IGH - ROCH 158 October 18 by In Good Health: Rochester's Healthcare Newspaper

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OCTOBER 2018 • ISSUE 158

WOMEN’S HEALTH

Podiatrist John Ellie developing new outpatient podiatry clinic at St. Ann’s Community

SPECIAL ISSUE

n App for preventing pregnancy. Is it reliable? n Sports concussions: Much worse for women n Vaginal rejuvenation: FDA cautions about procedure n How food can affect urinary tract infection PLUS: Breast Cancer Awareness Month

Why some people catch a cold and others don’t n Related: Savvy Senior: Which flu shot is right for you

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Obamacare Health insurance coverage rates have held steady in the U.S., despite continued commotion over the future of the Affordable Care Act, a new government report shows. n Related: Excellus reports Upstate’s uninsured rate remains at historic low

New Apps Pay You to Walk

Forget about bitcoins. The new thing now is ‘Sweatcoins’ — the more you walk, the more you earn

Acorn Squash Acorn squash, of all the winter squashes, has many of the most important vitamins we need. See SmartBites inside

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Handy Tool or Bacteria Haven? Tips on how to sanitize one of the filthiest spots in your home. Yes, the kitchen sponge.

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Obamacare Enrollee Numbers Aren’t Falling: Report H ealth insurance coverage rates have held steady in the United States, despite continued commotion over the future of the Affordable Care Act, a new government report shows. About 28.3 million Americans were uninsured during the first quarter of 2018 — not significantly different than 2017, and 20.3 million fewer than in 2010, before the health insurance reform law (often called Obamacare) was passed. “Things are relatively stable. During a time with a lot of uncertainty — there’s been a lot of political turmoil over what will or won’t happen with Obamacare — these gains we’ve made in reducing the number of uninsured have held pretty steady,” said health economist Ellen Meara. She is a professor with the Dartmouth Institute for Health Policy & Clinical Practice, and was not involved with the new report. About 8.3 million Americans

now carry health insurance plans purchased through an Obamacare state-based marketplace, according to the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). Millions more are covered under the Affordable Care Act’s expansion of Medicaid. In Medicaid expansion states, the percentage of uninsured adults has decreased from 18.4 percent in 2013 to 8.7 percent this year, the report found. But in states that haven’t expanded Medicaid, there’s been a slight uptick in the uninsured, from 17.5 percent in 2015 to 18.4 percent in early 2018. The NCHS report, “Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-March 2018,” was published Aug. 29. Claire McAndrew is director of campaigns and partnership at Fam-

ilies USA, a health care consumer advocacy group. “People fare better in terms of access to coverage if their state has expanded Medicaid,” she said. “The fact that the poor and nearpoor still remain disproportionately uninsured really points to the need for states that have not yet expanded Medicaid to do so,” McAndrew added. The numbers show that actions taken by President Donald Trump have not yet resulted in the undermining of Obamacare, McAndrew and Meara said. These actions include expanding the sale of cheap plans that can deny coverage to people with pre-existing conditions; cutbacks in funding to promote open enrollment and assist

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

people in buying insurance; and reductions to cost-sharing payments to insurance companies, the experts said. “People want health insurance. They’ve become accustomed to the consumer protections and financial assistance available to them,” McAndrew said. “Even though the Trump administration has been doing work to undermine health coverage, people still are fortunately getting coverage and care.” There are some troubling trends within the numbers, however. The percentage of adults with high-deductible health plans increased from 43.7 percent in 2017 to 47 percent this year, according to the report.

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PRIMARY CARE • HEALTH ASSESSMENTS • CARE COORDINATION • MEDICATION REVIEW October 2018 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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CALENDAR of

HEALTH EVENTS

Oct. 3

Hickok Center holds comedy night fundraiser

The first “Laugh Til’ You Hick Up” comedy fundraiser to support the Hickok Center for Brain Injury, Inc. will be held from 6 to 8 p.m. Wednesday, Oct. 3, at Comedy @ The Carlson. This is an opportunity to show support for those impacted by brain injury, while enjoying an evening of comedy. The night will feature two standup comic acts: Reverend Mother (Phyl Contestable) and Todd Youngman. Host Bob Holtzworth will also perform material throughout the night. There will be complimentary appetizers with drinks available for purchase at the bar. Tickets are $20 for adults 21 and over. Purchase tickets online at https://t.co/pphhWR6vhT. The Hickok Center for Brain Injury provides supports to people with brain injuries and other neurological challenges to design and direct their own life journey. All proceeds will benefit the group.

Oct. 5

Own,” is a one-day workshop offered for divorced or widowed women who want to rediscover joy and contentment, and to gain the knowhow to forge a meaningful life on their own. You’ll meet others in similar circumstances and learn practical strategies to overcome loneliness, rediscover your true self and socialize in a couples’ world. The workshop takes place at House Content Bed & Breakfast in Mendon from 9:30 a.m. to 4 p.m., Friday, Oct. 5. Breakfast snacks/coffee/tea and a delicious healthy lunch will be provided. The workshop fee of $165 includes interactive discussion, empowerment exercises and helpful resources you can trust. Gwenn Voelckers, who writes the column “Live Alone and Thrive,” published monthly in In Good Health, leads the workshop. Voelckers recently wrote the book “Alone and Content — Inspiring, Empowering Essays To Help Divorced And Widowed Women Feel Whole And Complete On Their Own.” For registration and more information, send an email to gvoelckers@rochester. rr.com or visit www.aloneandcontent.com.

Oct. 6

Workshop for women who Free mammograms in live alone Wayne County Do you live alone? Is it a challenge for you? “Alone and Content: How to Survive and Thrive on Your

In honor of October’s Breast Cancer Awareness Month, UR Medicine

Excellus Makes $100,000 in Community Health Awards Available to Nonprofits Nonprofit organizations in the Rochester region are invited to apply for grants. Deadline to apply: Oct. 8.

onprofit organizations in Upstate New York can apply for Excellus BlueCross BlueShield Community Health Award grants that add up to a total of $100,000, which the company is offering to help fund health and wellness programs in Upstate New York. Nonprofit, 501(c)(3) organizations in Excellus BlueCross BlueShield’s 31-county Upstate New York region are invited to apply for an award of up to $4,000 each. The award can be used for programs that have clear goals to improve the health or health care of a specific population. Programs that improve the health status of the community, reduce the incidence of specific diseases, promote health education and further overall wellness will be considered. The deadline to submit an application to be considered for an Excellus BlueCross BlueShield Community Health Award is Monday, Oct. 8. To access additional information and the online application, go tohttps://www.excellusbcbs. com/wps/portal/xl/news/company-information/corporate-giving. Award winners will be announced in November.

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“The company’s Community Health Awards demonstrate a corporate commitment to support local organizations that share our mission as a nonprofit health plan,” said Holly Snow, director, community health engagement, Excellus BlueCross BlueShield. “These awards complement our existing grants and sponsorships with agencies that work to enhance quality of life, including health status, in Upstate New York.” Earlier this year, 13 Rochester area organizations were selected from among 36 nonprofit applicants to share in $91,200 in Community Health Awards. The awardees were Angel Care Ministry of St. Marianne Cope Parish, AutismUp, Boys and Girls Clubs of Rochester, Council on Alcoholism and Addictions of the Finger Lakes of Ontario County, DePaul Community Services, Friendship Children’s Center, Home Meal Service, Inc. of Wayne County, InterVol, Spiritus Christi Prison Outreach, Inc., St. John Fisher College, The Partnership for Ontario County, Inc., Ontario County, Volunteers of America of Western New York, Inc., and Wilson Commencement Park.

Breast Imaging — in conjunction with the Breast Cancer Coalition of Rochester, Cancer Services Program of Monroe County, and Susan G. Komen Upstate NY — is offering free annual mammograms to women age 40 and older. The screening sessions will be held 8 a.m. to 12 p.m., Saturday, Oct. 6 at UR Medicine Breast Imaging at Red Creek. A similar events took place in September. Appointments are required. To schedule a mammogram, call 585487-3304. Transportation is available for those who may need it, and financial assistance is available to women with high deductible plans. UR Medicine Breast Imaging has been offering free mammograms for the past decade and has served hundreds of women who may not have been screened otherwise. Mammography can detect breast cancer that is too small for women to find with a self-exam and early diagnosis is the best weapon in the fight against breast cancer. Parking is free and refreshments will be provided. Women who cannot make the screening are encouraged to schedule an appointment for a different day by calling 585-487-3304.

Oct. 21

Vegan group to discuss animal rights

The public is invited to attend the new meeting of the Rochester Area Vegan Society to hear about animal rights in Rochester, titled “Touching Hearts and Minds.” It will be presented by Tina Kolberg, president of Animal Rights Rochester (ARRoc) and Bubbie Staron, secretary at ARRoc. The event will be held with a vegan dinner starting at 5:30 p.m., Sunday, Oct. 21; the program will start at 7 p.m. It will take place at Brighton Town Park Lodge, 777 Westfall Road. Dinner is a vegan potluck. Vegan means no animal products (no meat, poultry, fish, eggs, dairy products or honey). Please bring a dish with enough to serve a crowd, and a serving utensil; also bring a place setting for your own dinner. We can help non-vegetarians or others uncertain about how to make or bring a vegan dish; please call 2348750 for help. Cost to attend is $3 for non-members and free for member. For more information, visit rochesterveg.org.

Nov. 6

Hearing Loss Association announces programs

Hearing Loss Association of America Rochester Chapter invites anyone interested in hearing loss to any or all of several events on Tuesday, Nov. 6. All programs are held at St. Paul’s Episcopal Church, East Avenue at Westminster Road, Rochester, across from the George Eastman Museum. • 10 a.m. “Hearing Other People’s Experiences (HOPE)” at the church’s vestry room. Prospective or new hearing aid users can share their experiences, questions, and hearing loss journeys in an informal round table discussion facilitated by retired audiologist and hearing aid user Joseph Kozelsky. • 11 a.m. to 1 p.m. “HLAA National Activities 2018” with Peter Fackler at Parish hall. Program begins at noon. Fackler, member of HLAA’s national board of directors

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

and former president of the Rochester chapter, presents the latest news from the national office, including news that Rochester will play host to the HLAA annual convention in June 2019. • 7 to 9 p.m. “Personal Safety Planning in Emergencies” with Tim Kohlmeier at parish hall. Program begins at 8 p.m. Kohlmeier, director at Monroe County’s Office of Emergency Management will advise people with hearing loss on coping in situations of no electricity, snow, rain, shootings or other events when communication with helpers is questionable . All HLAA programs are free. Anyone interested in hearing loss is welcome. For more information, view the organization’s website at hlaa-rochester-ny.org or telephone 585 266 7890.

Nov. 17

Muscular disorders group to hold art festival

The Friends and Families Muscular Disorders Foundation Inc., a 501(c)(3) nonprofit organization based in Rochester will hold its annual Fall Arts, Crafts from 9 a.m. to 3 p.m. Nov. 17 at the RIT Inn and Conference Center, Henrietta. It’s seeking additional vendors for the festival. For more information, call or text 585-519-1917 or send an email to friendsnfamiliesmdf@gmail.com. The group’s mission is to help members who suffer from lupus, multiple sclerosis, muscular dystrophy and other related disorders.

Thompson flu shot clinics offered at several locations

UR Medicine Thompson Health has held several public flu clinics in a number of locations in September. It will continue to offer clinics in October. Administered to those 9 and older at these clinics, the standard 20182019 vaccine provides protection against four flu viruses, including H3N2 and H1N1. This year, there is a second option — a high-dose flu vaccine — for those 65 and older. This contains additional antigen designed to create a stronger immune response in the person getting the vaccine. The high-dose vaccine protects against three flu viruses. The clinic schedule is as follows: • 3 to 7 p.m., Wednesday, Oct. 10, Farmington Town Hall, 1000 County Road 8 in Farmington • 11 a.m. to 3 p.m., Saturday, Oct. 13, Victor Fire Department, 34 Maple Ave. in Victor • 3 to 7 p.m., Tuesday, Oct. 16, Canandaigua Emergency Squad, 233 N. Pearl St. in Canandaigua • 3 to 7 p.m., Tuesday, Oct. 30, Thompson Health Farmington Urgent Care, 1160 Corporate Drive in Farmington, • 3 to 7 p.m., Tuesday, Oct. 30, Thompson Health Newark Urgent Care, 800 W. Miller St. in Newark As a courtesy, Thompson Health will bill Medicare, MVP products, BlueCross BlueShield products and commercial insurances. Patients must present an insurance card at the time of the visit. The self-pay cost is $40 for the standard vaccine and $70 for the high-dose vaccine (cash, check, MasterCard or Visa). Call 585-924-1510 for more information.

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John Ellie, DPM Podiatrist developing new outpatient podiatry clinic at St. Ann’s Community Q: Can you describe podiatry’s niche in the broader medical picture and how it differs from M.D./D.O. practice? A: We’re opening up a podiatry office that will be combined with the Wound Healing Center at St. Ann’s. It’s an outpatient facility serving Rochester and the surrounding counties. We treat foot issues, lower extremity down. It incorporates things from routine diabetic foot care to bunions and hammer toe surgery, to heel pain and plantar fasciitis. The wound center, of course, offers treatment for other traumas; other practitioners can take care of patients there. But basically as far as podiatry, we focus on anything from the ankle down. We have an X-ray machine on site to diagnose bone pathologies with the patient in the room. Anything from mild pain that can be treated with stretching or injections to surgeries, which are done over at Rochester General or outpatient surgery centers. Q: Who are your typical patients? A: Our demographics are pretty wide. I’ve treated 1-month-olds up through mid-90s. You can see a podiatrist at any age. People with diabetes will probably see us the most, referred by their primary care doctor for diabetic foot and nail care because they’re at a high risk for ulceration,

especially older patients. But sports and pain issues, we’ll see a lot of patients in their teens, 20s, 30s and 40s. We can recommend and provide measurements for certain shoe gear and accessories. Q: Are diabetic foot issues your most common complaint? A: Because we’re associated with the Wound Healing Center, we see more of that type of patient. Maybe 60 percent is diabetic foot care and 40 percent is sports issues and general pain. Q: Are the pain issues usually structural? A: The most common complaint would probably either be heel pain or flat feet, which are often diagnosed. That’s when the arch is a little bit depressed. That can be helped with something as simple as using an insert to bump up the arch, which can help them walk longer distances, experience less pain. There are also a lot of pathologies that can develop from flat feet, things like bunion and hammer toes, tendon issues, strains. Q: What causes flat feet and fallen arches? Are people just born that way, or do the problems develop? A: It can be genetic for the most part. But also as we age, the tendons pull and weaken, especially with

improper footwear. So the arch can collapse a little more from those factors. We can’t really fight the genetic component, but we can help it not get worse. Q: What sort of accessories do you prescribe? A: I usually start off with overthe-counter inserts to make things easier on the wallet. Those can range from $15 to $40. And then there are custom inserts that are molded in the office and sent down to the lab. They usually run a couple hundred dollars, so nothing too crazy. Q: What will your role be in the clinic? A: I’ll be the chief podiatrist, but as of right now it will only be me. I’ll be seeing patients for foot and ankle issues, and any ulcerations will be sent to the wound center. Q: Will you be taking on additional podiatrists? A: It’s definitely going to grow. We’ll meet the need as time goes on. But this is a good way to treat patients in the area, with Rochester General right across the street and our ability to work with the wound center. I think that will help us stand out from a typical podiatric practice. Q: Does insurance usually cover podiatry? A: We’ll be accepting all insurances shortly, everything from Medicare, to Medicaid, to Excellus, Aetna, etc. Q: Normally would a patient be referred to you, or just walk in? A: Walk-ins are accepted. Referrals mostly come from a primary care doctor, especially if the insurance requires a referral. But a lot of insurances these days will cover walk-ins. Q: Philosophically, where do you see the podiatrist’s role relative to the medical industry? A: I’ve been working with specialists out of Rochester General, everything from orthopedics, endocrinologists, general practitioners, as well as a lot of private practices in the local area.

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Q: How did you become interested in podiatry? A: I was actually in college and my sister was in podiatry school. I ended up shadowing her and really liked what I saw. I ended up going to school in New York City, graduating, and then wanting to move back up here to my home. I started my practice three years.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

Name: John Ellie, DPM Position: Chief podiatrist at St. Ann’s Community Hometown: Greece, NY Education: Pace University; New York College of Podiatric Medicine; SUNY Downstate Medical Center Affiliations: St. Ann’s Community, Rochester General Hospital, Unity Hospital Organizations: American Board of Podiatric Medicine; American Board of Podiatric Surgery Family: N/A Hobbies: Working out, tennis, running

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Kitchen Sponge: Handy Tool or Bacteria Haven? Tips on how to sanitize one of the filthiest spots in your home By Deborah Jeanne Sergeant

very home has one and it’s the most bacteria-laden surface under the roof. The toilet seat? The garbage can? Try the kitchen sponge that you use to wash utensils, wipe counters and scrub plates. It’s likely dripping with disease-causing pathogens. A study by German researchers revealed 362 different types of bacteria present on household kitchen sponges — and half of those types were harmful bacteria. While to most healthy people, the bacteria they encounter in their everyday life doesn’t unduly affect them, people who are immuno-compromised must remain vigilant about keeping bad bacteria at bay. And, for those who can’t stand the “yuck” factor of germy kitchen sponges, here are a few options. n Ditch sponges altogether. “We don’t recommend kitchen sponges,” said Jeanne Schell, senior public health sanitarian at Monroe County Public Health. “You can use them a few times, that’s fine, but you cannot sanitize them. We don’t see them much in restaurants. They use cloths.” Restaurants typically hold their

dishcloths in a bucket of bleach-diluted water to prevent contamination. n Replace cloths. “Use a new cloth daily,” Schell said. “Wash cloths in hot water.” Of course, after the cloth has been exposed to a known germy surface, like raw meat juice, grabbing a clean cloth doesn’t hurt. Some washing machines offer a “sanitize” setting. n Nuke your sponge. Some experts recommend microwaving a wet sponge for two minutes to clean it. Schell isn’t convinced. “I don’t think it’s the best option,” she said. “Others say dishwasher every night, but there are too many nooks and crannies in the sponge.” n Use the right cleaner. Evelyn Lannak, professor in hospitality at Monroe Community College, recommends a bleach solution in a spray bottle or bucket, one tablespoon of bleach per gallon of water. “Allow it to air dry afterwards for safety,” Lannak said. n Soak tools. Every day, soak item such as bottle brushes, sponge wands or sink brushes in the bleach solution for 30 seconds, Lannak recommends.

A study by German researchers revealed 362 different types of bacteria present on household kitchen sponges — and half of those types were harmful bacteria. n Go disposable. “Handi Wipes are nice because you can throw them away,” Lannak said. “They’re single use.” She added that especially for very germy chores, such as cleaning up after cutting up a raw chicken, a single-use cloth or paper towel prevents bacteria from spreading. n Limit germy messes. For example, many people believe they must wash their raw, whole chicken before roasting it. Lannak said that doing so spreads bacteria, since the rinse water splashes around the sink. Anyone worried about the chicken’s cleanli-

ness should realize that processors clean the birds before wrapping them for selling. “Since you’re cooking it, it kills any bacteria that could be in it,” she said. She added that drying the chicken with a paper towel, using single-use gloves for handling the raw chicken and sanitizing the cutting board after the raw chicken was on it can minimize the spread of bacteria. Lannak recommends using the dishwasher or a bleach solution for cleaning the cutting board.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

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Upstate’s Uninsured Rate Remains at Historic Low U pstate New York’s health insurance uninsured rate continued to hold at the historic level of 4 percent, while the state’s uninsured rate hit its lowest level in history, according to an Excellus BlueCross BlueShield analysis of the U.S. Census Bureau’s 2017 American Community Survey issued in September. The 4 percent rate for Upstate New York compares favorably to a statewide uninsured rate of 5.7 percent. The national rate is 8.7 percent. “More people than ever before are reporting they have coverage that provides them with access to the high-quality health care available in Upstate New York,” said Christopher Booth, chief executive officer of Excellus BCBS. “We’ve never seen these percentages of the population with

coverage.” The American Community Survey is the largest and the U.S. Census Bureau’s recommended source for examining uninsured data at national, state and regional levels. It reports the yearly uninsured rate for geographic areas with populations of 65,000 or more. The county-level data were aggregated to calculate the Upstate uninsured rate cited by the health plan. “We believe the historically low uninsured rates for Upstate are a result of lower-cost health care in this market of nonprofit health plans and nonprofit hospital systems,” Booth said. By comparison, the 2016 uninsured rate for the state was 6.1 percent, while the U.S. rate was 8.6 percent.

Upstate New York’s 2017 uninsured rate is:

30% lower + 54% lower than the U.S. rate

than New York’s rate

2017 Uninsured rates 4.0% Upstate

5.7% New York state

8.7% United States

5.0% 3.4% 3.7%

4.0%

4.9%

Illustration by Excellus BlueCross BlueShield

Healthcare in a Minute Source: 2017 American Community Survey, 1-Year Estimates https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_16_1YR_S2701&prodType=table

By George W. Chapman

More NPs and PAs Assuming Role as Main Care Providers

he collective term “advanced practitioner” refers to nurse practitioners and physician assistants. They are assuming an increasing role in the provision of care every year. It is projected that they will account for two-thirds of the new providers (MDs included) added to the workforce over the next decade. (It should be noted that the number of physicians entering the workforce is somewhat limited by the number of residency positions available.) The number of NPs/

PAs per 100 MDs has been rapidly increasing since 2000 and will be 55/100 by 2030. The workforce projections for 2030 are about 1,076,000 MDs, 397,000 NPs and 184,000 PAs. The Association of American Medical Colleges continues to predict a shortage of 120,000 MDs by 2030. Many believe that is vastly overstated because the prediction doesn’t account/acknowledge the increase in the aforementioned advanced practitioners, technology, super drugs and artificial intelligence.

Genetic Testing

many employers who are increasingly taking matters into their own hands. More and more employers are contracting directly with narrow, high-performing provider networks to both shift and lower costs. Some companies are investing in primary care clinics and setting up preferred provider networks for their employees. Seventy percent of employers responding to a survey by the National Business Group believe a new entrant from outside the healthcare industry is necessary to really disrupt the unsustainable and unaffordable status quo protected by too many vested interests. Hospital Ratings Conundrum

A recent article in the Wall Street Journal points to a huge gender gap in genetic testing. By a 3 to 1 margin, more women were tested for inherited gene mutation (like cancer) than men. Genetic counselors also report having far more women than men as clients. Experts have speculated: women are very concerned about breast cancer and more in tune with their health; men have historically been less likely to seek medical care; and men are less likely to embrace the results of genetic testing. Employers Taking Charge On average, employers cover two-thirds of an employee’s health premium. The rising cost of care has become an existential threat to the future of many businesses. The well-publicized joint effort by Amazon, Chase and Berkshire Hathaway to redesign how care is delivered and paid for has actually detracted from what is already happening with

CMS established a “hospital compare” site so consumers can check a particular hospital’s ratings on measures such as mortality, safety, cost, timeliness of care, patient experience and readmissions. While this is all well and good, it begs the question: “What is one to do when a particular hospital rating is below October 2018 •

average and that is where my physician admits?” This is becoming more of a dilemma as consumer choices are being limited by employers contracting with narrower networks, increased government incentives for hospitals and physicians to develop alliances; more physicians becoming employees of hospital systems; and insurance plans favoring particular hospitals. Going “out of network” is rarely a good option because you will lose your physician — and out of network co-pays are intentionally prohibitive. The best advice is to discuss your concerns and trepidations about a hospital with your physician. The physician may have an alternative for you. All hospitals are very concerned about their ratings and will take your concerns (and especially a physician’s concerns) seriously. Med School Tuition-Free The medical school debt students carry averages $200,000. This on top of their college debt. The other cost to consider: physicians don’t start earning money until their late 20s due to four years of medical school plus at least three years of residency. Magnanimously, the NYU school of medicine will begin to cover the cost of tuition regardless of the student’s financial situation. NYU is the first and only top 10 ranked medical school to do so. Incoming students this year will have all their tuition paid for and existing students will have the remainder of their tuition covered. Physicians are still No. 1 when it comes to income. According to a recent report from Glassdoor, the median base salary for physicians is $196,000, about 4 percent higher than 2017. NPs and PAs averaged about $108,000. Controlling Drug Prices The federal government regulates and determines what it will pay

for physician and hospital services delivered to Medicare and Medicaid patients, government employees, and veterans. Most commercial payers tend to follow their lead and closely mirror those fees. The drug lobby has been particularly effective in avoiding government regulation of their fees and most agree the government should avail itself of its purchasing power (Medicare, Medicaid, VA, etc.) and get price concessions from drug manufacturers. In an effort to do just that, control Medicare Part D drug prices, CMS would give Medicare Advantage plans more flexibility in determining what drugs are on their formularies. It is called “indication based formulary design” and, obviously, cost would be an indication and consideration. But provider and patient advocacy groups are not happy with the Administration’s efforts to get Part D drug costs under control, which would eventually help commercial plans. The AMA argues this is a detriment to patients by introducing unfair complexity to Medicare patients and gives more power to insurers to decide on treatment plans. There is special concern about limiting the formulary for cancer treatment. It should be noted that physicians and hospitals received $8.4 billion in payments from drug companies in 2017 for research, “related expenses” and ownership and investment interests held by physicians and immediate family members. George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 9

Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

October Can Be a Perfect Time to Change It Up!

all is my favorite time of year. For me, it means all good things: relaxing in front of a cozy fire, making soup on Sunday afternoons, donning my well-worn leather jacket for long walks and turning my attention to all those inside projects I neglected over the summer. The colors, aromas and industriousness that come with the fall season really appeal to me. But this hasn’t always been the case. After my divorce, this time of year and all its romantic charm would leave me feeling melancholy. Nostalgia and wistfulness would creep in, and I just wanted to retreat into myself. For those who live alone, the month of October has some unique challenges. Not one to wallow in a “woe is me” state of mind, I began to develop and employ some strategies to rekindle my love of the fall season. It can be the perfect time to mix it up, get busy and take some risks. Below are elements of my annual fall “game plan.” Take a look and see if one or more of these suggestions might not add a little color to your

life pallet this fall: Tackle indoor projects. Fall is a great time to accomplish all those indoor projects that fell by the wayside in the warmer months. I have a long list and keep it right in front of me — a reminder that I have plenty to do. Idle time is not a friend at any time of year, but it can become downright unfriendly when the days grow shorter. Now is the time to keep busy: organize your storage space, do some touch-up painting, update your wardrobe, or redecorate a tired bedroom or bath. There’s nothing like feeling productive to beat the October blahs. Get up and get going. Staying active when there’s a chill in the air can be difficult. I can remember many a dreary morning when all I wanted to do was hit the snooze button, pull up the covers and stay in bed. As nice as sleeping in can be from time to time, I don’t recommend a steady diet of it. In my experience, there’s no better way to start your day than to wake early. In the peace and quiet, there is glorious time to read, think and breathe. I use this important time

to myself to plan my day, write and answer emails. As the day brightens, so does my mood and gratitude for the precious day before me. Enjoy the great outdoors. Sunshine, fresh air and even a light rain can be invigorating, especially if you’ve been cooped up all day. I’m grateful every day for Scout, my adorable springer spaniel, who needs to be walked twice a day. Do if feel like walking her all the time? No. Do I feel better after taking her out? Yes, without fail. Whether you have a dog to walk or not, make an effort to leave your house and get outdoors. It will help relieve feelings of isolation during this cooler month. Learn something new. Going back to school and fall go hand in hand. Who among us isn’t reminded of the excitement (OK, perhaps nervous excitement) associated with returning to school after the summer break. Each fall I like to identify some new skill or subject to master. Last year, it was flower arranging; this year I’m looking at various lecture series. Continuing education opportunities are abundant in the community. Check out offerings by colleges and universities, libraries, community centers, and arts and cultural institutions. You’ll also find workshop listings online and in local newspapers. Start your search today! Invite people in. Over the years, I’ve discovered a few simple and manageable ways to bring people into my world and into my home. One way is to organize a gathering around a TV show or streaming movie.

Years ago, I invited my single friends over to watch West Wing with me on Wednesday nights. I provided the soup and salad; they provided the good company, refreshments and an uplifting mid-week change of pace. Football games, your favorite weekly sitcom/drama, a recent release on Netflix — any of these can become reasons to gather together with friends. The benefits? You’ll hone your cooking skills (boy, do I now have some great soup recipes!) and you’ll connect with people. What better way to enjoy a nice fall evening? There are so many wonderful and meaningful ways to enjoy this season and to ward off the blues that can sometimes emerge during October. If you are feeling sluggish, lonely, or isolated, try a few of the strategies above. They have stood me in good stead and have reinvigorated my appreciation for change and the possibilities and personal growth that can come with it. With a little “elbow grease,” as my father would say, these strategies can work for you, too. Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive empowerment workshops for women held throughout the year in Mendon. To purchase her new book “Alone and Content” visit Amazon.com. For information about her upcoming workshops or to invite her to speak, visit aloneandcontent.com, call 585-624-7887, or email gvoelckers@ rochester.rr.com.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

Are your eyes dry, irritated or burning?

Why Some People Catch a Cold and Others Don’t

hether you catch a cold this winter or make it through the season scot-free may depend in part on how many “stressors” your nose and airway passages encounter, a new study suggests. The research looked at two defense mechanisms that cells in a person’s airway use to protect themselves from threats: one that protects against viruses like the common cold virus and another that protects against “oxidative stress.” This form of cell damage is triggered by viruses and other irritants, such as cigarette smoke or pollen. The study found that there’s a trade-off between these two defenses: more protection against oxidative stress damage (for example, damage induced by cigarette smoke) means less protection against invaders like rhinovirus, which is the main cause of colds. “Your airway lining protects against viruses but also other harmful substances that enter airways,” senior study author physician Ellen Foxman, an assistant professor of laboratory medicine at Yale School of Medicine in New Haven, Conn., said in a statement. “The airway does pretty well if it encounters one stressor at a time. But when there are two different stressors, there’s a trade-off,” Foxman explained. “What we found is that when your airway is trying to deal with another stress type, it can adapt, but the cost is susceptibility to rhinovirus infection.” The study was published Sept. 11 in the journal Cell Reports. Defense “trade-off” Respiratory viruses cause an estimated 500 million colds and 2 million hospitalizations in the United

Do you sometimes find it hard to focus your eyes when you have been reading or using the computer for a long time?

States every year, the researchers said. However, some people can be exposed to a virus without getting sick, because the cells that line their airways clear the virus before it causes symptoms. But for other people, this clearance doesn’t happen, and they wind up sick. To better understand why some people get sick from cold viruses while others escape illness, the researchers examined airway cells from healthy human donors. The cells were obtained from the lining of people’s nasal passages or of their lungs. Researchers found that the nasal cells had a stronger inherent defense response to viruses, while the lung cells had a stronger defense against oxidative stress. Later experiments revealed that there was indeed a trade-off between these two defense mechanisms. For example, when the researchers exposed nasal cells to cigarette smoke to trigger an oxidative-stress response, the cells became more susceptible to rhinovirus. “They survive the cigarette smoke but can’t fight the virus as well,” Foxman said. “And the virus grows better.” The finding might explain why cigarette smokers tend to be more susceptible to rhinovirus infection compared to people who don’t smoke, the researchers said. The results also suggest that finding ways to protect the cells lining the airway from oxidative stress “may lead to effective strategies to enhance natural defense against rhinovirus infection,” the researchers concluded. However, more studies will be needed to investigate this idea.

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In Good Health is published 12 times a year by Local News, Inc. © 2018 by Local News, Inc. All rights reserved. 154 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: Jim Miller, Deborah J. Sergeant, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Ernst Lamothe Jr.,, Carol Kreider, Ronni Ehlers, Sara Roback, Christine Birnie, Julie Halm • Advertising: Anne Westcott, Linda Covington • Layout & Design: Dylon Clew-Thomas • Office Assistant: Kimberley Tyler No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

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Page 11

Certified Nurse Anesthetist: Average Salary: $169,330 The job growth for between 2014 and 2024 is projected at 31 percent, nearly twice that of registered nurses By Deborah Jeanne Sergeant

f you’ve experienced in-patient surgery, you likely have received care from a certified registered nurse anesthetist (CRNA). Cheryl Spulecki, president of New York State Association of Nurse Anesthetists, works as a professor at University at Buffalo. The association represents more than 1,600 CRNAs statewide. “The reason many are interested in the program is they think they’d find it a very satisfying career if they’ve worked in acute care, the emergency room or intensive care unit and they’d like to advance their career,” Spulecki said. CRNAs administer all types of

anesthesia in the operating room. Their care begins at the pre-operation assessment, throughout the surgery, preparing the patient for awakening to recovery and follow-up post-surgery to make sure they’re comfortable and their pain is managed safely. In addition to more skills, the degree prepares CRNAs for leadership, administrative or education roles. Like other nursing specialties, CRNA candidates beginning in 2020 will need to complete a higher degree — a doctorate in this case — by 2025. That degree allows CRNAs to transition into education. To apply to a CRNA program, candidates must have a bachelor of

science in nursing or any appropriate bachelor’s degree, a license as a registered nurse, and a minimum of one year acute care nursing. Most master’s programs take 26 months to complete. The doctorate takes 36. After completing the education required, candidates must pass national board examinations and then recertify every eight years. Four continuing education credits are also required every four years. “We advise nurses or undergraduates to understand the prerequisites,” Spulecki said. “They should have critical care experience. They should enjoy the autonomy of working in that environment, working

CoreLife Eatery Opens in Brighton Fast-growing active lifestyle restaurant open twelfth New York location

oreLife Eatery, an active lifestyle restaurant offering a variety of greens, grains and broth-based dishes, has opened a new location in Brighton. It’s the 12th restaurant in New York, where the brand was founded. It’s located at 2600 Elmwood Ave. CoreLife Eatery brings together Page 12

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scratch cooking with flavorful source ingredients and a fast, casual service line for a healthy and affordable eating alternative. CoreLife Eatery offers a wide variety of fresh ingredients that are transformed into custom-created dishes. All foods are free of trans fats, artificial colors, sweeteners, other artificial additives and GMO’s. The

chicken and steak used are sustainably raised and never given antibiotics or hormones, and the bone broth is slow simmered all day for maximum taste and nutrition. “There’s a widespread belief that food can’t possibly be both healthy and delicious. CoreLife Eatery’s mission is to debunk that myth,” said Todd Mansfield, partner and well-

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

under supervision and medical direction of a physician and caring for patients with all types of anesthesia.” For Jay Cody, a CRNA at UR Medicine’s Strong Memorial Hospital for 15 years, being able to learn more about the medical aspect of taking care of patients drew him to the program. “I also liked being able to do procedures: epidurals, arterial lines and central lines,” he said. “I’m fascinated about anesthesia in particular because of the medications we give and it produces the effect so people are unaware of what the surgeon is doing. We can give a medication and they don’t feel the procedure itself.” He said that career opportunities abound as the nursing shortage extends to CRNAs as well. CRNAS work in hospitals, ambulatory surgical centers, free-standing clinics and OB-GYN offices. He thinks that people who have a good attention to detail, clinical instincts, communication skills and assertiveness make good CRNAs. “You have to be committed to it because it is a pretty long training process,” Cody said. “I think it’s not something you can enter into lightly. You have to make the decision that you’re going to do it. The rewards are fantastic. It’s an incredible job that I have. I get compensated quite well for it. It’s one of the best-paying nursing positions outside a management position. “And the opportunities are just going to expand even more with the way health care is going right now.” According to the Bureau of Labor Statistics, the average CRNA in New York makes an average annual salary of $169,330. The job growth between 2014 and 2024 is projected at 31 percent, nearly twice that of registered nurses. ness champion for CoreLife Eatery. “We have an innovative menu made entirely from fresh, simple ingredients that taste fantastic and our customers look forward to eating. We know CoreLife Eatery will quickly become a community staple in Brighton.” “CoreLife Eatery is much more than a brand,” said Scott Davis, president and chief concept officer of CoreLife Eatery, said. “We’re making clean eating easy, convenient and affordable without sacrificing a bit of flavor.” During his tenure as chief concept officer at Panera Bread, Davis led many key initiatives that drove the long-term success of the company and now applies his proven knowledge and expertise to this new and emerging concept. CoreLife Eatery strives to promote active lifestyle activities by offering and participating in a number of health-related events in the community. CoreLife Eatery staff members are proactively sharing their food concepts as well as wellness ideals through talks at local organizations and participation in community events. Led by CEO Larry Wilson, the CoreLife Eatery executive team brings individual successes and skill sets to help the restaurant grow to meet the needs of more communities lacking convenient access to healthy and affordable eating alternatives. CoreLife Eatery plans to expand to 300 locations, including both corporate and franchise restaurants, nationwide over the next five years.

SmartBites

The skinny on healthy eating

Nature’s Vitamin Pill:

Nutrient-Rich Acorn Squash

ome foods serve up a little amount of a lot. While no superstar in any one nutrient, these foods boast decent amounts of many. Acorn squash, of all the winter squashes, falls into that commendable category. Of those “many,” however, acorn squash does shine with a few standouts. Though not as rich in beta-carotene (a precursor to vitamin A) as other winter squashes, this nutrient-dense squash is a very good source of vitamin C, potassium and manganese, and a pretty good source of some B vitamins, fiber and magnesium. One cup of acorn squash delivers nearly 25 percent of our daily vitamin C needs. A multi-tasking vitamin (and powerful antioxidant!) that’s essential for good health, vitamin C plays a vital role in collagen production, helps speed wound healing and may even lower our risk of many chronic diseases by inhibiting the activity of cell-damaging free radicals. Another noteworthy perk: Acorn

squash may contribute to heart health, thanks to its potassium and magnesium. While potassium helps to regulate blood pressure by lessening the negative affects of too much sodium, magnesium helps the heart maintain a healthy rhythm. Many studies have found that people with a higher dietary intake of both potassium and magnesium have a lower risk of heart disease and stroke. This dark green squash is a great source of thiamin (B1), an essential vitamin that contributes to healthy nerve and brain cells and helps convert food to energy, and a respectable source of folate, another important B vitamin that helps to reduce birth defects, maintain a healthy heart, and possibly thwart depression. Mellow-tasting acorn squash is low in fat, cholesterol, sodium and calories (about 60 per cubed cup), and offers a modest amount of fiber: 8 percent of our daily needs. As for carbs, acorn squash boasts the good ones—the complex carbs that provide a steady stream of energy because they take longer to digest.

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Roasted Parmesan Acorn Squash Serves 2-4 1 acorn squash, washed 2 tablespoons olive oil 1/4 cup grated Parmesan 1 teaspoon garlic powder 1 teaspoon dried thyme ¼ teaspoon coarse ground pepper ½ teaspoon kosher salt (or, to taste) Preheat oven to 400 degrees. Trim ends from squash. Position squash upright on widest end and cut in half, using a large serrated knife (rind is tough!). Scoop out seeds and slice each half into ½” half moons. In a large bowl, mix together olive oil, cheese, garlic powder, thyme, pepper and salt. Add squash and, using your hands, toss to coat slices with mixture. Lay the squash out on a baking sheet and bake for 30 minutes. Serve immediately.

Helpful tips

Choose squash with a dull, dark green rind: a shiny rind means it was picked too early (will taste less sweet) and an orange rind means the squash is overripe (will be tough and fibrous). Store in a cool, dry place for up to a month. Squash that has been cut or cooked may last up to two weeks in the refrigerator. To maximize its nutritional benefits, steam or bake acorn squash to prevent the nutrients from being lost in the cooking water.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 13

Cancer Ways Mobile Mammography Helps Prevent Breast Cancer By Ernst Lamothe Jr.

arriers to healthcare exist nationwide. Whether those are obstacle within the healthcare industry or issues individuals place on themselves, it can often produce dire circumstances. However, once those barriers are eliminated on both sides, access to healthcare becomes simpler. “We need to continue to raise awareness for breast cancer and remove any obstacles women may have to being screened for breast cancer,” said Katherine Rogala, vice president of women’s health at Rochester Regional Health. “We want to make it convenient and as easy as possible for women to make and keep their appointments.” Through a $4 million multiyear grant from the state, Rochester Regional operates a mobile mammography coach that travels to provide easier access to breast cancer screenings. The custom built coach features two private changing areas, a reception area and state-ofthe art 3-D imaging equipment. The program started in August across eight Upstate New York counties, including Monroe, Ontario, Wayne, Cayuga, Seneca, Yates, Steuben and Livingston counties. Among United States women last year, there were an estimated 252,710 new cases of invasive breast cancer,

according to the American Cancer Society. While breast cancer incidence rates are highest in white women, breast cancer death rates are highest in African American women. Here are five ways the mobile mammography program helps women in need

Removing accommodation barriers Women are busy with work and other commitments. Scheduling a mammography is far from convenient. Women either have to worry about lack of extended weekend hours or figuring out how to make their scheduled appointment around their workday. Oftentimes between the drive to the appointment, sitting in the waiting room and the examination, several hours pass by. And not everyone can afford or has the time to take a half day of work for an appointment so their options remain losing a valuable day worth of income or holding on to their money and possibly sacrificing a needed check-up. “With our mobile mammography center, instead of taking hours out of your day for an appointment, we can come to a company’s workplace and the whole process from registration to getting back to your desk

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would take less than 30 minutes,” said Rogala. “If a woman is making minimum wage she may not be able to afford taking time off for a screening.”

Removing travel barriers Even if you have the time to schedule a screening, there remain possible hurdles to get to your appointment. Depending where you live, especially in rural areas, it may not be easy and may take too long to get to a medical campus. “By taking our mobile mammography center to women where they live, we are addressing some of the challenges of travel and public transportation to getting to their appointment,” said Rogala. “Not every community offers convenient access to care close to home. In Wayne County, a woman might have to travel over 30 miles to get a medical campus and that can be a prohibitive barrier for a screening.”

Removing any thoughts of a lesser experience Sometimes convenience comes at a price. You can’t order gourmet fast food. However, the mobile mammography center is an exception. Bringing healthcare to your doorstep

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

Katherine Rogala, vice president of women’s health at Rochester Regional Health won’t affect the quality of the service. “The quality of care and level of service is no different in the mobile mammography center than a breast imaging center on a medical campus. We have the same expert team of professionals you would find at any of our breast imaging centers,” said Rogala. “Women are receiving the same overall high quality experience.” Patients receive the results of their screenings between 24 to 48 hours if they sign up for Rochester Regional Health’s patient portal online. Otherwise, a woman will receive the results in the mail. Any follow up that is required is done by a phone call.

Removing financial barriers Under the state’s insurance law, health insurers are now required to provide medically necessary coverage for tomosynthesis or 3-D mammography screenings without co-pays, coinsurance or deductibles. The screening is more effective at detecting cancer in dense breast tissue, which is common in women of color. An added benefit of the grant is that women who are not insured or underinsured can receive free mammography screenings. “We have an established relationship with the New York Cancer Services Program which will cover the cost of a mammogram,” she said. “What we are trying to do is make sure that there are no cost barriers that deter women from getting their mammogram and obtaining follow up care after the screening if needed.”

Removing lack of knowledge barriers While the pink ribbon has become the universal symbol throughout October, women are still dying from breast cancer due to lack of early detection. Medical experts believe it is essential to remain steadfast about education. “We can’t stop educating women about breast cancer and empowering them to take the best care of themselves,” said Rogala. “The importance of early detection saving lives cannot be understated.”

Cancer Advances Rely on U.S. Funding: Report

lmost two dozen new cancer treatments received U.S. Food and Drug Administration approval in the past year, a new report reveals. These treatments include innovative immunotherapies that target cancer cells (called CAR T-cell therapies) and targeted radiotherapies, according to the report from the American Association for Cancer Research (AACR). Government-funded research is helping scientists find new ways to prevent, detect, diagnose and treat

cancer, the association reported. “The unprecedented progress we are making against cancer has been made possible largely through basic research,” said physician Elizabeth Jaffee, president of the AACR. Now, a continued increase in federal funding is necessary to make major headway moving forward, she added in an association news release. According to the report, the fight against cancer to date has scored impressive wins: • Adult deaths from cancer declined 26 percent from 1991 to 2015.

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That’s nearly 2.4 million lives saved. • Public education and policy initiatives have reduced the smoking rate to 14 percent among U.S. adults, from 42 percent in 1965. However, cancer still poses enormous public health challenges, the report stressed. New cancer cases in the United States are expected to increase from more than 1.7 million in 2018 to nearly 2.4 million in 2035. The increase is due largely to an aging population. More than 600,000 Americans are expected to die from cancer this year alone. In addition, although the HPV (human papillomavirus) vaccine could prevent nearly all cases of cervical cancer and many cases of oral and anal cancer, less than half of U.S. teens aged 13 to 17

have had the recommended number of vaccinations. And another serious concern: Advances in the fight against cancer have not affected everyone equally. Disparities in medical care still persist. The increasing cancer burden highlights the need for continued cancer research to develop new approaches to prevention and treatment. The report calls for Congress to increase funding to the U.S. National Institutes of Health (NIH), the FDA and the U.S. Centers for Disease Control and Prevention’s cancer prevention and control programs. Specifically, it urges Congress to add at least $2 billion in funding to the NIH in 2019, for a total of at least $39.1 billion.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 15

Cancer

CURE Helps Pediatric Cancer Patients, Families By Deborah Jeanne Sergeant

hildren with cancer and their families need more than a competent medical team. They could also use some support and understanding. That’s where CURE Childhood Cancer Association comes in. The Rochester-based organization was founded in 1976 to offer peer-to-peer emotional support and education for the entire family and financial assistance. The organization also financially supports research on cancer cures. “What we do is incredibly important but we’re behind the scenes,” said Holly Dutcher, executive director. “CURE” stands for counseling, understanding, research/resources and education. The organization supports young patients with cancer or chronic blood diseases and their families. “The mentality of our organization is to advocate and care for the parents as much as we can so they can better take care of their child and focus on their child as much as they can so their child can get better,” Dutcher said. Supportive gestures include gas cards and parking permits for par-

ents making many trips to the hospital or grocery store gift cards, rent assistance or covering utility bills to lighten their financial burden. “A family called us last fall when their hot water tank blew,” Dutcher said. “It was a single parent who was taking family medical leave to care for their child.” Another family ran out of fuel oil for heat in the middle of the winter and CURE covered the cost for more oil. The organization’s support groups help parents feel that others understand what they’re going through. Special events such as Parents’ Night Out allows parents to take a break, yet still feel supported by others who understand what they’re going through. “It’s a fun outing and a place for parents and caregivers to relax,” Dutcher said. “It gets parents out of the house and connected with other parents. Parents really enjoy it and appreciate it. At the end of the activity, they start talking. It’s like an informal support group.” The group has gone kayaking, experienced The Great Escape Room, and joined haunted hayrides. CURE supports the patients directly in several ways. The orga-

By Carol Kreider

Page 16

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Started in the mid-1980s, CURE’s parent advocate program has been replicated nationwide. CURE also sponsors families during the holiday season by collecting wish lists for the entire family and trying to buy or receive a donation of the items on the lists. Recipients include oncology and sickle cell patient families and recently bereaved families. “Some of these families are so busy that shopping and purchasing gifts, as much of a joy as it is to them, is incredibly time consuming,” Dutcher said. “They may not have the time or money.” The organization operates thanks to donations, fundraisers and grants. From the CURE website (https://curekidscancer.com): Worldwide, every three minutes a child is diagnosed with cancer. In the United States, one in five children diagnosed will not survive. Of those who survive, two out of three will suffer long term effects from treatment.

Going Vegetarian to Cut Colon Cancer Risk

Women’s Health: Cancer Awareness earing a diagnosis of cancer is a devastating occurrence to the patient as well as to the family support system. It is not just enough to educate the public about the signs and symptoms of cancer, the associated risk of developing metastatic disease or the treatment options available. A cancer diagnosis should include a review of survivorship within a comprehensive multidisciplinary team. The multidisciplinary team should include the patient, support system (if available), the primary care provider, oncologist/hematologist, and a mental health expert. The long-term effects of treatment include the physical course of drug therapy on the body along with psychological and psychosocial implications of surviving a cancer diagnosis. The health care team should consider what survivorship means to the patient. Cancer survivorship focuses on the person living with, being treated for or surviving cancer. It challenges the person’s perception of life with or following a cancer diagnosis and how to address changes that may occur physically, emotionally, and psychologically. In order to fully address a comprehensive approach to health maintenance, one must explore what survivorship means to the individual

nization helps meet the educational needs of children who feel well enough to do some school work at home but cannot attend school because of a weakened immune system or the rigors of a school day. Instead of allowing the children to fall behind, CURE works with the school to develop ways the children can keep up with their studies, such as tutoring. Dutcher said that not all schools automatically extend these opportunities to sick children. CURE has two parent advocates working at Golisano Children’s Hospital who are parents of long-term cancer survivors who help guide parents through their family’s cancer journey. “They connect families with each other and with other organizations in the community,” Dutcher said. “They’re there to listen to parents as they go through some of the hardest days of their lives. It’s nice to have a peer.”

and provide the necessary tools or resources to assist with transitioning care before, during, and after a cancer diagnosis. Women’s cancer survivorship is unique since in many families the woman is the primary caregiver. It becomes a challenge in addressing the role reversal when a woman has been diagnosed with cancer. She may experience a loss of sexual identity as a partner within a relationship, worry constantly about how a cancer diagnosis will impact the life of a loved one, and the financial repercussions of surviving or living with a cancer diagnosis. The primary goals of asserting a survivorship care plan and referencing associated guidelines, is to assure that once cancer treatment has stopped, the patient continues follow-up care. Carol Kreider is a family medicine nurse practitioner at Oak Orchard Health in Brockport.

here’s no disputing the fact that regular colonoscopies, now suggested to start at age 45 for those with an average risk of colorectal cancer, can help prevent the disease by finding — and removing — precancerous growths. And a study of 77,000 adults published in JAMA Internal Medicine found that you can also lower your risk of this cancer by making changes in your diet right now, whatever your age. Doctors know that eating red and processed meats raises the risk of colorectal cancer, while eating fiber-rich foods lowers it. The JAMA findings got more specific about different types of diets. On average, eating vegetarian may lower colon cancer risk by 19 percent and rectal cancer by 29 percent compared to non-vegetarians — people who eat meat at least once a week. Besides eating less meat, the vegetarians in the study ate fewer sweets, snacks, refined grains and high-calorie beverages and more fruits, vegetables, whole grains, beans and nuts. However, the protective effects vary with the type of vegetarian diet, the researchers said. By the study’s numbers:

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

• Pesco-vegetarians: Eating fish and seafood, but avoiding other meats lowers colorectal cancer risk by 43 percent. • Lacto-ovo vegetarians: Avoiding meat, but eating eggs and/or dairy products lowers colorectal cancer risk by 18 percent. • Vegans: Avoiding all meat, eggs and dairy lowers colorectal cancer risk by 16 percent. • Semi-vegetarians: Eating meat less than once a week lowers colorectal cancer risk by 8 percent. Research can’t yet explain exactly how eating vegetarian helps. But one theory says it could be because vegetarians often follow other healthy behaviors, such as exercising and not smoking, which also reduce cancer risk.

Meet Your Provider

Eye Doctor George Kornfeld Focuses on Low Vision Dr. George Kornfeld, a low vision optometrist, received a bachelor’s degree in psychology from Yeshiva University and graduated from The Pennsylvania College of Optometry in 1971. He is a fellow of the American Academy of Optometry and a member of its low vision section. He is also a member of the International Academy of Low Vision Specialists (IALVS), a group striving to enable low vision patients to access the optical and digital technology that will transform their lives. Dr. Kornfeld is passionate about low vision care and making a difference for his patients. He sees patients in Rochester, Syracuse, Buffalo, Niagara Falls, Elmira, Watertown, and Scranton Pa. Dr. Kornfeld trained with Dr. William Feinbloom, a founder of modern day low vision and the inventor of many of the low vision telescopes and microscopes used today.

What is Low Vision? — Low vision is caused by eye disease, genetics, trauma or other events,

where fully corrected vision with conventional glasses, contact lenses or refractive surgery, remains insufficient to do what the patient wants to do. Dr. Kornfeld considers low vision starting at 20/40 and worse when one can’t see well enough to do the tasks one wants to do even with the best glasses (contacts or refractive surgery). That is sufficient reason to seek the help of a low vision specialist.

What causes low vision? — Medical conditions causing low vision are age-related macular degeneration (ARMD) both wet and dry, inoperable cataracts, diabetic retinopathy, and glaucoma. Genetic conditions causing low vision are retinitis pigmentosa, albinism, Stargardt’s disease (a juvenile form of macular degeneration), and retinopathy of prematurity (ROP).Traumatic causes of low vision are stroke and traumatic brain injury. What is a low vision evaluation? —Dr. Kornfeld

determines what the eye condition

is and how the patient uses his eyes. What are his goals? The idea is to help the person achieve those goals. Dr. Kornfeld demonstrates how patients can see with the use of telescopes, microscopes, special reading glasses and other low vision aids.

Can a person with low vision drive? — A person with low vision

and visual acuity between 20/40 and 20/70 with a 140 degree field of vision has the potential for driving. And vision between 20/70 and 20/100 with a 140 degree field while looking straight ahead and also 20/40 while looking through a superiorly placed telescope mounted in the glasses also has the potential for receiving a telescopic driver’s license. This can help a person maintain his or her independence. A low vision evaluation may help to determine if it is a possibility.

Dr. George Kornfeld, a low vision optometrist in Rochester.

is to enhance patients’ vision and help them gain confidence in themselves, do the activities they want to do, and to help them maintain their independence. Dr. Kornfeld strives to make patients’ vision better, not perfect. “Working in the field of low vision has made my professional life most rewarding Goals — Some of the most as I watch my patients who have poor and important goals of low vision patients compromised eyesight begin to read again, are to read, watch television, recognize walk around more confidently, drive cars faces, play cards, play music and drive and trucks, and in general get a new lease a vehicle. One of Dr. Kornfeld’s goals on life,” says Dr. Kornfeld.

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Women’s Health

App for Preventing Pregnancy Gets FDA Approval. Is It Reliable?

smartphone app for preventing pregnancy has just become the first of its kind to receive marketing approval from the U.S. Food and Drug Administration (FDA), but some experts are wary. The app, called Natural Cycles, is essentially a high-tech version of the so-called rhythm method, also known as fertility awareness. It uses an algorithm to calculate the days of the month when a woman is most

likely to be fertile and tells a woman to abstain from sex or to use protection (such as condoms) on these days. The app requires that women take their temperature every morning, using a sensitive thermometer called a basal body thermometer, and enter the measurement into the app. These thermometers — which are provided to women who sign up for a yearly subscription to the app

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What is Sleep Apnea? Sleep Apnea is the temporary stoppage of breathing during sleep. There are three types of apnea: obstructive, central and mixed; of the three, obstructive is the most common. People with untreated sleep apnea stop breathing repeatedly during the night, maybe hundreds of times.

Sleep Disorder Symptoms

If you experience any of the following symptoms, you may suffer from a sleep disorder: • Daytime fatigue • Morning drowsiness • Insomnia • Gasping for breath in the middle of the night • Snoring You don’t have to face hearing loss alone. The Rochester Chapter of the Hearing Loss Association of America (HLAA) unites people with all degrees of hearing loss. Come to one of our monthly chapter meetings to meet others with hearing loss and learn from the professionals who treat it. Visit our website for details: HearingLossRochester.org

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— can detect slight increases in body temperature around the time of ovulation. This data, along with information about a woman’s menstrual cycle and factors such as how long sperm can survive in the woman’s reproductive tract, is used to determine whether a woman is fertile, Natural Cycles says. (Typically, a woman can get pregnant on only about four or five days each month, according to the FDA). “Consumers are increasingly using digital health technologies to inform their everyday health decisions, and this new app can provide an effective method of contraception if it’s used carefully and correctly,” physician Terri Cornelison, assistant director for the health of women in the FDA’s Center for Devices and Radiological Health, said in a statement released Aug. 10. “But women should know that no form of contraception works perfectly, so an unplanned pregnancy could still result from correct usage of this device.” Outside experts, however, are wary of using an app for pregnancy prevention. “I don’t feel that it can reliably take the place of [other] contraceptive method[s],” said Taraneh Shirazian, a gynecologist at NYU Langone Health. “I wouldn’t encourage women to rush and use this app” until more research has been done on it, she said. The company has done its own studies involving 15,570 women who used the app for an average of eight months, according to the FDA statement. If women used the app perfectly, meaning exactly as directed, about two in 100 women would get pregnant over the course of a year, the studies found. However, during a year of “typical use,” which accounts for women sometimes not using the app as directed (for example, by having unprotected sex on a “fertile day”), about seven in 100 women would get pregnant. That would mean Natural Cycles is about as effective as birth control pills, which have a 9 percent failure rate during a year of typical use, according to the Centers for Disease Control and Prevention (CDC). And it would mean that the app is more effective than traditional fertility-awareness-based methods (such as basal-body-temperature monitoring without an app, or the calendar method), which have a failure rate of around 24 percent.

Women’s Health

Sports Concussions: Much Worse for Women Heading the ball accounts for 25 percent of concussions among female soccer players By Deborah Jeanne Sergeant

he injury caused by concussion appears to be worse for women than for men, according to research presented in the July journal Radiology. While part of the phenomenon may include women’s general willingness to discuss medical issues and a better ability to accurately describe their physical condition, non-subjective measures also correlate. MRI scans used in the study show greater damage among female soccer players who “head” the ball than males. Heading the ball accounts for 25 to 30 percent of concussions among female and male soccer players, respectively. Jim Grant, performance enhancement specialist and head athletic trainer at St. John Fisher College, said the reason women’s outcomes are

worse than men’s is “the million dollar question.” He added that “it’s certainly something we see here. Women tend to take a little longer to get better from concussions.” Grant said that some research points to the difference between male and female neck strength. A stronger neck can absorb more of the force of the blow to the head than a weaker neck. Other research points to a hormonal effect, as women who are menstruating may experience concussion differently than women who aren’t, he added. Following a strict return-to-play policy after a concussion is vital to minimize the risk of lasting damage. At St. John Fisher, athletes receive a baseline test before playing so that if they suffer a concussion, they can compare their steps of recovery to their baseline reading. Those recovering from concussion must meet with a trainer from the athletic department daily for further testing on factors such as balance. Another app tests for baselines and later tests visual and verbal memory and reaction time. Trainers can also test athletes on the sideline right after a hard hit. “If they’re not at their baseline, there’s probably something going on,” Grant said. In addition, knowing the students

well can help coaches and trainers recognize when players are hurt and when they’re not. Most back-to-play plans gradually return players with sufficient rest followed by incrementally increasing activity levels. If players regress and exhibit symptoms, they may have to repeat a step. At St. John Fisher, a sports medicine doctor visits weekly and can help monitor players. If the player hasn’t fully recovered after two weeks, he may need to see a doctor. Most players injured by concussion recover within that timeframe. “What I feel is important is we’re pretty adamant about kids seeing us daily so we know where they stand,” Grant said. “For high school athletes, it’s important for the parents to speak to their kids daily and see what type of symptoms they’re having.” Grant said that a few years ago, a player said he felt like he was going to faint at the beginning of a practice. He had sustained a concussion, hid it and continue playing. He later played another game. By the time he started the next practice, “he could hardly stand up,” Grant said. “He had to go home and rest. Prolonging it can make it worse. Sudden impact syndrome happens, where kids have one injury on top of another.” That can result in symptoms that last for many weeks and even permanent damage. Mike Conroy, head athletic trainer at Nazareth College, said that the school provides to athletes annual education on concussion signs and symptoms. “The more aware they are, and the better educated the parents and students are, the better they can advocate for themselves,” he said. He recommended the app Impact

for creating a baseline and measuring the effects of a hit. “In the world of concussions, everyone’s brain reacts differently to concussions,” Conroy said. Nazareth, like St. John Fisher and many schools, uses a step-by-step return to play protocol to help keep injured athletes safer. “They must get back to the baseline before they can participate,” Conroy said. Todd Nelson, assistant director of the New York State High School Athletic Association in Latham, encourages parents to help their young athletes to reduce their risk. “If they can get with a strength conditioner, they may be able to strengthen their neck muscles,” Nelson said. “That may help reduce risk of a potential head injury.” He said that’s also important to play by the rules and regulations of the particular sport and to use the safety equipment properly. “In soccer, a lot of players during practice won’t wear shin guards that are required during competition,” Nelson said. “We expect students to wear gear during practice.” If there’s a hard hit, the officiate should stop play and remove the injured player. Athletes, coaches and officiates should understand the signs and symptoms of concussion and what happens when they don’t report concussions and try to keep playing while injured. “Unfortunately to high school athletes, that’s a detriment that they go back before fully healed,” Nelson said. The National Federation of High Schools offers a free concussion management course to students at www. NFHSlearn.com.

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Women’s Health

How Food Can Affect UTIs By Deborah Jeanne Sergeant

f you frequently suffer from urinary tract infections, consider your diet. It can make a difference. To better support urinary tract health, consider making a few dietary changes. Marge Pickering Picone, a certified nutrition consultant, is CEO of Professional Nutrition Services of Rochester, Inc. She asks clients who experience UTIs about their diet, particularly alcohol and starchy carbs such as white flour and sugar. Picone She said that supplements containing L-cysteine and amino acids can help “calm down bacteria in mucus membrane.” She also reminds clients that high stress can change the flora in the gut and make the body more hospitable to bacteria. It can also increase acidity levels of the body. Drinking more water and cutting back on wine can make a big difference in reducing UTIs. “Bodies don’t process things as well when we age, so your body is handling a lot more glucose in the

body,” Pickering Picone said. “The muscles aren’t as strong so they don’t store as much glucose in their muscles. It’s the whole body itself are changing. It’s not just the diet.” Cindy Fiege owns and operates Harmony Health Store in Spencerport, said it’s important to avoid irritants to the bladder, including caffeine, alcohol and spicy foods and sugar, to reduce the risk of UTIs. And what about the home remedy of cranberry juice? Fiege said that cranberry juice cocktail contains added sugar, an ingredient that feeds bacteria. Those with an artificial sugar substitute may irritate. A serving of a cranberry drink that contain a blend of apple and cranberry juices without any sugar represent the best option for cranberry juice. “You can also buy cranberry supplements,” Fiege said. They are said to make it difficult for bacteria to stick to the lining of the urinary tract. Adding whole cranberries (not the jellied kind eaten at Thanksgiving) to smoothies or other foods can also help. Barb Goshorn, a registered nurse with a master’s degree in applied clinical nutrition who works at Goshorn Wellness in Webster, said that consumption of water is important to fight UTI.

“You should hydrate while you have a UTI,” she said. “You want to flush out the system. Water will reduce the bacterial count in the urine.” She said that it’s also important to supplement with acidophilus to support digestive and urinary tract health, as this boost the immune system and can prevent the colonization of bacteria. Fermented foods like plain yogurt and kefir contain this good bacteria. “Onion and garlic have sulfuric properties,” Goshorn Goshorn said. “There’s a tremendous amount of research about the effects of these on digestive health.” She also said that flax seed can soothe the lining of the urinary tract. It’s also important to pay more careful attention to hygiene, such as avoiding powder in the underwear

or douching. “Wipe from front to back, not the other way,” Goshorn said. Loose styles of cotton underwear allow better air circulation. People prone to UTIs should also remove damp clothing after exercise or swimming, as these can promote irritation and infection. “Don’t hold your urine,” Goshorn added. “We get busy and try to hold it, but when you have to go, go.” She recommends seeking the advice of a health care provider for anyone who suspects a urinary tract infection, since the infection can affect the bladder and kidneys if not treated promptly with antibiotics. Symptoms include increased urine frequency, burning, and possibly blood. “The older population might not have those symptoms,” Goshorn said. “They might have mental changes that are similar to dementia, but are very sudden. Or cloudy urine that has a foul smell. They should definitely have a check for UTI.”

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Vaginal Rejuvenation: FDA Cautions About Elective Procedures

Stair Lift

By Deborah Jeanne Sergeant

hildbirth, menopause and the passage of time can affect both the appearance and function of women’s vaginal tissues. For some, dryness and lax tissue make intercourse less pleasurable and even painful. Some health care providers, including gynecologists, dermatologists and plastic surgeons, now offer non-surgical treatments to restore both vaginal moisture and tightness. In July, the FDA issued a cautionary statement about providers using energy-based devices for elective vaginal procedures. The FDA statement read that “the safety and effectiveness of energy-based devices for treatment of these conditions has not been established” and that “non-surgical vaginal procedures to treat symptoms related to menopause, urinary incontinence, or sexual function may be associated with serious adverse events.” The FDA has approved energy-based devices — radiofrequency or laser — for dermatological and general purposes, including removal of genital warts, growths or pre-cancerous tissue. The FDA has not specifically approved some of these devices for vaginal procedures. It states that using the devices for cosmetic reasons may cause “vaginal burns, scarring, pain during sexual intercourse, and recurring/chronic pain.” Robert A. Jason, board-certified gynecologist and cosmetic gynecologist, believes that the FDA statement has caused a great deal of confusion, though there’s merit in warning women to approach vaginal rejuvenation carefully. “They should go to a gynecologist who understands the benefits and pros and cons of non-invasive vaginal rejuvenation equipment,” Jason said. Jason serves as medical director and owns the Laser Vaginal Rejuvenation Institute of New York, in Jason New York City and Lake Success on Long Island. He said that vaginal rejuvenation should be overseen by a gynecologist or cosmetic gynecologist physician in charge. Patients should also maintain realistic expectations. Women seeking tighter tissue, for example, should understand that non-invasive procedures may not offer the tightness they want. Jason said that he and other gynecologists use certain lasers or radiofrequency devices as a scalpel or knife. He added that there are also other lasers and radiofrequency devices on the market that are used as non-invasive, non-surgical devices that gynecologic and non-gynecological physicians use for non-invasive

vaginal rejuvenation. “That is the confusing part,” Jason said. “After careful examination, if the right candidate uses non-invasive procedures, myself as well as many colleagues across the country have had excellent results, over 90 percent success rates. “The problem is that when women need more involved surgical repairs, their expectations were not met and that non-invasive procedures done by offices not well-versed in vaginal health can have less than desired or harmful results.” He said that many women had procedures that were not appropriate for them and were hurt, prompting the FDA’s warning. “To truly put this in prospective, laser hair removal in the wrong person’s hands can cause burns and harmful results also,” Jason added. David Gandell, clinical professor of OB-GYN practicing at Rochester Gynecologic & Obstetric Association, PC, uses MonaLisa Touch for what he likes to call “vagina revitalization, which is restoring some of the qualities which have changed from chemotherapy, radiation or menopause,” he said. The MonaLisa Touch website describes the treatment as “a vaginal probe is inserted into the patient’s vagina, and delivers gentle laser energy to the vaginal wall, stimulating a healing response.” Gandell said revitalization stimulates blood supply to the tissue to improve moisture and improve the quality of the tissue without damaging it. Patients may return to normal activities immediately and sex within two or three days. Gandell views MonaLisa Touch as an option for women who can’t or won’t use hormone replacement or medication to resolve these issues. The protocol is three treatments, scheduled six weeks apart. Each treatment takes five minutes. Gandell said that the effect is similar to that of vaginal estrogen for post-menopausal women. The effects last on average a year to 18 months. Re-treatment should last another year. The procedure is contraindicated for women with undiagnosed vaginal bleeding, presence of a mesh in the vaginal wall, complete prolapse, or any active infection. He also wants women to realize that not all genital conditions may be fixed by surgery, laser treatment or hormonal therapy. Gandell said that women may experience mild irritation that lasts a few hours to a few days and a little spotting. “I’ve had patients who’d been unable to have intercourse 10 years who are now are satisfyingly sexually active again,” Gandell said. “I’ve seen it work beautifully for couples.”

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St. Joseph’s Neighborhood Center at 417 South Ave. in Rochester serves more than 3,000 patients and performs over 22,000 visits each year at a cost of only $10 per visit.

Meeting the Needs of the Uninsured in Rochester By Ronni Ehlers, Sara Roback and Christine Birnie

espite government efforts to provide health care insurance to all, 8.8 percent of people nationwide are still uninsured, according to Census data published in January. Rochester, and Monroe County as a whole, are no exception. Government estimates in 2017 showed that Monroe County had almost 37,000 uninsured people under the age of 65, with over half of those individuals (19,000) living in the city of Rochester. St. Joseph’s Neighborhood Center provides comprehensive physical and mental health services to the underserved in Rochester. Located at 417 South Ave., in the South Wedge of the city of Rochester, the center is in a prime location to help community members who are at the highest Page 22

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risk of being underinsured. The center’s integrated and comprehensive care model provides the ability to serve a wide variety of patients who range from underinsured, uninsured or uninsurable. To meet the needs of this population, the center has grown to include a vast array of services. Patients have access to specialties such as primary care, dentistry, massage therapy, chiropractic services, acupuncture, ophthalmology, mental health and counseling services, among others. This allows the center to be a truly integrated and comprehensive healthcare center. As pharmacy students, we came to the center for a six-week clinical rotation prepared to use our clinical pharmacy skills and knowledge to

serve a local population in need. We were quickly integrated into the center’s multicultural, interdisciplinary team. The center, which is composed of paid staff and more than 250 volunteers from both medical and non-medical backgrounds, serves more than 3,000 patients and performs more than 22,000 visits each year at a cost of only $10 per visit. As pharmacy volunteers, we have engaged in many levels of patient care including counseling patients on medications, reviewing patient medical history and creating patient specific care plans with the medical providers. We have been able to use our knowledge of pharmacy to impact the lives of the patients at the center while developing our own professional skills. In one interaction, we were able to apply our patient care skills to improve a patient’s quality of life. We spoke with a patient who is frequently treated at the center for his uncontrolled asthma. Due to financial constraints, the patient was using a long-term asthma control inhaler only when he was experi-

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

encing symptoms. We were able to help the patient understand the importance of using this type of medication every day in order to better control his asthma. We also supplied him with more of this maintenance inhaler to help alleviate some of the cost burden. Recognizing both the socioeconomic barriers and individual therapeutic needs of this patient, we were able to provide him the access to care that he required. St. Joseph’s Neighborhood Center truly meets the needs of patients in the Rochester region. Providing holistic, comprehensive care, the center provides patient care for a population who would be left with limited access to health care if were not for the center. Our experiences at the center have taught us to be more sensitive to the socioeconomic needs and barriers to care that patients experience. This has emphasized the importance of practicing holistic health care. As young professionals, our experiences at St. Joseph’s Neighborhood Center have impacted the way we will practice pharmacy in the future. If you are interested in helping to meet the needs of the uninsured in the Rochester region, St. Joseph’s Neighborhood Center is always looking for volunteers. Both medical or non-medical volunteers are welcome. The center also needs donations of physical items that are used on a day-to-day basis. A complete list of the current needs is listed on the center’s website at: www.sjncenter. org/wish-list For more information, please visit www.sjncenter.org, call 585-3255260 or send an email to Volunteer Coordinator Mary Jo Albert at mjalbert@sjncenter.org. Ronni Ehlers and Sara Roback are both final-year pharmacy students at Wegmans School of Pharmacy at St John Fisher College, who have participated in the service learning clinical rotation at St. Joseph’s Neighborhood Center. Christine Birnie, registered pharmacist (RP.h.), PhD is the dean of the Wegmans School of Pharmacy and served as the preceptor for the service learning rotation.

By Jim Miller

Dear Savvy Senior, I’ve been reading that there are a bunch of different flu vaccines for seniors this flu season. Which flu shot is right for me?

Flu-Conscious Carol Dear Carol, It wasn’t that long ago that if you wanted to get protected from the flu, you simply got a flu shot. But now days, there are so many flu vaccine options you might feel like you are ordering off a menu. To help you decide which flu shot is right for you, you need to consider your health, age and personal preferences. Here’s what you should know. Flu Shot Options Just as they do every year, the Centers for Disease Control and Prevention (CDC) recommends a seasonal flu shot to everyone 6 months of age and older, but it’s especially important for seniors who are at higher risk of developing serious flu-related complications. The flu puts more than 200,000 people in the hospital each year and kills an average of 24,000 — 80 to 90 percent of whom are seniors. Here’s the rundown of the different vaccine options. You will only need to get one of these: Standard flu vaccines: If you want to keep things basic, you can’t go wrong with a “standard (trivalent) flu shot,” which has been around for more than 40 years and protects against three different strains of flu viruses. This year’s version protects against two A strains (H1N1 and H3N2), and one influenza B virus. Or, for additional protection, you should consider the “quadrivalent flu vaccine” that protects against four types of influenza — the same three strains as the standard trivalent flu shot, plus an additional B-strain virus. Senior specific vaccines: If you’re age 65 or older and want some extra protection, you should consider the “Fluzone High-Dose” or “FLUAD.” The Fluzone High-Dose has four times the amount of antigen as a regular flu shot does, while the FLUAD contains an added ingredient

called adjuvant MF59. Both vaccines provide a stronger immune response for better protection. Egg allergy vaccines: If you’re allergic to eggs, your flu shot options are “Flucelvax” or “FluBlok.” Neither of these vaccines uses chicken eggs in their manufacturing process. Fear-of-needle vaccines: If you don’t like needles, and you’re between the ages of 18 and 64, your options are the “Fluzone Intradermal” or “AFLURIA” vaccine. The Fluzone intradermal flu shot uses a tiny 1/16-inch long micro-needle to inject the vaccine just under the skin, rather than deeper in the muscle like standard flu shot. While the AFLURIA vaccine is administered by a jet injector, which is a medical device that uses a high-pressure, narrow stream of fluid to penetrate the skin instead of a needle. You should also know that if you’re a Medicare beneficiary, Part B covers all flu vaccinations, but if you have private health insurance, you’ll need to check with your plan to see which vaccines they do or don’t cover.

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Which Flu Shot Is Right for You?

Wendi’s dad was getting to a point where he needed more care than she and her mom could provide. “It reached a point with my dad that we were unable to take care of him at home.” For Wendi, moving her dad out of his house was one of hardest things she ever had to do. Hurlbut™ Care Communities made her father’s transition easier. And Wendi’s mom has even made friends with the staff. “I’m at peace now because I know how well he’s taken care of.”

To learn more, visit HurlbutCare.com

Pneumonia Vaccines Two other important vaccinations the CDC recommends to seniors, especially this time of year, are the pneumococcal vaccines for pneumonia. Around 1 million Americans are hospitalized with pneumonia each year, and about 50,000 people die from it. The CDC recommends that all seniors, 65 or older, get two vaccinations — Prevnar 13 and Pneumovax 23. Both vaccines, which are administered just once at different times, work in different ways to provide maximum protection. If you haven’t yet received any pneumococcal vaccine you should get the Prevnar 13 first, followed by Pneumovax 23 six to 12 months later. Medicare Part B covers both shots, if they are taken at least one year apart. To locate a vaccination site that offers both flu and pneumonia shots, visit Vaccines.gov and type in your ZIP code. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book. October 2018 •

Age 3:

Despite my being camera shy, Dad loved taking my picture.

Age 19:

Age 16:

Dad patiently taught me how to drive a stick shift.

Dad walked me down the aisle.

Age 64:

So happy to be there for Dad as he moved to his own new apartment!

With maintenance free living in one of our spacious apartments, you'll find you have even more time to enjoy life's special moments.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Ask St. Ann’s

By Christine Freeley

How Can My Pharmacist Help Me Remain Independent?

he phrase “ask your pharmacist” is becoming increasingly common — and with good reason. Today’s pharmacists are an integral part of the healthcare community and are relied upon as an important source of knowledge. Pharmacists can help people stay on track with medications—especially important for seniors and others taking multiple medications. They are an excellent resource for information on any prescription (Rx) and over the counter (OTC) drugs you take. You can count on them to: • Answer questions about medications and proper dosing • Explain side effects that could impair judgment or cause a fall or an accident • Screen for Rx drug interactions, as well as interactions with OTC medicines, herbal supplements, or certain foods • Check for possible allergic reactions • Recommend generic substitutes in place of brand names to make medications affordable Best of all, you don’t need an appointment or insurance to talk to your pharmacist; just stop in or pick up the phone. Here are a few tips from the in-patient pharmacists at St. Ann’s Community on how your pharmacist can help you manage your medications: • Choose one pharmacy. As a regular customer, you’ll get to know the pharmacist and have your entire medication history in one place. With the click of a mouse, your pharmacist can check for and troubleshoot prescription and drug interaction problems and advocate for changes on your behalf with your healthcare provider. • Establish a routine. Refill all your prescriptions at the same time every month to eliminate confusion and to stay on track. Ask your pharmacist about prescription packaging options, such as daily doses in pouches, or electronic pillboxes.

Either tool may make it easier to remember to take your medications as prescribed. • Carry a medication list. Keep the paper in your purse or wallet so you or your family or first responders will find it. Whether you’re at a routine check-up with your doctor or on your way to the emergency room, healthcare providers need to know what you take before prescribing or administering drugs. • Get rid of old medicines. There’s no reason to keep old Rx and OTC drugs in your home; in fact, having them in your medicine cabinet may create confusion. Take old medications to your pharmacist or local police department for proper disposal instead of throwing them in the garbage or down the drain. You’ll help protect the environment and eliminate the risk of other people misusing them. Finally, when you or your loved one needs skilled nursing care, be sure to choose a facility with full-time pharmacists on staff and a full-service pharmacy on site for quick prescription delivery. St. Ann’s Home has both to ensure the health and safety of its residents and provide the best care possible. With so many medications and opportunities for confusion, it’s easy to understand why having a good pharmacist is the prescription everyone needs to stay healthy and independent. Christine Freeley, a registered pharmacist (RPh), is director of pharmacy at St. Ann’s Community in Rochester. Contact her at cfreeley@ MyStAnns.com or 585-697-6450, or visit www. stannscommunity.com.

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(585)-284-3455 Page 24

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Ask The Social

Security Office

From the Social Security District Office

Workers’ Compensation and Certain Disability Payments May Affect Your Social Security Benefits

any people working nowadays have more than one job, so it’s not uncommon for them to have several sources of income. Owning multiple small businesses, seasonal jobs and the gig economy add to the mix — and complexity — of our modern day economy. It’s important to keep in mind that having multiple sources of income can sometimes affect your Social Security benefits. Disability payments from private sources, such as private pensions or insurance benefits, don’t affect your Social Security disability benefits. Workers’ compensation and other public disability benefits, however, may reduce your Social Security benefits. Workers’ compensation benefits are paid to a worker because of a job-related injury or illness. These benefits may be paid by federal or state workers’ compensation agencies, employers or by insurance companies on behalf of employers. Public disability payments that may affect your Social Security benefits are those paid from a federal, state or local government for disabling medical conditions that are not job-related. Examples of these are civil service disability benefits, state temporary disability benefits, and state or local government retirement benefits that are based on disability.

Some public benefits don’t affect your Social Security disability benefits. If you receive Social Security disability benefits, and one of the following types of public benefits, your Social Security benefits will not be reduced: • Veterans Administration benefits; • State and local government benefits, if Social Security taxes were deducted from your earnings; or • Supplemental Security Income (SSI). You can read more about the possible ways your benefits might be reduced at www.socialsecurity.gov/ pubs/EN-05-10018.pdf. Be sure to report changes. If there is a change in the amount of your other disability payment, or if those benefits stop, let us know. Tell us if the amount of your workers’ compensation or public disability payment increases or decreases. Any change in the amount or frequency of these benefits is likely to affect the amount of your Social Security benefits. An unexpected change in benefits can have unintended consequences, but not if you’re informed and have financially prepared yourself. Visit our benefits planner webpage at www.socialsecurity.gov/planners for information about your options for securing your future.

Elders Living in Senior Facilities have rights Elders living in nursing homes and assisted living facilities have legally protected rights. For example, residents and their families may advocate for better care. Facility management may not like such organized advocacy. Running an elder care residence is demanding. To management, resident advocacy might be misunderstood as “ungrateful” or “hostile.” Nonetheless, resident advocates and facility managers can usually resolve concerns through cooperation. Where a resident advocate is particularly vocal, however, management may want to remove the resident from the facility. If the resident is paying for the cost of their own care, this could come in the form of a notice to vacate — and eviction, if the resident refuses to leave. Nursing home residents cannot be removed because they need Medicaid to help to pay for their care — there are other techniques that facilities use to remove “problem” residents. For example, if a facility can no longer meet a resident’s needs, management can require the resident to find a new placement. Sometimes,

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

“we can no longer meet Mrs. Smith’s needs” serves as “shorthand” for “we are tired of complaints about Mrs. Smith’s care.” There are methods of contesting a facility’s decision — but most people just find a new care environment. Facilities sometimes resort to illegal tactics to rid themselves of problematic residents. One such tactic is called “dumping.” There, the facility sends the undesired resident to the emergency department, often based on a minor physical issue like an upset stomach. Management then informs ED staff that the resident cannot return. The resident, now effectively homeless, is stuck in the hospital — placing their family under time and financial pressure to find a new facility. Dumping is illegal. If you or a family member has been victimized, you can fight back. Article submitted by Parker Law Office, which has two offices in Rochester. To learn more, attend an upcoming presentation. Call 585-281-0717 for more information.

H ealth News Canandaigua VA gets $844,415 for pilot program The Canandaigua VA Medical Center has received an $844,415 grant from the Office of Rural Health to provide therapeutic horticulture and agricultural training to veterans interested in agricultural vocations. The grant allows for the expansion of the medical center’s existing community partnership with EquiCenter in Mendon and the development of other community partnerships. Funding will support the participation of 86 veterans in this program which is part of VA’s Whole Health Initiative to provide personalized, proactive patient-driven care to achieve better health care outcomes. Canandaiguas is one of 10 VAs across the country to receive grant monies. Two other VAs in the New York/New Jersey area to receive similar funds are the VA Hudson Valley and VA New Jersey Health Care System.

St. Ann’s has new volunteer services manager St. Ann’s Community, Rochester’s leading senior housing and health services provider, announced the addition Maureen Murphy as manager of volunteer services. A resident of Rochester, Murphy has more than Murphy 20 years of experience in various leadership and volunteer management roles in the nonprofit sector. Most recently she served as executive director of NeighborWorks Rochester. Prior to that she held leadership positions with Habitat for Humanity of Ontario County and Lifespan of Rochester. As manager of volunteer services, Murphy manages a pool of more than 250 volunteers who donate their time and energy to support the residents of St. Ann’s Community. Volunteers serve in a variety of roles such as transporting residents to activities, helping with arts and crafts, running the library, staffing the gift shop, and assisting with pastoral care. “It all adds to the richness of our residents’ lives,” says Murphy. “The volunteer team makes it happen!”

cine in Portsmouth, Dominica, and completed her residency at St. Joseph’s Hospital Health Center in Syracuse. She is board certified in family medicine and has special interests in preventive care, nutrition, sports Rast medicine and continuity of care. Initially she will see patients in both Lima and Thompson’s Honeoye location. Once space allows, she will be working entirely out of the Lima practice for the long term.

Victor Family Practice. Reisinger joined Thompson in 2017. She is a graduate of Emory University School of Medicine in Atlanta who completed her residency at the University of Rochester Medical Center and is trained in both laparoscopic and robotic surgery. Community members are invited to meet Tessa her during a Victor OB-GYN Open House from 5:30 to 7 p.m. on Wednesday, Oct. 10.

UR Medicine Thompson Health Gynecology & Obstetrics now has a new location at 53 W. Main St. in Victor. As a service of F.F. Thompson Hospital, physician Tessa Reisinger is now seeing patients in the new OBGYN suite adjacent to Thompson’s

National Mature Media Awards. The program recognizes the nation’s finest marketing and communications materials designed and produced for older adults. St. Ann’s website —www. stannscommunity.com — received a bronze award in the web-based and

mobile resources category, healthcare division. The website is managed by the marketing department of St. Ann’s Community. The awards are presented by the Mature Market Resource Center, a national clearinghouse for the senior market. Entries were judged by a panel of mature-market experts from across the United States for overall excellence of design, content, creativity and relevance to the senior market.

St. Ann’s website earns Thompson opens OB-GYN national award St. Ann’s Community was location in Victor named a winner in the 27th annual

Rochester Regional Health announces new affiliation

ochester Regional Health (RRH) and St. Lawrence Health System (SLHS) have recently signed a non-binding letter of intent to negotiate an affiliation agreement between the two entities. The signing of the letter of intent means that RRH and SLHS have agreed to work toward a final, definitive agreement to be signed by the end of 2018. Throughout the next few months, both parties will engage in additional due diligence and discussions to work toward a definitive agreement. While any final agreement is subject to customary regulatory and board review and approval, hospital leaders hope to implement the final agreement no later than the fall of 2019. Both RRH and SLHS will keep its stakeholders and community updated as there are developments to share. RRH’s mission is to enhance lives and preserve health by en-

abling access to a comprehensive, fully integrated network of the highest quality and most affordable care. “That mission is an outstanding fit for our communities in the St. Lawrence Valley,” said David Acker, president and CEO of St. Lawrence Health System. “We have always believed that our patients deserve nothing less than leading-edge health care and they should not have to travel far to get it. Partnering with Rochester Regional allows St. Lawrence Health System to continue to elevate the standard of care delivered right here in our communities,” he added. “We are thrilled to be working toward an affiliation with St. Lawrence Health System,” stated Eric Bieber, president and CEO of Rochester Regional Health. “We are committed to working collaboratively with St. Lawrence Health System to preserve and expand the high-quality primary and specialty care that is needed in

the communities that St. Lawrence Health has been serving so well for generations.” In 2017, St. Lawrence Heath System began a process of evaluating potential strategic partnerships that could enhance opportunities and access in its region. “Several potential partners recognized St. Lawrence Health System’s value and shared our vision for elevating the level of care in the St. Lawrence Valley. Board members and executives traveled to potential, qualified partner health systems and evaluated the extent to which a partnership would meet our patients’ needs, fit with our community’s culture and as well as our own mission to provide exceptional health care in Northern New York,” Acker said. “Rochester Regional Health was the clear choice.”

Check us out on Facebook

Lima practice welcomes new physician Physician Katherine I. Rast recently joined UR Medicine Thompson Health and will be based at its Lima Family Practice, 7325 Community Drive in Lima. Rast earned her medical degree at Ross University School of Medi-

Rochester New York’s Healthcare Newspaper October 2018 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 25

New Apps Pay You to Walk

Forget about bitcoins. The new thing now is ‘Sweatcoins’ — the more you walk, the more you earn By Julie Halm

ouldn’t it be nice if someone would pay you just to take a stroll? It turns out the notion is not, in fact, far-fetched at all. There are several apps on the market that claim to do this and as a mom of a young boy with whom I go on walks every day, I thought I’d give one of them a try. Why not make a little cash for something I’m already doing? My initial download was Bitwalking. What attracted me about this particular app was that it claimed to have a global outlook and aimed to “reset the balance of global wealth.” Essentially, users all over the world could generate this cryptocurrency by moving and they would be paid the same no matter where they are. You could also send your currency to other users who perhaps need the funds more. In addition, the program claims that it does not sell your data and doesn’t have advertisements. It seemed like a pretty good deal. Unfortunately, I had trouble downloading the app and getting the access code to my account. Once I was in, I couldn’t find a clear answer as to how to redeem my cryptocurrency for anything and a Google search didn’t turn up any useful answers either. Frustrated, I quickly deleted it from my phone. I went on the hunt for another app to download and came across Sweatcoin. The Pros Sweatcoin does not pay you in dollars and cents. Instead, you accrue cryptocurrency by the same name as the app. According to the fine print of the program, 1,000 steps will get you one Sweatcoin, minus a 5 percent commission. I found that while I had my phone in my pocket, the tracked steps were nearly identical to what Page 26

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my Garmin Vivofit was counting. Once it converted, however, I found that I sometimes lost some of my steps. Different settings on your phone can affect this conversion and only outdoor steps count toward your Sweatcoin bank, but we’ll come back to those topics in a moment. On the basic account, you can earn up to five Sweatcoins per day. For a fee of 20 Sweatcoins a month, you can upgrade your account to earn as much as 20 Sweatcoins per day. When I joined, each membership offered a trial run of a month, but recently it downgraded to seven days per trial. The prizes are cool, no doubt about it. Gift cards to Forever 21, Nike and Xbox as well as Delta Airways credits, audiobooks, temporary membership to a coffee club, an iPhone 8 and even $1,000 PayPal cash have come across the store dashboard since I joined last month. This app also certainly provided me motivation as well. Although I was already up off the couch on a regular basis, my walks with my little guy became a bit longer and an extra evening stroll became a more regular part of our routine. The Cons I have a fairly new phone with a relatively good battery life, but Sweatcoin gives it a run for its money. In order to properly track steps, the program must always be running in the background. This can be a real downside for someone who doesn’t have a place to recharge midday or has a battery that already struggles to make it through. The app doesn’t currently count steps taken indoors, so those fitness classes and treks on the treadmill won’t generate any cryptocash. In a climate such as ours, that might make the app seem a little superfluous during the long winter months when strolls outside are not exactly

How Apps Pay Most apps don’t pay out cash directly. Several of them pay what is known as cryptocurrency. The definition of cryptocurrency is “a digital currency in which encryption techniques are used to regulate the generation of units of currency and verify the transfer of funds, operating independently of a central bank.” What this means for you as a user is that it is essentially a foreign currency that can only be used in a practical sense in particular venues, typically, the app’s store. Some apps let you accrue points which can then be cashed in for prizes, deals, or in rare cases, cash. The app achievement is the exception to the rule, paying directly through PayPal, however the sum of money users receive will be reduced by a fee when the cash is transferred. pleasant. I did find that while my walks with my son got longer, I found myself pulling out my phone all too frequently to check how my steps were doing. It was a distraction from our usual bonding time — and for me, that was certainly a drawback. While the potential rewards are great, some are obtainable while some are nearly impossible to earn. The box of different coffees that I thought might make a great present for my mom was a mere five Sweatcoins plus shipping which was less than $4. What had caught my eye initially, thought, was $1,000 through PayPal. That reward, however, is a whopping $20,000. Even with the highest membership, the cash would take nearly three years to earn. That

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018

would also necessitate walking more than 20,000 steps outdoors each day, which is roughly 10 miles, depending on your stride length. So if you’re in it for the big ticket items, you might have to rethink your strategy. During the course of roughly a month, I have earned about 80 Sweatcoin and traded five of them in for a two-month subscribtion to the digital book platform called Scribd. The Gray Area In an interview with the New York Times at the beginning of the year, the founders of the app said that they do not and will not sell users’ data to third parties. The app reportedly generates revenue by marketing the products of third party vendors to its users. One must be conscious that their data is being collected however and such a promise shouldn’t be taken as a guarantee. The Alternatives There are dozens of apps on the market that claim to pay or reward users for their physical actvities. If you are looking for something philanthropic, Charity Miles allows you to earn money and then donate it to any one of more than two dozen charities. Bounts claims to give rewards for all kinds of activities and the plus is that it can be linked to other fitness trackers, so you need not have your phone on you at all times. The store looks as though it doesn’t offer much, however. The app called Achievement pays out actual cash via PayPal, unlike many other apps. The drawback seems to be that it takes quite some time to earn a fairly minimal bit of money. You can earn up to 80 points a day and you need a whopping 10,000 points to earn $10.

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Taste of the Season atatChapel St. Ann’s Community Cherry Oaks Ridge

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stannscommunity.com/chapel-oaks Page 28

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • October 2018