2021 EDITION featuring advice from a number of medical experts to keep you feeling Healthy and well
A SAVVY CONSUMER’S GUIDE TO MEDICAL SERVICES IN THE GRANITE STATE
A Publication of
magazine
Your
kick up
Immunity for better health
Food for the Good Fight page 6
Boost Immunity With Gut Health page 5
Stay Fit by Making Exercise Fun
page 8
Back to the Basics to Block Illness page 9
w h at ’ s i n s i d e
A Publication of
magazine President/Publisher Ernesto Burden x5117 eburden@mcleancommunications.com
A SAVVY CONSUMER'S GUIDE TO MEDICAL SERVICES IN THE GRANITE STATE
Editor Rick Broussard x5119 editor@nhmagazine.com Art Director John R. goodwin x5131 jgoodwin@mcleancommunications.com
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Managing Editor Erica Thoits x5130 ethoits@nhmagazine.com Assistant Editor Emily Heidt x5115 eheidt@nhmagazine.com Contributing Editor Bill Burke x5112 bburke@mcleancommunications.com Production Manager Jodie Hall x5122 jhall@nhbr.com Senior Graphic Designer Nicole Huot x5116 nhuot@mcleancommunications.com Senior Graphic Designer Nancy Tichanuk 5126 ntichanuk@mcleancommunications.com Group Sales Director Kimberly Lencki x5154 klencki@mcleancommunications.com Business Manager Mista McDonnell x5114 mmcdonnell@nhbr.com Senior Sales Executive G. Constance Audet x5142 caudet@nhmagazine.com Sales Executives Josh Auger x5144 jauger@nhmagazine.com Jessica Schooley x5143 jschooley@mcleancommunications.com Events & Marketing Manager Emily Samatis x5125 esamatis@mcleancommunications.com Business/Sales Coordinator Heather Rood x5110 hrood@mcleancommunications.com Digital Media Specialist Morgen Connor x5149 mconnor@mcleancommunications.com
NH Hospitals
Health & Vitality Page 14
Boosting Your Immunity
Walk-In Care Centers/ Ambulatory Surgery Groups
Page 2
Page 4
Is Stress Weighing on You? Page 10 Breast Cancer Screening Page 12
Page 16 Elder Care Services Page 18 First Do No Harm Page 20
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This guide does not serve as a recommendation or endorsement by New Hampshire Magazine.
© 2021 McLean Communications, Inc.
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Submit corrections and additions to Smart Health NH, New Hampshire Magazine 150 Dow St., Manchester, 03101. This publication is designed as a health care resource and is not intended for commercial use. SMART HEALTH NH 2021 | New hampshire magazine 1
n h h o s p i ta l s
N
ew Hampshire is consistently one of the healthiest states in the country, and to help keep it that way the state is blessed with a variety of hospitals, large and small, charged with sustaining the quality of health for their communities. Hospitals are like capitals of health care for the regions they serve. Although equipped to handle everything from emergency care to diagnostics and surgery, many hospitals focus on special areas of medicine like cancer and heart disease, and many have developed their own centers for medical specialties. Even the smallest hospitals in the Granite State are hubs for private specialists and group practices. They are the perfect starting point for anyone seeking medical treatment or advice. Highlighted in Red = Specialty Hospitals
Alice Peck Day Memorial Hospital
10 Alice Peck Day Dr., Lebanon (603) 448-3121 / alicepeckday.org
Since 1932, Alice Peck Day Memorial Hospital (APD) has been the community hospital of the Upper Valley, delivering high-quality care in a friendly environment where patients come first. Today, APD has more than 95,000 patient encounters from communities throughout New Hampshire and Vermont. Long known for providing personalized care, APD also offers a wide range of services that include orthopaedic surgery, neurosurgery, pain management, primary and family care, senior care and women’s care. Through APD’s affiliation with Dartmouth-Hitchcock in 2016, we affirm our commitment to creating a sustainable health system to improve the lives of the people and communities we serve for generations to come. Bed Count: 25
to providing high-quality services. Cheshire Dartmouth-Hitchcock Keene offers primary and specialty care physician services, state-of-the-art diagnostic tools, programs for improving the health of the community, preventing illness and treating infirmity. Bed Count: 169
Concord Hospital
250 Pleasant St., Concord (603) 225-2711 / concordhospital.org
Concord Hospital is a nationally accredited nonprofit health system providing comprehensive acute-care services and programs to residents throughout New Hampshire. Our cornerstone Centers of Excellence for orthopaedics, cancer, cardiac, urology and women’s health reinforce Concord Hospital as a regional health resource for specialized care that consistently provides unprecedented diagnoses, treatment and support for more than 40 medical specialties. Bed Count: 295
Androscoggin Valley Hospital Cottage Hospital 59 Page Hill Rd., Berlin (603) 752-2200 / avhnh.org
79 Swiftwater Rd., Ste. 2, Woodsville (603) 747-2900 / cottagehospital.org
Androscoggin Valley Hospital is the leading provider of health care to thousands of families in the small-town communities of New Hampshire’s North Country. As a critical access hospital, AVH offers 24/7 emergency care, in-house treatment of most medical issues and an arrangement for treatment of all other problems with the nearest tertiarycare facility. AVH is a community-owned, nonprofit, critical-access hospital that has positioned itself to continue to provide comprehensive, quality medical care for the greater Androscoggin Valley. Bed Count: 25
For 110 years, Cottage Hospital has served the residents of the Upper Connecticut Valley. Today, Cottage Hospital is a thoroughly modern, 25-bed critical-access hospital that has been recognized for providing exemplary care. Staffed by just over 250 employees, 37 medical staff providers and dozens of dedicated volunteers, Cottage Hospital offers low-cost, high-quality health care by using creativity and common sense, and by keeping an eye to the future as well as the present. Bed Count: 25
Catholic Medical Center 100 McGregor St., Manchester (603) 668-3545 catholicmedicalcenter.org
Catholic Medical Center (CMC) is a nonprofit regional health system, with a commitment to delivering the highest quality and most advanced health care to patients across New Hampshire. CMC is the home of the New England Heart & Vascular Institute, listed among Becker’s Hospital Review’s “100 Hospitals with Great Heart Programs” for 2016. CMC’s birthing unit, The Mom’s Place, was the first hospital in the state to have a neonatal unit based on “couplet care.” With primary care practices that care for the very young to the young at heart and our dedication to community outreach programs, CMC is helping to foster a healthier community, every day. Bed Count: 330
Cheshire Medical Center/ Dartmouth-Hitchcock
580 Court St., Keene (603) 354-5400 / cheshire-med.com
The unique partnership of a regional medical center and a multispecialty physician practice has resulted in an integrated health system with a clear focus and coordinated approach
Crotched Mountain Specialty Hospital
1 Verney Dr., Greenfield (603) 547-3311 / crotchedmountain.org
Crotched Mountain Specialty Hospital is a post-acute facility for pediatric and adult patients who require acute and sub-acute rehabilitation following injuries and other complex medical conditions including traumatic brain injuries, stroke, spinal cord injuries, ventilator management and weaning and wound care. Bed Count: 62
and recognized for high performance in nine clinical specialties and procedures. Dartmouth-Hitchcock Health also includes the Norris Cotton Cancer Center, one of only 51 NCI-designated Comprehensive Cancer Centers in the nation; the Children’s Hospital at Dartmouth-Hitchcock, the state’s only children’s hospital; affiliated member hospitals in Lebanon, Keene, New London and Windsor, Vt., and Visiting Nurse and Hospice for Vermont and New Hampshire; and 24 Dartmouth-Hitchcock clinics that provide ambulatory services across New Hampshire and Vermont. The D-HH system trains nearly 400 residents and fellows annually, and performs world-class research in partnership with the Geisel School of Medicine at Dartmouth and the White River Junction VA Medical Center in White River Junction, Vt. Bed Count: 396
Formerly HealthSouth Rehabilitation Hospital, Encompass Health Rehabilitation Hospital of Concord provides a higher level of comprehensive services designed to return patients to leading active, independent lives. Accredited by the Joint Commission for meeting or exceeding their national standards of quality and safety, Encompass Health specializes in stroke, orthopedic, spinal cord, and brain injury rehabilitation utilizing intensive, customdesigned occupational, physical, and speech therapy programs coupled with specialized nursing care. Bed Count: 50
1 Elliot Way, Manchester (603) 669-5300 / elliothospital.org
Elliot Health System is a nonprofit organization serving the needs of the community since 1890. The largest provider of comprehensive health care services in Southern New Hampshire, Elliot Hospital, a 296-bed acute-care facility and the first community hospital in the state, serves as the cornerstone of the health system. Elliot is home to Manchester’s designated Regional Trauma Center, Elliot Breast Health Center, Elliot Urgent Care, a Level-3 Newborn Intensive Care Unit, Elliot Physician Network, Elliot Regional Cancer Center, Elliot Senior Health Center, Visiting Nurse Association of Manchester and Southern New Hampshire, Elliot Health System/ Dartmouth-Hitchcock 1-Day Surgery Center, Elliot Memory & Mobility Littleton Center, NH Arthritis Center, Regional Hospital Elliot Retail Pharmacy, Elliot Medical Centers Cottage Hospital in Londonderry and Hooksett and The Elliot at River’s Edge. Bed Count: 296
Upper Connecticut Valley Hospital
Weeks Medical Center Hospital
Androscoggin Valley Hospital
1 Medical Center Dr., Lebanon (603) 650-5000 / (603) 650-8034 dartmouth-hitchcock.org
2 New hampshire magazine | SMART HEALTH NH 2021
254 Pleasant St., Concord (603) 226-9800 encompasshealth.com/concordrehab
Elliot Hospital
Dartmouth-Hitchcock Medical Center
Dartmouth-Hitchcock Health (D-HH) is New Hampshire’s only academic health system and the state’s largest private employer, serving a population of 1.9 million across northern New England. D-HH provides access to more than 2,400 providers in almost every area of medicine, delivering care at its flagship hospital, Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon. DHMC was named again in 2020 as the No. 1 hospital in New Hampshire by U.S. News & World Report,
Encompass Health Rehabilitation Hospital
Dartmouth-Hitchcock Medical Center
Alice Peck Day Memorial Hospital
Memorial Hospital
Speare Memorial Hospital Huggins Hospital
Lakes Region General Hospital
New London Hospital
Crotched Mountain Rehabilitation Center
Monadnock Community Hospital
Frisbie Memorial Hospital
Franklin Regional Hospital
Valley Regional Hospital
Cheshire Medical Center
Encompass Health Rehabilitation Hospital New Hampshire Hospital Concord Hospital
Veteran’s Affairs Medical Center St. Joseph Hospital Southern NH Medical Center
Wentworth-Douglass Hospital
Catholic Medical Center Elliot Hospital
Portsmouth Regional Hospital Exeter Hospital
Hampstead Hospital Parkland Medical Center Northeast Rehabilitation
Exeter Hospital
5 Alumni Dr., Exeter (603) 778-7311 / exeterhospital.com
Exeter Health Resources is comprised of three affiliates — Exeter Hospital, Core Physicians and Rockingham Visiting Nurse Association (VNA) & Hospice. Exeter Hospital is a 100-bed community hospital with comprehensive services in breast health, cardiovascular, orthopedics, emergency care, the Family Center, the Center for Cancer Care with Massachusetts General Hospital Cancer Center physicians and more. Core Physicians is a patientcentered group practice offering primary care, pediatrics and more than 20 specialty services at locations throughout the Seacoast area. Rockingham VNA & Hospice provides high-quality home care, hospice and community outreach programs in the greater Seacoast area. Bed Count: 100
Franklin Regional Hospital 15 Aiken Ave., Franklin (603) 934-2060 / lrgh.org
Franklin Regional Hospital is a critical-access community hospital, offering a wide range of medical, surgical, specialty, diagnostic, as well as therapeutic services, wellness education, support groups, and other community outreach services. Bed Count: 25
Frisbie Memorial Hospital 11 Whitehall Rd., Rochester (603) 332-5211 / frisbiehospital.com
Frisbie Memorial Hospital has provided quality health care services to the greater Rochester community for over 80 years. By creating space for new services, programs and the latest diagnostic and surgical technology available they are committed to meeting the ever-changing health care needs of those communities they serve. Bed Count: 112
Hampstead Hospital
218 East Rd., Hampstead (603) 329-5311 / hampsteadhospital.com
Built in 1974, Hampstead Hospital was the first private psychiatric hospital licensed by the State of New Hampshire. The 100-acre landscaped grounds are a fully accredited private specialty hospital serving the psychiatric and chemical dependency needs of patients and their families throughout the area. Bed Count: 111
Huggins Hospital
240 S. Main St., Wolfeboro (603) 569-7500 / hugginshospital.org
Huggins Hospital is a nonprofit community hospital that endeavors to offer the best of two worlds — the warmth and friendliness of a small town and the technical expertise of modern medicine. Huggins provides medical services to a year-round population of 30,000 residents and approximately 120,000 seasonal residents and visitors who come from all over the world to enjoy the Lakes Region of New Hampshire. Bed Count: 25
Lakes Region General Hospital 80 Highland St., Laconia (603) 524-3211 / lrgh.org
Nestled in the beautiful Lakes Region of New Hampshire is LRGHealthcare, a nonprofit health care charitable trust representing Lakes Region General Hospital (LRGH) and Franklin Regional Hospital (FRH). It is a comprehensive provider
network with a broad array of services and programs. Bed Count: 137
Littleton Regional Healthcare 600 St Johnsbury Rd., Littleton (603) 444-9000 / littletonhealthcare.org
Little Regional Hospital values integrity, compassion, accountability, respect and excellence. It has made significant improvements, including expanding the campus and adding the latest in technology. More importantly, they have increased specialty services provided by highly skilled physicians and clinicians. LRH continues to work hard to meet the growing health care needs of those they serve. Bed Count: 25
Memorial Hospital
3073 White Mountain Hwy., North Conway (603) 356-4949 / memorialhospitalnh.org
Since 1911, Memorial Hospital has served with distinction all the critical access and health care needs of the Mt. Washington Valley community. Its hospital services include a 24-hour emergency room, surgery center, clinical laboratory, heart health and wellness programs, family birthing center, sleep center, wound care and hyperbaric medicine center. Bed Count: 25
Monadnock Community Hospital
452 Old Street Rd., Peterborough (603) 924-7191 monadnockcommunityhospital.com
In 1919, Robert M. Parmelee donated his summer home in Peterborough for use as a community hospital, and in 1923 “The Peterborough Hospital” opened its doors. Now known as Monadnock Community Hospital, its physicians and staff offer extensive services utilizing state-of-theart technology, while maintaining the personalized care of a community hospital. Bed Count: 25
New Hampshire Hospital 36 Clinton St., Concord (603) 271-5300 dhhs.state.nh.us/dcbcs/nhh
New Hampshire Hospital is a state-operated, publicly funded hospital providing a range of specialized psychiatric services. NHH provides acute treatment services for children, adolescents, adults and elders with severe mental illness. NHH advocates for and provides services that support an individual’s recovery. Bed Count: N/A
New London Hospital
273 County Rd., New London (603) 526-2911 / newlondonhospital.org
New London Hospital is a rural community hospital with a long-term extended care center dedicated to serving the Lake Sunapee region. Also a critical-access hospital, NLH shares an established relationship with a tertiary care hospital, met by a collaborative agreement with Dartmouth-Hitchcock Medical Center. Bed Count: 25
Northeast Rehabilitation Hospital Network
70 Butler St., Salem (603) 893-2900 / northeastrehab.com
Since opening its flagship location in Salem in 1984, Northeast Rehab has added three more acute rehabilitation hospitals located
in Nashua, Portsmouth and Manchester. Additionally, the network includes over 20 outpatient centers, a home care division, a sports medicine division, an outpatient pediatric division and many other services for those in need of rehabilitation. The leader of that effort, Howard Gardner, M.D., was an Army neurosurgeon who had seen, firsthand, the benefits rehabilitation was offering wounded soldiers. Returning to the Merrimack Valley and establishing a neuroscience practice, New England Neurological Associates, Dr. Gardner and his associates set out to build the first free-standing acute rehabilitation hospital in New Hampshire. Total Bed Count: 150
western New Hampshire and northern Massachusetts. The organization provides high-quality, compassionate care that contributes to the physical, emotional spiritual well-being of its community. St. Joseph Hospital, with 208 beds, is a designated Magnet hospital for nursing excellence, a Top Performer, and leads the way in the prevention, diagnosis and treatment of disease. Its extensive physician practice network is recognized for outstanding quality measures and personalized, patient-centered care. Bed Count: 208
Parkland Medical Center
181 Corliss Ln., Colebrook (603) 237-4971 / ucvh.org
1 Parkland Dr., Derry (603) 432-1500 parklandmedicalcenter.com
Parkland Medical Center serves southern New Hampshire with comprehensive, personalized medical care around the clock. Partnerships with The Lahey Hospital & Medical Center and the New England Heart and Vascular Institute bring specialized medicine by highly skilled physicians, innovative approaches to treatment and advanced technology to their patients. Bed Count: 86
Portsmouth Regional Hospital
Upper Connecticut Valley Hospital
Upper Connecticut Valley Hospital strives to improve the well-being of the rural communities it serves by promoting health and assuring access to quality care. Presiding over the nurses station, an etched portrait of Dr. William H. Gifford, considered to be the founding father, hangs with the inscription that he was “a man of magic, medicine and miracles.” Bed Count: 16
Valley Regional Healthcare 243 Elm St., Claremont (603) 542-7771 / vrh.org
Since the late 1800s, Portsmouth Regional has been delivering compassionate medical, surgical and mental health services with a tradition of exceptional responsiveness, patient satisfaction and community involvement. Portsmouth achieves high honors for quality patient care and holds several prestigious accreditations. Bed Count: 209
As well as a critical-access hospital, Valley Regional health care professionals are available to address cardiac care, childbirth, health care careers, hospital services, pediatric/child care tips, weight control and more. VRH also coordinates hospital tours and other programs for local organizations. The hospital offers these informational programs free of charge as a community service. Bed Count: 25
Southern New Hampshire Health System
Veterans Affairs Medical Center
Southern New Hampshire Medical Center began as an eight-bed emergency hospital in 1893 and has grown to an acute-care facility that retains the personal touch of a traditional community hospital. As a clinical affiliate of Massachusetts General Hospital, SNHH provides its patients with access to collaborative programs in pediatric specialties, cancer care, trauma, and the management of stroke. Bed Count: 188
Honoring America’s Veterans with quality health care services, part of the largest integrated health care system in the US the Veterans Affairs Medical Center in Manchester has expanded acute inpatient contract care at Concord Hospital. Bed Count: N/A
Speare Memorial Hospital
Weeks Medical Center’s caring and compassionate staff is committed to providing the highest quality and efficient health care services to the communities of New Hampshire’s North Country with satellite physicians offices in the towns of Whitefield, Groveton, North Stratford and Lancaster. Bed Count: 25
333 Borthwick Ave., Portsmouth (603) 436-5110 / portsmouthhospital.com
8 Prospect St., Nashua (603) 577-2000 / snhhealth.org
16 Hospital Rd., Plymouth (603) 536-1120 / spearehospital.com
From humble beginnings as a soldiers’ and sailors’ hospital to being nationally recognized as one of the best community hospitals, Speare Memorial Hospital is a 100,000-square-foot critical-access hospital adjacent to Plymouth State University. It strives to be a leader in helping the communities of central New Hampshire achieve optimal health. Bed Count: 25
St. Joseph Hospital
172 Kinsley St., Nashua (603) 882-3000 / stjosephhospital.com
St. Joseph Health is a regional fullservice health care system comprising St. Joseph Hospital, founded in 1908, and a large multispecialty physician group practice serving the greater Nashua area,
718 Smyth Rd., Manchester (603) 624-4366 / manchester.va.gov
Weeks Medical Center
173 Middle St., Lancaster (603) 788-4911 / weeksmedical.org
Wentworth-Douglass Hospital 789 Central Ave., Dover (603) 742-5252 / wdhospital.com
Conceived on March 15, 1904, WentworthDouglass Hospital is an acute-care hospital in the Seacoast region. In 1982, it became the first Seacoast hospital to be designated as a trauma center and incorporated as a nonprofit community hospital. Today it is one of the largest acute-care hospitals in the Seacoast Region. Bed Count: 178
SMART HEALTH NH 2021 | New hampshire magazine 3
t o y o u r h e a lt h
Your
Boosting
Immunity Need a Boost? Here’s Help From the Experts
Face masks, lockdowns, contact tracing, herd immunity: While so much about the onslaught of COVID-19 and our reactions to it has become controversial, one thing is certain — we could all use a little boost to our immune systems. An immune system that’s firing on all cylinders is important even in a typical flu season when it could mean the difference between riding out a fever at home and winding up in the hospital. With the additional threat of the novel coronavirus in our midst, that scenario is suddenly much more dire. So, along with hand washing, social distancing, mask use and the other good habits we’re all learning, here are some ways you can harden your core resistance to diseases of all sorts. We’ve asked four experts, each in a relevant specialty, to offer their best tips. And if we retain just a few of these best practices we’re all learning in this pandemic year, we may be on the path to a healthier state and nation once this crisis has dissipated into a horrid memory and a cautionary tale for the next generation.
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Go With Your Gut Better immunity through gut health
by Erin Holt, Certified Integrative & Functional Nutritionist You might have heard that 70-80% of our immune system lives in our gut. Specifically, what’s happening at the level of our intestines is super-important. I refer to the small intestine as “where the magic happens.” Not only is this where we extract nutrients from our food, but the lining of the small intestine also serves as a barrier system to keep the good stuff in and the bad stuff out. If there is any damage here, it can cause widespread inflammation and immune dysfunction, since our immune system lives just on the other side of this barrier. The large intestine is what houses the several pounds of bacteria, fungi and viruses collectively referred to as the gut microbiome. Without these little
critters, we don’t have a functioning immune system. Our microbiome regulates inflammation, provides protection against pathogens, aids in detoxification, and even produces important vitamins and compounds that help to modulate the immune system. So how do we support our guts — and by extension — our immune system? Contrary to popular belief, securing good gut health isn’t as simple as taking a probiotic pill. 1: You must remove the irritants in order to heal the gut. The good news is that the gut is self-healing and can regenerate every few days. But it can’t do that if it’s constantly being exposed to irritants. Think of it like a brick wall — if you’re
SMART HEALTH NH 2021 | New hampshire magazine 5
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removing bricks faster than you’re replacing them, you don’t have a very good barrier system. To support immune health, we should focus on reducing anything that promotes inflammation or damages the lining of the gut. This includes reducing refined sugars, processed carbohydrates, and food additives such as dyes and artificial flavors. Other overlooked things that negatively affect our microbiome are alcohol use (don’t shoot the messenger — alcohol suppresses the immune system and is a direct gut irritant), antibiotics, glyphosate, NSAIDs, BPA and even poor sleep. 2: Keep the good bacteria in our guts well fed and happy. Eat like it matters, because it does. Your gut and immune system are reliant on good nutrition. Here are the biggest things to focus on adding to your daily diet. • Lots of color. Pigment-rich fruits and veggies contain polyphenols, which help our healthy bacteria thrive. • Food rich in prebiotic fibers, such as root veggies and legumes, feed our good bugs.
• Naturally probiotic-rich foods, such as fermented veggies (think kimchi), also enhance our gut and immune system. • During this time, it’s not a bad idea to consume as many naturally antiviral foods as you can, including oregano, sage, rosemary, thyme, astragalus, garlic, ginger, shiitake mushrooms, peppermint, cinnamon and turmeric. Trying to summarize gut and immune health in a few hundred words is no easy task. I typically take a more comprehensive approach to nutrition and health, which is why I started a podcast three years ago. If you like to geek out on this stuff, be sure to tune in to “The Funk’tional Nutrition” podcast for weekly deep dives on gut health, immune health and more!
Erin Holt, of Erin Holt Health, can be reached at erinholthealth.com.
6 New hampshire magazine | SMART HEALTH NH 2021
Food for the
Good Fight Dietary recommendations to support optimal immune function by Nicole Schertell, N.D., C.C.T.
“Let food be thy medicine and medicine be thy food” are the wise words of Hippocrates, and this advice still stands true over 2,400 years later. A simple yet powerful way to maintain optimal immunity is by finding the willpower to say “No, thank you” to sugary treats over the holidays. Studies have shown spikes in sugar may dampen the effectiveness of our white blood cells to fight infection by 50%, lasting up to five hours after consumption — yikes! To satisfy a sweet tooth without compromising your immune function, reach for a square of “keto chocolate,” sweetened with a safer alternative, such as erythritol or Monk Fruit powder, and use these to sweeten your own baked goods. When it comes to supporting the immune system in dealing with COVID-19, there are several nutrients that are key players — specifically vitamin C, zinc, vitamin D and vitamin A. Intentionally selecting healthy foods that are dense in these
nutrients will empower you, and helps provide a level of control over your health when so much feels out of our control during the pandemic. Foods highest in vitamin C include broccoli, cauliflower, Brussels sprouts, red bell peppers, pineapple, kiwi, papaya, mango and strawberries — all of which offer even greater amounts of vitamin C than oranges. To boost vitamin A levels, consume foods high in betacarotene, which is a precursor to this antiviral nutrient. Examples include organic canned pumpkin (yes, canned provides more concentrated beta-carotene) and red/yellow/ orange vegetables like bell peppers. To boost zinc levels, snack on cashews or pecans, and seeds like pumpkin, sunflower and chia. More therapeutic levels of zinc may be achieved through inexpensive daily supplementation; however, supplements should be balanced, with a ratio of 10mg-to-1mg of zinc to copper when taken long term. Research demonstrating the importance of vitamin D for our health is vast. Studies have found that vitamin D could possibly reduce some impacts of COVID-19. We all know vitamin D comes from sunshine, but if you’re reading this magazine, chances are you’re headed toward a sunshine deficiency during winter. Since there are scarce amounts of vitamin D found in food products, supplementation may be required, and, in my experience, most of my adult patients require around 4,000iu of vitamin D3 daily throughout wintertime. Don’t be shy to request testing, and blood levels between 50-100ng/ml may offer optimal protection.
Lastly, a healthy gut has an extremely strong correlation to a person’s immunity. Consider making a batch of bone broth soup every Sunday to sip throughout the week. No time? Most grocery stores now carry quality bone broths made from organic or freerange livestock. Bone broth is rich in minerals, contains loads of collagen, and is a source for lipids, which are essential to white blood cell production. Fresh vegetables and other foods, like avocado and plain yogurt, can boost gut probiotic levels. All of these nutrients are critical for white blood cell count balance, reduction of inflammation and balanced immune function. Since ancient times, herbs have been used as natural treatments for various illnesses, including viral infections. In addition to the above dietary guidelines, there are a few herbs, spices and foodderived extracts that have potential for blocking viral replication, building immunity, balancing inflammation and offering mucolytic support. Based on my own research, I commonly recommend the following to my patients who are specifically seeking COVID-19 targeted immune support: NAC (N-acetyl cysteine), garlic, quercetin, eleutherococcus and andrographis. For more information about our naturopathic health care services, contact us for a free 15-minute informaNicole Schertell, N.D., C.C.T. tional consultation at Vibrant Health of Vibrant Health Naturopathic in Portsmouth, (603) 610-8882. Medical Center in Portsmouth SMART HEALTH NH 2021 | New hampshire magazine 7
t o y o u r h e a lt h
Live
la Pura Vida
by Lisa Maria-Booth
Danielle Perreault and I have been coaching healthy lifestyle for 30 years, sharing with the Fortitude community and the people of New Hampshire the holy grail of immunity, happiness and, ultimately, longevity. The secret really isn’t a secret. The Costa Ricans have been living la pura vida or, translated, good or simple life, for centuries. It works. Here are the principles: 1. Eat colorful foods that look the same as they did coming out of the ground. 2. Get at least seven hours of sleep per night. 3. Get outside into sunshine at least 15 minutes per day. 4. Surround yourself with people who make you happy and activities that bring you joy. 5. Love the decisions that you make.
6. Act naturally, be uninhibited. 7. And, drum roll, engage in daily vigorous activities. Break a sweat at least three times per week! At Fortitude, we coach the whole person. Your happiness, your immunity, your health and your longevity depends on the integration of these seven principles. Regarding breaking a sweat — that’s what we specialize in. The exercise you choose must bring you joy in order to be sustainable. I get on the treadmill, I go home, I show up the next day and get back on the treadmill, I go home ... you get it, boring. That’s sure to get old fast. It has to be fun, and it has to make your body feel great in order to stick with it and to give it 100%. Reap the benefits of variety. Whether you’re in personal
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training, attending a group class, an at-home livestream or part of a hybrid small group training, Fortitude believes in pulling from the following principles in order to bring spot on all levels exercise: classic strength training, higher-energy bootcamp, kickbox, barre, yoga and cycle. Mixing it up, outside and inside, with safe, yet challenging exercise that you truly enjoy, guarantees to keep those positive endorphins rolling. We all need that! Your brain stays sharp, and as an organ that works in tandem with the other organs in your body, it sends positive receptors out to keep your whole body healthy — heart health, cholesterol, liver and kidney health, respiratory health — the list goes on. Physiologically, each bout
of enjoyable (particularly whole-body dynamic cardiorespiratory) exercise instantaneously mobilizes billions of immune cells, especially those cell types that are capable of carrying out the recognition and killing of virus-infected cells. Our bodies were built to move; find safe and enjoyable ways to exercise and get through the winter months in top health. Live La Pura Vida! ●
Lisa Maria-Booth is the co-owner and CEO of Fortitude Health and Training in Manchester, and she is a certified personal trainer.
Your Best Shot at
Prevention by Alexander Granok, M.D., F.A.C.P.
By now, many of us know someone who has had COVID-19 and, hopefully, they came through it OK. The coronavirus, technically known as SARS-CoV-2, is one that has never infected people before, so we have no immunity to it. Our immune system is made up of a combination of white blood cells and special proteins in our blood and tissues, which recognize, attack and destroy foreign cells (like cancer), bacteria and viruses. Many people have asked me what they can do to stay healthy and prevent themselves from getting sick, and want to know if there something they can do to boost their immune system. First and foremost, the health of the immune system is intimately tied to our overall health. As simplistic as it may sound, it pays to eat right, exercise regularly and get plenty of sleep (never bad advice). Stress can have a very negative impact on the function of the immune system, so having a healthy, safe way to relieve stress such as practicing a favorite hobby or enjoying a vigorous workout is also very important. Taking care of chronic health conditions, such as diseases of the heart and lungs, and especially diabetes, will also benefit the immune system. High blood sugars reduce the effectiveness of white blood cells and puts you at increased risk of contracting a number of infections. It’s important to keep up to date on your vaccinations, whether you’re a child or an adult. Contrary to what some people think, vaccines don’t weaken your immune system. Vaccines provide your immune system the opportunity to encounter a weakened or inactive form of a bacteria or virus. This allows you to get a “head start” at fighting an infection should you ever run across the real disease, thus preventing serious illness or even death. Some viruses (influenza and measles, for example) can weaken your immune system, leading to additional infections, but fortunately, we have vaccines against these viruses. This year, especially, you should make sure your vaccinations are up to date. Finally, there is a growing body of medical literature that shows how vitamin deficiencies, particularly vitamin D deficiency, can lead to increased susceptibility to certain infections. Our bodies produce vitamin D when they are exposed to sunlight, and New Hampshire only sees around 200 sunny or partly sunny days a year. Furthermore, our northern latitude means Dr. Granok specializes that our winters are particularly dark. I therein infectious disease fore recommend that most people living here, and travel medicine in consultation with their health care providfor Southern New er, should consider taking a multivitamin or a Hampshire Health in Merrimack. standard vitamin D supplement. ● SMART HEALTH NH 2021 | New hampshire magazine 9
stress less health and stress, and ultimately find realistic ways to decrease levels of stress. The body’s stress response — known as “fight-or-flight” — is critical to survival and allows us to adapt to our ever-changing environment. Fight-or-flight is a complicated interaction between our nerves and the hormones
While eliminating stress from our lives completely will never be a realistic goal, there are several ways to prevent the negative effects of chronic stress.
Is Stress Weighing on You?
Understanding the link between chronic stress and obesity By Emily Hill, P.A.-C.
Obesity, chronic stress and poor sleep are common issues in modern society — and they all have an impact on each other. Stress, defined as a real or perceived threat that can be physical, psychological or social in nature, has been identified as a factor that may contribute to
obesity. Common sources of stress include relationship conflicts, a stressful work environment, financial struggles and lack of social support. At New England Weight Management Institute, we help our patients to understand the relationship between weight,
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that regulate stress. This reaction affects important body functions such as breathing, heart rate, blood pressure, hormone release and digestion. When fight-or-flight is activated, stress hormones signal to our body to increase sugar and fat in our blood stream to provide energy for important organs such as our brain, heart and muscles. Unfortunately, these hormonal changes can negatively affect many important body functions that are not necessary for immediate survival, such as digestion, growth and reproduction. Exposure to chronic stress can have a significant, spiraling impact on our health. Short-term stress can help give our body access to important energy stores. Long-term stress has the opposite effect, often making it more likely that energy is stored
as fat. This is especially true of fat stored in the midsection, which is associated with worsened health. Chronic stress can also lead to medical conditions such as high blood pressure, elevated cholesterol and diabetes. The release of a stress hormone called cortisol can increase a person’s appetite and result in cravings for foods high in fats and sugar. Unfortunately, these types of foods appear to worsen the brain activity involved in processing of stress and anxiety. Stress can also lead to insomnia or difficulty sleeping, decreased motivation, and increased alcohol consumption — all factors that can contribute to weight gain. While eliminating stress from our lives completely will never be a realistic goal, there are several ways to prevent the negative effects of chronic stress. Research has shown that some ways to help decrease your stress response include participating in regular physical activity, meditation or other relaxation techniques (such as breathing exercises), getting more sleep, keeping a journal, and talking to someone. Using a variety of these tools, even in small amounts, can have a significant positive impact on helping us manage stress and therefore help prevent the development of many diseases including obesity. If you would like to explore strategies to reach your weight goals, the team at CMC’s New England Weight Management Institute can offer you guidance on medical and surgical options, as well as long-term support. ●
Emily Hill, P.A.-C. CMC New England Weight Management Institute
SMART HEALTH NH 2021 | New hampshire magazine 11
detection & prevention
Breast Cancer Screening More important than ever by Rebecca Kwait, M.D., F.A.C.C. In today’s modern, fast-paced world, women are typically incredibly busy. Between motherhood, careers, taking care of family members, and volunteering in the community (even when there is not a pandemic occurring) self-care and regular screenings often slip down the totem pole of priorities. Some women actively avoid mammograms due to fear of a cancer diagnosis, pain, or concerns over radiation and cost. However, with a woman’s risk of developing breast cancer being 1
in 8 in her lifetime, screening is more important than ever. At Exeter Hospital’s Center for Breast Heath, we recommend that women start annual screening mammograms at age 40. This is in keeping with guidelines per the American College of Radiology (ACR) and the American Society of Breast Surgeons (ASBrS). Other guidelines exist, supporting delayed and less frequent screening patterns, however annual mammography in the 40-50 age group results in a
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reduction in breast cancer mortality of up to 29%. Importantly, more than 40% of the years of life lost to breast cancer are among women diagnosed in their 40s. These tumors tend to be more aggressive and more difficult to treat, hence why early detection leads to better outcomes. Women at higher risk should begin screening earlier. There are a number of risk factors for breast cancer, including age, family history, genetics, atypia, history of radiation, and hormonal and lifestyle factors. Many of these are outside of our control but certainly smoking, alcohol consumption, obesity, physical activity, and the use of hormone replacement therapy can be mitigated. Lifestyle improvements may help to lower risk but, in the meantime, additional options exist for screening high-risk women. At Exeter Hospital’s High Risk Breast Health Program, patients may undergo high-risk screening breast MRI, especially when they have dense breasts. Breast MRI, when combined with mammography, can increase the screening sensitivity of cancer detection, compared to mammography alone (94% vs. 38% in a pooled analysis). High-risk patients also have the opportunity to meet with a Massachusetts General Hospital medical oncologist to discuss chemopreventive strategies and can be referred for genetic evaluation, if appropriate. Few cancers are truly hereditary, i.e., related to a specific pathogenic gene
mutation that is passed from parent to child. The most well-recognized genes pertaining to breast cancer risk are BRCA 1 and 2. In only 5-9% of breast cancer patients do we find a clinically significant mutation, however this information can be critically important so that steps can be taken to reduce cancer risk, or help with early detection or even prevention. Patients with a BRCA mutation should initiate screening breast MRI at the age of 25 with routine mammography by the age of 30 and have the opportunity to discuss the risks, benefits and timing of prophylactic surgery with a breast surgeon. Discussing breast cancer family history with your doctor can help to determine whether a gene mutation such as BRCA could be present and referral to a high risk program warranted. The Center for Breast Health at Exeter Hospital is focused on helping women decrease breast cancer risk and obtain appropriate screening based on risk factors. The earlier the disease is detected, the smaller the chance of spread and the lower the likelihood that more aggressive therapies such as chemotherapy or mastectomy would be needed. Talk to your doctor about your breast health and initiate a screening today. Patients who appear to have a high risk for breast cancer may be referred to Exeter Hospital’s High Risk Breast Health Program. For more information, contact the Center for Breast Health at (603) 580-6867. ●
Rebecca Kwait, M.D., F.A.C.C. Core General Surgery/Exeter Hospital Rebecca Kwait, M.D., F.A.C.S. is the medical director at Exeter Hospital’s Center for Breast Health. She is a fellowship-trained breast surgeon with Core General Surgery, which is affiliated with Exeter Hospital. She works with Massachusetts General Hospital Cancer Center oncologists at the Exeter Hospital Center for Cancer Care, and plastic surgeon Dr. Kimberly Marble to treat breast cancer.
Here’s to Your Health! 2021 EDITION
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New Hampshire Magazine is dedicated to keeping our readers healthy and fit to fully enjoy life in the Granite State. Along with annual guides to the state’s top doctors, nurses and dentists, each issue showcases current medical trends, technology and expertise. Subscribe and check out our online resources at nhmagazine.com/health-education. 603 LIVING
HEALTH
HEALTH
Emotional Fitness Strategies for staying healthy BY KAREN A. JAMROG
Y
ou might figure you’ve got your physical health pretty well covered with regular exercise, healthful eating, and plenty of shut-eye. But don’t overlook your emotional fitness, which has far-reaching implications and, given the times we live in, might need a little more TLC than usual. Our mental outlook and emotions can affect more than our tendency to be grumpy or good-humored. Optimism, for example, has been linked with longer life and a significantly reduced risk of dying from several major causes of death, including cancer, heart disease, stroke, respiratory disease and infection.
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“There is a connection between what we think, what we’re feeling, what our behaviors are, and even how our body behaves physically in terms of illness and recovery,” says Ann-Marie Bishop, MSW, LICSW, an outpatient behavioral health clinician at Catholic Medical Center. “Our body tries to synchronize things so that they all work together, so if someone has a belief that ‘I’m going to be OK’ ... it leads to feeling better and it will kind of lean the body toward doing the things that it needs to do healthwise” to help achieve that outcome. Thoughts and feelings affect physical health indirectly by influencing behavior.
illustration by gloria diianni
People who are depressed, for example, might attempt to cope through substance abuse or misuse. They might sleep too much, eat poorly or withdraw from others, says Justin Looser, LICSW, ACHE, the New Hampshire market director for Behavioral Health at Frisbee Hospital, Parkland Hospital and Portsmouth Hospital. But thoughts and emotions alone can also directly affect our physical well-being. Stress, for example, prompts the body to release cortisol, a hormone that hampers the immune system, leaving us more susceptible to disease. Chronic stress raises the risk of many health problems, including heart disease, digestive trouble, headaches and weight gain. The correlation between what’s in our head and what happens in the rest of our body has gained increasing attention among healthcare professionals, Looser says, with the recognition that whether a doctor is treating high blood pressure or some other ailment, “if your patient is going back to a house that’s fraught with financial stress, marital problems, family problems — whatever it may be — you’re never going to get to the root of someone’s overall health unless you address all of their socioeconomic and psychosocial stressors.” Many primary care offices, Looser says, now employ therapists to supplement and dovetail with physical care. In addition, individuals can help themselves through a variety of techniques. The first step is to pay attention to what you’re thinking, Bishop says. Rather than going through your days on autopilot as so many of us do, try to recognize your habitual thought patterns and change the thoughts that you associate with situations that make
illustration by gloria diianni
Thoughts and feelings affect physical health indirectly by influencing behavior.
you anxious, stressed, angry or feeling some other negative emotion. Deep breathing, mentally “stepping away” from the problem, positive thinking, and believing in your ability to handle the situation will help defuse rising emotions so that the fight-or-flight instincts can “simmer down,” Bishop says, and enable the part of the brain related to reasoning and decision-making to think more clearly. These steps, along with seeking outside help when you need it, will not only improve your odds of achieving goals or making positive changes in your life, they will help you feel better and protect your physical health. “If you feel like you’re going to fail, then it’s more likely that you will,” Bishop says. “And if you feel like there might be a positive outcome and you feel that you can find a creative way to overcome things, then your brain and your body are going to follow suit. ... Calm thinking leads to calm chemicals [being released in the body],” which allows your body to relax and avoid the physical harm that can result from having a negative outlook or emotions. Emotional and mental health are not to be trifled with. “It’s an important subject,” Looser says, “and I think the largest thing we can do around mental health and physical health is to decrease the stigma around mental health and what that means. It’s a real thing [that] can be treated and cured” when problems arise. NH
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what’s known as the alphabet soup. “What gets people confused is the A, B, C, D of the Medicare parts, and then what makes it even more confusing is the Medicare supplement plans F, G and N,” says Alcorn. The G and F plans, he explains, have high deductibles, and people understandably confuse them with parts A through D. “I don’t know who came up with all these terms, but yikes,” he says. “It is mind-boggling. I only work in the Medicare space. It’s just so complicated that I focus only on this one thing,” says Alcorn, who has more than 40 years of experience in financial services. Trying to understand Medicare is so overwhelming that tomes are written on the subject. The US Department of Health and Human Services publishes and distributes, free of charge, the 120-page book “Medicare & You” annually. On its website (aarp. org) the AARP has dozens of articles and links to help decipher all the ins and outs of the program. An updated “Medicare for Dummies” by Patricia Barry will be released and available for sale on November 3. It is the fourth edition and contains a colossal 408 pages.
For better health, express yourself
If you struggle emotionally, don’t ignore it or keep it to yourself. To help safeguard physical as well as mental health, share your concerns or feelings with someone, whether it’s a family member, friend, healthcare provider or hotline worker, so that harmful emotions and thoughts do not escalate, says Justin Looser, LICSW, ACHE, the New Hampshire market director for Behavioral Health at Frisbee Hospital, Parkland Hospital and Portsmouth Hospital. Left to our own inner negative thinking, our thoughts tend to snowball. Work-related stress, for example, might initially manifest itself in sleepless nights, then progress to worries of job loss, and escalate into fears of losing home and family, “when the actual reality is unlikely to be that you’ll be homeless,” Looser says. Keeping worrisome thoughts to yourself enables them to intensify and to worsen stress and anxiety. To break the cycle, “let people know how you feel,” Looser says. “Letting that stress out of you and putting it out in the world ... makes it an actual thing that can lead to a plan to improve it. By keeping it in, those emotions will only continue to compound themselves” and potentially put physical health at risk.
The Basic Do’s and Don’ts of Medicare
2. Perform self-exams. Unfortunately, “a lot of women don’t do self-exams,” Kwait says. For some women, especially those with lumpy breasts, a self-exam can be anxiety-inducing, but regular self-exams will help you notice a lump that feels different from the others, or a firmness in the breast that previously did not exist. Perform your self-exam at the same time each month or at the same time within your menstrual cycle, and if something doesn’t feel right, tell your doctor right away.
Medicare coverage is available to anyone aged 65 or older who has worked at least 10 years in the United States, but there is no simple explanation of how it all works. To help cut through the chaos, Patricia Barry has written two companion books, “Medicare for Dummies” and “Medicare Prescription Drug Coverage for Dummies.” Here are some do’s and don’ts from the author, and free information can also be had from the federal government at medicare.gov or (800) 633-4227. • Do give yourself plenty of time to get informed about the many different plan choices and deadlines. • Don’t expect to be notified when to sign up unless you’re already
3. Know your family history. “Having a mother or sister with breast cancer doubles your own lifetime risk of breast cancer,” says Michael DeLeo, M.D., chief medical officer at Foundation Medical Partners in Nashua and a fellowship-trained radiologist who specializes in breast and oncologic imaging. Talk to your doctor about your risk and whether you should consider closer monitoring.
receiving Social Security benefits. Be proactive. • Do enroll before the deadlines to avoid permanent late penalties. • Don’t worry that poor health or preexisting conditions will deny you coverage or make you pay higher premiums. They can’t. • Do realize that this program isn’t free. You pay premiums and are responsible for certain copays. • Don’t assume Medicare pays for everything. There is a wide range of coverage, but there are gaps and that’s why you need to buy a Medicare Advantage or a Medicare Supplement plan.
You’ve planned well.
Steps to Breast Health
Now is the time to live well.
Understanding Medicare
Early detection and prevention both matter
The best way to explore life at The Huntington is to experience it for yourself.
To say it’s confusing is an understatement
by Karen a. Jamrog / illustration by gloria dilanni
T
here’s no getting around the fact that some of the risk factors for breast cancer, such as genetics and age, are out of our control. But there are steps you can take to maximize your breast health and minimize your chance of developing breast cancer.
by lynne snierson / illustration by victoria Marcelino
Y
ou’ve likely seen that TV ad with former NFL quarterback Joe Namath, the one where he assures you that all it takes to get no-cost, no-worries, full Medicare coverage stacked with free perks and benefits is a simple phone call to a toll-free number. Though Namath may have famously guaranteed his New York Jets would upset the heavily favored Baltimore Colts in Super Bowl III in 1969, these days his advice as the paid pitchman for a private, for-profit lead generator is no sure bet.
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“If you’re attracted by the Joe Namath commercials that say, ‘We’ll give you a zero premium and then we’re going to add all this other free stuff on to it,’ well, there is no free lunch,” says Dan Alcorn, who grew up in Nashua and is a nationally certified Medicare plan specialist, licensed agent and the principal of D.J. Alcorn & Associates headquartered near Albany, New York. “When you call that 800 number, you’ll just get a telemarketer on the other end of the line. I want people to make informed decisions,” adds Alcorn.
Easier said than done. Much easier. Medicare, currently covering 61 million Americans, is a federal health insurance program for people aged 65 and older and for some younger people who receive Social Security disability benefits. It sounds straightforward enough. But navigating the Medicare maze is oftentimes arduous at best. Not only are the rules and restrictions bewildering because they’re different for people in different circumstances — and can even be different for spouses — but you can easily drown in
1. Look in the mirror. Many of us rush through our daily routine with nary a glance at our unclothed body. Make it a habit to regularly pause and take a look in the mirror, says Rebecca Kwait, M.D., F.A.C.S., medical director and breast surgeon at Core General Surgery and Exeter Hospital’s Center for Breast Health. Look for subtle changes in the
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shape of your breasts or nipples, as well as discharge, and rippling, dimpling or redness in the skin. “Know what you’re starting out with,” Kwait says, so that you have a baseline for comparison if something changes.
4. Get an annual, clinical breast exam. Less than 10% of breast cancers are detected through clinical breast exams, Kwait says, “but when they are, those tend to be more aggressive.” If your healthcare provider does not routinely perform a clinical breast exam as part of your annual check-up, do not feel bashful about requesting one, she says. 5. Get a yearly mammogram. Numerous studies have shown that mammographic screening results in a highly significant decrease in breast cancer-specific mortality, Kwait says. For older women, especially, screening is well worth the time and temporary discomfort. “For example, women ages 60-69 who had mammograms had a 33% lower risk of dying from breast cancer compared to women who did not,” DeLeo says. Go for 3D screening (also known as to-
“Having a mother or sister with breast cancer doubles your own lifetime risk of breast cancer.” — Michael DeLeo, M.D.
replacement therapy, which can fuel breast cancer growth, DeLeo says. Ask your doctor whether you are at elevated risk and if you should have supplemental screening.
How to perform a breast self-exam
Women should perform a breast self-exam once a month, preferably at the same time within their menstrual cycle, says Rebecca Kwait, M.D., F.A.C.S., medical director and breast surgeon at Core General Surgery and Exeter Hospital’s Center for Breast Health. Not sure how to do it? Lying down, use the first few finger pads of the hand that is opposite the breast to make concentric circles, or to make a sweeping pattern across the breast from the outside toward the inside or from the inside to the outside of the breast — whichever way enables you to check all of the breast tissue. Feel for lumps and bumps and changes in your breasts over time, and gently squeeze each nipple to check for discharge. If you notice anything worrisome, contact your doctor. For more information about breast health, see breast360.org, the website of the American Society of Breast Surgeons Foundation. Also see the Susan G. Komen website at ww5.komen.org. mosynthesis), a technology that is available at many New Hampshire hospitals and that provides valuable imaging particularly of dense breasts. While dense breasts are common and normal, women who have them face a breast cancer risk that is 1.5 to 2 times higher than that of women who do not have dense breasts, DeLeo says. Guidelines vary regarding the scheduling of mammograms, DeLeo says, but many
medical groups recommend that women of average risk have a screening mammogram every year starting at age 40. 6. Talk to your doctor. Incidence of breast cancer is high; within the average population, one in eight women will develop breast cancer in her lifetime. But many women face even higher risk due to a number of factors such as the use of hormone
7. Lead a healthy lifestyle. The main lifestyle factors for breast cancer that women can control, Kwait says, are weight, body mass index (BMI, a measure of body fat), physical activity, alcohol use, smoking and hormone replacement therapy use. Obese women have a higher risk of breast cancer than women who are not obese. “Even just a 5-10% weight reduction in women who are overweight can significantly reduce their risk for breast cancer,” Kwait says. As for alcohol consumption, if you’re wondering how much alcohol is OK, experts say to drink alcohol in moderation or not at all, which means women should have no more than one 5-ounce glass of wine, one 12-ounce beer or 1 ounce of spirits per day. Also note that “you can’t bank your drinks,” DeLeo says. “You can’t not drink for say, three days, and then [overindulge] the following day. It doesn’t work that way.” NH
EVEN APART, WE STAY
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JOIN THE MAKING STRIDES AGAINST BREAST CANCER MOVEMENT IN NEW HAMPSHIRE Making Strides has always been more than just a walk — it’s a movement. This fall will look different but our passion to end breast cancer is the same. We envision a future where our children will no longer live with the threat of breast cancer. But that future is at risk, so we need you. Get involved today. Visit www.MakingStridesWalk.org to learn how you can make an impact on the fight against breast cancer in your community.
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convenient care
Health & Vitality Renew your organization’s health in 2021 by Kristen Trimble, M.S.N., A.P.R.N., F.N.P-C. As Americans took unprecedented precautions to protect themselves from COVID-19, upward of 85 million adults are estimated to have delayed medical care in 2020 due to their concerns about COVID-19. Similarly, many children have not received routine health or dental care due to the virus. Preventative health care is a key to long-term health and vitality. Here are some tips for catching up on routine care and renewing the health of yourself, your staff and their families. Offering routine testing at your facility can be a vital component to the wellness of your company. Mobile health providers like On-Site Medical Services, based
in Newport, New Hampshire, bring a variety of convenient, cost-effective medical services to employers. Mobile testing, screening, telehealth and health care apps such as Wellbility are some of health care’s fastestgrowing segments. Remind your employees to check with their doctors to see what tests, immunizations and procedures are overdue. Most adults get annual or biannual dental and eye exams, and physicals that include screenings for high blood pressure, cardiovascular disease, diabetes, certain cancers and mental health conditions. Calls can be placed to providers to inquire about the
safety measures in place, and changes in office procedures, such as seeing patients without symptoms during certain days or hours. Many providers now offer telemedicine appointment options, such as a video consult. Telemedicine has become an important feature of medical practices and is expected to be a standard practice in postpandemic times. On-Site Medical Services provides state-of-the-art mobile screenings for COVID-19, influenza, strep throat, and for drug, alcohol and nicotine use. On-Call Telehealth is available 24 hours a day, seven days a week. Wellbility
is the app that makes tracking COVID-19 symptoms easy and effective for organizations. With features such as a symptom assessment tool, which prompts users to take appropriate clinical steps, Wellbility puts the power of health and wellness in your hands. Keeping your staff healthy and safe is the best way to ensure that your doors remain open throughout 2021. ●
Kristen Trimble, M.S.N., A.P.R.N., F.N.P-C., chief health officer, On-Site Medical Services and WellbilityTM
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1 Pillsbury St., Concord (603) 223-2300 1279 South Willow St., Manchester (603) 644-3330 14 Broad St., Nashua (603) 889-2354 concentra.com
3 Nashua Rd., Bedford (603) 472-6700 73 Daniel Webster Hwy., Belmont (603) 737-0550 8 Loudon Rd., Concord (603) 226-9000 14 Webb Place, Dover (603) 742-7900 351 Winchester St., Keene (603) 352-3406 551 Meadow St., Littleton (603) 761-3660 42 Nashua Rd., Londonderry Coming soon 2 Dobson Way, Merrimack (603) 471-6069 565 Amherst St., Nashua (603) 578-3347 599 Lafayette Rd., Portsmouth (603) 942-7900 1 Portsmouth Ave., Stratham (603) 772-3600 125 Indian Rock Rd., Windham (603) 890-6330 convenientmd.com
Core Physicians Advanced Appointment Access Offering same-day appointments and extended office hours. After hours available at: 9 Buzell Ave., Exeter Early Morning Pediatric Walk-In 9 Buzell Ave., Exeter 212 Calef Hwy., Epping corephysicians.org
Concord Hospital Walk-In Urgent Care 60 Commercial St., Concord (603) 230-1200 concordhospital.org
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Elliot at River’s Edge
185 Queen City Ave., Manchester (603) 663-3000 elliothospital.org
Elliot Urgent Care at Londonderry
40 Buttrick Rd., Londonderry (603) 552-1550 elliothospital.org
Elliot Weekend After Hours Clinic
275 Mammoth Rd., Manchester (603) 626-5113 elliothospital.org
Exeter Hospital: Fast Track Division of the Emergency Department (ED) 5 Alumni Dr., Exeter (603) 580-6668 exeterhospital.com
ExpressMED Urgent Care 1 Highlander Way, Manchester (603) 625-2622 35 Kosciuszko St., Manchester (603) 627-5053 159 N. Broadway, Salem (603) 898-0961 expressmednh.com
Health Stop
228 Daniel Webster Hwy., Nashua (603) 888-9200 healthstopnashua.com
Immediate Care of Southern NH 8 Limbo Ln., Amherst 300 Derry Rd., Hudson 696 Daniel Webster Hwy., Merrimack 112 Spit Brook Rd., Nashua 29 Northwest Blvd., Nashua 33 Windham Rd., Pelham (603) 577-2273 for all locations immediatecareofsnh.org
11 John Stark Hwy., Newport (603) 863-4100 newlondonhospital.org
Occupational Health Services Convenience Care Hillside Medical Park 14 Maple St., Lot C, Gilford (603) 527-2896 lrgh.org
Parkland Urgent Care at Salem 31 Stiles Rd., Salem (603) 890-2727 parklandmedicalcenter.com
Saco River Medical Group 7 Greenwood Ave., Conway (603) 447-3500 15 Rte. 302, Glen (603) 383-3005 sacodocs.com
Seacoast RediCare
396 High St., Somersworth (603) 692-6066 seacoastredicare.com
Walk-In Care at Memorial Hospital
3073 White Mountain Hwy. North Conway (603) 356-5461 memorialhospitalnh.org
Wentworth-Douglass Express Care 701 Central Ave., Dover (603) 609-6700 65 Calef Hwy., Lee (603) 868-8507 wdhospital.com/express
White Mountain Medical Center 2531 White Mountain Hwy. Sanbornville (603) 522-0186 frisbiehospital.com/walk-in-care
a m b u l at o r y S u r g e r y g r o u p s AVH Surgical Associates 7 Page Hill Rd., Berlin (603) 752-2300 avhnh.org
Barrington Surgical Care 141 Rte. 125, Barrington (603) 664-0100
Bedford Ambulatory Surgical Center
Nashua Eye Associates 5 Coliseum Ave., Nashua (603) 882-9800 555 Nashua St., Milford (603) 672-8800 30 Lowell Rd., Hudson (603) 598-6400 nashuaeye.com
NH Eye SurgiCenter
11 Washington Pl. #1, Bedford (603) 622-3670 bedfordsurgical.com
105 Riverway Pl., Bedford (603) 627-9540 nheyesurgicenter.com
Concord Ambulatory Surgery Center
Northeast Surgical Center
60 Commercial St., Ste. 301 Concord (603) 415-9460 concordasc.com
Concord Eye Surgery Hospital Campus
248 Pleasant St., Ste. 1600, Concord (603) 224-2020 South Campus 2 Pillsbury St., Ste. 100, Concord (603) 228-1104 concordeyecare.com
The Cottage Hospital Day Surgery Center
90 Swiftwater Rd., Woodsville (603) 747-9156 cottagehospital.org
Elliot Health System and Dartmouth-Hitchcock 1-Day Surgery Elliot at River’s Edge
185 Queen City Ave., Manchester (603) 663-5900 dartmouth-hitchcock.org
Hillside Surgery Center 14 Maple St., Gilford (603) 524-7514 hillsidesurgerycenter.com
Laconia Clinic Ambulatory Surgical Center 724 Main St., Laconia (603) 524-5151 laconiaclinic.com
Nashua Ambulatory Surgical Center
2299 Woodbury Ave., Newington (603) 446-6278 northeastsurgerycenter.com
Orchard Surgical Center 16 Keewaydin Dr., Salem (603) 401-6466 http://orchardsurgical.com
Orthopaedic Surgery Center 264 Pleasant St., Concord 14 Tsienneto Rd., Ste. 100, Derry (603) 224-3368 concordortho.com
Portsmouth Regional Ambulatory Surgery Center
333 Borthwick Ave., Ste. 200, Portsmouth (603) 433-0941 http://prasc.com
Skyhaven Surgery Center 13 Health care Dr., Rochester (603) 509-9161 frisbiehospital.com/locations/ skyhaven-surgical-center
Stratham Ambulatory Surgery Care 4 West Rd., Stratham (603) 772-2076 strathamasc.com
Surgery Center of Greater Nashua
10 Prospect St., Ste. 101, Nashua (603) 578-9909 surgerycenternashua.org
Wentworth Surgery Center, LLC 6 Works Way, Somersworth (603) 285-9288 wentworthsurgerycenter.com
15 Riverside St., Nashua (603) 882-0950 nashuasurgical.com
SMART HEALTH NH 2021 | New hampshire magazine 17
elder care services
SENIOR RESIDENCES BY REGION
The following is a list of retirement, assisted living and residential care facilities in New Hampshire. Hunt Community
RiverMead Retirement Community
Huntington at Nashua
Summerhill Assisted Living
Langdon Place of Nashua
Dartmouth/ Lake Sunapee
10 Allds St., Nashua (603) 882-6511 / huntcommunity.org 55 Kent Ln., Nashua (800) 298-6608 thehuntingtonatnashua.org 319 East Dunstable Rd., Nashua (603) 888-7878 sunbridgehealthcare.com
Nashua Crossings
Seacoast Clipper Harbor of Portsmouth
188 Jones Ave., Portsmouth (603) 431-2530 25 Worthen Rd., Durham sunbridgehealthcare.com / (603) 292-3147
Harmony Homes Assisted Living
40 Briggs Way, Durham, (603) 292-5175 1 Stagecoach Rd., Durham (603) 292-6087 harmonyhomesnh.com
Langdon Place of Dover
60 Middle Rd., Dover / (603) 743-4110 sunbridgehealthcare.com
Maple Suites
30 Holiday Dr., Dover (603) 617-4413 / holidaytouch.com
The Mark Wentworth Home 346 Pleasant St., Portsmouth (603) 436-0169 markwentworth.org
RiverWoods at Exeter
7 Riverwoods Dr., Exeter (800) 688-9663 / riverwoodsrc.org
Birch Hill
200 Aliance Way, Manchester (603) 626-7721 / birchhillterrace.com
Carlyle Place
40 Rte. 101, Bedford / (603) 472-2000
Courville at Manchester
Summercrest Senior Living
The Birches at Concord
Sunapee Cove Independent and Assisted Living
200 Pleasant St., Concord (800) 678-1333 presidentialoaks.org 300 Pleasant St., Concord (603) 369-4417 benchmarkseniorliving.com
The Residence at Salem Woods
Windham Terrace
Greystone Farms
242 Main Street, Salem (603) 898-5393 benchmarkseniorliving.com
Hanover Hill Health Care Center 700 Hanover St., Manchester (603) 627-3826 / hanoverhill.com
Havenwood-Heritage Heights 33 Christian Ave., Concord (800) 457-6833 / hhhinfo.com
3 Church Rd., Windham (603) 437-4600 windhamterrace.com
Monadnock region Bentley Commons
197 Water St., Keene (603) 499-4546 / kapdev.com
Langdon Place of Keene 136 Arch St., Keene (603) 357-3902 sunbridgehealthcare.com
Maplewood Assisted Living
201 River Rd., Westmoreland (603) 399-4912 / co.cheshire.nh.us
Langdon Place of Exeter 17 Hampton Rd., Exeter (603) 778-1024 sunbridgehealthcare.com
Webster at Rye
795 Washington Rd., Rye (603) 964-8144 / websteratrye.com
Merrimack Valley All American Assisted Living
1 Button Dr., Londonderry (603) 537-9898 / allamericanal.com
Arbors of Bedford
70 Hawthorne Dr., Bedford (603) 647-9300 benchmarkseniorliving.com
Aynsley Place
80 Lake St., Nashua / (603) 881-4190
Bedford Falls
5 Corporate Dr., Bedford (603) 471-2555 bedfordfallsassistedliving.com
Bentley Commons
66 Hawthorne Dr., Bedford (603) 644-2200 bentleyatbedford.com
Birch Heights
7 Kendall Pond Rd., Derry (603) 505-4398 / birchheights.com
125 Mascoma St. #23, Lebanon (603) 448-7474 / alicepeckday.org
Presidential Oaks
Courville at Nashua
151 Langley Pkwy., Concord (603) 224-0777 / graniteledges.com
Harvest Hill
Kendal at Hanover
6 Sally Sweets Way, Salem (603) 890-0580 residencesalemwoods.com
Granite Ledges of Concord
183 Old Dublin Rd., Peterborough (603) 924-6238 / summerhillal.com
674 West Hollis St., Nashua (603) 882-2898 benchmarkseniorliving.com
44 West Webster St., Manchester (603) 647-5900 22 Hunt St., Nashua / (603) 889-5450
150 Rivermead Rd., Peterborough (603) 924-0062 / rivermead.org
80 Lyme Rd., Hanover (603) 643-8900 / kah.kendal.org 169 Summer St., Newport (603) 863-8181 / summercrest.net
1250 Route 11, Georges Mills (603) 763-0566
Wheelock Terrace 32 Buck Rd., Hanover (603) 643-7290 wheelockterrace.com
Woodcrest Village LLC 356 Main St., New London (603) 526-2300 woodcrestvillage.com
Lakes region Golden View Health Care Center 19 NH Route 104, Meredith (603) 279-8111 / goldenview.org
The Golden Crest
29 Baldwin St., Franklin (603) 934-6742 thegoldencrestnh.com
Wolfeboro Bay Care and Rehabilitation Center 39 Clipper Dr., Wolfeboro (603) 569-3950 sunbridgehealthcare.com
ADULT DAY CARE CENTERS All Generations Adult Day Program
Huggins Hospital — Adult Day Care
Silverthorne Adult Day Care Center
Castle Center for Adult Group Day Care
Kearsarge Good Day Respite Program
The Homemakers Health Services
460 Amherst St., Ste. 4, Nashua (603) 880-3473 allgenerations.com
312 Marlboro St. Keene, (603) 352-2253 caring.com
Connecticut Valley Home Care Day Out
958 John Stark Hwy., Newport (603) 542-7771 vrh.org/content/CVHC/day_out.php
Easterseals New Hampshire
555 Auburn St., Manchester (603) 623-8863 easterseals.com/nh
Gateways Adult Day Service Program 200 Derry Rd., Hudson (603) 882-6333 gatewayscs.org
18 New hampshire magazine | SMART HEALTH NH 2021
240 South Main St., Wolfeboro (603) 569-7500 hugginshospital.org
82 King Hill Rd., New London (603) 526-4077 kcpcnlnh.com/missions-good-day-respite. html
Monadnock Adult Care Center 22 North St., Jaffrey (603) 532-2428 mfs.org
Sarahcare Adult Day Services 201 Rte. 111, Hampstead (603) 329-4401 sarahcare.com
Seaside Elderly Day Out Center 441 Rear Lafayette Rd., Hampton (603) 929-5988 seasideelderlydayoutcenter.com
23 Geremonty Dr. Salem, (603) 893-4799 silverthorneadultday.org
215 Rochester Hill Rd., Rochester (800) 660-1770 thehomemakers.org
TLC Medical Day Care For Adults 211 Loudon Rd., Courtyard Square, Concord (603) 415-3435 adultday-servicesnh.org
Upper Valley Good Day Respite Program
18 School St., Lebanon (603) 526-4077 lakesunapeevna.org/services/ upper_valley_respite
Vintage Grace Adult Medical Day Program
12 Peabody Rd. Derry, (603) 425-6339 vintagegrace-online.com
r i s k vs r e w a r d
First
do no harm With Covid-19 not going away anytime soon, patient safety protocols have never been more important by Matthew Wilkening, M.D. On March 4, Kenwood “Woody” Jones Jr. walked into my office with worsening back pain, an MRI showing severe nerve compression, and several months of unsuccessful physical therapy. He was ready to discuss surgery, but previous operations made a definitive solution complicated. “Surgery might not be worth the price of recovery,” I told him, “Look at it this way — you can still walk.” I ordered additional imaging studies and asked him to follow up in two weeks.
Nine days later, COVID-19 was a national emergency. Area hospitals canceled all elective surgeries, and apocalyptic images began emanating from Queens, New York. Businesses had to decide how to remain viable due to mandatory closures and limited customers. With few patients willing to venture into a clinic, and elective surgeries canceled, our practice faced an existential dilemma: Stay open and risk bankruptcy, or furlough employees, divert
20 New hampshire magazine | SMART HEALTH NH 2021
patients and protect the practice. Trust is the basis for the unique relationship between patients and surgeons. It permits the shared and intimate dichotomy of risk and reward. In the chaos of canceled appointments and uncertain finances, our doors stayed open because our patients trust that we will be there when they need us. Woody was one such patient. When he returned on March 18, Woody could no longer walk. In the early days of the pandemic, treating patients while protecting them from COVID-19 was a task for which we lacked even the most basic knowledge. Forget treatment protocols and optimal ventilator settings — we didn’t even know who among us might already be infected. In the months since the crisis began, hospital staff worked tirelessly to develop extensive safety measures: They created isolated wards, testing became nearly instantaneous and mandated, and N95 protection was at last abundant. None of that existed when Woody was presented with an option — risk exposure and undergo surgery that might reverse his symptoms, or play it safe from his wheelchair and accept them as permanent. Woody chose surgery. COVID-19 has forced us to rethink the status quo. At New Hampshire Orthopaedic Center, we took advantage of changes to CMS guidelines and were among the first to offer telehealth services. Patients can wait in their cars until their turn for evaluation, and those who choose the waiting room will find chairs socially distanced and
fewer people. Masks are mandatory for both staff and patients, and every room is thoroughly cleaned between patients. In Woody’s case, something even more drastic was in order. He convinced me to send him home the day after surgery, unable to walk, with a drain in his back, and pain that was controlled only by oral medications and his iron will. For the first week I visited his home, and for months afterward he relied on friends, neighbors and his indefatigable wife Linda to provide day-to-day support. In many ways, Woody’s recovery has mirrored the struggles of our nation. Some of his loss will be permanent. It has been a monumental effort even to regain what strength he has. But when he came for his follow-up visit at the end of July, with the aid of a walker, Woody stood up and walked. New Hampshire Orthopaedic Center has been serving most of southern New Hampshire for more than 30 years. We evolved from small groups of well-trained general orthopedists to a consolidated group of fellowshiptrained subspecialty orthopedic surgeons. We offer a full range of subspecialty orthopedic surgery, including sports medicine, arthroscopy, total joints, hand and upper extremity, foot and ankle, and spine. Our subspecialty focus allows us to provide the most up-to-date and focused care. One of our subspecialties is in spine, which includes both cervical spine or neck issues, as well as lumbosacral or back issues. ● Matthew Wilkening, M.D. Dr. Wilkening is a spine surgeon at New Hampshire Orthopaedic Center. Kenwood “Woody” Jones Jr. is a New Hampshire native, lifetime skier and retired co-owner of Ken Jones Ski Mart.
We all have a lot to carry these days! Let our spine team take the pressure off.
Meet Our Spine Team: Christian M. Klare, MD, Dinakar S. Murthi, MD Matthew W. Wilkening, MD