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Meet Your Doctor
CNYHEALTH.COM
FEBRUARY 2019 • ISSUE 230
Meet the New Boss at Upstate
Gastroenterologist Amy Lazzarini excited to have moved back to CNY (from Virginia), where she now practices integrative medicine in Chittenango
Psychiatrist Mantosh Dewan, the new interim president of Upstate Medical University, wants to strengthen relations with Crouse, St. Joe’s, Syracuse University and SUNY ESF. He talks about his career, goals and his annual trips to India, where he teaches at his alma matter, Mumbai University.
Live Alone Columnist: Resolve to enjoy Valentine’s Day
BEST DIET Atkins diet, paleolithic diet, DASH diet, Dukan diet, MIND diet, the Beverly Hills Diet — find out what’s the best diet to follow today
Stick to Your New Year’s Resolutions
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Heart Disease
One in every four deaths in the U.S. is caused by heart disease, considered one of the most preventable health ailments. Because February is Heart Month, we decided to speak with cardiologist Theresa Waters, who practices at Cardiovascular Group in Syracuse. She offers five simple steps people should take to prevent heart disease. Page 16
A conversation with Bob Natoli, a 12-time Guinness Fitness World Record holder
Raisins
Many athletes consume raisins for the rapid energy they provide. Should you? Page 15
Sex After 65 Majority are satisfied with their sex lives; nearly one in five older men uses medications or supplements, says poll Page 23
EMERGENCY SERVICES
When trust is critical, say,
“Take Me to Crouse.”
Open for You: Our New Pomeroy Emergency Services Department • •
The region’s newest, most up-to-date ER One convenient access and evaluation point for acute care and treatment of minor illnesses and injuries 24/7
Advanced Facility, Advanced Care • •
High-quality care delivered promptly and with Carepassion® Modern design allows us to move patients faster – and more comfortably
All this adds up to superior emergency care from the hospital you trust – Crouse Health.
Official healthcare provider of Syracuse Athletics ®
crouse.org/ER Page 2
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
TAKE CHARGE Get Informed More than 60 million Americans have some form of heart disease. Heart disease is hereditary in some cases. But in many cases, making healthy lifestyle choices may help reduce the risk of getting heart disease. If you have more questions, you should talk to your provider.
Partner with Your Provider
Be Heart Smart
To determine whether you have a heart condition, your health care provider will do diagnostic tests and procedures. If you have heart disease or have had a stroke, members of your family may also be at higher risk of having the disease. It’s very important to make healthy choices now to lower risk.
A healthy diet and lifestyle are your best weapons in the fight against heart disease. Here are healthy tips that help protect your cardiovascular system. ♥Get Active ♥Eat Better ♥Lose Weight ♥Control Cholesterol ♥Manage Blood Pressure
New to Medicare? Let WellCare help you live healthier. Jason Hollister, Sales Manager 1-716-846-7900 www.WellCareNow.com
Always talk with your doctor(s) about the care that is right for you. This material does not replace your doctor’s advice. Source: www.Heart.org.
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WellCare (HMO) is a Medicare Advantage organization with a Medicare contract. Enrollment in WellCare (HMO) depends on contract renewal. A sales person will be present with information and applications. For accommodation of persons with special needs at sales meetings, call 1-877-699-3552 (TTY 711). There is no obligation to enroll. Please contact WellCare for details. WellCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-877-374-4056 (TTY: 711) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-374-4056 (TTY: 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務 。請致電 1-877-374-4056 (TTY: 711) 。 Y0070_NA029115_WCM_FLY_ENG CMS Accepted 05242015
February 2019 •
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YOUR
CONCUSSION
EXPERTS
CALENDAR of
HEALTH EVENTS
Feb. 2
ACR Health sponsors sledding derby
ACR Health will hold its ninth annual Sled for RED Cardboard Sledding Derby at 4 p.m., Feb. 2 at Four Seasons Golf & Ski Center in Fayetteville. Each cardboard sled team competes to win the fastest sled, the slowest sled, the loudest cheer team, the highest fundraiser, the best decorated sled, most social team, and the best team costume. Each team must fundraise a minimum of $250 to compete. A team has five members. A snow tubing party follows the derby at a reduced cost of $15 per person; or come inside the heated tent, enjoy warm beverages. Food and beer sampling for $10 per person; $5 for age 10 and younger. New this year is a family marshmallow-roasting/S’mores-making fire pit area sponsored by Wegmans. All proceeds from Sled for RED support ACR Health’s mission to create healthy communities by stopping the spread of HIV/AIDS; leading the charge for LGBTQ equality; and the fight against addiction and poverty. For more information or to register, call 315.475.2430 or visit www. ACRHealth.org.
Feb. 4
JCC to offer free tutoring program CLAUDINE WARD, MD, MEDICAL DIRECTOR AND PATIENT
Older adults are more likely to sustain injury from falls --especially in the colder months with snow and ice under foot. A fall can result in a concussion, even if you don't hit your head. Common symptoms of concussion include headache, dizziness and memory problems. Most people recover from concussion in a week or two, but when symptoms last longer, ask for the experts. The Upstate Concussion Center provides comprehensive evaluation and treatment services for concussion and sports concussion.
MORE INFORMATION 315.464.8986 OR VISIT UPSTATE.EDU/CONCUSSION
Many children can likely benefit from tutoring, but finding a convenient time to schedule it can be challenging for busy parents. The Sam Pomeranz Jewish Community Center of Syracuse in collaboration with the Michelle Schotz Foundation Reading and Tutoring Support from Caterpillar to Butterfly and SUNY Oswego, is starting a free tutoring program. The Caterpillar to Butterfly Reading and Tutoring Support Program will provide one-on-one reading tutoring 4:30 to 5:30 p.m. Mondays and Wednesdays for children in grades K–2 and grades 5–6 who are performing below their grade level. A separate small-group writer’s workshop will also be offered from 5:30–6 p.m. Mondays and Wednesdays for any child in grades K–2 and grades 5–6. This free program will start Feb. 4 at the JCC, 5655 Thompson Road, DeWitt. It will run through early May and is scheduled to return in the
fall. Children must register for the entire spring session and attend both days. For more information and to enroll a child in the free Caterpillar to Butterfly Reading and Tutoring Support Program at the JCC, contact Pamela Ranieri at 315-445-2040, ext. 123, or pranieri@jccsyr.org.
Feb. 9
Taste of Chocolate to benefit Lafayette food pantry
The event A Taste of Chocolate will be held from 10 a.m. to 2 p.m., Feb. 9 in the Columbian Presbyterian Church session building, located on the corner of routes 11 and 20 in Lafayette. This is a food-sampling event where you can purchase samples of dozens of home-made goodies with one thing in common: Chocolate. Choose from white, dark or milk chocolate in cookies, muffins, candies, breads and more. Samples are only 50 cents, or 22 samples for $10. Fifty percent of the proceeds will be donated to Lafayette Outreach (the local food pantry). Taste some treats here, then fill a box for your sweetheart. For more information, call 315-677-3293, email cpresbyt@twcny. rr.com or visit www.ColumbianPresbyterianChurch.com .
Feb. 17
Jammin’ Klezmer Sunday scheduled at JCC
The Sam Pomeranz Jewish Community Center will host its second Klezmer Sundays, a free musical event that will be held from 2 to 4 p.m. Feb. 17 in the Anne and Hy Miller Family Auditorium at the JCC, 5655 Thompson Road in DeWitt. The performance is open to the public and anyone wishing to join in the musical “jams” is welcome. A variety of light refreshments will be served. The first event took place Jan. 13. The local Keyna Hora Klezmer Band will be the program’s host band. Community members and independent Jewish musical groups are invited be a part of the performances. For more information, contact Sid Lipton at 315-682-8489 or liptonsl@windstream.net
Onondaga, Oswego, Cayuga and Madison Counties
CNY’s Healthcare Newspaper
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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.
ASK FOR THE EXPERTS. ASK FOR UPSTATE.
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo Contributing Writers: Jim Miller, Gwenn Voelckers, Deborah Banikowski, George W. Chapman, Deborah Sergeant, Anne Palumbo, Melissa Stefanec, Chris Motola, Ernst Lamoth Jr., Eva Briggs (MD), Mary Beth Roach, Payne Horning, David Brickman, Aaron Gifford, J C Trussell, M.D. • Advertising: Amy Gagliano, Cassandra Lawson • Layout & Design: Dylon Clew-Thomas • Office Assistant: Kimberley Tyler No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.
Say hello to healthy.
59 dedicated physicians and healthcare providers. Say hello to a more convenient way to stay healthy in Oswego County. Formerly known as NOCHSI, 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.
February 2019 •
IN GOOD HEALTH – CNY’s Healthcare Newspaper
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Meet
St. Joseph’s Health Kicks off 150th Amy L. Lazzarini, M.D. Anniversary Gastroenterologist moves from Virginia to CNY; she Celebration now practices integrative medicine in Chittenango
Your Doctor
By Chris Motola
S
t. Joseph’s Health began a year-long celebration of its 150th anniversary Jan. 23 with a mass honoring Saint Marianne Cope’s birthday. Bishop Robert Cunningham, the 10th bishop of the Diocese of Syracuse, presided the mass. Born in 1838, Mother Marianne, driven by her passion and commitment to the poor and the ailing, would become a leader in health care innovation. “As one of the founding leaders of what was then St. Joseph’s Hospital, her life and leadership helped establish the legacy of caring that has worked to improve the health of our community since 1869–the legacy that we celebrate today,” said Leslie Paul Luke, president and CEO of St. Joseph’s Health. Recognizing the need for basic health care in a city of immigrants, a small group of the Sisters of St. Francis, including Mother Marianne Cope, defied convention by purchasing a saloon and transforming it into a hospital to serve the needs of a diverse community. Here they welcomed everyone and provided the same quality of care regardless of race, ethnicity, religion, or economic means. They pioneered rules of patient’s rights and cleanliness practices not seen before in the United States. “Their Franciscan values of reverence, justice and compassion continue to drive the legacy of St. Joseph’s Health and serve as our guiding values as they have for 150 years,” said Luke. The 15-bed facility that was established 150 years ago has evolved into a nationallyrecognized and award-winning health care system that, in addition to the hospital, includes a college of nursing, psychiatric emergency program and physician’s office building – as well as many community-based locations, specialty services, and affiliated hospitals. “I am confident that if she were here today, Saint Marianne would be pleased that her vision continues to be fulfilled,” said Luke. St. Joseph’s Health employees will embark on community service projects throughout the year. There will also be many special events, including a Heart Walk at SRC Arena March 23.
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Q: How do you distinguish integrative medicine from alternative medicine? A: There’s a lot of confusion out there regarding the meaning of integrative medicine, and it’s often confused with the phrase “alternative medicine.” Alternative medicine is the use of non-mainstream practices in place of conventional medical treatment. With integrative medicine, conventional and alternative approaches are used together in a way that combine to benefit the patient and, hopefully, help them regain health. Q: What appeals to you about integrative medicine as a physician? A: I like the model because, at least in the two integrative medicine practices I’ve worked at, I’ve been able to spend more time with patients. Getting their complete history and story, finding out when they last felt well. We look at the patient as a whole; I know that sounds kind of cliched, but it’s true. We take into account not only their physical symptoms, but also their emotions, their state of mental health, their spiritual health, environmental influences, their beliefs surrounding health and healing. Q: What types of non-traditional medicine do you use? A: A lot of the time, patients are already receiving conventional medical care. It depends on what they’re coming for. But I always want to address what I call core principles of health, such as one’s diet and nutrition. Movement. Exercise. Stress management. And especially sleep. I feel like the quality of our sleep is overlooked. I haven’t seen a patient get better if they don’t get a good night sleep. It just doesn’t work. I also incorporate herbs and nutritional supplements that have shown efficacy for certain types of symptoms and conditions. I’ve seen people with gastrointestinal issues like inflammatory bowel disease see improvement in their symptoms after taking polyphenols, for example, curcumin. I tend to choose therapies that have some research behind them.
IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
Q: Beyond the research supported efficacy, do you find there’s value in any placebo effects that might come with alternative treatments? A: Yes, I do. There have been studies on that. If a patient is told something is going to happen, good or bad, it can happen. Honestly, I think if a patient improves, I’m happy, even if it’s a placebo effect. Aside from the placebo effect, research shows that things like yoga, meditation or journaling, can affect a patient’s emotional health, which in turn can help their quality of life. In some cases, that can even affect inflammatory markers in their blood so it also has physiological effect. Q: You’ve also practiced integrative medicine in Virginia. Are there differences between the state’s regulatory regimes that affect what you can and can’t do? A: There probably are, but I’m not entirely aware of them. It’s mostly the same. One thing that I have noticed is that a lot of the integrative medicine tests I could order in Virginia, I couldn’t get here, like certain stool and blood tests. There are still less optimal tests I can get here, but that’s a little bit frustrating. Q: Is that a matter of insurance or regulations? A: It has to do with the New York state regulatory process and how they certify lab tests. So it’s a state-driven aspect. The most restrictive states are New York, California and Maryland. I think the companies just find it’s not worth the effort or
the money to get those tests certified in this state. Q: I interviewed your colleague Dr. Heidi Puc recently. We talked a bit about integrative medicine in the context of Lyme disease. Are you involved in treating Lyme? A: Yes, I am. Lyme and other tick-borne illnesses are commonly seen in Virginia, too. Many times patients present with a wide range of seemingly unrelated symptoms from various bodily systems and many times they don’t get the typical bulls-eye rash. They may just have a summer time flu, with fever, joint pain and headaches, but they’ve never seen a tick on them. This can go on to chronic Lyme, which can be misdiagnosed as other diseases. The current blood tests for Lyme are far from optimal for diagnosing it. Many times we have to rely on symptoms and the history of possible tick exposure, which can be done through the use of a validated screening questionnaire. These patients often have lots of gastrointestinal complaints, too. The bacteria that causes Lyme disease has been found through PCR testing in tissue samples from the gastrointestinal tract of children with chronic gastrointestinal and other symptoms despite negative blood tests for Lyme. These samples were obtained at the time of colonoscopy or upper endoscopy. And ticks that carry Lyme disease are not just in the Northeast now, so it’s something to consider in patients who present with multiple symptoms in a lot of different bodily systems, from any part of the country. Q: What kinds of effects do you see in the gastrointestinal system, and what kinds of therapies seem to help? A: It can affect the gastrointestinal tract at pretty much any level. It can affect motility. Symptoms patients can present with include chronic constipation, diarrhea, abdominal bloating, nausea, vomiting and heart burn. Those are the GI symptoms we tend to see.
Lifelines
Name: Amy L. Lazzarini, M.D. Position: Physician at Integrative
Medicine of Central New York, P.C., Chittenango Hometown: Vestal, NY Education: Georgetown University School of Medicine; residency in internal medicine and fellowship in gastroenterology through SUNY Upstate Medical University; fellowship in integrative medicine through George Washington University School of Medicine and Health Sciences Career: Virginia Center for Health & Wellness, Aldie, Va.; BodyLogic MD of Aldie, Aldie, Va.; adjunct instructor, integrative medicine program, George Washington University; gastroenterologist at Crouse Hospital; assistant professor, SUNY Upstate Medical University Organizations: American College of Gastroenterology; American Gastroenterological Association; Institute for Functional Medicine; Metabolic Medical Institute; and ILADS (International Lyme & Associated Diseases Society Family: Husband, stepchildren Hobbies: Hiking, working out, cycling
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February 2019 •
IN GOOD HEALTH – CNY’s Healthcare Newspaper
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Page 7
Working More, But Getting Less Done? Study: Productivity starts to fall considerably after the 50th work hour of the week
I
t’s no surprise that many Americans are working overtime. Conservative estimates say that 19 percent of adults put in 48 hours or more a week and 7 percent log in 60 or more. But what you might not realize is that, after a certain point, extra hours could be hurting both your health and your productivity. In addition to a variety of medical issues and unhealthy lifestyle choices associated with long hours, a British study used cognitive tests to show that working 55 hours a week was associated with lower scores in vocabulary and reasoning, and can lead to cognitive problems as you get older. Adding insult to injury, research done at Stanford University found that, besides the personal toll that overtime takes, you probably aren’t working effectively. Productivity starts to fall considerably after the 50th work hour of the week and gets worse with every additional hour. So, if you put in 70 hours a week, you’re not likely to accomplish anything worthwhile during those last 15. One reason for this is that you might be too stressed or tired to function at peak level since working overtime usually results in your getting less sleep — and that in turn leads to making mistakes that can set you back at work. Take action to improve the balance between your personal life and your work life. Prioritize responsibilities and focus on the most important ones. Assert more control over time-draining tasks like answering emails. If you check your email every few minutes, cut down to every half hour or just scan the subject lines and open the most essential ones. And when you must stay late, make getting sleep a priority so that you’ll be well rested when you’re back at work in the morning.
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
EDITOR@ CNYHEALTH.COM
5
Top Health Stories of 2018
1.
Here are the top stories covered by news media last year
Rates of opioid-linked fatal overdoses nearly double
The scourge of opioid addiction and related deaths cut through American society again in 2018, capturing headlines and making it the year’s top health story. Rates of opioid-linked fatal overdoses have nearly doubled over the past decade and topped 70,000 in 2017, according to data released in November by the U.S. Centers for Disease Control and Prevention. Many of those tragic deaths occurred among young adults and were linked to fentanyl, a synthetic opioid that’s 50 times more potent than heroin. All of this means that for three years in a row, U.S. average life expectancy reversed a long-term upward trend and actually dropped — from nearly 79 years in 2014 to 78.6 years now. “We’ve been talking about the fact that our children will live less long than we will, and that’s clearly coming to pass,” said physician Georges Benjamin, executive director of the American Public Health Association. Other top health stories of 2018,
as compiled by editors at HealthDay, an online business that produces health-related content:
rates soar among the 2.Vaping young Even as smoking rates fell to alltime lows among teens, another form of addictive nicotine intake, the e-cigarette, was poised to take its place. The latest federal data on youth behaviors found vaping among American teenagers rising dramatically in 2018, with nearly two of every five high school seniors (37 percent) reporting they’ve tried an e-cigarette during the past year. That’s up from 28 percent the year before. Many worry that the sleek “cool” factor of the leading e-cigarette brand, Juul, may be luring the young to take up vaping which many experts worry is a merely a bridge to traditional smoking. Seeking to reverse these trends, the U.S. Food and Drug Administration in November announced that it would take steps to limit or ban access to flavored e-cigarettes, much favored by teens.
3.A deadly flu season
A virulent dominant strain of influenza, relatively low uptake of the flu shot, and a poor match between the vaccine and the dominant strains of virus combined to make 2017-2018 one of the worst flu seasons in recent memory. Over 80,000 people — many of them the frail elderly or the very young — died from complications of flu, the CDC reported, and hospitals were jammed with patients battling the virus. So far, the new season seems milder, but CDC experts warn that influenza can still bring surprises, so they urge vaccination.
4.Marijuana use rises
product, medicinal CBD oil, became hugely popular in 2018. A form of CBD liquid, Epidiolex, became the first marijuana-derived drug ever approved by the FDA. It is used to help ease certain forms of epilepsy. Not everyone was happy about widening access to marijuana, however. “The problem here is we’re at the beginning of this massive experiment with unknown outcomes,” said Fred Muench, president and CEO of the Partnership for Drug-Free Kids.
5.Obamacare holds on another year Despite promises by the Trump White House and Republicans in Congress to repeal it, the Affordable Care Act (ACA) — also known as “Obamacare” — kept providing health care to Americans in 2018. In fact, despite pessimistic midyear predictions, ACA sign-ups for 2018 held steady at near 12 million, and were only down slightly for 2019.
By 2018, 33 U.S. states had legalized marijuana for medical use, and neighboring Canada also legalized the drug for recreational use. Aging baby boomers seemed to embrace pot, and in a HealthDay/Harris Poll conducted in July, 85 percent of U.S. adults agreed that pot should be allowed for medical purposes, while 57 percent supported recreational use. One legal marijuana derivative
Healthcare in a Minute By George W. Chapman
Consumers Happy with Providers, Not So Much With Their Office Staff
A
survey by NRC Health, which focuses on researching and providing consumer data to the industry, found that 87 percent of consumers felt their provider treated them with courtesy and respect, but only 67 percent felt the same about the office staff. Seventy-seven percent of respondents were generally dissatisfied with waiting times. Yet, while expressing satisfaction with providers on one hand, a staggering 80 percent of the respondents said they would switch providers for con-
venience alone. In defense of medical office staff, they are typically the ones who have to explain why the doctor is running behind and then may have to explain why the patient’s insurance doesn’t cover something. Once in the exam room, most patients tend to be more demure with their provider and don’t voice their concerns. Rather than leaving the practice altogether, filing a polite suggestion, (versus an angry grievance), will prove more valuable to the practice and you.
ACA Deemed Unconstitutional A federal judge in Texas has ruled that the Affordable Care Act is unconstitutional by virtue of the individual mandate that requires you to have health insurance or suffer a penalty if you don’t. Because the individual mandate is so essential or “inseverable” to the act, the judge concluded the entire law to be invalid. By striking down the law, components like expanded Medicaid, premium subsidies/tax credits, pre-existing condition protections, value based payments to hospitals and physicians, and cost reductions are also wiped out. There is far more in the ACA than meets the average consumer’s eye. Hospital systems and physicians have invested heavily to comply with the ACA. An appeal may well reach the Supreme Court.
The ACA is still law of the land and the exchanges remain open for business because the judge issued a declaratory decision versus an injunction. The major healthcare trade associations, including the American Hospital Association, America’s Health Insurance Plans and the American Medical Association have all expressed their disapproval of the ruling. Neither Congress nor the Trump administration has plans for a viable alternative. Older Americans Worried About Coverage According to a poll conducted by the University of Michigan, people between the ages of 50-65 are, understandably, worried about their health coverage as they head toward retirement and Medicare. Twenty-seven percent of respondents
fear they won’t be able to afford their employer-provided insurance next year and almost half — 45 percent — fear they won’t be able to afford their insurance after they retire. Thirteen percent said they postponed or delayed a medical procedure because of the related out-of-pocket costs. Twenty percent said they would keep working past 65 to retain employer-sponsored insurance. Researchers found that fears are stoked by the lack of consistent policies from Washington, the constant attacks on the ACA without viable alternatives and threats by Congress to balance the budget by cutting funding for Medicare and Medicaid which most likely means decreased benefits coupled with increased premiums. Specialty Drug Costs Insurers say they are disproportionately driving up the cost of care and premiums. According to the California Department of Insurance, specialty drugs accounted for just 3 percent of all prescriptions, but accounted for 50 percent of total drug costs. Major insurers including Aetna, Anthem, Cigna and United spent $606 million on specialty drugs in 2017. That works out to about $81 per member per month or almost $1,000 per member per year. Depending on your plan, that $1,000 is about 16 percent of the total annual premium. On average, specialty prescriptions were $2,361 per script. Brand name scripts averaged $236 and generics averaged just $29 per script. The most frequently prescribed specialty drugs are the HIV drug Truvada, the immunosuppressant drug Humira, the diabetes drug Victoza and the hormonal drug Androgen. Despite February 2019 •
the limited audience for these drugs, most of us recognize these drugs from the ubiquitous ads on TV. Dementia/Alzheimer’s About 5.7 million Americans are afflicted with the disease. It is the sixth leading cause of death in the U.S. and there still is no cure. However, there is some heartening news coming out of a study conducted by the University of Kentucky. Our “cognitive good health” has been expanding further beyond 65, which means any signs of dementia are presenting later and later in life. According to the researchers, about 10 percent of those over 65 will actually contract dementia, or its most common form — Alzheimer’s. About 20 percent to 25 percent of seniors will suffer only mild impairment. The researchers are not sure why the onset is occurring later in life. Here are the common symptoms of Alzheimer’s: trouble completing easy tasks; difficulty solving problems; change in mood or personality; withdrawal from family and friends; problems communicating; confusion about people, places, events; trouble understanding images. 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.
IN GOOD HEALTH – CNY’s Healthcare Newspaper
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Page 9
Live Alone & Thrive
By Gwenn Voelckers
Practical tips, advice and hope for those who live alone
Resolve To Enjoy Valentine’s Day February (and that perennial “day of love”) is just around the corner, so why not beat Cupid to the punch? Add a resolution to your New Year’s to-do list that includes a decision to warmly embrace Valentine’s Day with grace, confidence and humor. Following the start of the new year, we haven’t been able to walk into a store, open a magazine or even shop online without being bombarded by candy hearts, flowers and pink teddy bears. Yes, the countdown to Valentine’s Day has started even before we set down our glass of Veuve Clicquot. It’s already in full force, and it’s no wonder that those without a special someone on their arm may dread what Hallmark promises to be the most romantic day of the year. What’s a single person to do? Before drowning your sorrows in a box of Godiva chocolates, consider these tips for surviving the day dedicated to amour: n Adopt a new attitude. Take the broadest possible view of Valentine’s Day and decide it’s
not just a day for couples, but a day to celebrate love in all its glorious manifestations: love of self, love of family, love of friends and — one of my favorites — love of pets! I already have my eye on a little heart-festooned collar for Scout, my lovable springer spaniel, just 3 years old now. n Express your love. Send cards to people you care about, buy one of those cuddly pink teddy bears for your favorite niece, connect with someone with whom you’ve lost touch or treat your office mates to some bagels (with cherry cream cheese) and coffee. Even better, surprise your lesser-known colleagues down the hall. n Have fun and laugh. Why not? It’s just a day. Invite some of your single friends over for wine and pizza or agree to meet anywhere that’s not sporting a Valentine’s Day theme. Raise a glass and toast to your independence, your freedom and your triumphant escape from the commercialism of this “holiday.” Valentine’s
Day is only depressing if you let it be. Have some fun with it. n Do something for someone else. One of the best ways to avoid a downward “woe is me” spiral is to think about others in need and how you might brighten their day. Consider baking a little goodie for a neighbor who lives alone, calling your uncle who lost his wife last year or committing one of those random acts of kindness. Spend Valentine’s Day celebrating your relationships with those you care about. You just might make someone’s day. Or show a little love for those less fortunate. On Feb. 14, consider making a contribution to a local or national organization that helps people in need. You’ll feel better for having expressed your love and gratitude in such a meaningful way. I’m going to write checks to the ACLU and NAACP.
n Do something for yourself. Didn’t get around to making any New Year’s resolutions? Make Feb. 14 your new New Year’s Day and make good on those New Year’s resolutions that have yet to see the light of day: quit smoking or drinking, renew your membership at the gym (better yet, go to the gym), schedule your annual physical, organize your paperwork, and vow to do those things on your list that will improve your outlook, your health, and your future. Your life is in your hands whether you are with or without a special someone. Make the most of it. And my final tip? I’m serious now. Make your bed on Valentine’s Day morning and place a candy heart on your pillow. It will be waiting for you when you turn in for the night, reminding you that you are loved, by the person who matters most — yourself! Gwenn Voelckers leads “Live Alone and Thrive” empowerment workshops for women in Mendon, Monroe County, 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 a book or invite Voelckers to speak, call 585-624-7887, email gvoelckers@rochester.rr.com, or visit www.aloneandcontent.com
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
What’s the best advice you could give to someone who has taken up a New Year’s resolution? Always have a start date, an end date and a goal. When someone says to me, “I would like to lose 20 lbs.” for example — well, what does that mean? That’s pretty much a dream. To turn that into a real vision — what I call a “True Vision” — you have to have a start date, an end date, a goal, and of course a plan to get to the goal. So it takes more than just setting a lofty goal? You need to find a way to make it more definite so you can hold yourself accountable and stick to it? Exactly, and make sure the goal is attainable, but not easily attainable. A lot of people set their goals too high. If someone finds themselves 50 lbs. overweight, often they want to lose 50 lbs. and they want to lose them in three days if they can. That’s ridiculous as we know. So, what I like to do with people in that case is say that’s a great goal — that’s the ultimate goal. Let’s have steps leading to it — say 10 lbs. at a time, and it works better that way. The goals have to be specific. It’s essential. If it’s not specific, how does it get done regardless of what the goal is? Put a plan down. When you have details in your goals for your vision, you can then start putting your mind to work visualizing it happening. What if your New Year’s resolution is difficult to calendar because it doesn’t conform to a natural end date — like a commitment to quit smoking? My suggestion is to get out of it the way you got into it. We know how you got into it, therefore we know how you can get out the same way. So, if you smoke 20 cigarettes per day, now you’re going to smoke 15 per day this month. And then we are going to whittle it down month by month until the final month of the year when you’re not smoking at all. What are the biggest pitfalls people don’t recognize when they start their New Year’s resolution journey? A good example is working out. Someone says, “I’m going to get in shape this year.” So, they get up Jan. 1 or Jan. 2 — depending on what they did New Year’s Eve — and say I’m going out to run, then I’m going to lift weights, and then I’m going to do squats, and then I’m going to jump rope. The next day they can’t walk — and then what happened to your goal? You can’t work out the next day or the day after that. They overdo it because they want it so bad. That’s the typical beginner’s mistake. Do you find people are more successful when they have a partner to help hold them accountable? That’s actually the best way to do it, I call it the buddy system. But beyond that, let’s talk about support units. If you have a family and if your spouse is overweight and you are losing weight, there might be a little jealousy there. There might be — gee, if he or she loses too much weight, he or she might not be interested in me anymore as opposed to a real healthy relationship and healthy support unit you have around you who encourages you. Losing weight with a friend is the very best way to do it, which is one reason why Weight Watchers works. You all have a similar goal. That’s really important.
find by February that you’ve lost seven or eight — you say, “This really happening, I can do this!” I read a study recently. It takes 17 times to attempt to quit smoking before you actually do it. Think of each individual time — blood and guts all the way. Each time you fail, you try again and again and again. Ignore the failures. Keep going forward. It’s like the child learning to walk. Does he ever say I can’t do it, I’m going to lay here, and then you’re being carried around at 14? You never see that because he doesn’t know he can’t. He gets back up. It’s the same thing. You have to disregard your temporary emotion at the time. At any given time in any given situation, everyone feels like quitting. As long as you take that next step and get up and go and keep going, you will succeed — with a good plan.
How to Stick to Your New Year’s Resolutions into February and Beyond A conversation with Bob Natoli, an award-winning Central New York entrepreneur, author, businessman, philanthropist, and 12-time Guinness Fitness World Record holder By Payne Horning What would you recommend to people when they are confronted with temptations while trying to stick to their goals — like someone who gave up drinking alcohol and finds themselves at a party? What should their inner voice tell themselves at that moment? “It’s not for me.” That’s backed up by a vision — we all think in pictures not words. If they’re trying to give up drinking alcohol, picture yourself drinking anything else and you have that vision of yourself. You know ahead of time — you’re planning for that question. “Would you like a cocktail?” “No thanks, I would rather have a ginger ale.” You know that — you heard yourself say it in your mind’s auditory section.
It’s rehearsal, and now I’m doing it in reality. The commitment that it takes has to supersede all of the temptations around. In order for that to happen, you really have to have that true vision for success in whatever endeavor that you’re attempting to succeed at. And if you really have that, it becomes easy — not right away, but in about 66 days, which is what it takes to create that habit. Most people drop their resolutions after January. For those who are sticking to it, does it ever get easier? Interestingly enough, it’s not based on time, it’s based on success. If you want to lose 20 lbs. and you
Bob Natoli founded and was owner of Rentavision, the largest independently owned rental company in the United States until its sale for close to $100 million. He holds several Guinness Fitness World Records including most chin-ups in one minute and most squats in one minute while carrying a 60-lb. pack. He chronicled his steps to success in “True Vision 4 Success,” a self-help book about assisting others in achieving their own goals. Copies of the book can be found at the True Vision 4 Success website and on Amazon. February 2019 •
What if you already failed your resolution and decided to drop it altogether? How do you get back into it? You failed through January or February, OK so you say March is coming up — March 1 I am going to begin again and this time I am going to do it right. I’m going to write it down, I’m going to write how I’m going to do it, I’m going to write down all of the tips, I’m going to write exactly what tempts me and how I failed last time, I’m going to learn from my mistakes, and this time I am going to succeed! In order to win, you have to fail. It’s kind of a conundrum. People can look at someone that succeeded in any endeavor and say it was easy for them and use a lot of excuses because they didn’t succeed at their goal. Stop with the excuses. You’re just using that “shield of excuse” so you feel better when you fail. Stop. What do you want out of life? Articulate that, put it down in writing, and set a plan. You can restart. It happens, but if you have to restart what’s the alternative? Giving up? Never give up! Do you think it’s even worth setting and following through with your New Year’s resolutions? I think any time is a good time to set goals for yourself. What New Year’s resolutions do is give you a yearly time period where you are obliged to set your goals for the year. I’ve been doing it for decades. Every New Year’s I will set a minimum of 10 goals for various aspects of my life — physical, spiritual, mental, business, etc. I strongly encourage everyone to do it because you get a chance to step back and take inventory of yourself, and that’s difficult for people to do. And I say write it down because when you write it down, it’s kind of like you’re writing your own personal newspaper. When you’re thinking it, you’re saying it, and now you’re writing it – it gives it more power. If you want to improve through life, it happens moment by moment. People say, “this is Thursday like every other Thursday.” It’s not! This Thursday is 52 Thursdays from last year’s Thursday and what have you done with your life? Have you helped others, have you helped yourself, have you helped your family? I get emphatic about this because people don’t self-analyze enough, and goals help you do that. They help you become better at everything. How do you fail and how do you lose when you’re going forward?
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My Turn
By Eva Briggs
There Are Drugs, Then There Are Nutraceuticals, Electroceuticals
M
uch of the practice of medicine involves finding ways to persuade the body to make something happen or to stop happening. The bone marrow might need to be persuaded to make more red blood cells in the anemic patient. Or the brain must be prompted to stop seizures. How do you communicate that to the body? The most familiar way is through drugs, more formally called pharmaceuticals Another way to send a message is through therapeutic food substances. Think Alice and the mushrooms she eats to grow larger or smaller in the book “Alice in Wonderland.”
Called nutraceuticals, these are regulated as dietary supplements or food additives. Some familiar examples are probiotics and antioxidants. The body can also be persuaded through the power of electricity. Anyone who has ever accidentally touched an electric fence can attest to that. Electroceuticals are devices that harness the power of electricity to treat illness via electrical impulses. You might not recognize that term, but some electroceutical devices have been around for a long time and are familiar to most people. Take the pacemaker. The first implantable pacemaker dates back to 1958. For trivia buffs, the very first patient treated with an implantable pace-
Cardiovascular Group of Syracuse Northeast Medical Physicians Christopher Nardone, M.D. Mark Charlamb, M.D. Andrew Weinberg, D.O. Theresa Waters, D.O.
North Medical Physicians Larry Charlamb, M.D. Charles Perla, M.D. Dana Aiello, M.D. Matthew O’Hern, M.D.
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
maker ultimately received a total of 26 different pacemakers before dying at the age of 86. He outlived both the inventor and the surgeon. A newer but also familiar technology is the cochlear implant. This electronic device stimulates the nerve cells in the cochlea of the inner ear, enabling profoundly deaf people to perceive sound. The very first cochlear implants were developed back in the 1950s. Deep brain stimulators connect electrodes to brain regions. They are approved to treat a host of central nervous system disorders: Parkinson’s disease, epilepsy, dystonia, essential tremor and obsessive-compulsive disease. They are being studied in a host of other conditions such as addiction, chronic pain, multiple sclerosis, Tourette syndrome and Huntington’s disease. One type of electroceutical poised to take off in future years to treat assorted conditions is the vagus nerve stimulator (VNS). The vagus nerve is one of 12 cranial nerves arising from the brain stem. The name vagus comes from the Latin word for wandering — think vagrant or vagabond. The name fits. It’s the longest cranial nerve, extending all the way from the brainstem down to the colon. Many branches wander off to different parts of the body and affect a variety of functions. It detects sensations in areas of the skin, as well as receiving sensory input from internal organs (throat, larynx, esophagus, trachea, heart, and digestive tract). The vagus nerve also controls muscles in the
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pharynx, larynx, soft palate, heart, and digestive tract. Recent discoveries show that the vagus nerve produces chemicals that regulate the immune system. Electrically stimulating the vagus nerve might someday treat autoimmune and inflammatory conditions. Existing drugs to treat these conditions often cause serious side effects. By targeting the vagus nerve, more effective and safer treatments could be developed for autoimmune diseases like rheumatoid arthritis and Crohn’s disease. Vagus nerve stimulation might potentially treat some diseases with inflammatory components, such as cardiovascular disease or lupus. There might be applications to preventing immune rejection of transplanted tissues. Most currently used vagus nerve stimulators are implants. The device is inserted under the skin below the collarbone. Wires wrap around a branch of the vagus nerve and deliver electrical signals. But there are noninvasive handheld vagal nerve stimulators approved to treat migraine headaches and cluster headaches. They deliver mild electrical stimulation to the nerves via the skin of the neck or ear. Challenges to the wider adoption of electroceuticals include the cost of implants and the need for surgery. As technology improves and becomes less invasive, these problems should ease. More research is still needed to determine how vagus nerve stimulation affects various conditions and what is the best way to target electrical impulses. Eva Briggs is a medical doctor who works at two urgent care centers (Central Square and Fulton) operated by Oswego Health.
Common Gym Mistakes to Avoid
nce you’ve taken all the right steps to find a gym suited to your needs, avoiding some common mistakes will ensure maximum results for the time spent working out. First, don’t just congratulate yourself for joining a gym — you actually have to go. It’s easier to stick to a schedule when you ink it in your calendar. Even if you can get there only two or three times a week, make the commitment — being consistent is the only way to get results. Another mistake is not adjusting exercise equipment to your size and your abilities. That means small but important changes like moving the seat and back positions on weight machines for the best positioning. That’s just as necessary as moving the pin on the weight stack. If not, you’re likely to use bad form, and that can lead to injuries. Speaking of form, take advan-
tage of the availability of gym staff to make sure you’re using correct form, whether in a yoga class or strength training. A trainer’s objective eye can help you move through your full range of motion. Resist getting into a competition with other gym members, even if it’s only in your head. Embrace the spirit of camaraderie so that you can motivate each other. Avoid settling into a predictable pattern. One advantage of a gym is the variety it offers, from equipment to classes. So don’t get locked into a “forever” routine. That can erode your motivation and lead to fitness plateaus and even an overuse injury. Finally, don’t forget good gym manners. Leave your phone in your locker, but remember a towel so you can wipe off any sweat as you finish working on each piece of equipment.
Upstate University Helping Develop Heroin Vaccine By Payne Horning
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cientists at the Walter Reed Army Institute of Research have created a heroin vaccine specifically designed to prevent the drug’s psychoactive effects. If successful in humans, the vaccine would stop heroin’s addictive qualities. Doctors at Upstate Medical University are now involved in the study and may soon oversee human trials of the vaccine. Physician Stephen Thomas, a professor of medicine and microbiology and immunology at Upstate, is in charge of the project. He got involved after contacting a former colleague at Walter Reed, where he had spent 14 years of his 20-year career. “I called him back up and asked if he was still working on it,” Thomas said. “He said yes, and we’ve had great success in mice and rats and we are at the stage where we need to think about how we are going to transition this to clinical development. And I said this is perfect timing then because we are in the midst of an epidemic up here.” Thomas is neither a toxicologist nor an addiction expert, but he has not been immune from the fallout from the opioid public health epidemic. As head of the division of
infectious disease at Upstate, Thomas is regularly consulted to help deal with the far-reaching complications caused by opioid abuse. Heroin users who inject unsafe substances with dirty needles often inadvertently place bacteria in their blood, causing the accumulation of large collections of infected fluid in their spine, bones and brains. “Now what happens is the person is in the intensive care unit,” Thomas said. “They are calling the infectious disease doctor, they’re calling a cardiothoracic surgeon, they’re calling in a kidney specialist — all of these different disciplines that in the relatively recent past weren’t being exposed to this type of population of people are now [called] to stop them from dying. It’s absolutely a crisis.” Heroin is an opioid drug made from morphine that is injected, inhale or smoked. According to the National Institute of Drug Abuse (NIDA), the number of deaths related to the drug more than doubled in New York state to 1,307 from 2012-2016. New York state allocated $247 million in last year’s budget alone to combat the scourge of opioids. Thomas believes the heroin vac-
cine could help alleviate this problem. Based on what researchers have found in the animal studies, the heroin vaccine works similarly to other vaccines designed to fight infectious diseases. A protein that mimics and looks like the active metabolite of heroin is packaged into a vaccine and injected into the blood. The body’s immune system then mounts a response to the heroin-like protein by manufacturing antibodies that attach to it, preventing the metabolite from crossing the blood-brain barrier. That prevents the euphoria or high associated with the drug when the actual heroin metabolite is injected into the body. Upstate has been awarded a $3.7 million preclinical grant from NIDA, which covers everything before the human testing. The researchers will use that funding to finish the animal testing, manufacture the vaccine, and put together the proposal for how to test the heroin vaccine in humans. The U.S. Food and Drug Administration will then review the application and determine whether or not to fund the execution of that plan, which could start as soon as 2020. Thomas says the human study would likely involve a large group of heroin users who have committed to rehabilitation. Half of them would receive the vaccine plus the current standard of care for opioid addiction treatment, and the others would receive a placebo plus the current standard of care for opioid addiction treatment. The team leading the study would then track the groups and record the number of remissions in each, ultimately with the goal of determining if there is a statistically significant difference between them
or not. Among the questions they hope to answer are how long the effects of the vaccine last and how often it needs to be administered. Even if the vaccine does prove to be successful, Thomas says it is not a “magic bullet.” The medication would need to be administered as part of a comprehensive treatment, such as counseling, to treat the underlying substance abuse disorder. But he says it could play an integral role in helping those who are struggling to stay sober. “Knowing that recovery is often a try-fail cycle, maybe this could be a powerful tool to make that cycle shorter in duration, and maybe we can help people on the first try and avoid the devastating health and family and community suffering that goes along with the epidemic,” Thomas said. “That would be the hope.” Thomas says a secondary and perhaps more ambitious goal of the study is to learn how to replicate this formula to make vaccines for other substances that people abuse. Theoretically, he says, it could be developed to combat the effects of other deadly drugs like fentanyl. Physician Stephen Thomas, a professor of medicine and microbiology and immunology at Upstate, is involved in the vaccine project.
4.0% UNINSURED RATE 30% LOWER
THAN THE NEW YORK STATE AVERAGE
54% LOWER
THAN THE NATIONAL AVERAGE In 2017, the uninsured rate across upstate New York averaged just 4.0 percent. This maintains our region’s historically low uninsured rate. It compares with a New York state average of 5.7 percent and a national average of 8.7 percent. Our 2018 and 2019 rate increases in the small group and individual markets were the among the lowest in upstate New York, which helped keep our local health insurance affordable and uninsured rate low.
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Free Dental Clinic Cares for Nearly 700 Patients in 2018 Amaus Dental Clinic provides free dental treatment in downtown Syracuse By Mary Beth Roach
T
he staff at the Amaus Dental Clinic in downtown Syracuse give their patients plenty to smile about. The dentists and staff, who all volunteer their time and skills, offer the services free of charge to their patients: the homeless, unemployed and uninsured in the Syracuse area. The services are for adults only, since care for children requires different equipment than the clinic has. Just because patients may be financially disadvantaged doesn’t mean they shouldn’t get high quality care. “We want them to feel comfortable coming in here,” said dentist David Dasher, who helped establish the clinic in 2014, oversaw its expansion in 2017 and is its current director. The clinic, located at 259 E. Onondaga St., came about as part of the Amaus Health Clinic and is an outreach of the Cathedral of the Immaculate Conception in downtown Syracuse. The cathedral offers them space rent-free and pays for the utilities. Its annual budget of $19,200 is covered by donations. This year, nearly 700 patients have received services, which include exams, X-rays, hygiene, fillings and routine extractions. That number has grown steadily since the clinic first opened. Dasher said that the increase can be can be attributed to several factors, including word of mouth, repeat patients, more dentists to offer services and the expanded facility that opened in February 2017. Using comparative fees for the
services they provide, he has estimated that their patients received services valued at $121,700 in 2018. The clinic’s staff includes as many as eight dentists, six hygienists, four assistants and an administrative staff of eight — all who volunteer their time at the clinic, which is open 20 hours a week, Dasher said. It is not on a walk-in basis; appointments are required. Some of the dental assistants are pre-dental students, from LeMoyne and Syracuse University, who work in the clinic for a while, gain some practical experience, and then apply to dental school. Dasher is hopeful that their early work in the clinic will plant a seed to do similar volunteer work later in their career. “Maybe they can find their way to give back somehow,” he said. Gradual growth Upon retiring from the U.S. Air Force in the late 1990s after a 23-year career, Dasher started a community dental health program outside Dallas. When he came to Syracuse, Dasher began working at the Syracuse Community Health Center. He also did a study of 14 medical training programs in this area for a health foundation of Western and Central New York, to see what, if any, dental training the doctors might receive. He said students in medical school don’t get the appropriate knowledge of dental care. He said he offered to teach classes for these programs, but due to a lack of time in their curricu-
Hospital Bill:
Price Transparency Now in Effect By Deborah Jeanne Sergeant
A
s of Jan. 1, health care providers have been required to post the price of their services online and make the prices available to anyone who asks. Instead of receiving services and having to wait for the bill, patients can know what their visit, procedure or tests cost by going online, thanks to the Inpatient Prospective Payment System rule. The movement toward transparency was largely patient-led, as more and more patients have become uninsured or have otherwise taken Page 14
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on more financial burden of paying for their health care through high deductible plans in the wake of the Affordable Care Act. With social media and various quality measures related to different providers, patients can shop on the basis of patient satisfaction, along with price. In the past, patients tended to stick with one provider. Now that they bear more of the cost, they want to look around. Since the prices are readily available online, they can. “It’s hightime competition came to the medical field,” said physi-
IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
Dentist David Dasher, director of Amaus Dental Clinic in downtown Syracuse, treats a patient. The clinic offered free dental services to about 700 patients in 2018. In the back is volunteer dental assistant Rebecca Vignogna. lums, most of the programs weren’t able to accommodate him, except for LeMoyne College. He has been teaching in that college’s physician assistant program for about five years. Physician Lynn Satterly, founder of the Amaus Health Clinic, knew of his study and asked him if he’d be interested in starting a dental program as part of the clinic. So, in 2014, the dental clinic opened with one treatment room and donated equipment. The room lacked access to plumbing, so the dentists used a portable sink with plastic containers to provide sterile water and collect waste water. As the number of patients and volunteers both increased, they needed a larger space, according to Dasher. And in February 2017, the new clinic at 259 E. Onondaga St., was opened. The $200,000-plus expansion included three treatment rooms, digital X-rays, electronic dental records, a sterilization center, a reception and waiting area, supply spaces, and a break/consultation room. The funding and dental equipment came from various foundations, dentists, dental supply companies and other individuals.
The need continues, and Dasher knows that they’re only beginning to scratch the surface, that there are thousands more who could their help. But while the need might be great, finding volunteers and funding can be a challenge. “You can help people without going on a medical mission to Guatemala or Honduras. Just come to downtown Syracuse,” he said. Despite these challenges, Dasher finds the work rewarding. “The patients really appreciate it, and the good feeling you get from helping them and seeing them appreciate it,” he said. Smiles all around.
cian Joseph Barry who practices at Preventive Medicine Associates in Camillus. “Third-party payers have stifled competition. People should know the cost at doctor’s offices and hospitals.” He compares the medical system to a grocery store shopper entering the store to purchase milk, but the costs depends upon how he chooses to pay for it. “There are enormous forces still not played out,” Barry said. “For people with huge deductibles, they’re out shopping. As long as we have a third-party payer, we will have no real transparency.” Since those payers negotiate for the price for services, they can pay different prices than those listed by providers. Barry hopes that greater transparency will lead to greater competition among providers and lower cost. More options, such as independent surgery centers, concierge medicine and integrated medicine providers, have contributed to a health care culture of consumer choice. Price represents yet another factor. Prices listed by any medical facility should be considered esti-
mates, as the length of a hospital stay and complications can change it. Like a service writer’s estimate at a car repair garage, the estimates listed online can change. Patients can also call the health system for an estimate. Most providers offer a payment plan and works with patients to find any grants available to help with costs, if needed. “Trinity Health is committed to working with consumers, payers and policymakers on developing the best solutions for achieving price transparency goals,” said Jamie Arnold, communications officers with St. Joseph’s Health, which is a member of Trinity Health. Arnold added that St. Joe’s has participation in the Centers for Medicare and Medicaid Services and that rule-making process demonstrates the hospital’s “strong interest in public policies that support better health, better care and lower costs to ensure affordable, high quality, and people-centered care for all.” Arnold said that patients can learn about the cost of procedures and the new policy by visiting www. sjhsyr.org/price-estimates.
Free Dental Care The Amaus Dental Clinic provides free dental care out of its offices at 259 E. Onondaga St., Syracuse. It’s located at the back of a parking lot next to the offices of Cathedral of the Immaculate Conception in downtown. Appointments are required. The phone number is 315-802-6741.
SmartBites
The skinny on healthy eating
Boost Energy and Teeth Health with Raisins
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he strangest thing happened to a friend of mine, a vegetarian, the epitome of good health. A few months ago, she began dropping things and knocking into furniture. She complained about feeling exhausted and confused. A busy woman, she chalked it up to stress. But finally, she saw a doctor. The diagnosis? She was anemic. Promptly, she began incorporating more iron-rich foods into her diet. To supplement her iron intake, I suggested she also tuck some small boxes of raisins into her purse. Raisins contain more iron than many other types of fruits. While they don’t hold an iron candlestick to meat, shellfish or spinach, they do provide some: a small box delivers about 5 percent of our daily needs. A vital nutrient we can’t live without, iron is essential for making red blood cells and transporting oxygen throughout the body. It also supports our immune system and brain function, and helps maintain healthy skin, hair, and nails. You might be surprised to learn that low iron is the most common nutritional deficiency in the U.S. Raisins contain “non-heme” iron, the type found in plants that requires multiple steps to absorb it. Since vitamin C nearly doubles the absorption
of non-heme iron, it’s a good idea to eat raisins with other vitamin C-rich foods. Many athletes consume raisins for the rapid energy they provide. One small box of raisins (1.5 ounces) provides 130 calories, 34 grams of carbs and 26 grams of sugar. According to several studies, raisins provide the same performance-enhancing benefits as Sports Chews or Sports Jelly Beans — and for a whole lot less money. Because raisins are dried grapes, it’s natural to wonder how the health benefits of raisins compare to grapes. While both are antioxidant superstars, raisin’s star shines about three times brighter, since the drying process concentrates many of these compounds. On the downside, however, raisins contain less vitamin C and resveratrol (a polyphenol that may benefit hearts) than grapes, since this same drying process compromises them. Low in fat, sodium and cholesterol, raisins are also a good source of potassium (helps maintain a healthy heart) and fiber (promotes regularity; ferries cholesterol and other toxins out; fills us up). Lastly, sweet and sticky raisins may help fight — not cause — cavities. According to researchers at the
USA Department of Food and Nutrition, raisins contain chemicals that suppress the growth of oral bacteria associated with cavities and gum disease.
Toasted Couscous with Almonds and Raisins
Adapted from calraisins.org; serves 6-8
1 1/2 cups couscous 1/2 cup slivered almonds 2 cups vegetable or chicken stock 2 stalks celery, diced 1 clove garlic, minced (or, ½ teaspoon garlic powder) ½ teaspoon cumin pinch of cayenne pepper Salt and pepper, to taste 1 cup raisins 2 teaspoons lemon zest, optional Heat a large nonstick skillet over moderate heat. Add couscous and toast grains, stirring pan frequently until brown and fragrant. Transfer to a plate. Add almonds to the hot skillet and toast them, stirring frequently until light brown. Transfer them to another plate. Bring stock to a boil with celery, garlic, cumin, cayenne, salt and pepper. Simmer about 3 minutes or until celery is slightly softened. Add couscous and raisins to saucepan and stir gently just to mix. Cover pan;
What’s the Best Diet for 2019? Experts Weigh In
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or many, the start of the new year signals the start of a new diet. But what’s the best way to eat if you want to lose weight? For overall healthy eating, the best diet plan is the Mediterranean diet, according to U.S. News & World Report’s annual diet review. The DASH (Dietary Approaches to Stop Hypertension) diet was ranked second on the magazine’s overall Best Diets 2019 list, followed by the Flexitarian plan. All three plans focus on eating a mostly plant-based diet (veggies, fruits and whole grains), healthy fats and lean protein sources. “I hope these rankings steer people in the direction of doing something healthful,” said nutritionist Samantha Heller of NYU Langone Health in New York City. “I wish though, that we weren’t so obsessed with weight loss and diets, per se. I wish the focus was on adopting a healthy lifestyle, like eating a more plant-based diet, getting regular exercise, getting enough sleep and managing stress, all of which help us live a better quality of life,” Heller said. To that end, she said the top three diets are all similar in their food content, and all can be healthy eating
U.S. News & World Reports recentlly reviewed a number of diets and ranked the best ones for weight loss and overal health. regimens. The Mediterranean diet has been linked to increased longevity and a decreased risk of chronic illnesses, the report said. The Mediterranean diet was also ranked high in multiple categories including: easiest diets to follow, best diets for healthy eating, best diets for diabetes, and best diets for heart health.
If weight loss is part of your plans, here are plans that topped the rankings for the best weight-loss plans: • WW (Weight Watchers) • Volumetrics • Flexitarian diet (tie) • Jenny Craig (tie) • Vegan diet (tie) February 2019 •
Helpful tips
Give the box or bag of raisins a good shake before buying. If the raisins rattle inside, it means they are dried out. Tightly sealed raisins will last about a month when stored in a cool, dark place and up to a year in the refrigerator. Dried-up raisins can be revived by blanching them in boiling water for 10 minutes. remove from heat and allow to stand about 5 minutes or until couscous is tender. Add almonds and lemon zest (if using) to couscous and gently fluff grains with a fork. • Note: Toasting the couscous gives it a rich, nutty flavor. Stir frequently to make sure it browns evenly.
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.
Feel the need to knock off some pounds quickly? Here are the best fast weight-loss plans: • HMR program • Atkins (tie) • Keto diet (tie) • Optavia (tie) • WW (Weight Watchers) (tie) Heller said that many people feel that they need to “kickstart” their weight loss for motivation. The problem with plans that focus on fast weight loss, however, is that they don’t teach you how to eat well every day. “On these types of diets, you often don’t learn how to manage holidays, stressful days or special occasions. You don’t develop strategies for life,” she said. The magazine asked a panel of nutrition experts to review 41 diet plans. Like Heller, the expert panelists emphasized the importance of well-balanced, sustainable diets that aren’t overly restrictive. These types of diets can help teach lifelong positive eating habits. Lifestyle diets, such as the Mayo Clinic diet and MIND diet, are healthier and more sustainable than weight-loss plans such as the Ketogenic or Atkins diet are, the panelists concluded. Although the popular Keto diet ranked high for fast weight loss, it landed way down on the Best Diets list — tying for number 38. Other diets at the bottom of the list included the Dukan diet, the Body Reset Diet and the Whole30 diet.
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Things to Know About Preventing Heart Disease
One in every four deaths in the U.S. is caused by heart disease, considered one of the most preventable health ailments
By Ernst Lamothe Jr.
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hile it remains one of the most preventable health ailments, heart disease continues to be the leading cause of death, disability and health care spending in the United States for men and women. About 610,000 people die of heart disease in the United States every year — that’s one in every four deaths, according to the Centers for Disease Control and Prevention. The most common type of heart disease in the United States is coronary artery disease, which affects the blood flow to the heart. Heart disease is focused on coronary arteries which supply the heart with blood. You can develop plaque build-up, which affects your arteries and blocks flow to the heart. “Heart health is important and there are several things you can do to prevent heart attacks and strokes that people may not be aware of,” said Theresa Waters, cardiologist for Cardiovascular Group in Syracuse. “You should know everything you need to know about living healthier and longer.” Walters recently discussed five most important things things you need to know about heart health.
1.
Men and women have different symptoms While women can also have the same common heart attack symptom such as chest pain or discomfort, they are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea, vomiting and back or jaw pain. Many women think the signs of a heart attack are unmistakable — the image of the feeling of an elephant on your chest,
comes to mind — but they can be subtler and sometimes confusing. “Sometimes when you just feel fatigued that may be the only symptoms you feel,” said Waters. “You have to know that it is not always going to have the classic chest pounding pain. Eight million women in the U.S. have heart disease and that is a significant number.”
2.
Eating healthy can’t help you alone Being overweight continues to be a risk factor for heart disease and stroke. Keeping your heart healthy by making healthier food choices isn’t as hard as it sounds. Fresh, filling and hearthealthy, fruits and vegetables are an important part of your overall healthy eating plan. They are high in vitamins, minerals and fiber and low in fat and calories, according to the American Heart Association. However, eating healthy is not the only silver bullet. “Certain anxiety you can have can cause palpitations. It can cause rapid heart beating and shortness of breath,” said Waters. “How you live your lifestyle and if you let stress overcome can negate all the healthy aspects you do for your heart.” Also other risk factors include high blood pressure and smoking, she said.
3.
Check family history Asking if heart disease or stroke runs in your family is an important question that must be asked. Knowing your family’s health history can help you avoid both heart disease and stroke. Both the risk of heart disease and risk factors for heart disease are strongly linked to family history.
“If your first degree relatives such as your mom, dad, brother and sister have heart disease you are definitely more likely to be predisposed to it,” said Waters. “While there is not a specific genetic test that can determine if you will definitely have heart disease, I would recommend getting evaluated by a cardiologist on a regularly basis when this is a condition that has affected layers of your family.” You can be evaluated by stress test, EKG and sometimes imaging tests, Waters said.
4.
Find the right diet Every new year, a new diet is all the rage. There are some that can be detrimental to your health and others that have found success. Two diets have been approved by the American College of Cardiology and the American Heart Association. They are the Dietary Approaches to Stop Hypertension (DASH) and Mediterranean diets. The DASH diet is an eating plan to lower or control high blood pressure. The diet emphasizes foods that are lower in sodium as well as foods that are rich in potassium, magnesium and calcium such as nutrients that help lower blood pressure. The DASH diet features menus with plenty of vegetables, fruits and low-fat dairy products, as well as whole grains, fish, poultry and nuts. It offers limited portions of red meats, sweets and sugary beverages. The Mediterranean diet incorporates the basics of healthy eating, plus a splash of flavorful olive oil and perhaps a glass of red wine, among other components characterizing the traditional cooking style of countries bordering the Mediterranean Sea.
Weight Affects Heart Failure Risk By Deborah Jeanne Sergeant
T
he Centers for Disease Control and Prevention (CDC) states that 5.7 million Americans have heart failure, a condition that contributes to nearly one in 10 deaths. About 50 percent of those diagnosed die within five years. The CDC also reports that research indicates people who have lived with obesity earlier in life but have later lost weight are at higher risk of heart failure than people who have maintained a healthy weight lifelong. While it’s never a bad idea to get back down to a healthy weight, it’s better to prevent obesity to begin with. “This study provides additional support to the thought that obesity in younger people is significantly correlated with cardiovascular disease as we age,” said Daniel Villarreal, cardiologist and professor of medicine at Upstate Medical University. Page 16
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“Even though they might have lost weight, they may result in complicated heart issues.” Villarreal explained that early onset obesity may have already set in place factors that stay dormant until later in life, when they result in heart failure. He encourages patients to stay vigilant about their weight, instead of letting the pounds continue to pile on. A body mass calculator such as at https://bmicalculatorusa.com can help determine what’s a healthy weight based upon weight and height. A normal body mass index is less than 35. Between 25 and 30 is overweight and over 30 is obese. Villarreal recommends a sensible diet and sufficient physical activity as key for maintaining a healthy weight. Otherwise, heart failure and a bevy of other health problems may eventually arise, such as hypertension, diabetes, metabolic syndrome,
IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
stroke, heart attack and coronary artery disease. “Those are very dangerous factors that will shorten the lifespan of every individual,” Villarreal said. “Being aware of the potential effects that obesity has on several levels is an important motivator to maintain a healthy weight.” He said that temporarily reducing calorie intake to 1,500 daily can help foster weight loss, and then maintaining a moderate amount of calories afterwards can help maintain a healthy weight. Ideally, preventing obesity reduces risk of the co-morbidities it brings. Villarreal said that many people learn unhealthful eating habits and sedentary lifestyle as youngsters and continue them into adulthood. “People have to be aware of the importance of healthy weight control in early life, in childhood and adolescence,” he said. “Childhood
Cardiologist Theresa Waters practices at Cardiovascular Group in Syracuse. Most healthy diets include fruits, vegetables, fish and whole grains, and limit unhealthy fats. “These diets focus on healthy fats and lower cholesterol foods,“ added Walters. “They target the issues that people have in symptoms of heart disease. It is always important what you put in your body.”
5.
It’s a myth that if you take a cholesterol-lowering drug you can eat anything Cholesterol in the bloodstream comes from two sources — your liver makes some and you get some from certain foods. Statins reduce the amount of cholesterol made by the liver. This causes blood levels of cholesterol to drop, which, in turn, reduces the amount of cholesterol deposited in your arteries. If you take a statin and continue to eat foods that are high in cholesterol plus saturated fat, the drug will not be as effective, and your cholesterol level will not fall. “The statin theory says that it lowers your cholesterol better when you are eating healthier then when you are doing unhealthy things to your body,” said Waters. “There is scientific evidence that says you can’t just do anything you want and expect medication or anything else to solve the problem regardless.” and adolescent obesity leads to adult obesity.” Families also need to take more time to stay physically active so that children learn from their parents’ example. Finding fun activities that burn calories helps ensure consistency in exericise. Physician Az Tahir, who practices holistic integrative medicine at High Point Wellness in Syracuse and Internal Medicine Internal Care in Henrietta, said that weight loss “is not a simple thing.” Beyond eating less and exercising more, he said that people who need to lose weight should also look at aspects of health such as a hormone imbalance, food intolerance, or thyroid disorder which can contribute to weight gain. “The best thing is to find the root cause,” Tahir said. “I think some patients like to have a quick fix. That can be harmful. People can lose weight temporarily, but the best thing is to find the root cause. If that is not addressed, the person’s weight will be an issue and the root cause may have other problems.” n See related stories on page 22.
CBD:
Safe and Studied By David Brickman
W
ith the signing of the 2018 Farm Bill this past December, nearly a century of prohibition of hemp came to a close, removing it from the list of federally controlled substances and ending policies that have hurt farmers and consumers alike. Hemp, possibly the world’s most useful plant, is food, fuel and fabric. And hemp is medicine. Both hemp and marijuana come from the species Cannabis sativa, but they are cultivated for different characteristics. Hemp produces a negligible amount of the cannabinoid THC, the psychoactive compound that is responsible for the “high” marijuana users seek — federal law stipulates that the THC content of hemp be 0.3 percent or less. You cannot get high from hemp.
Cannabis also produces cannabidiol, aka CBD, which has been shown to have medical benefits to humans and their mammalian pets alike. It is not uncommon to see exaggerated claims that CBD is a cure-all. It is not, but a recent Consumer Reports nationally representative survey showed that 15 percent of adult Americans had tried CBD and a majority (83 percent) said it helped, to some degree, the symptoms they were treating. These findings are consistent with our observations at Hemp it UP. Another commonly voiced and valid concern is that, at present, the Food and Drug Administration does not regulate CBD products. Hemp it UP works only with producers who meet our strict criteria. First and foremost, producers must commission and
publicly present the results of independent lab testing on each batch of their product. This is critical in the absence of FDA oversight, ensuring that the products contain the listed amount of CBD and that they contain no harmful impurities. Further, all hemp must be grown using organic practices. There is much to learn about the most effective ways to use and dose CBD products. Finding a provider who can help separate fact from fiction is important, as is doing one’s own reading. Pay no heed to claims that there have been no studies on CBD. A database of studies can be found online at www.projectcbd. org/about/clinical-research. Another excellent resource is the National Institute of Health’s own website: www.ncbi.nlm.nih.gov/pubmed/. The NIH site is not CBD specific, so
readers may wish to include “cannabidiol” among the search terms. David Brickman is the owner of Hemp it UP (www. HempItUpGifts. com) and Bodymind Float Center (BodymindFloatCenter.com), both with locations in Syracuse and Rochester. He is a violinist in the Amenda Quartet (www.AmendaQuartet. org) and lives in Rochester with his wife and business partner Patricia Sunwoo and their daughter Lillian.
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February 2019 •
1/23/2019 IN GOOD HEALTH – CNY’s Healthcare Newspaper •
9:16:00 AM 17 Page
U.S. Healthcare Spending Highest Among Richer Nations H igher costs, not better patient care, explain why the United States spends much more on healthcare than other developed countries, a new study indicates. U.S. healthcare spending was $9,892 per person in 2016. That was about 25 percent more than second-place Switzerland’s $7,919 and more than twice as high as Canada’s $4,753, researchers found. It was also twice what Americans spent in 2000, and 145 percent higher than the Organization for Econom-
ic Cooperation and Development (OECD) median of $4,033. The OECD includes 34 countries. “In spite of all the efforts in the U.S. to control health spending over the past 25 years, the story remains the same — the U.S. remains the most expensive because of the prices the U.S. pays for health services,” said study author Gerard Anderson. He’s a professor at Johns Hopkins Bloomberg School of Public Health in Baltimore. “It’s not that we’re getting more;
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
it’s that we’re paying much more,” Anderson said in a school news release. Evaluating the drivers behind soaring U.S. spending, his team cited higher drug prices, higher salaries for doctors and nurses, higher hospital administration costs and higher prices for many medical services. Despite those higher costs, Americans have less access to many healthcare services than residents of other OECD countries, according to the study. In 2015, for example, there were 7.9 practicing nurses and 2.6 practicing physicians for every 1,000 Americans, compared to the OECD medians of 9.9 nurses and 3.2 physicians. That year, the United States had only 7.5 new medical school graduates per 100,000 people compared to the OECD median of 12.1. And the nation had just 2.5 acute care hospital beds per 1,000 people compared to the OECD median of 3.4. Yet the United States ranked second in the number of MRI machines per person and third in the number of CT scanners per person, suggesting relatively high use of these expensive resources. (Japan ranked first in both categories, but was one of the lowest overall healthcare spenders in the OECD in 2016).
Among the other findings: • U.S. health spending outpaced that of the other OECD countries between 2000 and 2016 — growing an average of 2.8 percent a year compared with the OECD median annual increase of 2.6 percent. • Inflation-adjusted spending on pharmaceuticals rose 3.8 percent annually in the United States versus an OECD median of 1.1 percent. • In 2016, U.S. health care spending accounted for more than 17 percent of gross domestic product, compared with an OECD median of less than 9 percent. The findings appear in the January issue of the journal Health Affairs.
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Little Expectations
A
What sort of expectations do I have for my children?
s we make our way through life, we become collectors of subjective experience. We collect knowledge, love, hurt and wisdom. Some of the things we pick up along the way stay with us. Maybe we forget the people, time or place surrounding that thing, but certain things make their mark. Personally, I like to collect concepts. I like to turn them over in my head until I can finally fit them into my life. Lately, I’ve been coming back to one concept with loving regularity. I can’t remember where I heard or read it, but I can’t shake it. This concept is fairly simple, but changing my ways because of its implications is not. The concept is: you derive frustration and disappointment by possessing expectations. So, if any of us wants to be content, happy or less stressed, we need to manage our expectations. We can’t manage other people, so we owe it to our mental wellbeing to self-regulate. I’ve been thinking a lot about this concept as it relates to parenting. (I start asking reasonable questions but then quickly go face-first down the proverbial slippery slope.) What sort of expectations do I have for my children? Are they realistic? Are they age appropriate? Am I dooming myself and my kids to a perpetually frustrating relationship because I can’t manage my expectations? Why have any expectations at all? Do happy people end up abandoning their expectations and thus thriving in a noisy, unkept, wild and beautiful world? As much as I like to fancy myself a part-time parenting philosopher, I’m not. I’m just a mom who is fumbling through this crazy parenting journey. I can only answer my little and reasonable questions. So, here it goes. My expectations are not always reasonable or age appropriate. Therefore, sometimes, I cause myself, my husband and my children needless frustration. I also inherently welcome needless disappointment into my life. In the hallowed ambition of less stress, disappointment and frustration, here are a few, simple questions I am asking myself in regards to expectations for my children. n Would I expect this of an adult? Do I expect an adult to drop everything they are doing the second I tell them to, no matter how invested in an activity they are? Would I expect top-notch work out of someone when they are tired or hungry? Would I expect an adult to never disagree with friends of family? I would not. So, I certainly can’t place these expectations on my kids. n Am I comparing my child to others? I need to have my expectations meet the capabilities of my kids. What works for one of my kids isn’t necessarily going to work for the other one. I can’t expect my kids to do something just because the other
kid is doing it. My kids have individual strengths and weaknesses, and I need to craft my expectations around those. n Have I been consistent in the past? If I haven’t been consistent or have made empty threats in the past regarding a certain scenario, I need to expect that my kids may not act the way I want them to. I need to acknowledge that changing certain behaviors will take time and consistency. n Am I being clear about my directives? Sometimes, I get busy and offer murky directives. I’ve found my kids to be more compliant when I offer them clear and concise directives, as well as clear consequences for not following a directive. It may sound silly, but the fewer words I use, the better my 4-year-old responds. If I say “pick up your robots and put them in your toy box” instead of “pick up this room” he can usually rise the occasion. n Am I taking an all-or-nothing approach? Sometimes, I don’t value the progress my kids make on things. Instead of being elated they did 90 percent of what I asked them to do, I focus on the missing 10 percent. Would I want to be in a work environment or relationship where I always had to give 100 percent or do things 100 percent right? That would suck. I shouldn’t put my kids in that environment. I know there is a fine line between managing my expectations and ignoring or condoning bad behavior from a child. I’m sure there are some grumpy and contrary people out there who think managing expectations is lazy or under-reactive parenting. I can assure you it is quite the opposite. I’m not advocating for a life without consequences. I’m not saying, “my kid is being a big jerk, but it’s really my fault. I expected my kid to be nice. Shame on me.” What I am trying to do is have healthy and realistic expectations of what my kids are capable of. Self-regulation is extremely challenging, so this is no easy undertaking. However, self-checking my expectations will let me save my frustration and disciplinary action for the times they are deserved (like when my son calls his daycare provider dumb when he is told to pick up toys). If I don’t keep my expectations in check, I am expecting more of my children than they are psychologically able to give. I’m expecting a 4-year-old to act like an 8-year-old or my son to act my like my daughter. That is irrational and a recipe for familial disaster. I will inevitably make my children feel like they are failing a lot. The only time I want my kids to feel the pain of failure and disappointment is when they do something to deserve it. It shouldn’t be a common thing. I owe to myself and my family to aspire to reasonable expectations.
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Play It Safe With Winter Sports
kiing, snowboarding, skating and sledding are great ways to have winter fun, but be sure to take steps to reduce your risk of injuries, experts say. In 2017, U.S. emergency departments, doctors’ offices and clinics treated 68,809 people for skiing-related injuries, 54,349 people for snowboard-related injuries, 52,308 people for ice skating-related injuries, and 4,499 people for toboggan-related injuries, according to the U.S. Consumer Product Safety Commission. “Overexerting yourself on the slopes can lead to injuries ending your run for the season,” said physician Lori Reed, a spokeswoman for American Academy of Orthopaedic Surgeons (AAOS). “Individuals are at an increased risk of injuries such as sprains, strains, dislocations and fractures due to exhaustion,” Reed said in an academy news release. “You can prevent these by staying in good physical condition year-round and listening to your body. Don’t push your body when you are in pain or too tired.” Here are winter sports safety tips from the AAOS:
February 2019 •
• Stay in shape and condition muscles before starting winter sports. Warm up thoroughly before an activity. Cold muscles, tendons and ligaments are at increased risk for injury. Drink plenty of water before, during and after activities. • Wear several layers of light, loose and water- and wind-resistant clothing. Layering allows you to adapt to your body’s changing temperature. Wear footwear that keeps your feet warm and dry, and has good ankle support. • Take lessons from a qualified instructor, especially in sports such as skiing and snowboarding. Learning how to fall correctly can reduce the risk of injury. Check that equipment is in good working order and wear appropriate protective gear. • Know and follow all rules of the sport. Don’t do a winter sport alone. Monitor for and heed warnings about storms and severe drops in temperature. • Seek shelter and medical attention immediately if you or anyone else develops hypothermia or frostbite. Make sure everyone knows how to get help in the event of injuries.
IN GOOD HEALTH – CNY’s Healthcare Newspaper
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Page 19
Meet the New Boss Physician Mantosh Dewan In the main lobby of Weiskotten Hall on the Upstate Medical University campus. Photo Provided.
New interim president of Upstate Medical University wants to strengthen relations with Crouse, St. Joe’s, Syracuse University and SUNY ESF By Aaron Gifford
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hen physician Mantosh Dewan was hired on as a faculty member at Upstate Medical University in 1979, psychiatry was still largely based on Freudian psychotherapy models of care where it took months or years of one-on-one sessions with a patient before significant improvements were noticed. In the decades that followed, Dewan, a psychiatrist by trade, was part of a specialty that saw staggering innovations in its field as more was learned about the human brain. With new medications, deep brain stimulation technology and developments in cognitive trauma therapy, mental health providers enjoyed rapid results in patient care. “We are talking about 12 sessions now compared to three years of treatment,” he said. During that same period, health care became a term that was not just associated with hospitals, but also with clinics, outpatient surgery centers and community partnerships. As a practitioner who treated thousands of patients during those eras of rapid change, Dewan is now leading Central New York’s only academic medical center and the region’s largest employer, with 9,460 workers. Dewan was recently appointed to the position of interim president in December, selected because of his experience, patience, professionalism, personality, integrity and leadership. He replaced pediatrician Danielle Laraque-Arena, who resigned Dec. 22. Prior to this appointment, Dewan served as the chairman and a distinguished service professor in Upstate Medical University’s psychiatry department. He also directed Upstate’s undergraduate education and Page 20
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residency programs. Dewan graduated from medical school at University of Bombay in his native India before moving to Syracuse for psychiatry training in 1975. He became a full-time employee at Upstate four years later. He was focused on a career in psychiatry at a young age. “I was interested in how people react in different circumstances,” he said, “and I liked it because it was the specialty where you get to spend the most time with a patient.” Dewan’s body of published work includes 35 books and book chapters and 75 papers. He has made presentations on topics ranging from brain imaging, to the economics of mental health care, to psychotherapy. He continues to practice psychiatry and is listed in The Best Doctors in America. He is a Distinguished Life Fellow of the American Psychiatrists Association, and also received the Scientific Achievement Award from the National Alliance for the Mentally Ill. Despite his impressive credentials and the demand for psychiatrists nationwide, Dewan never desired to move away from Central New York. He has always considered Upstate Medical University “one big family.” “We have a wonderful leadership team,” he said. One of his priorities will be to strengthen relations with Crouse Hospital, St. Joseph’s Hospital Health Center, Syracuse University and SUNY College of Environmental Science and Forestry. “We want to build on those partnerships,” he said, “and work with the community at large.” As a health care entity, Upstate under Dewan’s leadership will strive to do the best job possible every min-
IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
ute of every day and always provide top-notch care, he said. As a teaching hospital, he added, Upstate needs to continue to graduate doctors that it can always be proud of. And as a research institution that currently has more than 600 funded projects, Upstate will be challenged by its newest leader to continue as an innovator. “Our goals have always been threefold — health care, education and research,” he said. The school has 1,500 students split between the college of medicine, graduate studies, health professions and nursing programs. It also has a campus in Binghamton. There are 500 students in Upstate Medical University’s residency and fellowship trainings programs. For the past 25 years, Dewan has returned to India annually to teach at his alma matter, now called Mum-
bai University. Many of his former students continued their training at Upstate Medical University and joined the faculty. He has shared the knowledge he obtained here with his friends and students overseas, and has also borrowed some of their ideas. “In India, they can do a great deal with very little,” he said. “Those ideas can definitely be integrated here.” When he gets some free time, Dewan loves to play tennis. He and his wife have two children and two grandchildren. Their son works for a private equity bank in New York City, and their daughter is an attorney in Los Angeles. “We couldn’t talk them into a career in medicine,” he said with a laugh. “They could see that it takes so much of your time.”
Upstate Medical University Interim President Mantosh Dewan, MD, with Health Justice Conference organizers Sydney Russell Leed, left, and nurse Adaobi Ikpeze. The Health Justice Conference, held Jan. 21, addressed such issues as refugee health, the health effects of inequality and Native American health care. Leed is an MD/MPH student and Ikpeze is an MD student, both studying at Upstate’s College of Medicine. Photo provided.
Careers in Healthcare
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erhaps you’re interested in health, but a career in hands-on care isn’t for you. Or maybe you enjoy communicating and sharing information, but teaching isn’t the right fit. Consider the role of community health educator. According to the Bureau of Labor Statistics, the entry level annual salary was $45,360 or $21.81 per hour in 2017 and the employment outlook for growth between 2016 and 2026 is 16 percent, much faster than average. “It’s a growing field and there are new opportunities for students looking to peruse this career,” said Diane Oldenburg, senior public health educator with Oswego County Public Health. “Public health in general is a career where we’re seeing a lot of folks looking toward retirement and aging out.” She said that the role can also include prevention education about eating right, healthy sexual behavior, exercising and immunization through programs in county departments of health, schools, medical centers and hospitals, all of which could be places where community health educators work. They may also collect and analyze data to evaluate where the community needs additional health education. Most community health educator positions require a bachelor’s level program and certified health education specialist credentialing. Master’s level education is also available. The position is growing in part because doctors and nurses lack the time to talk with people about preventative health. Community health educators help people the message of prevention in terms they understand, along with actionable steps to make it happen. Lee Livermore, public education coordinator with Central New York Regional Poison Control Center in Syracuse, said that nonprofit public health entities or countywide health departments are typical places someone can work in health education, but “there can be many different areas, depending upon the person’s background and the size of the organization.” In some larger organizations, some degree of specialization may be required, as it may have departments
related to immunization, family planning or sexually transmitted infections; however, it may require experience as a general community health educator to get to that point. Community health educators can advance to supervising the department at a larger organization, which may mean shifting from delivering the message of health to managing the program. Livermore feels that his background in corporate training, business consulting and entrepreneurship prepared him well for public health education. He advises anyone interested in community health education, to “make sure you take complete ownership for all the diversity in your background and take all those skills with you.” He enjoys both the importance and the diversity of his work, which can include designing programs, traveling, continuing his education and public speaking. “It’s not like some jobs which can become very constricting and pigeonholed,” Livermore said. Other helpful skills for the position include written communication, organization, collaboration, compassion, and science. In addition to the required education and background, working in public health also demands good research skills, which involves in identifying reliable sources and effectively using the information found there. The information may be used for a presentation, press release, social media statement or other form of communicating with the public. Other topics tend to be seasonal, such as Lyme disease in the summertime. Jackie Shostack, public health education supervisor with Onondaga County Health Department, said that as a health crisis arises, “you have to become an expert on that. You have to be a content expert on anything.” Shostack thrives on the variety and diversity of her work, which can take her onto social media, into schools and elsewhere into the community. “It’s so interesting because you have to be able to know a lot about a lot of things,” Shostack.
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http://cir.care IN GOOD HEALTH – CNY’s Healthcare Newspaper • Page 21
Golden Years
Need a Ride? You Have Options By Deborah Jeanne Sergeant
H
alf of non-drivers who are 65 and older stay home because they lack transportation options, according to www.seniorliving.org, a website specializing in senior-related issues. This means that they may become more and more isolated, not buy fresh groceries as often as they need them and miss medical appointments. But groups in the Central New York are working to change this, especially in outlying areas without public transportation and for people who struggle to afford paying for transportation. Some older adults need rides to see multiple specialists for chronic conditions. Or they may need multiple rides to address an acute issue, such as the up to 10 rides for cataract treatment, including pre-op visits, lens fitting, surgeries and post-op care. For those with working or geographically distant family members, providing all those rides becomes challenging. Without transportation, it’s easy for older adults to become isolated. “You have a lot of people left alone,” said Dave McLoughlin, operations manager for Empire DM, which provides medical transportation in Syracuse. “The family may work so no one’s around. Our employees have interaction. Riders build a rapport with drivers.” Unlike a bus or taxi driver, Empire DM personnel ensure riders can safely make it from the threshold to the vehicle and back. Riders include those who are ambulatory, use walkers or wheelchairs. McLoughlin said the service
offers discounts for groups of seniors picked up at one location and also people who schedule regular rides for ongoing care, such as dialysis. Rates start at around $25 each way or $30 for wheelchair transportation. For some seniors, paying for rides can take a significant part of their income. Organizations like Westcott Community Center in Syracuse provide senior curb-to-curb rides to errands and appointments. Joan Royle, executive director, said seniors come to the center for a meal and socializing, as well as the opportunity to ride to the grocery store, doctor appointments, and other places. “If you’re an adult living in poverty, becoming a senior is much more difficult,” Royle said. “You face many more challenges.” She added that for many lower income seniors, services like theirs are essential for them to get out of their own homes because transportation costs too much for them. “Uber is still costly, though less than a taxi,” Royle said. “Most seniors don’t have a cell phone with the app. The cheapest means is the bus and at $2.50 a pop, is not that cheap, if you think about how limited their income truly is.” The bus also doesn’t provide curb-to-curb service. Westcott serves more than 400 seniors annually. Of those, 83 percent live in poverty. The center employs one driver and wants to take on more volunteer drivers. Last year, Wescott provided 5,726 rides to seniors who live on the west side of the city. No riders are required to pay for the
A senior getting a ride with a volunteer. Photo courtesy of Gelfand-Piper Photography. services. The same hold true for Community Of DeWitt Friends In Service Here (COD/FISH). Anyone living in DeWitt (whether senior or not) can obtain free rides to medical appointments. In addition to rides to receive medical care, riders also receive interaction with others. “It’s important for all of us,” said Jean Kimber, COD/FISH’s co-chairwoman. “Some drivers get to know clients well and clients enjoy their company.” She said that organizations like hers fill a need for people who aren’t financially or physically able to use public transportation. The organization gave 168 rides last year. “I think it makes everyone feel good that they can assist someone in a pretty personal way,” Kimber said. Laker Limo in Skaneateles offers rides on the basis of free-will donations to other places in Skaneateles and to Auburn and Syracuse for residents of the Skaneateles school district. Randy Stockweather, executive director, said that few other options can help residents in the four senior facilities in Skaneateles as well as others without transportation. “We don’t have a bus service in Skaneateles and calling a taxi is expensive,” Stockweather said. His organization offers free rides for the economically challenged, though suggested donations are $3 to $5 for those able to help. Like
Exercise After Heart Attack Reduces Risk By Deborah Jeanne Sergeant
E
xercise after recovery from a heart attack may improve longterm survival rates, according to several sources. The American Heart Association says that exercise for those who have recovered from heart attack can help them reduce their risk of a second incident shortly after the first. It may seem counter-intuitive to exercise a recovering heart; however, a Swedish study of 22,227 heart attack patients recently published by the American Heart Association indicates that exercise is helpful. Researchers asked participants about their activity level six to 10 weeks after their heart attack, and about a year later. The follow-up with these patients indicated those who said they were “constantly active” experienced a 71 percent lower risk of death in the two to four years after their heart attack compared with the inactive group. But even those with more Page 22
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moderate exercise regimens during that period experienced a 44 percent decrease risk of a second heart attack. It’s clear that any amount of exercise is beneficial to heart attack survivors, but more regular exercise offers the greatest reduction in subsequent heart attack risk. Recovery all starts with following the cardiologist’s plan. Following the recovery from a cardiac event, Oswego Health’s cardiologist Thomas Grady Jr. recommends his patients take part in a cardiac rehabilitation program. Oswego Health’s Lakeside Heart Center provides cardiac rehabilitation to community members who have recently experienced a cardiac event. “Each individual has a program tailored to meet their specific needs,” said Grady said. Patients exercise under medical supervision by specialists in heart recovery and while they wear heart
IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
monitoring equipment that can detect heart problems. Patricia Briest, nurse manager for cardiopulmonary rehabilitation at St. Joseph’s Health, said that completing cardiac rehabilitation “improves the overall quality of life for individuals recovering from heart attacks, reduces the likelihood of reoccurrence —largely due to improvement in general health habits which includes healthy diet and exercise — and in the event of a reoccurring heart attack, improves survival rates.” She added that patients are stronger and healthier if they sustain their new, healthy habits. That’s why it’s important to continue eating right and exercising after cardio rehabilitation. Providers like St. Joseph’s and Oswego Health also offer education on supporting heart health to help ensure patients continue their healthy lifestyle. Physician Az Tahir said that
Westcott, Laker Limo receives state funding for the program, which provides curb-to-curb service to medical appointments and other errands. “There’s a social aspect to what we do,” Stockweather said. “We have a driver and escort, who helps them on and off, and engages them in conversation. There’s interaction a lot of seniors don’t experience otherwise. “Since we provide transportation, we enable them to stay in their homes longer.” All of his senior transportation drivers are volunteers who usually drive one day per month. He works with their schedule to make volunteering more convenient and provides training. The volunteers drive vehicles that belong to the organization. In addition to appointments, Laker Limo provides outings to venues like Beak & Skiff Apple Orchards and Lights on the Lake. Lake Limo could also use more volunteers, as demand continues to grow. Need a Ride? For information on rides in Onondaga County, visit: www. ongov.net/aging/documents/OnondagaCountyTransportationServices.pdf. For information on rides in Oswego County, visit: www.oco.org/ transportation For information on rides in Central New York, visit: https://211cny.com/taxsearch. php?&tax=B&tax=BT
following the cardiovascular rehabilitation recommended by one’s cardiologist “is very, very safe” and that walking is also both safe and effective. Tahir practices holistic integrative medicine at High Point Wellness in Syracuse. He recommends that patients who have completed rehabilitation should ask the cardiologist about high intensity interval training (HIIT). “That has not too much stress to the heart and has been shown to benefit the heart,” Tahir said. HITT involves a burst of exercise — brisk walking, running, jumping rope, pedaling on a stationary bicycle, etc. — for 30 to 60 seconds at high intensity followed by a active rest of one to two minutes. Active rest could include slowly walking or simply reducing the rate of movement to a comfortable pace. But Tahir cautioned that exercise has to be under the physician’s guidance. “The cardio rehab should be done and gradually increased,” he said. n See related stories on page 16.
5
Unexpected Rewards of Becoming a Caregiver
By George Shannon
I
t’s true, the life of a caregiver can be demanding, difficult and daunting. I spent seven years of my life in that role, keeping an eye on my wife’s every move. Just about every night, Carol and I awoke from our slumber at least five times to make trips to the bathroom. We spent endless nights in hospitals and long days in doctor’s offices. If given the chance to do it all over again, I would. Those years of being a caregiver constitute the best seven of my life. I learned a ton about myself and my famil y, became a more fulfilled man, and had the incredible chance to fall in love with my wife all over again. While I could easily list 20 wonderful things about serving in a caregiving role, here are five very important and unexpected rewards:
1.
Golden Years
A Better Relationship
When I started being a caregiver, time slowed down. Because the role can be so demanding, you must focus on the person. In the process, you learn what makes them tick — maybe things you hadn’t noticed before. Putting these nuggets of wisdom to use can make that person so happy, which in turns makes you feel good. For Carol it was pancakes. When she needed a boost, a single pancake
could do the trick. Every once in a while, she’d be down in the dumps. The minute I saw this, we were on the way to our local breakfast joint. Carol’s smile would make my day.
2.Precious Moments
Similarly, you get to be a part of some very special moments. Before my wife’s strokes, we’d spend some time together but did our own thing most of the time. After Carol got sick, I spent 90 percent of my time with her and I got to be a part of so many meaningful moments. Her father had come to live with us for a few years during her illness. He was around 90 at the time. Every night the Pittsburgh Pirates played on TV, they stood, held hands and sang “Take Me Out to the Ball Game” every time. You could just feel the love and joy between them. I’ll never forget those moments.
3.Discovering Humility
This might be the most hidden of rewards. Before my wife became ill, I was a decent man and generally thoughtful of others, but my world had veered toward self-centeredness. I was set in my ways and had been accustomed to the order in my world. At first, out of necessity, I began taking care of her needs. Soon thereafter, I started feeling good when I did things to help her. Then some-
Sex After 65 Majority are satisfied with their sex lives; nearly one in five older men uses medications or supplements, says poll
A
new poll busts stereotypes about the sex lives of older Americans — and reveals gender and health-related divides on key aspects of sexual health, while highlighting the need for more people to talk with their health providers about sexual issues. Forty percent of people between the ages of 65 and 80 are sexually active, according to the new findings from the National Poll on Healthy Aging. Nearly three-quarters of people in this age range have a romantic partner and 54 percent of those with a partner are sexually active. Whether or not they have an active sex life, nearly two-thirds of older adults say they’re interested in sex, and more than half say sex is important to their quality of life. And when asked if they are
satisfied with their current sex life, 73 percent of the nationally representative sample of 1,002 people polled said they were. The poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and sponsored by AARP and Michigan Medicine, U-M’s academic medical center. The poll explored how older adults might seek help or advice for sexual problems, and if they’ve talked with their doctors or other health care providers about their sexual health. In all, 18 percent of older men and 3 percent of older women say they’ve taken medications or supplements to improve sexual function in the past two years. But only 17 percent of older adults said they have talked with their doctor or other
thing tremendous occurred, I began to derive sustained joy when making her life better. By the time she died, I’d committed my life to completely serving her and felt total fulfillment. Why? I had become entirely selfless. There may not be a better feeling in the world.
4.A Deeper Relationship
As I gave myself over to her, my wife started to really feel the love. And in turn, she began outwardly show her love and appreciation. A day wouldn’t go by when she would tell me that “You’re too good to me,” or “Thanks for all that you do for me.” I never sought these assurances but when she’d offer them, it would light up my day. It was then I realized that we were falling in love all over again. It was during this rekindled time that we showed our truest selves. From her, I got to see a hidden sense of humor and sharp tongue that often had me belly-laughing. For her, my wife saw a much more tender side and the softer edges of my soul.
5.A Stronger Family
Only one of my siblings and one of our three sons lived in Pittsburgh where I lived when my wife got sick. At first, I felt sort of alone in dealing with her health crisis but that didn’t last very long. The one son who lived the closest moved in health care provider about sexual health in the past two years. Most who had engaged in such discussions said they brought the topic up, suggesting the need for more proactive conversations by clinicians with their older patients. “Sexual health among older adults doesn’t get much attention but is linked closely to quality of life, health and well-being,” says U-M’s Erica Solway, Ph.D., co-associate director of the poll. “It’s important for older adults and the clinicians who care for them to talk about these issues and about how age-related changes in physical health, relationships, lifestyles and responsibilities such as caregiving, affect them.”
Gender, age and health status divides Solway notes that the poll finds some sharp differences along health, age and gender lines. For instance, compared with the 45 percent of respondents with excellent, very good, or good health who reported they were sexually active, only 22 percent of those who said they are in fair or poor health were sexually active. Only 28 percent of those with fair or poor health said they were extremely or very satisfied February 2019 •
for a year. My other two kids came by regularly and showered their mother with love. My siblings came by all the time and called when they couldn’t. I’ve lived my life abiding by the philosophy that what happens to you isn’t as important as how you respond to it. My entire family responded with love, concern, help and support. Each time, their acts and deeds made Carol and I feel wonderful. I took great pride in seeing my family come together. Don’t get me wrong, it wasn’t always easy. Yet, at the end of each day of caregiving, I always received a small gift — a sense of fulfillment. And now, when I look back at those seven years, I am reminded that my life had purpose which is the greatest reward of them all. George Shannon chronicles his experience caring for Carol in his new book, “The Best Seven Years of My Life: The Story of an Unlikely Caregiver” (December 2018), which he wrote with his son, Chad Patrick Shannon. For more information, visit https:// bestsevenyears.com. with their sex lives. There are also differences within age groups. Those between the ages of 65 and 70 were nearly twice as likely as those in their late 70s to be sexually active. One-third of those in their late 60s said they were extremely or very interested in sex, compared with 19 percent of those in their late 70s. The gender gaps that emerged reveal some differences that may create challenges for relationships. For instance, women were less likely than men to be sexually active — 31 percent overall, compared with 51 percent of men — but were more likely to be extremely or very satisfied with their sex lives. And while 84 percent of older men said sex was an important part of a romantic relationship, 69 percent of older women agreed with that statement. But the biggest gender difference was the percentage of those who said they were extremely or very interested in sex. Half of men aged 65 to 80 said they had this level of interest, compared with just 12 percent of women in the same age range. A key takeaway from the poll, Solway notes, is that there appears to be opportunity for more proactive conversations between providers and their older patients about sexual health.
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Son’s ‘Heart-To-Heart’ Talk Helps Mom Decide To Quit Smoking For Good Syracuse resident Michelle R. wants to be an inspiration to those looking to quit smoking
A
common resolution tops many tobacco-users’ to-do lists during the holiday season: making 2019 the year they finally quit for good. Smoking is an addiction and difficult to overcome, but thousands achieve a smoke-free life each year with support and medication from their healthcare providers and the New York State Smokers’ Quitline. One Central New Yorker knows this very well, as Michelle R. of Syracuse gained freedom from nicotine this past August. Michelle R., now 45, said she began smoking at age 18 because her parents smoked. Unlike many smokers, Michelle R. was fortunate to be able to quit on her first attempt during the summer. Support and medication from the New York State Smokers’ Quitline played a major role in her success, and a heart-toheart conversation with her son was
the final impetus to become smokefree. “My son is getting married in October of 2020 and told me he wants to be a father soon after. He said, ‘Mom, I want you to be there for my kids to have a grandmother.’ I want to be around, too,” said Michelle R.. “Besides the New York State Smokers’ Quitline, my son was my No. 1 supporter. He lives in St. Louis but called me every day to check in during the beginning of my quit process. He reminded me to overcome my three triggers for smoking: driving in the car, talking on the phone and having my morning cup of coffee.” In addition to receiving free nicotine replacement therapy from the New York State Smokers’ Quitline, Michelle R. worked with the Quitline’s quit coaches to develop a personalized plan. “They were compassionate, respectful and genuinely wanted to get to know me and my
lifestyle,” she said. “Every smoker who’s trying to quit needs a friend for support along the way. I think the Quitline offers an extra place for someone to confide in.” Michelle R. is amazed at her vastly improved sense of smell and taste. Her high cholesterol numbers have come down, she no longer wheezes at night and she no longer wakes up coughing. With the new-found ability to breathe deeply, Michelle now turns to increased exercise and dog-walking to replace the time she would have “wasted” smoking cigarettes. “Smoking continues to be the leading cause of preventable death in the world, but many free resources are available in New York State to help smokers quit,” said Chris Owens, director for the Central New York Regional Center for Tobacco Health Systems, based at St. Joseph’s Health in Syracuse. “By combining coaching and medication, the odds
for quitting successfully increase threefold. Healthcare providers play a major role in getting the process started, between prescribing the right medications and making referrals to the New York State Smokers’ Quitline for added support. Health plans, especially Medicaid, often cover extra nicotine replacement therapy and local cessation classes. Quitting smoking is the best thing you can do for your health, so use all the benefits available to make it happen.” For more information, call the New York State Smokers’ Quitline at 1-866-NY-QUITS (1-866-697-8487). Additional resources are available online at www.nysmokefree.com.
A Snip in Time: Vasectomy Men generally resume intercourse within two weeks with more than half of men reporting an increase in frequency By J C Trussell, M.D.
T
he vasectomy is a popular and very effective form of permanent birth control. When compared to a tubal ligation, a vasectomy is simpler, faster, less expensive, safer and can be done under local anesthesia, with much less time off work. In fact, it is reasonable to return to non-physical work one day after the procedure. It is important to meet your surgeon pre-operatively to discuss your health, surgical risk and expectations. You should expect the vasectomy to result in a permanent form of birth control. Having said that, the vasectomy can fail — with an unintended pregnancy occurring in one of 2000 procedures.
A vasectomy does not produce immediate sterility. To minimize the risk of failure, birth control measures must continue until a post-procedure semen analysis shows no sperm — the first check typically occurring after two months. Secondly, to ensure proper healing of the vas tube, patients should refrain from ejaculation for one week post-operatively. During the pre-op doctor visit, be sure to tell your doctor about any bleeding disorders or use of anti-coagulants (including aspirin). A physical examination will ensure there is no concurrent testis pathology (such as a tumors), hernias or sensitivity/ difficulty palpating the vas deferens — whereby general anesthesia is preferred.
Although older literature may raise some post-vasectomy health concerns, large, well-performed, contemporary studies have shown no increased risk for: prostate cancer, heart disease, stroke, hypertension, dementia, testis cancer or lipid disorders. In contrast to other surgeons who use two openings, I perform a delicate vasectomy using a single, midline scrotal opening no wider than a pea. After the procedure, which usually takes less than 15 minutes, the opening is closed with absorbable sutures, which do not need to be removed as they dissolve on their own. Men generally resume intercourse within two weeks with
J C Trussell is a urologist practicing at SUNY Upstate. more than half of men reporting an increase in frequency and/or improvement in sexual satisfaction, according to studies. Overall, 80-100 percent of vasectomized men would recommend the procedure to others, according to researchers.
Amy Lazzarini, MD, MSHS
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Page 24
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
By Jim Miller
What You Should Know About Your Aging Parents’ Finances Dear Savvy Senior, My siblings and I don’t know much about our elderly parents’ financial situation or their wishes if something happens to them. When mom broke her hip last year, it got me thinking we need to be better prepared. What’s the best way to handle this, and what all should we know?
Tentative Daughter Dear Tentative,
Many adult children don’t know much about their elderly parents’ financial situation or end-of-life plans, but they need to. Getting up to speed on their finances, insurance policies, long-term care plans and other information is important because some day you might have to help them handle their financial affairs or care, or execute their estate plan after they die. Without this information, your job becomes much more difficult. Here are some tips that can help. Have the Conversation If you’re uncomfortable talking to your parents about this topic, use this column as a prompt or start by talking about your own finances or estate plan as a way to ease into it. Also see TheConversationProject. org, which offers free kits that can help you kick-start these discussions. It’s also a good idea to get your siblings involved too. This can help you head off possible hard feelings, plus, with others involved, your parents will know everyone is concerned. When you talk with your parents, you’ll need to collect some information, find out where they keep key documents and how they want certain things handled when they die or if they become incapacitated. Here’s a checklist of areas to focus on. Personal & Health Information • Contacts: Make a list of names and phone numbers of their doctors, lawyer, accountant, broker, tax preparer, insurance agent, etc. • Medical information: Make a copy of their medical history (any drug allergies, past surgeries, etc.) and a list of medications they take. • Personal documents: Find out where they keep their Social Security card, marriage license, military discharge papers, etc. • Secured places: Make a list of places they keep under lock and key or protected by password, such as online accounts, safe deposit boxes, safe combination, security alarms,
etc.
• Pets: If they have a pet, what are their instructions for the animal’s care? • End of life: What are their wishes for organ or body donation, and their funeral instructions? If they’ve made pre-arrangements with a funeral home, get a copy of the agreement. Legal Documents Will: Do they have an updated will or trust, and where is it located? Power of attorney: Do they have a power of attorney document that names someone to handle their financial matters if they become incapacitated? Advance directives: Do they have a living will and a medical power of attorney that spells out their wishes regarding their end-of-life medical treatment? If they don’t have these documents prepared, now’s the time to make them. Financial Records • Debts and liabilities: Make a list of any loans, leases or debt they have — mortgages owed, car loans, medical bills, credit card debts. Also, make a list of all their credit and charge cards, including the card numbers and contact information. • Financial accounts: Make a list of the banks and brokerage accounts they use (checking, savings, stocks, bonds, mutual funds, IRAs, etc.) and their contact information. • Company benefits: Make a list of any retirement plans, pensions or benefits from their former employers including the contact information of the benefits administrator. • Insurance: Make a list of the insurance policies they have (life, long-term care, home, auto, Medicare, etc.) including the policy numbers, agents and phone numbers. • Property: Make a list of the real estate, vehicles or other properties they own, rent or lease and where they keep the deeds, titles and loan or lease agreements. • Taxes: Find out where they keep copies of past year’s tax returns. For more tips, see the Eldercare Locator publication “Let’s Talk: Starting the Conversation about Health, Legal, Financial and Endof-Life Issues” at N4A.org/files/ Conversations.pdf. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.
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February 2019 •
IN GOOD HEALTH – CNY’s Healthcare Newspaper
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Page 25
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
I
f you are not self-employed, Social Security taxes are typically taken out of your paycheck automatically. You and your employer each pay a 6.2 percent Social Security tax on up to $132,900 of your earnings and a 1.45 percent Medicare tax on all earnings in 2019. You don’t have to do anything extra for the coverage you will one day receive because your employers handle the deduction as well as matching that contribution. Then they send the taxes to the Internal Revenue Service (IRS) and report your wages to Social Security. If you’re self-employed, the process is a little different. You report your earnings for Social Security and pay your taxes directly to the IRS when you file your federal income tax return. You pay the combined employee and employer amount, which is a 12.4 percent Social Security tax on up to $132,900 of your net earnings and a 2.9 percent Medicare
Q&A Q: I worked for the last 10 years and I now have my 40 credits. Does this mean that I get the maximum Social Security retirement benefit? A: Probably not. The 40 credits are the minimum number you need to qualify for retirement benefits. However, we do not base your benefit amount on those credits; it’s based on your earnings over a lifetime of work. To learn more about how you earn Social Security credits and how they work, read or listen to our publication “How You Earn Credits,” available at www.socialsecurity.gov/ pubs. Q: I recently applied for a replacement Social Security card, but I might be moving before it arrives in the mail. What should I do if I move before I get it? A: Once we have verified all your documents and processed your application, it takes approximately 10 to 14 days to receive your replacement Social Security card. If you move after applying for your new card, notify the post office of your change of address and the post office will forward your card to your new address. If you do not receive your card, please contact your local Social Security office. To get a replacement, you will have to resubmit your evidence of identity and U.S. citizenship, or your lawful immigration status and authority to work.
tax on your entire net earnings in 2019. You are considered self-employed if you operate a trade, business or profession, either by yourself or as a partner. If your net earnings are $400 or more in a year, you must report your earnings on Schedule SE, in addition to other tax forms you must file. Net earnings for Social Security are your gross earnings from your trade or business, minus your allowable business deductions and depreciation. Some income doesn’t count for Social Security and shouldn’t be included in figuring your net earnings. You must have worked and paid Social Security taxes for a certain length of time to get Social Security benefits. The amount of time you need to work depends on your date of birth, but no one needs more than 10 years of work. You can read more about self-employment and Social Security at www.socialsecurity.gov/pubs/EN05-10022.pdf.
Q: Someone stole my Social Security number, and it’s being used repeatedly. Does Social Security issue new Social Security numbers to victims of repeated identity theft? A: Identity theft is one of the fastest growing crimes in America, so you aren’t alone. If you’ve done all you can to identify and fix the problem, including contacting the Federal Trade Commission (FTC), but someone is still using your number, Social Security may assign you a new number. If you decide to apply for a new number, you’ll need to prove your identity, age, and U.S. citizenship or immigration status. You’ll also need to provide evidence you’re having ongoing problems because of the misuse of your current Social Security number. You can read more about identity theft at www.socialsecurity.gov/pubs. Q: I was speaking with my sister and she told me that she receives half of her spouse’s benefit. Why am I not eligible for benefits from my spouse? A: If your spouse is eligible for Social Security benefits, you could be eligible for one-half of their benefit at your full retirement age. However, if you worked and are eligible for Social Security benefits on your own record, your own benefit may be higher than what you could be eligible for on your spouse’s record. If you have questions regarding your eligibility for benefits, please call 1-800-772-1213 (TTY 1-800-325-0778) between 7 a.m. and 7 p.m. Monday through Friday.
H ealth News Dr. Azar joins Nephrology Associates of Syracuse,
Physician Antoine Azar has joined Nephrology Associates of Syracuse, PC as the newest partner. “Over the past two years, Dr. Azar has successfully transitioned from the hospital setting to private practice Azar nephrology care,”according to a statement issued by the practice. Azar earned his medical degree from University of Aleppo, Syria, and is board-certified in internal medicine and nephrology. He completed his nephrology fellowship at SUNY Upstate Medical University and his internal medicine residency at UIC/Advocate Christ Medical Center in Chicago. He previously worked at Crouse Hospital.
St. Joe’s gets accreditation from AHA
St. Joseph’s Health Hospital is now the eighth hospital in the nation to be awarded the American Heart Association’s Cardiovascular Center of Excellence accreditation, a comprehensive level of designation for cardiovascular care. It recognizes hospitals committed to following proven treatment guidelines incorporated into a comprehensive system of care to fully address the needs of patients with complex cardiac conditions. Hospitals accredited as cardiovascular centers of excellence must meet or exceed standards established using multidisciplinary treatment models for all types of cardiovascular patients. These standards include 24/7 cardiovascular services, comprehensive training for all staff caring for this patient population, a strong internal and external systems of care approach to deliver services and extensive community outreach to help their population recognize and participate in cardiovascular health. Cardiovascular centers of excellence accredited facilities are recognized as champions in their populations’ health. St. Joseph’s Health Hospital underwent reviews by the American Heart Association’s accreditation review team. During the reviews, cardiovascular quality improvement specialists reviewed the hospital’s policies, procedures and operations to ensure appropriate diagnosis, treatment and education protocols were in place and executed for the cardiovascular patients. The facility also had to demonstrate efforts in enhancing their community’s awareness on the importance of cardiovascular health. Key areas in which St. Joseph’s Health Hospital demonstrated excellence in early patient and community engagement, external support and scientific, evidence-based, guide-
lines-driven care during critical health events when patients needed it the most. “St. Joseph’s Health Hospital is thoroughly committed to providing our patients the highest quality cardiovascular care centered in cur-
rent scientific research,” said Leslie Paul Luke, President and CEO at St. Joseph’s Health. “The American Heart Association’s Cardiovascular Center of Excellence Accreditation has highlighted our accomplishments and recognizes of our commitment
to continually work to improve the overall multidisciplinary treatment and care for our patients.”
Continued on next page
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H ealth News St. Joseph’s recognized for orthopedics, obstetrics
St. Joseph’s Health Hospital has been named as one of best hospitals for obstetrics and one of the best hospitals for orthopedics by the Women’s Choice Award, America’s trusted referral source for the best in healthcare, according to a hospital news release. The award signifies that St.
Joseph’s Health Hospital is one of the top healthcare providers in the country based on a review of nearly 5,000 hospitals. St. Joseph’s Health is the only hospital in Onondaga County to earn these awards. This is the second year in a row that St. Joseph’s Health has received the orthopedics award, and the third year in a row that they have received the obstetrics award. The methodology for the America’s Best Hospitals is unique in that
it combines national accreditations, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results and hospital outcome scores with primary research about women’s healthcare preferences. It is the only award recognizing excellence in patient services based on robust criteria that consider patient satisfaction and clinical excellence. Additionally, each service line award has supplemen-
tary criteria that are specific to the service line. “In addition to high-level performance on a national level, St. Joseph’s Health Hospital provides the care that women value most, including easily accessible services, timely diagnosis, exceptional care and a true dedication to their community,” said Delia Passi, the founder and CEO of the Women’s Choice Award.
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The Kidney Care Center recently opened at St. Joseph’s Health in Syracucse. The center is a partnership between the hospital and Fresinius Kidney Care. Shown are Mark Murphy, vice president SJH (cutting the ribbon) and he’s joined by several dignitaries including Onondaga County Executive Ryan McMahon, Assemblyman Al Stirpe, state Sen. Bob Antonacci and Rob Simpson, president of CenterState CEO.
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
resenius Kidney Care, the dialysis division of Fresenius Medical Care North America and the nation’s leading network of dialysis facilities, has partnered with St. Joseph’s Health to open a new home therapies dialysis center in Liverpool, offering people living with kidney failure more convenient access to quality care as well as the option to dialyze at home. It was scheduled to open late in January. Many experts agree that home dialysis — either peritoneal or hemodialysis — is the best option for treating kidney failure with dialysis. Choosing at-home dialysis can mean greater scheduling flexibility, fewer food restrictions and better outcomes. Home dialysis treatment can also be done longer and more frequently, making it gentler on the body. “Home dialysis allows patients to integrate this life-sustaining treatment into their lifestyle and schedule in the most convenient way possible,” said physician Jeffrey Hymes, chief medical officer for Fresenius Kidney Care. “We be-
lieve that home dialysis should be offered to all patients, and thanks to advances in technology, awareness and support, we are making this a reality. “ Dialysis treatment for kidney failure rids the body of unwanted toxins, waste products and excess fluids by filtering the blood. When kidneys fail, they are unable to filter the blood for toxins. People living with kidney failure generally dialyze three days a week for four hours per treatment to filter their blood. “We are truly fortunate to have a health care provider like St. Joseph’s in Central New York,” said town of Clay Supervisor Damian M. Ulatowski. “Their position in the health care industry is top notch and their partnership with Fresenius Kidney Care is just one more example of how cutting edge a provider can be. The innovative approach that these two providers bring to patients alternative care demonstrates their commitment to modern medicine and we are proud to have their latest facility in the town of Clay.”
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February 2019 •
IN GOOD HEALTH – CNY’s Healthcare Newspaper
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H ealth News Excellus Selects Nonprofits to Receive Community Health Awards
E
xcellus BlueCross BlueShield Health Awards are: has chosen seven organizations • Cayuga Centers, Auburn, to from among close to 30 Central provide SafeCare staff with improved New York nonprofits that submitted technology and program participants applications to receive the Commuwith such household health and safenity Health Awards it made available ty equipment as cabinet locks, safety in Upstate New York last fall. gates, furniture wall straps, window Each award recipient recently guards, electrical outlet covers and received up to $4,000 allocated by first aid kits. SafeCare is a parent the company to help fund health and training program intended to prewellness programs in the company’s vent child abuse, maltreatment and five-county Central New York region. neglect in Cayuga County. Through a competitive appli• Cayuga Community Health cation process, Excellus BlueCross Network, Auburn, for a falls prevenBlueShield’s Community Health tion and exercise program to help Awards support programs that have residents aged 65 and older develop clear goals to improve the health or core strength and improve balance. health care of a specific population. Program participants will also be Awards focus on improving offered home assessments to reduce the health status of the community, their chances of falling and provide reducing the incidence of specific connections with community rediseases, promoting health education sources or health care providers as and enhancing overall wellness. Win- needed. ning organizations are selected based • Food Bank of Central New on the proposed program’s scope of York, Syracuse, to help fund its need, goals and the number of people four-part Diabetes & You series for expected to benefit from it. low-income individuals at partner The seven nonprofit organizaagencies in Onondaga, Jefferson and tions in the Central New York region St. Lawrence counties. The educaselected to receive Excellus BlueCross tional series provides healthy foods BlueShield’s Fall 2018 Community and empowers 18.XXX_Urology_MeetTheTeam_Horiz.qxp_Layout 1 11/14/18 9:28participants AM Page 1 to man-
age their diabetes and take charge of their health. • Helio Health, Syracuse, to purchase equipment for The Recovery Center’s fitness program, which expects to enroll 48 individuals through eight, six-week sessions held throughout the year. The Recovery Center is a drop-in community center for adults who are part of the substance use or mental health disorder recovery community. • REACH CNY, Syracuse, to purchase 66 Bluetooth scales for patients and caregivers involved with the Heart Failure Transitional Care Project in Onondaga County. The scales will allow the daily weights of patients to be automatically reported to their cardiac care teams, allowing them to monitor weight changes and quickly address problems. • Rescue Mission, Syracuse, to purchase two automated external defibrillator units for the organization’s facilities in Auburn and Binghamton. Both locations serve hundreds of men, women and children who are experiencing homelessness, at risk for homelessness, or otherwise in need.
• Retired and Senior Volunteer Program, Oswego, to offer classes, updated training materials and CPR/AED training for the Osteo Bone Builders program volunteer trainers, and equipment and brochures for program participants. The educational exercise program helps participants rebuild bone density and improve balance through weight training and exercise. “The company’s Community Health Awards demonstrate a corporate commitment to supporting local organizations that share our mission as a nonprofit health plan,” said Jim Reed, regional president, Excellus BlueCross BlueShield. “These awards complement our existing grants and sponsorships with agencies that work to enhance quality of life, including health status, in upstate New York.” Throughout its more than 80 years of providing access to high-quality, affordable health care in Upstate New York, Excellus BlueCross BlueShield has supported hundreds of programs that help residents in our community live healthier and more secure lives.
MEET THE UPSTATE UROLOGY TEAM Chairman Urologic oncology; robotic and laparoscopic surgery of prostate, kidney, bladder and adrenal
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JOSEPH JACOB, MD
OLEG SHAPIRO, MD
RYAN SIDEBOTTOM, DO
DMITRIY NIKOLAVSKY, MD
NICK LIU, MD
Pediatric urology, treatment of hernias and hydroceles, robotic surgery, urinary tract infections, penile abnormalities
JONATHAN RIDDELL, MD
Female and reconstructive urology, urinary incontinence in women, pelvic floor treatment and neurourology
General urology
IMAD NSOULI, MD
Urologic oncology; robotic and laparoscopic surgery of prostate, kidney, bladder and adrenal
General urology, male health, urologic oncology, enlarged prostate, kidney stones , and robotic surgery
MAHMOUD CHEHAB, MD
Incontinence, urethral stricture disease, vesicovaginal fistula, reconstructive surgery, transgender care
General urology, male health, urologic oncology, enlarged prostate, kidney stones At Upstate Urology of Auburn.
Pediatric urology, treatment of hernias and hydroceles, robotic surgery, urinary tract infections, penile abnormalities
MATTHEW D. MASON, MD
JC TRUSSELL, MD
Urologic oncology and endourology, robotic and laparoscopic surgery of prostate, kidney, bladder and adrenal; kidney stones
NATASHA GINZBURG, MD
General Urology, Endourology and Laporoscopic Surgery
General Urology, Endourology
SERGEY KRAVCHICK, MD
EDWARD IOFFE, MD
Urologic oncology robotic and laparoscopic surgery of prostate, kidney, bladder, and adrenal
RAKESH KHANNA, MD
General urology, female and reconstructive urology
ELIZABETH FERRY, MD
General Urology; Female Urinary Incontinence
MICHAEL CASTELLO, DO
MRI fusion, male health, prostate cancer and kidney stones
TIMOTHY K. BYLER, MD
Reconstructive urology; incontinence, prosthetics, urinary fistula, neurogenic bladder, urinary diversion. Robotic surgery.
STEPHEN BLAKELY, MD
Urologic oncology; robotic and laparoscopic surgery of prostate, kidney, bladder and adrenal
RUBEN PINKHASOV, MD, MPH
UROLOGY FOR QUESTIONS OR TO MAKE A REFERRAL, CALL 315.464.1500 Page 30
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IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
For Jack it’s personal!
“She and I were one. What they did for her, they did for me.”
UPSTATE LEGACIES The appreciation is evident in Jack Gorham’s voice when he talks about the way Upstate University Hospital physicians, nurses, physician assistants and staff treated his wife Colleen throughout her 17-year journey with cancer.
Have you or your family experienced Upstate’s heart and
hope?
Jack wants to help maintain this level of care and compassion for future cancer patients. That is why he has remembered the Upstate Foundation in his will. That is his heart and hope.
Understanding firsthand how charitable gifts impact the lives of others can change the lives of those who give and those who receive. Your gifts have an immediate impact on the programs and services you care most deeply about. Thoughtful gift planning can help to minimize costs and maximize future impact of those gifts, helping to ensure your personal legacy continues long into the future. Would you like to learn more about high-impact, low-cost Legacy Gift opportunities that can help you meet your personal and philanthropic goals? For free and confidential information contact, or have your professional advisor contact, our planned giving professionals at 315-464-6490 or email HamiltoL@upstate.edu.
Impacting patient care, education, research, and community health and well-being through charitable giving.
www.UpstateFoundation.org February 2019 •
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Natural Weight Loss www.AcupunctureCenterUSA.com 7th Generation Medical Acupuncture Anti-Inflammatory Acupuncture Therapy: More than Pain Management Inflammation Builds Roots of Most Diseases, 7th Generation Medical Acupuncture Builds Host Immunity and Power Philosophy of Care: Treat the Roots of Diseases Rui Wang, MD of China, L.AC. Experienced in both Western Medicine & Traditional Chinese Medicine Experienced in both Academic & Private Practice Experienced in both Basic Science & Clinical Science Experienced in Cancer Research at Major Medical Centers in USA
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Page 32
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LIFE CHANGING MEDICINE, MOVING MEDICINE FORWARD
IN GOOD HEALTH – CNY’s Healthcare Newspaper • February 2019
