Smart Health 2022 Edition

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A publication of





Mental Health: Reasons for Hope page 9

Don’t Forget About Coping With Return- Vaccine Schedules Essential Screenings to-School Anxiety Explained page 10

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NH Hospitals

Coping With Covid

The Pandemic’s Hidden Toll

Walk-In Care Centers

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Reasons for Hope Page 9

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Page 14 Elder Care Services Page 16

Essential Health and Cancer Screenings

Healthier Than Ever

Ambulatory Surgery Groups

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Taking the Extra Step

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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. Specialty Hospitals are Highlighted in Red

Alice Peck Day Memorial Hospital 

10 Alice Peck Day Dr., Lebanon (603) 448-3121 /

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 /

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 /

79 Swiftwater Rd., Ste. 2, Woodsville (603) 747-2900 /

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

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 /

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 /

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 /

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


254 Pleasant St., Concord (603) 226-9800

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 /

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 /

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 /

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 /

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 /

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 /

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 /

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 /

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

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

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 /

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 /

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 /

1 Parkland Dr., Derry (603) 432-1500

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 /

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 

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 /

8 Prospect St., Nashua (603) 577-2000 /

16 Hospital Rd., Plymouth (603) 536-1120 /

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 /

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 /

Weeks Medical Center 

173 Middle St., Lancaster (603) 788-4911 /

Wentworth-Douglass Hospital  789 Central Ave., Dover (603) 742-5252 /

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






Covid-19 is like one of those horror-movie monsters that just won’t die. The vaccines offered — and still do — much hope, but the virus continues to mutate and spread, leaving us to make our way through each day knowing that it’s lurking, perhaps closer than we might think. It’s a beast that presents numerous threats, from illness and death to economic worries and isolation. “This is the sort of experience that researchers — social scientists, mentalhealth researchers — will be studying for a long time to come because it’s so multifaceted,” says Robert E. Brady, Ph.D., director of Dartmouth-Hitchcock psychology training programs and director of the anxiety disorders service at Dartmouth-Hitchcock. ➜




hile grim death counts, images of people on ventilators, and news of makeshift morgues provide stark reminders of Covid-19’s effects on physical health, reports of increased depression, anxiety and substance abuse quietly reflect the harm done to our mental and emotional well-being. People of low socioeconomic status have been among the hardest hit, experiencing “increased depression and an increase in a sense of helplessness,” says Justin Looser, L.I.C.S.W., A.C.H.E., market director for behavioral health services at Portsmouth Regional Hospital, Parkland Medical Center and Frisbie Memorial Hospital. Individuals who already struggled with mental illness before the pandemic are now largely limited to using telehealth services, which further isolates them, he says. Social isolation has also been particularly rough for the elderly. “The older population has certainly seen spikes in anxiety and depression,” Looser says. “A lot of those folks aren’t as tech-savvy as teenagers and people in their 20s who have grown up with that technology. Our older generation really counted on being able to meet people in person.” The loss of connection — not being able to see and touch people — can be very difficult, he says. And masks, as valuable and necessary as they are, worsen the emotional disconnect that many people feel. The general uncertainty that surrounds many aspects of the pandemic also wears on people. “[There] is a very deep-seated anxiety around that feeling of not knowing,” Looser says. “Even though we’ve been in the pandemic for over a year now, people often aren’t sure what the best thing is

For help or more information about mental health, contact: Anxiety & Depression Association of America at Association for Behavioral and Cognitive Therapies at American Psychological Association at NH Chapter of the National Alliance on Mental Illness at


to do. ... [There is] real anxiety around ‘Can I go out?’ ‘Should I go out?’ ‘Should I see my friends?’ ‘Can I go out to dinner?’ ‘I don’t want to go out to dinner. Is that okay?’” Indeed, humans like to have a reliable routine, Brady says. If our fairly predictable life suddenly changes and the range of what we can do is abruptly restricted, “that is mentally taxing because we have to now make decisions in ways that we didn’t have to before,” Brady says. We have to think more about what to do when. Having to create a new routine, he says, “is stressful for folks.”

“This is the sort of experience that researchers — social scientists, mental-health researchers — will be studying for a long time to come because it’s so multifaceted.” — Robert E. Brady, Ph.D.

A sense that external forces are largely driving our lives also makes us uneasy. “When things are out of your control, you can feel out of control as well,” Looser says, “and that’s when anxiety starts to kind of creep in.” Even worse, anxiety tends to feed upon itself, he says, intensifying and multiplying the worries that swirl in our minds. The pandemic delivered yet another blow to our mental well-being by stripping away many of our go-to coping mechanisms. “We have seen increases in anxiety, depression and substance abuse not just because of the [pandemic-related] fear, which is real, but also the sudden withdrawal of the usual means of coping” that people in normal times relied upon, Brady says. Someone who visited with friends and family, for example, or went to the gym for a mental break and stress relief but now can’t do those things “feels like they’re kind of floundering,” Brady says, “so there would absolutely be an expectable increase” in their anxiety and depressive feelings. Attempting to subdue anxiety and other emotions through substance use is clearly not a wise choice, but one that many people appear to make. Research reported in JAMA Network Open indicated that across the country, frequency of alcohol consumption among adults aged 30 and older in 2020 increased 14% compared to 2019. Among women, heavy-drinking episodes spiked a whopping 41% compared to 2019. In general, boredom, easier access to alcohol via home delivery and curbside pick-up, and anxiety stemming from the pandemic have been cited as possible contributors to increased alcohol use. Prior to the pandemic, New Hampshire already had a substance-abuse problem, ranking among the highest in the nation for overdose deaths related to opiates. COVID-19 has not helped matters. In addition to seriously endangering




Three Hospitals. One System. We are a charitable organization which exists to meet the health needs of individuals within the communities we serve.

CONCORD | LACONIA | FRANKLIN 250 Pleasant Street Concord, NH 03301

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T O Y O U R H E A LT H Tips to help you stay mentally healthy during the pandemic ➜ In addition to experiencing Tilt-A-Whirl-like changes during the pandemic, many of us have lost access to activities that provided positive reinforcement or reward, Brady says, such as working out at a gym or dining out with friends. Make it a point to adapt favorite activities that you’ve been missing — say, by taking online exercise classes if you’re a gym goer — or learn a new one. “I always am heartened when I hear about the sudden and new enjoyment of bread making,” Brady says. “That is an example of adaptation. It’s the very reason,” he says, “why I now have about 10 pounds of tomatoes. I got into gardening.” Seek out healthful or at least not-harmful behaviors that make you feel happy or rewarded, and keep the good feelings coming.

➜ Avoid information overload. “[Covid] is obviously on the top of our minds,” but taking in a steady stream of pandemic news is not likely to help your mental outlook, says Robert E. Brady, Ph.D., director of Dartmouth-Hitchcock psychology training programs and director of the anxiety disorders service at Dartmouth-Hitchcock. That does not mean you should ignore or avoid all Covid news or updates, “but we need to moderate our intake of that information.”

physical health, excessive alcohol consumption and substance abuse — examples of what experts call maladaptive coping methods — can exacerbate whatever mental troubles we are trying to escape. Having a drink, for instance, might temporarily alleviate anxiety, but because alcohol is a depressant, in the end it compounds anxiety and depression, and leads people “into a more isolated environment,” Looser says. Help for depression, anxiety and substance abuse is out there if you need it, although there might be a bit of a wait; even before the pandemic, a shortage of qualified providers made available appointments scarce. People looking for treatment should keep in mind that they might not necessarily need a licensed psychologist, Brady says. (They should, however, check provider qualifications and look for interventions or services that are evidence-based.) “We do not have, in my opinion, a shortage of mental-health treatments,” he says. “We have a shortage or a deficit of access to those treatments.” Some people might want to consider innovative ways to receive care, such as through telehealth, mental-health apps — some of which are free, some modestly priced, Brady says — or text-based counseling that is akin to using a chat function to communicate with a therapist. For an old-school, analog option, check out self-help books, some of which include


many of the same foundational principles as those used for in-person therapy, Brady says. There are drawbacks to therapy that is not face-to-face, though. For example, not everyone has access to technology, practitioners are still needed to provide some of the electronically delivered services, and patients who try therapy from a distance might find that “it’s harder to engage” and be successful with it, Brady says. If you are “really struggling” and need help right away, Looser says, “as a last resort, you can always go to an emergency room.” One thing everyone can and should do to help themselves, he says, is to “reach out to just anybody and start a discussion of how you feel. I think people don’t do that because of the stigma [related to mental health]. But once we put that out there and say, ‘Hey, I’m having a really hard time. I’m feeling increasingly anxious’ or however you feel — once you explain how you feel to anybody — that opens up a dialogue, and it frees you from that feeling a little bit.” That doesn’t mean people shouldn’t seek professional help, Looser adds. “Community mental health centers, therapists, hospitals — all have avenues where you can reach out for that help, but the first step is to know you’re not doing OK, and it’s OK to not feel OK. If you hold that in, it’s just going to compound upon itself.” ●

Mental Health: Reasons for Hope

By John T. Broderick, Jr. / Senior Director of External Affairs,

For the last five years with the help and support of Dartmouth-Hitchcock, I have traveled throughout northern New England speaking at 300 middle schools and high schools on mental health awareness and the most common signs of mental illness. I have spoken to tens of thousands of students, and have hugged or been hugged by thousands of them during our confided conversations. My eyes have been opened. One in five adolescents has a diagnosable mental health issue, and 50% of all mental illness begins by age 14. Young people are in the bullseye but less than half the kids I hug are getting help anywhere. My hat is off to public school counselors, psychologists and teachers who are doing all they can to help students who are suffering — but for meaningful change to happen, and for a real mental health system to be created, we all need to first engage and change

the culture and conversation around mental health to remove the underserved stigma that has been part of its history. Ironically, Covid might be just the catalyst we need. Although Covid has exacerbated our communities’ mental health across the board, it has also triggered increased awareness and publicity about the scope of the problem, and both government and the private sector are beginning to step up. We are now seeing greater use of telehealth services in psychiatry and counseling, a real push for more mobile crisis units, greater emphasis by employers on establishing vibrant EAP programs and policies, enhanced training for police in responding to mental-health crises, a more focused discussion on the need for enhanced outpatient psychiatric services and more transitional housing. As harsh as things have been, there is some reason for optimism. ●

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DETECTION & PREVENTION If you have postponed your regular health screenings, it’s important to get those scheduled soon. Physicians Primary Care. Then learn about any specific screenings from our experts in breast, colorectal, lung and urologic cancers: • Breast cancer screening: Learn about screening options, risk factors and self-exams. Rebecca Kwait, M.D., medical director, Center for Breast Health at Exeter Hospital


Health and CANCER Screenings What’s right for you? BY WENDY LANNON, M.S., R.N., A.C.S.M.-C.E.P. When the Covid-19 pandemic first hit, the stay-at-home order meant that people canceled their regular health screenings. For a short time, hospitals had to temporarily suspend some of these and other elective services, but nearly all health care facilities — including Exeter Hospital and Core Physicians — are now fully open for all services. Covid-19

vaccines, face masks and other supplies are plentiful, and health care facilities have many precautions in place to ensure patients are safe when they come in for care. If you have postponed your regular health screenings, it’s important to get those scheduled soon. The earlier any health concerns are identified and treated, especially


cancer, the better. Core Physicians and Exeter Hospital providers have put together a series of short videos describing what health screenings are important for men and for women throughout their lives, as well as screening options for various types of cancer. Watch the videos here:

Begin by watching the brief overview of essential screenings for men by John Fetchero III, D.O. or for women by Gabrielle Phaneuf, D.O., both of Core

• Colorectal cancer screening: Learn about colonoscopies as well as at-home fecal tests such as Cologuard. Francis MacMillan, Jr., M.D., F.A.C.G., Core Gastroenterology • Urologic cancer screening: Learn about prostate cancer screening, as well as other urologic cancer symptoms and screenings. E. William Johnson, M.D., M.P.H., Core Urology • Lung cancer screening: If you are a smoker or quit less than 15 years ago, find out if you qualify for lung cancer screening and why it’s important. John Brennan, M.D., F.A.C.C.P., Core Pulmonary & Critical Care Medicine, Wendy Lannon, M.S., R.N., C.E.P. navigator, lung cancer screening program at Exeter Hospital ●

Wendy Lannon, M.S., R.N., A.C.S.M.-C.E.P., Exeter Hospital Manager, HealthReach Community Education Navigator, Lung Cancer Screening Program

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 /

Barrington Surgical Care

141 Rte. 125, Barrington / (603) 664-0100

Bedford Ambulatory Surgical Center

11 Washington Pl. #1, Bedford (603) 622-3670 /

Concord Ambulatory Surgery Center 60 Commercial St., Ste. 301 Concord / (603) 415-9460

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

The Cottage Hospital Day Surgery Center

Hillside Surgery Center

14 Maple St., Gilford / (603) 524-7514

Laconia Clinic Ambulatory Surgical Center 724 Main St., Laconia (603) 524-5151 /

Nashua Ambulatory Surgical Center

15 Riverside St., Nashua (603) 882-0950 /

Nashua Eye Associates

Skyhaven Surgery Center 13 Health Care Dr., Rochester (603) 509-9161 skyhaven-surgical-center

Stratham Ambulatory Surgery Care

4 West Rd., Stratham (603) 772-2076 /

Surgery Center of Greater Nashua

NH Eye SurgiCenter

Wentworth Surgery Center, LLC

105 Riverway Pl., Bedford (603) 627-9540 /

Northeast Surgical Center 2299 Woodbury Ave., Newington (603) 446-6278

Orchard Surgical Center

Elliot Health System and Dartmouth-Hitchcock 1-Day Surgery

Orthopaedic Surgery Center

185 Queen City Ave., Manchester (603) 663-5900

333 Borthwick Ave., Ste. 200, Portsmouth (603) 433-0941 /

5 Coliseum Ave., Nashua / (603) 882-9800 555 Nashua St., Milford / (603) 672-8800 30 Lowell Rd., Hudson / (603) 598-6400

90 Swiftwater Rd., Woodsville (603) 747-9156 /

Elliot at River’s Edge

Portsmouth Regional Ambulatory Surgery Center

10 Prospect St., Ste. 101, Nashua (603) 578-9909

6 Works Way, Somersworth (603) 285-9288

16 Keewaydin Dr., Salem (603) 401-6466

264 Pleasant St., Concord 14 Tsienneto Rd., Ste. 100, Derry (603) 224-3368 /

Protecting the interests of Healthcare Providers and Employers for over 165 years. New Hampshire | Massachusetts | Maine | Rhode Island | Connecticut | | 603-223-2800 SMART HEALTH NH 2022 | NEW HAMPSHIRE MAGAZINE 11



WITH COVID Navigating the anxiety of returning to school Ensuring health and safety during the Covid-19 pandemic required most students, parents and educators to spend the last 18 months juggling remote or hybrid learning. Today, students and teachers are returning to the classroom while the Delta variant continues to spread through communities. Although every school district has its own masking and other strategies in place to reduce Covid-19 illnesses, excitement and anxiety are common feelings shared by students, parents and teachers. To help process and normalize those emotions, Dartmouth-

Hitchcock Health (D-HH) recently kicked off the third installment of its virtual roundtable series: “Heads Up: Coping through Covid-19,” with a session titled, “Returning to the Classroom: Excitement and Anxiety.” The panel featured Steve Beals, principal of Alvirne High School in Hudson, New Hampshire; John Broderick, senior director of Public Affairs at Dartmouth-Hitchcock (D-H); Angelica Ladd, the parent of two daughters who are not old enough to be vaccinated; and Emmett Smyth, a high school freshman at Rivendell Academy in Orford, New Hampshire.


Adjusting to in-person learning Beals shared the experiences of kids returning to Alvirne High School and its Career Technical Education Center. While masks are recommended in Hudson as the school year begins (which moves on a scale of discretionary, recommended and required as cases go up or down), the majority of students and teachers are not wearing them. Beals chooses to wear one indoors daily to model that it’s fine to do so, regardless of the current protocol. Sports, theater and extracurricular activities are being offered as they were pre-pandemic, and there is a general feeling of excitement throughout the school. “As we open school in Hudson, our focal point is about teacher and student well-being. We

opened our building with 15 brand-new educators. And what we are saying to them is it’s okay to ask for help. Do not view asking for help as a weakness,” Beals said. “We are fortunate at Alvirne High School that our staff cares about each other. And there is nothing more important in a school environment.” Smyth discussed how most of his middle school experience happened during Covid-19. While he was able to participate in theater remotely, he is starting high school without a typical middle school background. Smyth has to wear a mask at school but otherwise is “… excited to learn, to see the new curriculum, meet new teachers and just experience high school,” he said. Like many parents, Ladd was extremely anxious about sending her third grader to school and two-year-old to day care. Without vaccinations available to them, she struggled with the decision but ultimately realized it was the best choice for her daughters. She shared how gathering reputable information helped her effectively weigh the pros and cons and led her to feel she made the best choice. As the session concluded, Broderick encouraged students to reach out to trusted adults and know they are not alone. “My advice to students ... is to just be patient with yourself. If you have any worries or concerns, be free to talk about it. Talk to a teacher, talk to a counselor, talk to your parents, but know that it’s okay to feel a little uncomfortable,” he said. “You’ll get back in the swing of things. It may take a little longer than you want, but it’ll happen.” ●

This “Heads Up: Coping Through Covid-19” series will also feature sessions on returning to work and mental and emotional health in a post-pandemic world. To review past series, visit the Heads-Up website:


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WA L K- I N & U R G E N T C A R E Laconia Clinic Convenience Care 724 Main St., Laconia (603) 527-2896

Milford Medical Center Urgent Care 444 Nashua St., Milford (603) 673-5623

MinuteClinic (at CVS) 4 Hall St., Concord 321 Lafayette Rd., Hampton 271 Mammoth Rd., Manchester 214 Daniel Webster Hwy., Nashua 512 South Broadway, Salem 250 Plainfield Rd., West Lebanon (866) 389-2727 for all locations

Newport Health Center Access Walk-In Injury Clinic

Located at Access Sports Medicine & Orthopaedics

Occupational Health Services Convenience Care

1 Hampton Rd., Exeter (603) 775-7750 /

Hillside Medical Park 14 Maple St., Lot C, Gilford (603) 527-2896 /

Barrington Urgent Care


426 Calef Hwy., Barrington (603) 664-0955 /

Cheshire Medical Center Walk-In Clinic The Center at Colony Mill

149 Emerald St., Keene (603) 354-5484 /

Catholic Medical Center 5 Washington Pl., Bedford (603) 314-4567

ClearChoiceMD 24 Homestead Place, Alton (603) 822-4713 96 Daniel Webster Hwy., Belmont (603) 267-0656 1 Beehive Dr., Epping (603) 734-9202 410 Miracle Mile, Lebanon (603) 276-3260 750 Lafayette Rd., Portsmouth (603) 427-8539 558 Mast Rd., Goffstown (603) 232-1790 1228 Hooksett Rd., Hooksett 75 Laconia Rd., Tilton

Concentra Urgent Care

1 Pillsbury St., Concord (603) 223-2300 1279 South Willow St., Manchester (603) 644-3330 14 Broad St., Nashua (603) 889-2354

Concord Hospital Walk-In Urgent Care 60 Commercial St., Concord (603) 230-1200

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

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

Elliot at River’s Edge

185 Queen City Ave., Manchester (603) 663-3000


Elliot Urgent Care at Londonderry

40 Buttrick Rd., Londonderry (603) 552-1550

Elliot Weekend After Hours Clinic

275 Mammoth Rd., Manchester (603) 626-5113

Exeter Hospital: Fast Track Division of the Emergency Department (ED) 5 Alumni Dr., Exeter (603) 580-6668

ExpressMED Urgent Care 1 Highlander Way, Manchester (603) 625-2622 35 Kosciuszko St., Manchester (603) 627-5053 159 N. Broadway, Salem (603) 898-0961

Health Stop

228 Daniel Webster Hwy., Nashua (603) 888-9200

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

11 John Stark Hwy., Newport (603) 863-4100

Occupational Health Services Convenience Care Hillside Medical Park 14 Maple St., Lot C, Gilford (603) 527-2896

Parkland Urgent Care at Salem 31 Stiles Rd., Salem (603) 890-2727

Saco River Medical Group 7 Greenwood Ave., Conway (603) 447-3500 15 Rte. 302, Glen (603) 383-3005

Seacoast RediCare

396 High St., Somersworth (603) 692-6066

Walk-In Care at Memorial Hospital

3073 White Mountain Hwy. North Conway (603) 356-5461

Wentworth-Douglass Express Care 701 Central Ave., Dover (603) 609-6700 65 Calef Hwy., Lee (603) 868-8507

White Mountain Medical Center

2531 White Mountain Hwy. Sanbornville (603) 522-0186

Sandhya Dasari, MD Nashua Center for Internal Medicine

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SENIOR RESIDENCES BY REGION Langdon Place of Keene 136 Arch St., Keene (603) 357-3902

Maplewood Assisted Living

201 River Rd., Westmoreland (603) 399-4912 /

RiverMead Retirement Community 150 Rivermead Rd., Peterborough (603) 924-0062 /

Summerhill Assisted Living

183 Old Dublin Rd., Peterborough (603) 924-6238 /


188 Jones Ave., Portsmouth (603) 431-2530 25 Worthen Rd., Durham / (603) 292-3147

Harmony Homes Assisted Living

40 Briggs Way, Durham, (603) 292-5175 1 Stagecoach Rd., Durham (603) 292-6087

Langdon Place of Dover

60 Middle Rd., Dover / (603) 743-4110

Maple Suites

30 Holiday Dr., Dover (603) 617-4413 /

The Mark Wentworth Home 346 Pleasant St., Portsmouth (603) 436-0169

RiverWoods at Exeter

7 Riverwoods Dr., Exeter (800) 688-9663 /

Langdon Place of Exeter 17 Hampton Rd., Exeter (603) 778-1024

Webster at Rye

795 Washington Rd., Rye (603) 964-8144 /

MERRIMACK VALLEY All American Assisted Living

1 Button Dr., Londonderry (603) 537-9898 /

Arbors of Bedford

70 Hawthorne Dr., Bedford (603) 647-9300

Bedford Falls

5 Corporate Dr., Bedford (603) 471-2555

Bentley Commons

66 Hawthorne Dr., Bedford (603) 644-2200

Birch Heights

7 Kendall Pond Rd., Derry (603) 505-4398 /

The Birches at Concord 300 Pleasant St., Concord (603) 369-4417

The Courville at Bedford

40 Route 101, Bedford / (603) 472-2000

The Courville at Manchester

Harvest Hill

The Courville at Nashua-Aynsley

Kendal at Hanover

The Courville at Nashua

Summercrest Senior Living

Granite Ledges of Concord

Sunapee Cove Independent and Assisted Living

44 West Webster St., Manchester (603) 647-5900 / 80 Lake St., Nashua / (603) 881-4190

22 Hunt St., Nashua / (603) 889-5450 151 Langley Pkwy., Concord (603) 224-0777 /

Greystone Farms

242 Main St., Salem (603) 898-5393

Hanover Hill Health Care Center 700 Hanover St., Manchester (603) 627-3826 /

Havenwood-Heritage Heights 33 Christian Ave., Concord (800) 457-6833 /

125 Mascoma St. #23, Lebanon (603) 448-7474 / 80 Lyme Rd., Hanover (603) 643-8900 / 169 Summer St., Newport (603) 863-8181 /

1250 Route 11, Georges Mills (603) 763-0566 /

Wheelock Terrace 32 Buck Rd., Hanover (603) 643-7290

Woodcrest Village LLC 356 Main St., New London (603) 526-2300


Hunt Community

Golden View Health Care Center

Huntington at Nashua

The Golden Crest

10 Allds St., Nashua (603) 882-6511 / 55 Kent Ln., Nashua (800) 298-6608

Langdon Place of Nashua

319 East Dunstable Rd., Nashua (603) 888-7878

Nashua Crossings

674 West Hollis St., Nashua (603) 882-2898

19 NH Route 104, Meredith (603) 279-8111 / 29 Baldwin St., Franklin (603) 934-6742

Wolfeboro Bay Care and Rehabilitation Center 39 Clipper Dr., Wolfeboro (603) 569-3950


Presidential Oaks

Genesis Lafayette Center

The Residence at Salem Woods

Mineral Springs of North Conway Care and Rehabilitation Center

200 Pleasant St., Concord (800) 678-1333 6 Sally Sweets Way, Salem (603) 890-0580

RiverWoods at Manchester

200 Aliance Way, Manchester (603) 645-6500 /

93 Main St., Franconia (603) 823-5502

1251 White Mountain Hwy. North Conway (603) 356-7294

Windham Terrace

Morrison Nursing and Rehabilitation Care


Riverglen House of Littleton

3 Church Rd., Windham (603) 437-4600

Bentley Commons

197 Water St., Keene (603) 499-4546 /


6 Terrace St., Whitefield (603) 837-2541

55 Riverglen Ln., Littleton (603) 444-8880

ADULT DAY CARE CENTERS All Generations Adult Day Program 460 Amherst St., Ste. 4, Nashua (603) 880-3473 /

Castle Center for Adult Group Day Care

312 Marlboro St., Keene (603) 352-2253 /

Connecticut Valley Home Care Day Out

958 John Stark Hwy., Newport (603) 542-7771

Easterseals New Hampshire

555 Auburn St., Manchester (603) 623-8863 /

Gateways Adult Day Service Program

200 Derry Rd., Hudson (603) 882-6333 /

Huggins Hospital — Adult Day Care

240 South Main St., Wolfeboro (603) 569-7500 /

Kearsarge Good Day Respite Program

82 King Hill Rd., New London (603) 526-4077

Monadnock Adult Care Center 22 North St., Jaffrey (603) 532-2428 /

Sarahcare Adult Day Services 201 Rte. 111, Hampstead (603) 329-4401 /

Seaside Elderly Day Out Center 441 Rear Lafayette Rd., Hampton (603) 929-5988

Silverthorne Adult Day Care Center

23 Geremonty Dr., Salem (603) 893-4799

The Homemakers Health Services

215 Rochester Hill Rd., Rochester (800) 660-1770 /

TLC Medical Day Care For Adults

211 Loudon Rd., Courtyard Square, Concord (603) 415-3435 /

Upper Valley Good Day Respite Program

18 School St., Lebanon (603) 526-4077 upper_valley_respite

Vintage Grace Adult Medical Day Program

12 Peabody Rd., Derry (603) 425-6339 /

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 603 LIVING



Emotional Fitness Strategies for staying healthy BY KAREN A. JAMROG


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.

94 | July 2020

“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


603 living / seniority

603 living / health

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 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


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


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. | July 2020


84 | October 2020

“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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603.821.1200 The Huntington at Nashua is a gorgeous, suburban Life Plan Community for active, independent adults aged 62 and better, all situated on 55 acres of rolling, tree-lined ridges.

55 Kent Lane, Nashua NH part of the

family | October 2020



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, the website of the American Society of Breast Surgeons Foundation. Also see the Susan G. Komen website at 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



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 to learn how you can make an impact on the fight against breast cancer in your community. | October 2020

NHmagazine.comSMART HEALTH NH 2022 | NEW HAMPSHIRE MAGAZINE 17 | October 2020




than ever Following the recommended vaccination schedule prevents illness and death BY CAROLYN CLAUSSEN, M.D. Children these days are, statistically speaking, healthier than ever. Accidents are the most common cause of injury and mortality in children, according to the Centers for Disease Control and Prevention (CDC). One hundred years ago, however, it was disease. In fact, in 1920, more than 18% of children born in the United States died before their 5th birthday. Child mortality rates these days are at an all-time low — less than 1% — thanks to antibiotics, sanitary living conditions and vaccines. “When I talk with families,” says Dr. Carolyn Claussen of Willowbend Family Practice, “I

start with the reasons why we have the immunizations. It’s to prevent death.” In fact, the current birthto-18 immunization schedule (see graphic above) prevents 15 once-fatal diseases like measles, diphtheria and polio, as well as six types of cancer. “Some vaccines also have the added benefit of preventing other common childhood ailments,” says Dr. Claussen. “The childhood vaccines, for instance, protect against pneumonia, meningitis and ear infections, among other illnesses, in babies.” In addition to the early childhood vaccines, your family’s


provider will talk to you about recommend vaccines in early adolescence and again when your child gets ready to go to college. “Meningitis is a devastating disease that is very deadly and can have some significant neurologic consequences if a patient recovers. It really spreads in group settings, like on school campuses,” says Dr. Claussen. “The vaccine recommended for pre-teens prevents four different strains of bacterial meningitis—A, C, W and Y. A second vaccine guards against meningitis B, and that is available for 17- to 18-year-olds.” One of the greatest strides in vaccine development is the HPV vaccine. If given on schedule, the HPV vaccine is about 80% effective in preventing the

human papillomavirus. “It’s hugely important and can prevent 90% of six different types of cancer like oral pharyngeal cancer and cervical cancer. HPV is extremely common, so we have to think about this vaccine as a cancer prevention immunization.” The Covid-19 vaccine is currently not on the CDC’s immunization schedule, but it is recommended for children ages 12 and older (at the time of this printing). “Not to scare parents,” says Dr. Claussen, “but it is the younger and the unimmunized who are getting sicker with the Delta variant. Eligible children who are vaccinated protect themselves, as well as their younger siblings and other family members who can’t get immunized or are immunocompromised.”●

Carolyn Claussen, M.D. Medical Director, CMC Primary Care

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FOCUSED C A R E history and physical exam, I was suspicious of her having an orthopedic problem called “hip impingement.” Also known to us in the health care field as femur impingement (FAI), hip impingement has become a relatively recent orthopedic problem identified in the literature. In the past, we were not as well equipped, nor

Her pain was not getting much better, and she was concerned that she was going to miss her upcoming soccer season.


EXTRA STEP Specialized equipment and care lead to diagnosis and better treatment BY PETER M. EYVAZZADEH, M.D. A patient came in with her mother to our New Hampshire Orthopaedic Center (NHOC) Nashua office, and told us that she has been having ongoing pain toward the front of her hip for quite a number of months. She had already seen another orthopaedic surgeon, and had gotten some preliminary X-rays, as well as an MRI of the hip, which was read as being normal.

She was initially treated with some general physical therapy exercises, seemingly without an explicit diagnosis. She was concerned since her pain was not getting much better, and was worried that she was going to miss her upcoming soccer season during her next year in college. We reviewed her outside doctor notes and evaluated her prior imaging. After going through her


did we know as much about hip impingement, which was often diagnosed as a pulled groin that never seemed to get better. Here at NHOC, we have all the diagnostic tools and nonoperative treatment options to target this type of problem. We obtain a special series of X-rays that could show us, in better detail, if there is a bony prominence on the ball or socketside of the hip joint, which could be causing tearing in the labrum (i.e., the gasket seal that surrounds the socket side of the hip joint). Sometimes a regular MRI of the hip can miss a tear in the labrum of the hip, so we obtain a special type of MRI called an MRI Arthrogram of the hip instead. This is where we perform an X-ray-guided injection of contrast into the hip joint, right before getting the MRI — this shows us

better detail and resolution of the hip joint. More often than not, when I see patients with hip impingement issues with a normal MRI, we have seen positive labral tears after obtaining the special MRI Arthogram. In the same sitting of the contrast injection, we sometimes perform a cortisone injection as well to both confirm our diagnosis, but also to help with continuing nonoperative treatment, since the majority of hip impingement patients get better without needing surgery. In the minority of patients who do not get better with nonoperative treatment options but are surgical candidates, we have special equipment and technology at Nashua Ambulatory Surgery Center (NASC) to perform hip arthroscopies. This procedure requires a special table and surgical tools to perform minimally invasive outpatient surgery inside the hip joint, to be able to repair the labral tear, and contour down any bony prominences that we may see under X-ray guidance. The special table we have at NASC has been shown to prevent certain potential complications associated with the procedure. Returning back to our soccer player, we obtained our special X-ray series and updated MRI Arthogram, which did show a labral tear. She did receive a one-time injection of cortisone in the hip joint. Eventually, she improved with focused and redirected physical therapy, to the point that she could return to soccer practices with her team when she went back to school. ●

Peter M. Eyvazzadeh, M.D. Dr. Eyvazzadeh specializes in sports medicine. To make an appointment, please visit or call (603) 883-0091.

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