Buffalo Spree's Medicine in WNY 2019

Buffalo Spree Magazine MEDICINE IN WNY

2019-2020

WNY addresses the opioid epidemic Learn the ABCs of CBD

Amazing innovations are happening here www.buffalospree.com • 2019

A periodical supplement to Buffalo Spree November 2019

Dr. Jarod Masci of Landmark Health Systems

SPECIALIZING IN AESTHETIC & RECONSTRUCTIVE SURGERY FOR MORE THAN 30 YEARS Buffalo Niagara Plastic Surgery has been a leading authority in aesthetic and reconstructive surgery for more than 30 years. Led by renowned surgeon Dr. Robert J. Perry, the practice is rooted in the belief that plastic surgery is meticulous, custom work that demands finesse and attention to detail.

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MEDICINE IN WNY 2019

2019 16 | ABCs of CBD

Get the facts on this ubiquitous product

2019-2020

P. 16

BY DEVON DAMS-O’CONNOR

26 | The danger of concussions

Know proper protocol to protect your student athletes

BY LISA LITTLEWOOD

34 | What’s new downtown

Roswell and BNMC are just the beginning

BY NANCY J. PARISI

42 | Comprehensive and creative mental

health care Allentown’s Landmark Health Systems prioritizes the individual 48 | On the cutting edge

Local innovations in medicine

BY KATHLEEN RIZZO YOUNG

54 | New prosthetics from a Buffalo native

The Center for Anaplastology

BY KATHLEEN RIZZO YOUNG

P. 26

62 | Fighting the opioid epidemic in WNY

The resources that save lives and some gripping personal stories

BY KATIE COLEMAN 70 | Good nutrition as disease prevention

You are what you eat… but how does it work?

BY JANA EISENBERG

80 | WNY BloodCare

A comprehensive center for blood and clotting disorders

BY JANA EISENBERG

88 | What to expect from joint replacement

surgery This is not your grandpa’s surgery

BY KATHLEEN RIZZO YOUNG

94 | Good to the bone

“Release and relief ” from carpal tunnel syndrome

BY KATHLEEN RIZZO YOUNG

O N T H E C OV E R :

A new mental health facility blends cutting edge therapies with personalized treatment.

Photo by Stephen Gabris Design by Jean-Pierre Thimot

CBD PHOTO COURTESY OF CBD BEST OIL; DR. FAROOQ AND DR. REYNOLDS PHOTO BY NANCY J. PARISI

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MEDICINE IN WNY 2019

Pamper Your Pet at Cara Mia 2019-2020

PUBLISHER

Barbara E. Macks EDITORIAL EDITOR-IN-CHIEF

Elizabeth Licata SENIOR EDITOR

Wendy Guild Swearingen CONTRIBUTING EDITOR/HOME EDITOR/ MEDICINE IN WNY EDITOR

Donna Hoke ART & PRODUCTION CREATIVE DIRECTOR

Jean-Pierre Thimot PRODUCTION DIRECTOR

Jennifer Tudor The Best of WNY

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HOSPITAL PHOTO BY NANCY J. PARISI

Feedback We’d love to hear what you think! Email editor@buffalospree.com.

By mail, contact us at: Letters to the Editor, Buffalo Spree Publishing, 1738 Elmwood Avenue, Ste. 103, Buffalo, NY 14207.

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LETTER FROM THE EDITOR

I

IF YOU’VE BEEN INSIDE THE NEW OISHEI CHILDREN’S

H O S P I T A L , or even just driven through the Buffalo Niagara Medical Campus, you can see what a stunning addition it is to our downtown landscape. But while most of the medical buzz has been centered on development and research updates from this newest source of pride, there’s so much more that’s and happening with medicine in Western New York.

From new inventions in both pediatrics and oncology to increased services for opioid addiction to leaders in new protocols for concussion treatment, Buffalo is on the ball. The level of available resources and standard of care, and number of leading practitioners and researchers, continue to make our city an attractive draw for even more premier medical professionals, as well as a place where we can feel secure in knowing that when we need treatment, it will be the latest and best.

Donna Hoke EDITOR, MEDICINE IN WNY

WELCOMING focused on providing excellent, compassionate care for all of

A Comprehensive and Compassionate Approach to Your Health Care.

a continual commitment to the highest quality, patient-centered

• Neurology

Your life. Your health. Your choice.

As one of the leading medical groups in the community, we are Western New York and beyond. Healthcare that demonstrates

• Neurosurgery

care, in a warm and friendly setting. We are welcoming patients

• Interventional & Chronic Pain

Williamsville, NY and additional satellite offices throughout WNY.

• Primary Care – Internal Medicine &

When it comes to you and your family’s health, we hope that we

• Functional Medicine

know that nothing is more important than being there for the

• Urology

to our main office at 400 International Drive in the heart of

Management

Family Practice

can earn your trust and exceed your expectations. Because we

• OBGYN • Women’s Health

people you love.

• Radiology

We strive to display the highest standards of excellence and

• Physical Therapy

options. We provide you with all the information you need to

• Medical Massage • Med Spa Services

decision will likely affect your health. We are your partners in

• Headache & Migraine Treatment Center

• Rheumatology • Psychology

strongly believe in helping you understand all of your treatment

• Chiropractic • Infusion Services

make a wise decision and assist you in understanding how your

• Acupuncture

optimizing your health and well-being.

• Medical Marijuana

Diagnostic Imaging Associates Invision Health is one of Buffalo’s leading full service, outpatient radiology and imaging centers serving the Western New York community since 1984. DIA Invision Health offers the most advanced technology for all your imaging needs with a team of dedicated and highly trained technologists and radiologists providing you personalized care.

Adult & Pediatric Radiology • 3T MRI • CT • Ultrasound • X-Ray • Fluoroscopy • Nuclear Medicine • (DEXA) Bone Densitometry • Interventional Radiology • 3D Mammography

Relax and enjoy your spa treatment and know that you are in caring hands. It is our mission to provide and exceptional experience that refreshes, invigorates, and rejuvenates body, mind and skin.

Massage Therapy • Facials • Organic Skin Care • Anti-aging Treatments • Laser Skin Rejuvenation • Laser Hair Removal • Spider Vein Treatments • Laser Hair Removal • Silk Peel Dermal Infusion • Reflexology • Nutrition • Weight Loss

400 International Drive, Williamsville, NY 14221

NEW PATIENTS! Your life. Your health. Your choice.

OBGYN A Commitment to a Lifetime of Care for Women

David Kurss, MD, FACOG, NCMP

is a well-known, experienced and trusted Board Certified OBGYN clinician and surgeon.

He is a nationally certified menopause specialist, a Fellow in the American College of OBGYN and a nationally recognized thought leader, author and lecturer. Dr. Kurss is a pioneer of In- Office GYN surgery, In-Office Familial GYN Cancer genetic counseling/ testing and believes in a Holistic approach to the practice of gynecology.

Dr. Kurss has a superb reputation for providing compassionate, personable, individualized and expert state-of-the-art OBGYN and minimally invasive surgical care to women of all ages. He would love to help you-from your first GYN visit through your postmenopausal years.

Dr. Kurss has been voted a TOP DOC by Castle Connolly for the past fourteen years.

Your life. Your health. Your choice.

Urology covers a wide range of conditions for both men and women alike. In addition to treating the male reproductive system, urologists treat diseases and conditions involving the urinary tract in both men and women throughout all stages of life.

Women may experience urological health issues that are unique to their anatomy. While numerous urological conditions can affect women of all ages for a variety of reasons, childbirth, menopause or a hysterectomy can alter the body in ways that could lead to urologic health concerns. Though women

Every stage in a woman’s life presents unique medical situations and concerns.

Whether you need gynecology care, family planning services or a surgical procedure… you deserve personalized, professional and state-of-the-art care.

The Women’s Center at Invision Health covers women’s special health needs through every stage of life, from a young woman’s first visit to pregnancy, routine & advanced gynecologic care, cancer screenings, contraception and menopause.

Because every woman is unique we believe the relationship between doctor and patient is vital to your health. Our expert staff is here to discuss all of your concerns and provide you with prompt, compassionate care

You and Your Baby

Pregnancy is one of the most exciting times in a woman’s life and we are glad to have the opportunity to guide you through the next nine months. Our goal is the best health of our mothers and babies and a wonderful pregnancy experience.

At The Women’s Center, we take pride in offering preconception planning and prenatal care to make sure you are as healthy as possible before becoming pregnant. This high standard of care continues for you and your baby throughout your pregnancy. Providing the most personalized care and attention from the first trimester to the delivery of your baby, and beyond. We look forward to welcoming your new baby into the world.

Alexander Eswar, MD is board certified in Obstetrics & Gynecology and is fellowship trained in Minimally Invasive Surgery specifically focused on gynecologic diseases. Dr. Eswar completed his fellowship at The Center for Minimally Invasive & Robotic Surgery at the University of Buffalo in 2015.

In addition to diagnosing and treating a comprehensive range of women’s health conditions, Dr. Eswar provides alternatives to traditional gynecological surgeries by using minimally invasive robotic surgery to perform even the most complex and delicate procedures.

Dr. Eswar is also very proud to deliver the most personal and comprehensive pregnancy care for you and your baby’s well-being. Personalized care that includes preconception, routine pregnancy care and the expertise that high risk pregnancy and multiple births require.

UROLOGY

can be reluctant to talk about these sensitive issues, it is important to share details with and seek treatment from a certified urologist.

Not doing so not only diminishes your quality of life, but can put you at serious risk.

The urology team at Invision Health offers comprehensive evaluation and treatment for all female and male urologic disorders.

Women with urologic problems might not know how common and treatable they are, which keeps them from seeking proper care. But help is available.

James A. Turecki, MD

is board certified by The American Board of Urology and earned his Bachelor of Arts degree in Biology from Cornell University.

He earned his Doctor of Medicine from Albany Medical School and completed his training in General Surgery & Urology at the University of Cincinnati Medical Center. Dr. Turecki provides comprehensive urologic care for men, women and children alike, with a particular interest in complicated urologic problems.

www.InvisionHealth.com

Phone: 716-631-3555

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MEDICINE IN WNY 2019

THE ABCS OF CBD

It’s time to separate fact from fiction

by Devon Dams-O’Connor

17

PHOTO COURTESY OF CBD BEST OIL

Glenna Colaprete-Hudson, Owner and CEO of CBD Best Oil and husband Pat Hudson

I N T H E PA S T C O U P L E Y E A R S , three little letters have become ubiquitous in the health and wellness marketplace: CBD. Products containing this “miracle” ingredient are seemingly sold everywhere from corner stores and supermarkets to CBD-centric boutiques, headshops, hair salons, and gas stations. It’s in everything from gummy bears to dog shampoo. Everyone, it seems, has jumped on the bandwagon to sell or use CBD.

What is CBD?

Let’s start at the root of CBD: the hemp plant. Hemp and marijuana are the same species of cannabis but are cultivated differently to produce two distinct plants with separate purposes. The primary difference between hemp and marijuana, besides legalities that vary state by state, is the amount of tetrahydrocannabinol (THC)—the psychoactive chemical that makes people high—that’s present in each

BUFFALOSPREE.COM

2019-2020

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Expect a good bottle of CBD tincture to be eighty to 150 dollars.

The ABCs of CBD continued

strain: marijuana has more THC, while hemp must have below point-three percent.

The oft misunderstood close association between the two plants resulted in both being banned in the United States since 1937, but over time laws have changed. Some states have begun to legalize medical marijuana. The 2018 Farm Bill removed industrial hemp from the Controlled Substances Act, and since then the amount of farmland licensed to grow hemp has quadrupled to more than 511,000 acres, many of those right here in Western New York.

While hemp has been cultivated over thousands of years for its strong, fast-growing fibers used to make things like paper, ropes, and sails, its medicinal use is what’s behind the recent explosion of popularity in the United States.

The healing compound extracted from hemp is called cannabidiol—or CBD for short—and its seemingly endless list of potential health benefits has sparked interest in folks from athletes to the elderly.

To create health and wellness products with CBD, the compound is extracted from the hemp

plant and then diluted in a natural carrier oil like coconut or hempseed oil. It is most commonly swallowed as an infused tincture, food, or beverage, or rubbed on the skin as part of a lotion or salve.

How it works

Dr. Lazlo Mechtler, medical director at DENT Neurologic Institute, director of DENT’s Cannabis Clinic, and chief of neuro-oncology at Roswell Park Comprehensive Cancer Center, explains how researchers currently believe CBD helps people and pets feel better.

“We have this system in our body called the endocannabinoid system that controls stress, healing, and behavior in many ways,” says Dr. Mechtler. “We think CBD changes the physical properties of the connection of what we call protein-to-receptor, so it indirectly affects how the endocannabinoid system works. A lot of people think we have a deficiency in this system that we are improving and stabilizing by introducing CBD. Instability in this system may lead to migraines, IBS, insomnia, and other ailments.”

PHOTO BY STEPHEN GABRIS

MEDICINE IN WNY 2019

2019-2020

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Motivated by their own experiences with CBD, many Western New York entrepreneurs have begun to craft their own lines of CBD products to meet growing customer demand. One such evangelist is Glenna Colaprete-Hudson, owner and CEO of CBD Best Oil based in Rochester.

“I have nerve damage and was searching for a holistic solution for chronic pain,” Colaprete-Hudson shares. “My husband is from Colorado so we go often, and that’s where I discovered CBD tincture before it was available in New York. It helped the pain, but I didn’t like the taste, so I developed a better-tasting tincture with a few different flavors like lemon, spearmint, and tangerine. Then I expanded into salves for shoulder pain. Then my friends and family wanted some. Now we have forty-two products and two stores and have been online since 2016.”

At first, Colaprete-Hudson sourced her CBD from two farmers and a scientist-led lab in Colorado, but she wanted to have a New York-based supply so she could keep the business local and control the quality at every stage of the process. She now has a hemp farm just south of Rochester that uses only organic farming practices, and she enlists third-party testing for purity and potency with results published for public review.

That kind of rigorous quality control plays heavily into the decisions Brenda Boyle, district manager for Feel-Rite Fresh Markets, makes about which CBD brands to carry in Feel-Rite’s five stores. From the hundreds of CBD companies knocking at her door, Feel-Rite carries products from just four established manufacturers.

“The companies have to have complete transparency with certificates of analysis for every batch,” explains Boyle. “We have to have the confidence that they’re doing their job of protecting you. Consumers are becoming more educated and seeking out more info themselves, and it makes a difference in their choices. We limit the number of brands we carry so we can stay 100 percent current with the ones we partner with and know them inside and out. If we had twenty, we couldn’t do that.”

Who uses CBD?

CBD products aren’t confined to one age group or lifestyle. ColapreteHudson says her customers range from a one-year-old who went from having fifty-three seizures a day down to fifteen, and her grandma, who is 102 and uses CBD lotion.

Justin Schultz, owner of Buffalo-based Bison Botanics, which produces all New York State-grown hemp products sold at over forty stores locally, says he also sees parents who are seeking alternative treatments for seizures and behavioral issues. He also helps customers who are looking to treat pets for separation anxiety, fear of fireworks, and joint relief (in older dogs); Bison even offers lower-dose supplements for smaller dogs.

But CBD may not be for everyone.

“It should not be used in pregnancy as far as we know, but we don’t know enough,” says Dr. Mechtler. “It may be used in kids under eighteen only for specific diagnoses like epilepsy, autism, severe irritable bowel syndrome; otherwise, I’d stay away from it in children. Similarly, I have patients who are 103 and we keep an eye on them. Research is also needed on how they work with certain drugs like blood thinners.”

Dr. Jennifer McVige, a board-certified physician of pediatric neurology, adult and pediatric headache and neuroimaging at DENT, says she’d prefer that kids be at least eleven or twelve—old enough to describe how they feel—before parents consider giving them CBD. She adds that while her adult and adolescent patients use CBD—and DENT even manufactures its own line of CBD products— as a physician she can’t write a prescription for it.

“It’s illegal to prescribe CBD in New York State,” McVige explains.

CBD MAY SPELL RELIEF

W H I L E C L I N I CA L RESEARCH INTO THE EFFECTIVENESS OF CBD

is still in its infancy in the US, international studies and plenty of anecdotal evidence support CBD’s ability to provide relief from dozens of conditions. Here are just a few.

•

Joint, muscle, and nerve pain

•

Chronic inflammation

•

Insomnia

•

Anxiety

•

Depression

•

Epilepsy and seizures

•

Multiple sclerosis symptoms

•

Acne

•

PTSD

•

Burns and wounds

•

Irritable bowel syndrome

•

Cancer treatment side effects

•

Alzheimer’s and cognitive decline

•

High blood pressure — D. D-O

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Bringing CBD to WNY consumers

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“It is a legal substance. You can fly with it and cross state lines, but it’s still illegal to prescribe it. Medical cannabis can be prescribed with CBD; we just have to state the ratio of THC to CBD. But not CBD by itself. And if I can’t prescribe it, I can’t research it.”

Cautions and considerations

The Food and Drug Administration (FDA) has so far only approved one prescription drug that contains CBD; it’s called Epidiolex and is intended to treat seizures associated with Lennox-Gastaut syndrome and Dravet syndrome, two rare, severe childhood-onset epilepsies. This lack of federal oversight also means there aren’t established guidelines or testing requirements to control what actually ends up in CBD products sold to customers.

“The problem with the CBD program is that it’s not regulated,” says Dr. Mechtler. “Because of that, studies show two major problems with some CBD products. First, there is either no CBD in them or inadequate doses, or too much THC in them. The presence of THC is a big deal if you’re drug tested; you could lose your job. Secondly, tests find contaminants like insecticides, pesticides, heavy metals, and fungus. Products are hit or miss, and mostly miss. Consumers have to look for thirdparty documented testing by a reputable lab.”

Dr. McVige adds that good quality CBD is expensive to produce, and customers should be especially skeptical about how much CBD, if any, is in low-cost products. “A decent bottle of CBD tincture should be $80-150,” she says. “It is costprohibitive for a lot of people, but it’s important that people demand quality products.”

Even with high-quality CBD products from reliable sources, Drs. Mechtler and McVige point out that doctors and scientists still don’t fully understand everything there is to know about CBD. Because the FDA hasn’t begun to regulate CBD, it doesn’t approve or fund its research either.

Doctors and CBD enthusiasts in the United States rely on research conducted overseas, primarily in Spain, the Netherlands, and Israel, where formal studies have begun to suss out specifics about the compound’s efficacy.

Given the shortage of research and FDA oversight, “I’d be very cautious if you see outrageous medical claims about cures,” warns Dr. Mechtler. “Even if there are testimonials on their websites. It only helps symptoms. When patients come to me and ask about cannabis to treat something, I will not treat someone if they say they’re stopping their medical treatment.

It’s an addition to mainstream medicine. Your

primary physician should also be aware of whatever you’re taking. Too many people feel that over-the-counter supplements and meds are safe, but too many things or too much of them can cause problems.”

Reputable CBD product manufacturers and the medical community are eager for FDA regulation, which they believe will weed out poor-quality products and open the door for the kind of research that can help improve patient outcomes.

“When we can study CBD, I’d like a pure consistent product so that we know everyone is getting the same thing,” says McVige. “I’d love to study it in autism, seizures, and concussions. The first two usually come with a huge cocktail of drugs with heavy side effects, whereas CBD and THC have significantly fewer. For pain patients, we think we can get people to lower doses of opioids if we can also prescribe CBD.”

Pregnant women should not use CBD, advises Dr. Lazlo Mechtler.

PHOTO BY KC KRATT

MEDICINE IN WNY 2019

2019-2020

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ASK THE EXPERT

ZYGOMATIC DENTAL IMPLANTS - by Dr. Igor Kaplansky, DDS, FAGD, FICOI WHAT ARE ZYGOMATIC DENTAL IMPLANTS AND AM I A CANDIDATE?

DR. IGOR KAPLANSKY ABOUT • Fellow International Congress of Oral Implantologists • Fellow International Dental Implant Assocation • Fellow Academy of General Dentistry • Member American Dental Association • Member New York State Dental Association

CONTACT (716) 267-6266 drkaplansky.com LOCATION 8030 Rochester Road Gasport, NY 14067

Simply put, these are dental implants that anchor in the cheekbone (zygomatic bone) and are used in cases where a patient has suffered moderate to severe bone loss in the upper jaw (maxilla). With the loss of enough bone, it becomes difficult or impossible to anchor traditional implants. Ordinarily, bone grafting is the only way to reestablish enough bone volume to anchor traditional implants – this procedure is costly, time consuming, can require multiple treatment rounds, and, worst of all, STILL has a high rate of failure! Zygomatic implants require fewer clinical visits, can result in immediate dental function for the patient, and can allow prosthetic teeth to be fitted directly following the procedure. If you have exhausted options to relieve your dental discomfort and embarrassment because you have been told that you don’t have enough upper jawbone volume for traditional implants, then you may be a candidate for zygomatic implants.

“Zygomatic implants require fewer clinical visits, can result in immediate dental function for the patient, and can allow prosthetic teeth to be fitted directly following the procedure.”

HOW DOES THE ZYGOMATIC IMPLANT PROCEDURE WORK? After a thorough examination using advanced imaging technology, the most structurally sound location(s) for placement are identified.

This technology creates the most accurate surgical plan to allow for the quick and safe placement of multiple implants in a single session. Such accuracy also helps to minimize the risk of post-operative discomfort and

other complications. The zygoma implants themselves are placed at an angle in the upper jaw to firmly anchor into the cheekbone.

Being longer than traditional implants, zygoma implants anchor at a much greater depth, ensuring a more secure fitting. In as little as 24 hours – or LESS! – a patient can be ready for the placement of a temporary full arch of teeth.

DOES THE PROCEDURE HURT? Minimizing discomfort is a foremost concern for any dental surgeon. For this procedure, patients are placed under monitored I.V. sedation by a board-certified anesthesiologist: you come in, you go to sleep, and you wake up with the procedure completed. Most patients can return to work in 1-2 days.

WHY DR. KAPLANSKY? Innovative procedures require innovative doctors. Dr. Igor Kaplansky is a very experienced implant dentist who has been placing and restoring dental implants for 20 years.

Committed to his craft, he has not stopped furthering his knowledge ever since he first became a dentist. He regularly attends continuing education courses, both nationally and internationally, to ensure that he is always at the forefront of advancements in dentistry.

With Dr. Kaplansky, you are in expert care.

_______________________________________ Dentistry by Dr. Kaplansky was founded in 2002 and is located in Gasport, NY. Dr. Igor Kaplansky graduated cum laude from The University at Buffalo School of Dental Medicine in 1998. He built his current, 6,500sq/ft office in 2007 and expanded it in 2019 to become one of the most advanced offices of dentistry in WNY.

SPECIAL PROMOTION

2019 FACES OF WNY MEDICINE

THE FACE OF

EMERGENCY MEDICINE

Mercy Flight is proud to welcome two new team members, both of whom have made a recent return to Buffalo. UBMD’s Dr. Kaori Tanaka has assumed the role of System Medical Director, providing oversight and guidance for Mercy Flight’s clinical operations. Matthew Randall is returning to his childhood hometown to lead the organization’s clinical team as the new Director of Medical Operations.

To learn more about Mercy Flight’s nonprofit mission, visit www.mercyflight.org.

Photo by Stephen Gabris

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MENTAL HEALTH AND SUBSTANCE USE TREATMENT: WE ARE HERE TO HELP. How do I know if I need help?

More times than not people needing treatment know something doesn’t feel right. Fear tends to inhibit taking the next step. Learning is a process and not an event. You will be the voice and the decision maker in your own care.

If I am ready for treatment, what would that look like?

ANNE D. CONSTANTINO PRESIDENT & CEO

HORIZON HEALTH SERVICES ABOUT • One of the area’s largest and most comprehensive providers of recovery and support services for adolescents, adults and families affected by mental health and/or substance use disorders • Not-for-profit founded in 1975 serving Western New York • Voted a “Best Place to Work” in both Western New York and New York State for eleven consecutive years • Together for Recovery. Changing Lives.

Saving Lives.

CONTACT Admissions Specialists: 716-831-1800 horizon-health.org LOCATIONS Locations in Erie, Niagara and Genesee Counties.

Substance use and mental health conditions are treatable. Treatment includes being seen by a trained clinical team who will assess, diagnose and make treatment recommendations including medication options.

Who do you treat at Horizon?

Horizon works with adolescents, young adults, adults, veterans, first responders and families in need of mental health and/or substance use treatment.

Do you often see young people struggling with alcohol/drug use, depression and anxiety issues?

Which problem is primary and what treatment would be most effective?

Alcohol and/or drug abuse and mental health disorders such as depression or anxiety can occur at the same time. These are called “co-occurring” disorders or “dual diagnosis”, and reflect two distinct problems with unique symptoms. However, these separate problems can affect each other and the treatment and recovery process. It is important to note that while mental health issues and substance use issues may be linked, one does not necessarily cause the other. The first step is to obtain a comprehensive assessment for your loved one. The most effective treatments for co-occurring disorders address both the symptoms and the core causes, as well as ongoing risks and patients and their families developing the strategies and skills necessary for recovery.

The treatment team should include doctors and therapists who can assess and work with your

loved one to develop a comprehensive plan for treatment. These professionals will support you and your family member’s continued healing and growth. You will learn to better understand and regulate your feelings, practice healthy behaviors and develop a strong support system. Although both mental health and substance use disorders present significant challenges, people can and do recover.

With so many treatment providers out there, what should we be looking for and how do we know if it’s the right fit?

Selecting quality behavioral healthcare treatment for a loved one requires careful attention. Organizations may provide treatment in a variety of settings including outpatient, inpatient, residential, partial hospitalization, day treatment or online.

It is important to focus on the key indicators of their effectiveness including appropriate licensing, reputation, quality of care, available follow-up services, and staff credentials and training.

A quality treatment substance use program not only targets drug use, it also addresses the emotional pain and other factors that contribute to the addiction. Note also that, regardless of how long a patient may participate in a treatment program, long-term support and follow-up are crucial to recovery.

The bottom line is - don’t give up! You and your loved one deserve the best possible treatment.

A good treatment program should be dedicated to providing respectful care - with collaboration between the staff, patients and their families – that is rooted in the belief that recovery is possible for everyone. _________________________________________ Horizon provides progressive, innovative and proven services for both individuals and their families.

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MEDICINE IN WNY 2019

THE DANGER OF CONCUSSIONS And how proper protocol can protect our student athletes

by Lisa Littlewood

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between one-point-seven and three million sports- and recreation-related concussions occur, and half of them go undetected or, worse, unreported. That number encompasses both professional and student (through college) athletes, and represents a sharp rise in the number of concussions making their way into doctors’ offices and emergency rooms. Among children and youth ages five to eighteen, football is the number one concussion-risk sport, followed by—in no particular order—hockey, soccer, basketball, lacrosse, and cheerleading.

A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head or body that causes the brain to move rapidly back and forth. This sudden movement can cause the brain to twist in or hit the skull, which can effect chemical changes in the brain or damage cells.

While people can agree that sounds serious, concussions often go untreated because of lack of awareness of symptoms at time of injury, particularly because the symptoms can be ambiguous.

Although concussions sometimes cause a loss of consciousness, most do not; as a result, people can EACH YEAR,

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MEDICINE IN WNY 2019 Neurologist Dr. Osman Farooq and neurosurgeon Dr. Renee Reynolds stress that parents, coaches, and teammates must be vigilant about head injuries.

have a concussion and not realize it. To complicate matters further, student athletes are often afraid to admit that they might be hurt or that something feels “off ” for fear of letting teammates down.

Dr. Renée Reynolds, pediatric neurosurgeon with University at Buffalo Neurosurgery, Medical Director of Pediatric Neurosurgical Outreach and Education at Kaleida Health, and Vice President of PUCCS (Program for Understanding Childhood Concussion and Stroke), has been trying to raise awareness of the dangers of concussions. In her various roles, she sees kids at both ends of the spectrum: extreme patients who need emergency surgery following a head injury as well as healthy kids at schools and community events where she educates parents, coaches, and students on concussion protocol.

“It’s a challenging problem from so many angles,” says Reynolds. “Socially, kids don’t want to tell their peers that they’re not doing well, they don’t want to let their team down. They often hide what they’re feeling because they don’t want to tell their friends, but it’s not something you can act on if you’re not aware.”

The most threatening problem, Reynolds says, is Second-Impact Syndrome (SIS). This is where an athlete who has not fully recovered from a first concussion—either because they didn’t realize they had one or ignored the symptoms—incurs another. Outcomes for second concussions can be substantially worse than for the first, in some cases causing severe brain damage, long-term effects on mental health, even death.

Because Dr. Reynolds has seen the worst scenarios, advocacy and education about signs and symptoms, as well as proper post-concussion care has become a passion for her. “We’re not trying to keep kids out of sports,” she says. “We just want them to play in a safe manner. We have

two mottos. Number one is, ‘If you see something, say something’, and that goes for everyone. The coaches, teammates, even parents in the stands. If something doesn’t look right to you, make sure you say something and have that player evaluated. The second motto is ‘It’s okay to not be okay.’ This one is more for the students. It’s okay to miss that one practice or that one game to make sure things are okay before returning to play.”

Dr. Osman Farooq, a neurologist with UB Neurology, advocates the same principles. As a neurologist, he is often one of the first physicians to see a student after a concussion. Many young people, he says, are hesitant to admit the severity of their symptoms or injury because they don’t want to miss play time.

“The example I give to my patients is that of a professional athlete,” he says. “After a hit to the head, they are paid to sit out because if they continue to play, they can worsen the injury. If they have a second injury before they recover from the first, it could be the end of their career, so it’s very important to take the time to recover.”

Local and national efforts to raise concussion awareness include a law passed on September 2 by New York Governor Andrew Cuomo. Beginning in December, the law will require all tackle football programs to provide parents or guardians of participating children with informational packets regarding concussions and the injuries that can result from receiving sub-concussive blows.

Doctors hope this is just the beginning of ongoing efforts to provide the parents of students in all impact sports with the information they need to keep their kids safe.

Concussion protocol

The Centers for Disease Control and Prevention (CDC) released updated concussion protocols just

PHOTOS BY NANCY J. PARISI

Student athlete concussions continued

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last year, in September 2018, which are now used to guide medical treatment across the country, but also to inform athletic teams—from Little League to the National Football League—how to accurately watch for and treat a player who is showing signs of a concussion. Here’s a summary: Be aware

Whether you’re a coach, teammate, or parent, if you see a hit and notice the player isn’t acting normally afterwards, say something. Documenting, assessing, and monitoring the first hit is paramount to preventing Second-Impact Syndrome.

Speak up

When you notice something, say something. The NFL now requires spotters on the field, as well as in the review room, watching film to make sure nothing is missed; your kids deserve no less. If something looks off, or a child is feeling off, don’t brush it off. Tell the coach the player should be pulled and evaluated.

Take action

Players exhibiting extreme symptoms, like vomiting, severe dizziness, loss of consciousness, etc. should be taken directly to an emergency room for evaluation. For less severe symptoms, players should still be pulled until they can visit their pediatrician or local neurology or concussion facility.

Dr. Farooq started the UB|MD Pediatric Concussion Clinic to fast track patients who have suffered concussions directly into proper care (see sidebar for contact information). Several years ago, Dr. Farooq noticed how complicated and time consuming it could be for families to navigate head injury care from the ER to proper neurological follow up. He now tries to get patients in for follow-up care within three days of a head injury.

Follow proper “return to play” protocol

There is a specific six-step return to play model that the CDC recommends for injured athletes.

The steps include slowly returning to regular, non-athletic activities (like school), and gradually working a player back into workouts with noncontact type exercises like light jogging, stationary biking, and weight training. A detailed list can be found on the HEADS UP page at cdc.gov, an excellent resource for concussion information.

The steps are intended to be met in succession, and a student should be monitored carefully for a return of symptoms along the way. After navigating all six steps, athletes should always be formally cleared by a medical professional before returning to competitive play.

HOW TO SPOT A CONCUSSION is an important directive in concussion protocol, but what exactly are you looking for? The effects of a concussion are usually temporary, but can include headaches, as well as problems with concentration, memory, judgment, and balance.

“ I F Y O U S E E S O M E T H I N G , S AY S O M E T H I N G ”

According to the Centers for Disease Control and Prevention, the most common symptoms observed and reported (though there can be others) are:

Observed • • • • • • • • •

Can’t recall events prior to or after a hit or fall Appears dazed or stunned Forgets an instruction Is confused by an assignment or position Is unsure of the game, score, or opponent Moves clumsily Answers questions slowly Loses consciousness, even briefly Shows mood, behavior, or personality changes

Reported • • • • • • •

Headache or “pressure” in the head Nausea or vomiting Balance problems, dizziness, double or blurry vision Bothered by light or noise Feeling sluggish, hazy, foggy, or groggy Confusion or concentration or memory problems Just not “feeling right” or “feeling down”

Signs and symptoms generally show up soon after the injury.

However, you may not know how serious the injury is at first and some symptoms may not show up for hours or days. It’s best to pull and observe an athlete who has suffered a hit.

What is a concussion protocol?

Concussion protocol is an agreed upon plan for managing concussions, from pre-activity education to return to play policies. For more information about education, precautions, and protocol, call these centers: UB|MD Pediatric Neurology Clinic (started and facilitated by Dr. Osman Farooq) 716-932-6080 Dent Neurologic Institute 716-250-2000 UB Concussion Management Clinic 716-204-3200

— L.L.

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MEDICINE IN WNY 2019

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In addition to commercial space and apartments, the Trico reuse includes a hotel that will provide short-term stays for visiting medical researchers.

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WHAT’S NEW DOWNTOWN

BNMC and Roswell lead the charge toward a stronger medical community

by Nancy J. Parisi

ROSWELL

PHOTO BY NANCY J. PARISI

CENTER,

PARK

COMPREHENSIVE

CANCER

celebrating its 121st anniversary, began with three rooms as the NYS Pathological Laboratory at the University of Buffalo medical school led by forward-thinking Dr. Roswell Park, surgery professor and chair of the medical school.

Today, it’s a twenty-eight-acre site that includes a hospital and specialized research labs as part of the 120-acre Buffalo Niagara Medical Campus (BNMC) bordered by Main, North, and Goodell Streets, and Michigan Avenue.

Roswell’s international reputation has earned it the designation of “one of the nation’s elite comprehensive cancer centers” by National Cancer Institute (NCI), the principal federal agency for cancer research and training. It’s the only NCIdesignated New York state cancer hospital outside of downstate and, on its list of Best National Cancer Hospitals for 2019-2020, U.S. News & World Report ranked Roswell Park #14.

Since 2015, Roswell’s President and CEO has been Candace Johnson, PhD, recently named by City & State New York multimedia news organization as one of its inaugural Health Care Power 50, citing her “joint trip to Cuba with Gov. Andrew Cuomo to advance research on a promising lung cancer treatment developed on the island.” Johnson is the first woman to lead the cancer center and the only female leader of a free-standing comprehensive cancer center in the country.

“I believe in the culture of positivity,” says Johnson. “It may sound trite but, in life, the more positive you are about your situation, the happier you’ll be. My positivity helps people who work for me be positive and you can feel that optimistic view here at Roswell Park. And if you’re a cancer patient that’s hope, the hope we have for every patient who walks through those doors that they’re going to get treated and walk back out of those doors, cured of their disease.”

Roswell attracts patients from all over the world for some of its specialized treatment. “We have a brain tumor vaccine. And Dr. Odunsi, the deputy

director of the cancer center [and Roswell Park’s Department of Gynecologic Oncology Chair] is a specialist in ovarian and GYN cancers and he has patients from South America who come here once a month to be treated,” she says.

“And we are the only hospital with Cimavax, the [lung] cancer vaccine from Cuba.”

These immunotherapy drugs are among the newest cancer therapies. “One of the approaches is using CAR T-cells. These are T-Cells that are activated, specialized cells that fight the cancer,” Johnson explains. “We are one of a handful of centers around the country–I think it’s twenty centers–that can give Car T’s to patients. We’ve been giving CAR T cells for about a year for lymphomas and leukemias; where conventional therapies don’t give you much hope, there are cures with Car T. We have a big immunotherapy program now and we’re designing our own Car T-cells. For example, Car T-cells that we have specifically developed for multiple myeloma, another disease that’s difficult to treat. You can keep folks with that chronic disease alive, but sometimes the quality of life is not great; the real hope is that Car T may actually treat that disease.”

Johnson is quick to note that it was the Center’s belief in immunotherapy that made these life-saving advances possible. “Four or five years ago, when immunotherapy was just starting to come into its own, there were many skeptics saying that this was something that we should not invest in, but we wrote a grant to the NCI to help fund some of this and we raised some philanthropic dollars and in one of our lab buildings across the street, we built out a floor that houses production facilities to manufacture the T-cells used for this immunotherapy,” she says. “Some would say it was risky to build it because we didn’t know if immunotherapy was going to make an impact, but we believed it would. One of the reasons we were able to capitalize on it and make this program so rapidly is we already had the facility available.”

As one of fifty-two NCI-designated centers, Roswell collaborates with the others to ensure treatments are available to all patients. “We will send a patient somewhere else if they need

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What’s new downtown continued

The BNMC hasn’t just boosted Buffalo’s medical reputation, it’s also proven a boon to the city.

Below: Dr. Lindsay Linpinski, a new neurology hire.

a treatment that we don’t have, or we might not have to send them if the drug can be sent from another cancer center,” she says. “Besides the absolute incredible care that you get here, you get the advantage of all the brains of cancer researchers around the country.”

Increasingly, the best of those are at Roswell. Top doctors and researchers are always attracted to center and, since 2015, Errol Douglas, Senior V.P./Chief Human Resources Officer at Roswell Park Comprehensive Cancer Center is the one tasked with finding them. “We have an average of about 200 opportunities at any given time, and it can be as high as 300 openings and that doesn’t necessarily include physicians or scientists,” says Douglas. “We’ve been growing for the past three fiscal years, about 100 employees a year. We’re at just over 3,500 employees right now. For our size and our market, we are a giant in terms of name recognition and, more importantly, our advances in cancer work. We hire the best of the best from all over the world.”

One of the center’s newest recruits is new Chair of Dermatology Dr. Oscar Colegio, a Yale School of Medicine graduate who has a research program focused on melanoma and skin cancers.

Another newcomer is neurosurgeon Dr. Lindsay Lipinski, who after a six-year neurological surgery residency at the University at Buffalo and training Roswell Park in neuro-oncology, then served in the Navy for four years. She and her family returned to Buffalo in May of 2019 for her new job at Roswell. “[Neurology] is an exciting field to be in because there are constant changes and constant development in terms of diagnosis and treatments,” says Lapinski. “Imaging modalities are becoming higher and higher tech in smaller spaces, with better pictures, allowing us to diagnose disease earlier. The resolution is so fine on

PHOTOS BY NANCY J. PARISI

Bringing in the best

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PHOTO COURTESY OF ROSWELL PARK COMPREHENSIVE CANCER CENTER

BNMC spurs urban development

Meanwhile, he University at Buffalo Medical School and Children’s Hospital are drawing major development, including The Grid, a $35 million multi-use project north of SummerBest that is intended to draw medical students and staff to its 200 apartments, and, south of Best at 1091 Main, a new medical office from Ellicott Development. The six-story building without a nickname is going to have 167,000 square feet of office and retail space with underground parking for fifty cars. Downtown, it’s hard to miss the repurposing-in-progress of the former Trico plant: an $87 million project that is slated to be completed in 2021. Included will be 200 apartments, commercial space, and a hotel intended to serve short-term extended stays for visiting medical researchers and innovators.

This is just a sampling of what BNMC is generating. “Here is an interesting number,” offers Matt Enstice, President and CEO of BNMC, who oversees what’s happening at Innovation Center, dig, and the 120 acres that comprise the medical campus, home to 150 public and private business ventures. “Since 2012, forty percent of new building permits pulled in the City of Buffalo are within a one-mile radius of the BNMC and that does not include Roswell park or UB Medical School because they don’t have to pull permits. We are lighting the fire and the community is making these investments: the ‘build it and they will come’ adage is true.”

More than that, BNMC employs 16,000 people within 140 mature and start-up companies. “Buffalo is on the cutting-edge of innovative districts, the group of fifteen innovative districts from around the world are meeting in November, and I will be there representing BNMC,” says Enstice, who serves on the steering committee for the Global Institute on Innovation Districts. “People are looking at what we are building here; this is all opportunity for Western New York.”

DUCKS EASE KIDS’ FEARS

“ L E T ’ S TA L K A B O U T T H E D U C K S ! ”

says Roswell Park President and CEO Candace Johnson about the My Special Aflac Ducks developed to comfort kids with cancer. “Aflac wanted to do something for kids with cancer. When kids have cancer, they have these little ports where chemotherapy is delivered.

It’s hard for the parents to go through that period with their child; it’s a pretty traumatic experience.”

The Aflac ducks, about a foot tall, have their own small ports.

Through RFID-enabled emoji-printed cards, a child can prompt the computer inside the toy to express emotions like happy, scared, nauseous, and sad. “The Aflac CEO was here today, and said that a perfect example of how the duck works is that they just saw a child who had to have chemotherapy and just the sight of the needle coming towards his port made him start screaming,” Johnson shares. “So they held out the duck and said ‘Let’s give the duck chemotherapy,’ and they gave the toy his [pretend] chemotherapy. The child held onto the duck and became calm so that the medical staff was able to give him his chemotherapy.

“We had all these little children sitting in the front row of the auditorium and they came up to see the duck, play with the duck, they were enthralled,” she continues. “It was touching and moving to watch these kids interacting with this duck. Congressman [Brian] Higgins was here today. Today, we had six children but every child patient here will get a duck that they get to take home. Aflac said, ‘You can have as many ducks as you want.’”— N.J.P.

BUFFALOSPREE.COM

the MRIs now, showing us more details so we can treat metastatic diseases in the brain at a very early stage where previously you might not have even seen that the disease was there.”

Lipinski talks about the tools of her trade (Gamma Knife, MRI’s, PET scans, and CT perfusion, an emerging imaging tool that shows circulation and lesions), but is obviously excited about newer one in particular: the ORBEYE, that allows her to do “big screen surgery,” as Olympus, the company that developed the imaging technology, calls it.

“It’s microscope meets endoscope, a visualization aid with lighting that allows me to see in 3-D, and so you wear 3-D goggles in the OR and look at screens and the camera comes in over your shoulder so you can visualize the tumor,” she explains.

“On the screen, the tumor is huge but, in reality, it is teeny-tiny.

The ORBEYE is relatively new, and you have to do training and simulation sessions to get a sense of what it’s like to operate in 3-D. We are still learning the best applications for it.”

Johnson also discusses soon-to-be changes to the Roswell Park lobby, how the restructuring will mean that the welcome/ information desk that “wasn’t in the right place” will be moved closer to the front doors. There will be more comfortable seating areas in the lobby, the lobby sculpture will be moved outdoors (where it was originally intended), and the piano will be on a new platform. The entire area is getting new tile flooring to replace the carpeting, which is difficult to maintain in winter.

“Roswell has a different feel to it,” Johnson says. “We focus more on the patients over the past five years than we ever did before. We’re always trying to improve.”

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CHANGING THE ARCHITECTURE OF HEALTHCARE - by Allita Steward Why did you get involved in healthcare? What compelled you to pursue your own medical practice?

Dr. Raul Vazquez, M.D. ABOUT • Board Certified and a Fellow of the American Academy of Family Physicians • Associate Clinical Professor (State University of New York at Buffalo’s Department of Family Medicine • Member of the NYS Medicaid Advisory Committee • Member of the NYS Department of Health, Office of Minority Health Council • Treasurer for Medical Alumni Association (State University of New York at Buffalo, School of Medicine) • CEO of G-HEALTH Enterprises (Greater Buffalo United Accountable Health Network and Greater Buffalo United Accountable Care Organization)

CONTACT (716) 247-5282 www.gbuahn.org LOCATIONS 564 Niagara Street, Bldg. 2 Buffalo, N.Y. 14201 1319 Jefferson Avenue Buffalo, N.Y. 14208

This was a decision shaped by my commitment to “community” in a spirit of social justice. As a child, it was apparent to me that communities of color lacked the presence of medical professionals (particularly doctors) who looked like them, who look like me. I designed GBUACO to combat disparities in representation which is a significant social barrier to quality healthcare. What began as small family practice has matured into something greater.

As an organization we hope to “change the architecture of healthcare delivery.” Equity in healthcare will be a charge that I will pursue for as long as I am able because many lives depend on it. A great deal of The evolution and longevity of the Affordable care act, makes it clear that I am not alone in this journey toward equity and that other health care providers share a similar mission and “calling.”

The Medical field is growing exponentially in Western New York. From the expansion of the Medical Campus to the popularity of assisted living facilities the choices are overwhelming. How would the average person go about selecting a physician, specialist or facility best suited to address a particular ailment or procedure?

I get asked this question quite often because of the breadth of medical conditions and the scope of treatment options. Fortunately, for patients and practitioners alike, Greater Buffalo United Accountable Care Organization (GBUACO) is currently developing an independent rating model similar to what one would expect from Consumer Reports. However, our model moves beyond a compilation and comparison list, to present a more in-depth

and expansive resource guide. This is because our organization has set the pace for data gathering and collaboration among the area’s top medical professionals with the use of Artificial Intelligence to make identifying the right medical professional easy for patients and families. This empowers patients and grants them control of their health. It’s what we do at GBUACO. This is the future of healthcare because we understand that those closest to the pain should be closest to the power.

How does GBUAHN compare to other area healthcare organizations?

We are a new company but we are certainly not fledgling as innovation and quality drives everything we do. GBUAHN is a designated NYS Health Home with a primary care focus.

It was awarded a three-year NCQA Accreditation for Case Management with a near perfect score of 97%. Even more significant is that GBUACO was the first New York State approved Medicaid and Commercial ACO. The ACO was one of a small group of pilot initiatives that New York State allowed to expand the breadth of New York State Accountable Care Organizations and is one (1) of only four (4) ACO’S accredited by the NCQA in the country.

G-Health has expanded its regional presence with the purchase of 1195 Main Street on the Buffalo-Niagara Medical Campus. The location allows the company to advance its Strategic Expansion Plan which focuses on four (4) key areas: 1) Economic Development, 2) Job Creation, 3) Training in High-tech Medical Careers, and 4) Introducing Advanced Artificial Intelligence (A.I.) in Healthcare.

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MEDICINE IN WNY 2019 Dr. Jarod Masci offers Transcranial Magnetic Stimulation (TMS, a treatment for medication resistant depression.

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COMPREHENSIVE AND CREATIVE MENTAL HEALTH CARE

PHOTO COURTESY OF LANDMARK HEALTH SYSTEMS

Allentown’s Landmark Health Systems prioritizes the individual

LANDMARK HEALTH SYSTEMS is a private mental health practice offering an array of individual services. Located in the historic Allentown District’s gorgeous Florentine Building, Landmark’s visionary approach to mental health care echoes the neighborhood’s creative aesthetic.

President and CEO Dr. Jarod Masci and his team have curated a relaxed and caring environment to put patients at ease from the moment they walk through the door. The unobtrusive, soothing atmosphere is a far cry from the white-walled sterile environment typically associated with modern, high-tech health care, but be assured that Landmark is cutting edge in its mental health offerings.

Dr. Jarod Masci is a board-certified psychiatrist and addiction specialist. After observing individuals delaying mental health care because of discomfort or fear, he was inspired to establish a practice that could transcend this resistance. “I wanted to create a space that merged the latest therapies with the old-fashioned approach of listening to patients and working with them to develop a personalized treatment plans,” explains Dr. Masci. The idea is that encouraging patients to actively participate in their treatment will increase their chances of remission.

Given the complicated nature of psychiatric care, mental health treatments are often limited to conventional therapies. Landmark Health Systems prioritizes evidence-based medicine to help patients navigate their illnesses. Its core belief is that everyone deserves progressive medical care delivered with dignity and respect. Dr. Masci prides himself on discouraging the “one size fits all” model, and this

goes beyond just the treatments. “Details matter,” he maintains, “and I’ve worked hard to renovate this space to emanate comfort, safety, and confidentiality to empower our patients. It is difficult to ask for help, so the least we can do for our patients is to make our office as friendly and accessible as possible.”

This philosophy is the driving force for Dr. Masci’s diverse and hand-picked treatment team, a diverse group of mental health professionals who work together to provide psychiatry and psychotherapy, Neurostar Transcranial Magnetic Stimulation (TMS), access to newly approved medication therapies such as Spravato esketamine nasal spray, trauma counseling including Eye Movement Desensitization and Reprocessing (EMDR), genetic testing with personalized medication consultations, comprehensive substance use disorder treatment, medical marijuana certification and treatment assistance, nutrition and weight loss consultation, and much more. Dr. Masci continues to cultivate the best team of mental health care providers, medical professionals, and support staff to combine traditional and progressive treatments that support his belief in individually customized care.

Transcranial Magnetic Stimulation (TMS) is a treatment for medication resistant depression available at Landmark and only two other area clinics. This non-invasive procedure stimulates a targeted area of the brain thought to be less active in depressed patients. Each session takes less than thirty minutes, has minimal systemic side effects, and is safe for nearly all patients. It is one of the safest options for pregnant women, who often choose to stop taking antidepressants upon learning of their pregnancies, as they can be harmful to both mother and fetus.

TMS is approved by the Food and Drug Administration (FDA), therefore billable to insurance and often covered completely.

Landmark Health Systems also introduced WNY to Spravato (esketamine), a novel option for treatment resistant depression. The first in a new class of antidepressants, Spravato is a nasal spray approved by the FDA in March 2019. Clinical psychiatric pharmacist Maria Janda Pharm.D. established this program to increase resources for depression treatment.

“I was excited to have the opportunity to use my expertise to help patients by providing them with access to a new antidepressant,” she says. “Pharmacists are an underutilized

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professional resource for providers. I am fortunate enough to be working with such amazing mental health professionals who appreciate what I offer.�

Dr. Janda also established the Medical Marijuana Consultation program where one-on-one she helps to educate patients on the products available and guides their therapy while monitoring and minimizing drug-drug interactions.

Landmark Health Systems is also at the forefront of the opioid epidemic. One of the first programs Dr. Masci started is the Medication-Assisted Treatment (MAT) program. What started as a small operation has grown into an all-encompassing subspecialty clinic. Rose Duggan BSN, RN, Director of Personnel and Marketing, helps coordinate opioid replacement therapy, cognitive behavioral therapy, and psychotherapy, working one-on-one with patients to ensure their care is being managed in a comprehensive and customized manner.

Duggan prioritizes accessibility for the community in need, regardless of circumstance or income.

Her exhaustive efforts have resulted in the MAT program becoming one of the most affordable in the area, while still providing individualized, compassionate care.

Landmark’s Psychotherapy Program is led by Vice President Kelly Ghani LMHC and consists of mental health counselors, psychologists, and licensed social workers. Therapists are the lifeline of the practice and work closely with other providers to offer patients the well-rounded, personalized care.

Each therapist brings their own unique experience and skill set, which gives patients options for and control over their mental health care experience.

Clinical psychiatric pharmacist Maria Janda, Pharm.D.

Dr. Masci and his hard-working team promise to offer the best evidence-based medicine and creative practices in a welcoming environment.

They are excited to be growing and evolving with each new program and are looking forward to serving Western New York for years to come.

If you are interested in any of the programs mentioned here, or would like to discuss treatment options, please call the new patient line and the dedicated administrative team will be happy to answer your questions.

The Landmark lobby eschews clinical decor in favor of a warm and welcoming non-traditional environment.

PHOTOS COURTESY OF LANDMARK HEALTH SYSTEMS

MEDICINE IN WNY 2019

2019-2020

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Dr. K Kent Chevli was the first in our region to employ a new prostate cancer diagnostic, Multiparametric MRI, which helps identify cancers in need of urgent treatment.

ON THE CUTTING EDGE Local innovations in medicine

by Kathleen Rizzo Young

NEW TEST IDENTIFIES MOST DA N G E RO US P R O S TAT E C A N C E R

Prostate cancer is the most common form of cancer in men and the second leading cause of cancer-related deaths in men. Approximately forty-five percent of men biopsied have prostate cancer, but only about a third of them have significant cancer that requires treatment.

But how do urologists determine which patients are which?

Dr. K. Kent Chevli, MD, Chair of the Department

of Urology at the Jacobs School of Medicine and Biomedical Sciences and is president of WNY Urology Associates, has seen tremendous strides in this arena. He explains that, traditionally, the first step in diagnosing prostate cancer is a twopronged test-a PSA blood test and digital rectal exam; if one of those proved abnormal, a biopsy was ordered. This unfortunately resulted in over-biopsying, as many of the test results were negative or showed cancer levels so low as to not require treatment. This led urologists to seek more specific ways of determining which patients faced serious health threat.

The solution was an additional step between the PSA blood test and the biopsy, a special form of magnetic resonance imaging called a Multiparametric MRI (MP-MRI). This procedure isolates spots within the prostate that are not only cancer but are also the more aggressive form. When the test identifies such spots, the urologist and radiologist they perform a “fusion biopsy” using an MRI and ultrasound technology.

“The most important thing is to diagnose the cancers that are most likely to be lethal,” explains Dr. Chevli. “Utilizing this technique, we are able to identify two out of three of the men with significant cancers.”

PHOTOS BY STEPHEN GABRIS

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On the cutting edge continued

The test was original developed by the National Cancer Institute but Dr. Chevli was an early adopter and has helped Western New York stay ahead of the curve and made the procedure standard of care here, which is unfortunately not true of the rest of the country. Chevli was the first in the region to use the technique in association with Great Lakes Medical Imaging and has now been using the procedure for seven years, making his Harlem Road practice the most experienced in the nation at performing the MP MRI. As a result, WNY Urology and Great Lakes Medical Imaging currently have one of the largest databanks of MP MRI test results from men in the nation.

With prostate, bladder, and kidney cancer being among the most prevalent, it is not surprising that urologists diagnose twenty-five percent of all non-skin cancers. Given this, Chevli is committed to promoting the efficacy of the procedure by publishing his findings in medical journals and making presentations at conferences to urologists and students.

“Oncology is a huge part of urology training,” explains Chevli. “It used to be that we would identify aggressive prostate cancer too late in patients. Now we find it in the earlier, more curable stages.”

Praxis helps bring new drugs to market

We’ve become accustomed to the pharmaceutical advertising that pervades television, magazines, and the Internet, and turns foreign-sounding names like Chantix, Cialis, and Dilantin into household words.

But before ads can be created for new drugs, the Buffalo company Praxis plays a significant role in their approval.

Praxis was founded as a start-up in 2002 and originally based in Nashville, before Buffalo’s Crowley Webb—the company’s marketing arm from the beginning—acquired it in 2010 and moved the headquarters to Buffalo. From here, Praxis (gopraxis.com) works with the world’s leading pharmaceutical and biotech companies including Lilly, Takeda, Merck, and Sanofi, to bring drugs to market using non-traditional methods to identify prospective patients for clinical trials.

Once a pharmaceutical company has identified a drug or treatment for trial, Praxis determines a strategy to recruit participants. Patient centricity is critical, notes Praxis Senior Vice President and Managing Director Tricia Barrett, who has been with the company for sixteen years. “We want to get to know the patients’ struggles, barriers, and challenges,” she says. “We do this through comprehensive analytics and primary research, sometimes talking to patients directly, but also through social listening, support groups, forums, and patient advocacy groups.”

With an understanding of both the disease and those dealing with it every day, the company is in a much better position to create a campaign to reach and connect with them through a variety of vehicles—paid and digital media, as well as outreach to influencers, health care advocates, support groups, and associations specializing in the specific

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On the cutting edge continued

ailment or condition. The industry is guided by strict regulation and there can be no coercion or promises made to the participants, who are not only compensated for their participation in the trials, but also receive the drug/treatment at no cost.

Compensation is often beneficial to those whose afflictions have rendered them unable to work. The pharmaceutical companies have become more accommodating, as if they have no patients, their drugs will not get to market.

Understanding that participation might require time off from work, some companies have begun offering evening and weekend hours, home visits, and transportation to make it easier for patients to take part.

Locally, Praxis has conducted trials with local hospitals and healthcare providers such as Roswell Park Cancer Institute and Dent Neurological Institute. It has also recruited students from the University at Buffalo School of Pharmacy and MBA programs to review the scientific research and translate it into everyday English in order to communicate to prospective participants what the study’s goals are and why someone would or would not want to sign on.

“We are marketers, not scientists, but we have to review a lot of scientific protocols for these trials,” says Barrett. It is especially important to communicate trial information to those suffering from rare diseases, as there may only be a single person in a community or region with that particular condition. In these cases, the online community is a lifeline, connecting these individuals with fellow patients, message boards, discussion groups, and advocates.

Transcatheter Aortic Valve Replacement, or TAVR, can replace diseased aortic valves in patients too sick to undergo traditional open-heart surgery.

The Buffalo headquarters also handles international trials, overseeing the translation and fulfillment of marketing materials and ensuring that they are culturally appropriate.

Crowley Webb is the engine behind the marketing work and each campaign is customized for the product and the clients. The agency has always had a strong reputation for its creative work but has expanded its focus to become more science based since bringing Praxis in-house, with data and insight leading the way toward better creative and more effective results.

Barrett says that the company believes that its other agency clients have also benefited from their Praxis work, because “we can now use our heightened data/analytic capabilities to prove what is working.”

To date, Praxis has supported over 400 clinical trials, a number of which have resulted in new drugs coming to market, including some of the most wellknown treatments for conditions like endometriosis, rheumatoid arthritis, and depression.

For years, patients could only find out about clinical trials through their doctors. Now, many patients have become empowered to research alternative treatments and to serve as their own medical advocates. Clinical trial participants who were once viewed as “guinea pigs” are empowered and proactively seek possible cures and treatments. Awareness is a major challenge as people tend not to be aware that clinical trials are available. For example, only three percent of cancer patients have participated in a clinical trial while eighty-five percent are unaware that they could participate. Barrett sees this as a challenge for the entire industry.

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The time-saving Soterogram prevents physicians from having to send patients to another doctor for testing, which only delays results. No referral is needed and a primary care physician can do it in the office in fifteen minutes.

Currently, the machines are being used in New York City, South Florida, and California, and Bonk would like to see it adopted nationally and globally.

Over 800,000 people in the United States die of cardiovascular disease each year.

Redwood Valuation, which is doing Sotere’s valuation, was integral in the launches of Fitbit and WhatsApp, and Bonk believes that part of the Soterogram’s appeal lies in its prospective cost model: New device from 43North finalist takes “Our test costs between $200 and $400 compared to on the “widowmaker” a coronary incident which runs about $50-80,000.

43North, Buffalo’s successful startup competition And when you compare it to other tests that identify and accelerator program that invests millions in disease with the same level of accuracy, such as growing ventures, has brought a number of medical angiograms, MRIs, or CAT scans—we are a fraction inventions to the forefront since launching in 2014. of the cost.”

For example, one of the 2019 semi-finalists was a diagnostic device from Sotere Medical Solutions.

Sotere (from the Greek word for deliverance and preservation from harm) was purchased in April by Lee Caldwell, who has expertise in valuing medical practices, devices, and medical manufacturing companies. When she was considering investing in the company, Caldwell asked David Bonk, a CPA who did stints at Buffalo General and Kaleida, to take a look at it. Once she bought it, she named Bonk CEO; the South Buffalo native and lifelong Buffalonian has a thirty-year career in finance, healthcare, TAVR—a new option for elderly heart patients The Soterogram represents an exciting and healthcare informatics and is immediate past president of the Healthcare Financial Management development for those unaware they have progressive heart disease. But what happens when Association (HFMA).

Because of his background, Bonk understands the someone diagnosed with heart-valve disease is not cost pressure on physicians and insurance carriers a candidate for surgery because of age or other to find more accurate diagnostic tools and to reduce health conditions? A procedure being done at the costs. Enter the Soterogram, which allows for early Catholic Health Heart Center has seen positive detection of cardiovascular disease by detecting the results.

In 2011, the U.S. Food and Drug Administration early progressions of atherosclerosis when it is still (FDA) approved a breakthrough non-surgical in the coronary artery.

The blockage normally starts in the big arteries heart procedure called Transcatheter Aortic Valve around the heart and progresses to the extremities, Replacement, or TAVR, to replace diseased aortic when it’s usually discovered; by then, it is advanced. valves in patients too sick to undergo traditional While the incidence of the disease has plateaued open-heart surgery. somewhat, Bonk says that it has begun to be more TAVR is most often used to treat severe aortic prevalent in younger patients, especially those stenosis, a narrowing of the valve that regulates under thirty. blood flow from the heart to the aorta, the main “When you have blockage in coronary arteries, artery that carries blood to the body. Over the past it requires expensive risky procedures,” Bonk seven years in the United States, more than 135,000 explains. “Because there is no non-invasive way to patients—mostly elderly—have undergone TAVR. diagnose the blockage, it strikes people who never “We thread a small catheter, tipped with a demonstrated any signs of cardiovascular disease. It replacement valve, through a blood vessel in the is often referred to as the ‘widowmaker’ because of leg or chest and guide it to the heart,” explains the fatal results. Forty-eight percent of those who cardiac surgeon Dr. Stephen Downing, a member die from the widowmaker had no symptoms.” of the TAVR team at Mercy Hospital. “Once in place

“The time-saving Soterogram prevents physicians from having to send patients to another doctor for testing, which only delays results.”

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The entire FDA approval process may take seven to ten years. When the trial results are determined, some pharmaceutical companies thank the participants by sharing results, in order to let them know that their participation made a difference. “I hope that is a trend that continues and expands,” says Barrett.

“These companies owe a great deal to the clinical trial participants. They make it possible for a life-saving or life-enhancing drug to come to the market.”

How important are the clinical trials? Currently, eighty-six percent fail to enroll the desired number of patients within the planned timeframe, an issue that causes costly delays in bringing a new drug to market. “If Praxis can help shorten the window to get the drug to market, that’s the altruistic reason we do what we do,” Barrett says. “Our efforts complement those of physicians and drug companies. We can’t promise a cure or that this option will work, but we can give people hope.”

54 On the cutting edge continued

across the existing heart valve, the new valve is expanded, pushing the unhealthy valve aside to take over regulating blood flow in the heart.”

The procedure has made it possible to treat aortic stenosis in patients for whom there were limited options—especially those in their eighties and nineties. Recovery is also faster than openheart surgery; patients are usually able to resume normal activities in two to three days.

Over 50,000 US patients are expected to have this advanced minimally invasive procedure this year, and projections are for double that next year. Originally, TAVR was only available to high risk patients unlikely to survive open heart surgery. Two years ago, it was expanded to patients with moderate risk and the Food and Drug Administration (FDA) is expected to approve it for all patients by this fall.

UB pediatrician invents a “kangaroo care” device

“Kangaroo care” refers to the skin-to-skin contact mothers have with their newborns, a practice that benefits both mom and baby. The evidence-based benefits include improving the baby’s ability to breathe, regulating body temperature, and promoting weight gain. It also provides long-term advantages to the baby’s cognitive and motor development while benefiting parents and boosting the mother’s ability to lactate.

Historically, premature infants haven’t always been able to experience this comfort, even though the bonding has been proven to aid even the tiniest preemies. Munmun Rawat, MD and assistant professor Department of Pediatrics at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences, has a personal passion for this issue. Her own baby was born prematurely at twenty-eight weeks and spent sixty-two days in the neonatal intensive care unit.

“My baby was just 1,200 grams (about twopoint-six pounds), but as soon as he could be held, I ‘kangarooed’ him throughout the day, holding him on my chest,” says Rawat. “When I slept at night, my husband held him on his chest. Our son was ‘kangarooed’ for twelve out of twenty-four hours a day,” she says. Today her happy, healthy son is about to turn three.

Rawat, a neonatologist at the John R. Oishei Children’s Hospital and a physician with UB|MD Pediatrics, was concerned that babies who cannot be held—due to serious medical conditions— would not be able to benefit from kangaroo care.

“I was so familiar with the benefits that I wanted all babies to have them,” she says. “It triggered

Another view of TAVR

the thought, ‘if we can’t bring baby to the mother, why not bring mother to the baby?’”

For babies too fragile to be held, Rawat conceived the idea to replicate kangaroo care with an incubator mattress that is uniquely customized to mimic the rhythm of mom and dad’s breathing, and even their voices. To bring her design to fruition, she approached the Department of Biomedical Engineering, a joint department of UB’s School of Engineering and Applied Sciences and the Jacobs School.

Students and faculty enthusiastically embraced the project.

How does it work? To start, the team gives parents a necklace made of sensors to track their breathing patterns. The data is then uploaded into the mattress, which rhythmically inflates and deflates. The vibration of the parent’s heartbeat in echoed by a mechanical pump in the mattress and small doll “sleeps” with the mom to absorb her scent and then allow the baby to become familiar with it.

“Of course, the best thing is for the parents to be in direct physical contact with their baby,” says Rawat. “But if that’s not possible, we are hoping that until that can happen, this will be the very next best thing.”

IMAGE COURTESY OF CATHOLIC HEALTH SYSTEMS

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Making strides in facial and breast restoration

by Kathleen Rizzo Young

Michael Degnan would like to establish the Buffalo Center for Anaplastology as a training center for excellence in anaplastology and prosthetics.

IN JULY,

Michael Degnan opened the Buffalo Center for Anaplastology at 1800 Niagara Street. The Black Rock neighborhood medical practice is changing lives by offering facial and breast prosthetics and anoplastology services to surgeons and their patients on both sides of the border. The services are covered by most insurance policies as medically necessary treatment.

Founder Michael Degnan grew up in Buffalo’s University Heights and North Buffalo districts.

A graduate of City Honors, he began as an undergrad in medical illustration in a joint program of the Cleveland Institute of Art, Case Western University, and the Cleveland Clinic, three prestigious institutions at the top of their respective fields. The training path reflects the fact that anoplastology is both art and science.

“Early on, I had the good fortune to do an internship with an ocularist who provided artificial eyes to patients,” Degnan says. “That shifted my focus from medical illustration into prosthetics care.”

From that work, he trained at Johns Hopkins, moving from eyes to noses, ears, and other parts of the body, and being introduced to the use of 3-D technology. He next went to London because the United Kingdom is the only location to offer the unique maxillofacial prosthetist and technologist program (MPT), which allowed him to see all of the treatment paths combined in a single role.

Degnan explains that the practice is dedicated to those with a difference in face or body.

“The difference can be caused by a congenital condition or disease,” he explains. “A patient may have born without a part of the body or have lost a part of the body through illness, accident or violence.” It is easy to understand how, in a society focused heavily on looks, facial differences can disrupt lives as individuals curtail activities to avoid unwanted attention.

Degnan has spent time in Tanzania working with victims of machete wounds and has also treated victims of violence in our own community. “I recently treated a patient who was assaulted in a bar and, in the attack, the perpetrator bit off a part of his ear,” he says. “The man had a daily reminder of that trauma. We were able to create a realistic prosthesis that camouflages his facial difference.”

Degnan’s colleague at the practice is Irene Healey, CCA, (Clinically Certified Anoplastologist) who has twenty years of experience in the field of prosthetic restoration and is currently president of the Board of Certification for Anoplastology. Based out of Toronto and Albany, she specializes in realistic breast prosthetics for mastectomy patients. The pair are planning to establish their practice as a training center for excellence in anaplastology and prosthetics since this institutional education is so important, but rarely offered.

PHOTO BY STEPHEN GABRIS

MEDICINE IN WNY 2019

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FIGHTING THE OPIOID EPIDEMIC IN WNY Increased resources are helping to save lives

by Katie Coleman

ADDICTION IS A CHRONIC ILLNESS that does not discriminate, and opioids have recently dominated the news as a most dangerous one. The National Safety Council says Americans are more likely to die from an accidental opioid overdose than from a car accident. Western New York has not escaped the epidemic and, increasingly, resources have arisen to assist addicts with transition to sober lives.

BestSelf Behavioral Health, Inc. has thirteen local community centers that help people with mental health and substance abuse disorders. Its opioid treatment program features rapid access, or same day care, which means people in crisis can get help—including methadone treatment—the day they seek it.

“Opioid use disorder is a chronic illness,” says Jennifer Seib, director of clinical substance use services. “It’s possible that [those afflicted] are on medication life-long. We’re keeping their condition in remission.”

Club West is one of BestSelf’s newest programs and targets treatment for severe mental illness.

From January to June of 2019 Club West had 1,763 visits and prevented fifty-six emergency room visits.

“Many individuals are co-occuring, and have both mental health and substance abuse disorders, and may have a high use of the emergency room,” says Kelly Whitman, VP of Substance Use Disorders and Housing. “Sometimes, they’re overwhelmed and not in crisis and we can help them.”

BestSelf’s Recovery Community is the next step for people completing treatment. It takes a holistic approach to ongoing recovery by offering support groups, nutrition and exercise classes, art and music activities, trips, and life-skills training. “Treatment is not forever. People get better,” Seib maintains.

“Recovery Community is what’s next for a lot of them.”

BestSelf also works with the criminal justice system, drug courts, and jails, and uses a mobile team to make prison visits. “We can educate those individuals with substance abuse disorder [and explain that] that it’s a chronic relapsing disease, which helps with the stigma of it,” Whitman says.

Horizon Health Services also treats both mental health and substance abuse disorders with both residential and outpatient treatment, as well as support services, including some specifically for women. In particular, Horizon Village—an intensive residential drug treatment center in Sanborn—is a huge part of patient recovery.

“Once you’ve been very sick and impaired for a long time, you need time to figure out what to do,” says President/CEO Anne Constantino. “It’s important that we offer mental health counseling because there is a lot of depression and anxiety that goes along with opioid use disorder.”

Counseling and medication-assisted treatment are key to getting people to a place where they can even just start living again. It’s important,

PHOTOS BY STEPHEN GABRIS

Kelly Whitman and Jennifer Seib of BestSelf

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Constantino says, to get people help when they are motivated to seek it, which is why Horizon also offers sameday access. “Same day access mitigates the no-show rate and gives people the ability to say, ‘I need help,’ when they’re motivated,” Constantino explains.

“People with opioid use disorder are at high risk of an overdose, and we have so many resources. We can even start a conversation with them.”

Family is another big focus of their treatment and Horizon seeks to get family involved whenever possible. Families face their own anxiety and worry as they watch their loved ones struggle. Social media, too, says Constantino, can be powerful in recovery, because it allows story sharing and support. “There are a lot of positive forces out there,” she says.

Jewish Family Service of Buffalo and Erie County, while not a substance abuse treatment facility, does have services— including case management—for those struggling with addiction secondary to a mental health disorder diagnosis. It also offers counseling and social services for Holocaust and torture survivors, immigrants and refugees, and people with behavioral health issues. JFS also supports their family and caregivers.

“Finding a mental health clinician is really important,” says Juliana Teibel, director of development at JFS, who stresses the importance of reaching out to seniors. “Seniors are not seeking out mental health care in the same numbers as the younger generation because it’s more stigmatized and there’s less education.

Destigmatizing mental health is a huge step in treating substance abuse.”

A lot of seniors go to JFS with symptoms of grief and depression, but are not necessarily seeking mental health counseling, Teibel notes, and so JFS can offer treatment to seniors in their homes.

Many seniors seek help for other reasons, and are also struggling with untreated substance abuse or addiction.

“A person who’s been on OxyContin for twenty years and is dealing with another mental health diagnosis may not even realize that they’re also struggling with substance abuse issues,” Teibel says “We help clients address those contributing factors to enable them to live a better life.”

COLTON’S JOURNEY TO LIBERATION A one-stop for resources

Rebecca Barnell started Colton’s Journey to Liberation in honor of her son, Colton Lasker.

C O LT O N ’ S J O U R N E Y T O L I B E R AT I O N is a non-profit organization that acts as a hub of information and resources to get people the help they need. Peer-to-peer support groups take place once a month with speakers, and a free educational series teaches skills like stress and grief management around the holidays. CJtoL also offers four scholarships, fundraises annually, and donates to local organizations that assist with addiction struggles. The CJtoL.com website acts as a central place to find resources, and also encourages people to share their stories anonymously as yet another means of support.

Colton’s Journey was named for Colton Lasker, from Hamburg, who struggled with addiction for ten years before he passed away from overdose-related heart complications at twenty-three. At nineteen, Colton began using heroin, and often begged for help while his family struggled to find the right local resources. Often, they were turned away from facilities who said they didn’t have room and offered no alternatives.

Colton’s mother, Rebecca Barnell, and daughters Stephanie and Shayna, are working to reduce the stigma surrounding substance abuse and mental health, educate, and connect people to services that can help so that families don’t feel so alone in their crises.

“The entire time he was using he was trying to be sober,” Barnell says.

“For the family, watching it is horrible and not understandable. The secrets we keep can kill us. We initially didn’t know and it took a few years to recognize all the symptoms, which can be subtle, little flecks of desperation.

We need to change the approach in how we’re teaching and get to the root cause. I believe this is a whole community human condition.”

Colton’s sisters are both actively involved in Colton’s Journey to Liberation and have been healing in different ways. “I thought he was invincible,” Shayna says. “He came close to death so many times; I didn’t think he was going to die. After he died, I needed space and studied abroad. Now I’m back and getting more involved. Having to build myself up alone helped a lot.” For Stephanie, counseling, yoga, and working with people struggling with addiction have helped a lot.

According to Barnell, empathic communities willing to support those are who suffering are at the forefront of healing the addiction all around us. “People need to talk loud and proud, peer-to-peer style,” she says.

“Healing isn’t linear and is different for everybody. This doesn’t start with addiction and suicide; it ends there.”

To learn more, or to donate, visit cjtol.com.— K.C.

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THE OPIOD EPIDEMIC: WNY STORIES

The struggle is all around us

by Katie Coleman

TOM NEARY, THIRTY-FOUR,

from Canandaigua, lost his brother to an overdose. At Easter 2009, Neary’s family learned his brother David had been trying to detox from heroin, so David moved home and his parents tried to help. But David overdosed in parking lot and survived through a life-saving dose of NARCAN. “The relapse I remember the most was when I was with my kids at a museum and my brother called and told me I needed to pick him up from the airport that night,” Neary says. “That night, my dad confessed he was broke and had spent everything to help David get clean.”

In December 2017, Tom was driving for Uber when he got a call from his dad. “Dave’s gone,” his dad told him.

Other stories have happier endings. Courtney Marie Phillips, twenty-nine, from Panama, NY, used drugs for ten years before getting clean. “Heroin addiction brought me to my rock bottom,” she says. “I lost friends, countless jobs, opportunities, boyfriends, I totaled cars, and my family had just had it with me.”

Phillips’ family convinced her to go to rehab, and while it took more than one attempt, but after getting pregnant with her first daughter, she decided she was done. It’s been three years. “I have more to live for,” she says. “The ways I’ve stayed clean for this long is surrounding myself with good, clean people and giving up on old ‘friends,’ which is crucial to leaving that life behind.”

Phillips also goes to counseling and support groups for moms in recovery. Sums up Phillips, “Rehab got gave me coping skills to stay clean and live a life off drugs.”

Also twenty-nine and also clean for three years is Jesse Wiley from Perry, NY. “For all the years I used heroin, I never used a needle and I’ve never met another heroin addict who’s never used a needle before,” says Wiley. “I justified my use for years by telling myself I wasn’t addicted and could stop whenever I wanted to because I wasn’t shooting up.

No one starts out by using heroin every single day, and every person who’s ever become addicted to heroin has used many of the same justifications that

I used. I couldn’t stop whenever I wanted to, I was using every single day, spending every last dollar I had to get high, and neglecting all my relationships.”

Wiley grew up in a stable, middle-class home and had no serious trauma as a child. But at eighteen, he got into drugs as an alternative to alcohol, something recreational for shows and going out. “At first I was totally against pharmaceuticals in general and used to look down my nose at people who did those kinds of drugs,” he says. “At shows, I met people who introduced me to other drugs. Eventually, I stopped doing drugs altogether until moving in with some friends. Long story short, we got into pills like Vicodin and Percocet. My logic at the time was that I had tried all the other drugs and never became addicted and opiates would be no different.”

He was twenty-one the day a friend’s friend introduced him to heroin. After trying it and getting a similar high to the pills, his apprehension disappeared; eventually, he was doing heroin and nothing else.

“One night, I left work and called up my buddy and we rode up to the city to get high,” he recalls. “I did one bag and left to get on the 490 and I woke up in the hospital with a stability cage on my foot and two rods sticking out of my ankle because me and my friend passed out and crashed somewhere outside Chili. I was in the hospital for about a week and then had to get two surgeries. Both of us were still unconscious when the ambulances came.”

For four months, Wiley was in a wheelchair and in a lot of pain. After three, he was back to using; if he didn’t use, he got sick. And he was lying to friends and family that he’d stopped after the accident.

Finally, he sought outpatient help.

“Heroin addiction cost me years of my life, most of my friends, the respect of peers, the trust of family, my pride, probably around $50,000,” Wiley says. “I’ve been clean three years now, but my whole life changed.”

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DISEASE PREVENTION INCLUDES GOOD NUTRITION You are what you eat… but how does it work?

by Jana Eisenberg

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current Dietary Guidelines (2015-2020): “About half of all American adults have one or more preventable, diet-related chronic diseases, including cardiovascular disease, type 2 diabetes, and obesity.” It doesn’t get much clearer than that.

Some diseases are diet-related.

And they’re preventable.

The food you eat directly impacts your health—either negatively or positively— but the role proper nutrition plays in health maintenance disease prevention can’t be understated. Healthful eating prevents obesity, which is a major contributor to

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Disease prevention continued

stroke, heart disease, disease related to weakened organs and bones, even cancer. Eating enough calcium helps prevent osteoporosis. Eliminating saturated fat reduces both high “bad” cholesterol and high blood pressure, both of which are major factors in cardiovascular disease. Good foods increase your “good” cholesterol which protects you from these same diseases. And eating well also helps reduces sluggishness and boosts your mood.

Clearly, the knowledge that we should eat well isn’t rocket science, but our culture’s addiction to food that’s sugary, fatty, and overly processed is a hard one to beat, especially if it means limiting the convenience of prepared foods and restaurants.

So, what is healthful food and a good diet? How does it work to prevent disease?

Catherine Ayers, M.S., registered dietician and a certified dietician/nutritionist, works with physicians and provider teams at the Buffalo Medical Group. Her services include one-on-one nutrition counseling to help patients with weight loss, or those with diabetes who want to improve their glucose levels. She also assists with diet to help manage chronic kidney disease.

“I focus with patients on a ‘healthy’ diet, and

that can mean different things to different people,” says Ayers. “It’s important to have a healthy relationship with food and recognize that there’s no such thing as ‘bad’ or ‘good’ food. There are foods that nourish bodies; healthy food provides things like nutrients, antioxidants, fiber, vitamins, and minerals. So one definition of a healthy diet is gearing your choices to higher nutrient foods, including a variety of fresh, whole, real food.

“We literally are what we eat—every cell is made up of the vitamins, minerals, and antioxidants we eat,” she continues. “If you aren’t fueling your body, it can’t operate at optimal capacity.”

Donna Manquen is a certified nutritional counselor who also holds a certification from Cornell in plant-based instruction. She works independently with clients who want to lose weight, eat more healthfully, and/or make changes connected to health issues, and also with area medical practices to help them implement wellness solutions for their patients.

“Food makes such a big difference; it’s a major part of our health and well-being,” says Manquen, who firmly believes that eating a whole-food, plant-based diet (WFPB) is the way to go. She

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teaches courses that help people learn or relearn how to plan, shop for, and prepare meals.

“Education is important,” she says. “In my four years of teaching these classes, I’ve learned that you need to give people the right tools. Making changes to the way that people shop, cook, and prepare food can be overwhelming. So I help them start slow. A key component is actually practicing things like finding the right recipes. In some cases, people are also tasting new foods. We do some things together and they see how easy it is.

“Don’t eat a lot—or any—refined sugar, and you’re giving yourself a great gift, according to…everyone except most food manufacturers,” continues Manquen. “There are almost seventy types of refined sugars, and the food industry is sneaky. If you’re trying to read labels, you won’t always see ‘sugar’ spelled out—you might have no idea that there’s sugar added. Eighty percent of processed foods contain sugar; it’s added to everything from spaghetti sauce to milk and some chips. Sugar has a debilitating effect on the body, and it’s one of the hardest things to kick.

When you eliminate sugar, you start to taste food the way it’s meant to be tasted. It’s such a huge difference. When we eat a lot of processed, canned, and packaged foods, our taste buds become dulled.”

Ayers agrees that making choices and changes requires focus: “It starts at the grocery store; what we buy is what we will eat. Create a healthful food environment. You might not choose to snack on an apple, for example, if you have potato chips or a brownie in front of you. The brain gets excited by sugar, and it makes more nutritious foods seem less acceptable.”

Make small changes, Ayers suggests, like taking just one meal—maybe breakfast—and trying to include more fiber or protein. “That will help you feel fuller and keep you going till lunch,” she says, noting that you’ll be inclined to make better choices at lunch if you’re not ravenous.

Eating foods lower in sugar and fats, and higher in fiber, also contributes to a healthy gut and digestive system, which in turn is where a large part of our immune system gets its work done. “I’ve been talking to patients more and more about the importance of gut and digestive health; the gastro-intestinal tract is the largest immune system in body,” Ayers maintains. “We have billions of bacteria in our digestive systems that help to foster that healthy environment.

And it’s connected—your gut and your brain communicate all day long. It’s been shown that ninety-five percent of the body’s serotonin is produced by bacteria in the digestive system.”

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Serotonin performs a wide array of duties in the body; if your gut is not healthy, and your serotonin production is off, disease—including depression, irritable bowel syndrome, cardiovascular disease, and osteoporosis—can result.

“In our culture, and in the past, it seems like nutrition and diet were the last resort for people,” Manquen points out. “If they’re looking for the fastest way to lose weight or get healthy, they tend to look for a quick fix. But I tell them that it takes time; if you’ve gained fifty pounds over the years, you can’t expect to change your health in two weeks.

“There’s also more awareness now—people don’t want to go on as many medications if they don’t have to,” Manquen goes on. “There are ways, with nutrition and food, that we can reverse or prevent certain diseases and afflictions. We might take a look at food before prescribing medication.”

Manquen refers to each person’s “journey” of becoming healthier through eating a wholefood, plant-based diet, including her own. She lists the benefits that happened over time once she changed what she ate and drank: Easily lost weight. Can stand up without pain from sciatica and back issues that a chiropractor couldn’t help.

Can run around with grandchildren. Seasonal allergies went away. She’s more energetic.

The idea is to get away from what Ayers calls “manmade foods,” and Manquen calls “food-like” things. “Healthy eating and nutrition are not about calorie counting, or balancing ‘calories in/calories out,’” Ayers contends. “It’s bringing a focus on quality over quantity. Not all carbs are bad; you just need to choose higher fiber carbs.

And not all meat or protein is bad, but we need to choose healthier sources, leaner cuts, maybe more protein from plant-based foods like nuts and beans. Yes, even though nuts are higher in calories, they are good for you.”

She continues: “In addition to nuts, beans, and legumes, add fresh fruit and vegetables—a focus on that alone will help you make more nutritious food choices. It’s similar to a Mediterranean diet, one that’s rich with fresh vegetables, healthy fats, and whole grains.”

Ayers attests that people can set and reach goals that help show the upside of eating better.

And that doctors and other healthcare providers need to be part of the mix, assuring people that what they eat matters, and that health and diet are intrinsically linked.

“The culture in our healthcare system is becoming more aware of the importance of things like nutrition, exercise, and well-being,” says Ayers. “With that awareness though, people need specifics. If you read an article that says you need to watch your diet, what does that mean?

You need to eat more vegetables, eat a diet higher in fiber. What is your motivator? Doctors talk to their prediabetic patients about aiming for a low glycemic diet. It’s an ongoing process.”

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MULTIVITAMINS

should you take them or not?

MOST STUDIES, and there have been many, say that there’s not really a benefit to taking those multivitamins, no matter what your age is. “There is limited evidence that [multivitamins] offer any significant health benefits,” said a September 2018 article in Harvard Health Publishing. Harvard Medical School and Johns Hopkins researchers point to multiple recent studies that found multivitamins did not reduce the risk of heart disease or cancer, did not reduce risk for mental decline in men, and, in a comparison of heart attack survivors who took a multivitamin versus a placebo, the rates of later heart attacks, heart surgeries, and death were similar.

And, the Harvard article goes on, while the belief is that most supplements are not harmful, there can be possible health risks. They reviewed many study results, and list the following as possible negative consequences: • High doses of beta carotene have been linked to a greater risk of lung cancer in smokers.

• Extra calcium and vitamin D may increase the risk of kidney stones.

• High doses of vitamin E may lead to stroke caused by bleeding in the brain.

• Vitamin K can interfere with the anticlotting effects of blood thinners.

• Taking high amounts of vitamin B6 for a year or longer has been associated with nerve damage that can impair body movements (the symptoms often go away after the supplements are stopped).

As a research assistant professor in the Department of Medicine’s division of geriatrics and palliative medicine at the Jacobs School of Medicine & Biomedical Sciences, Dr. Kenneth Seldeen agrees with the larger medical and research communities’ conclusions. (As a PhD rather than an MD, Seldeen studies health through the lens of a scientist, looking at

things like global trends versus a medical doctor’s treating individuals.)

“When you look at most studies, the answer as to whether a multivitamin reduces cardiovascular and cancer risk, is ‘no,’” says Seldeen. “There are not many benefits for healthy individuals, and a lot of people find that surprising.”

Statistics show that fifty percent of Americans take multivitamins, which fall under the category of “dietary supplements.” And, it’s interesting to note that the Food and Drug Administration (FDA) is “not authorized to review dietary supplement products for safety and effectiveness before they are marketed.” (A 2018 estimate of the global market for the dietary supplement industry came in at $115 billion, and the U.S. market alone is forecast to rise to over $35 billion by 2024.)

The companies that make dietary supplements are responsible for ensuring the safety and effectiveness of their products themselves—and if a product is found to be either unsafe, or not effective for the claim it’s making, then the FDA can step in, pull the product and fine the company.

In February, FDA Commissioner Scott Gottlieb announced a “new plan for policy advancements with the goal of implementing one of the most significant modernizations of dietary supplement regulation and oversight in more than twenty-five years.”

At a cost of generally less than ten cents a day, price doesn’t deter most from taking supplements. Older people are likelier to consume vitamin supplements, says Seldeen, and it may be that as people age and their food consumption declines, they’re at higher risk for lower nutrition. “If there is a population that it helps, it could be older individuals who are not getting same amount of vitamins and minerals,” he offers.

As many others have concluded, Seldeen says that the food that you eat

every day is the place to get your vitamins and minerals. “If you have a balanced diet, you’re probably getting everything you need from the foods you eat. People should look at what the best diet for them is as they age,” he notes. “There are a lot of opinions about what’s a ‘healthy’ or ‘the healthiest’ diet, but one common thread through every diet is a high intake of vegetables. That’s a cornerstone for any healthy living strategy.”

If people are interested in seeing what they might be actually getting from their food, Seldeen suggests trying a dietrelated app, like MyFitnessPal, where you can enter all the food you’ve eaten, and then request a report that analyzes it, including what vitamins and minerals you’re consuming, and how much.

If you want to learn more about what you eat and what’s good for you, try to eat different things, he says. See what works.

You can also see a dietician or nutritional counselor. Many medical groups have one, or your doctor can recommend one.

And if your doctor has prescribed or recommended that you take a multivitamin? Educate yourself and ask questions. “Medical doctors themselves may have a belief about multivitamins, and be taking one,” Seldeen says. “And there are people who need to take supplements for one reason or another. Doctors can look at a person’s history and info: whether you’re a vegetarian, whether you exercise, and they can also see potential deficiencies in your bloodwork. With supplements and health science in general, it can be difficult to know the correct path.”

What’s the answer? We’re quoting Harvard again: “The message here is that supplements prescribed by a doctor are helpful for people with certain medical issues. Otherwise, it’s best to get your vitamins and minerals from food and not a pill.”

— J.E.

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WNY BLOODCARE A comprehensive center for blood and clotting disorders

by Jana Eisenberg

Renee Czarniak, medical technologist at BloodCare

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UNLESS

YOU

OR

SOMEONE

YOU KNOW HAS A BLEEDING

you probably don’t think about hemophilia very often, and likely haven’t even heard of the more common von Willebrand disease. For those affected by such conditions, Western New York BloodCare is a critical resource. Formerly Hemophilia Center of WNY, the nonprofit diagnostic and treatment center recently changed its name to better encompass the range of conditions it treats and services it provides.

Founded in 1969, the center has evolved in positive ways, says Executive Director Laurie Reger. Its latest move, combining administrative offices, adult and pediatric clinics and services, and adding a state-of-the-art hemostasis lab, makes the center the most comprehensive in the region for the education about, and diagnosis and treatment of bleeding and clotting disorders.

Both hemophilia and von Willebrand disease are hereditary, and while some might be aware that it runs in the family, many don’t know they have it or that they may carry the gene for it.

Primary care and pediatric physicians refer patients to the center after an unusual bleeding episode, e.g. during a surgical event. Easy bruising, bloody noses, or heavy menstrual periods can also signal a bleeding disorder.

Patients are usually seen within a week of contacting the center. To diagnose patients, hematologists first assess a patient’s history and symptoms. They will order basic screening blood tests, unless they have a solid indication of what disease they are looking at. With WNY BloodCare’s on-site lab, the staff can perform specialized tests to determine even complex diagnoses.

PHOTO BY STEPHEN GABRIS

DISORDER,

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“Prior to having our freestanding lab, all the work for the hemophilia center was done at Children’s Hospital,” says Karen Kovach, BloodCare’s lab manager.

“These coagulation tests, which all have to do with bleeding or clotting, must be ordered by a hematologist. Platelets are very sensitive; in order to get accurate results, testing must be done within four hours of the blood being drawn. We are able to get results within twenty-four to forty-eight hours. If you sent some of the testing to someplace like Quest, it could take weeks.”

Once there is a diagnosis, a treatment plan is put into place. Doctors and patients communicate about patient lifestyle, and any upcoming events, like surgery or pregnancy, that might be affected by the patient’s blood condition.

“If they are contemplating or scheduled for surgery, like a colonoscopy or dental work, the patient will come to the center, then go back to their doctor with a plan,” says Reger. “They may be treated here the day of surgery, and then come back for a follow-up.”

For women who have von Willebrand Disease or are known carriers of hemophilia, complete birth plans are made. “There’s a lot of coordination with the other doctors, like OB-GYNs and dentists,” says lab manager Kovach.

“They’ll discuss how the delivery should go, and if particular things happen, how to treat it. Doctors can’t know everything; sometimes they are afraid to do surgery on someone who has hemophilia, but it’s all very manageable as long as you have

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“With WNY BloodCare’s on-site lab, the staff can perform specialized tests to determine even complex diagnoses. ” the appropriate treatment.”

“In general, we see pediatric patients and their parents or caregivers every six months. If they are put on a factor for infusing, we do continuing training and education,” says Reger. “We have one mom with three little boys who have hemophilia. There are family conferences and camps for kids that where they can

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Specialized clinic provides care for women and girls

PHOTO BY STEPHEN GABRIS

Dr. Shaveta Malik, OB/ GYN, of BloodCare’s S.H.E. Clinic

learn more and find support as well. This is going to affect them their whole lives.”

The treatment for all ages can involve infusion with blood that possesses the factors patients are missing, and it’s expensive. “We dispense the replacement factors in the center; instead of waiting for a person to experience a bleed, the infusions can be done prophylactically, sometimes a few times a week,” says Reger. “It can cost $300,000 a year, and requires prior authorization from insurance. We also provide education and advocacy for patients. It’s important that they speak up to their legislators so that their access to proper care and treatment is not limited.”

As they’ve expanded and evolved, WNY BloodCare has added ancillary services to provide more in-depth care. “We now have a genetic counselor, dietitian, social

A F T E R O B S E R V I N G T H AT B L E E D I N G D I S O R D E R S in women and young girls were going undiagnosed, Dr. Shilpa Jain, a pediatric hematologist at Western New York BloodCare (formerly the Hemophilia Center of WNY; see main story, page 80), founded the Specialized Hematology Experts (S.H.E.) Clinic within the organization. Along with gynecologist Dr. Shaveta Malik, she sees women of all ages to diagnose and treat the disorders that affect everyday lives.

While hematology and gynecology exist separately in other practices, WNY BloodCare’s S.H.E. Clinic is one of a small but growing number in the United States that combine the two specialties. It’s an effective way to help females who may experience bleeding disorders, particularly connected with reproductive systems and milestones like the onset of menstrual cycles, pregnancy, and birth.

“One of the ideas behind a specialized women’s clinic is to help girls faced with a hemostatic challenge when they start menarche/periods,” says Jain. “A proper diagnosis of what’s causing heavy menstrual bleeding is important. Some girls and women might not even realize it’s a problem. They may say, ‘Oh everyone in my family has/had heavy bleeding. It’s normal.’ But it may be undiagnosed disorder; that’s the second most common cause for heavy bleeding in young girls. The most common cause for young girls is immaturity of the body, the hormones.”

Women can also experience it with anovulatory cycles [menstrual cycles when the body doesn’t release an oocyte from the ovary]. “If they are bleeding heavily and don’t seek care, it can impact quality of life, like frequent school absence for adolescents and teens,” explains Jain.

“They can also experience iron deficiency and anemia.”

With another doctor and a family nurse practitioner on the clinic staff, S.H.E. can also address things like miscarriage, which can be significant if a woman has a blood disorder. And because there’s a combined hematology/gynecology setting on site, care can be coordinated. “The OB-GYN understands what kind of workup the patient needs, and can provide input, not only understanding and explaining the physiological cycle, but also helping with management,” says Jain. “If a patient is advised to go on oral contraception to help regulate bleeding, the prescription needs to be tailored; pediatricians and family doctors may not necessarily be able to customize it correctly.”

As part of Western New York BloodCare, the S.H.E. Clinic has access to the hemostatic lab, and is able to offer rapid, on-site testing for its patients, making it easier to reach diagnoses more efficiently.

“Diagnosing rare and heterogeneous inherited bleeding disorders is challenging,” says Jain. “They can range from mild to severe to life threatening. Having a standardized hemostatic lab helps: the expertise in conducting and interpreting lab tests goes a long way in making correct diagnosis, especially if you don’t have the family history.”

It’s also about younger girls and women’s potential anxiety level.

“Adolescent girls entering this phase of life may have apprehension about going to an adult OB-GYN clinic; having an OB-GYN in our pediatric setting can help them feel more comfortable,” Jain adds. “With that, they are more amenable to follow-up and care, and that in turn creates better outcomes.” — J.E.

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84 WNY BloodCare continued MEDICINE IN WNY 2019

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worker, and physical therapist—they are not here full time, but come in a few times a month and see patients,” says Kovach.

“It’s helpful to have these additional services to maintain all aspects of our patients’ health.”

Building awareness with primary care physicians has always been part of the mission and, with the more encompassing name, WNY BloodCare hopes that when doctors see patients who, for example, have easy bruising or heavy menstruation, they may be more likely to refer them to the center.

For example, “The field of gynecology has come a long way,” notes Reger. “In the past, if women had a heavy period, she would automatically be given a hysterectomy. Now, there’s much more community outreach, doctors and women are more educated about what could be going on. But, because there can always be more awareness, and the need is somewhat specialized, our pediatric hematology doctor founded a women’s clinic here.” (See sidebar, page 83 for more on the center’s S.H.E. Clinic.)

Overall, Reger says the field is evolving quickly, including novel treatments that deliver an antibody factor subcutaneously; instead of replacing the missing factor, it binds a couple of other factors together and bypasses the missing one. Also in the pipeline is gene therapy.

Infusion treatment for hemophilia and other blood disorders has a negative history, especially for some older sufferers, who may have been treated with tainted human blood plasma.

“In the 1990s, prior to the invention of synthetic recombinant factor products, which work great, many people were infused with unscreened human blood plasma, and were infected with HIV and hepatitis, which eventually they died from,” says Reger. “That can make older patients hesitant to try new things.”

Now, she added, with the highly effective treatments available, many pediatric patients have never experienced a bleed and, unlike older patients, don’t even know what it feels like. And with the advent of social media, where patients and families can share information and experiences, there’s an increased feeling of being able to live well with these conditions. That’s part of the mission, too.

Western New York BloodCare 1010 Main Street, Suite 300 Buffalo, NY 14202 wnybloodcare.org

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WHAT CAN A PATIENT EXPECT FROM ANAPLASTOLOGY CARE? Anaplastology care is patient-centered and uses the term “prosthetic restoration” to describe the complete care offered through our profession. Often, our primary focus is to

Buffalo Center for Anaplastology

restore the patient’s appearance by providing realistic life-like prostheses so patients can return to their daily activities and have a quality of life. We also ensure the safety of our patients by using the appropriate medical-grade silicones to fabricate prostheses, as well as maintaining proper clinical and laboratory procedures. Anaplastology treatments should be painless experiences that build toward restoring the privacy, dignity, and comfort of the patient.

WHAT PATIENTS NEED PROSTHETIC RESTORATION? Patients who are missing a part of their face or body and for whom surgical reconstruction is not an option. Some patient lose a part of their body due to an accident or trauma. We also see patients who were born with incomplete or missing parts of the body. A large part of our practice is seeing patients with head & neck cancers and breast cancer.

We have the expertise and experience to offer a full range of soft tissue prostheses for the face and body and we often can provide solutions not available elsewhere. We welcome patients to see us for a consultation so we can discuss their needs and help them through our individualized care.

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HOLISTIC & COMPLEMENTARY PRACTITIONERS

Annette M. Romeo

Highly effective EFT/Tapping and Reiki Practitioner with many years of experience focusing on emotional stress, trauma, fears and pain management. EFT often works where nothing else will.

(716) 435-5167 amromeo83@gmail.com

Medical Qigong Therapist Susi Rosinski

Nancy Rizzo, Certified Coach

Stop waking up wondering why nothing in your life has changed!

Create sustaining, positive and forward-moving change using Mindset Navigation™! Improve home and work relationships through effective and peaceful Conversational Intelligence®!

Medical Qigong can help with pain, immune disorders, anxiety and more. Susi Rosinski specializes in Qigong Sensory Training for Autism in Children ages 6 and under!

Accupunture services also available.

(716) 803-0113 www.wnyqigong.com

WNY QiGong, LLC

Certified EFT Practitioner Certified Reiki Practioner

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For information on the Holistic Chamber of Commerce, visit www.holisticchamberofcommerce.com

Nancy Rizzo, CC

Life & Mindset NavigationTM Coach Smart & Simple Wellness

650 Airborne Parkway, Cheektowaga, NY 14225

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2019-2020

WHAT TO EXPECT FROM JOINT REPLACEMENT SURGERY

by Kathleen Rizzo Young

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FOR PATIENTS AFFLICTED WITH

DEBILITATING ARTHRITIS, congenital deformity, or post-traumatic joint problems, knee and hip replacements can restore function and pain-free mobility. As such, they’re among the most common orthopedic surgeries. In twenty-two years as orthopedic surgeon at Kaleida and UB|MD Orthopedics, Matthew J. Phillips, has performed more 10,000 joint replacements and has seen the procedures evolve dramatically.

“When I started, the average hip replacement was a three-hour operation,” Phillips says. “Afterward, patients spent four to five days in the hospital and then went to rehab for a week or two. They would use a walker or crutches for six weeks and then a cane for a few more weeks.” Recovery was generally long and uncomfortable.

Today, half of the procedures are done on an outpatient basis with the patient going home the same day.

Surgery time has been cut in half and if someone does stay in the hospital, the average stay is a day and a half.

Usually, weight bearing is tolerated with a walker for a few days and a cane for a few weeks. Rehab is reserved for the patients who are elderly, suffer other conditions, or live alone.

There are two major reasons why today’s joint replacement surgeries are quicker and more tolerable. “The first are improvement in surgical techniques,” Phillips explains.

“There is more muscle sparing and less traumatic surgery. We also use computer navigation and robotics in knee replacement surgery, which allows us to do surgery with fewer soft tissue releases, allowing for a better range of motion for the patients. We are also utilizing better implants that last longer.”

The other significant difference is improved pain management. “Years ago, knee replacement patients would rate their pain as a ten or twelve… out of ten,” says Phillips, who notes narcotics with side effects like nausea

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Atwal Eye Care specializes in Laser Vision Correction with countless refractive procedures performed on patients in Western New York and the surrounding areas, including Canada.

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Joint replacement continued

and dizziness only added to their anguish. “Now when I see them afterward, they say it is a now a one or two out of ten.”

For patients who had the surgery years ago and dread reliving that experience, Phillips happily tells them it’s a different experience. “Nowadays there are pain protocols—pre-op medications such as anti-inflammatories, Tylenol, medications for nerve pain—that allow us to minimize interoperative narcotics in favor of nerve blocks and local injections,” says Phillips. “Today’s anesthesia can last two or three days, can leave pain catheters in as well. This also tends to reduce bleeding, causing less blood loss, fewer systemic problems from losing blood, and less bruising and swelling.”

Not only does this mean Phillips can happily tell patients back to do the other knee what a different experience it will be, but also that patients with two bad knees can replace both at once, resulting in a single surgery day and recovery—a huge savings in both cost and work time lost. Of the 300 knee replacement surgeries he does each year, Phillips estimates fifty are bilateral. He does suggest not everyone is an ideal bilateral candidate; for example, cardiac or significantly obese patients fare better doing one knee at a time.

More good news? “Modern joint replacement can last twenty to thirty years,” Phillips says.

“Over ninety percent of hips and knees put in twenty years ago are still in and working, and today’s implants are even better than those were.”

While it is much easier to bring people back to full mobility today, the critical last stage of joint replacement surgery is physical therapy. “The surgeons do a wonderful job and then the patient leaves the surgeon’s realm and comes to us to complete the process,” says Ann Desotelle, MSPT, DPT, owner of Northtown Physical Therapy. “We represent an important transition from surgical to restorative health, to allow the patients to do everything they used to do with the shiny new hip or knee.”

The importance of physical therapy after joint replacement cannot be overstated. Although there is no specific formula for a speedy recovery,

patients who commit themselves to therapy visits and home exercises often see the most success.

“Everything we do has to be mimicked at home,” says Desotelle. “Doing the exercises in the office is not enough. It has to go home with them to achieve a full and quick recovery.”

In some cases, the first therapy appointment may take place prior to surgery. “We often do preoperative appointments as patients want to know how to use the cane or walker and may also have questions about what they can expect,” Desotelle says. “We tell them that they are going to feel a bit odd, that the ship needs righting.”

Desotelle and Aaron Hyrcko, DPT, have a manual therapy-based practice, meaning they use hands-on therapy to strengthen the muscles and achieve increased range of motion; patients make tremendous progress under the watchful eye of professional specialists directing their therapy. “We transition them back to work, back to whatever they were doing before and our goal is that they can do everything they did before the surgery,” she says.

“Some are terrified because they think they have to give up doing everything they did before,” says Phillips. “The average hip replacement patient can resume pretty much all of their activities—running, swimming, golfing, downhill skiing. They just have to remember that it is not the normal joint they had at eighteen years old.”

Desotelle also emphasized the importance of patient education and knowing what to expect at every step along the way. Kaleida’s Joint Ventures Program tackles this challenge in a comprehensive manual. Its Total Hip Replacement guidebook is a forty-eight-page booklet that answers all questions, and includes forms to be filled out before the surgery, as well as sections on pre-operative exercises, medications to avoid, pain management, and anesthesia options. There are even detailed instructions on how to perform daily tasks such as getting into a car (two- and four-door) and guidance on sex. kaleidahealth .org /services/pdfs/ortho/hipreplacement-guide-for-patients.pdfptatia

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Caring for adult and pediatric patients.

Specializing in the care of conditions such as

• • • • • •

sinus disorders nasal headaches sleep disorders voice disorders ears/audiology nasal cosmetic surgery

Dr. James Chmiel

Board-Certified Otolaryngologist

Dr. Gregg Zimmer

Board-Certified Otolaryngologist

Together, more than 40 years combined experience in the field!

Proud to be named consistently to WNYʼs “Top Doctors” 3950 E. Robinson Rd. St. 106 Amherst, NY

www.amherstent.com

716-691-3500

VA Western New York Healthcare System

Your care means a lifetime of difference to Veterans VA Western New York Healthcare System (VAWNYHS), consists of two health care facilities in Buffalo and Batavia, as well as community based outpatient clinics in Dunkirk, Jamestown, Lackawanna, Lockport, Niagara Falls, Olean and Springville.

We have multiple exciting opportunities at medical centers in Buffalo and Batavia, NY, including Nurse Practitioners, Physician Assistants, and Physicians!!

We offer an excellent beneďŹ ts package including time off, tuition assistance, education debt reduction, Thrift Savings Plan and a generous retirement package!

VAWNYHS is academically afďŹ liated with the State University of New York (SUNY) at Buffalo along with 66 additional universities and professional schools in biomedical sciences, audiology, dentistry, dietetics, health care administration, medicine, nursing, nurse anesthesia, occupational and physical therapy, pharmacy, psychology, speech pathology, and social work.

Our sites are located in the western part of New York State, within driving distance to Niagara Falls, the Great Lakes, and Canada, with tons of adventure and beautiful scenery for the whole family to enjoy all year long!

If interested in any of our clinical positions, please contact us today! Vacancies can be found on www.usajobs.gov, or visit the Buffalo campus Human Resources. In addition, please contact our recruiters Michael Ray or Tammy Neugebauer at Michael.Ray3@va.gov, or Tammy.Neugebauer@va.gov, or call us at (716)342-9031 for more information.

www.buffalo.va.gov

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95

“Release and relief ” from carpal tunnel syndrome

by Kathleen Rizzo Young

ALTHOUGH MORE THAN TWELVE MILLION

in the United States suffer from carpal tunnel syndrome, many put off surgery for fear of prolonged recovery periods that mean weeks of missed work.

Caused by compression neuropathy (compression of the nerve), carpal tunnel syndrome causes numbness, tingling, and pain in the thumb and the first three fingers of the hand. It also decreases blood supply and nutrients to the nerve; the results is pain and burning up the arm muscle, weakness in the hand, and wrist pain at night that makes sleeping difficult.

Carpal tunnel syndrome tends to be more common in women than men and while the public associates it with office work such as using a keyboard, mouse, or cash register, there is controversy on the exact role this plays. On a recent episode of ECMC True Care Healthcast, the podcast of Erie County Medical Center, Dr. Paterson, an orthopedic surgeon with Erie County Medical Center (ECMC) and General Physician, PC, elaborated: “There are certain jobs, particularly those that involve the use of a vibratory tool, that have a clear association with carpal tunnel, but the exact role office work plays really depends on the activities and how much you are doing of them.”

Non-surgical treatment for carpal tunnel syndrome includes splints, antiinflammatories, steroid injections, and activity modification. These tend to be effective for those who have had symptoms

PEOPLE

for less than six months. Now, a new treatment option offers hope for chronic carpal tunnel sufferers: release and relief.

“There is no need for an operating room anymore,” says Paterson, who is using the revolutionary, minimally invasive inoffice surgical procedure to relieve carpal tunnel syndrome. “A patient can receive an examination, diagnosis, and procedure, all in a single visit to the office.”

The procedure, which can be completed in approximately five minutes, is performed in a relaxed setting, featuring soft music of the patient’s choosing, as well as low lighting to reduce anxiety. Paterson, who is the only specialist in the region performing the new procedure, explains what makes it unique.

“The incision in the patient’s wrist is so small; we typically close it with just a small bandage, no stiches,” he says. “I use ultrasound to identify the best approach to reach the damaged ligament. From there, I use the SX-One MicroKnife to cut the damaged ligament. With the ligament released, the pressure on the nerve is gone, providing immediate relief to the patient.”

Many patients drive themselves home following the procedure. They may experience minor soreness for a week or two, but, in most cases, they can resume normal activities almost immediately. The procedure has produced dramatic results, says Paterson: “Patients who have suffered, in some cases for years, can now be pain free in one day.”

BUFFALOSPREE.COM

GOOD TO THE BONE

2019-2020

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MEDICINE IN WNY 2019

TO BECOME A SPREE ADVERTISER, CALL (716) 783-9119 Aesthetic Associates Centre (716)839-1700,www.gr8look.com.....................30

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Altman Dermatology, PC (716)810-0610..................................................74

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The Botanist

BestSelf Behavioral Health (716)842-0440, www.bestselfwny.org...............8

GBUAHN / Greater Buffalo United Accountable Health (716)247-5282, www.gbuahn.org................... 40

www.shopbotanist.com/buffalo........................9

General Physician PC (716)264-4195, www.gppconline.com..............82

The Woodhouse Day Spa

Birthing Center of Buffalo (716)835-2510, www.birthingcenterofbuffalo.com....................5

Feel Rite Fresh Markets (716)835-5686, www.feel-rite.com..................90

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Buffalo & Ellicott Centers Rehabilitation/Nursing (718)408-5100, www.centershealthcare.org....86

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Buffalo Medical Group (716)630-1000, www.buffalomedicalgroup.com...............14, IBC Buffalo Niagara Plastic Surgery (716)297-7040, www.buffaloniagaraplasticsurgery.com...........3 Calvin’s Furniture & Leather Gallery (716)688-6700, www.calvinsfurniture.net........ 15 Cara Mia Pet Resort (716)568-2272, www.caramiapetresort.com... 10 Carol Esposito / Howard Hanna Real Estate Services (716)864-0478, www.carolesposito.howardhanna.com...........25 Catholic Health System (716)706-2382, www.chsbuffalo.org.................7 CBD Best Oil (585)435-9283, www.cbdbestoil.com.............73 CBD Bio Care/ CBD By Diva (716)866-7202, www.cbdbydiva.com..............59 Connect Life (716)529-4300, www.connectlife.org............... 76 Crisis Services (716)834-3131, www.crissservices.org..............75

Holistic Chamber of Commerce (716)348-4125, www.holisticchamberofcommerce.com/ ny-buffalo-downtown.....................................86 Horizon Health Services/ Health Managment Group (716)831-2700, www.horizon-health.org..........24 Hospice Buffalo (716)686-8040, www.hospicebuffalo.com.........4 Howard Hanna / Dee Cammilleri (716)573-4751, www.howardhanna.com..........67

www.bcaprosthetics.com................................85 Menopause Ctr. Of WNY Plaza Group Roswell Park Comprehensive Cancer Center (877)275-7724, www.roswellpark.org............ IFC Southtowns Radiology (716)558-5400, www.southtownsradiology.com...................... 61 (716)322-4411, The McGuire Group Health Care Facilities (716)826-2010, www.mcguiregroup.com.........78 (716)458-5700, www.buffalo.woodhousespas.com..................39 UBMD (716)888-4703, www.ubmd.com......................33 VA WNY Healthcare System (716)834-9200, www.buffalo.va.gov...............93 Vascular & Endovascular Center of WNY. (716)837-2400, www.vecwny.com...................68 Vascular Associates of WNY (716)671-8393, www.wnyvascularhealth.com.. 79 Venous Institute of Buffalo (716)877-7000, www.VenousInstitute.com........ 21 Visiting Nursing Association of WNY, VNA Healthcare (716)630-8000, www.vnawny.org...................87

Hunt Real Estate/Michelle C. Winer (716)633-5350, www.michellewiner.com.........78

Visualeyes

Invision Health (716)631-3555, www.invisionhealth.com..... 12,13

Western New York BloodCare

Landmark Health Systems/ Jarod Masci, MD (716)462-0284, www.jarodmascimd.com/contact.... Front Cover

Western New York Pain Relief

Mercy Flight (716)626-4100, www.mercyflight.org..............23 Mount Mercy Academy (716)825-8796, www.mtmercy.org..................73 Neighborhood Health Center (716)875-2904 www.NeighborhoodHealthCenter.org.............92

(716)832-3452, www.visualeyeswny.com........64 (716)896-2470, www.wnybloodcare.org..........57 (716)650-7246.................................................38 Windsong Radiology Group, P.C. (716)631-2500, www.windsongradiology.com.........................84 WNED (716)845-7000, www.wned.org........................74 Wolfgang & Weinmann (716)855-0600, www.wolfgangandweinmann.com.................... 1