For Better Health SECTION C
THE NEWTOWN BEE, FRIDAY, OCTOBER 15, 2021
Senior Center Guest Offers —
Medicare Trends To Watch For 2022: Basics, Changes, And Resources By Shannon Hicks If nothing else, Robin E. Capone hopes that the attendees of her recent “Medicare Trends of 2022” presentation went away from the informative program knowing that there are many options for the national health insurance program. She also reminded attendees that they were seated within one of the best local resources they could hope for. Capone, the director of sales for Crowe & Associates, a national insurance company with a local office in Brookfield, spoke at Newtown Senior Center on September 24. “You will always make the decisions” about Medicare plans and options, Capone said that afternoon. “But we are here to educate you, walk you through every plan, and then you will make the decision.” The annual enrollment period for Medicare opens October 15. All US citizens and legal residents — who must have lived in the US for at least five consecutive years, including the five years just before applying for Medicare — are eligible for Medicare if they are age 65 or older; younger than 65 but with a qualifying disability; or any age with a diagnosis of end-stage renal disease or ALS. The Medicare program is administered by the Centers for Medicare & Medicaid Services (CMS), a federal agency in the US Department of Health and Human Services (HHS). CMS also works in partnership with state governments to administer Medicaid, the Children’s Health Insurance Program (CHIP), and health insurance portability standards. There are multiple parts to the Medicare Plan. Part A pays for hospital care, including hospice. “You’re not paying a premium for that because you paid for that through your working career,” Capone said. “If you have ten years or 40 quarters of work under your belt — and it doesn’t need to be 40 consecutive quarters — of work experience, your Part A is automatic. You don’t apply for it. It’s already
been applied.” Part B pays for doctor visits and other outpatient care. “You do apply for this,” she explained. “This is your doctor, your bloodwork, your MRIs, your outpatient surgery, that all comes under Part B. “If we get a shot at our doctor’s office, that comes under Part B, not our drug plan,” she added. These two parts are also called “Original Medicare.” Original Medicare helps with health care coverage, but enrollees should expect to pay some costs, including monthly premiums, deductibles, copays, and coinsurance. There is no limit on out-of-pocket costs. Original Medicare does not cover vision, dental, hearing, or prescription drugs. Original Medical is provided by the government. Medicare Advantage Part C is offered by private insurance companies. Formed in 2008 under President George Bush, Capone said, the plan is meant to incorporate everything under one roof. Part C plans generally offer the coverage of Part A and Part B, along with additional benefits. Medicare Part D, also offered by private companies, covers prescription drugs. Part D, Capone said, is the most complicated. “The formularies change all the time,” she said. “It’s very tough to keep up with.” Part D enrollment can be done as a standalone prescription drug plan, to go with Original Medicare coverage, through a private company; or as part of a Medicare Advantage Part C plan that includes prescription coverage, also through a private company. “In Medicare Advantage, one of the trends I’m seeing is that we’re moving away from HMOs, which is a locked network, and we have more PPO Plans, which means we can go out of network,” Capone told the approximately 30 people listening to her on September 24. ‘Advantage Greatly Improved’ When Medicare Advantage was
Open Enrollment for Medicare health and drug plans runs annually from October 15 to December 7. —Medicare.gov graphic
Robin E. Capone was the guest during a recent Lunch & Learn program at Newtown Senior Center. She spent time on September 24 explaining the basics of Medicare, and offering some updates that enrollees will see during the upcoming enrollment period and coverage year. —Bee Photo, Hicks formed in 2008, she said, people were scared. “The networks were not that great,” she said. “They’d get into a plan and their primary care physician might leave, and then they were stuck. People were very much afraid of getting locked into a network that they couldn’t deal with. “That really does not exist today,” she said. “The networks are huge and we’re seeing more PPOs, so if you don’t like a doctor you can go out of network, and there’s a little bit of an upcharge but not much.” More good news: brokers and their clients are seeing an increase in $0
premium plans in Medicare Advantage. “Medicare Advantage includes Part A, Part B, a drug plan, a supplemental, and it’s growing, and it does a great job,” Capone said, adding more drugs are appearing on Tier 1 and Tier 2 generic lists. “That’s great,” she said, “because in many of the Medicare Advantage plans, a Tier 1 drug might be a zero cost. There is an emphasis on adding drugs from the formulary to a Tier 1 and Tier 2.” Capone, who is on the advisory board of the UnitedHealthcare dental plan, said she and others are
also seeing more supplemental coverage. “We’re seeing more dental options and dental coverage, more vision coverage, diabetic supplies, and all of that,” she said. Some supplements have also been retired, she said. Retirement funds are precious, she noted — with many in the room nodding along with that statement — and increasing premiums can make a plan become too expensive for many retirees. “There were plans that, over 15, 18, 20 years, were going from $130 a month to $430 a month,” she said.
“That’s unaffordable.” Admitting it can be tough for many to keep up with such premiums, Capone offered some comforting advice. “You have options, always. If you are ever paying more than you can afford,” Capone told the group on September 24, “find yourself a broker, someone who can guide you through the process. “Align yourself with someone you trust,” she continued. “You have many options.” In addition, she said, every year there are new Medicare Advantage plans, new drug plans, and new supplement plans. There are also Medicare Supplement Insurance Plans, or Medigap, which help pay for some of the outof-pocket costs not covered by Medicare; and Special Needs Plans (SNPs), which have benefits that cover special health care of financial needs, and include prescription drug coverage. “It’s a lot to keep up with,” Capone admitted. Enrollment Periods A person’s Initial Enrollment Period (IEP) is their first change to enroll in Medicare. An IEP is seven months long, and includes the three months before the month a person turns 65, and the three months after their birthday month.
Once Medicare coverage is selected, changes can be made annual during the Medical Open Enrollment, which is October 15-December 7. CMS recently released the 2022 premiums, deductibles, and other key information for Medicare Advantage and Part D prescription drug plans in advance of the annual Medicare Open Enrollment to help Medicare enrollees decide on coverage that fits their needs. The average premium for Medicare Advantage plans will be lower in 2022 at $19 per month, compared to $21.22 in 2021, while projected enrollment continues to increase. The average 2022 premium for Part D coverage will be $33 per month, compared to $31.47 in 2021. There are a few times when a Special Enrollment Period can be accessed. A person may be able to switch their coverage when there are life changes, including retirement and the departure from a health care plan offered by their employer or union or a physical move out of a plan’s service area. “You have flexibility with supplements. You can change supplements throughout the year,” Capone explained. “You cannot change Medicare Advantage or Part D until Open Enrollment.” ( continued on page C - 3 )
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THE NEWTOWN BEE, FRIDAY, OCTOBER 15, 2021
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By Alissa Silber Even though autumn has arrived, many people are still doing last-minute projects before the inevitable snowfall comes in the colder months. Whether landscaping around the yard or working in the garage, there are countless activities that pose possible risks to people’s eyes. Since October is both National Eye Injury Prevention Month and Home Eye Safety Month, The Newtown Bee sought the expertise of two local doctors who weighed in offering precautions to prevent injuries and advice on what to do if they
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occur. It is inevitable that in a person’s lifetime they may get an eyelash or speck of dust in their eye that causes irritation. In most cases, these scenarios are a minor inconvenience that, if needed, can be remedied with an over-the-counter eye drop solution. There are situations, however, that are more severe and need to be taken seriously for long+term eye health. Dr Armand Daccache, a macular-retinal specialist at Connecticut Eye Consultants in Danbury, says that eye injuries can be divided into two categories: direct and indirect trauma. “Retained foreign bodies, corneal abrasions and lacerations, internal hemorrhages (i.e., hyphema), and in extreme cases ruptured globes are the type of direct injuries we encounter in our typical clinical days. They occur certainly more in the younger population but [are] oftentimes also seen in the elderlies while working outside without safety eyewear,” Daccache said. “Indirect injuries to the eye from fractured facial bones and direct impact are seen in motor vehicle accidents and falls in patients with mobility problems.” Dr Joseph Young, of Village Eye Care in Newtown, shared that two of the most common eye injuries are when a foreign body gets into the eye, like a shard of metal, or a form of abrasion occurs, such as scratch from a pet or scrape from a mascara wand. “Those are the two biggest ones that would warrant a phone call. They are immediately painful and debilitating,” Young said. People who are in careers that require a lot of hands-on work with potentially dangerous materials — such as landscapers, auto mechanics, carpenters, etc — have a higher chance of eye injury than someone working indoors, according to Young. Also, gardeners are more at risk for eye irritants being around poison ivy, plants with thorns, and toxic fertilizers, all
of which can cause problems when they come in contact with people’s eyes. To recognize an eye injury, Daccache notes that signs/ symptoms may include (but are not limited to) “pain, redness, difficulty seeing or total loss of vision, double vision or inability to move the eye in one direction, irregular pupil shape, [and a] black eye.” Remedy And Prevention After a trauma to the eye has occurred, it is important to get medical intervention as soon as possible to resolve the issue. As for who to call, Young said, “My advice is, if you have one phone call to make and you can’t make any other, you call 911.” However, if the person has a regular eye doctor that they visit and if they know what occurred to them, they can call their eye doctor for an immediate visit. It is crucial that a person notify their eye doctor of their injury whether or not they go to the emergency room, because that part of their medical history is important for their future eyecare. Daccache said, “Once an eye
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suffers a trauma, lifelong consequences could ensue, and the eye doctor will recommend the appropriate follow ups. Post trauma, eyes are at higher risk of developing cataracts [clouding of the lens], glaucoma [blinding disease from high pressure in the eye], retinal detachments, and scar to name a few.” A simple and easy resource that people can utilize is an eye wash kit that they can keep with their home medical first aid kit. This can be helpful for a variety of eye irritants and injuries. Also, Daccache mentioned, “Contrary to popular belief, most accidents do not happen at the job site but at home while cooking, working the yard, [doing] recreational craft hobbies, and could be prevented by wearing protective eyewear.” One of the best preventative measures people can take to avoid eye injuries is to use safety goggles. “If you are going to grab a weedwhacker or are cutting the grass, put safety goggles on. That’s going to prevent nine out
of ten problems,” Young said. Young recommends people use fenestrated goggles, which have ventilation holes on the side, so that they do not fog up. They can also fit over glasses. Keep in mind, though, that there is a difference with safety goggles and safety glasses. “Safety glasses are good, but they are only good for things head-on. If something comes up from the side, it can get behind it,” Young said. Eyewear protection is also a good option for children who play potentially dangerous sports. Young said, “It’s the adults’ responsibility to help the children.” With that in mind, households with children should also take preventative measures to childproof the home. What that looks like is making sure any toxic products, such as bleach, are not accessible to children and that furniture corners are padded so a child cannot hit their eye on them. Daccache reports, “In kids younger than 10, accidental strikes to the eye are the most
common cause [of eye injury].” Additionally, for those of any age that have allergies — whether it be to pollen or pets — that cause their eyes to become swollen, red, and itchy, there are over the counter medications that can help prevent an allergic reaction from occurring. For maintaining overall eye health, it is important to have a good nutritional diet and get annual eye checkups. “So many systemic diseases create ocular manifestations…” Young said. “A lot of eye issues sneak up on you.” Getting regular eye exams can help save a person’s vision before they even realizes there is a problem. Consult with a physician to find out how many times a year an exam is appropriate for your age and needs. For more information about eye safety, contact Connecticut Eye Consultants in Danbury at 203-791-2020 and Village Eye Care in Newtown at email@example.com. Reporter Alissa Silber can be reached at firstname.lastname@example.org.
Heart Association Advises—
There’s No Place Like Home... To Regularly Check Your BP
DALLAS — Adults who needed to track their blood pressure regularly to confirm or refute a hypertension diagnosis preferred monitoring blood pressure at home versus at a clinic, kiosk or with a 24-hour wearable device, according to preliminary research presented at the recent American Heart Association’s Hypertension Scientific Sessions 2021. The meeting is the premier scientific exchange focused on recent advances in basic and clinical research on high blood pressure and its relationship to cardiac and kidney disease, stroke, obesity, and genetics was just held virtually September 27-29. According to the American Heart Association, about one of every two of US adults has high blood pressure, or hypertension. More than one in three adults with high blood pressure might not know they have it. High blood pressure is defined as having a systolic pressure (the top number in a reading) of 130 mm Hg or higher, or a diastolic pressure (the bottom number) of 80 mm Hg or higher. “Most hypertension is diagnosed and treated based on blood pressure measurements taken in a doctor’s office, even though the US Preventive Services Task Force and the American Heart Association recommend that blood pressure measurements be taken outside of the clinical setting to confirm the diagnosis before starting treatment,” said lead study author Beverly Green, MD, MPH, senior investigator and family physician at Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington in Seattle. “It is the standard that blood pressure monitoring should be done either using home blood pressure monitoring or 24-hour ambulatory blood pressure monitoring prior to diagnosing hypertension.” Full-time ambulatory blood pressure monitoring devices, worn day and night to take continuous blood pressure readings, are generally considered the “gold standard” for out-of-office measurement to determine a diagnosis of high blood pressure. However, blood pressure measured on a home device, with a traditional blood pressure arm cuff, can be a more practical and convenient approach. Green and colleagues studied adherence and acceptability of different blood pressure measuring methods among 510 adults who had elevated blood pressure yet had not been diagnosed with high blood pressure. They were participants in the Blood Pressure Checks for Diagnosing Hypertension (BP-Check) trial. Study Details Participants in the study were an average age of 59 years old; 75% were non-Hispanic white, 7% African American, 6% Asian, 5% Hispanic white, and 7% other; half were male; and the average blood pressure was 150/88 mm Hg. None of the participants were taking blood pressure-lowering medications. Participants were randomly assigned to one of three groups for determining a new diagnosis of hypertension: clinic measurements, home monitoring, or kiosk blood pressure monitoring. Those in the group for clinic measurements were asked to return to the clinic for at least one additional blood pressure check, as is routine in diagnosing hypertension in clinical practice. The home group received home blood pressure machines, were trained to use them and were asked to take their blood pressure twice a day with two measurements each time, for five days, for a total of 20 measurements. The kiosk group was asked to take their blood
pressure at a kiosk in their clinic or at a nearby pharmacy on three separate days, with three measurements each time, for a total of nine measurements. All participants were asked to complete their group-assigned diagnostic regimens within three weeks, and then to complete 24-hour ambulatory blood pressure monitoring. Researchers compared adherence to and the acceptability among each diagnostic method. They measured adherence to monitoring by noting the percent of individuals in each group who completed their assigned measurement method as instructed. They measured acceptability with questionnaires. Research Findings Researchers found: *Overall acceptability was highest for the athome group, followed by the clinic and kiosk groups; 24-hour ambulatory blood pressure monitoring was the least acceptable option. *Participants were least likely to adhere to the monitoring regimen in the kiosk group. Adherence was more than 90% among those in the home testing group; more than 87% in the clinic group; nearly 68% in the kiosk group; and 91% for 24-hour ambulatory monitoring among all participants. “Home blood pressure monitoring was the most preferred option because it was convenient, easy to do, did not disturb their daily personal or work routine as much, and was perceived as accurate,” Green said. “Participants reported that ambulatory blood pressure monitoring disturbed daily and work activities, disrupted sleep, and was uncomfortable.” When asked which diagnostic testing regimen they would prefer, more than half chose home blood pressure monitoring, especially if they were assigned to the home group, where almost 80% preferred home monitoring. Green suggests health care professionals routinely offer home blood pressure monitoring to their patients with elevated blood pressure. This might involve providing home blood pressure monitors, training patients, and collecting and averaging several days of blood pressure readings. The American Heart Association is striving to improve blood pressure control rates in historically under-resourced communities across the country by providing training, technical assistance, and resources to community health centers for proper blood pressure measurement and management. In addition, collaborations with communitybased organizations provide blood pressure education, monitoring and management information, and resources to their neighbors. The association is also marketing directly to communities to raise awareness about the importance of self-blood pressure monitoring, and working with a health care professional on a plan for blood pressure control. “Health care professionals should work toward relying less on in-clinic visits to diagnose hypertension and supporting their patients in taking their blood pressure measurements at home,” Green said. “Home blood pressure monitoring is empowering and improves our ability to identify and treat hypertension, and to prevent strokes, heart attacks, heart failure, and cardiovascular death.” A study limitation is that participants were mainly white, which is not representative of all people who have high blood pressure. According to American Heart Association statistics, about 50% of white and Hispanic men and 40% of white and Hispanic women have high blood pressure, while 58% of Black men and women have it.
THE NEWTOWN BEE, FRIDAY, OCTOBER 15, 2021
Mobile Therapy Service Celebrates A Year Restoring Health, Independence By JiM Taylor Restore Mobile Therapy, LLC, is celebrating its one year anniversary this September, providing occupational therapy home care services to the local senior community, all in the comfort of their own homes. As a graduate of Sacred Heart University’s Master in Science, occupational therapy program, Stacey McIvor MS, OTR/L, owner of Restore Mobile Therapy, has been working in the greater Danbury area for almost a decade. She has experience in skilled nursing facilities, hospital settings, home health care services, primarily for the senior population. Her passion is working with older adults, helping them to resume activities and become as independent as possible in their daily lives in the client’s most natural environment, their own home. A licensed occupational therapist, McIvor is committed and passionate to providing her clients with the highest standard of services for their care and safety, while improving their quality of life. “Occupational therapists [OTs] are expert observers and uniquely skilled at assisting older adults to adapt to the physical, social, cognitive, and environmental changes that occur as we age, setting it apart from other therapy disciplines,” said McIvor. “The goal of occupational therapy is to promote independent living and provide the best quality of life possible, including prevention of disease progression or onset.” Restore Mobile Therapy provides occupational therapy that considers the whole person. Services fill a gap by providing clients with an alternative treatment setting that is functional and can not be replicated in a clinical setting, addressing the client’s real needs and challenges all in the comfort of their home. The occupational therapy services provided are covered at
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Stacey McIvor of Restore Mobile Therapy. little to no cost for Medicare recipients and with a prescription from a primary care provider, services can start immediately. “I think the biggest thing is that for those on Medicaid, my services costs nothing,” said McIvor. “For those who are having trouble feeding themselves or opening jars, it might seem daunting to hire an occupational therapist. But if it doesn’t cost very much, it’s worth checking into to improve their lives.” Newtown Lunch-And-Learn McIvor enjoys providing education to the community on how occupational therapy can benefit the senior population,
while promoting independence. She recently provided a lunch-and-learn at Newtown Senior Center, partnered with Synergy Home care, sharing simple tips and tricks to make daily tasks a little easier. McIvor said she focused on teaching attendees what occupational therapy is, and how it is set apart from other types of therapy. “I also showed them a number of gadgets and ‘simple tricks’ that seniors can add to their day to make it less tiring and a bit safer,” McIvor said. She is a preferred provider for Visiting Angels of Fairfield County, where she provides education for caregivers on how to improve confidence and
Medicare Trends To Watch For 2022: Basics, Changes, And Resources ( continued from page C - 1 )
Additional Resources For questions about Medicare and detailed information about plans and policies, call 800-MEDICARE (800-6334227), TTY 877-486-2048; both numbers are available 24-7. The official Medicare hand-
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Capone additionally noted that when former President George W. Bush rolled out Part C 13 years ago, he also rolled out the Late Enrollment Penalty. “When you retire, when you’re migrating from group insurance to Medicare, you need to get enrolled in a drug plan so that a penalty is not applied,” she said. “If you’re in a plan where you’re paying more than you can afford for drugs, come and talk to me,” Capone reiterated. She also strongly encouraged everyone in the room to stay on top of their plans. “Review your supplements every few years. There are changes to plans and premiums,” she reminded them, “especially Part D. “Part D is the most complicated portion of our Medicare system,” she said. “There are tiers, and every insurance company has different tiers, and they uniquely place different drugs on different tiers.” A Part D plan with one private insurance company, she said, and a Part D plan with a different insurance company can show big differences. Sharing a story of a recent client, Capone told the group about a man who had been paying $2,000 monthly for years for his supplemental plan. “I did some research and found that he had been paying for drugs that were initially experimental, years ago” she said. “He had had cancer and he was on a very expensive drug. No one ever checked his plan after he enrolled.” Following her homework, Capone said, the man’s plan was updated and he is now paying $85 a month. “That is a great example of staying close to somebody you trust, and staying on top of your plans,” she said. “Stay on top of not only your health and your drugs, but the entire Medicare process.”
Your Vision Whether you’re working remotely
Robin Capone responds to a question from an attendee of a Newtown Senior Center event concerning Medicare trends. The annual enrollment period for the national health insurance program opens October 15. —Bee Photo, Hicks book for Medicare programs, Medicare & You, is updated annually. Free copies can be downloaded from Medicare.gov (scroll down to Site Menu, then click on Forms, help, & other resources; then “Medicare &
You” handbook. Copies can also be requested by calling the Medicare Helpline (above). Additional information is also available online at MedicareMadeClear.com. Newtown residents are very lucky, Capone also told those listening to her last month. The town’s senior center has hosted educational programs regularly, and is “one of the best centers in the state,” she said in closing. She had heard during a recent visit about residents getting frustrated while trying to find answers online or over the phone for Social Security, Medicare, and other programs. “When something is frustrating you, and you need something to get done, come here to the senior center,” she said. “I can’t brag enough about this center. They keep rolling out great classes and helping you, in body, mind, and spirit. “Discuss your problem, and they’re going to hook you up with people that can solve that problem, and they’ll do it for you quickly.” Located at 8 Simpson Street, Newtown Senior Center can be reached at 203-270-4310. The center is open weekdays from 9 am until 4 pm.
safety while assisting their clients. Restore Mobile Therapy services include: *Home safety assessment *Endurance/strength training *Fall prevention *Fine motor and upper body coordination *Activities of daily living and caregiver education to promote independence Restore Mobile Therapy sees a variety of clients with a wide range of diagnoses such as: chronic COPD, heart disease, chronic pain, dementia, chronic or new onset of falls, new onset of weakness, stroke, orthopedic injuries, and post-operative orthopedics and hospice needs. McIvor said that occupational therapy was her second career choice. Her childhood dream was to be a teacher, but she decided that it ended up “not being a career path I wanted to take.” “Occupational therapy came up while I was job hunting,” said McIvor. “It’s like teaching but not in a classroom.” McIvor said she went back to school at Sacred Heart for her master’s in occupational therapy in 2010 and began her practice in 2012. She said occupational therapy is “functional therapy to provide to people” with plenty of practical applications. “It addresses real life challenges,” said McIvor. “Even for
simple tasks, it might be a big deal for them in their life. I get people back doing what they want to do. It’s a very rewarding career to be in.” McIvor said she sees a variety of people: some may have problems getting into and out of the shower and she works with them on strengthening exercises as well as modifying the environment of the home to make the transition easier. For those suffering with COPD, which makes breathing difficult, it can make some tasks like putting on socks “unbearable.” “I teach them breathing techniques and guiding strategies,” McIvor said. McIvor said she does not just work with people in their homes, but can also meet and assist people with strategies in how to deal with situations they may encounter at a grocery store or other places they go regularly. She also acts to help her clients hook up with local resources, equipment, and services during their recovery. Restore Mobile Therapy may be contacted by phone at 203744-9368, or by e-mail at info@ r e s t o r e m o b i l e t h e r a p y. c o m . Find them on the web at www. restoremobiletherapy.com and on Facebook at www.facebook. com/restoremobiletherapy.
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THE NEWTOWN BEE, FRIDAY, OCTOBER 15, 2021
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NEW YORK CITY — This year, more than 268,600 women and 2,600 men will be diagnosed with invasive breast cancer (cancer that has spread from where it started in the breast into the surrounding healthy tissue), and more than 42,260 will die from the disease. According to the Prevent Cancer Foundation, if diagnosed early and treated before it spreads, fiveyear survival rate for breast cancer is 99%. Yes, 99%. But no matter when breast cancer is suspected, one can be overwhelmed, and looking for answers to many questions, including what type of biopsy to have. While coping with the emotional turmoil that follows a breast cancer diagnosis, a woman must absorb a seemingly vast amount of information that will help her make important decisions about the treatment options available to her. Many women with early-stage cancer learn that while surgery will be needed, the decision of whether to attempt to remove just the tumor or the whole affected breast will be up to her. “Women are often puzzled that there isn’t a clear medical imperative that dictates which surgery she should have,” says plastic surgeon and breast reconstruction specialist Dr Constance M. Chen. “Her doctor will explain that given the characteristics of her particular tumor, the risk of her cancer recurring is low and her odds of survival are the same whether she undergoes mastectomy, which removes the entire breast, or lumpectomy, which attempts to remove only the tumor and conserve the breast. She can weigh the factors that go into this decision with confidence that either choice will enhance her chances of a full recovery.” Chen is a board-certified plastic surgeon with special expertise in the use of innovative natural techniques to optimize medical and cosmetic outcomes for women undergoing breast reconstruction. She is clinical assistant professor of surgery (plastic surgery) at Weill Cornell Medical College and clinical assistant professor of surgery (plastic surgery) at Tulane University School of Medicine. She reminds us that in the 18th Century, breast cancer came to be understood as a localized disease whose spread could be contained by isolating and removing the affected cells, thus giving rise to what we know today as mastectomy. The radical mastectomy was first performed in the late 1800s, removing not just the breast tissue and adjacent lymph nodes, but the underlying chest muscles as well in an aggressive attempt to control the spread of the disease. It was not until the mid-20th Century that radical surgery gave way to equally effective but less aggressive, less disfiguring treatments and not until the 1980s that research showed that lumpectomy fol-
with a very deformed appearance to their remaining breast. Further surgery may be necessary following a lumpectomy: If the pathology report shows cancer cells at the edge of the excised tissue, the lack of “clear margins” means additional tissue will have to be removed to try to ensure no remaining cancer cells. The additional excision may cause further disfigurement or, in some cases, mastectomy might be needed. It is important to note that while the survival rates are considered statistically equivalent for lumpectomy and mastectomy, there is a slightly higher risk with lumpectomy of local recurrence of cancer in the treated breast. These recurrences can often be successfully treated, usually with mastectomy.
lowed by a course of radiation treatment provided statistically equivalent survival rates as mastectomy. “As we came to understand that survival rates are similar for mastectomy and lumpectomy, many women chose the less invasive, breast-conserving lumpectomy,” said Chen, “but in the last two decades or so, influenced by public discussion of celebrities’ mastectomies and by advances in breast reconstruction that have made it possible to create a new breast barely distinguishable from a woman’s own, more women have turned again to mastectomy as the treatment that will work best for them.” Lumpectomy Advantages and Disadvantages Lumpectomy, also known as “breast-conserving surgery,” attempts to remove all the breast tissue affected by cancer as well as a small surrounding margin of normal tissue. A lumpectomy is almost always followed by a five-to-seven-week course of daily radiation therapy to reduce the risk of local recurrence in the breast. The primary advantage of lumpectomy is that it can preserve the breast and often with minimal change in sensation. It is a less invasive surgery, often performed on an out-patient basis or with a one-night hospital stay, so recovery is faster and easier. In addition, for women with larger breasts, the appearance of the breast may also be largely preserved. Disadvantages of lumpectomy may include the allbut-certain need for post-operative radiation therapy that has some side effects and requires daily trips to the treatment facility. Radiation may limit later options to achieve symmetry with the untreated breast as it permanently changes and distorts the tissue. Also, women with smaller breasts may be left
Mastectomy Advantages and Disadvantages For some women, even the low risk of recurrence in the breast following lumpectomy is enough for them to want to “just be rid of it,” to remove as much breast tissue as possible. For these women, mastectomy with or without reconstruction is their best option for peace of mind. The most significant disadvantage of mastectomy is the permanent loss of the breast. A simple mastectomy with no reconstruction can be an outpatient procedure with recovery time similar to a lumpectomy. This is even true for nipple-sparing mastectomy with no reconstruction, which preserves all options for the best possible breast reconstruction later on. If immediate breast reconstruction is added, mastectomy is a more complex surgery with a longer recuperation and with the possibility of additional surgery needed in association with reconstruction; even if the initial reconstruction is performed at the time of the mastectomy, adjustments are often needed later. “There are many factors that influence the selection of treatment options for early-stage breast cancer,” said Chen. “Your doctor will have carefully studied the size, location, and characteristics of your tumor as well as your general medical and genetic history before reaching the conclusion that you can safely make the decision of lumpectomy or mastectomy based on personal considerations,” Chen said. “If it is up to you, you will weigh questions like: How important is it to you to keep your breast? How anxious will you be about recurrence and annual screenings if you do keep your breast? How important are factors like surgical recuperation and daily radiation therapy? Your doctor, family, and friends may provide counsel and support but by weighing what is most important to you, you will come to the best decision for your health and for a cancer-free future,” Chen added. Learn more at constancechenmd.com.
Resources And Support Ease Stress For Professional, Family Caregivers FAIRFIELD — Caring for an aging parent or loved one can be a difficult responsibility. According to the Caregiving in the US 2020 report, more than one in five Americans are acting as a caregiver to a loved one. Many times, family members take on this critical role at the expense of their own financial and physical well-being. Connecticut home care agency Assisted Living Services, Inc, is caring for caregivers by offering them resources to ensure they remain empowered, energized, and enthusiastic. “Nothing quite prepares you for the stress of becoming a caregiver for a family member,” said Mario D’Aquila, MBA, COO of Assisted Living Services, Inc (ALS) in Cheshire, Fairfield, and Clinton. “We understand the demands of caregiving and have spearheaded multiple initiatives to ensure it is also a rewarding and fulfilling experience.” D’Aquila highlights a state program that can alleviate the financial burden of family
caregivers who often have to cut back on working hours, take a leave of absence, or quit their job entirely. The Connecticut Department of Social Services added the Adult Family Living/Foster Care Program (AFL) in 2013 under the Connecticut Home Care Program for Elders (CHCPE) and the Personal Care Assistance (PCA) Waiver Program. Assisted Living Services, Inc is a credentialed provider for this program, which means the company provides the oversight that helps caregivers succeed the “tools” needed to be comfortable with caregiving, along with the financial compensation that they deserve. The direct provider may be a relative of the participant as long as they are not a legally liable relative (such as a spouse). Under the program, the caregiver can receive a tax-free stipend of more than $500 per week. “Our role in the AFL program is to provide on-going support for caregivers, including access to a dedicated
senior care professional for questions, concerns, and planned visits. We also have bilingual professionals available,.” said D’Aquila. “Many caregivers may not know they are eligible to receive a significant amount of respite hour coverage as part of the AFL program. The care can be on an hourly basis or temporary live-in.” D’Aquila stresses the importance of taking time away as just one thing caregivers need to do in order to practice good self-care. He shares some other strategies: *Engage in regular activities as a reminder that you are more than just a caregiver. *Give yourself permission to take short breaks. Get out of the house throughout the day, even for ten minutes. Visit with friends. *Take care of yourself. Do not skip your own doctor’s appointments because you are too busy. Exercise, eat well, and do not sacrifice sleep. *Get up 15 minutes earlier and use the time just for you. Journal about your struggles
and feelings, meditate or stretch. *Watch out for signs of depression and do not delay getting professional help. *Give yourself credit for doing the best you can in one of the toughest jobs! Additionally, technology can act as a virtual care partner, offering constant monitoring for peace of mind. Through the ALS sister company, Assisted Living Technologies, Inc, devices such as automated medication dispensers can improve compliance, home safety devices can shut off a stove that is inadvertently left on, personal emergency response systems and fall avoidance technologies can supplement care with alerts. “For years we have been using technology as part of our CarePlus program, and more recently for all our AFL clients as well,” explains D’Aquila. “We provide one free wireless device to address a particular issue; however many clients utilize more than one type to assist with several areas of weakness.”
For example, one client was at high risk of falling. The client sleeps in his room on the first floor. His daughter and primary caretaker sleeps on the second floor. The father wakes up frequently during the night to use the bathroom. There were several instances where he would fall and not be heard for a period of time. “We provided a wireless bed pad sensor and alarm that alerts the daughter when her father sits up to get out of bed at night. Now she can quickly help her father get to the bathroom while reducing the risk of a fall,” said D’Aquila. Assisted Living Technologies, Inc also started offering a HIPPA-compliant remote patient monitoring solutions for remote visits and tracking health vitals. This remote solution allows for secure two-way video conferencing with family, friends, and health care providers. Clients can purchase a remote patient monitoring system from ALT by calling to order or though its newly revamped website www.assistedlivingtechnologies.com.
Protecting Your Back Better If You Are Carrying Extra Weight NEW YORK CITY — More than 20 years ago, federal health officials warned that a growing obesity epidemic was threatening the health of millions of Americans. Since then, the situation was gotten markedly worse. Today, according to the Centers for Disease Control and Prevention, the US adult obesity rate is more than 40%. “There’s a great deal of focus on the obesity-related conditions — heart disease, stroke, type 2 diabetes, and certain cancers — that are among the leading causes of preventable, premature death,” says Dr Kaixuan Liu, endoscopic spine surgeon with Atlantic Spine Center, “but often overlooked are the effects obesity can have on the spine. Excess weight places a great deal of additional strain and pressure on back and spine tissues. It shifts your center of gravity and taxes all of the muscles and joints at the core of the body.” Back pain is often attributed to the normal effects of aging. While it is true that aging tends to weaken the spinal column — the stack of bones
(vertebrae) and gel-filled cushions between them — excess weight accelerates the process, triggering a range of spinal disorders: *Disc degeneration occurs when the discs between the vertebrae weaken, they lose moisture, and begin to collapse. *Herniated disc, also known as a ruptured or slipped disc, occurs when a tear in the tough outer layer of the disc allows some of the soft inner material to protrude out of the disk. If the protruding material compresses a nerve, the symptoms of a herniated disc are felt wherever that nerve travels. *Spinal stenosis is a narrowing of the spinal canal that can compress the nerves that travel through the spine. *Osteoarthritis, which occurs when the protective cartilage that cushions the ends of the vertebrae wears down, can be triggered or exacerbated by excess weight putting additional stress on the spine. The spine is designed to support the body’s weight but excess weight makes it diffi-
cult for the spine to do its job properly and these conditions cause a variety of troublesome symptoms, including chronic pain, numbness, and tingling in the neck, back, arms, or legs. “It isn’t always possible to eliminate wear and tear on the back,” says Liu. “But there are steps you can take to reduce your risk. These include general best practices for good health, including
weight management, regular exercise, and not smoking.” Maintaining a healthy weight or losing weight can reduce stress on the spine and other joints as well,” he added. “Losing just four pounds reduces 16 pounds of pressure on the spine. But losing weight is not the only avenue to improved back health.” Liu highlights these important factors: *Regular exercise — cardiovascular exercise and weightlifting — strengthen the supporting muscles of the back, pelvis, and thighs and activities like yoga and tai chi stretch the muscles and improve flexibility. Exercise can also improve posture and improve the unnatural curvature of the spine that often results from obesity. *Good nutrition can also help your spine. Foods that are high in calcium and vitamin D, such as dairy foods and leafy green vegetables, can help prevent the bones in your spine from becoming thin and brittle. *Use proper lifting techniques. Do not bend at the waist. Bend your knees while
keeping your back straight and use your strong leg muscles to help support the load. *Practice good posture when walking, sitting, standing, and sleeping. For example, stand up straight with your shoulders back, abdomen in, and the small of your back flat. Sit with your feet flat on the floor or elevated. Sleep on a firm mattress and sleep on your side, not your stomach. *Stretch often when sitting for long periods of time. *Do not wear high-heeled shoes. “Obesity takes a toll on the spine,” says Liu, “and as more and more adults are carrying excess weight, we are seeing an increase in spinal disorders, particularly those that cause lower back pain. The best remedy is to lose weight but the good practices I’ve outlined can also improve back health for everyone at any weight.” Kaixuan Liu, MD, PhD, is a board-certified physician who is fellowship-trained in minimally invasive spine surgery. He is the founder of Atlantic Spine Center; learn more at atlanticspinecenter.nyc.
THE NEWTOWN BEE, FRIDAY, OCTOBER 15, 2021
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Taking part in the September 8 press conference are, on the top from left, Northwestern Community College Director of the Office of Student & Community Life, Title IX Coordinator, SART/CARE Team Coordinator Ruth Gonzalez, PhD, LPC; Kayla Garner; and Housatonic Community College Director of Counseling and Wellness Lisa Slade, NCC, LPC. On the bottom from left are 4Cs President Seth Freeman and Senator Mae Flexer (D-29th District).
Community Colleges Recognize Need To Improve Mental Health Services
By eliZa hallaBeck There is a need to expand in-person mental health services at state community colleges, according to participants at a recent Congress of Connecticut Community Colleges (4Cs) press briefing. In an announcement ahead of the conference, officials recognized “as students return to on-ground classes at community colleges in Connecticut, many with an increased need for mental health services due to the COVID-19 pandemic, they will find a decrease in availability for in-person mental health services at their college.” The announcement also noted that despite a “need for mental health services, not all colleges employ a full-time licensed counselor or operate an adequately staffed Counseling and Wellness Center.” 4Cs President Seth Freeman began the September 8 press conference sharing that the participating speakers would talk about the mental health needs of students and the need to expand mental health services to better support students in the different communities. As October includes Mental Illness Awareness Week from October 3 to 9, National Depression Screening Day on October 7, and World Mental Health Day on October 10, there is no better time than the fall, the start of the school year to focus on mental health for students, he noted. Gateway Community College graduate and current University of Connecticut student Kayla Garner was one of the first
to speak. Sharing her experience as a student who moved to the area from Georgia, Garner said the topic of mental health has been a hobby of hers since participating in the Mental Health Club at Gateway. While Garner said the wellness center at Gateway was a place she felt she could go for support, she feels it failed her when counselors were not available when the support center closed. The press conference was held after an announcement from the Connecticut State Colleges and Universities (CSCU) announced a partnership with TimelyMD to provide access to a 24/7 health and counseling services through telehealth technology, according to an announcement. The announcement later said the contract was a two-year agreement between CSCU and TimelyMD and that $659,223 contract entitles every Connecticut community college student to unlimited access to TalkNow, an “on-demand mental health support system, unlimited health consultations, as well as 12 scheduled individual counseling sessions per year,” the announcement reads. The full announcement can be read online at ct.edu/newsroom/cscu_announces_expanded_mental_health_options_ for_community_college_student. Not Enough Counselors The news of a mental health hotline, Garner said in the virtual press conference, was “insulting to students.” She asked legislators to support hiring more counselors to fully staff wellness centers
at community college campuses. “One counselor per school is not enough. We need adequate mental health care,” Garner said. Northwestern Community College Director of the Office of Student & Community Life, Title IX Coordinator, SART/ CARE Team Coordinator Ruth Gonzalez, PhD, LPC, spoke next. “Mental health has been a topic that we have discussed over and over... My hope is that with this partnership between CSU and TimelyMD [it] will create the much needed opportunity for dialogue,” Gonzalez said. Saying that she feels proud that Northwestern Community College has addressed student needs, Gonzales said the students are complex individuals who need more than academic support alone. “My hope is that we take this opportunity to look at the need and have those very much needed conversations with our on campus staff,” said Gonzalez. Housatonic Community College Director of Counseling and Wellness Lisa Slade, NCC, LPC, said she had mixed feelings when she first heard about the partnership with TimelyMD. Counselors, Slade observed, experience the student traumas first hand — including housing and/or food insecurities. Putting an investment into sourcing from outside the local communities, Slade continued, “is disturbing” without securing support for already existing programs. While offering understanding of the benefits TimelyMD can provide, Slade said, “We need to strengthen our founda-
tions and there needs to be professional licensed mental health counselors on every community college campus in Connecticut. Period.” Counselors have met the COVID-19 pandemic’s challenges, and Slade said there is a need to have counseling center departments that are fully staffed with competent professionals and appropriate technology and software to ethically service student needs. Slade also highlighted the inequality of only providing telehealth services as it does not take into consideration “what it takes for a student to ask for help.” There will be, she continued, many students who do not have their needs met. It is important for counselors to build connections with the campus community and faculty so they know how to identify students in distress and to reinforce those partnerships in the community. Senator Mae Flexer (D-29) closed the press conference saying that telehealth services are “nice” but it lacks the knowledge of the available resources in local communities. “Consolidation of our community college system is ruining the support networks that students have on their individual campuses,” said Flexer. Later she added, “We’ve got to do better.” The full press conference is available to watch online at facebook.com/watch/ l i v e / ? r e f = w a t c h _ permalink&v=651746652406173.
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Got EVOO? Study Shows Extra Virgin Olive Oil Promotes Cardiac Wellness DERBY — If you think you may be benefiting your health by substituting, or even directly consuming, extra virgin olive oil, there is more to the habit than you may know — and it could make a difference in what you are hoping to achieve. Research conducted by the Yale-Griffin Prevention Research Center in Derby found that extra virgin olive oil improved endothelial function, a marker of cardiovascular health, while refined olive oil did not. In this study, recently published in The International Journal of Cardiology, researchers compared consumption of high polyphenol extra virgin olive oil to refined olive oil on measures of cardiovascular health in a group of 20 adults with prediabetes. According to the Centers for Disease Control and Prevention (CDC), approximately 4.2 million Americans are diagnosed with type 2 diabetes, and another 88 million, or one in three, with prediabetes. People with diabetes or at risk for diabetes are more likely to develop other chronic health problems such as
cardiovascular disease, stroke, and hypertension, and have a higher risk of dying prematurely. The study team found that a single 50 milliliter dose (about 3½ tablespoons) of extra virgin olive oil, blended in a yogurt smoothie, led to improved endothelial function two hours after ingestion, while the refined oil did not. Endothelial function and blood pressure were measured before the meal, and two hours later. Endothelial function is a measure of blood vessel elasticity and how well blood vessels expand as blood flows through them, and is considered an independent predictor for risk of future cardiovascular events. The difference between the olive oils was statistically and clinically significant. No short-term effect on blood pressure was found with either type of olive oil. “While research over the past few years has shown that olive oil can offer considerable benefits to cardiovascular health, results of those studies have not always been consistent,” said Valentine Njike, MD, MPH, principal
A study conducted by the Yale-Griffin Prevention Research Center in Derby has found that extra virgin olive oil improved cardiovascular health.
investigator of the study. “This may be due to the fact that the nutritional content of olive oil varies. For example, all olive oils are relatively high in monounsaturated fat, which is thought to be ‘heart-healthy,’ but extra virgin olive oil contains higher levels of biophenols, natural compounds that modulate oxidative stress, and thought to slow the progression of cardiovascular disease.” Study co-investigator, David L. Katz, MD, MPH, noted the importance of the study’s findings. “There is tremendous interest in, and lively debate about, the health effects of oils, including olive oil,” Katz said. “Such debates should be resolved with data, and this study makes an important contribution by highlighting the relevance of not just the type of oil, but also its quality. We have added to an impressive weight of evidence indicating diverse health benefits from genuine extra virgin olive oil.” Njike emphasized the need for a larger study with a longer time frame to add to the findings of this study, as well as studies to help clarify how extra virgin olive oil influences cardiovascular health. The study is entitled “Postprandial Effects of Highpolyphenolic Extra Virgin Olive Oil on Endothelial Function in Adults at Risk for Type 2 Diabetes: A Randomized Controlled Crossover Trial.” Funding was provided by Cobram Estate, a manufacturer of extra virgin olive oil, and supported by the CDC. Cobram Estate is a premium extra virgin olive oil producer based in California and Australia that uses state-ofthe-art sustainable agriculture techniques. The Yale-Griffin Prevention Research Center (PRC) was established in 1998 through funding from the Centers for
Disease Control and Prevention (CDC). One of 26 Prevention Research Centers nationwide representing academic-community partnerships, the PRC is engaged in interdisciplinary applied prevention research designed to develop innovative approaches to
health promotion and disease prevention that will directly benefit the public’s health. The center has been researching the role of nutrition in chronic diseases for more than 20 years. Learn more about Griffin research at www.griffinhealth.org.
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THE NEWTOWN BEE, FRIDAY, OCTOBER 15, 2021
Newtown Physician Calls TMS Depression Treatment A ‘Game Changer’ By anDy hUTchiSon Are you suffering from depression — or is someone you know? On the heels of Mental Illness Awareness Week October 3-9, National Depression Screening Day on October 7, and World Mental Health Day on October 10, one local psychiatrist explained to The Newtown Bee that there is no better time than right now to look at one consideration for treatment: transcranial magnetic stimulation or TMS. According to myclevelandclinic. org: “TMS, is a treatment for people with severe depression whose illness has not been helped by at least one antidepressant medication. It is a type of brain stimulation therapy. TMS elicits magnetic energy, which turns into electrical current underneath the patient’s skull, to help regulate the patient’s emotions.” “TMS is a noninvasive method of brain stimulation that relies on electromagnetic induction using an insulated coil placed over the scalp, focused on an area of the brain thought to play a role in mood regulation,” according to hopkinsmedicine.org. “The coil generates brief magnetic pulses, which pass easily and painlessly through the skull and into the brain. The pulses generated are of the same type and strength as those generated by magnetic resonance imaging (MRI) machines. When these pulses are administered in rapid succession, it is referred to as ‘repetitive TMS’ or ‘rTMS,’ which can produce longer lasting changes in brain activity.” Newtown psychiatrist Dr John Woodall, who said depression is the leading cause of disability in the United States, continues to have great success with TMS. “I’ve been practicing for 40 years. TMS has been a game changer for my practice. People who were feeling truly hopeless because they had tried many medications without benefit and had thought that nothing could help them have had a new lease on life with TMS. That is very rewarding,” he said. Woodall gets satisfaction in helping not only patients but those from in and around his community of Newtown. “Having lived and worked in Newtown for so long, I’ve been fortunate to get to know the real heart of the town. I’ve seen so many people here who really show the best of what it means to be a
Dr John Woodall, of Newtown has seen great success treating depression with transcranial magnetic stimulation or TMS. —Photo/images courtesy John Woodall, MD.
This chart shows the impact of TMS treatment. human being. It’s very humbling and inspiring,” he said Woodall said 20 to 40% of people with depression will get better on their own in six months. Antidepressants increase this number by only 20%, and 40% of people who take antidepressants report side effects to their doctor; sexual side effects are common. “Treatment resistant depression is defined as a depression that doesn’t get better on its own and the person has tried at least two medications without sufficient benefit,” he said. “What makes
TMS so remarkable is that it is highly effective even with people who have treatment-resistant depression. Over 80% of those who have treatment-resistant depression [no benefit from antidepressants] are helped by TMS.” Impact And Benefits Woodall said side effects are very minimal in a very small number of people. “The vast majority have absolutely no side effects and report a reduction in anxiety, improved sleep, and the lifting of depres-
sion. Most have a very pleasant experience and find treatment very restful,” he added. Treatment is specific to each patient, however. “I complement my standard practice of medication management with a thorough examination looking for metabolic problems that can lead to brain exhaustion. I use medications, diet, lifestyle, and appropriate supplements as well as a variety of therapies to address the whole person. When used with TMS, these combinations of help are far more beneficial. A patient of mine told me the other day that she would say to her friends, ‘If you are struggling with depression, run, don’t walk to get TMS,’” he said. Longstanding untreated depression is associated with an increased incidence of dementia in later life, Woodall said. Woodall noted that TMS is not necessarily only for treatment of depression. “Two years ago, I spoke by phone with the doctor who is conducting the research for NASA about the use of TMS with astronauts. They are not using TMS to treat depression, but to promote optimal performance in them,” he said. According to the CDC in June 2021: *40% of Americans are struggling with some form of mental health challenge. *31% are struggling with anxiety or depression. *11% of all Americans have seriously considered suicide. *26% are dealing with the aftermath of some form of trauma or stress-related disorder. “The big concerns are the effects of COVID, joblessness and economic instability, social isolation, and the disruption of normal routines on mental health,” Woodall said. Woodall has practiced all over the country, including internationally, and been at several universities in his career. He was part of Harvard faculty for 17 years. “But this is where my heart comes back to,” said Woodall, adding that he welcomes calls for a free consultation at 475-225-5098. Visit johnwoodallmd.com and follow him on Facebook at: “John Woodall, MD” www.facebook.com/ John-Woodall-MD. Andy Hutchison can be reached at firstname.lastname@example.org
PATIENT HEALTH QUESTIONNAIRE-9 (PHQ-9)
PATIENT HEALTH QUESTIONNAIRE-9 More Nearly (PHQ-9) Several than half every
Over the last 2 weeks, how often have you been bothered by any of the following problems? (Use “✔” to indicate your answer)
Not at all
Over the last 2 weeks, how often have you been bothered 1. any Littleof interest or pleasure in doing things by the following problems? (Use “✔” to indicate your answer)
Not at all
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
7. Trouble concentrating on things, such as reading the newspaper or watching television
1. Little interest or pleasure in doing things
2. Feeling down, depressed, or hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired or having little energy
5. Poor appetite or overeating
9. Thoughts that you would be better off dead or of hurting yourselforinspeaking some wayso slowly that other people could have 8. Moving
FOR OFFICE CODING
9. Thoughts that you would be better off dead or of hurting yourself in some way
noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual
newspaper or watching television
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6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
More Nearly 3 than half every the days day
+ ______ + ______ + ______
1=Total Score: 2 ______ 3
theseCODING problems0 made it for you+ to______ do your+ ______ If you checked off any problems, how difficult have FOR OFFICE + ______ work, take care of things at home, or get along with other people? Somewhat difficult
Not difficult at all
=Total Score: ______
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Extremely difficult
Not difficult at all
Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.
This self-assessment scale is commonly used to see if one is depressed, Woodall said. It is called the “Patient Health Questionnaire-9.” The scores go from 0 to 27. *A score of 0-4 = Minimal Depression. *A score of 5-9 = Mild Depression. *ADeveloped score of by 10-14 Moderate Depression. Drs. = Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Inc. permission required toSevere reproduce, translate, display or distribute. *APfizer score of No 15-19 = Moderately Depression. *A score of 20+ = Severe Depression. A person with a score of 20+ ought to call for guidance/help on how to restore good brain health and feel good again.
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