Healthy hudon valley magazine 2016 composite esub

Ulster Publishing’s

Healthy Hudson Valley Magazine M i 2016-17

Examining healthcare

“Modern healthcare is so full of possible treatments and options that it really requires some assistance from a trained professional for patients to get the best out of it” From “Healthcare Navigation,”

by Chris Rowley

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• May 5, 2016

Healthy Hudson Valley

Watching the systems change Paul Smart explains that electronic prescriptions are only a part of the major national healthcare transition

WIKICOMMONS

How does one assess what’s happening with the healthcare consolidation and other changes?

As with digitalization of records and prescriptions, the entire industry is becoming more mobile, and less tied to single doctor-patient relationships.

A

s of March 27, physicians in New York State were required to submit electronic prescriptions to pharmacies. The law’s initial implementation was delayed one year to allow many larger health institutions more time to prepare for the switch. Earlier this year state health commissioner Dr. Howard Zucker issued a temporary blanket waiver from the mandate for certain circumstances that include oral prescriptions for patients in nursing homes and residential healthcare facilities,

for compound or other drugs for which directions are long and complicated, and for some of our state’s larger hospitals with tied-in doctors’ practices.

The e-scripting is a key component of New York’s I-STOP initiative, which has one eye on continuing digitization of medical records and another on curbing abuse of prescription medication. There’s been much talk about increasing the “portability” for patients’ prescriptions, as well as improved efficiencies in medical files and in records of what’s being prescribed when, the

Healthy Hudson Valley

better to avoid what one person euphemistically termed “medication misadventure.” There’ll also be fewer jokes about doctors’ illegible handwriting.

This new requirement is of course but a modest part of the larger consolidation in our region’s and the nation’s healthcare. Everywhere one looks one sees new partnerships, mergers, affiliations and buyouts among hospitals, medical practices, therapy affiliates, insurance companies and even gyms. The names to which we’re writing those checks seem to change every month.

“No man ever steps into the same river twice” is a supposed quotation from Heraclitus in a Platonic dialogue.

The second time he’s not the same man and it’s not the same river. American healthcare exemplifies this world of perpetual flux.

As of 2016, pharmacy benefit managers (PBMs) handle

May 5, 2016 • 3

pharmacy benefits for 266 million Americans. Operating within integrated healthcare systems, networks of retail pharmacies and health insurance firms, PRMs serve as intermediaries between drug manufacturers and pharmacies. They’re a highly concentrated component of the healthcare industry, with about 30 significant companies, the three major ones comprising 78 percent of the national market.

One of the hospitals fully to comply with the new “escripting” mandates in our region has been the small Ellenville Regional, where manager of pharmacy services Mike Stearns, who also works at Matthews Pharmacy in Ellenville, has been instrumental with getting everyone up to speed for the new changes.

“We were fully operational a couple of days before the required date,” said Stearns. “The original delay came

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about because the software wasn’t ready yet, and some hospitals are still struggling with new waivers in place.

Our biggest challenge was educating everybody on what needed to be done and getting the various different software elements working for providers [the doctor or hospital] and pharmacists, each of which requires outside ID authentication means provided by outside companies. It turned out to be pretty complex with the IT details pretty mindboggling.”

From Stearns’ perspective, the end result of mandated electronic prescriptions is positive from both the medical practitioners’ and pharmacy sides. That’s good for the patients in between, except for occasional “medication misadventure.”

Software now helps doctors, using “intuitive” technol-

ogy to suggest prescriptions and to warn of interactions. Prescriptions are then electronically transferred to pharmacies of a patient’s choice, but only after the accuracy of such a prescription, including frequency, is digitally determined to be correct. Even delivery can be affected; pharmacies can transfer pick-up of prescribed medications.

Some elements of the new prescription system seem to be having their desired effects. At the end of last year, following its initial rollouts, the New York State Department of Health reported that I-STOP had led to a 90 percent decrease in the number of “doctor shoppers,” the patients who visit multiple prescribers and pharmacies to obtain prescriptions for controlled substances within a three-month time period.

Contributors to this issue Scott Baldinger is a freelance magazine and newspaper writer and editor. He blogs about the Hudson experience in Word in the Street at GotoHudson.net.

Jennifer Brizzi writes on food and health for newspapers, magazines and books, and does recipe development, cooking demonstrations and teaching. Her website is www.jenniferbrizzi.com.

Elisabeth Henry, a writer and an actress who lives

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in Hunter with her husband, where they raised their children. She has written for many local and regional newspapers and magazines.

Amanda Howard worries that she knows way too much trivia about Buffy the Vampire Slayer.

Ann Hutton’s work has appeared in the Catskill Mountain Region Guide, Hudson Valley Magazine, Kaatskill Life Magazine, Green Door Magazine, as well as Ulster Publishing’s community weeklies.

Dante Kanter has received awards for his poetry and short stories. He has attended the Iowa Young Writer’s Studio and the New England Young Writer’s Conference, and will be attending a similar event at Kenyon College this summer.

Harry Matthews lives on an old farm on the Kaaterskill Creek outside Palenville with his partner Catherine and their three cats.

Chris Rowley is a reporter for the Shawangunk Journal and the author of many science-fiction and fantasy novels, most recently, the Netherworld trilogy, as well as a recent history of soccer, rugby and football.

Paul Smart, who writes for a living and edits several publications, is father to a ten-year-old, husband to an artist and arts administrator, and protector of two cats, a turtle and a young dog.

Violet Snow, a journalist, author and frequent Ulster Publishing presence, specializes in history, genealogy, suspense fiction and nature, and also expresses herself through photography, video and music.

Jack Warren’s work has been featured in the Goodlife Youth Journal as well as the Woodstock Day and Onteora High School literary magazines, the latter of which he is co-editor-in-chief. He will be attending Wesleyan University next fall.

This issue’s cover photo of operating surgeons was provided by the Woodstock-based stock photo and arts company The Image Works.

Healthy Hudson Valley

May 5, 2016 • 5

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Healthy Hudson Valley

The summer I couldn’t hear Ann Hutton discovers an unexpected little friend near her brain y left ear had been noticeably impaired for a long while, a condition accompanied by that constant ringing called tinnitus. Then I awoke one morning last spring unable to hear out of my right ear.

Since the symptoms in my left ear had developed over the decade I’ve lived in the Hudson Valley, I assumed this new auditory glitch might be caused by my increasing allergic reactions to pollen. The pollen count last year was especially high. I kept waiting for the trees and fields surrounding my house to stop dropping yellow dust all over the place. I thought my right inner ear would clear up when they did, and I could get back to the partial impairment of whatever had been going on in my left ear for years.

It didn’t happen. As autumn blew in, and my hearing got worse, I made an appointment with a local otolaryngologist, an ear/nose/throat specialist who vacuumed ear wax out of both my ears. I could hear again, almost instantly. The music coming out of the passenger-side speaker when I was riving my car was suddenly clear and loud. It was a miracle, I thought. But when I told my ENT doc that I still couldn’t hear as well with my left ear, he ordered me to have an MRI. Unilateral hearing loss was

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not normal age-related deterioration, he told me. He said something else might be causing my inability to hear.

An MRI revealed a vestibular Schwannoma, also called an acoustic Neuroma or auditory tumor. An intracranial tumor of the myelin-forming cells of the vestibulocochlear nerve — the nerve that connects the ear to the brain — is usually benign. This type of tumor grows slowly, so slowly that I might have hosted this one for 20 years or so, my doctor said. He opened his laptop to show me images of my own special little friend, located to the left of my brain stem.

My doctor was clearly concerned about the largest Schwannoma he’d ever seen. How was I taking the news? My reaction was one of curiosity. I asked questions. What does one do about a tumor in your skull?

What can happen if one doesn’t do anything?

Standard treatment calls for surgical removal or gamma-knife radiation, both endangering what little hearing still exists in that ear. Since both options involve working close to the nerve carrying muscular information back and forth to the brain, facial paralysis often results. Oh, and dizziness. Loss of balance. I tried to imagine my life under these altered circumstances.

My ENT recommended I consult with a neurosurgeon

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PHOTO SUPPLIED BY ANN HUT TON

When Ann Hutton found she couldn’t hear one morning, a process of medical examination began that eventually revealed vestibular Schwannoma, also called an acoustic neuroma or auditory tumor, causing the problem. Ann came to consider the intrusion as her “little friend,” seen here. immediately, which made me think I might end up in a hospital by the end of the week. Even though my tumor was benign, it could grow to press on my brainstem, my doctor said. And what would happen then? Your brainstem controls your bodily functions, he answered, indicating that such interference could shut down my breathing or my heart function.

My curiosity turned to dread, and then sadness. I telephoned our adult children to tell them their mother was in bad straits, ones that could, one way or another, end her life.

After making two appointments with neurosurgeons, I learned as much as I could about my strange condition, so as to be able to ask pertinent questions of these experts. It turns out that vestibular Schwannomas are what’s considered a “rare disease,” one of the 7000 rare disorders and diseases often misdiagnosed or missed altogether. This information came from a website celebrating Rare Disease Day. It turns out that approximately 3000 cases are diagnosed each year in the United States, comprising up to ten percent of all intracranial neoplasms in adults.

A vestibular Schwannoma can be difficult to diagnose, because the symptoms are similar to those of middle-ear

problems. It was a total coincidence that my middle-ear problem existed in the other ear — a lucky accident, it seems. Without it, I might never have visited the ENT. As it grows, the tumor may press against hearing and balance nerves. Symptoms can include ringing in the ears, loss of hearing on one side, dizziness, vertigo-related nausea and vomiting, and pressure in the ear. The intracranial pressure of larger tumors may cause headache, vomiting, and altered consciousness. Yippy, I thought.

Short of having surgery or radiotherapy — this second “fix” can actually cause new tumors to grow in nearby brain tissue or convert the irradiated tumor from benign to malignant — the conservative suggestion is to wait and see for an observation period of six months to a year. About a quarter of all vestibular Schwannomas are treated with medical management of symptoms, such as hearing aids when appropriate, along with periodic monitoring of a patient’s neurological status and serial imaging studies.

Both neurosurgeons I spoke with advised me to approach treatment conservatively. One said to come back in six months for a follow-up MRI. The other told me I could wait a year. Monitoring tumor growth annually is especially common in elderly patients, who often

May 5, 2016 • 9

Healthy Hudson Valley

die of other causes before the Schwannoma becomes life-threatening. This second neurosurgeon cited the studies of post-treatment satisfaction being low, with many older patients reporting regret for having had the surgery because of its life-altering side effects.

I considered the frustration I’d experienced all summer long while not being able to hear well. It seems that “unilateral hearing loss causes people to experience difficulties in group discussions and dynamic listening situations.” No kidding. I grew increasingly angry when family members didn’t get that I could not figure out what they were saying to me when they were in another room. I could hear the noise, but not the words. Just talking louder did not work.

I often felt like withdrawing into my own little world, rather than attempt to understand their gibberish. It was disconcerting, and now I had to consider the possibility of even more debilitating results if I went the surgical route.

I discovered organizations that help vestibular Schwannomas patients with their treatment decisionmaking and their recovery choices. Both the Vestibular Disorders Association [VDA] and the Acoustic Neuroma Association [ANA] offer online resources and informational support groups. The ANA website has a 20-minute long interview with Mark Ruffalo, the actor and environmental activist, who discovered his own Schwannoma through a disturbing dream. He talks frankly about his surgery and arduous recovery.

Somehow his story is comforting to me, even though I am still in wait-and-see mode.

Meanwhile, I am living in guarded uncertainty — a state of being that either drives you nuts or has you appreciating each day that comes along. I am visualizing my tumor as it shrinks and disappears. Meanwhile, I’m weighing the pros and cons of treatment, should it become mandatory, against the ruinous financial state I’ll be in if I go either way.

And meanwhile, this so-called “rare” disorder may be more ubiquitous than we think. If your ability to hear is markedly lopsided, or if, like Mr. Ruffalo, you dream you have a tumor in your head, tell your doctor about it.

You may discover a friendly Schwannoma tucked into the folds of your skull, one that could wreak quiet havoc in your life. At the very least, it will remind you take good care of yourself and others, and live in the present tense. That’s what my little friend has done for me.

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Healthy Hudson Valley

Healthcare navigation Chris Rowley learns the job involves support, education and empowerment

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he concept of a health navigator is associated with the arrival of Obamacare, the Affordable Care Act. To help people sort through the myriad offerings from insurance companies, at Platinum, Gold, Silver and Bronze levels, with different sets of costs, co-pays, co-insurance, networks and healthcare providers, the navigators had their jobs cut out for them. They were trained to help guide people through the labyrinth. Their job was to get the level of insurance peo-

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ple could best afford that would offer them the right network of providers.

Navigators have also become a crucial part of the healthcare system at the point of service. Because the medical system has grown so complex, navigating without help is for many intimidating, even exhausting.

Let’s take a journey into an area that none of us wants to visit, the oncology zone. Oncologists deal with cancer. Today, we understand that that single word “cancer” refers to at least 200 different diseases grouped inro five families: carcinomas, lymphomas, leukaemias, brain tumors and sarcomas. Treatments for all of these have multiplied in dizzying complexity.

Since cancer has long been synonymous with a death sentence, the dread of an imminent death hangs over the whole business. Progress has been made in many areas. A vast variety of treatments exist and continue to develop. Survivorship-- a relatively new term-- has become ever more common.

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ou have been referred to the Dyson Center for Cancer Care at Vassar Medical Center in Poughkeepsie, a Health-Quest affiliate. You’re frightened.

Confronting the awesome array of services and pro-

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viders, you’re feeling overwhelmed. That’s when you meet Julia Halligan, a specialist oncology navigator.

Halligan describes herself in several ways. Officially, “I’m a specialty oncology certified nurse, I have a specialty license added to my nursing license.” But just to be clear about everything, she adds, “What I really do is communicate. I talk to so many people in a single day, from my patients and their families over to many different types of providers.”

She laughs. “When I go home I don’t want to talk.

I’m done.” But soon her endlessly friendly and understanding voice continues, “The next morning you get up and you start all over again.”

You would meet her only if you were referred with gastro-intestinal cancer or melanoma. Those are her specialties.

“I meet patients usually after they’ve been referred here by GI doctors, and colonoscopies have been performed. So they know they have colo-rectal cancer. I make the first phone call, to reach out to the patient and their family members.”

After that, the navigator becomes the go-to person.

As Halligan soon explains, in that situation you will need her services. She answers patients’ questions about what treatments they’re going to have. She sets up appointments with all the healthcare providers, the specialists or the surgeons. She introduces patients to the people that are going to help them.

“In effect,” she says, “we provide a whole team. It may include oncology nutritionists, a radiation oncologist,

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a surgical oncologist as well as medical oncologists. So you can imagine if you’re someone with a new diagnosis and you have all these names and their specialties it can be overwhelming. So instead of the patient trying to keep all those balls in the air, they can turn to a navigator.”

Sometimes things become more complicated still.

Extraordinary effort is needed. Halligan admits that she and other navigators need to go beyond the limits of their job. “Sometimes we find that patients have barriers to receiving treatment,” sehe says. “Sometimes English is not their first language. Sometimes they have no health insurance. Sometimes they have no transportation. Sometimes they have no support system. It really ‘takes a village’ in many cases, and we all work together to give patients the skilled and timely treatment they need.”

P

atient navigation began with a doctor. Working in Harlem in 1990 with breast cancer patients, Harold Freeman realized patients would have better outcomes if they could navigate their way through their medical care. He trained lay people to support them.

“Navigation is still in its infancy stages,” explains Halligan. “It’s only been around for 25 years, and only in the past decade has it become more widely employed.

One example: the Oncology Nursing Society is currently working on a certification process for oncology nursenavigators. I’ve been participating, helping them decide

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From getting insurance to finding the right primary practice to making one’s way through modern hospitals requires whole new classes of navigators, much as the high seas once demanded the most of its grand skippers. how to test applicants and how to certify.”

Halligan is sure the concept is not only here to stay, but is likely to spread across the field of medicine.

“You could have a navigator in an emergency room, someone to navigate the multi-dimensional healthcare issues that anyone there might encounter.”

Again and again, Halligan returns to the same point. Modern healthcare is so full of possible treatments and options that it really requires some

assistance from a trained professional for patients to get the best out of it. “Even if someone is seeking a second opinion we help facilitate that. It goes beyond that, to working with pharmacists and home care, in fact any transitional service. You have to support and educate your patients and families from the earliest moment. I am an advocate for patients and I do whatever it takes to support and empower them.”

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Changes in child healthcare Jennifer Brizzi monitors how parent practices have shifted was a pediatric nurse for a decade. When I became a mom of young children I did what I felt was right for us: I carried them in slings, put them down to sleep on their backs for safety, practiced co-sleeping some of the time, and had them vaccinated regularly. My mother likely did only the last of those four for me. But I am no expert on how to raise healthy kids, and it’s clear that practices in keeping

I

your kids healthy vary throughout time and will keep changing as the world keeps evolving. As Dr. Benjamin Spock told parents, “Trust yourself. You know more than you think you do.”

When I was a kid at the Putney Grammar School on Vermont in the 1970s, Dr. Spock came to speak to us.

All I remember about his talk was his joking that he didn’t have the pointy ears we had probably expected.

WIKICOMMONS

Pediatrics has changed greatly since Dr. Benjamin Spock first published his hugely popular guides to raising kids. But at the heart of the relationship is still an essential sense of connection, as seen here in a recent photo of a U.S. Armed Forces doctor treating an infant Timorese refugee.

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Healthy Hudson Valley

At home we had a copy of one of his books, and when I became a mom a few decades later I bought a copy for myself.

Spock’s liberal approach to parenting and parentencouraging writing style appealed to many (his first book, published in 1946 sold 750,000 copies its first year, long before Twitter and without any advertising).

Its latest edition (with a co-author, since Spock had died in 1998) came out just a few years ago.

Many other experts have risen up to take his place as authorities, making those of us wanting to raise healthy happy children rather confused about whether to praise or punish, put babies to sleep on their stomach or backs, and myriad other issues. Docs from Spock to Sears have told us what to do.

Although children no longer have to walk five miles to

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Healthy Hudson Valley

back sleeping.

In 1994 the National Institute of Child Health and Human Development launched the Back to Sleep campaign, recommending that parents put babies to bed on their backs, even for naps, exclusively for their first year of life. They said that was the best course for reducing the risk of SIDS — Sudden Infant Death Syndrome, an infant death with no known cause. SIDS’ impact is of course heartbreaking and devastating, as I witnessed when a friend experienced it after giving birth to her first child. The Back to Sleep campaign resulted in a decrease in SIDS. Between 1992 and 2001 the toll fell from 120 deaths per 100,000 live births to 56. Since 2001 that figure has not improved much, however, per nbcnews.com.

Though premature babies in NICUs are often put on their stomachs for ease of access of bulky oxygen tubing, they are monitored closely. Once they are healthy enough to go home they’re used to sleeping on their tummies, and some have trouble adjusting to back sleeping. The National Infant Sleep Position Study in 2010 reported that as of that year, 75 percent of infants were being put down in the supine pose, which leaves about 25-30 percent being put down prone, against federal advice. Parents often choose to put their babes to sleep that way because they feel they sleep better and are in their opinion at low risk of SIDS due to lifestyle factors. The Internet is full of blogger opinions who feel that the baby and the whole family sleeps better that way, so the pendulum may again be swinging in the other direction.

Many co-sleeping advocates and experts feel that the practice of having the baby sleep all snuggled up with you, or in a co-sleeping attachment to your bed, or at least in the same room, helps prevent SIDS by allowing closer monitoring.

The prolific child-care expert William Sears, MD is a big co-sleeping advocate, having raised five of his eight children that way. Preferring to call it “sleep sharing” rather than “co-sleeping,” he studied the practice extensively in his home lab, concluding it was the healthiest for mom and baby. Although the practice had a weird hippie connotation when they started, he discovered that it is a common practice worldwide (more than half the planet co-sleeps), but has remained taboo in American society for a long time. “There are many nighttime parenting styles,” he writes, “and parents need to be sensible and use whatever arrangement gets all family members the best night’s sleep.” accinations are one topic that inspires big controversy. In the days when doctors’ words were considered gospel, most of us didn’t question whether we should have our kids vaccinated according to prescribed schedules. While I can only touch the tip of the iceberg on this huge subject, in our more recent history more and more groups of people have decided not to vaccinate their kids.

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Share our Gracious Lifestyle Welcoming, Authentic & Diverse We are an integral part of the close knit Woodstock, Kingston and Saugerties communities. From our front porch we enjoy the hustle and bustle of the farmer’s market, historical society concerts or a passing parade.

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Support for Independence Because self-development takes a full lifetime to pursue Taking care of all of life’s needs allows increased independence. Integral to this approach, we offer services that allow residents to live a longer, healthier and more satisfying life.

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Three delicious meals per day, approved by a dietician and prepared by trained chefs

Specialized Care For people with Cognitive Impairment We are the only Assisted Living in the area to offer a dedicated, secure memory care unit licensed by the New York Department of Health as a “Special Needs Assisted Living Residence.” In addition to providing consistent supervision and a secure environment, our experienced staff receive training in resident-entered, best practice support for people with dementia. Through our approach we are able to reduce the frustration experienced by people with cognitive impairment, while measurably increasing their quality of life.

Enhanced Programming Special license that allows residents to age in place Nurses are on site seven days a week, and our highly skilled staff has training and experience with accommodating, in a respectful and caring manner, the changes associated with advanced aging.

Our owner-operator, Joan Hyde, PhD is a professor of Gerontology and an internationally recognized researcher and published authority on assisted living and best practice care for people with cognitive impairment.

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• May 5, 2016

Healthy Hudson Valley

to their being constantly monitored, shuttled around by in the New England Journal of Medicine. All states but parents, with arranged play dates and scheduled activiMissisippi and West Virginia allow citizens the right to ties. Part of this is due to media attention to “stranger forego vaccinations, with certain religious communities danger,” with media-addicted parents fearful of child and more recently individuals who mistrust the safety molesters on every corner. of vaccines, exercising that right. This attitude has In 1969, 41% of kids walked or biked to school, but purportedly been the cause of several well-publicized by 2001 that had dropped to 13%. Part of that may be cases of outbreaks of measles, inspiring some to swing due to the increase in dual-income back to being pro-vaccine. families with less time to moniIt’s clear to most parents that tor the kiddies and a looser social today’s kids have things different It’s clear to structure, where mom is indoors on than we did as kids. According to Facebook instead of talking to Mrs. sociologist Dr. Markella Rutherford most parents Jones over the back fence about what at Wellesley College, who studied that today’s she saw her kid do. attitudes on childrearing from the Many who have studied childkids have things 1920s to the mid-2000s, children raising shifts through the years have are now more free of responsibilities different than theorized that we all still want our at home but facing tighter restricwe did as kids. kids to be physically and mentally tions outside the house. In the 1930s healthy, with strong senses of mowhat children ate and when they rality and a desire to be productive slept was dictated by their parents, members of society some day. But it seems that the and they pitched in around the house, with regular reway we make that happens has changed. We look less sponsibilities and chores. A decade later they had more to making our kids obedient and controlled and more freedom and independence, although chores continued to building strong, self-sufficient characters with indithrough the 1970s. But by the 1980s Rutherford found viduality and solid self-esteem. little parental interest in chores done by children, and In cases of youthful infractions, punishments through that more recently many children are expected to do the years have gone from the physical to the timeout, their homework and little else. grounding or loss of privileges. Also, nutrition has Outside the home, the trend has gone from kids being changed through the years, surely a crucial component of free to move about on their own or spend unsupervised child health and one that merits a whole article in itself. hours with friends (like I remember from my childhood)

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• May 5, 2016

Healthy Hudson Valley

Getting in shape

WIKICOMMONS

With a good insurance policy and the right gym in one’s area, it’s not hard to get or stay fit these days, especially now that yoga, Pilates and other regimes have become part of the plan for reimbursement tied to insurance wellness goals.

Amanda Howard explores insurance discounts for gyms and fitness programs

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etting and staying healthy is hard work.

Every little motivational boost helps, whether it’s fitting into that old pair of jeans or making it up the stairs without getting winded. As far as motivation goes, however, it’s hard to beat cold hard cash. Many insurance companies are partnering with gyms and fitness clubs to Hours: Mon.-Fri. 9-6 • Sat. 9-4

offer discounts and reimbursements for their customers getting fit.

My day job offers an annual benefit of $300 or $400 (depending on the insurance plan an employee chooses), payable every six months if the employee goes to the gym at least 50 times in that time period. I know, I can feel your eyes rolling from here, but 50 times is really

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not that bad.

Six months is roughly 180 days. Commit to go every Monday, Wednesday and Friday, and if you make it, that’s 72 trips in six months. And if you’re sick or busy or just can’t handle the thought of the treadmill on a random Wednesday, you’ve still padded your numbers and you’re fine at the end of six months. And you get paid for going!

The insurance I had previously paid $100 if I went to the gym 50 times in six months. My gym membership is $25 a month. So if I met the goal (which I did, although the first time was a stretch), I basically got four months worth of gym membership for free. Most insurance companies that participate in this benefit require proof, but gyms are happy to print out a record of your attendance.

If you’re not thrilled at the idea of rows of weights and treadmills or crowded Zumba classes, there may be other options. Many area yoga studios also provide receipts and/or proof of attendance, if your insurance

provider reimburses other forms of fitness. Some insurance plans only offer reimbursement at specific places, so you may have to do some checking to see if your favorite fitness choice is covered. CrossFit, swimming pools, nutritionists — health and wellness opportunities are everywhere, but some insurance plans are more flexible than others. Many gyms offer free or low-cost visits for new customers, so it doesn’t hurt to check out your options.

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local insurance company stresses other benefits of regular exercise besides healthy weight maintenance: reduced risk of depression, anxiety, heart disease, diabetes and high blood pressure. They also offer non-gym-related incentives, including health coaching services, discounts on home fitness equipment or books and magazines, memberships in weight-loss programs like Jenny Craig and Weight Watchers, and even discounts on home blood pressure monitors. Understandably, insurance companies

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Healthy Hudson Valley

members, and 300 to 400 of them are covered in some tend to toe the confidentiality line pretty firmly, and form by Silver Sneakers, a far-reaching program that were unwilling to provide information about how frepromotes health and wellness in communities. quently these programs are used. The only answer I Some customers are reimbursed 100% of their gym got from the insurance companies who chose to rememberships through insurance or programs like Silver turn my calls was “Yes, customers use these benefits.”

Sneakers. Others are partially reimbursed, depending The RAND Corporation, the research and analysis/ on plans. Fidelis Care and Oxford Health Care also policy improvement think tank, has done studies showfrequently reimburse Gold’s Gym customers. Healthing that most workplace wellness programs fall into two insurance customers are becomcategories: a lifestyle management ing better-informed about their program, including gym memberoptions, and more vocal about ships and weight loss programs, and If you’re not thrilled asking for what they want. Local a disease management program, at the idea of rows of businesses and health insurance focusing on managing chronic weights and treadmills companies are noticing, and helpconditions. This well-rounded apor crowded Zumba ing out where they can. proach is geared to address current classes, there may be There’s no guaranteed that and future health issues: “Disease other options. employees will sign up. The dimanagement addresses immediate rector of human resources of a health problems, whereas lifestyle local company with 56 employees management mitigates longer-term reported that the gym benefit was fairly simple for the health risks.” company to offer and also simple for employees to sign The Society for Human Resource Management up. When her company offered discounts for joining (SHRM) found that “Americans work harder, are more the local Y, however, it took a full year before anyone productive and miss fewer days of work as a result signed up. These programs are no magic solution. Their of wellness benefit programs.” Gym reimbursement availability is unlikely to inspire employees to perform was the number-one requested benefit, according to complete lifestyle overhauls. For employees already a survey of employees. However, according to a 2014 on the exercise train, of course, it’s a nice benefit. And SHRM employee benefits survey, only 34% of employit may be just the thing needed for someone who’s on ers are offering that benefit – up from 31% in a similar the fence. Cash rewards are a great deciding factor if 2011 survey. someone’s waffling about getting in better shape.

Gold’s Gym in Ulster County has roughly 5000

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Healthy Hudson Valley

A NEW PARTNERSHIP FOR YOUR HEALTH. HERE.

Westchester Medical Center Health Network is proud to welcome HealthAlliance.

Strengthening care in your community. That’s always been the mission of HealthAlliance, now made even stronger by partnering with the new Westchester Medical Center Health Network.

By combining a legacy of community-based care with WMCHealth, the region’s only comprehensive health network born right here in the Hudson Valley, we are building a stronger, healthier and more vibrant community.

And together, we’re doing more than just preserving your access to community care. We are: Expanding and strengthening services Bringing more advanced expertise closer to home Developing programs, including a Medical Village in Kingston, that will improve the community’s long-term health Retaining jobs here in the community Advancing care. Here. Where you live. Where we all live. To find out more, visit wmchealth.org.

Westchester Medical Center Health Network includes: WESTCHESTER MEDICAL CENTER I MARIA FARERI CHILDREN’S HOSPITAL I BEHAVIORAL HEALTH CENTER MIDHUDSON REGIONAL HOSPITAL I GOOD SAMARITAN HOSPITAL I BON SECOURS COMMUNITY HOSPITAL I ST. ANTHONY COMMUNITY HOSPITAL HEALTHALLIANCE HOSPITAL: BROADWAY CAMPUS I HEALTHALLIANCE HOSPITAL: MARY’S AVENUE CAMPUS I MARGARETVILLE HOSPITAL

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May 5, 2016 • 25

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• May 5, 2016

Healthy Hudson Valley

The commonality of creatures Elisabeth Henry explores the intricacies of human-animal relationships o matter how much I wanted a pony, if I had suggested to my grandmother that such a partnership was actually a form of therapy, she would have patted my backside to remind me what form of therapy she practiced. Times have changed. Animal therapy is a thing, a trend, a meme.

Google “animal therapy” and you are sure to find lots of respectable scientific sources that cite empirical proof of the benefits of the human/animal dynamic. But ask

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anybody what the term animal therapy means to them, and most likely the answer will be something like this: “Animal therapy is a type of therapy that involves animals as a form of treatment.”

How vague. Proponents of animal therapy, particularly those who hang out a shingle intending to profit on that obliqueness, use the very same definition to describe their practice. So how does it work, what’s true, and who should care? Where are the bona-fide professionals who can produce results?

WIKICOMMONS

Those with pets know the joys of taking care of another being, and being loved unconditionally in return. Now, such animal-human relationships are being increasingly formalized as part of senior care, as well as therapies needed for recovery in all sorts of patients.

May 5, 2016 • 27

Healthy Hudson Valley

Rachel McPherson was a farm kid known for working out the demons in troubled horses. She did this long before Monty Roberts insinuated that he had discovered natural horsemanship and that you too could tame a mustang by eyeballing one of his videos.

McPherson had a gift. Plus, animals filled a void for her. They were like siblings.

In college, McPherson majored in psychology and education. She visited children — some typical, some with physical or intellectual differences — and always brought her dog with her. She noted how the children interacted with her dog. She did not know it then, but those were the moments when she started on the path to creating The Good Dog Foundation. he same intuitive skill that healed the psyche of the horse was guiding her to develop a program where canines would help to heal the bodies and psyches of humans. McPherson wasn’t consciously aware of where that wind might be taking her yet. She became a documentary filmmaker. A good one.

She was about to launch a film project on the avantgarde actors Julian Beck and Judith Malina, but in her gut what she knew about dogs helping people nagged at her. She decided to do a film project on animalassisted therapy.

The film never got produced, but The Good Dog Foundation was born in 1998 and continues to grow today.

McPherson’s home base is New York City, but you can find her dogs and trainers working all over New York State, Massachusetts, Connecticut and New Jersey.

The therapy is tailored to the needs of physicians and

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Healthy pets

patients dealing with various maladies.

The Good Dog Foundation is dedicated to providing dogs for the medical community. It was Rachel McPherson in collaboration with St. Vincent’s Hospital who changed the very laws that prevented dogs from going in to hospitals.

Good Dog’s mission is to ease human suffering and promote recovery from trauma and stress using animalassisted therapy services that are recognized as among the most innovative and reliable in the United States.

The dogs must learn to assimilate a multitude of stimuli within a variety of environments. The keen senses of the dog must learn to accept and normalize the sounds and action of medical equipment and machines, the multitude of odors, the variety of human movements, and the changing levels of emotional intensity encountered in such environments. he core values at The Good Dog Foundation require that the animals adhere to a certain standard upon evaluation, and complete a thorough and rather rigorous training protocol. McPherson knows

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Healthy Hudson Valley

each dog. She supervises them, and she supervises the trainers. The trainers also must adhere to a certain standard and fulfill training qualifications to become certified. These prerequisites, and the continuum of training for both dog and trainer, differentiate The Good Dog Foundation from other organizations that claim to provide therapy. Some organizations merely require a handler to fill out an application on line, take an online course, and present the dog just one time to an “evaluator.” Then the pair are “registered.”

This casual approach has the expected pitfalls.

“Registration is not certification,” states McPherson emphatically. “The Good Dog Foundation is working towards instituting standards and practices within the industry to insure integrity and safeguard the practice as it expands.”

McPherson points out that the rigor of her evaluation and training process serves the recipients of the therapy as well as the dogs. She cites the example of a young man who was sure his dog, a pit bull, would make a wonderful healing partner.

“But the dog was too much puppy. Big breeds take a long time to mature,” says McPherson. “We rejected that dog for years, but the owner kept coming back.

And now, that big dog is a wonderful therapy dog, fully equipped to do his job well, and with our confidence

that he will meet every challenge. This does not happen overnight. Had he been sent out when he was too young and untrained, the consequences could have been dire for everyone. That, or he would have been rejected completely and finally by people who do not have the same methods of evaluation as we do. We thought he could do it, but only when he was ready.”

Does she prefer a certain breed? Nope. It’s a matter of individual potential, and whatever need The Good Dog Foundation seeks to fill. Right now, McPherson is looking for dogs in the mid-Hudson region, from Woodstock to Hudson, to develop as therapy dogs. (The Good Dog Foundation, toll-free 888-859-9992; info@ thegooddogfoundation.org).

Will she ever make that film about therapy dogs?

Maybe. But right now, her passion is for the research that supports the value of the foundation and its work.

Good Dog is the only certifying organization in New York City, and it boasts the largest resources of any certifying organization on the East Coast. The Good Dog Difference promises a meaningful experience for both volunteers and those receiving Good-Dog services. aren (Kay) Stanley-White, the founder of Saratoga Therapeutic Equine Program (STEP) is a dedicated medical professional practicing hippo-

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riding, called Classic Hippotherapy. therapy. A horsewoman all her life, it was when she The traditional therapeutic riding approach is exresearched the benefits of riding to the human anatpanded into a modeled systems approach, an integrated omy that she found her life’s work. She is a physical treatment system. This innovative approach, currently therapist with specialty certifications in orthopedics, undergoing professional peer review, has been in this spinal injuries, neuromuscular injuries, neurology, country since 1982, but utilized in Germany and other brain injury, pediatrics and, of course, hippotherapy. parts of Europe since 1977. STEP currently uses this The doctors at the clinic where she works routinely system. refer clients to STEP, the proNot all patients cam be acgram she founded and the facepted by Stanley-White for cility she built with her own The same intuitive skill the program. She assesses each hands in 1986. that healed the psyche person. Those with an unstable “When a person sits on a horse, cervical spine are not eligible, for the dynamic movement of the of the horse was guiding instance. Safety is one factor that horse mimics the movement her to develop a program cannot be minimized. of the human,” Stanley-White where canines would For those who can benefit, the explains. “The juxtaposition of help to heal the bodies experience can be life-altering. the human pelvis and spine to and psyches of humans.

“These are not glorified pony the spine and musculature of the rides,” Stanley-White says, “This horse allow for messages to be work is based on solid scientific sent up the spine of the person to research. We actually see miracles here. I have seen the cerebellum and brain. These are normalizing meslives change.” sages that cue the brain which ultimately strengthen One autistic boy uttered his first word when his the person neurologically and muscularly. “ pony’s pace got a little spicier. In another case, an It is important to note that this phenomenon can only adult stroke victim whose tone was so tight he could be achieved on the horse. Science and technology that not extend his hand or arm was able after a few leshas been tried to mimic it have failed. There is also sons to reach down and take an object from Stanleyan important difference between hippotherapy and White’s hand. Parents, loved ones, and facilitators “therapeutic riding.” Therapeutic riding can be taught are often moved to tears by these gentle triumphs. by riding instructors that have a basic level of skill and (Karen Stanley-White, barn phone: 518-374-5116; certification. Only rehabilitation professionals, or theraemail stepatnfec@yahoo.com) pists, can implement the second system of therapeutic

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hile both professionals in this writing adhere to strict regimens for their programs, both enjoy animals in a purely amateur fashion.

Like Earl, my neighbor, who remained cheerful and gregarious for all his 100 years. When his wife died, he was at risk of soul-sucking isolation. And then a goose showed up.

No one knows from whence the goose came, nor did anyone know, not even Earl, to where it returned after its daily visit. The point was, and is, the goose kept Earl lively. Earl sat on his front stoop that summer, pitching bread bits to his friend while contentedly waving his fly-swatter at passing cars.

Eventually, somebody took it into his or her head that Earl couldn’t care for himself any more. He couldn’t.

His house was a mess and every one of his senses was

W

Wayne W. St. Hill

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failing. They got him settled in a “home” somewhere.

Earl died within a month of the move. The goose, disoriented, got hit by a car. Was it so wise to wrench Earl out of his routine and the happy quid-pro-quo of his feathery alliance? Personally, I’d take good times with good friends any day over housework and knowing who’s the current president.

My fierce grandmother would have voted for sparkling counter surfaces and a torque-wrench grip on common sense. But it should be mentioned that she spent her last years in a tight girl crush with three pounds of toypoodle sass named Miss Dodie Dee. Miss Dee passed away before Grandma, which was fortunate. Death had come between Grandma and love before. She had buried three husbands. But God knows what she’d do to any mere mortal who laid a hand on that dog.

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• May 5, 2016

Healthy Hudson Valley

Thanatophobia Jack Warren and Dante Kanter decide to focus on living

THE COUNCIL CHAMBER BY EDWARD BURNE-JONES, 1872-1892

What do young men think of health? Death, we are reminded, has been a theme for youth to contemplate back through the ages, as well as a jumping-off point for poetic expression.

J

ack Warren begins.

Our friendship was sealed by a shared love of writing, YouTube videos, and the British timetraveling show, Doctor Who. In the five or so years since then, our respective interests have shifted and grown. As seasons have come and gone, so too have our love affairs with vampires, zombies, Dungeons and Dragons, video blogging, Minecraft, and other phases too brief, dated, or embarrassing to go through.

Even if we cringe while reading the list we’ve just written, we don’t regret these past lives. Instead, we mourn their loss.

Not two summers ago we were snuggle-toothed and at least half a foot shorter. As we’ve become more experienced with the passing of time, we’ve developed a new common interest: the fear of death.

“But you’re too young!”

Yes, we are. We’re mostly healthy and cautious. We live in areas with low crime rates. The probability of our dying in the next few years or even decades is low.

Unfortunately, the eventual probability of our deaths is 100 percent, which is chilling, particularly when we

haven’t had enough time or opportunities to prove that we’ve had a life worth living.

According to a 1982 study, our fears are only a little precocious. Many people first experience death anxiety, or thanatophobia, to throw in a little Greek, between ages 20 and 40, with the feeling peaking in the middleage years of 40 to 64. Ironically and fortunately, people become most comfortable with death as they age, with those 65 and older experiencing the least amount of fear.

The roots of Dante’s and my thanatophobia run deep.

For years, I could distract myself from the reality with belief in the afterlife. Whatever my fate was after my heart stopped beating, I was determined that it wouldn’t be oblivion, which scared me more than anything. In a monster-versus-monster tournament in a Halloween issue of Nickelodeon Magazine, the scariest monster was the “Bottomless Pit.” Worse than being torn apart by werewolves or eaten by zombies was the prospect of falling forever.

D

ante Kanter here.

When I was young, I passed out after having

May 5, 2016 • 33

Healthy Hudson Valley

my blood drawn because I’d gone the whole day without food or water, a numbskull move that later had my mother making me drink gallons before every checkup. It wasn’t my most extreme medical emergency. I’d spent some time in the emergency room after birth, and a dream week of 106 degree fevers that landed me in the ER with a diagnosis of Lyme.

Things went blurry, my sweat went cold. There was nothing — not even nothing, the absence of absence in those two minutes. My scared little brain had convinced itself that it was dying, and started shutting off senses one by one to conserve energy.

I thought about my parents crying over me, my memorial, what people would say after I was gone (I still wonder about that and always will, but that’s another article). In the end it was just a pinprick in my arm, but it was when the fear started settling in.

Thanatophobia isn’t as narcissistic as we’ve made it sound — it’s the fear of the death of others, too. With splattered crime-scene photographs in my head, I stop my girlfriend with my arm before we cross the street.

I bite my nails when kids climb trees.

It’s all so fragile. My mother had a seizure last week from a concussion she got after falling 14 feet off the ledge of a loft bedroom, and she was in the hospital for two days. With schoolwork and after-schoolwork and all that business, I only had the time to visit her once, but when I did the usual fears set in.

She was fine, they’d done an MRI and a CT scan and every test under the sun. They had had found nothing causing immediate alarm, which I was happy to hear.

But it was the hospital gown she was wearing that got me. With awkward seams and bagginess, they have a way of making everyone look undead, which is just how my mother looked then lying in the hospital bed.

I realized then that like me there would come a time like this when she would never get up. That put me in cold sweats for the rest of the day.

As time goes on, though, I can feel myself shaking off my thanatophobia like a dead snakeskin. I don’t know exactly where or when, but there’s a story about the Chinese sage Lao Tzu and a student that I’ll paraphrase. A student came to him and said, “Master, we ask so many questions, but why do we never ask what

Foster

happens after death?” Lao Tzu says something along the lines of “You jackoff! Why ask questions we cannot answer?” The older I get, the more I believe that Lao Tzu was right about everything.

Why worry about one of the few things we can’t control? It makes no sense to try to give ourselves that added anxiety. People say teenagers think that they’re invincible, but I disagree. Teenagers are like Lao Tzu. They know that death can come at any second. They know that they could drop dead of a heart attack in the middle of a QuickCheck or be bitten by a snake in history class. What comes next is an eternal mystery. Everything is fatal. And if everything is fatal, nothing is. ante signing off. Jack, take the reins.

Thanatophobia is a phobia unique in that there is no real cure for it. After talking through so many creative blocks, relationships gone foul, and general teenage angst, it is frustrating to bang our heads against such an insoluble problem.

We’ve come to the conclusion that the best way to think about death is as little as possible. There are a million different ideas about what it might be like to exist after consciousness. No matter which you believe, it won’t change the final, enigmatic outcome. Until that day, we should be doing our best to focus on living instead of dying. Finding damn good friendships is certainly a good start.

D

Hi Suzan, how are you?

Hi Mary, not so good. I am so worried about mom, she is going downhill.

She can't even get out of bed by herself.

Ohh! Have you tried Physical Therapy on her? I know a very good physical therapist in town who will travel to a patient’s home for therapy.

Really?? How do I reach them? Do they take insurance?

Love

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Oh yes! They take all kinds of insurance. I know they take Medicare, private, managed or any insurance and even cash, just give them a call for more information.

His name is Manan Shah. He has the best team of PTs in the area.

You can give them a call at 845-542-9245 for Shah PT!

34

• May 5, 2016

Healthy Hudson Valley

Better dying Violet Snow explores a shifting philosophy of treatment in the Hudson Valley or most of human history, the elderly expected to die at home, in familiar surroundings, embraced by the love of family members. In the middle of the twentieth century, as technology expanded exponentially, medicine in the U.S. began to operate on a simple paradigm that changed the way people died. Doctors were trained to use every tool at their disposal to prevent death, regardless of the doubtfulness of success of the interventions, the misery or damage they might cause to the patient, or the cost. Quality of life near the end of life went out the window.

By the late 1980s, only 17 percent of Americans died

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at home, according to physician Atul Gawande, author of Being Mortal: Medicine and What Matters in the End (Thorndike Press, 2014). The norm has been to die in a hospital, hooked up to machines, with medical personnel and possibly a family member or two present. But now the trend is beginning to reverse, with the expense of nursing homes and high-tech treatments spiraling out of control, while baby boomers watch their parents die and contemplate the options for the end of their own lives. Hospice services, Death Cafés, community organizations that help seniors remain in their homes, and a shifting philosophy of treatment are helping us find better ways to age and to die.

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Healthy Hudson Valley

n the Hudson Valley, Circle of Friends for the Dying was founded in 2012 to offer compassionate, competent end-of-life care and help change the prevalent view of death. “We live under the spell of biomedical technology and the myth and allure of more, that more is better,” said Circle founder Elise Lark, an oncology social worker at HealthAlliance of the Hudson Valley. “It’s easy to lose sight of the wisdom of enough.”

In The Hour of Our Death (Knopf, 1981), cultural historian Philippe Ariès observes that when death was a communal event, observed and ritualized as part of life, dying was less terrifying. Once it was removed to the hospital and became almost as taboo a topic as sex used to be, death became a lonely and dreaded affair.

“We are transitioning from what Ariès called the invisible death to what I envision as a new trend, actually a return, to a more social and visible death,” said Lark.

“This includes making space in the social environment for conversations about death and grief, as well as a preference for smaller, human-scale structures for aging and dying.”

I

The Circle has purchased a house in Kingston as a place to stay for terminally ill people with a life expectancy of three months or less, if they live alone or can’t remain at home to die. The group is now raising the funds to renovate the Home for the Dying and provide a small staff of professional caregivers. Trained volunteers will provide the better part of the 24/7 resident care. Family members will be able to stay overnight in a guest bedroom, when needed, to help ease their loved ones out of life in a comfortable and intimate setting, making their last days communal and meaningful. In this model, prevalent in northern New York State, the Home for the Dying and its operation are community-sponsored and free to the residents.

“Change in medical culture is slowly underway, nationally and locally, due to the advancement of palliative and hospice care medical specialties,” added Lark. “Almost daily, you can read stories about dying and death in The New York Times, often followed by a long trail of bloggers. A hallmark of these changes is healthy respect for limits, an appreciation for enough. Americans are beginning to recognize that how we die and care for the dying truly matters,

Many communities, recognizing the importance of quality of life for elders, are finding ways to help keep them out of nursing homes.

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• May 5, 2016

Healthy Hudson Valley

WIKICOMMONS

With so large a part of health costs and resources consumed by the last weeks and days of life, a movement has arisen to rethink the ways we face mortality, from open discussions through Hospice to newer means of accepting the natural end of life. for the dying and for those who remain.”

To help bring death into public and private conversations, the Circle has joined the efforts of the international Death Cafe movement, holding informal gatherings at restaurants, libraries, community centers, and houses of worship around Ulster County. Death Café attendees divide into small groups, drink tea or coffee, eat cake, and talk about issues surrounding death and dying. The wide-ranging topics might include deciding in advance how we want our dying and dead bodies treated; spiritual beliefs about what happens after we die; the fear of confronting death; how to talk to someone who has lost a child. “Mostly, it is a place to share stories about one’s own experience; everyone has a story to tell,” said Lark.

On Friday, June 3, in Kingston, the Circle will sponsor

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a screening of Griefwalker, a documentary featuring Stephen Jenkinson, teacher, author, storyteller, spiritual activist, and founder of the Orphan Wisdom School. A discussion led by Jenkinson will follow. On Saturday, June 4, he will facilitate a workshop, “Die Wise: Making Meaning of the Ending of Days,” based on his 2015 book about grief, dying and the great love of life. For details, see http://www.cfdhv.org. any communities, recognizing the importance of quality of life for elders, are finding ways to help keep them out of nursing homes. Woodstock’s Staying in Place (SIP) is a network of people who perform such services as visiting and reading to the elderly, changing light bulbs, balancing checkbooks,

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May 5, 2016 • 37

Healthy Hudson Valley

driving seniors to community events. New York Times health columnist Jane Brody addressed an SIP gathering a few years ago and remarked, “Assisted-living facilities are expensive. Most older people can’t afford them. It’s wonderful when there are community organizations to provide services.”

In the same vein, Meals on Wheels is a volunteer group that provides low-cost delivery of prepared food for those whose cooking abilities have declined. Even supermarkets, such as Poughkeepsie’s Stop & Shop, serve seniors who have a modicum of computer skills by offering delivery of groceries ordered online.

Gawande, looking at the situation from the point of view of a doctor trying to go beyond the save-life-allcosts protocol and figure out what’s best for his patients’ quality of life, feels that physicians must change the

way they relate to patients. “Our interventions, and the risks and sacrifice they entail, are justified only if they serve the larger aims of a person’s life,” he wrote.

“When we forget that, the suffering we inflict can be barbaric. When we remember it, the good we do can be breathtaking. I never expected that among the most meaningful experiences I’d have as a doctor ... would [be] helping others deal with what medicine cannot do.”

For more information on Circle of Friends for the Dying, or to participate in a Death Café, see http://www. cfdhv.org, visit https://www.facebook.com/CFDHV, or call 802-0970. For details of the Stephen Jenkinson workshop and film showing on June 4 at Health Alliance Hospital’s Mary’ s Avenue Campus Auditorium, see http://www.cfdhv.org.

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• May 5, 2016

Healthy Hudson Valley

The therapist is in Harry Matthews shares what he has learned about healing himself

O

nce upon a time not so very long ago psychotherapy was looked at by society at large as a treatment reserved only for truly troubled souls. To own that you might need help with what was going on in your head was a sign of weakness akin to defeat that most were unwilling to make. Thankfully, by sometime in the mid1960s I think it was, those days seem to have become a thing of the past. With the rise of the subsequent post-hippie generations of the Seventies and Eighties, spiritual quests and the deeper untangling of one’s inner self became the de rigueur fashion of the day.

Not only is talk therapy not the shame-inducingbag-over-your-head-exit-through-the-rear embarrass-

ment it was once viewed as, but in some circles these days it’s actually considered odd not to be in therapy.

Psychotherapy is, at its heart, an attempt to heal and to change one’s psyche, one’s inherent spirit, of those parts of ourselves that don’t feel right. Though it is not a physical practice of medicine but an exploration of a mind rife with grey areas, it can’t help but have the hopeful potential to lead to a spiritual conclusion and thus an elevated state of contentment. In translation the word psychotherapy breaks down to its two components from the Ancient Greek, giving us a “healing of the breath and soul,” which sounds pretty damn good if you ask me.

My parents, being of an artistic and liberal bent, raised

BOBALICÓN / SIMPLETON (LOS DISPARATOS / THE FOLLIES,) BY FRANCISCO GOYA

Not too long ago, therapy was the stuff of Woody Allen movies and the wealthy. Now, it’s a means not only of saving marriages and helping kids through the challenges of growing up, but also a way for us all to cope with the other complexities of our lives.

May 5, 2016 • 39

Healthy Hudson Valley

my siblings and me in the belief that an important part of leading a fulfilling life was the inward journey to the better understanding of oneself. To that end they were ever open to any possible path that might lead to a furthering of that knowledge, be it spiritual, intellectual or psychological.

I was sent to my first therapy session when I was about twelve, not necessarily out of the lofty idealism I just mentioned but because I was acting up at school. By the age of 15 I had seen a number of therapists and had even done EST (Erhard Seminars Training, now called the Landmark Forum) all in effort to understand why little Harry was unhappy and not doing his homework.

Over the years I have been in family counseling, couples counseling, group therapy, one-on-one sessions, and even spent a week on a farm in Tennessee doing equine therapy, which though fun was really just another name for paying to groom someone else’s horses. In the fairly recent past, I spent a year and a half working as a counselor in an outpatient rehab clinic, spending my days leading group-therapy and one-on-one sessions, which put my many years of being on the other side of the issues to good use. Each one of these experiences, depending on the therapist, had their own unique merits. What successful therapy ultimately comes down to is, I believe, the result of two things: the ability of the therapist and the willingness of the patient.

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Now the good thing about seeing a therapist is that you can tell them anything, spend the entire time just on yourself (me-me-me-me!), and know (or at least hope) that what you say will go no further. And as they (hopefully) have no outside connection to you any feedback they give should come from an unbiased perspective. A good therapist should be able to guide you in starting to understand your past, your relationships, any trauma you might have suffered, why you react the way you do, what your motivations are in your decision making, and why things make you feel the way you feel.

That said, much of a therapy session’s functioning comes down to the patient’s ability to be honest and to

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• May 5, 2016

Healthy Hudson Valley

PHOTO OF LAUGHING SILENT FILM ACTRESS COURTESY OF WIKICOMMONS

Attitudes towards mental health have shifted greatly over the centuries, from outright fear to the romanticizing of “melancholia” to the modern realization that there are spectrums for all behaviors. It all comes down to recognition, and learning how to cope. give the therapist something to work with.

Unfortunately, not all therapists exist on the same level of empathy, understanding and skill, which often comes only from years of practice. Finding the right one for you can take some searching. Asking friends or a family doctor is often a good place to start. But

everyone is different. What works for one person just may not for another.

I know a wonderful therapist in Uptown Kingston (which of late seems to have become a hotbed of great therapists, so I hear) who really helped my wife and me, and who also happened to be counseling a number

Healthy Hudson Valley

of our friends. We all thought he was great. So when I referred another friend to him and they didn’t hit it off and she never went back, we were all surprised. To each their own.

I

n an attempt to demystify some of the common beliefs/misconceptions about therapy I’ve listed a few items that might help in understanding how it works.

1. The first session is often just laying the groundwork for the future. Usually it takes at least three sessions to know if you feel comfortable and will be able to work with the therapist you’ve picked.

2. A good therapist should make you feel safe, particularly when dealing with past traumas. This is your life, and what you divulge should be on your terms. Don’t

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• May 5, 2016

Healthy Hudson Valley

forget that you have hired this person to help you so you decide how much you’re willing to reveal.

3. For therapy to truly work takes time, patience, humility and willingness. It doesn’t happen overnight.

4. Therapy is a two-way street between the patient and the therapist, meaning that it takes efforts on both sides for the work to get done.

5. Your therapist is not your friend. Not that it can’t develop into that, but this is a professional relationship.

Respect of boundaries needs to exist on both sides.

6, A patient can end this relationship at any time, take a break, and restart as he or she wishes. Therapy can get heavy at times, often a sign that progress is being made, and sometimes this can be too much all at once, and a break is needed to reevaluate and process. Don’t ever feel stuck in the routine if you need some time.

7. On a practical note, many therapists have a slidingfee scale based on what one can afford, and some insur-

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Healthy Hudson Valley

ance plans may cover some if not all of the fee as well.

If you still can’t afford it, Family of Woodstock offers free counseling, amongst their many other wonderful services.

I

n the end what works for one person may not work for another. I once had a therapist who was a very kind soft-spoken man who I genuinely liked but when it came to helping me seemed mostly ineffectual in his particular style of therapy.

At the end of one session I told him that sometimes I thought I just needed to be told what to do. “I need a drill sergeant!” I said. The next week when I sat down across from him he started almost yelling at me that I should stop seeing this girl and find a better job, amongst other things. It was so weirdly out of character that it

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freaked me out and I never went back.

That was a bad fit. My being a mildly neurotic prima donna did nothing to help the situation. Where I should have appreciated his effort I instead resented him for his overt unnaturalness. Damn, I was a pain in the ass.

In reality, I think any therapist could work for any person as long as there is a strong base of empathy, respect, compassion and honesty at the core of the sessions. It all comes down to being able to face up to those parts of you that you don’t like, having the courage to own them, and wanting to change. Therapy is rarely easy, but at its best has the potential to be immensely rewarding and thoroughly life-changing. So if you feel you need some help (and we all do) and you’ve been sitting on the fence about it, climb down, be brave, and give yourself a chance to heal. The therapist is in.

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44

• May 5, 2016

Healthy Hudson Valley

Living through the years Scott Baldinger provides his recollections of the AIDS epidemic

AIDS GET WELL CARD, COURTESY OF WIKICOMMONS

AIDS shaped more than just one community over the past 40 years. It has given added power to the rise of gay rights and has led to a number of key medical and healthcare realizations and advances.

“I

t does what?”

The year was 1983, and I had been only three years out of college. I was living in a dilapidated loft with a rent of $125 a month in the then not-so-glamorous area of the West 20s. Since 1981, my rather surly roommate and I had been keeping abreast of every ghastly detail of the emerging illness

that had been killing hundreds of gay men, known, until around then, as GRIDS (Gay Related Immune Deficiency Syndrome).

Most of the reporting was by The New York Native, a gay paper that soon would start to spout exotic theories about the increasing death toll of the disease as a conspiracy by the likes of the CIA, or being caused by

Healthy Hudson Valley

the use of poppers. GRIDS, renamed AIDS, was proven to be caused by a contractible virus. The paper often disputed that fact.

The paper of record, The New York Times, under the covertly homophobic leadership of editor Abe Rosenthal, reported on the disease only fitfully. (It buried its now-famous first article, “Rare Cancer Seen In 41 Homosexuals� on page A20 in 1981, and the few subsequent ones went even further back in the paper.

As Randy Shilts wrote in And the Band Played On in 1987, the paper was setting the tone for non-coverage nationally. “There was only one reason for the lack of media interest, and everybody in the in Centers for Disease Control task force knew it: The victims were homosexual.�

It wasn’t until 1983 that I truly felt the terror. One evening, said roommate told me about the disease’s newest finding. By this time there were 1450 cases — 558 of them already ended in death — that had been reported, finally, by The Times. “Would you believe, they just found out that the virus can incubate for years without symptoms?� This is when the scary music blasted loudest in my head. We stared at each other, and all I could say was “This is just like a horror film.� The fear, trepidation and grief increased exponentially after that. It never really went away.

From the start of the epidemic, I wasn’t dumb enough to think I wasn’t directly threatened. I had the foreboding experiences to show for it. I had been sexually active since I was a precociously out 16-year-old. After my first sexual experience in the early 1970s I had contracted a serious sexually transmitted disease (STD). I also had a bout of Hepatitis A, which turned out to be caused by restaurant food and not sex, though I wasn’t convinced.

During the latter part of the Seventies, on summer breaks from college, I spent an awful amount of time in the baths as well as Central Park’s Rambles, witnessing, if not often participating in, the now legendary amount of anonymous sex that was going on behind overgrown bushes and long untended grass and weeds.

In less bucolic settings in the city, a handsome but crazy fellow I “dated� briefly during that period even took me to the notorious after-hours club The Mine Shaft.

Even as an 18-year-old, I had the good instincts actually to be turned off by the saturnalian sight and smell of the whole place. (A full description is unsuitable for publication here.)

May 5, 2016 • 45

The list of what I actually saw, and gingerly partook in, goes on and on. Even though as horny as the next fellow at these places, I had always had a sense of sexual hygiene and a definitively Jewish aversion to anyone going near my backside, except for a casual grope. Even though I was scared by the emerging news, I felt assured that I needn’t worry, even though sex was on my mind all the time and often acted upon. But the virus’ diabolic complexity, reported bit by bit in the press, made not worrying at all an impossibility. I have to admit with some embarrassment that, unlike so many others, I wasn’t experiencing the hideous deaths and heartbreak firsthand during this time. Most of my friends were straight, and I didn’t have a lover or steady boyfriend. But the ominous portents would come to life in my very bed.

One very beautiful Julliard student I was casually seeing told me he was terrified because he had had unprotected anal sex with someone who had just developed AIDS. Having lost touch with this fellow, I have no idea what happened to him. Another told me had become a divinity student at Yale because he didn’t expect to live in the long run. He was so healthy, spiritual and good-looking that I simply had to reassure him. I also lost touch with him too soon to know his fate.

Word of the death of one acquaintance or another would trickle in on a regular basis. In the early nineties, while I was totally preoccupied by my burgeoning career as a magazine editor, I ran into AIDS in all its horror. The brother of my oldest friend was dying, and my friend was taking care of him at the apartment in which they had grown up in the Village. When I went to visit both of them, my friend’s brother looked worse than on death’s door, a wasted skeletal specter of his former self. He was not taking it well, and said, after I gave him a little gift of a Noel Coward Playbill, “Why did I get this and not you?�

It seemed that so many people during this time who had gotten sick and died were the most friendly, attractive, open, free-spirited and intelligent gay men I had ever met. They all had “good air,� and the fact that people of this sort seemed to be the most vulnerable targets confirmed to me all that was bad in the world. It also gave me the feeling that the very people who were dying were those who’d I’d want as a real boyfriend. (I did find one, but that’s another story.)

With Reagan, the specter of dying people walking the street, and a burgeoning crime rate, the Eighties

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Healthy Hudson Valley

and early Nineties on New York City and other major cities really sucked.

Somehow I managed to continue working, getting ahead in the crazy magazine business and expanding my social life through the Nineties, when the death rate from the disease in America was reaching the hundreds of thousands. I had luckily moved in with a boyfriend, and we stayed together for the next seven years.

It wasn’t until some time in 1996 that some form of reprieve came in my internalized trepidation. At the opening of a new Off-Broadway play, I saw a theater producer who looked like he had come back from the dead. Though previously he had shown clear signs of imminent demise, he now seemed as healthy and vibrant as he once had been.

He was a tangible example of the success of the “AIDS cocktail,” a combination of antiretroviral drugs

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that failed to work separately but brought immediate results when taken together. This struck me as nothing less than a miracle. I was amazed and relieved. Still, the death rate in the United States had grown from those initial 41 cases to the current astonishing total of 636,000. Worldwide, the toll is 25 million, making AIDS the eighth deadliest epidemic in world history.

The drug cocktail, now so effective that HIV/AIDS patients are able to go into viral undetectability in six months, worked so well and so quickly that gay men, having been encased in a rubber of terror for so long, went not a little crazy. An epidemic of people started using crystal meth. Unsafe sex was the lemming-like way in which we responded.

When I write “we,” I definitely mean we. This is where, after a painful breakup with said boyfriend, I found myself losing my sense of self-preservation, diving into the party-and-play scene as if it were a biological necessity.

But even during my own descent into this sometimes thrilling but inevitably totally destructive behavior, “gay hell” as the songwriter Rufus Wainwright put it, I kept a vigilant eye on what I was doing, always thinking about how low I had been sinking, how vulnerable I was making myself, and always wondering how it all was going to end.

It seemed to me that constant stimulation — and the need for ever greater forms of it – was the problem.

My solution was leaving New York City altogether and moving to Hudson in 2003. Which bring us into the next phase of the disease. My own crisis seemed to me a harbinger of a new sensibility among gay men and women. We had learned that the bright lights of the big city could lead to very dark places indeed. What had once been unfathomable — a life in the country, and even marriage — was the necessary next step in our evolution.

The prevalence of gay men and women in a town as small as Hudson — and the emergence of gay marriage as the movement’s most crucial and consciousnessraising issue throughout the country — is emblematic of this change. The same is true of much of the Hudson Valley in general. It’s almost a cliché to read about some gay couple’s impeccably decorated house in one of the area’s counties in the same New York Times that once shunned us.

Places like Hudson seem to be becoming a gaymarriage Mecca. A search of businesses catering to the gay-wedding market in the area provides a plenitude almost too numerous to count. As the Huffington Post has reported, “The folks [here} are known for being the open-minded sort, making the Hudson Valley one of the most LGBT friendly spots in the country.”

On the epidemiological side of things The Alliance for Positive Health (aka The AIDS Council of Northeastern New York) has set up branches for free testing and counseling throughout the area. Its annual Dining for Life fundraiser to fund its services was scheduled for April 28. In addition, a reading of Samuel G. Freedman and Kerry Donahue’s Dying Words, a book about Jeff Schmalz, The New York Times’ first prominent reporter

Healthy Hudson Valley

May 5, 2016 • 47

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The setting might be bucolic, and the stimulation —

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Healthy Hudson Valley

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