In Good Health: WNY #92 - June 2022 by In Good Health: WNY's Healthcare Newspaper

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JUNE 2022 • ISSUE 92

10,000 STEPS

Is 10,000 daily steps really the magic number for staying in great shape? Or have we all fallen for a marketing campaign? We discuss with local sources. P. 15

INSIDE: WELLNESS SPECIAL ISSUE

Integrative health seems to bring the best of conventional and complementary approaches together in a coordinated way.

ERECTILE DYSFUNCTION John Rutkowski, urologist with UBMD Urology, discusses erectile dysfunction. ‘It’s often a harbinger of bad things to come,’ he says of the condition. P. 4

MEET THE JAZZ DOCTOR P. 19

INTEGRATIVE MEDICINE From reflexology to lifestyle medicine to gua sha: Find 13 health modalities that may help improve your health

Week Off Social Media Boosts Mental Health: Study Participants who took a break from social media had signiﬁcant improvements in wellbeing, depression and anxiety, compared with those who continued to use social media

t’s no secret that too much social media can be bad for one’s mental health. Now, research suggests that taking even a brief break from TikTok, Facebook, Instagram and Twitter can ease symptoms of depression and anxiety. Staying off social media for a week meant, for some study participants, gaining about nine hours of free time, which improved their well-being, British researchers report. “If you’re feeling like you use too much social media and this is negatively impacting your mental health, then taking a break may be worth a try and give you at least some shortterm improvements,” said study author Jeff Lambert, an assistant professor of health psychology at the University of Bath. These findings could have implications for how people manage their mental health, offering another option for people to try, Lambert said. “However, further research is needed to examine longer-term effects and whether it is suitable in a clinical context,” he added. For the study, the researchers randomly selected 154 people aged 18 to 72 who used social media every day, instructing them to either stop using all social media for a week or continue using it as usual. People in the study spent an average of eight hours a week on social media. Those who took a break from social media had significant im-

provements in well-being, depression and anxiety, compared with those who continued to use social media, the study found. Those who took the week-long break used social media an average of 21 minutes, compared with about seven hours among those who didn’t, Lambert said. The findings were published recently in the journal Cyberpsychology, Behavior and Social Networking. Scott Krakower, a psychiatrist at Zucker Hillside Hospital in New York City, thinks that for some people, social media can result in feelings of depression and anxiety as

they compare themselves to others on these sites. “They may feel inadequate because they’re not like those people that they’re interacting with,” he said. “You know nothing about them, yet you still know a lot of information and you may feel like you’re being excluded because of some of the things that other person is doing so that evokes feelings of inadequacy and lowers self-esteem.” Krakower doesn’t think abandoning social media altogether is necessarily the best strategy for people who experience negative feelings. It’s better, he believes, to develop

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Very informative. I learn something every time I read In Good Health! Charles Vallone, Tonawanda Subscriber since March 2022

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It’s very informative and easy to understand. Perfect for us ‘old folks’ Ron Yormick, Hamburg Subscriber since March 2022

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Page 2 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2022

a plan to manage social media use, which might involve going to these sites less or taking regular short breaks. “I think if you have a suspicion that the depression [and] anxiety is coming from being online or you’re getting upset by looking at things you notice in social media, and it’s getting in the way of your functioning, then I think you need to take a little break, even if it’s a day or two days, and see how you do without it,” Krakower said. “I don’t think you have to be off completely unless you feel like you’re completely addicted to it, but I think you need to monitor it,” Krakower said. Another expert said that staying off social media is not the answer, rather it’s learning how to use these sites in healthy ways. “While abstention may indeed improve well-being, it may not be realistic, feasible or even advisable long-term,” said Melissa Hunt, associate director of clinical training in the Department of Psychology at the University of Pennsylvania. “Ultimately, our goal needs to be focused on harm reduction with these platforms, not abstention,” she said. “These platforms have become an important part of daily life for most people under the age of 30. The real challenge is to help people use the platforms mindfully and adaptively.”

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Meet

Your Doctor

By Chris Motola

John Rutkowski, MD Nurses’ Long Shifts May Have Downside: Study

urses who work long shifts are more likely to experience job dissatisfaction and burnout, and their patients’ care may suffer, according to a new study. The research included nearly 23,000 registered nurses in California, New Jersey, Pennsylvania and Florida. Sixty-five percent of the nurses worked shifts of 12 to 13 hours. The three-year study found that nurses who worked shifts of 10 hours or longer were up to 2.5 times more likely than nurses who worked shorter shifts to report job dissatisfaction and burnout. In addition, seven of 10 patient outcomes assessed in the study were significantly worse when nurses worked the longest shifts, the University of Pennsylvania School of Nursing researchers found. In hospitals with more nurses working longer shifts, a greater percentage of patients reported that nurses sometimes or never communicated well, pain was sometimes or never well controlled, and they sometimes or never received help as soon as they wanted. The study was published in the November 2021 issue of the journal Health Affairs. “Traditional eight-hour shifts for hospital nurses are becoming a thing of the past,” Amy Witkoski Stimpfel, a registered nurse and postdoctoral fellow at Penn Nursing’s Center for Health Outcomes and Policy Research, said in a school news release. “Bedside nurses increasingly work 12-hour shifts. This schedule gives nurses a threeday work week, potentially providing better work-life balance and flexibility.” However, when “long shifts are combined with overtime, shifts that rotate between day and night duty, and consecutive shifts, nurses are at risk for fatigue and burnout, which may compromise patient care,” she added. The researchers recommended that the number of consecutive hours worked by nurses should be restricted, nurse management should monitor nurses’ hours worked (including second jobs) and state boards of nursing should consider possible restrictions on nurse shift length and voluntary overtime.

Urologist with UBMD Urology discusses erectile dysfunction. ‘It’s often a harbinger of bad things to come,’ he says of the condition Q: I’ve heard from some urologists that there’s some concern that the COVID-19 pandemic is leading to a rise in erectile dysfunction. Any truth to this? A: Erectile dysfunction can be a problem for patients as they get older and unhealthy. But specifically related to the pandemic, as in “is there a relation between getting the virus and having erectile dysfunction?” That would be very challenging to prove. I don’t know of any literature on that. You’d need a real investigative trial to come up with that answer. But have I, specifically, seen patients who appeared to develop erectile dysfunction with no explanation beyond COVID? No. I haven’t seen any evidence regarding that.

erections; especially if you’re combining obesity, diabetes and smoking. That’s almost a guarantee you’re going to run into erectile issues. Age is also important. If you’re seeing it in a patient in their 40s and they’re smoking, obese and have diabetes and they start having erectile problems, that’s a sign of bad things to come. Usually their larger vessels will be affected next.

Q: I imagine it would be confounded by a lot of the lifestyle alterations brought about by the last two years. A: Yeah, it’s very difficult to prove. And erectile dysfunction is a very common reason people come to our offices, so we see a lot of it. But so far, I’ve seen no evidence of a direct connection.

Q: That was going to be my next question. To what degree is erectile dysfunction a harbinger of more serious health problems? A: Especially with the smokers— it’s amazing how many patients still don’t know that smoking contributes to erectile dysfunction. But, yes, it’s often a harbinger of bad things to come. There have been some great papers written on that. Patients already having some problems in their 40s and 50s really need to start thinking about what’s going to happen down the line with their heart. I always bring that up to patients. Smoking cessation really is critical.

Q: Generally speaking, what are the factors that tend to lead to erectile dysfunction? What’s the difference, let’s say, between an older man with no issues and one who has erectile dysfunction? A: That’s a good question. There are different types, but we generally think of it as a vascular problem. It’s a problem of small blood vessels. Anything that affects small blood vessels can potentially cause erectile dysfunction. As you might imagine, the common ones are diabetes, high blood pressure, obesity, high cholesterol and smoking. Smoking is clearly a killer of

Q: What kinds of treatments are available for erectile dysfunction? Can it be cured, or just managed? A: There are all sorts of different treatments. We don’t like to just throw medications at patients. The most important part is lifestyle modifications: controlling blood pressure, losing weight, controlling diabetes, smoking cessation. Sometimes medications can contribute to erectile dysfunction. There are some blood pressure medicines in particular that are known to cause it. Exercises that increase blood flow to the pelvis can help. So that’s number one. We also try to rule out hormonal issues, like some patients will have low testosterone. We can screen for that and address it if needed. That’s the primary focus. There are medications a lot of people are already familiar with that have been on the market for a while. They’re now generic, which is nice, because they’re a lot more affordable and they work fairly well. Then we have three other options.

Page 4 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2022

Q: What are those? A: We have the vacuum erection device, which increases blood flow to the penis. We have injection medications. And there are surgical options that work well, but are typically the last resort. Q: Have baby

boomers brought more attention to the subject? A: I think so. I’ve been practicing for about 12 years and it no longer seems taboo to talk about. Most patients are freely able to talk about it without the shame we might have seen in previous generations. Patients are also bombarded by advertisements on TV, radio and the internet, which has good and bad impacts. But we talk about it as urologists every day. It’s no longer something to fear. Q: With regard to lifestyle changes for erectile dysfunction, are there any targets to hit, at which you can expect symptoms to improve? A: I think it’s different for everybody. It’s certainly a process. The important thing is things are pointing in the right direction. During the pandemic, we’ve seen a lot of patients go in the wrong direction; staying home, overeating and unfortunately gaining a lot of weight. Losing weight and eating better tends to have a positive effect on their overall health. I usually tell patients that a hearthealthy lifestyle is a prostate- and bladder-healthy lifestyle. Stay away from a lot animal proteins and eat a more plant-based diet. Those things are important. The other thing, too, is the importance of screening. Even before the pandemic there were a lot of confusing messages about prostate cancer screening being conveyed to patients. And then during the pandemic, patients stayed away from the office. Now some are presenting with more advanced cancers than we’d like. Screening is very critical when it comes to cancers, not just urological ones. Q: Has there been an increase in STD rates as of late? A: Yeah, I think there has, particularly chlamydia; some other STDs as well. But yes, there has been. Again, we are seeing that in the office and screening the appropriate patients. You have to remind patients to have safe sex. Q: Is that across all age groups? A: Good question. I’m not exactly sure how the demographics break down. Typically it’s in the more sexually active age groups, but even in older patients. Just because you’re in your 60s or 70s, it doesn’t mean you can just forget about STDs. They’re really quite common. And those patients can certainly still be active. So if the patient presents with those symptoms, we usually screen with urine and blood testing.

Lifelines

Name: John Rutkowski, MD Hometown: Buffalo Afﬁliations: Western New York Urology Associates, UBMD Urology Education: Medical degree from the State University of New York at Buffalo; general surgery internship and urology residency also at University at Buffalo; clinical fellowship in urologic oncology at the Cleveland Clinic in Florida. Currently a clinical associate professor at University at Buffalo having received the Faculty Teaching Award in 2021 Organizations: American Urologic Association; Erie County Medical Society; Society of Urologic Oncology Family: Wife; one child Hobbies: Running, biking, skiing, hanging out at the park

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Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

On Your Own: Finding Your ‘Happily Ever After’

recently heard from an “In Good Health” reader. Divorced and on her own for several years now, she shared by email how much she appreciated my advice and encouraging words over the years. I was touched by her kindness and also curious. I wanted to learn more about her journey in search of contentment after her marriage ended. And so began an email exchange in which she shared her early struggles, as well as her efforts to make ends meet, stay connected with others and, ultimately, find joy. With her permission (and using her first name only), I’ve included portions of Kathy’s email correspondence below, in hopes her story might offer some insights and inspiration for other readers. KATHY: I opted to end my unhappy marriage and initiate a divorce about ﬁve years ago. Since then, I’ve been on my own. It wasn’t easy at the beginning. I was surprised to discover that many of my married friends no longer included me in things, maybe fearing I was some kind of threat. But, I also dropped the ball. I made my daughter the singular focus in my life, and lost contact with family and friends alike. Over time, I developed the attitude that I had nothing to offer and slid into a mild depression, during which my world became very small.

Finances were another issue. I was a stay-at-home mom and enjoyed caring for my daughter but, after my split, found it necessary to get a job to make ends meet. Kathy, like many divorced women (including myself), found herself bewildered and fearful of the future when her marriage collapsed. For many, the experience of having a marriage of many years unravel is not unlike becoming the victim of an unwelcome catastrophe. No matter what, and even though more Americans are waiting longer to walk down the aisle, most of us still hold onto the dream of “happily ever after.” That dream is powerful. Letting go of it can seem next to impossible. While getting and being divorced can feel overwhelming, most women (and men, too) press on and, lo and behold, experience a change in attitude and perspective that ultimately enriches their lives and opens up possibilities — possibilities they couldn’t have imagined when they were in pain and the throes of loss. KATHY: It’s taken me time to get it together. I went back to college and graduated with a degree in nursing. Nursing keeps me busy, but now my only child is preparing to leave for college. Life will be very different (and a lot quieter) without her here, so I am being proactive. I like to be physically active, so I joined a walking group and became

When Is the Right Time to Tell a Child They Have Autism?

ella Kofner, a 24-year-old graduate student in special education at the College of Staten Island in New York, was 10 when her parents first told her she had autism. Developmental psychologist Steven Kapp, now 35, was 13 when he was told the same. So, is there a best time to tell children they have the developmental disorder? New research suggests that younger is better. Kofner, Kapp and their col-

leagues answered that question by asking 78 university students about how and when they found out they had autism. For the most part, the investigators found that telling kids when they are younger helped them feel better about their lives as they grew up. “Talking openly with autistic people about being autistic when they are young may help them grow into adults who feel happier and more comfortable with who they are

Page 6 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2022

a member of the YMCA. I also recently joined Meetup, which was reactivated after a hiatus during COVID. It’s social, it’s fun, and I’ve met some great people on my Meetup excursions. Note: Meetup is an online social networking program that gives members a chance to find and join others who share common interests — things such as hiking, reading, food, movies, pets, photography, hobbies ...well, you get the idea. KATHY: I also make a point of getting out more with my colleagues at work. And, I’m no longer waiting for an invitation; I’m initiating the get-togethers. That feels good! Reading your columns — always so positive and full of great tips — inspired me to take better care of myself, to get up off the couch, and to make healthy decisions. I often clip them out and hang [them] on the fridge. I’ve learned that even small changes can make a big difference in my day. I now create a nice place setting for dinner, stock my cupboards with healthy food, and try to keep my kitchen counter clear of clutter. I put a sweet “Welcome Home!” wreath on my front door, replaced some threadbare towels in my bathroom, and purchased a pretty comforter for my bed. These small changes and others turned my house into a home — my home. While few women and men consciously decide to live singly, more and more are finding themselves alone and on their own in midlife. The good news? Like Kathy, they are making healthy choices and learning to enjoy their newfound freedom and independence.

choose to live alone does not mean that I am alone: I have many people around me and I am very content. I am no longer frantically seeking the next relationship or the next big thing that will cause excitement in my life. I am happy to spend time at home alone, or to go out with friends. I even date from time to time. As I’ve embraced my singlehood, I have also realized that I am responsible for the positive changes in my life. That realization is empowering. I’m active, and I’m having fun for the ﬁrst time in many years. On her own, Kathy has fashioned a life that works well for her. You can, too. Being single can give you the time you need to sustain a diverse and interesting network of friends, to date, to pursue your professional or personal aspirations, and to experience adventures yet to be imagined. Below are some final words from Kathy, in answer to my question: What advice do you have for others? KATHY: My advice? Don’t close yourself off from people. It’s so easy to stay home, dig a rut and wallow in it — but that’s a big mistake. Grab the Weekend section of the newspaper, check out Meetup, or look at an online “What’s Doing” calendar. Find something interesting and fun to do. Go ... even if you have to go alone. Who knows what you might discover?! Kathy has found her “happily ever after.”

KATHY: After my divorce, I had this dreaded thought that I would be alone for the rest of my life. I identiﬁed with Whistler’s Mother, in a dowdy dress and rocker. I now realize that just because I

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

than they might become if they don’t learn this key information about who they are until later in life,” said lead study author Kristen Gillespie-Lynch, an assistant professor of psychology at the College of Staten Island. “Learning that one is autistic at a younger age can aid better self-understanding as well as access to support, which in turn lays a foundation for well-being as an adult,” added study author Tomisin Oredipe, a graduate student at the College of Staten Island. The new study, which was published recently in the journal Autism, is based on Oredipe’s thesis paper. It’s not just age that matters though, Oredipe said. Other factors include your child’s developmental level, curiosity, support needs and personality. “Almost more important than when an autism diagnosis is disclosed is how it is disclosed,” said Kapp, a lecturer in psychology at the University of Portsmouth in Hampshire, England. Make sure to talk about your child’s strengths as well

as their challenges in a language they can understand, he said. “My mother said my brain worked differently, and I thought that was a good explanation,” recalled Kapp. It doesn’t have to be a one-and-done conversation either. “Do it in pieces over time,” Kapp added. Sharing a child’s diagnosis with them is a very personal decision, said Lindsay Naeder, vice president of services and support and community impact for Autism Speaks. “Your child may or may not seek more information and ask you questions after your initial discussion,” said Naeder. “All children, especially those with autism, need to hear certain information multiple times.” Help them understand how you, their teachers and therapists all want to help them. “Don’t forget to remind them that everyone needs help sometimes,” she said. It may comfort your child to hear that autism is common and that there are many children like them, Naeder added.

RIDES, GAMES & GOOD TIMES GALORE

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Thursday ˙ June 23

1 in 4 Hospital Physicians ‘Mistreated’ by Patients, Visitors

Female doctors are nearly two times more likely than male doctors to face this abuse

early 1 in 4 hospital doctors are mistreated at work by patients, visitors and other doctors, and female doctors are nearly two times more likely than male doctors to face this abuse, a new study reveals. “All members of the health care team share the responsibility to mitigate mistreatment,” said senior study author, physician Mickey Trockel, a clinical professor of psychiatry and behavioral sciences at the Stanford University School of Medicine and director of evidence-based innovation for the Stanford WellMD/WellPhD Center. “Those wielding leadership influence hold particular responsibility to establish policies and expectations of civility and respect from all members of the healthcare community — including patients and visitors,” Trockel added. In the study, researchers surveyed just over 1,500 doctors on the clinical faculty at Stanford University School of Medicine in September and October of 2020 and found that 23.4% reported mistreatment at work during the past year. Patients and visitors were the main culprits — reported by about 17% of physicians and accounting for more than 70% of all events — followed by other physicians. The most frequent forms of mistreatment were: verbal, reported by 21.5% of respondents: sexual harassment (5.4%); and physical intimida-

tion or abuse (5.2%). Women were two times more likely (31%) to report mistreatment than men (15%), and were more likely to encounter sexual harassment and verbal mistreatment. Mistreatment also varied by race but the number of respondents wasn’t large enough to conduct a detailed analysis by race or ethnicity, according to the authors of the study. The findings were published May 6 in the journal JAMA Network Open. The researchers noted that workplace mistreatment has been associated with increased burnout, lower job performance and depression, and that studies of U.S. physicians over the last decade have found job burnout rates of 40% to 60%. “To address the issue of physician mistreatment, organizations must first recognize its prevalence and then know where to look,” said study first author, Susannah Rowe, an ophthalmologist at Boston Medical Center and chairwoman of the Wellness and Professional Vitality Council at Boston University Medical Group. “With the strong association of mistreatment to workplace dissatisfaction and physician burnout, it is imperative that health care organizations take steps to address these issues as quickly as possible for the well-being of their staff, as well as their patients,” Rowe said in a medical center news release.

SERVING WESTERN NEW YORK A monthly newspaper published by Local News, Inc. Distribution: 33,500 copies throughout more than 1,500 high-trafﬁc locations. In Good Health is published 12 times a year by Local News, Inc. © 2022 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

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One group of expert emergency physicians. It takes a lot to provide excellence in emergency care. It takes quick and easy access to care, state-of-the-art technology, and most importantly, it takes physicians who have dedicated themselves to achieving excellence every single day. Physicians who have seen it all and know how to handle essentially anything. That excellence can be found at the Emergency Center at DeGraff Medical Park (formerly DeGraff Memorial Hospital). Our physicians are second to none and combined with our highly-trained nurses and staff, they all share one goal – to provide patients with outstanding medical care. In fact, they’re the same physicians who provide emergency care at Millard Fillmore Suburban Hospital.

Writers: Deborah J. Sergeant, Jim Miller, Gwenn Voelckers, Anne Palumbo, Brenda Alesii, Daniel Meyer, Jenna Schifferle, Ernst Lamothe Jr., Jana Eisenberg, Amanda Jowsey Advertising: Anne Westcott, Amy Gagliano Layout & Design: Joey Sweener • Office Manager: Kate Honebein 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.

Where excellence is. DeGraffEmergency.org June 2022 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • Page 7

Cost of Having Baby Puts Many U.S. Families at ‘Financial Risk’

ringing home a baby should be an exciting and blissful time, but for many new parents, colossal out-of-pocket costs for pregnancy and delivery take the joy out of this milestone. Some low-income families spend close to 20% of their annual income on medical costs during the year

of pregnancy and birth, a new study found. “Being pregnant and delivering a baby puts many families at financial risk,” said study author physician Jessica Peterson, a maternal-fetal medicine fellow at the Icahn School of Medicine at Mount Sinai in New York City. “Medical bankruptcy

is rampant in this country, so it is possible that unpaid bills from pregnancy and delivery can lead to other unpaid health care bills and bankruptcy caused by medical debt.” Unfortunately, the United States doesn’t have policies in place to help stave off these catastrophic health expenditures, Peterson said. For the study, the researchers compared health care costs that were more than 10% of a family’s income among more than 4,000 new parents to those of nearly 8,000 people who were not pregnant. To do this, they used data from the Medical Expenditure Panel Survey from 2008 to 2016. As income declines, the amount that pregnancy and delivery consume goes up, the study found. New parents with low incomes had the highest risk of catastrophic health expenditures that exceeded 10% of family income in a given year, the study showed. These families spent about 19% of household income on health care expenses, and this increased to 30% when health insurance premiums were included in spending. New parents were also more likely to be unemployed and report high rates of gaining and losing Medicaid in the delivery year.

Having a baby is very expensive in the United States, even with private insurance — or especially with private insurance, the study authors noted. Folks with low incomes who have public health insurance, including Medicaid, were less likely to be hit with high out-of-pocket costs, especially when health insurance premiums were factored in spending, the study showed. Despite its promise, the Affordable Care Act did not significantly lower the risk of high out-of-pocket payments for new parents. “Having private insurance doesn’t protect you from catastrophic health expenditures for pregnancy and delivery. It’s actually a risk factor due to premiums and deductibles,” Peterson said. If you are planning to become pregnant, start saving now, she advised. Still, many people who are trying to conceive haven’t reached their full earning potential yet, so saving is easier said than done, she acknowledged. The study was published online March 10 in Obstetrics and Gynecology.

telemarketing calls, texts, social media platforms and door-to-door visits. The scammers are trolling for your personal information and Medicare information. In the continuing saga of opioid fraud, in April the OIG convicted 14 defendants from Alabama, Florida, Kentucky, Ohio, Tennessee, New Jersey and West Virginia of illegally prescribing more than seven million pills resulting in more than $7 million in losses to Medicare. Not to be outdone, a physician in California was recently convicted of defrauding Medicare of $12 million. The physician recruited Medicare patients and then performed medically unnecessary vein ablation procedures. He then upcoded (over charged) Medicare. To cap it off, he repackaged and reused single use disposable catheters.

all specialties, are better positioned to form comprehensive all-inclusive health systems capable of accepting capitation and or value-based payments from insurers.

Healthcare in a Minute

By George W. Chapman

ACA Has Record Enrollment: 35 Million People Insured

he Affordable Care Act of 2010 has survived more than 60 attempts to repeal it. Twelve years later, a record 35 million people (one in 10 of us) will receive health insurance via discounted commercial insurance on an exchange or expanded Medicaid eligibility. The uninsured rate is 8.8% or about 29 million. Most of the uninsured are younger adults electing not to be

covered, lower income people living in states that did not accept Medicaid expansion and people who lost employer-based coverage. The increase from last year’s 31 million to a record 35 million covered this year is due partly to increased income eligibility for discounted insurance on the exchange and additional states (Oklahoma and Missouri) opting for expanded Medicaid.

Medicare Prior Authorization

According to health officials, we have transitioned from a COVID-19 pandemic to a COVID-19 epidemic, despite continuing related deaths and seemingly a new variant every week. On May 5, we surpassed a grim milestone: more than one million Americans have now died from COVID-19. There have been, reportedly, 15 million deaths worldwide, but experts are skeptical of numbers from autocracies like Russia, China, North Korea, etc. Early on, several epidemiologists and public health officials were scoffed at for their dire predictions of a million deaths if COVID-19 was not taken seriously and managed effectively. Another wave of infections is predicted for this summer, so we are urged to exercise caution.

Critics view prior authorization for medical services as an unnecessary barrier to timely care and a way for insurers to reduce claims. Prior authorization has been an administrative nightmare for busy medical practices trying to provide appropriate care for their patients. Proponents of prior authorizations, namely the insurance industry, argue that prior authorizations ensure their members will receive the right care, at the right time, in the right setting. Recently, the Office of Inspector General is investigating complaints from providers and patients that Medicare Advantage plans are requiring prior authorization for services normally covered by traditional Medicare. More than half of seniors are covered by a Medicare Advantage plans that are operated by commercial carriers like the Blues, United, Aetna, Humana, Cigna, etc. There is a push for electronic prior authorization which would standardize what services require prior authorization, reduce human error, speed up the approval and make it easier for medical practices.

Deadly Milestone

Fraud

The OIG is constantly on the alert for fraud. Most of their investigations originate from tips from consumers or honest medical professionals. Every month, millions of Medicare dollars are recovered from fraudsters. OIG has issued a warning concerning COVID-19 scams whereby individuals offer free testing sites, free at home tests, free supplies etc. through

Page 8 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2022

Hospital Mergers

Last month’s (now prescient) column addressed the justification for hospital mergers. I did not anticipate the recently announced potential merger of SUNY Upstate Medical University Hospital with Crouse Health in Syracuse. If approved by the NYS Department of Health, it will be a merger of public and private organizations. Upstate acquired the former Community General hospital in 2011. Both Crouse and Community General were under financial duress. The Upstate/Community/ Crouse hospital and health system will be the dominant provider in Central New York with approximately 1,200 beds. This matches multi-hospital systems in Buffalo (Catholic), Rochester (Strong and Rochester Regional), Utica (Mohawk Valley Network) and Albany (Albany Medical). Multi-hospital systems are more successful at attracting and retaining quality physicians and ancillary professionals and in many cases can be credited with saving smaller rural hospitals near closure. Hospital systems, covering large geographic areas with hundreds of physicians in virtually

PBMs Face Scrutiny

Pharmacy Benefit Managers purportedly negotiate drug prices on behalf of insurance plans and self-insured businesses. Their effectiveness is questionable. The Senate Commerce Committee has conducted hearings on their role in the pharmaceutical marketplace and rapidly rising drug prices. Based on complaints from insurers, consumers and providers: PBMs lack transparency; there is very little competition; and there are potential conflicts of interest or collusion. Are they working for the drug manufacturer or the client? Prior to negotiating, a drug manufacturer could mark up the price then agree to a “discount” to the PBM. The client is then presented with a list of “savings” from which the PBM generates its fee. Retail pharmacies have complained about direct and indirect remuneration (DIR) fees paid to the PBM whenever the pharmacy fills a prescription for a PBM negotiated drug. The PBM industry has aggressively fought reform. If PBMs can negotiate drug prices, why isn’t Medicare?

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.

and alcohol abuse; is gambling a legitimate concern and viewed in the same way? A. Yes, it certainly is a legitimate concern and gambling addiction is frequently linked with alcohol, nicotine and drug use. We’ve found that 73.2% of problem gamblers have an alcohol use disorder and 38.1% have a drug dependency. It’s very difficult to nail down what came first, it’s the proverbial chicken-or-the-egg theory. With some of those dependencies, the problem can be overt, but gamblers can easily hide their addiction. For example, a person can be lying in bed next to their partner, placing bets on their phone, without their partner knowing any differently.

Q A &

with Jeffrey Wierzbicki

‘With mobile gambling available in our state, it is easier than ever to simply pick up the phone and start placing bets,’ says leader of New York Council on Problem Gambling in WNY. By Brenda Alesii In the spring of 2021, the New York state legislature approved a bill allowing for mobile sports betting. An advertising blitz across the broadcast and print media soon followed, informing state residents that online betting would soon be a reality. On Jan. 9, at 9 a.m., mobile sports book sites went live, meaning placing a wager could be accomplished with just a few keystrokes on a smartphone or other device, all from the

comfort of one’s home, in a bar, at the beach, virtually anywhere a device can be used. In Good Health spoke with Jeffrey Wierzbicki, who serves as the Western team leader at New York Council on Problem Gambling. The North Tonawanda resident discussed the impact this new legislation has on our community. Q. Much has been written about drug

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Q. Is there a typical proﬁle of a problem gambler? A. Men typically start gambling earlier than women, often due to being in competitive sports or because of peer pressure, but problems develop later. Women, on the other hand, typically start gambling later in life but develop issues sooner. Women have said that they find gambling to be an outlet for boredom, grief, loneliness. Now, with mobile gambling available in our state, it is easier than ever to simply pick up the phone and start placing bets. Q. What are the most popular forms of gambling in Western New York? A. For people in this area, going to a casino is the most popular place to gamble, followed by the purchase of lottery tickets. Q. What are some of the signs of a gambling addiction? A. Gambling disorder is an actual diagnosis listed in the Diagnostic and Statistical Manual or DSM. The addiction affects the brain with a high similar to what one experiences with alcohol or drugs. The following are the criteria used by clinicians: • Needs to gamble with increasing amounts of money in order to achieve the desired excitement. • Is restless or irritable when attempting to cut down or stop gambling. • Has made repeated unsuccessful efforts to control, cut back, or stop gambling. • Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). • Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed).

• After losing money gambling, often returns another day to get even (“chasing” one’s losses). • Lies to conceal the extent of involvement with gambling. • Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. • Relies on others to provide money to relieve desperate financial situations caused by gambling. Unlike conversations parents have with children about drugs, alcohol, safe sex, the potential of developing a gambling addiction is rarely talked about. With the advent of the new law, gambling among younger people is becoming normalized. Q. While it is being normalized for younger folks, are there still many elderly people who gamble on a regular basis? A. Yes. We have helped many older adults who faced financial ruin due to their addiction. One situation stands out in my mind. An elderly couple lost their retirement account after one of the individuals gambled away thousands of dollars. They were at the end of their rope. Many times people realize they’ve lost control and know they need help. We’ve had people contact us in the middle of the night, sitting in a casino parking lot, desperate for help. There have been other instances in which people spend their last $20 on lottery tickets, sacrificing the purchase of diapers, food, other necessities. That type of behavior wreaks havoc on people. According to our national statistics, one in five problem gamblers will attempt or die by suicide. Among all addictions, I think the highest rate of suicide is committed by problem gamblers. Q. Your agency is funded by the Ofﬁce of Addiction Services and Support, a state organization. When people call, are they speaking to someone locally-based? A. We have a network of specially-trained clinicians here in Western New York. I want to emphasize that we are not the gambling police. Our goal is to connect the client to the best resources for their particular situation. With the massive accessibility of mobile betting, there’s an awful lot of work to be done. But we’ve had many success stories, helping people overcome the addiction. There is help and hope. Q. How can your agency be reached? A. Our local, confidential number is 716-833-4274. We can also be reached via email: westernpgrc@ nyproblemgambling.org.

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- Comprehensive care management - Care coordination and health promotion - Comprehensive transitional care - Individual and family support - Referral to community and social support services - Health information technology 716-883-8002 | www.csevery1.com/ | 180 Oak St., Buffalo, NY June 2022 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • Page 9

AMERICA’S DEADLIEST SHOOTINGS ARE ONES WE DON’T TALK ABOUT

Rushing sea. Whistling winds. Gulls calling. If you’re missing out on life, friendly support and help are available. Schedules and registration for free programs can be found at hearinglossrochester.org or call 585.266.7890

On any given day in America, an average of 63 of our mothers, brothers, partners, and friends are taken from us by gun suicide. But tomorrow’s deaths could be prevented. Give your loved ones a second chance at life. Store your guns safely: locked, unloaded, and away from ammo.

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Snoring: Not Necessarily Sleep Apnea

Experts: You are most prone to sleep apnea if you have a large neck size, are older, male or menopausal By Deborah Jeanne Sergeant

he ear-splitting, chainsaw-like sounds coming from the other side of your bed does not necessarily mean that your beloved has sleep apnea. “Snoring and sleep apnea are considered two syndromes at the extreme end of a spectrum,” said physician Ali A. El Solh, associate chief of staff, research and development at VA Western New York Healthcare System. “Snoring affects more men than women and can occur also in children. Snoring can be light, occasional, and not concerning, or it may be the sign of a serious underlying sleep-related breathing disorder.” El Solh also serves as a professor of medicine and epidemiology at UB. About half the population snores sometimes. The phenomenon occurs during sleep when the muscles relax and the base of the tongue vibrates. With sleep apnea, the person’s airway becomes blocked and for 10 to 20 seconds, they do not get enough air. The individual may gasp and choke as the brain wakes the body

enough to breathe. As a result, the person feels unrested in the morning. During deep sleep, apnea is worse, as the muscles relax even more. With snoring, it is usually just the non-snorer whose sleep is disrupted. Sleep apnea fragments sleep, making the person feel less rested. Quality of life is typically why patients seek treatment for sleep apnea. But sleep apnea can contribute to an increased risk for many health conditions. “Sleep apnea is more serious than snoring because it involves a drop in blood oxygen level and cessation of breathing during sleep,” El Solh said. “The consequences of sleep apnea can be detrimental to the health and wellbeing of patients. These individuals complain of excessive daytime sleepiness, loss of memory, loss of coordination and are at risk of motor vehicle accidents.” Soda Kuczkowski, sleep health educator and owner of Start with Sleep in Buffalo, listed weight gain, memory loss, and tied to a greater risk of high blood pressure, heart attack, stroke, congestive heart failure, atrial fibrillation, diabetes, and

certain cancers among the increased risks associated with untreated sleep apnea. Risk factors for developing sleep apnea include being overweight or obese, large neck size, age, male or menopausal, having hypertension or high blood pressure, a family history of apnea, diabetes, being a member of a minority, or being a veteran. “Veterans are four times more likely than other Americans to suffer from sleep apnea,” Kuczkowski said. The disruption in breathing deprives the brain and the rest of the body of sufficient oxygen. The condition has four types: obstructive, central, complex and positional. Obstructive “involves a decrease or complete stop in airflow despite an ongoing effort to breathe,” Kuczkowski said. “It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway.” Central sleep apnea involves the brain not sending signals to the muscles that control breathing. Kuczkowski said that this breathing disorder involves problems in the brain or heart, not a blockage. Complex sleep apnea is a mixture of obstructive and central apnea. Positional sleep apnea is as its name denotes: sleep apnea involving body position during sleep. Easy, home remedy interventions for snoring include a nose dilator, eucalyptus essential oils, side sleeping, using a humidifier, proper hydration, limiting alcohol and maintaining proper weight. However, sleep apnea requires professional screening and, if warranted, treatment. “We spend one-third of our lives sleeping, so it must be important,” said Alberto Monegro, pediatric and adult sleep medicine physician with UBMD Pediatrics and UBMD Internal Medicine. “If you snore and have risk factors, you should be screened.” Monegro promotes using the STOP BANG score: S-Snoring, T-Tired, O-Observed apnea, P-high blood Pressure, B-high Body mass index, A-Age greater than 50, N-Neck circumference greater than 17 inches for a man or 16 for a woman, G-Gender is male. “If you score three or more, you

Page 10 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2022

Soda Kuczkowski, sleep health educator and owner of Start with Sleep in Buffalo. may consider seeking further evaluation,” Monegro said. He is also an assistant professor in the department of medicine at Jacobs School of Medicine and Biomedical Sciences at UB. Emerging research may indicate that race could make a difference in death caused by sleep apnea. Physician Yu-Chee Lee, medical resident in the Jacobs School of Medicine and Biomedical Sciences at UB, who sees patients through the Catholic Health System, authored a study that indicates more Black men die from obstructive sleep apnea than whites and more than Black women. Published in February’s Sleep Medicine, the study looked at data from 1999-2019. The mortality rates plateaued beginning in 2008 for whites and Black women, indicating that compliance with using continuous positive airway pressure devices (CPAPs) may be one reason for the continued increase in the rate of death for Black men. “Even the socio-economic status, access to care and facility behaviors may be factors,” Lee said. Typically, insurance coverage permits patients to self-refer to a sleep specialist. Most people can have a sleep study performed at home. Some do need to stay overnight at a sleep center. Many patients also assume that treatment means sleeping with a cumbersome CPAP. But newer therapies like dental devices and Inspire, an implantable device, can make treatment easier.

SmartBites By Anne Palumbo

The skinny on healthy eating

you’ve already reached more than one-quarter of the recommended daily limit (nearly one-half if you’re watching your salt intake). While our bodies need salt for many essential body functions, too much can lead to high blood pressure, heart disease, and stroke.

Homemade Dill Pickles 1 cup fresh dill sprigs 3-4 garlic cloves, chopped 1 tablespoon red pepper flakes (optional) ¼ cup chopped onion (optional) 1-2 English cucumbers (shrinkwrapped in plastic) 1 cup water 1 cup white vinegar 1 tablespoon Kosher salt 1 tablespoon sugar

Are Pickles Good for You?

e eat a lot of pickles here in the Palumbo household, and we are not alone. Americans eat about 20 billion pickles a year. Thatzalotta pickles! But, are pickles healthy? They can be for many, but pickles and their high salt content are definitely not for everyone. So let’s take a look at the pros and cons of this crispy, crunchy, salty snack. Since pickles start as cucumbers, their nutritional profile is quite similar to this non-starchy veggie’s. One dill pickle spear is high in water, low in calories and boasts a decent amount of vitamin K: nearly 20% of our daily needs. Vitamin K helps maintain strong bones, ensures proper blood clotting and may offer protective health benefits in older age. New research, published in “The American Journal of Clinical Nutrition,” has found

that low levels of vitamin K among older adults may increase their risk of early death. While the exact reason for the link is unclear, scientists know that vitamin K helps prevent calcium buildup in arteries, which is associated with decreased blood flow throughout the body. Whether you’re watching your weight or are looking to lose some, pickles are a dieter’s dream food.

Helpful tips Read pickle labels carefully, as salt contents vary. When buying refrigerated pickles full of good bacteria, look for the words “probiotic” or “fermented” on the label (not all say it, though!).

Adding These Foods to Your Diet Could Keep Dementia Away

diet rich in the antioxidants that leafy, green vegetables and colorful fruit deliver is good for your body, and now new research shows it also protects your brain. In the study, people whose blood contained the highest amounts of three key antioxidants were less likely to develop all-cause dementia than those whose blood had lower levels of these nutrients. “The takeaway is that a healthy diet rich in antioxidants from dark leafy greens and orange-pigmented fruits with or without antioxidant supplements may reduce the risk of developing dementia,” said physician Luigi Ferrucci, scientific director for the U.S. National Institute on Aging (NIA), which funded the study. “But the only way to prove the connection between antioxidants and brain health is with a long-term, randomized clinical trial to see whether fewer people who take a carefully controlled amount of antioxidant supplements develop de-

mentia over time,” Ferrucci added. For this new research, study author May Beydoun of the NIA, in Baltimore, and colleagues studied nearly 7,300 people, aged 45 to 90, who had a physical exam, an interview and a blood test for antioxidant levels. The individuals were divided into three groups, depending on the level of antioxidants in their blood, and followed for an average of 16 years and as many as 26 years. The researchers found that those who had the highest amount of the antioxidants lutein and zeaxanthin in their blood were less likely to de-

They’re fat free, low in calories (only 4-5 calories per spear) and have scant carbs and sugar. What’s more, all the water and all the vinegar in these tangy babies may help you feel full longer. Pickles made by fermentation have probiotics, which are beneficial bacteria linked to better digestion, enhanced nutrient absorption and improved immune function. Fermented pickles, found in the refrigerated section of grocery stores, are made when bacteria break down the natural sugars found in the flesh and turn them into lactic acid. Most pickles you’ll find on grocery-store shelves, however, are unfermented vinegar pickles that don’t offer the same probiotic benefits that fermented pickles do. Pickles brim with salt, with an average spear delivering about 300 mg. Consume just two spears and velop dementia than those who had lower levels. Lutein and zeaxanthin are found in green leafy foods like kale, spinach, broccoli and peas. Every increase in standard deviation (a measure of how dispersed the data is in relation to the average) of those antioxidant levels in the study was associated with a 7% decrease in dementia. For those who had high levels of another antioxidant called beta-cryptoxanthin, every standard deviation increase was associated with a 14% reduced risk of dementia. Beta-cryptoxanthin is found in orange-pigmented fruits, including oranges, papaya, tangerines and persimmons. “Experts believe that consuming antioxidants may help protect cells of the body — including brain cells — from damage,” Ferrucci said. The impact of antioxidants on de-

Place dill, garlic, red pepper flakes, and onion in a quart-size mason jar. Fill jar to the top with cucumbers that have been sliced horizontally for chips or quartered lengthwise into 4-5” spears. Heat the water, vinegar, salt, and sugar in a small saucepan over medium heat. Stir until the sugar and salt dissolve, about 1 minute. Let cool slightly and pour over the cucumbers. Cool to room temperature, place top on jar, and refrigerate. Homemade pickles will be lightly pickled in 1 day, and will become more flavorful every day after that. Store in fridge for several weeks.

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.

mentia risk was reduced somewhat when researchers also accounted for education, income and physical activity. Those factors may help explain the relationship between antioxidant levels and dementia, the study authors said. The study also only measured blood at one time and may not reflect participants’ antioxidants levels over their lifetimes. “It is important to keep in mind that experts do not yet know how much antioxidants we need to consume each day through our diet and supplements for a healthy brain,” Ferrucci said. Determining ways to prevent the development of dementia is an important public health challenge, he added, but the results of previous studies have been mixed. The researchers said that antioxidants may help protect the brain from oxidative stress, which can cause cell damage. “Population studies that follow healthy people over many years for the development of dementia enable us to look for potential risk factors and also protective factors, such as dietary and lifestyle choices,” Ferrucci noted. The findings were published online May 4 in the journal Neurology.

June 2022 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • Page 11

“Don’t Trust Your Cocaine”

ollowing at least four Erie County resident deaths in mid-May with suspected cocaine and fentanyl involvement, the Erie County Department of Health is sharing a stark warning with local residents: Don’t trust your cocaine. The local supply of cocaine generally contains fentanyl, a potent opioid. Individuals who use cocaine that contains fentanyl are hit with the “high” of the cocaine, and the “low” of the fentanyl. The effects can stop or slow breathing, and stop the heart, leading to death. “The main message that we want to share is that we need to keep people alive,” said Commissioner of Health Gale Burstein. “As we see all too often with opioid overdose deaths, cocaine and fentanyl are a deadly combination. People should never use any drug alone and always have Narcan on hand just in case of an overdose.” “To have overdose scenes where a person, or multiple people, die when a dose of Narcan could have saved their lives — these are heartbreaking situations,” said Erie County Opiate Epidemic Task Force Director Cheryll Moore. “Families and loved ones live with that pain, but we continue to transform that pain into progress with our task force activities.” The work of the Erie County Opiate Epidemic Task Force is rooted in harm reduction. Harm reduction tools include: • Narcan (naloxone): Carry Narcan and know how and when to use it. Local trainings at www. erie.gov/opioidtrainings • Text for Narcan: Text 716225-5473 to receive Narcan by mail for free. The only question we ask is what address to use for mailing. • Never use alone: Have someone with you who can use Narcan if you overdose. Or contact the Never Use Alone service —neverusealone.com or (800) 484-3731. • Test before use: Use fentanyl test strips on any drug (cocaine, marijuana) before use • Connect with care: Support and resources are available, from immediate access to buprenorphine through NY Matters at local emergency rooms, to the Buffalo & Erie County Addiction Hotline at (716) 831-7007. Submitted by Erie County Department of Health.

TOP INTEGRATIVE HEALTH MODALITIES IN WESTERN NEW YORK Some tips to help you live better By Deborah Jeanne Sergeant

ntegrative health “brings conventional and complementary approaches together in a coordinated way,” according to the National Institutes of Health. This can include multiple interventions in addition to conventional medicine. Integrative health is on the rise. According to www.goodtherapy. com, almost 69% of Americans use some form of complementary medicine in any given year. The most popular modalities are (in order): massage therapy, chiropractic care, nutrition counseling, health and life coaching, acupuncture, reflexology, detoxification, B12 shots, acupressure and alternative healing, as listed on www.mindbodybusiness.com. The growth in popularity is particularly notable considering many people pay for these services in full. Although chiropractic care is sometimes covered by health insurance, typically complementary modalities are out-of-pocket expenses. The Buffalo region offers numerous integrative health modalities from a large variety of providers. Here are five of them:

el Wachowiak, licensed acupuncturist, diplomate of oriental medicine, Chinese medicine practitioner and owner of Northeast Integrative Medicine in Buffalo. “Once we have that, we look at all the branch symptoms. We use a combination of herbs that will support each other in the formula and support the person’s health.”

way the body is treating a cut.”

• Why it works: It addresses the reason for the health issue, not only the symptoms.

• How it works: “I advise people on healthful diet,” said physician Sanford Levy, who practices integrative, holistic medicine in Buffalo as a board-certified physician in both Internal Medicine and Holistic Medicine. “The general principles are that a Mediterranean diet with a wide variety of fruits and vegetables—eat the darkest colors—a wide variety of whole grains, nuts and seeds, fish, extra virgin olive oil and limited red meat and refined foods.”

• Caveats: “You have to be compliant and I think people can be challenged in doing so, especially when things are out-of-pocket and not covered by insurance,” Wachowiak said.

• How it works: “We try to find the root cause and look at the person’s overall health constitution,” said Ari-

3. Nutrition Counseling

• Why it works: “This provides optimal nutrition.” • Caveats: “It can be hard for people to stick with it.”

4. Preventive Care 2. Acupuncture • How it works: “I slide a thin needle about the size of a strand of hair through the cells,” Wachowiak said. “I see a lot of patients for pain issues. My niche is chronic illness, so sometimes when people can’t figure out the Western medicine answer, they come here.”

1. Chinese Botanical Medicine

• Caveats: “People get a little squirrely thinking about needles but these are not like vaccination needles. They are so thin that they are not painful to use.”

• Why it works: “There are a lot of different theories as to why it helps,” Wachowiak said. “The one that resonates most with me is it works like a microtrauma. Where the needle is inserted, all the healing mechanisms, white blood cells, will rush to the area to make it become red and that’s the

Page 12 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2022

• How it works: “When someone comes in saying, ‘What do you recommend for healthy aging?’ I say, ‘The foundation of healthy aging and preventive care is lifestyle and nutrition, exercise (a combination of weight training and aerobic exercise) and stress management,” Levy said. “I talk about optimal health, immunizations and screening.” • Why it works: “It is tailored to the person, based upon individual health needs, family history and the patient’s health.” • Caveats: “It’s easier said than done, but it’s important.”

5 COMPLEMENTARY HEALTH MODALITIES YOU’VE PROBABLY NEVER HEARD ABOUT

heat deficiency, which can manifest in many different ways, like infertility and chronic pain.” Caveats: “If someone has a loss of their ability to feel temperature, you wouldn’t want to use it because you wouldn’t want to burn someone.”

4. Biofield Tuning What it is: The practitioner uses tuning forks of specific frequencies near a client lying on a table, fully clothed. How it’s used: “As you go through life and have difficult or traumatic events—everything from you’re 5 and moving and won’t see your best friend again to really major accidents and injuries—some of the energy in the event is held in the energy field around the body and it ties up your life force,” said Carol McCoon, licensed massage therapist at Wheeler Healthy U in East Rochester. “If you’re 40, 50, 60 years old, all these events are tying up your lifeforce.” Why it’s used: People who seek it often feel they have little energy or motivation or are recovering from a major health issue. “After multiple sessions, more and more of their lifeforce is returned to their body and is available for the body’s natural healing ability,” McCoon said. Caveats: It is contraindicated for people who are pregnant, in the middle of cancer treatments or who are severely obese.

5. Eminus Mirus (EM) Energy Medicine What it is: “It’s like a request, asking the universal chi—the energy available to all of us—to examine and find and address what might be causing problems,” McCoon said.

By Deborah Jeanne Sergeant

ou may be familiar with many of the more commonplace complementary health modalities. However, some are less well-known than others. These are all available in Western New York.

1. Cupping What it is: A heated glass cup is applied to the skin. The heat allows the cup to form a vacuum on the skin. How it’s used: “I use it most for people who are healthy but have an acute injury, like athletes,” said Ariel Wachowiak, licensed acupuncturist, diplomate of oriental medicine, Chinese medicine practitioner and owner of Northeast Integrative Medicine in Buffalo. Some athletes use cupping to shorten recovery time between workouts. Why it’s used: “The suction creates a healing response, like acupuncture,” she added. It is thought that the suction stimulates blood flow to help heal the minor trauma caused by the cup. This hastens the recovery of the injury in question. Caveats: “Downsides of cupping is people are depleted and that’s where

their health issues are stemming from. Cupping can be a little too powerful and draining for a lot of constitutions.” Cupping also leaves circular bruise marks on the skin.

supporting their overall health and constitution. We don’t want to drain them away; that will negative impact on them.”

2. Gua Sha

What it is: “It is the burning of mugwort,” said Stephen Sedita, licensed acupuncturist with NeuroloQi Acupuncture in Rochester. “In Chinese medicine, there are different ‘flavors’ of medicine. The moxa or mugwort puts ‘hot’ energy back in the body. Moxa is one of the few ways to add energy.”

What it is: “It’s taking a tool, a gua sha, a Chinese soup spoon and scraping it against an oiled area of skin,” Wachowiak said. It is thought that the tool scrapes away dead skin cells and stimulates blood flow to promote recovery from injuries to deeper tissue. How it’s used: “It is good for someone in good health, like an athlete, who has pain. The direction varies on the person. We think about energy flow. If we’re going to work on someone’s shoulder and neck area, we might go towards the head to bring energy up or towards the feet, if we’re bringing energy down. It could be both types of energy, emotional or physical.” Why it’s used: “Similar to cupping and Chinese medical massage, it is going to create a healing response by bringing blood flow to the area.” Caveats: “The person has to have robust health or this will overwhelm their system. It’s a delicate balance between addressing a problem and

3. Moxibustion

How it’s used: “Let’s say a child has a recurring strep throat,” she said. “With the EM request, the strep bacteria are eliminated from the body.” Why it’s used: “It can be used to address almost anything,” McCoon said. “It supports a person’s health for many different diseases.” Caveats: “Similar to tuning, there are people who should not have it, like those who are pregnant or undergoing chemotherapy or radiation. It’s used in conjunction with and not instead of Western medicine.”

How it’s used: “It’s only mugwort and only the heat is released,” Sedita said. “It’s not aromatherapy. We have smokeless moxa. It’s charcoal version of it. It comes in a stick like a cigar and you hold it over the point you’re working on. It doesn’t touch the skin. Why it’s used: It is used to address “pain, digestive issues and in some cases, to calm emotions. From the Chinese medicine side of things, it is used for

June 2022 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • Page 13

WELLNESS

5 Things You Should Do for Healthy Joints By Deborah Jeanne Sergeant

f your joints hurt, it can be challenging to meet your fitness goals: cardiovascular health, flexibility, balance and strength. To minimize and even prevent pain, try these strategies:

1.Eat right

“We use MyPlate and the UDA dietary guidelines to discuss an overall healthy eating pattern for the general public,” said Justine Anna Hays, dietitian with SNAP-Ed New York, based in Buffalo. “If an individual has specific dietary conditions or concerns, they should speak with their physician and dietitian.” Following MyPlate or any other

well-balanced eating plan will not reverse the effects of arthritis overnight; it certainly supports the effect of reducing inflammation and improving the chances of losing weight. “Eating an anti-inflammatory diet and maintaining healthy weight are the best ways to manage joint health,” said Mary Jo Parker, registered dietitian and nutrition therapist in practice at Nutrition Services in Williamsville. She encourages patients to eat a diet rich in vibrantly colored vegetables, including salad greens, as these are rich in antioxidants. Vitamin C builds collagen and phytochemicals inherent to produce protect joints. Parker suggested foods like cherries, peppers, greens, toma-

Men: Beware of Osteoporosis Overall, men’s long-term osteoporosis outcomes are worse By Deborah Jeanne Sergeant

steoporosis is an often-overlooked health concern for men. About 25% of men older than 50 will experience a bone break associated with osteoporosis. About 20% of osteoporosis cases are men, but their hip fractures account for almost 30% of hip fractures. Overall, men’s long-term osteoporosis outcomes are worse. One of the reasons that men— and their care providers—do not think about osteoporosis is that its effects are not as apparent as with women. “Men start out with bigger bones,” said Susan Brown, Ph.D., of Center for Better Bones in East Syracuse. “You don’t see the bone loss as quickly.” Brown is a medical anthropologist, certified nutritionist and author of “Better Bones, Better Body.” She offers a library of bone health information and screening tools at www. betterbones.com. Brown said that men are not necessarily seeking bone density testing because their risk is perceived as small because of their heavier frames. This does not account for higher male risk factors, such as greater prevalence of smoking (17.5% of men vs. 13.5% of women, states the American

Lung Association), drinking alcohol in excess (men are twice as likely to binge drink, states the Centers for Disease Control and Prevention), and use of certain bone-weakening medication such as proton pump inhibitors and prednisone (although both genders take these medications at the same rates, women usually take lower doses sooner compared with men, according to the National Institutes of Health). Men typically learn about their osteoporosis as a secondary diagnosis, usually after a fracture or because of low testosterone testing and not as part of a routine work-up. While most men have a larger frame than most women—a protective factor for guys—those men with a lighter body weight and smaller frame have a higher risk for lower bone density. Genetics also matters. “Look at your family history,” Brown said. “If you have a history where a man’s father had fractures, what prescriptions did they use? What was their diet like? You could have genetic quirks like vitamin D metabolizing.” For those with higher risk factors, mitigating those risks is essential for preventing osteoporosis and debilitating bone breaks. Maintaining muscle mass can also help protect bones. As people

toes and citrus. “Eat foods that are rich in omega 3 fatty acids, fatty fish like salmon, mackerel, tuna, sardines, walnuts and flax seeds,” Parker said. Spices like turmeric or curcumin and herbs like rosemary and oregano are also beneficial. While little research has proven their benefit, some people report anecdotally that they find relief taking supplements containing glucosamine, chondroitin, hyaluronic acid and/or methylsulfonylmethane, a chemical inherent in plants and animals. Parker also said that adequate hydration is also important for joint health, as well as keeping bones strong through consuming sufficient calcium, magnesium and vitamin D-rich foods or supplements. “Avoid pro-inflammatory foods like sugars, excess alcohol, saturated and trans fats, non-whole grains,” she added. White bread, crackers and rice, pastries, cookies and white pasta are a few examples of foods to skip—or at least minimize.

Vary your cardio routine

Always engaging in high-impact activities and excessively practicing a sport or physical activity can mean joints will wear out too soon. “Limit high-impact activities and over-use,” said Peter Obourn, an osteopathic physician specializing in sports medicine at URMC Orthopedics. For example, instead of running five days a week, try water-based age, they tend to lose muscle and bone. Diminishing fitness can also include reduced sense of balance and less flexibility, which can contribute to falls. To prevent this cascade towards deconditioning, Brown stressed the importance of strength training and weight-bearing exercise. She also encourages people to manage their stress. “Surprisingly, stress damages bone,” she said. “It’s very important to recognize you’re stressed and worried and take time to have silent walks in the woods and meditate. You can nourish the nervous symptom in quiet.” Brown looks at the overall diet—and not just about consuming three daily dairy products for their calcium. Foods rich in minerals such as magnesium, found in nuts and seeds, and vitamin C, inherent to citrus fruits, tomatoes and many other fruits and vegetables, help keep bones strong, along with other nutrients. Vitamin D, the “sunshine vitamin” also makes a difference. It takes moderate weekly sun exposure and/or supplementation to get D as few foods contain D naturally. To ensure the body absorbs nutrients, Brown promotes an alkaline diet, which emphasizes eating eight to 10 cups (precooked) of vegetables daily and eschewing processed, empty-calorie foods. “One-third of people in New York don’t eat one fruit or vegetable daily,” Brown said. “They have the calories in their diet but not the nutrients.” For a “meat-and-potatoes” man, making dietary changes can

Page 14 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2022

exercise, using an elliptical machine or biking. Obourn said that activities like yoga, Pilates and tai chi “offer high resistance, but not a lot of impact.” When running, wear proper footwear and try to walk on soft surfaces. “For those with active symptoms, we may refer to physical therapy to focus on a strong, stable healthy joints and reducing future injury by improving stability of a joint,” Obourn said.

3.Keep moving

It may seem sensible to stop exercising if you experience joint pain, but Obourn said that becoming sedentary will only make chronic joint pain worse. “It increases stiffness and disease and contribute to further morbidity like increasing weight,” he added. Of course, acute pain from an injury should be treated and the care provider will likely recommend rest. Providers tell most people with chronic joint pain from arthritis to continue exercising in a safe fashion.

4.Don’t smoke

“Smoking increases inflammation and makes your pain worse,” Obourn said. Cessation is worth the effort for many other health benefits too.

5.Lose weight

“Putting extra weight on joints stresses them and increases inflammation,” Obourn said. He encourages patients to lose pounds for overall health and to make life easier for their joints. be tough. Incorporating more veggie-based meals in the week can help improve the diet, such as chicken taco salad or chili heavy on beans and veggies and light on meat. Dairy products are one of the diet’s richest sources of calcium. “In our programs, we frequently discuss the role of calcium-rich foods, such as dairy foods, as a way to increase bone strength and prevent osteoporosis,” Justine Anna Hays, dietitian with SNAP-Ed New York. “Additionally, USDA dietary guidelines recommend choosing calcium fortified nondairy beverages or yogurts if dairy foods do not fit into your lifestyle. “MyPlate recommends making half of your plate fruits and vegetables at most meals and snacks. Many vegetables, such as dark green and leafy vegetables are rich in calcium.” In addition to eating right, Hays also advised engaging in two to five hours of physical activity weekly, including two days of strength training, such as lifting weights and body weight exercises and body weight bearing exercises, such as yoga, Pilates, walking or dancing. Mary Jo Parker, registered dietitian and nutrition therapist in practice at Nutrition Services in Williamsville, also promotes a healthful diet and regular exercise. She noted that it is vital to not overdo protein consumption. “Too much protein intake can strip calcium from bones,” she said. “Men are often more likely to overeat protein.”

WELLNESS

The 10,000 Steps Myth Walking does a lot more for your health than people realize By Deborah Jeanne Sergeant

o you really need to take 10,000 steps a day to stay in great shape? And where did that magic number come from, anyway? According to Harvard professor of epidemiology I-Min Lee, the notion of walking 10,000 daily steps finds its roots in a branding campaign for a Japanese pedometer. The Japanese writing for 10,000 looks like a person walking. Manufacturers of tracking products and sneaker companies have adopted the number as a catchy way to market their products. While a clever marketing campaign, many people cannot find the

time or muster the endurance to walk 10,000 steps a day. In her research published in the Journal of the American Medical Association, Lee related that women in the study averaging 4,400 daily steps experienced lower mortality rates during the study than those who logged only 2,700 steps. But the positive effect plateaued at 7,500 steps. Going for the 10,000 steps did not seem to bring additional benefit. The study included 16,000 American women. “There’s no magic in the 10,000 number,” said Mike Cook, personal trainer and owner Achieve Personal Fitness, Inc. in Snyder. “The idea is to be more active. If taking 10,000 steps helps you be more active, that’s

Planks for a Tight Core

Wherever you are, you can likely perform planks By Deborah Jeanne Sergeant

eyond gaining enviable washboard abs, the benefits of planks include greater core stability, lower likelihood of back injuries and improved balance. “Planks are a great, safe exercise to strengthen the core,” said Mike

Cook, personal trainer and owner of Achieve Personal Fitness, Inc. in Snyder. He advises clients to perform planks with the hips aligned, back straight and maintaining the natural curve of the lower back. “Don’t ‘cheat’ by raising your hips up to put the weight on your

great, but just getting up and doing more than you would is where the benefit is.” Especially for someone who is otherwise sedentary, he sees merit in setting a goal for walking. However, it’s not for everyone. For someone who wants to lose weight, the body will adapt and the weight loss will likely plateau. Or for people with arthritic knees and hips, for example, swimming or water aerobics may be activities that they can perform longer and more regularly than walking. Cook prefers to take a more generalized approach to increasing activity for fitness than rigidly adhering to a specified number of steps. Joe Fox, personal trainer, certified functional strength training coach and owner of Train Smart, Buffalo, likes to take a 30-minute walk as one of his physical activities. “Walking does a lot more for your health than people realize,” Fox said. Even clients with low back pain find that they can walk with greater comfort than they can do many other activities. “It is more important for me to get a workout than a walk,” Fox said. If he must choose, he goes for his cardio and strength training workout over walking, though he likes if he can do both. “Walking briskly matters,” Fox said. “Walk at least two to two and a half miles per hour to get the maximum medicinal benefit.” To maintain a healthy level of activity, most people need 30 minutes or more of moderate to vigorous physical activity every day. This can include designated periods of activity, such as time spent engaging in a sport or other movement, or short, frequent spurts of activity, such as arms,” Cook said. “Start with a standard plank and progress from there. Don’t try to conquer the world at the start. You’ll definitely hurt yourself.” Joe Fox, personal trainer, certified functional strength training coach and owner of Train Smart, Buffalo, tells people of any athletic ability— from beginner to elite athlete—to not hold a plank position to the point of fatigue. Going longer can cause the person to switch to a passive, locked joint position that is more passive and not engaging muscles. Instead of minutes-long planks, “you’re better off doing 10 to 15 seconds and not struggling. Choose quality over quantity. I love planks; they’re critical but don’t push fatigue,” he said. The active plank engages the muscles to hold the position. The back should be straight with any style of plank (you know, like a plank). Perform several planks per session a few times per week. Apt recommends holding the position for 10 seconds and increasing the time by five seconds every week. For beginners, knee planks may be the way to go, as the person rests forearms and bent knees on the floor and then raises the torso and buttocks off the floor. The knees and feet stay on the floor and the head remains neutral. The classic plank is a little tougher, with the legs extended and all the body weight resting on the forearms and the balls of the feet. The body

Mike Cook, personal trainer and owner Achieve Personal Fitness, Inc. in Snyder. “The idea is to be more active,” he says. lifting free weights before breakfast, and going for a 15-minute walk after lunch and dinner. While walking can help people lose some weight if they are otherwise sedentary, walking does not burn many calories. For people who need to increase their level of fitness or lose weight, additional exercise at an increased level of vigor will be necessary, along with proper nutrition. If tracking steps on a device helps provide motivation, there’s no harm in using it. Some fitness apps build in a social facet where walkers can compete with others’ logged steps. Most allow users to compare their own number of steps per day over time. But missing the 10,000 steps goal should not kindle discouragement. Any amount of physical activity is healthful and better than none. Choosing a physical activity or sport that is enjoyable helps ensure sufficient activity each day. remains stationary. There is also the straight arm plank, where the body is positioned like the classic plank, but the arms are straight, so the weight rests on the balls of the feet and the palms. The oblique plank turns the plank on its side with the weight resting on one forearm and the side of one foot (the other is on top of it). As with all planks, the body remains straight. Eventually, the free arm is raised straight in the air to increase the difficulty. Make it even harder by trying the walking plank. Begin with the straight arm plank and shift laterally with the right arm and right leg moving at the same time and the left arm and left leg moving at the same time to scuttle across the floor five steps right and five steps left to complete one set. Try performing a few sets. In a similar vein, try tapping a target ahead of you or your own shoulder or raising your feet on a low stool while performing a straight arm plank. Fox created the around the world plank. It begins in the classic plank position. The person sequentially lifts each hand and foot a little and holds each off the floor for a few seconds. “The key is to keep the hips and shoulder level, lumbar spine neutral,” Fox said. Talk with a healthcare professional before starting any new exercise program.

June 2022 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • Page 15

A Caregiver’s Challenge: Navigating Care Transitions By Amanda A. Foster, Christopher J. Daly and David M. Jacobs

person’s transition of care from hospital to home or another healthcare facility can be stressful for everyone involved. However, when there is poor communication within the healthcare system, stress levels can multiply and avoidable medical errors and preventable hospital readmissions may occur. The following is an interview with a local caregiver, Elena, during her mother’s care transition experience. It’s provided in detail for the reader to fully appreciate Elena’s experience and challenges. By the end, you may discover, unfortunately, a common disadvantage of our healthcare system and how caregivers play a key role in decreasing the chances of error during care transitions. “Overall, the healthcare system in this country has so many cracks it’s pathetic,” Elena said. She described a series of communication breakdowns in the healthcare system during her mother’s care

and transition between healthcare facilities. The first major one occurred when the initial hospital was insistent on discharging her mother despite new complaints of stroke-like symptoms. After Elena advocated, the hospital halted the discharge, ran additional tests and determined her mother had indeed suffered a stroke. “If I didn’t speak up to the discharge nurse and scream for a doctor, my mom could have suffered another stroke and died on me in the car on the way home,” Elena said. Her mother was in serious condition and needed immediate transport by ambulance to a heart-focused hospital. She was further aggravated when the healthcare system didn’t appear concerned about how long it was taking for the ambulance to arrive. Elena was told that her mother may not survive the next hour—it took more than an hour for the ambulance to finally arrive. Before departing, Elena communicated her mother’s life-sustaining treatment

decisions to the paramedics. If Elena had not spoken up then, her mother may not have received the proper treatment. Upon arriving at the heart-focused hospital, Elena discovered that her mother’s life-sustaining treatment decisions were again not provided, nor updated, in the transfer process. She sat with her mother, who was in critical condition, and explained her wishes to a healthcare professional for a third time. Once the hospital stabilized Elena’s mother, she was transferred to an observation unit awaiting a heart procedure. As the highly anticipated procedure date got closer, her mother’s healthcare team decided to delay it a few days due to fluid build-up. Elena went home since the surgery was no longer happening the next day. However, at 6 the next morning, Elena’s mother called and said they decided to do the procedure after all and were immediately taking her to surgery. It took Elena more than two

“If I didn’t speak up to the discharge nurse and scream for a doctor, my mom could have suffered another stroke and died on me in the car on the way home.” 5 Tips for Caregivers at Care Transitions: While change takes time, all caregivers should be aware of the above tips to create a smoother care transition with their loved one. • If you see something, say something.

• If you notice a new symptom or your loved one is acting unusually different, report it to the healthcare team immediately.

• Keeping asking questions to the healthcare team.

• While it may feel uncomfortable or out of character, keep asking questions to the healthcare team until you get the answers you need.

• Document everything.

• Be sure to document what you are told by each provider, including new diagnoses, medication changes, and status of health conditions, so you may advocate for your loved one when needed.

• Know before you go.

• Be sure you and your loved one understand all discharge instructions and all their needs are met before you leave the hospital.

• Be prepared.

• Have all legal paperwork regarding your loved one’s medical wishes, list of medications, and list of providers up-todate and ready to provide at any time during a care transition.

hours to receive a correct answer on her mother’s situation and finally locate her within the hospital. By this time, her mother had already gone into surgery and all she could do was wait; never having the opportunity to offer her mother comfort or hold her hand before surgery. Elena was brought to joyful tears when the doctor finally came out of surgery and explained that everything went well. During the recovery, 48 hours later, Elena was provided an information packet on rehab facilities and told to “do her research” on where she would like her mother to be transferred. The social worker representative wasn’t even aware the hospital had an acute medical rehabilitation unit just two floors above the floor where Elena’s mother was recovering. Elena had to remind them and said that was her preference for continuum of care due to its proximity and ease of access to the full scope of critical medical resources at the hospital. “You shouldn’t have to scream and act out of character to get results,” Elena said. This situation highlights the critical cracks in communication within the healthcare system when transitioning between healthcare facilities. Elena is a retired medical and scientific illustrator and graphic designer within a hospital-based creative services department and still had to face many challenges navigating her mother’s situation. It’s upsetting to think about what someone not familiar with the healthcare system may experience. We can all agree that things need to change in the healthcare system. But the question is: “How?” One method is to speak up and make your voices heard. Whether by participating in research projects, completing healthcare system surveys, contacting legislators or speaking out in the media, caregiver and patient voices need to be heard. Power and change come with unity and numbers. We all must remember that any one of us could go through similar experiences as Elena faced or her mother endured. We need to start making a difference now. Amanda A. Foster is a postdoctoral clinical research fellow in the department of pharmacy practice at University at Buffalo School of Pharmacy and Pharmaceutical Sciences; Christopher J. Daly is clinical assistant professor in the department of pharmacy practice at University at Buffalo School of Pharmacy and Pharmaceutical Sciences; and David M. Jacobs, Ph.D., is an assistant professor in the department of pharmacy practice at University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

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Affordable memory care

How Medicare Covers Alzheimer’s Disease Dear Savvy Senior, What exactly does Medicare cover when it comes to Alzheimer’s disease? My husband was recently diagnosed with early-stage Alzheimer’s, and we would like to ﬁnd out what’s covered and what isn’t. — Planning Ahead

Dear Planning, I’m very sorry to hear about your husband’s diagnosis, but you’ll be happy to know that most medical costs to treat beneficiaries with Alzheimer’s disease are covered by Medicare. Unfortunately, long-term custodial care costs that most patients eventually need are not. Here’s a breakdown of what Medicare does and doesn’t cover when it comes to Alzheimer’s disease, along with some tips that can help you plan ahead. • Medical care: For the most part, ongoing medical care to diagnose and treat Alzheimer’s disease is covered by Medicare Part B, including visits to primary care doctors and specialists, lab tests, speech and occupational therapy, home health care and outpatient counseling services. Medicare pays 80% of these costs, and you will be responsible for the remaining 20% after you’ve met your annual $233 Part B deductible. Sixty days of inpatient hospital care is also covered under Medicare Part A after you pay a $1,556 deductible. Beyond 60 days, a daily coinsurance fee is added. • Medications: Most Alzheimer’s medications are covered under Medicare’s Part D prescription drug plans, but coverage varies so check his plan’s formulary. The only exception is Aduhelm, the controversial new drug that is estimated to cost $28,200 per year. Medicare Part B will only cover this drug if your husband is enrolled in a clinical trial. • Long-term custodial care: It’s important to understand that original Medicare does not cover long-term custodial care. This includes nursing home care, the costs of assisted living facilities and adult day care. Medicare does, however, pay for some shorter-term nursing home care, but only up to 100 days following a three-day inpatient hospital stay.

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Hiring home help for bathing, toileting and dressing (this is known as custodial care) is not covered by Medicare either unless your husband is also receiving skilled-nursing care or physical or occupational therapy. To help with these costs, you may want to look into getting a longterm care insurance policy or shortterm care plan (see aaltci.org/stc) if possible, or if your income and assets are very limited, you may qualify for Medicaid. To investigate your financial options for long-term care, go to PayingForSeniorCare.com. • Hospice: In the final stages of the disease, Medicare Part A covers nearly all aspects of hospice care, including doctor services, nursing care, drugs, medical equipment and supplies, physical and occupational therapy, homemaker services, counseling and respite care. To qualify, a doctor must certify that a patient has six months or less to live. • Other Insurance and Assistance: If your husband is enrolled in original Medicare and he doesn’t have a supplemental insurance (Medigap) policy, you should consider getting him one. A Medigap plan will help pay for things that aren’t covered by Medicare like copayments, coinsurance and deductibles. To search for plans in your area, go to Medicare.gov/plan-compare and click on “Medigap policy only.” Or, if you’re enrolled in a Medicare Advantage plan (like an HMO or PPO), his plan must provide him at least the same coverage as original Medicare does. Some advantage plans may also offer additional coverage for home care services. If you can’t afford your Medicare out-of-pocket costs or need help with medication expenses, there are Medicare Savings Programs and the Extra Help program that provide financial assistance for medications. To learn more, see Medicare.gov/your-medicare-costs/get-help-paying-costs. You can also get help through your State Health Insurance Assistance Program (see ShipHelp.org or call 877-839-2675), which provides free Medicare and long-term care counseling.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.

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that allow you to work temporarily without losing your disability benefits. For more information about Q: What is substantial gainful activity disability benefits, read our pub(SGA)? lications “Disability Benefits” and A: We use the term “substan“Working While Disabled — How We tial gainful activity,” or “SGA,” to Can Help.” Both are available online describe a level of work activity and at www.ssa.gov/pubs. earnings. Work is “substantial” if it involves doing significant physical or Q: Often, I need assistance with day-tomental activities or a combination of day tasks. My daughter offered to help both. If you earn more than a certain me with my Social Security claim and amount and are doing productive wants to represent me. Is that OK? work, we generally consider that you A: You can choose to have a are engaging in SGA. For example, representative help you when you do the monthly SGA amount for 2022 is business with Social Security. We’ll $1,350. For statutorily blind individwork with your representative in the uals, that amount is $2,190. In these same way we would work with you. cases, you would not be eligible for Select a qualified person, because disability benefits if you made over this person will act for you in most those amounts. You can read more Social Security matters. First, you about substantial gainful activity and will need to fill out the Appoint a if your earnings qualify as SGA at Representative form at www.ssa.gov/ www.ssa.gov/oact/cola/sga.html. forms/ssa-1696.pdf. Keep in mind that an attorney or other individual who wants to collect a fee for proQ: Will my Social Security disability viding services in connection with a benefit increase if my condition gets claim must generally obtain our prior worse or I develop additional health authorization. problems? A: No. We do not base your Q: Are Supplemental Security Income Social Security benefit amount (SSI) benefits subject to federal income on the severity of your disability. tax? The amount you are paid is based A: No. SSI payments are not on your average lifetime earnings subject to federal taxes. If you get SSI, before your disability began. If you you will not receive an annual Form go back to work after getting disabilSSA-1099. However, your Social ity benefits, you may be able to get a Security benefits may be subject to higher benefit based on those earnincome tax. Learn more at www.ssa. ings. In addition, we have incentives gov.

Page 18 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2022

The Jazz Doctor

Michael DiGiacomo: In Tune with Medicine — and Music By Deborah Jeanne Sergeant

s your mental image of a physician a sedate professional in a white coat with a stethoscope around the neck and a quiet demeanor? Or, perhaps a musician performing smooth jazz with his saxophone at a concert? If it’s the latter, you likely know Michael DiGiacomo, a psychiatrist at UB and a part-time jazz musician who has performed at events throughout the region and contributed to jazz music recordings. DiGiacomo nearly became a full-time musician except that he did not think a career in music would support him without also teaching or moving to a big city. He was not interested in teaching music or moving to New York City to perform. “There are already a lot of good jazz musicians on the scene in the city,” he said. “When I hear them live, I realize I made the right decision.” Instead, he turned to another interest he had held for years: medicine. “I always liked the idea of having a knowledge base to help people with their medical problems,” he said. “I always liked doctors and had a lot of respect for them.” He finished his fellowship training in June 2015 and began

practicing. But DiGiacomo has not abandoned music entirely. His musical inclination began when he was a mere 5 years old, learning piano. Many musicians consider piano a “foundational” instrument. DiGiacomo switched to saxophone at age 9 in elementary band. As his technique and skill improved, he moved on to jazz ensemble. By high school, he played so often that he considered attending a musical conservatory. After graduation, and throughout college and medical school, he played professionally at coffee shops and bookings for private events. He joined two bands and played at venues throughout Buffalo. Through these experiences, he met pianist Ken Kaufman, a prolific jingle writer in Western New York. His jingles include “Tops Never Stops” for the grocery chain and jingles for law firm Cellino & Barnes, West-Her Automotive and Hamburg Overhead Door. For many of Kaufman’s recordings, DiGiacomo is the saxophonist. His experiences in recording led him to his current involvement in music: recording projects. The pandemic closed opportunities for playing live, so DiGiacomo turned to digital recording to share his music with the public. “I’m scheduled to be in a recording with Hussalonia and I’m in

a quintet with Jonathan Hughes, a friend,” DiGiacomo said. His music is available on Apple Music and Spotify. “Being in the recording studio has been a way to keep music going without having to leave my family for hours and hours for a gig,” DiGiacomo said. “It’s fun and creative.” Jesse Mank, founder of Hussalonia, has a professional recording studio in his home and DiGiacomo said he has a “modest” one as well. Since the pandemic began, DiGiacomo’s work life has become much busier, but he hopes to soon finish recording an album he wants to post on Spotify and Apple. “I think that recording music and being creative only helps me in my medical decision making,” DiGiacomo said. “It forces me to be creative in all aspects of my life. When I come to work, I’m more mindful of the decisions I’m making. I’m more careful in how I’m writing and speaking. A lot of the music I write has lyrics so editing the words. I tend to start with a melody. It’s a puzzle making component to get the right rhythms.” He encourages other physicians to seek engaging hobbies as “there has to be more to your life than seeing patients. It can be easy to fall into a trap where you’re working all the time. There’s a need for doctors to work all the time. I’m at my best when I’m not just working.”

His band name is “Willing to Cooperate,” based on a patient’s comment made while DiGiacomo was in medical school and on the collaborative effort his group makes to combine their talents to make music together.

Michael DiGiacomo is a psychiatrist at UB and a part-time jazz musician who has performed at events throughout the region and contributed to jazz music recordings.

June 2022 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • Page 19

Dr. Igor Puzanov

Senior Vice President of Clinical Investigation

LINKING RESEARCH AND CLINICAL TRIALS FOR BETTER OUTCOMES At Roswell Park Comprehensive Cancer Center, we are linking breakthrough research and clinical trials with advanced clinical care and technologies to create the best possible outcomes for people fighting cancer.

Learn more about the path from innovation to impact at Roswell Park — one of only 52 National Cancer Institute-designated comprehensive cancer centers in the country, and the only one in Upstate New York. Visit RoswellPark.org/innovation or call 1-800-ROSWELL (767-9355)

Page 20 • IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2022