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PRICELESS

5 THINGS YOU SHOULD KNOW ABOUT IT Physician Stephen Thomas, chief of infectious diseases at Upstate Medical University, explains the basics of the virus that has killed more than 2,000 so far

NEW CHIEF Physician Duane Tull is Oswego Health’s new chief medical officer. He talks about his new position and his plans

CNYHEALTH.COM

March 2020 • ISSUE 243

SHOULD YOU SKIP BREAKFAST? Celebrity TV doctor Mehmet Oz recently said people should skip breakfast. Should you heed his advice? Do we really need the ‘most important’ meal? P. 16

Top Health Innovations CANCER CARE Nurse Christine Sherman is the director of Auburn Community Hospital Cancer Center, which opened recently. She talks about the center

Healthcare is always changing as new research and discoveries lead to changes that improve care. Area experts discuss what they see as the top innovations in development now or coming very soon. P. 30

PARKINSON’S

How to detect the disease and what to do when you’re diagnosed

Little Lentils Dish Up Big Benefits

Visits to Pediatricians on the Decline

P. 17

P. 12


EMERGENCY SERVICES

Why more people say …

#TakeMeToCrouse One Team. Second to None. More than 150 experienced, passionate emergency medicine physicians, nurses, physician assistants, nurse practitioners, pharmacists, social workers, care managers and support staff.

Cardiac Emergencies. We Put Our Heart into Saving Yours. •

Door-to-cardiac treatment times among the lowest in the region

Only area hospital designated by American Heart Association (AHA) as a Mission: Lifeline Gold provider

Strong teamwork with our local and regional EMS partners

Joseph Battaglia, MD Chief of Cardiology Miron Cardiac Care Center

Comprehensive Stroke Center “Crouse is the place you go when you have a stroke.

It’s that simple.”

One of just 15 in New York State

Aggressive door-to-treatment times exceed national average

Earned Gold Plus–Elite Honor Roll status from AHA

— CNY musician Todd Hobin

Proud to be the official healthcare provider of Syracuse Athletics. Best of luck this season to Coach Boeheim and the Orange! #CrouseForTheCuse ®

crouse.org Page 2

IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020


‘Spring Forward’ Brings Surge in Fatal Car Crashes Daylight saving time begins Sunday, March 8

Y

CONTINUED SUCCESS

I’m finally back to who I am supposed to be. I’ve gotten so many good comments about my body… my friends and family telling me I look fantastic and slim, that I look younger and like myself again. Hypnosis has helped me with more than just weight loss: I’m less stressed, I sleep better, my confidence is much better, my self-confidence is through the roof now, I feel like I can accomplish anything I want to now because I have the tools now to go and reach my goals. After hypnosis, I feel I’ll never go back to having a problem with gaining weight again The way I eat and stay active now, it’s just the person I am and I know it will last the rest of my life.

YOU HAVE NO ENERGY

Being overweight was painful. I didn’t like who I was. I couldn’t do the things I wanted, like hiking and horseback riding… the things I enjoy. And I got anxiety every time I thought about getting dressed in the morning.

NOTHING ELSE WORKED

saving time was not consistently observed. After controlling for factors like year, season and day of the week, they found a consistent rise in fatal accidents in the week following the spring time change. Notably, that spike moved in 2007, when the Energy Policy Act extended daylight saving time to begin on the second Sunday of March instead of the first Sunday in April. “Prior to 2007, we saw the risk increase in April, and when daylight saving time moved to March, so did the risk increase,” said Vetter. “That gave us even more confidence that the risk increase we observe is indeed attributable to the daylight saving time switch, and not something else.” With the arrival March 8 of daylight saving time, clocks shift forward by one hour, and many people will miss out on sleep and drive to work in darkness — both factors that can contribute to crashes. 

1 in 5 Insured Hit with Surprise Bills for Surgery ou scheduled your surgery and made sure both your doctor and hospital are in your insurer’s approved network of providers. Everything went without a hitch — until a whopper of a bill showed up in the mail for “out-of-network” care during your operation. The average out-of-network surprise bill tops $2,000, a new study finds. And about 20% of patients who had surgery using a doctor and hospital considered in-network for their insurance got a surprise bill. So, what gives? In some cases, surprise bills are for medical imaging during surgery or for assistants that patients didn’t even know would be involved. “In this study, we narrowed it

Accountant says goodbye to 47 painful pounds, says, “hello size 2!” “My name is Jeanne Joslyn, and I’m from Cazenovia. I lost 47 pounds and 21 inches in six months with this program and kept it off. I went from a size 14 to a size2!”

F

atal car accidents in the United States spike by 6% during the workweek following the “spring forward” to daylight saving time, resulting in about 28 additional deaths each year, according to new University of Colorado Boulder research. The study, published in February in the journal Current Biology, also found that the farther west a person lives in his or her time zone, the higher their risk of a deadly crash that week. “Our study provides additional, rigorous evidence that the switch to daylight saving time in spring leads to negative health and safety impacts,” said senior author Céline Vetter, assistant professor of integrative physiology. “These effects on fatal traffic accidents are real, and these deaths can be prevented.” The findings come at a time when numerous states, including Oregon, Washington, California and Florida, are considering doing away with the switch entirely amid mounting research showing spikes in heart attacks, strokes, workplace injuries and other problems in the days following the time change. For the study — the largest and most detailed to date to assess the relationship between the time change and fatal motor vehicle accidents — the researchers analyzed 732,835 accidents recorded through the U.S. Fatality Analysis Reporting System from 1996 to 2017. They excluded Arizona and Indiana, where daylight

Discover how-

down to those cases where patients did as well as they could checking to make sure the surgeon and hospital were in-network, and still one in five got an out-of-network bill,” said the study’s lead author, physician Karan Chhabra of the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor. He said 37% of the surprise bills came from out-of-network surgical assistants. Another 37% came from anesthesiologists. The average outof-network surgical assistant bill was more than $3,600; anesthesiologist bills topped $1,200. The findings were published Feb. 11 in the Journal of the American Medical Association.

Every week I would start a diet on Monday… 24 hours later I would blow the whole thing. I was constantly starting exercise routines and none of them seemed to stick.

FREE SCREENING

I won’t cost you one red cent to find out how quickly this program can help you. Everything was explained in detail. The free, no obligation screening is fun and informative. My first impression of Alternative Hypnosis was how relaxed and welcoming the environment is. It really felt like a safe place to be. When I first came in I was skeptical, but during the free screening I realized it wasn’t scary or mysterious at all. It’s very comfortable and I learned it can be very easy. I believe in the program 100%. It worked for me. I’ve recommended it to my friends, that’s why I’m sharing my story with you. Do what I did, call for your free hypnosis screening right now.

STOP THE PAIN, FOUND SUCCESS

I was in my doctor’s office and saw an ad for weight loss hypnosis in a newspaper there. I knew I had to try something different, so I called right away because I didn’t want to go on the way I was. I knew something had to be done.

INSTANT SUCCESS

It is the best weight-loss program I have ever been on. I noticed a change in my behavior immediately. It seemed like things just started to happen magically. After just one session, I easily walked past the table of desserts and sweets at didn’t want any of them, and it just stayed that way!

“I am proud of the fantastic results I got with this program and Since the program, I have saved 50-100 would recommend it to anyone. dollars per month that used to be for Call now for your free hypnosis junk food and soda screening.” MONEY SAVED

MORE RESULTS…. “So far, I have lost 77 pounds. I recommend this program very highly.” Ella Mae – Machine Operator “I have lost over 90 pounds and changed my life.” Michael Poirier – Customer Service, Clay “After three weeks, I lost 12 pounds and blew my physician away with my lowered blood pressure.” Don McMaster – IT Manager “This time I know I can maintain the weight loss permanently” Melody Mariani – Educator, Syracuse

“Now I’m eating apples again.” Kathleen Veri - Retired LPNPhlebotomist, Syracuse “I had gastric bypass, and I was sabotaging the surgery. Hypnosis helped achieve the things I wanted with my weight.” Jean Ferguson Retired, Auburn

QUIT NICOTINE, TOO! “I don’t crave cigarettes. Quitting has been so easy, I don’t need their free rehypnosis.” Alexandra – Fitness Provider, Syracuse

WEIGHT LOSS • NITCOTINE • STRESS R E L AT I O N S H I P • P E R F O R M A N C E OTHER PROBLEMS • PROFESSIONAL FA C I L I T I E S • F R E E N O R I S K S C R E E N I N G

Lose Weight March 2020 •

www.destinyhypnosis.com

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Right Care. Right at home. EMERGENCY ROOM OR URGENT CARE? For illnesses or injuries that are not life-threatening but still need immediate medical care.

URGENT CARE. RIGHT AT HOME. When it comes to non-emergency injuries, illnesses, or symptoms, Oswego Health is right at home. Our convenient urgent care locations at the Fulton and Central Square Medical Centers are just minutes away, and our team of skilled professionals and board certified physicians are there when you need it.

WHEN TO VISIT URGENT CARE Cuts or wounds that may require stitches Sprains, strains or deep bruises z Mild to moderate asthma attacks z Ear infections z Upper respiratory infections z Coughs and congestion z Sore throats z Insect bites and rashes z z

URGENT CARE

To avoid lines and check in online visit our website. Wait in the comfort of your home and we will send a text when it’s almost your turn. oswegohealth.org/urgent-care

EMERGENCY SERVICES. RIGHT AT HOME.

The unknown. The unexpected. It’s not really something we ever prepare for but when an emergency happens, Oswego Health is right at home. Oswego Hospital’s emergency services department is staffed 24 hours-a-day by board-certified physicians, nurse practitioners, physician assistants and nurses. Our highly-trained and experienced emergency medicine staff is ready to treat a range of emergent conditions quickly, safely and within minutes at our technology-advanced Emergency Department.

CALENDAR of

HEALTH EVENTS

April 1

Falls prevention program offered in Oswego  A “Stepping On” balance and falls prevention program leader training class will be offered for the first time in Oswego County, beginning April 1. The three-day training course will take place from 8:30 a.m. to 4 p.m. April 1, 2 and 3 at the Oswego County Health Department, 70 Bunner St. in Oswego. The course is free of charge to all participants. Lunch and snacks are provided each day.  Participants who successfully complete the three-day leader training class will have the knowledge and skills necessary to facilitate evidence-based “Stepping On’ workshops in the community. New

SUMMER CAMP FUN! JCC CAMP JOE & LYNNE ROMANO

June 29 – August 21 315-445-2360 • Preschool, school-age and teen day camps. • Reserve your child’s spot today!

5655 Thompson Rd., DeWitt www.jccsyr.org    

WHEN TO VISIT THE EMERGENCY DEPARTMENT z z z z z z z z

Severe bleeding Difficulty breathing Chest pain or pressure Broken bones Trauma or injury to the head Sudden dizziness or difficulty seeing Severe abdominal pain Pregnancy related complications EMERGENCY DEPARTMENT

oswegohealth.org/emergency-services

When it’s Urgent we’re Right at home.

Remember, if you have a medical emergency, go to your nearest emergency room or call 911.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

class leaders will work in conjunction with others to schedule and facilitate “Stepping On” workshops. New leaders will be expected to co-facilitate at least one workshop during the 2020 calendar year. “Stepping On” is an evidence-based program; researched and proven to reduce falls in older people. Each workshop meets for two hours a week for seven weeks. The program is designed specifically for anyone who is 60 years or older, has had a fall in the past year or is fearful of falling, lives at home and does not have significant memory issues. Experienced certified trainers lead workshops. In addition, local guest experts provide information on exercise, vision, safety, and medications. To register or for more information, call the Oswego County Health Department at 315-349-3391.

  

Math • Reading • Technology • Music • Art DĂƚŚZĞĂĚŝŶŐdĞĐŚŶŽůŽŐLJDƵƐŝĐƌƚ Study Skills/Writing • Social Awareness ^ƚƵĚLJ^ŬŝůůƐͬtƌŝƚŝŶŐ^ŽĐŝĂůǁĂƌĞŶĞƐƐ 



Who: Students 6 to 11 years of age tŚŽ͗^ƚƵĚĞŶƚƐϲƚŽϭϭLJĞĂƌƐŽĨĂŐĞ



When: July 7, 2020 to August 13, 2020 tŚĞŶ͗:ƵůLJϳ͕ϮϬϮϬƚŽƵŐƵƐƚϭϯ͕ϮϬϮϬ  Every Tuesday, Wednesday & Thursday 9:00 am to 2:45 pm ǀĞƌLJdƵĞƐĚĂLJ͕tĞĚŶĞƐĚĂLJĂŶĚ dŚƵƌƐĚĂLJĨƌŽŵϵ͗ϬϬĂŵƚŽϮ͗ϰϱƉŵ Where: Pine Grove Middle School 6318 tŚĞƌĞ͗WŝŶĞ'ƌŽǀĞDŝĚĚůĞ^ĐŚŽŽů Fremont Road East Syracuse, NY 13057 

ϲϯϭϴ&ƌĞŵŽŶƚZŽĂĚ Register online at ĂƐƚ^LJƌĂĐƵƐĞ͕EzϭϯϬϱϳ launchcny.org/summer-adventures-learning  

or call (315) 720-9148 for more information. ZĞŐŝƐƚĞƌŽŶůŝŶĞĂƚ ůĂƵŶĐŚĐŶLJ͘ŽƌŐͬƐƵŵŵĞƌͲĂĚǀĞŶƚƵƌĞƐͲůĞĂƌŶŝŶŐ  ŽƌĐĂůů;ϯϭϱͿϳϮϬͲϵϭϰϴĨŽƌŵŽƌĞŝŶĨŽƌŵĂƚŝŽŶ͘ 

Call 315-342-1182 to advertise and reach nearly 100,000 health-conscious readers in the region 


Say hello to healthy.

66 dedicated physicians and healthcare providers. Say hello to a more convenient way to stay healthy in Oswego County. ConnextCare offers a comprehensive set of services family and internal medicine, pediatrics, dentistry, psychiatry, social work under one medical group. Patients within our network can now visit any of the six locations at any time. And because we’re seamlessly connected, our staff can access your medical records at the touch of a button. It’s a faster, more convenient and easier way to keep yourself and your family healthy.

Learn more at connextcare.org — or better yet, stop in to one of our six sites Located in Fulton, Mexico, Oswego, Parish, Phoenix, Pulaski and say hello.

March 2020 •

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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36 Upstate Hospitals Get $29.3 Million from Excellus for Quality Improvements

T

hirty-six Upstate New York hospitals and health centers last year earned $29.3 million in quality improvement payments from Excellus BlueCross BlueShield as part of the nonprofit health insurer’s hospital performance incentive program. Since 2005, Excellus BlueCross BlueShield’s program has paid out more than $311 million in quality improvement incentives. “When we launched this initiative several years ago, we knew that its success would hinge on a high level of cooperation and collaboration among our health plan and our hospital partners,” said Carrie Whitcher, vice president for care improvement at Excellus BlueCross BlueShield. Central New York region hospitals that participated in this program in 2019 shared $6.1 million in quality improvement incentive payments. Among the participants were Guthrie Cortland Medical Center, Cortland; Crouse Hospital, Syracuse; Oswego Hospital, Oswego; St. Joseph’s Health Hospital and Upstate University Hospital (two sites), Syracuse. “In 2019, Excellus BlueCross BlueShield’s hospital performance incentive program evaluated participating hospitals on 38 unique performance measures,” said physician Stephen Cohen, senior vice president and corporate medical director at Excellus BlueCross BlueShield. “The best evidence that this collaboration is a success is that our hospital partners met 96% of all quality improvement targets.” Areas targeted for 2019 improvement included: • Clinical Processes of Care — Focused on improvements in follow-up after hospitalization, diabetes, chronic obstructive pulmonary disease (COPD), surgical care and other measures unique to each participating hospital. • Patient Safety — Centered on reductions in hospital-acquired infections, readmissions, and other adverse events or errors that affect patient care. • Patient Satisfaction — Used the hospital consumer assessment of healthcare providers and systems survey, which is a national, standardized, publicly-reported survey of patients’ perspectives of hospital care. In addition to meeting required clinical and patient safety measures in 2019, other nationally endorsed measures and target outcomes were jointly agreed upon by each hospital and the health insurer using benchmarks established by the Centers for Medicare & Medicaid Services, the Institute for Healthcare Improvement, and others.

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Meet

Your Doctor

Duane F. Tull, M.D. By Chris Motola

New chief medical officer at Oswego Health wants to increase awareness of services, surgeries offered locally and to build a culture of safety Q: How did you come to be medical director at Oswego Health? A: I came from a small, critical access hospital in central Pennsylvania where I was mostly doing endoscopies. We decided, my wife and I, that if I was ever going to get back into being a general surgeon, we needed to start looking for new positions. And as we were looking, Oswego popped up on our radar.

be known for more? A: I think one of the issues is people don’t realize the services we can offer them right here at home. We have the ability to do joints, total hips, most general surgery. We have a full complement of services available that people may not understand or recognize are here. We’re trying to get that information out so that people know what we’re capable of.

Q: What did you find appealing about Oswego Health? A: I was working for a small hospital that got taken over by a large behemoth and was definitely starting to feel a little bit of the headaches of the larger health system. We came up, we interviewed, we checked out the place. It appeared to be somewhere my skills as a surgeon could be offered to the community to help expand the services that are here, as well as help me do more of what I was trained to do.

Q: What’s the scope of those services? A: Most any non-subspecialty service is available here. If you’re talking about open-heart surgery, lung surgery, spinal surgery, those are things you’d go to a tertiary care facility for, but just using general surgery as an example, gall bladder, colon lesions, hernias, [non-cosmetic] breast surgery. These are all things we can easily do here, do with more convenience for the patient and get outcomes that are comparable if not better than at a larger facility.

Q: What are your plans as CMO? A: We are trying to reinforce the services we offer here, including general surgery, colorectal surgery, bariatric surgery, breast surgery, orthopedic surgery, urology. And of course we do a lot of endoscopies. We’re trying to expand all of that while at the same time focusing on patient safety and building a culture of safety at Oswego Health. Q: For a rural hospital, Oswego Health does quite a few surgeries — more than 6,000 in 2018. Is that a wellknown fact? Is that something the hospital wants to

IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

Q: What factors play into that? A: Our patient satisfaction scores are usually much higher than the larger facilities because we have more of a hometown feel than a big university feel. We monitor our infection rates carefully, we monitor our return admissions; we keep records of everything. And because we’re a smaller facility, we’re able to keep a closer handle on it than some of the larger places. Q: You mentioned wanting to get back into general surgery. To what degree have you been able to retain your practice while

in an administrative role? A: My administrative role is basically about a third of my duties now. Realistically, it expands beyond that, but schedule-wise it’s taking about a third of my time. The rest of the time I’m doing after hours, I’m doing after hours, weekends, etc. But I maintain a full general surgery practice. I operate on Mondays and Fridays. I have office hours on Tuesday and Thursdays. My administrative day is Wednesday. Q: Does being involved in care give you a better sense of how to respond administratively? A: Oh, definitely. It gives me a better handle on the functioning of the facility and what changes we can make for the betterment of the facility. Q: You’re a general surgeon, but do you have any procedures you would say you informally specialize in? A: I would consider my specialty to be minimally invasive surgery. About 95% of my hernias I do laparoscopically. I do gall bladders laparoscopically. I do most everything with minimally invasive techniques. Q: How much does Oswego County’s infamous winter weather play into Oswego Health’s service strategies? A: We’re not a critical access environment, but we definitely offer services that would be difficult to obtain during the winter if we weren’t here. Q: For surgery sites, are we talking about the main campus, or satellites as well? A: At the moment our surgeries are done at the main hospital. The second floor is our main operating area with a separate entrance for same-day surgeries. We would eventually like to work toward an outpatient surgery center, but that’s in our future, not our present. Q: Are you partnered with any of the big hospitals in the region? A: We have multiple affiliations with other facilities in Syracuse. Nothing is at the partnership level, but we work with surgeons at Crouse for bariatric surgery. We work with radiology at Crouse. We work with cardiology from St. Joe’s. We have cancer services through Upstate. So we basically have affiliations with all of the major hospitals in Syracuse. Q: How do your wait times compare to bigger hospitals? A: We’re quite proud of the fact that we can get people to be seen within 24 to 48 hours. If needed, we can get them into the operating room within a week, or the following week. In general my experience with larger facilities, it’s weeks not days to be seen.

Lifelines Name: Duane F. Tull, M.D. Position: Chief medical officer at Oswego Health Hometown: Salisbury, Maryland Education: Eastern Virginia Medical School; Hampden-Sydney College Affiliations: Oswego Health Organizations: American Board of Surgery; American College of Surgeons Family: Wife Hobbies: Fishing, outdoor activities, cars


2 Million Lost Health Coverage or Access in Trump’s First Year

T

wo million more Americans didn’t seek health care from late 2016 through 2017 because they couldn’t afford it or lacked insurance, new research shows. The analysis of data from 2011 through 2017 also found that health care coverage and access improved with implementation of the Affordable Care Act (ACA), but reversed after President Donald Trump and congressional Republicans began working to dismantle it, according to Boston University researchers. “While we found the ACA isn›t unraveling, there are real consequences to some of the policies that have been put in place,” said lead author Kevin Griffith, a doctoral candidate in the School of Public Health. “We see that you have these policy changes that are affecting millions of people’s ability to get insurance, and millions of people forgoing care

because they can›t afford it.” For the study, Griffith and his team analyzed federal data on 18- to 64-year-olds. The investigators found that uninsurance rates dropped 7.1 percentage points between 2013 and 2016, then rose 1.2 percentage points during 2017, Trump’s first year in office. Rates of adults who did not seek care due to costs reflected similar trends. The 2017 reversals had the greatest impact on low-income residents of 14 states that didn’t expand Medicaid under the ACA. In those states, which are mainly in the South, decreases in insurance coverage and health care access were four to five times higher than in states that expanded Medicaid. The study also found that from 2013 to 2016, the gap in health care access between higher- and lower-in-

come Americans narrowed by about 8.5 percentage points in expansion and nonexpansion states. But between the fourth quarter of 2016 and the fourth quarter of 2017, that gap widened by 2.6 percentage points in nonexpansion states (a relative increase of 11%). It continued to decrease by another 1 percentage point in expansion states (a relative decrease of 8%). The study appears in the February issue of the journal Health Affairs. “Medicaid expansion seemed to be a really great way for states to insulate themselves from some of

the damage of these federal policies,” Griffith said in a university news release. “For states considering Medicaid expansion, this shows that it’s a good way to take care of your residents, even regardless of what’s going on in Congress.” He said the reversals revealed by the study are worrisome. “We had this narrowing of disparities in access and coverage, but that’s reversing,” Griffith said. “Since 2017, the split between white and black, between rich and poor, urban and rural, renters and homeowners — all of these disparities are getting wider again. That’s concerning.”

The corona virus, so named for its crown-like spikes, is unknown so its spread causes alarm. On top of it all, infectious disease experts (ID docs) are a dying breed. There has been a 40% decrease in medical students enrolling in ID training programs or residencies between 2009 and 2017. Infectious disease is one of just two subspecialties where not all residency slots are filled. Telemedicine can help by transmitting increasingly rare and valuable expertise to physicians working in even the remotest areas. Telemedicine also allows physicians to treat patients remotely, keeping them from coming into emergency facilities and offices and infecting provider staffs and other patients.

prices is a form of “socialism.” The rather timid bipartisan bill would authorize CMS to negotiate just 25 prices the first year, then ramp up to more over 10 years. Drug prices remain totally unchecked while CMS literally sets prices and fees for physicians and hospitals.

Healthcare in a Minute

By George W. Chapman

MD Association Endorses Universal Coverage

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he American College of Physicians — with about 160,000 members — joins the ranks of physician organizations to endorse some sort of universal coverage or single payer healthcare system. Historically, most physician groups have resisted any form of increased government involvement. Several factors contribute to this gradual about-face. Millions of patients still struggle with paying their medical bills, including those with insurance. Medical debt is the No. 1 reason for personal bankruptcies. Over the past 30 years, commercial insurance carriers have gradually lowered their payments to physicians to Medicare levels. Consequently, there is less support for multiple payers and more for a single payer if fees are about the same. More and more Americans are not covered by employer sponsored insurance. The

percentage of Americans covered by some sort of federal program now exceeds 50%: Medicare, Medicaid, VA and military, federal employees, Bureau of Indian Affairs and the Affordable Care Act. The aging of America means Medicare is the fastest growing insurance plan. Dealing with multiple insurance plans is a cost and bureaucratic nightmare for physicians and their staff. A single payer would significantly lower practice overhead. According to a study in the Annals of Internal Medicine, a single payer system would reduce administrative costs by $600 billion annually. Finally, increasingly, younger physicians and recent grads prefer employment with larger health systems vs. private practice. Consequently, they are less resistant to government intervention if it guarantees access and affordability.

Easing MD Shortage

“certified,” but they do not have licenses. They operate under the license of a supervising physician. Nurse practitioners have their own license and many states allow them to practice independently from physicians. “Nurse practitioner” is a master’s degree. Both APs have seen rapid growth over the past decade.

Physician assistants (PAs) and nurse practitioners (NPs) are both considered to be advanced practitioners (APs). Both of these professionals are helping to mitigate the increasing shortage of physicians, especially in primary care. The likelihood of being seen by an AP in any setting (private practice, urgent care or clinic) increases every year. There are approximately 125,000 PAs and 270,000 NPs in addition to about 950,000 active/practicing physicians. (PAs have only existed since 1967.) This year, PA schools will be required to offer a master’s degree. PAs must complete 100 hours of continuing education every two years. PAs are

The Coronavirus Vs. the Flu

With the coronavirus grabbing the headlines, we forget how pervasive and deadly influenza can be. Five to 20% of us (or 16 million to 66 million of us) will contract the flu every year. About 200,000 of us will be hospitalized every year with the flu on average, costing $10 billion a year.

Surprise Billing

There is typically no charge when you approve or request the transfer of your record from one provider to another. Up until recently, when you requested a copy of your record be sent to a third party, like a law firm, the provider could charge you, but not more than an imposed cap of $6.50 regardless of the record format, like digital or paper. In January, a federal judge eliminated the cap on what you could be charged as arbitrary and capricious. Healthcare lawyers are challenging the ruling.

Out-of-network providers and insurance companies have been feuding over how to settle surprise billing. Currently, the consumer is stuck with paying the difference between what the out-of-network provider charges and what their insurance company thinks is reasonable. Congress’ Ways and Means Committee has suggested a two-step process to resolve the dilemma. First, the provider and the patient’s insurance company have 30 days to resolve the dispute between themselves. If they can’t, step two involves a third-party mediator. The vast majority of surprise billing emanates from a visit to an emergency room. The bill proposes giving patients an “advance explanation of benefits” including a cost estimate of what they will owe out of pocket which is alright in non-emergent situations. However, the Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to treat patients regardless of their ability to pay.

In his State of the Union address, President Trump once again called for legislation to bring drug prices under control. The House bipartisan bill authorizing Centers for Medicare & Medicaid Services (CMS) to negotiate drug prices on behalf of the 165 million people covered by Medicare and Medicaid remains stalled in the Senate. Sen. Chuck Grassley, a Republican, spearheaded the bipartisan bill. Opponents of the bill have argued that negotiating

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

Request for Copy of Your Record

Drug Price “Uncontrol”

March 2020 •

IN GOOD HEALTH – CNY’s Healthcare Newspaper

Page 7


My Turn

By Eva Briggs

All You Need to Know About Psoriaris

M

y brother was a musician who started out as a classical guitarist. He had to switch to jazz because he had psoriasis. Wait, you might ask, psoriasis is a skin disease. What does that have to do with guitar playing? My brother developed brittle, pitted, ridged fingernails from his psoriasis. Classical guitar players need long fingernails on their right hand. No longer able to grow long fingernails, he changed his specialty to jazz. Psoriasis is characterized by red scaly patches on the skin. It’s an autoimmune disease, meaning the body’s immune system attacks its own tissues. This prompts the skin to build up more and more skin cells, forming the thickened plaques. It’s a chronic condition, worsening at times, and easing up at other times. Like many other autoimmune diseases, it arises from a combination of underlying genetic susceptibility plus environmental factors. Some known factors that may trigger psoriasis include infections, skin injury, stress, smoking, heavy alcohol use, vitamin D deficiency and certain medicines. Approximately 2% to 4% of the population has psoriasis. It affects men and women equally. It most often starts in adulthood, but it can start in children. There are five main types of psoriasis. n Plaque psoriasis, the most common form, consists of dry raised red skin lesions covered with silvery

scales. It may be itchy or painful and can occur anywhere on the body. n Guttate psoriasis appears as small, round, dot-like lesions. This accounts for 10% of psoriasis and often starts in children or young adults. It may be triggered by a strep throat infection. The word guttate comes from the Latin word “gutta” which means drop. n Inverse psoriasis produces bright red lesions in body folds such as under the arm, behind the knee, or in the groin. Patients with this type of psoriasis often have another type elsewhere on their body. n Pustular psoriasis consists of blisters filled with noninfectious pus surrounded by red skin. The pus contains white blood cells, but no infectious agents and it is not contagious. It occurs most often on the hands or feet. n Erythrodermic psoriasis is a very severe form leading to widespread redness over most of the body. It can cause severe pain and itching and cause the skin to come off in sheets. It is potentially life-threatening. Fortunately, it is rare. In addition to nail changes, psoriasis can be associated with arthritis. Psoriatic arthritis causes joint pain, swelling and stiffness. This arthritis can occur even without visible psoriasis skin lesions. One manifestation is painful, sausage-like swelling of fingers or toes. Patients with psoriasis have a higher risk of many other diseases, including eye disorders, obesity, Type 2 diabetes, high blood pressure, heart

disease, other autoimmune diseases, Parkinson’s disease, and kidney disease. There is also a slightly higher risk of several types of cancer. Although psoriasis can’t be cured, there are many treatments. The most frequently prescribed treatments for mild to moderate psoriasis are topical corticosteroids. Long-term use can cause skin thinning and topical corticosteroids might stop working over time. So they are usually used for short-term treatment during flares. There are many other topical medicines for psoriasis. Vitamin D analogs, synthetic forms of vitamin D, are available in prescription creams or solutions. Anthralin is a medicine that can remove scales and make the skin smoother. It may irritate the skin and it stains anything it touches. Topical retinoids are vitamin A derivatives that can decrease skin inflammation. These can irritate the skin and increase sensitivity sunlight. Calcineurin inhibitors reduce inflammation and plaque buildup but are not recommended for long-term use due to an increased risk for skin cancer and lymphoma. Salicylic acid is available both in nonprescription and stronger prescription forms. It promotes shedding of dead skin cells to reduce scaling. Coal tar reduces scaling, itching and inflammation. But it’s messy, stains clothing and bedding, and has a strong odor. Moisturizing creams are useful addition to other medicines as they can lock in moisture to reduce itching, scaling, and dryness. Phototherapy uses natural or artificial ultraviolet light. Brief daily exposures to sunlight can be helpful, but patients should check with their doctors for the safest way to reap the benefits of sunlight while minimizing risks of skin damage. Various types of controlled doses of UVB (ultraviolet B) artificial light

• Care Management for Adults • •Care Management for Careand Management forAdults Adults Children and Children and Children

forms another treatment. Goeckerman therapy combines UVB and coal tar. Psoralen plus ultraviolet A (PUVA) combines a light sensitizing medication called psoralen with ultraviolet A light. Psoralen makes the skin more sensitive to UVA, and UVA penetrates the skin more deeply than UVB. This aggressive treatment is reserved for severe psoriasis due to side effects. Excimer laser uses a controlled beam of UVB light directed at psoriasis plaques. For severe or resistant psoriasis, there are oral and injected forms of medicine. Retinoids, related to vitamin A, can be used for severe psoriasis. Side effects include lip inflammation and hair loss. These medicines increase the risk of birth defects. Methotrexate suppresses inflammation and decreases the production of skin cells. It can also help psoriatic arthritis. Cyclosporine suppresses the immune system but can only be used for short term. Biologics are drugs that are targeted to alter the immune system. With so many potential treatments for psoriasis, patients should become established with a dermatologist to determine the best treatment in their case. As for my brother, he went on to a successful career as a jazz performer, music teacher, and music store owner until he died too young — from leukemia.

Eva Briggs is a medical doctor who works at two urgent care centers in the Syracuse region.

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5

W

Things You Should Know About Coronavirus

By Ernst Lamothe Jr.

ith the new strain of coronavirus — COVID-19 — hitting more than 2,000 in death toll and tens of thousands affected worldwide, much is still unknown by the general public about how the epidemic has spread. It was first identified in 2019 in the city of Wuhan, Hubei Province, China. Since then, the virus has been identified in multiple other countries, including in the U.S. According to the Centers for Disease Control and Prevention, human coronaviruses are common throughout the world. However, the new COVID-19 virus is a public health concern because of the many unknown factors and the fact that there is more than just one form of the virus. Physician Stephen Thomas, chief of the infectious disease division at Upstate Medical University in Syracuse, talks about five things people need to know about the coronavirus.

1.

There are multiple coronaviruses

The various coronaviruses can infect people and make them sick. Some human coronaviruses — not the new strain — were identified many years ago. Human coronaviruses commonly cause mild to moderate illness in people worldwide. “There are seven coronaviruses known to infect humans; four are

commonly found in people and cause about 10-30% of colds in the winter season — we test for these commonly in people with respiratory symptoms,” said Thomas. He added that three other coronaviruses can cause severe diseases and have been seen in recent epidemics, which includes SARS, MERSCoV, and now COVID-19–. Middle East respiratory syndrome coronavirus was first reported in 2012 in Saudi Arabia and has since caused illness in people in more than 25 other countries, including the United States, according to the CDC. Most people reported to have MERSCoV infection developed severe acute respiratory illness, including fever, cough, and shortness of breath.

2.

Coronaviruses are most commonly passed from person to person

Most often the virus is spread from person-to-person, which happens among close contacts about six feet away. It occurs mainly through respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. “It can spread when respiratory droplets with virus in them are pushed into the air by a cough or sneeze and someone is within close proximity to the infected person and

breathes in the virus,” said Thomas.

3.

The virus started in Wuhan

The Chinese government has mobilized many resources for containment and treatment. They have sent more than 10,000 medical workers, including military doctors, to Hubei province, where Wuhan is the capital and where the population has been hit hardest by the virus. The government has already spent $4.5 billion to handle the outbreak. The COVID-19 is thought to have originated at a market in Wuhan, China and has spread throughout mainland China and a number of other countries.

4.

Death toll rising

Confirmed cases are more than 70,000 in countries that include China, Japan, Singapore, Thailand, South Korea, Malaysia, Tawaiian, Australia, Germany, Vietnam, France, the United Kingdom and United States. “It appears about 2% of people with confirmed COVID-19 infection develop severe disease and die, but it is unclear how many total people have been infected making it difficult to access how severe this infection may be,” added Thomas.

5.

No vaccines yet

Thomas said there are

Physician Stephen Thomas, chief of the infectious disease division at Upstate Medical University in Syracuse. no approved drugs or vaccines to specifically treat or prevent COVID-19 infection or disease. He and other medical experts do offer some suggestions, which include washing hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer. In addition, avoid touching the eyes, nose, and mouth with unwashed hands, avoiding close contact with people who are sick and staying home when you are not feeling well. Also some of the same habits discussed when you have a cold such as covering your cough or sneeze with a tissue, then throwing the tissue in the trash and cleaning and disinfecting frequently touched objects and surfaces.

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Page 11


Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

On Your Own: See the Glass as Half Full! “Every one of us has been given a great gift: the cup of life. It is half full and half empty. We choose which half to focus on, at every moment.” - Marc Allen, triathlon coach Seeing the glass as half full rather than half empty is all about focusing on what’s positive in our lives, regardless of what comes our way. It’s about being thankful, appreciative and grateful. It’s about concentrating on our strengths rather than our weaknesses. I’m convinced that our thoughts and attitudes determine the life we have. And experience has taught me that seeing the glass as half full can make a big difference for those who live alone. We have a choice. We can choose to see the positive or we can choose to wallow in the negative; we can open our eyes to possibilities or begrudge what life has offered up. So, how do you view the cup of life? Take a look at the list below, which contains actual quotes from divorced or widowed women and men I’ve had the pleasure to meet in my workshops or public speaking engagements. Do you find yourself identifying with one perspective over another? NOT BEING MARRIED – Half empty “Something must be wrong with me. All my friends are married, and

here I am alone and miserable.” – Half full “Not in a million years did I expect to be divorced at my age, but I am resourceful and persistent. I’ve always wanted to travel and try new things, and now I have that opportunity — to create a life that’s rewarding and full of new people and experiences that bring me joy. And, who knows? I may meet a special someone along the way.” DECISION MAKING – Half empty “Are you kidding? I don’t know enough to buy a house or a car. Those are the big decisions my spouse used to make. I wouldn’t know where to begin.” – Half full “Finally, I am making all my own decisions! No one is around to second-guess my choices. I just purchased my first car all on my own: a 2020 Subaru Outback. I did the research and was completely prepared when I went to the dealership. My color choice? Autumn green metallic. I love it!” IN A CRISIS – Half empty “I’m no good in a crisis. I go to pieces. When I hear bad news, I’m embarrassed to admit that sometimes I long to be taken care of and protected. Living alone makes all this worse. There’s no one to turn to.” – Half full

s d i K Corner

Visits to Pediatricians on the Decline

C

ommercially insured children in the U.S. are seeing pediatricians less often than they did a decade ago, according to a new analysis led by a pediatrician-scientist at the University of Pittsburgh and UPMC Children’s Hospital of Pittsburgh.  But whether that’s good or bad is unclear, the researchers say in the study, published in January in JAMA Pediatrics.  “There’s something big going on here that we need to be paying attention to,” said lead author, physician

Page 12

Kristin Ray, assistant professor of pediatrics in Pitt’s School of Medicine. “The trend is likely a combination of both positive and negative changes. For example, if families avoid bringing their kids in because of worry about high co-pays and deductibles, that’s very concerning. But if this is the result of better preventive care keeping kids healthier or perhaps more physician offices providing advice over the phone to support parents caring for kids at home when they’ve got minor colds or stomach bugs, that’s a good thing.” 

IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

“Being alone in a crisis isn’t the end of the earth. In fact, some of my most significant growth has been during tough times. When I got the call that my father had had a heart attack, I took charge, made calls, and brought the family together. I learned I could take care of myself and others, too.” DATING – Half empty “I can’t imagine re-entering the dating scene. What could anyone possibly see in me at this age, with my graying hair, expanding waistline and grandchildren?” – Half full “I believe that warm friendships, even romance, can happen at any age. I’m now remarried. We met in a grief support group and the rest is history. Next year, we are celebrating our fifth anniversary.” FINANCES – Half empty “My spouse took care of all the finances — the bills, the taxes, everything! I feel helpless and, honestly, I fear dying alone and penniless.” – Half full “I knew it wouldn’t be easy, but I knew I could do it. Getting help with my finances was one of the first things I did after my divorce. I picked up the phone and asked for help, did my homework, and now enjoy peace of mind. I’m very proud of myself.” COOKING FOR ONE – Half empty “Why would I go to any lengths to create a special meal for just myself? It hardly seems worth it. I can fill up on chips and salsa and call it a night.” – Half full “Creating a pleasant ‘table for one’ makes me feel good about myself. It means I’m nourishing my body as well as my spirit. When I prepare a nice table setting and sit down to a simple home-cooked meal, a sense of serenity comes over me. I feel at home with my own good Ray and her colleagues examined insurance claims data from 2008 through 2016 for children 17 years old and younger. The data came from a large commercial health plan that covers millions of children across all 50 states with a range of benefit options. In that time span, primary care visits for any reason decreased by 14%.  Preventive care, or “well child” visits, increased by nearly 10%. This change occurred during the years when the Affordable Care Act eliminated co-pays for such visits. But that increase was eclipsed by a much larger decrease in problem-based visits for things such as illness or injury, with these visits declining by 24%. Among problem-based visits, decreases were seen for all types of diagnoses, except for psychiatric and behavioral health visits, which increased by 42%.  “This means that children and their families are visiting their pediatrician less throughout the year, presumably resulting in fewer opportunities for the pediatrician to connect with families on preventive care and healthy behaviors, like vaccinations and good nutrition,” said Ray, also a pediatrician and director of health system improvements at UPMC Chil-

company.” DISCOVERING YOUR TRUE SELF – Half empty “I’m a creature of habit, too old to re-invent myself. And, what’s the point anyway? There’s no one to share my life with. – Half full “It’s never too late. Today, I have an opportunity to fashion a life that reflects my dreams, my style, my true self. Just recently, I signed up for dancing lessons, a lifelong dream of mine. My niece is also coming into her own, and I love being a role model for her. TIME ALONE – Half empty “Living alone is for the birds! I just want to stay in bed and pull the covers up over my head. – Half full “Living alone need not be a time of diminished opportunities. It can be a time of expanding possibilities and new relationships. Used wisely, the time can be an adventure in self-discovery and reveal opportunities for personal growth, spiritual awakening, and quiet fulfillment.” If you don’t like the results you are getting in your life, consider changing the attitudes that are producing those results. Who knows what new journeys and joy await those who focus on gratitude and embrace the wisdom of seeing the glass half full.

Gwenn Voelckers leads Alone and Content empowerment workshops for women held in Mendon and is the author of “Alone and Content: Inspiring, empowering essays to help divorced and widowed women feel whole and complete on their own.” For information about workshops, to purchase her book, or invite her to speak, call 585-624-7887, email gvoelckers@rochester.rr.com, or visit www.aloneandcontent.com. dren’s Community Pediatrics. “The question is: Why? We don’t have the definitive answer, but our data give us some clues.” One possible explanation is that children are getting care elsewhere. Visits to urgent care, retail clinics and telemedicine consults for problem-based care increased during the study period. But that increase accounted for only about half of the decrease in visits to primary care pediatricians.  Higher out-of-pocket costs probably also explain why some parents aren’t taking their children to the pediatrician for medical concerns, Ray said. During the time period studied, out-of-pocket costs for problem-based visits increased 42%, while inflation-adjusted median household income rose by only 5%. Previous studies have found that even $1-$10 increases in copayments are associated with fewer visits.  Other factors also could be at play, the research team noted. With more parents working, some may find it difficult to bring children in for care. And there may be less need for some visits. Vaccination has dramatically reduced rates of ear infections and hospitalizations.


Parenting By Melissa Stefanec

MelissaStefanec@yahoo.com

A

Halftime Shows and Fulltime Violence

s this column won’t run until March, most of us will have forgotten the scandal surrounding Super Bowl LIV’s halftime show. The nation will have redirected its anger and musings. “Will somebody please think about the children” will be replaced with “You’re an idiot if you don’t vote for [insert name here] on Super Tuesday.” People like being outraged almost as much as they like being outraged by others’ outrage. It’s all part of the human comedy. However, I would be amiss if I said the halftime show didn’t give me pause. It was overtly, blatantly and patently sexual. Those two ladies had no qualms about the message they were sending to viewers: we are Latina, American and totally at peace with our sexuality and the power it brings. At first, I wasn’t sure what I felt about the last part of that message. • The setting When the halftime show aired, my kids were already in bed. I was immediately glad. I didn’t want them to watch this. Then, as I try to do when confronted with my own knee-jerk reactions, I asked myself if I was being fair. It didn’t take me long to arrive at an answer — no. It was morally inequivalent for me to be fine with kids watching a bloodthirsty and aggressive sport but shun overt female sexuality. I almost immediately realized my hypocrisy, but why did I react this way? • A trip down memory lane With that thought, I was instantly transported to one of the most profound moments of my childhood. It took place during a film class I took my senior year of high school. At the onset of the class, my mother had to sign a permission slip stating I could watch R-rated movies. Because I wasn’t 18, the school needed signoff from a guardian. With that signature, I could watch restricted movies at school (or so I thought). One of those movies was “The Godfather.” I had already seen it; however, watching it in class gave me a different perspective. The teacher taped a large piece of paper to the top of the television. That piece of paper was used to cover the screen during a single scene. That scene depicted one couple’s sexual encounter on their wedding night. However, later in the movie, I got a front-row seat to the man in that couple beating the snot out of his pregnant wife. Even as a high schooler, I was enraged. How could I be allowed to watch so much senseless violence but have to be “protected” from a very tame and wholesome romantic encounter? That class turned out to be one of the most progressive courses on misogyny and sexism I have taken to date. Sometimes, life’s most

important lessons are unintended. • Back to football and dancing After my trip down memory lane, I returned to dealing with my own hypocrisy. I allow my children to watch a violent game where people physically harm each other. In football, men use their physical power to establish dominance over each other. It’s a prime example of animal masculinity — men using their physical strength to become the victor. The payouts are power, fame and money. Whether you love or hate football for that fact doesn’t obscure that fact’s reality. Many Americans don’t think twice about exposing their children to this game. However, some people are clearly upset by women using their sexuality for similar gains. They are even more upset if their children bear witness. A man being angry, physical and driven is widely accepted. A woman being proud, physical and driven is clearly frowned upon. How can we let our consciences exist in both of these realities? • The takeaway I think there is conversation to be had. We need to examine how and when we expose our children to sex and violence. However, we can’t normalize one while vilifying the other. Placed side by side, sex is the healthier of the two. A healthy sexual relationship is an important part of adult life. However, there is limited moral room for healthy aggression and substantially less for healthy violence. Instead of worrying about the “dangers” of suggestive rump shaking and skimpy outfits, we should ask ourselves why we’re making these women scapegoats for our own failings. How are we, as parents and caretakers, making sure our children consume media in way that encourages healthy development? How can we change our own consumption habits to ensure we don’t normalize violence and simultaneously shun sex? Do we have frequent conversations with our kids about how the media portrays sex and violence and how society reacts to that portrayal? If we glorify violence and vilify sex, we will damage another generation. It is our burden (and opportunity) to have honest conversations that push back against double standards, even if that means engaging in some difficult introspection. If we don’t ask tough questions of ourselves, our children will recognize our hypocrisy before we can even acknowledge it. P.S. For the record, I like football. I just don’t think children should watch much of it.

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Page 13


Dental Care

Routine Care Vital With Braces By Deborah Jeanne Sergeant

I

f you or your child has just been fitted with braces, it may seem like your orthodontist has all the bases covered as you visit every eight weeks or so. Although orthodontist are general dentists with additional training in orthodontia, you still need to see your general dentist for routine cleanings just as before braces. “The general dentist is scrutinizing the teeth for tooth decay and gum-related problems,” said dentist John Carlile, owner of John Carlile, DDS General & Cosmetic Dentistry in Skaneateles. “If they’re not coming to see the general dentist and just seeing the orthodontist, although they may work with them for oral hygiene, tooth decay issues can get missed. They’re focusing on their work, the braces. The general dentist focuses on oral healthcare advice and scrutinizing for any decay issues.” Before applying braces, orthodontists perform X-rays and clean the teeth as part of the procedure, but that’s not the same as a general dentist appointment since it doesn’t include all of the services a general dentist provides. “We have some who say, ‘I saw the orthodontist, so I don’t need to get my teeth cleaned,’ but it’s even more important to continue with your regular hygiene schedule,” said Kristin Nylen, dentist at Oswego

Family Dentistry in Oswego. “You need dental visits to remove the deposits that build up.” The general dentist maintains the oral hygiene through visits every six months, or more often as prescribed. Most orthodontists don’t do general or routine cleaning as a general dentist does. Nylen said that regular visits are also important to prevent periodontal problems, check for decay and screen for oral cancer. Some people mistakenly believe that wearing braces causes white discoloration on the teeth, but Nylen said that’s really caused by improper home care. The discoloration is called demineralization. “If we see that’s starting to happen, we can prescribe fluoride supplement toothpaste to minimize the damage to the teeth,” Nylen said. For people who choose clear aligners over traditional braces, Nylen said it’s also “really important to keep the teeth clean under the aligner. Any food, drink or plaque is held in place by the aligner and has prolonged exposure to the teeth.” Before braces are applied, the patient should already have a good understanding of home care and good dental health and then ramp it up while their braces are in place. “Oral hygiene is more difficult to maintain with braces and plaque

can accumulate more easily,” said Anna Romans, dentist and owner of Romans and Sotani Dentistry in Camillus. “Good brushing, flossing and rinses will help out on a daily basis. The hygienist can point out areas you’re missing. When you have brackets and wires, you have new angles to reach above and below the wire. Without braces, it’s easier. Flossing will be trickier as you have to thread the floss through.” In addition to obstructing brushing and flossing, part of the reason that brushing is harder with braces is that the extra items in the mouth — bands, brackets, wires and linked elastics — provide irregular surfaces to which food debris can cling, according to Charles DiCosimo, III orthodontist in private practice at Raineri and DiCosimo Orthodontics in Liverpool and Baldwinsville. “There are significantly more areas for food and plaque to attach,” he said. “Flossing and brushing becomes more of a challenge and braces patients must allot more time to properly clean their teeth, gums, and all around their appliances. Patients

with braces also require special tools in order to properly navigate around the brackets and wires while flossing, since regular flossing techniques would be blocked by the wire. These include such products as floss threaders, proxabrushes, and superfloss.” He also advises avoiding sticky, sugary, and high acid foods, which can change the pH of the mouth and lead to enamel breakdown. A. Gregory Sohrweide, dentist at Cato Dental Services, LLC, advises special care should be taken around the gum line, where the teeth and gums meet. A Water Pik cleaner and water flosser may aid in the process, but Sohrweide said these don’t replace standard brushing and flossing, since a mechanical means of removing food debris is necessary. “The difference is the pik shoots a steady stream of water, but the flosser shoots a pulsating stream of water,” he said. “It does a little more thorough job. I recommend both very highly. They do an excellent job of washing around the braces.”

Dry Mouth: Important Health Clue

I

f you find that your mouth often feels parched, it’s not a symptom you should ignore, unless it’s only when you’re nervous. When it persists as a regular problem, dry mouth, called xerostomia in the medical world, can indicate a number of important health concerns. Instead of constantly reaching for lozenges, hard candy or a drink, you should see a healthcare provider. Dry mouth may seem like a minor nuisance, but it’s not. “It puts the person at high risk for decay,” said Kristin Nylen, dentist at Oswego Family Dentistry in Oswego. “Your saliva neutralizes the acid in food and the acid that’s caused by the bacteria living in your mouth. If you have less saliva, it can’t neutralize that acid and the acid ends up dissolving the enamel and leading to an increase in decay.” She added that using hard candy or lozenges that contain sugar only exacerbate the effect. Nylen said that one of the main causes of dry mouth is medication. Others include autoimmune disorders and radiation treatment for cancer. Age can also play a role.

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“It can have many, many causes,” said physician Az Tahir, who practices at High Point Wellness in Syracuse. Tahir said that dry mouth could be a localized problem from a blocked salivary gland in the mouth, or a systemic issue such as Sjogren’s syndrome, which can also cause dry eyes. Sjogren’s is an autoimmune disease that often accompanies other autoimmune conditions such as lupus, Hashimoto’s disease and rheumatoid arthritis. Anna Romans, dentist and owner of Romans and Sotani Dentistry in Camillus, said that someone with Sjogren’s may also notice dryer eyes and possibly joint problems, which need a primary care provider’s attention. “The mouth is gateway for overall health,” Romans said.” It may mean more health problems elsewhere. Overall, oral health has been shown to have a relationship with heart disease.” Beyond the chance of association with other conditions and the annoyance of feeling like your tongue is sticking to the roof of your mouth, dry mouth can cause dental health

IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

issues as well, such as increased plaque, tooth decay, gingivitis, mouth sores, thrush, cracked and dry lips, and, because saliva helps initiate the breakdown of food, digestive issues and nutrition problems. She added that drying out the mouth can hasten the gingivitis process, since saliva helps wash away food debris and neutralize acid in the mouth. Sometimes, dry mouth isn’t a local or systemic condition but is caused by an external injury that damages the salivary glands or a mechanical issue, according to John Carlile, dentist and owner of John Carlile, DDS, General & Cosmetic Dentistry in Skaneateles. “It could be sleeping habits,” he said, “if you sleep with your mouth open. If you have dry mouth, typically where it does the most damage is at night while you’re sleeping. During the day, you might drink water or chew specific types of gum or lozenges to stimulate the salivary flow.” He added that opening the mouth during sleep exacerbates the effect of naturally lower saliva flow at night.

Drinking more water and using mouthwash made to combat dry mouth can help, as can addressing any sleep issues like sleep apnea, which causes the lower jaw to drop open. Chemotherapy and radiation as a cancer treatment can cause dry mouth. Patients undergoing these treatments should ask about ways to keep more comfortable. Some medications can cause dry mouth, like some antihistamines, anti hypertensive drugs, and antidepressants, so it’s a good idea to bring this up during a visit with a healthcare provider, as an alternative medication or treatment option may be available. Dry mouth should also be addressed at a dental visit, since the dentist and hygienist can look for any signs of gingivitis and make recommendations on strategies to mitigate and prevent dry mouth. Using alcohol, tobacco products, or illicit drugs also contribute to dry mouth, so quitting use of these can help restore better moisture to the mouth.


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IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Should You Skip Breakfast? Celebrity TV doctor Mehmet Oz recently said people should skip breakfast. Do we really need the ‘most important’ meal? By Deborah Jeanne Sergeant

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elebrity doctor Mehmet Oz recently said that people should skip breakfast. That seems to fly in the face of the age-old adage that breakfast is the most important meal of the day and the means to jumpstart the metabolism, but Oz explained that most people respond to society cues to eat, whether they need the calories or not. Oz explained that eating later in the evening causes the hormones to make the body crave calories — primarily carbohydrates — first thing in the morning. Stopping eating around 7 p.m. resets the hormones so that by 7 the following morning, the body has been fasting 12 hours and it doesn’t feel hungry right away. He added that the data comes from animal research and anecdotal input from professional athletes. Oz’s advice seems to correlate with emerging research on intermittent fasting, which advocates for eating only during eight hours of the day and abstaining from food for the rest of the 24-hour period. Oz believes that skipping breakfast can help people not only maintain healthful weight, but also perform better both physically and mentally, and even age more slowly. He also believes that it’s an easy way for people to lose weight and maintain healthful weight, since it doesn’t involve counting calories or points, severe food restrictions or continual efforts (although eating a generally healthful diet of moderate calories is still a good idea). Even when eating the same number of calories over an eight-hour period compared with an 18-hour

period, people tend to lose weight, according to Oz. Also as part of his System 20 eating plan, adherents are permitted a cheat day so their bodies don’t get in a rut — and they can enjoy an occasional breakfast out. Or, instead of skipping breakfast, they can skip dinner that evening to maintain the eight hours of eating. Debbie Wolfe, a home and lifestyle writer based in the metro Atlanta area, posted in February on She Finds, “if you think skipping breakfast will help you lose weight faster you may be making a big mistake.” She bases this on the low blood glucose levels people have after not eating for 12 hours since their previous evening’s dinner. “When you wake up, your glycogen stores are low,” Wolfe wrote. “Glycogen is the glucose that has been stored in your muscle and liver tissues and is released slowly so your blood sugar levels are stable overnight. When you skip breakfast in order to fast, all of the energy from the glycogen stores is used up, your body starts to break down fat to produce energy. You may lose weight with this method, but you can also experience reduced energy levels and fatigue.” She added that eating breakfast can add a nutritious boost to the day, improve energy levels and metabolism and prevent poor food choices later. Physician Az Tahir, who practices at High Point Wellness in Syracuse, sees merit in intermittent fasting. “It has been shown to help people lose weight and prevent and treat diabetes,” Tahir said. “It causes blood

He usually eats oats or muesli with fresh berries and greens on the side or a shake alongside his oatmeal. As an avid mountain biker, Ruszkowski said he needs the calories to replenish what he’s using. Someone with a more sedentary lifestyle may not need the extra calories. “Drink a glass or two of water to start the hydration process,” he said. “Being dehydrated gives you the feeling of being hungry. Most of the time we need fluids and that’s the biggest thing for health. Make sure you’re adequately hydrated.” Laurel Sterling, registered dietitian, nutritionist and educator for Carlson Laboratories in Canastota, also believes that cutting out breakfast is relative. “Breakfast depends on the person, and what the person ate the night before and at what time they ate,” she said. While she sees health benefits for different types of fasting, she also recognizes that for people who are diabetic, have low blood sugar or take medication with food, breakfast may be necessary. “A breakfast could be a Greek yogurt, an egg, cottage cheese, or avocado toast,” she said.

pressure and blood glucose markers to go down.” He likes the simplicity of fasting while still drinking water or tea, since it’s easy for people to understand and follow. Tahir said that after two or three days, people fasting for 18 hours per day don’t feel hunger anymore. Adam Ruszkowski, physical therapist with Summit Physical Therapy in Syracuse and active outdoorsman, does see merit in occasional fasting since it can cut overall caloric intake for the week. But he believes that skipping breakfast may not benefit all. “Breakfast isn’t really healthful or unhealthful,” he said. “If you’re hungry, reach for a well-balanced meal with fresh greens, protein and carbohydrates. If you’re not hungry, you can skip it.” For those who do eat breakfast, it shouldn’t be a sugary cereal, waffles or white flour pastry. These foods tend to cause blood sugar to spike and crash, leaving diners hungry before noon and prone to overeating. They also lack nutrients and fiber. “You can have green leafy vegetables or slow digesting oats,” he said.

National Kidney Month

Slowing the Progression of Kidney Disease By Antoine Azar, M.D.

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arch is National Kidney Month, and it is a great time to remind people in Central New York of the importance of our kidneys. It’s also a good time to talk about what nephrology is. Simply put, nephrology is the branch of medicine that deals with the functions and diseases of the kidneys. The kidneys serve many important functions, including filtering blood and wastes, regulating blood pressure, producing vitamin D and controlling production of red blood cells. Nationally, over 30 million people suffer from kidney disease — most are unaware they have a kidney problem. This is a serious concern as by the time symptoms appear kidney disease may have progressed to a more serious stage. The potential symptoms of kidney disease include fluid retention in the legs and face, difficulty

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breathing, decreased appetite, difficulty sleeping, difficulty concentrating and skin itchiness. Diabetes and high blood pressure are the major causes of kidney disease. Other risk factors include heart disease, obesity and a family history. The only way to find out if people have kidney disease is through blood and urine tests to measure kidney functioning and check for protein in the urine. Lab test results are extremely important to measure kidney function. Patients and providers at our practice, Nephrology Associates of Syracuse (NAS), work together to develop a plan to slow the progression of kidney disease, and regularly monitor health status. Encouraging patients to understand their illness and become engaged in their health care is a priority at NAS. Individual, one-on-one patient

IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

education visits are available for patients and their loved one to meet with a kidney disease practitioner, and have an in-depth discussion about the patient’s condition and what can be done in terms of diet, exercise, and lifestyle to best manage health. Medical nutritional therapy is available from a registered dietitian on site. To prevent kidney disease and lower risk for kidney failure, control blood pressure and blood sugar levels, maintain a healthy body weight, avoid smoking and check with your doctor before taking certain medications. I recommend that individuals with risk factors or who are experiencing symptoms be screened by their primary care physician. If warranted, your provider will make a referral for a kidney consultation at our office.

Physician Antoine Azar earned his medical degree from University of Aleppo, Syria, and is board-certified in internal medicine and nephrology. He completed a nephrology fellowship at SUNY Upstate Medical University and his internal medicine residency at UlC/Advocate Christ Medical Center in Chicago. He has been with Nephrology Associates of Syracuse since October 2016. For more information, visit www.nephrologysyracuse.com or call 315-478-3311.


SmartBites

The skinny on healthy eating

Little Lentils Dish Up Big Benefits A small but mighty member of the legume family, lentils have so much going for them it’s hard to know where to begin. Nutritionally dense and loaded with wide-ranging health benefits, lentils are considered by many to be a “superfood.” Lentils are remarkable high in fiber — both soluble and insoluble — with one cooked cup providing around 16 grams of this cholesterol-lowering nutrient. According to the American Heart Association, the average American adult needs about 25 grams of fiber a day to reap its benefits. On average, however, American adults eat only 10 to 15 grams of fiber a day. Why bump up your fiber intake? Multiple studies have confirmed that eating lots of fiber can reduce your risk of dying from heart disease, cancer, stroke, and Type 2 diabetes. Lentils’ impressive amounts of folate and magnesium also contribute to heart health. Folate helps lower levels of homocysteine, an amino acid that when elevated can lead to hardening of the arteries and blood clots, while magnesium helps maintain a steady heartbeat and normal blood pressure. Heart benefits notwithstanding, folate is critical for preventing neural tube defects in newborns. Seeking to increase your intake of plant-based protein? Look to lentils, the bean that delivers the second

most protein per cup (soybeans take top honors): a whopping 18 grams. A building block of bones, muscles and skin, this powerhouse nutrient can also be a dieter’s best friend, as its slower digestion helps to curb snacking, and its metabolic boost (protein takes the most energy to digest) can be a bona fide calorie-burner. Similar to other beans, lentils are packed with antioxidants — those magical compounds that can help prevent a host of age-related maladies, from heart disease to cancer to Alzheimer’s. Lentils’ antioxidants do a body good by helping to reduce inflammation, lower blood pressure

By Anne Palumbo and fight free radical damage. A versatile bean that cooks in a jiff, lentils are naturally low in fat, sodium, cholesterol and calories: only 230 per cooked cup. This ancient legume — nearly 10,000 years old — is also a good source of manganese, phosphorous and iron.

Lentil Bolognese Adapted from Cuisineathome.com 2 tablespoons olive oil 2 cups sliced white or cremini mushrooms (or more) 1 cup chopped onion 3 cloves garlic, minced 1 cup each sliced carrot and celery 2 teaspoons Italian seasoning 1/4 teaspoon red pepper flakes 1 tablespoon tomato paste 2-3/4 cups low-sodium broth: vegetable or chicken 1 can diced tomatoes (14.5 oz.) 3/4 cups lentils 1/4 cup 2% milk 1 teaspoon balsamic vinegar

Helpful tips Store dry lentils in an airtight container in a cool, dry place for up to a year (can be stored longer, but taste may deteriorate). Cooked lentils will last about a week in refrigerator or up to six months in freezer. Canned lentils have a similar nutritional profile to dry lentils, but may be slightly higher in calories and sodium. Check label and be sure to rinse well before using. salt and pepper to taste 8 to 10 oz. pasta of choice shredded Parmesan Heat oil in a large saucepan or skillet over medium heat. Add the onion and garlic and sauté until onions become soft, about eight minutes. Add the celery, carrots, mushrooms, Italian seasoning, and pepper flakes; sweat, partially covered until softened, about 10 minutes, stirring occasionally. Stir in tomato paste; cook two minutes. Add broth, tomatoes, and lentils; simmer, partially covered, until lentils are tender, 45-50 minutes, stirring occasionally. Meanwhile, cook pasta in a pot of boiling salted water according to package directions; drain. Stir milk and vinegar into bolognese; season with salt and coarse black pepper. Serve bolognese over pasta; top with Parmesan.

Anne Palumbo is a lifestyle colum-

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

One Egg Per Day Is Heart-Healthy, After All I t’s no yolk: Americans for decades have gotten dietary whiplash from the back-and-forth science on whether eggs are good for them. But a major new study will have many egg-lovers relieved: You can enjoy an egg a day without having to worry about your heart. “Moderate egg intake, which is about one egg per day in most people, does not increase the risk of cardiovascular disease or mortality even if people have a history of cardiovascular disease or diabetes,” said study lead author Mahshid Dehghan. She’s an investigator at the Population Health Research Institute (PHRI) of McMaster University in Hamilton, Canada. The study, which analyzed data on more than 177,000 people, was funded by various provincial government health agencies in Ontario, and nonprofit groups focused on heart health. It received no funding from the egg industry. Dehghan’s group poured over data from three large, long-term international studies, all conducted at the PHRI. The three studies involved people with various income

levels living in 50 countries on six continents, so the results are widely applicable, the researchers said. Most of the people in the studies had one or fewer eggs a day, suggesting that this level of consumption is safe, Dehghan said. “Also, no association was found between egg intake and blood cholesterol, its components or other risk factors,” she said in a McMaster news release. “These results are robust and widely applicable to both healthy individuals and those with vascular disease.” Eggs are an inexpensive source of essential nutrients, but some nutritional guidelines have advised that people should limit intake to fewer than three eggs a week, due to concerns they increase the risk of heart disease. But as study principal investigator Salim Yusuf pointed out, prior studies about eggs and health have yielded conflicting findings. “This is because most of these studies were relatively small or moderate in size and did not include individuals from a large number of countries,” Yusuf said in the news release. He directs the PHRI.

Two U.S. experts in nutrition and heart health agreed that maybe it›s time — again — to give eggs a break. “The case of eggs causing heart disease has been cracked — Humpty Dumpty can remain on the wall,” said physician Guy Mintz, who directs cardiovascular health at the Sandra Atlas Bass Heart Hospital in Manhasset, Long Island. “This very large study has clearly demonstrated that people can have one egg a day

March 2020 •

without any cardiovascular consequences.” Mintz believes eggs are a good source of many nutrients, and he stressed that no deleterious effect was seen, even in people who already had heart disease or were taking medications. The study was published recently in the American Journal of Clinical Nutrition.

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Addiction The Talk: Discussing Drugs with Your Kids By Deborah Jeanne Sergeant No parents want to see their children use drugs, yet many parents don’t know what to say to their children about drugs. Or they assume that the school program suffices or maybe hope that if they yell at their children about drugs, their children won’t try drugs. All of these strategies are a big gamble. “Parents are the biggest influence on their children,” said Cortney Pitcher, parent educator at Prevention Network in Syracuse. “It’s really important for that conversation to come from parents, starting early before it happens. Just a five-minute talk. Children really want to do well by their parents. It’s not all one big conversation. “ She advises starting with questions such as what they think about a hot topic related to drug use. Then prepared parents can offer science-based information on the drug. “’I’ statements are so useful to tell kids without targeting other people or things in the past,” Pitcher said. She advises open and honest conversation that comes from a viewpoint of love and concern. If the children sound curious about drug use or admit they or their friends are dabbling, Pitcher said to avoid yelling, blaming, accusing or threatening, since scaring children curtails

learning about the topic. “It does something to the brain and changes the wavelength on how it’s supposed to stay calm,” she said. “Reframe it. Take a time-out. If we talk with our children any further about the conflict right now, it can turn into anger and things we regret. Maybe we were taught these things growing up. Are there other ways we can handle these things?” Ideally, parents should start at the pre-K age by talking about their children’s vitamin supplements as not candy, but only something a parent should give them once a day, like the label says. By elementary school, children could learn about the differences between medicine and illicit drugs and why prescriptions should be taken only as prescribed and by who’s on the prescription. Substance abuse education at school can provide a springboard to conversation and to answer any questions they have. In addition to drug talks, children also need to learn problem solving for lasting solutions so they won’t feel the need to turn to drugs to solve problems or deal with stress, as well as how they would respond to offers of drugs. “Empower them to do what’s right,” Pitcher said. “Ask them what they would do in a situation, like text the parent. If they’re in a situation

Despite Drop, Overdose Still Poses Serious Threat By Deborah Jeanne Sergeant Between 2018 and 2019, death because of drug overdose in New York has decreased by 4.6%, from 2,386 to 2,276, according to the most recent, non-finalized statistics from the Centers for Disease Control and Prevention; however, any death from drug overdose is one too many. While prompt medical attention can sometimes reduce the chances of fatality from use of opioids and other substances, that medical care doesn’t always happen, especially when

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young people are involved. Fear of their parents’ response or legal repercussions may cause teens and young adults to not seek medical help in some cases. Some may hope their friend will sleep off the effects or fear that by helping, they will reveal to their parents their drug use. “It does happen,” said Cortney Pitcher, parent educator Prevention Network in Syracuse. “Kids are afraid they’ll get in trouble. It ties into, are parents someone they can talk with? They’re afraid they’ll be in trouble so they don’t say anything.” Some may fear their parents’ response over their friend’s possible death in part because of previous experience with run-ins with their parents. Parents can help reduce this effect by responding in a more measured fashion when their children break the rules. “The parent needs to say, ‘You can come talk with me about anything’ and then the parent needs to not snap or shut them down but just listen to them,” Pritcher said. Youth may also fear their friends’ response if they call for help during a possible overdose incident. “Let them know their friends will get over you telling on them because you saved their life,” Pritcher said. “If you didn’t make that call, how

IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

with peer pressure what they would do? Tell them to talk with you and you’ll figure things out.” She added that seeking outside sources of help such as the pediatrician is also a good idea. Websites such as www.talk2prevent.ny.gov and www.samhsa.gov may also help. Around the pre-teen years, young people need to feel they can talk with their parents about anything without judgment or a harsh response. They need to feel that their parents will simply listen without rushing in to fix or teach all the time. Also at the pre-teen age, it’s time to establish rules with consequences, long before something happens. Most young people can’t imagine that smoking a joint one time or taking a single pill will land them in a lifelong addiction. That’s why it’s wise to emphasize more immediate and likely consequences. For example, if they use drugs, they will get kicked off their sports team or other activity that means a lot to them. JoLynn Mulholland, Drug Free Cayuga County project coordinator, would you feel? It’s a little more harsh, but it’s being honest and using real-life examples. I know I would live with that for the rest of my life that I had a choice to make the call or not make the call. Let them know to make the call regardless.” It can be difficult for young people to know what their friend took, how much and how it could affect their friends’ health. Pritcher said that Good Samaritan laws protect both the patient and the person who sought medical attention. A study in Washington State indicates that 88% of people surveyed who use opioids would feel more likely to call 911 in case of an overdose because of the law. Most teens feel invincible, as if terrible things won’t happen to them or their friends such as dying from a drug overdose. Doing nothing seems like the right answer to some teens since it’s really difficult for them to believe that another young person could die. Some teens don’t recognize the signs of when a friend is in trouble with substance abuse and in need of emergency help. Mulholland said that the major indicators of possible overdose may include incoherent speech, repeatedly falling, drowsy appearance but waking up quickly and breathing problems. Give Narcan (naloxone) to anyone suspected overdosing on opioids and call 911. Narcan is available over-the-counter at pharmacies and will not harm people who are misdiagnosed as overdosing on opioids; however, patients who have taken

stressed the importance of a solid relationship with teens. “Your children need to know they can trust you,” she said. “That is the biggest thing that can help with prevention.” Teens who experiment with drugs often have different reasons for their behavior than their parents may think. It could include scheduling stress, anxiety about the future, a response to bullying or other reasons. “Help them develop coping skills,” Mulholland said. “No one wants to grow up to be an addict. Many use substances for a coping mechanism. Teach them yoga, breathing technique or things to do when they’re upset and how to use words and to otherwise express themselves are helpful in the long run. It’s also important to lead by example. If you rush for a glass of wine every evening after work, it signals teens that using a mood-altering substance can help them relax, too. If you have used drugs in the past, use your experience to indicate the negative effects of using drugs. “As a parent, you can be open and say, ‘You’re right. I turned out fine but that doesn’t mean down the line that the addiction won’t come out,” Mulholland said. “You don’t know if you’ll become addicted or not. That’s the danger.’” Teens may also tell parents who did not experiment with drugs that their lack of experience means they don’t know the truth. Mulholland offered as an answer to that line of thinking: “’I was given the knowledge and information and I made the choice not to use.’ Explain why you didn’t do drugs, like to get good grades or stay healthy. Sometimes it triggers mental health problems, weight gain and other problems.”

By the Numbers According to the Centers for Disease Control and Prevention’s most recent statistics: • 70,237 drug overdose deaths occurred in the United States in 2017. • The age-adjusted rate of overdose deaths increased significantly by 9.6% from 2016 (19.8 per 100,000) to 2017 (21.7 per 100,000). • Opioids — mainly synthetic opioids (other than methadone) — are currently the main driver of drug overdose deaths. Opioids were involved in 47,600 overdose deaths in 2017 (67.8% of all drug overdose deaths). • In 2017, the states with the highest rates of death due to drug overdose were West Virginia (57.8 per 100,000), Ohio (46.3 per 100,000), Pennsylvania (44.3 per 100,000), the District of Columbia (44.0 per 100,000), and Kentucky (37.2 per 100,000). • States with statistically significant increases in drug overdose death rates from 2016 to 2017 included Alabama, Arizona, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Maine, Maryland, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, West Virginia, and Wisconsin. other drugs may need different treatment. Administering Narcan is not a substitute for dialing 911 and waiting with the patient.


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3.5% UNINSURED RATE 35% LOWER

THAN THE NEW YORK STATE AVERAGE

61% LOWER

THAN THE NATIONAL AVERAGE

Upstate New York’s 2018 uninsured rate is among the lowest ever recorded. According to recently released numbers from the U.S. Census Bureau, the uninsured rate in upstate New York was just 3.5 percent in 2018, compared with a New York state uninsured rate of 5.4 percent and a national rate of 8.9 percent. Low health-care costs are a key factor in upstate New York’s low uninsured rate.

For private insurance, Rochester and Syracuse are ranked as having among the lowest health care spending rates among 306 hospital referral regions across the country.* Upstate New York has a proud history of affordable, high-quality health care. It’s the result of regional partnerships and a commitment to nonprofit health care. It helps make our community a great place to live and work.

*Source: “The Experts Were Wrong About the Best Places for Better and Cheaper Health Care.” The New York Times, December 15, 2015 A nonprofit independent licensee of the Blue Cross Blue Shield Association

March 2020 •

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Antioxidant Use During Chemotherapy Risky for Breast Cancer Patients

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reast cancer patients who take the dietary supplements known as antioxidants, as well as iron, vitamin B12, and omega-3 fatty acids, during chemotherapy may be at increased risk of disease recurrence and death, according to new study results appearing in the Journal of Clinical Oncology. Led by researchers at the SWOG Cancer Research Network, a cancer clinical trials network funded by the National Cancer Institute (NCI) through the National Institutes of Health, the study confirms previous medical guidance advising cautious use of any supplements, other than a multivitamin, for cancer patients undergoing chemotherapy. A small but growing body of research in the last 20 years shows that, despite their cancer-fighting reputation, antioxidants such as vitamin E, beta-carotene and selenium can actually increase risk of some cancers, cause some cancers to return after treatment or interfere with the effects of chemotherapy. As part of the nation’s oldest and largest publicly-funded cancer research network, SWOG has conducted some of this work. Its landmark Selenium and Vitamin E Cancer Prevention Trial (SELECT) showed that vitamin E supplementation increases the risk of prostate cancer in healthy men. What’s unique about the new study, led by Christine B. Ambrosone, Ph.D., of Roswell Park Comprehensive Cancer Center, is that it is the first investigation of the effects of supplement use during breast cancer

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(315) 464-HOPE

IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

treatment, and only the second to investigate the effects of supplement use during any kind of cancer treatment. The first was conducted by physician Charles Fuchs, the director of Yale Cancer Center, who found that vitamin C may be helpful for people undergoing chemotherapy treatment for colorectal cancer. “Although this is an observational study and the number of users of supplements was fairly small, the results are compelling,” said Ambrosone, chairwoman of the department of cancer prevention and control at Roswell Park. “Patients using any antioxidant before and during chemotherapy had an increased risk of their breast cancer returning and, to a lesser degree, had an increased risk of death. Vitamin B12, iron, and omega-3 fatty acid use was also associated with poorer outcomes.” Here’s what researchers found: • Patients who reported taking any antioxidant — vitamins A, C, E and carotenoids and Coenyzme Q10 — were 41% more likely to have their breast cancer return when they took the supplements both before and during chemotherapy treatment. • Patients had a similar, but weaker, increased risk of death when taking those antioxidants. • Patients taking vitamin B12, iron, and omega-3 fatty acid supplements were at significantly greater risk of breast cancer recurrence and death. • Patients taking multivitamins showed no signs of poorer or better outcomes after chemotherapy.

How Exercise Can Lower Cancer Risk

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ngaging in regular exercise is good for you for many reasons, and one of them is to lower your risk of getting cancer. According to the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention, getting more physical activity is associated with a lower risk for several types of cancer, including breast, prostate, colon, endometrium, and possibly pancreatic cancer. Physical activity can help regulate some hormones that contribute to the development of cancer and help keep the immune system healthy. Regular exercise also helps you stay at a healthy weight, which helps regulate hormones and helps the immune system. In fact, being overweight or obese is a factor in an estimated 14% to 20% of cancer deaths in the US. Losing even a small amount of weight has health benefits and is a good place to start. Another advantage to exercising is that when you’re exercising, you aren’t just sitting. Evidence is growing that sitting time, no matter how much exercise you get when you aren’t sitting, increases the likelihood of developing several types of cancer,

as well as obesity, type 2 diabetes, and heart disease. Adults should get at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity activity each week, preferably spread throughout the week. But even lower amounts of activity can help. For people who haven’t exercised in a while, it makes sense to start slowly and build up gradually. And clear any new activity with your doctor. Kids should get at least one hour of moderate- or vigorous-intensity activity each day, with vigorous-intensity activity at least 3 days each week. Examples of moderate intensity activities include brisk walking (3 mph), dancing, leisurely bicycling, yoga, golfing, softball, doubles tennis, and general yard and garden maintenance. Examples of vigorous intensity activities include jogging, running, fast bicycling, swimming, aerobic dance, soccer, singles tennis, and basketball. All of these activities are in addition to those that are part of your usual routine at home and work things like walking from your car to the garage, and climbing a flight of stairs.


Rendering of the infusion department at Auburn Community Hospital Cancer Center.

Auburn Community Hospital Opens Cancer Center Upstate Cancer Center at Auburn Community Hospital already treating patients from Cayuga County and surrounding area By Deborah Jeanne Sergeant

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or cancer patients in Cayuga and neighboring counties, receiving care just became a little easier. Partnering with Upstate Cancer Center, Auburn Community Hospital opened the doors to Upstate Cancer Center at Auburn Community Hospital in January, providing fairly comprehensive cancer care closer to home. “For the patients in this area, there is nothing except a small practice with one doctor who’s local,” said Christine Sherman, the new center’s director. “Otherwise, it’s 45 minutes to Upstate or [two hours to] Roswell.” More than just convenience, the new center’s close location augments the treatment its providers offer. “Driving a great distance is the last thing you want to do while undergoing cancer treatment,” Sherman said. “It’s a barrier to care. Some opt to not get treatment because they lack transportation or their family can’t get off of work. “When you’ve watch patients suffer and they don’t feel good and they have to drive, it hinders their healing process. It’s stress on a family and the patients themselves.” Sherman said that the center has worked out arrangements with a local transportation company so if a patient needs transportation, he or she can receive it at little to no cost. Any current Upstate cancer patients who want to do so may transfer their care to the Auburn facility if they decide it’s more convenient, Sherman said. Located at the first floor of Auburn Community Hospital, the space dedicated to the center includes three exam rooms, five oncology infusion bays, six non-oncology infusion bays, a waiting room, restrooms and a small kitchenette if patients want to eat lunch on the premises. The

facility provides a social worker and pharmacist to accommodate patients right at the cancer center. Each infusion area includes chairs for family members and a reclining chair for patient use with its own television, heat panel and heated blankets to help make patients as comfortable as possible. Free parking is also available. The development project cost $1 million and took about two years from conception to completion. The center represents phase one of a three-phase project, which will also include radiation oncology

and surgical consultation. Sherman said it’s likely that further hospital renovation will accommodate the expansion of the center’s oncology offerings. These phases will also be a joint venture with Upstate. The American College of Surgeons Commission on Cancer has ranked the Upstate Cancer Center in the top 20% of cancer care programs nationwide. It is the only program accredited by this organization in the 17-county area of Central New York. The physicians and nurse practitioners working in the Auburn location came from Upstate. All the

Christine Sherman, the director of Auburn Community Hospital Opens Cancer Center. “For the patients in this area, there is nothing except a small practice with one doctor who’s local,” she says. “Otherwise, it’s 45 minutes to Upstate or [two hours to] Roswell.” March 2020 •

nurses have been trained in oncology services and are Auburn Community Hospital employees now, while Upstate employs the physicians. Sherman served as nurse manager of the multi-disciplinary suite at Upstate Cancer Center. She developed the idea of the multi-disciplinary approach to cancer care, such as all the providers going to the patient instead of the patient having to make multiple appointments for each provider. “It’s all one visit, one co-pay,” Sherman said. “The cost of co-pays is also a barrier to care, as is the cost of gas and parking. If you have to have lab work, we make sure it’s billed within that appointment so there’s not two co-pays. These are small details that add up. We want to incorporate everything into one visit.” This streamlined approach also helps facilitate more timely care, which is especially important for people with fast-growing cancer. A graduate of Auburn Community College, Sherman feels proud to bring her knowledge back to her town. She began nursing at then-Community General Hospital in Syracuse in 2002 as a medical surgery nurse and realized she wanted to specialize in oncology. She moved into the administrative role at the Cancer Center at Upstate in 2013. “My career has been spent advocating for patients and dealing with barriers to care and why they don’t follow through with the care they know they need,” Sherman said. “Living in Auburn, it became clear this area needed these services. I’ve advocated for this space for a long time. It’s a dream come true kind of thing.” She hopes to complete her master’s degree in hospital administration at SUNY Brockport. Sherman said that the center is working on obtaining more equipment to broaden its capacity. The presence of the facility in Auburn will relieve some of the patient load from Upstate, which means more patients can receive care sooner. “Our goal in oncology care is to be empathetic and as accommodating as we can for our patients and to go that extra mile for that patient and family going through the worse time of their life,” Sherman said.

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Meet Your Provider Center for Audiology and Hearing Aids at Oswego Health An interview with Audiologist Kathleen Burch. Q: How long have you been an Audiologist? A: 25 years Q: What about being an Audiologist interested you? A: Initially I was fascinated with the intricacy of the anatomy of the ear, how all the parts work together and how the coding of frequencies received in the ear is replicated in the temporal lobe of the brain. Then as I began to work clinically with patients, I enjoyed being able to help them understand their hearing diagnosis and steer them in the right direction for help, be it a medical referral or hearing aid use. Q: What personal rewards do you receive in your position? A: I enjoy meeting new people and getting to know my patients. It’s very satisfying to help people improve their quality of life and relationships through better hearing. Q: What makes you different from other Audiologists in the area? A: With my years of experience

in medical environments, I approach testing and diagnosis from a medical perspective, and a commitment to do what is in the best interest of the patient, not our practice. Q: Why should someone consider seeking your professional services? A: People should consider seeking services here because of my experience, professionalism and concern for the well being of each person I serve. I stay up-to-date on hearing research and the latest in hearing aid technology and connectivity to other devices. Q: What are the early signs of hearing loss? A: Complaints from loved ones about difficulty hearing, TV volume is increased, asking for repetition during conversation, missed or misheard words in conversation, trouble hearing women and children’s voices, difficulty hearing in noisy environments. Q: Anything else you feel readers should know about your experience and your practice? A: You will find myself and staff

very personable and easy to work with. When hearing aids are recommended, I provide different options based on the person’s hearing loss, concerns, and lifestyle. I review the different levels of hearing aid technology and the pros and cons of each style of hearing aid. One size does not fit all; and I do my best to customize a hearing solution for each patient.

Audiologist Kathleen Burch holds a Certificate of Clinical Competency in Audiology (CCC-A) and practice at the Fulton office of Center for Audiology and Hearing Aids at Oswego Health

Center for Audiology and Hearing Aids at Oswego Health 98 N. Second St., Suite 102; Fulton, NY 13069 • 315-326-3792 • oswegohealth.org

Processed Foods Highly Correlated with Obesity Epidemic in the U.S.

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s food consumed in the U.S. becomes more and more processed, obesity may become more prevalent. Through reviewing overall trends in food, George Washington University (GW) researcher Leigh A. Frame, PhD, concluded that detailed recommendations to improve diet quality and overall nutrition are needed for consumers, who are prioritizing food that is cheaper and more convenient, but also highly processed. Her conclusions are published in a review article in Current Treatment Options in Gastroenterology. “When comparing the U.S. diet to the diet of those who live in “blue zones” — areas with populations living to age 100 without chronic disease — the differences are stark,” said Frame, co-author of the article, executive director of the office of integrative medicine and health, and assistant professor of clinical research and leadership at the GW School of Medicine and Health Sciences. “Many of the food trends we reviewed are tied directly to a fastpaced U.S. lifestyle that contributes to the obesity epidemic we are now

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facing.” The rising obesity epidemic in the U.S., as well as related chronic diseases, are correlated with a rise in ultra-processed food consumption. The foods most associated with weight gain include potato chips, sugar-sweetened beverages, sweets and desserts, refined grains, red meats and processed meats, while lower weight gain or even weight loss is associated with whole grains, fruits, and vegetables. Other food trends outlined in the report include insufficient dietary fiber intake, a dramatic increase in food additives like emulsifiers and gums, and a higher prevalence of obesity, particularly in women. In mice and in vitro trials, emulsifiers, found in processed foods, have been found to alter microbiome compositions, elevate fasting blood glucose, cause hyperphagia, increase weight gain and adiposity, and induce hepatic steatosis. Recent human trials have linked ultra-processed foods to decreased satiety (fullness), increased meal eating rates (speed), worsening biochemical markers, including inflammation and cholesterol, and more weight gain. In

IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

The foods most associated with weight gain include potato chips, sugar-sweetened beverages, sweets and desserts, refined grains, red meats and processed meats contrast, populations with low meat, high fiber, and minimally processed foods — the “blue zones” — have far less chronic diseases, obesity rates, and live longer disease-free. “Rather than solely treating the symptoms of obesity and related diseases with medication, we need to include efforts to use food as medicine,” said Frame. “Chronic disease

in later years is not predestined, but heavily influenced by lifestyle and diet. Decreasing obesity and chronic disease in the U.S. will require limiting processed foods and increasing intake of whole vegetables, legumes, nuts, fruits, and water. Health care providers must also emphasize lifestyle medicine, moving beyond ‘a pill for an ill.’ ”


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FamilyCare Medical Group 4900 Broad Rd, Suite 4K Physicians Office Bldg Syracuse, NY 13215 (315) 492-5784

Fairmount Family Medicine Welcomes Meghan Doran, FNP-C, DCNP Meghan is a cer�fied dermatologic nurse prac��oner with 7 years of experience. She treats all common and not so common dermatologic illnesses which include acne, rosacea, psoriasis, abnormal moles, skin cancers, skin surveilance, eczema, warts and more. To schedule an appointment with Meghan, please call (315) 488-0996 and ask to speak with Olivia

Fairmount Family Medicine 436 Hinsdale Road Camillus, NY 13031 (315) 488-0996 March 2020 •

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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CNY’s Healthcare Newspaper

A monthly newspaper published by Local News, Inc. 35,000 copies distributed throughout more than 1,000 high traffic locations, including all Wegmans stores.

In Good Health is published 12 times a year by Local News, Inc. © 2019 by Local News, Inc. All rights reserved. Mailing Address: P.O. Box 276, Oswego, NY 13126. • Phone: 315-342-1182 • Fax: 315-342-7776. Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo Contributing Writers: Deborah Sergeant, Jim Miller, Gwenn Voelckers, Deborah Banikowski, George W. Chapman, Anne Palumbo, Melissa Stefanec, Chris Motola, Eva Briggs (M.D.), Ernst Lamothe Jr., Antoine Azar (M.D.) • Advertising: Amy Gagliano, Cassandra Lawson Layout & Design: Dylon Clew-Thomas • Office Manager: Nancy Nitz No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

First increase after four years of decline

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fter four years of declines, life expectancy in the United States increased in 2018, health officials reported in February. The jump in longevity comes as deaths from opioid overdoses dropped for the first time in 28 years, as did deaths from six of the 10 leading causes. The new data could be a glimmer of good news for Americans’ health, with recent declines in average lifespans initially casting doubt on progress made over the past decades. “The three-year trend in life expectancy for the total population either decreasing or remaining steady has stopped, with the increase in life expectancy in 2018,” said lead researcher Kenneth Kochanek, from the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). “The decrease in mortality from unintentional injuries in 2018 is a reverse from the 2014-to-2017 trend,” he added. “From 2014 to 2017, the increase in deaths from unintentional injuries contributed the most to the decrease in life expectancy, with decreases in cancer mortality offsetting this change in life expectancy,” Kochanek said. Between 2010 and 2014, life expectancy increased from 78.7 years to 78.9 years, then fell between 2014 and 2017 from 78.9 years to 78.6 years. But in 2018, it went back to 78.7 years, which is still below the peak of 78.9 years in 2014, Kochanek said. The 10 leading causes of death in the United States are heart disease, stroke, chronic respiratory disease, Alzheimer’s disease, diabetes, flu, kidney disease, suicide, cancer and accidents. Between 2017 and 2018, decreases in deaths from cancer and unintentional injuries contributed the most to the increase in life expectancy, with increases in mortality from influenza and pneumonia offsetting the change in life expectancy, Kochanek added.

According to Dr. Howard Koh, a professor at Harvard T.H. Chan School of Public Health in Boston, “After years of plateauing and declining U.S. life expectancy, this one-year uptick is certainly welcome news.” But more detailed evaluation over time is needed to judge whether declining trends are truly being reversed, he said. Another expert agreed that the increase in life expectancy was welcome news, but must be taken with a grain of salt. “It’s good news U.S. life expectancy increased for one year, interrupting its fall over the past three years, but the overall picture remains bleak,” said Steven Woolf, director emeritus and senior adviser at the Center on Society and Health at Virginia Commonwealth University School of Medicine, in Richmond. For many years, life expectancy in other wealthy nations has been higher than in the United States, and their life expectancy rates have been climbing, Woolf said. The increase in life expectancy between 2017 and 2018 is statistically significant, but time will tell whether it holds, he added. A similar increase occurred between 2013 and 2014 before falling the following year. Other findings in the report include: • Among the 10 leading causes of death, only deaths from suicide and flu-related pneumonia rose. • More than half the increase in life expectancy in 2018 was from fewer deaths from cancer and accidents. • Drug overdose deaths dropped 4% from 2017 to 2018, from about 70,200 in 2017 to nearly 67,400 in 2018. The majority of drug overdose deaths (90%) were unintentional. • Drug overdose deaths in 2018 dropped in 14 states and the District of Columbia. Across the country, the overdose death rate was 20.7 per 100,000 in 2018 and 21.7 in 2017. The report was published Jan. 30 in the CDC’s NCHS Data Brief.

Allen Speiser Memorial Fund Accepting Applications For Grant Opportunity

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he Allen Speiser Memorial Vocational Rehabilitation Fund is now accepting grant applications. Grant applications will be accepted from programs that promote the placement and retention of employees with disabilities in the workforce. The application deadline is March 6. Eligibility is limited to 501(c)(3) nonprofit, human service organizations that serve people with disabilities in Onondaga, Madison, Oswego, Cortland or Cayuga counties. Collaborating entities may apply and creativity is encouraged. Also this year, consideration will be given to governmental departments, educational departments and student service offices.

Visit www.cnycf.org/SpeiserGrants for guidelines on how to apply. Questions may be directed to Danielle Gill at 315-883-5554 or Dgill@cnycf.org. Formerly the C.I.G.S. Foundation, the Allen Speiser Memorial Vocational Rehabilitation Fund was established in 2001. The fund offers grants to support special projects, make new investments or provide additional staff training — filling in the gaps that aren’t covered by government sources or other private funding. Vocational rehabilitation is the process of assisting people with any disabling condition to acquire the social, educational and work skills that will lead to employment.


By Jim Miller

How to Detect Parkinson’s Disease

Dear Savvy Senior,

What are the early warning signs of Parkinson’s disease? I was just diagnosed with it after noticing hand tremors for nearly a year, but looking back, I’m wondering if I missed any other early warning signs. Tremoring Tom

Dear Tom, The holy grail in any progressive disease is to find it early enough to start effective treatment before irreversible damage has occurred. But recognizing the early warning signs of Parkinson’s disease is challenging because they’re usually subtle and can be easily overlooked, dismissed or even misdiagnosed. Parkinson’s disease, which afflicts around 1 million Americans, is a degenerative disorder that occurs when the brain’s dopamine-producing neurons die or become impaired. This happens in the part of the brain that controls movement, which can cause tremors (or shaking), stiffness, and difficulty with walking, balance and coordination. The symptoms usually begin gradually and get worse over time, and the progression of symptoms is often different from one person to another. Some people with Parkinson’s become severely disabled, while others may experience only minor motor disruptions. While the cause of Parkinson’s disease is unknow, scientists believe genetics and environmental factors (exposure to certain toxins) play a key role. Most people with Parkinson’s first develop the disease around age 60 or older, and men are more likely to develop it than are women.

Early Warning Signs

Parkinson’s disease is difficult to diagnose because there’s no definitive test to confirm it. Doctors, usually neurologists, will do an examination and evaluate a combination of warning signs, but symptoms can vary greatly by patient which often leads to confusion and misdiagnosis. That said, here are some of the key signs and symptoms everyone should know. • Trouble sleeping: Thrashing around in bed or acting out dreams — kicking or punching — when asleep. This is a REM sleep behavior

disorder and one of the strongest and earliest pre-diagnostic symptoms of Parkinson’s disease. • Loss of smell: Not being able to smell certain foods very well like bananas, dill pickles or licorice. This too is one of the earliest symptoms. • Constipation: Problems with digestion and bowel movements are a big problem for people with Parkinson’s, and an early sign that can occur up to 20 years before this disease is diagnosed. • Changes in handwriting: Writing may become harder to do, and your handwriting may appear much smaller than it has in the past. • Tremors: Slight shaking or tremor in your finger, thumb, hand or chin. The tremor usually happens at rest, and when you move the extremity it may disappear. This is the most common and recognizable outward sign of Parkinson’s disease, but by the time tremors start, the brain has already lost more than half of its dopamine-producing cells. • Slowed movement: Over time, Parkinson’s disease can slow movements, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk. • Speech changes: Speaking softly, quickly, slurring or hesitating before talking. Your speech may be more of a monotone rather than with the usual inflections. • Loss of automatic movements: Decreased ability to perform unconscious movements, like blinking, smiling or swinging your arms when you walk. • Impaired posture and balance: Stooping, leaning or slouching when you stand, and/or balance problems can all be a sign of Parkinson’s.

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Treatments

Currently, there is no known cure for Parkinson’s disease, but there are a variety of medications that can provide relief from the symptoms. In some later cases, surgery may be advised. Other treatments include lifestyle modifications, like getting more rest and exercise. For more information, visit the Parkinson’s Foundation at Parkinson. org.

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

TOGETHERWEFIGHT hoacny.com March 2020 •

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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Loretto Expands Telehealth to More Locations By Joelle Margrey

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ore residents at Loretto Health and Rehabilitation Center in Syracuse can now benefit from telehealth services as Loretto expands the ImagineMIC program to connect patients with doctors and a team of medical staff 24/7. Telemedicine services were first launched when Loretto’s restorative care unit opened in 2018 and expanded in 2019 to Loretto’s PACE-CNY — Program of All-inclusive Care for the Elderly. Now, telehealth will be available to residents throughout the Cunningham skilled nursing and Fahey rehabilitation buildings on Loretto’s main campus. The expansion is part of the organization’s continuous effort to invest in innovative technology, minimize hospital and emergency room visits, and keep long-term care affordable. Telehealth systems like ImagineMIC not only allow participants to stay with long-term care facilities like Loretto or in one’s home without compromising access to doctors and trained medical staff 24/7, but can also detect subtle changes that may not be visible to the patient or the medical care team. Each participant receives a lightweight, disposable patch that collects and monitors basic vital signs like pulse, heart rate, blood pressure and temperature. The system also has

• • • • • 

the capacity to detect early warning signs of some health issues such as chronic heart failure, COPD, pneumonia and sepsis. Existing residents and newly admitted residents who show first signs of health issues would benefit the most. The data tracked by the patch is monitored 24/7 by physicians and clinical staff at a dedicated monitoring site. Each telehealth participant will be guided by trained staff every step of the way, to assist with the application and daily monitoring. Loretto first launched ImagineMIC at its PACE-CNY in summer 2019. Loretto and PACE-CNY plan to add even more telehealth technology to its programs and services over the coming years, eventually incorporating telehealth at all of Loretto’s locations. Joelle Margrey is vice president of skilled nursing and rehabilitation at Loretto.

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IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

Apply Online for Medicare Even If You’re Not Ready to Retire

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id you know that you can apply online for Medicare, even if you are not ready to retire? We can help you make an informed decision about when to apply for benefits based on your individual and family circumstances. Applying online can take less than 10 minutes. There are no forms to sign and usually no required documentation. We’ll process your application and contact you if we need more information. Visit www.socialsecurity.gov/ benefits/medicare to begin. There, you can apply for Medicare and find other important information. If you’re eligible for Medicare at age 65, your initial enrollment period begins three months before your 65th birthday and ends three months after that birthday. Some Medicare beneficiaries

Q&A Q: My same-sex partner and I recently married. Will we qualify for Social Security benefits? A: You may be eligible to apply for Social Security benefits. Many factors affect your eligibility for benefits, including how long you worked and your age. Social Security is now processing more claims in which entitlement or eligibility is affected by a same-sex relationship. We encourage you to apply for benefits right away, even if you aren’t sure you’re eligible. Applying now will protect you against the loss of any potential benefits. You can apply safely and securely at www.socialsecurity. gov/applyonline. Learn more about Social Security for same-sex couples by visiting www.socialsecurity.gov/ same-sexcouples. Q: I am receiving Social Security retirement benefits and I recently went back to work. Do I have to pay Social Security (FICA) taxes on my income? A: Yes. By law, your employer must withhold FICA taxes from your paycheck. Although you are retired, you do receive credit for those new earnings. Each year Social Security automatically credits the new earnings and, if your new earnings are higher than in any earlier year used to calculate your current benefit, your monthly benefit could increase. For more information, visit www. socialsecurity.gov or call us at 1-800772-1213 (TTY 1-800-325-0778).

may qualify for Extra Help with their Medicare prescription drug plan costs. To qualify for the Extra Help, a person must be receiving Medicare, have limited resources and income, and reside in one of the 50 states or the District of Columbia. For more information on Extra Help, read www.socialsecurity.gov/pubs/EN05-10525.pdf. You may also be interested in reading these publications: • “Apply Online for Medicare — Even if You Are Not Ready to Retire” www.socialsecurity.gov/pubs/EN05-10530.pdf. • “When to Start Receiving Retirement Benefits” www.socialsecurity.gov/pubs/EN-05-10147.pdf. Helping a friend or family member with this information can improve the quality of their life. Share these resources with someone you love today.

Q: What is the benefit amount a spouse may be entitled to receive? A: If you are eligible for both your own retirement benefit and for benefits as a spouse, we will always pay you benefits based on your record first. If your benefit as a spouse is higher than your retirement benefit, you will receive a combination of benefits equaling the higher spouse’s benefits. A spouse generally receives one-half of the retired worker’s full benefit unless the spouse begins collecting benefits before full retirement age. If the spouse begins collecting benefits before full retirement age, the amount of the spouse’s benefit is reduced by a percentage based on the number of months before he or she reaches full retirement age. For example, based on the full retirement age of 66, if a spouse begins collecting benefits: • At age 65, the benefit amount would be about 46 percent of the retired worker’s full benefit; • At age 64, it would be about 42 percent; • At age 63, 37.5 percent; and • At age 62, 35 percent. However, if a spouse is taking care of a child who is either under age 16 or disabled and receives Social Security benefits on the same record, a spouse will get full benefits, regardless of age. Learn more by reading our Retirement publication at www. socialsecurity.gov/pubs/10035.html.


H ealth News Rochester Regional investing more in Geneva Healthcare is about to get a little more convenient for residents of Geneva and its surrounding communities. Rochester Regional Health (RRH) recently announced a major expansion of its campus at 875 Pre-Emption Road, set to open in May. “For most patients, the majority of their healthcare is delivered in the office and outpatient settings,” said physician Art Equinozzi, assistant medical director of Finger Lakes Medical Associates,part of Rochester Regional Health. “The destination campus at Pre-Emption Road makes accessing high-quality, safe care easy for our patients.” Already home to RRH Finger Lakes Medical Associates, RRH Finger Lakes Bone & Joint, and the region’s only¡ open MRI, the campus will be transformed into a destination, one-stop facility with additional services and programs being added this spring. “This is the kind of convenient access to care that patients deserve,” said Mark Ryan, primary care physician and medical director of Rochester Regional Health’s Finger Lakes Medical Associates. By May, the following Rochester Regional Health services will be added to the campus: primary care general surgery, vascular surgery, endocrinology, allergy and rheumatology and nutrition counseling. Later this year, Rochester Regional will be adding specialty services, including neurosurgery, gastroenterology and urgent care, making RRH at Pre-Emption Road a convenient, one-stop destination medical campus for residents of the region. “Rochester Regional continues to invest in the communities of the Finger Lakes Region,” said Rochester Regional Health Eastern Region President Dustin Riccio, a physician. “The new Marshall Birthing Unit at Newark Wayne Hospital, the construction of Clifton Springs Medical Village and now, a destination medical campus at 875 Pre-Emption Road, are just a few of the ways we have raised the level of care available in the region.” “Rochester Regional Health has been enhancing the health and wellness of Geneva and the region for more than 50 years,’ said physician Bridgette Wiefling, senior vice president of the Rochester Regional Health Primary Care Institute. “Our significant investment in the development of our newest destination campus at 875 Pre-Emption Road, delivers on our commitment to deliver the best possible care in the most convenient setting for our patients.”    

Healthcare Management Association elects board of directors The Health Care Management Association of Central New York (HCMACNY) has elected a new board of directors for 2020. Laura Shea, executive director

of marketing and public relations for Claxton-Hepburn Medical Center in Ogdensburg, was elected president. Independent Healthcare Consultant Diane Bradley of Rochester was appointed treasurer. Matthew Van Pelt, director of business and service line development at St. Peter’s Health Partners in Albany, was named secretary. Immediate past president of the Central New York chapter is Nancy Daoust, chief ambulatory officer at Upstate University Hospital in Syracuse. Kurt Calman, vice president of operations at Rochester Regional Health, has been named chapter regent. Re-elected to the board were: Kenan Baldridge, supervisor of the town of Rose; retired hospital executive James Connolly, of Saratoga; Mini Malhotra, administrator of neurosciences and physical medicine and rehabilitation at Upstate Medical University and Upstate University Hospital in Syracuse; and healthcare consultant Bertine Colombo McKenna. Newly elected members of the board of directors are Cheryl Abrams, director of communications and digital media at Crouse Health in Syracuse; Amber Foster, director of ambulatory administration and practice management at the University of Rochester Medical Center; and Mary Zielinski, assistant vice president of MVHS Medical Group at Mohawk Valley Health System in Utica.

New medical director at St. Joe’s cardiac rehab St. Joseph’s Health welcomes physician Stephen Nash as the medical director of St. Joseph’s Health cardiac rehabilitation program. In this role, Nash will oversee all cardiac rehabilitation services and help advance the cardiovascular programs at St. Joseph’s Health. Nash is certified in cardiovascular disease, internal medicine and clinical lipidology with more than 20 years of clinical experience in New York state. He began practicing preventive cardiology in 1990, has extensive research experience and has lectured internationally. Nash In addition to clinical experience, Nash has been a clinical assistant professor of medicine at SUNY Upstate Medical University for more than 25 years and serves on the editorial board for The Journal of Clinical Lipidology. Nash earned his medical degree from SUNY Upstate Medical University and completed his medical training with a residency at Rush University Medical Center, formerly Rush-Presbyterian-St. Luke’s Medical Center, in Chicago. Nash also completed a cardiology fellowship at University of California San Francisco Medical Center at Mount Zion in San Francisco.

Urologist Angelo DeRosalia to Lead A.M.P.

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ffective March 1, urologist Angelo DeRosalia will be the new chairman and CEO of Associated Medical Professionals (A.M.P.), a multispecialty medical practice with more than 50 providers, 325 support staff and 10 offices. A.M.P. provides service to nine hospital systems across five counties in Central New York. He succeeds retiring physician Howard Williams, who served in that position for a decade. DeRosalia, who also serves as chief of the urology service at St. Joseph’s Hospital, has been with the practice since it was formed in 2008. In the last 10 years, he has contributed to pioneering minimally invasive treatments that have placed A.M.P. at the forefront of innovation, according to a news release. He has always embraced surrounding himself with a team of innovative, compassionate members and strives to continue this approach. He has been described as level-headed, calm and forward - thinking, someone who does his best to elevate the team at A.M.P.. He received a Bachelor of Science degree from Cornell University followed by his medical degree from SUNY Stony Brook. He then completed his surgical and urological training at SUNY Downstate Medical Center, affiliated with

Memorial Sloan-Kettering Cancer Center. He is a recipient of numerous awards and the author of several publications. DeRosalia has made presentations at multiple national annual American Urological Association meetings as well as the New York Academy of Medicine. He will continue to see his patients at the A.M.P. North Medical location in Liverpool. For a complete bio please go to our website at: https://www.A.M.P.ofny.com/urologists/angelo-r-derosalia-md/

Honored For His ‘Global Vast’ Contribution:

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hysician Shawky Badawy, professor and former chairman of the department of obstetrics and gynecology at Upstate Medical University, was recently honored by the Egyptian Fertility and Sterility Society for his “global vast contribution in the field of infertility” and for March 2020 •

his support of the society. Badawy was recognized at the society’s Silver Jubilee in November 2019 at the Annual International Conference of the Egyptian Fertility and Sterility Society. Badawy has been a member of the Upstate faculty since 1973.

IN GOOD HEALTH – CNY’s Healthcare Newspaper

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H ealth News Nash assumed his role in January 2020.

Dr. Lisa Gaffney joins St. Joseph’s Health

St. Joseph’s Health welcomes physician Lisa Gaffney to St. Joseph’s Primary Care Center West in Syracuse. Gaffney joins a team of diverse and highly qualified family physicians who provide comprehensive health care to the community. She is a board-certified pediatrician with over a decade’s experience. Most recently, Gaffney served as a staff pediatrician at Wee Care Pediatrics in Cicero and as director of pediatrics at the volunteer clinic at Amaus Health Services at Cathedral’s in Syracuse. Prior to Gaffney that, Gaffney spent five years at St. Joseph’s Health’s Maternal Child Health Center. Before returning to New York state, Gaffney practiced at Cornerstone Pediatrics in Cary, North Carolina. Gaffney earned her Bachelor of Science degree in biochemistry from Hofstra University in Hempstead, New York, and her Doctor of Medicine degree from the SUNY Upstate in Syracuse. She completed her medical training with a residency at SUNY Upstate.

that to them.” As executive director DeCaire will oversee every aspect of the CAC; from investigation and counseling, to advocating for children and families and the prosecution of offenders. He will also be actively involved with identifying grant opportunities and fundraising events such as the CAC’s upcoming Wing Fest and Pinwheel Campaign. “I’m grateful for the opportunity to lead the CAC,” said DeCaire. “One of my top priorities will be to conduct a thorough needs assessment. The CAC has a very talented staff of professionals. I want to eliminate any barriers that may interfere with the work they do and ensure that the staff has the resources they need to help children and their families heal and move on with their lives.”

Crouse Medical Practice announces appointments Crouse Medical Practice recently announced the following professionals have joined its practice. • Physician Steven Zygmont, board-certified and fellowship-trained in endocrinology, diabetes and metabolism, as well as in internal medicine, joined the practice at its 5000 Brittonfield Parkway, East

Syracuse, location. Zygmont comes to Crouse from Auburn Memorial Medical Services, where he served as staff endocrinologist and director of Auburn Diabetes and Endocrinology since 2011. He received his medical degree from SUNY Health Science Center in Zygmont Syracuse and completed his residency in Internal Medicine at Strong Memorial Hospital in Rochester. Zygmont completed his fellowship in endocrinology, diabetes and metabolism at the University of South Carolina in Charleston. He also received certification in fine needle aspirations of thyroid nodules through ultrasound from the American Association of Clinical Endocrinologists in 1999. Zygmont is a member of the American Association of Clinical Endocrinologists, the Endocrine Society, and the American Diabetes Association. He has conducted extensive research, particularly focused on endocrine disorders and diabetes management.

• Kristy Ventura has joined the endocrinology team at Crouse Medical Practice. Ventura is based at the practice’s Camillus location at 5417 West Genesee St., corner of Knowell Road. VentuVentura ra comes to Crouse from Auburn Memorial Medical Services, where she had served since 2008 as a family nurse practitioner in the endocrine and orthopedic departments. There, she was responsible for diagnosing and treating endocrine disorders; insulin pump management; overseeing the successful implementation of an osteoporosis program and infusion center; and presenting community outreach programs in osteoporosis and pre-diabetes. Prior to working in endocrinology, Ventura served as a family nurse practitioner with Auburn Orthopedics Specialists; as a registered nurse in the emergency room at Auburn Community Hospital; and as a registered nurse in the medical intensive care unit at Strong Memorial Hospital.

Tory DeCaire to lead Child Advocacy Center Former Oswego Police Chief Tory DeCaire has been chosen as the Child Advocacy Center of Oswego County’s new executive director. A native of Oswego, DeCaire recently retired after 22 years on the Oswego Police Department. DeCaire While he had no immediate plans for future employment, when approached with the opportunity to lead the CAC DeCaire felt compelled to do so. “Throughout my career the Oswego Police Department collaborated with the CAC and its partners in the investigation of child abuse cases,” said DeCaire. “Shortly after becoming police chief I toured the CAC offices. It gave me a clear picture of the CAC and a better understanding of the scope of its work and the tremendous job its staff does to help children and their families recover emotionally from the trauma of physical and sexual abuse. I felt that if I could be a part of that mission, and that my experience may move the CAC forward, then I should offer Page 28

Franklin G. Fry, executive director of the American Heart Association’s Greater Syracuse Division, presents Nascentia Health President and CEO Kate Rolf with a gold medallion in recognition of the system’s gold level recognition in the American Heart Association’s 2019 Workplace Health Achievement Index.

AHA Recognizes Nascentia Health for Workplace Health Achievement

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ascentia Health, a local leader in healthcare services focused on providing integrated care and in-home service delivery, has achieved gold level recognition in the American Heart Association’s (AHA) 2019 Workplace Health Achievement Index. The AHA created the index with its CEO Roundtable, a leadership collaborative of more than 40 CEOs from some of America’s largest companies who are committed to

IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

applying evidence-based approaches to improve their employees’ overall health. The index uses science-based best practices to evaluate the overall quality and comprehensiveness of workplace health programs. A unique feature of the index is that it calculates an average heart health score for employees of participating companies that securely submit aggregate health data. Companies receive benchmarking reports, which allow them to identify potential areas of improvement so

that they can advance their annual performance and recognition in the Index and help their workforce move toward ideal heart health. “Nascentia Health is proud to be one of only two locally-based companies to earn gold level recognition for 2019,” said President and CEO Kate Rolf. “I commend our employees for their combined efforts to improve their health and boost our performance from 2018. Jumping from bronze to gold level recognition in the space of just a year is truly a testament to their hard work and dedication and to Nascentia’s continued commitment to fostering a corporate culture of health and wellness.”


CANAL EDGE HAIR SALON

H ealth News She earned her bachelor’s degree in nursing from the University of Colorado Health Science Center in Denver; completed the nurse practitioner program at Community General Hospital in Syracuse; and earned her Master of Science in Nursing from Upstate Medical University in Syracuse. She is certified by the American Nurses Credential Center; is a certified fracture liaison; and earned her specialist assistant certification in orthopedics. • Physician Taewan Kim joined the practice’s bariatric surgery, affiliated with Crouse Health. He comes to Crouse from SUNY Upstate Medical University/ University Hospital and join colleagues in the Crouse weight loss surgery program, founded in 2011. Taewan Since 2001, Kim has served as an attending surgeon at the Syracuse Veterans Administration Hospital and at Upstate, where he also continues serving as assistant professor of surgery. He received his medical degree from and served his residency at SUNY Health Science Center. He completed a fellowship in minimally invasive surgery at Upstate. A Fellow of the American College of Surgeons, Kim is board-certified through the American Board of Surgery. • Physician assistant Melinda Shaw also joined the bariatric team. She earned her master’s degree and physician assistant certification through the physician assistant program at Northeastern University. She received her bachelor’s Shaw degree with a concentration in human biology from the College of Agriculture and Life Sciences at Cornell University. Shaw is a member of the American Academy of Physician Assistants; New York State Society of Physician Assistants; and Central New York Physician Assistant Association. Physician assistant Ashley Maxam joined the practice’s primary care team at its Camillus location, 5417 W. Genesee St., corner of Knowell Road. Maxam earned her Bachelor of Science in biology, with a minor in chemistry and psychology, summa cum laude, from Le Moyne College, where she also earned a Master of Science in physician Maxan assistant

studies. At Le Moyne, she earned a number of academic honors, including the Susan E. Henninger Medal in First Year Pure Science for Academic Year 2014-2015; the Family of T. Frank Dolan, Jr. Medal in Sophomore Pure Science for Academic Year 2015-2016; the William J. Ryan Medal in Junior Pure Science for Academic Year 2016-2017; the 2018 H. Paul Nelligan Medal in Pure Science; and the 2018 Marie Arnold Chapin Medal in Biology. While at Le Moyne, Maxam served as a graduate tutor for first-year physician assistant students. In addition to her position with Crouse Medical Practice, Maxam has work experience as a patient care technician and emergency department technician at Oswego Hospital. She holds certifications in basic life support; advanced cardiology life support; and neonatal resuscitation. • Physician Steven Gelb joined the practice as a general surgeon. Gelb, board-eligible in general surgery, comes to Crouse from Baystate Medical Center, the regional campus of the University of Massachusetts Medical School, where he has served as chief Gelb surgical resident for the past three years. Previously, he was a surgical resident at SUNY Upstate Medical University from 2013 to 2016. Gelb earned his medical degree from the Medical School for International Health at Ben-Gurion University, Beer Sheva, Israel, in collaboration with Columbia University Medical Center in New York City. He received a bachelor’s in economics, with a minor in biology, from the University of Rochester. He has served as a clinical instructor at the Tufts University School of Medicine and as a resident educator of junior residents at Baystate Medical Center Simulation Center and Goldberg Surgical Skills Laboratory. He is a member of the American College of Surgeons and American Medical Student Association. From his research and practice abroad in Israel, Palestine and the Philippines from 2009 to 2013, Gelb brings an international healthcare perspective to Central New York. His work overseas included a multinational, multidisciplinary and mission-affiliated experience with Smile Train, a global children’s charity that provides cleft lip and palate surgeries. He is fluent in Romanian with a knowledge of French, Spanish and Hebrew.

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Top Health Innovations Healthcare is always changing as new research and discoveries lead to changes that improve care. Here’s what area experts see as the top innovations in development now or coming very soon. By Deborah Jeanne Sergeant

From physician Robert Corona, boardcertified in neuropathology and in pathology and general informatics at Upstate Medical University • “Precision medicine where we see diagnostics, molecular genomics and personalize therapeutics. Much of the way we categorize disease states on location or appearance. A glandular cancer you call it based on where you find it. We’re starting to call it on its molecular characteristics. A glandular cancer in the breast might be associated with the colon. You can more quickly develop medication. If this glandular cancer had a certain enzyme that the chemo therapeutic was targeting, a drug using the same mechanism might be able to target it better. It has the same underlying mechanism. • “Liquid biopsy, where you take blood. If you find circulating cancer cells before they form a mass, it might be easier to treat if limited to a small area in an organ and in the bloodstream. Once you know the enzyme that’s characteristic of that cancer, you can tailor the therapeutic to it to cause less toxicity to the patient and more targeted therapy. • “It’s hoped that every cancer patient has a genetic profile done and as drugs become available, we’d be able to treat it. • “Artificial intelligence software packages are used to determine if someone is having a stroke. You can use technology to level the playing

Page 30

field. Maybe in the future we’ll need fewer specialists because you’ll need less knowledge. You’ll need operational knowledge and the backup of AI with the diagnosis. Technology is leveraged to level the playing field. A general practitioner in the middle of nowhere can use AI. What’s the latest literature? It doesn’t have to even be something complex, but a certain bacteria causing ear infections and the AI can show trends moving in the trend of where that patient is.”

From physician Az Tahir, High Point Wellness in Syracuse • “One exciting thing is stem cell studies. It’s amazing the conditions that were not treatable before. Research is going on in diabetes, spinal cord injuries, dementia and ALS. Tendon and joint injuries won’t need as many surgeries because of stem cells. • “Gene therapy is still experimental but it’s amazing. Retinitis pigmentosa — there’s no treatment for that. Usually, people go blind in two to three years’ time. Now the patient is able to see. It’s very expensive. It’s amazing and has quite a future. • “With genetic diagnosis, people can prevent things from even happening. Diagnosis in the future will be very deep. We’ll be able to do mitochondrial diagnosis and know what’s happening in the cells. • “The power to the patient is going to be even bigger. They’ll have more knowledge on new condi-

IN GOOD HEALTH – CNY’s Healthcare Newspaper • March 2020

tions and how they can stay healthy through technology. They can find out their sleep at night and other health statistics through things like the Apple watch. You can see your blood pressure and blood sugar levels 24 hours. More and more things will be coming up. People will be able to diagnose conditions very, very early. • “Reversing diseases is growing. Diabetes, cholesterol and hypertension, now, with individualized food prepping, we can reverse diabetes, lower cholesterol without medication and diminish medication. • “There will be vaccine for not only infections but also cancer, Type 1 diabetes and other diseases. • “Artificial intelligence has many potential uses coming up. Many hospitals are using this so the patient can communicate with the nurse through Alexa, ‘Tell the nurse I have pain.’ There’s a lot of potential.”

From Joelle Margrey, vice-president of Skilled Nursing at Loretto • “We’ll see more using and implementing telehealth to meet quality initiatives that improve patient outcomes, not just in post-acute facilities but across healthcare. It will reduce preventable re-hospitalization. • “Telehealth improves the patient’s access to healthcare expertise, especially in rural areas. They can coordinate care upon discharge from the hospital. As far as patient

care, the use of telehealth improves the quality of care and outcomes. There’s a reduced gap in the time of care. Some patients have an inability of getting to care because of a lack of transportation and because of living in a rural area. They can stay close to home and their supports. • “A big component is they can play an active role in their healthcare. Telehealth can provide some good information on signs and symptoms so it doesn’t get to that place where they do need hospitalization. • “The system I’m going to be implementing in a couple weeks is a centralized monitoring intervention method. The patient has a disposable patch he can wear on his chest. It lasts five days. It streams hemodynamic data to a centralized monitoring station. This monitoring station is staffed 24/7 with emergency room physicians and nurse practitioners. They monitor respiratory rates, oxygen saturation levels, blood pressure, blood glucose, skin temperature, heart rate, rate and if you fall. We can hook up an EKG to it. This can help us track and trend any changes in condition so orders can be obtained to treat earlier and treat in place. The patient has access to the provider at the click of a button because they have an iPad and can call up the monitoring center and can talk with the provider. If we recognize a change in their condition, a call is made to the RN.”


Dramatic Increase in Flu Cases in NYS

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he number of confirmed flu cases in New York state has increased dramatically compared to the same time last year, according to a review of health tracking data by Excellus BlueCross BlueShield. As of Feb. 1, the Department of Health confirmed 89,597 cases of flu statewide, 54,554 more cases than at this time last year. This flu season has been especially difficult for children. More than 50% of all confirmed cases have been among children 17 and younger. Upstate New York is also being hit hard by flu. During the week of Feb. 1, there were 4,844 confirmed flu cases, with the Utica-Rome and North Country region experiencing the most cases this week: • Western New York: 1,033 flu cases • Rochester/Finger Lakes: 913 flu cases • Central New York: 779 flu cases • Central New York’s Southern Tier: 745 flu cases • Utica/Rome/North Country: 1,374 flu cases “We’ve confirmed an increase in flu activity week-over-week in Upstate New York, so we may not yet have reached the peak of this flu season,” said physician Stephen Cohen, senior vice president and corporate medical director at Excellus BCBS in early February. “I can’t stress enough that it’s not too late to get the

Confirmed Flu Cases in NYS

Activity during the week ending Feb. 1, 2020 Source: NYS Department of Health. Chart by Excellus BlueCross BlueShield. flu vaccine.” Studies support the effectiveness of the flu vaccine in preventing flu, and in reducing the severity of illness in vaccinated people who get sick. With few exceptions, the Centers for Disease Control and Prevention recommends that everyone six months old and older gets vaccinated. Only about one in three Upstate

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New York adults gets the flu vaccine. Cohen said there is a social responsibility to getting vaccinated. “Someone carrying the flu virus can spread it to unsuspecting people up to about six feet away, mainly by expelling microscopic droplets into the air when talking, coughing, or sneezing,” Cohen said. For young children, the elder-

ly, and people with compromised immune systems, the flu virus can be deadly. Last year’s flu, and complications from flu, killed 34,200 people in the United States, according to the federal CDC.

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