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Features CONTACT INFO EDITORS J. Todd Alderfer, MD Eric R. Gejer, DO Nancy Croll Bucks County Medical Society 200 Apple Street Quakertown, PA 18951 (215) 536-8665
PLASMA: More Than Just Your Screen
BCMS Annual Dinner Recognizes Years of Service
For My Love of History
Keep Calm and Bake On
EXECUTIVE DIRECTOR John S. Detweiler CONTACT firstname.lastname@example.org WEB bcms-pa.org BOARD PRESIDENT, 2015 Bindukumar C. Kansupada, MD PAST PRESIDENT Eric R. Gejer, DO PRESIDENT-ELECT J. Todd Alderfer, MD VICE PRESIDENT Sean P. Butler, DO TREASURER Irwin J. Hollander, MD SECRETARY Kieran D. Cody, MD
Bucks County Medical Society • Letter from the Editor .......................................................... Page 4 • Meet Your Board................................................................... Page 6
PAMED Updates • Telemedicine......................................................................... Page 8 • Frustration with Physician Credentialing.............................. Page 9 • Nurse Practitioners Will Continue to Work Under Physicians........................................................ Page 10 • Malpractice Cases Down..................................................... Page 11 • ICD-10 is Here. Is Your Practice Ready?.............................. Page 13
PUBLISHER Hoffmann Publishing Group, Inc. 2921 Windmill Road Reading, PA 19608 610.685.0914 x201 HoffPubs.com
Health & Wellness • Staying Safe in the Summer................................................. Page 23 • Bites & Stings Can Lead to Other Things............................. Page 24 • Alzheimer’s Disease: What Healthcare Providers Need to Know........................... Page 26
• Relief For Chronic Pain on the Horizon................................ Page 28
Karen Zach 610.685.0914 x213 Karen@HoffPubs.com
On the Cover: Left to right: Bindukumar C. Kansupada, MD, BCMS President; Karen A. Rizzo, MD, PA Medical Society President and John S. Detweiler, BCMS Executive Director
Production Associate Lauren Barron
The written and visual contents of this magazine are protected by copyright. Reproduction of print or digital articles without written permission from Hoffmann Publishing Group, Inc., and/or the Bucks County Medical Society is forbidden. The placement of paid advertisement does not imply endorsements by Bucks County Medical Society.
Letter from the Editor
Driver’s Seat this Eric Gejer, DO
With summer comes warmer weather at last and more outdoor activity. Many will look to get involved in projects that need attention like our lawns and gardens. As physicians it’s a great reminder to us to put some attention into another often neglected project, dealing with the regulatory effects on our profession. The only thing that we can expect from the future is change. We should not fear this, but at the same time we should not let it run us over. Physicians need to weather and react to change, but not hide from it. We should accept those things that preserve the patient-physician relationship, but speak out when this relationship is being assaulted and our profession eroded. As physicians we take a Hippocratic oath to care for our patients. Does that care just involve prescribing a medication or performing a surgery? What we see happening now is encroachment by outside groups, outside non-physician providers and outside agencies into the physician-patient relationship. Should physicians stand by while others try to dictate the terms of the care that we give? The medications we can prescribe? The timing of surgery? Access to care? Cost of care? As physicians we should stay in the driver’s seat in caring for patients. Unfortunately in today’s world that involves more than just picking up our stethoscope or scalpel. It involves efforts to inform our patients, insurers, and legislators as to our value as leaders of the medical team. Our value in providing the best care to our patients at the lowest cost. Our value in understanding why a procedure 4
is necessary and holding ourselves to the high standards that we have developed with appropriate use criteria and medically accepted standards of care. Accountability for physicians should come from physicians.
“Should Physicians be involved in the precertification process for procedures?” Should Physicians be involved in decisions as to what oversight is necessary with extenders like nurse practitioners and physicians assistants? Should Physicians be involved in legislative efforts to improve the practice of medicine in a cost-effective value-based over volume-based world? I would hope the answers to these questions from all of us is a resounding yes. But these questions should not be answered by anyone other than you, physicians who have trained longer than other providers to obtain licensure to practice medicine and care for patients from the beginning of their lives until the end. There is a push by nurse practioners to practice without physician oversight. I work with nurse practitioners both inside and outside my practice and see the valuable care they provide as part of the BCMS-PA.org Bucks County
Letter from the Editor medical team. However, the training a physician undergoes of 12,000 to 16,000 hours is significantly more and up to 24 times the hours of a nurse practitioner’s training. While nurse practioners care is supportive, it is not equivalent. Physicians should continue to support a team based approach and resist attempts to splinter it, which may lead to more costly and less effective care. Can people afford the health care that they now have access to? Are high deductibles keeping patients from seeking medical care or even worse, delaying care that is necessary like a surgery or procedures? It appears that the patients least likely to afford insurance now have access to it but with deductibles that are so high they cannot afford the care that they’ve been offered. Others who have insurance are seeing deductibles rise exponentially due to mandates. Can we, as physicians, do better?
Eric Gejer, DO Editor
z , Oye Is t Oyez r u o ! The CSession n i w No THE OFFICIA
I write this, not to inspire and not to scare and not to threaten, but to inform all that the practice of medicine is at a turning point. There are times when we are called to act, to participate and to acknowledge that our input is needed and necessary for the survival of American medicine and the protection of the physician-patient relationship. I hope that those reading this will become more involved in organized medicine for the protection of those ideals. Those ideals represent our patients’ lives. We took a Hippocratic oath for our patients’ health. That oath should extend outside the exam room.
SUMMER COU DEL AWARE
It is important to raise questions and understand what is happening in medicine today. Going with the flow and letting others decide what is best for physicians and patients without physician input will affect not just our careers but our patients’ lives.
TURNING THE PAGES TO YOUR SUCCESS
E/OUT INSID MEDIA ART IN
For advertising information contact Karen Zach 484-924-9911 Karen@Hoffpubs.com
BCMS Board Profile
Board Meet Your
David A. Levin, D.O.
Favorite part of practicing medicine: Diagnosing a patient is like solving a puzzle. As a radiologist, I enjoy being given a piece of the puzzle and consulting with other physicians to help put together all the pieces. More often than not, the missing piece is there on film in black and white. Where do you practice, and why did you settle in your present location or community: My father joined my current practice, Grand View Radiology Associates, a year before I was born. He was with our group for almost 40 years before retiring in 2013. Prior to joining Grand View, I practiced in central New Jersey, but my young family and I felt removed from our extended family who live closer to Philadelphia near where my wife and I grew up. When a position opened at Grand View, it seemed too good to be true Judith E. Gallagher-Braun, MD Favorite part of practicing medicine: My favorite part of practicing medicine is using my skills and knowledge to help patients. Where do you practice, and why did you settle in your present location or community: I practice in Bucks County. Initially I came here to join my brother in practice and because my family lives in the Philadelphia area. Most live in NJ. I often joke with my husband that I dragged him from Bergen County, NJ to live in the boondocks of PA. After raising our three children here, we couldn’t imagine being anywhere else. We have access to Philly and NYC but are also close to rural areas. The traffic is manageable and schools are excellent. We are within 1-2 hours driving distance to almost all of our extended family members. Both my husband and I have 5 siblings each. Bucks County is rich with history and the geography is also beautiful with the Delaware River nearby and forests and hiking.
and we moved “home” in 2008. I had the privilege of working with my father for five years. I have been a partner since 2009. Are you or any family members actively involved in any community, non-profit or professional organizations: I serve as vice president of the Montgomery Township Historical Society. My wife is a writer and editor. The eldest of our two sons is a second-grade student council representative at his elementary school. Hobbies & interests when not working: I enjoy reading, gardening, long-distance running, and working with BCMS.
What’s your vision for a better healthcare delivery system: I hope for a healthcare system that encourages people to take responsibility for their own care, and allows physicians to order tests and treatments for patients that are appropriate rather than “are covered by insurance.” Are you or any family members actively involved in any community, non-profit or professional organizations (if so, please list name of participants and groups): Our children attend Catholic schools. Most of our involvement is with our children and the schools they attend: Holy Ghost Prep, Nazareth Academy and St. Andrew School in Newtown, PA. Hobbies & interests when not working: I enjoy snow skiing and boating and water sports, which we do in property we own in Lake George, NY. We also enjoy the NJ shore with family. My husband enjoys taking photos at our children’s sporting events and other school activities and often puts together videos for the end of year celebrations. He has about 30,000 shots from over the years. What’s your vision for a better healthcare delivery system: My vision for a better healthcare delivery system is something that is much more simple. Currently, it is so complicated and cumbersome that it frustrates patients as well as providers. People feel that getting the most out of insurance is nearly impossible. I don’t know how to accomplish this, and am pessimistic that it can ever happen. At times it seems that insurance is the elephant in the room. It comes between the doctor and patient more than it facilitates the relationship. BCMS-PA.org Bucks County
BCMS Board Profile Joseph G. O’Neill, D.O. Favorite part of practicing medicine: The majority of my practice is treating Geriatric patients. I enjoy hearing their stories and experiences they have witnessed in their lives. As someone who practices in a more rural area, I also enjoy really knowing my patients, as if I am a part of their family, not just their doctor. Where do you practice, and why did you settle in your present location or community: I practice in “downtown metropolitan Ottsville” in Upper Bucks. I was recruited out of my residency 24 years ago to establish a family practice. I am employed by St. Luke’s Physician Group and serve on the Hospital Board of St. Luke’s Quakertown Hospital and as Medical Director at Phoebe Richland, a skilled nursing and rehabilitation center in Richlandtown.
Are you or any family members actively involved in any community, non-profit or professional organizations (if so, please list name of participants and groups): My son recently achieved the rank of Eagle Scout and was awarded a National Scouting Award called the Medal of Merit. He received this for rescuing an elderly woman from a smoldering vehicle after a serious car accident. For his Eagle Scout project, we built an outdoor classroom at his high school, CB South. Hobbies/Interests when not working: I enjoy various activities such as landscaping, home improvement projects, and spending time with my family. I have participated in a weekly spinning class for the last 10 years as part of my fitness regimen. What’s your vision for a better healthcare delivery system: My hope for a better healthcare system involves everyone having realistic expectations about what medicine can and can not do. We need to understand that some care can be futile and wasteful without improving quality or satisfaction. I hope that each individual can decide for themselves what they would like done, particularly at the end of their life.
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Telemedicine Pennsylvania with limited specific exceptions. An important principle is that the practice of medicine occurs in the state where the patient is located. • Professional Liability Coverage— Professional liability coverage requirements would apply to providers of telemedicine/ telehealth. • Evaluation and Treatment of the Patient—A proper provider-patient relationship would need to be established if such action would otherwise be standard acceptable medical practice in the provision of the same service not delivered via telemedicine/telehealth. A list of minimum requirements is outlined to include a virtual face-to-face examination, and, if necessary, incorporates peripherals and diagnostic tests with limited specific exceptions.
PA Med Board Approves Draft Legislation to Address Barriers to Telemedicine in PA With a growing number of services being provided via telemedicine technologies, there is a need for a set of safeguards and standards to support the appropriate coverage of and payment for telemedicine services. Geography, weather, availability of specialists, transportation, and other factors can create barriers to accessing appropriate health care, including behavioral health care. One way to provide, ensure, or enhance access to care given these barriers is through the appropriate use of technology to allow health care consumers access to qualified health care providers. On May 19, 2015, the Pennsylvania Medical Society (PAMED) Board of Trustees approved draft legislation from PAMED’s Telehealth Task Force, which is aimed at addressing barriers to telemedicine in Pennsylvania and bringing clarity to the expanded use of telemedicine in the commonwealth. Provisions in the draft legislation include: •
Participation Eligibility — A variety of health care providers would be eligible to participate in telemedicine/ telehealth in addition to physicians. The draft legislation offers as examples the Medicare list of eligible providers. Providers would be required to practice within their scope subject to state licensure laws and regulations. Licensure—Physicians and other eligible providers who provide telemedicine/telehealth care to patients in Pennsylvania would be required to be licensed in
Informed Consent and Privacy Practices—Providers would need to comply with informed consent rules as they relate to telemedicine/telehealth as well as follow all privacy practices, such as the Health Insurance Portability and Accountability Act (HIPAA).
Medical Records—Providers would be required to maintain a complete medical record of the patient’s care in accordance with the standards applicable to traditional face-to-face encounters for documentation, maintenance, and transmission of records.
Fraud and Abuse—Providers would be required to follow all applicable state and federal statutes and regulation for fraud and abuse.
Coverage of Telemedicine Services—Health insurers would be required to provide coverage for the cost of health care services provided through telemedicine/ telehealth on the same basis that the insurer would for the provision of the same service provided through in-person consultation or contact.
• Medicaid Program—Telemedicine/telehealth coverage would be required to be provided by Medicaid, HealthChoices Physical Health Managed Care Organizations, and HealthChoices Behavioral Health Managed Care Organizations. Continued on page 9. BCMS-PA.org Bucks County
PAMED Updates PAMED Advocacy staff will work with other affirmative stakeholders to have the bill introduced and enacted. PAMED Past President Marilyn Heine, MD, chairs the task force that drafted the legislation to bring to the PAMED Board for its approval. Task force members include representatives from a number of specialists and primary care physicians nominated by their state specialty society. The task force also sought feedback on the draft legislation from counties, specialties, and the Hospital and Healthsystem of Pennsylvania. Addressing barriers to telemedicine, improving access to care while ensuring patient safety, is one of PAMED’s many advocacy priorities for 2015. Many have asked what is the difference between telemedicine and telehealth.
Frustration with Physician Credentialing Survey says: Credentialing Process Burdensome and Costly for Physicians Physicians, especially new physicians, find themselves unable to treat privately insured patients until they are fully credentialed by insurance companies—a lengthy and oftentimes frustrating process that creates administrative hassles and delays patient care. To confirm the level of this frustration, the Pennsylvania Medical Society (PAMED) recently polled members through its daily email, the Daily Dose. While this was only an informal poll, it confirmed that, as expected, at least half of the problems occur when attempting to credential a new physician. Physicians’ biggest hassle is that the process simply takes too long. Most respondents said it took more than 90 days (50 percent said the process took 90 days; 23 percent said it took 120 days, and 13 percent said it took 120 days.) The majority felt that the main contributing factors to the delay were the health plan and the cumbersome application process, and they said that that delay cost them money (33 percent said $20,000-$40,000, 22 percent $45,000-$60,000, 22 percent less than $10,000, and 15 percent more than $80,000). SUMMER 2015
The draft legislation says that: “Telehealth is defined as the use of electronic information and telecommunications technologies to support longdistance clinical health care, patient and professional healthrelated education, public health and health administration. Technologies include videoconferencing, store-and-forward imaging, streaming media, and terrestrial and wireless communications. Telehealth refers to a broader scope of remote health care services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth includes remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.”
When asked what they considered a reasonable time period for commercial insurers to complete the credentialing process, provided that physicians were able to retroactively bill for dates of service that coincide with the effective date on the credentialing application, 46 percent said 30 days and 39 percent 60 days. PAMED believes that payers should be required to make a credentialing determination within 90 days of receiving a completed application and to reimburse provisionally 15 days into the credentialing process. We have drafted legislation and are in discussions with a potential bill sponsor in the House. In addition to easing the burden on physicians, this bill would also help ensure access to care and reduce their out-ofpocket expenses for patients. “What we currently have is a private health insurance credentialing system or process that is at best inefficient, blind to the needs of patients residing in rural and underserved areas, and unfair to newly trained physicians who simply want to begin putting into practice the skills they have learned during nearly a decade of training,” said PAMED President Bruce MacLeod, MD.
Nurse Practitioners Will Continue to Work Under Physicians Overwhelming majority of Pennsylvanians say keep the care team together and “no” to nurse practitioners working without physician collaboration
safeguards prohibit them from “full practice authority,” nurse practitioners can diagnose, treat, and even prescribe medications just as physicians do, a privilege not seen in many other states.
A poll of 700 Pennsylvanians overwhelmingly indicates the state’s residents do not support current legislative efforts in Harrisburg to allow nurse practitioners to work without physician collaboration, suggesting such efforts are out of touch with most Pennsylvanian residents.
Nurse practitioners also claim that they are more likely to practice in rural areas and provide care to underserved Pennsylvania communities. Geomapping studies of nurse practitioner practice patterns indicate that is not the case: they are more likely to practice in urban areas. Expanding care to underserved areas involves expanding access to telemedicine, training more physicians, and incentivizing them to work in underserved areas, not fragment the care team.
The Patient Poll, conducted March 6-12, 2015, by Susquehanna Polling and Research and commissioned by the Pennsylvania Medical Society, indicates only 15 percent of those polled believe nurse practitioners should be allowed to practice independent of physicians. The poll has a margin of error of 3.7 percent. Pennsylvania law currently requires nurse practitioners to care for patients as part of a physician-led health care team. Last year, in further support of “team-based care,” the general assembly unanimously approved Act 198 that promotes integration and teamwork among all health care providers. A small cadre of activist nurse practitioners have been lobbying our state senators and representatives hard to remove physicians from health care teams. “Clearly the public does not support those efforts, says Karen Rizzo, MD, president of the Pennsylvania Medical Society. “Nor do all nurse practitioners, many of which see physician collaboration as key to providing quality care statewide.” Nurse practitioners are misleading legislators by describing their current ability to see patients as “handcuffed” by existing law. Despite claims that patient
“Quality medical care for Pennsylvania involves providing access to the most highly educated and best trained medical providers, which are physicians, and working together with other health care providers to effectively treat patients,” says Dr. Rizzo. “There is a reason, a very good reason, why it takes a primary care physician 11 years of education and 12,000 hours of supervised clinical training before Pennsylvania law grants them the authority to practice independently.” “I can’t imagine why our legislature would want to fragment the care team and grant independent medical practice authority to any professional with less training than a physician,” Dr. Rizzo added. “In comparison, becoming a CRNP can take as little as 2 to 4 years of post-graduate study and only 500 clinical hours of training. As the Patient Poll suggests, Pennsylvanians want the assurance that a physician is involved in decisions regarding their healthcare. Why would we consider anything less?”
BCMS-PA.org Bucks County
Malpractice Cases Down liable will only be responsible for their proportionate share of award.
Number of medical malpractice cases filed in Pennsylvania reaches 14-year low According to the Administrative Office of Pennsylvania Courts (AOPC), the number of medical malpractice cases filed in Pennsylvania declined last year to the lowest it has been since statewide tracking began in 2000.
Certificate of merit — Requires attorneys who file a professional liability action to file a certificate of merit stating that he/she has in hand a supporting report from a qualified expert within 60 days of filing claim.
The AOPC data shows that there were 1,463 new cases filed in Pennsylvania’s civil courts in 2014 — the fewest ever recorded and a 46.5 percent decline from the number posted in the “base years” of 2000-2002. In Philadelphia, the state’s judicial district with the largest number of cases, the decline has been 68.3 percent during the same time period.
Punitive damages — Punitive damages are allowed only if a health care provider engaged in willful or wanton conduct or in reckless disregard to rights of others, and are capped at 200 percent of compensatory damages except in case of intentional misconduct.
Affidavit of non-involvement — Defendants can obtain quick dismissal by filing an affidavit stating that they were not involved with the plaintiff’s care, or obligated to provide care, individually or through agents and employees.
The Unified Judicial System of Pennsylvania’s press release said that the base years are the period just prior to two significant rules changes made by the Supreme Court of Pennsylvania that required: •
Attorneys obtain from a medical professional a “certificate of merit” that establishes that the medical procedures in a case fall outside acceptable standards.
Collateral source rule — Limits double recoveries for past “losses” covered by collateral sources such as private health and disability insurance.
Medical malpractice actions to be brought only in the county where the cause of action took place — a move aimed at eliminating so-called “venue shopping.”
Periodic payment — Mandates periodic payment of future medical damages with automatic cut-off at death.
Reduction to present worth — Mandates reduction to present worth of future work loss damages.
Statute of repose — Seven-year absolute time limit on filing of claims except in the case of an injured minor or foreign object left in the body. Preserves the existing twoyear absolute limit on filing of wrongful death or survival claims except in case of fraud or wrongful concealment of cause of death.
Remittitur — Requires the court to consider the adverse impact of a verdict on availability or access to health care in the community when ruling on a motion to reduce verdict.
Physicians often ask us, “What has the Pennsylvania Medical Society [PAMED] done to address this problem in the past and what are you doing now to achieve meaningful tort reform in Pennsylvania?” While there is certainly more to be done to enact meaningful tort reform in Pennsylvania, PAMED has achieved many important remedies addressing major physician concerns, including: •
Apology — Physician apologies and other benevolent gestures (except admissions of fault or negligence) to a patient after a poor outcome are inadmissible to prove liability in a medical liability action.
Expert witness qualifications —Establishes expert witness qualifications, including active practice or teaching and either same or similar specialty or board certification in same or similar specialty when defendant physician is board certified.
Venue — Medical liability actions may be filed only in the county where the cause of action arose, or if multiple defendants, only in a county where action against one of the individual defendants could be brought.
Joint and several liability — Modifies joint and several liability rule so that defendants less than 60 percent
OCTOBER 23—24, BCMS 2015 Board Profile
PAMED ANNUAL EDUCATION
CONFERENCE Educational Sessions
Who can attend:
Enhancing Cultural and Linguistic Competencies: Improving Health Care and Building Effective Teams Horace DeLisser, MD
All Pennsylvania physicians
Healthy Teams, Healthy You: Interpersonal Skills to Reduce Stress and Improve Interactions with Patients, Providers and Peers David Steinman, MD
Hershey Lodge, Hershey, Pa.
Meta Leadership 2.0: Swarm Intelligence Leonard Marcus, PhD Finding Purpose and Pleasure in Medicine: Better Patient Care and Improved Physician Well-Being Bruce Bagley, MD
Where: When: Friday, Oct. 23, 2015 – Saturday, Oct. 24, 2015
Cost: Members: Free! • PAMED Nonmembers: $149 •
Physician Advocacy 2.0 Michael Fraser, PhD, CAE; Larry Light Opioid Abuse: Addressing the Crisis Scot Chadwick, JD
REGISTER ONLINE AT www.pamedsoc.org/Conference15
BCMS-PA.org Bucks County
ICD-10 IS HERE.
Is Your Practice Ready? After being delayed twice, ICD-10 is finally supposed to be implemented by all healthcare organizations by October 2015. There are many enhancements and improvements to ICD-10 compared to ICD-9. Although ICD-10 has been around for nearly two decades, we are adopting it only now. The new ICD-10 will have more than 68,000 codes compared to approximately 18,000 codes in ICD-9. Some major advantages of ICD-10 include: • Improved disease management • It is very specific to the body part and site • Addresses the issue of laterality (right or left) • Improved coding accuracy and richness of data for analysis • Improvement in medical research • Supports interoperability and exchange of health data among different systems • HIPAA compliant There are significant differences in classification, terminology, meaning and definitions between ICD-9 and ICD-10. Implementing ICD-10 will be no easy task. It takes a great deal of planning and execution, and time, money and resources to get it implemented by the deadline. The Center for Medicare and Medicaid (CMS) has come up with the following implementation plan with six phases: 1. Planning 2. Communication and awareness 3. Assessment 4. Operational implementation 5. Testing 6. Transition For a better understanding of the challenges facing U.S. Markets, we can review a list of expected and unexpected outcomes from Canada’s implementation of ICD-10 between 2001 and 2005. Unexpected outcomes • Underestimation of how much work was involved • Both timelines and budgets were grossly underestimated • Magnitude of change was underestimated Expected outcomes • Training of coders alone is not sufficient • Physician involvement is crucial • Physician should correctly document all clinical aspects of the patient SUMMER 2015
ICD-10 will impact the following people and technology: • Physicians • Billers and coders • Clinicians • Information system and technology • Software vendors • Billing system • Documentation All current systems that use ICD-9 will be affected by the change, as it includes applications, software interfaces, state, federal and other reporting, vendor applications, internal and external interfaces, etc. It will also impact processes, systems, operations and finances. Of special note, financial impacts include: • Initial revenue decrease • Payment error rate due to errors in implementation • Payment delays due to claim rejections Enterprise outreach, education and communication is very crucial to the success of the project. We recommend you complete your own enterprise readiness selfassessment questionnaire, as it’s not too early to prepare for the ICD-10 transition.
Are You Ready? My facility has an implementation timeline My facility has an interdisciplinary steering committee Executive management is aware and supportive My facility has a communication plan My facility has completed an inventory of all systems affected My facility has created a budget for implementation My facility has a training plan
Your assessment should include a full review of your systems and applications, vendor readiness, ICD-10 training, technology, people and processes. Siva Mahalingam is the President of Cube Info Solutions, an IT consulting firm specializing in healthcare IT.
Plasma By: David S.C. Pao, MD
Non-thermal plasma sets the stage for further advancement in ophthalmic medicine In 1796, Edward Jenner developed a method to protect individuals from smallpox by exposing them to the cowpox virus. In his famous experiment, he rubbed the contents from a dairymaid’s cowpox abscess into scratches on the arm of his gardener’s 8-year-old son. Jenner then exposed the boy to smallpox six weeks later, which he did not develop, hence creating the revolutionary process of vaccination. In 1842, and after first being demonstrated by Boston dentist, William T.G. Morton, American surgeon, Crawford W. Long, used ether as a general anesthetic during surgery, setting the stage for the development and worldwide use of general anesthesia. In 1867, Joseph Lister was convinced of the need for cleanliness in the operating room, a progressive idea at the time. He later developed antiseptic surgical methods using carbonic acid to clean wounds and surgical instruments. The immediate success of Lister’s methods lead to a general adoption, causing death from infection to decrease significantly. Throughout history and even into today, momentous advances in medicine all begin with a single belief that blends practice and theory. All it takes is one person, an idea, and a vision to seek to improve the world’s health for the better. On a local level, Gregory Fridman, Ph.D., co-director of the plasma medicine laboratory at the A.J. Drexel Plasma Institute, Drexel University; Kristina Pao, M.D., of the Wills Eye Hospital and Thomas Jefferson University; Justine Han, B.S., of the A.J. Drexel Plasma Institute, Drexel University; and Bucks County Medical Society member, David S.C. Pao, M.D.,
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Thar Screen You
also of the Wills Eye Hospital and Thomas Jefferson University, are pursuing their groundbreaking vision for non-thermal plasma to be utilized in the field of ophthalmology. Plasma as a whole is produced when energy is put into a gas through electrical or other methods. This creates ions and neutral reactive species, all having gained energy from this gaseous plasma. Thermal plasma is plasma that heats its surroundings. Examples are the sun, lightning, and welding arc. Non-thermal plasma is plasma that does not heat its surroundings. Examples are plasma televisions, fluorescent bulbs, and the aurora borealis, also known as the Northern Lights. Studies have shown non-thermal plasma has antibacterial, wound healing, and anti-mitotic (cancer) properties. Nonthermal plasma produces minimum sensation and no heat to human tissue in control studies and may be readily accessible for human treatment trials as the next step. Think of how this could be implemented in hospitals and healthcare facilities. Rather than washing your hands with antibacterial foam, you could do so with painless, non-thermal plasma. Plasma applied to walls could sterilize operating and patient rooms. The same goes for sterilizing surgical instruments. The Ophthalmic Plasma Probe is another example of the application of this non-thermal plasma. It produces plasma BCMS-PA.org Bucks County
Feature between the probe tip and the treated tissue. Developed by Fridman, Pao, Han, and Pao, this new probe was tested on live New Zealand white rabbit corneas and porcine eyes inoculated with Staphylococcus aureus, the bacteria that is the most common cause of staph infections. Half were then treated with the plasma. It was found that those eyes that had received the plasma treatment had a marked reduction in the number of bacterial colonies cultured from their corneas. Histological examination of the eyes also showed no damage from the procedure under controlled parameters.
and Surgeons. Following a medical internship at George Washington University Hospital, he returned to Philadelphia to complete an ophthalmology residency at Thomas Jefferson University Hospital followed by a retinal fellowship at Wills Eye Hospital.
This ability to treat small areas has high potential in ophthalmology. Antibacterial treatment of incision sites following cataract surgery, retina-vitreous surgery, and intravitreal injections for macular degeneration can eliminate the cost and time needed to administer topical antibiotics. It may also eliminate the emergence of antibiotic resistant bacterial strains. Treatment of surface eye and lid lesions (cancerous), and sub-scleral (just below the surface) intraocular tumors such as melanomas is feasible.
He was the chief of Ophthalmology for the Army of New England at Cutler Army Hospital, Fort Devens, Massachusetts and the only retinal surgeon for the Army, Navy, Air Force and veterans’ hospitals in the New England area for two years, serving with the rank of Major in the Army Medical Corps.
Companies such as Advanced Plasma Solutions in Exton, PA see the potential in equipment such as this and seek to create a commercialized probe that will become more of a standard in healthcare. However, at this time, research is only at the developmental and animal stages. Hopefully in the next few years the Ophthalmic Plasma Probe will be able to get into the clinical trials under protocol for human treatment. Plasma medicine is a new field with many applications in ophthalmology due to its unique specialty. Much like the idea of electricity some 100 years ago, the potential for plasma in medicine and, in this case, ophthalmology, is vast and has only just begun. David S.C. Pao attended Swarthmore College, graduating with a B.S. degree in electrical engineering. His M.D. degree is from Columbia University, College of Physicians SUMMER 2015
He returned to Pennsylvania and began private practice in Bucks County for the past 30 years. During this time he has been on the staff of Wills Eye Hospital and Thomas Jefferson University Hospital and is engaged in teaching medical students and supervising residents. With an engineering degree background, Dr. Pao has been involved in the development and manufacture of instruments in diagnostic and surgical ophthalmology. He holds six patents and has developed various clinical instruments in use today. Among the more well known are the publication and development of the coaxial bipolar cautery, LKC retinal physiology system for electroretinography (ERG), electrooculography (EOG), which both record electrical responses from the retina; and visual evoked response (VER) which records electrical responses of the brain from visual stimuli; and the first irrigation-aspiration instrument for extra-capsular cataract surgery. Dr. Pao is involved with many medical societies including the American Academy of Ophthalmology – American Medical Association, Pennsylvania Medical Society, American Society of Cataract and Refractive Surgery and the Association for Research in Vision and Ophthalmology. He is past president of the Pennsylvania Academy of Ophthalmology, Bucks County Medical Society, and the Chinese American Ophthalmological Society.
Bucks County Medical Society
Annual Membership Dinner Recognizes Years of Service
The Bucks County Medical Society held its annual Membership Dinner Meeting on May 13, 2015, at the Aldie Mansion, Doylestown, PA, at which time it honored physicians celebrating ten, twentyfive, forty and fifty years in medicine. Dr. Karen Rizzo, PA Medical Society President, was onhand to support the BCMS award recipients. A 29-year member of PAMED, Rizzo was on its board of trustees from 2003 to 2011 as a surgical specialty trustee. She was vice chair of the board from 2009 to 2011.
Currently, Rizzo is a member of PAMEDâ€™s Political Advocacy Council, Task Force on State of Medicine and Task Force to Improve Governance Processes and Structures. She also is past president of Lancaster City & County Medical Society and the state chapter of the American Academy of Otolaryngology/Head & Neck Surgery. She now serves on the academyâ€™s board of governors. Rizzo, a Lancaster otolaryngologist, is a graduate of the Temple University School of Medicine, and practices medicine at Lancaster Ear, Nose and Throat.
BCMS-PA.org Bucks County
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For My Love of By: David A. Levin, D.O.
My family and friends say I’m an American history buff. I first became interested in that subject during my tenure as a radiology resident in Illinois; aptly, I read a book about the history of Chicago. After my residency, I returned to my roots in Pennsylvania, moving to Philadelphia to join a fellowship program there. I became interested in – and read my first biography of – Benjamin Franklin. The rest, as they say, is history; when I am not working or spending time with my family, there is usually a history book in my hands. When my wife and I decided to settle in the Montgomeryville area when I took a position at Grand View Radiology Associates in 2008, I knew I wanted to buy and live in an old house. I contacted the Montgomery Township Historical Society (MTHS) to get information about old homes in the area. That year, we purchased a 200-year-old restored farmhouse on Baker Place, and I became an active member of the society. I manage the MTHS website (www.knappfarm.org), which I recently rebuilt, and currently serve as vice president. John Baker (circa 1787-1863), the original owner of my house, was a merchant seaman who transported goods by ship between the colonies. He served in the War of 1812 and was a prisoner of war. He owned at least one property in Philadelphia as well as the farm in Montgomery Township. When my family moved into our house, MTHS gave me a packet of letters, transcribed from the originals, between Captain Baker and his grown children who
had lived in Charleston, South Carolina. Many detail day-to-day minutiae, but some, toward the end of his life, give a glimpse of the times. In letters written to Baker by his children in the early 1860s, they expressed disappointment in the election of Abraham Lincoln as president; his daughter wrote, “[Lincoln] may be a very good rail splitter, but he is certainly not fit for high office.” Montgomery Township: A Brief History While Philadelphia was one of the centers of the Revolution, and the second capital of the United States, Montgomery Township, on the edge of the city, does not have as dramatic a history. However, ordinary people lived, worked, and died there while the colonies were fighting against the rule of an oppressive British overseer, and those people – and that history – is something worth knowing about. Earliest available records show that William Penn sold 5,000 acres of land to William Stanley in 1682, and the land eventually became Montgomery Township. Through the 1700s, the area was settled by a considerable number of Welshmen. The area was largely rural and consisted of mostly farmland until 1776. Many residents fought for local militias in the Revolution. After the war, due to considerable traffic along the Springhouse and Hilltown Turnpike (now Bethlehem Pike) between Allentown and Philadelphia, business (namely two taverns) in Montgomery Square grew considerably.
BCMS-PA.org Bucks County
Feature The Challenge of Preservation The preservation of historical structures in the township has been an uphill battle due to a tremendous amount of development in the area, which inevitably results in the destruction of old properties; the most recent example is the building of the new Route 202 Bypass. The Historical Structures Survey, which was completed in 1989, determined that there were 118 historical structures – those more than 100 years old – in the township at the time. Today there are approximately only 88.
MTHS has managed to save several properties, including the Selzer house. The Selzer house was the birthplace of General Winfield Hancock, a famous Civil War general who fought in the Battle of Gettysburg and was once a candidate for president (who lost to James Garfield), as well as Knapp Farm, the only building in the township on the National Registry of Historical Properties. Knapp Farm, built in 1760, served as George Washington’s headquarters for a short period of time after the Battle of Germantown. It was home to the Knapp family for nearly 150 years and was once home to Florence Knapp who, at the time, was the oldest person on Earth; she died at age 114. Lisa Knapp-Siegel is the current president of the society, and the farmhouse now serves as its headquarters. Montgomery Township celebrated its 300th anniversary in 2014, and the society was proud to participate in many commemorative events.
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Keep Calm and Bake On
By: Meredith A. Ray, MD
While working full time in family medicine at Doylestown Hospital, Dr. Meredith Ray still makes time to nurse her creative side through the art of cake decorating I’ve been decorating cakes, cupcakes and cookies since my medical school days when I took my first decorating class Merideth A. Ray, MD, & daughter Madison back in 1998. It was a welcome mental break from my grueling coursework and a wonderful way for me to tap into my creative side. Besides, is there anything better than homemade cake? Every week I went to a local cake decorating supply store and learned the basics: mastering perfectly smooth buttercream frosting, perfecting my basic piping skills and finally figuring out how to create those classic buttercream roses. After my residency, I enrolled in additional night and weekend classes in sugarwork and gumpaste flower making.
Additionally, over the past few years, I earned my certificate as an independent Wilton Method Instructor and have performed a few demonstrations and taught a few beginner classes – all while balancing my role as a full-time family physician at Doylestown and Warrington Family Practice in Doylestown, PA. My newest creative culinary challenge has been entering local and statewide sugar art and cake competitions. To my delight and surprise, I have actually won a few cash prizes at Peddler’s Village in Lahaska, PA in the cupcake and gingerbread contests over the past few years. I also took home a second and third prize for my cookies and cake, respectively, at the White Rose Cake Decorators/ PA ICES Cake Show in York, PA last year. One of the best things about hobby cake decorating is sharing the delicious dividends with family and friends. But, for me, my hobby now means so much more. Cake decorating has given me yet another way to connect and spend time with my seven-year-old daughter, Madison. I must say she is my best student! She even has all of her own tools – kid sized, of course – and all of her hard work is paying off, too. In 2014, she won first prize in the Kids Cupcake Contest at Peddler’s Village. That same year, she placed at the Pennsylvania ICES Show in York, PA. She won Best in Division in the Youth category as well as first prize in the “Little People” category for cake decorators under age eight.
I am a relative newcomer to Bucks County, having moved from Hunterdon County, New Jersey back to Pennsylvania a few years ago. I recently joined the membership and the board of the Pennsylvania chapter of the International Cake Exploration Societe’ (PA ICES). I take advantage of PA ICES’ wonderful “Days of Sharing” (whenever I am not scheduled to be on call!) and travel to locations across the vast state of Pennsylvania. I also worked up the courage to enroll myself in a few more focused, advanced sugar art classes. I am so fortunate that I have been able to meet and now start to get to know amazing experts and national champions in the wedding cake and sugar flower competition circuit. Madison with her prize winning tea party cake.
BCMS-PA.org Bucks County
Feature Madison prefers to work with fondant which is a very moldable and versatile “play-doh” like, sweet, edible material. She has small fingers, which allows her to create amazing edible miniatures. For example, for the York, PA cake show, she created an entire “tea party” on a cake. Her prize winning Peddler’s Village cupcakes were “Minion faces” for which she used yellow fondant with candy and edible markers to draw on the faces. The Ace of Cakes, Duff Goldman, shared the minion cupcakes she made recently on the Ace of Cakes Facebook page. We were both thrilled! Fondant is also often used to cover entire cakes to give a very smooth look. It can be stenciled on, textured or left smooth. One of my favorite mediums to work with is gumpaste, which is what is used to create those realistic fullsized flowers and other botanicals you often see on wedding cakes. Calla lilies, roses, orchids and Gerbera daisies are just some of the varieties I have made out of gumpaste. Typically, in competition, flowers should be made to look as botanically correct as possible. They may be hand-modeled or created with the help of botanically correct cutters and veiners. The petals and leaves are later wired together or may be left unwired. Florist tape, floral wire and commercial stamens are permitted as long as they do not pierce the surface of the cake. There are many recipes to make gumpaste but I have found it can be difficult to make the consistency needed for very durable yet delicate looking flowers. Some top wedding cake decorators keep their favorite gumpaste recipes a closely guarded secret. Personally, as a hobby baker, I prefer to stick with the commercially available gumpaste and particularly like working with the Platinum paste, which must be imported from the United Kingdom.
The product I have been most excited about recently is called “Cake lace” which is also imported from the United Kingdom. It is an edible, patented, gelatin like material that you spread onto intricately detailed silicone mats. When it dries, it can be peeled off of the mat and applied to your cakes. My gingerbread “Ice castle” was covered with hundreds of delicate snowflakes made from wafer paper and cake lace. I was beaming with pride for days when the inventor of the Cake Lace, Claire Bowman, shared a photo of my ice castle gingerbread creation with all of her Facebook followers – which now number over forty thousand! Buttercream and royal icing, on the other hand, are more traditional decorator icings and are used to hand “pipe” decorative details directly onto a cake or sugar display. In order to do this, frosting is loaded into a decorator’s bag fitted with a metal tip that corresponds to the shape you desire. Piped embellishments may include swags, fancy borders, freehand embroidery and basket weave. Basic bead or shell borders and simple dots, lines and writing are taught in many beginner classes at local craft stores. Royal icing is often used on gingerbread houses and can be used to hold gingerbread together because it will dry like concrete and helps the Gingerbread structure last for weeks on display. Some of the most impressive cakes that utilize these techniques are the sculptured cakes in which real cake is carved to create three-dimensional sculptures. At a recent PA ICES day
Feature of sharing, I got to meet as well as learn from Colette Peters who is famous for her “topsy-turvy” and sculpted cakes. You may know her from her Food Network appearances. I, myself, have just started to venture into the vast world of stacked and shaped cakes. I have also recently tried my hand at a technique using shaped “Rice Krispie” treats for the rounded portions of my sculptures. Using this technique, I have fashioned an enchanted Disney teapot, a brightly colored beach ball and a hulk hand from this popular childhood treat. I use colored fondant on top to enhance the shape and details. Standard cake shapes, such as round, square or oval, are stacked, doweled and then may be carved to create unusual shapes such as animals, figures or vehicles.
My advice to new cake decorators is join a group, meet up with others who share your interest and try to absorb everything you see. Devour cake magazines, pin your favorite cakes on Pinterest, Google recipes and culinary articles, watch YouTube videos, read sugar artist blogs, take advantage of free online Craftsy classes and everything else you can find. Strive to be constantly learning and expanding your knowledge. Find your own style instead of just trying to copy other people’s designs. Explore your own techniques. Try, fail, and then try again. I have had a few “cake wrecks” over the years and I will admit I have shed a few tears over cake. Remember, everyone started from somewhere and no one was born making their awardwinning sugar show pieces. Decorating is 1% inspiration and 99% hours and hours of hard work, but I love every minute of it and I hope you will too. As they say over in the UK, keep calm and bake on!
BCMS-PA.org Bucks County
Health & Wellness
Staying Safe in the Summer Sun Grand View Health and Fox Chase Cancer Center educate individuals on early signs of skin cancer and how to protect skin from sun damage With sunny summer here, chances are you’ll be baring more of your skin. In honor of Skin Cancer Awareness, Fox Chase Cancer Center and Grand View Health seek to educate individuals on the early signs of skin cancer and how to protect their skin from sun damage. According to the American Cancer Society (ACS), skin cancer is the most common cancer in the U.S. Each year, skin cancers are diagnosed more than all other cancers combined. There are three main types of skin cancer. Basal cell and squamous cell skin cancers are most common by far and are often found in areas exposed to the sun—such as the head and neck. They are much less likely than melanomas to spread to other parts of the body and become life threatening. Melanoma is much more dangerous and life threatening and can occur anywhere on the body. In 2015, the ACS estimates about 73,870 new melanomas will be diagnosed and about 9,940 people will die of melanoma. “Fortunately, detecting any type of skin cancer early often means it can be treated effectively,” notes surgeon Jeffrey M. Farma, MD, FACS, Fox Chase Cancer Center. “I highly encourage everyone to have their skin checked annually by a physician or dermatologist and to take the time to examine their own skin from head to toe each month. All it takes is eyes and a mirror, yet the consequences may be significant.”
edge of a mole or mark • A change in sensation, such as itchiness, tenderness or pain “If you notice any of these warning signs, contact your physician immediately” notes Dr. Farma. “And remember that anyone can develop skin cancer – so be smart and lower your risk of skin cancer by avoiding prolonged exposure to the sun and practicing sun safety.” Consider these everyday sun-safety tips: • Seek shade, particularly between 10 a.m. and 4 p.m., when the sun’s rays are strongest. Use the shadow test to determine the strength of the sun’s rays: if your shadow is shorter than you, the sun’s rays are the strongest, so be sure to protect yourself. • Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher every day. Reapply every two hours and after swimming, toweling dry or sweating. Use sunscreen even on hazy or overcast days. • Do not burn. Even a single sunburn increases your risk of developing melanoma. • Cover up with protective, tightly woven clothing and a broad-brimmed hat. UV-blocking sunglasses are also essential for protecting the delicate skin around the eyes and the eyes themselves. • Avoid tanning beds, booths and sunlamps. According to the Centers for Disease Control and Prevention (CDC), studies have shown consistently that indoor tanning increases a person’s risk of getting skin cancer, including melanoma. Indoor tanning and tanning outside are both dangerous.
Some early signs of skin cancer include: For more information on skin cancer contact your doctor. • Any change on your skin, especially in the size or color of a mole, growth, spot or a new growth (even if it has no color)
• Scaliness, oozing, bleeding or a change in the way a bump or nodule looks • The spread of pigmentation (color) beyond its border, such as dark coloring that spreads past the
Health & Wellness
Bites and Stings Can Lead to Other Things Pennsylvania physicians offer summer health advice on ticks, mosquitoes, and bees For many people, bug bites and bee stings aren’t a big deal beyond a small irritation. But for some, it could mean the start of a painful – possibly long-term or even deadly – experience. Despite their size, ticks, mosquitoes, and bees can pack a wallop. Every summer, reports appear about the havoc they can cause through Lyme Disease, West Nile Virus, and allergic reactions. As such, Pennsylvania physicians are urging residents and guests to the state to take precautions as they hit the outdoors this summer, and know what to do if you have the misfortune of being bitten or stung. “The old saying ‘an ounce of prevention is worth a pound of cure’ really holds true when it comes to bites and stings,” says Karen Rizzo, MD, president of the Pennsylvania Medical Society and a practicing physician in Lancaster. “Simple things like checking yourself for bugs and wearing bug spray can make a difference in the long run.” Pennsylvania’s Tick Threat Of all insects, possibly ticks raise the greatest amount of concern in Pennsylvania, particularly in light of an April 2015 study released by the Pennsylvania Department of Environmental Protection (DEP). The study raised eyebrows when it indicated Lyme Disease is now a risk in all 67 Pennsylvania counties. Before this study and according to statistics from the Centers for Disease Control and Prevention (CDC), it was well known that Pennsylvania had the highest number of confirmed Lyme Disease cases in recent years of all states. CDC data suggests there were nearly 5,000 confirmed cases of Lyme Disease in Pennsylvania during the 2013 calendar year. 24
The state DEP study prompted acting Pennsylvania Physician General Rachel Levine, MD, to offer advice on precautions the public can take. Among those recommendations are: • Avoid tick-infested areas • Wear protective clothing • Use insect repellent • Do a full body check after spending time outdoors “If an individual develops signs and symptoms of Lyme disease after a tick bite, we urge them to seek medical attention,” Dr. Levine says. “Early diagnosis and treatment of Lyme disease may prevent late-stage complications.” According to Paul Killian, MD, president of the Pennsylvania Rheumatology Society, early symptoms within the first 30 days of a tick bite could include • A red and expanding rash • Fatigue • Chills • Fever • Headache • Muscle and joint aches • Swollen lymph nodes “This is something you want to catch early,” says Dr. Killian, who practices in Monroeville. “A large percentage of patients who go untreated tend to face bouts of arthritis including severe joint pain and swelling. A small percentage may even develop chronic neurological issues such as shooting pain, numbness, or tingling in the hands or feet.” In 2014, Pennsylvania passed legislation to raise awareness of Lyme disease and increase prevention efforts. The new law created a task force at the Department of Health (DOH) to educate the public about Lyme disease and related tick-borne illnesses, and to collaborate with other key agencies.
BCMS-PA.org Bucks County
Health & Wellness Mosquitoes Transmit Diseases Mosquitoes essentially use their mouthparts to puncture human skin and feast on blood. Most mosquito bites do little harm, possibly leaving the puncture area swelling, sore, and red. However, if the mosquito is carrying a virus or parasite, then the victim could experience severe illness. “Mosquitoes, particularly those in tropical environments, have been linked to some nasty illnesses including yellow fever and malaria,” says G. Alan Yeasted, M.D., FACP, president of the Pennsylvania Chapter of the American College of Physicians. “Here in Pennsylvania, we don’t see a lot of those diseases. Instead, we more often will associate mosquitoes with West Nile Virus.” According to the Pennsylvania’s West Nile Virus Control Program, West Nile virus first appeared in Pennsylvania birds and mosquitoes in 2000. Typically, West Nile is a mild disease that mimics the flu and lasts only a few days. However, some cases – about one in 150 – can be severe, causing encephalitis, convulsions, paralysis, or death. One of the keys in the fight against West Nile Virus is to make it difficult for mosquitoes to breed. Property owners play an important role. Mosquitoes tend to enjoy stagnant water. Eliminating stagnant water from locations like wading pools, clogged gutters, and other locations helps. But, it can be tough to totally avoid mosquitoes, and Dr. Yeasted, who practices in Pittsburgh, suggests the following tips for patients: * Take normal steps to prevent insect bites * Wear appropriate clothing when outdoors * Use mosquito repellent
Bee Stings Can Cause an Allergic Reaction Like ticks and mosquitos, bees as well as wasps and hornets have the ability to cause little or a lot of harm. While many people will have a mild reaction to a bee sting, some may end up with an allergic reaction that could be life threatening.
Association, a severe allergic reaction could cause low blood pressure or swelling that could impact breathing. “It’s very important for a person having a severe allergic reaction to a bee sting to seek immediate medical care,” says Dr. Green, a practicing allergist in Pittsburgh. “Even moderate reactions can be problematic.” Dr. Green s says treatment for a bad reaction may include antihistamines, epinephrine, or in the worst of cases a breathing tube. According to the US Department of Labor Bureau of Labor Statistics, between 2003 and 2010, of all insect bites, bees caused the most fatal injuries to workers. Typically, people with known allergies to insect venom and food will carry an EpiPen to treat anaphylaxis shock. In 2014, Pennsylvania passed House Bill 803 to make EpiPens more easily available in school settings. The law became effective just in time for schools returning from the December holidays. The new law allows schools to maintain a supply of EpiPens in a safe, secure location, and allows students who are having an allergic reaction to self-administer the injection. It also will allow schools to train employees to administer the injection. Physician organizations including the Pennsylvania Medical Society and Pennsylvania Allergy and Asthma Association supported the legislation.
According to Todd D Green, MD, FAAAAI, president of the Pennsylvania Allergy & Asthma SUMMER 2015
Health & Wellness
What Healthcare Providers Need to Know
In 2011, the first wave of Baby Boomers began turning 65 — the age when a person’s risk of developing Alzheimer’s disease begins to significantly increase. Currently there are more than 5 million people in the United States living with Alzheimer’s and every 67 seconds another person gets the disease. In order for people living with Alzheimer’s to receive the best care and guidance possible, knowing the warning signs of Alzheimer’s and getting diagnosed early is vital. WHAT IS ALZHEIMER’S? Alzheimer’s, the most common form of dementia, is a progres-
sive brain disease that causes a slow decline in memory, thinking and behavior. Persons with Alzheimer’s eventually lose the ability to carry on a conversation and respond to their environment. Most people survive an average of eight years after a diagnosis of Alzheimer’s but some individuals can live for as long as 20 years with the disease. This reality places increasingly intensive care demands on caregivers and negatively affects their health, employment, income and financial security. Alzheimer’s is not a typical part of aging; it gets worse over time and it is fatal. Today it is the sixth-leading cause of death in the United States, and the only cause of death in the top ten in America without an identified way to cure, prevent or slow its progression. BCMS-PA.org Bucks County
Health & Wellness WHO’S AT RISK? Advancing age is the greatest risk factor because most persons diagnosed with the disease are age 65 or older. When the disease strikes individuals in their 40s or 50s, it is called youngeronset Alzheimer’s. Another risk factor is family history. Those with a parent, brother, sister or child with Alzheimer’s are more likely to develop the disease and have a higher risk if more than one family member has the illness. There might also be a strong link between serious head injury and future risk of Alzheimer’s, especially when trauma occurs repeatedly or involves loss of consciousness. Additionally there is a strong link to high blood pressure, heart disease, stroke, diabetes and high cholesterol. Studies suggest that plaques and tangles in brain tissue are more likely to cause Alzheimer’s symptoms if there is evidence of “Many families feel they are isolated and alone while facing the stroke or damage to the brain’s blood vessels. enormous challenge of caring for loved ones with Alzheimer’s disease and related dementias,” said Dr. Daniel Haimowitz of St. TREATMENT IS ONLY TEMPORARY Medications approved by the U.S. Food and Drug Administra- Mary Medical Center in Langhorne, Pennsylvania. “There are many resources available, but this education takes a lot of time. I tion (FDA) might temporarily delay memory decline and treat Alzheimer symptoms for some individuals, but none of the cur- have found the Alzheimer’s Association incredibly helpful working collaboratively with me to provide families the resources and rently approved drugs is known to stop or prevent the disease. Certain drugs approved to treat other illnesses might sometimes support they so desperately need.” help with the emotional and behavioral symptoms of Alzheimer’s. One important part of treatment is supportive care that helps individuals and their families come to terms with the diagnosis; obtain information and advice about treatment options; and maximize quality of life through the course of the illness. The Alzheimer’s Association can help. Our Chapter’s 24/7 Helpline (800.272.3900) is available to patients free of charge and can help individuals and families navigate the journey. While a diagnosis of Alzheimer’s disease can be difficult to comprehend, there is no doubt that having one does allow the individual and their family time to connect with available resources and with each other. Early detection and diagnosis also allows for more time to plan for the future and gives the person living with Alzheimer’s the opportunity to take part in making key decisions around care, living arrangements, transportation, safety, and financial and legal matters. COLLABORATING FOR CHANGE Since 2013, the Alzheimer’s Association Delaware Valley Chapter has been increasing engagement with local physicians who treat Alzheimer’s disease. Through this initiative, the Chapter has visited more than 500 physicians in the Delaware Valley region.
Dr. Haimowitz is leading the way on working with organizations like the Alzheimer’s Association. In addition to referring patients to the Helpline and support programs, he also volunteers with the Chapter as a member of the Medical & Scientific Committee, which provides expertise and support to Chapter leaders. HOW TO GET INVOLVED The Alzheimer’s Association encourages physicians who work with patients with Alzheimer’s disease or related disorders to engage with the Delaware Valley Chapter. If you are interested in learning more about what the Chapter can do for you and your patients, contact Elizabeth.Crane@alz.org or call 800.272.3900. It takes time to talk about Alzheimer’s disease. We have the time. The Alzheimer’s Association is the leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer’s. For more information, visit www.alz.org/delval or call 800.272.3900.
Health & Wellness
for Chronic Pain on the Horizon Spinal Cord Stimulation (SCS), a form of neurostimulation, is a proven therapy that has been used for more than 40 years for managing chronic pain of the arms, legs and trunk or pain resulting from Failed Back Surgery Syndrome (FBSS). Spinal Cord Stimulation involves the implant of a small device that powers thin wires placed along the spinal cord. The device emits low levels of electrical energy to interrupt or mask the transmission of pain signals to the brain. Traditional SCS therapy is delivered through tonic stimulation, a mode of delivery that refers to a steady, consistent frequency of electrical energy pulsed at uniform intervals. Chosen For Nationwide Study St. Luke’s University Health Network was among 20 exclusive sites nationwide chosen to participate in the SUNBURST™ study. The SUNBURST (Success Using Neuromodulation with BURST) study will evaluate whether a new proprietary mode of stimulation therapy called “burst” stimulation can be more effective in managing chronic pain than traditional tonic stimulation. The randomized, prospective, multicenter, clinical study is designed to demonstrate the safety and efficacy of the Prodigy™ Chronic Pain System using tonic and burst stimulation therapy.
Chronic pain is an epidemic affecting approximately 100 million people in the United States and costs the nation up to $635 billion annually in medical treatment and lost productivity. For many, finding relief is as painful a process as coping with the pain. When the pain is chronic, management of daily living results in less activities, depression, and, in some, can result in addictive behavior to pain medications.
The SUNBURST study is being conducted under an Investigational Device Exemption (IDE) from the U.S. Food and Drug Administration (FDA). The Prodigy neurostimulator is not yet approved for use in the U.S. (outside of this study). Scott Loev, DO, Medical Director and Interventional Pain Specialist at St. Luke’s Spine & Pain Associates, and Steven Falowski, MD, Functional Neurosurgeon with St. Luke’s Neurosurgical Associates, were chosen to participate in this pivotal study because of their multidisciplinary and collaborative approach to pain management. Burst Technology Standard neurostimulators for pain management provide a constant rhythm of pulses that mask the electric signals going up the spine. The brain seems to overcome this type of noise and BCMS-PA.org Bucks County
Health & Wellness The Prodigy system features the longest-lasting battery life, even at the highest settings, of any rechargeable SCS device in its class. Additionally, its small size allows for a smaller incision, which gives physicians increased flexibility in selecting the implant location and is intended to make the site less visible and more comfortable for patients. The Science Behind The Concept Research has shown that certain neurons fire in bursts, followed by periods of dormancy, while other neurons within the same sensory system fire in more consistent or tonic pattern, allowing them to respond to tonic stimulation therapy. Pain is transmitted from the spine to the brain along two different pathways. Tonic stimulation engages one pathway, while early research suggests that burst stimulation engages both pathways. The parallel firing modes of neurons suggest that a combination of tonic and burst stimulation therapies may maximize the effectiveness of pain management. Although it is not a cure, SCS therapy can provide significant pain relief and thus enable many patients to increase their activity levels and improve their overall quality of life. Partnering Together Studies reveal that SCS therapy had a “positive, symptomatic, long-tern effect in cases of refractory angina, severe ischemic limb pain secondary to peripheral vascular disease, peripheral neuropathic pain, and chronic low-back pain, and that, in general, spinal cord stimulation was a safe and effective treatment for a variety of chronic neuropathic conditions.” Severe pain influences every aspect of a patient’s quality of life. When a patient’s self-management of their pain fails, they turn to specialists offering a narrow range of treatments. The ideal methodology for chronic pain treatment is an interdisciplinary approach of assessment, diagnosis and therapy. For more than four years, Dr. Loev and Dr. Falowski have partnered to improve care for those who suffer from chronic pain in the Greater Lehigh Valley, Bucks and Montgomery counties. “Not all patients will benefit from this type of therapy. Nationally, the average success rate is 50%”, says Falowski. He added, “We’ve been able to achieve an 80% - 85% success rate due mainly to our collaborative approach. The patient is trialed with the device before a permanent implantation. During the trial the device is adjusted to address the patient’s pain points and tolerance.” Dr. Loev said, “In determining a candidate’s success, we identify their current pain patterns, progression of the patient’s disease, and their psychiatric or psychological comorbidity.” For more information about the SUNBURST study or SCS therapy, visit www.sluhn.org/lesspain.
Community Programs The following programs take place at the Health Connections by Doylestown Health in the Cowhey Family ShopRite in Warminster located at 942 West Street Road. Health Connections is located across from ShopRite’s instore pharmacy. The programs are free. Registration is required. Call 215-672-1870 to register.
Are You at Risk for Falling? 10:00 AM - 12:00 PM Wednesday, July 29
Physical therapist Jeannine Greenberg, DPT, PT, from MossRehab at Doylestown Hospital, will talk about fall risk and prevention. Plus, get a personalized balance screening. Appointments required.
What’s In Your Pantry? Understanding Food Labels 10:00 AM - 12:00 PM Wednesday, August 12
Join nutrition expert Audrey Fleck, MS, RDN, LDN, CFSP, to learn what ingredients to avoid when reading food labels. Plus, find out how to “purge” your pantry of harmful ingredients and learn about healthier substitutes. Registration required.
Speech and Language Development in Children
1:00 - 4:00 PM Sunday, September 20
The Event Center by Cornerstone 46 N. Sugan Road, New Hope Bring your family and friends to the 2nd Annual Boardwalk Bash to support Doylestown Health’s Carol & Louis Della Penna Pediatric Center! Enjoy boardwalk-themed food and activities, such as face painting, balloon animals, caricatures, great snacks and much more. All proceeds will benefit the expansion of Doylestown Health’s pediatric services. Tickets are $30 for adults, $15 for children. Sponsorship opportunities are also available. For more information, contact Garrett Owen at email@example.com or 215-345-2802. See you on the boardwalk!
14th Annual Circle of Life Auction 6:30 PM - 10:00 PM Friday, November 13
Join us at the 14th Annual Circle of Life Event, which features a live and silent auction and a raffle drawing for a new BMW 320i or $20,000 cash. All proceeds benefit Doylestown Health’s Cancer Institute and Doylestown Hospital Hospice. Whether or not you are able to join us at the event, there are many ways you can help support these invaluable resources in our community which offer people hope, comfort and essential care at the most critical times in their lives. To learn more, visit DoylestownHealth.org/CircleOfLife or call 215-345-2141.
10 am (Birth to 24 months) 11 am (Ages 2 to 5) Tuesday, August 18
MossRehab speech language pathologist Scott Littig, MA, CCC/SLP, will provide information on speech and language development in young children and make recommendations on developing communication skills. Adults only. Childcare available; space is limited. Registration recommended.
Mindful Management of Chronic Pain 10:00 AM and 11:00 AM Friday, September 11
Meet staff psychologist Dan Leichter, PsyD, from MossRehab at Doylestown Hospital, to learn ways to cope with chronic pain through mindfulness. Registration encouraged.
BCMS-PA.org Bucks County
Health Awareness Calendar
Health Awareness Calendar AUGUST
• Cord Blood Awareness For more information visit www.cordblood.com
• Children’s Eye Health & Safety For more information visit the American Optometric Association at www.aoa.org
• Juvenile Arthritis Awareness For more information visit the Arthritis Foundation at www.arthritis.org
• National Breastfeeding For more information visit www.healthychildren.org
• National Cleft & Craniofacial Awareness & Prevention For information visit the American Cleft Palate-Craniofacial Association at www.acpa-cpf.org
• National Immunization Awareness For more information visit the Immunization Action Coalition at www.immunize.org
SEPTEMBER • National Atrial Fibrillation Awareness For more information visit the American Heart Association at www.heart.org • Childhood Cancer Awareness For more information visit the American Cancer Society at www.cancer.org • Ovarian Cancer Awareness For more information visit www.cancer.org • Prostate Cancer Awareness For more information visit www.cancer.org • National ITP Awareness For more information visit the Platelet Disorder Support Association at www.pdsa.org • Blood Cancer Awareness For more information visit the Leukemia & Lymphoma Society at www.lls.org
• Psoriasis Awareness For more information visit the National Psoriasis Foundation at www.psoriasis.org • National Pediculosis Prevention For more information visit The National Pediculosis Association at www.headlice.org • National Sickle Cell For more information visit the Sickle Cell Society at www.sicklecellsociety.org • National Traumatic Brain Injury Awareness For more information visit the American Speech-Language-Hearing Association at www. asha.org • Newborn Screening Awareness For more information visit the National Newborn Screening & Global Resource Center at www.genes-r-us.uthscsa.edu • World Alzheimer’s Month For more information visit the Alzheimer’s Association at www.alz.org • World Suicide Prevention Day (10) For more information visit the American Association of Suicidology at www.suicidology.org
Steven Falowski, MD, Functional Neurosurgeon and Scott Loev, DO, Interventional Pain Specialist
If you are one of the millions of Americans living with chronic pain, help is available. St. Lukeâ€™s leads the region in chronic pain treatment using a proven innovative approach to managing pain, increasing mobility and improving quality of life. Our fellowship-trained doctors work together to provide a comprehensive approach for targeting chronic pain. Learn how we improve the quality of our patientsâ€™ lives by increasing function and decreasing pain. If you have tried multiple treatments without relief and pain is interfering with your life, call InfoLink at 1-866-STLUKES to learn more or to schedule your appointment.