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Buffalo & WNY’s Healthcare Newspaper
January 2015 • Issue 3
RESOLUTIONS
A conversation with Catholic Health cardiologist Joseph Gelormini
Why do we keep making them year after year? Experts explain how to make resolutions we can achieve
Also: What your doctor wants you to do in 2015
THE PILL
Page 10
It remains the most common method of birth control followed by IUDs
PTSD Not Just a Soldier’s Problem
Activity tracking bracelets
Should you get one?
Kidney Transplant New rules for those awaiting kidney transplants in the United States went into effect in December
Although many people picture post traumatic stress disorder as a mental problem afflicting soldiers who experienced battle, anyone can suffer from it Page 7
Good Bye Paper Scripts
US Birth Rate Hits All-Time Low
If your physicians still write paper prescriptions, they won’t much longer. As of 9 March 27, New York state mandatesPageelectronic prescriptions. Says Mohammed Chhipa, pharmacist at Warrens Pharmacy, Inc. in Rochester: “It’s excellent. You don’t have to call the doctor to figure out what it says.”
Find out why this is happening now
What Makes Romaine So Remarkable
Page 5
Page 2 page 16
See Smart Bites on page 12
SUNSCREEN IN THE WINTER? January 2015 •
People Inc.
Making a difference page 20
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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Page 1
Suicide Risk Falls Substantially After Talk Therapy
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BABIES US Birth Rate Hits All-Time Low
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he U.S. birth rate reached an alltime low in 2013, as the number of babies born in the country declined for the sixth straight year since the peak in 2007, a new report finds. The country’s birth rate dipped to 62.5 births per 1,000 women between ages 15 and 44, according to a Dec. 4 report from the Centers for Disease Control and Prevention (CDC). That is 10 percent lower than the birth rate in 2007, which was 69.3 per 1,000 women, and a record low since the government started tracking birth rates in 1909, when birth rate was 126.8.
In 2013, there were 3.93 million babies born in the U.S., down less than 1 percent from 2012, and down 9 percent from 2007, when a record-breaking 4.32 million babies were born in the U.S. But trends in the birth rate varied among age groups. Among women under age 30, childbearing is on the decline, whereas it continues to rise among women older than 30, in line with the general trend over the last three decades. In fact, 2013 birth rates for women aged 35 and over was “at the highest levels seen in approximately 50 years,” the researchers wrote in their report. In 2013, the birth rate for women
Attention Medicare Part D Members
ages 35-39 reached 49.3 births per 1,000, and for women ages 30–34, the rate reached 98 births per 1,000, both small increases from the previous year. The rate for women aged 40 to 44 was unchanged from the previous year, at 10.4 births per 1,000, whereas for women ages 45 to 49 the birth rate increased from 0.7 to 0.8 per 1,000. In contrast, among teenagers the birth rate fell 10 percent from 2012, dropping to 26.5 births per 1,000. Rates also declined by 3 percent for women aged 20 to 24, continuing the general decline of birth rates for women under age 25 over the last two decades, the researchers said.
epeat suicide attempts and deaths by suicide were roughly 25 percent lower among a group of Danish people who underwent voluntary short-term psychosocial counseling after a suicide attempt, new Johns Hopkins Bloomberg School of Public Healthled research suggests. The findings are believed to be the first to show that talk therapy-focused suicide prevention actually works, averting future suicide attempts in this very high-risk population. Although just six-to-10 talk therapy sessions were provided, researchers found long-term benefits: Five years after the counseling ended, there were 26 percent fewer suicides in the group that received treatment as compared to a group that did not. A study on the findings is published online Nov. 24 inLancet Psychiatry. “We know that people who have attempted suicide are a high-risk population and that we need to help them. However, we did not know what would be effective in terms of treatment,” says the study’s leader, Annette Erlangsen, an adjunct associate professor in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health. “Now we have evidence that psychosocial treatment — which provides support, not medication – is able to prevent suicide in a group at high risk of dying by suicide.”
You may have been affected by recent changes in your current Medicare Part D plan. If you are self-enrolled in Univera, you recently received a notice that Walgreens and Rite Aid are no longer part of its Medicare Part D pharmacy network as of January 1, 2015. If you need to switch pharmacies, or need advice, we hope you'll consider Wegmans Pharmacy as your new partner in wellness. ¥ Wegmans accepts most Medicare Part D plans ¥ Member of the Univera pharmacy network for over 40 years ¥ Recently rated the #1 Pharmacy in America
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2015
Drug Overdose-related Deaths Double from 1999 to 2012
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he number of yearly deaths from drug overdoses in the United States more than doubled between 1999 and 2012, according to a new report. In 2012, more than 41,000 people died of drug overdoses in the United States, compared with about 17,000 in 1999, according to the report released Dec. 2 by the Centers for Disease Control and Prevention. However, the report also found that the number of yearly deaths due to an overdose of opioid pain relievers, such as oxycodone and hydrocodone, actually decreased 5 percent between 2011 and 2012. Still, about 16,000 of the deaths in 2012 involved opioid pain relievers, according to the report. There are a variety of reasons drug overdoses have increased over the past few years, said Rich Hamburg, deputy director of Trust for America’s Health, a nonprofit organization that advocates for public health policies. Some of those reasons include increased availability of prescription drugs and the tendency for physicians to overprescribe, said Hamburg, who was not involved in writing the new report. The report also found that the overall national drug-overdose death rate increased from an average of 6.1 deaths per 100,000 people in 1999 to 13.1 deaths per 100,000 people in 2012. In some states, the death rate was much higher. West Virginia had the highest rate, with 32 deaths per 100,000 people, followed by Kentucky (25 deaths per 100,00 people), New Mexico (24.7 per 100,00 people), Utah (23.1 per 100,00 people) and Nevada (21 per
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WNY Pediatric Gastroenterology, PLLC 100,00 people). The rate of heroin-related deaths nearly tripled between 1999 and 2012, increasing to 1.9 deaths per 100,000 people in 2012. In 2012, almost 6,000 deaths were due to a heroin overdose, according to the report. Hamburg said there might be a perception that prescription drugs are less dangerous than other drugs. But this can put people at higher risk for accidental overdoses. There is no catchall solution to reverse the trend in drug-overdose deaths, Hamburg said. More education for both prescribers and patients is needed. Prescription monitoring is not mandatory in all states, and that makes it easier for patients to “doctor shop,” and seek prescriptions from multiple doctors, he said. Fear of liability may also play a role in why drug overdose deaths are so high. For example, people who give friends prescription drugs may be afraid to get those people medical attention when they need it, for fear of arrest, Hamburg told Live Science. Eliminating liability could help decrease death rates. The new report includes overdose deaths caused by accidental overdoses, suicidal overdoses, homicide and undetermined intent. The CDC did not include drug overdoses if the death certificate did not say which types of drugs were involved.
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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Page 3
Blood Test That Gauges Heart Attack Risk Approved by FDA The screen is meant for people without history of heart disease
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he U.S. Food and Drug Administration in December approved a new blood test that can help determine a person’s future odds for heart attack and other heart troubles. The test is designed for people with no history of heart disease, and it appears to be especially useful for women, and black women in particular. “A cardiac test that helps better predict future coronary heart disease risk in women, and especially black women, may help health care professionals identify these patients before they experience a serious [heart disease] event, like a heart attack,” Alberto Gutierrez, director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health, said in an agency news release. The test tracks the activity of a specific biological signal of vascular inflammation, called Lp-PLA2. Vascular inflammation is strongly associated with the buildup of artery-clogging plaques in blood vessels, the FDA explained. As plaque accumulates, arteries narrow and the chances of a serious cardiovascular event increase. “Patients with test results that show Lp-PLA2 activity greater than the level of 225 nanomoles per minute per milliliter are at increased risk for a [heart disease] event,” the FDA said. The FDA said its approval of the new blood test comes from data compiled in a study funded by the U.S. National Institutes of Health. Almost 4,600 people aged 45 to 92 with no prior history of heart disease took part in the study, and were followed for an average of just over five years. In subgroup analyses, the test seemed especially sensitive for black women, because they experienced a “higher jump” in the rate of heart attack and other heart disease events when their blood levels of Lp-PLA2 exceeded a certain level. “As a result, the test’s labeling contains separate performance data for black women, black men, white women and white men,” the FDA said. The test is manufactured by San Francisco-based diaDexus, Inc. According to the U.S. Centers for Disease Control and Prevention, heart disease remains the leading killer of Americans, and coronary heart disease is the most common form of the illness, killing over 385,000 people each year. “Almost two-thirds of women and half of men who die suddenly of coronary heart disease have no previous symptoms,” the FDA noted.
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Meet
Your Doctor
By Chris Motola
Joseph Gelormini Catholic Health cardiologist talks about balloons, stents, open heart surgery and ways people can prevent all of that Q: Give us an overview of your specialty. A: I’m a cardiologist. My training specializes in cardiovascular diseases. Beyond that I have training in interventional cardiology, which means that I perform angiograms — tests in which we inject dye into the blood to evaluate the functioning of the cardiovascular system. I also open up blocked arteries using balloons and stents. Q: As an interventional cardiologist, are most of your patients coming to you through the emergency department? A: No. There’s a specialized lab within the hospital where we perform these procedures and determine whether or not people should go on to have stents placed or to have open heart surgery. Q: Now that we have stents and balloons, how common is it to have to perform open heart surgery? A: Not everyone can have an angioplasty or stenting for blocked arteries. Some people have such extensive blockage that you really can’t open them all up with balloons or stenting. In those types of situations, the person would be better off with several bypasses. Also, certain combinations of blockages in critical spots lend themselves better to bypassing. Also, people who need valve repair or replace-
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2015
ment might need open heart surgery. Q: What kinds of conditions lead to needing a valve replaced? A: Valve-replacement would need to happen if it was leaking severely and causing heart function to be reduced, which can lead to shortness of breath or even congestive heart failure. Valves may also need to be replaced if they’ve narrowed. Sometimes valves can thicken or calcify as people age and cause problems. Q: I remember a few years back there was talk about serious side effects arising from stenting. Have those been addressed? A: Stenting has come a long way. Stenting is the best way to open an artery and having it stay open for a long period of time. It’s better than ballooning or drilling the artery. Most stents have a drug coating that helps prevent re-narrowing within the stents. You’re referring, perhaps, to second-generation stents, where some of them were prone to abrupt closure. That has been significantly improved with the new generation of stents. The chance of re-narrowing within a stent is fairly low. Q: Describe your typical patient. A: My patients are often people who have risk
factors that help promote blockage of their arteries. The traditional risk factors are smoking, high-blood pressure, diabetes, high cholesterol, family history of heart disease. Certainly older people are more at risk, as are men. All of those factors may put a patient more at risk for developing blockages in their arteries. Patients present with a wide variety of things: chest pain, shortness of breath, lightheadedness, fatigue. Q: It’s fairly easy to wrap your head around how cholesterol blocks your arteries, but how to does smoking affect them, exactly? A: It’s probably a number of things. We know that the inhalation of the poisonous gases is carcinogenic. They can also cause spasms and constriction of the arteries in the heart and other places. Chronic shortness of breath, low blood oxygen, certainly these things affect the heart. The abnormal chemicals certainly help the progression of these blockages. Q: How did you become interested in this specialty? A: My father was a doctor and I felt it was something that I’d like to do for people. When I was in training, I enjoyed taking care of heart patients. It led me to want to pursue training in this specialty. Q: What do you do to keep your patients healthy after you see them? A: Those patients most often will be taking medications to prevent them from having recurrence of blockages. Certainly if they have high blood pressure or diabetes, it’s important for them to get those under control. If they haven’t been up to that point, we encourage them to lead a healthy lifestyle: weight loss, quitting smoking, exercising and eating well. If need be, we’ll send them to dietitians so that they understand what’s important to their health nutritionally. For some people, it may benefit them to undergo supervised exercise programs for cardiac rehabilitation and to improve their fitness. Those sorts of things. Q: What’s something you wish your patients knew about their cardiovascular system? A: Just the general awareness that you’re only born with one heart and one circulatory system. You should try to take care of it by not allowing yourself to become overweight, continuing a sedentary lifestyle. Even walking five days a week if you can’t engage in vigorous exercise is known to be helpful. And of course, avoid smoking to avoid the initiation of cardiovascular disease.
Lifelines Name: Joseph Gelormini, M.D. Specialty: Invasive and interventional cardiology Position: Medical director, cardiovascular service line, Catholic Health Hometown: Syracuse, NY Education: SUNY Buffalo Affiliations: Mercy Hospital, Sisters of Charity Hospital St. Joseph’s Campus Organizations: Buffalo Heart Group, American College of Cardiology, American College of Physicians Family: Married 32 years; one son; one daughter Hobbies: Tennis, hiking, boating Personal Motto: “Do your best, all the time.” Personal Influences: Father. “He was a very well-rounded individual.”
Good-bye Paper Scripts
reduce incidences of contraindication. Some health conditions and other prescriptions preclude a patient from taking certain medications. While doctors and pharmacists have always worked together to eliminate these conflicts, electronic prescribing adds another layer of oversight, especially if patients forget to mention medication or if they use more than one physician and/or pharmacy, a common cause of medicinal contraindication. A small percentage of prescriptions will still require a call to the doctor’s office for clarification if they have out of the ordinary requests, such as a formulation not available but necessary for a particular patient. For example, if a pill is available only in a dyed capsule, but the patient is sensitive to dye, the prescribing physician must note the issue in the computerized form, which can be tricky to those new to electronic prescribing. Overall, Gilham likes the convenience and accuracy of electronic prescriptions, but also foresees a possible problem. “Someone might try to hack the system is the only thing,” Gilham said. “As long as we can guarantee the security, it’s a good thing. Since the electronic forms typically rely upon clicking selections instead of manually writing out a drug’s name,
Starting in March, all prescriptions will be in the electronic form By Deborah Jeanne Sergeant
I
f your physicians still write paper prescriptions, they won’t much longer. As of March 27, New York state mandates electronic prescriptions. Area pharmacists sound positive about the change, as most primarily work from electronic prescriptions already. “I kind of like it,” said Lee Gilham, pharmacist at Larwood Pharmacy in Aurora. “Electronic prescriptions are very precise. You don’t have to worry about sloppy writing or errors.” Gilham guesses that the pharmacy receives about 80 percent of its prescriptions electronically already, and he’s eager to see paper prescriptions disappear. “I graduated in ‘70, so I used to type out prescription labels back then,” Gilham said. “Electronic prescriptions should cut down on fraud with controlled substances. It will really be a good thing.” Going with only electronic prescriptions will include controlled substances, which have previously been banned from electronic prescriptions. The only way to generate a prescription is using the encrypted, password-protected system accessible only through
the medical system’s mainframe. A forged or fabricated prescription won’t work. Electronic prescriptions also make recordkeeping easier, since the prescriptions automatically enter the patient’s electronic health records. “E-scribing is safer on the doctor’s side because there’s an exact record on what was prescribed,” said Mark Cohen, internal medicine physician and pediatrician with Lifetime Health. “If it’s on paper, you have to make sure it’s in the notes. In the past, they’ve had to [photocopy] it and put it in the notes.” Paper scripts may be mislaid by doctors, patients or pharmacists, unlike electronic prescriptions. Rowland Lifetime Health uses its own private network run off servers, so no individual has patient information store on his own desktop or laptops. Electronic prescribing can help
dosage, and instructions, it might be easier to click the wrong box. Despite improved clarity on prescriptions, pharmacists like Gilham still work with providers and patients to spot potential errors and ensure that prescriptions are filled accurately. The electronic system also helps snag data entry errors, but the doctor, pharmacist and patient should work together to spot human errors and increase prescription accuracy. In case of technical problems, power outages, or a few other exceptions, paper prescriptions will be honored after the March deadline.
Healthcare in a Minute By George W. Chapman
U.S. Still No. 1 When it Comes to Healthcare Spending
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ur annual spending on healthcare increased 3.6 percent in 2013, which has been about average since 2009. We spent $2.9 trillion or $9,255 per person in 2013 to once again retain the dubious No. 1 ranking in the cost of care among developed countries. Healthcare spending is 17.4 percent of the nation’s gross domestic product. Many experts attribute the historically modest increases to lingering effects of the recession. The fear is that as the economy picks up, so will the annual increase in healthcare spending. Despite another year of modest medical inflation (3.6 percent) most likely your premium (through the exchange or through your employer) for next year will increase two to three times the medical inflation rate. Almost half of that increase is attributable to taxes on insurers for: Obamacare subsidies, number of participants or insured in their plan and health information technology. Insurers must charge the same for comparable plans offered on the exchange or through employers. Retail clinics gaining acceptance. Walgreens, RiteAid, CVS and Target all offer primary care services. The Advisory Board, a healthcare consultancy group, surveyed users of these retail clinics and found the following to be the main reasons for user satisfaction: centralized online scheduling, extend-
ed hours, price transparency, less than 30 minutes waiting time and a broad range of services. Some see these clinics as a threat to traditional private practices and others see them as the future of primary care and a way to mitigate the shortage of primary caregivers. In any event, these successful and growing companies have seized upon opportunity in the market and are becoming more popular with consumers. 2014 is active year for hospital mergers. Odds are if your favorite hospital hasn’t already merged with another hospital or hospital system, it may do so in the next couple of years. 2014 was a busy year in the industry for healthcare mergers and acquisitions. Worldwide, healthcare related deals reached $438 billion, which is about 14 percent of all mergers and acquisition business. Hospitals also continued to gobble up physician practices to shore up their market share and achieve operating efficiencies. Rural hospitals continue to be most at risk if they continue to stand alone. There are too many hospital beds in the US and mergers/ acquisitions often result in the reduction of beds. Twenty years ago there were about one million licensed beds in the US. Today, there are about 800,000 and on an average day, 35 percent are vacant/unused.
Integrating your medical device with your EHR. There are a lot of personal medical devices on the market ranging from heart, blood pressure and sugar monitors to Fitbits. iHealth is a leading developer in taking these devices a step further by integrating the information from them with your electronic medical record. iHealth is working with Apple, Duke, Stanford and Epic, which is the largest EHR vendor in the country. Critics caution that while the intent is great, already over taxed clinicians could be further overwhelmed with this additional data. Paying upfront. More and more providers are requiring their patients to pay their deductible or coinsurance upfront prior to an elective procedure. In the past, the provider would bill the insurance company after the procedure was performed. The insurance company would pay the provider the negotiated fee less whatever the patient owes in deductible or coinsurance. The provider would then, in turn, bill the patient. However, with 20 percent of us now having a high deductible plan, bad debt for providers has increased significantly. Consequently, they are requiring payment up front. Many hospitals offer payment plans directly or through outside loaners like Banker’s Healthcare Group.
January 2015 •
Future of Obamacare. Republicans now control both houses in Congress. They are proposing to repeal the 2.3 percent excise tax on medical device sales, which will cut $30 billion in revenue over the next 10 years from the Affordable Care Act. Experts predict that this cut alone, if not replaced, could increase premiums by 45 percent. The G.O.P. also wants to increase the work week definition (hours an employee works per week to receive health insurance from their employer) from 30 hours to 40 hours. The Congressional Budget Office estimates 1 million people would lose their employer based coverage if hours were increased to 40. Finally, the US Supreme Court will hear a challenge to the federal government offering tax payer subsidized insurance rates through the 34 federally run exchanges. The 16 state-run exchanges could continue to do so.
GEORGE W. CHAPMAN is a health consultant who operates GW Chapman Consulting in Upstate New York. To reach him, email gwc@gwchapmanconsulting.com.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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CALENDAR of
HEALTH EVENTS
Jan. 14
Jan. 21
Memory care support group Bereavement support held in Williamsville session scheduled for W. Seneca The McGuire Group’s Harris Hill Nursing facility in Williamsville will host two memory care support groups on Wednesday, Jan. 14. A general support group will be held at 3 p.m. and a daughter’s support group will be held at 5 p.m. The facility is located at 2699 Wehrle Drive The support groups are held on the second Wednesday of every month and coordinated by memory care professionals from The McGuire Group in conjunction with the Alzheimer’s Association of WNY. Support groups are a great way to share caregiving tips and coping mechanisms with others who are experiencing similar situations while caring for loved ones with Alzheimer’s disease or dementia. For more information, contact Sarah Pietrowski at 632-3700. Information can also be found at www.mcguiregroup.com in the support groups section.
The McGuire Group will host a free bereavement support session for anyone coping with grief, sadness or loss at 5 p.m., on Wednesday, Jan. 21, at Seneca Health Care Center, 2987 Seneca St., West Seneca. Bereavement and support groups are held on the third Wednesday of the month and hosted by experts from The McGuire Group who understand the feelings caused by sadness and loss. Those interested in attending should call 828-0500. For more information about bereavement and support groups held throughout the remainder of the year, visit www.mcguiregroup.com and go to the support groups section.
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Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo Writers: Deborah J. Sergeant, Jim Miller, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Ernst Lamothe Jr., Julie Halm, Patrick Sawers, Deborah • Advertising: Donna Kimbrell, Jasmine Maldonado, Marsha Preston • Layout & Design: Chris Crocker • Officer Manager: Alice Davis
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2015
New U.S. Kidney Transplant Rules Take Effect Changes intended to make organ allocation more equitable
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ew rules intended to create a more level playing field for those awaiting kidney transplants in the United States went into effect in December. The changes are designed to lengthen the time younger patients will have working transplants, increase kidney availability and improve the odds for patients with hard-to-match donors, according to physician Richard Formica, who chairs the kidney transplantation committee of the Organ Procurement & Transplantation Network and United Network for Organ Sharing. “Our intention was to make allocation of kidneys as class-, race-, age- and gender-free as possible,” said Formica, who is also director of transplant medicine at the Yale School of Medicine in New Haven, Conn. “So if you got kidney disease, everybody is treated exactly the same — that’s the goal.” Demand for lifesaving kidneys is far greater than the supply, said Tonya Saffer, the senior federal health policy director at the National Kidney Foundation. “No policy for allocating donor kidneys can possibly match every patient in need with a donor, but this new system is expected to decrease re-transplantation and waiting times,” she said. About 16,000 kidney transplants
are performed each year in the United States, while more than 100,000 people are on the waiting list, the kidney foundation estimates. Although waiting time for a transplant varies across the country, the average wait is 36 months, Formica said. Last year, more than 4,400 people died while waiting, he added. Under the new rules, which apply to kidneys from deceased donors, people will get credit for being on the kidney waiting list from the time they start dialysis, not from the time they get on the list, Formica said. In the current system, someone with kidney failure could be on dialysis for years before being added to the transplant waiting list, he explained. “We think it is important people get credit for all the time they spent on dialysis,” he said. Also, under the new proposals young patients will receive healthy kidneys from younger donors. This may help cut down on the need for re-transplants, Formica explained. “Over 15 percent of people on the waiting list are waiting for a repeat transplant. By taking kidneys that are going to last longer and giving them to people who are going to last longer, we can reduce the amount of return to the waiting list and make things better for folks coming on to the waiting list,” he said. The new program will also move people to the top of the waiting list if they have hard-to-match blood or antibodies that can cause organ rejection, Formica said. Kidneys from older donors will be put to greater use under the new guidelines, Formica said. These organs are often overlooked because they can’t be transported over long distances without deteriorating. Now, patients will be able to get older donor kidneys in their area, he noted.
Drivers Wanted Buffalo’s healthcare newspaper — In Good Health — is expanding its distribution area and is now looking for additional drivers. The job consists of getting the monthly paper at our storage area in Kenmore and distribute it to various locations in the area, mostly at doctor’s offices, hospitals and other high traffic locations. We provide a list of places that receive the paper regularly. The job needs be performed during the day, roughly from 9 to 5. One or two days per month only. No heavy lifting. $9 an hour plus mileage allowance (30 cents per mile). Great for active retirees and for stay-at-home mom who have some free time. Call 332-0640 and ask for Alice for more information.
Post-traumatic Stress Not Just a Soldier’s Problem By Deborah Jeanne Sergeant
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lthough many people picture post-traumatic stress disorder (PTSD) as a mental problem afflicting soldiers who experienced battle, anyone can suffer from PTSD. Experiences such as victimization, including domestic violence, assault and robbery, can cause PTSD, as can witnessing trauma, such as a loved one dying in a house fire, watching a horrific car accident or viewing a catastrophe on television. The Mayo Clinic defines PTSD as “a mental health condition that’s triggered by a terrifying event, either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.” They may also experience irritable behavior, angry outbursts, acting in a reckless or self-destructive fashion, hyper-vigilance, sweating, nausea, an exaggerated startle response and problems with concentration and with sleep. Arthur Becker-Weidman, psychologist in Williamsville, said that people may experience PTSD from an overwhelming, acute event that happened during toddlerhood, but not ongoing neglect or abuse from a caregiver, which he categorized as complex trauma. “PTSD generally refers to an external event,” Becker-Weidman said. With pre-verbal PTSD, “a caregiver would notice the Becker-Weidman symptoms. [The child] may not have explicit memory of the event. Something may trigger that.” Treating small children usually involves progressive exposure until they no longer exhibit the same level of intense response and, eventually, no negative response. Older clients often respond to cognitive behavior therapy, commonly known as “talk therapy.” “It is an evidence-based therapy,” Becker-Weidman said. “It’s important for the individual to see a professional who can determine the cause of the condition because there are different treatments for different conditions.” Some people experience horrible trauma, but don’t develop PTSD. Experts believe that it’s partially genetic and partially environmental. “The depth and breadth of your social relationships [make the difference],” Becker-Weidman said. “People who have significant emotional connections with others tend to weather traumas better.” Most people feel stressed by traumatic events, but that stress and associated symptoms subside within a few days, weeks or months. People with PTSD don’t find that kind of relief as time passes. Sheryl Schechter, licensed master
social worker practicing in Getzville, uses prolonged exposure therapy. It helps clients become accustomed to their triggers and break the trigger’s association with trauma. Through gradual, long-term exposure, the clients eventually respond to the stimuli like anyone else would. It’s important for clients’ physical health to receive effective treatment. “When you have the autonomic nervous system in high alert and the body doesn’t remember how to turn it off, then you run into a lot of physical issues, like muscle aches, the heart rate is elevated, and you can have hypertension,” Schechter said. “The body can’t sustain that.” Corrin Matthews-Rutkowski, certified clinical hypnotherapist with Extraordinary Change Hypnosis in Buffalo, said that when clients come to her after receiving a diagnosis of PTSD by a doctor, she uses three tools: stress inoculation therapy, cognitive behavior therapy and exposure therapy. “These bring the client to cope and manage anxiety and not just the mental part, but the physical part,” she said. “Once we teach them to control their stress, we can go into cognitive behavior therapy that changes the way they think which changes the way they feel. They can have a balanced, accurate response.” She uses exposure therapy last so clients can better control their reaction. Lesley A. Martin, licensed mental health counselor at Holistic Counseling Center in Amherst, uses Eye Movement DesensitizaMatthews-Rutkowski tion and Reprocessing (EMDR) as one of her tools for treating PTSD patients. The World Health Organization has identified EMDR as an effective means of treating PTSD. “It addresses in a holistic manner their thoughts, emotions and body sensations,” Martin said. The therapy combines talking, feeling and body sensations and/or eye movement. The therapist asks what image, smell or sound represents the worst part of the traumatic memory. The patient also shares any negative beliefs that their trauma has caused, such as a sexual assault victim blaming himself for the crime. “We ask what they’d like to believe about themselves, even if they’re nowhere close to believing it now,” Martin said. “We ask how true that positive statement feels.” The therapist also asks about the emotions and bodily responses they experience when exposed to triggers. The session starts with the client visualiz-
ing a trigger. The therapist stimulates more areas of the brain by exposing the client to lights that flash into each eye or a physical sensation in each hand. With ongoing sessions, “anxiety goes down,” Martin said. “They’re no longer responding like the trauma is in the moment. They realize there was nothing they could do. Their [trauma] rating gets to zero and they believe the positive message.” While it may seem like physical stimulation has little connection with emotional memories, Martin explained that “negative or traumatic memories are stored in a different area than positive or adaptive ones. With PTSD, those memories get stuck in the emotional area of the brain. This therapy stimulates both areas, so the memory doesn’t stay stuck.” Recovery depends upon many factors. Some recovery fully; others achieve better functionality, but still experience triggers. The coping skills the latter group develops helps them lead happier lives. It’s not just about the event but about ourselves. ‘If I’d spent more time with mom, she wouldn’t have died.’ or ‘If I’d given her the medication an hour
January 2015 •
sooner, she would’ve lived a few more weeks.’” “The story behind the trauma is more important than the trauma,” she added. “We use a specific type of therapy to learn coping, reduce the amount of association to keep people in the present rather than going too far in the future or in the past. We help the brain heal itself.” Eye motion desensitization and reprocessing represents a major treatments for PTSD. By mentally revisiting the trauma while stimulating the body physically, the mind can process the memory in a healthful way. It becomes just part of the person’s history, not a controlling force. “Some people have full recovery,” Martin said. “Others have a very high level functionality where there a lot of the dysfunctional behaviors are gone but they still have nightmares and flashbacks and triggers. But they have made great progress in reducing symptoms.” She added that many therapies are available for treating people with PTSD.
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Page 7
Live Alone & Thrive
By Gwenn Voelckers
Practical tips, advice and hope for those who live alone
A Dozen Dont’s for 2015 Fruit Flies with Better Sex Lives Live Longer Can sexual frustration be bad for your health? Male fruit flies that expected sex — and didn’t get it — experienced serious health consequences and aged faster
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ex may in fact be one of the secrets to good health, youth and a longer life — at least for fruit flies — suggests a new University of Michigan study that appears in the journal Science. Male fruit flies that perceived sexual pheromones of their female counterparts — without the opportunity to mate — experienced rapid decreases in fat stores, resistance to starvation and more stress. The sexually frustrated flies lived shorter lives. Mating, on the other hand, partially reversed the negative effects on health and aging. “Our findings give us a better understanding about how sensory perception and physiological state are integrated in the brain to affect longterm health and lifespan,” says senior author Scott D. Pletcher, Ph.D, professor in the department of molecular and integrative physiology at the U-M Medical School and research professor at the U-M Geriatrics Center. “The cutting-edge genetics and neurobiology used in this research suggests to us that for fruit flies at least, it may not be a myth that sexual frustration is a health issue. Expecting sex without any sexual reward was detrimental to their health and cut their lives short.” U-M scientists used sensory manipulations to give the common male fruit fly, Drosophila melanogaster, the perception that they were in a sexually rich environment by exposing them to genetically engineered males that produced female pheromones. They were also able to manipulate the specific neurons responsible for pheromone perception as well as parts of the brain linked to sexual reward (secreting a group of compounds associated with anxiety and sex drive). “These data may provide the first direct evidence that aging and physiology are influenced by how the brain processes expectations and rewards,” Pletcher says. “In this case, sexual rewards specifically promoted healthy aging.” Fruit flies have been a powerful tool for studying aging because they live on average 60 days yet many of the discoveries in flies have proven effective in longer-lived animals, such as mice. Page 8
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’ve shared lots of “do’s” in the past to help people live alone with more success. Here are a few “don’ts” — some lighthearted — that may also help you on your journey toward contentment in the New Year: Don’t isolate. Get up, get dressed, lose the PJs or sweat pants, and get out of the house (or get on the phone). We humans are social animals; we’re meant to be with others. Solitary confinement is for criminals, not for people who live alone. Stay connected! Don’t go on a shopping spree to fill an emotional void. Your savings account will thank you. Don’t make Cocoa Puffs your main course for dinner. Well . . . maybe on occasion. But as a general rule? No. Create a nice place setting, fill your plate with something healthy, light a candle, pour yourself a glass of wine or cranberry juice, and enjoy some well-deserved time to yourself. A favorite magazine or book can make for a nice dining companion. Bon appetite! Don’t label yourself a loser just because you are spending Saturday night alone. It’s not the end of the world. It doesn’t define you. Stream a Netflix movie or clear some clutter and call it a night. If the prospect of a Friday or Saturday night alone is too difficult, reach out to a friend today and make plans for next weekend. Don’t put too much stock in that Dreamcatcher. If you find yourself wide awake in the middle of night fighting demons, you might try meditation, journaling or aromatherapy. I fill my diffuser with lavender oil and do some deep breathing while I repeat the phrase, “Sleep is
healing.” If that doesn’t do the trick, I get up and prepare myself some warm milk or herbal tea. I return to bed with fingers crossed and eyes closed. If all else fails, consider sleep aids. Don’t avoid dancing lessons because you don’t have a partner. Good teachers know how to incorporate singles into their classes by making introductions or by partnering with single members to demonstrate steps. Lucky you! Don’t jump into someone’s arms out of loneliness. Feelings of desperation can make you easy prey for a “suitor” with dubious intentions. It’s a risky place to be. Getting good at living alone will build your self-esteem and improve your chances of meeting someone who appreciates your strengths, not your weaknesses. Don’t get behind the wheel after a night of drowning your sorrows with friends. No explanation needed. Drink and drive responsibly. Don’t be afraid to travel alone. Some of my best trips have been taken with my favorite traveling companion: myself. I create my own itinerary, go at my own pace, and meet all kinds of interesting people along the way. Even a small jaunt can boost your confidence. On your own, you’ll discover your own resourcefulness, ability to solve problems, and capacity to spend some time alone. It can be an enlightening adventure in self-discov-
KIDS Corner Higher Birth Weight Indicates Better Performance in School
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t’s no secret that low-birth-weight babies face significantly greater risks for certain health problems early on, such as respiratory distress or infection. Now, a new study from researchers at the University of Florida and Northwestern University shows that lower weights at birth also have an adverse effect on children’s performance in school, which is likely due to the early health struggles small babies often face. Using a unique set of data that matched birth and school records from 1.6 million children born in Florida
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2015
between 1992 and 2002, the researchers found that the higher the weight at birth, the better children performed on reading and math tests in school. The findings held true throughout elementary school and into middle school regardless of the quality of the schools children attended. These findings held true when socioeconomic and demographic factors were equal among children’s families, said Jeffrey Roth, Ph.D., a research professor of pediatrics in the UF College of Medicine and a co-author of the study.
ery. I highly recommend it. Don’t decline an invitation because it means walking in (and walking out) alone. You can do it. Make a beeline for the host to say “hello” and ask for an introduction to someone, if you are surrounded by strangers. Or, get in line at the refreshment station. You’ll be engaged in conversation before you know it. Be yourself, be sincere, and be curious about others. Go and have fun! Don’t act your age. You are free, unencumbered, and on your own. What better time to spread your wings, be silly, and otherwise express your glorious, outrageous self. Put yourself with people who make you laugh. For me, that’s my sister. So keep your sense of humor. After all, life can be funny. Don’t take these “don’ts” too seriously. You are in the best position to decide what to do or not to do — no shoulds, musts, or other people’s agendas. That’s one of the best benefits of living alone. Don’t I know it! Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon, New York. For information about her workshops or to invite Gwenn to speak, call 585-624-7887, e-mail gvoelckers@rochester.rr.com
But when socioeconomic factors and demographics are not equal, higher birth weights don’t always translate to better performance in school. For example, lower-birth-weight babies of highly educated parents tend to perform better in school than heavier babies of high school dropouts because the educational level of a child’s mother is a stronger predictor of school success, Roth said. But when researchers compare children with similar family backgrounds, birth weight plays a key role in predicting future school success. “We tend to think that good schools are places where struggling kids get special attention and motivated teachers can correct any problems with learning,” he said. “This research indicates that is not always the case. Good schools are good for everyone, but even the best schools don’t seem to differentially help kids with early health disadvantage.”
Meet Your Provider
WNY Pediatric Gastroenterology
Batavia practice specializes in pediatric, adolescent gastroenterology and nutrition, including infusion
Tell us about WNY Pediatric Gastroenterology? WNY Pediatric Gastroenterology is a medical practice that specializes in pediatric and adolescent gastroenterology and nutrition. We both are board-certified pediatric gastroenterologists with extensive clinical and academic expertise. Our main office is located in Batavia and we also have a satellite clinic in Olean.
hours of a referral. We offer a warm, personalized office setting tailored to pediatric patients. Each room has a theme to appeal to children as well as a play room to ease patient’s anxiety. We offer our patients same-day blood draws and provide necessary supplies for home collection. We also have infusion suite with all amenities for the comfort of our patients and their families.
Are you both local to the Western New York? Yes, we are local to the area and well regarded in the community. We both previously worked at WCHOB [Women & Children’s Hospital of Buffalo] prior to opening this practice in Batavia in May 2014. We are very happy in WNY and are both raising our families in the Williamsville area. We enjoy the community and are happy to provide clinical care in our centralized location.
Infusion suite? What do you infuse and why? Intravenous infusions is one of the therapeutic options for our patients with inflammatory bowel disease (Crohn’s disease, ulcerative colitis or indeterminate colitis). Inflammatory bowel disease (IBD) in pediatric and adolescent patients can be a very debilitating disease with occasional complications requiring surgery. Intravenous infusions with Infliximab (Remicade) has been used in some of pediatric and adolescent patients with IBD to keep disease in remission. Our infusion suite is designed to provide a comfortable environment for patients and their families with all
What other services does your office provide? Our office can accommodate most appointments within 48 to 72
of the necessary amenities and experienced staff. Our office works with families to accommodate their busy working and school schedules. What conditions do pediatric gastroenterologists treat? Pediatric Humaira Hashmi and Daniel Gelfond are board-certified gastroenterologist pediatric gastroenterologists with extensive clinical and treat a wide range academic expertise. They live in Williamsville. of gastrointestinal disease involving What are the most common conditions esophagus, treated in your practice? stomach, intestines, liver and There are many conditions pancreas. We also treat nutritional managed by our practice. Formula problems ranging from formula intolerance or allergies is common intolerance, food allergies, poor among infants. Reflux or constipation growth and obesity. We work in has been more common among older collaboration with pediatricians and children and adolescents. Other primary care providers to evaluate diseases, such as celiac, IBD, irritable and manage symptoms of abdominal bowel syndrome and allergic disease pain, nausea, vomiting, diarrhea and have been more common in pediatric nutritional and allergic conditions in population over the last several years. our patients
WNY Pediatric Gastroenterology • 166 Washington Ave., Batavia • 585-250-4132 • www.wnypedgi.com
Tracking Bracelets
They have become widely popular, but do they work? Local experts weigh in By Deborah Jeanne Sergeant
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ctivity tracking bracelets, such those made by Fitbit, Microsoft and Misfit, can help you get and stay fit. Ranging from nondescript, rubbery bracelets to gold-tone and silver-tone fashion jewelry (Fitbit’s higher-end bracelets were inspired by designer Tory Burch), the bracelets include a bevy of features. The bracelets record the body’s statistics and wirelessly transmits
them to the user’s handheld device or other computer. Users can set personal goals and receive real-time feedback on the bracelets. Depending upon the brand and model, they track resting time and movement, monitor heart rate, display calories burned and compare the user’s performance from day to day. The devices also allow users to seamlessly track caloric and fluid intake and weight, too. Providing all this real-time information has made wearing activity tracking bracelets popular — but do they work in keeping people fitter? Area fitness experts weighed in. Bob Alessi, certified personal trainer and owner of Bob Alessi Personal Training in Buffalo, said that many of his clients use them, but the bracelets may not help everyone. “It’s a certain type of mentality that will get a lot out of it,” Alessi said. “They’re really working out and it can be a good tool to stay on track and stay encouraged. For those who have a competitive edge and want to beat their own best personal records, it works well.” For other clients, an appointment with their trainer offers more motivation
to get moving and stay moving than a device. It’s easy to simply turn the bracelet off and forget about it, unlike trainers and human workout companions. The bracelets also rely upon the user’s ability to use the equipment honestly and to use proper form. Jared Byer, certified personal trainer, health coach, and owner of Made 2 Move Fitness in Buffalo, also said that the public’s desire for accountability has helped the devices become so popular. “Having a device track your activity and give you feedback is highly effective at developing a healthier lifestyle,” Byer said. “These devices allow you to set personal goals and track your progress like a health coach on the device, smartphone/tablet and Internet. Most people do not realize how inactive they are without a true measure using an activity tracker.” He recommends the bracelets to anyone who wants to increase their amount of movement each day, since they vibrate if the user remains still too long. (It may be turned off for sleeping times). Understanding the science behind the device can help you find a truly helpful piece of tracking jewelry. Some represent little more than high-tech — and expensive — pedom-
January 2015 •
eters. Low-end models start at just under $100. If you want the most features, compare brands and models on the higher end, around $300. The devices also may not sense stair stepping vs. strolling downhill, which differ greatly in calories expended. For this reason, it’s important to realize that the calories spent figure isn’t entirely accurate. Ask plenty of questions before investing. Most websites selling the jewelry offer consumer ratings. You should also ask a personal trainer or other fitness professional who is familiar with both you and the devices, as to his recommendation for the activity tracking jewelry that’s right for you.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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Page 9
NEW YEAR’S RESOLUTIONS
What Your Doctor Wants You to Do in 2015
Losing weight and quitting smoking are on top of doctors’ wish lists for their patients By Deborah Jeanne Sergeant
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o many people, New Year’s Day represents a clean slate and an opportunity to do better this year. Maybe you’d like this year to be the year you get a raise, get organized or spend more time with your family. Area doctors have a few ideas of New Year’s resolutions they would like their patients to make. Diana G. Wilkins, a family medicine physician with UBMD Family Medicine, wants patients to “cherish, prioritize, and maintain their health,” she said. “This will, of course, have a different meaning for each patient as some may be dealing with a new health issue or recovering from one. Others may need to make better choices, [such as to] eat less, eat healthier, or quit smoking. “Some are already making good choices, have their health and need praise for working hard at this. And, finally, some need a reminder to cherish all that they take for granted by being healthy.” Vijay S. Iyer, PhD, and a cardiologist with UBMD Internal Medicine, wants
patients to “quit smoking; get 20 to 30 minutes of daily exercise and take ownership of their health and be better informed.” Smoking negatively affects nearly every function and organ of the body. It can contribute to the development of cancers, and lung and heart diseases. Smoking also makes it harder to ward off illness. It may seem like if you’ve smoked for decades it won’t may any difference if you quit now; however, the American Cancer Society states that 20 minutes after quitting, the heart rate and blood pressure drop. Just 12 hours after quitting, the carbon monoxide level in the blood drops to normal. In only two weeks to three months after quitting, circulation improves and lung function increases. A year after quitting, the excess risk of coronary heart disease is half that of someone who continues to smoke. If you keep up the resolution, five years from now, your risk of cancer of the mouth, throat, esophagus,
and bladder decrease by half. Risk of cervical cancer risk falls to that of a non-smoker. After 10 years of quitting, your risk of dying from lung cancer is about half that if you kept smoking. “These are just a few of the benefits of quitting smoking for good,” the organization’s site states. “Quitting smoking lowers the risk of diabetes, lets blood vessels work better, and helps the heart and lungs. Quitting while you are younger will reduce your health risks more, but quitting at any age can give back years of life that would be lost by continuing to smoke.” “Make sure you do that which you feel is healthful for yourselves and to serve as role model for your families,” said David Kurss, a physician with Vision Health in Buffalo. “Maintain a
proper attitude toward life. Be positive. Try to embrace and serve others, like, people in the extended family and neighbors.” As for a few practical steps, Kurss added, “Eat more fresh, raw fruits and vegetables. Drink more water. Water is very important. Eat less carbs and more lean sources of protein. Engage in more weight bearing exercise, cardio exercises and stretching. Those are the most important things people need to do.” He also wants to keep better tabs on clients’ health. “Make sure you see your doctor regularly to ensure yourself that there’s nothing present that is asymptomatic going on with your health,” Kurss said. “Sometimes we can be sick and not even know it.”
Resolutions: Why are they so hard to keep? By Deborah Jeanne Sergeant
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bout a year ago, you felt sure 2014 would be the year you’d get in shape, keep regular doctor check-ups and kick bad habits to the curb. Yet it’s a new year and nothing has changed. Why must you keep making the same resolutions year after year? “We are conflicted,” said Susan Varney, PhD, who sees clients in Buffalo. “The behaviors we want to initiate or cease reflect a conflict we house within ourselves, part of which remains unconscious.” A chronic compulsive shopper may resolve to cut back her spending habit and succeed for a while. If she suffered emotional neglect as a child and found comfort in occasional gifts, shopping may represent a bulwark of her emotional health. “Wanting to stop shopping is thus not enough to outweigh the tidal Marschner wave of emotions that would await her if she stopped,” Varney said. Ceasing an unwanted behavior and/or establishing a new behavior is difficult enough of itself. “Change is hard,” said Wendy Page 10
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Baum, registered, licensed clinical social worker practicing in Buffalo. “To assign the task of making resolutions or having found resolve in one day, quite frankly, seems ridiculous.” Of course, short-term behavior modification works, but it’s unrealistic to expect long-term changes to happen simply because the calendar flipped over to a new year. Baum views change as a more gradual process. “I believe that all of us are on a path, or on our own psychological and spiritual journey, until the day we die. Decisions that we make or fail to make all day long affect who we are.” A resolution begins when you decide that’s what you really want, she said. Only then can you take practical steps toward change. It’s also important to forget past failures and resolve to do better each morning, or, even each hour. “The problem of making New Year’s resolutions is that once broken, we set aside the dialog within ourselves until the next New Year,” Baum said. “When we practice every day mindfulness, we are free to change anytime.” Many people find that marking gradual steps with built-in accountability enables them to make life-long changes. Frederick Marschner, registered, licensed clinical social worker practicing in Buffalo, said that the “Stages of Change” theory includes pre-contem-
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2015
plation, preparation, maintenance and transcendence. He explained that pre-contemplation involves considering whether or not the individuals should even try to change. “It’s a stage of not knowing or denial,” Marschner said. “They may not see that they have a problem. During contemplation, they weigh pros and cons.” Once they decide to change, people step into the preparation stage. Those resolving to get in shape might get a physical check-up, purchase a gym membership, fitness equipment and free weights or sign up for a physically active class like dance or martial arts. “They do the research at this point,” Marschner said. “If the gym is open Jan. 2, they might make the plan to start Jan. 2nd.” Once the person takes action, maintenance is the next step. “Maintenance is keeping to the schedule and the plan,” Marschner said. If you struggle with this step, perhaps a reminder alarm in your phone or memo in your planner can help you remember to stick with your plans. Some people like to go public with their goals by blogging or posting on social media about their progress. Whatever your goals, self-evaluation, whether public or private, can help you analyze if you’re making positive steps towards your goal.
“Now that they’re going to the gym on a regular basis, they might have a scheduling trap, like a child getting sick so they have to stay home with child instead of going to the gym,” Marschner said. “Or a holiday takes place where the gym is closed. But they can change their schedule to accommodate the gym being closed. Scheduling can be a huge help for making change take place.” The final stage is transcendence, where the change is part of the routine. Without thinking, people who have reached transcendence do what they have resolved because it’s who they are. Overall, making changes “can be complicated by if you’re making multiple changes at the same time, or if you’re making more than one big change,” Marschner said. “If you’re trying to make a really big change, chances are there are a lot of other changes you’ll have to make as well.” For example, someone who resolves to workout daily may need to go to bed earlier so they can rise earlier and get to the gym. Or someone who wants to eat better may need to prepare a bagged lunch to avoid eating calorie-heavy meals out. Change isn’t easy, but it is possible. If you’re not immediately successful in keeping healthful resolutions, keep trying. Once you meet one goal, move on to tackle another. You don’t have to wait a year to improve your health.
What Western New Yorkers wish for in the New Year Some of their wishes include not to text and drive, read more and quit smoking By Julie Halm
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long literary lines, Erika Carlson, 24, of the village of Depew, said that this will be the third year she has resolved to read 50 books in 365 days, and she has had varying levels of success. In 2013, she reached 48 but in 2014, she faced some challenges, and only made it to 28. A busier schedule and lengthier choices set her back. This year, she is resetting her resolve and trying to reach 50 once again.
Carly Miceli, 20, of Buffalo, is planning to put her safety first in 2015. “My New Year’s resolution is to stop using my phone while driving,” she said. “It’s too dangerous and sadly [I] do it way too much.” Health and wellbeing is also foremost of on the mind of Alyssa Moran. New Year’s Eve is her son’s first birthday, and that’s when she plans to quit smoking.
Doctor: Set Resolutions that Will Make You Feel Good
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ew Year’s resolutions are challenging to keep — nearly anyone who has set one knows it can be a struggle — but why is that the case and how can people make reaching their goals a little bit easier? The first step is to determine why you are setting a particular goal. Jarod Masci, a professor of psy-
chiatry at UB who works at Landmark Psychiatry PC, thinks that what motivates a person to choose their New Year’s resolution plays a major role in their likelihood to successfully complete it. “So basically a Weinstein New Year’s resolution is an opportunity for people to better themselves and I think a lot of times folks look at it like there’s something wrong with
them they need to fix and if they don’t they’re going to feel guilty,” he said. “I think that’s a self-defeating way of looking at it.” Masci suggests instead, that people should set goals that will make them feel good about themselves and which they will enjoy reaching. While he believes that the overall goal need not be terribly specific, the method of reaching it should be. Small, specific, incremental goals, Masci said, can help a person stay on track and be more successful overall. For example, he said, a young student may have a life goal of being a doctor, but they should focus first on a smaller goal of receiving an “A” in their biology class. The same principle should be applied to New Year’s resolutions. Susan Weinstein, a licensed clinical social worker with Linwood Psychotherapy Associates, agreed, saying that sometimes individuals create roadblocks for themselves by setting too many goals, or making them too overwhelming.
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First, Weinstein suggests that people not set too many goals at once. “We only have so much willpower,” she said. “One thing at a time.” Like Masci, Weinstein suggests that those setting resolutions this January should break their larger goal into smaller parts. “There’s the idea of partializing, or cutting things down into doable pieces,” she said. While those setting the resolutions must draw from inner reserves of self-restraint, Weinstein suggests that the people we surround ourselves with can also have a significant impact on our ability to achieve goals. “Having good role models helps as well,” she said, adding that seeing success allows us to visualize our own and believe that it’s possible. In the end, however, Weinstein said that the secret to success is simple. “Somebody once gave me the best advice,” she said. “The people who get there are the ones who don’t give up.”
“I want his gift to be my health,” she said. For Laura Rickard, 26, of North Tonawanda, saving some money is the goal, but she plans on doing so in an unconventional way. She plans to trade clothes with Erika Carlson of friends and family, Depew said she rather than purwill able to read chasing them. 50 books in 2015. “My sister and her friend did it and they saved about $3,000,” she said. Drew Smith, 29, of the town of Tonawanda, doesn’t jump into resolutions too quickly. “I usually take the whole month to decide. I start with things I don’t like about me or where I want to be a year from now and go from there,” he said. “If you don’t take the time to think or care about it, you won’t care by February.” Smith previously set a resolution to lose 50 pounds and was able to achieve it. He did so, primarily, by exercising patience. “[I] keep telling myself that I may have setbacks, so don’t give up at the first hiccup,” he said.
– By Julie Halm
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Page 11
SmartBites
serving), this delicious green, with its incredibly high water content, keeps me hydrated, happy and full.
By Anne Palumbo
The skinny on healthy eating
Helpful tips Choose crisp, compact heads of romaine lettuce that are free of holes or discoloration. To help romaine last longer in the fridge: cut off the core, separate the leaves, wash it, pat it dry, then wrap it with paper towels to remove excess moisture. Store away from ethylene-producing fruits, such as apples, bananas and pears, since they will cause the leaves to turn brown. Limp leaves can be revived by immersing them in ice water for a few minutes.
What Makes Romaine So Remarkable
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h, January…month of snug waistbands and shirts that won’t button, no thanks to the endless supply of goodies over the holidays. But the eating season has come to a close and we all know what that means: Time to get back in the saddle and “eat clean” for a while until those favorite jeans fit again. My favorite go-to “clean” food is lettuce; and of all the varieties, romaine finds its way onto my plate more than any others. Crunchy like iceberg, but much more nutritious because of its darker green color, romaine delivers the goods: it’s tasty, it’s super low in calories, and it’s loaded with nutrients. To begin, romaine is a vitamin A heavyweight, providing over 100 percent of our daily needs in an average serving (about two cups). A nutrient we can’t live without, vitamin A benefits the body in several ways: it promotes good vision; it helps keep our immune system healthy; and it’s needed for normal bone growth and proper tooth development. While deficiencies are rare in countries like ours, they do occur and typically present with a decreased ability to see in dim light. Romaine also packs an impressive vitamin K punch, knocking off over 100
Charred Romaine with Gorgonzola and Toasted Pecans Adapted from Bon Appetit Serves 4
percent of our daily needs with just a few cups. Vitamin K, which helps blood clot properly, is a key ingredient in maintaining strong, healthy bones. As a middle-aged boomer with budding osteoporosis, I’m always looking for foods that will fortify my bones. I also reach for romaine because it’s a decent source of two more vital nutrients: folic acid (a B vitamin that reduces the risk of birth defects and may reduce the risk of heart disease and stroke) and heart-healthy fiber (2 grams per serving). Romaine is not only my go-to “clean” food during January, it’s also my yearlong salad staple. Remarkably low in calories (only 15 per average
3 cups crumbled Gorgonzola cheese ½ cup light mayonnaise ½ cup plain yogurt ¼ cup water 1 to 2 cloves garlic, minced ¼ teaspoon hot pepper sauce (optional) 2 heads of romaine lettuce, outer leaves removed, halved lengthwise 1 to 2 tablespoons olive oil Kosher salt ½ cup pecan halves, toasted, coarsely chopped Blend 1½ cups cheese, mayonnaise, and yogurt in food processor. Add 1/4 cup water, garlic and hot pepper sauce;
blend until smooth. Season with salt and pepper. (Can be made 1 day ahead. Cover; chill. Whisk before using.) Prepare grill for medium-high heat. Drizzle cut sides of romaine with oil; season with salt. Grill, cut side down, until charred, about 3 minutes. Turn and grill just until warmed through, about 30 seconds. Place romaine on plate, charred side up, and drizzle dressing over lettuce. Sprinkle with pecans and remaining cheese. Anne Palumbo is a lifestyle columnist, 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.
Help for Cracked Heels Experts say there are easy ways to alleviate problem By Deborah Jeanne Sergeant
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any people find that when winter returns, their heels grow dry and split open. Heel cracks snag on socks and hosiery and detract from the appearance of the feet. But more than just unsightly, heel cracks can become painful and even badly infected, especially in people with neuropathy. “It can be a seemingly small problem that can escalate into something serious,” physician Animesh Sinha, Rita M. and Ralph T. Behling professor and chairman of dermatology in the UB School of Medicine and Biomedical Sciences. Sinha sees patients through UBMD, the practice plan of the UB medical school. The combination of dry skin and pressure causes heel cracks. Although heels can crack at any time of the year, the dry air from November through March makes heel cracks more likely during the winter. “As we age, we lose moisture,” Sinha said. “The main reason is the Carrel lack of moisture, Page 12
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but there can be some other causes. Scaling that can be related to psoriasis or eczema makes fissures worse. Other skin disorders make people prone to this.” Fortunately, you can prevent and treat heel cracks. Going barefoot places more pressure on the heels, so it’s better to wear socks and shoes to absorb the impact of walking. Shoes with gel inserts can relieve the pressure. Closed shoes, not open-back clogs, sandals or slippers, provide more protection to heels. Exposure also promotes drying. For dressy events, women should opt for pumps instead of sling-back heels, for example. Though clogs offer comfort and some styles absorb shock well, they leave heels exposed to cold air more than sneakers. Moccasin-style slippers represent a better choice than mule styles at home. Keeping heels moisturized helps prevent cracks; however, you should moisturize Lema properly. Sinha rec-
ommends using hydrating cream, since water forms the base of most lotions. Even better than cream, petroleum jelly, with the heel wrapped with plastic wrap and covered by socks, can help heels heal. Don’t leave moisturized feet bare, since that makes feet prone to slipping. If cream or petroleum jelly doesn’t help, Jeffrey Carrel, podiatrist with Podiatry Affiliates in Buffalo, recommends moisturizer with urea. Overthe-counter preparations contain 10 to 25 percent. Prescription formulas contain up to 40 percent. “The thicker the consistency, usually, the better the application and maintaining the medication next to the skin,” Carrel said. Since cracks form in dried-out, callused skin, it’s also helpful to remove the dry skin. Use a rough towel, pumice stone or loofah to buff heels after bathing, when dead skin sloughs off readily. Carrel said that a metal foot file, available over-the-counter at drug stores, can help safely file down dead skin if the user is careful. Using a blade “is not advisable,” Carrel said. “We see people multiple times cut themselves and develop secondary skin infection.”
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2015
Cutting callused skin off is quicker, but using a blade makes it too easy to scrape the skin too deeply and harm the sensitive skin underneath, especially if you can’t see your heels. Bethany Lema, board certified dermatologist with Cosmetic Vein & Laser in Buffalo, said that products that help slough off skin “can help prevent heel cracks over time. Try ones with alpha hydroxy acid or salicylic acid. Moisturize morning and night.” She said that filling in a crack with super glue or liquid bandage can help prevent heel cracks deepening. If you experience a crack that is deep, sore, inflamed or red, have a doctor check it. The crack could be infected that requires an antibiotic. Diabetics should take special care with their feet since neuropathy makes it hard to recognize foot problems. People with heel cracks should monitor them daily, using a mirror or enlisting help if they cannot see their heels readily. “It can be a portal for infection,” Sinha said. “Yeast and bacteria can gain entry through a breach in the surface of the skin.” Worsening cracks and ones that become painful need medical attention.
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Flavor Trends to Watch in 2015
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ver half of Americans consider themselves adventurous eaters and most are open to trying new flavors. Fortunately, consumers have more varieties of flavors to choose from than ever before and the choices are expanding every day. In the November issue of Food Technology magazine published by the Institute of Food Technologists (IFT), Senior Digital Editor Kelly Hensel writes about the top five flavor trends that flavorists, chefs and trendspotters predict consumers will be seeking out in the coming year. These include:
1. Sweet + Heat More consumers today are indicating they enjoy spicy food, and the spicy snack category is growing because of millennials’ love for bold flavors. The current obsession with sriracha, a Taiwanese hot sauce made from
chili peppers, is a key example of the new trend. Sweet and hot flavor profiles can also be found in beverages sector with drinks such as Mexican hot chocolate and jalapeno margaritas.
over a century ago by a Japanese chemist. The flavor is evoked by glutamic acid, a compound that is found in authentic ramen noodles and new seaweed snack foods. Umami even has health benefits, since it enables manufacturers to use less sodium while adding a depth of flavor.
2. Sour, Bitter & Tangy Consumers are starting to reach for bold, tangy, bitter flavors — both at the dinner table and at the supermarket. Kimchi, a common ethnic dish from Korea, has contributed to the popularity of sour and fermented flavors. It is made by salting and preserving fermented cabbage in a bed of pepper, garlic, ginger, and scallions. In addition, an increased prevalence of pickling has added to the sour, tangy trend.
3. Umami
5. Middle Eastern & North African Middle Eastern and North African foods are increasingly becoming menu items at restaurants. Even if the dish itself isn’t Middle Eastern, many of the traditional spices — sumac, za’atar, coriander, and cardamom — are gaining popularity with chefs. Flavor innovation is on the rise and new food products continue to permeate the consumer market. In addition to food scientists, innovative chefs are always experimenting with flavor; and if those flavor profiles are popular in a restaurant, they are bound to end up on supermarket shelves. Consumers are ready to experiment and try new things, and if the flavor is tasty, it’s likely to be a success.
4. Smoke & Oak Smoke — a flavor typically associated with meat — can now be found in soda, spirits, and craft beer. In the future, it is likely consumers will see more oak and other woods in combination with cranberry, sorrel, and honey in nonalcoholic beverages. Smoke adds a depth to any flavor, and depending on what wood or material is smoked, the result can be very different.
The concept of umami — the fifth basic taste — was born
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Women’s issues Genetic Testing: Is It for You? Tests at Roswell Park Institute let patients know if they are at a higher risk of certain ailments By Ernst Lamothe Jr.
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ome people don’t want to know their future for fearful reasons even though it would arm them with more knowledge. For others, the future offers them a playbook, which could be reassuring or help them on their way toward prevention. Those who fall into the latter category go to Cara Dresbold, a genetic certified counselor at Roswell Park Institute in Buffalo. Genetic counselors are trained healthcare professionals who combine their knowledge of basic science, medical genetics and genetic risk assessment skills to educate and counsel individuals who are interested about diving deep into their family’s genetic makeup. The profession is expanding and creates the opportunity for people to know if they have a higher risk of certain health ailments, including certain cancers. Genetic tests have been developed for thousands of diseases and are used to diagnose rare genetic disorders. Most tests look at single genes. In addition, some genetic tests look at rare inherited mutations of otherwise protective genes, such as BRCA1 and BRCA2, which are responsible for some hereditary breast and ovarian cancers, said Dresbold. Some of the other cancers that genetic testing checks for are breast,
pancreas, male breast cancer and skin cancer, among other disorders. Dresbold said that during the past decade, there has been significant growth in people’s understanding and accepting of genetic tests. “The process is we tend to ask patients about their family history as we perform genetic history,” said Dresbold. “We are trained to understand the genetic testing and we talk to families about if this is something they are interested in.” There are more than 2,000 tests available, according to the National Institute of Health. Doctors use genetic tests for several reasons. These include finding genetic diseases in unborn babies, finding out if people carry a gene for a disease and might pass it on to their children, screening embryos for disease and testing for genetic diseases in adults before they cause symptoms. It also helps make a diagnosis in a person who has disease symptoms and helps figuring out the type or dose of a medicine that is best for a certain person. After the initial hour to an hourand-a-half consultation with the patient, providers administer the test. Dresbold identifies genetic factors associated with hereditary cancer syndromes and calculates increased familial risk. There are people who have a his-
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Nicoleta Voian, a physician who directs the clinical genetics service at Roswell Park, counsels a patient. tory of cancer in their family and they want to learn more and see what genetic testing can offer them. Patients want to know if they have a substantial risk and if they have a genetic mutation. “People seem to feel very empowered knowing the information,” added Dresbold. “There is a sense that knowing makes you better prepared to battle whatever may come in the future. There are going to be some cases that even though people have a family history of cancer, the results come back
The Pill Remains Most Common Method of Birth Control But long-acting IUDs are gaining in popularity, experts note
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he pill remains one of the most popular methods of birth control for women, along with female sterilization and condoms, a new report shows. Among the two-thirds of women aged 15 to 44 who used birth control between 2011 and 2013, approximately 16 percent used the pill. Female sterilization, where women have their fallopian tubes closed or blocked, was used by 15.5 percent of women, while 9.4 percent used male condoms, according to the report published Dec. 11 by the U.S. National Center for Health Statistics (NCHS). But intrauterine devices (IUDs) and implants, both types of long-acting reversible contraceptives, are close on the heels of these other forms of birth control, with 7.2 percent of women using them. “Use of long-acting reversible contraceptives is becoming more popular,” said report author Kimberly Daniels, of the NCHS. Their use has nearly doubled since the last report on findings from five years earlier, when approxiPage 14
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mately 3.8 percent of women were using them, Daniels said. The most popular long-acting reversible contraception is the IUD, used by 3.5 percent of women in 2006 to 2010 and by 6.4 percent of women in 2011 to 2013, according to Daniels. The IUDs available in the United States include two hormonal versions, Mirena and Skyla, and one containing copper, ParaGard. This increase in long-acting reversible contraception has followed changes in guidelines by leading health care organizations that now recom-
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2015
mend their use to younger women and those without children, said Laura Lindberg, a senior research associate at the Guttmacher Institute. When IUDs came out years ago, there were concerns they might raise the risk of pelvic infection and jeopardize a woman’s fertility. But IUDs currently on the market don’t carry those risks, according to the American Academy
of Pediatrics. The academy now recommends these contraception devices as the first option for teens.
negative.” Despite the many scientific advances in genetics, researchers have only identified a small fraction of the genetic component of most diseases. Therefore, genetic tests for many diseases are developed on the basis of limited scientific information and may not yet provide valid or useful results to individuals who are tested, according to the Centers for Disease Control and Prevention. “On the other side, it is not for everyone because there are people who feel a sense of anxiety about knowing the information. There are people who sometimes feel overwhelmed knowing,” said Dresbold. Dresbold said that some situations are complicated. While everyone would love to have a definitive answer when they come in, at times there are inconclusive results. Those results do not rule out the increased risk, but unfortunately the tests are not able to tell the person whether there is a genetic component that would increase their risk. “We understand that there are some limitations in genetic testing. We explain that to the clients so they understand that they may not always get the conclusive results they are looking for,” she added. “There is still a lot we don’t know because genome is an expansive science, but we do learn more every day.” Now, medical experts can test genetics multiple genes at one time, which incorporates several diagnoses. They can check multiple mutations and the technology continues to rapidly move forward, giving more hope of future tests. “It is very important to stay up to date with the most recent guidelines and you have to keep updating your family history as it comes,” said Dresbold. “There are so many things that happen where they could overlap in conditions and you could fit into more than one diagnosis.” For more information, call 1-877275-7724.
Women’s issues Hyperemesis Gravidarum: More than Morning Sickness By Deborah Jeanne Sergean
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he former Catherine Middleton, Duchess of Cambridge, has brought hyperemesis gravidarum again into the spotlight with her second pregnancy. With each of her pregnancies, the royal mum has experienced what’s commonly known as “severe morning sickness.” Although caused by pregnancy, hyperemesis gravidarum represents far more than the run-of-the-mill morning sickness most women suffer as their hormones elevate for pregnancy. Regular morning sickness causes moderate nausea and sensitivity to odors and flavors for all or part of each day, and not necessarily in the morning. Going on an empty stomach or eating foods Kurss poorly tolerated can cause vomiting. Patients with hyperemesis gravidarum vomit up to 50 times per day and can become debilitated. “Hyperemesis gravidarum is quite severe, and may require hospitalization and IV support for electrolytes, but doesn’t happen very often,” said David Kurss, an OB-GYN with Vision Health in Buffalo. Doctors are not certain why some women have hyperemesis gravidarum. Only about one-half to 2 percent of pregnant women experience it. “Sometimes, it’s a function of mul-
tiple pregnancies,” Kurss said. “It may happen if someone has had hyperemesis previously or is intoleranct to birth control pills, which has estrogen and is associated with morning sickness. Sometimes there’s a genetic basis for it.” Diagnosis includes checking for signs of dehydration and the frequency of vomiting. Physicians can test for ketones in the urine, which indicate the body is breaking down its own stores of fat and muscle for survival. “Usually, it’s not likely it will significantly impact the health or the life of the mom or baby, but if it’s untreated it could restrict the growth of the baby but that’s uncommon,” Kurss said. The earlier women start treating hyperemesis gravidarum, the more likely they are to minimize its effect. Taking a prenatal vitamin before pregnancy can, in general, reduce nausea. University of Buffalo in conjunction with Rochester Medical Center is currently studying medication for women with hyperemesis gravidarum to help them through the first portion of their pregnancy. At present, some women find relief in taking doctor-recommended vitamins, like B-6. Doctors may also prescribe anti-nausea medication, like metocloperaminde or Zofran. Physician Marcy Mulconry with Rochester Regional Health System first suggests that clients with severe morning sickness try a few tips at home. “Eating small, frequent meals, avoiding having your stomach empty and start eating before you get out of
bed,” she said. “Eat things like crackers. The earlier you start treating this, the more likely you are to ward off hyperemesis.” Sticking with bland foods such as plain noodles, rice and toast and avoiding spicy foods, dairy, “green” foods, fatty items and strongly-scented foods helps, too. Many women tolerate sweet or salty things, in addition to bland foods. A few tolerate sour foods. Women who aren’t coping well at home may need to be admitted to the hospital to receive intravenous fluids and nutrition and for observation. Some patients need IV help so frequently throughout their bout with hyperemesis gravidarum that they opt for a peripherally inserted central catheter (“PICC line”), an IV inserted into the arm that travels between the heart and junction in the shoulder. Thankfully, hyperemesis gravidarum doesn’t harm baby. By 15 to 20 weeks of pregnancy, hyperemesis gravidarum ends for 90 percent of women.
Do you or does anyone you know have any of the following symptoms? n Easy bruising n Frequent or prolonged nosebleeds n Prolonged or heavy menstrual bleeding n Prolonged bleeding following surgery, dental work, childbirth, or injury If so, you should know that these symptoms occur in a common bleeding disorder called von Willebrand disease (VWD). Learn the facts about VWD. Call the Hemophilia Treatment Center of WNY at (716)896-2470 ext, 4012 to get more information. Comprehensive treatment of all bleeding and clotting disorders. In one place, at one time.
716-896-2470 • wwwhomophiliawny.com January 2015 •
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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Sunscreen in the Winter? Experts say it’s a good idea to keep it handy — and use it By Deborah Jeanne Sergeant
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ou’ve likely packed up your flip flops, swimsuit and shorts weeks ago, but don’t stow sunscreen. The summertime essential is really meant for year-round use to protect against the signs of aging and skin cancer. “The sun is still there throughout the year,” said physician Animesh Sinha, Rita M. and Ralph T. Behling professor and chairman of dermatology in the UB School of Medicine and Biomedical Sciences. Sinha sees patients through UBMD, the practice plan of the UB medical school. “Though the rays are less intense, UV radiation still is reaching the earth’s surface in winter’s months. UV radiation is an important factor in aging and sunburns.” Although your skin may be more prone to burning in the summertime, the effects of sun damage is cumulative — and the sun is more dangerous because of the snow. “It can be a little more intense with reflection off snow and ice,” said Bethany Lema, board-certified dermatologist with Cosmetic Vein & Laser in Williamsville. “With people who are going to 1,000 feet above sea level, the
radiation exposure increases 5 percent for every 1,000 feet above sea level.” Fortunately, winter apparel covers lots of skin; however, for the face, neck, ears and hands, it takes sunscreen to stay safe from ultraviolet rays. “A lot of moisturizers have SPF of 15,” Sinha said. “You’re probably OK with just that unless you’re doing something recreational outside. Applying SPF 15 daily with moisturizer is sufficient for normal activity.” Lema advises clients to use a dollop about the size of a quarter for covering just the face. The amount of sunscreen needed may vary. Balding men, for example, may need more unless they wear a hat. Bearded men may need less. Re-apply about every 120 minutes when engaging in outdoor recreation. Take special care to apply enough when at high elevation. Wearing a ski mask and goggles that have UV lenses can help protect you, as can SPF-rated lip balm. Lema recommends broad spectrum UVA/UVB sunscreen and products that contain zinc oxide or titanium dioxide. They block close to 100 percent
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The Social Security Office
Column provided by the local Social Security Office
Unflinching In The Fight Against Fraud
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f you’re like most people, you protect what’s valuable to you. To protect your family financially, you buy health and life insurance. To protect your home, you get homeowner’s insurance, a security alarm or perhaps a large dog. To protect your jewelry, you hide it in a safe place or buy insurance in case you need to replace it. To protect your money, you invest it, perhaps in a bank that offers FDIC coverage. Social Security is much the same. We value the people we serve, our employees who work hard to provide world-class customer service and the integrity of our programs. We protect these by using many tools to identify, prevent and stop fraud, and we seek the maximum punishment for those who commit it. The tools we use help us predict where fraud may occur and, by monitoring cases closely, we identify fraud Page 16
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sooner rather than later. We also have stiff penalties that discourage people from committing fraud. Social Security has a zero-tolerance policy for fraud. While we cannot prevent every instance of fraud any more than law enforcement can prevent all crime, we aggressively investigate and pursue prosecution of those who try to cheat the system. Our message to those who would defraud Social Security is clear: We will find you; we will prosecute you; we will seek the maximum punishment allowable under the law; and we will fight to restore to the American public the money you’ve stolen. Social Security takes fraud seriously and so should you. If you suspect someone is committing Social Security fraud, report it online at http://oig.ssa. gov/report or call the Social Security Fraud Hotline at 1-800-269-0271.
of harmful rays, unlike sunscreens that absorb some of the rays. “Titanium oxide and zinc oxide are broad spectrum and aren’t as readily absorbed into the skin,” Lema said. Before buying sunscreen, check the bottle’s expiration date. Expired sunscreen may not be as effective as new sunscreen. Sun exposure stimulates the body to produce vitamin D, a pre-hormone that regulates many bodily functions; however, dermatologists recommend
Q&A Q: I’m creating my budget for 2015. How much will my benefit increase at the beginning of the year? A: The monthly Social Security and Supplemental Security Income benefits for nearly 64 million Americans will increase by 1.7 percent in 2015. This annual cost-of-living adjustment (COLA) is tied to the Consumer Price Index as determined by the Department of Labor’s Bureau of Labor Statistics. This New Year, you can enjoy your COLA starting in January. Q: I’d like to change the healthcare coverage that I signed up for through Healthcare.gov. How can I do that? A: The open enrollment period for Affordable Healthcare coverage takes place from Nov. 15, 2014 to Feb. 15, 2015. During this four-month period, you can enroll in a new plan or change current plans using the Affordable Care Act’s Marketplace. To continue health coverage in 2015, simply renew the current health plan or choose a new plan through the Marketplace between now and Feb. 15, 2015. Once the open enrollment deadline passes, the only way to get coverage for 2015 is to qualify for a “Special Enrollment Period” due to a qualifying life event as specified by HealthCare.gov. You have four months to decide what type of coverage you want, but the sooner you act, the sooner you will enjoy the security of affordable healthcare. Q: I went back to work after retiring, but now the company I work for is downsizing. I’ll be receiving unemployment benefits in a few weeks. Will this affect my retirement benefits?
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2015
dietary and supplemental sources of D instead of sunlight exposure. “It’s not clear the extent to which we need vitamin D supplementation,” Sinha said. “Some are strong advocates of this and others are less so. There is new research indicating the importance of sufficient vitamin D, the need and extent for supplementation is still being discussed.” A balanced approach may be to take a multi-vitamin with 100 percent of the USRDA of vitamin D and avoid excessive sun exposure.
A: When it comes to retirement benefits, Social Security does not count unemployment as earnings, so your retirement benefits will not be affected. However, any income you receive from Social Security may reduce your unemployment benefits. Contact the state unemployment office for information on how your state applies the reduction to your unemployment compensation. Q: I was wounded while on military service overseas. What are the benefits for wounded warriors, and how can I apply? A: Through the Wounded Warrior program, Social Security expedites processing of disability claims of current military service members or veterans disabled while on active duty on or after Oct. 1, 2001. Also, service members and veterans who have a Veterans Administration compensation rating of 100 percent permanent and total (P&T) may receive expedited processing of applications for Social Security disability benefits. Keep in mind, this expedited process applies to only the application for benefits. To be eligible for benefits, you must meet Social Security’s strict definition of “disability,” which means: • You must be unable to do substantial work because of your medical condition(s); and • Your medical condition(s) must have lasted, or be expected to last, at least one year or to result in death. You can apply online at www. socialsecurity.gov/applyfordisability or call our toll-free number, 1-800-7721213 (TTY 1-800-325-0778). You can find more information for veterans at www.socialsecurity.gov/ people/veterans.
New Study: Jogging Keeps You Young A
By Jim Miller
How to Improve Your Balance as You Age Dear Savvy Senior, I’ve always been a walker, but when I fell last month my doctor suggested I start doing some balance exercises. Is this really something I need to practice? What can you tell me? Avid Walker Dear Walker, Most people don’t think much about practicing their balance, but you should, the same way that you walk to strengthen your heart, lungs and overall health, or you stretch to keep your body limber.
As we age, our balance declines — if it isn’t practiced — and can cause falls. Every year more than one in three people age 65 years or older fall, and the risk increases with age. A simple fall can cause a serious fracture of the hip, pelvis, spine, arm, hand or ankle, which can lead to hospital stays, disability, loss of independence and even death.
How Balance Works
Balance is the ability to distribute your weight in a way that enables you to hold a steady position or move at will without falling. It’s determined by a complex combination of muscle strength, visual inputs, the inner ear and the work of specialized receptors in the nerves of your joints, muscles, ligaments and tendons that orient you in relation to other objects. It’s all sorted out in the sensory cortex of your brain, which takes in the information from those sources to give you balance. But aging dulls our balance senses and causes most seniors to gradually become less stable on their feet over time. Poor balance can also lead to a vicious cycle of inactivity. You feel a little unsteady, so you curtail certain activities. If you’re inactive, you’re not challenging your balance systems or using your muscles. As a result, both balance and strength suffer. Simple acts like strolling through a grocery store or getting up from a chair become trickier. That shakes your confidence, so you become even less active.
Balance Exercises
If you have a balance problem that is not tied to illness, medication or
some other specific cause, simple exercises can help preserve and improve your balance. Some basic exercises you can do anytime include: • One-legged stands: Stand on one foot for 30 seconds or longer, then switch to the other foot. You can do this while brushing your teeth or waiting around somewhere. In the beginning, you might want to have a wall or chair to hold on to. • Heel rises: While standing, rise up on your toes as far as you can. Then drop back to the starting position and repeat the process 10 to 20 times. You can make this more difficult by holding light hand weights. • Heel-toe walk: Take 20 steps while looking straight ahead. Think of a field sobriety test. • Sit-to-stand: Without using your hands, get up from a straight-backed chair and sit back down 10 to 20 times. This improves balance and leg strength. For additional balance exercises visit go4life.nia.nih.gov, a resource created by the National Institute on Aging that offers free booklets and a DVD that provides illustrated examples of many appropriate exercises. You can order your free copies online or by calling 800-222-2225. Some other exercises that can help improve your balance and flexibility is through tai chi and yoga. To locate a beginner’s class in your area that teaches either of these disciplines, call your local senior center, health club or wellness center, check your yellow pages or try online directory sites like americantaichi.net and yogafinder.com. If nothing is available near you, there are DVDs and videos that offer tai chi and yoga instructions and routines for seniors that you can do at home. Some good resources for finding them are amazon.com, collagevideo.com and iefit.com, or check with your local public library. 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.
Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.savvysenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.
new study by researchers at Humboldt State University and the University of Colorado in Boulder is shedding light on an unexpected benefit of jogging in older adults. The study looked at adults over the age of 65 —some of whom walk for exercise and some who run for exercise. The researchers found that those who run at least 30 minutes, three times a week were less likely to experience age-related physical decline in walking efficiency than those who simply walked. In fact, the older runners were 7-10 percent more efficient at walking than those who didn’t jog. The paper was published online in the journal PLOS ONE Nov. 20. “What we found is that older adults who regularly participate in high aerobic activities — running in particular — have what we call a lower metabolic cost of walking than older, sedentary adults. In fact, their metabolic cost of walking is similar to young adults in their 20s,” said Justus Ortega, a Kinesiology Professor at Humboldt State and director of HSU’s Biomechanics Lab. Metabolic cost is the amount of energy needed to move and naturally increases as we age. High metabolic cost contributes to making walking more difficult and tiring. Decline in walking ability is a key predictor of morbidity
in older adults. In the study, researchers looked at self-reported older joggers over the age of 65 — those who ran at least 30 minutes a day, three times a week — and self-reported walkers, those who walked three times a week for 30 minutes. Participants were asked to walk on a treadmill at three speeds (1.6, 2.8 and 3.9 miles per hour) as researchers measured their oxygen consumption and carbon dioxide production. Overall, older joggers were 7-10 percent more efficient at walking than older adults who just walked for exercise. Their metabolic cost was similar to young people in their 20s. Researchers aren’t yet sure what makes joggers more efficient than walkers but they believe it may have something to do with the mitochondria found in cells. Evidence suggests that people who exercise vigorously have healthier mitochondria in their muscles. “The bottom line is that running keeps you younger, at least in terms of efficiency,” said Rodger Kram, a professor of integrative physiology at the University of Colorado, Boulder, and a co-author of the paper. Future studies are planned to examine whether other highly-aerobic activities—such as swimming and cycling—also mitigate age-related physical decline.
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Sovaldi: A Miracle Cure to Hepatitis with a Monster Price New proven drug against hepatitis comes with a high price tag: About $1,000 a pill or $84,000 for the full course of treatment By Patrick Sawers
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ith an estimated 3.2 million Americans currently suffering from hepatitis C, a new product from Gilead Sciences is being hailed as an exciting medical breakthrough, a long-awaited “miracle drug” with the ability to erase all traces of the virus from a patient’s body. Until recently, the treatment and management of that disease has been an uphill battle, a rocky road paved with frustrating limitations and debilitating side effects. “One of the biggest fears people have had about going into treatment for hepatitis C was a lengthy list of some pretty signifWacker icant side effects,” said physician Timothy R. Wacker, a specialist at Buffalo Gastroenterology Associates, LLP. “Prior to this the mainstay of treatment has been Interferon, which has an effect on the body’s entire immune system, making it a fairly difficult and extremely uncomfortable experience for the duration of treatment.” Interferon, which for years has been the go-to drug for combatting hepatitis C, had to be taken intramuscularly — a self-administered daily injection — with side effects ranging from severe nausea and headaches to extreme fatigue and overall general discomfort. A full course of treatment usually lasted six months, and with a Page 18
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success rate of around just 50 percent most doctors and patients have been anxious to see something new and improved hit the market. Then, late last year, the Food and Drug Administration approved Sovaldi (generic name sofosbuvir), a once-daily pill that not only eliminates the need for daily injections, but one which also boasts an astonishing 90-percent cure rate in just half the amount of time. “Sovaldi is like an antibiotic for viruses,” said Wacker. “It works directly on the virus itself, instead of targeting the body’s entire immune system as a whole. With Interferon it’s a little like chemotherapy, in that the whole body is under attack, whereas Sovaldi acts solely on its specific target. That gives it a very good side effect profile, which is one of the greatest things about Sovaldi” Initially, Wacker said, it was still necessary in most cases to supplement a Sovaldi regimen with a smaller amount of Interferon. “For the first year of its existence Sovaldi was largely used in this country in combination with Interferon,” said Wacker. “There are different genetic subtypes of hepatitis C that we call genotypes, and prior to Sovaldi all types involved Interferon. Sovaldi provided us with the first one where we could have an Interferon-free regimen, but that was only for genotypes two and three, which typically respond very well [to Sovaldi alone] but are less common in this country than genotype one. Genotype one, which accounts for 70 percent of all hepatitis C cases found in the United States, until recently
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2015
had to be treated with Sovaldi plus a weekly shot of Interferon, and that meant patients still were subject to the unpleasant barrage of side effects that came with it. But now, Wacker said, Interferon has been phased out altogether, and “Sovaldi is currently available in combination with another direct-acting antiviral, so it gives us the first Interferon-free regimen for genotype one, which is the most common in the United States. For these patients, it’s now as simple as one pill a day for 12 weeks.” Melissa Sheehan, a 27-year-old mother of two living in Buffalo, recently completed the Sovaldi treatment and says she is now cured. “Unless I get re-infected, I do not have hepatitis C,” she said. “I’m still considered a carrier, because the antibodies remain present in your body, but I’m not sick.” The side effects, Sheehan said, were “minimal and completely manageable,” nowhere near as harsh as she had prepared herself for. “Mine lasted about a week,” she said, “but they were hardly what I had been expecting, having heard so many horrible things from so many people who had taken the Interferon cure. They told me, ‘Be prepared to be sick for six months. You’ll be nauseous, you’ll be sick.’ But with Sovaldi, honestly, I was able to function pretty much normally after about a week.” Then there’s the not-so-good news: the cost. A full course of Sovaldi treatment comes with an unfortunate $84,000 price tag, and at about $1,000 a pill that makes its cost almost as prohibitive as
its effects are miraculous. Insurance companies quite naturally are in an uproar, decrying the drug’s price as wildly exorbitant and therefore drastically restricting which patients they choose to make it available to. “At a time when Americans are looking for affordability when it comes to their health care, the price of Sovaldi is unsustainable,” said Clair Krusing, director of communications at America’s Health Insurance Plans, a trade association that represents around 1,300 health care coverage providers in the United States. “When you look down the pipeline, what’s concerning is that patients are being prescribed drugs with price tags of five or six figures, and you have to ask yourself, where’s the stopping point? The system can’t sustain those prices and the patients can’t sustain those prices,” she insisted. “There are finite resources, and you can’t have an enormous price tag on one drug that’s treating one condition when patients are facing multiple chronic conditions that require very costly treatments.” To Wacker, however, those concerns are easily outweighed by the urgent need for this important medical breakthrough. “As someone who spends a large portion of his time treating this disease, my excitement has been somewhat tempered by frustration because of limitations insurance companies are placing on the availability of this medication,” he said. “Now that we have a highly successful, very safe treatment, it’s not right that that treatment is being very tightly rationed.”
H ealth News Kaleida Health achieves ISO 9001 certification Kaleida Health is one of just nine hospitals and health systems in New York state and among the first 100 in the United States to achieve ISO 9001 certification by DNV GL. Created by the International Organization for Standardization (ISO), ISO 9001:2008 is a quality management system recognized by businesses around the world as the benchmark for continual quality improvement. DNV is Kaleida Health’s accreditation agency. The goals of ISO 9001 are to provide consistent service, improve patient satisfaction and continually improve the organization through proper documentation of all processes. “This achievement is further proof that we are leading from the bedside,” said Jody L. Lomeo, president and CEO, Kaleida Health. “It is clear that our workforce has turned the corner to believe in a new Kaleida Health, one that continues to be patient-centered and values every patient, co-worker and physician.” To achieve ISO 9001 certification, Kaleida Health underwent an intense on-site evaluation where the organization demonstrated quality management system processes and compliance in areas such as inpatient care, outpatient care, medication security, food service, operating and administrative procedures, medical equipment management, and infection control. “Beyond the quality manual that outlines procedures to ensure compliance with ISO 9001 and explains how major processes interact to provide consistently high quality results, employees can say what they do, do what they say, prove it and improve it,” added David Hughes, executive vice president and chief medical officer, Kaleida Health.
Jakson receives dentalfacial esthetics fellowship Andy Jakson, Polish Immigrant and Williamsville resident received the International Academy for Dental-Facial Esthetics Fellowship. Fellowship in the ADFE is by invitation to those members of the dental industry who have distinguished themselves in their respective professions. He was nominated by Joe Massad, regent of the International Academy for Dental-Facial Esthetics Jakson serves as the president of Evolution Dental Science, one of the largest and fastest growing laboratories in Western New York. He was also among the honorees receiving this year’s 2014 Buffalo 612’ award in health care, presented by Buffalo Business First. The academy is an honorary service organization whose mission is to foster interdisciplinary education in the area of facial esthetics. It includes, among its membership, many outstanding individuals of the various associated professions who have a desire to create new bridges whereby the esthetic patient can be better and more
knowledgeably served. The fellowship is conferred during a cap and gown ceremony at which time new fellows are presented with the certificate of fellowship and the designated membership pin. The ceremony is followed by a cocktail reception and dinner. The 2014 annual meeting was held in conjunction with the Greater New York Dental Meeting Dec. 1 at the Harmonie Club.
Buffalo General’s bariatric program recognized The Center for Minimally Invasive and Bariatric Surgery at Buffalo General Medical Center has again been named an American Society for Metabolic and Bariatric Surgery Bariatric Surgery Center of Excellence (ASMBS BSOE). The center of excellence designation recognizes surgical programs with a demonstrated track record of favorable outcomes in bariatric surgery. In addition to 2014, the program received this designation in 2007 and 2011. The Centers for Disease Control and Prevention report that nearly 35 percent of all U.S. adults are obese. Morbid obesity typically defined as being 100 lbs. or more over ideal body weight or having a body mass index of 40 or higher, has become a significant national health issue. “Kaleida Health recognizes the importance of bariatric surgery to the region, and has made unprecedented investments in support of our program,” said physician Aaron Hoffman, chief of surgery, Kaleida Health and medical director, Center for Minimally Invasive and Bariatric Surgery. “Given the high rates of obesity and diabetes in Western New York, our center is committed to providing world-class bariatric care right here in Western New York at the epicenter of the Buffalo Niagara Medical Campus.” Physician Alan Posner, bariatric surgical director, is pleased about the designation, which reflects the hard work of the entire bariatric program team. “Success with bariatric surgery requires a multidisciplinary approach to patient care, not only leading up to the operation, but also for life-long follow up. Our entire team is fully committed to the care of our patients, earning us a continued center of excellence status.” Posner was one of the first in Western New York to offer laparoscopic bariatric surgery, and is one of the few locally who is fellowship-trained in advanced laparoscopic surgery.
Facilities partner to be ‘Be a Santa to a Senior’ The Amherst Center for Senior Services joined with Home Instead Senior Care of Williamsville to coordinate a “Be a Santa to a Senior” program. The area office of Home Instead Senior Care, the world’s largest provider of non-medical home care and companionship for older adults, this year teamed with Rich Products,
Orchard Park patient cared by Hospice Buffalo featured in Consumer Reports A good death can be hard to achieve without advance planning, according to a new end-of-life guide published in the December issue of Consumer Reports, which includes survey findings on how Americans want to die. The report and accompanying 17-minute video documentary chronicles the last months of Hospice Buffalo patient Paul Scheier, an 87-year-old retired dentist from Orchard Park, who succumbed to lung cancer. The dentist had outlined the way he wanted to die in advance — in his own bedroom with his wife of 62 years and their four grown children at his side. Consumer Reports highlights the choices Scheier and his family made to ensure that his wishes were carried out. The report also includes results from a recent Consumer Reports survey of 2,015 adults which found that 86 percent of Americans would want to spend their final days at home and receive end-of-life care there, according to a news released issued by Hospice Buffalo. Only 36 percent said they’d want to receive that same care in a hospital setting. Perhaps most surprising, the
Catholic Charities, Buffalo Meals on Wheels, and Schofield Adult Day Care to help provide presents to seniors who otherwise might not receive a gift this holiday season. The Amherst Center for Senior Services provided the names of 40 seniors in need through its senior outreach services, Amherst Meals on Wheels and Amherst Adult Day Care programs. Their names and wish items were placed on “Be a Santa to a Senior” tags and those tags were placed on the tree located in the front foyer at The Amherst Senior Center.
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new release states is the fact that only 47 percent of seniors over 65 have completed an advance directive, also known as a health care proxy in New York state. And 61 percent of those polled have never heard of palliative care — the use of medication or other therapies to ease the pain and symptoms of disease for anyone with a serious illness. “People who have palliative care can also be going for life-sustaining treatment. Palliative care helps with short- and long-term goals and planning,” said Bethany Calkins, Hospice Buffalo’s home care physician for Scheier. “Hospice care is all of palliative care, but for people whose condition is within the last six months of life.” Consumer Reports advises that it’s crucial for Americans to think about end-of-life concerns long before a crisis arrives. The most effective way to enforce end-of-life wishes is to create an advance directive or a living will and to appoint a health care proxy, the magazine states. To see a video of Paul Scheier, go to http://web.consumerreports.org/ endoflife.htm.
Golden Years Special Issue Advertise in the February issue of In Good Health. Please call 332-0640 for more information about the issue.
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rehabilitative therapies and counseling services, are based at one location.
The less fortunate
“From a health standpoint, adults with developmental disabilities are no different than anyone else. They have the same health problems, the same medical concerns and the same needs for quality care as the next person,” Azzarelli said. “What makes them different is they can be hounded by multiple health problems at the same time due to their particular disability.” That is why People Inc. takes great care in offering many different types of programs suitable for the unique needs of the people they serve, according to Forgione. Its senior day habilitation program is a semi-retirement program for adults over age 50 with developmental disabilities that focuses on the interests and needs of seniors to maintain the skills of daily living. The flexible, comfortable, appropriately paced environment allows participants to enjoy creative and social activities, according to People Inc. program managers. “We work on what is important,” Caggiano said. “That can be something Roman Baker, a patient at the Elmwood Health Center, with Lisa R. Zambron, a physical therapist. Zambron helps Baker improve his new or the activities that our particphysical fitness. ipants enjoy. Things do not always have to be fast-paced. Our staff enjoys coordinating many different activities and we tend to see dementia more with and new opportunities for our particithis age group,” says Vanessa Kosis, pants.” program manager at People Inc. Day habilitation programs focus on The goal of the programs, Caggiaincreased independence, productivity no said, is to ensure all participants and positive approaches to behavior adjust to their environment and staff management. Participants’ individualprovides any modifications needed as ization and interests are always strongwell as safe surroundings. ly encouraged. The staff is trained in identifying “There are no limits on what our and addressing the changing needs of participants can or cannot do,” Cagthe senior population. giano said. “For example, we recently “With age comes deterioration of By Deborah Blackwell painted windows at the South Creek muscle tone as an example,” says Frank Wesleyan Church in Hamburg. Our Azzarelli, associate vice president at Offering health care, employment, s the population of adults with participants are still vital and active. People Inc. and director of Elmwood residential, community outreach and disabilities grows, the team at They have a desire to be part of the Health Center in Buffalo. “Where once recreation programs, as well as famiPeople Inc. continues to grow community.” a person with physical limitations ly-centered support services, all of its and expand right along with it. There are many ways that program could get around with some effort, age program participants can enjoy more The nonprofit health and human members can participate in happy makes mobility much tougher and thus productive, healthier lives. services agency located in Buffalo proand healthy daily lifestyle activities. travel becomes much more difficult, This is a critical factor for adults vides programs and services to more Exercise groups, tai chi, yoga, art and and there are other health risk factors diagnosed with developmental disthan 12,000 people with special needs pet therapy are just a few. A nutritionist as well.” abilities, who now make up nearly 19 and their families, and nearly 5,000 of monitors lunches and staff encourages Maintaining comprehensive care percent of the population, according to those are over age 50. healthy choices in meal preparation, can be a challenging task in a nation of the U.S. Census Bureau. “The people we serve, regardless cooking and eating. The family newsongoing healthcare crises, case manof their age, are just like you and me letter includes helpful health tips. Meeting growing needs agement, and service coordination (this and would like to be treated as equals,” Community projects are also part In 1970, only 11 percent of adults needs clarification). Everything from says Jacqueline Shapiro, program manof the activities offered in People Inc. over age 50 carried that diagnosis. But safe housing, to vocational training, to ager at People Inc. programs. From bake sales to benefit due to improvements in healthcare, the proper medical care must be addressed. Since it’s founding in 1971 by a the Alzheimer’s Association, to Operpercentage is expected to grow to 22 Elmwood Health Center, an small group of parents and professionation Christmas Child and Dog Days percent by 2040, according to a report affiliate of People Inc., offers specially als, People Inc.’s focus is to help those of America, staff continually seeks opfrom The President’s Committee for designed services for individuals with with special needs reach their highest portunities for participants to integrate People with Intellectual Disabilities. developmental disabilities. The center potential of becoming responsible, into the community. As well, the life expectancy of develhas received national recognition for its active, contributing members of a welAccording to Shapiro and Kosis, opmentally disabled adults is now patient-centered care, with clinicians coming and accepting community. seniors participate in weekly communinearing that of the general population, who serve patients from newborn to el“We look at the complete total picty group visits to senior living locations according to the Comprehensive Adult derly with many types of needs. More ture and always have the lines of comwhere they make ceramics, enjoy coffee Student Assessment System (CASAS.) than 10 percent of People Inc.’s particmunication open,” says April Caggiaand have conversations with seniors People Inc. continues to expand ipants over age 65 receive care at Elmno, senior program manager at People who are not developmentally disabled. its services and programs to meet the wood. All services, including medical, Inc. “Our day program and residential While many people with developneeds of this growing staff work together so everyone is on mental disabilities live with challenges segment. the same page in order to help individthat may increase as they age, this is Caggiano said uals meet their personal choices, needs not a new challenge for agencies that many older adults and goals. support adults with developmental of any ability face To successfully address the needs disabilities. ambulatory issues. of both children and adults with develConnie Kriegbaum’s brother, PatBut older adults opmental disabilities, People Inc. has rick McCarty, 63, both of Tonawanda, with developmental grown by leaps and bounds since its inhas attended the Brighton Park Day disabilities may have ception, according to Nicole Forgione, Habilitation program for 25 years. other health issues, Public Affairs manager, People Inc. “My brother is severely mentally including intellectual Now, with 2,500 full- and part-time challenged. The daily routine that he impairments, vision, employees, along with 300 volunteers, has is important. He is non-verbal, but ambulatory issues this special organization offers an encommunicates through a communicaand memory loss. tire spectrum of services to a multi-gention book. He shows the staff photos “People that we erational population, over a wide geoof what he wants to do during the serve over the age of graphical area in Western New York. day,” Kriegaum said. “For Patrick, the 50 may experience The agency’s ongoing dedication routine and structure is so important. more difficulty with to provide services matching the needs It would be very difficult to fill in the general mobility isof the community it serves is evident gaps without the program.” Gail Martinke with Elizabeth Danwin at People Inc. Brighton sues, they often have through its programs. Park Day Habilitation in Tonawanda. physical limitations,
People Power Adults with developmental disabilities thrive at People Inc.
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • January 2015