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Meet Your Doctor


JANUARY 2019 • ISSUE 161

Lead physician of Physician House Calls program at Jewish Senior Life, Brenda Baratta loves spending time with patients — at their homes


What to do during the long winter months when our comfort-food cravings are besting our better judgment? Check inside for some nutritious makeovers that may satisfy your longings without compromising your health. Page 14



Milk: Are They All the Same? Oat milk, soy milk, coconut milk, hazelnut milk — alternative options for dairy milk have grown in popularity in the last two decades. But how do they compare to dairy milk? P. 13

• More women than men reporting higher levels of stress • You’re not alone: Half of older women suffer incontinence • C-section rates have nearly doubled since 2000 • Alcohol and breastfeeding: Do they go well together?

Fitness Trends for 2019 Find out what’s hot, according to local experts

Arugula Super low in calories and rich in fiber, this ‘carcinogen killer’ is a healthy choice for those looking to lose or maintain their weight.

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Into Saunas? Love your time in the local sauna? Your heart may love it, too, according to a new study recently released.

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Jan. 8

Jan. 20, 22

Hearing Loss Association of America Rochester Chapter invites anyone interested in hearing loss to any or all of several events on Tuesday, Ja. 8. 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 church 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., parish hall program begins at noon. Making of “The Hit Makers” with Ralph Meranto, senior director of arts and culture, Rochester Jewish Community Center. • 7 to 9 p.m. at parish hall. Program begins at 8 p.m. “Hearing Loss and Mental Health: Is There a Connection? with Barbara Isaman-Bushar. For more information, view the organization’s web site at or telephone 585 266 7890.

The public is invited to hear physician Michael Klaper, a pioneer of the vegan movement, to speak about “The Keys to Healing in the 21st Century.” The meeting is sponsored by Rochester Area Vegan Societyand will take place at 7 p.m., Jan. 20, at Brighton Town Park Lodge, 777 Westfall Road, Rochester. Preceding the meeting, at 5:30 p.m., the group is organizing a vegan potluck. The group can help non-vegetarians or others uncertain about how to make or bring a vegan dish; please call 2348750 for help. Cost is free to RAVS members; $3 guest fee for non-members.  Physician Klaper will also be part of the Lifestyle as Medicine Lecture Series at the Rochester Academy of Medicine at 7:30 p.m. Jan. 22, at Rochester Academy of Medicine, 1441 East Ave., Rochester. He will present a lecture on “What I Wish I Had Learned About Nutrition in Medical School. At 6 p.m. there will be an optional vegan gourmet tasting dinner catered by Lori’s Natural Foods, with jazz piano accompaniment. Tickets and information at

Expert to discuss hearing loss and mental health

Vegan pioneer to speak in Rochester events

Saunas Seem to Do a Heart Good, Research Shows


ove your time in the local sauna? Your heart may love it, too. New research from sauna-loving Finland suggests that for people aged 50 and older, saunas may lower their odds of risk of dying from heart disease. Specifically, just 5 percent of Finns in the study who spent more than 45 minutes in a sauna each week died of heart disease over the 15-year study period, compared to 10 percent of those who spent less that 15 minutes a week in saunas, the researchers said. Of course, the study couldn’t prove cause-and-effect — it’s possible that sauna-loving folk have other heart-healthy habits that might explain the findings. Still, “there are several possible reasons why sauna use may decrease the risk of death due to cardiovascular disease,” said study co-author Jari Laukkanen, physician and head of cardiology at the University of Eastern Finland. His team published its findings Nov. 28 in the journal BMC Medicine. “Our research team has shown in previous studies that high sauna use is associated with lower blood pressure,” he noted in a journal news release. “Additionally, sauna use is known to trigger an increase in heart rate equal to that seen in low- to moderate-intensity physical exercise.”

One U.S. expert who looked over the findings agreed that heat can often be therapeutic to the human body, but the sauna experience might differ a bit in America. “The greatest benefit [in the study] was observed in individuals who took four to seven saunas per week, a frequency that Americans are unlikely to achieve,” noted Cindy Grines, who directs cardiology at Long Island Jewish Medical Center in New Hyde Park on Long Island. “In addition, this study used dry heat, and whether the results are similar with steam baths or hot tubs is not known,” she said. Laukkanen’s team agreed that because the data came from one area in Finland, the findings might not apply to other populations. The study relied on data from nearly 1,700 Finnish men and women. Participants were asked about their use of saunas, and these data were compared with deaths from cardiovascular disease. Data for the study were collected between 1998 and 2015 and the average follow-up was 15 years. Frequency of sauna use did seem tied to heart health. Among people who used a sauna four to seven times a week, 3 percent died from heart disease over 15 years, but that number rose to 10 percent for those who used the sauna just once a week, the study found.


day is likely spent sitting. Too much sitting is linked to heart disease and other serious issues. Sit all day at work? Set a reminder to stand every hour. Stand when on a conference call or eating lunch. Or, try a walking meeting with a co-worker.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

Home is where

the help is.

Living Well Companion Care provides non-medical services to make living in your own home feel manageable again. We can support you with daily routines, transportation, housekeeping and more. Companions undergo comprehensive background screenings and we only hire those we would trust to care for our own loved ones. Now hiring in and serving eastern Monroe and Ontario counties.

“Knowing there is someone who can help, makes me feel better about our future!” –Len, client with his companion, Maureen

We’re Hiring Companions! We offer flexible schedules and meaningful work.

Call us at (585) 248-5021 or visit to learn more or to apply to be a companion. A service of Jewish Senior Life COMPANION CARE • HOUSEKEEPING • RESPITE & 24 HOUR CARE January 2019 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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s many as four out of five Americans withhold important information from their doctor that could prove crucial to their health, a new study shows. Between 60 and 80 percent of people admit they avoid telling their doctor details that could be relevant to their well-being. “I know at some level this is a ‘no duh,’ of course, people mislead, but I was surprised how pervasive it is,” said senior researcher Angela Fagerlin, chairwoman of population health sciences at the University of Utah in Salt Lake City. “A lot of people are not fully honest with their provider. They don’t tell them all the information they could tell them.” Shame and fear appear to be at the root of this lack of communication, the researchers found. Patients don’t want to admit that they disagree with their doctor or don’t understand what the doctor has told them, Fagerlin said. People also don’t want to fess up about their unhealthy behaviors. But keeping this information secret can lead to some very dire consequences. American Academy of Family Physicians President John Cullen recalled a situation years ago when

a patient with apparent appendicitis was being prepped for surgery. “Unfortunately, methamphetamine can sometimes present the same way as appendicitis,” said Cullen, a family physician in Valdez, Alaska, with more than 25 years of experience. “As we’re getting ready to take him to the operating room, I remember saying, ‘We’re about to cut you open here. Are you sure you don’t want to tell me anything else?’ “That’s when we found out about the methamphetamine use,” Cullen continued. “Indeed, that was the cause, and we stopped the surgery.” Sharing information can also help doctors prevent drug interactions, or change a patient’s treatment plan so he or she will be more likely to comply with it, Fagerlin said. For the study, Fagerlin and her colleagues surveyed two different pools of patients, 4,510 in all. One group had an average age of 36, while the other had an average age of 61. The younger group of patients consistently tended to withhold information more often than the older folks, 81 percent and 61 percent, respectively. The most common thing people don’t tell their doctor is that they

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

don’t agree with the physician’s recommended course of treatment, the researchers found. About 46 percent of people in the younger group and 31 percent in the older group said they’d done this. This is not good because people who disagree with their doctor might not follow through on taking prescribed medications or receiving recommended follow-up tests, Fagerlin said. Second most often, people wouldn’t admit that they didn’t fully understand the instructions a provider gave them. That happened with 32 percent of younger patients and 24 percent of older patients. After that, patients most often withheld information about personal habits that could be unhealthy: poor diet (24 percent for younger and 20 percent for older patients); not taking medication as prescribed (22 and 18 percent); not exercising (22 percent in both groups); or taking someone else’s prescription medication (14 and 9 percent). The researchers also asked why patients didn’t tell the whole story, and the No. 1 reason was that they didn’t want the doctor to give them a hard time about their behavior (82 and 64 percent); “They didn’t want to get a lecture from their doctor,” Fagerlin said. “They didn’t want to get scolded.” Other reasons included: • I didn’t want to hear how bad a behavior is for me (76 and 61 percent). • I was embarrassed to admit something (61 and 50 percent). • I didn’t want the provider to think I’m a difficult patient (51 and 38 percent). • I didn’t want to take up any more of the provider’s time (45 and 36 percent). • I didn’t think it mattered (39 and 33 percent). • I didn’t want the provider to think I’m stupid (38 and 31 percent). • I didn’t want this information in my medical record (34 and 31 percent). The new study was published Nov. 30 in the journal JAMA Network Open.

January 2019 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Your Doctor

By Chris Motola

Brenda Baratta, M.D. Lead physician of Physician House Calls program at Jewish Senior Life loves spending time with patients — at their homes

Working More, But Getting Less Done? Study: Productivity starts to fall considerably after the 50th work hour of the week


t’s no surprise that many Americans are working overtime. Conservative estimates say that 19 percent of adults put in 48 hours or more a week and 7 percent log in 60 or more. But what you might not realize is that, after a certain point, extra hours could be hurting both your health and your productivity. In addition to a variety of medical issues and unhealthy lifestyle choices associated with long hours, a British study used cognitive tests to show that working 55 hours a week was associated with lower scores in vocabulary and reasoning, and can lead to cognitive problems as you get older. Adding insult to injury, research done at Stanford University found that, besides the personal toll that overtime takes, you probably aren’t working effectively. Productivity starts to fall considerably after the 50th work hour of the week and gets worse with every additional hour. So, if you put in 70 hours a week, you’re not likely to accomplish anything worthwhile during those last 15. One reason for this is that you might be too stressed or tired to function at peak level since working overtime usually results in your getting less sleep — and that in turn leads to making mistakes that can set you back at work. Take action to improve the balance between your personal life and your work life. Prioritize responsibilities and focus on the most important ones. Assert more control over time-draining tasks like answering emails. If you check your email every few minutes, cut down to every half hour or just scan the subject lines and open the most essential ones. And when you must stay late, make getting sleep a priority so that you’ll be well rested when you’re back at work in the morning.

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Q: One of the more unusual aspects of your practice is that you do house calls. A: We at The Physician House Calls program see patients on campus at our assisted living and independent living facilities, but we also have an outreach center to see patients in their homes and some assisted living centers in the community. We have a team of myself, a nurse practitioner, two RNs that job-share and we also access a clinical nurse psychologist and a social worker. So it’s a team approach. We visit home outpatients one-on-one to address their needs medically, socially and psychologically. It’s just a very exciting program to be a part of. Q: Walk me through what one of your house calls might look like. A: Basically we get their information from their previous physician and I review their records before even sitting down with them. Then I have a one-on-one face-to-face interaction with them where I go over their medical history and medications. It helps me to see any barriers they might have to care. It helps me see what their goals are and really coordinate their care. And coming from that, I look at test they might need and basic routine medical care they haven’t had access to because they haven’t been able to get

to a doctor. So many of our homebound adults are only using medical care in times of crisis when they go to emergency rooms. This kind of care prevents them from having to do that. Then we have a follow-up with my nurse practitioner to answer questions and talk about lab results. I also help them navigate medical advance directives for end of life. That can take a lot of time, so I help them fill out forms and answer their questions. Q: What are some of the advantages of going to the patient? A: I get to understand what medications they’re actually taking and how they’re taking it. In an office setting, you don’t necessarily get to see that. I can also pick up on cognitive problems a lot more easily in seeing how they interact with their environment than I can in an office. I can also identify barriers to care, how much mobility they really have. I also get so much gratification from it. I get to learn more about my patients and their families. And families get to know me and trust me. When you have that personal connection, people trust you and they’re

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

more likely to take your recommendations seriously. Q: Is this covered by insurance? A: Yes. While it feels like a concierge service, it doesn’t cost our home-bound patients anything extra. I spend face-to-face an hour to two hours with patients. And follow-up visits might be a half-hour to two hours. I’m there to do what I need to do without time limitations. Q: What does this mean in terms of time management for you? You’re spending longer with patients, and you’re commuting to them on top of that. A: There’s a two-fold piece to that. Number one, Jewish Senior Life really believes in the program. So they support me having extra time with patients. The other part is that I am a physician who believes it’s OK to do my paperwork at home on my personal time. Every one of my team members believes in the same philosophy. It’s not a money-making practice. You hope for that to be the case, but the focus is on spending the time with patients. Our program is so successful that our census is going up. It’s an extremely positive and growing one. We’re having a parttime physician joining me soon. All our patients have to be over 65 and have difficulty getting to the office, but we work to keep patients in their homes and keep them independent. Us going to them rather than having to have their family drive them around also helps them feel more independent. Some don’t even have family members to bring them. Q: Do you find the outcomes are better? A: Absolutely. They did a study at the University of Rochester that looked at it and our program reduced hospitalizations and E.D. [emergency department] visits by half. And the reasons are multifactorial. We have good follow-up, so we’re there frequently enough to notice coughs and edemas in their legs, so we can intervene before they’re in a time of crisis. So I think that’s the first piece that’s causing us to have better outcomes. But I think it’s also providing excellent medical care in a team approach, and help families support their loved ones as well.

Lifelines Name: Brenda Baratta, M.D. Position: Lead physician of Physician House Calls program at Jewish Senior Life Hometown: Auburn, NY Education: University of Rochester Medical Center Career: Primary care internal medicine physician at Park Ridge Hospital (19921995) and Lifetime Health (1995-2015). Physician reviewer, Maximus Federal Services (2014-2015); physician leader, Physicians House Calls, Jewish Senior Life (2015-present) Affiliations: Highland Hospital, Strong Memorial, Rochester General, Unity Organizations: Monroe County Medical Society; American Board of Internal Medicine Family: Husband, two daughters Hobbies: Piano, classical music, tap dancing, singing in church choir

Electronic Health Records Bogging Down Docs


lectronic health records are supposed to help doctors, but stress from using them may lead to burnout — and primary care doctors are at greatest risk, new research suggests. “You don’t want your doctor to be burned out or frustrated by the technology that stands between you and them,” said study author Rebekah Gardner. She’s physician and an associate professor of medicine at Brown University’s Warren Alpert Medical School in Providence, R.I. “In this paper, we show that EHR [electronic health record] stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics,» she added in a university news release. In the study, Gardner’s team analyzed the responses of nearly 1,800 doctors in Rhode Island who took part in a state health department survey about health information technology-related stress. Of the 91 percent who reported using EHRs, 70 percent reported at least one measure of EHR-related stress. Those measures included frustration with using EHRs, spending time on EHRs while at home, and not having enough time for documentation while at work. Doctors who didn’t have enough time for documentation while at work were 2.8 times more likely to have burnout symptoms than those without that pressure. The other two measures were associated with about a two-times higher risk of burnout symptoms. The researchers also found that all three measures were reported by more than one-third of dermatologists (36 percent) and primary care doctors, including general internists (40 percent), family medicine physicians (37 percent) and pediatricians (34 percent). Nearly 31 percent of hospital medicine specialists reported all three measures. Meanwhile, less than 10 percent of anesthesiologists and radiologists reported all three measures, according to the study. The findings are “a signal to health care organizations that if they’re going to ‘fix’ burnout, one solution is not going to work for all physicians in their organization,” Gardner said. “They need to look at the physicians by specialty and make sure that if they are looking for a technology-related solution, then that’s really the problem in their group,” she concluded.

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Don’t Miss the February Issue of In Good Health Special issue highlighting senior issues, disabilities, heart health and much more. Special story on inflammation, “the mother of all diseases.” To advertise and reach nearly 1000,000 readers, please call 585-421-8109 or send an email to January 2019 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Make the Most of This New Year by ‘Letting Go’


re you convinced you’ll never be good at relationships? Or, do you regret the way you behaved in your marriage? Still angry at your ex? Or yourself? Holding on to past hurts, slights, negative thinking, or lost opportunities can compromise your sense of well-being and ability to live alone with contentment. Whether it’s emotional baggage or tangible reminders that keep you from moving forward, I encourage you to let them go in favor of a fresh start. “Letting go” is a beautiful thing. And not just for those who live alone. Letting go of old ways of thinking, of a poor self-image, or of destructive thoughts or behaviors can free you up to embrace life’s blessings and the possibility of feeling whole and complete on your own. I discovered the power of letting go quite by accident. It was years ago, after I purchased my country cottage, which sits on six acres of wooded and open land. One of my first home-improvement projects was to carve out a fire pit in my backyard. I’ve always loved a bonfire: the warm glow it casts on the faces of those gathered around it,

the earthy scent of burning branches, the flames that invite inspection ... and, importantly, introspection. Little did I know that when I built my fire pit that it would also become the ceremonial dumping ground for my “old baggage” — those useless memories, beliefs and feelings that were holding me back and keeping my life small. I remember one evening in particular. I’d been holding on to my old Day-Timers — large, leather-bound calendar/ planners that were used in the ‘90’s before everything went digital. In those Day-Timers, I made calendar entries that captured “the good, the bad, and the ugly” over the course of what turned out to be a dismal and highly disappointing decade. Why I hung onto these Day-Timers I’ll never know. Maybe out of misplaced sentimentality. But this I do know: Whenever I looked at the neat stack of volumes stashed away in my closet, I would wince inside. But then I decided, no more. On an early spring evening, I held my first letting-go ceremony. I grabbed my Day-Timers, made my way to the fire pit and built a bonfire.

belief or thought in a “Letter to Self.” Put it down on paper and get it out of your system. n Third: Hold your own letting-go ceremony, in whatever style or fashion that suits you. I like the bonfire approach, but you may prefer another method. Tying your Letter to Self to a stone and throwing it into a lake may be more fitting and symbolic. Or perhaps you’ll prefer to bury your anger in your backyard. You decide. On your own or in the company of friends or family, let go of what’s holding you back and keeping you stuck. Doing so may help liberate the hope, passion and power residing deep inside you. It can be a meaningful step toward independence. Needless to say, letting go ceremonies aren’t a cure-all. Believe me, my long-held feelings about my difficult decade didn’t magically dissipate with the burning of my Day-Timers. But I did feel better and more empowered afterwards. I could go on and on, but you’ll need to excuse me. It’s a new year. I have a bonfire to build and some baggage to burn.

There I sat with my memories (and glass of wine) while I slowly, deliberately leafed through each bound year of my life, before tossing it on the hot embers. It was a moving experience. Sad at times. But, mostly, I began to feel lighter, freer. And I felt something I didn’t expect: a sense of peace and self-satisfaction for having taken control and done something good for myself. That evening set the stage for many letting-go ceremonies to come. I look forward to them and the release of the pent-up, negative energy they promise. Might you consider holding your own letting-go ceremony? Here are some tips: n First: Identity what is holding you back or keeping you stuck. Be honest. Ask yourself what negative beliefs or thoughts are getting in the way of your ability to feel hopeful and enthusiastic about yourself and your life. What do you need to release to move forward? Resentment toward something or someone? Regret over a past mistake? Guilt? A negative self-image? A bad habit? Or deep sadness? n Second: Identify something tangible (as I did with my Day-Timers) that conjures up painful or disappointing memories. This negative “something”— a photograph, gift, letter or other reminder — can be powerful. Even if it’s out of sight, you know it’s there and just having it in your possession may keep you tethered to a painful past. If nothing tangible comes to mind, try describing your negative

Gwenn Voelckers leads “Live Alone and Thrive” empowerment workshops for women in Mendon, Monroe County, and is the author of “Alone and Content: Inspiring, Empowering Essays To Help Divorced And Widowed Women Feel Whole And Complete On Their Own.” For information about workshops, to purchase a book or invite Voelckers to speak, call 585-624-7887, email, or visit

Many infections clear up on their own without antibiotics. Instead, your pediatrician might suggest over-the-counter pain medication to ease discomfort. Surgery to

insert ear tubes to drain fluid is also becoming less common. The tubes themselves don’t stop infections and the procedure could damage the eardrum.

s d i K Corner

What’s Best for Babies With Recurring Ear Infections


nfant ear infections can be a source of frustration for parents and babies alike. But there are steps to lessen them and, when they do occur, “less is more” is a better way to treat them. A typical infection can begin with bacterial growth. Inflammation can lead to fluid buildup behind the eardrum. The eustachian tubes, which connect the middle ear to the back of the nose and throat, could become swollen. Babies and children are more prone to these problems than adults because their still-developing immune systems have a harder time fighting off infections. And the size Page 8

and position of ear passages make it easier for germs to reach the middle ear and for fluid to get trapped. According to a 2016 study in the journal Pediatrics, breastfeeding and decreasing exposure to smoking help reduce ear infections. Also, try to protect baby from getting frequent colds — 46 percent of infants had the common cold before their ear infection diagnosis. Middle ear infections are the leading cause of doctor visits and prescriptions for antibiotics. But more doctors are now taking a waitand-see approach for two to three days unless it’s severe or baby is still an infant.

Is it an ear infection? Know the signs:

• More crying than usual. • Difficulty sleeping or hearing. • Fever. • Headache. • Fluid from the ear. • Excessive tugging on an ear. To help limit the spread of germs, make sure kids know how to thoroughly wash their hands from an early age and keep them up to date on vaccines vaccinated children get fewer ear infections.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

Couch Potato Nation 1 in 4 adults sits more than 8 hours a day


early half of Americans sit for far too many hours a day and don’t get any exercise at all, a new study finds. A survey of some 5,900 adults found that nearly 26 percent sit for more than eight hours a day, 45 percent don’t get any moderate or vigorous exercise during the week, and about 11 percent sit more than eight hours a day and are physically inactive. “Being sedentary increases the risk for heart disease, high blood pressure and dying early,” said lead author Emily Ussery. She is an epidemiologist at the National Center for Chronic Disease Prevention and Health Promotion, part of the U.S. Centers for Disease Control and Prevention. Ussery pointed out that sitting may not be bad in itself, but is a proxy for not getting enough exercise. Study co-author Peter Katzmarzyk added, “In recent years, we have begun to understand the

health hazards of excessive sitting.” Although all the reasons why prolonged sitting is unhealthy aren’t known, Katzmarzyk speculates that “when people sit, they deactivate the large muscles in their legs, and this has a host of metabolic consequences that seem to be harmful.” More and better efforts are needed to get people moving, said Katzmarzyk, who is associate executive director of population and public health sciences at the Pennington Biomedical Research Center in Baton Rouge, La. “Programs that increase physical activity and reduce sitting might be especially effective at reducing health risks,” he noted. A few minutes can help The new edition of the U.S. Physical Activity Guidelines for Americans says that any amount of physical activity — even two minutes’ worth — can add up to huge health benefits. When the new guidelines were released recently, Adm. Brett Gi-

roir, assistant secretary for health at the U.S. Department of Health and Human Services, said, “Physical activity is about finding opportunities to add movement throughout the day as part of a bigger commitment to healthy living.” Being inactive causes 10 percent of early deaths in the United States, according to Giroir. If 25 percent of inactive people got at least the recommended 150 minutes of moderate exercise a week, nearly 75,000 premature deaths could be prevented. According to the new guidelines: • A single bout of physical activity can sharpen your mind, reduce

your anxiety, lower your blood pressure, improve your sleep and strengthen your body’s ability to convert blood sugar into energy. • Regular physical activity can improve your brain health, reduce your risk of eight different forms of cancer, and lower your risk for excess weight gain. • Chronic health conditions improved by physical activity include osteoarthritis, high blood pressure, Type 2 diabetes, anxiety and depression. The latest report was published Nov. 20 in the Journal of the American Medical Association.

Healthcare in a Minute By George W. Chapman

Healthcare Consolidation: Fewer Options for Consumers, Higher Prices


hether hospitals or insurance companies, most consolidations have resulted in fewer choices and higher prices for consumers. The healthcare watchdog group The Commonwealth Fund estimates 90 percent of metropolitan statistical areas are “highly” or “super” consolidated. While some consolidations should create economies of scale and lower prices, most have resulted in market dominance and price increases. Many experts believe that the government’s attempts to foster competition may be too late. To boost competition, the FTC needs greater resources to evaluate proposed consolidations and then to break them up if prices go up and consumers choices go down. In defense of hospitals, most are operating precariously close to

break-even and the very survival of some hospitals, especially in rural areas, may depend on merging with a larger hospital system. If hospitals do not consolidate in markets dominated by a single insurer/ payer, they will lose negotiating power. Moody Investor Services paints a semi-gloomy outlook for 2019. Hospitals are experiencing decreasing inpatient operating revenues as more and more care transitions to outpatient venues. Hospitals are also facing competition from new, non-traditional providers like for-profit urgent care centers, retail store based clinics and independent physician operations. New players in the industry, like Google, Amazon and Apple are determined to drive down costs and reinvent how care is delivered.

Feds Fostering Competition In Healthcare Responding to an executive order from the President, a working group of members from the departments of HHS, Labor and Treasury issued a 119-page report on how to promote choice and competition in our healthcare system. Among some of the recommendations/suggestions were: broaden the scope practice for nurse practitioners, physician assistants and hygienists so they can be paid directly and operate with less physician supervision; increase

reimbursement for telemedicine; allow multistate medical licenses and across state lines for telemedicine; reallocate funding for residency programs based on the most in demand specialties like family practice, pediatrics, internal medicine, OB-GYN and psychiatry; reduce restrictions on physician-owned hospitals (none in NYS); allow hospitals to expand or contract without certificate of need approval from the state; scale back the ACA’s employer insurance mandates; expand the use of health savings accounts to all, including those January 2019 •

on Medicare; increase price transparency; make it easier for patients to access their records. Reactions from the American Hospital Association and the American Medical Association were both expected and mixed.   Telemedicine Increasing According to the AMA, telemedicine has been embraced the most by radiologists (40 percent), psychiatrists (28 percent) and cardiologists (24 percent). The average across all specialties is 15 percent. The acceptance of telemedicine is expected to increase due to a shortage of physicians, reduced costs for the technology, consumer preference and improved reimbursement to physicians. It is far too early to tell what the long range impact of telemedicine is on a person’s overall health versus face to face office encounters.    NYS Bans Short-Term Plans With the slow dismantling of the ACA and associated penalties for not having insurance, many states are allowing the sale of cheap, short-term health insurance good for three years. NYS is not one of them. The ACA mandated minimum coverage/benefits for bronze, silver and platinum plans. So consumers could confidently shop around for the best price because all insurers had to offer the same mandated benefits per bronze, silver or platinum plan. Short-term plan shopping is a gamble because you have to compare both price and benefits across divergent plans. As with anything else, you will get what you pay for. Short-term plans do not cover pre-existing conditions.    Primary Care Physician Visits Decline According to a study of claims data from 2012 to 2016, the Healthcare Cost Institute reported an 18 percent decrease in office visits to primary care physicians. Visits to

advanced practitioners, (nurse practitioners and physician assistants), increased a staggering 129 percent over the same four years. There is plenty of speculation why. Since more medical students are favoring specialties over primary care, the influx of new primary care physicians into the market is declining while older primary care physicians are retiring. Consequently, the role of APs in providing primary care, by necessity, has increased. Convenience may be a factor. Younger/healthy patients don’t want to wait for an appointment with their physician, so gladly schedule sooner with an AP. Many consumers are electing to get primary care from walk-in retail clinics or urgent care centers which are staffed primarily with APs. Finally, more and more states are loosening their requirements for physician supervision of APs, allowing the APs more latitude in scheduling patients.   Top Healthy New Year’s Resolutions We all make them. Here are the most popular ones regarding health: More exercise, 38 percent; lose weight, 33 percent; eat healthy, 32 percent; be more active, 15 percent; learn a new skill/hobby; spend more time on personal well-being; consume less alcohol; stop smoking. By picking just one, you will accomplish some of the others.   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

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 9

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ouples generally come to counseling hoping to “stop fighting” but couples need to address dissatisfaction in order to promote healthy relationships. Rather than working to eliminate fighting, give yourselves permission to have a healthy fight. You may be pleased to learn that healthy fighting actually helps the relationship, even when it feels uncomfortable. No hitting below the belt. Resist the urge to criticize your partner by making accusations of ill intent or degrading their character. You always try to make me feel guilty! You’re so lazy! Instead, identify the behavior that you want to change, how you feel when your partner does that behavior, why you feel that way, and what you want your partner to do instead. Communicate that clearly and gently. When you frequently point out what I do wrong, I feel unappreciated because I try to show my love for you. Please let me know what you appreciate about me and what you wish I did instead.


Resist the urge to hijack your 2. partner’s grievances. Rather than defending yourself

or blaming your partner in response, allow your behaviors and their effect on your partner to remain the subjects of the discussion. Commit to a proper resolution. Your own grievances can be addressed later. Bringing them up now will only cause your partner to feel unheard by you and will not help in getting your own complaints resolved. I hear what you’re saying. I think I would be frustrated about that too. Now that you mention it, I wish I handled that differently. Control your brain to control your 3. mind. When emotions are intense, the

limbic system in the brain is hogging much of the brain’s energy leaving little for the prefrontal cortex, which

is responsible for rational thought. To encourage the limbic system to share energy with the prefrontal cortex, train yourself to become curious about the situation at hand. When you are curious about something, the prefrontal cortex will draw energy from the limbic system and decrease the intensity of the emotions. Let your goal to be to understand your partner rather than to win the fight. Hmmm. You got angry so fast that time. What did it mean to you when I said _____? Be intentionally self-aware. 4. Check in with yourself during discussions. Notice when you

feel defensive and want to say something hurtful. Communicate your need to take a break from the conversation then use that time to identify what you are feeling and why. I’m aware that I am feeling defensive and I don’t want to say something hurtful. I need a few moments to organize my thoughts. Let’s return to this in about 15 minutes. Notice that none of these tips require you to give up your right to be treated well. They communicate your openness to identifying your contribution to the problem and your commitment to repairing the rupture in the relationship. Nicki Ditch is a licensed mental health counselor (LMHC) who specializes in treating PTSD, anger management, grief recovery and borderline personality disorder. She also works with couples and families to facilitate healthier relationships and much of her work includes teaching clients how speak assertively. For more information, visit or 585-210-3663.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

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than 200 tissue and blood samples and found that it was 90 percent accurate in detecting cancerous cells, CNN reported. The test detected breast, prostate, bowel and lymphoma cancers but the researchers believe it can also detect other types of cancer. Large clinical trials need to be conducted before the test could be used on patients, CNN reported.

Meet Your Provider Kavod Psychotherapy Helping couples embrace healthy relationships, intimacy and sexuality Q: What is the mission of Kavod Psychotherapy? A: Founded in 1993, Kavod Psychotherapy helps people from all walks of life, religious backgrounds and sexual orientations learn how to bring true intimacy into their lives and form healthy relationships. Couples trust Kavod therapists and counselors to help them deal the betrayal, trauma and fallout created when something or someone comes between them. That includes: poor communication, lack of trust, infidelity, pornography, anonymous hook-ups, emotional distance or detachment, work and money issues, a loveless, sexless relationship. Our approach to couples work is unique in a few ways: • We never take sides. By neutralizing any divisiveness upfront, we ensure each partner has a safe and confidential environment in which to pursue therapy. • We use a team strategy. Kavod pairs each partner with his or her therapist to uncover and address personal issues. Once each

person begins to heal, couples can Co-founder of Kavod Psychotherapy, Daniel Morris says his team wants to educate choose to meet with our couples people about an epidemic hiding in plain sight: Internet addiction and the excessive therapist to rebuild trust and open the lines of communication with each use of pornography. (CBT), EMDR trauma treatment, Institute of Trauma and Addiction other. Lastly, each partner particiart therapy, movement therapy, Professionals (IITAP). pates in one of our weekly men or yoga classes, guided meditation Q: What are your aspirations women’s groups. Having a supportfor the future? ive community that understands and classes, psycho-educational groups, intensives and workshops and 12A: An essential next step for honors all the couple has done to Kavod Psychotherapy is commureclaim their lives and relationship is step support. Also, Kavod offers the latest, nity outreach. We want to educate often the most powerful part of the most effective outpatient treatment people about the epidemic hiding journey for both people. available for sex and relationship in plain sight: Internet addiction • We cultivate trust. Couples tell addiction and partner trauma in and the excessive use of pornogus our approach doesn’t make them the region. To ensure the integrity of raphy. Healthcare providers need feel teamed up against, which keeps our program, every Kavod therapist to recognize that these and other them coming back to Kavod, stayis also a Certified Sexual Addiction problematic behaviors destroy ing open to each other, and moving Therapist (CSAT). relationships, alienate families, and forward. Our founders — Dan Morris ruin lives more often than we know. Q: What services do you offer? and Robert Meadows — were early Starting the conversation is not A: In addition to an excellent proponents for the treatment of easy, but with Kavod as a resource, team of therapists and counselors addictive and compulsive behaviors healthcare providers can encourage with decades of experience, Kavod around sexuality. As LCSWs and people to seek help and begin the Psychotherapy offers an array of therapeutic modalities and programs Certified Sexual Addiction Therapist- healing to rebuild their lives. Supervisors (CSAT-S) with more than on site to address the needs of 70 years of combined experience, If you’d like us to speak to your our clients. It includes: individual Morris and Meadows share their organization about this epidemic therapy, couples therapy, group expertise with therapists through or any of the work we do, please therapy, trauma therapy, partner New York state seeking CSAT contact Dan Morris at dmorris@ therapy, dialectical behavior therapy credentials through the International (DBT), cognitive behavioral therapy

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The skinny on healthy eating

Open Your Eyes to Arugula’s Many Benefits


ating healthier tops many New Year’s resolutions lists, and who can blame us? We’ve been forced to consume all kinds of sinfully rich treats throughout the holidays and now can’t seem to fasten our waistbands. Go figure! When the urge for clean, simple, healthy food strikes our household in January — and it always does — we load up on leafy salad greens, the darker the better. Lately, we’ve been reaching for arugula (pronounced uh-roo-guh-la), a nutrient-dense green with a distinct peppery flavor and aroma. Super low in calories (only 8 calories per 2-cup serving) and rich in fiber, arugula is a healthy choice for those looking to lose or maintain their weight. Not only is it flavorful and filling, but it’s packed with an impressive array of nutrients. Like many of the darker greens, arugula delivers decent amounts of vitamins K and A. While both vitamins contribute to overall bone health — a boon for boomers with looming osteoporosis — vitamin K also helps blood clot properly and vitamin A promotes a healthy immune system and good vision. Worried about age-related macular degeneration (AMD)? Consuming

arugula may help protect against this disease, as it also contains substantial amounts of two carotenoids that further support eye health: lutein and zeaxanthin. In fact, according to the National Eye Institute, studies have found that dietary intake of lutein and zeaxanthin is associated with a lower risk of developing advanced AMD. Arugula, along with cabbage, Brussels sprouts and broccoli, is a cruciferous vegetable. These protective vegetables — a.k.a. “carcinogen killers” — teem with anti-cancer compounds that neutralize free radical damage and slow the aging process. Since studies support a strong link between cruciferous vegetables and a reduced rate of certain cancers, many health agencies—including the American Cancer Society—recommend regular consumption of this kind of vegetable. Lastly, arugula is super good for hearts, thanks to many factors: its inflammation-lowering antioxidants, its unique arsenal of minerals that help control blood pressure (calcium, magnesium, and potassium), and its healthy dose of folate, a B vitamin that helps to reduce arterial hardening.

Lemony White Bean-and-Arugula Salad Adapted from Cooking Light

2 tablespoons extra-virgin olive oil 1 teaspoon grated lemon rind plus 3 tablespoons fresh juice (from 1 lemon) 1 garlic clove, minced 1 teaspoon Dijon mustard ½ teaspoon kosher salt ¼ teaspoon coarse black pepper 1 (15-oz.) can unsalted cannellini beans, rinsed and drained ¼ cup thinly sliced red onion 3-4 cups firmly packed baby arugula Combine oil, lemon zest, juice, garlic, mustard, salt and pepper in a large bowl, stirring with a whisk. Add beans and onion; toss well to coat. Add arugula; toss gently to combine.

Helpful tips

If buying fresh, select arugula that looks vibrant and green, avoiding leaves that are wilted, yellow or slimy. If buying prepackaged arugula, check the bag for excess water, as moisture can cause arugula to rot quickly. When stored properly in the refrigerator—in a plastic bag with a dry paper towel—arugula can last up to two weeks.

Anne Palumbo is a lifestyle colum-

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

Fitness Trends for 2019

Rowing, online personal training and increasing use of apps among some of trends By Deborah Jeanne Sergeant


hat’s new for fitness in 2019? Local fitness experts offer their top picks for the coming year’s hottest trends. • “Rowing is kind of like the ‘new spinning.’ What I like about it is it’s a great aerobic exercise because it uses both the upper and lower body. The benefits are so much better because the heart has to work so much harder. It’s low-impact. We’re seeing a lot of endurance. We’re seeing rowing classes staring up across the country. • “American Ninja Warrior — now we’re seeing gyms replicating the movements on TV. As far as I know, there’s 18 of those gyms available in the state. We have a staff member who was on the show. • “Another trend we’re seeing streaming cardio more and more so people can see it at home. Blowflex has it on their treadmills. • “People always like Zumba, but they’re adding core work with strength and balance. • “Group yoga outside is becoming more popular. We’re seeing more developed fitness programs for seniors to prevent falls, increase muscle mass and bone density and Page 12

increase basic living skills which we don’t want to lose. • “Multi-function equipment is a piece of equipment that develops cardio and strength. • “Bodyweight movements are very popular, like planks, push-ups, bridges and squats. — Phil De Angelo, personal trainer and owner Penfield Sport & Fitness, Rochester. • “Newer pieces catching on, like the Versaclimber, commercial cardio equipment that aids with overall body conditioning. It combines stair climber and wall climbing together. • “At a lot of these pop-up gyms group fitness has become the norm. You hear personal training being used, but it’s associated with a group where a personal trainer is training 10-15 clients at a time. • “There’s also spin classes where they’re integrating dumbbell training. • “I’m seeing a lot of online personal training. A lot are turning to Facebook and Instagram to build their business. They’ll put a program together with nutritional guidelines and an exercise guideline and video

chats and updates with the trainer. Clients can purchase these online and have access to these trainers.” — Wayne Haygood, fitness director and certified personal trainer, Penfield Sport & Fitness, Rochester. • “In this day and age, going about your daily life without technology is unheard of. Why should your exercise routine be any different? Tracking your latest run or calories burned can be as simple as wearing a watch. Apps on all of your devices can keep you motivated and provide a variety of exercises at your fingertips, from anywhere Haygood in the world. Technology in the fitness world has been a top trend for the past couple years and I believe there is plenty more to come. • “Exercise for aging adults is a topic that I see firsthand daily. The

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

baby boomers are getting older and the next generation is catching up to them. The population is living longer and working longer. It is our job as fitness professionals to make sure these people are healthy enough to complete their daily routines safely and effectively. ‘ • A significant portion of keeping our population healthy is functional training. Simply being able to tie your shoe or go up a flight of stairs may be difficult for some. Maintaining your strength, balance, and mobility are important in every aspect of day-to-day life. • Fitness is not solely a physical component. Becoming more aware of your spiritual and emotional well-being is just as imperative. We have noticed the interest in yoga and meditation programs rise dramatically in recent months. The ideas of stress management and relaxation through these techniques are very enticing in the workplace and can be performed with little equipment or space. — Daniel DiMarco, manager of the Riedman Wellness Center at Rochester Regional Health

Oat milk, soy milk, coconut milk, hazelnut milk. Alternative options for dairy milk have grown in popularity in the last two decades. But how do they compare to dairy milk?

Dairy Milk Vs. Non-Dairy Milk. Are They All the Same? By Deborah Jeanne Sergeant


or the past 15 years, plant-based “milk” beverages have offered alternatives to dairy milk, which originates from animals. While those choosing plantbased beverages may have different reasons for selecting them — including lactose intolerance, allergy to milk protein, vegan lifestyle or concerns about animal welfare — milk offers more nutrition compared with alternative beverages, according to local experts. Protein is the biggest difference, noted Adrienne Markus, nutrition consultant at The Louis S. Wolk Jewish Community Center of Greater Rochester. “There’s more in dairy milk,” she said. “Soy is the one Markus non-dairy milk that has protein. They all have vitamin D and calcium, but it’s absorbed differently in the body.” While plant-based beverages may seem a nutritious choice, they don’t contain the same nutrients as their sources because they’re highly processed. Most of their nutrients come from supplementation. Markus said that most non-dairy beverages function as a carrier for transporting supplementation, which is far different from drinking a glass of milk with inherent nutrients. “A whole food is better than individual nutrients, Markus added.  Though for people whose allergy or lactose intolerance prohibits them from drinking milk, it’s better to look for fortified alternatives because of the problems milk can cause.

For example, someone who is allergic to dairy milk or lactose intolerant can experience significant gastrointestinal difficulties drinking dairy milk. Milk is among one of the top eight food allergens, according to the US Department of Agriculture. “If you can tolerate milk, there are advantages in milk that you can’t get in alternatives,” Markus said. April Ho, clinical dietitian Ho with University of Rochester Medical Center’s Center for Community Health and Prevention, said that milk contains one gram of protein per ounce of milk. It’s also top-quality protein. “It’s complete, with all the essential amino acids,” Ho said. “It’s also very easily digested — one of the tops, even higher than beef or soy. Not only are you getting 8 grams of protein per serving, but also a form that has top quality.” Milk includes naturally occurring calcium and also vitamin B-12, which is hard to find in a plant-based food except for nutritional yeast. Nearly every brand of milk is fortified with vitamins A and D. “When looking at plant-based milk, there can be fortification, but it’s not consistent,” Ho said. “They might fortify it just like cow’s milk, but not always.” Ho also said that the calcium natural to cow’s milk is easily absorbable, unlike some types of fortification. “You may see fortified products with 33 percent more calcium, but January 2019 •

that doesn’t equate to how much your body can absorb and use,” Ho said. “It’s not equal. You can’t directly equate it based on how many milligrams are on the food label.” Soy alternatives contain protein similar in quantity to milk and peabased beverages run a close second place; however, it’s not absorbed as readily as dairy protein. Nut-based beverages may seem like a good source of protein since nuts are healthful; however, Ho said that they’re not the same. “A lot of the nutrition is filtered out,” Ho said. “Almonds are high in fiber, protein and calcium, but when it’s made into a beverage, you lose all the protein and fiber,” Ho said. “You don’t get the full nutrition you’d get from eating nuts. The same is for quinoa or oats.” Ho said that vegans can balance several types of protein to create a well-rounded diet, but they cannot expect to obtain it from one source. Coconut alternatives contain little protein but have been touted for improving the metabolism; however, Ho cautioned about its regular use since it contains high levels of saturated fat. Nut-based beverages do represent good sources of polyunsaturated fats, and are sources of vitamins A and E. Ho also said that hemp beverages provide omega-3 fatty acids and magnesium. Since many non-dairy milk alternatives contain sweeteners, those looking for the most healthful beverage should look at milk again. It contains no added sugar, unless it’s a flavored milk such as chocolate or strawberry. Milk does contain lactose, which is the natural, inherent sugar that causes problems for those who are lactose intolerant or lactose

sensitive. Some of the non-dairy milks can be sweetened or unsweetened. If sweetened, they’ll be higher in sugar. Lactose is dairy sugar, so it’s not added unless it’s chocolate milk or strawberry milk. Among plant-based milk alternatives, rice milk contains less sugar than others. But Ho warned that “several rice milks have been shown to have 70 percent more arsenic than the World Health Organization standard for drinking water. The USbased products are less safe. Rice in Thailand or Asia are better. That goes for rice or rice products.” US milk is highly regulated for safety concerns. Milk sold commercially must be pasteurized, which kills any bacteria. But before it even leaves the farm, all milk is tested for bacteria and antibiotics. Any batch found contaminated is thrown away, as mandated by law. Some non-organic farmers use rBST, a synthetic growth hormone, to help cows produce more milk. The hormone is specific to species, meaning it doesn’t affect humans drinking the milk. Pasteurization destroys 90 percent of any traces of the hormone present in milk and the rest is broken down during digestion. The Food and Drug Administration has deemed the use of rBST with dairy cattle as safe and their stance has been approved by National Institutes of Health, World Health Organization/Food and Agriculture Organization and American Medical Association. Though organic milk bears an identical nutritional panel as traditionally produced milk, grass-fed milk offers higher levels of beneficial omega-three fatty acids. Grass-fed herds also have access to pasture in season.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 13

Guide to Comfort Food By Anne Palumbo

Satisfy comfort-food cravings with healthy makeovers


omfort food is food that soothes the soul and satisfies the appetite. Often, it’s food that’s associated with the security of childhood, like Mom’s grilled cheese, Grandma’s chicken potpies or Dad’s mashed potatoes — food that brings back a good memory, a warm feeling or a special relationship.

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Stress sometimes triggers our hankering for certain comfort foods. Bad day at the office? Only pizza will do! A fight with your significant other? Bring on the ice cream! A stretch of dreary weather? More mac and cheese, please! And while there’s no requirement that these foods be rich, heavy or unhealthy, research shows that our go-to comfort foods tend to be. Perhaps we lean in this direction because our physical response to comfort foods is grounded in food science: many common comfort foods have a higher fat or sugar content, which in turn provides a short-term physiological boost. Comfort foods may help raise our body temperature, provide a burst of energy and even improve our moods. We all crave different comfort foods. When I’m feeling out of sorts, all I want is grilled cheese and Campbell’s tomato soup. My husband, on the other hand, longs for his mom’s beef stew. My sister pines for chocolate chip cookies. Plus, we seem to crave these foods more during the cold winter months.

Why does winter affect our cravings?

Some researchers suspect fewer daylight hours may play a significant role in why we crave for comfort food during the winter. Since sunlight is one of the factors that triggers the release of the hormone serotonin, a known mood booster, and we’re getting less of it during winter months, we’re more inclined to reach for foods that also prompt the release of serotonin: carbohydrates. People who suffer from seasonal affective disorder, a type of depression that’s related to changes in seasons, are particularly vulnerable. Boredom, inactivity and being cooped up inside can all have a pronounced affect on what and how much we eat. When “cabin fever” strikes our house, we eat a lot more cheese-blanketed nachos — my kids’ favorite comfort food — than at any other time of year. Same goes for pizza, mashed potatoes and hot chocolate: They all just taste so darn good and comforting during the dark days of winter. Of course, there are consequences to an uptick in winter munchies, especially if your munchies involve comfort foods that run higher in calories, fats and carbs. According to studies at Johns Hopkins University, people tend to gain five to seven pounds on average during winter months. Weight gain aside, many comfort foods are simply not all that healthy to consume on a regular basis — from super-salty French fries to high-fat ice cream to empty-calorie candy. What to do during the long winter months when our comfort-food cravings are besting our better judgment? Read on for some nutritious makeovers that may satisfy your longings without

compromising your health.

Grilled Cheese

Ah, grilled cheese…nothing says “mom” quite like a grilled sandwich of white bread, slathered with butter on the outside and loaded with bland American cheese on the inside. But must you stick with those exact ingredients to conjure images of mom? Of course not! Try fiber-rich whole-grain bread instead of white; use a mix of cheeses that includes low-fat mozzarella and full-flavored cheddar, and substitute some of the cheese with sliced tomatoes, salsa or whatever healthy ingredient your heart desires. To create a nice golden outer crust — without all the butter — try this: Heat one teaspoon canola oil in a medium nonstick skillet over medium heat. Roll it around to coat the pan and then cook your sandwich until golden, about two minutes per side, slightly depressing each side with a spatula.


Unless you make it yourself, it’s tough to eat pizza you feel good about. On average, one slice of pepperoni pizza serves up around 300 calories, 12 grams of fat, 30 grams of cholesterol and more sodium than four small bags of potato chips. Yikes! Fortunately, you can turn takeout pizza into a healthier pizza with just a few tweaks: Order a smaller size for fewer calories per slice; choose a thinner crust over a deep-dish or regular crust (and don’t get it stuffed!), request whole-wheat if it’s offered; ask for reduced cheese; skip the dipping sauce; and pile on the veggies.

Mashed Potatoes

Even though plain potatoes are low in calories, mashed potatoes — especially those made in restaurants — aren’t always healthy. Typically made with whole milk and butter, mashed potatoes run about 250 calories per serving; add gravy and your total intake could exceed 400 calories. Here are just a few tricks to make your mashed potatoes healthier: Mash your potatoes with Greek yogurt, low-fat sour cream, 1 percent milk or chicken stock; bump up

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

the flavor with garlic, chives or spice of choice; and use olive oil (full of healthy monounsaturated fat) instead of butter (full of unhealthy saturated fat). Eating out? Order a plain baked potato and mash it with salt, pepper and a drizzle of olive oil.

Mac and Cheese

When prepared traditionally, mac and cheese is not so comforting. Low in nutrients and high in fat, mac and cheese dishes up about 400 calories per cup. And who eats just a cup? It’s easy, however, to turn this popular dish around. Use whole-wheat pasta for added fiber and lots of B vitamins; tuck in some roasted veggies; skip the buttery crumb topping or simply replace it with crunchy whole-wheat breadcrumbs; add flavor to the cheese sauce with fresh or dried herbs; use reduced-fat milk and cheese; and replace some of the cheese with plain Greek yogurt.

Chocolate Chip Cookies

While it seems sacrilege to even think about tampering with this classic cookie, it doesn’t take much to make it a tad healthier. Consider the following easy-to-implement changes: Replace some (or all) of the refined white flour with white whole-wheat flour; add oats and nuts; reduce the sugar and chocolate chips by half; and replace some (not all) of the butter with tahini — a sesame seed paste. More nutritious makeovers of favorite comfort foods abound on the internet. If, however, you must have the “real deal,” then do what the French do and practice portion control, limiting yourself to smaller servings and just one cookie not three.

Anne Palumbo is a lifestyle columnist, food guru, and seasoned cook, who has perfected the art of preparing nutritious, calorie-conscious dishes. She is hungry for your questions and comments about SmartBites, so be in touch with Anne at

Women’s Health

More Women Than Men Reporting Higher Levels of Stress Stress is on the rise for women — nearly half of women in survey said their stress has increased over the past five years, compared with only 39 percent of men by Deborah Jeanne Sergeant


tressed out? How you perceive it and respond to it can vary depending upon your gender, according to the American Psychological Association. The organization’s website states that “men and women report different reactions to stress, both physically and mentally. They attempt to manage stress in very different ways and also perceive their ability to do so — and the things that stand in their way — in markedly different ways.” For example, women are more likely to report physical and emotional symptoms to which stress is contributory, including headache, feeling as though they could cry, upset stomach, interrupted sleep and more. According to the association,


stress is on the rise for women. Nearly half of women surveyed said that their stress has increased over the past five years, compared with only 39 percent of men. “It’s unbelievable how much women do,” said Melissa Endres, general manager at Relax The Spa in Rochester. In the business 20 years, Endres said that stress levels for women have never been higher, and part of the reason is that women take on so many different roles. Compared to men, women usually complete more cooking and housekeeping tasks, manage the household’s social calendar and primarily care for their children or elderly relatives, all on top of working a job. According to the Bureau of Labor

Statistics American Time Use Survey in 2015, adult women spend an average of two hours, 15 minutes on household activities daily, compared with men’s one hour, 25 minutes. Both indoor and outdoor chores were included. The bureau also states that women spend twice as much time caring for others in the household than men. About 72 to 75 percent of adult women have worked full-time since 1968. Physician Rob Kiltz, who heads CNY Healing Arts and CNY Fertility in Rochester, said that women’s stress “is a very important area that I’ve been involved with a long time. Healing Arts is about stress reduction,” he said. He said that the emotions directly relate to the coronary system, gastrointestinal system and other bodily systems. “Stress hormones affect every organ system,” he said. “It causes fatigue, exhaustion, pain and increases inflammation, and ultimately the core of all diseases, is related to inflammation. It’s the foundation of every disease.” Though the body can experience physical stressors from illness, injury, environmental attacks or depletion, emotional stress can contribute to physical stressors that cause “pretty much every disease we suffer form,” Kiltz said. Taking care of themselves doesn’t end up high on their to-do list. “If they don’t take care of themselves, stress is like a build-up of tension in the body and mind,” said Erin Whiting, reiki master and owner of Soleil Wellness in Victor. “They end up developing anxiety, depression and a lot of times, even physical illness. So if they don’t use and practice many of the many things to manage stress, they burn out in some form or another, physically or mentally.”

Reducing Stress

Cutting back on commitments, controlling screen time, eliminating or setting boundaries on toxic relationships and lowering self expectations can lower possible sources of stress; however eliminating stress isn’t possible. Plus, some circumstances that contribute to stress are generally pleasant — a promotion, new baby, or surprise party. Managing stress is vital for reducing its ill effects. “I often find that stress is related

a lot more to your perception on life,” Whiting said. Maintaining a positive outlook really does make a difference. In the midst of a difficult circumstance that could be stressful, look at possible solutions and what’s going right. “When I’m in a fight or flight mode, breathing techniques stimulates the rest and relax response if you’re breathing properly,” Whiting said. She also recommends emotional freedom technique tapping, which involves tapping on acupressure points. Taking time for pleasurable pursuits can help manage stress. Whiting said that it’s important that the activities don’t require a specific outcome. For example, if bowling a perfect game makes the activity stressful, walking in nature or taking yoga would provide greater stress relief. Whiting added that it’s important to “allow yourself to just be OK to sit still. We don’t give ourselves permission to just be and not feel guilty.” Ron Pratt, licensed acupuncturist and owner of Ronald Pratt Acupuncture in Rochester, advises women to focus on physical self-care, such as quality sleep, hydration, eating right and exercising. Because without selfcare, physical issues often manifest. “There is often a physical component to dealing with stress,” Pratt said. “Mental, emotional and physical health are inter-related.” While under stress, hormones secreted to aid in physical defense can divert energy from digestion may reduce the absorption of nutrients. Pratt said an old Chinese proverb goes, “Eating a good meal standing is like eating a rock.” In modern times, eating while watching the news, checking email or skimming through social media can result in stress-filled eating. “It seems like a good way to multi-task, but it’s not good for you,” Pratt said. “If you take a break to eat, you’ll think clearer.” He also advises cultivating a habit of gratitude and taking time each morning to “enjoy your cup of coffee or take the dog for a walk, which gets your mind in the right place.” Modalities such as massage, talk therapy, and acupuncture can help reduce the effects of chronic stress.

You’re Not Alone: Half of Older Women Suffer Incontinence, Many Don’t Tell Their Doc

early half of older American women have urinary incontinence, but many have not talked to a doctor about it, a new national poll shows. More than 1,000 women, aged 50 to 80, were asked questions about their bladder control. The poll found that 43 percent of those in their 50s and 60s had urinary incontinence. That percentage jumped to 51 percent among those over 65. But two-thirds of those women had not discussed the problem with a doctor, and only 38 percent said they

do exercises to strengthen muscles that can help keep urine from leaking. “Urinary incontinence is a common condition that may not be routinely screened for in primary care, yet it can impact a woman’s quality of life and health, and is usually treatable,” said Carolyn Swenson, a urogynecologist with the University of Michigan. She helped develop the poll questions and analyze the findings. Of the women who said they’d experienced urine leakage, 41 perJanuary 2019 •

cent said it was a major problem or somewhat of a problem. One-third of those with leakage said it occurred almost every day. Most found ways of coping on their own, according to the poll — from using pads or special underwear to wearing dark clothing and limiting fluid intake. But nearly half worried it would get worse as they got older. “It’s not an inevitable part of aging and shouldn›t be overlooked, Swenson noted in a university news release.

The most common triggers of urine leakage were coughing or sneezing (79 percent), trying to get to a bathroom in time (64 percent), laughing (49 percent) and exercise (37 percent). The poll, published Nov. 1, was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and sponsored by AARP and Michigan Medicine, the university’s medical center.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 15

Women’s Health Alcohol & Breastfeeding.

Do They Go Well Together? Lactation consultant in Rochester says many moms receive mixed information on alcohol and breast feeding by Deborah Jeanne Sergeant


hould nursing moms avoid alcohol? While alcohol doesn’t offer any benefits, lactation experts agree that those who drink may do so — with limitations. Ellen Derby, certified lactation counselor and birth doula, has 17 years’ experience in the field. She said that whether breastfeeding or not, alcohol should be consumed only in moderation; however, “that doesn’t mean you can’t drink at all when pregnant.” Derby, who operates Birth and Mother’s Milk Lactation Services, which serves the Rochester area, explained that while pregnant, babies are directly exposed to the alcohol the mother consumes. Pregnant women should never drink alcohol, she said. While nursing, the baby’s not continuously connected to mom for nutrition, so it’s OK to have an occasional drink. “If you want to go to a party and have a drink, the thing to do is nurse your baby before you begin to imbibe — remember that it takes an

hour to process 1 ounce of spirits, 6 ounces of wine or 10 ounces of beer,” Derby said. “The alcohol goes into our blood stream and back out in one hour. If you’re going to be at a big party and your baby will need to eat, don’t nurse while there’s alcohol in your system.” The time it takes for alcohol to leave the body depends upon the individual’s tolerance level, which can lower after abstaining from alcohol for nine months, as well as through changes inherent to pregnancy. Small babies need to nurse often all day and night long. Imbibing may be harder to do with a newborn through about 6 months. “Breast milk is a blood product,” said Alison Spath, international board certified lactation consultant with Beautiful Birth Choices in Rochester. “If you have alcohol in the blood, it’s in the breast milk.” Spath warned that moms who drink regularly or to excess, can find that their babies won’t nurse as much because alcohol affects the taste of

breast milk and their milk supply can decrease. “It takes a longer time for babies to eliminate alcohol,” Spath said. “We don’t want infants exposed to alcohol; it’s not safe.” Even after a small exposure through the breast milk of light drinkers, infants don’t sleep as well. Those who drink more may have their babies gain weight more slowly and exhibit decreased gross motor development. While drinking water during and after alcohol consumption may aid in minimizing hangover symptoms, Spath said that water won’t clear alcohol out of the system faster. Expressing breast milk with a pump and disposing of it (known colloquially as “pump and dump”) doesn’t help, either. “It doesn’t speed the alcohol leaving the milk,” Spath said. “The body has to metabolize it out of your blood and milk. You have to wait the one to two hours.” Pumping may help keep breast at a comfortable level of fullness; however, it does nothing to clear out alcohol from the body since the blood alcohol level correlates with alcohol in breast milk. Moms who pump while drinking should not bottle feed their babies with that milk. Spath said that some moms have told her they’ve heard that they should drink a beer a day to increase the milk supply. “That’s an old wives’ tale,” she said. “It’s not true. More nursing or pumping will help you make more milk. There’s no solid evidence that anything mom eats will affect milk

supply. Anecdotally, some things women claim makes a difference, like oatmeal, but there’s not research. We definitely want a breastfeeding mother to drink to thirst. Our bodies take from us what the baby needs.” Relaxing with the baby and managing stress scan help improve milk let-down. Dianne Cassidy, international board certified lactation consultant with an advanced lactation certificate and Bachelor of Science in maternal child health/lactation, operates Dianne Cassidy Consulting, in Rochester. She said that based upon what moms tell her, many moms receive mixed information on alcohol and breast feeding. “It makes for a lot of confusion,” she said. In addition to waiting around two hours or more for alcohol to clear the system, she advises moms to “plan on having someone else watch your baby. You shouldn’t make decisions while under the influence.” That includes caring for the baby. Cassidy wants moms who drink and are going out with friends to arrange for childcare for the night. “It’s not just alcohol in the milk but your behavior while drinking and taking care of a child.” While she doesn’t think moms should deprive themselves if they want a drink, she urges them to make plans, know their limits, and not imbibe while caring for their infants. “Like always, be safe about it,” Cassidy said. “Because you’re a breastfeeding mom doesn’t mean you have to give everything up.”

C-Section Rates Have Nearly Doubled Since 2000: Study


he number of women delivering babies via cesarean section has nearly doubled worldwide since 2000, to about 21 percent, new research shows. That’s significantly higher than the 10 percent to 15 percent considered medically necessary, researchers said. When complications develop, C-sections can save the lives of mothers and their babies. But the surgery is not risk-free and has been linked to difficulties with future births. “The large increases in C-section use — mostly in richer settings for nonmedical purposes — are concerning because of the associated risks for women and children,” said physician Marleen Temmerman, lead author of three studies published Oct. 11 in The Lancet. Temmerman is a professor of obstetrics and gynecology at Aga Khan University in Nairobi, Kenya. Worldwide, C-sections rose nearly 4 percent a year between 2000 and 2015, the study found. That translates to 16 million of the 132 million live births in 2000 and 30 million of the 141 million live births in 2015. The fastest rise (6 percent) took place in South Asia, where researchers said C-section deliveries were underused in 2000 but overused 15 years later. C-sections were also overused in the United States, Canada, West-

Page 16

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

ern Europe, Latin America and the Caribbean, where rates rose about 2 percent a year over the study period of 2000 to 2015. In North America alone, C-section births rose from about 24 percent to 32 percent during that time span, the study found. Fifteen nations, including Mexico and Cuba, had C-section rates that topped 40 percent. Some women choose an elective cesarean delivery because it allows them to skip the pain and uncertain timing of natural labor. A C-section is medically necessary when complications develop such as bleeding, high blood pressure or the baby is in an abnormal position in the womb, endangering mother or child. But the procedure is unavailable to many women in low-income countries and overused in many middle- and high-income countries, the researchers found. Six out of 10 nations do too many C-sections and a quarter perform too few, the study found. Moreover, wide differences exist between rich and poor, public and private sectors, and between regions, the researchers said. “In cases where complications do occur, C-sections save lives, and we must increase accessibility in poorer regions, making C-sections universally available, but we should not overuse them,” Temmerman said in a journal news release.

Women’s Health

The Value of Mammography in Women 75 and Over ‘It is important to encourage the women in this group to continue annual screening.’


Stamatia Destounis is a physician specializing in radiology diagnostic. She is affiliated with Elizabeth Wende Breast Cancer, LLC.

nearly one in five breast cancers diagnosed are in this population. Mammography performs well in this population — recall rate is low and the positive predictive value for biopsy and cancer detection is high. Despite this, the 75-plus age group continues to be given conflicting recommendations concerning the necessity of mammography. This led us to pursue a retrospective investigation of our patient population over a 10-year period (2007-2017), which included 763,256 screening mammography appointments; 76,885 which were performed in patients aged 75 and older. 3,944 screen-detected malignancies were found; 645 malignancies in those 75 and over. This population made up a small percentage of our overall screening population (10 percent) yet made up 16 percent of all screen-detected cancers diagnosed. Tumors identified were invasive (82 percent), node negative (93 percent), and low stage (71 percent), yet intermediate to high grade. Surgical intervention was pursued by 98 percent, suggesting these women intend to continue to live a long life, and these are cancers that need to be found. The largest generation born in American history is approaching age of 75; it is important to encourage the women in this group to continue

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urrent average life expectancy for American women is 81.30 years, with one out of every 10 women living past age 95. Though this number is expected to continue to rise, societal recommendations conflict regarding when to stop breast cancer screening. This is largely because there is little evidence evaluating the benefit of annual mammographic screening in the population of women over the age of 75. For average risk women of screening age, mammography is the gold standard for breast cancer detection, proven to substantially reduce breast cancer mortality. Annual screening provides the most benefit — detecting cancers when they are smaller, lower stage and grade, requiring less invasive treatment and better prognosis. These benefits continue for women past age 75. Increasing age is the greatest breast cancer risk factor;


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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Women’s Health

Help Wanted: School Nurses Understanding the Basics of Hypertension By Kim Bagley


ong-term untreated high blood pressure or hypertension will cause damage to organs such as your heart and kidneys. Generally speaking the American College of Cardiology agrees that hypertension is a blood pressure reading above 130/80 on a consistent basis. Everyone should periodically check their blood pressure. This can be done at your local pharmacy or grocery store. Most of these machines are regularly calibrated and accurate. If possible I do recommend using the same blood pressure machine. If you are thinking of purchasing your own electronic blood pressure cuff, there are many good machines on the market. I usually recommend an arm cuff versus a wrist cuff. Omron is the brand I recommend. When checking your blood pressure: • Sit and relax for about five minutes prior to checking • Both feet should be flat on the floor. Avoid smoking and caffeine 30 minutes prior to checking. • Record readings. Goal is to average your readings obtained on different occasions to estimate your individual blood pressure levels. • If you note your blood pressure is consistently above 130/80, please let your physician know on your next follow-up appointment. Remember blood pressures do fluctuate and many external factors can cause a temporary rise in blood pressure. Initial treatment recommendations include lifestyle changes which can decrease your blood pressure by approximately 4 to 11 mm HG. These include decreasing salt intake and regular aerobic physical activity. For approximately every 1-2 pounds weight lost your blood pressure will drop by 1-2 mm HG. For weight loss I generally recommend a more plantbased diet with less meat and less processed foods. These measures should be started in conjunction with close follow up with your doctors and, if needed, along with initiation of medication to help control your elevated blood pressure. Kim Bagley is a nurse practitioner at University of Rochester cardiology division at Clinton Crossings.

Page 18

Only 45 percent of America’s public schools have a full-time school nurse By Deborah Jeanne Sergeant


hould your child become sick or hurt while at school, a school nurse may not be as readily available to help. Nationwide, schools are struggling to find enough nurses. Statewide, public schools average 1,007 students per one school nurse, according to the National Education Association. “There is definitely a shortage, like a shortage of all nurses: 1 million by 2022,” said Mary Maher, head of nursing at Nazareth College. “School nurses are going to be as adversely affected as anywhere else, but school districts don’t always see the need for school nurses.” Only 45 percent of America’s public schools have a full-time school nurse, according to the National Association of School Nurses. But that doesn’t mean school nurses aren’t needed. The New York State Association of School Nurses supports legislation that would place a school nurse in every school building. With childhood obesity on the rise, the complex health issues related to obesity may not receive the care they need. More children than

ever have been identified as having life-threatening allergies. Many districts have shed routine screenings for health issues, which shifts the burden onto pediatricians — providing parents schedule regular well-child visits. Eileen Davis, director of school nurse services for BOCES, said that “it’s a struggle” to provide nursing coverage to every school in the district. Sometimes, support staff may help with routine, non-medical tasks to reserve those with training for medical issues. “We take care of the needs and we have an ongoing list of things that are not as important,” Davis said. “If we get some down time, we play catch-up.” She also said that some screenings have been set aside so that acute needs receive the help they need. “Children that are in pain cannot learn so we focus on their needs,” Davis said. Davis said that maintaining school nurses is more than about applying ice packs and bandages. School nurses may be involved with assessing risks during emergency

situations, assisting with medication and other health-supportive therapies, and counseling students on health, nutrition and hygiene. Families without sufficient health care coverage may rely upon the school nurse for their children’s routine health care needs and screenings. Without a school nurse, those children may not receive the care they need. Children often confide in nurses as they build trust with them. For example, a child may tell a school nurse about domestic violence or a lack of food at home. “It’s their safe place,” Davis said. “They feel like their school nurse is someone they can trust to talk with.” She thinks that training aides for just performing screenings would give nurses more time to focus on medical needs. The aides could also save money in the budget since their pay would be at a lower rate than that of registered nurses. “If we train these individuals so they can do screenings, it’s fewer tasks for the nurse so she can provide the needs and comfort care for the students,” Davis said.

Skin: the Forgotten Organ By Deborah Jeanne Sergeant


n recent years, more attention has been given to probiotics as they relate to digestion and, by extension, the entire body. Terms such as the “second brain” in reference to the gut pay tribute to the emerging knowledge about the importance of gastrointestinal tract and the vital role probiotics play in overall health. The skin is also becoming more recognized for its function in protecting the body as well as the microbiome living on it. “Whether for your skin or belly, the probiotics are important,” said Melissa Endres, general manager at Relax The Spa in Rochester. Her organization uses an all-natural organic skin care line, that offers built-in probiotics in the cleansers. Endres said that’s important because “if you put something unnatural on the skin, it’s being absorbed into the body. With probiotics in our cleaners, they help neutralize things attacking the skin and willow bark controls the oil. They work together to help the skin become healthier.” Physician Nana Duffy, with Rochester Regional Health’s Genesee Valley Dermatology and Laser Centre, said that like the gut’s microbiome keeping the gut healthy, the skin’s microbiome keeps it healthy. “When that microbiome is disrupted the skin cannot perform its proper function,” Duffy said. “One of

the ways you can support your skin’s microbiome is to not overly cleanse the skin with harsh soaps. “Regarding the skin barrier, products that support the skin barrier often contain ingredients called ceramides. Ceramides are like the mortar in between the bricks of your skin cells. These products are easy to find over the counter and do a great job of keeping the skin supple and well moisturized.” Ceramides also help form a protective barrier that keeps out bacteria and environmental toxins. By scrubbing these away, people unknowingly injure their skin. People with eczema, psoriasis and advanced age have lower levels of ceramides present in the outer layer of their skin than younger people and those without these conditions. Lynn Schapp, owner of The Soap Hag in Springwater, began her all-natural line of soaps and lotions because she and her husband, Wayne Schapp, experienced rashes and dryness from commercially produced store-bought products. Eventually, the hobby grew into a business that uses ingredients such as aloe vera, glycerin, goat’s milk, olive oil and essential oils for bath and body products. “Glycerin is what’s taken out of commercial soaps,” Schapp said. “We leave it in there and it benefits your

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

Duffy skin. We knew all about the gut microbiome for a while now. Who knew there was a microbiome on the skin?” She added that traditional skin products damage the microbiome, especially antibacterial products. “They kill off your layer of skin that helps protect your skin from drying out,” Schapp said. “We use food grade ingredients that are backto-nature.” Consuming sufficient dietary fats from sources such as fatty fish, nuts, seeds, avocadoes and olive oil can help promote production of healthy skin.

remind a loved one

to get a mammogram.

By Jim Miller

Does Medicare Cover Dental Care? (585) 442-2190 Batavia

Dear Savvy Senior, I will turn 65 in a few months and will be enrolling in Medicare, but I am concerned about Medicare’s coverage of dental care. Does Medicare cover dental procedures? And if not, where can I get dental coverage?

Almost 65

Dear Almost, Medicare’s coverage of dental care is extremely limited. It will not cover routine dental care including checkups, cleanings or fillings, and it won’t pay for dentures either. Medicare will, however, cover some dental services if they are required to protect your general health, or if you need dental care in order for another health service that Medicare covers to be successful. For example, if you have cancer and need dental services that are necessary for radiation treatment, or if you need surgery to treat fractures of the jaw or face, Medicare will pay for these dental services. Although Medicare’s coverage of dental services is limited, there are other ways you can get coverage and care affordably. Here are several to check into. Consider a Medicare Advantage plan While dental services are mostly excluded under original Medicare, some Medicare Advantage plans do provide coverage for routine dental care. If you are considering joining a Medicare Advantage plan, find out what dental services, if any, it covers. Also, remember to make sure any Medicare Advantage plan you’re considering covers the doctors and hospitals you prefer to use and the medications you take at a cost you can afford. See or call 800-633-4227 to research plans in your area. Purchase dental insurance If you have frequent gum problems and need extensive dental care, a dental insurance plan may be worth the costs versus paying for care yourself. Expect to pay monthly premiums of $15 to $40 or more for insurance. To find dental plans, go to and use the “find a dental plan” tool. Then review a specific plan’s website. Consider dental savings plans While savings plans aren’t as comprehensive as insurance, they’re






Are you unable to work because of a severe impairment or illness? I have over 20 years experience successfully obtaining a good option for those who can’t get covered. How this works is you pay an annual membership fee — around $80 to $200 a year — in exchange for 10 to 60 percent discounts on service and treatments from participating dentists. To find a savings plan, go to (or 888-632-5353) where you can search for plans and participating dentists, as well as get a breakdown of the discounts offered.

Mary Perry,

Shop around and lets you look up the cost of different dental procedures in your area, so you can comparison shop – or ask your regular dentist for a discount. Try community health centers or dental schools There are many health centers and clinics that provide low-cost dental care to those in need. And all university dental schools and college dental hygiene programs offer dental care and cleanings for less than half of what you would pay at a dentist’s office. Students who are supervised by their professors provide the care. See to search for a center, clinic or school near you. 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. January 2019 •

for those deserving benefits. For best results, let me represent you. 


585-385-6855 |

Check veterans’ benefits If you’re a veteran enrolled in the VA health care program or are a beneficiary of the Civilian Health and Medical Program (CHAMPVA), the VA offers a dental insurance program that gives you the option to buy dental insurance through Delta Dental and MetLife at a reduced cost. The VA also provides free dental care to vets who have dental problems resulting from service. To learn more about these options, visit dental or call 877-222-8387.

Social Security Disability/SSI


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MONITOR– count your medication regularly

SECURE– lock up any medication you do not want anyone to access

DISPOSE– drop off any unwanted/unused and expired medication to your local disposal site

Medication Drop Box Locations: Bristol: Town Hall

Farmington: State Troopers

Canandaigua: FLCC (Keuka Wing) The Medicine Shoppe Ontario County DMV Office Canandaigua Police Dept. Thompson Hospital (lobby) Mental Health Clinic

Clifton Springs: Hospital (Lobby)

Geneva: Police Station North Street Pharmacy Richmond: Town Hall CVS Pharmacy

East Bloomfield: Town Hall Manchester/Shortsville: Red Jacket Pharmacy Naples: Village Hall Phelps: Community Center Rushville: Village Hall

Victor: Meade Square Pharmacy Questions, please call us at 585-396-4554.

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Rochester New York’s Healthcare Newspaper IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 19

Ask The Social

Security Office

From the Social Security District Office

Disagree With Your Disability Decision? We Will Take Another Look


ocial Security is here to help secure today and tomorrow by providing benefits and financial protection for millions of people. This assistance allows people with severe disabilities and health conditions to take care of the necessities of living, such as food, shelter, and medications. It is imperative that we continue to protect the integrity of the disability program for everyone by ensuring we make the correct decision on each claim. However, if you do not agree with our decision, you can ask us to take another look by filing an appeal. Generally, there are four appeal levels: 1) Reconsideration, 2) Hearing, 3) Appeals Council Review, and 4) Federal Court Review. At the reconsideration level, someone who did not make the first decision on your claim will conduct a review and accept any additional evidence. Please note, in some states, appeals may proceed directly to the next step — the hearing. If you disagree with the reconsideration decision, you can file another appeal and your case will go to the hearing level. You, and any witnesses you bring, may present your case in front of an administrative law judge during this stage. The judge will then make a decision based on the information. If you disagree with the hearing decision, you can ask for a review by the Social Security Appeals

Council. The Appeals Council can either make a decision or return your case to the judge for further review. If you disagree with the Appeals Council’s decision or they decide not to review your case, the last step in the appeals process is filing a lawsuit in a federal district’s court. You will be notified of our decision in every step of the process and the notice will have the information needed should you decide to appeal the decision. If you receive a denial notice, you have 60 days from that date to file an appeal. There are several ways to obtain the proper appeal forms. The easiest and quickest way is filing online by visiting www.socialsecurity. gov/benefits/disability/appeal.html. You will be able to submit documents electronically to associate with your appeal request. You can also call us at 1-800-772-1213 or visit your local Social Security office to obtain the forms. Many people wonder if they need a lawyer when filing and appealing disability benefits. Whether you choose to appoint an attorney or authorized representative is completely up to you. However, it is not required that you have one in any part of the process or in conducting business with Social Security. If you decide to appoint a representative, be sure to complete the necessary documents to authorize us to speak to them on your behalf. You can also

read our publication Your Right to Representation at Social Security takes considerable pride in administering program benefits timely and accurately. The


Q: I’m expecting a baby this June. What do I need to do to get a Social Security number for my baby? A: Apply for a number at the hospital when you apply for your baby’s birth certificate. The state agency that issues birth certificates will share your child’s information with us, and we will mail the Social Security card to you. You can learn more about the Social Security number and card by reading our online publication on the subject, available at Q: I haven’t received my Social Security statement in the mail the last few years. Will I ever get one again? A: In September 2014, Social Security resumed mailing Social Security Statements to workers ages 25, 30, 35, 40, 45, 50, 55, and 60 who aren’t receiving Social Security benefits, and who don’t have a My Social Security account. Rather than once every five years, those over age 60 will receive a statement every year. Instead of waiting to receive a mailed statement once every five years, we encourage people to open a My Social Security account at myaccount so they can access their statement online, anytime.

disability program is no exception. This is why we encourage you to contact us as soon as possible if you disagree with our decision. Give us a call, visit the local office, or go online at disability/appeal.html so we can take another look at your claim.

Q: I’m thinking about getting disability protection from a private company. If I become disabled and have a private policy, would it reduce my Social Security disability benefit? A: No. Having private insurance does not affect your eligibility for Social Security disability benefits. But, you may be interested to know that workers’ compensation and certain other public disability payments may affect your Social Security benefit. You can learn more and even apply for disability benefits at www. Also, read our publication, How Workers’ Compensation and Other Disability Payments May Affect Your Benefits, available at pubs. Q: What is the difference between the disability application and the disability report? Do I have to complete both? A: A disability application is a claim for Social Security disability benefits. A disability report provides information about your current physical or mental condition that we need to process your disability application. To establish a claim for disability benefits, you need to file a disability application, submit a disability report, and provide an authorization to release medical records. The best place to start is at

Parkinson Disease Care NEW YORK (PDCNY) is a unique program open to individuals with Parkinson disease (PD) throughout New York State. The program aims to address barriers to accessing care, improve quality of care, reduce caregiver burden and lower the cost of care through a coordinated telemedicine program. Telemedicine is the use of smartphones, computers, and tablets to provide clinical care from a distance. About our Program: Through this care program, individuals with PD can see a Parkinson’s specialist from the comfort of their own home through simple web-based video conferencing. A video visit is like a regular doctor’s visit. During these visits, your doctor will ask questions about your medical history, provide a focused examination, and give you recommendations to improve your health. The PDCNY care team includes a Parkinson’s disease specialist, a nurse who specializes in PD care management, and an experienced telemedicine coordinator. This is a good alternative for someone who: · Is not currently seeing a neurologist who specializes in Parkinson’s · Has to travel a long distance to see their doctor · Has difficulty getting to a doctor’s office What is Covered: The care program is 100% funded by the Greater Rochester Health Foundationand the Edmond J. Safra Foundation. All care from the PDCNY team is provided at no cost and health insurance is not required. Medications or treatments provided via a referral from our care team are not covered. PDCNY can even provide you with a webcam free of charge, if needed. For those who cannot easily access internet at home we have satellite sites in five locations across the state of New York. Learn more: For more information, please contact the PDCNY care team at (585) 276-8784 between 9 a.m. and 4 p.m., Monday – Friday, or visit

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

Ask St. Ann’s

Why is Speech Therapy Important for Aging Adults?

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By Nicole Urbanczyk


s we age, we have a lower threshold for illness or injury. Weakness caused by surgeries or other medical conditions may impact one’s ability to communicate or swallow. If you are having trouble talking or swallowing, it is time to ask your doctor for a speech therapy referral. Early evaluation and treatment, can help seniors regain and optimize their function to resume their daily routine safely. Know the signs If you experience any of these speech or swallowing issues, see your doctor: • Chewing food takes longer, especially meats • Throat clearing, coughing or choking while eating • Food sticking or moving sluggishly through the esophagus • Difficulty swallowing water or thin liquids • Unclear verbal expression and pronunciation of words • Voice problems • Disorientation; poor memory or judgment • Difficulty completing familiar tasks • Recurrent respiratory infections and pneumonia • Unexplained weight loss and dehydration Keep track of the cause, frequency and time of day surrounding each episode. Note whether you feel tired, stressed or anxious at these times. In addition to obtaining the speech evaluation referral you need, this information will help your doctor determine if a neurology, gastrointestinal or ear/nose/throat consult is also needed for an accurate diagnosis. Don’t wait to get help Speech therapy should also be a top priority when a senior receives a diagnosis of Parkinson’s or another neurodegenerative disease. Early evaluation and therapy will help maintain as many communication

skills as possible, for as long as possible. Many eldercare communities provide speech therapy as part of a continuum of care. St. Ann’s Community has five full-time licensed speech language pathologists to regularly assess skilled nursing residents at St. Ann’s Home and St. Ann’s Care Center and rehab patients that come to our Transitional Care Center. For outpatient care, seniors can find licensed speech therapists at many healthcare clinics and doctors’ offices, or through home healthcare agencies.

Taking some basic precautions can prevent a speech and swallowing problem from interfering with spending time with others and doing things you love: • Practice good posture when eating or drinking • Choose foods that are easier for you to eat • Avoid dry, coarse or hard foods • Take small bites; chew slowly and thoroughly • Be sure you’re well rested • Choose a quieter environment for gatherings Remember—recovering from speech and swallowing problems takes time and patience. Be kind to your self. Speech therapists are ready to help. Nicole Urbanczyk, MS, CCC-SLT, BCS-S is a speech pathology coordinator at St. Ann’s Community, a senior community offering a full continuum of care in Rochester. Email her at nurbanczyk@, call 585-697-6503 or visit

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In Good Health is published 12 times a year by Local News, Inc. © 2019 by Local News, Inc. All rights reserved. 154 Cobblestone Court Dr., Suite 121 – P.O. Box 525, Victor NY 14564. • Phone: 585-421-8109 • Email:

Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo Writers: Jim Miller, Deborah J. Sergeant, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Nicole Urbanczyk, Kim Bagley, Stamatia Destounis, MD, Nicki Ditch • 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.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 21

H ealth News St. Ann’s to open adult day program in Irondequoit A new program coming to Irondequoit will soon help families overcome challenges they may face as their loved ones advance in age. St. Ann’s Community is opening an adult day program in the Durand Senior Apartments that are now under construction on Culver Road near Seabreeze. The program will be open both to residents of the apartments and to the greater community. It will provide both medical and social services, and it will also offer transportation. Participants will enjoy structured social activities, hot midday meals, assistance with medications, wellness programs, entertainment, health monitoring, and skilled nursing care if needed. St. Ann’s adult day programs are ideal for older adults and people with disabilities who need medical services or skilled nursing care, have a chronic illness or memory problems, are socially isolated or depressed, or have decreased mobility and need rehabilitation support. Adult day programs also offer respite for caregivers while providing a safe, supervised, social environment for loved ones during the hours when it is needed most. The program is scheduled to open this month.

Docs certified as lifestyle medicine practitioners Rochester Lifestyle Medicine Institute (RLMI) announce that physicians Josephine Ellis and Scott Liebman recently received certification from the American Board of Lifestyle Medicine (ABLM) in the newly-recognized specialty of lifestyle medicine. Ellis is a family physician practic ing with UR Medicine Primary Care. Liebman is a nephrologist practicing with UR Medicine Nephrology. They join a group of five Rochester-area physicians who were among the Ellis first group of health practitioners certified by ABLM in 2017. They are: Ted D. Bar nett, Kerry Graff, Susan Friedman, Thomas Roberts and Sandra Sarnoski-Roberts. Rochester Lifestyle Medicine Institute (roclifemed. com) was Liebman formed in 2015 to offer an array Page 22

of educational and medically-supervised programs that empower patients to take charge of their own health including: lifestyle medicine consultations; the complete health Friedman improvement program; the 15-day jumpstart program; a six-week plant-based nutrition course; and the lifestyle as medicine lecture series.

St. Ann’s voted ‘Favorite Senior Living Community’ St. Ann’s Community has been named Rochester’s Favorite Senior Living Community, winning the 2018 Rochester’s Choice Gold Award. More than 20 senior living communities were nominated by residents of Greater Rochester who then voted for their favorite. The awards are sponsored by the Democrat & Chronicle. “We are humbled and honored to know that St. Ann’s Community continues to earn the vote of ‘Favorite Senior Living Community’ from our employees, residents, families, and the Greater Rochester community,” read an statement issued by St. Ann’s.

Rochester Lifestyle Medicine gets AHP grant Rochester Lifestyle Medicine Institute (RLMI) is the recipient of a Population Health Innovation Award from Accountable Health Partners (AHP) for 2019. RLMI has been awarded the grant to provide its plant-based diet course to 40 AHP physicians, who will then each refer five patients to RLMI’s 15-day plant-based jumpstart, a total of 200 patients. The plant-based diet course is an RLMI program which has been offered since 2012 and has been given to more than 700 people, including many area physicians and health care providers. The jumpstart, an innovative program offered by RLM for the first time in 2018, gives patients the opportunity to experience, in a short time frame, the dramatic health benefits of adopting a whole-food, plant-based diet. The jumpstart clinical results are expected to yield insight into the benefits of plantbased eating, as well as guidance to practitioners and insurers in providing patient care.

Dr. Friedman publishes paper on healthy aging Physician Susan M. Friedman is the lead author of the American Geriatrics Society’s (AGS) recently published white paper on healthy aging. Friedman, medical director of Rochester Lifestyle Medicine Group

and a faculty member of the University of Rochester School of Medicine and Dentistry, is also a fellow of the American Geriatrics Society. In 2017, Friedman was among the first group of health practitioners to be certified by the American Board of Lifestyle Medicine in the new specialty of lifestyle medicine. Friedman’s paper calls on the AGS and its members to play a more active role in promoting healthy aging. She points out that, while life expectancy has increased dra-

matically over the last century, the additional years of life are often associated with illness, discomfort, disability and dependency. According to Friedman and her co-authors, a “realistic, dynamic, multi-dimensional view of healthy aging,” which includes cognitive health and social engagement for seniors, is an important goal attainable through both traditional and innovative models of health promotion.

Rochester RHIO and Jewish Senior Life Partner to Share Data and Build a Better Patient Record Jewish Senior Life is first senior living facility to send clinical data to Rochester RHIO


ore than half of Americans will require long-term care in their lifetime — and while an aging population turns to retirement communities and skilled nursing facilities, many of these individuals will continue to receive care from multiple community providers and hospitals. Recognizing the benefit to building a complete patient record, Jewish Senior Life, a continuing care retirement community (CCRC) that offers all levels of care from independent living to skilled nursing, has become the first senior living facility to send clinical care data to Rochester RHIO. “At Jewish Senior Life, we care for nearly 2,000 people every year, working to enhance their quality of life, health and well-being. By partnering with Rochester RHIO to contribute secure patient data, we are ensuring that these individuals will receive the best possible care no matter where they are being treated,” said Mike King, president and CEO of Jewish Senior Life. Through RHIO’s Contribute service, organizations achieve bi-directional exchange, meaning they can share data that helps caregivers provide better care for their patients. Contribute is used by hospitals, healthcare organizations, private practices and long-term care facilities to improve healthcare quality, coordination and efficiency. Jewish Senior Life is the first long-term care facility to meet the New York state requirements to send RHIO clinical care documents. Clinical access requires patient consent. Data sharing builds a more complete medical record for communities and individuals. When connected healthcare providers share patient data, it results in fewer repeated tests, better diagnosis and monitoring of chronic conditions, and more comprehensive patient health record. “Collaboration with partners

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

such as Jewish Senior Life reflects that coordinated care is extending across a much wider spectrum of facilities than ever before,” says Denise DiNoto, director of community services. “Its commitment is the first of many we expect from senior living organizations, making the community’s ability to deliver efficient and effective healthcare all the stronger.” As the number of participants that use Contribute grows, providers gain a more complete picture of a patient’s health, including recent hospitalizations, laboratory tests and imaging, medications administered, etc. Earlier this year, Rochester RHIO announced that 500 data sources are now contributing patient data, representing hundreds of healthcare organizations that serve more than a million residents each year.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 23

But nobody wants to get old. So tell me, how does that work? At St. Ann’s Community, we believe that the key to staying young is feeling young. That’s why we provide a full range of senior living options and services to keep you healthy, active and enjoying all that life has to offer - no matter what your birth certificate says.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • January 2019

Profile for In Good Health: Rochester's Healthcare Newspaper

IGH - ROCH 161 - January 19  

IGH - ROCH 161 - January 19  


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