Gv igh 95 july 13 by In Good Health: Rochester's Healthcare Newspaper

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New App Brighton trainer Anne Osovski creates fitness apps for adults, children

Rochester–Genesee Valley Healthcare Newspaper

July 2013 • Issue 95

Doctors for Dollars

Some local doctors and health organizations receive money from drug companies to recommend their products raising conflict of interest issues. One doctor has received almost $1 million since 2009.

Which is Healthier?

Subway or MacDonald’s: Where are you going to ﬁnd a healthier sandwich?

Dr. Hart & Dr. Hart Father and son tackling a growing problem: hearing loss

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Grilling & Cancer Dana-Farber nutritionist offers tips to reduce cancer risk while grilling Page 13

URMC Student Bikes Across America

Mindful Awareness

Practice is becoming popular but what is it?

New Unity dentist devoted to treating the homeless

Medical Residency The first months are the most stressful for most, according to residents Page 8 July 2013 •

Second-year medical student Cara Hall is taking part in the Big Ride Across America, a seven-week, 3,300-mile bicycle ride across America to raise money and awareness for the American Lung Association and its research. Page 4

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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HELP REDUCE ER CROWDING. FOR COLD AND FLU SYMPTOMS, SEE YOUR DOCTOR. A recent study found that each year there are hundreds of thousands of emergency room visits in upstate New York that could be avoided. Minor conditions like cold and ﬂu symptoms, congestion, back pain, earaches and sports injuries are best treated by your doctor. If your doctor isn’t available, consider visiting an urgent care facility. And do your part to relieve ER crowding.

Sponsored by the Monroe County Medical Society, Finger Lakes Health Systems Agency, and Excellus BlueCross BlueShield. A nonproﬁt independent licensee of the BlueCross BlueShield Association

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

Cancer Side Effect: Higher Bankruptcy Rates Study: Cancer diagnosis puts people at greater risk for bankruptcy; situation is worse for young patients

eople diagnosed with cancer are more than two-and-a-half times more likely to declare bankruptcy than those without cancer, according to a new study from Fred Hutchinson Cancer Research Center. Researchers also found that younger cancer patients had two- to five-fold higher bankruptcy rates compared to older patients, and that overall bankruptcy filings increased as time passed following diagnosis. The study, led by corresponding author Scott Ramsey, an internist and health economist at Fred Hutch, was published in the journal Health Affairs. Ramsey and colleagues, including a chief judge for a U.S. Bankruptcy Court, undertook the research because the relationship between receiving a cancer diagnosis and bankruptcy is less well understood than the much-studied link between high medical expenses and likelihood of bankruptcy filing. “This study found strong evidence of a link between cancer diagnosis and increased risk of bankruptcy,” the authors wrote. “Although the risk of bankruptcy for cancer patients is relatively low in absolute terms, bankruptcy represents an extreme manifestation of what is probably a larger picture of economic hardship for cancer patients. Our study thus raises important questions about the factors underlying the relationship between cancer and financial hardship.” Among the study’s key findings: • Between 1995 and 2009 there were 197,840 people in western Washington (the population in which the study is based) who were diagnosed with cancer and met the inclusion criteria for the study. Of those, 4,408 (2.2 percent) filed for bankruptcy protection after diagnosis. Of the matched controls who were not diagnosed with cancer,

2,291 (1.1 percent) filed for bankruptcy. • Compared to cancer patients who did not file for bankruptcy, those who did were more likely to be younger, female and nonwhite. • The proportion of cancer patients who filed for bankruptcy within one year of diagnosis was 0.52 percent, compared to 0.16 percent within one year for the control group. For bankruptcy filings within five years of diagnosis, the proportion of cancer patients was about 1.7 percent, compared to 0.7 percent for the control group. • The incidence rates for bankruptcy at one year after diagnosis, per 1,000 person-years, for the cancers with the highest overall incidence rates were as follows: thyroid, 9.3; lung, 9.1; uterine, 6.8; leukemia/lymphoma, 6.2; colorectal, 5.9; melanoma, 5.7; breast, 5.7; and prostate. 3.7. The incidence rate for all cancers combined was 6.1. The high bankruptcy incidence rate for those with thyroid cancer may be because thyroid cancer affects younger women more often than other cancers do according to the researchers. “Compared to men, younger women are more likely to live in single-income households and to have lower wages and lower rates of employment, and therefore less access to high-quality health insurance — leaving them more financially vulnerable,” the authors wrote.

Hospitals Profit When Patients Develop Bloodstream Infections

ohns Hopkins researchers report that hospitals may be reaping enormous income for patients whose hospital stays are complicated by preventable bloodstream infections contracted in their intensive care units. In a small, new study, reported online in the American Journal of Medical Quality, the researchers found that an ICU patient who develops an avoidable central line-associated bloodstream infection (CLABSI) costs nearly three times more to care for than a similar infection-free patient. Moreover, hospitals earn nearly nine times more for treating infected patients, who spend an average of 24 days in the hospital. The researchers also found that

private insurers, rather than Medicare and Medicaid, pay the most for patient stays complicated by CLABSIs — roughly $400,000 per hospital stay — suggesting that private insurers would gain the most financial benefit from working with hospitals to reduce infection rates. “We have known that hospitals often profit from complications, even ones of their own making,” says physician Peter J. Pronovost, senior vice president for patient safety for Johns Hopkins Medicine and one of the authors of the research. “What we did not know was by how much, and that private insurers are largely footing the bill.” July 2013 •

The distribution of In Good Health — Rochester-Genesee Valley’s Healthcare Newspaper has recently been audited by the Circulation Veriﬁcation Council.

Here are some of the results

100,000 Readers � Reliable Circulation. Nearly 100% of copies are picked up by readers vs. the national average of 75%.

� Readership. Each issue is read by 3.05 people vs. the national average of 1.8.

� High Retention. Nearly 50 percent of readers keep an issue of In Good Health for a month or more.

� Positive Results. The average for positive ad results in our publication is 51%. The national average for positive ad results is 74%, largely due to manufacturer’s coupons

� Ideal Readership. Over half of In Good Health readers are female. Over half of readers lives in households with incomes of over $75,000.

Health In Good

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Rochester-Genesee Valley Healthcare Newspaper

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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ummer is a good time to take stock of your personal financial situation. Are you finding it difficult to keep up with paying your bills, tracking income and expenses, or finding that form you need to fill out in the piles of paper on your desk? Perhaps you’d like a referral to a long-term care insurance agent or a new financial advisor. Maybe you have a son or daughter who just graduated from college, is starting a new job, and needs help setting up a spending plan. A Daily Money Manager (DMM) can help with all of these activities. DMM’s look at your entire personal financial picture and can refer you to other professionals when needed. Some DMM’s are certified in this field and are known as Professional Daily Money Managers (PDMM’s). All DMM’s adhere to high ethical standards and commit to providing the best possible service to their clients. For more information, please visit www.aadmm.com or call Jacquelyn M. Bell CPA, PLLC, at (585) 229-4477. Page 4

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intensive programs that will offer participants the chance to treat and cure stuttering. The intensive programs are threeweeks in duration and run Monday through Friday. Participants spend six-hours daily with experts and other people suffering from stuttering. At the end of each day, attendees return to their homes to complete assign-

ments with their families and friends. Each adolescent and adult attendee receives a manual, created by Susan M. Cochrane, owner and operator of Freedom to Speak, with the input from various experts. The program typically totals more than 90 hours of treatment. In addition to treatment, an initial evaluation is completed as well as a final summary and recommendations for future work. One month of therapy continues over Skype or in-person if so desired. The programs will take places July 8 through July 26 in Honeoye Lake in the Finger Lakes region; and from July 29 through Aug. 16 in Naples, Fla. Up to eight people will be accepted in each group For more information, call 585-3290616 or visit www.stuttertherapy.com.

URMC Student Bikes Across America To Benefit Lung Association By Maggie Fiala

econd-year medical student Cara Hall is spending her last free summer before medical rotations by taking the ride of a lifetime. Hall, a student at the University of Rochester’s School of Medicine and Dentistry, is taking part in the Big Ride Across America, a seven-week, 3,300 mile bicycle ride across America to raise money and awareness for the American Lung Association and its research. “I knew I wanted to spend my last free summer before studying for the boards doing something somewhat research related, but also doing something more for myself. I have never done an endurance challenge like this, and I knew I wanted to be outside a lot during summer,” Hall said. Hall, 23, first learned about the ride from a fellow U of R medical student, Benjamin Coconougher, who had participated in the ride in 2012. On that trip, he began a research project that studied the development of asthmalike symptoms in fellow cyclists. Hall will be continuing this research by periodically measuring riders’ lung function with spirometry during the course of the ride. Spirometry is a common test of lung function used by physicians in which test subjects breathe into a device called a spirometer. The test is used to assess conditions such as asthma and chronic obstructive pulmonary disease, or COPD. It’s a mission close to Hall. The West Hall Seneca native is riding in honor of her mother’s fiance’s father, Jim Nosbisch, who passed away from lung cancer in 2011. Jim and Hall only met once but she was struck by his kindness. “The thing that struck me is that I have only met him once and he would always send me letters, and his wife continues to send me articles about anything remotely related to medicine or biking. We are a very close knit

family,” she said. Hall battled with childhood asthma and can recall many nights when her mom stayed up with her while she was using her nebulizer, so that she could breathe well enough to sleep. “I never would have thought that I would go from those nights spent wheezing and coughing to now kicking asthma in the butt and riding cross country, breathing in the fresh air of 12 states,” Hall wrote on her blog page, action. lung.org/goto/ CaraHall The bikers started the journey in Seattle, Cara Hall poses after ﬁnishing the Rochester Tour de Cure, Wash., on June 17, and will arrive a fundraising cycling event to beneﬁt the American Diabetes in Washington Association. D.C. on Aug. 3. p.m., riding an average of 83 miles a Hall was most looking forward to the day, six days a week. They camp most first leg of the trip, which spans over nights with a few nights in college two weeks in the Northern Rockies. dorm rooms. Hall, who received her undergraduate Hall, an indoor spin instructor, degree in neuroscience from Pomona started spinning more than four years College in California, fell in the love ago, but recently started outdoor road with the West Coast and has been biking this year. missing it ever since. “They are both challenging in “It will be the most scenic and different ways. Outdoor [biking] offers challenging, and once we finish that its perks in that you can see where you leg, it will be all downhill from there,” are going and experience nature, but at she said. Each day, the group starts the same time there is a whole added biking at sunrise and ends around 4 element of wind and hills that you can’t simulate in the spin room,” Hall said. She sees the ride as an opportunity to accomplish several goals, while To support Cara Hall in the Big Ride helping to raise money and having fun. Across America, visit her personal “I’m excited to be on my bike and webpage at action.lung.org/goto/ just be riding for this cause,” she said. CaraHall.

Supporting Cara Hall

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

Prediabetes: Do You Have It? How Do You Know? One in every four Americans over the age of 20 are walking around with prediabetes

iabetes is one of the most misunderstood medical conditions. “It’s not just about sugar. It’s about your heart,” says Nancy Ryan, a registered dietitian, board-certified in advanced diabetes management at Greenwich Hospital in Greenwich, Conn. Diabetes is the result of the body’s inability to properly use or make the hormone insulin, which is needed to convert sugar and starch from food into energy. Complications occur when sugar accumulates in the blood instead of going into the cells. This is referred to as high blood sugar or a high glucose level, and it can trigger higher than normal cholesterol and blood pressure, leading to increased risk of heart attack, stroke and vascular disease in the legs. According to statistics from the National Institutes of Health and Centers for Disease Control, about 79 million adult Americans (one in every four over the age of 20; and one of every two Americans over age 65) are walking around with prediabetes. This means they have blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as diabetes. Although prediabetes has no symptoms it is not benign, says Ryan. People with prediabetes have an increased risk for heart attack, stroke and neuropathy, which creates tingling sensations or numbing caused by changes in nerve function. Ryan adds, ‘If ignored, about half of all people

with prediabetes will go on to develop diabetes that can lead to kidney failure, blindness and serious blood circulation problems.” One factor is genetics; another is where you store your body fat. People with belly fat are at higher risk than those who store fat in their hips and thighs. Fat that surrounds the body’s vital organs presents a greater danger to good health and can cause insulin resistance, rising blood glucose levels, high blood pressure and abnormal blood fats such as high LDL cholesterol, low HDL cholesterol, and high triglycerides. Prediabetes is often diagnosed through blood tests associated with a routine physical exam. “It’s a wakeup call. The condition can often be reversed through diet and exercise. Changing direction can have a profound positive impact on your life,” says Ryan, adding, “The key is to eat well, maintain a good weight, and move, move, move. It’s as simple as keeping a food diary. Write down everything you eat and drink, as well as your physical activity, which should add up to a minimum of 150 minutes every week.” “If you have prediabetes, losing as little as five to seven percent of your body weight, or about 10 pounds for most people, can reduce your risk of developing type 2 diabetes by 58 percent,” says Ryan. “Most people can do that. Whether you have prediabetes or type 2 diabetes, a 10-pound weight loss usually makes you feel better and your clothes fit better. Your blood work reflects your success.”

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Nearly 5 Million Asthmatics Worldwide Could Beneﬁt From Antifungal Therapy

n estimated 4,837,000 asthmatics with allergic bronchopulmonary aspergillosis (ABPA) could benefit substantially from antifungal treatment, say researchers from the University of Toronto and Manchester University. Their work, published in May in the journal Medical Mycology, has also re-estimated the total number of asthmatics worldwide — to reveal a staggering 193 million sufferers. Twentyfour million asthma sufferers live in the

United States, 20 million each in India and China, and seven million in the United Kingdom. Clinical studies have shown that oral antifungal drugs significantly improve symptoms and asthma control in asthmatics with ABPA. This is the first time that a global estimate of ABPA numbers has been made. To view the paper titled, Global Burden of Asthma in Adults and ABPA, visit www.ncbi.nlm.nih.gov/ pubmed/23210682.

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In Good Health is published 12 times a year by Local News, Inc. © 2013 by Local News, Inc. All rights reserved. 106 Cobblestone Court Dr., Suite 121 – P.O. Box 525, Victor NY 14564. • Phone: 585-421-8109 • Email: Editor@GVhealthnews.com Editor & Publisher: Wagner Dotto Associate Editor: Lou Sorendo Writers and Contributing Writers: Jim Miller, Deborah J. Sergeant, Gwenn Voelckers, Anne Palumbo, Ernst Lamothe Jr., Maggie Fiala, Jason Schultz Advertising: Jennifer Wise, Donna Kimbrell Layout & Design: Chris Crocker Ofﬁcer Manager: Laura Beckwith No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

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Excellus BCBS Members Benefit from High Portion of Premiums Spent on Medical Care Out of $4.1 billion in premium revenues collected, the health plan paid out $3.8 billion in medical benefits for its customers

xcellus BlueCross BlueShield exceeded federal and state standards by $330 million in the amount it spent on medical benefits on behalf of its membership in 2012, officials reported recently. To cap profits and administrative costs of health plans in order to maximize medical benefits to consumers, the federal Patient Protection and Affordable Care Act and state regulations set certain medical benefit spending levels for insurers. For the second consecutive year of the new rules and reporting, Excellus BlueCross BlueShield exceeded the standards. “Our mission is to provide competitive, affordable access to quality health care,” said Christopher Booth, chief executive officer for the health plan. “What this means is that our members collectively got more hospital and physician services, prescriptions and other medical benefits throughout the year than what federal and state government standards require.” Some health insurers that didn’t meet the standards will be required to pay refunds. State and federal standards, as they apply to New York commercial insurance customers, set the minimum level of benefits to be 82 percent of premium revenues in the individual direct pay market along with small groups and 85 percent for large groups. Excellus BCBS reports that it spent 94.9 percent of premium revenues on medical benefits for its individual direct pay membership, 92.5 percent for small groups and 92.1 percent for large groups. Out of $4.1 billion in premium revenues collected, the health plan paid out $3.8 billion in medical benefits for its customers, about $330 million more than federal and state mandates require. Last year, federal officials reported that hundreds of millions of dollars in refunds were paid by other health plans throughout the country, even in states where the minimum standards are lower than those in New York. Page 6

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Meet

Your Doctor

By Lou Sorendo

Dr. Chaya Carl New dentist at Unity devoted to working with the homeless population in Rochester Q.: Why did you choose dentistry as a profession and what motivated you to work for Unity Health System’s mobile medical unit? A.: From the time I was little, I always wanted to go into something that was health related. My father was a physician, and I enjoyed biology. As I approached college age, I started to intern at dental offices and found that I liked it. The reason I joined Unity and its mobile medical unit is that I had done a job last year with a similar population of people. I felt it was more than just performing dentistry. I was helping people who really need it. When I moved to Rochester recently, I was looking for a job such as that. We see homeless people who are missing teeth and having pain, so there is more of a medical perspective to it. These are people who need it very much because they are underserved in general. Q.: How many homeless people do you see per day? Do you seek them out for treatment or vice versa? A.: We see anywhere from five to 15. It depends on the shelters that we are at and how much need there is. We also have a lengthy intake process that other dental offices don’t have because of government funding. We need to know a lot about their social and financial history and things of that sort. It’s not just one of two papers, but rather a whole packet of materials. We work off a mobile unit and we drive according to a schedule given out every month. We give schedules to different shelters so they know when we are going to be there. They compile a list of whoever needs treatment within their particular location so patients can be ready for a certain day. Some patients require continuous treatment, whether it involves denture work, more fillings and additional cleaning. We will tell them to come meet us the following week at a different shelter. We only go to particular shelters twice a month because there are so many in need.

they haven’t seen a dentist in a long time or because of lack of finances. Some of them also have a history of doing drugs at some point and show the effects of that. Others are on the street and have not sought shelter and are unable to access healthy food. In general, it’s poor. However, we do get people who just need cleaning. But for the most part, they need a lot of work. We do see people who need their teeth pulled because they are to that level where there is not much more we can do with them. We do a lot of denture work, tend of cavities and also see severe cases of periodontal disease that requires in-depth cleaning. Sometimes it is so bad we need to take all their teeth out and give them dentures. Q.: Does administering dental health also uncover other physical problems homeless people are suffering from? A.: Definitely. During our intakes, we take patients’ blood pressure. I would say on average, we send a per-

Q.: How would you rate their overall dental health? What are some of the more common maladies they present? A.: In general, it’s poor. It’s mostly because

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

son to the hospital by ambulance once a month because their blood pressure is so high they can have a stroke or heart attack at any minute. Q.: If homeless patients require oral surgery to correct problems, how does that happen without health coverage? A.: Our mission is to treat all patients regardless of whether they have insurance or not. We will refer them if something more complicated arises, such as major jaw surgery or cancer biopsies, things of that sort that we find orally. Q.: What are the foremost challenges involved in administering dental health to the homeless? A.: It can be frustrating when patients don’t come back for treatment when they definitely need it. If it’s not bothering them, they don’t come back. When it bothers them, it’s already too late. However, there are definitely a lot of motivated patients who don’t want their teeth to get worse or want to get dentures. They are motivated in that sense and we continue to see them. For a lot of people, their teeth might not be bothering them or they have a fear of the dentist and might not want to continue with the needed treatment. Q.: What is the most gratifying aspect of your job? A.: I feel like I am really able to help people who need it. These are people who have a lot of problems dentally. When you pull out a tooth that really hurts them and they are feeling better after, they thank you and that means a lot. I see that on a routine basis. Q.: What skills sets do you feel are necessary to be an effective and excellent dentist? A.: I think it actually doesn’t have much to do with the dentistry you perform. It has to do with how much compassion and social skills you have toward patients. You have to be understanding when performing dentistry, understanding the patient’s needs and what they are feeling at the time. In addition, no one likes going to the dentist, especially knowing that at some point something is going to hurt. However, a big component of it is administering that shot without them feeling it and making procedures as least painful as possible.

Lifelines: Birth date: November 1983 Birthplace: New York City Current resident: Rochester Education: Doctor of Dental Surgery from New York University College of Dentistry (2010); residency, New York Hospital of Queens Afﬁliations: American Dental Association; New York Dental Association Personal: Married with two children Hobbies: Taking care of her children and doing fun things with them; cooking; swimming

Strong Memorial Hospital’s facade.

STRONG PERFORMANCE

Strong and Highland fare better than other local hospitals in new survey and get rewarded with more money from Medicare By Ernst Lamothe Jr.

he new Medicare reimbursement system can be summed up in one word: accountability. The federal government is launching several new initiatives to make sure hospitals provide more quality service and earn their public money instead of simply being given the funds with few strings attached. They also want to reduce the flow of patients being readmitted to the hospital soon after their original visit. One in five elderly people return back to the hospital within 30 days costing $26 billion annually, according to the U.S. Department of Health and Human Services. And federal officials say two-thirds of that figure would be slashed if patients received proper treatment in the first place. “Health care reform is all about making health care work better for patients and families,” said physician Brad Berk, University of Rochester Medical Center CEO. Medicare began reducing payments in October to hospitals because too many patients were readmitted within a month. In all, $964 million was reduced in Medicare payment to hospitals nationwide, according to analysis of records released by the Centers for Medicare & Medicaid Services. Local hospitals that saw reductions include Unity of Rochester, Rochester General Hospital, Lakeside Healthcare in Brockport and F.F. Thompson Hospital in Canandaigua. On the other side, Strong and Highland hospitals fared well and were the only two hospitals in the

Rochester region that received more money back because of their dependable services. The Centers for Medicare & Medicaid Services tracks hospitals on three conditions; heart failure, heart attack and pneumonia. Any time a patient with one of these conditions is readmitted to any hospital within 30 days of being discharged, the original hospital is at fault. The government withholds 1 percent of each hospital’s Medicare revenues into a pool. A patient satisfaction survey — along with other quality measures — determines how much each hospital can earn back or lose. The hospital surveys consist of 27 questions about nurse and doctor communication with patients, hospital staff responsiveness, pain management along with the cleanliness and quietness of the hospital. The survey polled adult patients who had been discharged between 48 hours to six weeks after their hospital visits. Hospitals were judged on their timely and effective care, which accounted for 70 percent of the score. That included percentage of heart attack patients given medication to avert blood clots within the 30 minutes of arrival, whether patients received antibiotics when necessary and the quality of information given to patients when they were discharged. The measures also judged the patients experience and whether doctors and nurses communicated with them effectively, which accounted for 30 percent of the score. Hospitals could

1,427 Hospitals Across the Country See Reimbursement Reduced In all, Medicare is reducing payments to 1,427 hospitals, according to the Centers for Medicare & Medicaid Services. The maximum amount any hospital could lose was 1 percent of its regular Medicare payments. To view every hospital’s bonuses and penalties when related to Medicare go on www. kaiserhealthnews.org/Stories/2012/ December/21/value-based-purchasing-chart.aspx lose or gain up to 1 percent of their regular Medicare reimbursement in the first year. Some of the survey aspects can be viewed as slightly flawed because the majority of questions ask if the patient was “always” happy with a certain service instead of asking more nuanced questions. But many appreciate the survey. “We think that tying how much hospitals get paid to how well we deliver quality care and satisfy patients makes good sense, and it’s completely consistent with our emphasis on patient and family-centered care.” said Berk.

July 2013 •

Local Hospitals

Strong Memorial Hospital, which

is under the University of Rochester Medical Center umbrella, fared well in the survey and the Medicare readmission evaluations. In total Strong received $212 million from Medicare in the fiscal year ending June 2012, $6 million more than the previous fiscal year. The increase was due to many factors, including Strong Memorial’s solid readmission patient surveys. About $120 million in any year comes directly from the Centers for Medicare & Medicaid Services, a figure that is at risk every year if hospitals don’t meet readmission goals. The pressure for hospitals to improve their quality will increase, and by October 2014, up to 3 percent of that figure or $3.6 million will be at risk as part of the Patient Protection and Affordable Care Act. Strong and Highland hospitals received high marks in the patient survey for effective heart attack care. Upon discharge, heart attack patients should be given aspirin and a possibly a prescription for statins, which are a class of medicines that are frequently used to lower blood cholesterol levels. That was done to near perfection by both hospitals. In addition, Strong and Highland scored almost 100 percent in always giving heart failure patients instructions during discharge. When it came to timely surgical care, both hospitals scored 98 percent or higher in outpatients receiving antibiotics at the right time and making sure preventive antibiotics were stopped within 24 hours after surgery. More than 75 percent of patients said they would recommend the hospitals to others. “The survey provides a valuable tool for hospitals to measure how well we are doing in meeting patients’ needs and benchmarks that against our peers, so we welcome the survey,” said Berk. Even before the survey became a factor in how much hospitals receive, the University of Rochester Medical Center launched an intensive patient care initiative. The hospitals have addressed relaxing visitor hours and creating a quieter, more welcoming environment. Berk said studies show involving patients and families in the process reduces the chance of medical errors and makes patients feel more invested in their recovery. “I certainly know this to be true from my own personal experiences as a patient,” said Berk. “We’re not just doing this to score better grades. We know that this is the pathway to better medical care.” Rochester General Hospital also received high marks for pneumonia patients whose initial emergency room blood culture was performed prior to first hospital dose of antibiotics. More than 79 percent of the surveyed patients said doctors and nurses did a solid job communicating with them and 76 percent said they would recommend the hospital. There are several areas where the hospital can improve. Almost 40 percent reported that the staff didn’t always explain the medication they were given. And only 64 percent reported always receiving help as soon as they wanted. “Rochester General Health System always looks for opportunities to improve the patient experience by fostering a culture of safety and excellence,” said Marty Aarons, public relations officer for the health system. In 2009, RGH formed the Institute for Patient Safety and Clinical Excellence, an internal group that took the lead in developing programs and processes to improve quality and safety.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Medical Residency The first months of medical residency are the most stressful, residents say

By Jason Schultz

n 2012, approximately 25,000 firstyear residents were matched to a residency program in the United States, out of almost 40,000 applicants. The University of Rochester Medical Center at Strong hospital each year welcomes dozens of first-years, or interns, to a variety of medical disciplines. A recent visit to the hospital shed light on the duties and challenges faced by newly-minted M.D.s. One of the newest members of the Strong medical resident staff is Lauren Loss, an intern in the neurology program. Loss says a usual day for her begins around 5:45 a.m., when she signs out patients from the overnight shift interns, ensuring the care of her patients is transferred properly. Then it is off to the lab to check on her patient’s medical tests from the day before. After checking the charts and taking notes, Loss makes her rounds, spending time with up to eight patients to whom she is assigned. Around 9 a.m., Loss and the other residents in her group meet with Don Gullickson III, the attending physician overseeing their team. Along with Gullickson, the group does its rounds in the emergency room, meeting with several patients to give care and offer a teaching opportunity to residents. During rounds, one resident reviews the patient’s chart, along with any new information and changes in condition. Gullickson next asks questions of the residents to help them determine the best course of action in caring for each patient. One patient visited that morning was Margaret Murphy, who was recovering from a serious heart infection. The residents were checking up on her condition and tending to some sideeffects following her health problem. Murphy said she was feeling much better, though she complained of some swelling in her legs. “You guys are all awesome,” Murphy said. “You are all doing a fantastic

job with your care. The teamwork is amazing here. You are the reason I am back to where I am today.” This hands-on interaction is vital, Loss said, to developing interpersonal skills. “Having a good bedside manner is very important; if you have a bad rapport with patients, they won’t want to work with you in managing their healthcare issues,” she said. “People want to be proactive with their own care, as a physician you have to nurture that desire.” Hands-on training also fosters confidence for interns, said third-year resident Amy Becker, who manages her younger cohorts. Becker explains the first few months of residency are the most stressful for interns. “It takes three or four months to get your footing,” Becker says, adding that as she advanced in her residency,

Attending hysician Don Gullickson III, left, and resident Amy Becker. the article to personal work experithe workload and demands of the job ences, and discussed common probbecame more manageable. lems such as communication with the Finding confidence, Loss added, patient, family and outside healthcare was an important step in becoming an providers, proper education on posteffective resident. discharge treatment, and simple things, “The biggest challenge is learning such as ensuring a patient’s prescripto feel confident making decisions,” tion is filled out before they leave the she said. “After years of learning and hospital. reading about medicine, it is a big Marc Berliant, Strong’s chief of change when you actually start the general medicine and director of the practice of medicine and caring for resident-faculty practice at Strong, was patients.” present at this meeting to direct the Becker said interns are responsible discussion. Berliant said his role is to for providing primary care to patients oversee the education ambulatory (outand reviewing documentation on their condition. In the second and third year, patient) care to Strong’s residents, who follow a panel of patients over a period residents take on supervisory roles for of time learn to how outpatient care new interns, and manage multiple patients in the team’s care. Depending on differs from their morning rounds. “The biggest difference in inpatient their specialty, residents either continue vs. outpatient care is that in the hospiwith up to four years in a residency tal, you are treating patients with acute program or begin a fellowship. Becker conditions very briefly, with the goal said she will begin her geriatrics felof getting them out of the hospital and lowship next year. back home,” Berliant said. “With outAfter their morning rounds, patient care, the goal is on longitudinal another group of residents met with care, which requires much more folsenior physicians to address different low-up, coordination with healthcare aspects of providing care. This day’s providers and communication with the session involved reviewing an article Third-year resident Nick Paivanas speaks on the problems patients face once they patients and their families.” To foster teamwork, Berliant elicduring a review of a medical article. “That are discharged, and developing best practices at Strong to improve post-dis- ited input from nurses and pharmacists ﬁrst year is terrifying; people are calling present at the meeting to give their percharge care. you ‘doctor,’ and looking to you to know spective on improving post-discharge Residents related information from what to do,” he said. treatment. Sitting in on this discussion was Nicholas Paivanas, a third-year resident and Georgetown med school graduate. Originally from Fairfax, Va., Paivanas was drawn to Strong for its excellent cardiology program, and the opportunity to be with his wife, who is in the obstetrics and gynecology program. Paivanas said he is excited to complete his third year in the program, as he will begin the next three years of his cardiology concentration, and also assume the duties of chief resident. With three years under his belt, Paivanas was able to give perspective on how he has grown as a doctor. “That first year is terrifying; people are calling you ‘doctor,’ and looking to you to know what to do,” he said. “But by the end of that year, you start to get comfortable and gain confidence. In the second year, you start to supervise interns, and I liked that transition, because it gives you a better overview of how the hospital is run and the third year gives you time to focus on electives and branch out to private clinics Medical student residents, from left, Lauren Loss, Jaclyn Burch, Laura Mekher, Sabrina MacDuff and Amy Becker prepare for morning that focus on your specialty.” rounds at Strong Memorial Hospital

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

Though the mix of excitement and anxiety has always been a part of an intern’s initiation into life as a physician, Berliant said many things have changed since he went through Strong’s resident program himself in the late ‘70s. “The biggest change in caring for patients is that we now approach patients more holistically, in both in and outpatient care,” Berliant explained. “There is more emphasis on team-based care, and working with the patient, family and outside care providers to provide longitudinal care both during a hospital stay and after discharge.” Another change Berliant has seen over the years is the notoriously grueling work schedule for residents A typical day for Strong’s residents. usually lasts 10–12 hours, a result of the 80 hours-per-week duty restrictions instituted in 2003, though those in the ICU still work 24-hours shifts to better manage patient care. The duty-hour restrictions make life better for residents, but the number of patients they treat and the hours they gain experience are lessened, and due to the increase in hand-offs, there is very little evidence these restrictions have improved patient safety, Berliant said. That a greater emphasis be placed on teamwork, Berliant concluded, was a natural outgrowth of more patient care transfers. A strong focus on teamwork at Strong has both improved patient care and been a boon to the resident’s training. “I was very impressed with the teaching programs at Strong,” Loss said of her experience so far. “At every level of your education, you feel like you have access to expert’s opinions; it is a true privilege to have that ability.” Becker stated Strong’s residency program was her top choice after graduating from SUNY Buffalo’s medical school. “I was drawn to the tight-knit residency feel vs. the bigger cities I was applying to.” Becker added Strong’s familyoriented approach to patient care, which recognizes the importance of the patient’s relatives in managing health problems, helps build rapport and improve care once patients are discharged from the hospital. That feeling of family extends to the support system around the residents themselves, ensuring teamwork in dealing with patient care. “One worry I had when I left medical school was that I would be alone if something serious happened to one of my patients, and I wouldn’t know what to do,” Becker said. “But there has always been someone there to assist me and work as a team on a complicated medical issue.” Berliant said Strong is transitioning to a block model for residency scheduling, in which blocks of time are set aside to work on outpatient and inpatient care alternately. He said this allows for more immersion, opportunities for teamwork and more ambulatory training, which makes up 70 percent of a resident’s preparation. Berliant added that despite years of working with residents, he still gets inspired by being their passion and enthusiasm. “The exciting thing about teaching residents is that they are bright and excited about taking care of patients,” he concluded. “They have pure motives and it is refreshing to be around their energy.”

Brighton Trainer Creates Fitness App By: Maggie Fiala

oes your workout routine need a shake up? Brighton personal fitness trainer Anne Osovski has an app for that. Osovski, a certified fitness instructor and co-owner of F.I.T. Gym in East Rochester, created the mobile applications, “Workout in a Bag” and “Workout in a Bag for Kids,” to create fun and challenging workouts for adults and kids. You set your time, fitness level, and then “shake the bag” to randomly select an exercise. Moving photos and audio demonstrate each exercise. You can track your calories burned, store your favorite workout bags and link with your iTunes music library. The apps are available on iTunes for $2.99 each. “The most exciting part has been how many people I can help impact through social media and this amazing technology,” said Osovski. She came up with the concept six years ago. She wrote a hand full of exercises and tossed them in a brown paper bag. During class, she asked her clients to shake the bag and draw out the next exercise. Osovski threw in some relaxing exercises too — smile for 50 seconds or pay a compliment to someone else in the group. The response was great, she said. “I was trying to make it engaging and fun,” she said. Osovski replicated the concept for her personal clients whom she only saw a few days a week. It became a big hit at

Anne Osovski, a certified fitness instructor in East Rochester, recently created the mobile applications, “Workout in a Bag” and “Workout in a Bag for Kids,” to create fun and challenging workouts for adults and kids. the gym, Osovski said. “I thought to myself, ‘Gosh how can I package “Workout in a Bag” so other people can benefit from it?” she said. At first she wanted to create an off-theshelf product, but her husband suggested she create an app instead. “I said to him ‘I don’t even know how to do something like that’,” Osovski said. She turned to Facebook to ask for help. She connected with a high school friend, Sam Carini, who owns Net360 Technologies in Fairport, to develop her app. In 2012, she launched “Workout in a Bag” for adults and in April released the app for kids. ”I had to make it even more engaging for the kids,” she said. “Hopefully, it will be an entertaining game, so they want to keep doing it.” Osovski developed it alongside her daughters Madeline, 11, and Samantha, 7, who urged their mom to make the app more of a game; users can win gold coins when they complete a bag, unlock special badges and new workout buddies the more they exercise. Her daughters helped pick out the exercise names and drew the workout buddies. For every download in July and August, Osovski is donating 15 percent to the Rochester chapter of the Juvenile Diabetes Research Foundation. Osovski’s hopes to create more apps that target different groups, including brides and new moms. Osovski. eated by Anne She also hosts “Workout in a Bag” cr ps ap o ct tw le se of s” is one randomly id to K r g” fo challenges on her Facebook page, ba ag e B th a “shake “Workout in level, and then s www.facebook.com/WorkoutInABag. es tn fi e, tim You set your an exercise. July 2013 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

How Do You Want to Feel Six Months From Now?

n last month’s column, I talked about “silver linings” and how life-changing it can be to adopt a positive attitude, anchored in gratitude. I agree with Norman Vincent Peale who said, “Change your thoughts and you change your world.” But I know, too, that it takes more than a sunny attitude to create the life you want. It also takes action. In my “Live Alone and Thrive” workshops, I lead the group through an empowering three-step exercise that has helped many participants get “unstuck” and on the road to a happier, more contented life. The first step is to put it all out there. I ask everyone to share their worst fears, their self-doubts, and the negative inner-talk that gets in the way of their feeling better and finding contentment. It sounds like this: • I fear being so lonely • I fear I’ve lost my confidence for good • I fear no one cares and that I won’t be missed • I’ll die alone, penniless, and miserable • I’ll forever be eating alone • I fear the holidays • I feel helpless when it comes to home repairs • I may never find love again or feel special, as if I’m “Number One”

• I fear for my safety and feel vulnerable alone • I don’t have the know how to manage my finances • I fear losing all my energy and motivation • I worry that no one will be here to care for me if I get sick • I dread a “quiet house” • I may never enjoy touch and affection again, no one to kiss me goodnight • I fear making big decisions all alone • I’ll become stagnant and not take risks • I fear I’ll never feel joy again I’m always struck by the depth of the anguish. All these negative thoughts — while very real — are distressing. And depressing. This is when I remind the group that healthy change and personal growth is next to impossible when one is immersed in negative thinking. And so, we change direction. I next ask the group, “How would you like to feel six months or a year from now?” The response is heartening: • I want to feel at peace, calm, and

settled • More confident and courageous • More “me” — in touch with myself and who I really am • Able to accept my circumstances • I want to feel more forgiving — of others and of myself • Proud of my behavior and to be a role model for my children • Safe and willing to take risks, maybe travel on my own • Willing and able to help others — I will have “graduated” from self-pity • I want to feel competent, able to make decisions big and small • Happier and able to enjoy things • More in control and secure financially • Adventuresome and open to life in general • Healed and hopeful about the future • Strong enough to reach out and invite people into my life, perhaps even date • More trusting of others and in my own abilities and instincts • Joyful, light, and free • More content!

Now that’s more like it. The energy in the room has changed (for the good!) at this point, and we’re on a hopeful, more optimistic path. In the third and final step of this exercise, I ask participants to identify an action step or steps they can take that will help them realize their six-month goal. Each participant is unique and each outlines an action step specific to her particular goal or goals. Some share their next steps with the group, others choose not to. But all are committed to taking an action step that will lead toward feeling better in the future. The good news? This exercise really works. I’ve been moved and inspired by the success stories I’ve heard from participants who have embraced living alone and taken deliberate steps to improve their life circumstances and overall well-being. If what I’ve shared today resonates with you, I encourage you to give this exercise a try and see what comes of it. I’d love to hear how it goes, and hope you’ll share your experience with me at the email address below. You can also contact me at this email address for a copy of my “Next Step — Goals Worksheet” and “Goal Setting Guidelines.” Chances are, you’ve heard the expression, “Actions speak louder than words.” Well, they also speak louder than loneliness, helplessness, and hopelessness. Take some action today and I’m confident you’ll feel better six months from now. Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon. For information about her workshops or to invite Gwenn to speak, call 585-624-7887 or email gvoelckers@rochester.rr.com.

What to Consider Before Joining a Clinical Trial

ach year, hundreds of thousands of Americans participate in clinical trials in hopes of gaining access to the latest, and possibly greatest, but-not-yet-on-the-market treatments for all types of illnesses. But you need to be aware that clinical trials can vary greatly in what they’re designed to do, so be careful to choose one that can actually benefit you. Here’s what you should know along with some tips for locating one.

Clinical Trials

A clinical trial is the scientific term for a test or research study of a drug, device or medical procedure using people. These trials — sponsored by drug

companies, doctors, hospitals, federal government and private companies — are conducted to learn whether a new treatment is safe and if it works. But keep in mind that these new treatments are also unproven, so there may be risks too. Also be aware that all clinical trials have certain eligibility criteria (age, gender, health status, etc.) that you must meet in order to be accepted. And before taking part in a trial, you will be asked to sign an informed consent agreement. You can also leave a study at any time.

Things to Know

Before deciding to participate in a

trial, you need to first discuss it with your doctor. Then, schedule an appointment with the study’s medical team and ask lots of questions. Here are some to get you started. • What’s the purpose of the study and can it improve your condition? You may be surprised to know that many drug or procedural trials are not designed to find a cure or improve a patient’s health, but only to provide scientific data. • What are the risks? Some treatments can have side effects that are unpleasant, serious and even lifethreatening. • What kinds of tests and treatments does the study involve, and how often and where they are performed? • Is the experimental treatment in the study being compared with a standard treatment or a placebo? Keep in mind that if you get the placebo, you’ll be getting no treatment at all. • Who’s paying for the study? Will you have any costs, and if so, will your insurance plan or Medicare cover the rest? Sponsors of trials generally pay most of the costs, but not always. • What if something goes wrong during or after the trial and you needs extra medical care? Who pays? • If the treatment works, can you keep using it after the study?

Find a Trial

Every year, there are more than Page 10

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

See clinical research conducted in the Rochester area on pages 2 and 24 100,000 clinical trials conducted in the U.S. You can find them at conditionfocused organizations like the American Cancer Society or the Alzheimer’s Association, or by asking your doctor who may be monitoring trials in his or her specialty. Or, use the National Institutes of Heath’s website at clinicaltrials.gov. This site contains a comprehensive database of federally and privately supported clinical studies in the U.S. and abroad on a wide range of diseases and conditions, including information about each trial’s purpose, who may participate, locations, and phone numbers for more details. If, however, you don’t have Internet access or could use some help finding the right trial, use the Center for Information and Study on Clinical Research Participation (ciscrp.org). This is a nonprofit organization that will take your wife’s information over the phone and do a thorough clinical trials search for you, and mail or email you the results in a few days. Call 877-6334376 for assistance. By Jim Miller The Savvy Senior

Subway Not Much Healthier Than McDonald’s S

ubway may promote itself as the “healthy” fast food restaurant, but it might not be a much healthier alternative than McDonald’s for adolescents, according to new UCLA research. In a study published May 6 in the “Journal of Adolescent Health,” the researchers found that adolescents who purchased Subway meals consumed nearly as many calories as they did at McDonald’s. Meals from both restaurants are likely to contribute toward overeating and obesity, according to the researchers. “Every day, millions of people eat at McDonald’s and Subway, the two largest fast food chains in the world,” said physician Lenard Lesser, who led the research while a Robert Wood Johnson Foundation Clinical scholar in the department of family medicine at the David Geffen School of Medicine at UCLA. “With childhood obesity at record levels, we need to know the health impact of kids’ choices at restaurants.” The researchers recruited 97 adolescents aged 12 to 21 to purchase meals at McDonald’s and Subway restaurants at a shopping mall in Carson, Calif. The participants went to each restaurant on different weekdays between 3 p.m. and 5 p.m., and paid for the meals with their own money.

Researchers used the participants’ cash register receipts to record what each customer ate and estimated calorie counts from information on the chains’ websites. The researchers found that the participants bought meals containing an average of 1,038 calories at McDonald’s and an average of 955 calories at Subway. “We found that there was no statistically significant difference between the two restaurants, and that participants ate too many calories at both,” said Lesser, who is now a researcher at the Palo Alto Medical Foundation Research Institute. The Institute of Medicine recommends that school lunches not exceed 850 calories. An adolescent should consume an average of about 2,400 calories in a day. Among the researchers’ other findings: • The sandwiches purchased by participants contained an average of

Vs.

784 calories at Subway vs. 572 calories at McDonald’s. • Participants purchased sugary drinks averaging 61 calories at Subway, and 151 calories at McDonald’s. • Customers in the study purchased side items such as French fries and potato chips that added an average of 35 calories at Subway compared with 201 calories at McDonald’s. • Participants consumed 102 grams of carbohydrates at Subway; 128 grams at McDonald’s. • The meals contained an average of 36 grams of sugar at Subway; 54 grams at McDonald’s. • Meals contained an average of 41 grams of protein at subway; 32 grams at McDonald’s. • Sodium intake averaged 2,149

mg at Subway; 1,829 mg at McDonald’s. “The nutrient profile at Subway was slightly healthier, but the food still contained three times the amount of salt that the Institute of Medicine recommends,” Lesser said. Lesser recommends that McDonald’s customers eliminate sugary drinks and french fries from their meals. “And if you go to Subway, opt for smaller subs, and ask for less meat and double the amount of veggies,” he said.

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SmartBites

By Anne Palumbo

The skinny on healthy eating

High on Jicama’s Fiber

rue confession: I’m a big snob when it comes to tubers. I go with what I know, eschew anything that looks too gnarly, and give others the short shrift. It’s embarrassing. Looking to mend my snooty ways, I ventured out of my comfort zone last week and scoured the tuber aisle, seeking something that would add some snap to a summer salad. Jicama (pronounced HICK-a-ma) caught my attention. Popular in Mexican cuisines, jicama is a ready-to-eat tuber that looks like a turnip, tastes like a cross between an apple and a potato, and has a nice crispy bite. Another confession: I assumed jicama, because of its bland coloring, would be a nutritional no-show. How wrong I was! Jicama packs a decent nutritional punch. To begin, jicama is a fiber superstar, providing 6 grams of fiber per cup. Since we need between 25 to 30 grams a day, that’s nearly a fourth of our daily requirements. Fiber plays a key role in

make those Doritos a tad less tempting between meals). Last confession: Celery root still gives me the willies.

Helpful tips

Choose small to medium-size jicama bulbs that are firm, fairly round, and unblemished. Smaller bulbs have a crisper texture and sweeter flavor. Store jicama in a cool, dry, dark place for up to three weeks. If storing cut jicama, cover loosely with a paper towel, place it in a plastic bag, and put in fridge. It should last about two weeks. Before eating, peel off brown skin with a paring knife or vegetable peeler.

Jicama, Black Bean, and Roasted Corn Salad Adapted from Bon Appetit

keeping our body healthy by promoting regularity, ferrying cholesterol out of our system, and helping to stabilize blood sugars. Jicama is also an excellent source of vitamin C, with one cup providing a little over 40 percent of our daily needs. A powerful antioxidant with immuneboosting capabilities, vitamin C works hard to keep our bones, muscles and blood vessels in tip-top shape. Need to shed a few pounds? Jicama is a dieter’s dream food for three slimming reasons: it’s fat free; it’s low in calories (only 50 per cup); and it’s high in super-filling fiber (which should

1 ½ cups roasted corn* (recommend: Trader Joe’s frozen roasted corn) 1 can black beans, drained and rinsed 1 ½ cups jicama, peeled and cut into thin sticks ¾ cup carrots, peeled and diced 1 red bell pepper, diced 1/3 cup thinly sliced green onions 1/3 cup chopped fresh cilantro (or basil) 3 tablespoons fresh lime juice 2 tablespoons orange juice 2 teaspoons grated lime peel ½ teaspoon ground cumin 2 – 3 tablespoons olive oil salt and pepper to taste

Place corn, black beans, jicama, carrots, bell pepper, green onions and cilantro in big bowl. Gently mix. Whisk lime juice, orange juice, lime peel, cumin and olive oil in small bowl. Mix dressing into salad. Season with salt and pepper. (Can be made 4 hours ahead. Cover; chill. Let stand at room temperature 1 hour before serving.) *Grill husked corn for 10 minutes or sauté canned corn in a little olive oil with spice of choice. Anne Palumbo is a lifestyle columnist, food guru, and seasoned cook, who has perfected the art of preparing nutritious, calorie-conscious dishes. She is hungry for your questions and comments about SmartBites, so be in touch with Anne at avpalumbo@aol.com.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

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Grilling Season: Two Risk Factors to Keep in Mind

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Dana-Farber nutritionist offers tips to reduce cancer risk while grilling The arrival of summer means it’s time for picnics, parties and the kick off of outdoor grilling season. But before taking that first juicy bite, there are a few things to know about barbecuing safely. All that sizzling and flipping on the gas or charcoal grill may also be cooking up cancer-causing chemicals, warn experts at Dana-Farber Cancer Institute. And surprisingly, those chemicals have been linked to breast, stomach, prostate, and colon cancer, according to the American Institute for Cancer Research, But Stacy Kennedy, a Dana-Farber nutritionist, says that doesn’t mean giving up those tasty summer time treats like burgers, steaks, and ribs. “It’s really about planning ahead and making wise choices.” There are two risk factors to keep in mind. First, research has shown that high-heat grilling can convert proteins in red meat, pork, poultry, and fish into heterocyclic amines (HCAs). These chemicals have been linked to a number of cancers. “What happens is that the high temperature can change the shape of the protein structure in the meat so it becomes irritating in the body and is considered a carcinogenic chemical,” explains Kennedy. Another cancer-causing agent, called polycyclic aromatic hydrocarbons (PAHs), is found in the smoke. PAHs form when fat and juices from meat products drip on the heat source. As the smoke rises it can stick to the surface of the meat. “That’s where the main cancer causing compound occurs in grilling,” says Kennedy. “So you want to reduce the exposure to that smoke.” How to lower the risk? Here are some tips.

Prep the Meat

• Choose lean cuts of meat, instead of high-fat varieties such as ribs and sausage. • Trim all excess fat and remove skin. • When using marinades – thinner is better. Thicker marinades have a tendency to “char,” possibly increasing exposure to carcinogenic compounds.

• Look for marinades that contain vinegar and/or lemon. They actually create a protective barrier around the meat.

Limit time – limit exposure

• Always thaw meat first. This also reduces the cooking time. • Partially cook meat and fish in a microwave for 60 to 90 seconds on high before grilling and then discard the juices. This will lower cooking time and reduce risk of cause smoke flareups.

Grilling techniques

• Flip burgers often - once every minute – to help prevent burning or charring. • Place food at least six inches from heat source. • Create a barrier to prevent juices from spilling and producing harmful smoke. Try lining the grill with aluminum foil and poking holes, and cooking on cedar planks.

Plan ahead and choose wisely

• Lean meats create less dripping and less smoke. • Choose smaller cuts of meat, like kabobs, as they take less time to cook. • Try grilling your favorite vegetables. They do not contain the protein that forms harmful HCAs.

Farmers Market at Canandaigua VA The Canandaigua VA Medical Center is hosting a weekly farmers market. It takes place from 1:30 5 p.m. every Tuesday through Oct. 8. Local vendors sell fresh fruits and produce in the Andrew Jackson Parking Lot, located in front of Building #1. The Farmers Market is open to the general public. For more information, please contact Debbie Brahm, at 585-3937803. The Canandaigua VA Medical Center is located at 400 Fort Hill Ave., Canandaigua. July 2013 •

African-Americans

are under-represented in health research. You can help change that.

Every day, clinical trials and studies are helping to ﬁnd better ways to treat and prevent disease. But there’s one problem: AfricanAmericans don’t participate in health research as much as others do. And that means we don’t know enough about the best ways to keep you healthy. There’s something you can do to change that: Consider participating in a clinical trial or study to improve treatments for diseases like diabetes and high blood pressure. To learn more, visit RocHealthResearch.urmc.edu or call (585) 758-7877.

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ince ancient times, women desire a full, lush set of lashes. But when nature doesn’t favor you or illness or injury makes lashes scanty, many women turn to artificial eyelashes. Still others add glamorous beads or glitter on their lashes for a special event. While they may create the dramatic look you like, eyelash enhancement may pose a health hazard. Rebecca Nally, a doctor of optometry at URMC’s Flaum Eye Institute and blogger for fashion and beauty site www.thefluffreport.blogspot.com, said that allergy to the adhesive used to apply lash enhancement can cause problems. “If you have lid tenderness, discharge or redness, you need to discontinue wearing them,” she said. “See an eye care professional.” How you wear them also makes a difference. Not removing them before bedtime, for example, may lead to irritation or infection. Nally advises that false eyelash wearers use the same protocol for handling their eyelashes as when wearing contact lenses: wash your hands, keep the container clean and don’t sleep with them. Remove them with great care. If they get stuck on too well, they can pull out your natural lashes. “Some you can use more than once, but others are one-time use,” Nally said. “There’s no disinfecting solution or regimen. A lot of them are reusable, but I feel like the more that you use them, the higher your chances for infection and contamination.” Many adhesives for false eyelashes use formaldehyde and the problem is that most people aren’t aware if they’re allergic to it or not. “When people take super glue and inadvertently glue their lids together, it doesn’t wash away,” said Gwen K. Sterns, ophthalmologist with Rochester General Hospital and its chief of ophthalmology. “I’ve seen kids that have

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

done that. The eyelid and eyelash area is very sensitive. I personally would be hesitant to have someone that close to my cornea putting a solvent on that could drip on the cornea and injure it.” She also advises against applying tiny beads and flecks of glitter near the eye. “If you cry, you could wipe your lashes and they can get in your eye and scratch them,” she said. “It’s really a foreign body that can cause scratches and infection.” Just a few lashes can go a long way. Instead of using a full set of reusable lashes, Nally recommends going with individual lashes. “You can use a couple and throw them away when you’re done,” she said. Or, instead of false lashes, she recommends trying Latisse. It was a main ingredient in an eye drop medication used to treat glaucoma. “They found a side effect that it creates long, full eyelashes,” Nally said. “They reformulated it and you can apply it to the top lash line before bed. Over the next few weeks, the lashes grow.” Most people need to use it daily for 30 days before seeing results, and then a few times per week to maintain the full lashes. It discontinued, the lashes will thin out again. Latisse costs about $110 per month.

s Women’issues

The BRCA1 Gene Angelina Jolie raises awareness of prophylactic mastectomy By Deborah Jeanne Sergeant

n April, actress Angelina Jolie publicly announced that she had undergone prophylactic mastectomy — preventive double mastectomy — to reduce her chances of breast cancer. A genetic risk and family health history indicated Jolie carried a whopping 87 percent lifetime chance of breast cancer and 50 percent risk of ovarian cancer. Though Jolie exhibited no signs of either disease, she chose the radical approach to reduce her risk to 5 percent. The American Cancer Society states that if a woman has a first-degree relative such as mother (in Jolie’s case), daugher or sister who has had breast cancer, especially if at an early age, she bears twice the risk of developing breast cancer. If she has two first-degree relatives, the risk triples. Though it’s rare, male breast cancer in the family tends to be related to a genetic predisposition to female breast cancer. Only .24 percent of the population carries what is known as the BRCA1 gene, whose presence can indicate Medeiros a higher risk for breast cancer based upon many different factors. Jolie is part of that unfortunate statistic and in her case, the risk was very high. Lori E. Medeiros, medical director at Rochester General Hospital Breast Center, said that providers look at the patient’s entire medical picture before suggesting genetic testing. “You don’t need to go out and get that test randomly, but under the guidance of genetic counseling,” she said. “What you do with the information is what’s important.” The testing is not always crystal clear on how much of risk of the mutation is present in a patient. “We sometimes don’t have enough information to say if it’s medium, high or low risk,” Medeiros said. “Some have a 60 percent mutation risk. The main thing is that it’s never 100 percent, but like anything else, it’s what your risk tolerance is. Most women would rather try to avoid breast cancer. Prophylactic surgery is hard. It takes a lot of thought and those decisions are never reached easily.” An easy blood test can reveal genetic predisposition. “If they’re positive, family members may also want to be tested,” Medeiros said. Women should keep in mind that “for most women with breast cancer, it’s not genetic,” Medeiros said. For women who do have the BRCA1 gene, Medeiros counsels women about their options. “The most extreme is bilateral

mastectomy and is the most effective at reducing that 85 percent risk lifetime to 10 or less percent,” she said. “Some women just opt to be followed more closely. But you have to deal with the idea that something might pop up. Women who haven’t had their kids yet, we generally monitor more often.” These patients visit their providers annually for a clinical breast exam, perform self breast exams and, around age 30, begin mammograms and MRIs of the breasts. “If their mom had breast cancer at 30, we might start doing MRIs early,” Medeiros said. “It’s very individualized.” The close monitoring does not reduce the risk of having breast cancer, but does allow doctors to find it early Shayne and thereby improve the patient’s chances for successful treatment. For some patients, removing the ovaries as well may prove a helpful preventive measure against ovarian cancer and reduces the chances of breast cancer by 30 percent. “It does put women into early menopause,” Medeiros said. “We don’t recommend that until at least 35 because there is protective effects

of the hormones against problems elsewhere in the body.” Medication may also block estrogen and cut the risk by 40 percent, but patients experience menopausal side effects such as hot flashes. So far, area women have been more interested in BRCA testing in the Rochester area since Jolie’s announcement. “Patients want to know all their options, not just mastectomy,” said Michelle Shayne, breast oncologist for Wilmot Cancer Center at the University of Rochester Medical Center. “Mostly, it’s women with family history. Shayne added that the wide availability of information has led to a savvier patient than in the past, so she doesn’t think women are needlessly worrying about the BRCA1 gene. Shayne urges women with family history to “discuss with your primary care physician who knows you well. They can help you decide whether or not referral to genetics is warranted. “[Jolie’s story] is one woman’s personal response to a genetic diagnosis. The nice thing about it is she chose

very bravely to share this with us to open our eyes and create more opportunity for dialogue within families and between doctor and patient. It took a tremendous amount of strength and bravery on her part since she’s very much about beauty and that’s part of her persona. Talking about a prophylactic bilateral mastectomy can put the procedure in a more favorable light.” Reconstructive breast surgery usually follows the procedure.

Despite New Guidelines, Women in 40s Continue To Get Routine Mammograms at Same Rate Insurance coverage for annual screening likely one reason for persistence

omen in their 40s continue to undergo routine breast cancer screenings despite national guidelines recommending otherwise, according to new Johns Hopkins research. In 2009, the U.S. Preventive Services Task Force (USPSTF) sifted through the evidence and recommended that while women aged 50-74 should continue to undergo mammograms every two years, those between the ages of 40 and 49 without a family history of breast cancer should discuss the risks and benefits of routine screening mammography with their physicians to make individual decisions. As a result of the altered recom-

mendations, Lauren D. Block, a clinical fellow at the Johns Hopkins University School of Medicine, and her colleagues expected to find fewer women in their 40s getting routine mammograms. Instead, they found no impact on mammography rates among younger women. “Patients — and likely their providers — appear hesitant to change their behavior, even in light of evidence that routine screening in younger women carries substantial risk of false positives and unnecessary further imaging and biopsies,” says Block, leader of a study published online in the Journal of General Internal Medicine. “Women have been bombarded with

July 2013 •

the message ‘mammograms save lives,’ so they want them no matter what.” That research has shown that mammography’s impact on younger women is mixed at best: routine screening increases rates of detecting cancer in young women, but reduces mortality risk by a very small percentage. It is more likely, studies show, to result in over-diagnosis, and unnecessary treatment, including biopsies, lumpectomies and mastectomies, and weeks of radiation and potentially toxic drugs. False positives result in avoidable procedures and psychological trauma. Many of the cancers detected will probably never be dangerous, but are aggressively treated.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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s Women’issues Laser Spa: Taking Care of Unwanted Hair Laser Spa offices in Brighton offers solutions By Ernst Lamothe Jr.

ichael Spitale has been in the hair business for almost 38 years, owning his own salon. His focus was making sure his customers maintained their hair and kept their stylish look. Then he ran into a woman who was actually concentrating on the opposite results with hair. She was an independent contractor working on laser hair removal. Once he learned more about the business, he figured his wife, Diane Spitale, would be a perfect fit for this new endeavor, which could be an ideal complement to his salon. The couple opened their first Laser Spa in Brighton, 2240 Monroe Ave., in February 2007. The business offers laser hair removal and laser cellulite reduction treatment. Laser hair removal is a medical procedure that uses an intense, pulsating beam of light to remove unwanted hair. He said his business mission is to provide the best body hair maintenance available for customers. “People are constantly using waxing creams, tweezing and shaving to remove hair, and all that can be quite a hassle,” said Michael Spitale, of Irondequoit. “People have hair in places they don’t want and it can be painful and expensive to keep plucking it for the rest of your life.” Diane Spitale meets with customers when they come in and want to learn more information about laser hair

treatment. She said it’s an emotional journey for them because people feel uncomfortable having unwanted hair. Whether it’s women who have upper lip, chin and other facial hair or men who have back hair, both genders feel a sense of awkwardness in their current look. “It really breaks my heart when I see some women come in, and while talking to me, they put their hands over their mouths because they don’t like the look of their facial hair,” she said. “Then we have men who tell me they are uncomfortable taking off their shirts in the gym or the beach even though they are athletic because of hair all over their back and shoulders. Now people don’t have to live life feeling uncomfortable.” During the procedure, a laser beam passes through the skin to an individual hair follicle. The intense heat of the laser damages the hair follicle, which inhibits future hair growth. Although laser hair removal effectively slows hair growth, it doesn’t guarantee permanent hair removal. It could take six to eight hair removal treatments to provide an extended hair-free life. The treatments can take anywhere from 15 minutes to an hour-and-a-half. Besides some hair being resistant to laser treatments, some people have side effects including skin irritation, redness and swelling during the procedure. But those symptoms typically disappear

Diane Spitale (left) does a laser hair removal on a client. Spitale co-owns Laser Spa in Greece and Brighton.

within several hours. In some people, laser hair removal darkens or lightens a person’s skin temporarily. That is one of the reasons why the Spitales recommend coming in for a free consultation to discuss these possibilities along with other questions. They evaluate hair color, type of skin, a client’s medical history and whether the person burns easily. In order to give customers the safest experience, the family hired Brian Dailey as the laser safety officer, who has overseen procedures and trained staff. They also give their customers a two-year guarantee. “While customer service is our number one priority, what surpasses that is the safety of our guests. Nobody does a laser procedure on a customer, even if they had previous experience, until we feel 100 percent confident that they are working up to our standards,” he said. “We want to run into our customers at the grocery store and other places and hear about them being very satisfied.” The family understood the necessity and niche that a laser spa would

provide. But even they couldn’t predict the steady success it would have for them. Four years after opening their first location, they opened second one at 2844 W. Ridge Road in Greece, right across from Ridgemont Plaza. “I can’t believe it has grown this fast,” he said. “It really blew me away how after having steady growth, we ballooned up during 2010 and 2011. Now we are back to being slow and steady.” But outside financial success, the experience has been rewarding for Diane Spitale. She said she had a young family member who suffered from unwanted facial hair and it was very difficult growing up. She wishes that laser treatment were more common knowledge back then. “I take great pride in doing this because I know how hard it is for some people to even come in,” said Diane Spitale. “Just seeing that person walk out of the door feeling more confident, self-assured and with a smile on their face makes me happy. I honestly love what I do and everything is going well with the business.”

How Can Physical Therapy Help Me To Stop Wetting My Pants? By Zoe Fackelman

nexpected wetting of your pants has got to be on the top of the most embarrassing moments in life. However, there is help for you when you see a physical therapist specifically trained to treat women, men and children with urinary incontinence. Urinary incontinence is the leakage of urine at unexpected times. The leakage occurs because the pelvic ﬂoor muscles are not strong enough to stop the ﬂow of urine. For many, certain behaviors or habits may contribute toward incontinence. Women have a tendency to leak urine due to a medical history of pregnancy, labor and delivery, changes in estrogen level or chronic low back, hip or pelvic region pain. Many do not know where the

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pelvic floor muscles are located on the body or how the pelvic floor muscles work. The pelvic floor muscles consist of a group of muscles that attach to the coccyx (tailbone), and the ilium, (pelvic bone). The muscles are in the “crotch” area. They form a bowl to support the internal organs and when strong help to prevent or reduce organ prolapse. The pelvic floor muscles allow us sexual appreciation (painfree intercourse and orgasm) and they are the muscles that prevent us from leaking urine or feces. The low back, sacroiliac joint and hips depend upon the pelvic floor for stabilization. There are four types of urinary incontinence. 1 — Stress urinary incontinence (SUI) is urinary leakage associated to exertion, activity or movement,

laughing, sneezing or coughing. 2 — Urge urinary incontinence (UUI) is urinary leakage associated to strong urges to urinate. 3 — Mixed urinary incontinence (MUI) is the term used when you have both stress and urge urinary incontinence. 4 — Functional urinary incontinence (FUI) is associated with urinary leakage when you cannot get to the restroom in time due to a physical limitation, dementia, confusion, delirium, environmental barriers or psychological problems such as depression or anger. The rehabilitation program consists of behavioral modiﬁcation/ educations about habits, unbeknownst to you, that contribute toward your symptoms. Rehabilitation also includes

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

biofeedback and instruction of proper technique of pelvic ﬂoor and hip muscle exercises. Some may require techniques such as pain reﬂex release techniques to resolve nerve and muscle tension issues to accomplish dryness. A good program is one that teaches you how to take care of yourself. Zoe Fackelman is a physical therapist and the owner of Lake Country Physical Therapy and Sportscare, PC in Canandaigua. For more information, visit www. lakecountrypt.com or send her an email at zoe@lakecountrypt.com.

Doctors for Dollars

Some local doctors and health organizations receive money from drug companies to recommend their products raising conflict of interest issues. One doctor has received almost $1 million since 2009 By Ernst Lamothe Jr.

erception is powerful. In any profession whether that is journalism, law, government or medical, great lengths are taken to avoid a conflict of interest. Judges will recuse themselves from cases, city and town board officials will abstain from voting if they know the person bringing up the proposal and print reporters are not allowed in some cases to even take a free lunch from a source. Medical professionals take a Hippocratic oath to do no harm or injustice and prescribe regiments for the good of patients. Some wonder if the comfortable relationship between pharmaceutical companies and doctors might blur that line. Pharmaceutical companies have spent $2 billion in payments to doctors, medical institutions and other health care professionPhysician als from 2009–2012. A Paul Levy, database titled “Dolchairman of lars for Docs” was the department compiled by ProPubliof medicine ca, an independent, nonprofit newsroom at URMC, that produces investibelieves there gative journalism. is a symbiotic, The database mutual and provided a detailed beneficial list of doctors who relationship have taken money for between drug research, consulting, presentations, trips, companies, gifts and meals from doctors and health officials. 15 drug companies. The data accounts But he said that for only 47 percent relationship of the prescription needs to be drug sales in the monitored U.S. market because several dozen comcarefully if panies have failed to a particular disclose payment. The doctor or payments are legal institution and taking them does is receiving not mean a health excessive professional has done payments that anything wrong. There are some may influence who see the payments their practices. as necessary to re-

search and improve new drugs. Others see the matter as more complicated and murky, believing some doctors can be too intertwined with pharmaceutical companies, especially with large sums of money changing hands. “Anything that could influence the doctor-patient relationship should be exposed,” said physician James Fetten, president of the Monroe County Medical Society. “If a physician is being given a lot of money from a medical device maker or a pharmaceutical company, patients might be less likely to trust their recommendations. They need to know that the medical advice they are getting is unbiased information.” ProPublica found that the state medical boards or other regulatory agencies had disciplined more than 250 physicians who were recruited by the drug companies to be speakers and consultants. “I’m not saying what the pharmaceutical industry or doctors are doing is inherently wrong, but it’s a good thing to shine a light on this issue,” said Fetten. “Too many times there is not enough transparency in health care.” Teva Pharmaceutical Industries Ltd., who pays doctors and other health professionals for research, speaking engagements and meals, said they are fighting the good cause to help

the public in an honest way. “At Teva, we are committed to furthering the advance of medicine and scientific exchange through support of physician-led educational programs and research in a fully transparent manner,” said Nancy Leone, director of brand communications

Rochester Connection

More than $142 million has gone to doctors and other health professional in New York from 2009 to 2012. Last year, hundreds of Rochester area medical professionals took cash from drug companies for various reasons. The top donation for 2012 was $1.1 million for research given to Rochester General Hospital by Pfizer, the drug company that produces Lipitor for cholesterol, Lyrica for epilepsy, Celebrex for arthritis pain and Viagra for erectile dysfunction. That was followed by the $270,000 given to Rochester Ophthalmological by Allergan who makes products for glaucoma, ocular hypertension, dry eye and also manufactures Botox. Rochester Clinical Research rounded out the top three being paid $234,473 by Merck, which makes products for asthma, allergies, diabetes, HIV and hypertension. Michael Brennan, clinical research sub investigator for Rochester Clinical Research, supports the money given by

Top Five Here are the top ﬁve Rochester doctors who have been paid the most money by drug companies since 2009, according to data compiled by ProPublica, an independent, nonproﬁt group that produces investigative journalism. 1. 2. 3. 4. 5.

Dr. Sarah Atkinson Dr. Robert E. Heinig Dr. David Kleinman Dr. Tulio R. Ortega Dr. Seth Charatz July ly 2013 •

$893,763 $191,837 $146,205 $136,072 $95,871

Merck. His staff of 25-employees conduct dozens of research concurrently and the facility is paid on a per patient, per visit basis similar to how HMOs and health insurers would be reimbursing a primary care provider. He said the money from Merck goes to pay for the staff and the studies performed. “The pharmaceutical industry is investing in the research and development of new and improved medications to make life better for all of us,” said Breenan. Breenan said a local example is the clinic working on a vaccine for meningitis B after Tyler Putnam, a West Irondequoit High School student athlete who played hockey and lacrosse and died of that disease on July 7, 2011. The disease causes one-third of bacterial meningitis in the United States. The first Rochester area doctor to appear on the 2012 list for something other than research was Robert Heinig, an internal medicine specialist for Rochester General Hospital, who was given $52,950 for a speaking fee paid by Merck. In total, he has received $191,837 from drug companies since 2009 for speaking and other fees. In an emailed-statement, a spokesperson for RGH said “there is a commitment to ethical conduct by our health system and all of all clinicians. Each employee must sign and agree to abide by the Employee Ethical Standards of Conduct.” The RGH policy mandates that receiving any compensation or having interest in a company whose value may be affected by research must be disclosed to the Institutional Research Board. The hospital does not currently require disclosure of educationrelated compensation from pharmaceutical companies in funding medical education. The University of Rochester Medical Center has an advisory board made up of various departments that monitors “Anything the money pharmathat could ceutical companies give to its doctors. inﬂuence the Every URMC docdoctor-patient tor must submit an relationship annual financial should be report and the board exposed,” reviews the informasaid physician tion, making sure no James Fetten, unethical or negative president of the impact has occurred Monroe County in research, programs Medical Society. or clinical practice. URMC has doctors who have been paid for research, consulting and speaking engagements. Physician Paul Levy, chairman of the department of medicine at URMC believes there is a symbiotic, mutual and beneficial relationship between drug companies, doctors and health officials. He wants to build a healthy bridge between drug development and medical innovation. But he also understands that relationship needs to be monitored carefully if a particular doctor or institution is receiving excessive payments that may influence their practices. “Putting out the information keeps everyone honest,” said Levy. “We have to keep our eye on the ball to make sure that as a health care industry we are not risking our integrity. We have to create the right environment to advance the field, while avoiding the pot holes that have been brought to light.” In the Dollars for Docs database,

continued next page

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Doctors for Dollars

“Even though it’s legal, it can be concerning when someone is getting paid hundreds of thousands of dollars consistently by drug companies.” from previous page certain services are labeled “research.” Fetten, the president of the Monroe County Medical Society, said that term is too vague because in certain cases pharmaceutical companies would pay for one drug to be compared to another in a clinical trial. However sometimes the drug company controls the information, dictates the parameters of the research and buries the data if it happens to be negative. “Research isn’t always an altruistic endeavor,” added Fetten. “What we really need to know is a detailed description of who wrote the clinical trial, how much the doctor is getting paid to put each patient into the clinical trial and if the company turned that research into paying a doctor for future speaking engagements.” Levy agrees that future database information needs to be more specific. “When you look up a doctor all you see is a name and a dollar amount without any context,” he said. “There are some doctors that get paid more money because they developed a patent that helped advance science.”

Oversight

In an effort to make things more transparent, the federal government has mandated all drug companies to report their financial dealings by Sept. 30, 2014 to comply with the Affordable Care Act. Companies must turn over the data by March and doctors will

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have 45 days to review the information for accuracy before it becomes public, according to ProPublica. Companies who fail to report would be fined between $1,000 to $10,000 for each undisclosed payment. If a company deliberately tried to cover up the payment, the fine increases to up to $1 million. Most of the companies only decided to fully disclose payments in the current database as part of a settlement with the federal government over allegation of improper marketing. Physician James Scully, medical director for the American Psychiatric Association, said pharmaceutical companies provide the necessary drugs to make patients feel better, while doctors provide the scientific knowledge that could improve those drugs. But he also understands that transparency is paramount in the process. “Pharmaceutical companies do provide better drugs for patients who are suffering. We just have to make sure everything is above board and we have to be willing to write up negative evaluations of drugs when it occurs,” added Scully. “Even though it’s legal, it can be concerning when someone is getting paid hundreds of thousands of dollars consistently by drug companies.” Fetten agrees with transparency saying if you are operating in a professional and ethical manner then you won’t have anything to hide. “Patients should be able to see the information and make up their own minds,” he said. “Nothing should ever interfere with the doctor-patient relationship.” To view the entire database on how industry dollars reached your doctors from 2009-20012, go to projects.propublica.org/docdollars/

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What They Want You to Know:

Orthodontists By Deborah Jeanne Sergeant

“Retainers after treatment is necessary the rest of your life.”

he American Association of Orthodontists states, “Orthodontists are specialists in moving teeth and aligning jaws.” After high school, their further education to become an orthodontist can include 10 or more years, including college, dental school and orthodontic residency. • “Most people think that they should wait until all their child’s baby teeth are out until they see the orthodontist for the first time. They should start seeing an orthodontist by age 7 or 8 to get an idea early on to see what treatment they may need. • “Some people think that because they see us it replaces seeing their regular dentist. It doesn’t. They still need cleanings every six months or even more often since with braces on, hygiene is even more important. • “People think they’re way too old for braces. We have a lot of different treatment options, like clear braces or ones that go behind the teeth. As long as you have nice, healthy teeth they’re movable. • “When you have braces, stay away from sticky and crunchy stuff. If you feel like you’ll bite into something and something will break it probably will. Try not to dive into stuff with your front teeth. Break things up and crunch with the back teeth. Don’t let foods stay on your teeth. Still brush two times a day. Take a brush to school or work. • “People think you can’t floss if you have braces but you can with floss threaders. Michael Molisani, orthodontist at Comella Orthodontics, Rochester. • “Most people are surprised that retention with retainers after treatment is necessary the rest of your life. It’s hard enough to get teeth straight, but harder to keep them straight. We use bonded retainers glued on the inside of the teeth. In the old days, it was retainers until you’re 21. Most people’s teeth

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

will shift after treatment if they stop wearing a retainer. • “Most people in general will stop wearing or lose or break retainers that are removable. Our patients, years later, still have beautiful teeth. They have to have the retainer monitored by the dentist to make sure it’s clean and once a year I’d like to see them. • “There’s no referral necessary. At most orthodontists, there’s no charge for the initial exams. We take free photos and initial X-rays. I tell people to come in, listen to what we have to say, and at least you’ll be informed as to what you need to correct your teeth. If young people come in, ones that are 7 to 9, I see them every six months for no charge until they’re up to the age where they need braces. • “Adult orthodontics has exploded lately because of Invisalign braces. Twenty-five percent of my practice is for adults. We have clear braces and inside braces technique where people can’t see them. Most adults worry about how it looks. Each brace is molded for each individual tooth. It’s all custom. • “Because they fit so well on the teeth, they’re a lot easier to take care of. People always wonder how often they need to be seen. It’s on average every eight to 10 weeks so children don’t have to miss school and adults don’t have to miss work. It’s much more convenient. We try to do as much as we can at every appointment. • “A lot of people pick an orthodontist for how close it is to their house. Now that we’re seeing people every eight to 10 weeks, I tell people find the best orthodontist, not just the most convenient.” Bradley Kaufman, orthodontist at Kaufman Orthodontics, Rochester.

Deborah Jeanne Sergeant is a writer with In Good Health. “What Your Doctor Wants You to Know” is an ongoing column that appears monthly to give our area’s healthcare professionals an opportunity to share how patients can improve their care by helping their providers and by helping themselves.

Father and Son Tackling a Growing Problem: Hearing Loss By Ernst Lamothe Jr.

hen you observe your father first hand at a young age doing something he loves, it’s a memory that sticks with you. When a son sits around the dinner table and his father is talking about his workday with excitement, you know you are in the presence of something rare. Yet that was Peter Hart’s upbringing. It’s one of the reasons he wanted to follow his father, Stephen Hart, into the practice of helping those with mild or severe hearing impairments. The pair is part of a team of five audiologists at the Hart Hearing Center, which has offices in Irondequoit, Brighton, Greece, Fairport, Brockport and Watertown. The business has served the area for more than 35 years. Peter Hart saw his dad interacting with patients growing up. He jumped at the opportunity to be there alongside him. “For some people working with their fathers wouldn’t be a plus. But I am lucky because I have always gotten along with him, and he has been a wonderful model for me in life and in my career,” said Peter, 27, of Rochester. “ I am new to this profession and it is great having someone I trust to help me.” The younger Hart joined the practice last July. At the time he received his bachelor’s degree from SUNY Geneseo, he was still considering business management as a career. But the more he thought about it, the more his interest veered toward the auditory field. He received a doctorate from Northeast Ohio AuD Consortium, which is a joint program between The University of

Akron, Kent State University, and the Cleveland Clinic. He completed his clinical internship at the Canandaigua/ Rochester Veterans Affairs Medical Center. “This was always something in the back of my mind and I started to zero in on it,” he said. “At the end of the day, I am a social person so I wanted a career where I could interact with people. This is a gratifying profession.” His father saw early that his son could be interested in this career as far back as high school. He never pushed him to follow in his footsteps, but as any proud papa will tell you, he enjoyed that his son took an interest in something he loved. “He’s always been a pretty focused person,” he said. “It feels great to have my son here not only because he is family, but because he has a great work ethic and relates well with people of different ages.” Stephen Hart, 58, early on in his career worked for the Rochester Institute of Technology making products for the deaf and hearing impaired. When he first got into the auditory profession in the late 1970s, the career hadn’t made its culture mark on the landscape. Few people knew its potential possibilities. “I saw that I could do a lot of good work and just had a passion for it,” said Hart. He opened the Hearing Center, which focused on three areas: hearing loss, tinnitus or ringing in the ear along with dizziness and balance. Hearing loss is now the third most prevalent chronic health concern among adults in the U.S.

Peter Hart, left, joined Hart Hearing in July 2012. The practice was founded by his father, Stephen. The elder has noticed the trend of people coming into his office at earlier ages, including some in their teen years. The audiologist attributes that to teenagers cranking their iPods up with the latest music or middle-aged individuals who have absorbed intended and ambient noises for decades. He’s seeing clients come in to have hearing tests because they know their work and quality of life is suffering slightly with each day. Before there was a stigma in wearing hearing aids with their big, clunky look taking over the inner ear. However with the technological advances in the auditory profession, many hearing aids are so diminutive they can’t be seen unless someone is up close to the ear. “With hearing loss increasing, people are not ignoring it as much as they used to,” said Hart. “They are dealing with it and want it taken care of instead of just sitting back and waiting for the situation to get worse.”

His son said the current environment lends itself to these auditory problems. The average eighth grade student today is four times as likely to suffer from noise-induced hearing loss than 10 years ago. Also, according to the American Tinnitus Association, there are as many as 50 million Americans who experience ringing in the ear. But only a third of those people actually seek treatment. “The world is just getting louder and louder around us,” said Peter Hart. “Headphones are designed to give the listener the loudest and most intense bass. We tell people that you can’t just hope the problem goes away.” Both doctors suggest protecting your ears with plugs or headphones when cutting the lawn or using power tools. If problems with hearing persist, they suggest a visit to an audiologist. “It’s harmless to get your hearing checked so don’t be afraid,” said Stephen Hart. “Even knowing nothing is wrong can be a big relief.”

RGHS, Excellus BCBS and GRIPA Reach Groundbreaking Payer Agreement

ochester General Health System (RGHS), Excellus BlueCross BlueShield and the Greater Rochester Independent Practice Association (GRIPA) have finalized a health care delivery and reimbursement agreement designed to curb costs, increase transparency and accountability, and improve patient care and the overall health of the community. The agreement is part of a new, comprehensive Care for Health Accountable Care Partnership initiative between RGHS and GRIPA. The landmark five-year agreement will help the industry move from the current “fee for service” health care payment system that compensates based on quantity of care to one that truly rewards outstanding clinical performance, promotion of health and wellness, and greater efficiency all with the central goal of improving the health of the Greater Rochester area. “Our emerging Care for Health accountable care payment and delivery system will serve as a regional and national model as communities nationwide prepare for health care reform,” said Mark Clement, president and CEO

of RGHS. “Our goal with this initiative is to develop a truly integrated and accountable delivery system where every key stakeholder in the process is focused on keeping our patients’ longterm health a top priority.” This payer agreement with Excellus BCBS serves as an important foundational element from which to build this patient-centered system of the future. RGHS, Excellus BCBS and GRIPAmember physicians work together as partners in this innovative approach to manage the health of nearly 110,000 patients in the area. Leveraging developments in electronic medical records and care management support to improve care coordination, the partnership will enable patients to benefit from better, more proactive care by providers and the Health System. All physicians affiliated with GRIPA and RGHS are poised to receive this additional support, while being financially rewarded to keep patients healthy — vs. being compensated solely for performing tests and procedures. Fee-for-service has been the health care industry standard, and is facing significant change in light of the Af-

fordable Care Act. “Rising health care costs impact everyone and that’s why we’ve developed with our partners an innovative provider payment arrangement that will help to reduce these costs while at the same time improving the quality of care a patient receives,” said Christopher Booth, CEO of Excellus BCBS. “Supporting providers in their efforts to take charge of managing their patients and ensuring they receive routine and preventive care helps to improve health and reduce the risk of more serious and costly care.” Also leading this agreement are local physicians, dedicated to ensuring patients receive even better care through proactive care management. “In the new era of health care, it is critical to provide the right support to primary care physicians to enable them to succeed in filling their central role of active patient health oversight,” said physician Joseph Vasile, president and CEO of GRIPA. “GRIPA’s care management approach provides comprehensive, collaborative support to primary care providers, and has demonstrated proven results to improve the health of the patients we serve.” GRIPA uses an

July 2013 •

advanced data repository and Information Technology system to identify and target high-risk patients in need of extra care, and then works closely with primary care physicians and their patients to help them get on a healthier path. With care management, patients receive hands-on support to lead healthier lifestyles, both for their benefit and now for the additional benefit of reducing medical costs. Care managers assist patients in areas such as medication compliance and lowering prescription drug costs, and navigating the complex health system to ensure better coordinated care and attention. Rochester leaders have already seen the accountable care model succeed. Cynthia Reddeck-LiDestri is a former cardiologist who gave up her practice to run the health and wellness program for LiDestri Foods, a local company that uses GRIPA care management. “The care managers from GRIPA have helped many of our employees take a more active role in their wellness,” she explained. “People can significantly improve their lives with this approach to health care.”

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ave you been thinking about applying for Social Security disability benefits, but you are unable to visit a Social Security office to complete the interview? Or perhaps your disabling condition makes it difficult to visit a Social Security office. We have good news: you can complete your application for Social Security disability benefits from the convenience of your home. Get started at www. socialsecurity.gov/disability. The application process involves determining 1) whether you have sufficient work to be eligible for Social Security; 2) the severity of your medical condition; and 3) your ability to work. Because we carefully review so many cases — more than three million each year — it can take us three to five months to determine whether you are eligible to receive benefits. The amount of time it takes to make a decision on your application can vary depending on a number of factors, such as: • the nature of your disability; • how quickly we obtain medical evidence from you, your doctors, hospitals, or other medical sources; and • whether we need to send you for a medical examination to obtain evidence to support your claim. We have several important initiatives to speed up the process. For example, our Compassionate Allowances initiative allows us to fast-track certain cases of individuals with very severe disabilities. Two hundred different types of disabilities qualify for this expedited decision, and the list continues to expand. Since Compassionate Allowances began in 2008, the agency

Q&A

Q: I need proof of my Social Security income. Can I get verification online? A: Yes! And the best way to get a benefit verification letter is by using a “my Social Security” account. Your personal “my Social Security” account is a convenient and secure way for you to check your benefit and payment information, change your address, phone number, and direct deposit information, and to get your benefit verification letter. You can use your benefit verification letter to verify your income, retirement or disability status, Medicare eligibility, and age. When you use “my Social Security” to get it, you can request which information you would like included in the letter. Learn more, use “my Social Security,” and get your benefit verification letter now at www.socialsecurity.gov/myaccount. Q: I heard there is a Social Security video available in American Sign Language. Where can I find it?

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

has fast-tracked more than 250,000 disability applications, getting benefits to people in a matter of days instead of months. Learn more about Compassionate Allowances at www.socialsecurity.gov/compassionateallowances. Another way we speed up decisions is with our Quick Disability Determinations initiative, which uses technology to identify applicants who have the most severe disabilities and allows us to expedite our decisions on those cases. Read more about Quick Disability Determinations at www. socialsecurity.gov/disabilityresearch/ qdd.htm. There are things you can do to help speed up the decision process too. The more information you provide up front, the less time it will take us to obtain the evidence we need — and the faster we can make a decision on your application. The types of information we need include: • medical records or documentation you have; we can make copies of your records and return your originals; • the names, addresses, and phone numbers for any doctors, hospitals, medical facilities, treatment centers, or providers that may have information related to your disabling condition; • the names, addresses, and phone numbers for recent employers and the dates you worked for each employer; and • your federal tax return for the past year. If you’re not able to work due to a disability and getting to an office is troublesome, don’t worry. You can apply online for Social Security disability benefits at www.socialsecurity.gov/disability.

A: Yes, it’s true, and you can find the video on our website. The video is called “Social Security, SSI and Medicare: What You Need to Know About These Vital Programs.” The video is available in American Sign Language and it presents important information about our programs. You can watch the video now at www.socialsecurity. gov/multimedia/video/asl. The video is a part of our larger collection of ondemand videos and webinars available at www.socialsecurity.gov/webinars. Q: Can I apply for retirement benefits online? A: Yes, you can and it is quick, convenient, and easy. You’ll find the application information at www.socialsecurity.gov/applyonline. You also can calculate your estimated benefits by using our Retirement Estimator at www.socialsecurity.gov/estimator. Apply online and save a trip to the office and a wait in line. For more information, visit our website at www.socialsecurity.gov.

Mindful Awareness The practice is gaining popularity, but what is mindful awareness?

By Jim Miller

Simple Television Remotes Designed for Seniors Dear Savvy Senior, Can you recommend some easy-to-use television remote controls for seniors? I got my 74-year-old mother a new HDTV for her birthday, but the remote control is very confusing for her to operate. Shopping Son Dear Shopping, It seems like most television remote controls today come with dozens of unnecessary buttons that make them very confusing to operate. Add in the fact that many people use two or three remotes to operate their home entertainment equipment (TV, cable box, VCR and DVD player, etc.) it compounds the problem even further. Fortunately, there are several universal TV remotes available today that are specifically designed for seniors and the technically challenged. These remote controls have bigger buttons and fewer options that make them much easier to see, program and operate.

Simplified Remotes Two popular senior-friendly products to consider are the Flipper Remote and the Super Remote SR3. The Flipper works all major TVs including cable, satellite and digital TV receiver boxes with only one remote. Available for $25 at flipperremote.com, it offers a tapered design that makes it easy to hold, and for simplicity it has only six large color-coded buttons that are exposed (On/Off, Channel Up and Down, Volume Up and Down, and Mute.) All others buttons are accessed by sliding the top panel down, so they won’t get in the way during day-to-day TV watching. Flipper also has an optional feature that lets you program up to 30 of your mom’s favorite channels for easy access. The Super Remote SR3 from

By Deborah Jeanne Sergeant

Universal Remote Control, Inc. (sold through amazon.com for around $13) is a slightly more sophisticated userfriendly remote that can control three devices — TVs, cable or satellite boxes, and DVD players. It offers a light-weight ergonomic design, large easy-to-see numeric buttons each in the shape of the number it represents, and a centrally located My Button that gives your mom the ability turn on the TV and set the tuner to her favorite channel with a single button press. It also provides four Favorite buttons for one-touch access to her favorite channels, and an All Off button that lets her shut down the entire home entertainment system with a single button press.

Super-Sized Remotes There are also a number of oversized TV remotes that are ideal for seniors with vision problems. The Tek Partner, Big Button, and Tek Pal remotes all made by the Hy-Tek Manufacturing Company (bigbuttonremotes. com, 630-466-7664) in Sugar Grove, Ill. are three solid options to consider. If you’re interested in an extra large remote control, the $40 Tek Partner — which is 5 1/2 inches wide and 8 1/2 inches long — is their biggest. It offers huge brightly lit buttons with big readable characters, and a narrowed center (3 1/2 inches), which makes it easy to handle for a big remote. It also contains only the essential functions making it easy to use and program, and it operates any combination of TV‘s, VCR’s, DVD players, cable boxes and satellite dishes. If you’re looking for something a little smaller (2 1/2 by 9 1/2 inches), there’s the $25, rectangular-shaped Big Button remote that offers the same large and illuminating buttons as the Tek Partner and the exact same features. Or, if you only want a basic remote for the TV, there’s the Tek Pal that comes with just six large buttons (On/ Off, Mute, Channel Up and Down, and Volume Up and Down buttons) that light up when pushed. Available for $19, the Pal will only work with televisions that have cable wired directly into the TV.

he likes of media tycoon Rupert Murdoch and former South Carolina Gov. Mark Sanford have publicly embraced mindful awareness. The Mental Health Foundation estimates upwards of 30 percent of general practitioners advising the therapy for depressed patients. So what is mindful awareness therapy? Some trace its roots to ancient meditation or spirituality. Others say it developed from secular psychology of the ‘70s. Perhaps both contributed to the practice. Anne Marie Farage-Smith, licensed mental health counselor with Counseling Connections in Rochester, explained how mindfulness therapy works. “A therapist can sit down and work with a client on different mindfulness exercises like focusing on the breath, sitting and walking meditations,” she said. “It’s about being in the present moment and not thinking about the past or worrying about the future. It’s something that takes practice on a daily basis until it’s a part of you. You learn to observe and notice disturbing thoughts and shift your focus from those to something not distressing to you.” The therapy can help a variety of Johnston mental health issues. Farage-Smith mentioned depression, anxiety, and addictions. “You can get a better understanding of how your thoughts relate to your behavior,” she added. “You can respond rather than react to the situation.” Our reaction to stressors can impact physical health, too. Frank Johnston, owner and therapist with Johnston Psychology Associates in Rochester, said that there are two forms of stress: how the body reacts and how the mind thinks about things. “Stress triggers cortisol, the stress hormone, and that reacts to our DNA dispositions,” he said. “If we didn’t have that stress, that DNA wouldn’t be triggered. If you study a group of people who have a very stressful

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit www.savvysenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book. July 2013 •

event, two to three years later, there are molecular, biological changes.” Mindful awareness therapy skills can help the person better cope with current and future stressors. After a 10 to 12 week program, many patients are equipped with the skills they need to better deal with stress. Janet Chaize, licensed mental health counselor practicing in Rochester, explained that instead of letting the brain stay in the stressed “survival mode,” mindful awareness skills enables the individual to process what’s happening in a more objective fashion without negative internal messages or judgment. “You can interrupt the automatic process,” she said, “and you’re in the moment. You can see what’s going on without being so enmeshed in it. You practice it when you’re not upset so when you’re stressed, you can take three breaths, say, ‘This will change and I know what to do.’ It decreases the stress.” Instead of turning to negative means of handling stress, such as suppressing emotions, abusing substances or behaving irrationally, people can work through emotional upheaval in a positive way. “I give clients tools to move up to that non-stressed state of mind,” Chaize said. “I help clients learn to say things like, ‘Do not judge; this will pass.’ If they have a lot of negative feelings, I teach skills on doing a natural flow of feelings, expressing anger, sadness, guilt and they realize there was something unfair going on in their lives. “I help people learn to self-regulate their feelings and to lovingly observe themselves and develop a sanctuary within themselves where they’re safe. They can have compassion for themselves.”

585-421-8109 • editor@GVhealthnews.com IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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H ealth News Thompson offers single-site gallbladder removal Thompson Hospital recently became the first in the Finger Lakes to offer single-site gallbladder surgery, performed with the breakthrough technology offered by the da Vinci Surgical System. “With gallbladder disease affecting a significant percentage of our population and gallbladder removals one of the most common surgeries performed, Thompson is pleased to be able to offer this minimally invasive option to our patients,” says Thompson Health President/CEO Michael F. Stapleton, Jr. The operation is the latest made possible with the da Vinci Surgical System acquired by Thompson Health in 2012. This robotic system was already in use at Thompson for gynecological, urological and colorectal procedures.

A. David Peter, a board-certified general surgeon with the Canandaigua Medical Group and member of Thompson’s medical staff, underwent specialized da Vinci training for the single-site gallbladder removals. These surgeries, which involve a small incision in the navel, allow Peter to utilize 3 D, high-definition visualization and to make smaller, more precise movements. Potential benefits include minimal pain, a quick recovery and high satisfaction among patients, who are left virtually scar-free. “It’s nearly invisible because it’s hidden within the belly button,” says Peter. According to Peter, the more conventional laparoscopic gallbladder removal — which involves four small incisions — is still an excellent option for many patients. In addition, he notes, not all patients are candidates for single-site gallbladder removal.

St. Ann’s Community honors employees

RGH launches biplane angiographya suite

St. Ann’s Community presented five employees with the St. Ann’s Award of Excellence at a ceremony on June 6. The honorees were carefully selected from a pool of 1,100 employees. This year’s recipients are Mariya Podviyna, Pasquale Conca, Lisa White, June Dubois and Patty Raymond. The St. Ann’s Award of Excellence acknowledges the extraordinary efforts of front line staff. It recognizes individuals who have demonstrated a willingness to go well above and beyond their day to day job expectations and requirements. “These individuals truly bring a special compassion and personal commitment to their jobs each and every day,” read a news release issued by the hospital.

Rochester General Hospital (RGH), the flagship affiliate of Rochester General Health System (RGHS), has added a key piece of imaging technology that enables the hospital to provide advanced stroke care and enhanced interventional radiology treatments. The biplane angiography unit, located in the RGH radiology department, was officially launched in a ribbon-cutting ceremony June 5. Biplane angiography produces simultaneous images of the same area from contrasting angles, for diagnostic scans of very high quality and accuracy. Used in conjunction with a conebeam CT, the biplane unit can also generate real-time, three-dimensional views that enable physicians to perform complex catheter-based vascular procedures, especially in the brain and other areas of the body with small, delicate blood vessels. “With this unit, our interventional radiology team can perform advanced procedures including uterine fibroid embolization, kyphoplasty and cerebral angiography with greater speed, precision and safety,” said Bob Nesselbush, president of Rochester General Hospital. “It also complements our existing capabilities as the region’s leading stroke center, and allows Rochester General to provide truly comprehensive stroke services to our growing community of patients.” “Biplane technology is an important addition to our hospital, and to our health system,” said Mark Clement, president and chief executive officer of RGHS. “This resource, utilized by our skilled radiology and neurology teams, allows our patients to benefit from innovative imaging-guided procedures and upholds our commitment to deliver the highest quality health services to the people of greater Rochester and beyond.”

Blossom South Nursing raising money for MDA Greater Rochester Health Foundation board chair Essie Calhoun-McDavid and president and CEO John Urban enjoy the White House Champions of Change Award reception with YMCA of Greater Rochester president and CEO George Romell and board chair MaryBeth Copper on June 6, 2013 in Washington, D.C.

Health Foundation and YMCA Honored at White House

reater Rochester Health Foundation received a White House Champions of Change Award June 7 as a partner to the YMCA of Greater Rochester. The Champions of Change program recognizes individuals, business and organizations that are doing extraordinary things to empower and inspire members of their communities, and acknowledges the work of the Health Foundation and the YMCA of Greater Rochester for their work to transform the Rochester community and make it a better place in which to live. Representing the Health FoundaPage 22

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tion at the White House ceremony were John Urban, president and CEO, who accepted the award, and Essie Calhoun Mc-David, Health Foundation board chairwoman. Joining them from the YMCA of Greater Rochester were George Romell, president and CEO, and YMCA board chairwoman MaryBeth Cooper. The YMCA of Greater Rochester is one of the 12 YMCAs in the country to be recognized for their work and invited to nominate a White House Champion of Change. Romell nominated the Health Foundation for its work with the YMCA to prevent diabetes,

increase the number of urban families at a healthy weight, and improve the 90 year-old Maplewood branch to accommodate programs, as well as for the Foundation’s work to improve neighborhood health and health care delivery. “The Health Foundation is a longterm community partner that we have worked with the closet to advance the agenda of healthy living, and I knew right away that John Urban, on behalf of the Health Foundation, was who I would nominate for the Champions of Change award,” said Romell.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013

Blossom South Nursing and Rehabilitation Center recently participated in the Muscular Dystrophy Association effort to raise money through its “LockUp” event. The nursing was able to reach and surpass its goal. As Christopher Roberts, Blossom South administrator, volunteered his time being “locked up” at the MDA’s event, held at the Inn on Broadway, Blossom South was busy working to raise his “bail money” which was donated directly to the MDA. The staff held fundraisers and asked family, friends, and other supporters of Blossom South to contribute and help the facility reach its fundraising goal. “We are most appreciative of Chris’s efforts and that of Blossom South, “said Sally Cramer, director of the MDA of the Greater Rochester Area. “[The] dollars raised will be put to good use in the Greater Rochester and Finger Lakes community.”

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • July 2013