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November 2016 • Issue 135

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When Will the Flu Peak This Season?

John Casey of Canandaigua and his family. Story on page 11.

page 19

Living with Spinal Cord Injuries

MVP’s New Medical Chief: Background in Engineering

Nut Butter November is National Peanut Butter Lovers’ Month! What better time to celebrate all that’s wonderful about this healthy plant-based protein?

Muscular Dystrophy URMC physician Robert Griggs published a study showing a safe and effective treatment for Duchenne muscular dystrophy. This could pave the way for first U.S.-approved treatment for the disease.

‘Doc, This Election’s Killing Me!’ More than half of Americans report stress as Clinton, Trump battle for the White House

A

s Donald and Hillary duke it out on the campaign trail, Americans are feeling pummeled, too, a new poll finds.

The 24/7 coverage of the acrimonious U.S. presidential election has caused stress for more than half of American adults, regardless of party

affiliation, according to a survey conducted by the American Psychological Association (APA).

“We’re seeing that it doesn’t matter whether you’re registered as a Democrat or Republican — U.S. adults say they are experiencing significant stress from the current

election,” said Lynn Bufka, APA’s associate executive director for practice research and policy.

“Election stress becomes exacerbated by arguments, stories, images and video on social media that can heighten concern and frustration, particularly with thousands of comments that can range from factual to hostile or even inflammatory,” she added in an association news release.

Overall, 52 percent of Americans aged 18 and older said the election is a somewhat or very significant source of stress. That included 55 percent who align with Democrats and 59 percent with Republicans.

The survey also found that 38 percent of respondents said political and cultural discussions on social media causes them stress. More than half who use social media said the election is a very or somewhat significant source of stress, compared with 45 percent of those who don’t use social media.

Men and women were equally likely to feel stressed by the Trump-Clinton battle, but there were differences between generations.

Only 45 percent of Generation Xers — those born from 1965 to 1980 — reported election stress, while nearly six out of 10 “matures” did so, according to the online survey conducted in August. Matures were born pre-1946.

In addition, 56 percent of millennials and half of baby boomers said the election is a very or somewhat significant source of stress.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

Number of Americans With Severe Joint Pain Keeps Rising Close to 15 million people live with the problem

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evere joint pain plagues an increasing number of aging, often arthritic Americans, a new report finds.

In 2002, about 10.5 million people in the United States said they battled severe joint pain, but by 2014 that number had jumped to 14.6 million, said researchers from the U.S. Centers for Disease Control and Prevention.

The CDC team defined “severe” joint pain as discomfort measuring 7 or more on a 1-to-10 score on a questionnaire, with 1 being no pain and 10 being “pain and aching as bad as it can be.”

The problem may only get worse, the researchers said, since much of this joint pain is linked to arthritis. One in every four people with arthritis in the new study rated his or her pain as “severe,” and arthritis cases among Americans are expected to rise.

In the United States, “arthritis affected an estimated 52.5 million [22.7 percent] adults in 2010-2012 and has been projected to affect 78.4 million adults by 2040,” wrote the team led

by CDC researcher Kamil Barbour.

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CALENDAR of

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HEALTH EVENTS Fibromyalgia group holds

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Wine and food pairing at Cherry Ridge

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Rochester wine expert Holly Howell continues her wine-tasting series at St. Ann’s Community at Cherry Ridge. The next event will take place from 3 to 4 p.m., Nov. 3, in the Community Center at Cherry Ridge, 900 Cherry Ridge Blvd, Webster. Howell will focus on holiday wine and food pairing, and will offer suggestion for the upcoming holiday parties.

Howell is the Democrat & Chronicle’s wine columnist. She grew up in a food-loving family in Pittsford and spent a year in France exploring her love of wine and French cuisine.

After years of advanced study, she operated a cooking school and coordinated culinary programs with chefs from all over the world.

She is a certified sommelier through the Master Court of Sommeliers in London and a certified specialist of wine through the Society of Wine Educators. An enthusiastic supporter of the Finger Lakes, she leads tours throughout the region as well as winery seminars and classes at restaurants and local festivals.

For more information about the event, call 585-697-6000 or visit www. stannscommunity.com.

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Children Awaiting Parents holds luncheon In honor of National Adoption Month, Children Awaiting Parents (CAP) will host it 10th annual Heart Gallery and Luncheon starting at 11:30 a.m., Friday, Nov. 4, at the Staybridge Suites, 1000 Genesee St., Rochester. It will focus on the need for permanent adoptive homes for the longest-waiting, older children in foster care.

Don Alhart of WHAM 13 will emcee the event. Alhart has helped CAP find adoptive families for more than 30 years by featuring waiting child videos and profiles on WHAM

13’s “Friday’s Child” segment.

Keynote speaker will be Loryn Smith, CEO of Finally Home Christian Adoption Services and the mother of 15 children, 10 of whom became part of the family through the foster care system. She will offer practical application of parenting skills for children impacted by abuse and neglect.

This year’s Heart Gallery display will feature moving photos of foster children waiting to be adopted as well as successful adoptive families.

Cost to attend the luncheon is $60 per person or $100 for two people. Cost to attend the workshop, which will also take place during the event, is $30 per person.

For tickets and more information, visit www.ChildrenAwaitingParents. org or call 585-232-5110.

Nov. 8

Nov. 14

meeting in Rochester

Ruben Orona, Jr., a local registered nurse who has found success in helping patients with fibromyalgia, will share his knowledge at a support group meeting sponsored

by The Fibromyalgia Association of Rochester New York. The meeting will take place from 7 to 8:30 p.m. , Monday, Nov.14, at the Greece Town Hall Meeting Center, 1 Vince Tofany Blvd., Rochester.

The meeting is free and open to the public. No prior registration needed.

For more information, visit www. farny.org, email info@farny.org or call 585-225-7515 or 585-356-1399.

The Fibromyalgia Association of Rochester New York was formed in spring 1993 to educate and inform others about fibromyalgia syndrome, as well as to serve as a support system.

Election Day Senior Fair at Nov. 19 Pancreatic cancer group Perinton Square Mall This election day voters can cast holds 5K, Fun Day event their ballot, get a flu shot and learn about services for seniors all at the same time. The Election Day Senior Fair is sponsored by Fairport Baptist Homes and Perinton Square Mall merchants and is designed to help older adults, families and friends learn about health and wellness, senior housing options and available services.

More than 45 local agencies, community support groups, health service and senior housing providers, will be at Perinton Square Mall from 9 a.m. to 2 p.m. Nov. 8 as part of the 11th Annual NNORC Engage Election Day Senior Fair. The fair is part of an initiative supported by a Neighborhood Naturally Occurring Retirement Community (NNORC) grant from the New York State Office for the Aging.

“Each year we’ve had a great response from vendors, voters, and shoppers alike regarding the NNORC Engage Election Day Senior Fair,” says Biagio Zarcone, NNORC coordinator. “We are very pleased that it’s grown each year, and we’re

The seventh annual Step It Up! Cure Pancreatic Cancer 5K & Family Fun, sponsored by the Pancreatic Cancer Association of WNY, will take place starting at noon, Nov. 19, at Gordon Field House on the campus of Rochester Institute of Technology, One Lomb Memorial Drive. The 5K walk will start at 1:30 p.m.

Organizers say this will be an afternoon of fun for the whole family with entertainment, raffles and activities for all ages. There will be princesses, team mascots, and Batman as well as jugglers and Zumba.

Proceeds benefit local research efforts that will help provide a comprehensive approach to fighting pancreatic cancer.

Registration fees are $25 adults ($30 day of event); $15 students (age 1321) and $5 for children from 4 to 12.

It’s free for those under age 3.

Free participation gift for all paid registrants (while supplies last).

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Mental Health Special Don’t miss the December edition

IN GOOD HEALTH Rochester’s Healthcare Newspaper.

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Brightening Spirits by Becoming a DePaul Holiday Helper

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ith the holiday season nearly upon us, DePaul, a nonprofit human services agency based in Gates, is seeking the community’s support for its annual holiday helper program. Individuals, businesses and service and faithbased organizations, can “adopt” clients from DePaul’s mental health residential programs who may not have family support during this meaningful time of year.

Participants can select from items on a wish list or choose to donate generic gifts such as hats,

gloves, personal care items or socks for adults. Past client wishes have included items as simple as a piece of chocolate cake, boots or basic clothing items.

For nearly 20 years, generous members of the community have made the season special for someone less fortunate by taking part in DePaul’s holiday helper program.

DePaul serves some 5,000 people annually in programs that encompass mental health residential and treatment services, senior living residential services, addiction prevention

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

and support programs, vocational programs and affordable housing.

For more information about the holiday helper program, call Amy Cavalier at 585-426-8000, ext. 3102 or via email at acavalier@depaul.org.

Learn more about DePaul or make a tax-deductible monetary donation to the holiday helper program by visiting www.depaul.org or by liking DePaul on Facebook at https://www.facebook.com/depaul. org.

Healthcare in a Minute

By George W. Chapman

Hospital Ratings

The recent five-star ratings of hospitals by Medicare raised the issue of whether large teaching hospitals got a fair shake because the survey upon which the ratings were based (Hospital Consumer Assessment of Healthcare Providers and Systems) did not account for patient acuity. Large teaching hospitals treat more trauma and often care for difficult patients transferred to them by surrounding rural and suburban hospitals. A study published in the Journal of General Internal Medicine looked at online hospital reviews by consumers on Yelp. About 25 percent of the almost 3,800 hospitals in the Medicare survey also had ratings on Yelp. The correlation between the Medicare rating received by a hospital and the Yelp reviews was very strong. Yelp reviewers reported on staff quality and compassion, access, convenience, bedside manner, cost, billing, scheduling, treatment of family and visitors. Researchers found that consumers are more savvy than the industry thinks. Hospitals that performed better on both outcome and processes enjoyed greater market share and growth. Word gets around and patients seek care where it’s the best.

Telemedicine Many argue telemedicine will never be as effective as a real face-toface encounter between patient and provider. So far, the technology has proven effective in many scenarios, such as: the patient is incapacitated (sick, injured, contagious); foul weather; transportation is unavailable (commercial or caregiver); patient just needs remote monitoring; patient needs encouragement or compliance pep talk; patient needs

medicine checked; patient has mental issues and acts out; patient can’t leave work; on call provider can refer to video visit.

RomneyCare update

Industry observers keep an eye on what is happening In Massachusetts because it is considered the harbinger of things to come under the Affordable Care Act. The Massachusetts Center for Health Information reported that costs in 2015 were $8,424 per capita which is an increase of 3.9 percent over 2014. The benchmark or target was an aggressive 3.6 percent. (Everyone in Massachusetts has insurance.) As with the rest of the nation, drug costs were responsible for most of the cost “overrun,” accounting for a third of all costs. Larger, more efficient healthcare systems are putting a lot of financial pressure on smaller community hospitals and rural systems.

2016 election

Both candidates agree drug companies seemingly raise prices arbitrarily and something needs to be done. Trump would allow Medicare/ Medicaid and commercial payers to purchase drugs from countries like Canada. Clinton would appoint a federal watchdog to monitor price increases and limit the amount of income consumers would have to spend out-of-pocket on drugs. But controlling the pharmaceutical industry, let alone prices, will not be easy unless the revolving door between the FDA and the drug manufacturers is controlled. The FDA has data on how many of its former employees now work as consultants or lobbyists to the pharmaceutical industry but has not released such data.

National spending

In 2014, we spent $9,523 per capita on healthcare — still the most by far of any developed country. At $3 trillion, healthcare was 17.5 percent of our GDP in 2014. (It is currently trending at 18 percent.) Medicare and Medicaid accounted for 36 percent of spending. Commercial insurance accounted for 33 percent and out of pocket another 11 percent. The remaining 20 percent is VA, federal employees, Public Health Service and other federal programs.

Specialty rankings

According to a study of online physician reviews published in Becker’s Hospital Review, consumers report the highest satisfaction levels with neuromuscular specialists, thoracic surgeons, podiatrists, plastic surgeons and colorectal surgeons.

The lowest ranking were with psychiatrists, preventive medicine specialists, pain specialists, emergency physicians and neurologists.

Physicians refusing care

A debate over how much autonomy a physician should have when he/she has a conscientious objection to providing a service like abortion, birth control, unnecessary testing and assisted suicide is published in the Journal of Bioethics. Those who argue a physician does not have the right to refuse care feel access to care, especially when there are few if any alternatives, must override a physician’s personal beliefs. Those who argue a physician does have the right to refuse care argue they are entitled to have values like everyone else. Sweden and France bar physicians from refusing any legal service and can suspend or revoke a practi-

tioner’s license. The US, Canada and the UK have historically allowed the refusal of services based on conscientious objection. Most physicians who will not provide certain services due to moral objections will be happy to refer their patients to another provider without disrupting the overall relationship between them.

Watch your scale

The good news, according to a study by a Cornell professor published in the New England Journal of Medicine, is your weight might be at an annual low right now. The bad news is that, thanks to the upcoming holidays, you will gain weight and a lot of the gain will be permanent, if you don’t pay attention. Weight gain typically starts 10 days before the holiday season and peaks around New Year. Because the study participants were aware they were in a weight study, the professor believes the weight gains were probably artificially low to moderate and that weight gain in the general public is worse. Other studies have found that after 30, most of us gain two pounds of permanent weight every holiday season.

George W. Chapman is a healthcare consultant who works with hospitals and medical groups. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@gwchapmanconsulting.com.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 5

Meet

Your Doctor

By Chris Motola

Robert Griggs, M.D. New hope for those who suffer from certain types of muscular dystrophy Q: You’ve been heavily involved in research lately. Do you still see patients?

A: I still do see lots of patients in the hospital, but have associates who see patients in outpatient settings.

I’ve been at the university for over 40 years, but now my focus is on researching treatments for muscular dystrophy.

Q: A lot of people have only a vague idea of what muscular dystrophy is. Can you give us a rundown?

A: The term actually applies to many muscle diseases. The most common is what’s called Duchenne muscular dystrophy. It affects little boys starting around the age of 4 or 5. They begin to have trouble walking. By the time they’re 10, without treatment, they’ll often need a wheelchair.

By age 15, they’ll begin to have trouble breathing. By age 20 they’re either on a ventilator or they may not survive because their muscles are so weak. There are other muscular dystrophies, such as myotonic muscular dystrophy, which is the most common in adults. Facioscapulohumeral muscular dystrophy is probably the third most common.

I’ve done research on all three.

Q: How far has our understanding come?

A: It’s exciting to now know the cause of all three of these diseases. In the case of Duchenne, which is the

Page 6

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most severe, we actually have a treatment. This has been a career-long search for me to find treatments, so it’s gratifying to become successful recently.

Q: What is the cause?

A: The cause of each of these is a genetic defect. It’s a mutation in a gene. The reason Duchenne affects only boys is because it’s an abnormality on the X-chromosome, which causes a loss of the protein called dystrophin. Since males only have one X-chromosome, they’re more vulnerable to the mutation. So a lot of our research has been on ways to restore dystrophin to the muscle.

We’ve gotten to the point

where there’s one drug that provides a partial improvement by restoring some dystrophin to the muscle fibers.

Q: To what degree are you able to treat the condition now?

A: That’s the key question, isn’t it? What we found, 20 years ago, was that prednisone immediately caused an improvement in strength and would for a number of months.

After about a year-and-a-half they’d stop improving, but they stayed better than they would have been if they hadn’t been taking it. So instead of needing a wheelchair at 10, they could continue to walk into their teens, and they could avoid the ventilator until their late 20s, with many living into their 30s and even 40s. Many of them are able to go to college and even into the workforce.

So it’s transformed their condition.

However, it is not a cure. So what we’re trying to do is find a medication that can do better than that, and that’s what’s just been improved, not by my work, but by the work of a group in Ohio State. The FDA just approved a treatment that slows the progression of the disease in about 13 percent of the patients. The new treatment is called exon-skipping, which reverses the loss of the protein and causes a small amount of protein to be created in boys who have the right kind of gene abnormality.

Q: Do these have applications for the other types as well?

A: For myotonic dystrophy, a group here at Rochester has made a mouse with myotonic dystrophy and has developed a treatment that cures the mouse. So there are clinical trials now to see if it can do the same for patients. There’s also another treatment that’s going to be tried for facioscapulohumeral that’s under study in this department.

Q: Prednisone seems to be something of a double-edged sword, extremely useful with broad applications, but with a lot of unpleasant side effects. How much has that complicated treatments and research?

A: Extremely good question.

That’s something we set out to address over a decade ago. When we surveyed the world, we found that a lot of people weren’t getting prednisone because of side effects. In other countries, they were giving less than the recommended dose. So we found that there were 29 different regimens being used around the world. In some, like France, it wasn’t being used at all. We set out to address that problem and got a grant from the National Institutes of Health to study it. So we’re looking to see if we can prevent the side effects and see which of the three regimens we’re testing is most likely to help, and which have the fewest side effects.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

In the news

URMC physician Robert Griggs recently published the results of a study showing a safe and effective treatment for Duchenne muscular dystrophy.

The findings, which appear in the journal Neurology, could pave the way for first U.S.-approved treatment for the disease. He was the lead author of the study.

It’s a critically important study, because we know prednisone helps, but we don’t know which regimen is best.

Q: What does it do to muscular dystrophy?

A: It increases strength and slows the destruction of muscle protein, but it doesn’t affect the dystrophin, so how it works is still a little bit of a mystery. It keeps the body from destroying its own muscle proteins, but it’s not specific to the mutation like the new exon-skipping treatment is. The silver bullet would fix the gene abnormality. The treatment that was just approved is a partial correction, but there are approaches on the drawing board that might fix the problem. That would be an incredible breakthrough and could mean we wouldn’t have to give steroids.

Q: How is the quality of life for patients receiving treatment for Duchenne?

A: We don’t want to just be prolonging misery. What’s great about a lot these boys is how resilient they are and how motivated they are to achieve. They’re optimistic and enjoy being able to get around and see their friends. That’s one of the things we’re looking at with our study; which regimen maximizes quality of life. One of our patients just graduated from RIT and is looking for a job.

He’s proud of graduating.

Lifelines Name: Robert Griggs, M.D. Position: Professor of neurology, pediatrics, pathology, and laboratory medicine at University of Rochester Hometown: Wilmington, Del. Education: University of Delaware; University of Pennsylvania. Trained in internal medicine at Case Western Reserve University and the University of Rochester where he was chief resident in medicine and fellow in immunology Affiliations: University of Rochester Medical System Career: He has published over 350 scientific papers and 24 texts, which span the fields of medicine and neurology. He served as president of the Association of University Professor of Neurology (1994-1996). He has served on the Council of the American Neurological Association. He served as editor-in-chief of Neurology (1997-2007).

Organizations: American Academy of Neurology (former president); Journal of Neurology (former editor) Family: Married, two daughters, three grandchildren Hobbies: Running marathons, playing piano, church activities

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By Ernst Lamothe Jr.

B

eth Malko was very committed to the environmental concerns of the world. While majoring in biology at Rensselaer Polytechnic Institute, she realized that various organizations were doing very cool things in the world to improve overall quality of life.

“Engineering was something that I had a passion about. There are a number of significant health issues that people don’t know about that can be caused by the industrial waste dumps of companies,” said Malko.

“Quality of life is essential.”

Those last five words — “quality of life is essential” — have been some of the guiding principles in Malko’s career as she transitioned from engineering to the medical field.

Malko was recently named the new chief medical officer at MVP Health Care. She succeeds Allen Hinkle.

Malko — who is board-certified in family practice — has more than 20 years of managed care experience, bringing her medical expertise to both for-profit and nonprofit payor settings. She comes to MVP from a position as executive vice president for clinical transformation and operations at Evolent Health in Arlington, Va. Previously, Malko served as the executive vice president and chief medical officer for Fallon Community Health Plan in Worcester, Mass.; as the regional medical director for WellPoint Inc.’s state-sponsored business; and as a lead medical director for Anthem BCBS in New Hampshire and Connecticut. Earlier in her career, she also served as a family physician in private practice and as a chief engineer in several environmental engineering firms.

“Dr. Malko brings great talent and experience to MVP and I am confident that she will play a significant role in our ongoing transformation as we meet and manage the challenges presented by an ever-changing industry,” said MVP President and CEO Denise Gonick in a press released issued by MVP. Malko has extensive management experience, including leadership of engineers, physicians, pharmacists, nurses and administrative and managed care staff.

She led a staff of more than 350 associates at Evolent in clinical strategy and relationships.

Malko, who received a master’s degree in engineering and environmental engineering from Rensselaer Polytechnic Institute — and later earned her medical degree from the University of Connecticut — believes her engineering background gave her the technical knowledge and skillset to take on various healthcare roles.

“You learn to execute and as an engineer that is not something necessarily taught, “she added. “It has helped me have the mindset to fix healthcare one member and one

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Malko provider at a time to build a system with solutions. And my love for the environment still has a tremendous impact on me as I champion clean water and air around the world.”

Born and raised in New York, when she was deciding on her next career step, coming back to her home state definitely appealed to her. “You know the saying if you can make it in New York, then you can make it anywhere,” said Malko. “People in this state are passionate about everything from life to healthcare so I think it is the perfect place for me to be.”

She understands the health care climate continues to evolve, sometimes at a pace frustratingly fast for patients, medical officials and insurers.

“When you look at the United States compared to other countries, we are not delivering health outcomes the way we need to even though we are spending so much on healthcare,” adds Malko. “We spend more than double the cost. We have to focus on giving the patient the best experience while still keeping our cost low.”

She believes healthcare will always be very local and that providers will have to take a larger role in the situation. It’s a critical time in organizations like MVP, especially any organization that deals with seniors.

“What thing that drew me about MVP is that they do great work in the Medicare and Medicaid field.

Outside the healthcare field when she does have free time, she enjoys the outdoors. Whether that is kayaking or playing golf, fresh air and water resonates through her life.

In addition, she likes travelling the world.

“I recently took my longest vacation ever which was three weeks. My husband, daughter and I spent that time all around the United Kingdom.

It was so relaxing and I am glad I did it.”

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Page 7

Community dignitaries, leaders from the Rochester area, and JCC leaders, donors, staff cut the ribbon at the Louis S. Wolk JCC of Greater Rochester.

The New JCC

Under the leadership of Arnie Sohinki, JCC celebrates the completion of $17 million, 26,000-sq-ft. renovation and expansion project

By Ernst Lamothe Jr.

A

rnie Sohinki knew it wouldn’t be easy. Nothing worth doing really is. But when he came in as executive director of the Jewish Community Center in 2015, Sohinki understood that the extensive $17 million, 26,000-square-foot renovation and expansion project would have its challenges and hurdles. But now he can enjoy the work his team produced as the project is officially complete and open to the public.

“It really was a journey, but when you see how everything turned out it was so worth it,” said Sohinki, 64, of Pittsford. “We have created with this expansion something that really hits all the areas we needed.

I think anyone who comes in will be amazed at the amount of classes, programs we have available and the overall facility.”

His road to the Louis S. Wolk Jewish Community Center of Greater Rochester, 1200 Edgewood Ave. in Brighton, started in Upstate New York. He received his master’s degree in social work at the University of Buffalo, mostly doing work with teenagers. He enjoyed interacting with the younger population and seeing firsthand the good work that could be done.

It launched him to his first full time job landing him in Minneapolis at the Bnai B’rith Youth Organization.

That position also took him to Atlanta and Washington D.C. “The issue is when you are a consultant and travelling to many cities, you are not truly part of a community,” said Sohinki. “You feel more like you are visiting. I wanted to be in one location and truly feel entrenched in the community.”

After recruiters brought him to the JCC in Los Angeles as executive director, as well as chief executive officer in Maryland, then there was an opportunity to come back to Upstate New York. The Jewish Community Page 8

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Center executive director in Rochester was retiring and he received the call about the opportunity.

“I just felt that it was such a great match for me,” said Sohinki. “The number one attraction was coming back to Western New York and becoming involved in a wonderful community. I had already lived in the Buffalo area so the snow and cold of New York wasn’t going to scare me from coming back.”

Grand opening

In early fall this year, the JCC hosted a grand opening party for its expanded center. More than 700 people attended the grand opening as the celebration caps a year and a half of significant construction, renovation and upgrades that began in May 2015.

That includes a state-of-the-art two-floor fitness facility, outdoor splash pool, second pool for recreation with lazy river and bubble bench, exercise and therapy, café, renovated community space and more. The project was made possible by the support of many, but especially one family.

“There will never be enough ways to thank the Louis S. and Molly B. Wolk Foundation for their extraordinary support of the JCC,” said Harold Bobry, campaign chairman at JCC who has been responsible for raising $14.1 million of the $17 million goal.

“Their support totals nearly $6 million over the court of JCC’s history, supporting important projects, such as the Wolk Children’s Center, the dining hall at our day camp, Camp Sisol at Markus Park and our current capital project. We are thrilled and honored for the JCC to be known as the Louis S. Wolk Jewish Community Center of Greater Rochester moving forward.”

The all-new JCC will offer contemporary, competitive, first-rate

programs and services in fitness, aquatics and cultural arts for all members of the Greater Rochester community, including adults, families, children and seniors.

“One of our main focus helping the community be fit and exercise.

We believe that healthy bodies and healthy minds work together,” said Sohinki. “We wanted to make sure there was a variety for people to find their own routine that they enjoy.”

The new 13,000-square-foot fitness facility features more than 100 pieces of new cardio and strength training equipment, functional fitness areas and more. Spanning two floors, it’s surrounded by glass, with natural lighting and a view of the new pool. It houses the only Hub Training System in Western New York, ideal for personal training

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

and small group functional training.

According to the company’s website, “the HTB allows trainers to work with multi-ability groups on a variety of programs. There are multiple suspension training anchor points for ropes, bands and tubes, and space to work with free-standing equipment.”

JCC’s new zero-entry pool has no steps, making it suitable for children and individuals with mobility issues and ensuring accessibility and safety.

With this step-free pool, JCC can now offer specialized physical therapy, rehabilitation programs and water sports. The renovation also includes an outdoor splash pool and expanded patio area.

“We are a community center for all,” added Sohinki said. “We have been in the Greater Rochester community for over 100 years, and this celebrates the evolution of our organization. We intend to identify new and innovative programs that meet the needs of our diverse membership. We are so proud of our new state-of-the-art facility and welcome everyone of all ages, backgrounds and affiliations to come experience the brand new JCC.” The center also has cooking and sleep management classes, which are two of the most important pillars to health living. Sohinki understands the importance of a healthy lifestyle himself. He works out three times a week doing cardio and weight training machines. To balance his life, he spends time with his wife, and events occurring in the community.

The family gets to Pittsburgh and New York City where both his children live. Special programming will be offered for individuals who suffer from Parkinson’s disease (“Stretching the Limits”) and dementia and Alzheimer’s disease (“Music, Mindfulness and Motion”) Sohinki said he has a special connection to the area and is excited not only for the center but the community to bring this new project to its full conclusion.

“I tell people all the time that Rochester is really great kept secret,” said Sohinki.

“The food, the culture, the people are incredible.

It is such a warm and welcoming place. Maybe being a secret has allowed Rochester to keep its personality.”

Arnie Sohinki

Shortage of Primary Care Doctors Continues New physicians often opt for specialties that pay more, which generates a shortage of much-needed primary care doctors

By Deborah Jeanne Sergeant

H

as it been hard to get an appointment to see your primary care physician?

Get used to it.

In an April report, the Association of American Medical Colleges stated that in the next 10 years, the nation will experience a shortage of primary care physicians ranging from between 14,900 and 35,600.

Why is this shortage happening now?

It’s all about economics, said Nancy Adams, executive director of the Monroe County Medical Society in Rochester.

“Medical students coming out of schools have a tremendous amount of debt,” Adams said. “For many, it’s way over $300,000. The primary care, internal medicine and family practice salaries aren’t as competitive as specialists. That’s why many are going into specialty.”

Physician reimbursements from insurance companies have not kept pace with the rising costs of overhead. To make up for the shortfall, many physicians have increased the volume of patients and decreased the time span of each visit.

“Declining payment and dramatically increasing costs are a formula for high volume and high stress,” said Vito Grasso, executive vice president of the New York State Academy of Family Physicians in Albany. “Those are two factors that are deterrents for students gravitating towards careers in family medicine.”

They’re also factors that lead to physician burnout and early retirement.

Grasso said that 23 years ago, 90 percent of his organization’s members were independent. Today, two out of three physicians work in offices not their own. When large health systems buy out solo practices, physicians lose more control and many times gain a host of new patients.

Another factor that’s ramping up usage is the fact that more people are using health care, including aging baby boomers’ growing need and those who now have health insurance. The Health Resources and Services Administration attributes the effect of population growth and aging as 81 percent responsible for the growth in demand and the Af-

18 CONVENIENT LOCATIONS IN MONROE AND LIVINGSTON COUNTIES

fordable Care Act as responsible for 19 percent.

Electronic medical records have made accessing health records easier.

But creating them has caused significantly more administrative work for doctor’s offices. Some physicians who cannot afford to hire more administrative helpers work an additional two hours daily entering records. It’s either that or they must enter data during visits.

What patient wants to meet with a physician whose face is buried in a laptop the entire visit? But to check off all the new required screenings and questions, doctors face a time crunch.

“Most patients come into a visit with multiple concerns and symptoms,” Grasso said. “Following anything formulaic diverts questions from what the patient wants to bring up. If it’s not on the drop-down menu, you won’t get to it.”

Some solo physicians also are not willing to invest large sums of money in all the electronic records equipment, which is very expensive. Some prefer to retire or join a large medical practice.

The hospitalist movement has also diverted more medical students from primary care.

Starting in the Rochester area around the early 2000s, the hospitalist model establishes an in-house physician — the hospitalist — to provide primary medical care to admitted patients. The patients’ own physician won’t have to make rounds to approve or assess treatment, so in that regard, the hospitalist model saves time for primary care physicians. But since hospitalists are trained as primary care, internist or family practice physicians, that leaves fewer practicing in offices.

Working as a hospitalist attracts more residents because for most of them, about 90 percent of their residency takes place in a hospital setting, a natural segue to working at a hospital. Plus, as a hospitalist, “there is mostly shift work associated with the job,” Grasso said. “You do a certain amount of hours in a row and when you go home at night, you’re done. There are no phone calls and paperwork.”

November 2016 •

Close to Where You Work or Live

Early Morning and Late Evening Hours for Your Convenience LATTIMORE PHYSICAL THERAPY NETWORK AVON PHYSICAL THERAPY 490 Collins Street Avon, NY 14414 Phone: 226-2480 Fax: 226-2494 Co-Clinical director: Jon Gerenski, DPT Co-Clinical director: Leslie Summers, PTA Owner: Mario Melidona, PT DANSVILLE PHYSICAL THERAPY 40 Village Plaza Dansville, NY 14437 Phone: 335-2456 Fax: 335-3494 Owner: Matt Marino, MS, PT

LATTIMORE OF IRONDEQUOIT PT 1299 Portland Ave Suite 10 Rochester, NY 14621 Phone: 286-9200 Fax: 286-9203 Clinical Director: Lindsey Yu, DPT, LMT LATTIMORE PHYSICAL THERAPY AND SPORTS REHABILITATION 1655 Elmwood Ave Suite 130 Rochester, NY 14620 Phone: 442-9110 Fax: 442-9049 Clinical Director: Erin Tobin, PT, DPT

LATTIMORE OF FAIRPORT PT 59 Perinton Hills Shopping Ctr Fairport, NY 14450 Phone: 385-0444 Fax: 385-0442 Clinical Director: Matthew Stoutenburg, MS, PT, CSCS

LATTIMORE PHYSICAL THERAPY (Land and/or pool based therapy) 383 White Spruce Blvd Rochester, NY 14623 Phone: 442-6067 Fax: 442-6073 Clinical Director / Owner: Andrew Chatt, DPT, OCS Owner: Cynthia Shuman, MS, PT, ATC

LATTIMORE OF GATES-CHILI PT 5 Fisher Road Rochester, NY 14624 Phone: 247-0270 Fax: 247-0294 Clinical Director: Jeff McGiven, PT

NORTH GREECE PHYSICAL THERAPY 515 Long Pond Road Rochester, NY 14612 Phone: 227-2310 Fax: 227-2312 Owner: Tim Anne, MS, PT, MLD-CDT

LATTIMORE OF GENESEO PT 4577 Morgan View Road Geneseo, NY 14454 Phone: 243-9150 Fax: 243-4814 Clinical Director: Johanna Kaufman, DPT

PIANO WORKS PHYSICAL THERAPY 349 W. Commercial St. Ste. 1275 East Rochester, NY 14445 Owner: Leah Gerenski, DPT, OCS

LATTIMORE OF GRPT 2000 Empire Blvd. Building 2 Webster, NY 14580 Phone: 671-1030 Fax: 671-1991 Clinical Director: Melissa Graham, DPT, OCS

PITTSFORD MENDON PT 20 Assembly Dr. Suite 101 PO Box 212 Mendon, NY 14506 Phone: 582-1330 Fax: 582-2537 Clinical Director: Dustin Maracle, PT, DPT, MS, SCS, COMT,CSCS

LATTIMORE OF GREATER PITTSFORD PT 40 State Street Pittsford, NY 14534 Phone: 387-7180 Fax: 387-7182 Clinical Director: Adam Ellis, DPT

RUSH HENRIETTA PT 60 Finn Road Suite C Henrietta, NY 14467 Phone: 444-0040 Fax: 444-0052 Clinical Director: Karen Shufelt, DPT, CHT

HILTON PHYSICAL THERAPY 1026 Hilton Parma Corners Rd. Suite 1, PO Box 131 Hilton, NY 14468 Owner: Matt Landon, DPT HONEOYE FALLS LIMA PT 58 North Main Street Suite 200 Honeoye Falls, NY 14472 Owner: David Monsees, MS, PT

LATTIMORE OF SPENCERPORT PT 37 N. Union Street Spencerport, NY 14559 (585)349-2860 Fax (585)349-2995 Clinical Director: Russell Manalastas, DPT, SCS, COMT, CSCS LATTIMORE OF WEBSTER PT 1130 Crosspointe Lane, Suite 6 Webster, NY 14580 Phone: 347-4990 Fax: 347-4993 Owner: Adam Frank, MS, PT

www.lattimorept.com IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

•

Page 9

Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Are You Facing Thanksgiving Alone?

If you are facing Thanksgiving alone for the first time, you may be anticipating a lonely and depressing fourth Thursday of November.

But it doesn’t have to be so. Whether you’re divorced, widowed or just can’t make it home for Thanksgiving, this family-centered holiday can be an opportunity for personal growth and expression.

Below are some tips and creative ways to manage and embrace what can be a challenging day in the life of those alone this time of year: Be thankful. And why not start with yourself? Consider making a list of all the things you are thankful for this year: Your health? Your children? Those good friends who have stood by you through thick and thin? A career or volunteer job you love? A beloved pet? Or perhaps even this opportunity in your life to learn and grow?

Take the long view. While you may be alone this year, it doesn’t mean you’ll be dining solo on leftover stuffing the rest of your life. This one day doesn’t dictate your destiny.

Who knows what the future holds?

Over the next year, you may meet someone special or achieve a mea-

sure of inner peace and confidence that enables you to enjoy a holiday on your own or with a “family of friends.”

Do good. Helping others this time of year can take your mind off being alone and give you something worthwhile to do.

Shelters and food kitchens often welcome volunteers, but — truth is — many of these agencies fill up fast with regular volunteers.

You may need to plan ahead and be creative.

As an alternative, many local YMCAs host “turkey trot” races and need volunteers to register and cheer on runners of all ages. Instead of serving stuffing at the shelter, you could be serving up smiles at the finish line.

Throw your own little holiday dinner for fellow “strays” or “disconnected” persons. Have some fun! It doesn’t have to be elaborate or even planned far in advance. Sometimes last-minute dinner invitations can turn into the best, most memorable get-togethers.

Chances are you know others who may be alone this Thanksgiving.

Extend a warm invitation and ask people to bring a holiday side dish to pass. This gives everyone a chance to make a meaningful (and delicious!)

KIDS Corner U.S. Children Are Less Fit Than Others Around The World Aerobic fitness levels of children and youth across 50 countries; U.S. ranked 47 of 50

A

n international research team co-led from the University of North Dakota and the Children’s Hospital of Eastern Ontario (CHEO) studied the aerobic fitness levels of children and youth across 50 countries. The results were recently published in the British Journal of Sports Medicine.

“If all the kids in the world were to line up for a race, the average American child would finish at the back of the pack,” said Grant Tomkinson, associate professor of kinesiology in the UND College of Education & Human Development and senior author of the study. “Canada, on the other Page 10

•

hand, fared moderately well placing just above middle of the pack. This study is the largest of its kind so it’s exciting to have this evidence at hand.”

“Kids who are aerobically fit tend to be healthy; and kids who are healthy are apt to be healthy adults.

So studying aerobic fitness in the early years is very insightful to overall population health,” said Justin Lang, the report’s lead author. Ranking highlights: • Top 5 fittest countries: Tanzania, Iceland, Estonia, Norway, Japan • Canada placed 19 out of 50 • America placed 47 out of 50

contribution.

Beware of “euphoric recall.” When you are feeling lonely, it can be easy to glorify the past. Did last year’s Thanksgiving live up to the Norman Rockwell ideal? Or did all the bickering, bad blood, and woozy, overstuffed relatives make you want to run for the hills? Maybe, just maybe, being with your own good company is a blessing.

Rent a movie and indulge in a tasty guilty pleasure. Oh, why not? Rent a favorite “feel good” film and make a night of it. You might check out “Tootsie” or “On Golden Pond,” two of my favorite oldies, which never fail to warm my heart. Or find a new movie you haven’t seen and enjoy the novelty of seeing something for the first time. Top it off with a favorite treat. I love pumpkin pie ice cream this time of year!

Pick up the phone. I’ve adapted one of Abe Lincoln’s famous lines for my own purposes: Most folks are as lonely as they make up their minds to be. The difference between isolation and engagement can be as simple as dialing a seven-digit phone number.

My experience happily tells me that most folks welcome a call on Thanksgiving. An invitation to go for a walk or see a matinee while the turkey is in the oven is often seen as a nice diversion and chance to get out of the house. Others just love opening their homes, inviting friends in, and expanding the celebration. It can be a beautiful thing for everyone.

Decorate your home inside and out.

Do it for you. It may help put you in the spirit of the holiday. This past weekend, I recreated my annual stacked-pumpkin display for my front porch. It gives me a warm feeling every time I pull up to the house.

Create harvest accents for your home

and feel the essence of Thanksgiving in your heart.

Nurture yourself. On your own, Thanksgiving can be a great day to do whatever you enjoy doing. Treat yourself to well-deserved time to yourself to read, luxuriate in a warm bath, nap or take a nice walk to enjoy nature. Pamper yourself for at least 30 minutes and take a mini-vacation from your worries, doubts, and fears.

Write “thank you” notes. Now here’s an idea that’s so obvious it often gets overlooked on Thanksgiving.

“Build bridges the rest of the year, and cross them during the holidays,” said Craig Ellison, PhD, author of “Saying Goodbye to Loneliness and Finding Intimacy.” If you can’t be with friends or family this holiday, pick up a pen and thank them for their support and friendship.

Who wouldn’t love to receive a card on the day after Thanksgiving that begins, “I’m sitting here on Thanksgiving morning thinking of you. On this day of thanks, I can’t help but be thankful for our (fill in the blank).” In preparation for this kind gesture, purchase cards and stamps in advance.

So there you have it: Survival tips for a single-serving Turkey Day. The good news? It will be Friday before you know it and you can be thankful you got out of bed, rose to the occasion, and enjoyed your Thanksgiving.

Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon, New York. For information about her workshops or to invite her to speak, call 585-624-7887, or email gvoelckers@rochester.rr.com.

One in 5 U.S. Young Adults smokes a Hookah

H

ookah use has taken off among Americans in recent years, with almost one in five young adults using the water pipes, a new study says.

New York University investigators analyzed U.S. government data on tobacco use and found 12 percent of Americans had used a hookah during their lifetime.

They also found that the rate of current hookah use among adults ages 18 to 24 is nearly 20 percent — similar to their rate of current cigarette use.

“Hookah is addictive, causes similar health effects as cigarettes, and results in substantially higher inhalation of smoke than cigarette smoking, yet misperceptions persist that its use is safer than cigarette smoking,” say researchers led by physician Michael Weitzman. He is a professor in the departments of pediatrics and environmental medicine at NYU. Increases in hookah smoking are highest among single, adult males, and those with higher education and income. In contrast, cigarette smoking is more common among those who are poorer and have low levels of education, the researchers noted.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

John Casey of Canandaigua and his family.

He became paralyzed three years ago after his motorcycle was hit by a car on West Lake Road in Canandaigua. He is now the chairman of the board at Rochester Spinal Association, which helps people with spinal cord injuries.

Living with Spinal Cord Injuries

Rochester Spinal Association helps hundreds of people who live with spinal cord injuries

By Ernst Lamothe Jr.

J

ohn Casey was riding his motorcycle on West Lake Road in Canandaigua for a casual, leisurely ride after work three years ago.

A driver traveling on the same road wasn’t paying attention, didn’t see him and literally ran him over.

The result was 14 broken ribs, both lungs punctured, traumatic injury to his sternum, internal bleeding and a spine broken in two places.

“I was hospitalized and lying in a bed just thanking God for still being here,” said Casey, 60, of Canandaigua. “But that didn’t mean I wasn’t still scared of what was next.”

After his spinal cord damage that left him a paraplegic, he understood that having a strong support group would be necessary for his future.

That’s where the Rochester Spinal Association stepped in.

Currently celebrating its 25th anniversary, the organization has helped change and improve the lives of hundreds of individuals affected by spinal cord disabilities in the Rochester area. Its programs and services provide support and information for individuals and their loved ones, through care providers and professionals.

In honor of the anniversary, the organization’s goal is to financially help 25 individuals in the Greater Rochester area this year living with a spinal cord disability. In addition, the organization will continue supporting hundreds of people in the area who have the disability. Typical first-year expenses are $500,000 for a new case.

Strong Hospital handles over 75 new cases per year for spinal cord disabilities and impairments, according to the Rochester Spinal Association.

“I had to learn how to handle and adjust to various portions of my

for national, state and local change for people with disabilities. “We talk about issues that matter to someone who’s maybe in a wheelchair or suffered a spinal issue. We talk about sensitive issues about like sex and dating where they might feel uncomfortable talking to a doctor about.”

Woodward is also a proud disabled person and member of ADAPT, a national grassroots community that organizes disability rights activists to engage in nonviolent direct Rochester Spinal Association Oct. 7 hosted Variety Live, an event that helped raise action, including civil disobedience, funds to support individuals in Greater Rochester living with spinal cord disabilities. to assure the civil and human rights The former president and CEO of University of Rochester Medical Center, Brad Berk of people with disabilities to live in freedom. She said the organization (center) was honored during the event. Berk suffered a bike accident in 2009 that left talks to individuals about various him paralyzed from the shoulders down. topics even scenarios such as what do you do if an elevator is broken zation recently held a variety show and you need to get to the second life. It really can take you through community event where proceeds an emotional journey, especially will go directly support those living floor of a department store. The focus is answering the frequently asked when you don’t know where to reach with spinal cord disabilities. questions that many people would or out to,” said Casey, who is now the “We want to help as many peowouldn’t consider before the situaorganization’s chairman of the board ple as possible and let them know tion actually occurs. that oversees awareness initiative there is an organization available to “People think because you are and fundraising. “There are thougive them the support they need,” disabled that something is wrong sand of people in the area who live said Casey added. with you or that you need to be with spinal cord injuries but very RSA’s mission to enhance the fixed,” said Woodward. “That is not few associations who speak for those lives of people in the Greater Rochthe mentality that we have. You want individuals. They need an outlet to ester area living with spinal cord talk to others who have the same disabilities such as offering financial to be surrounded by people who experiences. It can provide so much assistance for essential — and costly understand where you are coming from and who are not treating you hope and knowledge.”

— home and vehicle modifications, different because of the wheelchair or Casey falls under two categories and continuing to host support any other issues.” of those who mostly incur spinal groups and social events for indiFor Casey, he knows firsthand cord injuries. More than 80 percent viduals, and their loved ones, living the positives of a strong support of spinal cord injuries occur among with a spinal cord disability. group. males, and vehicle crash spinal injuStephanie Woodward, a board “Along with my family and ries are the leading cause of injury, member for the organization, said it’s my children who really helped me followed by falls, acts of violence essential that there remains support through so much, I am thankful that (primarily gunshot wounds) and systems for those with disabilities.

I had yet another outlet,” added sports.

“You really need a personal Casey. “Prior to World War II, having Rochester Spinal Association touch and that is what we provide a spinal injury or living life in a brings a wide spectrum of programs here along with information,” said and backgrounds in a unified effort Woodward, a director of advocacy at wheelchair was basically a death to make a difference to those whose the Center for Disability Rights Inc, a sentence. But now people can focus lives have been changed due to not-for-profit corporation that works on living fulfilling lives and living a lot longer.” spinal cord impairment. The organiNovember 2016 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 11

SmartBites The skinny on healthy eating

Nutritious Nut Butters Boast Healthy Fats

N

ovember is National Peanut Butter Lovers’ Month! What better time to celebrate all that’s wonderful about this healthy plant-based protein?

Some things just go together: Tarzan and Jane, socks and shoes, peanut butter and jelly. Here’s one more: nut butters and good nutrition.

Surprised? Some people are. But according to dietitians, nutritionists and people in the know, nut butters are a convenient, low-cost, nutritious addition to most diets.

Although “peanut butter” comes to mind first when considering nut butters, there are many alternatives, each with their own unique health benefits. For the most part, however, all nut butters — from peanut to pistachio, almond to walnut — deliver about 200 calories, 7 to 8 grams of protein and 16 grams of fat per 2-tablespoon serving.

The calories and fat are what deter some from consuming this particular food; and, indeed, if you are closely monitoring either, then nut butters might not be right for you. But for many, nut butters, when eaten in moderation — say, a couple

with peanut butter, a childhood favorite that has a tad more protein, manganese and niacin than most.

Many wonder how nut butters, with their high fat content, can be considered a healthy food. Just like olive oil, nut butters tend to be richer in the types of fat that benefit heart health — monounsaturated and polyunsaturated fat — and not so rich in saturated fat. In fact, a 2-tablespoon serving of peanut butter has the same ratio of unsaturated fat to saturated fat as olive oil.

Another good reason to go crazy for nut butters: According to the Harvard School of Public Health, numerous studies have shown that people who regularly include nuts or nut butters in their diets are less likely to develop heart disease or type 2 diabetes than those who rarely eat nuts.

Last but not least? November is National Peanut Butter Lovers’ Month! What better time to celebrate all that’s wonderful about this healthy plant-based protein?

Helpful tips

of tablespoons a day — are a healthy choice.

Not so surprisingly, high-quality nut butters without added sweeteners, salt or preservatives have nutrient profiles similar to the nuts from which they are made. My go-to nut butter is the one with the most calcium: almond butter. My husband, on the other hand, reaches for walnut butter, a nut butter that’s loaded with heart-healthy omega-3 fatty acids.

Both my budget-conscious adult kids, however, stock their pantries

Unlike some of the other nut butters, there’s tremendous variation in the quality of peanut butters sold.

Scour the labels carefully (nutrition facts and ingredients list) and opt for peanut butters that are lower in sugar and salt and that do not contain added oils, especially “partially hydrogenated oil,” which is a source of trans fat. Steer clear of reduced-fat peanut butters, which replace the “healthy fats” with add-ins and starchy fillers that boost the spread’s sugar content. Choose natural and/or organic peanut butters that contain peanuts and salt (if you prefer a little salt) and nothing more.

Peanut Butter Pumpkin Soup Serves 4 to 6

2 tablespoons olive oil ½ medium onion, chopped 2 garlic cloves, minced 1 (15 oz.) can 100 percent pure pumpkin 1 cooked sweet potato or yam (baked or microwaved) ½ cup smooth peanut butter (or, nut butter of choice) 3 ½ cups sodium-reduced stock of choice (or, water) ½ teaspoon coarse black pepper 1 teaspoon salt (or, less) 1 teaspoon curry powder ½ teaspoon dried coriander ¼ teaspoon cayenne pepper (optional) snipped fresh chives, for garnish In medium soup pot, sauté onions over medium heat until soft, about 5 minutes. Add garlic and cook 1 minute more. Stir in the pumpkin, sweet potato and peanut butter.

Add the stock and spices and stir well. Bring to a boil and then reduce the heat to a simmer and cook for 20 minutes, covered. Puree with a handheld blender.

If soup seems too thick, add more water. Garnish with chopped chives.

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

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Page 12

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

When Will the Flu Hit?

Excellus doctor urges people get vaccinated regardless of the flu’s peak

G

uessing when the flu season will hit is a bit like playing the lottery, according to an analysis of confirmed cases of

the flu in New York state that was summarized recently by Excellus BlueCross BlueShield.

“To borrow the New York Lot-

tery’s expression, ‘Hey, you never know,’” said physician Jamie Kerr, medical director at Excellus BCBS. Excellus BCBS conducted a re-

Are you ready for this flu season?

Get your flu vaccine early to protect yourself before it starts.

(Because you just never know when it’s gonna hit...)

CONFIRMED FLU CASES IN NEW YORK STATE OCTOBER 2012 - MAY 2016

OCTOBER NOVEMBER

2012 – 2013

119

DECEMBER

977 13,968

2013 – 2014

88

JANUARY

268

133

6,481

5,013

7,621

7,026

8,298

4,676

3,128

504

193

291

763

Submitted by Excellus BCBS.

2,449

By Jim Miller

im Miller is the author of Savvy Senior, a column published every month in In Good Health.

347

1,508

Flu Vaccines Designed Specifically for Seniors

T

1,765

10,724

9,173

here are actually two different flu vaccines available this year that are designed specifically for seniors age 65 and older. One option is the Fluzone High-Dose, which has been available since 2010, and the other is the new FDA approved FLUAD vaccine (you only need to get one of these).

The Fluzone High-Dose (see Fluzone.com) is a high-potency vaccine that contains four times the amount of antigen as a regular flu shot does, which creates a stronger immune response for better protection. While the new FLUAD vaccine (FLUAD. com) contains an added ingredient called adjuvant MF59 that also helps create a stronger immune response.

The extra protection these vaccines provide is particularly helpful to seniors who have weaker immune defenses and have a great risk of developing dangerous flu complications.

MAY

1,964

23,228

134

APRIL

2,238

7,391

2015 – 2016

MARCH

16,734

9,155

2014 – 2015

FEBRUARY

The CDC estimates that the flu puts more than 200,000 people in the hospital each year and kills an average of 24,000 — 80 to 90 percent of whom are seniors.

But be aware that both the Fluzone High-Dose and FLUAD are not recommended for seniors who are allergic to chicken eggs or those who have had a severe reaction to a flu vaccine in the past.

You should also know that the Center for Disease Control and Prevention (CDC) does not recommend one vaccination over the other, and to date, there have been no studies comparing the two vaccines.

If you decide you don’t want to get a senior-specific flu shot, there are other options available to people 65 years and older including the standard (trivalent) flu shot, the quadrivalent flu shot which protects against four different flu viruses, and the FluBlok vaccine for those who have egg allergies.

To locate a vaccination site that offers any of these flu shots, visit Vaccines.gov and type in your ZIP November 2016 •

22,158

view of state statistics on confirmed cases of the flu for the past four years and found wide variations on when the flu begins to peak.

For example, during the 20122013 flu season, the virus hit state residents hardest in December and January, and then diminished month by month through May. But last flu season, the wave of cases hit hardest in February, peaked in March, and ended with the highest number of reported flu cases in years for the months of April and May. “Some common myths about flu shots are about their timing and effectiveness,” Kerr said. “Many people incorrectly think that once the flu season has started, it’s too late for the vaccination to work.

We’ve also heard people incorrectly assume that they should wait until later in the season to get their flu vaccination in order for it to last through May and beyond.”

According to Kerr, as long as the flu viruses are circulating, people who haven’t been vaccinated are at risk of getting sick. She also stressed that in most cases, getting the vaccine early will provide immunity for the entire flu season.

On average, 45,000 New Yorkers get the flu each year. Nationwide, the flu virus causes 200,000 hospitalizations and nearly 24,000 deaths each year, so Kerr cautions that the flu is not a virus to be considered lightly.

12,114

Poster designed by Excellus to show the peak of the flu season in the last four years. It can be downloaded for free at http://bit.ly/2cFbKCJ.

code. You’ll also be happy to know that as a Medicare beneficiary, Part B will cover 100 percent of the costs of any flu shot, as long as your doctor, health clinic or pharmacy agrees not to charge you more than Medicare pays.

Pneumonia Vaccines

Two other important vaccinations the CDC recommends to seniors, especially this time of year, are the pneumococcal vaccines for pneumonia. Around 1 million Americans are hospitalized with pneumonia each year, and about 50,000 people die from it.

The CDC is now recommending that all seniors, 65 or older, get two vaccinations — Prevnar 13 and Pneumovax 23. Both vaccines, which are administered just once at different times, work in different ways to provide maximum protection.

If you haven’t yet received any pneumococcal vaccine you should get the Prevnar 13 first, followed by Pneumovax 23 six to 12 months later. But if you’ve already been vaccinated with Pneumovax 23,

wait at least one year before getting the Prevnar 13.

Medicare Part B covers both shots, if they are taken at least 11 months apart.

J

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 13

Golden Years Forgetfulness: What’s Normal, What’s Not? Resources help assess presence of dementia

By Jim Miller

M

any seniors worry about memory lapses as they get older fearing it may be the first signs of Alzheimer’s disease or some other type of dementia. To get some insight on the seriousness of the problem, here are some resources people can turn to for help.

Memory Screening

Warning Signs

As we grow older, some memory difficulties — such as forgetting names or misplacing items from time to time — are associated with normal aging. But the symptoms of dementia are much more than simple memory lapses.

While symptoms can vary greatly, people with dementia may have problems with short-term memory,

Navigating the Hospice Learning Curve

By Phil Rice

A

bout 20 years ago a group of friends and I visited an acquaintance who was in a special hospice wing of a local hospital. We were told he had been taken there to die. We visited, and the next day he died.

For several years after this experience, my immediate association with the word “hospice” was a one-dimensional scenario of hopelessness personified. But my impression would change.

In 2005, my mother, who was suffering from non-Hodgins lymphoma and various other ailments, moved in with my 11-year-old son Paul and me. Mom was still ambulatory, but osteoporosis, arthritis and phlebitis were making movement increasingly difficult. During the first year of this arrangement she acquired vascular dementia brought on by a series of mini-strokes.

My son Paul and I spent several months caring for her at our home but we were woefully unprepared for the task. When her falls became more frequent and she clearly needed fulltime attention, I reluctantly agreed Page 14

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keeping track of a purse or wallet, paying bills, planning and preparing meals, remembering appointments or traveling out of the neighborhood.

To help readers recognize the difference between typical age-related memory loss and a more serious problem, the Alzheimer’s Association provides a list of 10 warning signs that you can assess at 10signs. org.

They also provide information including the signs and symptoms on the other conditions that can cause dementia like vascular dementia, Lewy body dementia, frontotemporal dementia, Parkinson’s disease, Huntington’s disease, chronic traumatic encephalopathy and others – see ALZ.org/dementia.

to let her be taken to a hospital. Five days later she was in a nursing home, and four months after that she was in an assisted living facility.

After three difficult years of such care, my cousin Starr asked me if I had considered hospice. My response was to assure her that although mom was in deep dementia and completely dependent upon physical assistance for even the simplest of tasks, there was no indication that her passing was imminent. Nevertheless, Starr urged me to look into hospice. I finally took her advice, and thus began a profound learning experience.

How it Worked for Me

A hospice evaluation soon confirmed that mom indeed qualified — and that her insurance would cover the services. This was an amazing revelation. From that day forward a hospice caregiver would come by three times a week and make sure Mom was properly bathed and generally being treated well. A registered nurse visited at least once a week to monitor any medications and health concerns, keeping me fully informed

Another good place to help people get a handle on memory problems is through the National Memory Screening Program, which offers free memory screenings throughout National Memory Screening Month in November.

Sponsored by the Alzheimer’s Foundation of America, this free service provides a confidential, faceto-face memory screening that takes about 10 minutes to complete and consists of questions and/or tasks to evaluate his memory status.

Screenings are given by doctors, nurse practitioners, psychologists, social workers or other healthcare professionals in thousands of sites across the country. It’s also important to know that this screening is not along the way. If there was a specific concern, the nurse visited more frequently. A chaplain and social worker each made regular visits as well.

Having hospice involved was a huge benefit toward ensuring that mom was comfortable and safe, which in turn eased my own stress.

This became even more important a couple of years later when my fiancée Janice had emergency brain surgery to remove a malignant brain tumor. Unable to visit with my usual frequency, hospice became my lifeline to Mom during those weeks.

When it became apparent that Janice was not going to win her battle, hospice again stepped to the front.

What Hospice Taught Me

After two months in the hospital we were able to bring Janice home.

Hospice provided all of the necessary equipment and supplies for us to properly care for her needs. The caregiver showed me how to bathe Janice and change her clothing and sheets with the least amount of discomfort.

The RN made sure I understood how to use the feeding tube and how to gauge her need for medication. I spent many hours a day alone with Janice, but I never felt alone. There was a team involved.

How Hospice Changes Lives

I have accrued years of experience in dealing with healthcare professionals and caregivers, from

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

a diagnosis. Instead, its goal is to detect problems and refer individuals with these problems for further evaluation.

To find a screening site in your area visit NationalMemoryScreening. org or call 866-232-8484. It’s best to check for a screening location at the end of October, because new sites are constantly being added.

See a Doctor

If you can’t find a screening site in your area, make an appointment with a primary care doctor to get a cognitive checkup. This is covered 100 percent by Medicare as part of seniors’ annual wellness visit. If the doctor suspects any problems, he may give the senior the Memory Impairment Screen, the General Practitioner Assessment of Cognition, or the Mini Cog. Each test can be given in less then five minutes.

Depending on the score, the doctor may order follow-up tests or simply keep it on file so he can see if there are any changes down the road. Or, he may then refer the senior to a geriatrician or neurologist who specializes in diagnosing and treating memory loss or Alzheimer’s disease.

Keep in mind that even if people are experiencing some memory problems, it doesn’t necessarily mean they dementia. Many memory problems are brought on by other factors like stress, depression, thyroid disease, side effects of medications, sleep disorders, vitamin deficiencies and other medical conditions.

And by treating these conditions the person can reduce or eliminate the problem. the top hospitals to the bare-boned assisted living facilities and nursing homes. Some were exceptionally dedicated and skilled, and most were genuinely compassionate and competent. But some were less than competent.

Hospice workers are different.

I’ve never encountered a hospice worker who was anything less than fully and passionately engaged with the difficult task at hand.

Where I once associated hospice with death, I now regard hospice as representing the essence of life itself.

Because of hospice Janice and I were able to experience life to the fullest in her final weeks, and I was able to share in her journey as much as humanly possible.

As a society we ascribe deep significance to the beginning of life; for many, birth is the moment where the physical is most connected with the spiritual. Hospice provides an opportunity to embrace the end of life just as profoundly and lovingly.

Easing the transition of a loved one and sharing the moment of passing are among the finest gifts we can hope to give and receive in this life. I consistently seek new ways to express my gratitude to hospice for my gaining this awareness.

Phil Rice is a native Tennessean and author of “Winter Sun: A Memoir of Love and Hospice.”

Dizzy or Feeling Your Head is Spinning?

Request either or both of our free booklets from our website www.AlbrightBuild.com

Treating it may be easier than you think

By Dustin J. Maracle

D

izziness, head spinning, nausea, feeling unsteady and off balance are all symptoms that you may feel as a result of vertigo.

Individuals who suffer from acute and chronic vertigo should consult with a physical therapist to determine the underlying cause of their symptoms to be properly treated.

One of the most common causes of vertigo is a condition known as BPPV, or benign paroxysmal positional vertigo.

To break down this condition, we will need to dig deeper into its definition: • Benign: A non-life threatening condition • Paroxysmal: It can come in sudden, brief spells, and may last minutes or hours.

• Positional: The vertigo can be triggered by sudden movements of the body and head, and can create the “vertigo” sensation.

• Vertigo: A false sense of spinning or rotational movement of the body, and can also present with numerous symptoms from a simple dizzy spell to as severe as nausea and vomiting.

BPPV is a mechanical problem that affects the inner ear, in an area known as the semicircular canals.

Dustin Maracle graduated from the University at Buffalo with a doctorate in physical therapy and works at Lattimore Physical Therapy & Sports Rehabilitation Network in Rochesterm, where he is co-owner and clinical director. To contact him, call 585-582-1330 or email him at dustinmaracledpt@gmail.com.

These canals are fluid filled and are directly responsible, along with their nervous system connection to the brain, for our equilibrium, and general position in space. In BPPV, “otoconia”, or the calcium crystals that are embedded in the base of these canals, can become dislodged, and may migrate into the fluid filled canals. This migration is sensed as “foreign” to the canals, and is interpreted as a disequilibrium, creating the sensation of vertigo. The fluid in the semi-circular canals is usually still, however, with the addition of the foreign otoconia, the fluid becomes more reactive to gravity, and with movements of the head causes the feeling of vertigo.

The good news is that BPPV is easily diagnosed and treated by a physical therapist that has been properly trained in the condition. The diagnosis of BPPV can be done by the Dix-Hallpike technique, which puts the head in isolated positions meant to cause movement of the otoconia within the semi-circular canals. A positive test is usually accompanied by increasing vertigo symptoms, and possibly nystagmus, which is an uncontrolled movement of the eyes.

Treatment of BPPV can be done through a few techniques, and the most common and most effective is called Epley’s Maneuver. This technique takes very little time to do by a trained professional, and places the head in gravity dependent positions, meant to guide the otoconia back to the base of the semi-circular canals, thereby relieving the canals of the “foreign” object.

People of all ages can be affected

by BPPV, but it most often affects adults and seniors. If you have been affected by something you feel may be similar, don’t hesitate to contact one of our trained professionals. If your vertigo is as a result of BPPV, treatment is short and painless, and can usually be resolved within one to three visits. If you suffer from vertigo, call our office to set up an appointment, no referral needed.

James W. Albright, CAPS, GMB, CGR, CGP 5205 Johnson Hill Drive, Canandaigua, NY 14424 Cell (5850 230-4280; Fax(585) 396- 5879 albright1.j.s@gmail.com www.AlbrightBuild.com

IN GOOD HEALTH Rochester’s Healthcare Newspaper.

To advertise and reach nearly 100,000 readers a month, please call 585-421-8109 November 2016 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 15

Golden Years Cataract Surgery Has Come a Long Way Surgeries are quicker, more precise and allow many patients to discard their reading glasses

By Deborah Jeanne Sergeant

C

ataract surgery has become commonplace, but the techniques involved and results possible have improved over the past several years. Some patients may reduce their astigmatism and need for reading glasses, among other advances.

Largely associated with aging, cataracts affect many older people with yellow tinted vision, limited night vision, glare in bright light, cloudy vision and double vision.

Mostly a routine surgery widely performed at out-patient centers and hospitals, cataract surgery has developed much in recent years.

"I've been part of this for a while," said Allan Robbins, surgeon at Robbins Eye in Webster. "These advances are very exciting."

Most patients need only light sedation and return home the same day. The surgeon removes the cataract by making an incision in the cornea, breaking apart the cataract, removing it, and then placing a manmade, permanent lens in the eye to replace the cataract.

Instead of anticipating weeks of thrice a day drops, some surgeons offer no-drop surgery. While this may seem a minor advantage, it's a big deal when a widow who lives alone delays surgery — and her chance for clear vision — because she feels uncertain about administering the eye drops afterwards. Plus, patients won't have to pay for the drops, which can spare them three co-pays.

Laser cataract surgery has increased the surgeon's precision in

making incisions and breaking up the natural lens.

Many of Robbins' office's procedures use a laser, what he calls "mind boggling technology."

The equipment helps make cataract surgery more efficient, precise and, in some cases, can help the surgeon correct astigmatism for the right candidates.

"It allows us to address all or a significant percent of their astigmatism," Robbins said. "It does all this in 15 seconds. We've done similar things manually but with nowhere near the precision."

Though it's not suitable for all patients, candidates can improve their near vision and astigmatism.

By their late 40s, most people begin to lose near vision and need reading glasses. Monofocal lenses only helped people see mid-range and long-range.

"Very recently, the Symphony lens provides a better depth of focus," Robbins said. "It can reduce the need for reading glasses. Most patients see well in the distance, intermediate.

Some need a weak pair of readers for fine print in dim light situations, but they can do most of their tasks in the daytime."

Previously, people with small pupils challenged surgeons; however, a new advance has made treating

them easier.

"The new pupil expander device, the iRing, assists the surgeon in small pupil cases," said Ken Lindahl, ophthalmologist at Rochester Eye and Laser Center. "Small pupils are a known risk factor for complications during the cataract procedure."

What Causes Cataracts

A

llan Robbins, surgeon at Robbins Eye in Webster, offers a few ideas: • "There's some evidence that sunlight exposure could be a risk factor. You want a good pair of sunglasses if you're going to be outdoors for an extended period of time.

• "Those that exercise, eat properly and keep their weight down seem to have cataracts later in life.

• "Smoking is a big risk factor for macular degeneration, a disease for which we don't have a cure, and possibly cataracts.

We're not sure. If we live long enough, we're all going to get cataracts. we don't really know what causes them."

Ask St. Annʼs

When Should I Start Looking for Assisted Living or Long-term Care for My Parent?

By Diane Kane, MD

Y

ou've seen changes in Mom's memory for some time, but lately things have taken a turn.

She can't remember when she last took her medications, or if she already took them today. When you visit, you can tell that she hasn't showered in several days, and she's wearing the same clothes she had on two days ago.

You can see the day coming when she might not remember where she lives or who you are.

It’s time to think about moving Mom to an assisted living or longterm care community.

But which one?

Researching all the options will take time, and it won’t be possible if she needs to move immediately.

That’s why the right time to start looking is before a crisis. Thinking about this difficult process in advance gives you the ability to make choices and weigh your options. And you’re more likely to find the right fit Page 16

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for your loved one.

Watch for clues Our parents or other loved ones give us signs that issues are developing, often long before those issues turn into problems. By being observant, you can tell when things are changing.

Changes in personal care habits.

Is your loved one showering or bathing as often as they used to?

Are their clothes laundered, or are they forgetting to change clothes?

Sleeping patterns. Are they sleeping through the night, or do they complain of waking up after just a couple of hours’ sleep — or not falling asleep at all?

Food. Is there food in the house? Or is there too much food — a sign that your parent or loved one is not eating regularly?

Check the use-by dates on food in the refrigerator.

1.

2.

3.

4.

Falls. Do you see new bruises, or has your loved one mentioned falling? While a minor fall may not result in a serious injury, it can signal a change in balance or a shift in their ability to get around easily.

Memory issues. Is your relative taking medications on the correct schedule? Do they know what day it is, and what is planned for the day? Or do they drive to the grocery store but have trouble finding the way home? All of these issues are warning signs of a greater problem at hand.

Medical changes. Not everyone has the opportunity to go to a doctor’s appointment with a loved one, but insisting can be a good idea. When you visit the doctor, you may hear about things you didn't know were happening. If there's a home health aide, ask what they see changing as well.

When these signs first appear, it's

5.

6.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

time to begin exploring the options for assisted living or long-term care.

Personal preferences

When you have time to do the research, you can take your loved one's preferences into consideration.

If they like their privacy, you'll want to find a place with private rooms.

If they go to church regularly, that’s something to consider. Many people seek out St. Ann's, for example, because we have a strong Catholic tradition, daily mass, and pastoral care.

Doing your homework before there’s a health crisis will make choosing a new home for your loved one easier and the transition smoother.

Physician Diane Kane is chief medical officer at St. Ann’s Community.

She is boardcertified in internal medicine, geriatrics, and hospice and palliative medicine and has been involved in senior care for 29 years. Contact her at dkane@ stannscommunity.com or visit www. stannscommunity.com.

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By Jim Miller

Planning a Funeral?

Expect to Pay $11,000 or More Dear Savvy Senior,

How much does an average funeral and body burial cost? I need to make funeral arrangements for my aunt, who’s terminally ill, and would like to have a cost idea going in so I can plan and budget appropriately.

The Executor

Dear Executor,

It definitely pays to know what charges to expect when pre-planning a funeral. Most people don’t have a clue, and can often be upsold thousands of dollars worth of extra services you may not want or need.

Here’s a breakdown of what you can expect

Funeral Prices

The first thing you need to be aware of is that funeral costs will vary considerably depending on your geographic location, the funeral home you choose and the funeral choices you make. With that said, here’s a breakdown of what an average funeral costs, nationwide, according to recent data from the National Funeral Directors Association.

• Professional services fee: This is a basic non-declinable fee that covers the funeral provider’s time, expertise and overhead. $2,000 • Transfer of the remains: This is for picking up the body and taking it to the funeral home. $310 • Embalming and body preparation: Embalming is usually mandatory for open-casket viewing, otherwise it’s not required unless the body is going to be transported across state lines. Embalming costs $695. Other body preparations, which includes hairdressing and cosmetics runs $250.

• Funeral viewing and ceremony: If the viewing and funeral ceremony is at the funeral home, you’ll be charged for use of the chapel and any necessary staff. Costs: $420 for viewing, and $495 for funeral ceremony.

• Metal casket: This is a big money maker for funeral homes, with markups of up to 300 percent over the wholesale price. $2,395.

• Funeral transportation: Use of hearse and driver $318 to transport the body to the cemetery. Use of a service car/van $143.

• Memorial printed package: This includes printed programs and memorial guest book. $155.

In addition to these costs, there are a number of other related expenses such as flowers for the funeral (around $200 to $400), the newspaper obituary fee ($100 to $600 or more), the clergy honorarium ($200 to $300) and extra copies of the death certificate ($5 to $35 per copy depending on the state).

And, a number of large cemetery costs like the plot or mausoleum fee, the vault or grave liner that’s required by most cemeteries, and the opening and closing of the grave, all of which average between $2,000 and $4,000; and the gravestone, which typically costs between $1,000 and $3,000.

All told, the average cost of a total funeral today is around $11,000 or more.

Ways to Save

If your aunt’s estate can’t afford this, there are ways to save. For starters, you should know that prices can vary significantly by funeral provider, so it’s wise to shop around.

If you need some help finding an affordable provider, your area funeral consumers alliance program may be able to refer you. See Funerals. org/local-fca or call 802-865-8300 for contact information.

There are also free websites you can turn to, like Parting.com that lets you compare prices, and FuneralDecisions.com that will provide estimates from local funeral homes based on what you want.

When evaluating funeral providers, be sure you get an itemized price list of services and products so you can accurately compare and choose what you want.

But the most significant way to save on a funeral is to request a “direct burial” or “direct cremation.”

With these options your aunt would be buried or cremated shortly after death, which skips the embalming and viewing. If she wants a memorial service you can have it at the graveside or at her place of worship without the body. These services usually run between $600 and $2,000, not counting cemetery charges.

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

November 2016 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 17

The Social Ask Security Office

From the Social Security District Office

E

Supporting Our Wounded Warriors

very Veterans Day, the nation honors the brave men and women who risk their lives to protect our country and the freedoms we cherish. Social Security honors veterans and active duty members of the military every day by giving them the support they deserve. A vital part of that is administering the Social Security disability program.

For those who return home with injuries, Social Security is a resource they can turn to for disability benefits. Social Security’s Wounded Warriors website is at www.socialsecurity.gov/woundedwarriors.

The Wounded Warriors website has answers to many commonly asked questions, and shares other useful information about disability benefits, including how veterans can receive expedited processing of disability claims. Benefits available through Social Security are different from those available from the Department of Veterans Affairs and require a separate application.

The expedited process is available to military service members who

become disabled while on active military service on or after Oct. 1, 2001.

Even active duty military who continue to receive pay while in a hospital or on medical leave should consider applying for disability benefits if they’re unable to work due to a disabling condition. Active duty status and receipt of military pay doesn’t necessarily prevent payment of Social Security disability benefits.

Although a person can’t receive Social Security disability benefits while engaging in substantial work for pay or profit, receipt of military payments should never stop someone from applying for disability benefits from Social Security.

Learn more by visiting www.socialsecurity.gov/woundedwarriors.

With over 80 years of experience and compassionate service, Social Security is proud to support our veterans and active duty members of the military. Let these heroes know they can count on us when they need to take advantage of their earned benefits, today and tomorrow.

‘Give your word-of-mouth advertising a big boost’

Serving Monroe and Ontario Counties in good A monthly newspaper published

Health Rochester–GV Healthcare Newspaper

by Local News, Inc. Distribution: 33,500 copies throughout more than 1,500 high traffic locations.

In Good Health is published 12 times a year by Local News, Inc. © 2016 by Local News, Inc. All rights reserved.

154 Cobblestone Court Dr., Suite 121 – P.O. Box 525, Victor NY 14564.

• Phone: 585-421-8109 • Email: Editor@GVhealthnews.com

Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo Writers: Jim Miller, Deborah J. Sergeant, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Ernst Lamothe Jr., Jessica Gaspar, Lorraine Puleo, Cori Wyman, Diana Kane (MD), Dustin Maracle (PT), Phil Rice • Advertising: Donna Kimbrell, Anne Westcott • Layout & Design: Eric Stevens, Jeffrey D. Adkins • 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.

Page 18

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

In 2017, choose to advertise with In Good Health, Rochester-Genesee Valley’s Healthcare Newspaper.

Reaching health consumers, health professionals.

32,000 copies distributed each month. Close to 1000,000 estimated readers

In Good Health The Healthcare Newspaper (585) 421-8109

Hire Your Own Private Doctor

Physicians finding other ways to offer care

By Deborah Jeanne Sergeant

W

ant a doctor who really knows you and offers 24/7 availability or even house calls? These options have become reality as physicians reinvent how they provide care.

A few doctors in the area have begun offering alternative ways to deliver care, and not just because they want to enhance their patients’ experience.

As margins grow thinner and thinner in the healthcare industry, many providers take on additional patients to receive adequate reimbursement from insurers. Since they can’t add more hours to the day, this means that each patient receives less time during visits. Physicians in general also have little opportunity to develop a close patient/ doctor relationship. If they increase the number of visits they schedule, they must work longer hours, which affects their quality of life.

All of these factors add up to less satisfaction for doctors and patients.

Some have turned to offering retainer-based care, sometimes called concierge medical care.

Physician Anthony Ragusa, fellowship-trained in internal medicine and practicing in Greece, believes that affiliation with MDVIP (www. mdvip.com) for the past year has helped him solve the problem.

“He always wanted to provide the best service to patients, one-onone care,” said Blaise Ragusa, the physician’s brother and the practice administrator. “He wanted the patient to participate as much as possible and spend as much time as he could so the patient knew what to

do for his health.”

MDVIP, a patient-centered wellness program headquartered in Boca Raton, Fla., provides physicians with more direct access to providers for an annual fee. The program focuses on wellness and prevention as keys to good health.

Physician Ragusa tailors preventive plans to help patients stay healthy, including diet, exercise, and monitoring their weight, blood pressure and other vital statistics.

His brother said that patients can call the doctor whenever they like, 24/7. Instead of waiting weeks — even months — for appointments, patients can get in touch with the doctor any time they want. “If required, he’ll do a home visit or see the patient at the hospital for no extra charge. He’s always had a calling for caring for people,” the physician’s brother said.

Through his affiliation with MDVIP, Ragusa can link to top specialists nationwide to consult on tougher cases. MDVIP is not insurance, but he participates with insurance and bills them for services delivered on-site.

Patients pay about $136 monthly in addition to maintaining the health insurance required to comply with the Affordable Care Act. The fee includes preventive care, 24/7 access via phone or email, and regular maintenance visits for ongoing health concerns.

Serving the senior population

Some patients of physician Luis Postigo can remember the days of doctors making house calls.

For the past decade, Postigo,

Parenting

By Jessica Gaspar

A sick baby and the upcoming holidays

W

henever Timmy cries or if I take something away from him that he shouldn’t have and he lets out a little whimper, I always gently tease and say, “Life is so hard being a baby!”

In the case of a sick Timmy, life really is hard! In early October, he came down with a virus — was throwing up, had a fever and a stuffy nose to boot. A couple of nights, he was so restless I just snuggled and held him all night. Poor baby boy. I took him to the doctor who told me to monitor his fluid intake and give

him Tylenol for his fever.

Of course, a sleepless baby means a sleepless mama! Though I did miss one day of work, I didn’t mind. That’s what vacation and sick days are for anyhow. Luckily, I usually save my time throughout the course of the year so I have time left for emergencies.

Timmy sure is cruising around.

He loves crawling around just to check things out. Sometimes I’ll get down on my hands and knees and chase him around the house. He just laughs and laughs at his crazy mom.

November 2016 •

Some doctors in the area can provide you with home visits and 24/7 availability — and it’s less expensive than you think has served as a geriatric specialist who provides house calls to seniors 65 and older at no extra charge.

Though not a retainer-based provider, Postigo diverts from traditional medical practices by taking his care wherever the patients are, home or hospital — a big departure from the traditional model of patients lining waiting rooms to bring their needs to the doctor.

Postigo sustains his business without grants or extra income by keeping his expenses low. For example, he doesn’t see patients at his office — ever. He doesn’t employ nurse practitioners or physician assistants but sees all his patients directly. He doesn’t pay for an answering service, but takes patient calls personally when no one’s in the office. Technology also lends a hand by helping him keep electronic records and order X-rays or blood work on his computer.

Some of his clients also use email and texting to keep him up-to-speed on their health. He views telemedicine as the wave of the future.

Postigo accepts all insurance.

“I’ve been able to make it financially success,” he said. “I like what I do. There is a group of patients that are not so sick they need to go to a nursing home but are not so well that they can go driving around. Or they don’t want to bother their children to take them.

“I not only save the family money, but I save money for the government to pay for someone to take care of them. It’s a win-win situation.”

Though he doesn’t receive the fees that retainer-based doctors receive, Postigo said that his job satisfaction makes his medical model work for him.

“I think house calls and patient interactions will continue to change a lot,” Postigo said.

He is now waving to people and things. At the doctor’s office, his pediatrician waved to him as the visit was concluding. He stared at her as if he was thinking “Do I wave to this lady?” Then she said, “Oh, he’ll probably do it as soon as I walk out of the room.” Well, that’s all it took!

He waved bye-bye to her. We both got a kick out of that.

First thing in the morning, he stops to wave to the ceiling light in the bedroom. I’ll say, “Where’s the light?” and he will point and wave.

Sometimes he’ll point to random objects and say, “Ah!” so I’ll repeat back the name of the object, and then he will point to the next object he sets his big brown eyes on and so on.

It’s so much fun taking in these little moments.

He took on baby food pretty well when I started him on that a few months ago, and now I’ve begun sharing soft foods and small things off of my plate with him. He will eat pretty much anything, so I’m pretty happy about that. I hope he doesn’t become a picky eater. I’ve known kids who will only eat things like chicken fingers or hot dogs, which is

fine as long as they are eating something, but I prefer a balanced eater (as any mom does).

In terms of growth, Timmy is right on track. At his 9-month wellness check, he weighed 20 lbs. 6 oz. and stands 28.5 inches tall. The trouble I mostly have is with his clothes.

As I write this, Timmy is 9 months old and wearing 12-month size clothes. In some cases the 12-month size has been too small, so I’ve had to bump him up to an 18-month size in some things.

For Halloween, Timmy was an elephant — totally cute! And, I will admit that I have already started Christmas shopping for him. I used to work at the local BMW dealership, so I bought him a small BMW Baby Racer bike. (I work for a Toyota dealership now, but I couldn’t find any Toyota bikes or cars for babies.)

I’m really excited for the upcoming holidays. He will be too young to fully understand holidays like Thanksgiving and Christmas, but the house always seems so much more full and the holidays more meaningful when young kids and babies are around.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 19

The Evolution of The Healthcare Team

Meet your health coach: The newest member of your healthcare team

J

ust a few decades ago a person’s healthcare team consisted of a physician and an office nurse.

You went to them for all your health needs and concerns. If you became ill after office hours, there was always a way to get in touch with them. Some even made home visits! If you ended up in the hospital, your doctor would visit you there to check on your care.

Today, the number of people involved in an individual’s care has grown exponentially.

Gone are the days of having just one person to take care of you. You now have a care team watching over your health needs. Some of the people looking out for your well-being may include a primary care doctor, nurse, pharmacist, hospitalist, social worker, various specialists, dietitian, a care manager and maybe even a health coach.

Having all these people involved in your care can often become overwhelming. Occasionally, you may receive several conflicting instructions.

You may have multiple providers prescribing medications for various conditions. Making sense of all this can be a chore and often confusing.

A health coach may be part of the solution.

Q: What is a health coach?

What if you could choose?

5 Days or 45 Days

hoacny.com

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A health coach is a person who is there to assist a patient with achieving specific health goals. Coaches act as a go-between for patients and all the various specialists involved in their care. They are there to make sure patients are heard. They encourage and motivate the patients to achieve maximum health success.

Health coaches take the time, often missing from office visits, to reinforce things that were previously explained. They look at the whole patient. This takes into account social needs, barriers that may exist and patients’ readiness to change.

Rochester Regional Health, Rochester Institute of Technology and the Greater Rochester Independent Practice Association (GRIPA) have formed an alliance and have been training and adding student health coaches to the care management team since early 2014. The majority of patients they have assisted have been in the Monroe County area.

Plans are in place to expand the use of health coaches to neighboring counties.

Student health coaches consist of RIT students seeking a career in various healthcare fields including pre-med, physician assistants, nutritionists, etc. The focus is on how to communicate effectively with patients. When patients feel heard and their needs and goals are validated, the results are increased patient satisfaction and greater adherence to a treatment plan.

Q: Who is the patient population?

Health coaches are assigned to a patient who is already open to the GRIPA care management team. The

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

patient could have a new diagnosis of a chronic condition or might be struggling to manage existing ones. These patients are identified as people who could benefit from more frequent check-ins or additional education.

Q: What is the goal of the program?

The goal of the program is improved health outcomes for the patients. The personalized care plans and the additional attention provided to these patients have been shown to reduce their need to visit the emergency room by 90 percent as well as reducing hospital stays.

Q: Why is having a health coach available as part of your health team important?

A health coach is a valuable member of the health team. Coaches act as the middle person in the patient and provider relationship.

Patients can talk with a health coach in a relaxed setting. There, they may feel more confident discussing their health situation and what is happening in their life that is contributing to their physical illness. In this role, the coach can motivate the patient to change behaviors and self-manage the patient’s health. They work toward mutually agreed upon goals.

This helps the patient take a more proactive role in staying healthy!

Each member of the healthcare team has a specific role. These roles complement each other to ensure that safe, quality care is being provided to the patient. Together with a care team, one can develop a plan of care that meets individual medical needs as well as life goals.

Take the time to understand the different people involved in one’s care and get involved. Doing so can increase the chances of a happier, healthier outcome.

Lorraine Puleo, MS, RN-BC, is a certified nurse case manager; Cori Wyman, PharmD, CDE, CGP, is a consulting clinical pharmacist, certified diabetes educator and certified geriatric pharmacist.

Mental Health Special Don’t miss the December edition

IN GOOD HEALTH Rochester’s Healthcare Newspaper.

To advertise and reach nearly 100,000 readers a month, please call 585-421-8109

Health News Excellus doc honored by College of Physicians Physician Patricia A. Bomba, Excellus BlueCross BlueShield vice president and medical director for geriatrics, was recently honored with a Mastership by the American College of Physicians for her distinguished practice of internal medicine, academic contributions to her specialty, and her commitment to advancing the art and science of medicine.

Bomba is a Bomba nationally and internationally respected expert on end-of-life issues and served on the Institute of Medicine committee that produced the landmark report, “Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.”

Bomba pioneered New York’s medical orders for life-sustaining treatment program, known as MOLST, and the first-in-the-nation eMOLST. This set of medical orders physically and virtually stay with the patient as he/she moves through the health care system — facility to facility and physician to physician — to ensure that the patient’s wishes are followed by all who provide

care. Her efforts helped MOLST and eMOLST join the New York state health care proxy and living will as legally binding tools for advance care planning.

Oak Orchard Health gets perfect score Oak Orchard Health was recognized at its recent operational site visit by the US Dept. of Health and Human Services, Health and Services Administration’s (HRSA), Bureau of Primary Health Care for successfully fulfilling all 19 program requirements.

The accomplishment places Oak Orchard Health among a very small number of community health centers nationally to achieve this score. The federally[qualified health center has locations in Brockport, Albion, Lyndonville, Hornell and Warsaw.

The health center was measured on clinical, quality, financial, and operational performance and practices during the in-depth review. The site visit results provide a comprehensive assessment of the health center’s compliance and performance status.

“An operational site visit that results with no negative findings is very rare and a testament to the dedication put forth each day at Oak Orchard Health. I am proud of our team and its successful efforts to deliver high quality health care to our community,” said Jim Cummings, CEO of the health center.

Cases of Concussion Among Youth Rising Data show concussion diagnoses rising fastest among people aged 10 through 19. Fall is the season when problem peaks —male students more affected

C

oncussion diagnoses among New York state’s youth have risen steeply, with media attention on football-related concussions and state legislation aimed at preventing sport participants from “shaking off” signs of head injuries, according to a recent study released

by Excellus BlueCross BlueShield.

The report by the Blue Cross Blue Shield Association in Chicago, “The Steep Rise in Concussion Diagnoses in the U.S.,” represents a comprehensive study of medical claims for 936,630 diagnosed concussions suffered by Blue Cross and Blue Shield commercially insured members throughout the country from 2010 through 2015. Concussion diagnoses among adults rose significantly over the past six years, but the most significant numbers and rate of change applies to young people.

In New York state, concussion diagnoses for members aged 10 through 19 increased 72 percent, from a rate of 10.7 per 1,000 members in 2010 to 18.5 per 1,000 members in 2015.

This is similar to the national rate of concussion diagnoses for members aged 10 through 19, which spiked 71 percent from a rate of 8.9 per 1,000 members in 2010 to 15.2 per 1,000 members in 2015. Concussion diagnoses in New York state for all members age 64 and younger increased 42 percent, from 3.3 per 1,000 members in 2010 to 4.6 per 1,000 members in 2015.

Concussion diagnoses for all members age 64 and younger increased 43 percent nationally, from a rate of 3.0 per 1,000 members in 2010 to 4.3 per 1,000 members in 2015.

More detailed data pertaining to Upstate New York were not available November 2016 •

Among the more than 300 guests at the gala hosted by UR Medicine’s Thompson Health were, left to right, Mike Schwabl, Lauren Dixon, Coleen Emblidge, Dawn Borgeest and emcee Doug Emblidge. The gala raised more than $125,000 for Thompson.

Gala Nets More than $125,000 for Thompson

T

he annual gala hosted by UR Medicine’s Thompson Health recently raised more than $125,000 to benefit upcoming renovations at Thompson Hospital in Canandaigua.

Held Sept. 9 at the Inn on the Lake in Canandaigua, the sold-out event had more than 300 people in attendance, with Southern barbecue fare as well as music by The Skycoasters.

The money raised will go toward a new, 12-bed observation unit scheduled to open at Thompson Hospital in 2017. The unit is designed to

provide high-quality, personalized care for patients who require evaluation and treatment for a period of time between eight and 24 hours, allowing the hospital to reserve inpatient and emergency department beds for those patients who truly need them.

Of the more than $125,000 raised at the gala, $19,000 was raised through a “cash call” benefitting the SafeGait Balance and Mobility Training System recently installed in the rehabilitation services department, also at Thompson Hospital.

and would be less statistically significant than the larger statewide data.

The study also finds that nationally: n Fall is the peak concussion season for young people aged 10 through 19, with the most dramatic increases seen among males. Concussion diagnoses for young males in the fall are nearly double that of young females. n The growth of diagnosis rates for young females increased 118 percent, compared to an increase for young males of 48 percent during the study period. Young males are still diagnosed with 49 percent more concussions than young females. n Blue Cross and Blue Shield data in 2015 shows that patients aged 10 through 19 in some states have nearly a three times higher rate of concussions diagnosed than in other states. The Northeast experienced higher rates of concussion diagnoses than other regions overall. n The percentage of concussion patients across all aged diagnosed with post-concussion syndrome nearly doubled between 2010 and 2015 nationally. Throughout the study, post-concussion syndrome was diagnosed equally for males and females aged 10 through 19. Females aged 20 through 64, however, are nearly 60 percent more likely to receive such a diagnosis than males.

“What the national study illustrates is a heightened awareness of concussion as a real and potentially serious

injury,” said physician Nicholas Massa, medical director, Excellus BlueCross BlueShield, “and it stresses the need for prompt recognition of the injury, appropriate management and safe return to activities.”

New York is among the states that have enacted specific sports-related concussion measures backed and promoted by the National Football League. In 2011, Gov. Andrew Cuomo signed into law the “Concussion Management and Awareness Act” that directed the commissioners of health and education to implement rules for treating and monitoring students with mild traumatic brain injuries.

The law requires training for school personnel, the dissemination of injury information to parents of pupils who participate in sports, and medical clearance of youth athletes suspected of sustaining a concussion before sending them back into a game, practice or training.

This is the ninth study of the Blue Cross Blue Shield “The Health of America Report” series, a collaboration between the Blue Cross Blue Shield Association and Blue Health Intelligence, which uses a market-leading claims database to uncover key trends and insights into health care affordability and access to care.

For more information, visit BCBS.com/ healthofamerica.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 21

Health News Habitat for Humanity honors volunteers Flower City Habitat for Humanity (FCHH) and over 20 community members came together on Oct. 1 to recognize four volunteers who have each contributed 20 years and more than 8,000 hours toward increasing homeownership and affordable housing to more than 100 families in Rochester.

The honorees are: • Lauren Frasier, Fairport resident, part of hammer and saw crew, on-site supervisor and picnic volunteer.

• Harry Doty, Greece resident, also part of hammer and saw crew, cabinet shop co-founder, electrical crew and volunteer recruiter.

• Dianne Brown, Pittsford resident, past board member, committee chairwoman, construction volunteer, member and leader of the Habitat Interfaith Partnership Build Coalition.

• Dawn Pruszynski, Fairport resident, student organizer, committee

chairwoman, and homebuyer coach.

According to a news release, each of these volunteers has worked tirelessly to fulfill the agency’s mission, “Seeking to put God’s love into action, Flower City Habitat for Humanity brings partners together to build homeownership, communities and hope” and vision, “A world where everyone has a decent place to live”.

The “Trees for 20” ceremony was conducted at the Gateway Garden on Jay and Broad streets in Rochester where four new saplings were planted in honor of each volunteer.

This city garden is maintained by FCHH, and is also the home of the Brian Kimble Memorial Gazebo and the “Roger Cross Memorial”.

Flower City Habitat for Humanity, founded in 1984, is a non-denominational Christian housing ministry dedicated to eliminating substandard and poverty housing in Rochester. It has built or renovated more than 200 homes, and is one of the largest Habitat affiliates in the northeastern US.

Home is where

the help is.

Jill Halterman to lead clinical research at URMC Jill Halterman, an accomplished physician and scientist whose research has helped guide the delivery of asthma care in Rochester and elsewhere, has been appointed senior associate dean for clinical research at the University of Rochester Medical Center Halterman (URMC), pending approval from the University’s board of trustees.

Halterman, a professor of pediatrics at the University of Rochester School of Medicine and Dentistry who also serves as chief of the division of general pediatrics, begins her term Jan. 1.

“This is an exciting opportunity, and my hope is that we can continue to enhance community-based research and think about health on a broad, population level,” said Halterman. “I look forward to working with my research colleagues throughout the university to help them build on their ideas and achieve their goals.”

“Jill’s work with asthma delivery has centered on the development of models that are both sustainable and scalable,” said physician Mark B. Taubman, dean of the medical school and CEO of URMC. “Given her experience, we believe she’s the perfect choice to work with our researchers to help translate their work to affect health across a population.”

Stephen Dewhurst, Ph.D., Vice Dean for Research at URMC, mentioned Halterman’s long track record of impactful and innovative research and her reputation as a collaborator among the many reasons he felt she was a fit for the position.

“She’s very involved in issues of population health and that’s the direction the medical center needs to tilt toward,” said Dewhurst. “Her ability to build bridges with dispa-

“Knowing there is someone who can take care of us, makes me feel better about our future!”

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016

rate groups of stakeholders who may not already be working together — that’s a great strength and I anticipate she will bring the same strength to this role.”

In addition to her goals around population health, Halterman is also hoping to create a research environment where young investigators can thrive, and she feels strongly about ensuring that the proper mentorship and support is available to researchers early in their careers.

“We need to think about trainees and junior investigators and facilitate their involvement in this type of research,” said Halterman. “It’s vital for us to help shape the next generation of scientists who are working in this area.”

Halterman will replace physician Karl Kieburtz, who is stepping down from the position.

Chiropractic college names next president Chiropractor Michael A. Mestan has been selected as the new president of New York Chiropractic College, based in Seneca Falls. He will succeed Frank J. Nicchi, who’s retiring Aug. 31.

Mestan now serves NYCC as executive vice president and Mestan provost and holds an academic appointment in the chiropractic program. He joined the college in 2002.

“We are confident in his ability and excited to support him as he leads the College to even higher levels of excellence in the future,” said Thomas R. De Vita, chairman of the NYCC board of trustees.

Mestan held positions as department head for clinical sciences, dean of the chiropractic program, and executive vice president for academic affairs before being appointed to his current position in 2010. Previously, he held academic and administrative appointments at Parker University in Dallas.

He has also practiced chiropractic and served as a diagnostic imaging consultant.

Having earned his Doctor of Chiropractic degree from the National University of Health Sciences in 1994, Mestan completed his residency in diagnostic imaging at Southern California University of Health Sciences. In 2011 he earned a master’s degree, and in 2013 a Doctor of Education degree, both in educational administration with a specialization in higher education, from the University of Rochester’s Margaret Warner Graduate School of Education and Human Development in Rochester.

Mestan resides in Seneca Falls with his wife and three children.

IT’S ONLY SUPER IF YOU TAKE IT. According to the National Institutes of Health, up to 20 percent of patients fail to fill new prescriptions, and 50 percent of people with chronic health conditions discontinue their medication within six months. If you have a chronic condition like high blood pressure, diabetes or high cholesterol, taking your prescriptions as directed is essential to healthy living. So remember: If you’re not taking your prescriptions as directed, you’re taking a chance. To learn more, visit ExcellusBCBS.com/ TakeAsDirected.

#TakeAsDirected A nonprofit independent licensee of the Blue Cross Blue Shield Association

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Monroe Community Hospital LPNs and RNs for Baylor Program Work 32 hours on weekend, paid for 40.

Weekdays off and full time benefits To learn more and apply, please visit www.monroehosp.org or call 760-6226

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Page 23

Not a hotel.

(But you’ll feel like you’re in one.)

Recovering from surgery or a stroke is no vacation. But the Wegman Transitional Care Center offers advanced rehabilitative care in an environment that’s remarkably comfortable.

Rochester’s only freestanding transitional care center.

• Separate from St. Ann’s skilled nursing building.

• Singularly focused on helping you gain the independence you need to return home.

Hotel-like amenities.

• Spacious private rooms with shower, complimentary Wi-Fi, and flat-screen TV. • Country kitchen for use 24/7 and on-site bistro.

You’re the boss.

Where you go for rehab is strictly up to you. If you have a surgery scheduled, you can preplan your stay with us and eliminate last-minute decisions—and disappointments.

Call 585-697-6311.

Or visit www.StAnnsCommunity.com Wegman Transitional Care Center

1500 Portland Ave., Irondequoit

Specialized care to help you get better and get home fast.

• The latest technology and training to accelerate your recovery.

• Experienced, certified staff skilled in state-of-the-art rehab care.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • November 2016