IGH WNY 50 December 18

PRICELESS

Meet Your Doctor Chet Fox, chief medical officer at G-Health Enterprises and a local pioneer in the field of practice-based research in primary care medicine, talks about his organization, career

BFOHEALTH.COM

December 2018 • ISSUE 50

HOLIDAYS If the winter holidays are the most joyous time of the year, why do so many people get depressed?

INSIDE • This is a great time to put your family’s health history together • Gifts for the person who has everything • How to pick healthful food gifts for college students, parents, seniors

Starting on page 15

Tonsillectomies It turns out that most Tonsillectomies are not needed

NY Ranks High in New Cases

Spirit of Giving Buffalonians in general step up in a big way by volunteering, supporting or donating. That’s particularly true at this time of year, as the holidays seem to bring out the “good neighbor” in a big way. So, this year, Buffalo, as you shop ‘till you drop, also consider opening your hearts and wallets and giving back. page 16

Local experts say HIV figures in the state are skewed by the high numbers seen in New York City

Mussels These scrumptious mollusks possess the most impressive nutritional profile of all shellfish, especially when it comes to vitamin B-12, selenium and manganese page 13

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Need a Health Coach?

They can offer help on nutrition, wellness, stress and a number of other things

page 13

Blue Fund Awards $2.7 Million to Nine WNY Groups Groups ranging from KaBOOM! to Save the Michaels of the World receive grants from BlueCross BlueShield to implement healthrelated projects

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s part of its inaugural Blue Fund grant cycle, BlueCross BlueShield of Western New York recently announced $2.7 million in grant funding to nine major health-based projects across Western New York.

The nonprofit, community-based health plan launched the Blue Fund in July to support organizations and initiatives that work collaboratively to address key health areas and demonstrate enhanced measurable outcomes for the community.

This round of grants are for nine regional projects that will have a positive impact on behavioral health, cardiovascular health, diabetes, health-care workforce development, healthy children and the opioid epidemic.

“As the region’s longest-standing health plan, we’re investing in initiatives that address important needs in our community to create a healthier state for everyone,” said David W. Anderson, BlueCross BlueShield of Western New York president and CEO. “These and future Blue Fund grants will enhance local organizations and efforts that address barriers to health and improve key health outcomes.”

These grants, funded from the health plan’s reserves, were awarded in addition to the health plan’s current corporate partnerships and

sponsorships, which saw investments of more than $2 million in Western New York in 2017.

Below are the recipients of the inaugural Blue Fund awards: n Community Connections of New York, Inc. Amount awarded: $224,699 Purpose: To support expansion of positive emotional development and learning skills (PEDALS) in the Southern Tier. This project will bring a proven model for improving social and emotional development in preschool-age children to an additional population in the region and will benefit approximately 380 children over the two-year funding period. n The Horizon Corporations, $500,000 Purpose: To support construction of the training and family center, a new multi-purpose building that will provide a venue for advanced training for behavioral health workers, provide expanded and innovative programming for family members whose loved ones are in residential addiction treatment facilities, and develop a more robust after-care program for people successfully completing residential addiction treatment. n Jericho Road Ministries, $303,279 Purpose: To support the medically oriented gym program in jericho road ministries community

U.S. Smoking Rates Hit Record Low

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igarette smoking rates have dropped to the lowest level ever recorded, U.S. health officials reported in November.

“This new all-time low in cigarette smoking among U.S. adults is a tremendous public health accomplishment — and it demonstrates the importance of continued proven strategies to reduce smoking,” Centers for Disease Control and Prevention Director Robert Redfield said in an agency news release.

Among adult smokers, the smoking rate fell from 15.5 percent in 2016 to 14 percent in 2017.

That rate was 67 percent lower than it was in 1965.

Among young adults (aged 18 to 24), the rate fell from 13 percent in 2016 to 10 percent in 2017, according to the report.

“Despite this progress, work remains to reduce the harmful health effects of tobacco use,” Redfield added.

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fitness center. The gym will address the lack of affordable, safe access to fitness facilities in Buffalo’s East Side neighborhoods, work to decrease the effects of chronic disease, and aim to decrease health-care expenditures related to obesity, diabetes, hypertension, and cardiovascular conditions. n KaBOOM!, $300,000 Purpose: To support a community-built playground to give children equitable access to great play spaces. Two economically challenged Western New York communities, comprised of 5,000 children, will be playing more often and more actively. Volunteers, including BlueCross BlueShield of Western New York employees, will assemble play components, build decks, add landscaping and create murals — making the playgrounds beautiful community gathering spaces. n Visiting Nursing Association of Western New York, $500,000 Purpose: To launch a nurse residency program that addresses the growing need for home-care nurses in Western New York. The VNA will hire from a pool of more than 500 local graduate nurses each year and effectively train and prepare them for a career in home care. Funds will also be used for skilled nurse mentor preceptors and upgrades to training equipment. n Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, $200,000 Purpose: To support the expansion of emergency access to medication-assisted treatment (MAT) and rapid referral to long-term community treatment for patients with opioid-use disorder. With this project, emergency department staff can call a 24/7 hotline and schedule follow-up appointments at participating MAT clinics, and patients can choose from 64 weekly appointment slots at one of 27 Western New York substance-abuse treatment clinics. Each clinic has agreed to reserve spots for patients

in the program regardless of their ability to pay. This solution can be adapted for other patients and communities throughout the region. n Save the Michaels of the World, Inc., $100,000 Purpose: To support the courtto-treatment transportation program, which transports individuals who are being sentenced to inpatient rehabilitation facilities — resulting in long-term recovery, reduced recidivism, and saved lives. In partnership with the New York state court system, Save the Michaels of the World will expand its work to 44 courts in Western New York. n Say Yes Buffalo, $298,848 Purpose: To support a schoolbased health home-care management program that places Say Yes health home care managers in Buffalo public schools to address the vast health needs of children. The pilot program will provide school-based comprehensive care coordination, health promotion, patient and family supports, and service referrals to the neediest students. These interventions will take a holistic view of children’s health. n Western New York Land Conservancy, Inc., $246,000 Purpose: To support the design and implementation of the DL&W multi-use trail and linear park.

The project will transform the abandoned DL&W rail corridor into a safe and accessible recreational asset connecting downtown Buffalo near Canalside to the Buffalo River at Riverbend, through the Old First Ward, Perry, and Valley neighborhoods. The inspiring community gathering place will be the focal point of a revitalized, healthy community and restored natural ecosystem. As a welcoming space for people of all ages, abilities, and backgrounds, it will improve the physical and mental health for youth, residents, and visitors.

To learn more about Blue Fund and the 2019 grant cycle submission and selection process, visit bcbswny. com/bluefund.

cigars (3.8 percent); e-cigarettes (2.8 percent); smokeless tobacco (2.1 percent); and pipes, water pipes, or hookahs (1 percent).

Of the 47 million U.S. adults who use any tobacco products, about 9 million (19 percent) use two or more.

The most common tobacco product

combination was cigarettes and e-cigarettes.

The report was published in the CDC’s Nov. 9 Morbidity and Mortality Weekly Report.

About 16 million Americans currently have a smoking-related illness, the CDC researchers noted.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, agreed.

“Despite our progress, tobacco use still kills more than 480,000 Americans and costs $170 billion in health care expenses each year,” Myers said in a news release from the advocacy group.

He said full implementation of key initiatives — higher tobacco taxes, comprehensive smokefree laws, hard-hitting mass media campaigns and raising the smoking age to 21 — could lower rates further still.

The report found that one in five adults used a tobacco product in 2017, including smoked, smokeless and electronic tobacco products.

Among adults with serious psychological distress, two in five used tobacco products.

Cigarettes were the most commonly used tobacco product (14 percent) among adults, followed by cigars, cigarillos, or filtered little

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • December 2018

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Virtual Urgent Care: Connecting Doctors with Students New program introduced at Frontier Middle School in Hamburg is one of the first of its kind in the country

By Daniel Meyer

Turns Out That Most Tonsillectomies Not Needed

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onsillectomies were once very common. According to Medscape, 1.4 million tonsillectomies were performed in the United States in 1959.

However, by 1987 — less than 30 years later — that number had dropped to 260,000, and it is even smaller today. Now, a new study revealed that doctors may still be performing too many tonsillectomies.

According to a study conducted by the University of Birmingham and published in the British Journal of General Practice, seven out of eight tonsillectomies are unnecessary.

Researchers analyzed the medical records of more than 1.6 million children from the United Kingdom. What they found was that of the 18,271 children who had their tonsils removed, only 2,144 (or 11.7 percent) actually needed the surgery.

What’s more, they found many children who actually need tonsillectomies are not receiving them: 15,764 children had records showing sufficient sore throats to undergo surgery but only 2,144 (13.6 percent) actually received them.

Physician Tom Marshall, professor of public health and primary care at the University of Birmingham, explained in a statement, “Research shows that children with frequent sore throats usually suffer fewer sore throats over the next year or two.” For kids with enough documented sore throats, the improvement is slightly quicker after having a tonsillectomy, which means surgery makes sense in those situations, he added. But the research suggests children with fewer sore throats don’t benefit from the procedure enough to justify surgery because those sore throats tend to go away anyway.

Of course, one may wonder what the harm is in performing an unnecessary operation, especially on a body part we can certainly live without. However, according to the Mayo Clinic, tonsillectomies come with numerous risks, including uncontrolled bleeding, reactions to anesthetics or infections.

“Children may be more harmed than helped by a tonsillectomy,” Marshall said in the statement.

As such, researchers are hoping doctors and parents weigh the pros and cons of the procedure more closely.

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new healthcare initiative designed to use telemedicine in a school nurse’s office is helping to break ground while aiming to meet current day healthcare challenges, which includes reducing chronic student absences and helping to eliminate the large amount of students having to leave school for doctor appointments.

The new program was launched in November following approval by officials in the Frontier Central School District, who agreed to work with Mobile Healthcare Partners as part of a partnership that provides telemedicine services to the school system at no charge by billing insurance companies for students who have health care coverage.

The use of video conferencing technology is connecting doctors to their patients who are students at Frontier Middle School in Hamburg, which has close to 1,2000 boys and girls enrolled in grades six, seven and eight, the largest middle school in all of Erie County. It is believed this is one of only two programs of its kind to exist in New York state and is one of just a handful to be implemented in the entire country.

According to school district officials, nearly 14 percent of students who attended Frontier Middle School last year were defined as being “chronically absent,” meaning that each of those students had at least

18 or more documented absences during the 180-day school year. It is believed that a lack of healthcare and an inability for some families to have their children regularly visit a physician may have played a role in those students missing at least 10 percent of scheduled classroom instruction time.

“By increasing access to health care right in our nurse’s offices, we hope to be able to reduce the number of absences by seeing students become well faster,” said Richard J. Hughes, who serves as Frontier Central’s top administrator as district school superintendent. “We have also applied for grants that would allow us to expand the program to all Frontier students without spending local tax dollars.”

The Frontier school board was given a demonstration earlier this year that highlighted the many features of “remote doctor visits” that can take place inside the office of the school nurse, including providing medical care for numerous conditions, including sports injuries, seasonal illnesses and urinary tract infections, as well as helping identify mental health conditions.

The doctors are able to work with the nurse on duty at the school to review symptoms, analyze medications that the student is currently taking, perform examinations and ultimately develop

Breaking Down the Facts About Vaccines

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cientists years ago proved that vaccines are safe and effective, according to the Centers for Disease Control and Prevention, yet common misconceptions about vaccines can confuse parents.

As flu season approaches, physician Thomas Schenk breaks down the facts about vaccines in BlueCross BlueShield of Western New York’s latest free “Point of Health” audiocast. Schenk, a pediatrician, is senior vice president and chief medical officer of the health plan.

The flu vaccine helps maintain overall health and decreases

the number of deaths, hospital admissions and length of stay. It’s recommended that individuals aged 6 months and older receive the flu vaccine each year. It is generally available at local pharmacies and medical offices.

According to Schenk: • Vaccines are effective. Vaccines work by exposing your immune system to components of a bacteria or virus that might make you ill and allows your body to build immunity.

• Vaccines are safe. Vaccines undergo rigorous safety testing prior to being approved by the U.S. Food and Drug Administration (FDA) and

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • December 2018

a recommended treatment plan.

Electronic scripts can then be sent to the student’s primary care doctor and any other medical specialists for specific issues diagnosed during the check-up.

Doctors are available by appointment or can be summoned as needed. There is also an option for parents if they are available to be patched into the call so they can observe and even provide information during a video doctor visit, with a recording of each visit also being available for parents who are not available at the time but want to later review what was discussed.

In addition, school district officials say any student without health coverage will also be served.

Further advancements in technology leading to more in-depth remote doctor visits and acceptance of the program by other local school districts is expected in the future, but for now Frontier Middle School is the template that Mobile Healthcare Partners will use to gauge the slow rollout of telemedicine being used inside of a school nurse’s office.

“We look forward to working with parents and students as we pilot new ideas to positively impact our community,” said Hughes. “By providing an option for busy families to have access to medical care, we are embracing an initiative that we believe will help our students.” are continually monitored for safety.

• Vaccines cannot cause disease.

Vaccines contain broken down pieces of bacteria so the danger of developing the disease as a result is nonexistent.

• Vaccinating your child is key. Ask your doctor which vaccinations are recommended for the child’s age group.

• Adult vaccines are important too. Any adult 65 or older, should be administered the shingles and pneumonia vaccines once. Adults also want to keep an eye out for boosters and vaccines that have become available during their lifetime.

“As a pediatrician, the most important part of my job is to make sure that children maintain their health,” said Schenk. “We should be concerned about the numbers of illnesses and death that were seeing from vaccine-preventable diseases, including the flu.”

The new audiocast is the latest in the health plan’s “Point of Health” series launched in December 2016.

Hosted by BlueCross BlueShield’s vice president, corporate relations, Julie R. Snyder, “Point of Health” audiocasts are posted bi-monthly and feature an interview with experts on health insurance and health care, covering a variety of perspectives and information.

To listen to this episode, as well as past and future episodes visit www.bcbswny.com/pointofhealth.

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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11/20/18 9:29 AM

Meet

Your Doctor

By Chris Motola

Chester (Chet) H. Fox, M.D. Chief medical officer at G-Health Enterprises, a former UB professor, happy to be in the ‘real world’ Q: I recently spoke with the founder of GBUAHN in Buffalo, Dr. Raul Vazquez. The two of you do a lot of work together.

A: Yeah. Well, he’s the visionary.

I’m just the implementer. I have a fairly good idea of where the future’s going but, honestly, he’s four or five years ahead of everyone else when it comes to medical stuff. He was talking about ACOs [accountable care organizations] back in 2010 and electronic medical records back in 1996. He gave free transportation to his clients back when he was in private practice, before care coordination was really a thing. He’s always worked from the perspective of what’s best for the people I’m serving, and how do I do it in the most efficient way possible. I was a professor at UB in family medicine and was there for 24 years. And I basically retired to do this full time.

When I was in the academic center, it was all theoretical. Now I get to do it in the real world.

Q: What are some of differences between theory and practice that you’ve experienced?

A: Basically, the theory I had is what [Vazquez] had designed.

So it’s not different, it’s just that he’d already done it. I worked with practices all over the country.

We talked about guidelines and other things regarding how to put theory into practice. But all the best evidence shows you’re lucky to get 50 percent of them implemented, in part because there are too many guidelines. Unless there’s help from informational technology, additional staff, care coordination from training doctors in quality improvement, they’re going to do things the way they’ve always done, which is caring for sick people, not about preventing illnesses.

Q: How about the forensic medical unit at the Family Justice Center of Erie County?

A: So there are two pieces to domestic violence. There’s support for the victim, but there’s also offender accountability. Often in the emergency room, injuries weren’t well-documented, which allows the offender to get away with it. We got really good photographs and body maps that would stand up in court so no one could claim the injuries didn’t occur. We document the injuries. The patient tells the story. We’re just there to objectively say that the injuries do exist. One side effect we didn’t anticipate was that the pictures were so good, the defenders didn’t want them shown in court. So there was a lot more plea bargaining, which meant the victims wouldn’t have to confront their assailants in court and be retraumatized. They’re 8 x 11 glossies with a body map of where the injuries occurred.

Q: Since you’re dealing with traumas, what determines where a patient gets seen under?

A: Major trauma still goes to the emergency room. But a lot of minor traumas, like bruises, that go to the domestic violence center. But

it’s also not just about documenting the injuries. It’s about shelters, social work, social services.

Q: Do you also make determinations about what caused the injury?

A: No, it’s just documentation.

I had one case with a belt buckle where we saw an impression of a belt buckle across the chin. I’m not saying who caused the injury. In court, the woman might testify that’s a belt bucket across her face. I testify that’s a belt buckle impression on her face.

The jury makes the determination, or the defendant decides they really don’t want to take the case in front of a jury. It’s corroboration of the injuries.

Q: How does that fit in with the work you’re doing with ACOs? A: It’s a community service, but it’s separate from what I’m doing now. We do have a lot of patients that experience domestic violence.

In our elevator in our office, Erie County has put up ads with tearoff strips on them. In the last three weeks, 30 of those tags have been torn off. Domestic violence is a big issue, but it’s not usually handled in the primary care office. We do everything from public health to population health. In our basement there are a cooking kitchen and a dietitian as well as three personal trainers and a gym thats are all free for our patients. And there have been tremendous results from that wellness program for both highblood pressure and blood sugar because we don’t only make those services available, we invest in training. It’s really missing the boat to try to treat those diseases on the backend with expensive medicines.

I have a saying with regard to diabetes, “When diet and exercise fails, try diet and exercise.”

Q: Why do you think there’s still so much resistance to preventive medicine?

Tradition?

Inertia? Pennywise, poundfoolish?

A: I think there

Q: What are some projects you’ve had a hand in?

A: A couple big projects I’ve done. I started the Lighthouse Free Medical Clinic, a medical student-run screening and triage clinic in inner city Buffalo. Basically, some medical students came to a colleague and wanted to offer their services to the community. We partnered with the church. You can’t give free medical care with first-year students, but you can do a lot of screening and triage.

So we were able to do physicals and triage. And that program’s still going on.

are a number of factors. Part of that is medical school training. We’re trained to treat sick people, not how to keep people from being sick.

There’s also the tradition of only paying the doctor for services and not paying for clinical psychologists, social workers, other things.

Everything goes to the doctor and becomes medicalized. There’s also the fear that once you start, it will turn into a sinkhole. Same thing that happened with mental health treatment. Mental health was never treated that well because of the fear that it would cost too much money, even though prevention ultimately saves money.

Q: Since you’ve worked in both rural and urban settings, how different are the medical issues? Or are they pretty much the same?

A: They’re actually a lot different.

One of the big problems in the urban inner city is transportation of patients, no-show rates; there’s usually a lot more chaos in the urban patient’s life. The rural patient may not have a lot of money, but they tend to live in an environment where people know them. If a rural patient no-showed, there was a good chance I’d run into them in the grocery store and be able to talk to them. There are also racial differences in the populations, which can matter for things like blood pressure. If I saw a person with 230/140 in my old practice, I’d be calling the ambulance, but I see that all the time now and need three or four medicines to treat it. Hypertension is a much more serious disease in the African American population than the white population. And that seems to hold true across socio-economic lines.

Lifelines Name: Chester (Chet) H. Fox, M.D. Position: Chief medical officer, G-Health Enterprises (GBUAHN – GBUACO – Urban Family Practice) Hometown: East Meadow, NY Highlights: A local pioneer and leader in the field of practice-based research in primary care medicine; nationally recognized in the U.S. and Canada as an expert in the early detection and treatment of chronic kidney disease; has been decorated with 17 local and national awards for excellence in education and medicine. His work has been published in 63 times in peer-reviewed journals, and he has conducted more than 70 presentations on various medical topics at conferences, symposiums, and conventions all across the U.S. Education: SUNY Albany (bachelor’s degree); St. Louis University Medical School, St. Louis, Mo. (medical degree); SUNY Upstate (residency) Affiliations: Buffalo General Medical Center Organizations: Distributed Area Research and Therapeutic Network (DARTNet); National Kidney Foundation; American Academy of Family Physicians Family: Wife; one child, two stepchildren Hobbies: Golf, swimming

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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • December 2018

Identical twins Brittany and Briana Deane recently married identical twins Josh and Jeremy Salyers. Credit: TLC

Identical Twins Marry Identical Twins How genetically similar would their children be?

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couple of identical couples recently doubled up for life.

Identical twins Brittany and Briana Deane first met identical twins Josh and Jeremy Salyers last August at The Twins Day Festival in Ohio, according to ABC News. A year later, the couples had their weddings, together, wearing the same wedding outfits, at this year’s Twin Day Festival. Their weddings were documented for a TLC special called “Twins Marry Twins,” scheduled to air in 2019.

The double Deane-Salyers weddings raise a question: If one set of identical twins marries another set of identical twins, how genetically similar would their children be?

“In theory, we would expect their children to be genetically as similar as full siblings are to each other,” said Laura Almasy, a professor of genetics at the University of Pennsylvania.

Siblings born to the same set of parents share about half their genes with one another.

For every child that’s born, “it’s like drawing a handful of marbles from a jar — you get half of your DNA from mom and half from dad,” Almasy said. Cousins don’t draw from the same jar. But in this

case, the children of the two sets of parents would be drawing from two separate, but identical jars.

“So, the expectation would be that they would share half their DNA like full siblings would,” Almasy said. But just like typical siblings, “any particular pair of individuals could share more or less” of those genes.

What’s more, the identical twin parents may not have completely identical DNA; instead, there may be slight differences in their genes that could have occurred in the womb or because of environmental factors throughout their lives. These slight differences can also influence how similar the babies would be to one another.

“Environment doesn’t affect which genes [babies] get from their parents,” Almasy said. But the environment in which the parents grew up could change how an inherited gene is expressed in other words, how it turned off and on, she added. For example, if one mother smoked throughout her life and the other didn’t, both babies could receive the same gene, but the gene could express and influence the baby very differently.

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I SHOULD PROBABLY GET A RIDE HOME. BUZZED DRIVING IS DRUNK DRIVING December 2018 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Managing Microbiome Gut bacteria play crucial role in keeping healthy

By Jana Eisenberg

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ou’ve probably heard that fermented foods are good for you. You may even know it’s got something to do with the millions of bacteria living in your gut — in all of our guts.

Those little critters collectively referred to as our microbiome help keep us healthy. But did you ever wonder why, and why it might be important?

Here’s a helpful scientific summary from the blog “Science Based Medicine,” by Lucy Shewell: “The bacteria in fermented dairy and vegetables [are hardy enough to] survive their perilous journey through the digestive tract. Once they are there, it’s clear that [the bacteria] have at least some positive effects on human health, ranging from the enhanced nutritional contents of the foods themselves, to alleviation of inflammatory bowel conditions, to restoring normal gut microbiota after antibiotics, to enhancement of the immune system, and possibly even weight loss.”

We all need healthy gut bacteria to help us live, but our lifestyle and environments might be working against us. The overuse of antibiotics — medications that are supposed to kill “bad’ bacteria, in both humans and the animals we eat — can negatively affect our gut biome.

In addition, our mostly indoor lifestyles, with a hyper-emphasis on sanitizing things, can have a negative effect.

“Adding in low-sugar fermented foods is important and good for your health and immunity,” said Jennifer Jennings, owner, CEO and medical director at Cardea Health Integrative in East Aurora. “Fermented foods

Making the Most of Your Doctor’s Visit

By Jim Miller

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tudies have shown that patients who help their doctors by providing important health information and preparing themselves for appointments tend to get better care than patients who don’t.

Here are some simple things we can all do to help maximize our next visit to the doctor.

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have a plethora of benefits as they contain living microbes that can support immunity and a healthy microbiome. People who lack a diverse microbiome may have symptoms of intestinal dysfunction.”

“Sources of fermented foods include both plant-based and animal-based sources,” she added.

“Some common examples include yogurt, kefir (water or dairy), miso, sauerkraut, dark chocolate, pickles, kimchi, kombucha and raw cheese.”

Fermentation frenzy Certified plant-based chef Jessica Meyers Altman also is a proponent of a healthy microbiome supported by eating a broad variety of foods, including fermented ones.

“Fermenting is an ancient preservation process. As we’ve moved away from traditional diets and food Meyers Altman preparation, research shows that, for example, newer methods of preserving foods are impacting gut biome,” said Altman, who’s also an adjunct professor at Daemen College in Amherst.

In fact, there’s a rise in younger people being diagnosed with colorectal cancers, thought in part due to the fact these generations were generally brought up eating more highly processed foods, going out to eat more often, and not being in

Before Appointments Gathering your health information and getting organized before your appointment are the key steps to ensuring a productive meeting with your doctor. This is especially important if you’re seeing multiple doctors or are meeting with a new physician. Specifically, you need to: Get your test results — If you’re seeing a new doctor for the first time, make sure he or she has copies of your latest X-ray, MRI or any other test or lab results you’ve recently had, including reports from other doctors that you’ve seen. In most cases, you’ll need to do the leg work yourself which may only require a phone call to your previous doctor asking them to send it, or you may need to go pick it up and take it yourself.

List your medications — Make a list of all the medications you’re taking including prescription and overthe-counter drugs, supplements and herbs, along with the dosages and take it with you to your appointment.

Or, just put all your pill bottles in a bag so you can take them with you.

Know your health history — Being

Fermented foods, like kimchi, sauerkraut, pickles and yogurt, can be helpful for your microbiome and your overall health, according to experts. the habit of preparing meals at home from scratch.

“Consuming fermented foods, with their naturally occurring bacteria, can help reestablish healthy microbiome,” said Altman.

Since a salt-based brine is used in the fermenting process, Altman cautions those on reduced salt diets for medical conditions to be aware of the sodium levels.

People can have a healthy microbiome without eating any fermented foods, agree the experts, since eating plenty of high-fiber foods, called prebiotics, can help keep your gut bacteria healthy as well. Prebiotics — including many raw vegetables, alliums (onions, garlic, scallions, etc. — are even better for you when they come from foods that are organically grown and minimally processed without using harmful chemicals.

“Adding in prebiotic rich foods is especially helpful in feeding the ‘good bacteria’ in our microbiome, aiding in proliferation and communication amongst them,” said

Jennings.

“Many ‘Western’ diseases, like Type 2 diabetes, some cancers, obesity, inflammatory and cardiovascular conditions, can be prevented with diet and lifestyle changes. Traveling — being exposed to different bacteria in different environments — helps vary your biome,” said Altman. “It’s good for people to get out and play in the dirt; that’s not ‘dirty’ the same way that potentially harmful germs, say in a dirty bathroom, are. The degradation of our microbiome has led to us being generally less healthy.”

Bacteria make up around 3 percent of our mass; they outnumber human cells in the body by 10 to 1.

So be nice to them, and eat foods that help them stay healthy and flourish — and they’ll do the same for you.

able to talk to your doctor about any previous medical problems and procedures, even if they’re not the reason you are going to the doctor this time, can make an office visit much more efficient. Write it down if it’s complicated. Genetics matter too, so knowing your family’s health history can also be helpful.

Prepare a list of questions — Make a written list of the top three or four issues you want to discuss with your doctor. Since most appointments last around 15 to 20 minutes, this can help you stay on track and ensure you address your most pressing concerns first. If you’re in for a diagnostic visit, you should prepare a detailed description of your symptoms.

to do. It’s also a good idea to bring along a family member or friend to your appointment. They can help you ask questions, listen to what the doctor is telling you and give you support.

Also consider taking some notes or ask the doctor if you can record the session for later review. If you don’t understand what the doctor is telling you, ask him or her to explain it in simple terms so you can understand. And if you run out of time and don’t get your questions answered, ask if you can follow up by phone or email, make another appointment, or seek help from the doctor’s nurse.

For more information, the National Institute on Aging offers an excellent booklet called “Talking With Your Doctor: A Guide for Older People” that can help you prepare for an appointment and become a more informed patient. To get a free copy mailed to you, call 800-222-2225 or visit order.nia.nih.gov.

During Appointments The best advice when you meet with your doctor is to speak up and get to the point. So right away, concisely explain why you’re there. Don’t wait to be asked. Be direct, honest and as specific when recounting your symptoms or expressing your concerns. Many patients are reluctant or embarrassed to talk about their symptoms, which makes the doctor’s job a lot harder

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • December 2018

Certified plant-based chef Jessica Meyers Altman: “Consuming fermented foods, with their naturally occurring bacteria, can help reestablish healthy microbiome,” she says.

Jim Miller is the author of Savvy Senior, a column published every issue in this newspaper.

U.S. Hospitals Making Headway Against Infections

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ou’re less likely to pick up a nasty infection during a hospital stay in the United States than you were just a few years ago, a new report finds.

Between 2011 and 2015, a patient’s risk of catching a hospital-acquired infection dropped 16 percent, researchers said.

“The findings are encouraging.

Progress is being made in infections affecting hospitals in the United States. But more work needs to be done,” said the study’s lead author, physician Shelley Magill, a medical officer with the U.S. Centers for Disease Control and Prevention.

Health care-associated infections are a significant threat to patient safety. The study authors estimated that in 2011, about 648,000 patients had at least one health-care associated infection in the United States.

Pneumonia was the most common infection, followed by digestive infections and surgical site infections, the study found.

Most of the digestive infections were caused by Clostridioides difficile. These C. difficile infections are typically related to antibiotic use, and can be deadly. Magill said these infections didn’t show a decline.

Working with 10 state health departments, the researchers recruited up to 25 hospitals in each state to participate in the study. Each participating hospital chose one day during a specified time period to record how many patients had infections.

In 2011, 183 hospitals participated. In 2015, 199 hospitals were included.

Four percent of hospital patients had a health care-associated infection in 2011. By 2015, that number had dropped to 3.2 percent.

The biggest declines were seen in surgical site infections and urinary tract infections, according to the study.

Magill said fewer people had urinary catheters in 2015. Also, she said, there was a focus on getting those

Frequent, thorough hand-washing by health providers is one of the most important steps in infection prevention, according to experts. catheters out of patients as soon as possible to reduce infection risk.

The types of surgical site infection vary, but Magill said specific efforts to reduce these infections appear to be paying off. However, the new study didn’t collect information on the specific practices hospitals were taking.

Physician Ashish Jha, director of the Harvard Global Health Institute, said this was a very well-done study that captures data from a lot of hospitals.

“We’ve been making progress against health care-associated infections, and it’s hard to move the needle on a national level. But progress

is still slow. These findings shouldn’t make us complacent. We have a lot of work ahead still,” said Jha, who wasn’t involved with the study.

What can patients do to protect themselves?

One of the most important steps in infection prevention is remarkably simple — frequent, thorough hand-washing. Jha said if you haven’t seen a doctor or nurse washing their hands before they exam you, it’s fine to ask.

“There’s nothing wrong with making sure people are doing what they’re supposed to be doing,” he said.

Healthcare in a Minute

By George W. Chapman

‘Experimental’ Treatment: Jury Awards $25.5 M to Family

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nsurance companies typically will not pay for procedures/treatment that they consider to be “experimental” or “investigational,” even in cases where the patient’s life is at stake. Recently, a jury awarded $25.5 million to the husband of a woman who died after being denied proton beam therapy to treat her brain tumor. The jury wanted to send a message to her insurer, Aetna, in what was called a “bad faith” case. Aetna’s “experts” argued the treatment was experimental while the plaintiff’s experts argued proton beam therapy is a well- established form of treatment and is paid for by Medicare. The couple mortgaged their home and raised over $90,000 through “Go Fund Me” to pay for treatment at a renowned cancer treatment center while suing Aetna, but it was too late and the patient died. The question is how does

an individual insurance company eventually move treatments off their “experimental” list and on to their “approved” list? Proton beam therapy has been around for years. There is virtually no national oversight or agreement on what is considered to be experimental. It is left up to the insurer. A solution would be a panel of experts comprised of clinicians, payers and researchers empowered to determine what treatments are globally considered to be “experimental” and then which of them are either ineffective or approved for payment. There could be a federal fund established to pay for experimental procedures. How else will we know if the treatments are effective if people can’t afford to go through with them? Aetna could have treated almost 300 patients for the $25.5 million they shelled out for “bad faith.”

Insurance Administrative Costs Our average administrative costs for health insurance are the highest in the world. The Affordable Care Act limits what commercial insurers can retain for profit and administrative costs to 15 percent of their premium. That means they must spend 85 percent of the premium on actual claims. If they spend less than 85 percent on claims they must refund the difference to their members. Medicare, purportedly, has the lowest administrative costs of all insurers at just over 1 percent. So, is “Medicare for all” a way to lower premiums for all? Skeptics argue the 1 percent is artificially low because: the IRS col-

lects the taxes, Social Security collects the premiums, the FBI handles the fraud and then another seven federal departments also do work for Medicare. But Medicare’s annual report accounts for these costs. However, one third of Medicare eligible people are insured by private/commercial Medicare Advantage plans versus directly though Medicare. Including the administrative costs of these Medicare Advantage plans results in a combined 7 percent administrative costs which is much higher than Medicare’s 1 percent. Private plans average about 13 percent administrative costs, which includes profits.

Drug Ads on TV No one really knows what drugs

actually cost: manufacturers raise their prices to exorbitant levels to account for “discounts” given to pharmacy benefit managers; your out-of-pocket cost depends on your insurance plan; the same drug is cheaper in other countries. The Trump administration — CMS and DHHS — has vowed to control drug pricing or at least make it more transparent. Trump is proposing to require drug companies that sell drugs covered by Medicare and Medicaid to include their list price for covering a typical course of treatment in their ubiquitous TV ads. DHHS Secretary Alex Azar said, “We will not wait for an industry with so many conflicting and perverse incentives to fix itself.”

CMS Administrator Seema Verma said, “We are committed to price transparency across the board and prescription drugs are no different.”

The drug industry spends over $4 billion annually on TV ads. Of course the powerful drug lobby is pushing back and will challenge the policy in court arguing it violates their free speech. The drug lobby counters with providing language in their TV ads directing patients to online resources to determine what their cost would be. The AMA says this is a step in the right direction, but not a solution.

Affordable Care Act There have been 70 attempts to repeal the astonishingly resilient ACA (Affordable Care Act) over the last 10 years. The last attempt to repeal was thwarted by the late Sen. John McCain’s “no” vote. Failing to repeal the law, the Trump administration started gutting the ACA by: reducing advertising 90 percent and navigator funding 40 percent; allowing states to reduce coverage for pre-existing conditions; terminating the individual mandate; changing basic coverage requirements; and basically just making it difficult

December 2018 •

for insurers to hang in the market places. A promised “much better plan” was never offered — 20 million people depend on the ACA for their insurance. Ironically, concerns over the most popular and basic tenet of the ACA — pre-existing conditions — probably cost Republicans the House. Democrats made it an issue and Republicans running for office claimed they were always in favor of it. Now, with the House under Democratic control, it will be interesting to see if the ACA is resurrected (and improved) rather than slowly bludgeoned to death.

NRA v. AMA In addition to asking if you: exercise, smoke, drink excessively, use a seat belt, etc. to determine your health risks, your physician may also ask you if there are guns in the house. After the recent mass shootings, the AMA came out with a position paper calling gun violence a pubic health crisis. The NRA pushed back and told the AMA and several tweeting emergency room physicians to “stay in their lane.” The AMA is focusing on legislation that virtually prevents the Centers for Disease Control and Prevention from doing research on gun violence. As many as 35,000 of us die from gun violence each year and of that 21,000 are suicides.

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 gwc@gwchapmanconsulting.com.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 9

Live Alone & Thrive

By Gwenn Voelckers

Practical tips, advice and hope for those who live alone

Asking for Help: It Brings Blessings, Not Burdens

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elp with hanging holiday lights. A ride to the doctor’s office. Help with moving a heavy piece of furniture. An emergency pet-sitting request. We all need a helping hand from time to time.

Giving and receiving help from my friends and family has proved to be a wonderful way for me to deepen relationships and strengthen bonds. It’s another one of the many “life lessons” I’ve learned while on my own — that asking for help brings blessings, not burdens.

If asking for help is difficult or awkward for you, know that you’re not alone. Many people — and, regrettably, many of those who may need it most — find it hard to reach out and ask for help in times of need.

And why don’t they? There are many reasons, but my experience tells me that lots of women and men who live alone avoid asking for help because they fear being seen as weak or vulnerable.

I know that after my divorce I was reluctant to ask for help. I wanted to show the world that I was perfectly fine, thank you. When I really could have used some help, I avoided asking anybody for anything, determined to muscle through

on my own. It led to isolation and pointless hardships.

But the biggest shame? Not asking for assistance kept me distant from friends and family. I denied myself (and them) the chance to connect on a genuine and meaningful level.

Looking back, it’s clear to me that my healing and personal growth were compromised as a result.

I encourage you to let go of any excuses not to ask for help, in favor of being true to yourself and to those who love and want to support you.

Below are some words of encouragement and a few tips to help you help yourself: n Be honest. What keeps you from asking for help?

Could it be pride? Do you think you’ll be seen as incapable or weak?

Are you concerned about being a bother? Or, would asking for help force you to acknowledge that, indeed, you need it? Take a moment and reflect on what keeps you from asking for assistance. n Redefine what it means to be strong. Everyone needs support every once in a while, and seeking help is not a weakness. In fact, the strongest people are often those who have the courage to admit they need some assistance and reach out.

s d i K Corner

Sharp Rise Seen in Kids’ ER Visits for Mental Health Woes

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ental health issues are sending more and more kids and teens to hospital emergency rooms, and that increase has been most dramatic among minorities, a new report shows.

Between 2012 and 2016, overall admissions shot up 50 percent in the United States, the researchers said.

“Prior to our study, we knew that an increasing number of children with mental health concerns were coming to the nation’s pediatric emergency departments,” said study author physician Anna Abrams.

She is a resident physician with the Children’s National Health System in Washington, D.C. “What this new research demonstrates is that not only are these visits increasing at a staggering rate, but Page 10

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that there are significant racial and ethnic disparities in the trends of who visits pediatric emergency departments for mental health issues,” Abrams said.

Why this is so remains unclear, she noted.

“Our study really was an effort to characterize the frequency of these emergency department visits,” Abrams explained. “It was not designed to investigate the potential reasons that triggered these visits. We do plan to investigate this question in future work.”

The study team said that more than 17 million American children struggle with some form of psychiatric illness. In recent years, that has meant that somewhere between 2 percent to 5 percent of all pediatric

I’ve always admired this quality in others. Real strength is knowing your personal limitations and having the confidence to recruit assistance when you need it. n Have a little faith. Believe that people truly want to help. Just turn the tables and think about how you’d respond if a friend, family member or co-worker asked for a helping hand.

Chances are you wouldn’t hesitate.

You might even feel slighted if not asked, especially if someone you cared about was having real difficulty.

Know that others, too, want to be there for their friends and family in need. n Take a chance. When you choose to be vulnerable and ask for help, you are opening yourself up and exposing your authentic self.

While it may feel risky, when you are “real” like this, you have an amazing opportunity to cultivate deeper, more meaningful bonds with others.

It can be a positive, life- and relationship-changing experience, but only if you are willing to take a chance and make your needs known. n Make the ask. As a first step, put some thought into where you could really use some support and then ask for help with one specific item.

It could be something as simple as asking a neighbor for help shoveling snow to something as important as requesting a recommendation for a financial adviser.

If finding just the right words is hard to come by, you might start out by saying, “You know, I’m not very comfortable asking for favors, but I wonder if you might be able to help me with something?” n Express your gratitude. You know

this, of course. A heartfelt thank you in person or in writing will be warmly received by the person whose help you have accepted. No need to go overboard. Remember, people want to help others, and don’t expect to be remunerated for doing a good deed. n Offer help in return. Because giving can be as gratifying as receiving, you’ll want to make it known that you, too, are available to return the favor. We all have gifts, we all have needs, and we all can be of great assistance to one another. Look around, and you’ll find plenty of opportunities to help those who have helped you during your time of need.

Asking for help becomes easier with practice. Just as I did, you’ll soon discover the benefits that lie in the aftermath of the ask — benefits that include stronger relationships with existing friends and family members, as well as the prospect of making new connections with others.

The rewards inherent in accepting help and expressing your gratitude are many and go both ways. So, take it from me: Life can be better, just for the asking.

visits to the emergency department have been related to mental illness concerns.

To drill down on the trends, the investigators sifted through data that had been collected by the Pediatric Health Information System.

The team focused on the overall number of mental health-related visits to an emergency department among children up to the age of 21.

The mental health issues covered by the analysis included: acute anxiety and delirium states; adjustment disorders and neuroses; alcohol abuse; drug abuse (including opioid abuse); bipolar disorders; childhood behavioral disorders; depression; major depressive disorders; disorders of personality and impulse control; eating disorders; psychosis; and schizophrenia.

During the study period, investigators determined that more than 293,000 children — who were an av-

erage age of just over 13 — had been diagnosed for some type of mental illness in a pediatric emergency room setting.

Overall, these visits rose dramatically during the study period, up from about 50 visits for every 100,000 children in 2012 to nearly 79 visits per 100,000 by 2016, according to the report.

But when broken down by race, the investigators found that the observed rise had not unfurled at an equal pace.

For example, nearly 52 out of every 100,000 white children were visiting an ER for a mental health issue by 2016. But among black children, that figure shot up to 78. Among other non-Hispanic minorities, the number rose to more than 79.

The majority of all pediatric mental health visits (55 percent) was covered by some form of public insurance, the study authors noted.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • December 2018

Gwenn Voelckers leads “Live Alone and Thrive” empowerment workshops for women in Mendon, Monroe County, 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 a book or invite Voelckers to speak, call 585-624-7887, email gvoelckers@rochester.rr.com, or visit www.aloneandcontent.com

‘Buffalo MATTERS’ A

Emergency departments in WNY region finding a better way to treat opioid use disorder

n innovative, cost-effective program at more than a dozen hospitals in the Buffalo region provides medication-assisted treatment to opioid use disorder patients in emergency departments (EDs) and rapidly transitions them into longterm treatment at a community clinic, all within about 48 hours.

The Buffalo Medication Assisted Treatment & Emergency Referrals (Buffalo MATTERS) program, designed to expand emergency access to medication-assisted treatment, was developed by emergency medicine physicians at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

Now operating in 13 hospitals in Western New York, the program is serving as a model for similar programs that other regions and states want to develop.

Funded initially as a pilot project by the John R. Oishei Foundation, the program was recently awarded $200,000 from the Blue Fund of BlueCross BlueShield of Western New York to expand throughout the eight counties of Western New York.

The plan is to use the new funding to introduce the program into six additional hospitals in the region by providing training to ED providers and recruiting community clinics to agree to treat patients discharged from the ED. The program emerged from the growing awareness in 2014-15 that more needed to be done for the increasing numbers of opioid abuse disorder patients being seen in area EDs, where resources were being stretched as never before.

In 2015, more than 800 people died from overdoses in the eight counties of Western New York.

Area EDs were following the same standard of care as other hospitals around the nation, such as giving patients non-narcotics for symptom control, which are often not especially effective, and a list of clinic phone numbers where they could seek treatment.

Safety net

“Emergency departments are the

“It wasn’t sustainable,” said physician Brian Clemency, associate professor of emergency medicine at the Jacobs School, who began partnering with Lynch. “We needed a framework.”

Removing logistical barriers

Physician Joshua J. Lynch

Physician Brian Clemency

safety net for the medical system, so they are a critical point of entry for these patients,” said physician Joshua J. Lynch, clinical assistant professor of emergency medicine in the Jacobs School, a physician with UBMD emergency medicine and the program’s founder.

“When patients come to us in withdrawal, we need to be able to help control their symptoms and quickly transition them to community clinics,” he continued. “We knew we weren’t doing a great job on either one, but there weren’t many good alternatives out there.”

“When we saw that, we wanted to do it here,” Lynch said. He began to encourage colleagues to undergo the training providers need to administer buprenorphine, a controlled substance. After providers got the training, Lynch and his colleagues developed a standardized approach for evaluating and managing patients.

A member of the Erie County Opioid Task Force, Lynch then approached clinic directors to see if they would agree to see a few patients each week who had started buprenorphine in the ED either at Buffalo General Medical Center or Millard Fillmore Suburban. Both are teaching hospital partners of the Jacobs School and part of Kaleida Health.

“I was doing this on a case-bycase basis,” said Lynch, who was making each call to each clinic director every time a patient agreed to start treatment.

The need for a more systematic approach was clear.

Buprenorphine in the ED

Then in 2015, Lynch and his colleagues read a paper published by physicians at Yale University. It reported that patients going through withdrawal who were given the opioid treatment buprenorphine in the ED and provided with a clinic appointment were more likely to still be in treatment a month later and to have reduced their opioid use.

Clemency, an expert in prehospital care, knew that most EDs in the region didn’t have the resources either to implement a medication-assisted treatment program or rapidly transition patients to community clinics. But he knew they would be able to help many more patients if the barriers — many of them logistical — could be removed.

To begin with, they requested that Mercy Flight dispatchers, who are on the job 24/7, maintain a master clinic schedule for ED patients willing to be treated.

“So at three in the morning, I can make an appointment for a patient in the ED to start getting treatment at a clinic that’s convenient for them,” said Clemency. “And when the clinic opens up in the morning, the fax with all the patient’s information is there.”

The willingness of clinics to modify their policies in order to participate was a key factor. The program began with only three clinics, but as more clinics came on board, it became easier to get their buy-in, Clemency noted.

There are now 27 clinics in the Buffalo metropolitan area that collectively leave open 64 slots per week exclusively for treating ED opioid use disorder patients, usually within 48 hours of being discharged.

Patients are responding. “The patient in withdrawal who drives to the emergency room because they know they need help is typically looking for a way to get better,” said Lynch.

“When you hand them a list of 64 clinic appointments with 27 different locations they can choose from, they get interested.”

More information about Buffalo MATTERS and a list of participating hospitals and organizations can be found at https://buffalomatters.org.

FDA Approves Powerful New Opioid Despite Criticisms

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uling against the recommendation of one of its chief experts, the U.S. Food and Drug Administration recently approved an extremely potent new opioid painkiller, Dsuvia.

The drug is a 30-microgram pill that packs the same punch as 5 milligrams of intravenous morphine, according to the Washington Post.

The tiny pill comes packaged in a syringe-like applicator and would be used under the tongue for quick absorption. Dsuvia (sufentanil) will be marketed by California-based maker AcelRX. The drug is for very restricted use in operating rooms or on the battlefield. Indeed, its potential use by soldiers was one reason Dsuvia

was approved, according to FDA Commissioner Scott Gottlieb.

“The FDA has made it a high priority to make sure our soldiers have access to treatments that meet the unique needs of the battlefield, including when intravenous administration is not possible for the treatment of acute pain,” Gottlieb said in an agency news release.

But Dsuvia’s approval comes amid controversy, with an epidemic of opioid abuse continuing to ravage the United States. Experts worry that supplies of the drug will somehow make their way from doctors’ offices and pharmacies to addicts.

An FDA advisory committee did recommend for approval of Dsuvia in a 10-3 vote last month. But

the committee’s chairman took the highly unusual move of voicing his opposition at that time. Physician Raeford Brown, a professor of anesthesiology and pediatrics at the University of Kentucky, urged the FDA to reject the drug.

“I am very disappointed with the decision of the agency to approve Dsuvia. This action is inconsistent with the charter of the agency,” Brown said in a statement.

“I will continue to hold the agency accountable for their response to the worst public health problem since 1918.”

Public Citizen described the drug as “five to 10 times more potent than fentanyl and 1,000 times more potent than morphine.”

December 2018 •

But Gottlieb stressed that his agency has placed very tight restrictions on Dsuvia.

“To address concerns about the potential risks associated with Dsuvia, this product will have strong limitations on its use,” Gottlieb said.

“It can’t be dispensed to patients for home use and should not be used for more than 72 hours. And it should only be administered by a health care provider using a single-dose applicator. That means it won’t be available at retail pharmacies for patients to take home.”

The drug is also only for use by patients who cannot tolerate other painkillers, or for whom other painkillers have failed or are expected to fail.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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NY Ranks High in New HIV Cases Local experts say HIV figures in the state are skewed by the high numbers seen in New York City

By Deborah Jeanne Sergeant

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ew York ranked fourth in the nation for new cases of human immunodeficiency virus (HIV) in 2015, and ninth in 2016, according to statistics provided by the Centers for Disease Control and Prevention. Of those infected with HIV, one in seven doesn’t realize it.

Physician William Valenti, staff physician and co-founder of Trillium Health in Rochester, said that New York’s high ranking is somewhat skewed by New York City.

“We identify 50 to 100 new cases in the Rochester area per year,” he said.

That’s a far cry from the 2,052 people in New York City diagnosed in 2016, according to www.aidsvu. org.

More than 108,000 people living in New York City have HIV/AIDS and 20 percent do not know they are infected, states the website of Gay Men’s Health Crisis, a provider of HIV/AIDS prevention, care and advocacy in New York City.

Valenti said that although the rate of new HIV infections is higher in New York City than in Upstate, the rate is decreasing in New York City, unlike Upstate’s stagnant figures.

He said that behavioral intervention, such as using condoms and limiting sexual partners “are not as effective by themselves as a part of a medical and health care

intervention. Medical care will become biomedical intervention.

That is going to help turn this around.”

Physician Gale R. Burstein, commissioner of health for Erie County Department of Health, echoed Valenti’s opinion. “That population is higher in New York City than Western New York. The New York City rate drives those high numbers statewide.”

The CDC states that 9 percent (3,425) of new HIV infections nationwide are among those who inject drugs (that figure also includes 1,201 diagnoses among gay and bisexual men who inject drugs).

The CDC also says on its website that gay and bisexual men accounted for 67 percent (26,570) of all new HIV diagnoses in the U.S. and heterosexual contact accounted for 24 percent (9,578) of HIV diagnoses.

By identifying higher risk populations, health organizations can know where to target their attention.

Burstein said that upon a notification of a new HIV diagnosis, Erie County disease intervention specialists assess risk.

“We try to find those individuals who were exposed through sexual contact or injectable drug,” Burstein said. “We get them in to be tested to break the cycle of transmission.”

Those who test negative receive an offer of post-exposure

Rheumatologists in Short Supply By 2030 the nation will have only half the number of professionals it needs

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f you need to see a rheumatologist, get in line. You will have a long way to go until you see one — and this waiting period won’t improve anytime soon.

By 2030 the nation will have only half the number of rheumatologists it needs. Presently, the U.S. is at 13 percent below the ideal number of rheumatologists, according to research by Rheumatology Service at San Antonio Military Medical Center in Texas.

“It’s been a long-standing problem and hasn’t changed,” said physician Thomas Madejski, who specializes in internal medicine, geriatric medicine, hospice and palliative care, and leads the Medical Society of the State of New York.

He said that many issues have Page 12

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caused the shortage, such as liability issues and, locally, “the hassles” of working in New York.

“The state medical society is working to improve the practice environment in New York state and its liability rate. We want to reduce the regulatory burden and make it less expensive for doctors to practice,” said Madejski.

The demand for care has also increased, including the aging baby boomer population as well as better diagnostic efforts and more treatment options. Madejski said that for 80 to 90 percent of osteoarthritis cases, a primary care, internists or family physician could provide sufficient care; however, some patients demand more care, which has affected the issue to a small degree.

prophylaxis. It should be started within 36 hours but no later than 72 hours after exposure to HIV. Taken within that timeframe, it’s 80 percent effective.

Those with an infection receive anti-viral therapy to decrease their viral load.

“They hopefully won’t have any virus in their blood stream or genital excretions to transmit it,” Burstein said. “It’s about decreasing the community’s viral load.”

HIV-positive patients also receive regular follow-up to ensure medication compliance.

People with other sexuallytransmitted infections (STIs) may be at higher risk for HIV, according to physician Alyssa S. Shon, an infectious diseases specialist with UBMD Internal Medicine and medical director at Evergreen Health, a local provider who serves those who are living with chronic illness or who Shon are underserved by the healthcare system.

“When diagnosed with those infections, it’s a good time to discuss it with those patients,” Shon

said. “Many think they’re at low risk, but the vast majority of HIV transmissions are people who don’t know their own status. They have unprotected sex and spread it to other people.”

Shon feels like the war on HIV is progressing toward the goal of fewer than 750 new HIV infections by 2020, which would end its status as an epidemic.

Daniel Stapleton, public health director for Niagara County Department of Health, also said that New York has made progress in reducing HIV. “In Niagara County, the rate has decreased to a quarter of what New York state had,” Stapleton said.

He also believes the numbers from New York City skew the figures for the whole state. Niagara County had five new cases of HIV last year.

Stapleton said that public health education is a big part of the reason for the decrease.

Though organizations combating HIV still promote condom use, treating people with medication to suppress the virus represents the means of prevention that they believe will end HIV’s status as an epidemic.

“It’s a success story in public health, that’s a great accomplishment,” Stapleton said.

Physician extenders — nurse practitioners and physician assistants — can help rheumatologists see more patients; however, Madejski said that many primary care physicians even lack the experience and training to feel comfortable in prescribing some of the newer medication to treat patients with rheumatologic disorders.

“We need to re-examine how we educate and train physicians,” Madejski said. “We should be training physicians more at this level.

With telemedicine and tele-health we can leverage rheumatologists more to distill the essence of what we need: diagnosis and treatment so we can make it more efficient for them.”

Locally, the shortage persists as well, according to Raul Vazquez, founder and primary care physician at Greater Buffalo United Accountable Healthcare Network (GBUAHN). He said that the lack of sufficient rheumatologists in the region can make setting appointments with a rheumatologist a struggle for patients he wants to referred to that specialty.

“We try to manage the primary care type of cases,” Vazquez said.

“If they need infusions, we try to get them into rheumatologists.

Depending on insurance, if they’re

on Medicaid products, it’s difficult for them to get access to those services.”

Vazquez thinks that fewer new physicians specialize in rheumatology, partly because of the nature of rheumatology. The cases are usually complex and difficult to manage.

“More and more providers like specialties relating to oncology or surgery,” Vazquez said. “The reimbursement structure is better for those, too.”

He appreciates the importance and urgency of treating rheumatology patients right away, especially for those with rheumatoid arthritis, an autoimmune disease that attacks the joints.

“If you pick up on these cases early and treat them, you can prevent a lot of disabilities,” Vazquez said.

“A lot of the treatments that are available really do put the disease in a less aggressive state. It changes people’s lives.”

Spending weeks on a waiting list or receiving misdiagnosis can delay treatment, which causes more irreversible damage to patients’ joints, all while they may experience excruciating pain.

According to salary.com, New York state rheumatologists make an average of $ 231,375.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • December 2018

SmartBites

The skinny on healthy eating

Mussels pack a mighty nutritious punch

M

y husband and I eat a lot of mussels throughout the year and especially during the holiday season. We like them because they’re inexpensive, quick to cook and delicious. We also appreciate how incredibly nutritious they are.

According to some experts, in fact, mussels possess the most impressive nutritional profile of all shellfish.

Mussels are protein superstars, with about 10 mussels serving up 20 grams, an amount that satisfies a good chunk of average daily needs.

Unlike some red meat’s protein, a mussel’s protein is lean, with much less total fat, saturated fat and (depending on the cut) up to half the calories. As a 3-oz comparison: trimmed sirloin steak, 300 calories; 10 mussels, 150 calories. An essential nutrient that powers many chemical reactions, protein helps us build up, keep up and replace tissues.

Mussels are also a great source of many vitamins and minerals, with respectable amounts of several B vitamins, vitamin C, iron and zinc.

But these scrumptious mollusks really show their might when it comes to vitamin B-12, selenium and manganese. Just 10 cooked mussels provide around 300 percent of our

daily needs for both vitamin B-12 and manganese, and 100 percent of our needs for selenium.

Vitamin B-12 — a “high-priority” vitamin that’s critical to good health — helps produce red blood cells and DNA, keep nerves healthy, support bone health and synthesize serotonin (a.k.a. the “happiness” chemical).

Studies support that vitamin B-12 may help to boost energy, slow mental decline, prevent osteoporosis and improve moods.

The manganese that’s abundant in mussels not only plays an important role in bone health and energy production, but helps to regulate blood sugar, as well. Selenium, on the other hand, supports the thyroid gland and boosts immune system health. Both are noteworthy antioxidants that help to reduce inflammation and fight cellular damage.

Though low in fat, mussels boast an appreciable amount of hearthealthy omega-3 fatty acids: about 750 mg per 10 mussels. These special fats appear to benefit hearts by decreasing the risk of irregular heartbeats, lowering blood pressure and reducing the growth rate of plaque in arteries.

These scrumptious mollusks possess the most impressive nutritional profile of all shellfish, especially when it comes to vitamin B-12, selenium and manganese.

Coconut Curry Mussels

stir in lime juice and cilantro. Serve with crusty bread.

Adapted from Martha Stewart Recipes

1 tablespoon unsalted butter or olive oil 3 garlic cloves, minced 2 tablespoons minced, peeled fresh ginger (from a 2-inch piece) 1 can (13.5 oz) lite coconut milk 1 tablespoons red Thai curry paste 3 pounds mussels, rinsed, scrubbed and de-bearded (most come debearded) 2-3 tablespoons fresh lime juice ¼ cup chopped fresh cilantro Fresh, crusty bread (optional)

Helpful tips

Choose fresh-smelling, live mussels with tightly closed shells. Mussels taste best the day purchased, but can be stored in the refrigerator for a few days.

To store, place mussels in a bowl and simply cover with a damp paper towel (never store in water).

Rinse mussels under water before cooking and tap any mussels that are still open. If it closes, it’s alive; if it doesn’t, it should be tossed.

In a wide, shallow pot or sauté pan with a lid, melt butter over medium-high heat. Add garlic and ginger and cook until fragrant, one minute. Whisk in coconut milk and curry paste; bring the liquid up to a boil and immediately lower it to a lively simmer. Add mussels and stir to combine. Cover and cook until mussels open, about 5 to 7 minutes, stirring once. Remove pot from heat, discard any unopened mussels, and

Anne Palumbo is a lifestyle colum-

often help participants succeed while they save. For example, many gyms employ personal trainers and experts in nutrition who offer group programming. Group fitness sessions can foster accountability and camaraderie.

Community-based organizations such as YMCA and JCC offer fitness classes for short sessions.

There’s no long-term commitment so you can “try on” an activity and learn more about health.

Some gyms, martial arts schools and dance studios Privitera offer trial

lessons or memberships as well.

While these can’t replace regular exercise, they do provide an opportunity to experiment to see what activity could become lifelong without wasting money on an unused membership.

Workshops offered at the public library, health foods stores and other venues could offer a good way to learn more about good health (although these lack the ongoing motivation many need to stick with their goals). Read local periodicals and look on community bulletin boards to spot upcoming events.

“Should you have a friend that practices healthy behaviors, you can always approach them and many people will help each other best they can as friends,” Wu said. “Don’t be shy.”

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 avpalumbo@aol.com.

Need a Health Coach?

They can offer help on nutrition, wellness, stress and a number of other things

By Deborah Jeanne Sergeant

H

ealth coaching rides the trend of preventive health, but how could a health coach help

you?

Andrea Privitera, certified holistic health coach for University at Buffalo Neurosurgery (UBNS) and Child and Family Holistic Practice in Buffalo, said that health coaches’ services can complement what physicians do; however, she wishes more physicians would collaborate with health coaches to improve their patients’ health.

“I’d love to see us all work together to help patients understand the importance of quality of life and how we can make good decisions about food, exercise, and being mindful about these things to live our best lives,” she said.

She works with clients on nutrition, movement, mindfulness, stress and quality of life issues.

She’s also a certified yoga instructor.

She sometimes refers clients to chiropractors, massage therapists and to practitioners of whatever modality clients need.

Physician Joanne Wu, an experienced yoga teacher, health coach and wellness expert who sees patients in Buffalo, said that health coaches engage clients to focus on a healthful lifestyle.

“These skills are specialized,” Wu said. “Many people could use inspiring and accountable people in their lives so they can make sustainable change in daunting tasks such as exercise, lose weight, eat right, sleep better, and have less stress; however, not all health coaches are certified, are properly trained, or use evidence-based counseling tools to help their clients.”

The cost of health coaching — an average $50 to $80 an hour — may be covered by health insurance.

However, those not covered who can’t afford to hire a health coach have other options.

Simply getting out in nature and walking can help support good health.

“Movement is critical,” Privitera said. “You cannot be well and not move. Walk in nature or near water. Both of those are healing and soothing mentally and physically.”

Though a health coach may not be specifically covered by health insurance, Privitera said that many health plans cover massage therapy, chiropractic care and gym memberships — all of which may offer elements promoted by a health coach.

Seeking support in a group setting to meet health goals can

December 2018 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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6

Things You Should Know About SAD

By Ernst Lamothe Jr.

Winter is prime time for seasonal affective disorder. Here’s what you need to know

I

t often doesn’t get the attention it deserves, but seasonal affective disorder victims know the truth.

They understand the condition is real and can alter their mood and behavior for months at a time.

Called SAD, it is a seasonal mood disorder related to reduction of light, which happens during the winter months. It can affect between 4 to 6 percent of Americans, according to the American Association of Family Physicians. Another 10 to 20 percent have been diagnosed with a mild version of the condition.

People who live in places that rain for weeks at a time or who live in cloudy cities such as Buffalo are often most vulnerable.

SAD doesn’t always fall under the same umbrella symptoms as general mental health depression but can look very similar.

“Seasonal affective disorder is a common problem where people can feel sluggish and depressed during the winter because there are more cloudy and overcast days, said physician Steven Dubovsky, professor and chairman of psychiatry department at University at Buffalo.

“It is a sensitive issue that people have a hard time talking about because others don’t see it as serious issue but it is.”

Here are six facts about seasonal affective disorder.

to do with cold 1.Nothing weather The drop in temperature in the winter is sometimes associated with SAD. In actuality, it has nothing to do with the temperature.

“You will hear people confuse seasonal affective disorder and combine that with simply winter blues or the holiday blues but that

is not the case,” said Dubovsky. “It is deeply associated with the lack of sunlight.”

Dubovsky said the condition typically begins in September in the northern hemisphere and could last until April and May depending on where you live.

you should buy 2.Why artificial light The most effective way to battle through SAD and depression is light therapy. The body needs light, and many times, during the winter, cloudy and cold days produce an inability for that to occur. Dubovsky recommends purchasing an artificial light therapy lamp. Those with fluorescent lights are the most effective.

“When you are looking directly into the light and the light reaches your eyes, it can be the necessary light you need to absorb to change your mood and combat depression,” said Dubovsky The average living room has 100 lux as a unit of light flow, while a sunny day measures between 20,000 to 100,000 lux. The average light therapy box that someone purchases is about 10,000 lux, which is akin to being outside on a cloudy day.

“It has been known to have quite a bit of success for people. It can help you if you feel lethargic,” said Dubovsky. “People generally use the light in the morning for a half an hour. That amount of exposure makes an incredible difference in the lives of people who suffer from SAD.”

for worsening 3.Watch symptoms Some people might feel helpless

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when the condition hits them. Or they just think because this happens regularly to them that they should just survive through it. Dubovsky believes that because seasonal affective disorder affects each person differently people should not just go on with their lives as usual.

“If you see the light is not working, and you know you continue to get depressed as soon as the fall hits, then you should consult with someone and continue to find ways to combat it,” he added. “I especially advise that for people who have a family history.”

suffer more 4.Women than men The population who is affected the most by SAD is women. The latest statistics say women are four times more likely to develop the condition than men. They make up more than 70 percent of those who suffer and the age ranges from 18 to 55 years of age. Experts have said it is due to the serotonin levels which are affected by things like menopause and PMS.

5.Antidepressants work

Dubovsky said there are prescription medications that can help with serotonin levels in the brain. The biggest reason why that is an asset is because when we don’t produce enough serotonin, we can become depressed. Antidepressants — such as Prozac and Zoloft — can often raise serotonin levels. It can be a successful temporary use but physicians do not recommend it long term.

“It has been known to really combat seasonal affective disorder,” said Dubovsky.

Steven Dubovsky is a physician with the Regional Behavioral Health Center of Excellence at ECMC. He is also professor and chairman of the psychiatry department at University at Buffalo.

6.Consider exercising

With any health issue, medical officials see holistic, non-prescription options as viable. Exercise falls into that category. Walking outdoors especially in the morning hours is recommended. If this isn’t possible, consider going to the gym and get your body moving. You raise the endorphins in your body which helps you feel happier. It combats the feelings of sadness or anxiety you’re experiencing and allows you to concentrate better. But that does come with a caveat.

“The hard part about recommending exercise is that it works if you are motivated. But people who are severe suffers of SAD often don’t have the motivation to do much because of the depressed feelings and that includes the motivation to exercise,” Dubovsky added.

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Holiday Greetings

Learn More About Your Family Health History Holidays are a great time to put your family’s health history together

By Deborah Jeanne Sergeant

A

s you gather with your family this time of year, consider asking a few questions about your family’s health history.

It may seem a strange topic for conversation, but it can affect your health in significant ways.

Jacquelyn F. Langdon, public health director for Niagara County Department of Health, said to focus on your immediate family related by blood: parents, siblings and grandparents. Ask a relative who has a clear recollection of family health

about major medical issues that have been diagnosed, not their best guesses.

“The main reason you have these discussions is to mitigate and control risks you can modify,” Langdon said.

She said that a few elements are important in addition to the major medical issues diagnosed: cause of death, age of onset, environmental factors and ethnic background.

Cause of death means why the person died. Someone may have been diagnosed with prostate cancer

Give Healthful Food Gifts This Holiday Season

By Deborah Jeanne Sergeant

M

any people enjoy giving (and receiving) food gifts. They don’t end up as clutter and offer a treat the recipient might not otherwise indulge in.

Giving food also bears a few caveats, however.

It helps to know the preferences of the recipient and any dietary restrictions, both medical and selfimposed.

We spoke with some local experts and they offered a few suggestions.

While store-bought food gifts may seem convenient, they often contain plenty of sugar for taste appeal and additives to keep them self stable.

n Mary Jo Parker, registered dietitian with Nutrition & Counseling Services in Williamsville, recommended giving homemade treats, including healthful cookies, candied pecans or walnuts, low-fat fudge, granola cereal or granola bars, dried fruits, dark chocolates, and fruit jams. By making them yourself, you can choose healthful recipes.

She also suggested giving food gifts that can support healthful home cooking, including gourmet oils and vinegars and gourmet herbs and spices. All of these can jazz up vegetable dishes, for example.

Parker also mentioned specialty coffees and teas, fresh fruit baskets or boxes, healthful popcorn and popcorn maker, and “boxes of favorite foods, healthy snacks like bean tortilla chips, whole wheat pretzels, etc.; subscription box of foods, subscription for healthy magazines, newsletters, or healthy cookbooks,” she said.

(which is still important to know) but died 30 years later of something else. Age of onset means when the disease started. Environmental factors refers to outside contributors to the disease, such as working with asbestos resulting in cancer. Or lifestyle factors that affected health.

Many families share the same habits that can shape their health.

“There are so many different risks but there are also a lot of tools we can use to control those risks as much as possible,” Langdon said.

“We can control screenings and how often we do them. Or control blood pressure by having a blood pressure machine and lifestyle changes. We can’t eliminate all risks, but reduce a lot of them with effort.”

Also talk with your in-laws for the sake of your children. Knowing what health conditions run in your family can’t guarantee you won’t succumb to them but the knowledge can help you mitigate the effects or possibly prevent them from happening.

Physician Gale R. Burstein, commissioner of health for Erie County Department of Health, offered a few examples.

“There are certain heredity conditions known to certain ethnicities, so it’s important to read up on those and inquire if that has been a problem in the family,” she said. “Ashkenazi Jews have higher incidences of the BRACA gene that leads to breast cancer and ovarian cancer. African Americans are prone to sickle cell disease. For people of Mediterranean descent, it’s thalassemia.”

She said it’s important to know what to ask first so they can pose the

right questions.

Many people who have experienced the loss of a loved one feel especially vulnerable during the holiday season. Framing it as concern about family health can help make this potentially awkward conversation more comfortable.

Burstein said to start the conversation by asking parents about grandparents, what did they do for a living, if they had any health problems and the cause of death.

“If you approach it with questions that are less intrusive and transition to asking about health history and cause of death it creates a natural flow,” Burstein said.

“Everyone at the table would likely be interested if it’s a risk for them.

“It’s a great opportunity to know what your health risks are,” Burstein added. “It may lead someone to inquire with their health care provider if they need specific genetic or lab testing to check for certain conditions.”

Discussing your family health history with your care provider can also influence recommendations about health habits and other lifestyle choices — factors that may have contributed to your family’s health conditions.

Ask if anyone in the family has died unexpectedly from any cause and also ask about cardiovascular disease, cancer at any age, endocrine disorders, gastrointestinal conditions and any chronic illnesses.

“Holiday family gatherings are a great opportunity to learn about family health history,” Burstein.

especially those out of season.

“Many times seniors who live alone, or with just a spouse, are unable to get through large bags of produce, so a sampling of one or two is nice,” Burch said. “Dried fruits last much longer as well.”

Watch out for things that are hard to chew, as many older adults wear dentures, and salty items, since many watch their sodium intake.

For people eating “clean” and trying to lose weight, fruit also makes a welcomed gift.

College students may like graband-go options such as single-serving nuts, seeds and raisins. Packets of oatmeal or healthful granola bars can provide a quick breakfast. Fill a microwave popcorn bowl with a bag of kernels and a shaker of sea salt for those study night cravings. Keep their items simple and easy to fix.

Most microwavable foods will work,

but most dorms don’t have an oven or many kitchen tools.

Don’t forget about the children on your list. Burch likes to give gifts that can inspire them to get cooking, or some foods that seem like treats but are actually healthful.

“This could be something as simple as a healthier homemade dessert or homemade granola bars,” Burch said. “Or a basket with unique fruits they may have never had, like plantains, star fruit, dragon fruits, or a basket to make their own trail mix. It would include lots of different dried fruits, nuts, seeds and dark chocolate.

She also likes no-sugar-added dried fruit as a fun stocking stuffer or to tuck into a larger present.

“It offers protein, fiber, healthy fats, making it a nice, satisfying snack that will hold them over before their next meal,” Burch said.

As you compile your own gift basket, you can line it with a new tea towel and tuck in any accessories that complement the gift, such as a nutcracker with unshelled nuts.

Many party stores and discount stores sell cellophane outer wraps to keep your goodies in the basket.

n Erin Burch, registered dietitian and owner of Erin Burch Nutrition in Buffalo, likes gifts baskets with fresh fruit or nuts/seeds/trail mixes.

“Those would be the only options I would recommend buying,” she said. “Many of the other options are boxed items, filled with preservatives, or cured meats like sausages.”

Many older adults on a fixed income seldom buy fresh fruits, December 2018 •

Local experts suggest a food basket with fresh fruit or nuts/seeds/trail mixes can be a great holiday season gift.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 15

Holiday Greetings

Spirit of Giving Here’s how to make Christmas 2018 truly the season of thoughtfulness

Pet supplies

By Nancy Cardillo

O

ne of the reasons we began giving gifts at Christmas is to remind us of the presents the Wise Men brought to Jesus: gold, frankincense and myrrh.

Needless to say, today the tradition of giving and receiving gifts has, shall we say, grown.

According to the National Retail Federation, consumers will spend an average of $1,007.24 during this year’s holidays — a figure that’s 4.1 percent higher than last year. Of that amount, roughly $650 will be spent on gifts. Christmas is the season for giving, but it’s not just about buying flat-screen TVs or the latest musthave toy or electronic device. It’s about giving, particularly to those less fortunate.

Buffalo is called the “City of Good Neighbors” for good reason.

When there are those in need, Buffalonians step up in a big way by volunteering, supporting or donating. That’s particularly true at this time of year, as the holidays seem to bring out the “good neighbor” in a big way. So, this year, Buffalo, as you shop ‘till you drop, also consider opening your hearts and wallets and giving back.

To help you, here are some helpful tips for making that

charitable donation this holiday season: Before deciding where and what to give, Charity Navigator suggests you ask yourself these questions, so as to ensure your donation will reach those you are intending to help: n Does the charity match your passion? n Is the charity fiscally responsible, ethical and effective? n Does the charity have strong leadership? n Do you trust the charity enough to give without strings attached?

Once you’ve narrowed down your charity or charities of choice, the next step is to decide what to donate.

But before you start gathering or shopping, keep in mind you can’t just throw whatever items you no longer need or want into bags or the trunk of your car and drop them off at a donation site.

Call your charity of choice beforehand to make sure the items you’re donating are needed and wanted. Otherwise, the charity might have to pay someone to haul away items they can’t use, which defeats the purpose. Never donate anything that’s been recalled, banned or doesn’t meet safety standards.

Here are some of the most-

needed, most-appreciated items to donate:

Clothing

Warm clothing in particular is in demand, as are underwear and socks.

But please keep in mind any clothing items you donate should be clean, new or gently worn and in good condition — free of rips and stains.

Food

According to the Food Bank of WNY, one in eight people in its service area struggles with hunger, and depends regularly on places like food banks, pantries and soup kitchens. Most-needed items include cereal; peanut or other nut butters; canned tuna, chicken, soups, stews or chili; canned fruits or vegetables; beans, pasta or rice; spaghetti sauce and baby food, formula and diapers.

Not sure where to donate? Here are just a few organizations around Western New York that accept donations (hint: they need our help year-round, not just over the holidays):

n Buffalo Animal Shelter n Buffalo City Mission n Buffalo Pug & Small Breed Rescue, Inc. n Dress For Success Buffalo n Food Bank of WNY n Friends of Night People n Goodwill Industries n Harbor House Resource Center n Hearts For The Homeless n Jericho Road Community Health Center

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Hygiene Items

Items such as shampoo; diapers; toilet paper; feminine hygiene products; toothpaste and toothbrushes, hand sanitizer and laundry soaps are always in demand, particularly if they’re travel size and are sealed or still in their original packaging.

Donating Destinations

n Journey’s End Refugee Services n Joyful Rescues n Ken-Ton Closet n Operation Pets n Pet Connection Programs, Inc. n Salvation Army Buffalo n Second Chance Sheltering Network n SPCA Serving Erie County n St. Luke’s Mission of Mercy n Ten Lives Club

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • December 2018

Toys

Nobody wants to see a child go without, particularly at Christmas.

New toys — still in their original packaging — are always a welcome donation, particularly if they’re suited to older children. If you’re donating used toys, be sure they’re sanitized, safe and in good condition.

Let’s not forget to take care of our fur babies! By donating items such as food, litter, leashes and collars, toys and beds, you might be helping someone avoid having to turn over their beloved pet to a shelter because they can no longer provide care.

Miscellaneous

Items such as school supplies, backpacks, reusable water bottles, kitchen items, furniture, books and bicycles are always in need, as are old cell phones, computers (just remember to remove all personal information before donating) and office supplies, such as printer/copy paper or ink cartridges.

Cash

While it may not seem as “thoughtful” as tangible items, cash is always a welcome donation. Most charitable organizations depend on cash donations to some degree, and can use that money to purchase whatever they need. Not comfortable giving cash? How about a gift card?

Many charities have a running wish list on their websites of the most-needed, most-desired items, giving you a good place to start.

Keep in mind as you consider your donation that the rules covering income tax deductions for charitable contributions have changed. You can learn more on the Internal Revenue Service website.

Think Outside the Mall Gifts for the person who has everything

By Nancy Cardillo

M

aking that list, checking it twice and … still coming up short?

Here are some gift ideas for the “hard-to-buy-fors” on your list.

You know who they are: those people on your holiday gift list who are darned near impossible to buy for.

That’s because when they want something, they go out and buy it, leaving you scratching your head and biting your nails when it comes time to buy them a gift. That takes the fun out of the holidays just a bit, doesn’t it?

Well, this year you can relax, because the list below offers great gift ideas for those on your list who have everything and need nothing. It includes some exciting, unique, practical and touching gift ideas — in a variety of price ranges — for that oh-so-hard-to-buy-for loved one.

So, let’s think outside the mall. (And remember: some of the best gifts cost nothing at all!)

Give them an experience they’ll remember

Here in Western New York, gifting someone with a memorable experience is easy.

How about treating them to one of our many local history or architectural tours? Groups like Explore Buffalo or Buffalo Harbor Cruises offer a variety of interesting, educational and entertaining tours that let you discover Buffalo’s great architecture, history, neighborhoods and waterways.

What about a hot air balloon or horse-drawn carriage ride or a spa experience? If there’s something they’ve always wanted to do — such as learn to be a gourmet cook, master ballroom dancing or improve their photography or computer skills — purchase lessons for them.

Sites such as Groupon or Living Social can help make the gift more affordable.

Pay it forward

An especially good idea for seniors on fixed incomes is paying ahead for a regular service they use (or could use), including a thorough (or regular) housecleaning, pet walking or yard cleanup service, window washing or car detail-

and dear to their hearts?

Everyone has old home movies stashed away they can no longer view because they don’t have a Super 8 projector or a videocassette recorder. Places like Delaware Camera can digitize your movies and photos so they can be easily shared, duplicated and viewed.

What about commissioning a family photo or painting? Or creating a book or video journal that tells the family history, complete with photos. Many sites, such as Shutterfly, let you create personalized books, calendars and more from your computer.

Buffalo Harbor Cruises offers sightseeing and party cruises and private charters that feature breathtaking scenic views, picturesque sunsets and great entertainment aboard the Miss Buffalo II. Photo provided. ing, snowplowing or spring/fall yard cleanup.

Parents of young children might appreciate babysitting services (you could even volunteer your services). Most anyone would appreciate having healthy meals delivered right to their home, so check out services such as Hello Fresh or Buffalo’s Food Nerd.

Surprise them with a subscription or a membership

A subscription or membership is the gift that keeps on giving.

There are the usual options, such as a monthly fruit or flower delivery, a favorite magazine or newspaper subscription. But what about regular wine deliveries (www.goldmedalwineclub.com) or, for someone who loves to cook, an olive oil membership (www.amazingclubs.com/oliveoil.html).

How about surprising your loved one with season tickets to one of our many theaters or a membership to a local cultural attraction, such as the Darwin Martin House, the Burchfield Penney Art Center or the Buffalo Zoo?

Make it personal or personalized

For those on your list who simply don’t need more stuff, how about something personal or near

A walking tour led by one of Explore Buffalo’s trained, experienced and entertaining docents is a great way to learn about Buffalo, its history and architecture. Photo provided.

Donate in their name

There are so many worthwhile local organizations in need that a donation in the name of a loved one is a very special gift idea that will benefit not just one, but many.

Animal shelters, homeless shelters, cultural or health organizations — even the local police or fire department — are all great options.

Try to choose something that has meaning to the person in whose name you are making the donation.

Go ahead: Make their day more comfortable, relaxing or easier.

Keeping in mind that the best gifts come from the heart and cost little or no money, how about giving the gift of time — your time. Offer to run errands for that busy mom. Take the dog or cat to the vet for someone who works full time. Take a neighbor to the doctor. Take an elderly relative out for lunch or for a scenic fall car ride.

Other ideas to make life easier for someone: heated gloves or socks; refrigerator magnets with messages of love or sentimental photos; a roll of stamps and some return address labels (maybe even buy them assorted greeting cards to have on hand); portable phone chargers or homemade baked goods, jams or sauces. A gift card or certificate may not be a unique gift idea, but if you get one for a favorite store, salon or activity, it shows you’re paying attention to your loved ones’ preferences.

The Burchfield Penney Art Center is the only museum dedicated to the art and artists of Western New York, and features more than 30 exhibitions annually, including kidfocused, hands-on exhibits and public and private tours. Photo provided.

December 2018 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 17

Holiday Greetings

Sew New Memories in Angola is an adaptive clothing company that specializes in converting familiar home fabrics into something new for loved ones with special needs. In this case, owner Kim Sexton converted a table cloth into a dress.

Special Gifts for Special People Here are some gift ideas for elderly, handicapped

By Catherine Miller

T

he holiday gift-giving season is upon us.

If your gift list includes people with special needs, it’s unlikely that you’ll find the perfect present in the Sunday ads of big box retailers.

But rest assured there are plenty of options in the Western New York area and through online shopping to find the perfect gift for that special loved one.

Gifts of memories People with memory impairment issues are challenged every day with trying to function in a world that is growing increasingly unfamiliar.

Gifts that trigger sights, sounds and scents of years past allow aging people to relive those happy times.

Consider taking Mom’s old tablecloth and converting it to an apron or smock, complete with large pockets for the items she keeps close at hand. It may sound like a simple gift, but for an aging person with beginning dementia, wearing such clothing can bring back flocks of memories of sitting around the dinner table with family, having tea with friends, and sharing stories.

Sew New Memories in Angola is Page 18

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an adaptive clothing company that specializes in converting familiar home fabrics into something new for loved ones with special needs.

Owner Kim Sexton has converted tablecloths to aprons, favorite shirts and jackets to pillows, and treasured dresses to shawls.

“People love items that are made from items they remember,” stated Sexton, “It’s a way to keep hold of the happy times, and remember the people that were around when the items were used.”

Lap blankets, totes, shawls, and pillows make wonderful gifts and can be made from your loved ones cherished dresses, curtains or even a holiday table runner. Consider adding essential oils to a scarf or shawl to bring back memories of roses, lavender or other favorite scents.

Do you have a music lover on your gift list? Use a voice recording device, available online or at your craft store, to record a clip from their favorite song and have it inserted into the corner of a pillow.

If photographs bring comfort to your loved one, pictures of family members can be uploaded and put onto a blanket or coffee mug using many online sites including

Shutterfly and Snapfish. Just be sure to order early enough for the holidays.

Gifts of comfort, ease Physically handicapped people deal with daily challenges in a world made for mobility. Often times, able-bodied people don’t consider the issues a physically handicapped person faces just getting dressed.

Gift-giving time can be the perfect time to think about what they may need.

Sew New Memories is just the ticket to creating specialized items for those with physical limitations.

Sexton said that her niece, Alicia, who is wheelchair bound, was the inspiration behind many of her creations. Sexton began making items that would increase Alicia’s comfort and assist her aides in getting her ready for the day.

Thus were created coats that could be placed directly over a wheelchair, shirts that were altered with Velcro fasteners in the back and dozens of other items. If you have a person with mobility issues, Sew New Memories can alter clothing items to make getting dressed much easier.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • December 2018

“Whatever people need to make their loved one more comfortable and easier to care for, I can create,” Sexton said. This is true for people with diseases and chronic illnesses that make lifting extremities difficult and even those with arthritis that find buttoning buttons increasingly challenging.

Adult bibs can be made for people with movement and feeding issues to keep outfits clean. Including embroidered names on bibs and shirts for non-verbal people adds a reminder for caretakers to address them by name.

Shoes adapted with Velcro closures ease the efforts of people with finger dexterity issues. Any favorite clothing item can be altered to a person’s specific need. It may sound simple, but if you’ve ever had to dress a person with limited mobility, then you know the struggle is real for both the person with the disability and caretaker.

When choosing the perfect gift, think of the gift from the recipient’s point of view. What would make their life easier or more comfortable?

Warming mittens? A lap blanket?

Maybe a wheelchair pillow? Gifts of comfort can be a godsend and the perfect present this holiday season.

Why Do Some People Experience Depression During the Holidays?

Many people with depression symptoms experience a worsening of mood over the holidays.

T

he holidays can be a time of emotional highs, but also lows. It’s not uncommon to feel loneliness, anxiety, sadness interspersed with happiness. The bad news is the holiday blues can worsen depression symptoms in people struggling with chronic depression.

For Many With Depression, Loneliness is Heightened During the Holidays Many people with depression symptoms experience a worsening of mood over the holidays. A study of 420 Chicago-area college students investigated their feelings about the Christmas holiday and found

that three of the most common themes are loneliness, anxiety and helplessness. In another study, Canadian patients who were being evaluated in a psychiatric emergency service during the Christmas season reported feeling depressed and cited loneliness and being without a family as the most common stressors.

The Biggest Cause of Holiday Blues is Unrealistic Expectations Experts say one of the biggest causes of holiday depression symptoms is unrealistic expectations.

Studies have confirmed that the primary reason for holiday

depression is belief in the myth that everyone else is having a good time and engaged in loving family relationships. While this is certainly a common wish, it’s not necessarily a fact.

You may be holding on to what you remember as an ideal holiday from years gone by. Inevitably, you won’t be able to reproduce it.

You may also have the unrealistic expectation around the holidays that ‘everything must be perfect’, and perfection is, of course, rarely obtainable.

Symptoms Range from Fatigue to Family Tensions to Financial Limitations Besides all the unrealistic expectations, other reasons for feeling blue around the holidays are numerous. According to the National Mental Health Association, fatigue, financial limitations, missing loved ones and family tensions are all common reasons for feeling sadness and depression symptoms during the holidays. If you’re like most people, you associate the holidays with family and togetherness. But in today’s world of high divorce rates and fragmented family units, it’s common to feel stress and sadness when trying to work out how time between family members is shared. Being separated from loved ones, whether because of death, financial limitations, or divorce can be especially painful around the holidays.

Source: UHN — University Health News.

Beyond Seeing Eye: Service Dogs’ Many Jobs

By Deborah Jeanne Sergeant

W

hile the seeing eye dog may come to mind when picturing a service animal, service dogs can perform many other important jobs to help people with disabilities or medical conditions.

Carol Borden, founder/CEO with Guardian Angel Medical Service Dogs said that although guide dogs have been used in the US since 1929, other types of service animals have become widely known only in the past 40 years.

Based in Florida, Guardian Angel places dogs nationwide.

Borden said that service dogs can help with both “visible” and “invisible” needs, including mobility, retrieval, tasks and warning of seizures or low blood sugar.

“Dogs have a very sophisticated sense of smell,” Borden said. “They know as soon as there’s a chemical change in the body such as a diabetic change and they can alert if it’s too high or low.”

Guardian Angel trains dogs for a specific type of service to which the dog demonstrates interest and aptitude.

Puppies all receive the same basic training for socialization and desensitization and during that process, the dog’s talents becomes clear to trainers.

“Does he like to use his nose?”

Borden said. “Does he bring every stick and stone in the yard?”

It’s a 12- to 15-month process.

The organization also learns about potential recipients to see what needs they have and what type of dog would work well with their household.

Once a good match is made, the dog learns advance skills needed for that recipient. Then the dog and recipient train and bond together.

“Once they’re ready to go home, they’re in good working condition,” Borden said. “We continue to keep

up with them for the life of the team.”

Guardian Angel uses German shepherds mostly because they mature more quickly than other breeds and are a working breed that enjoys learning.

Beverly Underwood serves as president of Canine Helpers for the Handicapped, Inc. in Lockport. She said her organization is one of the first schools to work with people with multiple disabilities. In the organization’s 35 years, Canine Helpers has placed more than 750 dogs placed nationwide.

“There aren’t many disabilities for which dogs can’t help,” Underwood said.

Her organization has puppies raised in foster homes and then figures out the dogs’ aptitude. Each dog receives customized training and then trains with the client a couple weeks “to become an efficiently working team,” Underwood said.

Her organization provides lifetime support to the dog/handler team and the animals can receive additional training if they need to provide more services.

Canine Helpers will also train the individual’s pet dog if it has the right temperament and is the appropriate size to offer help.

So what’s the difference among a service animal, emotional support animal and therapy animal?

The Americans with Disabilities Act recognizes only dogs and, rarely, miniature horses as service animals.

Service animals:

• trained to help one person mitigate the challenges of a disability.

• performs at least tasks needed for daily living.

• allowed to go anywhere the person may legally go.

• considered a “medical device” legally.

Canine Helpers for the Handicapped, Inc. provided this service dog, Kevin, to client Cindy White.

• owners may only be asked, “Is this a service dog?” and “What tasks are your dogs doing?”

• are not required to have a special vest or owners to bear any paperwork (although the former can be helpful in identifying service dogs).

Emotional support:

• trained to help one person.

• not allowed everywhere in the same sense as service dogs (though some establishments allow them).

Therapy animals:

• trained to exhibit good manners and interact with a variety of people to spread goodwill but not help with any tasks.

• with permission and certification of training, may enter places such as nursing homes, schools, hospitals, or libraries for story hour.

Underwood said that she wishes more people understood that it’s

December 2018 •

important to never pet or engage with service animals that are on duty.

It’s distracting and goes against their training.

She also wishes more people understood that her organization will not train pet dogs to become service dogs just so that people without disabilities can take their pets everywhere.

Fake service dogs have become a problem, according to Borden.

Fraudsters obtain a counterfeit vest and identification card to impersonate someone who needs a service animal to take their pet dogs wherever they wish.

“It’s disrespectful to those who need to have these dogs,” Borden said. “I can’t tell you how many times our dogs have been attacked by impostor dogs. It damages the psyche of the service dog and they become defensive and bark at other dogs. They do not have the manners nor act appropriately. Service dogs should be invisible if they’re not doing anything.”

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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Page 19

Call 716-603-6851 SeanKellyMedicareAdvisor.com When you pick up the phone, so do I!!

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Local Medicare Professional Turning 65?, New to Medicare?, Questions about Medicare?

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From the Social Security District Office

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HOLIDAYS • This is a great time to put your family’s health history together • Six ways to go heartburn-free this season • How to pick healthful food gifts for college students, parents, seniors

n Sports concussions: Much worse for women n WNY Doulas assists women during pregnancy n Vaginal rejuvenation: FDA cautions about procedure n How food can affect urinary tract infection

Laughter Yoga

December 2018 • ISSUE 50

If the holidays are the most joyous tie of the year, why do so many people get depressed?

SPECIAL ISSUE

People of all ages and abilities gather weekly at Cleveland Hill Methodist Church in Buffalo to do mainly one thing: laugh. They are members of Many Ha Ha’s Laughter Yoga Club

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Healthy Sleeping

NY Ranks High in New Cases

Director of the Sleep and Wellness Centers of WNY talks about healthy sleeping

Page 10

Acorn Squash Acorn squash, of all the winter squashes, has many of the most important vitamins we need. See SmartBites inside

Page 13

Handy Tool or Bacteria Haven?

Tips on how to sanitize one of the filthiest spots in your home. Yes, the kitchen sponge.

Page 13

Spirit of Giving Buffalonians in general step up in a big way by volunteering, supporting or donating. That’s particularly true at this time of year, as the holidays seem to bring out the “good neighbor” in a big way. So, this year, Buffalo, as you shop ‘til you drop, also consider opening your hearts and wallets and giving back.

Local experts say HIV figures in the state are skewed by the high numbers seen in New York City

Mussels

These scrumptious mollusks possess the most impressive nutritional profile of all shellfish, especially when it comes to vitamin B-12, selenium and manganese

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716-332-0640 EDITOR@BFOHEALTH.COM Serving Western New York A monthly newspaper published by Local News, Inc. Distribution: 32,500 copies throughout more than 1,500 high traffic locations in the region In Good Health is published 12 times a year by Local News, Inc. © 2018 by Local News, Inc. All rights reserved.

3380 Sheridan Dr., # 251 • P.O. Box 550, Amherst NY 14226 Phone: 716-332-0640 • Fax: 716-332-0779 • Email: editor@bfohealth.com Editor & Publisher: Wagner Dotto • Associate Editor: Lou Sorendo • Writers: Deborah J. Sergeant, Jim Miller, Gwenn Voelckers, Anne Palumbo, Chris Motola, George W. Chapman, Ernst Lamothe Jr., Jana Eisenberg, Daniel Meyer, Nancy Cardillo Advertising: Anne Westcott, Amy Gagliano Layout & Design: Dylon Clew-Thomas • Office Assistant: Kimberley Tyler 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.

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n the digital age, frauds and scams are an unfortunate part of doing business online. During the holiday season, Social Security has traditionally seen a spike in phishing scams, and we want to protect you as best we can.

We urge you to always be cautious and to avoid providing sensitive information such as your Social Security number (SSN) or bank account information to unknown individuals over the phone or internet. If you receive a call and aren’t expecting one, you must be extra careful.

You can always get the caller’s information, hang up, and — if you do need more clarification — contact the official phone number of the business or agency that the caller claims to represent. Never reveal personal data to a stranger who called you.

Please take note: there’s a scam going around right now. You might receive a call from someone claiming to be from Social Security or another agency. Calls can even display the 1-800-772-1213, Social Security’s national customer service number, as the incoming number on your caller ID. In some cases, the caller states that Social Security does not have all of your personal information, such as your Social Security number, on file.

Other callers claim Social Security needs additional information so the agency can increase your benefit payment or that Social Security will terminate your benefits if they do

Q&A Q: I’m trying to figure out the best time to retire based on my future earnings. How can I calculate my own retirement benefit estimate?

A: We suggest you use our retirement estimator at www.socialsecurity.gov/estimator. Our retirement estimator produces estimates based on your actual Social Security earnings record, so it’s a personalized, instant picture of your future estimated benefit. Also, you can use it to test different retirement scenarios based on what age you decide to start benefits. For example, you can find out your estimated monthly payments if you retire at age 62, 70, or any age in between. Try it out now at www. socialsecurity.gov/estimator.

Q: How do I know if I meet the eligibility requirements to get Social Security disability benefits?

A: To qualify for Social Security disability benefits, you must have worked long enough in jobs covered

by Social Security (usually 10 years).

You must also have a medical condi-

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • December 2018

not confirm your information. This appears to be a widespread issue, as reports have come from people across the country. These calls are not from Social Security.

Callers sometimes state that your Social Security number is at risk of being deactivated or deleted. The caller then asks you to provide a phone number to resolve the issue. People should be aware the scheme’s details may vary; however, you should avoid engaging with the caller or calling the number provided, as the caller might attempt to acquire personal information.

Social Security employees occasionally contact people by telephone for customer-service purposes. In only a few special situations, such as when you have business pending with us, a Social Security employee may request the person confirm personal information over the phone.

Social Security employees will never threaten you or promise a Social Security benefit approval or increase in exchange for information.

In those cases, the call is fraudulent, and you should just hang up. If you receive these calls, please report the information to the Office of the Inspector General at 1-800-269-0271 or online at oig.ssa.gov/report.

Remember, only call official phone numbers and use secured websites of the agencies and businesses you know are correct. Protecting your information is an important part of Social Security’s mission to secure today and tomorrow.

tion that meets Social Security’s strict definition of disability. We consider an adult disabled under our rules if he or she has a medical condition, or combination of medical conditions, that are expected to last for at least one year or result in death, and that prevent the performance of any type of work.

If you think you may be eligible to receive disability benefits and would like to apply, you can use our online application at www.socialsecurity.gov/applyfordisability.

Q: Why is there a five-month waiting period for Social Security disability benefits?

A: The law states Social Security disability benefits can be paid only after you have been disabled continuously throughout a period of five full calendar months. Social Security disability benefits begin with the sixth full month after the date your disability began. You are not able to receive benefits for any month during the waiting period. Learn more at our website: www.socialsecurity.gov/ disability.

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By Jim Miller

How to Get Veterans’ Funeral and Burial Benefits Dear Savvy Senior, Does the VA provide any special burial benefits to old veterans? My dad, who has late-stage Parkinson’s disease, served during the Vietnam War in the 1960s.

Only Child Dear Only, Most U.S. veterans are eligible for burial and memorial benefits through the Department of Veterans Affairs (VA) National Cemetery Administration. Veterans who were discharged under conditions other than dishonorable are eligible. To verify your dad’s discharge, you’ll need a copy of his DD Form 214 “Certificate of Release or Discharge from Active Duty,” which you can request online at Archives.gov/ veterans.

Here’s a rundown of some of the different benefits that are available to veterans that die a nonservice-related death.

National Cemetery Benefits If your dad is eligible, and would like to be buried in one of the 136 national or 111 grant-funded state and tribal VA cemeteries (see www. cem.va.gov/cem/cems/listcem.asp for a list), the VA provides a host of benefits, at no cost to the family, including: a gravesite; opening and closing of the grave; perpetual gravesite care; a government headstone or marker; a United States burial flag that can be used to drape the casket or accompany the urn (after the funeral service; the flag is given to the next-of-kin as a keepsake); and a presidential memorial certificate.

National cemetery burial benefits are also available to spouses and dependents of veterans.

If your dad is cremated, his remains will be buried or inurned in the same manner as casketed remains.

Funeral or cremation arrangements and costs are not, however, taken care of by the VA. They are the responsibility of the veteran’s family, but some veteran’s survivors are eligible for burial allowances, which are explained below.

If you’re interested in this option, the VA offers a preneed burial eligibility determination program at www.cem.va.gov/pre-need or call the National Cemetery Scheduling Office at 800-535-1117.

Private Cemetery Benefits If your father is going to be buried in a private cemetery, the benefits available include a free government headstone or marker, or a medallion that can be affixed to an existing privately purchased headstone or marker; a burial flag; and a Presidential memorial certificate.

Funeral or cremation arrangements and costs are again the responsibility of the family (some burial allowances may be available), and there are no benefits offered to spouses and dependents that are buried in private cemeteries.

Military Funeral Honors Another popular benefit available to all eligible veterans buried in either a national or private cemetery is a military funeral honors ceremony. This includes an honor guard detail of at least two uniformed military persons, folding and presenting the U.S. burial flag to the veteran’s survivors, and the playing of “Taps” by a bugler or an electronic recording.

The funeral provider you choose will be able to assist you with all VA burial requests. Depending on what you want, certain forms may need to be completed which are always better to be done in advance.

For a complete rundown of burial and memorial benefits, eligibility details and required forms, visit www.cem.va.gov or call 800827-1000.

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Burial Allowances In addition to the burial benefits, some veteran’s survivors may also qualify for a $300 burial allowance (or $780 if hospitalized by VA at time of death) and $780 for a plot, to those who choose to be buried in a private cemetery. To find out if your dad is eligible, see Benefits.va.gov/ benefits/factsheets/burials/burial. pdf.

To apply for burial allowances, you’ll need to fill out VA Form 21P530 “Application for Burial Benefits.”

You need to attach a copy of your dad’s discharge document (DD 214 or equivalent), death certificate, funeral and burial bills. They should show that you have paid them in full. You may download the form at VA.gov/vaforms.

What’s come between you?

Lack of trust? Loveless, sexless relationship?

Excessive use of porn or social media?

Call Kavod Psychotherapy at 585.546.5180.

KavodRecovery.com | 585.546.5180 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.

December 2018 •

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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H ealth News ECMC appoints two new vice presidents Erie County Medical Center (ECMC) Corporation officials recently announced two appointments to their administrative team.

• Diane Artieri has been appointed vice president of materials man agement for ECMC Corporation. Artieri most recently served as director of materials management at Kaleida Health. She holds a bachelor’s degree in accounting Artieri from the SUNY Geneseo and is Lean- and ISO-certified in auditing. Her career spans over 30 years in accounting and supply chain services in manufacturing and health care within the Buffalo area. Artieri will work with ECMC materials management and Kaleida Health supply chain department managers and staff to streamline purchasing procedures.

• Janet Martin has been appointed vice president of finance for ECMC Corporation. Martin holds a bachelor’s degree in accounting and business administration from St. Martin’s University, Lacey, Wash., and a master’s degree in healthcare Martin management from the University of Texas, Tyler.

Most recently, she served as the regional chief financial officer for East Texas Medical Center near Tyler, Texas. Martin has over 25 years of healthcare financial management experience. She is a certified public accountant and a member of the Healthcare Financial Management Association.

Medical Health Associates has new finance director Barbara A. Nowakowski has recently joined Medical Health Associates of Western New York (MHA) its director of finance.

“Barb has been involved with managing accounting and financial operations for physician practices for more than Nowakowski 12 years. We are very happy to have her experience and approach to overseeing the financial systems of Medical Health Associates,” said physician Colleen Mattimore, president of MHA. Page 22

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Nowakowski received her Bachelor of Science degree in accounting from Canisius College. Her business, banking and medical practice accounting experience span more than a decade. She is a member of the New York Medical Group Management Association.

Medical Health Associates of Western New York is a collaboration of pediatric practices: Williamsville Pediatric Center, Western New York Pediatrics, Suburban Pediatrics and Tonawanda Pediatrics.

MHA operates with more than 50 pediatric clinicians and 200 staff with seven offices throughout Western New York — in Amherst, Williamsville, Grand Island, Alden and Orchard Park.

Independent Health gets high rating from CMS Independent Health has once again been recognized as a 4.5 star rated Medicare plan by the Centers for Medicare and Medicaid Services (CMS). The annual star ratings are designed to help Medicare beneficiaries assess the quality, value and performance of every Medicare Advantage plan throughout the nation.

Using a five-star quality rating system, with five being the highest-rated plan, the 2019 Medicare star ratings for all Medicare Advantage health plans and Medicare Part D prescription drug plans were released in Novmber. Independent Health’s HMO and PPO plans both earned 4.5 stars for 2019. This marks the ninth consecutive year that Independent Health’s HMO plan has received a 4.5 star rating and the fourth straight year that its PPO plan has achieved it.

“Independent Health takes great pride in the fact that our Medicare Advantage Plans have been consistently rated highly by CMS over the years,” said Cathy Aquino, director of government sales, Independent Health. “Our 4.5 star Medicare rating in 2019 is a testament to our long-standing efforts of providing the highest level of customer service and partnering with health care providers to make sure our members receive well-coordinated, high-quality care.”

New doctors join UBMD Physicians’ Group UBMD Physicians’ Group, the largest medical group in Western New York, has added 20 new physicians in the last few months.

They are: • Lalarukh Aftab, UBMD Pathology. She is returning to Western New York and the UBMD, bringing her specialized knowledge of hematopathology. She works with all Kaleida Health facilities and the Erie County Medical Center, and is based at Buffalo General Medical Center where she serves as the site medical director.

• Darren Alicandri, UBMD Family Medicine. A specialist in addictions medicine, Alicandri is also

Roswell Park Recognized as Center with ‘Great Oncology Program’ Roswell Park Comprehensive Cancer Center has again been named to Becker’s Hospital Review’s 100 Hospitals and Health Systems with Great Oncology Programs, an annual list of centers that are national leaders in patient care, cancer outcomes and research. Roswell Park is one of only six New York state centers to be included, and the only one in Western and Upstate New York.

“The hospitals and health systems selected for this list are at the forefront of cancer treatment and research,” the news outlet notes.

“This list also includes cancer centers with busy research institutes, multiple clinical trials and safety designations that exceed national benchmarks. Hospitals and health systems highlighted here have invested in growing oncology departments and regional cancer centers, providing an important service to patients locally and nationally.”

In selecting facilities for the great oncology programs feature, the Becker’s editorial team looks at resources including the U.S. News & World Report cancer care rankings, CareChex rankings and National Cancer Institute “comprehensive cancer center” designations.

Becker’s Hospital Review is a print and online news outlet that focuses on business and legal information for healthcare industry leaders.

Roswell Park has appeared on every version of this list since Becker’s Hospital Review initiated the program in 2010. For more informations, go to www.beckershospitalreview.com

serving as a clinical assistant professor within the Jacobs School, and is seeing patients at Family Medicine’s Amherst Additictions Medicine site and BestSelf Behavioral Health in Buffalo.

• Allison Binkley, UBMD Orthopaedics & Sports Medicine. A native of East Amherst and graduated from the Jacobs School where she completed her orthopedic residency, Binkley returns to the Buffalo area from Ohio and brings a specialty in pediatric orthopedics, scoliosis and sports medicine to the her group.

• Matthew Binkley, UBMD Orthopaedics & Sports Medicine. Another alumnus of the Jacobs School, Binkley returns to WNY from Ohio where he completed fellowship training at Johns Hopkins and surgical attending at Dayton Veterans Hospital, specializing in shoulder and elbow injuries, repairs and reconstruction, in addition to general orthopedics.

Binkley works with patients at the Erie County Medical Center and is accepting appointments at BrookBridge in Orchard Park..

• Keith Cross, UBMD Pediatrics. One of three new physicians at UBMD Pediatrics, Cross joins the pediatric emergency medicine team working at Oishei Children’s Hospital. Cross is an attending physician within the practice and new both to UBMD and the Buffalo region.

• Elizabeth Gabel, UBMD Family Medicine. Based at the practice’s office on Sheridan Drive in Tonawanda, she also teaches students in the Jacobs School as a clinical instructor.

Gabel is also new to the region.

• Csaba Gajdos, UBMD Surgery.

He is a new surgical oncology surgeon with UBMD Surgery. He focuses on complex melanomas, gastrointestinal cancers and stromal tumors, sarcomas and peritoneal surface malignancies, as well as chronic pancreatitis. He is chief of general surgery at the Buffalo VA Medical Center and teaches within the Jacobs School as a

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • December 2018

clinical associate professor.

• Sarah Gibbons, UBMD Psychiatry. A psychiatrist with a focus on emergency psychiatry, she is based at the Erie County Medical Center’s CPEP — Comprehensive Psychiatric Emergency Program.

• Dacia Harris, UBMD Internal Medicine. He serves as a new general internal medicine physician with the practice. Harris is taking appointments in Buffalo at the Hertel-Elmwood Internal Medicine Center.

• Meghan Jacobs, UBMD Pediatrics. A pediatric hospitalist, she joins UBMD Pediatrics’ presence within Oishei Children’s Hospital. She brings with her a focus on hospitalist medicine and general pediatrics.

• Abhijana Karunakaran, UBMD Internal Medicine. Specializing in endocrinology, Karunakaran sees patients at the practice’s Maple Road office.

• Sikandar Khan, UBMD Surgery. A graduate of the Jacobs School vascular residency program, Khan brings a wealth of knowledge to the UBMD Surgery team. His areas of expertise cover endovascular and open surgical treatment of peripheral arterial disease, abdominal aortic aneurisms, thoracic aneurisms and dissections, carotid and venous diseases, and dialysis access surgery.

Khan performs surgeries at both the Erie County Medical Center and Buffalo General Medical Center • Ankush Lahoti, UBMD Internal Medicine. New physician to the area, Lahoti is a structural interventional cardiology fellow. Specializing in cardiology, Lahoti works with patients at the Buffalo General Medical Center and Gates Vascular Institute.

• Robert Macek, UBMD Family Medicine. Family medicine physician is the associate program director for the Amherst office on Hopkins Road.

• Candace Marr, UBMD Internal Medicine. Another new physician with the practice, Marr works with the inpatient team at the Erie County

H ealth News Medical Center, and specializes in the diagnosis and treatment of infectious diseases.

• Matthew McIntosh, UBMD Internal Medicine. Joining as a primary care provider at UBMD Internal Medicine’s office in the Conventus building, he also has a concentration in pediatric medicine.

• Jeffrey Mullin, UB Neurosurgery. A newcomer to Buffalo, Mullin has held a fellowship in complex deformity spine at the University of Virginia. A specialist in neurospine disorders, spine deformities and general cranial neurosurgery, he sees patients on an outpatient basis at the practice’s Amherst and Orchard Park offices and performing surgeries at Buffalo General Medical Center and Gates Vascular Institute.

• Ajay Panchal, UBMD Surgery.

An alumnus of the Jacobs School, Panchal has worked in private practice for several years and is now part of the UBMD Physicians’ Group. A general surgeon, he performs general, laparoscopic and robotic surgeries at Millard Fillmore Suburban Hospital and sees patients on an outpatient basis at his office on Alberta Drive in Amherst.

• Karl Yu, UBMD Pediatrics. Has joined UBMD Pediatrics at its office in the Conventus building. He is an attending physician and specializes in pediatric infectious diseases. A newcomer to Western New York, Yu has also joined the faculty of the Jacobs School and works with students as a clinical assistant professor in addition to his work with patients.

Five Star changes name to WellNow Urgent Care Effective immediately and over the next couple of months, the transition will apply to all existing and future Five Star Urgent Care locations.

According to a news release, the comprehensive rebrand elevates the company’s investment in quality, convenient and patient-centered care. Further, the rebrand reinforces the company’s belief in empowering every patient when it comes to managing their health and decisions on where, when and how they receive treatment.

“We are proud and excited to announce the debut of WellNow for every patient we serve across New York state,” said physician John Radford, funder and president, WellNow Urgent Care, formerly Five Star Urgent Care. “This rebrand is about more than a name change. It represents a milestone evolution. Since we started in 2012, our company has been rooted in a strong history of putting our patients’ needs first. We’ve done this by delivering quick, quality, convenient urgent care, as well as putting the power in their hands by accessing up-to-date wait times at our facilities as well as being able to save their spot to be seen online before they come in. We feel that our new name and brand better reflect this philosophy and mission.”

New Entrance, Atrium Under Construction at ECMC

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onstruction of the new main entrance and the Russell J. Salvatore Atrium at Erie County Medical Center has begun.

ECMC announced in 2017 that the new entrance area would be named for the beloved Buffalo restaurateur and philanthropist Russell J. Salvatore who had generously

donated $1 million to the hospital’s capital campaign.

To date, thanks to Salvatore’s and other generous contributions, ECMC has raised over $9.5 million for its capital campaign, which will lead to the building of a new state-ofthe-art trauma center and emergency department, as well as other capital

improvements at the hospital, including the main entrance/lobby.

A donation of $500,000 in July 2014 by Salvatore led to the opening of the Russell J. Salvatore Orthopaedic Unit in 2015 on the sixth floor of ECMC. He had also previously in 2012 donated $250,000 to upgrade televisions in patient rooms.

Victor Filadora Named President of Great Lakes Cancer Care Physician Victor A. Filadora has been named president for Great Lakes Cancer Care.

He will lead the collaborative oncology efforts between Kaleida Health, ECMC, Cancer Care of Western New York, General Physician PC, UBMD, Great Lakes Medical Imaging, Western New York Urology Associates and Windsong Radiology Group.

“Great Lakes Cancer Care was born out of a simple idea; and that was to harness and organize our community’s top medical talent and most advanced technology in a unique partnership to diagnose, treat, and cure cancer,” said Filadora Jody Lomeo, president and CEO of Kaleida Health as well as the Great Lakes Health System of Western New York. “We are proud to have Victor lead this collaborative group. He brings tremendous experience in both oncology and healthcare administration.”

Filadora most recently served as the senior vice president and chief of clinical services at Roswell Park Comprehensive Cancer Center.

During this time in that role, he had responsibility for managing ambulatory services, perioperative services, sterile processing, pharmacy, patient and family experience, endoscopy services and therapeutic services programs. In addition to this, Filadora served as the clinical chief of perioperative medicine and associate dean for graduate medical education at Roswell Park and a clinical assistant professor within the department of anesthesiology at the University at Buffalo (UB) Jacobs School of Medicine.

Great Lakes Cancer Care comprises eight different organizations with more than two dozen locations (inpatient and outpatient) and offers medical oncology, radiation oncology, surgical oncology, and other support services to provide patients with the most collaborative and effective cancer care possible.

Thomas J. Quatroche Jr., PhD, president and CEO of ECMC, said, “Great Lakes Cancer Care is blending the strength of many of the best cancer care providers in Western

December 2018 •

New York to provide the best quality care for our community. We are pleased to have a leader like Victor who is a collaborator that can bring the various disciplines in Great Lakes Cancer together for the benefit of patients.”

Filadora spent more than 15 years at Roswell, rising through the ranks of medical affairs and administration. He began his career as a practicing anesthesiologist and quickly assumed leadership responsibilities as the medical director for perioperative services.

He joined Roswell from Brigham and Women’s Hospital in Boston, an affiliate of Harvard Medical School, where he served as chief resident for the department of anesthesiology. He served on the staff of Newton-Wellesley Hospital and the Tufts University School of Medicine faculty from 2004 to 2005, at which point he returned to Roswell as chief of perioperative medicine and director of the Center for Preoperative Evaluation.

He graduated from the State University of New York at Buffalo (UB) Jacobs School of Medicine & Biomedical Sciences. He also holds Master of Business Administration and Master of Science degrees from UB.

IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper

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How will weight loss improve my health? cancer Can I beat this cancer? fracture Where do I go for a fracture?

How do I get a transplant in time?

For many questions, one easy answer: ECMC. The answers to health questions are right at home in Western New York. Because ECMC’s medical campus is home to the services, resources, and facilities that make it a simple choice for patients— including a nationally-accredited bariatric program. Our community’s most accomplished head and neck cancer specialists. The state-of-the-art Russell J. Salvatore Orthopedic Unit. And the shortest wait times in the country for kidney transplant. No matter your health questions or concerns, learn how ECMC can be the answer:

The difference between healthcare and true care

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