JUNE 2020 • ISSUE 68
Patients Wanted Drastic reduction in patient population, layoffs, limited sources of revenue. How hospitals are managing one of the worst crises in the industry and what they are doing to recover from it. P. 13
In the Trenches
Oncologist Igor Puzanov discusses clinical trial led by Roswell Park and UB to test effectiveness of antiinflammatory drug for COVID-19
Back from Retirement Jim Millard, former president and CEO of Kenmore Mercy Hospital, along with retirees Cheryl Hayes (left), VP of patient care services at Kenmore Mercy, and Mary Hojnacki, a nurse manager, also at Kenmore Mercy. Story on page 12
Tired of COVID-19? Here’s one more thing to worry about this summer: disease-carrying ticks
Why You Should Eat Snapper This Summer P. 10
Baby Boom After Pandemic Lockdowns? P. 2
Baby Boom After Pandemic Lockdowns? Maybe Not
t’s happened before: Couples stuck at home during blizzards, hurricanes or other natural disasters enjoy some “alone time” — and a baby boom follows. But a new survey from researchers at the University of Florence in Italy suggests the same probably won’t unfold during the COVID-19 pandemic. Why? “What we found the main rea-
sons that led people to not wanting to conceive included worries related to future economic difficulties and consequences on pregnancy,” said study author Elisabetta Micelli, from the university’s Assisted Reproduction Technologies Center. The researchers conducted nearly 1,500 online interviews and found that nearly 82% of those surveyed said they didn’t plan to conceive during the coronavirus pandemic.
The survey was conducted in the third week of the lockdown in Italy and included men and women in a stable heterosexual relationship for at least one year. The findings were published May 7 in the Journal of Psychosomatic Obstetrics and Gynecology. Of the 268 participants who said that, prior to the pandemic, they had plans to have a child, more than one-third abandoned their intentions
when the pandemic struck. The main reasons were worries about future economic struggles (58%) and any potential consequences on pregnancy (58%) from the new coronavirus. Even though almost half of those who responded to the survey had not lost their jobs or income, “the fear of imminent and future economic instabilities led those who were searching for a pregnancy to stop their intention in 58% of cases,” Micelli said in a journal news release. Interestingly, 140 (11.5%) of the participants — mostly women — expressed a new desire for parenthood during quarantine, with the main reasons being “the will for change” (50%) and “the need for positivity” (40%). But only six of the 140 (4.3%) actually tried to get pregnant during the lockdown. “Again, fear of consequences on pregnancy in addition to the economic impact on families are probably the reasons why almost the whole group of couples who unexpectedly started to express a desire for parenthood during quarantine did not translate this dream into a concrete attempt,” said study co-author Gianmartin Cito, a specialist training in urology. The study also asked participants about their levels of sexual activity and found that two-thirds of those who didn’t express a wish to conceive before or during the pandemic reported no decrease in sex. The same was true for 60% of people already trying to conceive. It’s “unknown whether these findings will result in a substantial modification of birth rate in the near future,” the authors concluded.
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June 2020 •
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
BlueCross BlueShield Fitness at Canalside Series Goes Virtual BlueCross BlueShield of Western New York’s Fitness at Canalside series is going virtual for its sixth season, bringing a variety of free virtual exercise classes to individuals and families in the community — wherever they are. The series started May 25, when the area’s most recognized fitness coaches kicked off daily virtual classes. Special classes will be announced throughout the summer. “Visiting Canalside has become a favorite summer tradition for thousands of Western New Yorkers. Since we can’t be together physically at this time, we’re proud to bring Fitness at the Canalside to the homes of individuals and families in the community,” said Julie R. Snyder, senior vice president, chief marketing and communications officer. Virtual fitness classes are free and open to individuals of all ages, regardless of fitness level or experience. Monday through Friday at 11 a.m., and Saturdays and Sundays at 11 a.m. and 2 p.m., new fitness classes with be available through The Buffalo Waterfront website — https:// buffalowaterfront.com/canalside. For a full calendar of summer fitness offerings and healthy activities visit bcbswny.com/play.
Independent Health and YMCA present Fitness in the Parks: Home Edition Independent Health is once again teaming up with the YMCA to offer free fitness classes this summer with Fitness in the Parks: Home Edition. Through Facebook Live, a series of virtual fitness classes will be offered each week for the community to take part in from the comfort of their own home. All classes will continue to be led by certified YMCA instructors. “While we can’t work out together in the parks right now, we know that staying active and healthy is important now more than ever,” said Michelle Carbery, senior corporate wellness specialist at Independent Health.” The schedule is as follows: • Mondays at 6 p.m. – Boot Camp • Tuesdays at 4:30 p.m. – Kickboxing • Wednesdays at 9 a.m. – Fusion • Thursdays at 5 p.m. – Yoga • Saturdays at 9 a.m. – Cardio Kick People can simply join the live-stream class offered at the scheduled time from the Facebook page of either YMCA Buffalo Niagara or the Jamestown Area YMCA. For more information, visit www.independenthealth. com/fitpark Page 4
By Chris Motola
Igor Puzanov, M.D.
Chief of melanoma at Roswell Park discusses clinical trial led by Roswell Park and UB to test effectiveness of anti-inflammatory drug for COVID-19 Q: You’ve been working on a study related to COVID-19. Can you tell us a bit about it? A: The trial is for a treatment for patients who have really severe symptoms of COVID. They have this cytokine release storm, inflamed lungs and they may be intubated and on a ventilator. The drug we’re working with is called sarilumab. It’s normally used for patients with rheumatoid arthritis, but we also use it to suppress detrimental cytokine storms. But we have a lot more in the pipeline. We’re working on different approaches for both treatment and prevention. Prevention would be through things like a vaccine. Q: It may surprise people to hear that Roswell Park, which specializes in cancer treatment, is working on the virus. What’s the overlap? A: It’s not as surprising as you may think when you consider that a lot of cancer treatments are based on harnessing the power of the immune system. A lot of the processes the immune system uses to fight off the infection are also used to fight off cancer. For example, you activate your T-cells to kill viruses, and you activate your T-cells to attack tumors. So, there is an overlap between them. Q: So, there’s cooperation going on between Roswell Park and the University at Buffalo on this? A: I’ve been involved with Dr. Gene Morse [of the UB School of Pharmacy and Pharmaceutical Sciences]. He’s a world expert virologist with a focus on HIV. We cooperate, putting together everyone involved in drug development in Buffalo to work on this. So, when the virus showed up, we were kind of ready. He’s a virus guy and I am a drug developer for people with cancer. But the logistics and machinery of that is very similar to what you need to develop drugs for a virus. So that’s where we come in at Roswell even though we don’t have many patients who are infected with COVID. But we are in the region and we do have these tools and, the way I
view it, it’s a war. Instead of sitting on those weapons and doing nothing, we’re going to deploy them in the fight. It looks like our infected numbers are going down judging by the briefings from the governor and county officials, but we want to be ready to deploy if there’s a second wave. The priorities may change if the cases go down and we reopen our oncology services in a safe manner. We always want to use our skills to help people as best as we can. Q: What is a cytokine storm? A: What happens is, when you get a virus, you are supposed to activate your defenses. Initially it’s a generalized immunity that is provoked. Like a general signal we inherited from our ancestors like, “this is a bacteria,” or “this is a virus.” So you create these non-specific barriers to get rid of the virus, as well as activating your specific immunities, your T-cells and B-cells, which are more like a bullet that specifically targets that virus. If you do it successfully, you survive the infection and hopefully become healthy again and immune, and hopefully immune into the future. But if there’s something wrong with your response — maybe you just can’t clear it fast enough — or you have too many particles to get rid of quickly, you kind of get stuck. Your immune system keeps revving up going to a higher degree, higher degree, higher degree. At some point your immune
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2020
response may become harmful. It’s trying to kill the virus, but now it’s also damaging your good organs. So that’s what we mean by cytokine storm. The response is so severe it’s damaging your organs. Q: And that’s been a big problem with COVID? A: That’s right because basically when you get COVID virus, you just get it in the nose and it’s there. You may not even know you have it, never know you have an infection. You’re fine. In some people it goes into the lungs and starts revving up the immune system. Now you get a cytokine storm and inflamed lungs, you cannot breathe because it’s so inflamed. And now we know it’s not just inflammation, but these blood clots. So now you can’t exchange oxygen with your red cells because of these clots. So that’s why people sometimes collapse so quickly, because there is no blood flowing through the lungs. There’s no oxygen going to the brain. So that’s why people can look good, good, good and then suddenly they just die. It’s not everybody, though, so there must be some conditions that are connected to getting the really severe form of the disease. And we now know it could be diabetes, high-blood pressure. It could be genetics, it could be obesity. We know that obesity makes your body kind of inflamed. Fat is not an inert mass. Fat is an organ. It is working, and it’s working against your body. In this case, it seems to predispose people to bad outcomes. And, of course, it’s also associated with diabetes and high-blood pressure, so it’s a mix of things. We’re learning about the disease and how these things work together and make COVID worse for individuals. Q: What about this disease makes it hard to treat? Or are coronaviruses in general just hard to treat? A: Basically, we didn’t have a drug that showed good data that showed you could shorten the COVID symptoms. Now we have a drug that’s showing that can shorten symptoms by about one-third, maybe even better if you use it early like you would with Tamiflu. So we need it available, and we need it soon. And then hopefully even more effective agents and eventually a vaccine. Right now we don’t have a vaccine, but we have remdesivir for shortening time in hospitals. Even if it’s just shortening your stay from 15 days to 11, that allows you to see more patients and alleviates shortages of beds and ventilators.
Lifelines Name: Igor Puzanov, M.D. Position: Director of early phase clinical trials program at Roswell Park Comprehensive Cancer Center; chief of melanoma; professor of oncology at University of Buffalo Hometown: Prague, Czech Republic Education: Charles University (Prague); Vanderbilt University Affiliations: Roswell Park Comprehensive Cancer Center Organizations: American Society of Medical Oncology; Society of Immunotherapy in Cancer; American College of Physicians Family: Wife; Children (Igor Jr., Barbara, Veronica) Hobbies: Exercise; hiking, kayaking, rafting, skiing, camping
Drive-Thru Glaucoma Pressure Screenings Available for Patients At Risk of Vision Loss
COVID-19 DIAGNOSTIC TESTING
uring the COVID-19 pandemic, drive-thrus are common for COVID-19 testing and now for eye pressure tests, as well. UBMD Ophthalmology at the Ross Eye Institute offers glaucoma patients an alternative to in-office visits for their care with drive-up eye pressure testing. At the Orchard Park office, ophthalmologist Sandra Sieminski, a glaucoma specialist, has transformed the breezeway into a drive-thru testing clinic for glaucoma patients. “With glaucoma, a big component of the care and management of the disease is checking and monitoring the patient’s eye pressure,” says Sieminski, director of glaucoma services for UBMD Ophthalmology. “Are the eye drops working? Do they need a change in medication or is their condition remaining stable?” Glaucoma is a disease that if left untreated, can cause blindness. “This pandemic has added an additional layer of stress to our glaucoma patients who are already trying
DATE: TIME: PLACE:
to manage a potentially stressful chronic disease,” said Sieminski, director and assistant professor of ophthalmology at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. “We wanted to provide safe ways for them to receive follow-up care to help avoid them falling through the cracks and risking vision loss.” For more information, visit rosseye.com.
Erie County Department of Health Now Offering Free COVID-19 Antibody Tests
tarting Tuesday, May 19, the Erie County Department of Health (ECDOH) started offering a series of clinics for COVID-19 antibody testing throughout Erie County. The antibody test conducted by the Erie County Public Health Lab requires a blood draw from the arm. Appointments will be available in half-hour increments at clinics held three days each week from 10 a.m. until 6 p.m. These clinics will be set up in locations throughout Erie County, including Amherst, Buffalo, Cheektowaga, Depew, Hamburg, Lackawanna, Orchard Park, Springville and Williamsville. ECDOH will schedule appointments for Erie County residents ages 11 and older through its COVID-19 information line at 716-858-2929, which is open daily between 8 a.m. and 8 p.m. Antibody tests for COVID-19 should be done at least 21 days after onset of any COVID-19 symptoms. Those symptoms may include cough, shortness of breath, fever, chills, muscle pain, sore throat, or new loss of taste or smell. “We have the ability to provide 100,000 antibody tests to our residents, which will start to provide a sense of who has been exposed to COVID-19 in our community,” said Erie County Executive Mark C. Poloncarz. “This is a massive effort coordinated by our health department, many other county departments, and partners in our cities and towns, and our thanks go out to them and to the staff and volunteers who will be managing these sites.” “There are some important distinctions to make about the
EVERY THURSDAY FROM MAY 21, 2020 THROUGH JUNE 25, 2020 9 AM to 4 PM COMMUNITY HEALTH CENTER OF NIAGARA 2715 Highland Avenue Niagara Falls, New York, 14305
The Community Health Center of Niagara medical mobile unit will be available in our parking lot at 2715 Highland Avenue for COVID-19 testing. Please call (716) 986-9199, ext. 5907 to secure an appointment for testing. We are here for front-line nursing home staff of employers requiring you to be tested twice weekly according to Governor Cuomo’s mandate. You do not have to be a patient of ours to be tested. In addition, if you are experiencing fever, a dry hacking cough, chills, body aches, light head or dizziness, extreme fatigue, shortness of breath, or have been exposed to someone who has tested positive, you may have COVID-19. Don’t mistake these symptoms for the common flu. Come and get tested by our licensed medical professionals. Please note - If you do not have a primary care provider or if you do not have insurance, we welcome you to become a patient with us. Our insurance enrollers can help you with insurance. Schedule your COVID-19 diagnostic test today! Call (716) 986-9199 EXTENSION 5907
differences between a diagnostic test for COVID-19, and the antibody tests that we are offering through these clinics,” said Commissioner of Health Gale Burstein. “Antibody tests can indicate past exposure to a disease, but a positive test does not necessarily mean you are immune to a future COVID-19 infection. Regardless of your antibody test results, you should continue social distancing, wear a mask when you could be near other people, wash your hands with soap and water often, clean and disinfect frequently touched surfaces, and minimize the time you spend in public spaces, especially if you are elderly or have a chronic disease.” Appointments are required and will be scheduled on a first-come, first-served basis for the next three scheduled clinic days. “With our diagnostic test locations, we are seeing a significant number of noshow appointments,” said Burstein. “By having appointments scheduled within the next week, we hope to reduce those no-shows and maximize the number of people we can test.” There is no cost for antibody testing through ECDOH. To maintain physical distancing within each test site, only individuals who have a scheduled appointment and their parent or guardian, if under 18 years old, will be allowed into the testing area. Diagnostic COVID-19 tests where a nasal swab is collected continue to be offered through ECDOH by calling 716-858-2929. Diagnostic tests are available at this time for individuals who believe they may have been exposed to COVID-19 or if you feel you are at risk.
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June 2020 •
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
By the Numbers, COVID-19 Was Never ‘Like the Flu’
n the early days of the coronavirus pandemic, President Donald Trump announced that Americans need not worry because the new coronavirus was “like a flu.” Now, 1.4 million cases and more than 84,000 COVID-19 deaths later (as of May 17), a new report finds the comparison was never valid. “Public officials continue to draw comparisons between seasonal influenza and SARS-CoV-2 mortality, often in an attempt to minimize the effects of the unfolding pandemic,” wrote physicians Jeremy Faust, of Harvard Medical School, and Carlos del Rio, of Emory University School of Medicine in Atlanta. But those comparisons are “apples and oranges,” the physicians reported in an article published May 14 in the journal JAMA Internal Medicine. That’s because the numbers comparing COVID-19 and flu just don’t match up. For example, the U.S. Centers for Disease Control and Prevention produces an annual tally of deaths caused by flu. During the 2018-2019
flu season — by all accounts a moderate one — 34,200 Americans are thought to have died from complications linked to the flu. In more severe flu seasons, that number can go higher — the 2017-2018 season was linked to more than 61,000 deaths, for example. However, Faust and del Rio noted that confirming that flu caused a patient’s death (and not some other underlying condition) is often tough, so the CDC long ago issued their numbers as “calculated estimates” — not actual death counts as verified by death certificates. An annual number for verified flu deaths also exists, however, and it’s much smaller than the calculated estimates. Between 2013 and 2019, “the number of counted influenza deaths was between 3,448 and 15,620 yearly,” the report authors noted. Conversely, COVID-19 deaths occurring in 2020 have all been counted, not estimated. That means that by May 14, the more than 84,000 deaths from coronavirus are already about 5.5 times
higher than the highest annual death count for the flu over the past seven years. Those ratios widen even further when deaths are looked at on a weekly basis. “Statistics on counted deaths suggest that the number of COVID-19 deaths from the week ending April 21 was 9.5-fold to 44.1fold greater than the peak week of counted influenza deaths during the past seven influenza seasons in the U.S.,” Faust and del Rio said. Finally, there’s simply no comparison between flu and COVID-19 when it comes to what medical staff are experiencing on the frontlines. “In some hot zones of the pan-
demic … ventilators have been in short supply and many hospitals have been stretched beyond their limits,” the two experts noted. This overwhelming demand on hospitals, “has not happened before in the U.S. even in the worst of influenza seasons.” Finally, they said, the actual death count of COVID-19 may be even higher than current estimates, because “indirect” deaths linked to the pandemic aren’t factored in. Those include deaths that occurred because people with other, often fatal conditions couldn’t get the help they needed as health care systems became overwhelmed by COVID-19.
and group psychotherapy that are delivered in temporary expansion locations, including the patient’s home. Normally, patients would be required to receive these services at the community clinic.
‘CMS is allowing physicians, licensed in a particular state, to bill for telehealth services provided to their patients who may live across state lines.’
Healthcare in a Minute
By George W. Chapman
CARES Act Expands Beneficiary Coverage for COVID-19, Gives Providers Flexibility
n late April, the Centers for Medicare & Medicaid Services (CMS) issued radical changes to combat the COVID-19 pandemic. The Coronavirus Aid, Relief, and Economic Security Act expands beneficiary coverage for the virus and gives providers greater flexibility in delivering care. Some of the important provisions are summarized below. It should be noted that CMS rules pertain to Medicare and Medicaid beneficiaries. However, most commercial carriers tend to mimic CMS especially during this pandemic. If you are covered by a commercial plan, to be sure about coverage, contact them first.
You do not need a written order from your treating physician to get tested for the virus. An order (it does not have to be written) from any qualified healthcare practitioner authorized to do so under state law will be accepted. Pharmacies can do testing if enrolled with CMS as a lab. Beneficiaries can now be tested in so called “parking lot” sites operated by qualified entities such as hospitals, community health centers, pharmacies, etc. CMS will pay for the services related to the virus in full. The beneficiary will not be responsible for any deductible or co-pay.
Hospitals are allowed to temporarily increase their number of beds to accommodate COVID-19 patients. Inpatient psychiatric and rehab facilities may admit COVID-19 patients to relieve the pressure on hospitals. CMS has made it easier for inter-facility transfers. Page 6
Advanced practitioners (nurse practitioners, physician assistants, clinical nurse specialists) can provide home health care without physician certification. APs can order the services, establish care plans and certify that the patient is eligible for home care. Teaching hospitals are allowed to send available residents to other affiliated or non-affiliated hospitals to help out. Physical and occupational therapists can delegate routine maintenance services to their qualified assistants. During the COVID-19 emergency, hospitals and ambulatory surgery centers will not have to periodically reappraise staff privileges. This allows them to keep providers whose privileges would normally be expiring. It also allows them to temporarily bring retired physicians back.
Mental health delivery
CMS will allow and pay for individual psychotherapy, education
These temporary changes will most likely have the most profound and enduring impact on the delivery of care far beyond the pandemic. Up until the pandemic, telehealth was used sporadically and traditional face to face encounters were preferred. Red tape and low payment discouraged both physicians and patients from using telehealth. CMS and commercial carriers have long feared the easy use of telehealth would merely increase utilization without any real impact on outcome. As the pandemic lingers, both consumers and providers are adapting to telehealth. Most likely, some of these temporary changes below will become permanent. Physical, occupational and speech therapists can provide services via telehealth. Hospitals may provide and bill, as the originating site, for telehealth services provided to registered outpatient in their home. The patient’s home becomes an extension of the hospital’s outpatient department. Services provide remotely include counseling, education and therapy. Telehealth may be provided by audio only (telephone) versus audio and visual. Medicare is now covering some services when provided as audio only — this includes behavioral and patient education services. CMS has (finally) increased payments to providers for telephone encounters to match payments for traditional office visits.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2020
This is retroactive to March 1. CMS has promised to add to the list of approved telehealth services and to accelerate the approval process on a “sub-regulatory” basis. (As providers and consumers adapt, I think it will be very difficult for CMS to go backwards on telehealth once the pandemic subsides.) CMS is now paying rural clinics and federally qualified community health centers for providing telehealth services. CMS is allowing physicians, licensed in a particular state, to bill for telehealth services provided to their patients who may live across state lines. George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at email@example.com.
Things You Need to Know About Eye Care By Ernst Lamothe Jr.
ll of your five senses matter. The deterioration of any of them can greatly decrease quality of life. When it comes to vision, there are a variety of issues that may present themselves — blurriness, difficulty distinguishing distant and nearby objects, blind spots and fading of colors, among others. Different eye conditions affect vision in unique ways. Almost 12 million people aged 40 years and older in the United States have vision impairment, according to the Centers for Disease Control and Prevention. “Having good vision is important for our mental health and our ability to connect with the world,” said physician Sandra Sieminski, director of glaucoma services at Ross Eye Institute and clinical vice chairwoman of the department of ophthalmology at University at Buffalo. “It is essential to make sure your vision is preserved and that your eyes are healthy.” Sieminski discusses five tips to sustain good eye care.
Diet matters Proper eating habits affect every organ in your body, including your eyes. Eating a regular, healthy balance of leafy greens, vegetables and fish provides your eyes with the nourishment it needs. “Taking vitamins and supplements such as vitamin A and C and Omega 3 fatty acids can also be helpful to retinal health,” said Sieminski.
“But for most patients, taking a multivitamin and eating a balanced diet is more than sufficient. They help the nerve tissue in the back of the eye called the retina.” Sieminski said that a good diet can help prevent diabetes, high cholesterol and hypertension, which have all been tied to visual degeneration.
Protect your eyes All radiation is a form of energy, most of which is invisible to the human eye. Extended exposure to the sun’s UV rays has been linked to significant eye problems, including cataracts, macular degeneration and a host of other issues. To protect your eyes from harmful solar radiation, you should wear sunglasses that block 100% UV rays whenever you are outdoors in daylight. The World Health Organization estimates up to 20% of cataracts may be caused by overexposure to UV radiation. “We see so many serious eye injuries that could have been prevented if patients were wearing protective eyewear,” said Sieminski. In addition, when doing any outdoor activities such as gardening or construction, eye protection remains essential.
Family history Eye problems can be hereditary. There are hundreds of various genetic eye disorders. “In many serious glaucoma and
macular degeneration cases, the likelihood increases when you have a first degree relative with the same issue,” she said. “That is why it is essential to familiarize yourself with your family history, and every one to two years visit your physician. Many are surprised about how much can be discovered by a simple eye appointment. “When we look into your eyes, people don’t realize that we can directly see the blood vessels inside your eye. We can see how systemic diseases such as high blood pressure, stroke and diabetes affect these blood vessels, and many times we can help diagnose these diseases through our eye exams,” added Sieminski.
Stop smoking Smoking is as bad for your eyes as it is for the rest of your body. If you smoke, you can develop serious eye conditions that can cause vision loss or blindness. Cataracts or clouding of the eye’s natural lens are a leading cause of blindness in the world. More than 50% of Americans will have a cataract or have had cataract surgery by age 80. Smokers significantly increase their risk of developing a cataract compared with non-smokers. “Smoking can cause optic nerve damage and can increase your risk of a stroke to the blood vessels inside your eyes,” she said. “Dry eyes is another common condition that can worsen with smoking exposure.”
COVID-19 and eye care There have been reports of those infected by the coronavirus having a temporary loss of some of their key senses such as smell and taste. “There have also been studies out of China where patients had pink eye as a presenting symptom,” said Sieminski. “Also, as many already know, COVID-19 can be transmitted
Physician Sandra Sieminski is a glaucoma and cataract specialist at the Ross Eye Institute, where she serves as director of glaucoma services. She is also the clinical vice chairwoman of the department of ophthalmology at University at Buffalo. through direct contact with your eyes. That is why we stress handwashing and not touching your eyes, nose and mouth.” Sieminski said her office is taking all the precautions to keep people safe during their appointments. She understands that there is a heightened fear among everyone. “We do stress if you are having intense pain in your eyes or an acute loss of vision that you do not delay and make an appointment to get your eyes checked,” she added.
Venturing Out? Guard Yourself Against Disease-Carrying Ticks The latest? Asian long-horned tick is expanding its range and has moved into New York state, says expert
s pandemic-related restrictions ease and people return to parks and other outdoor spaces, remember to protect yourself against another threat — ticks. “With our latest mild winter, ticks have been active in much of the region on warmer days all winter long,” said Jody Gangloff-Kaufmann, an entomologist at Cornell University in Ithaca, who said it’s too soon to predict population trends for 2020. She added that it is clear, however, that ticks are expanding their geographic range and moving into colder regions. That’s why it’s important to know how to recognize them, take preventive steps and do a tick check each time you venture out. “Although ticks aren’t everywhere, they can be anywhere so be aware of your surroundings,” Gangloff-Kaufmann said in a news release. Though no notable change in distribution or density has been reported in the past year, there is one exception, according to Laura
Harrington, director of the U.S. Centers for Disease Control and Prevention Northeast Regional Center for Excellence in Vector-Borne Diseases at Cornell. Harrington said the Asian longhorned tick is expanding its range and has moved into New York state. “So far, it hasn’t been found infected with human pathogens, but it does transmit a hemorrhagic viral disease in Asia,” Harrington said. The bacterial infection that causes Lyme disease is the most important tick-borne illness in the United States, with an estimated 200,000 to 300,000 cases reported each year, she said. “The blacklegged tick or ‘deer tick’ is the vector of Lyme disease in most of the U.S.,” Harrington said. It also transmits other disease-causing organisms, including agents that cause babesiosis, anaplasmosis and Powassan disease. These ticks are most common in forested areas and shaded trail edges where there
Female deer tick on human skin. It can transmit Lyme disease.
are lots of fallen leaves and shrubs, she said. As such, you need to take steps to protect yourself when you’re headed outdoors. Harrington recommends wearing repellent, light-colored clothing and tucking pants into your socks. “You can also treat your clothing with permethrin or purchase permethrin-treated clothing,” she said. But don’t stop with those steps. It’s important to check yourself for ticks often. “For Lyme disease, time is on your side,” Harrington said. “It usually takes 24 to 48 hours after the tick has attached and started feeding before it can transmit Lyme bacteria. For some other pathogens, like Powassan virus, transmission
June 2020 •
can happen quickly, so check yourself periodically for attached ticks even when you are still outside.” Here’s how: Look for ticks all over your body, including on your back, neck and hairline. If you find one, use sharp tweezers to remove it, grasping the tick as close to the skin as possible, then pulling. Once you are back inside, remove your clothing and place it in a hot dryer for at least 20 minutes, if possible. If that’s impractical, place clothing in a sealed garbage bag and do it later, Harrington said. “This is also a good time to take a shower and perform a tick check,” Harrington said.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
Live Alone & Thrive
By Gwenn Voelckers
Practical tips, advice and hope for those who live alone
‘June is the perfect time for folks to dig in, get their hands dirty and grow their own vegetables at home. It’s also a good time to reflect the many life lessons that gardening offers to those who live alone.’
Gardening Blooms While We Shelter-in-place
ave you been to a gardening center or nursery lately? Vegetable seeds are in short supply, if not sold out altogether. People are revisiting the basics during this coronavirus lockdown. Many are returning to gardening — especially vegetable gardening — given slim pickings at the super market. As a vegetable gardener for years, I see this as a precious silver lining in this otherwise trying time. And June is the perfect time for folks to dig in, get their hands dirty and grow their own vegetables at home. It’s also a good time to reflect the many life lessons that gardening offers to those who live alone. It has taught me the value of planning, preparation, patience and pleasure — four essential “P’s” for a bountiful garden and ... a bountiful life. Fertile ground exists in each of us, and a little tending can produce beautiful results. Here’s what I have learned: • Plan. Realizing the garden of your dreams begins in your imagination, followed by careful planning. Diagram your garden and it will help you avoid planting onions on top of potatoes or mistaking basil for a
weed. Likewise, envisioning your life goals and committing them to writing can help you flourish and grow. • Cultivate. Good, cultivated soil promotes healthy, deep roots. When you add fertilizer to your garden you are rewarded with abundance. Adding essential ingredients to the foundation of your dream garden (and your dream life) will nourish all that follows. You can’t go wrong with nutritious food, a walk in nature, a good book, soothing music, or saying “yes” to a new adventure that’s been tugging at your heart. • Plant. So many choices! Revisit your plan and embed your carefully selected seeds or seedlings with a tender, loving touch, being careful not to overcrowd or plant more than you can manage. And remember: We reap what we sow, so follow your dreams. Plant a tomato and you get a tomato; plant a dandelion and you get a dandelion. Seed your future with healthy choices that promote well-being. • Weed. We all need room to breathe and space in which to blossom. It holds true for your garden and your life. Gardening is all about consistent caretaking. Slack off, even
s d i K Corner
Kids’ ER Visits for Mental Health Problems Soared Over 10 Years
hildren treated in America’s emergency rooms for mental health disorders jumped 60% over a recent decade, a new study finds. Between 2007 and 2016, visits for self-harm like suicidal thoughts and cutting soared 329% and treatment for drug abuse rose 159%, according to the study led by Charmaine Lo, from Nationwide Children›s Hospital in Columbus, Ohio. “This is happening in all emerPage 8
gency departments all across the country and in kids of all ages,” said Lo. “And regardless of whether it’s a children’s hospital or a general hospital, and whether or not they’re in an urban location or in a rural location.” Lo thinks that social media has put a lot more pressure on children. “Children, particularly teenagers, are feeling that. Also, there’s a lot more awareness of mental health, and children know that there are resources in
for a few days, and all things unwelcome show up and take root. Weed out the negativity and any dream-stealing toxins that contaminate your life, dash your hopes, or spoil your fun. When you pull out the bad, you can more easily focus on the good in your life. • Prune. When weeding is not enough, a major pruning may be in order. A job, relationship, or home that no longer satisfies or meets your needs may need a hard look. It may be time to pull out that pair of “life loppers.” • Mulch. Mulching keeps weeds at bay and the ground moist, and returns nutrients to the soil. It also adds a finishing touch. Mulch offers a blanket of protection, in the same way that regular doctor appointments, insurances, and safety measures protect our lives. We
place for them to seek help and get help,” she said. The coronavirus pandemic is only going to make things worse, experts say. “Although this study was conducted prior to the onset of the COVID-19 pandemic, the increase in social isolation and household stressors caused by the pandemic are likely to further worsen children’s mental health” said physician Jennifer Hoffmann from the emergency medicine division at the Lurie Children’s Hospital of Chicago. A study from China showed that children affected by the COVID-19 pandemic had more symptoms of anxiety and depression, Hoffmann said. The study researchers worry that emergency departments aren’t equipped to handle mental health problems in children, especially small hospitals in rural areas. “Preparation could be as simple as a screening training program for the nurses and doctors, because you don’t have to be a psychologist to take care of these kids, you just need to recognize whether they’re dangerous to themselves or others,” said study co-author physician Rachel Stanley, division chief of emergency medicine at Nationwide. “Those tools are currently available through various agencies, although they aren’t being used by most of the places that are taking care
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2020
can learn a lot from mulching. • Wait. We all know that “good things come to those who wait.” Enjoy the gradual unfolding of a garlic scape, a lettuce leaf, an idea, or a friendship. When you exercise patience, life can be savored and more deeply appreciated. • Each year, I look to my garden to remind myself that growth takes time. • Enjoy. Before you know it, your labor of love and patience will pay off. Take pleasure in the transformation as the colors, textures, and fragrances emerge. Too often, we fail to “stop and smell the roses” in our gardens and in our lives. So get busy, then step back and take a good look. There’s nothing quite as satisfying as admiring what you’ve accomplished. It’s reason to celebrate! By osmosis, gardening has taught me how to take better care of myself. I have absorbed its rich messages and learned how to nurture my inner garden and growth as a woman on her own. I encourage you to grab a spade and join me. Beauty, growth, and an energizing sense of renewal can be yours, season after season after season. Gwenn Voelckers leads Alone and Content empowerment workshops for women held in Mendon and is the author of “Alone and Content: Inspiring, empowering essays to help divorced and widowed women feel whole and complete on their own.” For information about workshops, to purchase her book, or invite her to speak, call 585-624-7887, email firstname.lastname@example.org, or visit www.aloneandcontent.com.
of these kids,” Stanley said. For the study, Lo and her colleagues analyzed data for children aged 5 to 17 from Nationwide’s emergency department databases. The researchers found that, while the number of children seen in the emergency rooms remained stable between 2007 and 2016, visits for mental health problems increased dramatically. Visits for alcohol problems actually fell 39%, while overall drug use visits grew substantially. This bears more investigation, the researchers said, given the opioid epidemic still raging in the United States. The types of mental health problems reviewed included adjustment and anxiety disorders; attention-deficit, conduct, and disruptive behavior disorders; impulse control and mood disorders; and psychotic disorders like schizophrenia. One in five U.S. children has a mental health disorder, according to background notes. Children with mental health disorders make up about 2% to 5% of all pediatric ER visits nationally, and this number is increasing. Until now, few studies have looked at where these kids go in an emergency, Lo and colleagues said. The report was published online May 11 in the journal Pediatrics.
Best Summer Produce for Diabetics Doctor: ‘[Diabetes] can be basically reversed with a healthy lifestyle’ By Deborah Jeanne Sergeant
ummer produce season is in full swing; it’s a great time to eat plenty local, fresh foods available at pick-your-own farms, farm stands and markets, and possibly at a home garden. These foods can be helpful for diabetics in improving their blood sugar levels because of their low glycemic index status, among other benefits. “[Diabetes] can be basically reversed with a healthy lifestyle,” says physician Az Tahir, who practices holistic medicine in Rochester. He says that in addition to exercise and stress reduction — both essential for a healthy lifestyle — eating plenty of produce “is part of the protocol for helping reverse effects of diabetes.” The glycemic index is based on a food’s carbohydrate content and how it affects blood glucose levels after a meal. According to Diabetes Self-Management (www.diabetesselfmanagement.com), “a glycemic index of 55 or lower is considered low, a glycemic index from 56 to 69 is considered intermediate, and a glycemic index of 70 or higher is considered high.” Most vegetables and fruits are within the range of 0 to 55. The person’s age, gender, weight,
number of active minutes per week and general health affect the ideal glycemic load that their diet can bear, as well as how the produce is prepared. In general, the lower the glycemic index, the better. That’s why incorporating produce makes sense. For their volume, many fruits and vegetables are low in carbohydrates. They are also rich in vitamins, minerals and naturally-occurring compounds that improve health in many ways. Exceptions include corn and potatoes. “Most of the other summer vegetables aren’t as starchy as corn or potatoes, so they wouldn’t likely cause a significant spike in blood glucose,” said Mary Jo Parker, registered dietitian and owner of Nutrition & Counseling Services in Williamsville. That doesn’t mean that corn and potatoes are entirely off-limits. “Corn is pretty starchy and should likely be limited to one serving — 1/2 cup or one ear — at a time to manage blood glucose elevations after consuming,” Parker said. “It is a good source of fiber, but can still create a spike, especially if the meal is high in carbohydrate. Fat and protein can help blunt this response.” Eating one buttered ear of corn with a grilled chicken breast, salad
and mixed berries can provide a much more balanced meal than having several ears of corn with a hotdog on a bun and potato salad. Parker advised eating banana greener, as at that point they have more fiber that can help offset the rise in blood glucose. “Watch quantities of fruits in particular because of their natural sugar content, but go for it and enjoy those vegetables,” she said. She recommends greens, and a variety of vegetables in many colors. “Glucose response is always individual though, so a person can assess his or her level two hours after eating or the next morning after eating to see the likely effect of a food or meal on blood glucose,” Parker said. “It’s always best to watch trends to see patterns over time.” The portion size also makes a difference in glycemic load per meal. Artichoke, asparagus, cucumbers, green or wax beans, Brussels sprouts, broccoli, celery, onions, mushrooms, greens, lettuce, peppers, okra, zucchini, and cabbage represent good choices, according to Diabetes Self-Management. “The most important thing is that all produce can fit into a healthy
diet,” said Samantha Paolini, clinical dietitian with UBMD Pediatrics in the division of endocrinology and diabetes. She doesn’t like labeling food as “good” or “bad” but reminds patients with diabetes that they may need to limit portion size of grapes, mangoes, oranges and bananas. Apples, berries, peaches, tangerines, pears, cherries and plums are good examples of low-gylcemic foods she recommends. “The low-GI foods are full of essential fiber, vitamins and minerals,” Paolini said. “Fruits and vegetables typically have a good amount of fiber. It assists our body in slowing the absorption of blood sugar. Fiber helps us feel full longer and it helps with portion control.” Dietary recommendations can vary depending up on many health, age and co-existing condition factors. Any food can be part of a healthful diet, though diabetics need to be especially careful about balancing what they eat and how they exercise under the guidance of their healthcare providers.
Restless Leg Syndrome is Treatable By Deborah Jeanne Sergeant
re your legs keeping you up at night? Restless leg syndrome may be the culprit. The central nervous system causes the condition which typically manifests at bedtime — but not while someone’s asleep. Physician Kenneth Halliwell, who is the medical director of Sleep Insights in Niagara Falls, Buffalo and Dansville, said many people think restless leg syndrome awakens them at night; however, that’s periodic limb movement. “Periodic limb movements and restless leg syndrome are distinct entities but sometimes are seen together,” Halliwell said. He added that symptoms may appear in the legs or other areas of the body and feel like an ache, itch, wiggle or tingle that cannot be relieved until the patient moves. Ignoring it only allows it to build. As patients stop moving, the symptom returns. Periodic limb movement involves involuntary and repeated movement of the limbs during sleep, which can cause patients to awaken. The movement occurs at least four times consecutively between five and 90 seconds. Since lack of movement is important to start sleeping, restless leg syndrome can prevent sleep. Periodic
limb movements disrupt sleep. Though some people experience restless leg syndrome as a minor nuisance, some find it so bothersome that they seek treatment. It may have a genetic component. “The first thing you want to try to do is identify any exacerbating factors and try to treat those first,” Halliwell said. Other sleep issues, like sleep apnea, worsen restless leg syndrome. Medication such as antihistamines, antidepressants and more can contribute to sleep issues. Halliwell also looks at iron levels, since low iron has been linked with restless leg syndrome. Halliwell explained that low levels of dopamine in the brain seems to affect restless leg syndrome and iron is thought to synthesize dopamine. The level of iron in the body is at the ferritin level, which means the iron stored in the body. “The ferritin level, we want it in the medium to high range,” Halliwell said. “A low, normal level will exacerbate restless leg. For a sleep doctor, the ferritin levels that appear normal won’t be fine.” The level of iron stored in the body should be up to three times the amount tested in the blood. Patients found deficient are advised to take iron supplements, which take about three months to improve their levels.
Restless leg syndrome sometimes appears — and, if pre-existing, worsens — with pregnancy, since pregnancy may deplete the body’s iron stores. Changes in the diet may help improve restless leg syndrome. Samantha Paolini, clinical dietitian with UBMD Pediatrics in the division of endocrinology and diabetes, suggested adding spinach and other leafy greens, bananas and fortified cereal to a patient’s balanced diet. In addition, “avoid caffeine and high sugar before bed,” Paolini said. “It provides a jolt of energy. Avoid coffee and tea — unless decaffeinated — chocolate, and anything high sugar.” In addition, Mary Jo Parker, registered dietitian and owner of Nutrition & Counseling Services in Williamsville, said that restless leg syndrome may be related to deficiencies in folate, magnesium or iron. “The best sources of these are greens, fortified cereals, legumes, whole wheat, nuts, red meat and dried fruits.” Alberto F. Monegro is a physician with both UBMD Internal Medicine and UBMD Pediatrics in the divisions of pulmonology, critical care, and sleep medicine and pediatric pulmonology. He said that alcohol can worsen restless leg syndrome. “Food depravation can make
June 2020 •
symptoms worse,” Monegro added. “We do recommend having a regular food schedule. That’s important. Have some active lifestyle overall, but not necessarily running marathons.” He also helps patients understand good “sleep hygiene,” such as keeping the bedroom dark and quiet, avoiding caffeine and engaging in a relaxing activity before bedtime. “Staying up late watching television and having a very erratic sleep schedule worsens restless leg syndrome,” Monegro said. “Do things that are relaxing.” Sleep specialists may also prescribe medication that increases dopamine or helps calm the nervous system. Monegro hopes people seek help for restless leg syndrome, which he said is really debilitating in some cases. “We’ve had some good successes where people can function and sleep. And couples who can barely sleep together because one has restless leg syndrome can do so again,” Monegro said.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
The skinny on healthy eating
Red Snapper Pops with Healthy Benefits
ere’s a quarantine surprise: More people are cooking seafood, especially now that certain meat products are becoming harder to find. Here’s a surprise of a different nature: Snapper, a popular white fish with a firm texture and a distinctive sweet, nutty flavor, has a nutritional profile that’s bound to intrigue. To begin, snapper is an excellent source of lean, high-quality protein, with an average serving delivering about 40% of our daily needs. What makes snapper’s protein particularly attractive is that, unlike, say, a comparable serving of ground beef, it’s much lower in fat, calories and sodium. What’s more, it has an admirable water footprint: snapper, 0 gallons; one hamburger, 450-600
By Anne Palumbo prevent cell damage, selenium is required for the thyroid gland to work properly and plays an important role in the health of our immune system. This flavorful fish is also a good source of omega-3s — healthy fats that have been linked to a lower risk of many life-threatening conditions. According to experts at the Cleveland Clinic, omega-3s have been shown to increase levels of good cholesterol and reduce blood clots, blood pressure, and inflammation. While all fish, including snapper, contain some cholesterol, they can still be part of a heart-healthy diet. The good news is, it’s the saturated fat in food that raises blood cholesterol levels, not so much the dietary cholesterol, and snapper is super low in saturated fat. It’s also relatively low in cholesterol: an average serving of snapper, 37 mg of cholesterol; an average serving of shrimp, 190 mg. As for its mercury levels, snapper is a “good choice” to eat once a week, according to the FDA. This advice is particularly helpful for women who are pregnant, breastfeeding mothers, and young children.
Grilled Red Snapper with Black Beans
gallons. We need protein to build and repair tissues, regulate hormones and increase feelings of fullness. Snapper is a vitamin B12 superstar. This high-priority vitamin helps to produce red blood cells and DNA, keep nerves healthy, promote bone health and synthesize serotonin — the “happiness” chemical. Many studies support that vitamin B12 may boost energy, slow mental decline and improve moods. Since many older people suffer from a B12 deficiency — whether through diet or poor absorption — it’s good to know that seafood is a great source of this essential B vitamin. Another nutritious hook? An average serving of snapper contains 50% of our daily needs for selenium. A powerful antioxidant that helps
1 teaspoon olive oil 2 red snapper fillets (halved) 1 teaspoon paprika 1/4 teaspoon cayenne (optional) 1 teaspoon salt 1/2 teaspoon garlic powder 1 teaspoon dried thyme 1 teaspoon dried oregano 1/2 teaspoon coarse black pepper 15 oz. can black beans, rinsed and drained 3 tablespoons chopped red onion 1 garlic clove, minced 1 tablespoon olive oil 2 teaspoons red wine vinegar 1 teaspoon Dijon mustard 1/2 teaspoon salt 1/4 teaspoon coarse black pepper
Fitness in the Finger Lakes New free hiking challenge offers incentives for people to get active on the trails this summer By Kyra Mancine
o encourage hiking on the more than 1,000 miles of trails across New York state this season, the Finger Lakes Trail Conference (FLT) has launched the FLT50 Challenge. FLT is a nonprofit based in Mount Morris, Livingston County. Walk, run or hike a total of 50 miles on FLT’s expansive trail system and you’ll receive a patch, certificate and sticker and be entered into monthly drawings for prizes. For you hiking overachievers out there, if you up your mileage to 50 miles for three months over the course of the year, you can earn a hat. Tag your progress on social media and you might even be highlighted on the FLT’s website and social media sites. “So many people have discovered the benefits of hiking and walking and being outdoors during this crisis — it’s been one of the few things we can still do,” said ChrisPage 10
ty Post, director of marketing and communications at FLT. “And I think that’s been great for people — and for families — especially now that the weather is getting nice. I know my kids and I are getting out more together, and I see a lot more people and families out on the trails than I used to.” If you’re concerned about maintaining social distancing outside, this is the perfect pursuit. “Activities that allow physical distancing will be the new normal for most of the summer, and trails give people the space they need to be safe,” said Post. “Our hope is that this challenge brings people and families together for healthy activity — with appropriate social distance — and brings us all together virtually with shared pictures and adventures on the trails.” Open to all ages, participation in the FLT50 is easy. Simply pick a
FLT trail, complete your miles and submit your tally once you’re finished. Largely built and maintained by volunteers, FLT’s numerous trails run from the Pennsylvania-New York border in Allegany State Park to the Long Path in the Catskill Forest Preserve and includes branch trails to Niagara Falls, the Genesee River valley, the Great Eastern Trail south of Corning, the central Finger Lakes and the Syracuse region. Founded in 1962, FLT’s mission is “to build,
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2020
Snapper fillets are readily available fresh and frozen. Fresh fish should be cooked the day it is purchased; however, it will keep for two days in the refrigerator if properly wrapped. Although it’s best to eat snapper the day it’s prepared, any leftovers will last three to four days in the refrigerator. Using a “grill pan” facilitates cooking snapper on the grill. Lightly coat both sides of snapper with olive oil. Mix together the paprika, cayenne, salt, garlic powder, thyme, oregano and black pepper. Sprinkle over each side of the red snapper. Set aside. Before grilling, coat your grates with a high-heat cooking oil, such as canola oil (spray or a paper towel coated with oil will work). Do the same if using a grill pan. Preheat the grill to high heat for 10-15 minutes. While grill is preheating, combine the beans, onion, garlic, olive oil, vinegar, mustard, salt and pepper in a medium saucepan. Cook, uncovered, over low heat for 10 minutes, stirring occasionally. Remove from heat and cover. Grill the snapper about 5 to 6 minutes on each side or until the fish reaches an internal temperature of 145 F. Serve topped with black bean mixture. (No grill? Heat 2 tablespoons canola oil in a large skillet over medium-high heat. Place snapper fillets in skillet and cook about 5 minutes on each side.)
Anne Palumbo is a lifestyle colum-
nist, food guru, and seasoned cook, who has perfected the art of preparing nutritious, calorie-conscious dishes. She is hungry for your questions and comments about SmartBites, so be in touch with Anne at email@example.com.
protect, enhance, and promote a continuous footpath across New York State. Forever!” Organizers say this is the perfect opportunity to get outdoors. They cite a RunRepeat study of over 12,000 people from 139 countries showing that during March people who normally exercised once or twice a week increased exercise frequency by 88%. Even moderate athletes who normally exercised three times a week increased their frequency by 38%. “This challenge came at exactly the right moment,” according to one FLT50 challenge participant. “We’d found ourselves moping about the house, putting on pounds and full of self-pity for backpacking trips canceled. I had no idea such incredible, sweeping vistas were less than 15 miles from home. I felt entirely transformed. I can’t wait to get out there again and rack up those miles!” You can start the challenge at any time, and miles must be completed and submitted by the end of 2020. If you want to join the FLT50 challenge, visit https://fingerlakestrail.org for more details, including maps and a mileage tracker you can download.
Losing ‘COVID-15’ After Quarantine By Deborah Jeanne Sergeant
he “freshman 15” weight gain experienced by many college students shares some similar origins of the “COVID-15” pounds packed on during quarantine: mindless stress eating, availability of food, boredom, poor food choices and lack of exercise opportunities. Plus, those who are working at home had little positive peer pressure. At the office, others would notice that second or third doughnut. Also absent at home are the lunchtime walking group, buying a healthful lunch at a nearby eatery and hitting the gym on the way home. While working at home, it’s easier to binge on unhealthful convenience foods and stressful news updates. Familiar movies in the evening — instead of workout videos — offer comfort. Despite the ease of gaining weight, it’s possible to shed unwanted pounds. “Remain mindful and make conscious decisions about what you eat and how much you move,” said Mary Jo Parker, registered dietitian and owner of Nutrition & Counseling Services in Williamsville. If you’re still working at home, she advises setting up a routine and a workspace that’s not in the kitchen, since food is too readily available. Wherever you work, “stick with a meal and snack schedule to avoid grabbing food haphazardly throughout the day,” Parker said. She said that it’s important to plan a healthful grocery list to keep
stocked up on healthful foods for meals and snacks, with limits on extra snacks and treats. Emphasizing whole grains, fresh and frozen fruits and vegetables, and lean sources of protein makes a big difference in weight loss and overall health compared with eating so many convenience foods. Parker also recommends substituting not-so-healthful cravings with healthful activities, such as reaching for a puzzle instead food during a mid-afternoon break. “Exercise regularly with a schedule, indoors and out,” she said. “Physical activity also helps diminish stress and improves immune function, among its many benefits.” Getting enough sleep can also help reduce release of stress hormones, “which are often a trigger to overeat,” Parker added. To prevent overeating, Justine Anna Hays, registered dietitian and owner of Justine Hays Nutrition in Buffalo, encourages clients to fill half their plates with fruits and vegetables — fresh, frozen, canned and dried are all fine — because “they’re nutrient-rich and low in calories,” Hays said. Many people drink many of the calories they consume. Even nutrient-rich juice still contains an average of 100 calories per serving. Instead of caloric beverages, Kim Fenter, doctor of naturopathic medicine, encourages patients to drink “an adequate amount of water, at least eight, 8-oz. glasses daily, or half our body weight
in ounces of water.” Fenter is a L.E.A.N Expectations Health Coach at Audubon Women’s Medical Associates in Williamsville. She also encourages patients to “reduce carbohydrates in the form of sugar, bread and pasta. It is an important part of a healthy metabolism. Concentrate on the complex carbohydrates, and in moderation ‘sprinkle in’ the occasional treat.” For example, a protein-filled breakfast such as an egg, turkey sausage or plain Greek yogurt can start off the day without simple carbohydrates such as the typical bagel, muffin or doughnut. Phil Haberstro, executive director of the Wellness Institute of Greater Buffalo, likes to simplify weight loss as a “calories in versus calories out” equation. “The challenge comes in the fact that the calories in side of the equation is always much higher than the calories expended by physical activity,” he said. It’s easy to think that a casual stroll down to the mailbox and around the office is burning lots of calories; however, Haberstro said that walking an entire mile burns only about 100 calories for an adult
— not even the caloric content of half a standard sized candy bar. At his organization’s website, www.creatinghealthycommunities. org, fact sheets on physical activity can help users get a more realistic picture at the amount of physical activity they need. He also directs people to the resources of the websites of the Centers of Disease Control and Prevention (www.cdc.gov), US Surgeon General (www.hhs.gov/surgeongeneral/ index.html), and American College of Sports Medicine (www.acsm.org). “They’re the most reputable and science-based,” Haberstro said. In general, five days of the week, an adult needs 30 minutes of moderate activity to maintain weight and more to lose weight. He also recommends resistance exercise, such as body weight exercises like squats and push-ups or using a weight bench. “If you can maintain a reasonable level of muscle mass, that increases your daily burning of calories,” Haberstro said. “Muscles, unlike fat, use energy. Balance between a little cardio work and resistance exercise.”
“Cellular phones are ideal vehicles for the virus of COVID-19,” he agreed. “They are repeatedly exposed to material exhaled from our mouth and nose, and spend literally hours in our rather filthy hands. Viruses of this type are known to survive on plastics and stainless steel for two to three hours; on aluminum for two to eight hours, on cardboard and paper for up to 24 hours, and on ceramic or glass for up to five days.” Tajouri’s advice: “Before you wash your hand, wash your phone,” he recommended. “To be safe, every single one of
us need to first acknowledge that mobile phone is a source of microbial contamination,” he said, and to effectively treat phones like “our third hand.” “You could do that by using a soft microfiber cloth with 70% ethanol or use of a nonabrasive disinfectant wipe to wipe off your phone,” said Tajouri, though he cautions users to consult phone manufacturers to identify cleaning products that are safe for electronic devices. The review was published online recently in the journal Travel Medicine and Infectious Disease.
Cellphones Are ‘Trojan Horses’ for Viruses, Study Finds
ellphones carry all kinds of germs, a new study finds, and researchers say phones should be cleaned regularly to cut the risk for coronavirus transmission. The advice follows a review of 56 studies that looked at the risk of cellphones being contaminated with bacteria, fungi or viruses. The investigations were conducted across 24 countries between 2006 and 2019, prior to the advent of COVID-19. The review shows “that mobile phones not only carry bacteria but also viruses, fungi, and protozoa in the thousands,” said study author Lotti Tajouri, an associate professor of genomics and molecular biology at Bond University in Queensland, Australia. On average, the review found that 68% of the mobile phones had been contaminated with a wide range of microorganisms. And some of those contaminants showed resistance to standard antibiotics. The investigators did not conduct any new tests to search for the presence of the COVID-19 virus on phones. However, Tajouri said his
team «hypothesize strongly that mobile phones are responsible for the rapid propagation of COVID-19.” Why? First of all, “the virus responsible for COVID-19 can live on glass, plastic, stainless steel for days,” Tajouri noted. And cellphones, he added, are “particularly receptive hosts for germs simply because we first never wash them, and we take them everywhere and all the time with us.» That includes where people eat, where they sleep, and where they go to the bathroom, he observed, as well as on board the planes and trains people use to travel the globe. And while acknowledging that all everyday objects are contaminated in some way, Tajouri warned that “mobile phones are like international ambulatory five-star luxury hotels” for germs. In fact, he said, “no other type of everyday object can compete.” That point was seconded by physician Stephen Berger, co-founder of Global Infectious Diseases and Epidemiology Network (GIDEON) in Tel Aviv, Israel.
June 2020 •
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
‘They Truly Are Heroes’ Former CEO Jim Millard: COVID-19 Incident Command Center leader battling in middle of pandemic storm By Michael J. Billoni
uring his nearly 35 years in the Catholic Health system in Buffalo, Jim Millard has always had a deep appreciation for the hospital’s frontline workers — doctors, nurses, operating room technicians and many others entrusted with patient care. That appreciation has been taken to a higher level in his new role as executive leader and incident com-
Jim Millard, former president and CEO of Kenmore Mercy Hospital.
mander of staffing for the system’s COVID-19 Incident Command Center at St. Joseph’s Hospital in Cheektowaga. He is responsible for round-theclock staffing needs, including upwards of 100 nurses per day to care for nearly 100 patients with the novel coronavirus (as of mid May), half of which are in the intensive care unit. “It has been extremely rewarding and reassuring to see the professionalism, dedication and willingness of the staff to help in this situation. Our nurses are not only doing their medical duties but they have now become family members for these patients because their families cannot enter the building,” said Millard, who came out of retirement to accept the position when Catholic Health President and CEO Mark Sullivan called in March. “It is so heartwarming to see these nurses taking the time to set up face-time and video chat for these patients and their families. Their dedication has shown in the many letters we have received from family members thanking our nurses and staff,” he added. Millard, who began as a pharmacy intern in 1981 at St. Joseph’s Hospital, retired in 2018 as president and CEO at Kenmore Mercy Hospital after serving in that same capacity at St. Joseph’s. While he and his associates have never experienced anything like the COVID-19 pandemic,
NESTLED IN THE HEART OF WILLIAMSVILLE, STILL WNY’S MOST AFFORDABLE ASSISTED LIVING AND MEMORY CARE • Three home-cooked meals daily and snacks • Beautiful, full-sized Chapel with daily services • Personally tailored Care Services • Stimulating social, educational and recreational activities • Housekeeping and laundry • Beauty/barber salon • Transportation services • Soda Shop open 24 hours a day • Generous common areas
Nurses from St. Joseph’s Hospital, part of Catholic Health. he said the hospital system has been through other similar challenges and there are frameworks in place to handle such emergencies. “By creating this command center, we have been able to work through these issues quickly but there certainly was no handbook on how to deal with this when we began,” he says. “We hold phone meetings twice daily with all of our responsible leaders to cover questions and concerns while creating policies and procedures. “The basic care that is being provided to our patients is the same we have been providing in our hospital system for a very long time. Now it becomes a matter of doing that while we protect our patients and staff so this virus does not spread any further than it already has. Our team has done a great job with that.” To accomplish those goals inside the incident center, Millard said three zones have been established — green, yellow and blue — and there are restrictions on who passes through each and what protective apparel they must wear. Millard has had to create new positions to staff, such as runners to carry supplies and equipment from one zone to another and someone to verify that those entering the zones are wearing proper
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apparel. To fill staffing needs, he reached out to other hospitals in the system since there were no elective surgeries and limited traffic in emergency rooms. With surgeries resuming, he says Catholic Health may have to hire for some positions in the COVID-19 Incident Command Center to cover future needs. “There has been no decision on when we will go back to what St. Joseph’s used to be, so for now, we follow the procedures we have established,” said Millard, adding that any staff member entering any of its hospitals has his or her temperature taken and are screened to ensure they do not have symptoms. As he reflects on the dedication of doctors, respiratory therapists, environmental team members and others, Millard emphasized his appreciation for the unit’s nurses. “Not only are they doing an exceedingly difficult job, but they are doing it while wearing this protective equipment of gowns and masks for 12-hour shifts. When they take the masks off, they have sores on their noses, and it is extremely uncomfortable. We just cannot thank them enough,” he says. “They truly are heroes.”
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2020
Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo • Writers: Deborah J. Sergeant, Jim Miller, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Michael J. Billoni, Ernst Lamothe Jr., Kyra Mancine, Jana Eisenberg Advertising: Anne Westcott, Amy Gagliano Layout & Design: Dylon Clew-Thomas • Office Manager: Nancy Niet No material may be reproduced in whole or in part from this publication without the express written permission of the publisher. The information in this publication is intended to complement—not to take the place of—the recommendations of your health provider. Consult your physician before making major changes in your lifestyle or health care regimen.
Where have all sick patients gone? The good news for the hospitals is that they are coming back... very slowly.
Patients Wanted Drastic reduction in patient population, layoffs, limited sources of revenue. How hospitals are managing one of the worst crises in the industry and what they are doing to recover from it By Deborah Jeanne Sergeant
hile healthcare providers caring for COVID-19 patients have been busy throughout the pandemic, providers in other areas of hospitals, such as numerous surgeons and related personnel, had been on furlough. The only surgeries permitted at hospitals during the pandemic were life- or limb-saving procedures or those that are time-dependent for positive outcomes. As a result, hospitals have lost considerable revenue. How much they have lost? According to a report released in May by the American Hospital Association, hospitals nationwide will have lost an estimated $202.6 billion from March 1 through June 30, an average of $50.7 billion monthly from direct and indirect effects of COVID-19. While the related costs include expenses for COVID-19 hospitalizations — additional personal protective equipment and extra support for some hospital employees — a large portion of that loss is from canceled and delayed elective surgery. Ambulatory surgical centers have also experienced losses.
Moving personnel, such as nurses going from the surgical team to an acute care team, isn’t as easy as some might think because of specialization in nursing. As a result, hospitals’ typical personnel shortages were exacerbated during the worst part of the pandemic. Some hospitals are considering options that could safely make an in-patient surgery an out-patient surgery to reduce the number of patients using hospital space and resources — especially since if the number of COVID-19 patients surges again, those beds will be needed. Rescheduling patients isn’t easy, even outside of a healthcare system coping with a pandemic. For hospitals and surgical centers, their economic survival may depend upon efficiently scheduling patients to both meet their healthcare needs and also generate much-needed income. “Surgery is the economic engine of a hospital,” said Dorothy Urschel, doctor of nursing practice who heads the nurse practitioner program at Daemen College and serves as chief operating officer at Columbia Memo-
rial Health near Albany. “We had to close some surgery sites and primary care sites.” She calls the current situation ironic since hospitals must care for the sickest patients while they had to furlough some staff. “Most hospitals look at their cash positioning and evaluate ‘How do we work together to make sure we’re financially healthy at the end of all this?’” Urschel said. Early in the outbreak, she didn’t think surgical units would have to be shut down, as even during a bad flu season, surgeries continue. Urschel said that she felt “shock” as state and federal orders suspended elective surgery. One big key is getting elective surgery patients back to the hospital for care. Many still feel concern over social distancing, especially in a medical setting. In general, they feel that visiting a hospital is a sure way to contract the coronavirus. “We’re working with the community at large and developing a ‘marketing campaign’ to make sure they understand it’s a safe place to come back to,” Urschel said. “We need to make sure that we present ourselves as a hospital they trust. What we’re looking at is COVID awareness, preparing the patients and staff and the community at large and each patient issue to still deliver a high quality of care.” Urschel also believes that it’s a good time for hospital administration to evaluate how they can improve their organizations and look at how they can manage resources better, grow and increase revenue. In an April 23 release, Catholic Health’s president and CEO Mark Sullivan said that the organization’s leaders would take temporary salary
June 2020 •
cuts, but that wouldn’t be enough to make up the difference. “Because we will not be able to resume full services at all our facilities for some time, we have made the extremely difficult decision to furlough associates throughout our system,” Sullivan said. “The steps we are taking are based on the needs of our system at this time and do not reflect our associates’ work performance, or the value we place on the care or services they provide. As always, high quality care and patient, resident, and associate safety remain our top priorities.” The health system furloughed up to 1,200 management and non-management in its first phase. “In times of crisis, we must make hard decisions to face the challenges before us, ensure we are able to meet the needs of our community, and provide for and protect our associates for the longterm,” Sullivan said. On May 6, area hospitals were given the green light to resume elective surgeries. Another area struggling is the emergency room. In an April 25 statement, David Hughes, MD, chief medical officer at Kaleida Health, acknowledged that some people fear seeking medical care for health threats. “We are still seeing people coming in with chest pains and stroke symptoms,” Hughes said, “just not the sheer volume that we had before. And there are some national statistics to show that people are staying away. We want people to seek care immediately if they are experiencing any signs or symptoms of a serious condition.” At that time, Kaleida was receiving about half the normal emergency room visits.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
Q A &
Kirsten Vincent Interim CEO at Recovery Options emphasizes the value of peer work in providing services to people with mental health issues By Michael J. Billoni
Too Many Sugary Sodas Might Harm Your Kidneys Drinking lots of sweetened soda may increase the risk of developing chronic kidney disease, two new studies find. “Consumption of 500 milliliters [16.9 fluid ounces] of a commercially available soft drink sweetened with highfructose corn syrup increased vascular resistance in the kidneys within 30 minutes,” the researchers found. In a second study, the investigators found changes in blood flow in the kidneys was caused by the corn syrup, not the caffeine, in the soda. The two studies included a total of 25 healthy men and women, with an average age of 22 to 24. Christopher Chapman, of the University at Buffalo in New York, and colleagues explained that vascular resistance occurs when blood vessels constrict, reducing blood flow in the kidneys and increasing blood pressure and impairing kidney function. “Collectively, our findings indicate that [highfructose corn syrup]-sweetened soft drink consumption increased renal vasoconstrictor tone at rest and during sympathetic activation,” the study authors said in a news release from the American Physiological Society. The report was published online recently in the American Journal of Physiology — Renal Physiology. Nearly 37 million Americans suffer from chronic kidney disease, according to the National Kidney Foundation. The foundation estimates kidney disease kills more people than breast cancer or prostate cancer.
Whom do you serve? “People who struggle with mental health or substance use disorders. Recovery Options is committed to decreasing stigmas by increasing the awareness of mental illness through information, education and advocacy. Efforts are focused on recipients, family members, community members and mental health professionals in the counties of Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Livingston, Monroe, Niagara, Orleans and Wyoming.” What is the benefit to a peer organization? “As peers we utilize our lived experience for the benefit of others. We have been there and we understand many of the struggles people face, and while my experience is going to be different from the person next to me, we still share the common theme of have lived experiences to that we can draw off to support each other. Being able to utilize our lived experiences really allows us to create genuine, authentic relationships with the people we work with, because we are people helping people.” How do you keep people out of the hospital? “Our hospital diversion programs give people alternatives to traditional hospital services while saving Medicaid millions of dollars every year. Our peer services provide a person centered, self-directed form of service that takes a holistic approach to working with a person.”
irsten Vincent, Ph.D., is interim CEO at Recovery Options, a nonprofit that provides housing and support services to individuals facing mental health issues. She has more than 25 years of experience in the field through her work in Western New York and the Finger Lakes regions and believes peer services are an integral part of creating a consistent, secure, safe and non judgmental circle of support. Recovery Options is a nearly $6.3 million annual operation. We recently spoke with her about the organization. What is Recovery Options? “Formerly Housing Options, we are a nonprofit-supported housing and community support agency developed and operated by and for
recipients of mental health services. Our aim is to achieve social equality for individuals with mental illness by providing housing and support services so individuals may live with dignity and have choices in the community. Recovery Options programs include housing, supported by peer care management. Care managers help those in recovery have access to and utilize the services they need. Respite for those in need of a time for rejuvenation is available in our Buffalo and Jamestown houses. Our Warm Lines help people across our footprint receive anonymous support when they need to reach out for support. Our Bridger and Renewal Center Hospital Diversion programs help people coming from Buffalo Psychiatric and Rochester Psychiatric Centers find their place in the community.”
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2020
Why was the organization rebranded? “We wanted our name to be a truer reflection of the work we do in supporting the recovery of individuals, their families and the community. In 1990, the agency was founded [as Housing Options] to support people who were coming out of the Gowanda Psych Center find safe and secure housing, and to provide continued supports to the people in our program. Through the ‘90s and early 2000s we expanded our housing program to cover multiple counties throughout Western New York. We then expanded our programs to include Peer Bridging, which is a program that has a certified peer work with someone who is coming out of the hospital to help support their reintegration into the community. We also opened our peer-run warmlines, which are a peer support phone lines and we opened the first multi-county recovery center for people with mental health issues. Then, in 2015 we opened two peer-run short-term crisis respites. These are 24/7 respites for anyone who is experiencing difficulties and who need a place to go and work through the crisis they are experiencing. In 2017 we then expanded into medically integrated programs such as our Community Integration Team and our partnership in The Renewal Center, which is a hospital diversion crisis center. Our rebranding will help people better understand how we can support their recovery.” How can people support you? “Many of our programs receive New York state or county funding, but we do require additional financial support through donations, which can be made by visiting www. recoveryoptions.org. For those in need of support, call 716-532-5508 or 800-421-1114.”
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PUR: New Test May Help Determine Prostate Cancer Risk How effective is the urine test for prostate cancer? It’s been available for about a year now. Is it working? By Deborah Jeanne Sergeant
fter receiving a diagnosis of prostate cancer, men and their healthcare providers have many decisions to make together. Prostate cancer treatment can result in urinary incontinence and impotence, and since many prostate cancers are slow-growing, a man may be a good candidate for active surveillance, depending upon many factors such as comorbidities, age and ethnicity. Other than periodic check-ups to ensure the cancer isn’t growing, he may not require further treatment. Historically, testing has involved a prostate specific antigen (PSA)
blood test, digital rectal exam and biopsies to determine if their cancer is growing. Understandably, prostate cancer patients don’t like the invasive tests. About a year ago, researchers in the UK announced a new prostate urine risk (PUR) test that may help test risk of their cancer becoming more aggressive. The trial included 500 men, most of whom had prostate cancer. It was able to detect men who are up to eight times less likely to need radical treatment within five years. “People don’t know about it and even most urologists don’t know
about them,” said physician John Rutkowski at UBMD Urology. “It’s an interesting idea, but there’s a lot of work that needs to be done for validating these ideas.” The test looked at the biosignature or genetic profile of patients and found 36 genes that enabled them to determine risk. Rutkowski estimates the PUR test likely won’t be available for five years or so. A blood or urine test is much less invasive than biopsy. The PSA blood test also gives false results — both negative and positive — so something more accurate that could
June 2020 •
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prevent the need for a biopsy would benefit patients. Rutkowski encourages men with prostate cancer to discuss all the options available. He said that a problem with the PSA blood test is that it’s not specific to prostate cancer as any number of health factors Rutkowski could elevate a man’s PSA without reflecting the presence of cancer or the aggressiveness of an existing cancer. The US Preventive Task Force has questioned the benefit of the PSA a few years ago because of false results; however, it has since said it offers some merit and it remains part of the ways urologists test for and manage prostate cancer. Prostate MRI is being used more than ever with diagnosed men, as biopsies can be painful and cause infection. MRI can also guide biopsy if providers see something that looks like cancer. Physicians can use MRI to focus radiation therapy on that focal point instead of treating the entire prostate. A newer tool in the urologist’s toolbox is the 4-K blood test, which tests a few molecular variations of the PSA and uses a formula that includes biopsy history, age and other factors to give a number indicating risk. John DeBerry, III, a board-certified urologist practicing in Buffalo, is also interested in the PUR test. “I think that it might be very useful, but it will depend upon different studies looking at it in a wider cross section of patients,” DeBerry said. He is also making use of MRI to “hone in on the higher risk cancer,” he said. “We have a higher yield of clinically significant cancer present and we can repeat MRI imaging for monitoring.” Health insurance typically covers annual prostate MRI for patients with a negative biopsy and elevated PSA or those diagnosed with cancer and are on active surveillance. “It doesn’t usually cover a screening MRI for someone with an elevated PSA but no biopsy,” DeBerry said.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
Volunteers are an integral part of hospice care, which coordinates symptom and medication management in addition to offering emotional, social and spiritual support. The photos can all be credited as “Courtesy of Hospice & Palliative Care Buffalo”
Hospice Care: The Hidden and Lesser-Known Benefits Hospices in WNY serve a wide range of people, provide sense of relief to patients and family By Jana Eisenberg
hile people are slightly more aware of what hospice care is than they have been in the past, misconceptions are still prevalent, like the belief that hospice is only appropriate and applicable for the very last days of a patient’s life, and only provides drugs like morphine. Hospice professionals and advocates are working hard to help doctors, patients and the general public better understand the range of care that hospices provide, when,
and for whom. The underlying philosophy of hospice care is to help people who are chronically or terminally ill maintain a comfortable, dignified and high quality of life while looking at their illness and circumstances with clarity. Hospice care takes into consideration the patient, as well as their family members and others who may be caring for them. At Hospice & Palliative Care Buffalo, Lynn Riker, director of outreach, said in addition to end-of-life care,
people of all ages and stages who are living with a chronic or serious illness might be candidates for the organization’s services. “For people with a chronic illness diagnosis, like congestive heart failure, chronic obstructive pulmonary disease, cancer or dementia, there is opportunity for quality of life care,” she said. “They may live for a long time with an illness, and the likelihood that they’ll need this type of care is high. Rather than learning about it when they are in crisis, we think a lot more people — patients and their families and caregivers — could benefit from learning about it long before they actually need it.” Jane James, a nurse practitioner and director of admissions for Niagara Hospice, added, “We are eager to have people, and even physicians, realize that hospice care isn’t just for the last days; it can be for months. Yes, it’s for people with late-stage illnesses, but we help with a collaborative approach that addresses everything including symptom and medication management, and use tools like weekly ‘team’ meetings to help communicate between the family, patient and caregivers to make sure they’re on the same page.” In addition, not everyone realizes that Medicare covers hospice care as well as many other insurance providers. If someone is not covered, but is a candidate for the services, the hospice provider will often provide the services regardless of the patient or family’s ability to pay.
Sense of relief Riker and James both say that a sense of relief is frequently an element that people interacting with hospice care experience. “Death is part of life, but we don’t talk about it a lot,” said Riker. “It’s very common when we’re talking with someone who has a progressive illness and declining health to hear them say things like, ‘I’m tired of going to the hospital; it’s not helpful anymore. My family and loved ones are seeing me decline and that’s hard; they need support. If I could choose, I’d rather die at home
than in the hospital.’” Aiming to bring quality of life and comfort of all types to the whole family unit, hospice care is capable of coordinating and providing people and services like nurses, social workers, spiritual care counselors, respite for caretakers, pharmacists, volunteers, and massage or music therapy. “There’s no better care when someone is struggling with advanced illness. When in hospice, you can call somebody 24/7, if there’s a new symptom or a new challenge,” said Riker. “There’s a sense of relief once patients and families get in the program — this can be absolutely overwhelming to everyone,” said James. “We specialize in this, we can confidently anticipate what’s going on and gauge how things are progressing.” Other services that many hospice programs offer include programs for children and teens with life-limiting illnesses, providing home-based palliative care — that’s controlling the symptoms, but not attempting to heal or cure — as well as other supports for the families. They also offer grief and loss support to caregivers and loved ones associated with that patient for up to 13 months. Veterans are frequently offered additional support. Both Riker and James iterated that providing guidance, resources, referrals, information and education are top-of-mind for their organizations, and that, even if you are not sure whether hospice is right for you or someone you know, it’s important to reach out, and learn more. And it should be sooner rather than later. Hospice & Palliative Care Buffalo 225 Como Park Boulevard Cheektowaga, NY 14227-1480 HospiceBuffalo.com 716-686-8000 Niagara Hospice 4675 Sunset Drive Lockport, NY 14094-1231 www.niagarahospice.org/ 716-439-4417
Hospice helped us much earlier than we thought
HospiceBuffalo.com (716) 686-8000
Visit HospiceBuffalo.com to hear Linda’s story. Page 16
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2020
Weare arehiring hiring Home Health We HealthAides! Aides!
By Jim Miller
What Older Diabetics Should Know About Coronavirus
If youare areNew NewYork YorkState-certified, State-certified, apply If you applytotojoin join ourfamily familyand andcare care for Niagara our NiagaraCounty County familiesfaced facedwith with late-stage late-stage illnesses. families illnesses.
NiagaraHospice.org/careers NiagaraHospice.org/careers 716-439-4417 716-439-4417
Dear Savvy Senior, My husband and I are both in our late 60s and have diabetes. We would like to find out if our diabetes increases our risk of getting the coronavirus. Concerned Diabetics
Dear Concerned, Currently, there’s not enough data to show that people with diabetes are more likely to get COVID-19, the disease caused by the coronavirus, than the general population. But the problem for diabetics is, if you do happen to contract the virus, your chance of developing serious complications are much higher. This is especially true if your diabetes isn’t well-controlled. Here’s what you should know.
Diabetic Risks Health data is showing that about 25% of people who go to the hospital with severe COVID-19 infections have diabetes. One reason is that high blood sugar weakens the immune system and makes it less able to fight off infections. Your risk of severe coronavirus infection is even higher if you also have another condition, like heart or lung disease. If you do get COVID-19, the infection could also put you at greater risk for diabetes complications like diabetic ketoacidosis (DKA), which happens when high levels of acids called ketones build up in your blood. Some people who catch the new coronavirus have a dangerous bodywide response to it, called sepsis. To treat sepsis, doctors need to manage your body’s fluid and electrolyte levels. DKA causes you to lose electrolytes, which can make sepsis harder to control.
How to Avoid COVID-19 The best way to avoid getting sick is to stay home as much as you can. If you have to go out, keep at least 6 feet away from other people. And every time you come back from the supermarket, pharmacy or another public place, wash your hands with warm water and soap for at least 20 seconds. Also wash your hands before you give yourself a finger stick or insulin shot. Clean each site first with soap and water or rubbing alcohol. To protect you, everyone in your
Subscribe to house should wash their hands often, especially before they cook for the family. Don’t share any utensils or other personal items. And if anyone in your house is sick, they should stay in their own room, as far as possible from you. The CDC also recommends that you stock up on medications and diabetes testing supplies to last for at least a month. The same goes for grocery supplies and other household necessities. Also know that Medicare is now covering the cost of telehealth visits, so if you have questions for your doctor, you can ask by video chat or phone instead of going into the office.
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5 THINGS YOU SHOULD KNOW ABOUT IT
If You Get Sick The most common symptoms of COVID-19 are a dry cough, fever or shortness of breath. If you develop any symptoms that are concerning, call your doctor about getting tested. If you find that you have contracted COVID-19, the first level of care is to stay home and check your blood sugar more often than usual and check your ketones too. COVID-19 can reduce your appetite and cause you to eat less, which could affect your levels. You also need more fluids than usual when you’re sick, so keep water close by, and drink it often. You should also know that many over-the-counter medicines that relieve virus symptoms like fever or cough can affect your blood sugar levels one way or the other. So, before you take anything check with your doctor. And be aware that if you start experiencing severe shortness of breath, high levels of ketones or DKA symptoms like severe weakness, body aches, vomiting or belly pain, you need to see your doctor or get to an emergency room right away. Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior. org. Jim Miller is a contributor to the NBC Today show and author of “The Savvy Senior” book.
Physician Nadia Kousar, infectious disease specialist at Rochester Regional Health, explains the basics of the virus that has killed more than 2,000 so far
DIABETES BREAKTHROUGH Buffalo endocrinologist Kathleen E. Bethin talks about breakthrough drug that improves the lives of kids with diabetes
MARCH 2020 • ISSUE 65
SHOULD YOU SKIP BREAKFAST?
APRIL 2020 • ISSUE 66
CORONAVIRUS Getting on with our lives in this new age Special Issue
Celebrity TV doctor Mehmet Oz recently said people should skip breakfast. Should you heed his advice? Do we really need the ‘most important’ meal? P. 13
Beware of Coronavirus Scams P. 13
Autism: Why Are Incidence Rates So High 2 million lost health coverage or access in Trump’s ﬁrst year
PARKINSON’S How to detect the disease and what to do when you’re diagnosed
‘Spring Forward’ Brings Surge in Fatal Car Crashes
Yes, there’s something new in the air in WNY — hatchets P. 11
Little Lentils Dish Up Big Beneﬁts P.12
RECORD NUMBER OF PEDESTRIAN DEATHS IN U.S.
Local experts discuss the dramatic increase in cases of autism in the U.S.
Study estimates 6,590 pedestrian deaths in 2019, an increase of 5% over previous years
The Amazing Beneﬁts of Olive Oil
Visits to Pediatricians on the Decline P.8
Pot Use Among Seniors Nearly Doubled in 3 Years
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uring this time when our physical offices are closed to the public, you may wonder, “How can I get help from Social Security without visiting an office?” You can find the answer at www. ssa.gov/onlineservices, which links you to some of our most popular online services. You can apply for retirement and disability benefits, appeal a decision and do much more. Our newest My Social Security feature, Advance Designation, enables you to identify up to three people, in priority order, who you would like to serve as your potential representative payee in the event you ever need help managing your benefits. We have updated our Frequently Asked Questions at faq.ssa. gov/en-us/Topic/article/KA-10039 to answer questions you may have about Advance Designation. You can also apply for Medicare online in less than 10 minutes with no forms to sign and often no required documentation. We’ll process your application and contact you if we need more information.
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Q: If I receive Supplemental Security Income (SSI) disability benefits, what is 6/2/10 9:46:04 AM the effect on my benefits if I work? A: In most cases, your return to work would reduce your benefit amount. Unlike Social Security disability, there is no “trial work period” for people who get SSI disability benefits. If your only income besides SSI is from your work, you can earn up to $ 1651 in a month (in 2020) we stop your payments. Re9:46:04 AM6/2/10before 9:46:046/2/10 AM 9:46:04 AM porting wages each month helps us pay the correct amount of SSI. Timely reporting may also prevent you from owing us money or may allow us to pay a higher amount. We have several publications about SSI, including Reporting Your Wages When You Receive Supplemental Security Income, available at www.socialsecurity.gov/ pubs. Note that there are other work incentives that can help you return to work when you receive SSI. You can read about them in What You Need To Know When You Get Supplemental Security Income (SSI), also available at www.socialsecurity.gov/ pubs. For more information, visit our website at www.socialsecurity.gov.
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2020
Visit www.ssa.gov/benefits/ medicare to apply for Medicare and find other important information. If you’re eligible for Medicare at age 65, your initial enrollment period begins three months before your 65th birthday and ends three months after that birthday. We’ve organized our Online Services webpage into four popular categories for easy navigation: • Review Your Information. You can access your secure, personal information and earnings history to make sure everything is correct. You can even print statements with ease. • Apply for Benefits. You can apply for retirement, disability, and Medicare benefits without having to visit a field office. • Manage Your Account. You can change your direct deposit information and your address online. • Find Help and Answers. We’ve answered your most frequently asked questions, and provided links to publications and other informational websites. Let your family and friends know they can do much of their business with us online at www.ssa.gov.
plan costs be reviewed and, if so, how often? A: If you get the Extra Help, Social Security may contact you to review your status. This reassessment will ensure you remain eligible for Extra Help and receive all the benefits you deserve. Annually, usually at the end of August, we may send you a form to complete: Social Security Administration Review of Your Eligibility for Extra Help. You will have 30 days to complete and return this form. Any necessary adjustments to the Extra Help will be effective in January of the following year. Go to www.socialsecurity.gov/prescriptionhelp for more information. Q: I went back to work after retiring, but now the company I work for is downsizing. I’ll be receiving unemployment benefits in a few weeks. Will this affect my retirement benefits? A: When it comes to retirement benefits, Social Security does not count unemployment as earnings, so your retirement benefits will not be affected. However, any income you receive from Social Security may reduce your unemployment benefits. Contact your state unemployment office for information on how your state applies the reduction to your unemployment compensation.
H ealth News Independent Health Recognized for Highest Member Satisfaction Independent Health is the highest-ranked health insurance plan for member satisfaction among commercial health plans in New York state, according to J.D. Power’s 2020 U.S. Commercial Member Health Plan Study. Conducted through an online survey across 21 market-based regions, J.D. Power’s annual syndicated study examines the experience of health plan members and recognizes health plans in the country that are committed Cropp to providing a high level of customer satisfaction for their members and their communities. For 2020, Independent Health scored the highest in four of six categories (customer service; coverage and benefits; information and
Roswell Park Appoints Three to Key Roles in Nursing, Clinical Research and Critical Care Roswell Park Comprehensive Cancer Center recently announced the appointment of new leaders in three key areas of clinical care. They are: • Mary Ann Long, who returns to Roswell Park as senior vice president of nursing. She brings critical experience to the table, and will focus on evaluating service in inpatient, outpatient and community practices and also providing leadership to all
communication; and provider choice) among the plans surveyed in New York state. Independent Health’s overall score was 783, which is 71 points above the state average score of 712 and a 36-point improvement over the company’s score from a year ago. “As a customer-centric company, Independent Health is honored to be recognized as the health plan with the highest member satisfaction in New York state by an organization that is internationally known as being the voice of the customer,” said physician Michael W. Cropp, president and chief executive officer, Independent Health. “Health care can be complex at times, which is why we are committed to making sure our members have the information, resources and tools they need to understand their benefits and make better decisions about their health. Now more than ever, it is critical for us to be a trusted resource to our members. During this particularly stressful time, we want our members to know they can count on us when it comes to coverage, services and questions related to the current pandemic.” J.D. Power’s 2020 U.S. Commercial Member Health Plan
Study is based on the responses of 31,283 members in 149 health plans throughout the United States. Results are based on experiences and perceptions of members surveyed from January through March 2020. Other honors for Independent Health
nursing teams across the center. Long was previously director of magnet at Roswell Park until her retirement in 2012. She and also served as assistant director of nursing and director of patient care services, in addition to more than 30 years of service as an intensive care unit nurse. She has a master’s degree in health services information from D’Youville College and a bachelor’s degree in nursing from the University at Buffalo. • Laurie J. Smith joins as vice president of clinical research services department (CRS), which provides treatment options for patients through clinical trials, or studies that assess emerging treatments or approaches, ensuring patient safety
and generating important data that guide oncology experts worldwide on new treatments. As vice president of CRS, Smith will support more than 400 active clinical trials a year and supervise staff engaged in study submission, study implementation, data collection and management. She previously served as an independent consultant and, prior to that, as vice president of clinical research for AMITA Health in Chicago. She received her master’s degree from Webster University and a bachelor’s degree from the University of Missouri. • Physician Timothy Quinn promoted to chief of critical care. He was previously co-director of the intensive care unit. He will work
• Independent Health was one of the highest-rated health insurance plans in the nation for clinical quality and member satisfaction, according to the 2019-2020 Private Health Insurance Plan Ratings by the National Committee for Quality Assurance (NCQA), a private, leading organization dedicated to improving health care quality. NCQA reviewed nearly 400 health plans throughout the country and rated each plan on a 5-point scale for consumer experience, prevention and treatment. Overall, Independent Health’s HMO/POS (commercial/private) plan received a 4.5 out of 5 rating. • Independent Health was named to U.S. News & World Report’s annual list of the best health insurance companies offering Medicare Advantage coverage in 2020. Independent Health was the only Western New York-based plan
be included on the list. U.S. News & World Report created the “Best Insurance Companies for Medicare Advantage” list by analyzing each plan’s Medicare Star Rating for 2020. • Independent Health’s Medicare Advantage plans received a 4.5 out of 5 star rating from the Centers for Medicare & Medicaid Services (CMS) for 2020. This annual star rating was created as a way for Medicare beneficiaries and CMS to assess the overall quality and service of Medicare Advantage plans throughout the country. Independent Health’s Medicare Advantage HMO plan has received a 4.5 star rating every year since 2011, and its Medicare Advantage PPO plan received a 4.5 star rating for the fifth straight year. • Independent Health is one of only five companies to be named “one of the best companies to work for” in New York State for the past 12 years. The ranking is based on a company evaluation and associate survey conducted by Best Companies Group. • From 2010 through 2013 and then again in 2016, Independent Health received the award from J.D. Power for ranking highest for member satisfaction in the New York-New Jersey region.
with members of Roswell Park’s intensive care unit and intermediate care unit to provide cutting-edge and evidence-based oncologic care to patients. A critical care anesthesiologist at the center, Quinn’s research interests include preoperative evaluation of high-risk patients, intraoperative care and postoperative quality-improvement initiatives. Quinn earned his medical degree from Georgetown University School of Medicine and completed residency and fellowship training at Brigham and Women’s Hospital/Harvard Medical School.
ECMC Again Earns Highest Patient Safety Rating in National Survey ECMC’s receives an ‘A’ for the second time from nation’s preeminent safety organization
rie County Medical Center Corporation recently announced that The Leapfrog Group, an independent, national nonprofit organization founded more than a decade ago by the nation’s leading employers and private health care experts, has again rated ECMC’s overall patient safety score at ‘A’. ECMC had previously earned the organization’s highest patient safety score in April 2017. The Leapfrog patient surveys assesses: medical errors, accidents, injuries, infections and patient experiences. The national organization is committed to driving quality, safety, and transparency in the U.S. health care system; their annual patient safety surveys assign A, B, C, D and F
letter grades to hospitals nationwide. ECMC was one of 12 hospitals in New York state to receive the Leapfrog ‘A’ patient safety rating. Nationally, ECMC joins the ranks of other national healthcare systems receiving a Leapfrog ‘A’, such as Cleveland Clinic and Mayo Clinic. “Our goal is to inform patients about local hospitals with the best safety measures in place and the strongest records,” said Leah Binder, president and CEO of The Leapfrog Group. “Every hospital can earn an ‘A’ grade, and we’re proud of the hospitals that are committed to making an effort to protect patients from harm.” Thomas J. Quatroche, Jr., Ph.D., ECMC president and CEO said, “On
behalf of the over 4,000 dedicated and skilled caregivers at ECMC, we are thrilled to again receive this exceptional rating from such a respected national organization. Leapfrog is all about quality and safety and confirms ECMC is a national best-inclass healthcare system. There are not many large public, academic, safety-net hospitals across the country who have achieved a Leapfrog ‘A’ let alone doing it twice. This confirms what we have witnessed repeatedly in recent years — the quality and compassionate care of our doctors, nurses, clinicians, environmental services, and our entire ECMC Family, has transformed ECMC into a leading, national healthcare system and hospital of choice for patients seeking
June 2020 •
our care.” Developed under the guidance of an expert panel, the Leapfrog Hospital Safety Grade uses 28 measures of publicly available hospital safety data to assign A, B, C, D and F grades to approximately 2,600 U.S. hospitals twice per year. It is calculated by top patient safety experts, peer-reviewed, fully transparent and free to the public. The Leapfrog Group states on its website that they “strive to make giant ‘leaps’ forward in the safety, quality and affordability of health care in the U.S. by promoting transparency through our data collection and public reporting initiatives. More than 2,600 hospitals voluntarily participate free of charge.”
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • June 2020