Bucks Physician Spring 2015

Your Community Resource For What’s Happening In Health Care

Sp r i n g 2 0 1 5

Why I am a

Birder

By Jeffrey Buckwalter, MD

Bucks Count y’s

Impressionist Bount y

Is your heart in the right place?

Mercer Bucks Cardiology is dedicated to providing complete cardiovascular care to our patients in a community setting Clinical Cardiology

Ashish M. Agarwal, MD Rim Al-Bezem, MD, FACC Kulpreet S. Barn, MD William E. Costanzo, MD, FACC, FACP Deirdre V. Donaghy, MD, FACC Ketan M. Gala, MD Steven M. Goldsmith, MD, FACC William S. Hirsch, DO, FACC Richard L. Hyman, MD, FACC, FASE Justin A. Karl, MD Alexander J. Koppel, MD Philip L. Lebovitz, MD, FACC Craig J. McMackin, MD, FACC Charles F Paraboschi, MD, FACC Jigar A. Patel, MD, FACC David N. Rosvold, MD, FACC Neil M. Rothstein, MD, PhD Steven A. Samuel, MD, FACC Paula S. Seth, MD, FACC Jerome M. Thomas, MD, FACC Keith R. Wolfson, MD, FACC

Interventional Cardiology

David W. Drucker, MD, FACC, FSCAI George P. Heyrich, MD, FACC, FSCAI, FSCCT Mark J. Soffer, MD, FACC Sunder Venkatesulu, MD, FACC Andreas Wolf, MD, FACC, FSCAI

Clinical Cardiac Electrophysiology Scott W. Burke, MD, FACC Rafael E. Pena, MD, FACC Michael J. Rozengarten, MD, FACC Eran S. Zacks, MD, FACC

Nurse Practitioners Linda Bartleson, NP Deborah Bob, NP Elaine Fidler, NP Marian Gelber, NP Louise Joyce, NP

Hyun Jin Lee, NP Denise Max, NP Stacey Nieves, NP Nicole Szilvasi, NP Patricia Patrick, NP

To All Nurses, Happy Nurses Week May 6th-12th. Thank You All!

Newtown, PA 215.860.3344 • Lawrenceville, NJ 609.895.1919 Robbinsville, NJ 609.890.6677 • The Arrhythmia Institute 215.741.5600 www.MercerBucksCardiology.com

Contents CONTACT INFO EDITORS Todd Alderfer, MD Eric Gejer, DO Bucks County Medical Society 200 Apple Street Quakertown, PA 18951 (215) 536-8665

Bucks County Medical Society • Letter from the Editor ............................................................ Page 4 • Meet Your Board................................................................... Page 12

PA MED Updates • What Physicians Should Know ............................................. Page 5

EXECUTIVE DIRECTOR John Detweiler

• Seven Reasons to Keep the Health Care Team Together....... Page 7

CONTACT info@bcms-pa.org

• Compassionate Use Program (FDA Releases Now Draft Guidance)...................................... Page 9

WEB bcms-pa.org

• Student Loan Forgiveness for Pennsylvania Physicians................................................... Page 10

• Naturopathic License Bill....................................................... Page 8

BOARD PRESIDENT, 2015 Bindukumar C. Kansupada, MD PAST PRESIDENT Eric Gejer, DO President-Elect Todd Alderfer, MD Vice President Sean Butler, DO Treasurer Irwin J. Hollander, MD

Feature Articles • Why I am a Birder, Jeffrey Buckwalter, MD............................. Page 14 • Bucks County’s Impressionist Bounty.................................... Page 18

Health & Wellness • Are Childhood Vaccinations Really Mandatory?..................... Page 23 • Colorectal Cancer and Colonoscopies................................... Page 24

PUBLISHER Hoffmann Publishing Group, Inc. 2921 Windmill Road Reading, PA 19608 610.685.0914 x201 HoffPubs.com Advertising Contacts Mark Schelling 610.685.0914 x205 Mark@HoffPubs.com

• Rethinking Stereotypes: Addictions and Older Adults............ Page 27 • Valvular Heart Disease - The Increasing Abnormality.............. Page 28

Your Community • St. Luke’s Singers Annual Spring Concert.............................. Page 29 • Healthcare Calendar.............................................................. Page 30 • Community Events................................................................ Page 31

Karen Zach 610.685.0914 x213 Karen@HoffPubs.com Maureen Keyte 610.685.0914 x212 Maureen@HoffPubs.com

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.

10% Post Consumer Waste Please Recycle

Letter from the Editor

Goodbye Winter and Hello Spring!

Todd Alderfer, MD Bucks County Medical Society

While the past few months have been challenging with brutal cold and snowy conditions your Bucks County and PA Medical Societies have been heating up the legislative agendas. We’ve had a busy few months looking at past efforts and future concerns so it’s more important, now than ever, that you stay abreast of the changing healthcare landscape.

Pennsylvania has a new Governor, who is setting a new agenda. The state also has new legislative district maps for 2015, which means your senators and/or congressmen may have also changed. We’re anticipating hundreds of health care bills during this new two-year session. These bills are certain to include issues such as scope of practice; physician-led team-based care; medical marijuana; credentialing; insurance; psychiatric bed shortages; tracking; and tanning law changes.

We ask you to take a moment to reconnect with your local legislators in hopes they’ll be more than ready to respond favorably to the health care challenges that lie ahead.

Bucks County Physician is your member magazine.

It’s designed to share Society and community health and wellness news with you and our Bucks County community. We invite you to place your office’s complimentary copy in your waiting room to expand our efforts to educate and inform the general public.

In this issue, we’ve taken the liberty of sharing some of the legislative agendas coming to the forefront, such as student loan forgiveness for PA physicians, Federal Drug Administration draft guidance for compassionate use programs, naturopathic licensure, and more. We believe all health care practitioners and all Bucks County residents can benefit from a broader understanding of the impact these items may have on our future ability to serve our community.

Public health awareness and education is also a critical component of our mission. Preventative health care can lead to lower costs and more vibrant lives so we’ve included several stories pertaining to timely and critical health topics. The articles about seniors and depression, colorectal screenings, vaccinations for children, and valvular heart disease provide plenty of insight for any reader. We hope you find some kernels of wisdom from one or more.

And, finally, we share some lighter personal stories and notes about life outside the practice of medicine, a community treasure, hospital and health care activities, and general community events. We hope you enjoy the stories and accept the invitations to join your community in celebration and activity.

Todd Alderfer, MD Editor

4

BCMS-PA.org Bucks County

Physician

PA MED Updates

The 2015 OIG Work Plan What Physicians Should Know Each year, the Office of the Inspector General (OIG) releases its work plan, which identifies the areas of health care on which the agency will focus its fight against fraud and abuse in Medicare and Medicaid.

The work plan serves as a roadmap that can make the challenge of navigating the world according to Medicare a bit less daunting.

• Independent Clinical Laboratory Billing Requirements — Medicare is the single largest payer of lab service, and the fact that lab spending has increased by almost 30 percent in a five-year period from 2005 and 2010 has got the attention of the OIG. The OIG will use 13 measures to indicate possible questionable billing practices.

This year’s work plan includes three new project areas:

OIG’s annual work plan also includes projects that have been carried over or extended from previous work plans, including:

• Hospital wage data used to calculate Medicare payments — The OIG will determine whether there are appropriate controls in place for the collection and reporting of wage data, to ensure that only eligible services and compensation are included in the wage data reported.

•

Adverse events in post-acute care — The OIG will examine adverse events and temporary harm events to identify contributing factors, the extent to which the events were preventable, and the associated costs to Medicare.

S pring 2 0 1 5

•

New inpatient admission criteria — A review will be done to determine the impact of new inpatient admission criteria on hospital billing, Medicare payments, and beneficiary copayments. The review will also report billing variations among hospitals.

•

Medicare oversight of provider-based status — Provider-based status allows facilities owned and operated by hospitals to bill as hospital outpatient departments. This can result in higher payments for the facilities, and increased beneficiary coinsu- ance liabilities. The OIG wants to determine whether

5

PA MED Updates

provider-based facilities meet the Centers for Medicare and Medicaid Services’ criteria.

•

Comparison of provider-based and free-standing clinics — Medicare payments for physician office visits in provider-based clinics and free-standing clinics will be compared to determine the difference in payments.

•

Oversight of hospital privileging — The OIG will determine how hospitals assess medical staff candidates prior to granting initial privileges, including verification of credentials a review will be done of the National Practitioner Databank. Medicare requires participating hospitals have a medical staff that operates under bylaws approved by the governing body.

•

Part B services during nursing home stays— Congress directed OIG to monitor Part B billing for abuse during non-Part A stays to ensure that no excessive services are provided. Several broad

categories of services, such as foot care, will be examined.

• Ophthalmologists inappropriate and questionable billing — Claims data will be reviewed to identify “potentially inappropriate and questionable billing” for ophthalmology services during 2012. This is driven by the fact that, in 2010, Medicare allowed more than $6.8 billion for services provided by ophthalmologists.

• Imaging Services, payments for practice expenses — A review of Medicare Part B payments for imaging services to determine whether they reflect the expenses incurred and whether the utilization rates reflect industry practices. The focus will be on the practice expense components, including the equipment utilization rate.

•

What makes a Top Hospital?

HIGH-QUALITY CARE. CONSTANT IMPROVEMENT. DEDICATED TEAM. BEST POSSIBLE VALUE.

S

t. Mary is the only Bucks County hospital, and one of only three in the Philadelphia region, to be named a 2014 100 Top Hospitals® award winner

by Truven Health Analytics™. This recognition once again demonstrates St. Mary’s commitment to providing the highest quality coordinated care at the best possible cost.

In addition, St. Mary received the Everest Award, an honor given to 14 hospitals on the list that attain the greatest rate of improvement over five years.

This achievement reflects what matters most at St. Mary every day — exceptional patient care delivered by tremendously dedicated colleagues, physicians, and volunteers. Thanks to each of them for making this award — and top care for your community — possible.

Healthcare Learn more at www.StMaryHealthcare.org For a physician referral, call 215.710.5888

6

BCMS-PA.org Bucks County

Physician

PA MED Updates

Seven Reasons to Keep the Health Care Team Together Many physicians across the state, as well as the Pennsylvania Medical Society (PAMED), support physician-led, team-based care, in which all health care team members work together collaboratively, but the physician is the leader of the team.

Legislation that has been already introduced in the House, House Bill 765, and is expected to be reintroduced in the Senate, proposes an unacceptable alternative — allowing certified registered nurse practitioners (CRNPs) to practice independently without a link to the team through their collaborative agreement with a physician.

Why keep the team together?

Here are seven reasons: 1. Increasing the responsibility of CRNPs is not the solution to shortage of physicians.

2. The best and most effective care occurs when a team of health care professionals with complementary — not interchangeable — skills works together.

3. The collaborative requirement between CRNPs and physicians enhances rather than impedes the ability of CRNPs to deliver quality patient care.

4. The education and training of a CRNP falls significantly short of the education and training of a physician.

S pring 2 0 1 5

5. Collaborative requirements do not prevent CRNPs from currently practicing in rural and underserved areas.

6. Current licensure standards are not arbitrary; they serve an especially important function in supporting critical safety and quality objectives.

7. A majority of states require CRNPs to have a physician’s collaboration or supervision in order to practice, with many states requiring even more stringent oversight than what currently exists in Pennsylvania.

Urge your state legislators to maintain physician-led, team-based care across Pennsylvania, and oppose HB 765 and any other legislation that would allow CRNPs to obtain independent licensure and eliminate collaborative agreements between CRNPs and physicians.

Learn more at www.pamedsoc.org/teambasedcare.

•

7

PA MED Updates

Naturopathic Licensure Bill Scheduled for Committee Consideration

By Scot Chadwick The House Professional Licensure Committee has scheduled a meeting on April 1 to consider HB 516, which would provide for the licensure of “naturopathic doctors,” and grant them a formal scope of practice.

The bill would permit licensed naturopaths to independently prevent, diagnose, and treat human health conditions, injuries, and diseases. They could order and perform physical and laboratory examinations, and order diagnostic imaging studies.

They would be authorized to utilize invasive routes of administration for their tests and treatments that include “oral, nasal, auricular, ocular, rectal, vaginal, transdermal, intradermal, subcutaneous and intramuscular.”

This concerns us for several reasons. The level of credibility that state licensure establishes could be misleading to the average Pennsylvanian by implying that naturopathy is equivalent to mainstream medicine.

There are also concerns of oversight and logistics.

HB 516 would require the State Board of Medicine to establish and maintain the necessary infrastructure for a mere handful of people. Our information is that fewer than 100 naturopaths would qualify for licensure under HB 516. The vast majority of Pennsylvania naturopaths would remain unlicensed after the bill is enacted, adding confusion and providing little, if any, protection to the general public.

Similar legislation was approved by the House during the 2013-14 session, but died in the Senate. As we did then, we’ll share our concerns with lawmakers.

Stay tuned, and we’ll keep you up to date on any important developments.

•

“Naturopathic medicine” is defined in HB 516 as “a system of primary health care.” Patients may see unproven and possibly unsafe treatments by “naturopathic doctors” as a substitute for conventional medical care.

If there is doubt about whether the bill allows naturopaths to perform a particular test or treatment, the question would likely be resolved in their favor, as Section 102 (4) specifically calls for the act to be “liberally construed.”

And, there is no requirement in HB 516 that naturopaths collaborate or refer complicated medical cases to a physician. Shouldn’t a naturopath who is concerned enough about a patient to order a CAT scan immediately refer that patient directly to a physician?

8

BCMS-PA.org Bucks County

Physician

PA MED Updates

Compassionate Use Program F D A R e l e a s e s N e w D raf t G u i dan c e The Food and Drug Administration (FDA) responded to physician and patient concerns that the process for gaining access to an unapproved drug outside of a clinical trial for “compassionate use” is too complex and has proposed a new application form.

The proposed form — Draft Form FDA 3926 — is intended to provide a streamlined alternative for submitting an Investigational New Drug Application (IND) for use in cases of individual patient expanded access. If finalized, it would replace the current Form FDA 1571.

Peter Lurie, MD, MPH, associate FDA commissioner for public health strategy and analysis, noted in a blog post that the existing form calls for “26 separate types of information and seven attachments” while the new form “will require only eight elements of information and a single attachment.”

“We estimate that physicians will be able to complete the finalized version of the form in just 45 minutes, as compared to the 100 hours listed on the previous form,” Dr. Lurie wrote.

The proposed changes, including the draft form, are outlined in draft guidance, which was announced in the Federal Register on Feb. 10, 2015. Those who want to submit comments must do so during the 60-day comment period ending on April 13, 2015. Instructions for submitting comments are included in the Federal Register.

In conjunction with their draft guidance announcement, the FDA has redesigned their compassionate use (also known as “expanded access”) website to include details regarding the proposed process.

•

Fast financing relief. No side effects.

At Provident Bank, we understand that healthcare businesses have unique banking needs – so we have a team of seasoned healthcare lenders that customize lending solutions for all types of medical practices, partnerships and physician/dental groups.

n TERM LOANS & LINES OF CREDIT n EQUIPMENT FINANCING n COMMERCIAL MORTGAGES n AMBULATORY SURGICAL CENTER FINANCING n CASH MANAGEMENT SERVICES n PRACTICE ACQUISITION FINANCING

Commitment you can count on.

To further strengthen our commitment to Bucks County, we have two former Team Capital branches to serve you: 18 N Main St., Doylestown • 210 Penns Trail, Newtown

Call one of our commercial healthcare lenders today!

John Bolich, FVP 973.656.2441 William Schmid, VP 973.644.5411

ProvidentPA.com S pring 2 0 1 5

87 branches in NJ & PA to serve you.

9

PA MED Updates

Student Loan Forgiveness for Pennsylvania Physicians There’s some good news for health care in Gov. Tom Wolf’s proposed budget, including more than $8 million to expand the state’s successful loan forgiveness program for physicians. The funds are allocated to support current grant recipients and recruit and retain doctors to work in medically underserved areas in Pennsylvania.

The Loan Repayment Program, which was previously administered by the Pennsylvania Department of Health, was also transferred to the Pennsylvania Higher Education Assistance Agency (PHEAA).

“We are encouraged by the proposed increase in loan repayment for physicians and look forward to working with the Governor and his team to expand this vital program to keep physicians in Pennsylvania,” said Michael R. Fraser, Executive Vice President of the Pennsylvania Medical Society (PAMED). “In addition, there is a lot of other good news for physicians and the health of Pennsylvania overall in the Governor’s budget. Of course now the issue becomes how to pay for it and move it forward with the General Assembly.”

Other wins for health care in Gov. Wolf’s budget plan include: •

$2.5 million increase to Behavioral Health Services and $5 million increase to the Department of Drug and Alcohol Programs to provide additional services to address heroin and opioid addiction.

• $2.1 million to implement the controlled substances database, known as the Achieving Better Care by Monitoring All Prescriptions (ABC-MAP) program.

Department of Health also received another $3 million in federal funding for health care innovation.

• $100,000 to develop a statewide Natural Gas Fracking Health Registry to monitor the health of individuals who reside near natural gas fracking operations.

•

$2.7 million to continue the operation of the Pennsylvania Health Care Cost Containment Council (PHC4), which continues to operate under an executive order.

While the sales tax initiative includes broadening the sales tax application to include some professional services, physician services were not included in Wolf’s tax proposal.

Gov. Wolf projects that his plan to expand Medicaid will save Pennsylvania $500 million next year.

Andy Carter, president and CEO of the Hospital & Healthsystem Association of Pennsylvania (HAP), said in a media article that the association is working to ensure a smooth Medicaid transition, but is disappointed at the hospital funding cuts.

These cuts include eliminating $17.5 million in state funding and $19 million in federal funding for hospital supplemental payments for burn centers, obstetrical and neonatal units and rural critical access hospitals.

• $3.8 million increase to reopen state health centers in counties where centers were closed.

PAMED will be giving the budget a close look, and analyzing it for its impact on Pennsylvania physicians and patients.

• $3 million to develop a State Health Care Innovation Plan for a multi-payer payment and health delivery system transformation. The

Supplied by PA Medical Society.

10

•

BCMS-PA.org Bucks County

Physician

Advertise in Bucks/Montgomery

A Sisters U Publication

Reach 35,000+ Career & Family-Minded Women in Bucks and Montgomery Counties Woman2Woman encourages women from diverse backgrounds to create connections, gain knowledge and open doors to strategic alliances that help build self-esteem and stronger communities. Its goal is to create and elevate more women leaders in Bucks and Montgomery counties by providing a platform to learn, share ideas and mentor others.

Editorial content explores topics relevant to women, focusing on entrepreneurship, business, careers, work/family balance, ITY FOR WOM EN CRE ATIN G COM MUN community and general health and wellness. Woman2Woman delivers engaging and relevant commentary, marketing and educational content, and fellowship initiatives that strengthen families, careers, the workplace, our community and the individual.

BUCK S/MO NTGO MERY

Cultivating Leaders

Learn More About The Growing

Trend

Sisters U provides women with education, resources and opportunities to foster self growth; while uniting as a group empowering women to move forward and create focused, positive changes that benefit our community as a whole. For more information visit SistersU.org.

For Advertising Information, Contact: Maureen Keyte 610.685.0914 ext 212 • Maureen@Hoffpubs.com

Publishing Group HoffmannPublishing.com

BCMS Board Profile

For Membership Information please contact Nancy Croll at the Bucks County Medical Society, (215) 536-8665 or info@bcms-pa.org

David S.C. Pao, MD

BCMS Director

Where do you practice, and why did you settle in your present location or community:

Personal interaction with patients. My specialty, ophthalmology, has a high success rate in improving people’s vision from glasses, lasers, and medicine to microscopic surgery.

Where do you practice, and why did you settle in your present location or community: Levittown and Southampton. My college years at Swarthmore, and my ophthalmology residency and fellowship in Philadelphia, were great environments professionally and personally. I have a teaching affiliation with Wills Eye Hospital, Thomas Jefferson University, supervising residents and lecturing medical students for over 30 years. This mutually beneficial relationship has allowed me have a private practice in ophthalmology full time.

Are you or any family members actively involved in any community, non-profit or professional organizations: My three daughters are grown and out of the nest. As a family we were involved locally in the founding of the Yardley Chinese Language School, teaching Chinese language and traditions to young Americans of their Chinese heritage. We also donated tennis court time and instruction to children at the Frosty Hollow Tennis Center in Levittown for over 20 years.

My wife, Anita, Tiffany(my youngest daughter still in Bucks County) and I are life members of the Guardians of the National Cemetery (Washington Crossing National Veterans Cemetery) and participate in its functions including Memorial Day and Veterans Day ceremonies.

Tiffany is an optometrist, and our second daughter, Kristina, is an ophthalmologist. They have been “schooled” in the importance that all medical decisions must be for the patients’ benefit. I have served as past president of the Bucks County Medical Society and the PA Academy of Ophthalmology (PAO), and continue as a board member of both. I am equally proud of my oldest daughter, Jennifer. She is an attorney, and I still speak to her. Kidding aside, she has done pro bono work and believes in fairness under our Constitution.

Hobbies & interests when not working: Tennis continues to be my predominate pursuit since age 10, playing competitively thru the senior divisions.

The rest of our time is filled with 5 grandchildren, ages baby to 6.

What’s your vision for a better healthcare delivery system: Depends on the definition of ”vision”. Vision may be what I wish it to be or reality vision is what I fear it to be.

It will be a better healthcare system since in the last 30 years we have seen almost all varieties of healthcare and the American people have seen the many flaws uncovered with the implementation of the various forms. I witnessed a similar form of health delivery 30 years ago in China and it was not successful. It’s interesting that the Chinese government recently helped establish a private eye hospital with private investors near Hong Kong. This was to give its citizens the care they wanted without going overseas for better care.

•

12

BCMS-PA.org Bucks County

Physician

BCMS Board Profile Kieran Cody, MD BCMS Secretary

Doylestown Health Partners

Specialty: Sports Medicine,

General Orthopedics

Medical School: Temple University Internship: University of Illinois/Chicago Residency: University of Illinois/Chicago Fellowship: Stanford University Hospital/San Francisco 49ers Undergraduate: University of Pennsylvania Dr. Kieran Cody is an orthopedic sports medicine specialist with particular expertise in correcting a broad range of shoulder and knee problems. While completing his sports medicine fellowship at Stanford University, he worked with the San Francisco 49ers as well as a number of Olympic athletes.

Board Certified by the American Board of Orthopedic Surgery, Dr. Cody is a Diplomat of the National Board of Medical Examiners. He served on the Bucks County Medical Society Board of Directors from 2003-2006 and was President of the Society in 2008. He is currently medical

John T. Gallagher, MD

BCMS Director Saint Mary Medical Center

Dr. John Gallagher attended Saint

Joseph’s University and received a

Bachelor of Science Degree in 1978.

Following that, Dr. Gallagher attended Hahnemann University Medical School where he received his medical degree in 1982. He completed his Otolaryngology and Head and Neck Surgical training at Thomas Jefferson University Hospital in1987 and has been practicing Otolaryngology since that time in the Bucks County area.

director of the Doylestown Surgery Center in Warrington.

For more than a decade, Dr. Cody has been the team orthopedic surgeon for Central Bucks East High School, and the team physician for New Hope Solebury High School.

Dr. Cody is an adjunct lecturer for Arcadia University’s Doctoral Physical Therapy Program. He has also done a number of community lectures, speaking about sports medicine and keeping athletes of all ages healthy. “Each patient brings his or her own unique problems and personal goals and my approach is to offer a range of options based on my medical knowledge and experience,” he says. “There is no single, right answer for everybody, and it takes a partnership to get the best results.”

Dr. Cody’s interest in orthopedics began as a child when his father, a physical therapist, would bring home bone models from work. That early introduction and a love of physics eventually led to the study of the physics of human motion. For Dr. Cody, returning people to motion is what orthopedics is all about.

Dr. Cody is an avid biker, skier and runner, and keeps busy raising four boys.

•

Dr. Gallagher has served as President of the medical staff and as Chairman of the Department of Surgery at Saint Mary Medical in Langhorne, Pennsylvania. He has been a member of the Board of Saint Mary Medical Center. He has been President of the Board and presently serves on the Board of the Bucks County Medical society. He is currently a Delegate to the Pennsylvania Medical Society. Dr. Gallagher resides in Bucks County with his wife and family.

•

Dr. Gallagher is Board Certified in Otolaryngology and Head and Neck Surgery. He is a Fellow of the American Academy of Otolaryngology and Head and Neck Surgery, and a member of the American Board of Otolaryngology. He is a member of the American Medical Association and the Bucks County Medical Society.

S pring 2 0 1 5

13

Feature

Why I am a

Birder

By Jeffrey Buckwalter, MD

I did not start out looking to become a birder. My interest in nature began with trees. From my childhood on, big old Oaks fascinated me. Anything to get me into the woods worked.

Before I knew it, Mary Jo, my wife to be, in the nineteen-seventies was talking bird talk as we hiked in Duke Forest or in the Blue Ridge mountains. It was hard not to become dependant on binoculars. She or another hiker would excitedly exclaim, “check out that bird�; seemingly miles away they spotted something of importance. Well, you can imagine my curiosity, handed a pair of binoculars, pointed in the general direction and advised to look across the lake. Not seeing a clear discernable figure, a bit of frustration suggested there must be more to this story. Back on the trail talk turned to wing beat, identifying markings and what birds belonged here at this time. Spotting a moving spec of darkness barely visible to the naked eye and then using rapid-fire words to convey the precise particulars struck me as a true marvel.

Going on in our bird talk we shared stories of bird culture highlighting the occasional or accidental spotting of the under appreciated bird. In these early exposures, the birding enthusiasts elevated my awareness. Motivated to explore further, I realized the mixture of skills I needed to evolve in growing as a birder: precisely observing nature, expanding powers of observation, and learning the language of birding. I now felt my early fascination for trees expanding to include birds. The fun of playing with

14

binoculars, catching the image of a streaking bird, and sharing the experience, inspired me to want more.

Looking back, I realized how much I enjoyed using the operating microscope for my practice of ENT surgery.

Discerning small details in surgery and in nature became a parallel inspiration to develop new skills of observation. Closing the circle I returned to my tree interest and began growing and caring for bonsai trees. The conBCMS-PA.org Bucks County

Physician

Feature nection continues to evolve. Now with expanding opportunities — arboretums, botanical gardens, garden tours, bird sanctuaries, bird flyways, waterways and more — I discovered the culture of like-minded observers. Inspiring moments from casual comments, when visitors looking at our garden feeders, exclaim at seeing the “pretty red” or the “large aggressive blue” or the “black capped” bird connect. But, what about the meticulously pruned maple? No matter, being with those that discover something unseen or talk about it as if seen, excite the imagination.

Onward! Always a tough one, a big birthday for Mary Jo was coming up and something special needed to happen. What to do? We had binoculars, but on frequent early Saturday morning bird walks at Peace Valley Nature Center we discovered the power of the spotting scope. Patiently, practiced enthusiasts would meticulously focus their scope on a distant duck or heron, sharing an amazing close-up view. Waiting not to be too pushy, to display my use of such an instrument I stepped up. Unbelievable, after a little coaching I had it, an intense, clear and detailed image of a creature.

Seeing the detail of wings, legs, beak and feathers motivated my competence at handling a scope.

Off I went to start researching. I discussed the multiple possibilities, Swarovski, Nikon, or perhaps a Zeiss, with several of my new experienced birder friends. By the time we got to eyepieces, durability and use for photography I knew we needed a hands on experience. So, off we went to Cape May Bird Observatory on an overcast and cold January weekend.

As we studied the many scopes carefully positioned to peer through the picture window at feeding

S pring 2 0 1 5

birds we had a great conversation with the Observatory’s expert. Checking out each scope, its weight, eye piece, lens sharpness, and ease of focus we drifted in and out of bird story digressions. As we viewed a pond full of over wintering ducks we suddenly became aware of the phone ringing several times making for vigorous exchanges blurting out streets and times.

Moments later, a seasoned bird enthusiast entered, moving quickly with cane and description. An accidental — bird talk — birthday surprise was about to happen.

The words, a Crested Caracara had been confirmed to be in Cape May. Oh girl, were we excited. Could we do it? We made the purchase, a straight eyed Swarovski, and a bird I did not know existed. Traveling at a careful maximum speed we raced toward the last described sighting. Frustrated, the sun setting, we drove past where we expected success with diminished hope.

And then a moment of synchronicity; across a wide school field we spotted the true sign of birding success, a small group of people with their binocular eyes and scopes to the sky. We found our bird.

Our fellow Crested Caracara spotters having driven from as far away as Virginia, for a rare bird sighting, offered inspirational bird talk. The adventure of Cape May made the language of birding a new way to communicate. We found ourselves monitoring the local hotline. Soon we heard of a Rough Legged Hawk at Sailors Point, Peace Valley Park.

15

Feature We grabbed our coats and were off. After a bit of driving, we saw the birders gathering and pulled over to join several bird spotters. Success! Other adventures to the Park connected us with A Big Year birder and the object of his distant travel, to see a rarely spotted Pink Footed goose.

More and more these “accidental” connections with birds and enthusiasts took flight in expanding initiatives. Local destinations Hawk Mountain Sanctuary, Bradford Reservoir, Bowman’s Hill Wild Flower Preserve, Morris Arboretum and other bird havens we support and love give us trees, birds and the opportunity to be with fellow enthusiasts. Planning distant flights in the states or abroad now includes relating to bird people and their bird knowledge of the region.

A lifetime plan to see Machu Picchu changed to include a side trip to see the Andean Condor at Colca Valley.

A day taking in the dramatic gorge and the rising flight of beautiful Condors brought the magic of many conversations into sharp focus.

What began for us, with birding, expanded into many new adventures.

Not that everybody is a birder, but a little bird language picturing the beauty, flight and unique character brings most people into conversation. On my journey I now find catching a lecture, or social time with the Bucks County Birders, or participating in the Christmas Bird Count an adventure in engaging man and nature. A phone call, e-bird alert or an incidental conversation may trigger an outing, always looking for the unexpected. In our community awareness The Great Backyard Bird Count and Feeder Watch gives an opportunity to record, report and respond to the scientific study of birds. In our front garden we have an active feeding center for birds, squirrels, skunks, foxes, raccoons and I am sure other creatures. Mary Jo has perfected the art: a properly positioned, comfortable chair with a clear view through a newly installed wide window, binoculars and camera at hand, a bird count list, and an iPad to report.

16

Bird Photos Courtesy of Mary Jo Buckwalter

For me, the journey continues fully relating to the inspiring beauty of birds and their observers, I now am practicing the study of trees, birds and landscapes through the art of painting.

•

BCMS-PA.org Bucks County

Physician

Honoring Our Commitments to Community Service

Bucks County Medical Society Members and Guest

Please Join Us for an Exciting Evening

Aldie Mansion 85 Old Dublin Pike Doylestown, PA 18901

INVITATIONS WERE MAILED LIMITED SEATINGRESERVATIONS ARE A MUST! Call Society Office for reservations at 215-536-8665 if you misplaced your invitation.

Wednesday, May 13, 2015

Guest Speaker Karen Rizzo, MD, FACS PAMED President

6:00 – 7:00 PM – Cocktails 7:00 PM Dinner

We will be honoring physicians celebrating ten, twenty-five, forty and fifty years in medicine.

10 years

25 years

40 years

50 years

Adeel H. Azam, MD

Angela C. Boylan, MD

Bruce M. Derrick, MD

Arthur J. Alderfer, MD

Deanna Blanchard, MD

Anthony Brandimarto, DO

Anil S. Deshpande, MD

Frances A. Barone, MD

Gregory J. Decardona, DO

Lawrence C. Brilliant, MD

Joel D. Jaffe, MD

Enrico J. DiRienzo, MD

Michael K. Fishman, MD

Ronald J. Costanzo, MD

James G. Kantor, DO

John S. Dobrota, MD

Youval Katz, MD

Richard A. David, MD

Joseph F. Majdan, MD

Eugene A. Dragnosky, MD

Evan B. Lenkowsky, DO

Elisa B. Mandel, MD

Martin R. Mersky, MD

Nand K. Gupta, MD

Andrew M. Mersky, DO

Chandresh A. Patel, MD

Mark E. Rayner, MD

Sudhir K. Marfatia, MD

Eydie S. Rudman, DO

Howard D. Rosenman, MD

Vincent J. Menna, MD

P. Michael Schelkun, MD

Jon H. Schwartz, MD

Joseph H. Werner, MD

Les A. Szekely, MD

Stanley J. Sliwinski, MD

Ali Yazdanyar, MD

David A. Travis, DO

Jay M. Springer, MD Ashokkumar S. Thanki, MD Barry L. Tonkonow, MD

S pring 2 0 1 5

17

Bucks Count y’s Feature

Impressionist Bount y James A. Michener Art Museum Showcases World-Class Collection of Pennsylvania Impressionist Art

Art enthusiasts are universally aware of the work of French Impressionist painters. But, in the late 19th and early 20th centuries, a group of highly regarded local artists were making major contributions to the impressionist genre here in our own backyard. Known as the Pennsylvania Impressionists, these artists worked primarily in New Hope and Bucks County, and were considered some of the country’s most accomplished painters. Today, a world-class collection of their works is within reach at the James A. Michener Art Museum in Doylestown.

The James A. Michener Art Museum The massive stone walls and warden’s house that make up the core of the Michener Art Museum today began as the Bucks County prison in 1884. After a century of use, the abandoned buildings and land were leased to house a new Museum.

After extensive renovation, the Museum opened in September 1988 as an independent, non-profit cultural institution dedicated to preserving, interpreting and exhibiting the art and cultural heritage of the Bucks County region. The museum is named for Doylestown’s most famous son, the Pulitzer-Prize winning writer and supporter of the arts who had first dreamed of a regional art museum in the early 1960s.

18

The Michener’s permanent collection comprises more than 3,000 objects that reveal the rich artistic culture and heritage of Bucks County and beyond. The museum is home to one of the finest collections of Pennsylvania Impressionists’ paintings in public hands and a growing collection of American paintings, sculpture, works on paper, furniture and decorative arts.

The Museum’s bounty of local impressionist art resulted from the generosity of Marguerite and H.F. “Gerry” Lenfest, who placed 59 paintings in trust to the Museum in 1999. Six years later, their promised gift was convert-

BCMS-PA.org Bucks County

Physician

Feature ed to an outright gift, an act that transformed the Museum into an exhibition and study center of Pennsylvania Impressionism. Since that time, numerous collectors and donors have made significant gifts of art and objects, along with acquisitions made through the Mandel Society, which have served to increase the sophistication of the holdings.

An Artistic Revolution The Impressionist Movement had its beginnings in France, as artists including Monet, Seurat, Degas and others experimented with revolutionary approaches to their art. They painted entire works outdoors or en plein air, as opposed to sketching outdoors and then creating the final work in the studio. Using bright colors and painting with very visible brushstrokes, they sought to capture immediate sensations, quickly observed. They were particularly interested in light as it struck various surfaces in different weather and at different times of the day. The impressionists’ concept of realism was to paint the reflected light, and to capture the effect light has on a landscape, a person’s face, or still life objects. The Impressionists also experimented with using blurred effects to simulate movement.

In 1915, the artist and critic Guy Péne du Bois characterized Pennsylvania Impressionist painting as America’s “first truly national expression.” Brian Peterson, the nowretired, Gerry & Marguerite Lenfest Senior Curator at the James A. Michener Art Museum, noted that “what most characterized Pennsylvania Impressionism was not a single, unified style but rather the emergence of many mature, distinctive voices: Daniel Garber’s luminous, poetic renditions of the Delaware River; Fern Coppedge’s colorful village scenes; Robert Spencer’s lyrical views of mills and tenements; John Folinsbee’s moody, expressionistic snowscapes; and William L. Lathrop’s deeply felt, evocative Bucks County vistas.”

Bucks County, in particular New Hope, was considered the epicenter of the American Impressionist movement.

Painters including Edward Redfield, Daniel Garber and Robert Spencer built stellar careers, and many Bucks County artists exhibited and won prizes at prestigious art venues throughout the United States. For a time, the art world came to Bucks County to find the most

The Pennsylvania Impressionists American Impressionism acknowledged the tenants of French Impressionism, yet American artists established their own distinctive approach. They followed the en plein air style, and focused on capturing a distinctive moment utilizing the play of light on surfaces to create the fleeting, shimmering moments we see on the canvas.

American Impressionists, particularly those of the Ashcan School, applied these techniques to urban scenes and industrial objects. But, here in Pennsylvania, a different style emerged, as painters focused their impressionistic creativity on landscapes, often at sites along or near the Delaware River. It was a movement considered one of the cutting edge, avant-garde styles of the day.

S pring 2 0 1 5

19

Feature accomplished and experienced artists, who would sell their work in galleries around the country and serve as jurors for important juried exhibits.

The New Hope Era During the American Impressionist movement, from Connecticut to California and many spots in between, art colonies were born and prospered. Each place had its own story, its colorful characters and its own personality.

Many of the colonies were made up of summer warriors, successful artists looking for a quiet place to make paintings when the weather was warm. New Hope was different. Here, artists were a colony year-round.

Lathrop taught year-round classes in outdoor landscape painting, sometimes using his barge as a floating classroom on the Delaware Canal.

The New Hope School of Impressionists was an alliance of Bucks County artists formed in 1916. They lived their lives, raised their families, painted and developed their artistic personalities here. The group exhibited their work together throughout the U.S. and Europe and came to represent the regional school of landscape painting in the larger art world. William Langson Lathrop was popularly considered the dean of the New Hope art colony.

His home and studio quickly emerged as the intellectual and spiritual colony’s center, as he ferried students to his studio and his wife Annie hosted weekly teas for his colleagues. A dedicated teacher, Lathrop mentored several members of the New Hope School’s first and second generation of painters. Lathrop taught year-round classes in outdoor landscape painting, sometimes using his barge as a floating classroom on the Delaware Canal.

20

A Poetic Voice In 2012, the James A. Michener Art Museum presented an exhibition of Bucks County painters titled “The Painterly Voice: Bucks County’s Fertile Ground.” In introducing the showcase, Brian Peterson noted that “the word ‘diversity’ doesn’t do justice to the depth and breadth of the story of the region’s masters of canvas and brush. It’s the elusive but essential quality of individuality — what some call style or originality, but is better described by the more poetic term ‘voice’ — that the rich creative soil of Bucks County has most nurtured over the decades.”

The voices of artists from the Pennsylvania, Bucks County and New Hope Impressionist movement continue to ring clear in works on permanent display at the James A. Michener Art Museum. Paintings in the collection include such noteworthy examples of the New Hope School as John F. Folinsbee’s River Ice (1935), Edward W. Redfield’s The Burning of Center Bridge (1923), Daniel Garber’s Springtime in the Village (1917), George Sotter’s Brace’s Cove (n.d) and The Windybush Valley (1939), Robert Spencer’s A Gray Day (1912), and Charles Rosen’s Opalescent Morning (ca. 1909).

The James A. Michener Art Museum is located at 138 South Pine St., Doylestown, Pa. For information about museum hours, exhibit schedules, special events, educational programs and more visit michenermuseum.org.

Notes: The following sources were used to inform this article: Resource Library, An American Tradition: The Pennsylvania Impressionists, ©2010 Westmoreland Museum of American Art; Resource Library, The Painterly Voice: Bucks County’s Fertile Ground, © 2011 James A. Michener Art Museum and Brian Peterson, Gerry and Marguerite Lenfest Senior Curator, Retired.

•

BCMS-PA.org Bucks County

Physician

Are

Health & Wellness

Childhood Vaccinations Really Mandatory?

By Angela Boateng, Regulatory Counsel In Pennsylvania, like many other states, children are required to get vaccinated before entering school.

This requirement is to “insure that school children are immunized against diseases which spread easily in schools and interrupt school life and learning for individuals and groups.”

Even though vaccinations are required, however, parents may seek exemptions on behalf of their children for medical, religious, and “philosophical” reasons.

Why is philosophical in quotes, you ask?

Well, under Pennsylvania law, the medical and religious exemptions are clearly identified; however, unlike the medical and religious exemptions, the “philosophical” exemption is not specifically named under the state’s regulations.

At some point after the creation of the regulation, someone or some entity interpreted the last 16 words of the religious exemption as the state’s philosophical exemption: • (b) Religious exemption. Children need not be immunized if the parent, guardian or emancipated child objects in writing to the vaccination on religious grounds or on the basis of a strong moral or ethical conviction similar to a religious belief.

According to data provided by the Pennsylvania Department of Health to PennLive, more than 80 percent of the vaccination exemptions granted during the 2013-2014 S pring 2 0 1 5

school year were religious and philosophical exemptions (38 percent and 43 percent, respectively).

With all of these exemptions, are childhood vaccinations really mandatory?

It’s odd to me that I even have to ask this question.

But, with the current trend of immunization rates in some parts of the nation and the ease with which the requirement can be side stepped in Pennsylvania, I feel compelled to ask.

And I ask because it seems to raise an ominous specter about the future of vaccination in general.

Historically, states have viewed vaccinations as a mandatory measure to protect the public’s health.

Currently, all 50 states have some mandatory vaccination requirements. State legislatures passed vaccine laws in

21

Health & Wellness response to the increasing prevalence and incidence of illness and death caused by disease such as measles, small pox, polio and other vaccine preventable diseases.

As a result of this mandatory intervention (often referred to as one of the top public health achievements of all time), many of us have been fortunate enough to enjoy life and liberty blissfully unaware of many of these diseases (this is, of course, until recently).

When establishing the vaccine requirements, legislators (informed by physicians, researchers, and other learned experts) weighed the benefits of vaccination against the risk of going without. In doing so, they reasonably deduced that for individuals with health issues contraindicated by vaccines, the risks of taking the vaccine outweighed its benefits. As a result, all states have a medical exemption and, understandably so; the rationale for medical exemptions are proven, documented, and not based on the choice of the individual.

And, then there are those who are exempt for religious reasons. Some religions prohibit certain activities (including medical interventions) and engaging in these activities would prevent them from faithful practice of their religion. I can understand this as well. Once again, the rationale for religious exemptions are documented, and not based on the choice of the individual (outside of their 1st amendment right to practice said religion).

What I haven’t quite wrapped my head around is the philosophical exemption

(and, I’ll readily admit, my public health training prevents me from doing so).

Parents who seek philosophical exemptions do so for a variety of reasons: vaccines cause autism; vaccinepreventable diseases no longer exist; natural immunity is better, etc. In order to obtain a religious or philosophical exemption, all a parent must do is complete a form (such this one or this one) by checking a box and write a brief comment or explanation regarding the religious belief or strong moral ethical conviction which conflicts with the vaccination requirement.

Pretty easy, right? Yep, it is. And, discussions on parent boards about immunization exemptions in Pennsylvania, coupled with the data on the number of religious and philosophical exemptions, confirm this fact. First of all, we know that the link between autism and vaccines has long since been debunked and its chief purveyor, Dr. Andrew Wakefield, discredited, so I won’t get into that here. Also, vaccine-preventable diseases do exist, as evidenced by the recent resurgence of measles from the Disney outbreak, the mumps in the National Hockey League, and let us not forget the prevalence of these diseases in other countries (... thanks to modern travel, a vaccine-preventable disease is just a plane ride and unimmunized person away!).

But, I digress. Regardless of the reason parents choose to not vaccinate, the overarching rationale is that their individual beliefs and liberty trump the need to adhere to mandatory laws designed to protect the public’s health.

And, as a result, the common good that has been realized through the childhood vaccination requirement is being compromised by the ease with which the “philosophical exemption” is obtained.

Believe it or not, individuals seeking philosophical exemptions from mandatory vaccinations have been around since the beginning of the 20th century, as noted in a famous public health case that made its way to the Supreme Court of the United States (SCOTUS): Jacobson v. Massachusetts.

In this case, the City of Cambridge, Massachusetts, under the authority of state law, required its citizens to

22

BCMS-PA.org Bucks County

Physician

Health & Wellness receive free smallpox vaccination due to the prevalent and increasing presence of the disease in the city. Mr. Jacobson, who according to the court was over 21 years old, refused to comply with the mandate. The dispute between Mr. Jacobson and the City of Cambridge made its way through the state courts and ultimately landed with SCOTUS. Mr. Jacobson argued, among other points, that Massachusetts’s mandatory vaccination law was “unreasonable, arbitrary, and oppressive, and, therefore, hostile to the inherent right of every freeman to care for his own body and health in such a way as to him seems best.”

This argument appears to be similar to the arguments made by parents who, for “philosophical reasons,” are against vaccinating their children.

SCOTUS ultimately ruled in favor of the state. In response to Mr. Jacobson’s argument, the court made several salient points drawing the distinction between individual rights and the public’s health. My favorite quote and I believe the one most related to the current debate is as follows: • “Even liberty itself, the greatest of all rights, is not unrestricted license to act according to one’s own will. It is only freedom from restraint under conditions essential to the equal of right by others.

It is, then, liberty regulated by law.”

In light of the court’s opinion in Jacobson, and the current state of affairs in Pennsylvania regarding the philosophical exemption, I ask my question again: With all of these exemptions, are childhood vaccinations really mandatory?

Corbin held a press conference to announce their plan to introduce legislation to eliminate the philosophical exemption from Pennsylvania’s vaccination requirement.

Pennsylvania is not alone. According to the National Conference of State Legislatures, as of February 2015, several states have introduced legislation that would eliminate non-medical exemptions.

I should note here that the Pennsylvania Medical Society does not have a policy statement on the merits of the philosophical exemption. The opinions reflected in this blog are my own. PAMED does, however, support legislation to: 1. Establish a parental duty to immunize their children in a complete and timely manner; 2. Mandate immunization of children prior to entry into group care arrangements including, but not limited to, preschool, child day care facilities, school, and camp in accordance with recommendations of the U.S. Public Health Service Centers for Disease Control Advisory Committee on Immunization Practices; and 3. Mandate Pennsylvania public health clinics provide all recommended immunizations as recommended by the Centers for Disease Control Advisory Committee on Immunization Practices (specifically Hepatitis B Vaccine).

So, we’ll see what happens with Pennsylvania’s philosophical exemption. As usual, the medical society will keep you posted as things evolve.

•

Yes, they are! But, unfortunately, the philosophical exemption and the ease with which it can be obtained undermines the force of this important requirement. As a result, the health and the well-being of those most vulnerable — individuals who cannot get vaccinated for medical and religious reasons — are left compromised by those who chose not to get vaccinated.

But perhaps Pennsylvania will see an end to the abuse of this exemption.

On Monday, March 2, 2015, Reps. Schlossburg and S pring 2 0 1 5

23

Health & Wellness

Grand View Health and Fox Chase Cancer Center Encourage Individuals to Schedule a Colonoscopy March was National Colorectal Cancer Awareness Month, and Fox Chase Cancer Center and Grand View Health encourage individuals to take charge of their health by scheduling a colonoscopy. Through regular screenings, colorectal cancer may be detected early — when it is most curable — or, in many people, completely prevented. This is because some polyps, or growths, may be found and removed before they have a chance to turn into cancer. In fact, regular screening may be the reason why, for more than 20 years, the death rate from colorectal cancer has been dropping in men and women.

Partners. “You may need to be tested earlier than age 50 if you have a family history of colorectal cancer or a personal history of colorectal polyps or gastrointestinal disease.”

In 2015, the American Cancer Society (ACS) estimates 93,090 new cases of colon cancer and 39,610 new cases of rectal cancer. One’s lifetime risk of developing colorectal cancer is about 1 in 20, or 5%, with men at a slightly higher risk than women. Colorectal cancer is the third leading cause of cancer-related deaths in the U.S. for both men and women.

• Physical inactivity. Physically inactive persons have a greater chance of developing colorectal cancer.

“Your risk for colorectal cancer increases as you age, so if you’re 50 years or older, get screened now,” advises Steven Cohen, MD, chief of gastrointestinal medical oncology at Fox Chase Cancer Center and medical director of medical oncology for Fox Chase Cancer Center

24

The ACS links several lifestyle-related factors to colorectal cancer, including: •

Certain types of diet. A diet high in red meats (such as beef, pork, lamb, or liver) and processed meats (hot dogs and some luncheon meats) can increase colorectal cancer risk. Diets high in vegetables, fruits, and whole grains have been linked to a decreased risk of colorectal cancer.

• Obesity. Very overweight individuals have an increased risk of developing and dying from colorectal cancer. Obesity raises the risk of colon cancer in men and women, although the link seems to be stronger in men.

• Smoking and alcohol use. Long-term smokers are more likely than non-smokers to develop and die from colorectal cancer. Heavy alcohol users also

BCMS-PA.org Bucks County

Physician

Health & Wellness have a high chance of developing colorectal cancer, possibly due to their lower levels of folic acid in the body.

The most common symptoms of colorectal cancer include: • A change in bowel habits, such as diarrhea or constipation, that lasts for more than a few days • A feeling that you need to have a bowel movement that doesn’t go away after doing so • Rectal bleeding, dark stool, or blood in the stool • Cramping or stomach pain • Weakness and fatigue “While many of these symptoms may be caused by conditions other than colorectal cancer, see your doctor right away if you experience any of them,” adds Dr. Cohen. “I cannot stress enough the importance of open dialogue between both patient and physician.”

As a Fox Chase Cancer Center Partner, Grand View Health has early access to new research discoveries on cancer prevention and treatment. Fox Chase Cancer Center Partners is a select group of community hospitals in Pennsylvania and New Jersey affiliated with Fox Chase Cancer Center — part of Temple Health — to provide the latest in cancer research, prevention, diagnosis, and treatment in their own communities. Fox Chase Cancer Center Partners offers patients, families, and their physicians enhanced resources to deal with the burden of cancer, including the newest clinical trials. Temple Health refers to the health, education and research activities carried out by the affiliates of Temple University Health System (“TUHS”) and by Temple University School of Medicine. TUHS neither provides nor controls the provision of health care. All health care is provided by its member organizations or independent

S pring 2 0 1 5

health care providers affiliated with TUHS member organizations. Each TUHS member organization is owned and operated pursuant to its governing documents.

About Grand View Health Now a century strong, Grand View Health offers a range of inpatient and outpatient care — with specialists in the areas of surgery and orthopaedics, women’s and children’s health, heart and vascular care, cancer treatment and post-acute care. As Bucks County’s first hospital, Grand View has provided residents of Bucks and Montgomery counties with comprehensive healthcare services since 1913. For more information about services and programs, visit www.gvh.org.

•

25

Technology Solutions to Help Your Healthcare Organization Deliver Better Care Bucks County Medical Society members trust Stratix Systems to take care of their technology pains.

IT Support & Network Services

Document Management

Managed & Cloud IT Services

Printing & Imaging Systems

Learn more. Call (610) 374-1936 or visit www.stratixsystems.com.

No one knows technology solutions like Stratix.

Health & Wellness

Rethinking Stereotypes: Overdosing in Older Adults Medications, Alcohol and the Emergency Room.

It’s no surprise that adverse drug events are a huge public health issue across the country. According to the Centers for Disease Control (CDC), these events “cause over 700,000 emergency department visits each year, with nearly 20% resulting in hospital admissions.”

What may surprise people is that a growing portion of these ER visits are in people age 65 and older, involving prescription medications, including in Bucks County. As people age, they are likely to take more medications – to cure infectious diseases, prevent problems from chronic health issues, and alleviate pain. But these same medications can also cause a great deal of harm.

“When alcohol is added to the mix, it only further complicates the issue,” according to Stacey Conway, Ph.D., director of evaluation and outcomes at The Council of Southeast Pennsylvania, Inc., a nonprofit advocacy organization focused on addictions prevention, intervention, treatment and recovery support. “Besides the potential dangers of using alcohol with a variety of medications, there is the additional problem of an aging metabolism, which usually doesn’t tolerate alcohol as well as it did when the person was younger.”

Telltale Signs for Family and Physicians.

increased opportunities for these kind of social interactions may lead to engaging in risky behavior without even realizing it. Being aware of this potential situation is the first step to helping an older loved one maintain a happy, healthy lifestyle.

Information and Referral Resource.

There is plenty of anecdotal evidence that this is a growing problem. “For instance, visiting nurses of older adults with chronic health problems are noticing the problem in patients they care for,” according to The Council’s Sandy Lochrie, R.N., who works with the medical community through a program called SBIRT — Screening, Brief Intervention, Referral and Treatment. The approach incorporates simple tools that can be used during a medical visit to determine if a person’s alcohol or drug use may be causing potential health problems.

The program offers guidance to health care providers to determine the right questions to ask at the right time. If they suspect that a substance abuse disorder may be at the root of their patient’s problem, The Council can be a valuable resource for the provider, their patient and/or the patient’s family.

Family and friends are usually the first to notice an older parent or other loved one struggling with falls and failing memory, who may now seem more accident prone; but they may just chalk it up to the aging process. And maybe that’s all it is. Or maybe there’s something more significant and avoidable at play.

SBIRT consultations and training are offered free of charge to all Bucks County health care providers, through the support of the Bucks County Drug and Alcohol Commission, Inc. (BCDAC). Beyond Bucks County, the program is offered to health care providers as a fee-for-service.

For example, with the growth in retirement communities, there are many more opportunities to enjoy social activities, some of which may include cocktail hours. While that may be harmless, over time, it could tie in to the reasons for the increase in falls or similar accidents. So, the

For confidential information and referral resources for all types of addictions recovery support, please contact The Council at our 24/7 intervention and recovery support line at 800-221-6333, by email at helpline@councilsepa.org, or by visiting us at councilsepa.org.

S pring 2 0 1 5

•

27

Health & Wellness

Valvular Heart Disease–

The Increasing Abnormality in American Population.

By George P. Heyrich, MD, FACC, FSCAL, FSCCT, Mercer Bucks Cardiology Valvular heart disease is an increasing abnormality in the American population.

The prevalence of aortic stenosis is up to 7% of the population over age 65. The male population tends to be affected to a greater degree than female. It is a health problem affecting millions of people in the United States. The most common valvular abnormality found in the symptomatic senior population is calcification aortic stenosis. Symptoms of aortic stenosis include exertional fatigue and dyspnea which limit lifestyle. Other prognostic symptoms of aortic stenosis include congestive heart failure, syncope and angina/chest pain. Symptoms of blackout or lightheadedness may be associated with a 50% one-year mortality. The risk factors for aortic stenosis include age, hypertension, smoking and elevated cholesterol.

The evaluation for aortic stenosis includes a physical exam with a notable heart murmur. A late peaking systolic heart murmur with decrease second heart sounds portends a severely restricted aortic valve. Further evaluation and potential treatment is guided by noninvasive echocardiography which easily identifies a calcified and restricted aortic valve. This restriction limits the blood supply from the heart muscle to the remainder of the body. The narrowed aortic valve increases the workload of the heart muscle which can provoke chest pain or angina. Advanced imaging and diagnostics may be required for confirming the diagnosis and treatment strategies which may include open heart surgery with aortic valve replacement. These diagnostic studies include cardiac catheterization and potential 3D transesophagael echocardiography.

28

Surgical aortic valve replacement with a bio prosthetic or metallic remains the “gold standard” for low to moderate risk patients. Patients who are evaluated for surgical aortic valve replacement (SAVR) and determined to be at high surgical risk for aortic valve replacement can be evaluated for a new minimally invasive replacement technique of TAVR. This treatment can be facilitated through a small incision in the femoral artery or chest wall via a transaortic/transapical technique. As part of the treatment evaluation, patients may require advanced imaging with CT angiography to evaluate the optimal route for endovascular access.

Potential candidates for TAVR are evaluated by a multidisplinary heart team consisting of a cardiothoracic surgeon and interventional cardiology team. This coordinated approach allows the determination of optimal treatment for these high risk patients.

Treatment of severe aortic stenosis with TAVR has been demonstrated to significantly improve quality of life as well as decrease repeat hospitalizations for congestive heart failure with improved survival. The benefits of TAVR are a minimally invasive approach, rapid recovery with hospital discharge being shortened by approximately 50% compared to surgical treatment and rapid resumption of usual activities. Proper evaluation by an experienced Heart Team is required to thoroughly evaluate eligible patients and outlines the risks and benefits of all potential treatment modalities.

•

BCMS-PA.org Bucks County

Physician

Community

St. Luke’s Singers Performs 23nd Annual Spring Concert On Sunday, May 3

“Sabbath Prayer” from Fiddler on the Roof and “Climb Every Mountain” from The Sound of Music. They will also sing new settings of Stephen Foster’s “Camptown Races” and the American folksong, “Aura Lee.”

The St. Luke’s Singers will present With a Voice of Singing spring concert on Sunday, May 3, at Wesley Methodist Church located at 2540 Center Street in Bethlehem.

The prelude portion of the program begins at 2:45 pm and the concert begins at 3 pm.

Tickets are $12 and may be obtained by calling 610-7596325 or by visiting the hospital gift shops, located at St. Luke’s Hospital — Bethlehem Campus, Allentown Campus, Anderson Campus and Warren Campus.

The concert begins with Martin Shaw’s “With a Voice of Singing” accompanied by organ. The Singers will present two contemporary pieces with a similar theme: “I Will Sing and Not Be Silent” by Allen Pote and “Cantate Domino” by Mark Hayes. Soloist Michelle Giletto will join the Singers on the spiritual, “Ride the Chariot.” Together they will close the first section with “River in Judea” accompanied by brass, percussion and bass.

In the second portion of the concert, the Singers are preparing three selections from musicals: “Gonna Build a Mountain” from Stop the World – I Want to Get Off,

“Relaxis”

Relief from Restless Legs Syndrome!

Advanced Medical Homecare Supplies is now accepting orders for Relaxis - the only FDA approved device for improving sleep in patients with primary RLS (aka Willis-Ekbom Disease).

Contact us for: Relaxis (RLS Device) CPAP Equipment and Supplies Oxygen

Lift Chairs Bathroom Safety Compression Therapy …and more

See our online catalog at www.advancedmedicalpa.com Or, come visit our new showroom.

Serving the local Philadelphia tri-state area since 2005.

To Place an Order Call 610-524-1510 1025 Andrew Drive, Suite 150, West Chester, PA 19380

We I m p r o v e Yo u r H e a l t h a n d I n d e p e n d e n c e .

S pring 2 0 1 5

The St. Luke’s Singers are the only hospital-based choir in Eastern Pennsylvania and annually perform a winter holiday and spring concert. Each year the group chooses a different beneficiary within the hospital community. This year’s holiday and spring concerts will benefit The St. Luke’s Singers Endowed Scholarship Fund for theTemple/ St. Luke’s School of Medical.

The primary mission of the St. Luke’s Singers is to raise funds to help support projects and services at St. Luke’s for the benefit of patients in need of treatment and care.

Since 1991, the St. Luke’s Singers have raised nearly $250,314 for various St. Luke’s recipients.

•

You take care of your clients, but who takes care of you?

We are committed to making your banking easier.

• On-site account opening • Remote deposit and mobile deposit • Commercial loans and lines of credit • Access to real people—even during evenings and weekends.

CONTACT

Virgil Haplea Senior Vice President, Commercial Lending

vhaplea@conestogabank.com Office 215-526-9264 Member FDIC

29

Hospital Community News

Doylestown Health Bucks County Designer House & Gardens: House Tours Sunday, April 26, 2015 to May 30, 2015 Location: Chalfont, PA Villa d’Braccia is a 7,800-square foot Mediterranean-style villa set on four acres.

Sponsored by the Village Improvement Association of Doylestown to benefit Doylestown Hospital and the mission of VIA. For Information, visit BucksCountyDesignerHouse.org

Grand View Health

Miller-Keystone Blood Drive Thursday, May 14, 7:00 am - 5:00 pm Location: Grand View Hospital Community Education Center

Nearly five million people in the US receive life-saving blood every year. Please consider donating during this hospital-wide blood drive. Please call 215.453.4300, or visit our website, gvh.org, for more information.

St. Luke’s Hospital St. Mary Medical Center Way to Wellness Program Way to Wellness is an innovative and interactive 10-week program that combines three integral components for living a healthy lifestyle.

Spring and Summer 2015 Sessions Contact: Merle Eskowitz, Manager, Way to Wellness Program, at 215-710-2815 or meskowitz@stmaryhealthcare.org

Aria Health System

5th Annual Charity Bike Ride Saturday, June 6 beginning at 10 am.

St. Luke’s Hospice is hosting its 5th Annual Charity Bike Ride as a way to raise funds and awareness of hospice care and to encourage exercise as part of the Get Your Tail on the Trail program.

Bike enthusiasts at all levels of ability will be able to participate in either the 15 mile or 30 mile trail ride, which begins on the D&L National Heritage Trail, Lehighton Trailhead, 200 North Main Lane, Lehighton, PA 18235 (just south of Jim Thorpe). Registration for the ride is required at www.active.com

Healthy Lifestyle Program The healthy lifestyle program is a six-session nutrition education program that focuses on helping you to build healthy habits to aid in weight management and to treat and prevent disease.

Starting May 11, 2015 Contact: 215-612-4863

30

Lower Bucks Hospital Organizing the Lower Bucks Hospital 60th Anniversary The Lower Bucks Hospital 60th anniversary committee is working to select a date early fall of 2015. If you have any stories, memories, or memorabilia you would like to share please feel free to post on their Facebook page... www.facebook.com/pages/Lower-Bucks-Hospital60th-Anniversary/430667207096175

BCMS-PA.org Bucks County

Physician

Bucks County Community Events

37TH ANNUAL ANTIQUE AUTO SHOW May 03, 2015

Sponsoring Partner: Bristol Borough Business Association Event Location: Bristol Borough Mill Street, Bristol, PA 19007 Phone: 215-788-3131 10:00 AM to 4:00 PM Admission: Free to Attend The Bristol Borough Business Association is proud to once again sponsor the 37th Annual Antique Auto Show. This Auto Show brings over 150 antique cars to Mill Street and more than 10,000 people from both local and far away into our town. The BBBA is always looking for sponsors to help offset the expense of the Auto Show.

This would be a great opportunity to promote your agency and give you exposure not only in the community, but also with antique car owners throughout the area. Rain date May 17.

15th Annual Arts Alive May 16, 2015

Event Location: Downtown Quakertown W Broad St, Quakertown, PA 18951 Info: QuakertownAlive.com 10:00 AM to 4:00 PM Admission: Free to Attend Broad Street in downtown Quakertown will be transformed into a festival of artists, crafters, jewelers, musicians, food vendors, activities, and so much more. This free, annual festival, now in its 15th year, features over 100 juried exhibitors and has something for everyone of every age. True treasures and unique finds can be found up and down East and West Broad Street, which will be dotted with unique food vendors, artists and crafters, and fun and informational booths. All the local merchants open their doors and invite you to browse their offerings, event specials, and extra goodies. From 2-4pm, the Main Street Cruisers will be performing their show on the West Broad Street stage. Be sure not to miss this amazing experience.

17th ANNUAL TILE FESTIVAL

From: May 16, 2015 - May 17, 2015 Event Location: Moravian Pottery & Tile Works Park Info: 215.348.6098 130 Swamp Rd (Rte. 313), Doylestown, PA 18901 Sat 10:00 AM to 5:00 PM, Sun 10:00 AM to 4:00 PM Take advantage of this unique opportunity to view historic and contemporary ceramic tiles featured by artists, dealers and collectors from around the country. Beautiful and rare examples of handcrafted tiles will be on exhibit and available for purchase. A free tour of the Tile Works is included.

Adult admission (age 18 and up) is $6; those under 18 and Members of the Tile Works are free. Proceeds will benefit the museum’s artifact collection and conservation efforts. Please, no pets. Rain or shine.

22ND ANNUAL GARDEN TOUR “THROUGH THE EYES OF A CHILD” June 06, 2015

Sponsoring Partner: New Hope Historical Society Event Location: Addresses Given Upon Registration New Hope, Bucks County, PA • Phone: 215-862-5652 • 1:00 PM to 4:00 PM • Admission: $35 Self-guided tour of private Bucks County Gardens. Tour includes a Retail Boutique where visitors can purchase greens and cuttings for their gardens. There will also be a book signing for a children’s history book, Let’s Visit New Hope, by the authors, Gayle Goodman and Roy Ziegler.

2ND ANNUAL DOYLESTOWN ART DAYS

June 04, 2015 - June 07, 2015 The Arts & Cultural Council of Bucks County is proud to be the presenting sponsor of the 2nd annual Doylestown Art Days!

Join us for an art extravaganza pairing local businesses with local artists. Art will be displayed in the shops, windows, restaurants, and court yards of our town for the enjoyment of the general public. General art will be available daily with special events (times varying). We are inviting artists of all varieties: students, professionals, painters, photographers, dancers, musicians, and more. Please join us to celebrate our town, our vibrant art community, and the second annual Doylestown Art Days!

Event Listings from VisitBucksCounty.com

•

MEDICAL PROFESSIONAL LIABILITY INSURANCE FOR PHYSICIANS BY PHYSICIANS

SAY HELLO TO NORCAL

EXPERIENCE THE MUTUAL BENEFIT

PMSLIC Insurance Company is transitioning to its parent company— NORCAL Mutual Insurance Company. Same exceptional service and enhanced products, plus the added benefit of being part of a national mutual. As a policyholder-owned and directed mutual, you can practice with confidence knowing that we put you first. Contact an agent/broker today.

HELLO.NORCALMUTUAL.COM | 844.4NORCAL

©2015 NORCAL Mutual Insurance Company