire, though. “If you are someone who gets good sleep regularly then taking a nap is fine,” added Brock. “But if you are someone who is incredibly sleep deprived then you should avoid it. Naps can decrease your sleeping drive and affect you at night when you should be tired.” If you must take a nap, the recommendation is on the shorter side like 20 minutes.

Check your medication Many medications can have adverse effects on sleeping. Look no further than water pills. It helps your body get rid of extra water by increasing the amount of urine you make. “Taking a water pill will make you go to the bathroom throughout the night which will disrupt your sleeping habits,” said Brock. “You need to know what side effects your medication has and talk to your physicians about it especially if you are someone who does have a problem sleeping.”

Caffeine and sleeping pills can be detrimental While everyone is different,

need to go pick it up and take it yourself. List your medications — Make a list of all the medications you’re taking including prescription and overthe-counter drugs, supplements and herbs, along with the dosages and take it with you to your appointment. Or, just put all your pill bottles in a bag so you can take them with you. Know your health history — Being able to talk to your doctor about any previous medical problems and procedures, even if they’re not the reason you are going to the doctor this time, can make an office visit much more efficient. Write it down if it’s complicated. Genetics matter too, so knowing your family’s health history can also be helpful. Prepare a list of questions — Make a written list of the top three or four issues you want to discuss with your doctor. Since most appointments last around 15 to 20 minutes, this can help you stay on track and ensure you address your most pressing concerns first. If you’re in for a diagnostic visit, you should prepare a detailed description of your symptoms. During Appointments The best advice when you meet with your doctor is to speak up and get to the point. So right away, concisely explain why you’re there. Don’t wait to be asked. Be direct, honest and as specific when

October 2018 •

Physician Eric Ten Brock, medical director of the Sleep and Wellness Centers of Western New York. drinking caffeine is typically not a wise decision if you want good sleep. The most obvious effect of the stimulant is that it can make it hard for you to fall asleep. One study also found that caffeine can delay the timing of your body clock, according to the National Sleep Foundation. “Because caffeine is a central nervous system stimulant, it causes a molecular effect that can temporarily delay your wave of sleepiness and make you more alert,” said Brock. In addition, he also urges people to stay away from sleeping pills. “Those are either a no fix or short fix when it comes to really getting to the core of your problem,” he said. “Pills like melatonin only shifts or advances your sleep and wake cycle. It doesn’t really make you tired.”

recounting your symptoms or expressing your concerns. Many patients are reluctant or embarrassed to talk about their symptoms, which makes the doctor’s job a lot harder to do. It’s also a good idea to bring along a family member or friend to your appointment. They can help you ask questions, listen to what the doctor is telling you and give you support. Also consider taking some notes or ask the doctor if you can record the session for later review. If you don’t understand what the doctor is telling you, ask him or her to explain it in simple terms so you can understand. And if you run out of time and don’t get your questions answered, ask if you can follow up by phone or email, make another appointment, or seek help from the doctor’s nurse. For more information, the National Institute on Aging offers an excellent booklet called “Talking With Your Doctor: A Guide for Older People” that can help you prepare for an appointment and become a more informed patient. To get a free copy mailed to you, call 800-222-2225 or visit order.nia.nih.gov.

Jim Miller is the author of Savvy Senior, a column published every issue in this newspaper.

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Hypnosis Helps Break Addiction Practitioners say technique achieves the positive results to fight addiction By Deborah Jeanne Sergeant

ddiction isn’t easy to break. More than 20 million Americans over the age of 12 have an addiction, excluding tobacco, according to AddictionCenter. Its site —www.addictioncenter.com — states that “100 people die every day from drug overdoses. This rate has tripled in the past 20 years.” Among the many types of assistance available, hypnosis has shown to help people beat addiction. “Hypnosis is a process of progressive relaxation,” said Kathy Calabrese, certified hypnotherapist and founder and CEO of The BrainBody Health Technology Institute, LLC in Buffalo. “The main benefit is when you go into a place of relaxation, it supports the parasympathetic nervous system. One of the characteristics of addiction is an imbalance Calabrese between the parasympathetic nervous system and the sympathetic nervous system. “The latter is overactive and you’re constantly in fight or flight stage. When you go thru hypnosis — and there are many other ways of

getting in that state — it’s designed to support the relaxation response.” She also said that the cause of addiction is a person’s unhealthy means of dealing with overwhelming depression and anxiety. Calabrese said that addictive substances can trigger the pleasure area of the brain, which induces the person to repeat using the substance to bring more pleasure and relief from emotional pain. By tapping into the reason clients had initially chosen addiction over healthy coping mechanisms, Calabrese said she can help them achieve better success in beating the addiction. For some people, simply working on the level of the conscious mind isn’t as effective. Using hypnosis, in addition to other therapy techniques, achieves the best results, she said. Hypnosis is not a matter of placing people in a trance and they wake up transformed. Clients are aware of the interaction, but in a relaxed state of internal focus in which they can explore what prevents them from doing what they need to do. “We don’t use a pocket watch,” said Corrin Matthews-Rutkowski clinical hypnotherapist, ordained reverend and owner of Extraordinary Change Hypnosis in Buffalo. “Everyone’s brain works differently.

When someone comes in, I do a lot of profiling and detailing the way their brain works fastest. “Some are visual; others are auditory and others are hands-on. Depending upon the type of brain depends upon the type of induction — getting the person into a hypnotic state.” Clients typically lie on a couch in a relaxed state and listen to Matthews-Rutkowski’s spoken suggestions. She may use regression therapy, where she helps clients think about key memories and then tell their younger selves what they have learned in the meantime. “I ask them to reinforce that subconscious method and they’ll nod or shake their head or get more comfortable,” she said. “I bring them back to present life and present day by counting them up. They are usually surprised by what they remember. They may feel touched that they never felt positive about themselves that way before. That was regression therapy.” To become successful, clients need to be willing to change. Depending upon the issue and the

New Opioid PSAs Local professionals say new campaign to curb use of opioids won’t work By Deborah Jeanne Sergeant

emember the public service announcements (PSAs) from the Partnership for a Drug-Free America in the 1980s depicting an egg in a hot pan to show “your brain on drugs” as it fried? New PSAs released by Office of National Drug Control Policy (ONDCP) to address the opioid crisis, the Truth Initiative and the Ad Council, also discuss drug abuse in a dramatic fashion. Based on true stories, they show people purposefully hurting themselves to obtain more prescription pain medication. For example, it shows people smashing their hands with a hammer or driving a car into a dumpster. Though the spots warn “opioid addiction can happen after just five days,” area experts contest the effectiveness of the new PSAs, which Page 12

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debuted on TV and social media in June. “I don’t think they’re effective,” said physician Tildabeth Doscher, who practices at UBMD Family Medicine and specializes in addiction medicine. “There’s mixed evidence about fear. People can remember it, but it doesn’t mean that people will change behavior. What’s the target audience?” While she does think that the new PSAs raise awareness, she’s not sure that the message they contain clearly connects the dots between how some people start taking opioids, as prescription medication after surgery, which eventually leads to addiction. “It should say it, ‘Ask your doctor for another option for pain relief,’” she said. “We have this idea

pain is supposed to disappear. You want to manage pain, not erase it.” She said that in the 1990s, pain became a vital sign and later a reimbursement issue. “If someone said their pain was not addressed, the doctors became docked,” Doscher said. “It’s the way physicians are trained. There wasn’t a lot of lifestyle choice training and that’s starting to change.” Patients have the right to ask for other, non-addictive means to manage pain than opioid medication when they’re injured or about to undergo surgery. Doscher wants a PSA to offer alternatives and script ways patients can ask for other means of pain management, while making it clear that legitimate pain medication is how everyday people

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

therapist, clients may need three to six sessions to resolve their issues. “They don’t realize they’re learning,” Matthews-Rutkowski said. “They always sit up and feel amazing, and lighter.” She continues to see clients weekly until their issues have resolved, and usually that takes 10 to 20 sessions. “Some people in traditional counseling may be in it for years,” Matthews-Rutkowski said. “I do recommend they keep a counselor because they often need someone as an adviser because they skipped certain development skills.” Clients Matthews-Rutkowski should also follow their doctor’s advice while undergoing hypnotherapy. Hypnotherapy rates range from around $105 to $150 per session. It’s usually not covered by health insurance. become addicted to drugs. “The ad reinforces the stereotype of the out-of-control drug addict,” Doscher said. She thinks that people who aren’t addicted to drugs may not readily identify with the extreme examples of self-harm depicted in the videos. Louis Francis Ciola, certified hypnotist and owner of Amherst Hypnosis, specializes in addressing pain management, habit control and stress, among other conditions. “The opioid PSA is not the right approach,” Ciola said. “It’s not really dealing with the issue.” He thinks that most people want surgery and injuries to be pain-free, so they ramp up demand for opioid painkillers. Ciola wants PSAs to focus on preventing opioid addiction and more in-patient rehabilitation facilities to help people currently addicted. “A lot of insurance companies don’t want to pay for rehab,” Ciola said. “In Buffalo, we should have a 500- or 1,000-bed treatment hospital. You need that in a lot of places in New York State.” He also wants police departments to carry Narcan, the antidote to opioid overdose, like they would carry Epipens and defibrillators, since during an overdose, minutes count.

SmartBites

The skinny on healthy eating

Nature’s Vitamin Pill:

Nutrient-Rich Acorn Squash

ome foods serve up a little amount of a lot. While no superstar in any one nutrient, these foods boast decent amounts of many. Acorn squash, of all the winter squashes, falls into that commendable category. Of those “many,” however, acorn squash does shine with a few standouts. Though not as rich in beta-carotene (a precursor to vitamin A) as other winter squashes, this nutrient-dense squash is a very good source of vitamin C, potassium and manganese, and a pretty good source of some B vitamins, fiber and magnesium. One cup of acorn squash delivers nearly 25 percent of our daily vitamin C needs. A multi-tasking vitamin (and powerful antioxidant!) that’s essential for good health, vitamin C plays a vital role in collagen production, helps speed wound healing and

may even lower our risk of many chronic diseases by inhibiting the activity of cell-damaging free radicals. Another noteworthy perk: Acorn squash may contribute to heart health, thanks to its potassium and magnesium. While potassium helps to regulate blood pressure by lessening the negative affects of too much sodium, magnesium helps the heart maintain a healthy rhythm. Many studies have found that people with a higher dietary intake of both potassium and magnesium have a lower risk of heart disease and stroke. This dark green squash is a great source of thiamin (B1), an essential vitamin that contributes to healthy nerve and brain cells and helps convert food to energy, and a respectable source of folate, another important B vitamin that helps to reduce birth defects, maintain a healthy heart, and possibly thwart depression. Mellow-tasting acorn squash is

low in fat, cholesterol, sodium and calories (about 60 per cubed cup), and offers a modest amount of fiber: 8 percent of our daily needs. As for carbs, acorn squash boasts the good ones—the complex carbs that provide a steady stream of energy because they take longer to digest.

Roasted Parmesan Acorn Squash Serves 2-4 1 acorn squash, washed 2 tablespoons olive oil 1/4 cup grated Parmesan 1 teaspoon garlic powder 1 teaspoon dried thyme ¼ teaspoon coarse ground pepper ½ teaspoon kosher salt (or, to taste) Preheat oven to 400 degrees. Trim ends from squash. Position squash upright on widest end and cut in half, using a large serrated knife (rind is tough!). Scoop out seeds and slice each half into ½” half moons. In a large bowl, mix together olive oil, cheese, garlic powder, thyme, pepper and salt. Add squash and, using your hands, toss to coat slices with mixture. Lay the squash out on a baking sheet and bake for 30 minutes. Serve immediately.

Helpful tips

Choose squash with a dull, dark green rind: a shiny rind means it was picked too early (will taste less sweet) and an orange rind means the squash is overripe (will be tough and fibrous). Store in a cool, dry place for up to a month. Squash that has been cut or cooked may last up to two weeks in the refrigerator. To maximize its nutritional benefits, steam or bake acorn squash to prevent the nutrients from being lost in the cooking water.

Anne Palumbo is a lifestyle colum-

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.

Kitchen Sponge: Handy Tool or Bacteria Haven? Tips on how to sanitize one of the filthiest spots in your home By Deborah Jeanne Sergeant

very home has one and it’s the most bacteria-laden surface under the roof. The toilet seat? The garbage can? Try the kitchen sponge that you use to wash utensils, wipe counters and scrub plates. It’s likely dripping with disease-causing pathogens. A study by German researchers revealed 362 different types of bacteria present on household kitchen sponges — and half of those types were harmful bacteria. While to most healthy people, the bacteria they encounter in their everyday life doesn’t unduly affect them, people who are immuno-compromised must remain vigilant about keeping bad bacteria at bay. And, for those who can’t stand the “yuck” factor of germy kitchen sponges, here are a few options. • Ditch sponges altogether. “Restaurants use dish cloths,” said Kristin Goss, department chairwoman of culinary arts and assistant professor in the culinary arts department at Erie Community College, and also a certified serve safe instructor. Restaurants typically hold their dishcloths in a bucket of bleach-diluted water to prevent contamination. • Replace cloths. “I see many people who have dish cloths that sit there forever. Replace every day with a clean one. Wash them at the highest temperature setting. If you don’t replace them with a clean one

daily, you allow an environment of bacteria to grow, especially if you wipe up after preparing raw products. That’s where cross contamination happens, especially if you wipe a counter where you were preparing chicken and then wipe again an area where you’d prepare a sandwich or a plate of raw vegetables. Or you set your purse on a counter or table and transfer bacteria that way.” Of course, after the cloth has been exposed to a known germy surface, like raw meat juice, grabbing a clean cloth doesn’t hurt. Some washing machines offer a “sanitize” setting. • Wash your sponge. “I wash the sponge in the dishwasher every other day and then ditch it after a week,” Goss said. • Keep your hands clean. “Most food borne illnesses happen because of you not washing your hands. Sing the happy birthday song while scrubbing your hands with soap and warm water. It should last at least 20 seconds.” • Use the right cleaner. Evelyn Lannak, professor in hospitality at Monroe Community College, recommends a bleach solution in a spray bottle or bucket, 1 tablespoon of bleach per gallon of water. “Allow it to air dry afterwards for safety,” Lannak said. • Soak tools. Every day, soak item such as bottle brushes, sponge

A study by German researchers revealed 362 different types of bacteria present on household kitchen sponges — and half of those types were harmful bacteria. wands or sink brushes in the bleach solution for 30 seconds, Lannak recommends. • Go disposable. “Handi Wipes are nice because you can throw them away,” Lannak said. “They’re single use.” She added that especially for very germy chores, such as cleaning up after cutting up a raw chicken, a single-use cloth or paper towel prevents bacteria from spreading. • Limit germy messes. For example, many people believe they must wash their raw, whole chicken before roasting it. Lannak said that doing so spreads bacteria, since the rinse water splashes around the sink. Anyone worried about the chicken’s cleanliness should realize that processors

October 2018 •

clean the birds before wrapping them for selling. “Since you’re cooking it, it kills any bacteria that could be in it,” she said. She added that drying the chicken with a paper towel, using single-use gloves for handling the raw chicken and sanitizing the cutting board after the raw chicken was on it can minimize the spread of bacteria. Lannak recommends using the dishwasher or a bleach solution for cleaning the cutting board. • Use separate cutting boards for raw meat and raw vegetables to avoid cross-contamination and to limit where bacteria goes. Clean spills promptly, since bacteria multiplies over time.

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Cancer

Group Promotes Education About GeneticallyInfluenced Cancer

Based in Akron, Familial Cancer Foundation of WNY has been active since its foundation in 2015 By Deborah Jeanne Sergeant

hen Andrea Whitmarsh’s mother, Dawn Sagerman, learned she had a genetic mutation predisposing her to breast cancer in her late 50s, she opted for a preventive double mastectomy. Whitmarsh was 30 and pregnant at the time. She learned she also carried the mutation. It put her at a 50 to 85 percent lifetime risk of developing breast cancer and a 40 percent lifetime risk of developing ovarian cancer. “The first thing they asked me was if I wanted to schedule surgery — but I wanted to nurse my first daughter,” Whitmarsh said. She nursed her daughter for 14 months. Once the girl was weaned, Whitmarsh began a regimen of annual breast MRI and breast ultrasound, alternating every six months. While she did not select preventive mastectomy, the significance of her genetic mutation hangs over her. “There is no support for people with this, women who have proactive mammogram,” Whitmarsh said. “We didn’t have chemotherapy or radiation.” However, the mutation elevates her risk of breast cancer, ovarian cancer, pancreatic cancer and melanoma. Men can also have the BRCA mutation, which raises all the same risks except for ovarian cancer and plus prostate cancer. Whitmarsh said her uncle wanted to receive testing and his doctor told him he didn’t need it, even though men can have breast cancer and that the presence of the mutation indicates higher risk for many other cancers. Insurance refused to cover it. After two years, he was diagnosed with a very aggressive prostate cancer. He was tested and found positive for the mutation. “When you have prostate

cancer and are BRCA-positive, you should have the prostate removed,” Whitmarsh said. “Any male under 55 with prostate cancer should have genetic testing, but his physician would not push it.” In 2015, Whitmarsh, her mother, and her mother’s physician, Yellamraju Kumar, founded Familial Cancer Foundation of Western New York to help promote education to physicians and the public about genetically-influenced cancer and provide support for those who need testing or have been diagnosed. The organization is based in Akron. “It’s been an uphill battle because we don’t know a lot of physicians who know about this,” Whitmarsh said. “We can’t say to people to ‘go talk with your doctor’ because the doctor won’t know what to do with them.” She said that since the health care system has become overwhelmed, doctors may not have the time to stay up-to-date on the very latest discoveries, including familial cancer. “My primary care doctor works 16 hour days, seven days a week,” she said. “How well is a doctor working and keeping up if they work that many hours a week?” Their organization’s board includes a genetic counselor. Identifying those who need testing represents a big part of the organization’s mission. Whitmarsh said that 95 percent of people who have a mutation don’t know. About 15 percent of cancers are related to genetic mutations. This fall, the organization is starting its salon and spa outreach. The idea is that many women going to a spa or salon enjoy talking with the stylist or spa staff. Educating them on genetic mutations can help them engage clients on the subject. Whitmarsh thought of the program after her aunt, who works

The Long-Term Financial Toll of Breast Cancer

he financial fallout from breast cancer can last years after diagnosis, particularly for those with lymphedema, a common side effect from treatment, causing cumulative and cascading economic consequences for survivors, their families, and society, a study led by Johns Hopkins Bloomberg School of Public Health researchers suggests. Excluding productivity costs,

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those with lymphedema were estimated to have an average of $2,306 in out-of-pocket costs per year, compared to $1,090 for those without lymphedema—a difference of 112 percent, the study found. When factoring in productivity costs, those with lymphedema spent an average of $3,325 in out-of-pocket costs, compared to $2,792 for those without lymphedema.

Andrea Whitmarsh co-founded founded Familial Cancer Foundation of Western New York in 2015.

comes out of the bottom line of the at a salon, kept running out of the organization’s brochures because she hospital,” Whitmarsh said. “It’s hard to hire genetic counselors because it handed out so many to clients. costs the hospital money.” “We want people to know the She knows women who endured criteria for being tested,” Whitmarsh cancer treatment before finally said. “If they put pressure on receiving genetic testing. Once physicians, they’ll start learning they test positive for a mutation, about it. We can provide the they finally have a physicians with whatever More Information double mastectomy — they need. “Doctors are so busy For more information surgery that performed preemptively could now, they don’t have about Familial the time to ask, ‘What’s Cancer Foundation of have spared them happened in your family Western New York, chemotherapy and lumpectomy. cancer history lately?’ A visit The foundation also lot of women might have www.fcfwny.org. promotes general good a better relationship with healthy lifestyle, such their salon worker than as stress reduction, eating well, and their doctor.” exercise to help people maintain Whitmarsh maintains that good health. Whitmarsh’s mutation insurance should cover genetic diagnosis caused her to focus more testing instead of the $2,000 outon her own health habits. of-pocket cost to patients. She said The organization has no paid that another reason it’s so hard to staff, but relies upon ten board obtain genetic testing is that they members and 15 to 20 volunteers. don’t hire many genetic testers Events such as a golf tournament in and these professionals can’t work independently of the hospital setting. June, wine tasting in November raise funds for the foundation. “When they see a patient, it

“That extra $2,000 or so may not break the bank in one year,” says study leader Lorraine T. Dean, ScD, assistant professor in the Department of Epidemiology at the Bloomberg School. “But it can take away discretionary spending, or whittle away retirement savings. If it’s a recurring burden each year, how can you ever rebuild? That extra $2,000 in spending can cripple people over the long term.” The findings, published Aug. 18 in the Journal of Supportive Care and Cancer, are a call to action for policymakers to develop new ways

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

to curb costs after cancer, the authors say. A growing body of research highlights the “financial toxicity” of cancer, a term that pertains to the harmful personal economic burden caused by cancer treatment, explains co-author Kala Visvanathan, a professor in the Bloomberg School’s department of epidemiology. The financial consequences of cancer have been shown to affect mental health and a variety of other health outcomes, including rates of death.

Cancer Advances Rely on U.S. Funding: Report

lmost two dozen new cancer treatments received U.S. Food and Drug Administration approval in the past year, a new report reveals. These treatments include innovative immunotherapies that target cancer cells (called CAR T-cell therapies) and targeted radiotherapies, according to the report from the American Association for Cancer Research (AACR). Government-funded research is helping scientists find new ways to prevent, detect, diagnose and treat cancer, the association reported. “The unprecedented progress we are making against cancer has been made possible largely through basic research,” said physician Elizabeth Jaffee, president of the AACR. Now, a continued increase in federal funding is necessary to make major headway moving forward, she added in an association news release. According to the report, the fight against cancer to date has scored impressive wins: • Adult deaths from cancer declined 26 percent from 1991 to 2015. That’s nearly 2.4 million lives saved. • Public education and policy initiatives have reduced the smoking rate to 14 percent among U.S. adults, from 42 percent in 1965. However, cancer still poses enormous public health challenges, the report stressed.

New cancer cases in the United States are expected to increase from more than 1.7 million in 2018 to nearly 2.4 million in 2035. The increase is due largely to an aging population. More than 600,000 Americans are expected to die from cancer this year alone. In addition, although the HPV (human papillomavirus) vaccine could prevent nearly all cases of cervical cancer and many cases of oral and anal cancer, less than half of U.S. teens aged 13 to 17 have had the recommended number of vaccinations. And another serious concern: Advances in the fight against cancer have not affected everyone equally. Disparities in medical care still persist. The increasing cancer burden highlights the need for continued cancer research to develop new approaches to prevention and treatment. The report calls for Congress to increase funding to the U.S. National Institutes of Health (NIH), the FDA and the U.S. Centers for Disease Control and Prevention’s cancer prevention and control programs. Specifically, it urges Congress to add at least $2 billion in funding to the NIH in 2019, for a total of at least $39.1 billion.

Going Vegetarian to Cut Colon Cancer Risk

here’s no disputing the fact that regular colonoscopies, now suggested to start at age 45 for those with an average risk of colorectal cancer, can help prevent the disease by finding — and removing — precancerous growths. And a study of 77,000 adults published in JAMA Internal Medicine found that you can also lower your risk of this cancer by making changes in your diet right now, whatever your age. Doctors know that eating red and processed meats raises the risk of colorectal cancer, while eating fiber-rich foods lowers it. The JAMA findings got more specific about different types of diets. On average, eating vegetarian may lower colon cancer risk by 19 percent and rectal cancer by 29 percent compared to non-vegetarians — people who eat meat at least once a week. Besides eating less meat, the vegetarians in the study ate fewer sweets, snacks, refined grains and highcalorie beverages and more fruits, vegetables, whole grains, beans and nuts. However, the protective effects vary with the type of vegetarian diet, the researchers said. By the study’s numbers: • Pescovegetarians: Eating

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fish and seafood, but avoiding other meats lowers colorectal cancer risk by 43 percent. • Lacto-ovo vegetarians: Avoiding meat, but eating eggs and/or dairy products lowers colorectal cancer risk by 18 percent. • Vegans: Avoiding all meat, eggs and dairy lowers colorectal cancer risk by 16 percent. • Semi-vegetarians: Eating meat less than once a week lowers colorectal cancer risk by 8 percent. Research can’t yet explain exactly how eating vegetarian helps. But one theory says it could be because vegetarians often follow other healthy behaviors, such as exercising and not smoking, which also reduce cancer risk.

October 2018 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 15

Some members of the Many Ha Ha’s Laughter Yoga Club, during one session of laughter yoga: from left are Dawn Werner, Evelyn Mietlowski, Carolyn Showers, Don Werner, Pat Fiedner, Tom Root, and Tom Dehoff. The group meets from 6:30 to 7:30 p.m. every Thursday from September through June at Cleveland Hill Methodist.

A Weekly Dose of Laughter

People of all ages and abilities gather weekly at Cleveland Hill Methodist Church in Buffalo to do mainly one thing: laugh. They are members of Many Ha Ha’s Laughter Yoga Club By Jenna Schifferle

hey say that laughter is the best medicine. The expression is used time and again to explain the uplifting feeling you get after a good laugh, the implication being that it can take away your ailments (if only for a moment). It’s a great excuse to crack a joke, no matter how ridiculous or corny. But it’s more than just an excuse. Research around the world has proven that there are numerous health benefits of laughter. A study conducted at Loma Linda University in California, for example, found that laughter can boost memory retention in elderly adults. Likewise, a study at the University of Maryland found that a sense of humor can decrease one’s risk of heart problems. Not to mention, a hearty laugh can put your

abs to work and help you feel more relaxed. As adults, it’s not always easy to exercise our funny bones. Responsibilities and daily stressors can inhibit our ability to find humor in situations, and it can be difficult to laugh when you’re not inspired. Dawn Werner, a Snyder resident and the founder of the Many Ha Ha’s Laughter Yoga Club in Buffalo, estimates that children laugh up to 300 times per day, while adults are lucky to briefly laugh 15 or 20 times per day. Craig Werner, Dawn’s husband and a founding member of the club, said that he’s surprised adults don’t laugh more often. “I enjoy being silly, and like all of us here [at the Many Ha Ha’s Laughter Yoga Club], I’ve been

Calorie Counts on Menus May Be Trimming Americans’ Waistlines

ith roughly 40 percent of Americans now obese, new research finds that one strategy may be helping Americans stay slim: calorie counts on restaurant menus. Following the passage of the Affordable Care Act of 2010, chain restaurants with 20 or more franchises must now list a meal’s calorie count on their menus and order boards. Page 16

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And some cities and states — including New York City, Philadelphia and Seattle, and all of California, Massachusetts and Oregon — have gone a step further, imposing broad calorie label mandates in full-service restaurants. Now, a snapshot of the ordering habits in two full-service, sit-down restaurants suggests the legislative moves are having an impact. “We conducted an experiment

laughing since I was born. I’m always amazed at how infrequently adults laugh — if you look at statistics — because Dawn and I laugh every day.” That’s where laughter yoga comes in. Laughter yoga is a workout developed by Madan Kataria, a medical doctor in Mumbai. According to his website, laughter yoga operates on the premise that your body cannot differentiate between fake and real laughter; the health benefits are the same either way. Kataria set out to prove this, and through the years laughter yoga has spread to more than 100 countries and made its way to Buffalo. The Many Ha Ha’s Laughter Yoga Club meets weekly from September through June at Cleveland Hill Methodist Church in Buffalo. People of all ages and abilities gather together to perform various exercises that promote laughter. Attendees will recognize the church by an appropriate sign out front that says: We need not think alike to love alike. In the Werners’ case, we need not think alike to laugh alike. Inside, the group gathers promptly at 6:30 inside an old cafeteria-style room. Chairs form a semicircle outside the group — accommodations in case anyone needs to sit during the session. Over the course of the next hour, participants walk through a series of scenes and scenarios that involve acting and a lot of laughter. One example is the Tootise Tot, where everyone collectively sings the song and dances along to the rhythm. Another example involves zooming around pretending to be “bumper cars” while chuckling continuously. Like traditional yoga, laughter yoga involves various breathing techniques, meditation, and chants. Unlike a traditional class, however, laughter yoga aims to uplift the body through laughter, which means replacing normal chants of “Om” with “Ho Ho, Ha Ha.” Evelyn Mietlowski, an Amherst resident and clown with Buffalo Clown Alley, said that when she leaves a session, she feels uplifted and invigorated. with over 5,500 diners in real-world restaurants and found that calorie labels led customers to order 3 percent fewer calories,” said study author John Cawley. The drop amounted to about 45 fewer calories consumed per meal. “This was due to reductions in calories ordered as appetizers and entrees,” he added, with little change seen in the calorie count of either drinks or desserts. That second finding struck Cawley, a professor in the departments of policy analysis and management, and economics at Cornell University, as surprising. “Before we started, I expected that people would reduce calories in desserts, but they didn’t,” he said.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

“I just love the way you feel when you’re done. It’s just a wonderful experience. The world needs more laughter.” Like Dawn Werner who became a certified laughter yoga instructor 11 years ago, Mietlowski is now on the path to becoming certified. While Werner obtained her certification in Miami Beach where she studied under Kataria, Mietlowski will be learning the 100 or more techniques on her own time. From there, she plans to spread the joy to others, especially at the sites where she volunteers, such as Brompton Heights, an assisted care facility. “We’re trying to boost the laughter quotient for the day. After you’re done with a laughter yoga session, people usually feel energized and their spirits are buoyed. It doesn’t matter if you just give a smile or if you’re rolling down on the floor because you’re laughing so hard,” Werner said. While some of the techniques might take people out of their comfort zone, Werner added that this is an important part of getting to the heart of the practice. While forcing laughter, people often find that they’re actually laughing. Don Dehoff, a resident of Snyder, a retired book binder, and a fellow laughter yoga instructor, said that he’s motivated to teach by his passion for helping others. In one instance, he was teaching a class in Buffalo to disabled people. Someone saw him performing the exercises and asked, “Don’t you feel silly doing that?” His response was simple: “Not as long as I can make you laugh.” Dehoff and the Werners offer classes throughout the Buffalo area at locations like the Independent Health Branch of the YMCA in Williamsville, Cheektowaga Town Park, and occasionally Canalside. Laughter yoga sessions returned to Cleveland Hill Methodist Church in September, and anyone interested can visit The Many Ha Ha’s Laughter Yoga Club website at http://yogalaugh33.wixsite.com/ manyhaha/. Why? “In interpreting that, it’s important to remember that people will change their behavior when the information is new or surprising,” he explained. “People may have already known that desserts are highcalorie and not cut back, but been surprised by the number of calories in appetizers and entrees, and so reduced calories there.” Cawley calculated that over a three-year period, the calorie cut would lead to weight loss in the range of 1 pound. “Not large,” he acknowledged, “but it’s also a cheap policy, and philosophically it’s attractive to allow people to make informed decisions.”

Careers Certified Nurse Anesthetist: Average Salary:

$169,330 The job growth for career is projected at 31 percent, nearly twice that of registered nurses By Deborah Jeanne Sergeant

f you’ve experienced in-patient surgery, you likely have received care from a certified registered nurse anesthetist (CRNA). Cheryl Spulecki, president of New York State Association of Nurse Anesthetists, works as a professor at University at Buffalo. The association represents more than 1,600 CRNAs statewide. “The reason many are interested

in the program is they think they’d find it a very satisfying career if they’ve worked in acute care, the emergency room or intensive care unit and they’d like to advance their career,” Spulecki said. CRNAs administer all types of anesthesia in the operating room. Their care begins at the preoperation assessment, throughout the surgery, preparing the patient

for awakening to recovery and follow-up post-surgery to make sure they’re comfortable and their pain is managed safely. In addition to more skills, the degree prepares CRNAs for leadership, administrative or education roles. Like other nursing specialties, CRNA candidates beginning in 2020 will need to complete a higher degree — a doctorate in this case — by 2025. That degree allows CRNAs to transition into education. To apply to a CRNA program, candidates must have a bachelor of science in nursing or any appropriate bachelor’s degree, a license as a registered nurse, and a minimum of one year acute care nursing. Most master’s programs take 26 months to complete. The doctorate takes 36. After completing the education required, candidates must pass national board examinations and then recertify every eight years. Four continuing education credits are also required every four years. “We advise nurses or undergraduates to understand the prerequisites,” Spulecki said. “They should have critical care experience. They should enjoy the autonomy of working in that environment, working under supervision and medical direction of a physician and caring for patients with all types of anesthesia.” Kristine Faust, director of the UB School of Nursing nurse anesthetist program, said that CRNAs have many opportunities available, such as at a dental office, podiatrist, plastic

surgery practice, OB-GYN, outpatient facility or hospital. “In New York, you have to be supervised by a physician,” Faust said. “That physician could be a surgeon or an anesthesiologist.” Faust likes the autonomy CRNAs enjoy. She added that the career offers a good salary, variety of patients and “every day is different,” she said. “You’re helping people in pain and assuring them they’ll be safe.” She wants to encourage more intensive care unit nurses to learn about how to become a CRNA. “There’s more to nursing than taking care of patients at the bedside,” Faust said. “You have to like taking care of patients in ICU, enjoy the critical care piece of it, and possess prioritizing and critical thinking skills.” Good grades help, too. Faust recommends at least a 3.0 GPA. About 20 percent of nurses are men, but men populate nearly half of CRNA classes. Faust thinks that is because more men in nursing gravitate toward emergency health, intensive care and other highadrenaline and autonomous nursing scenarios. Those are also the sources of CRNA candidates. Faust also thinks that men tend to seek leadership roles, too. According to the Bureau of Labor Statistics, the average CRNA in New York makes an average annual salary of $169,330. The job growth between 2014 and 2024 is projected at 31 percent, nearly twice that of registered nurses.

Health Careers: Social Worker Teresa Johnson gives us glimpse of responsibilities of licensed clinical social worker By Jana Eisenberg

nless you’ve had direct interaction with one, or know someone in the field, many of us would be hard-pressed to describe exactly what a social worker does. Many social workers actually can’t even define it succinctly. That’s because it’s a broad-based and far-reaching profession, with many different career paths. An underlying fact of any social worker’s job, whether they work as a private mental health counselor, in an agency like Child Protective Services, or doing humanitarian work, is a focus on improving people’s lives. They can operate at many levels, from the individual, to groups, communities, systems and entire societies. One specialization is the medical social worker. Most hospitals and health centers have social workers on staff, performing and providing an array of duties and services. Teresa Johnson is a licensed clinical social worker with a stateapproved privilege to perform psychotherapy reimbursable by insurance (designated as “LCSW-R”).

She works at Roswell Park Comprehensive Cancer Center in Buffalo. Most of Roswell Park’s social workers are master’s-trained and licensed in New York state because the oncology setting is so comprehensive and social workers must provide more in-depth emotional support. A bachelor’s-level social worker coordinates discharges to nursing homes and rehabilitation centers. Johnson’s role is to provide support to patients and families with medical issues. “Our support comes in many forms, ranging from emotional support through individual or family counseling,” she said. “Our goal is to help patients and families overcome practical and emotional barriers that may get in the way of them accessing and following through on their medical care.” Key part of team Medical social workers also communicate in many ways with the rest of a patient’s care team. “Social

Teresa Johnson, a licensed clinical social worker from Roswell Park, with a patient. workers may attend rounds, daily huddles or weekly conferences to discuss cases with nurses, doctors, physical and occupational therapists, case managers and dietitians,” Johnson explained. “Providers can also request social work services through the electronic medical record or secure email system. We also communicate any important information back to the providers directly and document our assessments and interventions in the electronic medical record.” When clients are faced with medical issues — like a serious or chronic illness, or mental or physical health challenges — social workers play an important part in the patients’ care team. They are providers that patients and their caretakers can learn to count on. The role of the social worker varies for each patient, depending

October 2018 •

on what they need. Social workers may meet with patients and families to support them through treatment decisions, assist with advanced care planning, and to provide crisis intervention or individual psychotherapy. “If a patient is admitted into the hospital, we may work with the team to coordinate a safe discharge plan or help facilitate communication between medical providers through a family meeting,” added Johnson. “A social worker is often a consistent point of contact for patients and families as they navigate medical treatment,” she said. “Social workers first complete psychosocial assessments to identify what patients’ and families’ needs may be. We can also educate them on resources that may be available and appropriate, both within the hospital and the community.”

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 17

Women’s Health

Labor of Love Group of experienced mothers assists families through pregnancy process By Daniel Meyer

y educating, reassuring and supporting first-time mothers and their families, a small but dedicated team of experienced mothers is assisting women with the life-changing experience of having a baby. WNY Doulas is led by Beth Carey and Tara Withey, each of whom has been thoroughly trained to safely guide expectant couples through labor, delivery and in some cases the early stages of parenthood. Having assisted more than 300 families who live throughout Western New York, the duo remais busy working directly with clients. “What we are is a unique collaboration of local birth professionals completely committed to helping educate and empower the expectant mother, her family and whoever else is supporting her during the pregnancy,” says Withey, who has been guiding expectant couples for the past eight years. “We help everyone get on the same page and discover the best path for them to take as the pregnancy advances and we reach childbirth and the postpartum stage of being a mother. It’s incredibly inspirational and satisfying work.” Withey and Carey work closely with Lisa McCloud, another trained and certified birth companion, and are also mentoring other future

doulas to work with clients and offer personalized assistance to families as they strive for a “better birth” that results in physically, mentally and emotionally stable mothers and babies. “We want to eliminate misconceptions and educate people about what we do,” says Carey, who has been a birth companion for 12 years. “Many Carey expectant mothers aren’t even aware that we exist and that we can provide a variety of services, advice and comfort they can directly benefit from the entire time they are pregnant, all the way up to the birth of their child and even after that as they make the adjustment to fullfledged motherhood.” WNY Doulas offers classes, workshops and courses on numerous topics, including fertility awareness, cesarean sectionsupport, dancing for birth and placenta encapsulation. They even offer birth pool rentals for anyone wanting to give birth in a non-hospital setting. While their work with clients occurs throughout the year, WNY

Doulas is always focused on coordinating their Better Birth Conference annual event. Next year’s gathering already been scheduled as Withey and Carey hope to increase their exposure and the number of attendees. “We are gearing up for May 5, 2019 and believe it will be easy for everyone to remember as it will be a ‘Cinco de Mayo’ filled with education and incredible access to numerous resources,” says Withey. “We bring in local chiropractors, yoga instructors, physical therapists, acupuncturists and other specialists and introduce them to the expectant mothers and allow everyone to interact and discuss how they can help Withey them. It’s just a

truly incredible day because you watch pregnant women who come in maybe a bit apprehensive and skeptical leaving with a wealth of knowledge that includes physical, emotional and information support that any expectant mother will welcome to help them before, during and shortly after childbirth.” In addition to establishing relationships with various community partners, including Catholic Health and BlueCross BlueShield, WNY Doulas supports nonprofit organizations like the Priscilla Project (refugee ministry for women) and the Western New York Perinatal Bereavement Network. “Anything we can do to help and provide comfort and guidance to expectant mothers is what we strive for,” says Carey. “We will always remain approachable and never forget the importance of surrounding them with loving and supportive people who truly care about them and their child.”

sugar represent the best option for cranberry juice. “You can also buy cranberry supplements,” Fiege said. They are said to make it difficult for bacteria to stick to the lining of the urinary tract. Adding whole cranberries (not the jellied kind commonly eaten at Thanksgiving) to smoothies or other foods can also help and are more easily tolerated that simply eating the tart berries. In addition to dietary changes, Nelson encourages clients with frequent UTIs to wear loose-fitting undergarments and remember to practice careful hygiene. “Wipe front to back and urinate after sex to get any bacteria out,” Nelson said. “If you have recurring

UTIs, talk with your doctor or OBY-GN about other birth control methods, as spermicidal and lubricated condoms can increase risk.” Seek the advice of a health care provider for anyone who suspects a urinary tract infection, since the infection can affect the bladder and kidneys if not treated promptly with antibiotics. Symptoms include increased urine frequency, burning, and possibly blood. For older people, the symptoms may not be as obvious. They may experience dementia-like symptoms that manifest very suddenly. Cloudy or foul-smelling urine can also indicate a UTI in an older adult.

How Food Can Affect UTIs By Deborah Jeanne Sergeant

f you frequently suffer from urinary tract infections, consider your diet. It can make a difference. To better support urinary tract health, consider making a few dietary changes. Carolyn Nelson is a registered dietitian and certified diabetes educator with Personalized Health Nutrition, PLLC with several offices in the region. She asks clients who experience UTIs about hydration. “If our goal is to support urinary tract health and prevent UTIs, drink enough fluids per day,” Nelson said. “That should be water, about two liters or eight 8-oz. cups per day.” Drinking more water means more frequent urination. Nelson said that bacteria accumulate when urine remains in the bladder too long. Drinking sufficient water flushes out bacteria. “Set an attainable goal and move toward that goal of eight, 8-oz. cups,” Nelson said. “You could go for four cups, five cups and so on each week.” Page 18

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Strategies to drink more could include keeping a glass of water nearby and taking water bottles along in the car. Nelson also encourages those who frequently experience UTIs to support healthy bacteria in the body. Eating more probiotic, fermented foods such as fresh sauerkraut, fresh kimchi, yogurt and kefir. Probiotic supplements can also help. Cindy Fiege owns and operates Harmony Health Store in Spencerport. She said it’s important to avoid irritants to the bladder, including caffeine, alcohol and spicy foods and sugar, to reduce the risk of UTIs. And what about the home remedy of cranberry juice? Fiege said that cranberry juice cocktail contains added sugar, an ingredient that feeds bacteria. Those with an artificial sugar substitute may irritate. A serving of a cranberry drink that contains a blend of apple and cranberry juices without any

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

Women’s Health

Sports Concussions:

Much Worse for Women Part of the reason may be because women have smaller and weaker neck muscles than males and they tend to report injuries more often, say experts By Deborah Jeanne Sergeant

he injury caused by concussion appears to be worse for women than for men, according to research presented in the July edition of the journal Radiology. Several factors may influence this finding. Physician John Leddy, director of UB’s Concussion Management Clinic in the Jacobs School of Medicine and Biomedical Sciences and an international expert on concussion, said that females tend to report more symptoms, perhaps in part due to their general willingness to discuss medical issues and a better ability to accurately describe physical condition. “What is pretty commonly reported in the literature, but not every study, is females report more symptoms than males do,” Leddy said. “It’s not known entirely why that is.” The school has presented research that indicates what physicians tell female athletes to do after a concussion appears to affect their perception of symptoms. “If you advise them to go home and rest, they report more symptoms than boys,” Leddy said. “If you advise light aerobic activity, then their symptoms go down to the level that boys report. We think that girls may ruminate on their symptoms more than boys.” Assigning an activity lends a measure of control that may lead to less worry about the injury. While part of the phenomenon may include women’s perception of and response to the incident, nonsubjective measures also correlate. MRI scans used in the study show greater damage among female soccer players who “head” the ball than males. Heading the ball accounts to 25 to 30 percent of concussions

among female and male soccer players, respectively. “It may be because the biomechanics of the injury,” Leddy said. “Females have smaller and weaker neck muscles than males and smaller bodies. They have more force transmitted to their brain given the same amount of force during a head impact. Some females may get more of a whiplash effect on the brain during an injury.” Leddy said that a small amount of research points to a hormonal effect, as women who are menstruating may experience concussion differently than women who aren’t. Physician Elad Levy, professor of neurosurgery and radiology, and chairman of the department of neurological surgery at University at Buffalo, said that some youth soccer

leagues have eliminated heading for younger players because of the lack of musculature and coordination. “We understand it’s part of a game, but trying to limit the amount of heads could be a tool,” Levy said. “Just like with football, they’ve taken out a lot of contact in practice. Potentially limiting it may help reduce the number of head injuries.” He said that’s also important to learn proper technique, play by the rules and regulations of the particular sport and to use the safety equipment properly. Contact with the ball isn’t that dangerous, he said. “The riskiest part is contact with another player, like catching an elbow or head to head with other players while heading,” Levy said. Michael Freitas, primary care sports medicine and concussion management physician with UBMD Orthopaedics & Sports Medicine in Cheektowaga, advises athletes to play heads-up and smart. “Play with a good skill set and how to head the ball correctly. Have good situational awareness. Good form and technique is important.” While some people have suggested that additional gear could help prevent concussions in soccer — like the use of helmets worn in football — Freitas said that they’re meant to prevent skull fractures and would do little to prevent concussions. Instead, players should avoid leading with their heads. If there’s a hard hit, the officiate should stop play and remove the injured player. Athletes, coaches and officiates should understand the signs and symptoms of concussion — and what happens when they don’t report concussions and try to keep playing while injured. Symptoms may include headache, dizzy, disorientation, confusion, nausea, blurred vision and stumbling. Following a strict return-to-play policy after a concussion is vital to minimize the risk of lasting damage caused by second impact syndrome. Levy recommends the resources offered by the Centers for Disease Control and Prevention (www.cdc. gov/headsup/highschoolsports/ index.html). Players identified as experiencing a concussion must have sufficient rest and see a health care provider or certified athletic trainer

Physician John Leddy, director of UB’s Concussion Management Clinic in the Jacobs School of Medicine and Biomedical Sciences and an international expert on concussion. “It may be because the biomechanics of the injury,” Leddy says as a potential reason for more incidence of concussion among women athletes. October 2018 •

MRI scans used in the study show greater damage among female soccer players who head the ball than males. Heading the ball accounts to 25 to 30 percent of concussions among female and male soccer players before returning to practice and play. Some schools offer a baseline test before playing so that if athletes suffer a concussion, they can compare their steps of recovery to their baseline reading. The testing may include balance, visual and verbal memory and reaction time. Trainers can also test athletes on the sideline right after a hard hit. In addition, knowing the students well can help coaches and trainers recognize when players are hurt and when they’re not. Most back-to-play plans gradually return players with sufficient rest followed by incrementally increasing activity levels. If players regress and exhibit symptoms, they may have to repeat a step. Most players injured by concussion recover within that timeframe. Todd Nelson, assistant director of the New York State High School Athletic Association in Latham, encourages parents to help their young athletes to reduce their risk. “If they can get with a strength conditioner, they may be able to strengthen their neck muscles,” Nelson said. “That may help reduce risk of a potential head injury.” The National Federation of High Schools offers a free concussion management course to students at www.NFHSlearn.com.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 19

Women’s Health

Vaginal Rejuvenation: FDA Cautions About Elective Procedures By Deborah Jeanne Sergeant

hildbirth, menopause and the passage of time can affect both the appearance and function of women’s vaginal tissues. For some, dryness and lax tissue make intercourse less pleasurable and even painful. Some health care providers, including gynecologists, dermatologists and plastic surgeons, now offer non-surgical treatments to restore both vaginal moisture and tightness. In July, the FDA issued a cautionary statement about providers using energy-based devices for elective vaginal procedures. The FDA statement read that “the safety and effectiveness of energy-based devices for treatment of these conditions has not been established” and that “non-surgical vaginal procedures to treat symptoms related to menopause, urinary incontinence, or sexual function may be associated with serious adverse events.” The FDA has approved energy-based devices — radiofrequency or laser — for dermatological and general purposes, including removal of genital warts, growths or pre-cancerous tissue. The FDA has not specifically approved some of these devices for vaginal procedures. It states that using the devices for cosmetic reasons may cause “vaginal burns, scarring, pain during sexual intercourse, and recurring/chronic pain.” Robert A. Jason, board-certified gynecologist and cosmetic gynecologist, believes that the FDA statement has caused a great deal of confusion, though there’s merit in warning women to approach vaginal rejuve-

nation carefully. “They should go to a gynecologist who understands the benefits and pros and cons of non-invasive vaginal rejuvenation equipment,” Jason said. Jason serves as medical director and owns the Laser Vaginal Rejuvenation Institute of New York, in New York City and Lake Success on Long Island. He said that vaginal rejuvenation should be overseen by a gynecologist or cosmetic gynecologist physician in charge. Patients should also maintain realistic expectations. Women seeking tighter tissue, for example, should understand that non-invasive procedures may not offer the tightness they want. Jason said that he and other gynecologists use certain lasers or radiofrequency devices as a scalpel or knife. He added that there are also other lasers and radiofrequency devices on the market that are used as non-invasive, non-surgical devices that gynecologic and non-gynecological physicians use for non-invasive vaginal rejuvenation. “That is the confusing part,” Jason said. “After careful examination, if the right candidate uses non-invasive procedures, myself as well as many colleagues across the country have had excellent results, over 90 percent success rates. “The problem is that when women need more involved surgical repairs, their expectations were not met and that non-invasive procedures done by offices not well versed in vaginal health, can have less than

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Security Office

From the Social Security District Office

Workers’ Compensation and Certain Disability Payments May Affect Your Social Security Benefits

any people working nowadays have more than one job, so it’s not uncommon for them to have several sources of income. Owning multiple small businesses, seasonal jobs and the gig economy add to the mix — and complexity — of our modern day economy. It’s important to keep Page 20

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in mind that having multiple sources of income can sometimes affect your Social Security benefits. Disability payments from private sources, such as private pensions or insurance benefits, don’t affect your Social Security disability benefits. Workers’ compensation and other public disability benefits, however,

desired or harmful results.” He said that many women had procedures that were not appropriate for them and were hurt, prompting the FDA’s warning. “To truly put this in prospective, laser hair removal in the wrong person’s hands can cause burns and harmful results also,” Jason added. Physician Samuel Shatkin, Jr., who practices at Aesthetic Associates Center, Amherst, would agree. He said that “if it’s done with the wrong energy in the wrong hands, it can create burns.” Shatkin is certified by the American Board of Plastic Surgery and trained in all aspects of facial and body enhancement. Shatkin said manufacturers of vaginal treatment devices generally provides training on their use. He said his office has had VaJaser equipment for more than a year and a half and uses the equipment to Shatkin help patients’ vaginal mucosa to feel moister and more supple. “Our patients experience improvement in the way they feel,” Shatkin said. “It won’t make changes in medical conditions. If they understand that, they are happy with the results.” A CO2 fractional laser, VaJaser “is scanned onto the vaginal wall to create micro channels where the tissues can produce new collagen and smooth the vaginal mucosa, the lining of the vagina,” Shatkin said. Treatment takes 10 minutes and patients can resume normal activity after one to three days and intercourse in three to four days. Patients receive two to three treatments four to six weeks apart, then, for maintenance, annually. “Make sure that when you go to an office, speak with the staff and make sure they have proper training

and the proper staff to do the treatment,” Shatkin said. “Make sure the practice is competent in doing the treatment.” At Western New York Dermatology in Williamsville, board certified dermatologist Michael Nazareth offers Thermiva, which uses radiofrequency energy to heat tissue to stimulate collagen growth and increase blood flow to the vaginal area. “A lot of obstetricians, dermatologists and plastic surgeons were oversold these devices on what they could do,” Nazareth said. “There’s no cure-all for vaginal dryness, incontinence or atrophy of tissue. However, the equipment does help those things.” Treatments at Western New York Dermatology take 20 to 30 minutes and patients receive three treatments. The first two are a month apart and the last is six months after with a maintenance visit annually. “We see an increase in lubrication in the tissue,” Nazareth said. Anecdotally, some patients experience improvement in urinary continence issues related to childbirth. Like most offices that aren’t gynecologic practices, Nazareth requires patients have their normal provider perform a gynecologic exam and pap smear. Contraindications include any abnormal bleeding, infections, lesions or irregular periods. Nazareth “We select only good candidates,” Nazareth said. Patients return to regular activity immediately and may have intercourse the following day. The side effects include warmth during the procedure, but little discomfort. “The success of these devices has to do with finding the right treatment for the patient so we can meet their expectations,” Nazareth said.

may reduce your Social Security benefits. Workers’ compensation benefits are paid to a worker because of a job-related injury or illness. These benefits may be paid by federal or state workers’ compensation agencies, employers or by insurance companies on behalf of employers. Public disability payments that may affect your Social Security benefits are those paid from a federal, state or local government for disabling medical conditions that are not job-related. Examples of these are civil service disability benefits, state temporary disability benefits, and state or local government retirement benefits that are based on disability. Some public benefits don’t affect your Social Security disability benefits. If you receive Social Security disability benefits, and one of the following types of public benefits, your Social Security benefits will not be reduced: • Veterans Administration benefits; • State and local government

benefits, if Social Security taxes were deducted from your earnings; or • Supplemental Security Income (SSI). You can read more about the possible ways your benefits might be reduced at www.socialsecurity.gov/ pubs/EN-05-10018.pdf. Be sure to report changes. If there is a change in the amount of your other disability payment, or if those benefits stop, let us know. Tell us if the amount of your workers’ compensation or public disability payment increases or decreases. Any change in the amount or frequency of these benefits is likely to affect the amount of your Social Security benefits. An unexpected change in benefits can have unintended consequences, but not if you’re informed and have financially prepared yourself. Visit our benefits planner webpage at www. socialsecurity.gov/planners for information about your options for securing your future.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

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Which Flu Shot Is Right for You? Dear Savvy Senior, I’ve been reading that there are a bunch of different flu vaccines for seniors this flu season. Which flu shot is right for me?

Flu-Conscious Carol Dear Carol,

It wasn’t that long ago that if you wanted to get protected from the flu, you simply got a flu shot. But nowadays, there are so many flu vaccine options you might feel like you are ordering off a menu. To help you decide which flu shot is right for you, you need to consider your health, age and personal preferences. Here’s what you should know. Flu Shot Options Just as they do every year, the Centers for Disease Control and Prevention (CDC) recommends a seasonal flu shot to everyone 6 months of age and older, but it’s especially important for seniors who are at higher risk of developing serious flu-related complications. The flu puts more than 200,000 people in the hospital each year and kills an average of 24,000 — 80 to 90 percent of whom are seniors. Here’s the rundown of the different vaccine options. You will only need to get one of these: Standard flu vaccines: If you want to keep things basic, you can’t go wrong with a “standard (trivalent) flu shot,” which has been around for more than 40 years and protects against three different strains of flu viruses. This year’s version protects against two A strains (H1N1 and H3N2), and one influenza B virus. Or, for additional protection, you should consider the “quadrivalent flu vaccine” that protects against four types of influenza — the same three strains as the standard trivalent flu shot, plus an additional B-strain virus. Senior specific vaccines: If you’re age 65 or older and want some extra protection, you should consider the “Fluzone High-Dose” or “FLUAD.” The Fluzone High-Dose has four times the amount of antigen as a regular flu shot does, while the FLUAD contains an added ingredient called adjuvant MF59. Both vaccines provide a stronger immune response

for better protection. Egg allergy vaccines: If you’re allergic to eggs, your flu shot options are “Flucelvax” or “FluBlok.” Neither of these vaccines uses chicken eggs in their manufacturing process. Fear-of-needle vaccines: If you don’t like needles, and you’re between the ages of 18 and 64, your options are the “Fluzone Intradermal” or “AFLURIA” vaccine. The Fluzone intradermal flu shot uses a tiny 1/16-inch long microneedle to inject the vaccine just under the skin, rather than deeper in the muscle like standard flu shot. The AFLURIA vaccine is administered by a jet injector, which is a medical device that uses a high-pressure, narrow stream of fluid to penetrate the skin instead of a needle. You should also know that if you’re a Medicare beneficiary, Part B covers all flu vaccinations, but if you have private health insurance, you’ll need to check with your plan to see which vaccines they do or don’t cover.

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Pneumonia Vaccines Two other important vaccinations the CDC recommends to seniors, especially this time of year, are the pneumococcal vaccines for pneumonia. Around 1 million Americans are hospitalized with pneumonia each year, and about 50,000 people die from it. The CDC recommends that all seniors, 65 or older, get two vaccinations — Prevnar 13 and Pneumovax 23. Both vaccines, which are administered just once at different times, work in different ways to provide maximum protection. If you haven’t yet received any pneumococcal vaccine you should get the Prevnar 13 first, followed by Pneumovax 23 six to 12 months later. Medicare Part B covers both shots, if they are taken at least one year apart. To locate a vaccination site that offers both flu and pneumonia shots, visit Vaccines.gov and type in your ZIP code.

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H ealth News BMG now using Apple Health Records

New Name for Mental Health Association: Mental Health Advocates of Western New York 56 year-old agency rebrands to reflect current mission, programs and service areas

he Mental Health Association of Erie County, Inc. has recently changed its name to Mental Health Advocates of Western New York (MHA). The new name and logo reflect the current programs, mission and geographic areas served by the nonprofit agency. From its inception in 1962, the agency has provided a comprehensive array of programs and services to individuals and families living with mental illness through advocacy, treatment linkage and outreach services. Over the years, MHA has increasingly taken a leadership role in the community in matters of behavioral health education, mental health awareness and promotion of issues surrounding mental illness. Most recently, the agency has renewed and expanded its focus on prevention and early detection/intervention and actively promoting mental health and wellness in the region. MHA programs now reach into all eight counties of Western New York — and beyond — providing services to tens of thousands of children, adults and organizations every year. “The golden thread that weaves its way through everything we do at the MHA is advocacy,” said Ken Houseknecht, executive director. “In recent years, we’ve expanded and developed programs and services that create a heightened awareness of and strengthen mental

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The director of pastoral care at Roswell Park, Beth Lenegan, PhD, has been elected to the board of directors of the National Association of Catholic Chaplains (NACC). During her two-yearterm, Lenegan will help advance the future of chaplaincy by shaping the professional standards, training and certification of chaplains. She will also serve as a liaison to the Association of Clinical Pastoral Education. “It is a great honor to be asked to serve the National Association of Catholic Chaplains,” said Lenegan. “I’ve worked with several wonderful chaplains in my time at Roswell Park and watched them minister with such compassion and sensitivity to cancer patients and their families. It will be a privilege to work on a national level to help these Lenegan caregivers apply their gifts to be of service to others.” The NACC is a national association that advocates for the profession of spiritual care and educates, certifies and supports chaplains as well as clinical pastoral educators. Each member must go through rigorous training to become a board-certified chaplain dedicated to the compassionate care of people experiencing pain, vulnerability, joy and hope. Chaplains serve across the nation in a variety of diverse fields, including health care, education and social work. Lenegan, who joined Roswell Park as director of pastoral care in 1999, was elected to the board of directors by members of the NACC. She will start her two-year term in January of 2019.

VNA of WNY to move to new location The Visiting Nursing Association (VNA) of Western New York will move its Erie County operations to Airborne Business Park next fall. “The new location will be designed and newly built to best fit

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health programming in schools, the workplace, communities of worship, and elsewhere. We will continue to develop programs and services that put the ‘health’ back into mental health. Historically, and continuing to this day, the MHA has been deeply committed to providing essential services that address the needs of individuals, families, and communities living with and experiencing mental health conditions.” “Our new name fully encompasses the crucial role that the MHA plays in Western New York. Advocacy is at the heart of our mission. The staff and volunteers of the MHA advocate for thousands of families a year at times of their greatest need,” said Tom Baker, MHA board chairman. Mental Health Advocates of Western New York’s mission remains unchanged, according to officials: to promote mental health and wellness and support individuals and families challenged by mental illness. MHA offers non-clinical programs and services providing assistance with navigating the mental health delivery system, referrals to clinics and mental health professionals, in-school educational programs, workshops, support groups, community education, training and legal services. To learn more about MHA programs and services visit www. mhawny.org or call 716-886-1242.

In an effort to continue to provide value to its growing patient base, Buffalo Medical Group (BMG) has become the first healthcare provider in Western New York to support personal health records on the iPhone through Apple’s recently launched Apple Health Records. BMG is now one of just 75 healthcare entities across the United States to utilize this technology for its patients, putting the healthcare provider in the company of prestigious industry leaders such as Duke University Medical Center and Johns Hopkins. “As a healthcare leader in Western New York and beyond, we know how important it is to provide our patients with the tools they need to manage their health and wellness,” said physician John Notaro, medical director of Buffalo Medical Group. “This user-friendly access through Apple Health Records does that, all while enhancing our ability to offer the best care through digital access for our patients.” Launched by Apple Inc. in March 2018 and extended to BMG patients at the start of August, the free and comprehensive Apple Health Records aggregates electronic medical records, and makes all information accessible through a single tab already installed on a patient’s iPhone. Information such as diagnoses, allergies, immunizations and lab results can be accessed with a scroll and click; and patients are able to exchange questions or share medical updates with their physician through a separate portal, MyBMGChart, powered by the EMR, Epic. All information is securely encrypted, allowing patients to feel safe about accessing their passwordprotected information while having more connectivity to their healthcare provider. This is available to both primary care and specialty care patients. “Patients are now using the Apple Watch, Fitbit, and countless other apps to monitor their exercise and diet, and in turn, maintain a healthy lifestyle,” said Notaro. “Apple Health Records is yet another tool at their disposal, and gives each patient the tools to quarterback the ongoing developments of their healthcare. That’s a good thing for both the patient and their physician.”

Pastoral care director elected to national group

You’re Not Alone Half of Americans are trying to slim down

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716-332-0640 EDITOR@BFOHEALTH.COM

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • October 2018

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SEPTEMBER 2018 • ISSUE 47

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You’re Not Alone Half of Americans are trying to slim down

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Health News 6 Free Issues our needs,” said Judy Baumgartner, president of the VNA of Western New York. “We will consolidate the Erie operations into this one new building, optimizing workflow and efficiency. This new space will also allow us more room for growth as the need for home care and communitybased services continues to expand.” Because of the its growth and evolution, the VNA’s Erie operations currently reside in three separate buildings within six-tenths of a mile along Wehrle Drive. Baumgartner added, “With the significant changes in technology and daily operations over the last 20 years, it is imperative that we design a flexible and adaptable workspace that will allow more accessibility to field staff and branches and support our continued growth.”

The VNA is the largest certified home health agency in Western New York and the fastest growing entity in the Kaleida Health organization. It provides care for more than 27,000 patients annually, performing more than 530,000 home visits. The agency is ranked among the top home health care agencies in the nation, with a 98 percent patient satisfaction rating. The VNA, a Kaleida Health affiliate, currently provides services to residents in ten Western New York counties including Erie, Niagara, Orleans, Genesee, Chautauqua, Cattaraugus, Allegany, Wyoming, Livingston and Steuben. The VNA also provides services in Pennsylvania through its affiliate, VNA of Northwest PA.

In Good Health

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From left are Smita Chutke, CHAI director of events and communications; Swaroop Singh, CHAI director of finance; Chris Jamele, Parkinson’s Foundation WNY executive director; Shrikar Chakravarti, concert organizer, and Sibu Nair, CHAI executive director.

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CHAI Supports Parkinson’s Community

Business/Organization________________________________________

he Council of Heritage and Arts of India (CHAI) has presented a check for $2752 to the Parkinson’s Foundation Western New York. The contribution resulted from proceeds raised through the Concert for a Cure that CHAI hosted in July. This concert showcased the “Melody of Indian.” CHAI was able to secure a date with world renowned musicians, members of

the Havaldar family, to perform in Buffalo. The organization reached out to the Parkinson’s Foundation, offering to donate proceeds from the show and to introduce the Parkinson’s community to this wonderful, and potentially healing, music. The Concert for a Cure was held on Saturday, July 21 in the screening room on UB’s Amherst Campus.

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Buffalo & WNY Healthcare Newspaper October 2018 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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ECMC-RET-RET-18108-1 IN GOOD HEALTH_AD_9_75X13_75_M | TRIM: 9.75X13.75”H | .125 BLEED | CMYK

By acting today, we can heal tomorrow’s traumas.

Nicholas Ball Trauma Patient

Karen Beckman-Pilcher, RN, MSN Clinical Nurse Specialist of Emergency Services

Amy Terpening Traumatic Brain Injury Survivor

Michael A. Manka Jr., MD Chief of Emergency Medicine

Donna Oddo, RN, BSN Nursing Care Coordinator Emergency Department

As Western New York’s only Level 1 Adult Trauma Center, the future of healthcare at ECMC is clear. With a steady rise in patient volume, we know that more of our neighbors will depend on our lifesaving trauma and emergency care more than ever before. And with your support, they’ll receive it in a new facility with state-of-the-art technology, more space and privacy, and designed for better experiences and outcomes for patients and their families.

The difference between healthcare and true care

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Learn how you can give to save lives in the most critical situations at SupportECMCtrauma.org

7/12/18 1:45 PM