Rochester IGH #152 April 18

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Meet Your Doctor URMC pediatrician Jill S. Halterman behind program that is making a difference for school children with asthma. Page 6


APRIL 2018 • ISSUE 151


Transgender Surgeries Up

Gender-affirming surgeries increase nearly fourfold since 2000. Page 7

How women can address hair thinning Heart disease: 10 things women should know When sex is a real pain • Monthly tracking apps Four myths about midwives

PLUS: For the First Time, Women Outnumber Men in Med School Story on page 11

“You cannot have a healthy body with a sick mouth,” says Rochester Dentist Salvatore “Sam” Guarnieri, owner and founder of Pittsford Dental Excellence Center in Pittsford. He is one of the local dentists featured in 2018 DENTAL GUIDE INSIDE

NEW GOLISANO AUTISM CENTER TO OPEN IN 2019 The founders of the Golisano Autism Center will be breaking ground at the Al Sigl Schwartz Family Campus on South Avenue near Science Parkway this spring in preparation for their grand opening in 2019. ALSO IN THIS ISSUE: 5 things you need to know about autism. P. 10

Eat Brown Rice While white rice certainly has some nutritional merit — as it’s enriched with some of the nutrients it loses in the milling process — it pales in comparison to its tawny cousin. SmartBites. Page 12


Which Medications Work Best to Deal with Your Spring Allergies? Page 13

What’s a Bigger Threat: Wolves, Bears, Sharks…

or the Family Dog?


ogs, farm animals and insects — not wild animals — are the cause of death for most U.S. residents killed by animals, according to a new study. The study reported that 1,610 people in the United States were killed by animals between 2008 and 2015. “Importantly, most deaths are not actually due to wild animals like mountain lions, wolves, bears, sharks, etc.,” said the study’s lead researcher, Jared Forrester, a physician. Rather, they’re “a result of deadly encounters with farm animals, anaphylaxis from bees, wasps or hornet stings and dog attacks,” said Forrester, with Stanford University’s Department of Surgery. “So, while it is important that people recreating in the wilderness know what to do when they encounter a potentially dangerous animal, the actual risk of death is quite low,” Forrester said. Forrester made his remarks in a news release from the journal Wilderness & Environmental Medicine, which published the study in its March issue. The death rate overall from

animal encounters “has remained relatively stable” from the last time this analysis was performed, covering 1999-2007, he said. Nonvenomous animals accounted for 57 percent of the deaths in the latest analysis. Most of those cases involved what the researchers classified as “other mammals” - including cats, horses, cows, other hoof stock, pigs and raccoons. Previous research has shown that most deaths from “other mammals” occur on farms, and that horses and cattle account for 90 percent of such farm accidents. “Preventing potentially fatal farm animal encounters should be a better-promoted and -supported public health initiative,” Forrester said. “Farming remains an industry with a deficit of work-related injury reporting, and opportunities exist to improve safety measures and injury reporting on farms in the U.S.” Dogs were the second most common cause of nonvenomous animal-related death, the study found. Children younger than 4 years had the highest dog-related death rate, at 4.6 deaths per 10 million people. That rate was almost two times higher

than the next most vulnerable group — people older than 65 — and four times higher than other age groups. “The burden of fatality upon young children after dog encounters remains troubling,” Forrester said. “These are preventable deaths.” Venomous animals accounted for about 86 deaths a year during the study period. Most of those were caused by wasps, bees and hornets. To reduce these deaths, Forrester

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

said, people who know they’re allergic to insect stings should carry a portable epinephrine delivery device with them at all times. “With an estimated 220,000 annual visits to the emergency department and nearly 60 deaths per year due to stings from hornets, wasps and bees, effective and affordable treatment [for severe allergic reactions to stings] is critical,” he said.

Jewish Senior Life’s Physician House Calls program brings a team of skilled, compassionate healthcare professionals and a wide range of services—directly to your home. Our doctor provides one-on-one primary care, medical assessments, and coordination of care with other home health services. The Physician House Calls team will work with you to develop a comprehensive care plan that will give you and your family peace of mind. This program is available to individuals 65 years and older.

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PRIMARY CARE • HEALTH ASSESSMENTS • CARE COORDINATION • MEDICATION REVIEW April 2018 • IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper • Page 3

Are you 60 years of age or older? Do you have trouble connecting with or getting along with others? If so, you may be eligible for current HARP studies. For more information, or to learn about other studies available for seniors, please call the study team at: (585) 276-6204 or email

Join us on Tuesday, May 1st Nationally known speaker on coping with hearing loss with reality and humor

Hearing Loss and Emotional Regulation: Building Resilience Sam Trychin, Ph.D. Dr. Trychin is one of a kind. Few that attend his presentations will ever forget him! He maintains competencies and interpersonal skills rarely found in anyone helping those living with hearing loss today. A not to be missed interactive presentation! Tuesday, May 1st 2018 • Doors open at 5:00 pm • Program begins at 6:00 pm Rochester Academy of Medicine 1441 East Ave., Rochester, NY 14610 • Free admission/parking • Accessible • Light refreshments will be provided. An induction hearing loop and captions will be used in the auditorium; an ASL interpreter will also be provided.

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Speaker to discuss qualities of chocolate

April 19

Neutral Ground Support Organization, a peer support nonprofit group for people who are divorced, widowed, separated or ending a significant relationship, is organizing a seminar to discuss the qualities of chocolate. Cheryl Minchella, community health educator from MVP Health Care, will be the guest speaker. Titled “Everything You Ever Wanted to Know About Chocolate,” participants will learn the history of chocolate, the different types, free trade vs. other sources and what the latest research says about the pros and cons of consuming chocolate. The event will take place from 7 and 8 p.m., Thursday, April 12, at Henrietta UCC, 1400 Lehigh Station Road, Henrietta. Tasting following the presentation. This event is open to the public and friends. A $5-donation from guests and public is requested. Members of Neutral Ground are asked to donate $4. All benefits will help fund the organization. For more information, visit https:/ or email

Neutral Ground holds spring support group Neutral Ground Support Organization, a peer support group for people who are divorced, widowed, separated or ending a significant relationship, announced it will begin its spring workshops starting at 6:30 p.m., April 19, at Henrietta UCC, 1400 Lehigh Station Road, Henrietta. The group will use the book “Getting Past Your Breakup: How To Turn A Devastating Loss Into The Best Thing That Ever Happened To You” by Susan J. Elliot, which is available on It will discuss and work through the issues, such as anger, guilt, fear, commonly associated with a breakup. This group primarily deals with the tasks and challenges of creating and sustaining a new healthy life. Workbook materials will be provided in group but participants will need to purchase Elliot’s book. For more information, visit https:/ or send an email to

April 23

April 13, 14, 15

Rochester Minimalists to focus on estate sales

Mindfulness training at Brighton Pathways Brighton Pathways in Rochester, an integrative health and wellness clinic led by licensed acupuncturist Diane Macchiavelli, will once again host the Dalai Lama’s Namgyal Monastery for a weekend event titled “Eight Verses for Thought Transformation.” All proceeds go to Namgyal Monastery, a 501(c)3 nonprofit organization based in Ithaca. Eight Verses for Thought Transformation is a seminal Buddhist text from the early 1100s that lays out a very easy to follow mindfulness meditation practice. Weekend seminars will be led by Geshe Lobsang Jhagmey, resident scholar monk and meditation master from Namgyal Monastery. There will be plenty of time for discussion and Q&A. The event will start with an introduction at 7 p.m., Friday, April 13, at Brighton Pathways near 12 Corners in Brighton. Then it will continue from 9 a.m. to 5 p.m. April 14 and from 9 a.m. to noon April 15. The introductory meeting is free; there is a fee to participate in the other ones. Registration is required. For more information, email info@, call or text

“Estate Sales 101” is the topic of a presentation sponsored by The Rochester Minimalists, a local group of like-minded individuals looking to share ideas, practice minimalism and have a positive impact on each other as well as the environment. This will be a short presentation about estate sales and household dispersal with Jim Heeks of Keepers of the Past, a family-owned and operated estate sales service provider serving Rochester for over 25 years. The presentation will be followed by a question and answer session. The event will take place from 6:30-8:30 p.m., Monday, April 23, at the Ruth Braman Room of Penfield Public Library, 1985 Baird Road, Penfield. For more information or to join Rochester Minimalist, go to www. or Minimalism-org-Rochester. The meeting is free and open to the public.

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

May 1

Psychologist to be HLAA featured speaker Sam Trychin, a psychologist specializing in improving communication strategies for people with hearing loss, is the featured speaker at the Tuesday, May 1, meeting sponsored by Hearing Loss Association of America Rochester Chapter. His talk, “Hearing Loss and Emotional Regulation: Building Resilience,” takes place at the Rochester Academy of Medicine, 1441 East Ave., Rochester. Doors open at 5 p.m.; the program starts at 6 p.m. Light refreshments will be served. The program is free. Anyone interested in hearing loss is welcome. Trychin is in private practice in Erie, Pa. He focuses on psycho-social interventions for people with hearing loss and their communication partners. He also deals with training for individuals with stress-related disorders. He is the mental health and rehabilitation adviser to Hearing Loss Association of America and serves on the Pennsylvania Governor’s Council on Aging. The author of 15 books and several professional book chapters and journal articles, Trychin has produced DVDs targeting skills for living better with hearing loss. He and his wife, Janet, an audiologist, frequently conduct workshops and training programs together. Sam Trychin is an engaging speaker, interacting humorously with his audiences. Enhancing hearing accessibility at the talk will be an inductive hearing loop donated by HLAA Rochester Chapter, open captions and ASL interpreting. For more information, visit or call 585 266-7890.

May 19

Rochester to host international cycling event The MVP Health Care Rochester Twilight Criterium will return to downtown Rochester for a fourth consecutive year Saturday, May 19. MVP Health Care is the new title sponsor for this health-focused, family-friendly community event, which is being held several months earlier than its typical late summer date. For the fourth straight year, the event is part of USA Cycling’s Professional Road Tour (the highest level of professional cycling in the U.S.). One of only nine criteriums on the calendar, the MVP Health Care Rochester Twilight Criterium will feature top male and female athletes from around the country and beyond. These professional men and women will race for $12,000 prize purses. As it did in 2017, the event will also showcase some of the nation’s finest 17- to 22-year-old amateur athletes. “The MVP Health Care Rochester Twilight Criterium brings outstanding athletes and thousands of spectators to Rochester each year for exciting races and a day full of fun activities for people of all ages,” said Mollie Rooney, MVP director of marketing and communications. “We are excited to join as title sponsor this year.” For more information and event schedule, visit: www.rochestercrit. com or

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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New Masthead


e’re excited with the new masthead of In Good Health. This is the first change we’ve made since the inception of the paper in Rochester in August 2005. Newspapers don’t change mastheads frequently but we thought this was a great time to introduce something new, fresh, more contemporary, something that better reflects the paper’s mission of disseminating news related to health, the healthcare industry and wellness. We believe the new masthead has the power to generate some new interest for In Good Health. It is cleaner than the one it replaces, more visually appealing and we hope will help draw more readers who see the paper at hundreds of high-traffic locations, including all Wegmans’ locations. We’re pleased that Melanie Watson accepted our invitation to come up with new ideas for the masthead. Watson has been a professional graphic designer for more than 25 years and has extensive experience in designing publications, logos, marketing collateral and a number of other products. In nearly two decades on the design team at Rochester Business Journal, Watson received nearly 20 awards from the New York Press Association and the Alliance of Area Business Publishers. Watson submitted not one or two ideas. In a matter of a day — we thought it would take at least a week — she was able to come up with seven designs for the masthead. Even better, all seven were outstanding. It was tough to pick the winner from among her ideas. “When designing the logo for In Good Health, I was focused on what the paper’s demographic might be attracted to,” she explains. “I was showing health as a lifestyle instead of a medical only issue. And the bold font simplifies the message,” We highly recommend Watson for any design work readers might need. Some of her work can be viewed at Please drop me a note, let me know what you think. If you have any story ideas, please feel free to drop me an email. And, please, consider In Good Health for advertising. We reach tons of people in the community. Wagner Dotto is In Good Health’s publisher and editor. To contact him, send an email to wagnerdotto@

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Your Doctor

By Chris Motola

Jill S. Halterman, M.D. URMC pediatrician: Local program making a difference for school children with asthma, serving as model for other regions of the country Q: You’ve been working on a program to help fight asthma in school children. How does it work? A: Our programs really focus on improving the delivery of preventive care to kids with asthma in the community. The idea is really that we know, first of all, that asthma is one of the most common chronic illnesses of childhood and that it leads to a lot of suffering including not only ongoing symptoms, but also emergency visits, hospitalization, limitation of activity, loss of school days and loss of work days for their parents. So, our goal is really to improve those outcomes for those kids. We also know that there are preventive treatments for asthma that can really make a difference if they get to the kids who need them. What we found in our early work is that there are many kids who should be receiving preventive care who aren’t. We’re trying to make sure that all those kids who would be helped by those drugs are getting them. Q: How has the program evolved? A: One of our earliest programs was a partnership with nurses from the city school district where we identified children who experienced significant asthma, and we partnered with the nurses to have them deliver one dose of the medication each day they were at school and give parents one less thing to worry about. We found that that model really helped kids improve their outcomes. The telemedicine piece was added to provide an assessment for the children and link them back to

their healthcare provider to see how well their asthma was controlled and whether any adjustments needed to be made to their medication. Q: Is this being used as a screening tool as well? A: No, it’s not being used to determine whether they have asthma or not, but one of the methods we used to screen was identifying those who have persistence symptoms and needed more preventive care. We know there are a lot of kids who have persistent symptoms whose providers may not be aware of those symptoms. Q: Do you distinguish between different types of asthma for this program? A: We didn’t really separate any groups, just looked at kids who were already diagnosed with asthma and were having ongoing symptoms. Because those are the kids who really need enhanced preventive care. So, any kid who has persistent asthma should be receiving a daily controller medication. Q: What are some of the challenges of getting asthma under control in children? A: It’s really tricky getting it under control because there are so many steps involved in getting a child optimal care. First, the family needs to recognize that the child is having significant symptoms and relay that to a healthcare provider. And there are often gaps just in that first step. Then once the provider is connected with the patient, they need to prescribe the med-

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

icine for prevention as the guidelines outline. Then families need to be able to afford, pickup and administer them to our children daily. It’s tricky because these medications are preventive, not symptom-relieving. So, it’s hard to remember every day when you don’t see an immediate response. And to be honest, there are misconceptions about the medications that make parents concerned about giving them daily. And then, over time, symptoms need to be reassessed to make sure the child is experiencing good control. That requires another connection with the primary care provider with appropriate symptom-screening and adjustments as needed. So, it’s very complex and there are many steps along the way. Our program is really designed to fill some of those gaps and reaching out to them where they’re spending most of their day. Q: Does the program tackle any issues associated with affordability? A: We try very hard to work within the child’s normal system of care, within their own health insurance. Fortunately, most children in Rochester have their own health insurance, which is great. However, there are significant barriers in terms of high co-pays or gaps in insurance. And, since we’re administering it in school, they need a second canister for home for the days when they’re not in school. The insurance companies need to be willing to pay for two canisters at once, even though they’ll last twice as long and help them avoid the emergency room. So, it’s a bigger cost upfront. Some insurance companies are willing to do it; others are more hesitant. Q: How have the outcomes been? A: The paper we just published found that the children who received the full intervention had a number of improved outcomes. They had more symptom-free days. They had fewer nighttime symptoms. Less activity limitations. And they were less likely to be hospitalized, which is also a big deal when we’re talking about cost. Q: Do you see this as a model that can be used for other pediatric diseases? A: We see it as a model in two ways. One is that we’re already seeing programs around the country implement similar systems of care using the resources in their community, and they’re consulting with us on how to make it work. And we’re also seeing it as a model for other chronic illnesses of childhood. Some physicians are trying to use telemedicine, for example, to check up on children with ADHD and adjust their medications if necessary.

Lifelines Name: Jill S. Halterman, M.D., M.P.H. Position: Executive vice chairwoman, department of pediatrics at University of Rochester School of Medicine; chief of the Division of General Pediatrics at URMC Hometown: Rochester Education: URMC Affiliations: University of Rochester School of Medicine Organizations: American Academy of Pediatrics; Academic Pediatric Association Family: Married, two children Hobbies: Spending time with family, outdoor activities

Transgender Surgeries on the Rise Gender-affirming surgeries increase nearly fourfold since 2000


he number of transgender people in the United States who’ve had gender-affirming surgery has risen with the expansion of insurance coverage for the procedures, a new study finds. There are an estimated 1.4 million transgender adults in the United States. Their gender identity differs from their biological sex, prompting some to seek hormone treatments, facial contouring and genital and breast surgeries, researchers from Johns Hopkins Medicine explained. The researchers found that more than 4,100 such surgeries had been done between 2000 and 2014, according to their analysis of medical records in a nationwide database. They also found that the number of gender-affirming surgeries increased nearly fourfold during that time. How people paid for these surgeries changed over time, according to the study. About half of those who had gender-affirming surgery from 2000 to 2005 paid out of pocket. That rose to 65 percent from 2006 to 2011. However, from 2012 to 2014, that percentage dropped. Just 39 percent paid out of pocket in 2014, with the rest covered by Medicare, Medicaid or private insurance. The Affordable Care Act banned discrimination on the basis of gender identity, leading to an increase in insurance coverage for gender-affirm-

ing surgeries, the researchers said. The data also showed that no deaths from gender-affirming surgeries had been recorded. That finding challenges critics who say the surgeries are not safe, the researchers said. The study was published Feb. 28 in the journal JAMA Surgery. Before this research, little was known about how many of these procedures take place and how they’re paid for, according to Brandyn Lau, director of research for the Johns Hopkins Center for Transgender Health in Baltimore. “Without data specific to transgender patients, we can’t tell what we’re doing right and what we need to improve, and this study was an attempt to address that problem with the best data we have available now,” Lau said in a Hopkins news release. As more data is collected, he said, researchers will be able to assess outcomes and disparities among transgender patients in the same way that they can now make assessments by age, race and sex. “Eventually, we can move from bean counting about how many gender-affirming surgeries have been done to patient- and clinic-reported outcomes,” said fellow researcher Joseph Canner, co-director of the Hopkins Center for Surgical Outcomes Research. That would “put these procedures in the same sphere as virtually all other types of surgeries.”

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. © 2018 by Local News, Inc. All rights reserved. 154 Cobblestone Court Dr., Suite 121 – P.O. Box 525, Victor NY 14564. • Phone: 585-421-8109 • Email: Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo Writers: Jim Miller, Deborah J. Sergeant, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Christine Green, Ernst Lamothe Jr., Kim Petrone (MD) • Advertising: Anne Westcott, Linda Covington • Layout & Design: Dylon Clew-Thomas • Office Assistant: Kimberley Tyler No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.

April 2018 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

April Showers Bring May Flowers... and So Much More!


h, the promise of spring! The warmer weather makes me want to bust open my windows and break out my “spring cleaning” supplies. I’m ready to pull on my rubber gloves and get busy. But scrubbing my tubs is only part of it. Creating a clean, soothing and safe haven for myself after my divorce was an essential part of starting my life over as a woman on her own. Intuitively, I knew I needed to walk through my new front door and into my very own “warm hug,” a place where I would be embraced and inspired by all things familiar and friendly. So I set out to create a retreat — a personal sanctuary where I could feel safe, sound and at peace. It was what I needed at the time. Now, years later, my home has evolved into much more than just a nurturing place. My living space became a pallet of personal expression where I gained a true appreciation for the value of having space to create and live freely, as Virginia Woolf

explored in her enlightening book titled, “A Room of One’s Own.” With yourself as your sole guide and decorator, your kitchen, living room and bedroom can become portraits of your values, your loves, and your life. Making a home your own becomes an adventure in autonomy and a chance to explore and express — perhaps for the first time in your life — your own tastes unleashed, without compromise. It can be liberating. Energizing. Even healing. One of the first things I did when I bought my own home (after I tore out the grass-green shag carpet!) was to frame and display photographs of my family and friends. I wanted to see their faces when I entered a room and to be reminded of good times and the love that surrounds me. This was just the beginning of a series of decisions that made living alone in my own space not just pleasant, but lovelier and more wondrous than I could have imagined. Paying attention to your sur-

roundings can have an immediate and lasting impact on how you feel about yourself and about living alone. What better time than now to put out the welcome mat and make your home your own. Here are some tips: n Follow your heart. You’re on your own now. There’s no one around to second guess your decisions or rain on your preferences. You are free to express yourself in the colors you choose, the fabrics, the art and the accessories. Don’t know where to start? Look at your wardrobe. There, you’ll find a reliable reference for your style and tastes in color. n Decorate with your senses. Is the hollow sound of loneliness bouncing off your walls? Is there a musty smell wafting up from the basement? Are your counter tops sticky to the touch? When I started paying attention to more than just visual aesthetics, my home became even friendlier territory. Transform your solitary space by creating a beautiful atmosphere filled with lovely music, pleasing aromas, and clean surfaces. n Banish the negative. If something makes you feel bad when you look at it, either get rid of it or repair it. Ratty dishtowels, old lampshades, faded curtains: Their very existence in your home can dampen your mood and erode your self-esteem over time. Don’t underestimate the negative power of unsightly or outdated objects. n Exhibit the positive. On the other hand, surround yourself with images and objects that lift your spirit and reinforce who you are or want to become. Photos of loved ones work for me. So do fresh flowers and original pieces of art I collect on my travels.

I believe in the symbolic nature of objects and find inspiration in what fills my home. n Reduce the clutter. Closets crammed with forgotten clothing, drawers loaded with useless stuff, dark corners made darker by a tower of boxes — all of these contribute to negative energy, according to the tenets of feng shui, the ancient Chinese practice of organizing space to achieve harmony and balance. In the same vein, the Danish philosophy of hygge promotes a way of life that embraces coziness and well-being. Similarly, Sweden advances the virtues of moderation and balance in a new lifestyle trend call lagom, which captures the Goldilocks principle of “not too little, not too much, just right” for any given moment, gathering or situation. I’m intrigued by all these concepts and have incorporated bits and pieces of each into my life. It’s made a positive difference; I encourage you to check ‘em out. Your home can become an oasis of independence and autonomy — a place that’s unconditionally yours, absent of compromise. Claim it. Fill it with who you are. Because once you make your personal space your own . . . there’s no place like home!

attainment, which in turn was related to greater occupational prestige and income later in life,” she said in a journal news release. “This study highlights the possi-

bility that certain behaviors at crucial periods could have long-term consequences for a person’s life,” she said.

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

s d i K Corner

Success in High School, Success Later in Life


eing a good student in high school seems to translate into a better job and higher pay down the road, a new study suggests. “Our research found that specific behaviors in high school have long-lasting effects for one’s later life,” said study lead author Marion Spengler. Those behaviors and achievements included being a responsible student, being interested in school and having good reading and writing skills. The results? Occupational success decades later. Specifically, having a better job both 11 years and 50 years after high school, the study found. The finding came from an analysis of data on Americans who were high school students in 1960, inPage 8

cluding follow-ups on nearly 82,000 of them in 1971 and on about 2,000 people again in 2010. The study found that positive high school factors were associated with higher income 50 years later, regardless of the person’s IQ or their parents’ income. The findings were published Feb. 26 in the Journal of Personality and Social Psychology. “Educational researchers, political scientists and economists are increasingly interested in the traits and skills that parents, teachers and schools should foster in children to enhance chances of success later in life,” said Spengler, who’s from the University of Tubingen in Germany. “Student characteristics and behaviors were rewarded in high school and led to higher educational

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

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Healthcare in a Minute By George W. Chapman

Survey Shows Toughest Healthcare Jobs to Fill


f the top 10 hardest jobs to fill in the U.S., half are in health care, according to CareerCast, which took into consideration Bureau of Labor forecasts, trade association data, graduation rates and their own job listing database. No. 4 is home health aide. No. 6 is medical services manager. No. 7 is nurse practitioner. No. 8 is personal care aide. Coming in at No. 9 is physical therapist.

Top US Hospitals. None from NYS IBM Watson Health just released its top 100 hospital list. A total of 2,840 hospitals were graded on publically available clinical, operational and patient satisfaction data to create a balanced scorecard. The 100 best hospitals outperformed the rest of the pack in survival rates, complications, infections, length of stay, ED wait times, patient satisfaction and expenses. Ohio led the way with 15 hospitals in the top 100. Texas was second with nine hospitals, followed by third place Illinois with eight hospitals making the top 100. New York state had no hospitals in the top 100.

Value-based medicine In a move toward paying physicians for outcomes or value versus just plain volume, new Health and Human Services Secretary Alex Azar proposed a four-point plan. 1. Give control of the patient’s record to patients. Poor interoperability among the many electronic record systems out there makes it almost impossible for the patient to have control of their own information. 2. Establish

incentives for providers to be more transparent about their fees. Because of higher deductibles and out-ofpocket expenses, consumers are more price-conscious. 3. Use Medicare and Medicaid to drive change. Commercial insurance companies are not getting it done and Azar knows they tend to mimic/follow Medicare’s lead. 4. Reduce regulatory burdens. Frankly, most providers would be thrilled if the government would simply stick to a set of regulations rather than constantly changing them.

Another huge merger Not to be outdone by the announced, but unapproved, merger of Aetna and CVS, Cigna has announced it will buy Express Scripts for $67 billion. The companies in both mega mergers are promising more services for consumers at thousands of locations; increased collaboration and coordination of care with providers; and additional opportunities for personalization via data analytics. Insurance companies are aggressively taking matters into their own hands, virtually wresting control away from April 2018 •

providers. Top exercises Running is tough on both joints and digestive system. The Harvard HealthBeat Newsletter suggests five other types of exercise, three to four days per week, for losing weight, strengthening muscles and improving mental health. 1. Swimming, considered the perfect exercise, for 30-45 minutes per day. 2. Tai chi. 3. Strength training using weights or your own body weight. 4. Walking 30 to 45 minutes. 5. Kegel exercises. VA in NYS Veterans are allowed to receive care from community providers when timely care cannot be received from the VA system. But according to a survey of 746 community providers by the RAND Corp, only 2 percent of civilian or private providers say they can accommodate veterans in timely manner. NYS ranks fifth in the number of veterans served. Spending for NYS veterans exceeds $6 billion annually. There are over 900,000 vets living in NYS. ACA hanging in Despite repeated attempts to repeal or sabotage the Affordable Care Act, it remains the only viable option for individuals seeking health insurance. A recent poll by the Kaiser Foundation found that 54 percent of us have a favorable view of the ACA. Currently, about 20 million people are covered by the ACA. Seven million purchase private insurance on the exchanges and 13 million people are eligible through Medicaid. Seventy percent of survey respondents feel non-disabled Medicaid recipients should be required to work. Meanwhile, a bipartisan congressional committee is scrambling to stabilize the insurance market that has been disrupted by the repeal of the man-

datory requirement to have insurance and the continued uncertainty in the marketplace. Insurance companies have until this summer to decide if they will continue to participate on the exchanges in 2019. Healthy Cities WalletHub used 40 metrics to grade US cities on healthy lifestyles. According to them, the top 10 healthiest cities are: No. 1 San Francisco. No. 2 Seattle. No. 3 Portland, Ore. No. 4 San Diego. No. 5 Washington, D.C. No. 6 Burlington, Vt. No. 7 Scottsdale, Ariz. No. 8 Honolulu. No. 9 Irving, Calif. No. 10 Denver. The top 10 unhealthiest cities are: 1. Brownsville, Texas. No. 2 Laredo, Texas. No. 3 Augusta, Ga. No. 4 Shreveport, La. No. 5 Gulfport, Miss. No. 6 Fort Smith, Ark. No. 7 Detroit. No. 8 Jackson, Miss. No. 9 Corpus Christi, Texas. No. 10 Memphis. Telemedicine/telehealth Congress has passed a law, whose acronym is CHRONIC, expanding Medicare reimbursement to providers for telemedicine. The committee that drew up the law felt Medicare was far behind when it came to embracing available the technology which will both save money and get critical services to remote rural areas. It is expected that most commercial plans will follow suit. George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 9

5 P

Things You Need to Know About Prevalence of Autism

By Ernst Lamothe Jr.

revalence and awareness don’t always go hand in hand. More than 3.5 million Americans, including one in 68 children, live with an autism spectrum disorder (ASD), according to the Centers for Disease Control and Prevention. However, the condition is still unfamiliar to many. It’s a condition that still suffers from many stereotypes and misperceptions. But doctors are slightly more hopeful now for many reasons. “A vast majority of the increase in prevalence — perhaps the entirety of the increase in prevalence — is because we, as a society, have made huge strides in identifying autism and getting children and adults the support that they need,” said physician Suzannah Iadarola, assistant professor of developmental and behavioral pediatrics at the University of Rochester Medical Center. Some research states that autism tends to run in families and many environmental factors are being examined as possible contributing factors or causes of autism. Changes in certain genes increase the risk that a child will develop autism. If a parent carries one or more of these gene changes, they may get passed to a child. The American Academy of Pediatrics in 2007 recommended that all children be screened for ASD at their 18-month checkups, and then again at either 24 or 30 months of age. Iadarola discusses five reasons autism diagnoses are on the rise. A broader definition The latest edition of the Diagnostic and Statistical


Manual of Mental Disorders has included a much broader definition of autism spectrum disorder that included both higher-functioning and lower-functioning individuals. “On the higher-functioning end of the spectrum, ASD now includes, for example, people who used to be given the diagnosis of Asperger’s syndrome,” said Iadarola. “That’s not a diagnosis that’s given any more — now those diagnoses are collapsed into one diagnosis of ASD — but it’s a term that many individuals still identify with.” In addition, statistics are capturing individuals with more significant difficulties. For example, children who used to be classified as having an intellectual disability may now be diagnosed with autism spectrum disorder. As rates climbed, rates of intellectual disability have fallen, suggesting that children may have been misidentified as having an intellectual disability in the past, said Iadarola. Increased awareness More people are aware of ASD than ever before. Whether that is because of characters with autism are being portrayed in movies and TV shows, including the hit series The Good Doctor, or because of health-related campaigns, the condition is coming to the forefront now more than ever. Also, parents whose children are missing milestones, or who are slower to communicate, are seeking out evaluations. Adults are self-referring more, as well. Parents and other caregivers who encounter someone who has autism should understand that they



may have difficulty with expressing themselves through language. Because of this, behavior is a key component for communication. “There are a lot of people who managed to get through life without being identified, but might have always struggled with social situations or with relating to others, and were searching for a reason why,” said Iadarola. “Now, those people are looking to get evaluated.” Early intervention and school-based services As more services have become available for children — through either community-based or school-based programs — correctly identifying children who qualify has become more important. These teams, active in communities all over the country, have helped cast an extremely wide net and are able to help direct families to the right places for diagnosis. “We routinely get referrals now that include information from schoolbased teams, who have shared their concerns with parents,” said Iadarola. Universal screening Several tests exist that are regularly used in pediatricians’ offices to help with identification, including the M-CHAT-R, which is also available online. Most notably, these universal screenings have aimed to reduce the gap in diagnoses across race and ethnicity groups. As the term spectrum would suggest, there are symptoms that will occur along a continuum. Some people with autism spectrum disorder can perform excellently at a tradi-



Physician Suzannah Iadarola tional school, while others may need a little more help. “The best available evidence suggests that ASD occurs pretty evenly across racial and ethnic groups, but there’s a lot of research suggesting that children of color or children whose primary language is not English are diagnosed later in life,” said Iadarola. “Early intervention is hugely important, so it’s vital that we identify children as early as possible.” The possibility that there has been an actual increase in prevalence Research has shown that genetics and biology play a prominent role in ASD — siblings of those with ASD are more likely to have ASD as well, for example. Additionally, there’s some evidence that the environment can contribute — with recent research focusing on exposures in the womb as a possible contributor. “But we don’t have any definitive evidence yet that there has actually been an increase in prevalence,” said Iadarola. “I suspect we will be at or near this one in 68 figure for a little while now.”



From 2012-2016, Excellus BlueCross BlueShield’s annual operating margin has averaged 0.3 percent, considerably lower than the average of the four major for-profit health plans. Based on a comparison of earnings before interest and taxes, we would have needed to collect $1.6 billion more in premium revenue to achieve the same level of earnings as the major carriers over that period. Because we’re a business, not a charity, we need to earn a margin. But we do not pay dividends to shareholders. That works in your favor. We’re a nonprofit health plan, so we deliberately budget for low margins to keep coverage more affordable. We know you have other important things that matter. We’re neighbors helping neighbors build healthier communities.

A nonprofit independent licensee of the Blue Cross Blue Shield Association.

Page 10

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

Let the real you shine through. Architectural rendering of the new Golisano Autism Center in Rochester. The center will have multiple autism providers and is expected to serve upwards of 10,000 individuals with autism in the Rochester area within the first three to five years.

New Golisano Autism Center to Open in 2019 Center will be based at Al Sigl Schwartz Family Campus and will provide a wide range of services By Christine Green


he founders of the Golisano Autism Center will be breaking ground at the Al Sigl Schwartz Family Campus on South Avenue near Science Parkway this spring in preparation for their grand opening in 2019. The Golisano Autism Center is a collaboration of CP Rochester, AutismUp and Al Sigl Community of Agencies. The three agencies will bring together multiple autism providers in one central location. “Why not bring the autism services agencies together in one hub and create this full array of accessible services for individuals and their families in the Rochester area?” said Mary Boatfield CEO of CP Rochester and board chairwoman of the Golisano Autism Center. Boatfield also works with Happiness House and Rochester Rehabilitation and noticed that there was a community need for a centralized autism center. She traveled the country researching and visiting other autism centers in order to see what they offered in their communities. CP Rochester, AutismUp and Al Sigl Community of Agencies used her research to create a business plan and present to philanthropist and Paychex founder Tom Golisano. Golisano pledged a $2.5 million matching challenge grant to fund the new center, and the Golisano Foundation donated $500,000 for total donation of $3 million. The center is finalizing the architectural plans for the 30,000 square foot building before breaking ground this spring. They hope to be open by the fall of 2019 to coincide with the beginning of the school year. Boatfield said that they expect to serve upwards of 10,000 individuals with autism in the Rochester area within the first three to five years of being open. Everyone who comes to the Golisano Autism Center will meet with an autism services navigator who will help them understand the many services available at the center as well as help them coordinate services at off site locations such as community centers and schools.

The center will provide services to both adults and children with autism as well as their families. Adult programs will include social and recreation programs, jobs exploration and training, and assistance finding housing, among many others. There will also be a fitness center for teens and adults as well as a full kitchen in order to provide cooking activities and training. Children’s programs will include evaluation services, a preschool, after school programming, a sensory gym and therapy room. Teens graduating from high school will get transitioning assistance as they decide if they want to attend college, find a job or volunteer in the community Lynn Rodrigues is a substitute school nurse and the president of the Brockport Central School District PTSA. Her 8-year-old son, Rocco, was diagnosed with autism spectrum disorder when he was 2. Rodrigues is excited for the opening of the Golisano Autism Center and believes it will make a big impact on her son and her family. “Networking with other parents, educators and therapists is the key to success. Up until now, we have had to travel to multiple facilities to receive social, recreational and therapeutic services. Having these opportunities available to all of us, under one roof, is so exciting! I believe it will allow us to expand our parental network and allow our children more time learning and playing instead of driving them all around Rochester to provide a well-rounded experience.” Boatfield and the board of the Golisano Autism Center hope that active collaboration between providers will make assisting those with autism and their families much easier for all involved. The center will alleviate the stress of undue travel and expense for families who right now must drive to various locations around the area. Currently, more than 10 providers are working collaboratively to develop the programs and services that the center will provide. To learn more about the Golisano Autism Center visit April 2018 •

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The skinny on healthy eating


Brown Rice Bursts with Health Benefits

ike many baby boomers, I grew up on white rice — at home, in restaurants, at the school cafeteria. And since I saw it as a backdrop to whatever was ladled on top, I never thought twice about its nutritional value, besides being starchy and filling. These days, I always consider what I consume, which is why, when it comes to rice, I only eat the wholegrain version: brown rice. While white rice certainly has some nutritional merit — as it’s enriched with some of the nutrients it loses in the milling process, like thiamine, folate, and iron — it pales in comparison to its tawny cousin. Brown rice, which hasn’t been stripped of its husk, bran and germ, is a good source of fiber, providing about 3.5 grams of fiber per cup (comparable to oatmeal). Current research shows fewer incidents of heart disease, diabetes and cancer in people who eat diets high in fiber. What’s more, people who eat more high-fiber foods tend to be thinner than those who don’t and also have lower blood pressure and cholesterol counts. Health-promoting antioxidants, which abound in the bran portion of a whole grain and help thwart the damage caused by free radicals, reign supreme in brown rice. According to the Harvard T. H. Chan School of Public Health, abundant evidence suggests that eating whole fruits, vegetables, and whole grains — all rich in antioxidants —

provides protection against cell-damaging free radicals that contribute to many chronic diseases, including cancer, heart disease, Alzheimer’s, and vision loss. Brown rice is an outstanding source of manganese, an essential mineral that plays an important role in bone health, energy production, nutrient absorption and blood-sugar regulation. A powerhouse antioxidant with anti-inflammatory properties, manganese is a widely known remedy for the treatment of sprains and arthritic symptoms, despite no reliable evidence as yet to indicate that it actually helps. Can you eat rice if you’re watching your carbs or have diabetes? Although no rice can really be considered a low-carb food (one cup of cooked brown rice has about 45 grams), whole-grain brown rice is healthier than refined white rice. Thanks to its fiber and protein, which both slow the absorption of glucose into the blood, brown rice contributes to more stable blood sugar levels. Switching to brown rice may also lower your risk of developing Type 2 diabetes, according to a Harvard School of Public Health study. All rice is contaminated with inorganic arsenic (a carcinogen), whether brown, white, organic or conventional. Brown rice has the most, however, which is something to consider if arsenic concerns you. While the Food and Drug Administration has set a limit on the amount of inorganic arsenic allowed in infant

rice cereal, they have not set a limit on the amount of rice adults should eat, recommending instead that adults maintain a diet that includes a variety of whole grains to minimize any health risk. Many experts agree that the levels of arsenic in rice are only a concern if you’re eating multiple servings of rice every day.

rinse under cold running water; drain. Put rice and 4 cups of water in a large saucepan and bring to a boil over medium-high heat. Reduce heat to low and simmer, covered, until the rice is tender and most of the liquid has been absorbed, about 45 minutes. Let stand 10 minutes, then fluff with a fork. For the dressing, put all the ingredients into a glass jar and shake well to combine. Combine the cooled rice and remaining ingredients in a large bowl. Add the dressing and mix well. Let stand for at least 15 minutes for the rice to absorb all the flavors. Taste; adjust seasonings; add more oil, if needed.

Helpful Tips Brown Rice Salad with Crunchy Vegetables Adapted from the Naked Food cookbook; serves 6 2 cups brown rice 4-5 scallions, thinly sliced, including light green parts 1 red pepper, chopped 1 green pepper, chopped 1-2 carrots, shredded 1 cup slivered almonds, toasted 1/2 cup flat-leaf parsley, finely chopped Dressing: 1-1/2 tablespoons olive oil 1 tablespoon sesame oil 1 tablespoon soy sauce 2 tablespoons lemon juice 1 tablespoon balsamic vinegar 1-2 garlic cloves, finely chopped Crumbled feta (optional) coarse black pepper and salt, to taste.

Place the rice into a sieve and

Those concerned about arsenic levels should (1) first rinse their rice; (2) cook their rice in six times the normal amount of water, which reduces the arsenic level by about half, according to the FDA; and (3) buy brown basmati rice from California, India or Pakistan, according to Consumer Reports. Store uncooked brown rice in the refrigerator or freezer in an airtight container: brown rice should last 6 months in the fridge and up to 2 years in the freezer. Store cooked brown rice in the fridge for up to 3 days.

Anne Palumbo is a lifestyle colum-

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

Drinking 100% Fruit Juice Leads to Weight Gain: Study Data from more than 49,000 women concludes that drinking 100 percent fruit juice leads to weight gain, while consumption of fresh whole fruit results in weight loss


he study, led by Brandon Auerbach, an internal medicine and primary care physician at Virginia Mason Medical Center, was posted online Jan. 9 by Preventive Medicine. “American adults gain an average of one pound per year, and it is a public health priority to determine which foods and beverages contribute the most to this gradual weight gain,” the report states. Specifically, this study analyzed data from 49,106 women in the United States enrolled in the Women’s Health Initiative between 1993 and 1998. Food-frequency questionnaires assessed food and beverage consumption, while their body weight was measured during in-person clinic visits. The study found that an increase of one six-ounce serving of 100 percent fruit juice per day was associated with a modest amount of Page 12

long-term weight gain. The average weight gain of 0.4 pounds (6.4 ounces) per person over three years was similar to two earlier published studies on this topic. This amount of weight gain was also similar to weight gain associated with increasing regular soda consumption (0.6 pounds or 9.6 ounces). On the other hand, increasing consumption of whole fruit by one serving per day resulted in the loss of 0.9 pounds (14.4 ounces) over three years.

“It is biologically plausible that drinking 100 percent fruit juice is associated with long-term weight gain,” the study concludes. “One six-ounce serving of 100 percent fruit juice contains 15-30 grams of sugar, 60-120 calories, little or no dietary fiber, and has a moderately high glycemic load. Even high-pulp, 100 percent orange juice is not a significant source of dietary fiber.” The study’s findings support recommendations of the “2015-2020 Dietary Guidelines for Americans”

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

that individuals should drink 100 percent fruit juice in moderation and choose whole fruits over fruit juice when possible. “Adults should have at least two servings of fruit a day, ideally more,” Auerbach said. “Even though 100 percent fruit juice has lots of vitamins, minerals and nutrients like antioxidants, it’s really better to get your daily fruit in the form of whole fruit. Especially for adults trying to lose weight, 100 percent fruit juice is not your friend.”

spray to treatment along with a nasal steroid inhaler. The additional medication provides added benefit for those with more severe allergies. Allergists advise people to start taking medication two to three weeks before symptoms normally start. According to ACAAI, if you begin your allergy medications before the worst symptoms hit this spring, your suffering won’t be as bad. Although people think spring starts in April, symptoms can begin earlier in warmer areas. Keep in mind when your symptoms normally appear and start your medication well in advance. 12, according to the guidelines. Many people go in search of “The guidelines recommend “natural” remedies. They might not nasal steroid sprays as the first line of know that immunotherapy — in defense instead of an oral antihistathe form of allergy shots and tabmine,” says allergist physician Dana lets — is a very natural treatment. Wallace, past ACAAI president and During allergy shots, you are given co-author of the guideline. “The task gradually larger doses of your exact force didn’t find evidence of better allergens. The slow increase causes results if oral antihistamines were your immune system to become less added to treatment alongBugow’s with the Driver sensitive, which reduces future allernasal steroid sprays. And oral Rehab antigy symptoms. Allergy tablets, taken histamines can cause sleepiness.” under the tongue, are available to For people with moderate to and Senior adults Driver Evaluations treat pasture grasses, ragweed and Teens, disabled severe seasonal allergies who are house dust mite and, to be effective, Driver Evaluations & Training older than 12, the guidelines suggest must be started 8-12 weeks before 315-341-8811the allergy season starts. adding an intranasal antihistamine

Which Medications Work Best to Deal with Your Spring Allergies? And how much do you need to take to be effective?


ow much suffering is too much when it comes to spring allergies? Anyone who has moderate to severe seasonal allergies knows that when you reach a certain point — when your itchy red eyes, runny nose and sneezing become overwhelming — you need relief. But what does relief look like and how do you get there? “Bottom line, very few people suffer from the same allergies or symptoms,” says allergist Bradley Chipps, president of the American College of Allergy, Asthma and Immunology (ACAAI). “You have to

create a personal treatment plan by first avoiding the things you’re allergic to, and then treating your specific symptoms. The question for many people is whether over-the-counter remedies are enough, or if prescription medications are needed.” According to a new practice guideline from the Joint Taskforce on Practice Parameters, more medications aren’t necessarily the way to go. Nasal steroid sprays are extremely effective and easy to get. They’re also relatively inexpensive and don’t have a lot of side effects. They are a good place to start for those over the age of

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Blood Pressure Check? There May Soon Be an App for That


omeday soon, a simple touch of a finger to a smartphone case might be enough to provide instant, accurate blood pressure readings. That’s the promise of new technology detailed by developers in the March 7 issue of Science Translational Medicine. Researchers say they’ve invented a special phone case, using high-tech 3-D printing, that contains an embedded optical sensor on top of a “force” sensor. When the user presses a finger onto the sensor embedded in the case, “it provides measurable pressure on an artery in the finger in the same way that a blood pressure cuff squeezes an artery in the arm,” according to a journal news release. That information is then fed to a smartphone app that converts the data to a real-time blood pressure reading, displayed on the phone, according to a team led by Ramakrishna Mukkamala of Michigan State University. The researchers tested the usability of the device on 30 people, and found that about 90 percent could position their finger correctly and get consistent readings after only one or two attempts. Two heart specialists said the device might one day be a game-changer. “An accurate blood pressure measurement technique is critical for making helpful decisions in the management of hypertension,” said physician Joseph Diamond. He directs nuclear cardiology at Long Island Jewish Medical Center, in New Hyde Park. He stressed, however, that more rigorous testing must be done before any new blood pressure measuring technology becomes standard.

Page 14

Chiropractic: A Promising Career Doctors of chiropractic have a variety of professional opportunities in the healthcare field By Deborah Jeanne Sergeant


tudents pursuing chiropractic degrees have every reason to look forward to a satisfying, solid career. Chiropractor J. Todd Knudsen, vice president of institutional advancement and special projects at New York Chiropractic College in Seneca Falls, represents one of the two chiropractic schools in the state. “Alumni of our doctor of chiropractic [DC] program have a wide variety of professional opportunities from which to choose,” Knudsen said. “For example, they might decide to be a principal in a solo practice, become an associate practitioner working for another chiropractor or seek employment in a multi-disciplinary or medical practice such as a VA medical center or a regional hospital. “A DC graduate can also pursue residency training and specialize in additional areas like nutrition, sports medicine, diagnostic imaging, orthopedics, neurology, pediatrics, teaching or spine care.” Over the past 10 years, chiropractic has developed and advanced over in many ways, including public perception. Knudsen, who is also a diplomate of the American Chiropractic Board of Radiology (DACBR) — a certified specialist in diagnostic imaging who can order and interpret advanced imaging such as a CT scans, MRIs and ultrasounds — said that a “strong body of scientific research” shows the value of chiropractic care as an effective alternative to taking medication and undergoing surgery for the issues it treats. Many people wary of prescription pain medication, including opioids, want an alternative approach to their pain. For those whom chiropractic is appropriate, they can often resolve issues more quickly than through rest alone. Chiropractic is also integrating

with overall health care organizations such as the VA health system. “Chiropractors have the very rewarding experience of making a difference in the lives of their patients by increasing the patients’ quality of life and bringing relief to suffering, often when relief has been unavailable through traditional medicine,” Knudsen said. While medical doctors usually work on-call hours, chiropractors typically set their own hours if they operate their own practice. Steven Sadlon, doctor of chiropractic at Chiropractic Health and Acupuncture Knudsen in Penfield, said that he enjoys the flexibility and the comprehensive nature of chiropractic. He said that although reimbursements from insurance companies have stalled in the last 20 years, more insurers are now covering chiropractic care. “We have different therapeutic options many providers don’t,” Sadlon said. “The opportunities are there, but anything you do, you have to make it happen.” For some, forming or joining a practice with massage therapists and other types of practitioners enables them to minimize overhead to make up for low reimbursements. Others forgo working with insurance companies so they can charge more realistic rates and spend the time with patients that they need. At Goshorn Chiropractic in Webster, chiropractor Steven Hill, said that chiropractors can enjoy a wide variety of ways to practice. “You can focus on nutrition, manual therapy and new technology with spinal

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

decompression,” he said. Spinal decompression, according to, is a type of motorized traction that may help relieve back pain by takeing pressure off the spinal disks. Some chiropractors operate a retail location selling durable medical equipment like neck braces and supports. Chiropractic “is getting better and better,” Hill said. “It’s going up. We’re on more insurance plans and are more accepted in the medical community. Now that insurance companies are beginning to recognize the cost-to-benefit ratio, that’s another boost in our favor. “It’s expanding and getting bigger. We’re on the forefront.”

Median Salary for Chiropractors: $67,520 Tuition and fees to become a chiropractor at New York Chiropractic College in Seneca Falls is $122,820 for the standard 10-semester program. The alumni have a .8 percent rate of student loan default. states that the rate is 11.35 overall for two- and four-year schools nationwide and 8.05 for New York. The Bureau of Labor Statistics’ outlook for chiropractors is 12 percent job growth nationwide from 2016 to 2026, compared with 7 percent for all jobs. The median pay nationwide was $67,520 in May 2016. New York’s annual mean wage for chiropractors is $90,570. In the Rochester area, it’s $67,880; in Western New York and it’s 63,380. No data was available for Syracuse / Central New York.


GUIDE INSIDE You Cannot Have a Healthy Body With a Sick Mouth Survey: More Americans Want to Visit the Dentist


You Cannot Have a Healthy Body With a Sick Mouth - Sam Guarnieri, DDS...........16 Winning The Battle Against Tooth Decay - Sam Guarnieri, DDS................................18 Improving Your Smile with Invisalign® - Jeremy Bateman, DDS.................................18 Saving Teeth With Endodontic Treatment - Harp Deol, DDS.......................................19 A Healthy Body Starts with Healthy Gums - Kenneth Tirone, DDS.............................19 What Makes You Smile? - Jill Nikas, DDS........................................................................20 April 2018 •

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 15

Special Advertising Insert

You Cannot Have a Healthy Body With a Sick Mouth Sam Guarnieri, DDS


he National Institutes of Health (NIH) have long since recognized the link between oral health and overall health. Oral infection such as periodontitis has been implicated as a contributor to many serious systemic diseases, including cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight babies. Inflammation is the concern. Different sources of inflammation can stem from oral infection, such as periodontal disease and tooth decay as well as from sleep breathing disorders. That's one of the reasons Rochester Dentist Salvatore "Sam" Guarnieri takes oral care so seriously. As owner and founder of Pittsford Dental Excellence Center in Pittsford, he knows dental care is not just about pearly white teeth or filling cavities. Dr. Guarnieri, or Sam as he prefers to be called, is passionate about continuing education. "A Doctor of Dental Surgery degree or DDS should not be considered a license to earn, but rather a license to learn," he argues. And learn he does. Since his earliest days, he's built on his DDS degree from Howard University School of Dentistry in Washington, DC, by completing continuing education programs from many of America’s most prestigious institutes of higher learning in dentistry. In fact, he's a clinical instructor at the internationally renowned Kois Center in Seattle and has earned certifications from many other similar organizations. "I'm trying to connect the dots about what I see in the mouth and how it relates to the rest of the body," Dr. Guarnieri said. "I call it 'wholeistic' dentistry. I don't mean just holistic with the teeth, but looking beyond the teeth to the systemic relationships between oral health and whole body health." As a result, he has studied many disciplines in healthcare. He has trained with cardiologists and an otolaryngologist (ENT) out of Harvard and Stanford, for Page 16

example, and he and his team work with naturopaths, lactation consultants, chiropractors, myofunctional therapists, functional medicine providers and sleep medicine specialists. He also collaborates with other medical and dental specialists, including pediatric dentists, periodontists, oral surgeons and other dental specialists. Of course, it's not possible for one person to become an expert in all areas of health. Dr. Guarnieri, however, endeavors to recognize issues in oral health that relate to other systems in the body so he can suggest patients follow through with the appropriate specialists while they are healthy and still have time. "It's about saving lives, where it's a collaborative effort between many different disciplines," Guarnieri added. "Everything we see has a broader implication. It’s not just about teeth." For example, he noted that a "scalloped tongue," which bears the imprint of the patient's teeth on the sides, has an 87 percent correlation with sleep disordered breathing. Children with open mouth posture also bear a higher risk for sleep disordered breathing. It is also a risk factor for attention deficit disorder or attention deficit hyperactivity disorder. “Children should never snore, as this can be a serious concern with health and behavior implications, including facial development dysfunction that can result in high palates, crooked teeth, and speech, breathing and cognitive issues,” Dr. Guarnieri explained. Even appearance can give clues to sleep disturbed breathing, like asymmetrical facial features, poor posture, dry lower lip or dark circles under the eyes. "You can't just use one indicator; you need a whole number of these before you can draw any conclusions, make any connections or offer any suggestions," Guarnieri said. In children, sleep-disturbed breathing can lead to behavioral and development problems, as children receive insufficient

restful sleep and lower oxygen levels as they sleep. Poor oral care can lead to infection throughout the body. This understanding has in recent years become better understood and more widely known. While furthering his training at Kois Center, Guarnieri first learned that certain bacteria in the mouth are highly pathogenic toward cardiovascular issues, arthrosclerosis and many different issues. "I always had a very strong awareness of the effects of infections in the mouth, even dental cavities," he said. “My studies at Kois only further confirmed my beliefs. "Your mouth is part of your whole body and there are certain inflammatory markers we look at to see if someone is being affected," Dr. Guarnieri added. "My training and experience was a good proving ground for diagnosing an issue with my brother-in-law. I noted the systemic links between his oral health and his cardiac issues. In fact, we had done an oral DNA test on my brother-in-law. I sent the results to Brad Bale, MD," Guarnieri said. A preventive cardiologist in Nashville and author of the book, “Beat the Heart Attack Gene,” Dr. Bale had a strong reaction. "After seeing the DNA report, Dr. Bale wrote back and said, 'If this person doesn't have his periodontal disease treated, he would be dead in two years,'" Guarnieri explained. Unfortunately, Dr. Guarnieri's brother-in-law delayed treatment until he felt sick and subsequently required open heart surgery. Dr. Guarnieri said that the same bacteria he had identified in the mouth of his brother-in-law were implicated in the man's cardiac disease. The patient fell into a coma following surgery. Within 18 months of Bale's response, Guarnieri's sister made the difficult decision to remove her husband from life

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

support. "He was like a big brother to me," Guarnieri said. "His death made me seek to understand more and more and more. It reinforced my convictions regarding treatment in my office." As a routine part of his office's hygiene protocols, each patient's tooth pocket depth is measured on six sites on each tooth. If there's significant bleeding, bleeding at certain sites, active infection or bone loss, then bacteria testing may be suggested. "It's integrated personalized care," Guarnieri said. ”That’s our approach to patient care.” At first, a patient may wonder why a dentist would suggest the possibility of heart disease, but Guarnieri says most patients heed him because he shares the account of his brother-in-law. "We talk about risk," Guarnieri added. "For one person, they can have many different risk factors and never have a manifestation." Guarnieri encourages anyone concerned about the health implications of oral health to seek the care of a provider who can identify issues of both oral and systemic health. For more information, visit

Sam Guarnieri, DDS

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Winning The Battle Against Tooth Decay Sam Guarnieri, DDS


n the battle against tooth decay, the best prevention is preventive care—brushing, flossing and visiting your dentist regularly. Detecting early decay and establishing a plan to address the issue is crucial. However, even in the dental chair, sometimes the smallest signs can still go undetected even with x-rays. To win the battle against early tooth decay, Dr. Sam Guarnieri of Pittsford Dental Excellence Center utilizes the latest digital technology designed to help detect and treat cavities early in the game. This technology scans for the presence of cracks and tooth decay before they are large enough to appear on dental x-rays. Then with an intraoral camera, images can be taken and displayed for immediate chair-side review with the patient. By finding

Improving Your Smile with Invisalign® Jeremy Bateman, DDS

tooth decay at its earliest stages, cavities can be treated and healed without drilling and filling. “New technology offers a radical shift from wait-andwatch to a preventive approach in treating tooth decay. It can detect decay on smooth enamel, root surfaces, biting surfaces, between the teeth and around existing fillings. The scan is safe, non-invasive, painless and fast. A scan takes about five seconds,” Dr. Guarnieri offers. “We were one of the first practices in the area to offer this advanced technology and patients have found it helpful. We believe in the importance of proactive detection and treatment of cavities as part of our holistic approach to patient care.” For more information, visit


ave you ever looked in the mirror and wished for straighter teeth? As an adult, there’s never been a better time to get the smile you’ve always wanted and there’s never been a better way to do it. Invisalign® is the most advanced orthodontic system available today with innovations no other clear aligner can claim. And Dr. Jeremy Bateman of Bateman Orthodontics is a top Invisalign provider in Western New York. Invisalign clear aligners are ideal for adults. One of the best things about Invisalign treatment is the minimal impact it has on your everyday life. The clear aligners are virtually invisible and removable making it easy to conceal treatment. You can eat the foods you enjoy and you can brush and floss

normally. Invisalign is also perfect for busy people and full schedules, with appointments about every twelve weeks and treatment complete in as little as a year. It’s never too late to straighten your teeth and you’re never too old. Dr. Bateman adds, “I have patients in every decade of life up to age 83 wearing Invisalign. To speed up the treatment timeline, we also offer AcceleDent in combination with your Invisalign treatment. This orthodontic device is the real deal and takes adult treatment to the next level. It helps to increase comfort— many adults have told me they have no soreness—and reduces treatment time by up to 50%.” For more information, visit

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

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here is misconception out there that root canals are painful? The fact is that root canal treatment actually relieves pain caused by a tooth that is severely decayed, infected or fractured. Millions of teeth each year are treated and saved with root canal (endodontic) treatment. Dr. Harp Deol and Dr. Tanjit Taggar of Progressive Endodontics are specialists in saving teeth and solely provide endodontic care using state-of-the-art technology. When a tooth becomes badly diseased or infected, simply removing it can lead to another set of oral health problems altogether. Root canal treatment can save the tooth and, with the latest dental advances available in local anesthetics, most patients have little to no

discomfort with treatment. “If the alternative is just having your tooth extracted with no replacement, then this procedure can definitely save your natural tooth,” adds Dr. Deol. Endodontists are dental specialists with specialized training beyond dental school. With modern technologies and advanced anesthetic techniques, endodontic treatment can often be completed in a single-visit. Progressive Endodontics also offers oral conscious and nitrous oxide sedation to supplement local anesthesia to help patients to feel calm and relaxed in the dental chair— making their visit to the dentist seem like a dream. For more information, visit

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ou eat right. You exercise. You know what it takes to keep your body healthy. But did you know that your oral health could affect your overall health? While bright, white teeth are a sign of a healthy mouth, your gums are important, too. In fact, your gums are a barrier that helps prevent inflammation that may damage your body. When your gums become infected, it is known as periodontal disease (gum disease). Periodontal disease is the leading cause of tooth loss in adults. Additionally, gum disease has been linked to health problems such as diabetes, heart disease, stroke, and premature births or low-

birth weight babies. With daily brushing and flossing and regular professional cleanings and exams with the dentist, you can keep gum disease at bay and keep your mouth in tip top shape. Dr. Ken Tirone knows that health and beauty go hand in hand. “A healthy, beautiful smile starts with a healthy mouth. A healthy mouth is important to your overall wellness,” adds Dr. Tirone. With preventive, cosmetic and restorative dentistry, you can have a smile that makes statement and be on your way to better health. For more information, visit

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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miling has benefits. According to studies, smiling can help reduce stress and boost the immune system. When you smile, you are viewed as more attractive, reliable, relaxed and sincere. Adults face a variety of changes to their smile, teeth and gums as they age. Teeth can yellow overtime or become stained from foods and beverages you enjoy. Overtime, excess wear and accidents can damage our teeth—all of which can age our appearance dramatically. If you are unhappy with some aspect of your smile, cosmetic dentistry can give you a youthful-looking smile. From subtle changes to major restorations, cosmetic techniques can reshape your teeth, close spaces, restore worn or short teeth, or brighten your smile. Dr. Jill Nikas has dedicated her

practice to making smiles look their best with the latest techniques and advances in cosmetic dentistry. While a great smile begins with healthy teeth, cosmetic dentistry gives you options to improve, restore and achieve a bright, white smile. “Improving your smile through cosmetic dentistry techniques aims to create a positive change to your teeth, your smile and your selfesteem,” Dr. Nikas explains. “Some methods will give you instant results in one dental appointment, while others may take longer, depending on your individual situation. Our goal is to ensure that your dental experience and the care you receive goes above and beyond expectations,” she adds. For more information, visit

Survey: More Americans Want to Visit the Dentist American Dental Association


mericans are still not seeing their dentist as much as they would like, according to a survey from Delta Dental Plans Association. For a second year, dentists topped the list of health practitioners Americans want

Page 20

to see more often, according to the Adults Oral Health & Well Being Survey. According to the survey, 42 percent of Americans don’t see a dentist as often as they would like, beating out their primary care doctor (29 percent),

dermatologist (23 percent) and the ophthalmologist (17 percent). Meanwhile, 85 percent of Americans believe that oral health is very or extremely important to their overall health, according to a Delta Dental news release. And while they recognize the importance, only a quarter (25 percent) of Americans are extremely satisfied with the health of their mouth, teeth and gums and another 49 percent are somewhat satisfied. Only 15 percent rated their current oral health as excellent. “Recognizing the importance of seeing a dentist is a good start,” said Dr. Bill Kohn, chairman of Delta Dental Plans Association’s Dental Science Committee. “Why not take that next step and make an appointment for a checkup?”

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

The Adult’s Oral Health & Well-Being Survey was conducted between Dec. 13-28, 2017 among 1,008 nationally representative Americans over 18. Some other dental visit statistics from the survey: Fifty-eight percent of those surveyed reported they visit the dentist at least one time per year, down from 62 percent in 2016. Fifty-two percent made their most recent appointment for the purpose of having a regular checkup. Seventeen percent made their most recent appointment to have a procedure done. Fifteen percent made their appointment because they were experiencing mouth pain. Source: American Dental Association

Women’s Health

For the First Time, Women Outnumber Men in Med School

‘Notable milestone,’ says president of Association of American Medical Colleges By Deborah Jeanne Sergeant


n 2017, more women entered medical school than men for the first time, according to the Association of American Medical Colleges (AAMC). Last year, women represented 50.7 of new medical school enrollees, compared with 49.8 percent the year before. “We are very encouraged by the growing number of women enrolling in U.S. medical schools,” said physician Darrell G. Kirch, AAMC president and CEO in a press release. “This year’s matriculating class demonstrates that medicine is an increasingly attractive career for women and that medical schools are creating an inclusive environment. While we have much more work to do to attain broader diversity among our students, faculty, and leadership, this is a notable milestone.” Locally, the trend is playing out. Nazareth College head of nursing Mary Maher had considered medical school in the late 1960s when she was still planning her career path. She said that only 9 percent of

applicants were women — a far cry from the more than 50 percent of enrollees. “I think that is evidence of a culture shift,” Maher said. “I think we’re seeing better interpersonal working relationships.” Maher said that at Nazareth, seniors take a course that includes case studies, where students of numerous disciplines interact as if they were part of a professional team. She said that the school does this to reflect real-world medical settings. “We’re seeing much more true respect and collaboration in health care settings because there’s that recognition,” she said. “Practicing medicine is not a gender-based position.” Maher serves as associate professor and department of nursing chairwoman, coordinator of nursing global studies and director of the public health program in Nursing. Women’s progress in the medical field pleases physician Flavia Nobay, associate professor and associate dean for admissions at University of Rochester Medical Center.

“I couldn’t be happier,” Nobay said. “I think it is wonderful to see the house of medicine reflect the population across the country. That should be reflected in medical school. It’s fantastic to see care providers reflect that. Nothing makes me happier than to see quality and diversity reflected at URMC.” She believes that for a long time, medicine has been a hierarchy. Women taking an equal role shows the work in promoting gender equality in middle schools, high schools and colleges. Encouraging girls to become involved in science, technology, engineering and math (STEM) means more women doctors. Nobay also believes that women bring a lot to the emergency room, exam room and operating table. “When a patient comes into a hospital for care, being able to find a provider who understands your unique needs is important,” Nobay said. “If you can reflect the population in the providers, patients will have a sense of safety. Women understanding women’s needs is uniquely

Mary Maher is head of the public health program in nursing at Nazareth College. special.” She also said that in general, many women exhibit strong skills in flexibility, teamwork, communication and relating to others in a meaningful, comforting fashion. “Women have a unique understanding that nurturing is our role and we bring that into the job we do,” Nobay said. “Of course you can connect with a male physician. Women feel like bringing that into the experience augments what they do.” She hopes that women continue to progress as medical researchers and medical educators.

10 Things Women Should Know About Heart Disease


early every minute, a woman dies from heart disease in the United States — it is the No. 1 killer of women, causing one in three deaths each year, according to the American Heart Association (AHA). When it comes to heart disease, women experience unique causes, symptoms and outcomes compared to men. In addition, certain conditions appear to increase heart disease risk in women, including pre-eclampsia and eclampsia, gestational diabetes, migraine headaches with aura, early onset menopause and autoimmune diseases such as lupus and rheumatoid arthritis. Physician Holly Andersen, at the Ronald O. Perelman Heart Institute at NewYork-Presbyterian/Weill Cornell Medical Center, and Jennifer Haythe, a cardiologist specializing in cardiac health during pregnancy at NewYork-Presbyterian/Columbia University Irving Medical Center, say more work needs to be done. Here’s why: Women are more likely to die from heart disease than men, according to the AHA.

1. 2.

Despite outreach efforts, a Women’s Heart Alliance survey of more than 1,000 women between 25 and 60 years of age found that 45 percent of women still don’t know that heart disease is the leading cause of death for women in the United States.

3. 4. 5.

Women are less inclined to call 911 when they believe they may be experiencing heart attack symptoms. Cardiovascular disease complicates up to 4 percent of pregnancies, and that number has been increasing. Women’s heart attack symptoms are often different from men’s. They may experience shortness of breath, nausea, palpitations, jaw discomfort or overwhelming fatigue, according to the AHA.

6. 7.

Women are less likely to be referred for cardiac rehab after a heart attack.

Women’s heart disease is under-researched: only 35 percent of participants in clinical trials of cardiovascular disease are women, and just 31 percent of the studies report outcomes by gender.


Pre-eclampsia is an independent predictor of developing cardiovascular disease later in life. Women who have had pre-eclampsia should be mindful of having their blood pressure, fasting glucose and cholesterol checked annually.


Women are less likely to receive bystander CPR in public than men (45 percent in men verApril 2018 •

sus 39 percent in women). Learning hands-only CPR can help save a life. Recent blood pressure guidelines from the American College of Cardiology recommend all people to have a blood pressure target of 120/80 or


lower. Additionally, after the age of 65, hypertension (high blood pressure) is more common in women. Stay up-to-date on your annual physical and have your doctor check your blood pressure and other cardiovascular disease risk factors.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

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Women’s Health

Boost Your Energy Busy routine has brought you down? Try a few things to get your energy back Cindy Fiege, owner of Harmony Health Store in Spencerport.

By Deborah Jeanne Sergeant


any women from their mid40s and older experience chronic low energy and

fatigue. Aside from the aging process, the responsibilities at work and home seem to peak around the 40s and 50s. School-aged children and teens need lots of time, as do elderly parents. Women are also in the most demanding part of their career as they’ve risen through the ranks but maybe not to the level where they have a personal assistant. At home, many women still perform the majority of household care and managing the family’s social life. “It’s hard for women to take time for healthy eating, exercise and sleeping enough,” said Anne Bowman Ryan, a physician with UR Medicine Primary Care. “When there’s a crisis like a work trip, sick child, and so on, women often make the sacrifice to make things work. We carry a lot on our shoulders as women.” While usually not immediately life threatening, fatigue can be related to stress, anxiety and depression. Ryan said that it’s important to speak with a health care provider. That conversation should include discussing medication which can cause fatigue. Fatigue could signal a medical condition such as anemia, thyroid or autoimmune diseases. Better self care can help women reclaim their energy levels to better

face everyday challenges and feel healthier. Of course, eating a variety of colorful produce, mostly whole grains, modest portions of healthful fat and sufficient protein is the first step in improving nutrition; however, Ryan wants more women to stop skipping meals. “Breakfast is fuel,” she said. “If you start the day with an empty tank, that won’t feel good as the day wears on.” Blasting through the mid-afternoon slump with a fancy coffee drink or candy bar may work short-term, but it’s not healthful. “Avoid foods with simple sugar, like white bread, sugary foods and others with high sugar con-

tent,” Ryan said. “They boost energy initially, but then you crash.” Instead, complex carbohydrates like oatmeal with fruit or eating protein and a vegetable, like carrots and hummus, provide nourishing fuel. “Caffeine in tea is still caffeine,” Ryan said. “Caffeine later in the day makes it hard to fall asleep and you can get into a cycle.” It’s important to remember that a serving of coffee or tea is eight ounces, not the giant cups offered by many restaurants. In addition, most people need seven to nine hours’ sleep per night, a goal Ryan said that most women don’t get. While exercising seems counterintuitive to people who have little energy, its effects include renewed energy. Ryan said that exercise releases naturally occurring chemicals in

the body that help women stay more relaxed and better able to sleep. Cindy Fiege, owner of Harmony Health Store in Spencerport, recommends practicing qi gong, an ancient Chinese method of stances and movements that she says “really get the energy flow through the body and re-energizes you. It helps in getting rid of negative baggage so you can proceed forward.” She also tries to take a brisk, 20-minute walk daily. She said that supplements like kelp naturally help to balance the thyroid to promote better energy, along with supplement blends that help to balance the adrenal glands. Fiege said that many people are so stressed that their adrenals “are overloaded. Everyone’s on constant fight or flight response. It tires the body.” By calming the body, women can get better sleep and feel more energized. Fiege is also a big believer in good sleep hygiene, including eschewing electronics before bedtime. Activities like watching stimulating shows or surfing the internet right before bed can keep the mind busy so the body doesn’t sleep well. “Do things that are common sense, healthy things,” Fiege said. “When those aren’t enough, talk with a doctor or health care professional.”

Is Your Medicine Safe at Home? Only YOU Can Secure Your Rx! Help us prevent addiction, accidental poisoning & protect the environment!

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MONITOR– count your medication regularly

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

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

Medication Drop Box Locations: Bristol: Town Hall

Farmington: State Troopers

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

Clifton Springs: Hospital (Lobby)

Phelps: Community Center

Richmond: Town Hall

Rushville: Village Hall

Shortsville/Manchester: Red Jacket Pharmacy

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

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Geneva: North St. Pharmacy Police Station

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

Women Can Address Hair Thinning

Women’s Health

Hair loss affects more than 40 percent of American women; problem may be more than an appearance issue, says dermatologist By Deborah Jeanne Sergeant


any men with thinning hair shave their heads or just accept thinning hair as part of middle age. For women, the social stigma surrounding hair thinning and hair loss can make the experience emotionally devastating. Forty percent of Americans with hair loss are women, according to the American Hair Loss Association. For most of them, it’s overall thinning, not the horseshoe-shaped pattern of baldness common to men with male pattern baldness. But they don’t have to resign themselves to thinning. UR Medicine dermatologist Mary Gail Mercurio said that women should talk with their doctors about their hair loss concerns because it may be more than an appearance issue. “It may be indicative of an underlying condition,” Mercurio said. Causes could include physical stress, eating disorders, thyroid or hormonal disorders and childbirth. Discussing these possible factors could help find ways to decrease shedding. “This type of loss is known as a telogen effluvium and while it can be quite alarming to see all the hairs coming out and can last for several months, it is almost always reversible and normalizes over time,” Mercurio

said. Some types of medication may cause thinning. Asking about alternatives could help slow shedding and restore what was lost. Androgenetic alopecia, commonly called female pattern hair loss, involves thinning on the top of the head. Women may notice their part seems wider than it used to. Usually, this happens gradually; however, an abrupt case can indicate a hormonal change. Mercurio recommends minoxidil, available over the counter. “This gives many women the impression that it is ineffective because is so easy to obtain, but this is not the case as many women are pleased with the results,” Mercurio said. “It is very safe but must be applied daily and indefinitely or the hair that resulted from its use will fall out.” Another option to help those with female pattern hair loss is lightbased technology. Mercurio said it’s delivered with a comb or cap to stimulate re-growth. Blood platelet injections have also shown good success, as a patient’s own blood cells are injected into the scalp skin to stimulate growth. Alopecia areata, an autoimmune disease, causes patchy hair loss on the head. Alopecia totalis bares the entire head and alopecia universalis causes all of the body’s hair to fall

Go with the Flow Painful menstruation cycles? Experts suggest way to cope with the problem By Deborah Jeanne Sergeant


en out of every 100 women experience menstrual pain that’s so intense that they cannot perform normal activities, according to the National Center for Biotechnology Information, U.S. in Bethesda, Md. But women can take steps to make menstruation easier. Knowing when it’s going to happen can help women plan ahead and stay prepared with products to deal with flow and cramps. The average cycle is 28 days long; however, it’s perfectly normal for a cycle to be as long as 36 days. To help anticipate the next period, Clue, Eve, Pink Pad, Flo, Period Tracker and other apps (all on iOS and Android) remind users of when to expect their period, along with other helpful tips.

Cindy Fiege, owner of Harmony Health Store in Spencerport, said that quite a few supplements and herbs may ease symptoms. Dong quai (Angelica sinensis) root can help take the edge off menstrual cramp pain, as well as help improve irregular menstrual cycles. She added that omega-6 and omoega-3, evening primrose and milk thistle may also help with cramping, along with wild yam, black kohash, magnesium complex. “Essential oils are very helpful, too, like jasmine, red mandarin, and pine,” Fiege said. Prescription medication can also reduce or even eliminate the symptoms of menstruation. Mitchell Linder, OB-GYN with University of Rochester Medical Center, said that using an intraApril 2018 •

The “before” and “after” photos are of a client at Integrated Hair Solutions in Rochester. Photo provided. out. Some people see patchy regrowth and even times of remission with substantial re-growth. Mercurio said that the patchy hair loss of alopecia is often treated with steroid injections into the places missing hair. Maintaining the existing hair, as well as using protocols to encourage growth, can help clients while they work on their treatment, according to Pam Spitali, hair replacement specialist and manager of Integrated Hair Solutions in Rochester. After an analysis to help determine the issue, Spitali recommends a healthful diet, supplements, sufficient sleep and exercise. These can all relieve stress and improve overall health, she said. Usually, clients need a combination of different treatment options, Spitali which could include low-level laser light therapy, topical scalp treatments, and supplements to stimulate hair follicles. For some clients, using hair extensions can create better fullness. Spitali uses gentle methods that don’t damage existing hair.

“If someone’s hair loss is beyond something we can help them re-grow, we create a scalp and hair prosthesis,” Spitali said. They can be partial or full head pieces, depending upon the client’s needs and desires. Rather than the previous generation’s “wiggy” looking hairpieces, these custom prostheses use the hair type, density and color that best suits the clients. The pieces feature a thin, breathable membrane made in Italy with anti-bacterial properties. The piece is affixed to the scalp with a medical-grade, FDA-approved adhesive so clients never need to fear it slipping. “They live in it,” Spitali said. “It becomes part of them.” Made with genuine human hair, clients can wash and style it just like hair growing from their heads. About every five weeks, clients return to Integrated Hair Solutions to have the prosthesis removed, their scalps cleaned, and the prosthesis re-applied, all in a private room. “Our goal is to reduce hair loss and prevent thinning in the future,” Spitali said. Her office provides private consultations at no charge to anyone who wants to do something about hair loss.

uterine device, a T-shaped piece of plastic inserted in the uterus, causes 20 percent of users to not bleed or experience menstrual cramps. “They’re totally safe,” Linder said. “They’re not the types of IUDs like in the ‘70s. They can be used in people who’ve never had a pregnancy or women who are 40 and are having irregular periods, even if not for birth control because they’ve had their tubes tied.” One example, Mirena, is FDA approved for contraception and period control. It lasts up to five years. For women who want better means of dealing with flow, menstrual cups may provide an easy way to get long-lasting protection. Brands such as Luna Cup or Diva are made of medical-grade silicone. Users fold the cup in half length wise, insert, and let it go so it resumes its previous shape while it forms a seal that prevents leaks and odors. The cup catches menstrual flow rather than absorbing it like tampons and pads. Many women can wear a cup up to 12 hours, depending upon her flow, without emptying it instead of changing a pad or tampon every few hours. Cups are reusable and long-lasting, which saves both money and

landfill space. “You take it out and wash it and put it in again,” Linder said. “If you’re worried you’ll get your period, you can stick one in and you’re covered.” Taking over-the-counter pain medication, using heating pads or microwavable rice bags may ease pain. Linder said that menstruating women may want to avoid coffee and caffeine, which are diuretics. “The bladder sits on top of the uterus so if it’s full, that’s uncomfortable,” Linder said. While it may seem a good time to curl up on the sofa hugging a pillow, exercise may improve symptoms. “You don’t have to run a marathon, but endorphins released through exercise can help,” Linder said. “Stay well hydrated; that will help with bloating.” A little pampering is also appropriate. Websites such as and provide mail-order subscriptions for products helpful during menstruation; however, The Period Store includes both utilitarian and luxury items to make this time of month a little easier.

IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 23

Women’s Health


Myths About Midwives

By Christine Green


ertified nurse-midwife Rebecca Skovgaard loved night shifts on the maternity floor at Highland Hospital before her retirement from Strong Midwifery at the University of Rochester. The quiet atmosphere allowed her to further bond with the laboring mothers she was working with whether that meant checking on their process, coaching them through delivery or simply sitting by their side. Skovgaard valued this special time together as two women — one helping the other through one of the most important moments of her life. Midwives like Skovgaard are health professionals trained to care for female reproductive health, specifically during pregnancy, labor and postpartum recovery. There are many myths surrounding midwifery care in the United States, mostly based on lack of knowledge or driven by fear for the safety of mom and baby.


Midwives are untrained or “fake” medical providers: False The New York State Education Department clearly states that midwives in New York must complete a master’s degree or higher degree program and pass a rigorous licensure test administered by The American Midwifery Certification Board (AMCB). “We practice evidence based care and are always learning new things through continuing education,” said Heather Lane, another certified midwife with Strong Midwifery. Certified nurse-midwife Martha Boudakian of Welcome Home Midwifery in Rochester agrees with Lane and noted that much of the fear surrounding midwifery care comes from people, “not understanding the educational pathways we take and the level of training we have.”

4. Heather Lane, left, a certified midwife with Strong Midwifery, working with mom Katelyn Sollame during her delivery at Highland Hospital. Photo courtesy of Gabriella Hunt. labor and delivery.” Still others choose midwifery well before delivery and are glad that their midwife is there to see them through such an important moment in their lives. Amanda O’Connell of Holley enjoyed having a midwife for prenatal care and at the delivery of her baby girl. She was grateful to have, “a midwife to listen to my fears, spend time with me (and not feel rushed), and include my husband in on the pregnancy.”


Having a midwife means you can only deliver a baby at home: False Midwives agree that homebirth is very safe for low risk, healthy mothers and babies, and many midwives like Boudakian and her colleagues at Welcome Home deliver babies in a home setting all the time. Rosa Davila of Brockport chose a home delivery when her daughter was born eight years ago: “Having a midwife allowed me to have the birth I wanted. I birthed at home in three hours with just my loved ones around. It was a loving, empowering experience for all involved. I couldn’t have asked for more.” But if an expecting mother prefers a hospital birth she can still choose midwifery care. In fact, most midwives in Rochester only deliver babies in a hospital. Katie Shuknecht of Clarendon Page 24

ter laboring at home for a time with her first son, Yaeger needed medical intervention and the midwife transferred her to a hospital. Her second child was born at home with the same midwife, and when she developed a serious medical complication during her third pregnancy she had to transfer to a physician. Yaeger’s midwife recognized when risks arose and employed necessary medical help when needed. The end result were three healthy sons. Heather Lane assures patients that, “we [midwives] have abilities to do interventions and recognize when things are going off the path.” “We don’t hesitate to get help with medical complications if you need them,” said Skovgaard. In fact, in some cases, delivering with a midwife can lower the possibility of medical interventions for low risk mothers. A recent analysis of hospital-level data conducted by researchers at the University of Massachusetts Amherst and the University of Minnesota revealed that hospital births attended by a midwife resulted in overall fewer cesarean deliveries and episiotomies (Journal of Midwifery & Women’s Health, 2017). “A C-section is not a horrible way to have a baby but you don’t want one unnecessarily,” said Skovgaard who also noted that the current rate of episiotomy at Strong Midwifery is only 1 percent.

3. Becky Skovgaard went to an obstetrics practice that employed both obstetricians and midwives, but she didn’t expect a midwife to be the on-call attendant at her delivery. It turned out to be a pleasant surprise. “At first I was nervous at the thought of someone who isn’t a licensed doctor taking care of me at such a serious time. But then when I met her and saw the way she handled the situation with such a calm, encouraging and positive approach. I felt extremely comfortable working with her as she coached me through

Having a midwife attend your birth is unsafe: False. Midwifery care is a safe option for a great many women and midwives are trained in detailed risk assessment through the entire childbearing cycle from preconception though delivery. Those women who choose midwifery care in New York can expect to work with highly trained professionals who work closely with patients so that labor and delivery is a safe experience. If a woman or her unborn child seems to be at any risk during a pregnancy they will work closely with doctors and collaborate, share or transfer care if necessary. Chrisa Yaeger of Hilton had three very different birth experiences, and it was thanks to a diligent midwife that all births went well, she said. Af-

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

Midwifery care is only for pregnant women: False Skovgaard’s oldest patient was in her 80s, clearly beyond the childbearing years. Midwives can care for teens and adults regardless of whether or not they are pregnant. And patients don’t have to have had a baby or even plan to have one. “We help women be in the best health that they can,” she said. And Boudakian mentioned that while gynecological care is a smaller part of the Welcome Home Midwifery practice, it is a “vital” one that allows her to maintain important longterm relationships with her patients. Karen Faris of Brighton had her baby with the midwives at Strong 14 years ago and still goes to them for regular care: “My childbearing years are over but I still use them for GYN services. And all the reasons why I appreciated them during the pregnancy years are still very much in abundance: kindness, compassion and a female centric understanding of how a woman’s body changes over time.” Intimacy of Care “People come to us seeking intimacy of care,” said Boudakian. “I like helping a woman find her center, her power, her voice.” Supporting women, respecting their choices regarding their health and childbirth, and educating their patients on those choices is the foundation of midwifery care. Midwives like Boudakian, Skovgaard, Lane, and their colleagues take this tenant very seriously and find great joy in their work. Lane sums it up: “It is a blessing to walk with women through their lives and some of their most intimate moments.”

Women’s Health

When Sex is a Real Pain Many factors may cause women to feel pain during sexual intercourse. Rochester doctor: ‘Sex should never be painful’

ALL THE COMFORTS OF HOME All the care of trusted experts

By Deborah Jeanne Sergeant


or a variety of reasons, many women experience pain with sex. Sexually transmitted diseases, vaginal infections, low hormone levels, vulvar skin issues, very tight or weak pelvic floor muscles, endometriosis and unknown issues can cause women pain during sex, for example. “Sex should never be painful,” said physician Pebble Kranz, owner of Rochester Center for Sexual Wellness. “It is always an issue that should be investigated by a healthcare provider and sometimes it takes a long time to get to the root of these issues and to find a provider who is skilled in evaluating and treating sexual pain, but one shouldn’t lose hope.” Sometimes pain during sex causes a vicious cycle of exacerbating the issue. As the woman experiences pain, she becomes more fearful of intercourse, according to Kranz. When the fear causes her body to tense up, the pain worsens. Libido can taper off. “This is made worse because many women keep the problem hidden, even from their partners, and feel shame about it,” Kranz said. She added that many care providers minimize women’s complaints and are not aware of sexual medicine as a specialty that includes physical and mental health. Treating sexual pain can include medication, physical therapy for the pelvic floor, mental health, relationship counseling and education. Kranz recommends a book by medical doctors Irwin Goldstein, Andrew Goldstein and Caroline Pukall, “When Sex Hurts: A Woman’s Guide to Banishing Sexual Pain.” “It is not only a great overview of the problem, but also helps women advocate for themselves within their relationships and with their medical providers,” Kranz said. For further reading, “Sex Rx” by Lauren Streicher, a physicians and assistant clinical professor at Northwestern University’s Feinberg School of Medicine, explores how decrease in estrogen levels can cause vaginal and vulvar thinning and dryness, among other reasons for sexual pain. “That’s the most common cause for sexual pain for women past menopause,” Streicher told In Good Health. About half her patients experiencing sexual pain are younger women. More of those seem eager to seek treatment. Streicher said that many mature women don’t seek treatment because of stigma or belief that painful sex is a normal part of aging. “Everything is fixable,” Streicher said. “That’s not what women are hearing from their doctors.” For some, finding a good lubricant solves their problem. Personal

Pebble Kranz, owner of Rochester Center for Sexual Wellness. lubricants include many formulations, so trying a few may be warranted. If the over-the-counter types don’t work, a doctor can prescribe medication to help. Some could relate to trauma of the muscular-skeletal structures or the soft tissue. During pregnancy, the tissues receiving more blood flow can become more sensitive. During the last trimester, the uterus can sit so low that sex hurts. After delivery and recuperation, moms may experience pain during intercourse for other reasons. Breast feeding women can experience atrophy as they have high progesterone levels. In only the most rare cases does a patient need surgery to resolve her sexual pain issues. Streicher recommends that women experiencing painful intercourse seek help from an expert in sexual pain or a menopause expert. “I’ve yet to have a woman with painful sex for whom I wasn’t able to alleviate the problem,” Streicher said. “Get yourself in the hands of someone who can help you. It may be a general gynecologist and maybe not. “If someone says there’s no solution, don’t believe it. Or if they’re dismissive and say, ‘This is a normal part of menopause,’ or that it’s normal after cancer or it’s a part of diabetes, don’t believe it.” Amy Benjamin, obstetrician-gynecologist with University of Rochester Medical Center, would agree that women need to self-advocate. “It’s important that if you see a provider who says, ‘Have a glass of wine before sex and you’ll be fine’, you realize that’s not appropriate,” Benjamin said. “Not all physicians and not all gynecologists are trained in managing these disorders. If you feel you don’t have an appropriate diagnosis or treatment plan, look for a second opinion.” Particularly since so many conditions can contribute to pain during intercourse, it’s important for physicians to take their time to fully evaluate the patient to determine the cause. April 2018 •

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 25

Find a Mental Health Care Provider You Can Trust By Kimberly Blaker


t least 100 million people currently living in the United States will, at some time in their lives, experience problems in relationships, become depressed or develop anxiety so serious that they will merit psychiatric diagnosis and would benefit from the services of a mental health care professional, according to Larry E. Beautler, Bruce Bongar, and Joel N. Shurkin in “A Consumer’s Guide to Psychotherapy: A Complete Guide to Choosing the Therapist and Treatment That’s Right for You.” Unfortunately, countless mental health care professionals lose their licenses each year as a result of patient abuse, sexual misconduct, fraud, substance abuse, unlicensed practice, medication violations and more. Should you be faced with a crisis, know how to find a reputable mental health care provider with the expertise you need and that you can trust. Finding a trustworthy, reputable therapist Most mental health care professionals adhere to ethical guidelines. But as with any field, there are always exceptions. So know how to screen. Begin your search by asking family or friends for recommendations or obtain a referral from your primary care doctor. You can also contact area clinics for recommendations or consult your yellow pages or online directory. Phone three or four therapists and ask about their credentials, policies and treatment methods. The following are good questions to ask: • What are your areas of expertise? • How much experience do you Page 26

have with my particular issues? • Are you licensed or certified by the state? • Has your license ever been suspended or revoked? If so, can you tell me about the situation? • What are your professional affiliations? • What forms of treatment and therapy do you provide? What evidence is there to support its effectiveness? Is there controversy among mental health care professionals regarding this treatment? • What are your fees? Do you accept my insurance or work on a sliding scale? If you can’t get answers to these basic questions over the phone, look elsewhere. If you’re satisfied with the therapist’s responses, check with your state-licensing department to verify the license status and to make sure no actions have been taken against the therapist. Evidence-based practice Once you begin therapy, complications could still arise. According to Beautler, Bongar, and Shurkin, therapists who base their beliefs on personal experiences often reject scientific findings that don’t coincide with their beliefs. As a consumer, do your research to assure the validity of your diagnosis or form of therapy or treatment. If you discover contradictions from reputable sources, discuss it with your therapist. It may be a simple misunderstanding or data of which your therapist was unaware. If your therapist rejects the information, ask why and determine if the reason is valid or is based on personal opinion.

If it’s preventing you from obtaining a proper diagnosis and/or treatment, find a therapist that recognizes those findings. Though rare, unethical therapists have been known to misdiagnose for financial gain. More common, those with questionable practices may recommend unnecessary, inappropriate, outdated or unproven treatments. That said, “Your therapist is obligated not to take advantage of you, either intentionally or unintentionally through negligence or ignorance, and to act only in your best interests,” explain Jack Engler, Ph.D. and Daniel Goleman, Ph.D. in “The Consumer’s Guide to Psychotherapy: The Authoritative Guide for Making Informed Choices About All Types of Psychotherapy.” Mental health care ethics There are certain rules set by state licensing divisions as well as the American Psychological Association and other mental health associations providers must follow. Be aware that mental health care providers may not: • disclose information about you without prior written consent or even verify that you are being seen by the therapist except under certain situations, such as when child abuse is reported. • suggest that you do something that is undeniably harmful, immoral or illegal. • treat you for or offer services that are outside his or her area of expertise. • offer experimental or unproven therapies without informing you of such. • make sexual advances whether

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

you approve of them or not. • treat you if you have any kind of relationship with the therapist outside of therapy. • degrade you because of your values or problems or pressure you to change them. These are only some of the ethics therapists must uphold. Handling ethics violations and negligence If you feel your rights have been violated or your therapist has treated you with negligence, there are several options according to Engler and Goleman. If the violations are minor, you might want to discuss the problem with your therapist. You can also seek a second opinion to determine whether it’s a misunderstanding or a valid complaint. If your complaint seems valid and is serious enough, you can file a formal complaint with the appropriate ethics committee or with the state licensing or certification board. This is an important step if there’s concern that someone else might be harmed by the therapist’s practices. Finally, if your therapist acted negligently, rather than just unethically, a civil malpractice suit may be in order. Remember though, most people have positive experiences with their therapist. By being aware of unforeseen problems and taking precautionary steps, you’ll reduce the risk of a negative experience. Kimberly Blaker is the author of a kid’s STEM book, “Horoscopes: Reality or Trickery?” She also writes a blog, “Modern FamilyStyle” at modernfamilystyle. com.

Three of 10 adults over 65 in Upstate Fell Last Year Excellus BlueCross BlueShield urging older adults to take steps to prevent fall-related injuries


ix in 10 Upstate New York adults aged 65 and older report that they have not taken steps to reduce their risk of falling and three of 10 adults in the same age group fell at least once in the past year, according to a review of New York state data by Excellus BlueCross BlueShield. “About 30 percent of those falls resulted in injury,” said physician Bruce Naughton, Excellus BlueCross BlueShield vice president and chief medical officer for Medicare. “Falling does not have to be an accepted part of the aging process. Older adults can work to improve their balance and develop their strength by incorporating more movement into daily activities. Also, they can do things to reduce tripping hazards in and around their homes.” The most common tripping hazards include: • Throw rugs that bunch or slide. • Clutter. • Stairs that are uneven, are too steep or too long, and have inadequate railings. • Lighting that’s either too dim, or so bright that it causes glare.

• Pets that follow too closely or lie in prime walking areas. • Unstable chairs or tables that can’t support a person’s weight. • Extension cords across walkways. • Bathrooms that lack grab bars, or have low toilet seats. • Sloping yards and driveways. • Cracks in sidewalks. • Uneven transitions between bare floors and carpeted rooms. Naughton, a specialist in geriatric medicine, is a proponent of the Timed Up and Go (TUG) Test, used to evaluate basic mobility skills and the risk of falling among older adults. “All you’ll need is a stopwatch or watch with a second hand, a chair, and a family member or friend to assist you with the TUG Test,” said Naughton. Wear your regular footwear and use a walking aid, if needed. Then mark a line that’s 10 feet away from the chair on the floor. Timed Up and Go“TUG” Test: • Sit in the chair • When your assistant says “Go,” standup from the chair • Walk to the line on the floor at your normal pace

Source: Centers for Disease Control and Prevention — Behavioral Risk Factor Surveillance System, 2016. • Turn around • Walk back to the chair at your normal pace • Sit down again “Your assistant should start timing on the word ‘go’ and stop timing after you sit back down,” said Naughton. “If you take 12 or more seconds to complete the TUG test, you might be at a higher risk of falling, and should seek your doctor’s advice on actions you can take to reduce that risk.” Lower body weakness and difficulty with balance are risk factors for falling, according to Naughton. He suggests taking a walk around the house during television commercial breaks or standing on one leg, and then the other, for as long as you can while doing the dishes or ironing. Proper vision care, up-to-date eyeglass prescriptions, proper nutrition and a thorough medication review

can help reduce the risk of falling. The risk for falling and the severity of an injury increase with age. Of Upstate New Yorkers ages 65 to 69: • 28 percent fell in the last 12 months • 32 percent who fell were injured from the fall Of Upstate New Yorkers ages 80 and older: • 32 percent fell in the last 12 months • 40 percent who fell were injured from the fall “People need to stay active as they age, keep their doctors informed about any issues with balance, vision or medications, and eliminate easy tripping hazards around the house and yard to reduce their chances of suffering fall-related injuries,” said Naughton.

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IN GOOD HEALTH – Rochester / Genesee Valley Healthcare Newspaper

Page 27

Ask St. Ann’s

By Kim Petrone, MD

How Do Our Dietary Needs Change as We Age?

Ask The Social

Security Office

From the Social Security District Office

What You Should Know About Enrolling in Medicare Parts A & B


ood nutrition is important at any stage of life. A healthy, balanced diet provides our bodies with the nutrients we need to function, grow and heal properly. But as we age, healthy eating takes on new importance. Our bodies become less efficient at absorbing and using vitamins and minerals. At the same time our appetites may decrease, meaning we take in less of what our bodies need. That’s why, as we get older, we need to be vigilant in making sure the foods we eat are nutritious and healthy. The National Council on Aging offers these tips to help you find the best foods for your body:


Look for important nutrients.

Make sure you eat a variety of foods to get all the nutrients you need. A healthy meal should include: • Lean protein (lean meats, seafood, eggs, beans) • Fruits and vegetables • Whole grains (brown rice, whole wheat pasta) • Low-fat dairy Pick nutrient-dense foods — they provide more nutrition with less calories. For example, roasted skinless chicken breast vs. chicken wings, an apple vs. slice of apple pie. Also, look for calcium, vitamin D, vitamin B12, minerals, and dietary fiber, which our bodies need as we age.


Read the Nutrition Facts label.

The healthiest foods are whole foods — those that have been processed or refined as little as possible and are free from additives or other artificial ingredients. These are often found on the perimeter of the grocery store in the produce, meat and dairy sections. When you do eat packaged foods, read the labels to find items that are lower in fat, added sugars and sodium (salt).


Know what a healthy plate looks like.

Start with a few of these small changes to create a healthy plate: • Make half your plate fruits and vegetables. Focus on whole fruits and a variety of vegetables. Page 28

• Make half your grains whole grains. • Move to low-fat and fat-free dairy items. • Vary your protein routine. (5-7 oz. per day is ideal.) Vary your protein choices between meats, seafood, eggs, nuts, beans/lentils. The USDA offers guidelines and tips for healthy eating at www. It’s a helpful resource for meeting your calorie and nutrient needs.


Stay hydrated

Water is an important nutrient, so don’t let yourself get dehydrated. Drink small amounts of fluids consistently throughout the day. Herbal tea and water are your best choices. Keep fluids with sugar and caffeine at a minimum.

Good Diet = Maximum Benefits Giving your body the right nutrients can help you stay healthy, independent and maintain a healthy weight. You’ll also reduce the risk of developing chronic diseases such as high blood pressure, diabetes, hypertension, and heart disease. If you have a chronic disease, eating well can help to manage the disease. And by choosing the healthy foods you like best, it can be enjoyable too! That’s important in developing a routine of eating right and getting the most from your diet.

Physician Kim Petrone is the medical director of St. Ann’s Community and the Rochester General Wound Healing Center at St. Ann’s. She is board-certified in internal medicine and geriatrics and has been providing medical care for seniors at St. Ann’s since 2005. Contact her at or visit www.

nderstanding Medicare isn’t as difficult as you might think. It’s a benefit most working Americans can count on. Here are some facts you might not know about the program. n Can I still get Medicare at 65? Yes, you’re still eligible for Medicare starting at 65, no matter what year you were born. If you or your spouse worked and paid Medicare taxes for at least 10 years, you’re eligible for Part A (hospital insurance) at age 65 for free. Part A helps pay for inpatient care in a hospital or skilled nursing facility following a hospital stay. It also pays for some home health care and hospice care. You’re also eligible for Part B (medical insurance) if you choose to get it and pay a monthly premium. Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment and some preventive services. If you are receiving Social Security benefits already, you will be automatically enrolled in Medicare Parts A and B at age 65. Because you must pay a premium for Part B, you can choose to turn it down. However, if you don’t enroll in Part B when you’re first eligible for it, and choose to enroll later, you may have to pay a late enrollment penalty for as long as you have Part B coverage. If you’re not receiving Social Security benefits, you have a seven-month period (your initial enrollment period) to sign up for Part B. Generally, your initial enrollment period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after your birth month. n If you are covered under an employer group health plan, you may have a special enrollment period for Part B. If you are 65 or older and covered under a group health plan, eiProudlyWelcomes ther from your own or your spouse’s ProudlyWelcomes current employment, you may have

a special enrollment period during which you can sign up for Medicare Part B. This means that you may delay enrolling in Part B without having to wait for a general enrollment period and without paying the lifetime penalty for late enrollment. Additional rules and limits apply, so if you think a special enrollment period may apply to you, read our Medicare publication at, and visit the Centers for Medicare and Medicaid Services at for more information. n To avoid a tax penalty, you should stop contributing to your Health Savings Account (HSA) at least six months before you apply for Medicare. If you have an HSA when you sign up for Medicare, you can’t contribute to your HSA after you your Medicare coverage begins or you may have to pay a tax penalty. Premium-free Part A coverage begins six months before the date you apply for Medicare, but no earlier than the first month you were eligible for Medicare. To avoid an unwanted tax penalty, you should stop contributing to your HSA six months before you apply for Medicare. You can withdraw money from your HSA after you enroll in Medicare to help pay for medical expenses like deductibles, premiums, coinsurance, or copayments. If you’d like to continue contributing to your HSA, you shouldn’t apply for Medicare or Social Security benefits. n How Much Does Part B Coverage Cost? You are responsible for the Part B premium each month. Most people will pay the standard premium amount, which is $134 in 2018 if you sign up for Part B when you’re first eligible. This amount can change every year. You can find up-to-date premium amounts on You can learn more about Social Security and Medicare at

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and if they accept Medicaid.

My mom has Alzheimer’s disease and has gotten to the point that she can’t live at home any longer. I need to find a good memory care residential unit for her but could use some help. Any suggestions?

n Tour your top choices: During your tour, notice the cleanness and smell of the facility. Is it homey and inviting? Does the staff seem responsive and kind to its residents? Also be sure to taste the food, and talk to the current resident’s family members, if available. Also, find out about staff screening and training procedures, their turnover rate, and the staff-to-resident ratio. They should have at least one staff member for every five residents. Make sure the facility offers quality activities that can keep your mom engaged, even at night when she may be awake. Ask how they respond to residents who may wander or become aggressive. If the answer is locked doors and antipsychotic drugs, that’s a red flag. Because transitions can be unsettling for dementia suffers, make sure that your mom will be able to remain at the facility for the foreseeable future. And find out what, if any, health conditions might require your mom to leave the facility or move to a higher and more expansive level of care. It’s also a good idea to make multiple visits to the facility including an unscheduled visit at night or on weekends when the staff is more likely to be stretched thin. To help you evaluate your visit, the Alzheimer’s Association offers a checklist that you can access at ALZ. org/residentialfacilities.

Exhausted Daughter Dear Exhausted, Choosing a good memory care residential unit for a loved one with Alzheimer’s disease is a very important decision that requires careful evaluation and some homework. Most memory care units, sometimes called special care units, are housed within assisted living or nursing home facilities. At their best, they offer staff extensively trained in caring for people with dementia, individualized care that minimizes the use of dangerous psychotropic drugs, a home-like environment and activities that improve residents quality of life. But at their worst, they can offer little more than a locked door. Here are some steps that can help you find a good facility and avoid a bad one. n Make a list: To identify some good memory care residential units in your area ask your mom’s doctor for a referral, and use the Alzheimer’s Association online tool at Make sure the facilities on your list are close to family members and friends who can visit often, because residents with frequent visitors usually get better care. n Research your options: Once you’ve made a list, contact your local long-term care ombudsman (see This is a government official who investigates assisted living and nursing home complaints and can tell you which facilities have had problems in the past. If you’re looking at a memory care unit within a nursing home facility, use Medicare’s nursing home compare tool (, which provides a 5-star rating system. n Call the facilities: Once you’ve identified a few facilities, call them to find out if they have any vacancies, if they provide the types of services your mother needs, what they charge

n Paying for care: The national average costs for memory care within an assisted living facility is over $5,000 per month, and over $7,500/ month for nursing home care, but costs can vary widely depending on your location. Since Medicare does not cover long-term care, most residents pay for care from either personal savings, a long-term care insurance policy, or through Medicaid (if available) once their savings are depleted. To help you research your financial options, visit the National Clearinghouse for Long-Term Care Information website at 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. April 2018 •

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H ealth News Wade Norwood named CEO of Common Ground Community leader and New York State Regent Wade Norwood will succeed Trilby de Jung as CEO of Common Ground Health, the region’s heath planning organization. Currently chief strategy officer for Common Ground Health, Norwood brings to the position more than three decades of service in public office, education and regional health improvement. His appointment is effective July 13. de Jung, who resigned her position, plans to rejoin her family in Portland, Ore., after her youngest son graduates from high school. “We will be saddened to say goodbye to Trilby; she has been an absolutely wonderful CEO,” said Marilyn Dollinger, board chairwoman of Common Ground Norwood Health. “She is an incredibly articulate communicator and gifted leader, skilled at bringing together diverse partners and helping them find common ground. Never one to seek the spotlight, Trilby always gives credit where credit is due, letting our collaborators know how deeply their community efforts are appreciated.” “We are also exceedingly fortunate to have among the ranks such a trusted and inspirational leader as Wade Norwood,” said Dollinger. “He’s a community organizing expert. As we seek to more effectively address the social determinants of health, such as poverty, poor housing and lack of education, we need a person with exactly Wade’s strengths— someone who can mobilize the community and bring us together to solve important health challenges.” In management at Common Ground Health since 2006, Norwood has been central to the strategic direction of the nonprofit and a consistent advocate for those most at risk. He is well respected regionally and state-

wide, noted Dollinger. He co-chairs the state’s workgroup on the health care workforce, serves on the Board of Regents and has deep and positive relationships with key offices in Albany, thanks to his two decades in state politics before joining Common Ground Health. Closer to home, Wade plays a leadership role on Assembly Majority Leader Joe Morelle’s cross-sector effort to integrate services and data for families impacted by poverty. He has a seat at the Finger Lakes Regional Economic Development Commission and is a decision maker for All Kids Thrive, a cross-sector initiative developing innovative early childhood interventions through Medicaid and education funding.

Highland gets $1.5 million for nutrition research Highland Hospital will receive a $1.5 million donation from the T. Colin Campbell Center for Nutrition Studies for a new nutrition research program. Lead by physicians Thomas M. Campbell II and Erin Campbell, this research venture will focus on plant-based nutrition and will be part of Highland’s new Weight Management & Lifestyle Center. Initial research done through Highland’s Weight Management & Lifestyle Center will focus on nutrition and cancer. The pilot project will be a first-of-its-kind study that looks at the effects of plant-based nutrition in patients with advanced breast cancer, who are also receiving conventional therapy. The center plans to do additional studies on nutrition as an intervention in a variety of diseases, partnering with experts in various specialties at the University of Rochester. “This funding and research will be crucial for patients and their families both here in Rochester and beyond,” said Cindy Becker, vice president and chief operating officer at Highland Hospital. “We are both honored and excited that Highland can provide a home for these potentially ground breaking studies.” The Highland Weight Manage-

ment & Lifestyle Center is a new program that builds on the regional leadership of Highland Hospital in weight loss treatment. Its clinical programs are a commitment to helping patients live more vibrant, sustainable lifestyles through weight loss, good nutrition and taking care of the whole person.

Hurlbut administrator receives award James Donofrio, administrator of Avon Nursing & Rehabilitation in Avon, has recently received the “New Administrator of the Year Award” given by the New York chapter of The American College of Health Care Administrators (ACHCA). The award was presented at the chapter’s awards lunch March 12. “In the short Donofrio time James has been in his administrator role, he has gone through one New York state survey at Wedgewood and one at Avon, with a federal look behind survey following shortly thereafter,” said Robert W. Hurlbut, president and CEO of Hurlbut Care Communities. “The survey at Wedgewood in October 2017 resulted in all low-level, no-harm citations that, by some accounts, was one of the best surveys the facility had ever had.” The Avon NYS survey was one of the first in the state to be conducted under the new survey process, occurring one day after the effective date of that process. Donofrio was licensed in New York state in March 2017 and that same month he was appointed as administrator of both Wedgewood Nursing & Rehabilitation and Avon Nursing & Rehabilitation, 29- and 40bed facilities, respectively. The ACHCA Awards program is an opportunity to recognize individuals with demonstrated contributions and exceptional commitment to ACHCA and the field of post-acute

and aging services leadership. The awards subcommittee ensures that all ACHCA awards and scholarships have objective eligibility criteria and follow a fair, credible process. Awards are issued at the individual, chapter/district, student, and facility level. Each year, nominees include new and seasoned administrators, members and non-members, business partners, chapters and districts, and other leaders.

Parkinson’s speech therapy at Thompson UR Medicine Thompson Health speech-language pathologists are now offering Speak Out!, a therapeutic protocol developed by the Parkinson Voice Project to improve and preserve the voices of individuals with Parkinson’s disease and Parkinson-plus syndromes. During 12 individual speech therapy sessions, the patient and the speech-language pathologist work their way through a series of speech, voice and cognitive exercises outlined in a comprehensive workbook. The program encourages patients to “speak with intent,” in a confident and deliberate fashion. Speaking with intent bypasses the neuropathways impaired by Parkinson’s disease, resulting in a stronger, clearer voice, according to a hospital news release. The practice tasks can also strengthen the muscles used in swallowing. This lessens the risk of aspiration, which is common with Parkinson’s disease.

Lifespan’s program wins national award Lifespan of Greater Rochester has been selected by Mather LifeWays Institute on Aging as one of three winners of the Promising Practices Award. The award highlights organizations that are moving away from conventional practices by developing and implementing innovative approaches in aging or long-term care services.

Excellus Awards Hospitals $24.2 Million for Quality Improvements


hirty-eight Upstate New York hospitals and health centers last year earned $24.2 million in quality improvement payments from Excellus BlueCross BlueShield as part of its performance incentive program. Since 2005, Excellus BCBS’s program has paid out more than $256 million. “We are very pleased that continued collaboration with our provider partners has resulted in improved quality of care for the communities we jointly serve. Aligning incentives across payers and providers will continue to advance care delivery and related outcomes,” said Carrie Whitcher, Excellus BCBS vice president health care improvement. Eight hospitals in the Finger

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Lakes region participated in this program in 2017, sharing $12.2 million in quality improvement incentive payments. Participating hospitals were Clifton Springs Hospital, F.F. Thompson Hospital, Highland Hospital, Newark-Wayne Community Hospital, Nicholas H. Noyes Memorial Hospital, Rochester General Hospital, Strong Memorial Hospital and Unity Hospital. In 2017, Excellus BCBS’s Hospital Performance Incentive Program evaluated participating hospitals on 48 unique performance measures. Hospitals that received quality improvement incentive payments achieved 88 percent of all quality improvement targets. In addition to achieving required

clinical and patient safety measures in 2017, other nationally-endorsed measures and target outcomes were jointly agreed upon by each hospital and the health insurer using benchmarks established by the Centers for Medicare & Medicaid Services, the Institute for Healthcare Improvement, and others. Areas targeted for 2018 improvement included: • Clinical Processes of Care — Focused on improvements in diabetes, chronic obstructive pulmonary disease (COPD), pneumonia and surgical care, and other measures that may be unique to each participating hospital • Patient Safety — Centered on reductions in hospital-acquired infections, readmissions and other

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

adverse events or errors that affect patient care • Patient Satisfaction — Used the Hospital Consumer Assessment of Healthcare Providers and Systems survey, which is a national, standardized, publicly-reported survey of patients’ perspectives of hospital care. “By improving the processes for caring for people, by concentrating on reducing the number of hospital acquired infections and adverse events, by listening to patients’ concerns, these hospitals are giving our members better quality care and improving their health outcomes,” Whitcher said.

Health News Lifespan’s Community Care Connections (CCC) service, which coordinates both medical care and community-based social services for older adults with multiple chronic illnesses and other risk factors, received the honor. In this service, Lifespan social workers are embedded in doctors’ offices and Lifespan’s licensed nurse practitioners work closely with medical care providers to coordinate care across the continuum — from doctors’ offices to hospital to home. “The Promising Practices Award honors Lifespan of Greater Rochester for its successful integration of social services with health care providers,” said Cate O’Brien, associated vice president, Mather LifeWays Institute on Aging. “By finding a way to break down the siloes of care for at-risk older adults, they are improving health outcomes for this vulnerable population.” According to a news release, the New York Academy of Medicine evaluated Lifespan’s Community Care Connections service and found that 72 percent of patients had fewer visits to the emergency department, and 65 percent had fewer hospitalizations, compared to 180 days pre-service. Estimates on return on investment for the program are between $2.27 and $4.58 per dollar spent, which adds up to $3.2 million in cost

avoidance for 437 patients.

Lifespan introduces service for older adults Lifespan of Greater Rochester is launching SilverlineNY, a new service with the goal of combatting loneliness for older adults. SilverlineNY matches volunteer “phone buddies” with older adults who are lonely, isolated or shut-in and who would benefit from friendly phone calls. “Our volunteers want to help people who feel alone; they want to make an impact,” shares Deb Palumbos, the SIlverlineNY program administrator at Lifespan. “Our hope is that the people we call will feel re-connected. The cure for loneliness could be a phone call away.” Palumbos is currently recruiting phone buddy volunteers, with training sessions scheduled at the Lifespan office at 1900 S. Clinton Ave. and in Geneseo. Lifespan is a regional provider of information, guidance and services that help older adults take on the challenges and opportunities of longer life. For more information about volunteering in the SilverlineNY program, call 585-287-6428.

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