in good ‘Doc, This Election’s Killing Me!’
November 2016 • Issue 25
Buffalo & WNY’s Healthcare Newspaper
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More than half of Americans report stress as Clinton, Trump battle for the White House
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Tom Mahl, MD Chief of gastroenterology at VA discusses liver diseases and the fact that most of those who have hepatitis don’t know they have the disease page 6
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‘Doc, This Election’s Killing Me!’ More than half of Americans report stress as Clinton, Trump battle for the White House
s Donald and Hillary duke it out on the campaign trail, Americans are feeling pummeled, too, a new poll finds. The 24/7 coverage of the acrimonious U.S. presidential election has caused stress for more than half of American adults,
regardless of party affiliation, according to a survey conducted by the American Psychological Association (APA). “We’re seeing that it doesn’t matter whether you’re registered as a Democrat or Republican — U.S. adults say they are experiencing
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insighteyecarewny.com significant stress from the current election,” said Lynn Bufka, APA’s associate executive director for practice research and policy. “Election stress becomes exacerbated by arguments, stories, images and video on social media that can heighten concern and frustration, particularly with thousands of comments that can range from factual to hostile or even inflammatory,” she added in an association news release. Overall, 52 percent of Americans aged 18 and older said the election is a somewhat or very significant source of stress. That included 55 percent who align with Democrats and 59 percent with Republicans. The survey also found that 38 percent of respondents said political and cultural discussions on social media causes them stress. More than half who use social media said the election is a very or somewhat significant source of stress, compared with 45 percent of those who don’t use social media. Men and women were equally likely to feel stressed by the TrumpClinton battle, but there were differences between generations. Only 45 percent of Generation Xers — those born from 1965 to 1980 — reported election stress, while nearly six out of 10 “matures” did so, according to the online survey conducted in August. Matures were born pre-1946. In addition, 56 percent of millennials and half of baby boomers said the election is a very or somewhat significant source of stress.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • November 2016
Number of Americans With Severe Joint Pain Keeps Rising Close to 15 million people live with the problem
evere joint pain plagues an increasing number of aging, often arthritic Americans, a new report finds. In 2002, about 10.5 million people in the United States said they battled severe joint pain, but by 2014 that number had jumped to 14.6 million, said researchers from the U.S. Centers for Disease Control and Prevention. The CDC team defined “severe” joint pain as discomfort measuring 7 or more on a 1-to-10 score on a questionnaire, with 1 being no pain and 10 being “pain and aching as bad as it can be.” The problem may only get worse, the researchers said, since much of this joint pain is linked to arthritis. One in every four people with arthritis in the new study rated his or her pain as “severe,” and arthritis cases among Americans are expected to rise. In the United States, “arthritis affected an estimated 52.5 million [22.7 percent] adults in 2010-2012 and has been projected to affect 78.4 million adults by 2040,” wrote the team led by CDC researcher Kamil Barbour.
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
Nov. 3, 15
Adoption STAR marks Adoption Month The Buffalo chapter of Adoption STAR is celebrating National Adoption Month this month with two events. The celebration focuses attention on the children in the child welfare system. Currently there are more than 100,000 children and youth in the U.S. foster care system that are waiting for permanent families. The agency helps place those children with adoptive parents. • Wine tasting fundraiser for Adoption STAR. This event will take place from 6 to 8 p.m., Thursday, Nov. 3, at Georgetown Square Wine and Liquor, located at 5225 Sheridan Drive, Williamsville. Tickets are $25 and include wine tasting, hors d’oeuvres and the chance to win raffle baskets • National Adoption Month celebration and open house. This event is sponsored by Key Bank and will take place from 11 a.m. to 6 p.m., Tuesday, Nov. 15, at Adoption STAR, 131 John Muir Drive, Amherst. This family-friendly, free event will feature: vendor tables from a wide variety of Western New Yorkbased businesses and organizations;
FREE Caregivers: This Day is for You Sat., Nov. 5, 2016 8 a.m. - 3 p. m. Millenium Airport Hotel 2040 Walden Ave., Cheektowaga Caring for one who is physically frail or memory impaired? Learn ways to reduce stress and make everyday chores easier Lunch provided Reservations required: 716-858-2022 or email email@example.com Care for memory impaired loved one may be provided at event: Inquire when you reserve Co-sponsored by:
Erie County Caregiver Coalition Page 4
information on Adoption STAR, Family STAR and Tapestry Books; activities for school-aged children; and a keepsake art project specifically geared toward adoptive families, among other things. At 1 p.m. Joe Vitale and Rob Talmas (Adoption STAR adoptive dads and co-plaintiffs in the lawsuit that legalized gay marriage throughout the United States), who make a presentation focusing on how the adoption of their son Cooper unexpectedly led them all the way to the Supreme Court of the United States. To RSVP and purchase your ticket to the event, visit www. adoptionstar.com and click on the link for the event on our homepage or call development associate Kristin Ackerman at 716-639-3900.
Workshop for caregivers in Cheektowaga “Caregivers: This Day is for You” is the theme of free day of workshops for caregivers set 8 a.m. to 3 p.m., Nov. 5, at the Millennium Airport Hotel, 2040 Walden Ave., Cheektowaga. The event is sponsored by the Western New York Alzheimer’s Caregiver Partnership (WNYACP) and the Erie County Caregiver Coalition. Caregivers will learn ways to reduce stress and make everyday chores easier. Whether caring for a loved one who is physically frail or one who has memory loss, participants will find useful information. Workshops include legal and financial issues, the cost of care, creating a back-up plan and laughter yoga. Supervision for memory impaired adults will be available; lunch and materials will be provided. WNYACP connects caregivers of persons with dementia to the support and services they need to reduce their burden and prevent burnout. Services include caregiver education, support groups, assessment, respite, joint enrichment events and transportation. WNYACP is funded through a New York State Department of Health grant and is composed of Catholic Charities of Buffalo, Alzheimer’s Association, WNY Chapter, and the Aging Services of Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara and Wyoming counties. The Erie County Caregiver Coalition promotes community awareness, sensitivity to, and action around caregiving issues. It is composed of 52 agencies and facilities in the county that serve and work with caregivers. Reservations are required. Call 716-858-2022 or email caregiver@erie. gov to make a reservation and for information about supervision for your loved one that day. For more information about
WNYACP, go to wnyacp.org, or call Catholic Charities at 716- 8966388. For information on volunteer opportunities, contact the WNYACP volunteer coordinator at 716-8966388 ext. 226.
Veteran’s Day Celebration to support PTSD clinic The local Association of the Airborne 3rd Battalion, 19th Special Forces Group of the United States Army National Guard will sponsor a patriotic Veterans Day celebration from 4 to 7 p.m., Friday, Nov. 11, at Russell J. Salvatore’s Patriots & Heroes Park, 6675 Transit Road, Williamsville. The celebration and the “Jump In On PTSD” reception will benefit the Jack H. Wisby, Jr. PTSD Clinic at the Veterans Administration Hospital in Batavia. The reception inside Russell’s Steaks Chops & More and Salvatore’s Grand Hotel is hosted by Russell J. Salvatore. The Veterans Day celebration in the Park begins at 4 p.m. with a USOstyle musical performance by Music On The Front Lines, led by founder, CEO and music director Van Taylor and COO Ron Walker, both of whom are members of the Buffalo Music Hall of Fame. All funds raised at the “Jump In On PTSD” event goes directly to assist Veterans at the clinic and the accompanying “Center for Hope,” a new resident facility for female veterans. Those wishing to contribute are encouraged to make checks to: VA WNY Healthcare System, and on the memo line, enter “GPF 1935 PTSD Residential Treatment Program.” This ensures every cent goes to the Jack H. Wisby, Jr. PTSB Clinic. Donations may be sent to CSM Alfred R. LaChance (RET), “Financial Minister,” 4732 Porter Center Road, Lewiston, NY, 14092. For more information about the event, contact call 716-735-9441 or send an email to Sneakypete5@live. com.
Pancreatic cancer group holds 5K, Fun Day event The seventh annual Step It Up! Cure Pancreatic Cancer 5K & Family Fun, sponsored by the Pancreatic Cancer Association of WNY, will take place starting at noon, Nov. 19, at Gordon Field House on the campus of Rochester Institute of Technology, One Lomb Memorial Drive. The 5K walk will start at 1:30 p.m. Organizers say this will be an afternoon of fun for the whole family with entertainment, raffles and activities for all ages. There will be princesses, team mascots, and Batman as well as jugglers and Zumba. Proceeds benefit local research efforts that will help provide a comprehensive approach to fighting pancreatic cancer. Registration fees are $25 adults ($30 day of event); $15 students (age 13-21) and $5 for children from 4 to 12. It’s free for those under the age 3. Free participation gift for all paid registrants (while supplies last).
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • November 2016
For more information or to register visit www.pcawny.org/ Step_It_Up_5K.html.
Through Nov. 19
Schofield features motherdaughter art team Oil paintings of Kenmore Arts Society member Dorothy Pennell will be on display alongside photographs taken by her daughter, Shawn Marie Kirwan, at the Schofield Residence, 3333 Elmwood Ave. in Kenmore. The exhibit that started Oct. 29 will continue through Nov. 19. Schofield’s partnership with the Kenmore Art Society promotes local artists with exhibits rotating each month. The exhibit is free and open to the public, with many pieces available for purchase. Hours for visitation are from 8:30 a.m. to 8:30 p.m. Monday through Friday, and from 9:30 a.m. to 8:30 p.m. on weekends and holidays. Schofield Residence is located at 3333 Elmwood Ave. in Kenmore.
Town Square for Aging holds fairs
emonstrating its commitment to seniors in Amherst and throughout Western New York, Town Square for Aging will hold a series of senior resource fairs, called Tuesdays at Town Square. Town Square for Aging is a nonprofit organization designed to provide seniors and their caregivers a full complement of necessary healthcare and social support services, through an innovative, convenient and collaborative delivery system that promotes health and wellness in order to enable seniors to continue to live independently. Tuesdays at Town Square will bring together many providers of services and information especially designed for seniors, their families, and caregivers. Free and open to the public, Tuesdays at Town Square will be held from 10 a.m. until noon at the Town Square for Aging building, at 2710 North Forest Road in Getzville (near Turtle Creek Senior Apartments). Each senior fair is themed, and there will be a mix of vendor tables as well as brief educational seminars. The series, which started Oct. 25, will continue on the following days • Tuesday, Nov. 15, Tune-up Home, Car, and Self for Winter. • Tuesday, Jan. 10, Health & Wellness. • Tuesday, Feb. 14, Tis the Tax Season. • Tuesday, March 14, Financial Wellness Check-up. • Tuesday, April 11, Clearing out the Clutter. For more information, call 716-216-2111 or email Karen. firstname.lastname@example.org.
Detox or Cleanse Diets: Do They Work?
Two experts offer opposing opinions about one of the most popular dietary trends in recent years By Tim Fenster
o-called detox or cleanse diets have become one of the most popular dietary trends in recent years, even as the medical community remains split on their purported benefits and risks. Though widely varied, the diets call for consuming only raw vegetables, fruits and fruit juices and water for a period of three to 10 days. Some call for special teas or supplements to be taken throughout, and some urge dieters to forego solid foods altogether for the entirety of the cleanse. Critics of these diets say our bodies continually remove toxins on their own, rendering a cleanse unnecessary, and that such diets can sometimes lead to mineral and vitamin deficiencies. In a May press release, the British Dietary Association called detox diets “nonsense.” “The body constantly
filters out, breaks down and excretes toxins and waste products like alcohol, medications, products of digestions, dead cells, chemicals from pollution and bacteria,” the BDA stated Odachowski in the press release. Allyson Odachowski, a dietitian and nutritionist at Custom Dietetics in Williamsville, agrees that cleanses do little to aid the body’s digestive systems or metabolism and can prove harmful for people with certain conditions. “For most people it’s unnecessary and for people with any health concerns,
it could be dangerous and there’s no question as to whether it’s necessary,” said Odachowski, who is also a media representative for the New York State Academy of Nutrition and Dietetics. But others disagree. Jennifer Jennings, owner and medical director of Cardea Health Integrative Medicine in Cheektowaga, says moderate cleansing can improve digestive health and help jump-start a more sustainable diet. She recommends cleansing twice a year to give your digestive system a break from the constant barrage of additives, pesticides, preservatives and other so-called toxins that accompany most modern diets. “All of us can use help. Our body does an exceptional job [removing toxins], but it gets tired and there can be disfunction within our gut, within our microbiome, within our gallbladder, within our liver,” Jennings said. “So giving that a bit of a break is not always a bad thing.” Jennings believes the ideal cleanse lasts from three to five days, and includes three meals a day of raw fruits and vegetables that have been blended into juice. She likes to use wheatgrass, kale, celery, parsley, cilantro, carrots, beets and sometimes an apple in her juices. Jennings also recommends daily consumption of bonebroth and lemon juice with water, both of which are said to help boost the body’s immune and
digestive systems. Cayenne pepper, another popular choice for cleanse diets, can also be added, as it can help speed up one’s metabolism. “Lemon juice is very good for someone to have in the morning for a cleanse,” she said. But while Jennings champions the benefits of cleansing, she also cautions prospective dieters to consult with their doctor before severely restricting their caloric intake. “Of course you have to assess whether or not this patient is capable of doing a cleanse,” she said. “So if this is someone who has blood sugar issues, who has malnutrition, who has some type of a chronic disease, they may not be a good candidate for this type of cleanse.” Meanwhile, Odachowski says that regardless of the dieter’s health, the risk is not worth the reward. She pointed out that the supplements many take while cleansing are not regulated by the U.S. Food & Drug Administration. “You may not know what you’re getting,” she said. What’s more, she says, one can reap the supposed benefits of a cleanse by hydrating more, eating nine daily servings of fruits and vegetables, and consuming more probiotics, which can be found in yogurt as well as fermented foods (sauerkraut, kimchi and kombucha). “Those are certainly things we’d recommend — just for overall health, not to cleanse,” she said.
Healthcare in a Minute By George W. Chapman
The recent five-star ratings of hospitals by Medicare raised the issue of whether large teaching hospitals got a fair shake because the survey upon which the ratings were based (Hospital Consumer Assessment of Healthcare Providers and Systems) did not account for patient acuity. Large teaching hospitals treat more trauma and often care for difficult patients transferred to them by surrounding rural and suburban hospitals. A study published in the Journal of General Internal Medicine looked at online hospital reviews by consumers on Yelp. About 25 percent of the almost 3,800 hospitals in the Medicare survey also had ratings on Yelp. The correlation between the Medicare rating received by a hospital and the Yelp reviews was very strong. Yelp reviewers reported on staff quality and compassion, access, convenience, bedside manner, cost, billing, scheduling, treatment of family and visitors. Researchers found that consumers are more savvy than the industry thinks. Hospitals that performed better on both outcome and processes enjoyed greater market share and growth. Word gets around and patients seek care where it’s the best. Telemedicine Many argue telemedicine will never be as effective as a real face-toface encounter between patient and provider. So far, the technology has proven effective in many scenarios, such as: the patient is incapacitated (sick, injured, contagious); foul weather; transportation is unavailable (commercial or caregiver); patient just needs remote monitoring; patient needs encouragement or compliance pep talk; patient needs
medicine checked; patient has mental issues and acts out; patient can’t leave work; on call provider can refer to video visit.
Industry observers keep an eye on what is happening In Massachusetts because it is considered the harbinger of things to come under the Affordable Care Act. The Massachusetts Center for Health Information reported that costs in 2015 were $8,424 per capita which is an increase of 3.9 percent over 2014. The benchmark or target was an aggressive 3.6 percent. (Everyone in Massachusetts has insurance.) As with the rest of the nation, drug costs were responsible for most of the cost “overrun,” accounting for a third of all costs. Larger, more efficient healthcare systems are putting a lot of financial pressure on smaller community hospitals and rural systems.
Both candidates agree drug companies seemingly raise prices arbitrarily and something needs to be done. Trump would allow Medicare/ Medicaid and commercial payers to purchase drugs from countries like Canada. Clinton would appoint a federal watchdog to monitor price increases and limit the amount of income consumers would have to spend out-of-pocket on drugs. But controlling the pharmaceutical industry, let alone prices, will not be easy unless the revolving door between the FDA and the drug manufacturers is controlled. The FDA has data on how many of its former employees now work as consultants or lobbyists to the pharmaceutical industry but has not released such data.
In 2014, we spent $9,523 per capita on healthcare — still the most by far of any developed country. At $3 trillion, healthcare was 17.5 percent of our GDP in 2014. (It is currently trending at 18 percent.) Medicare and Medicaid accounted for 36 percent of spending. Commercial insurance accounted for 33 percent and out of pocket another 11 percent. The remaining 20 percent is VA, federal employees, Public Health Service and other federal programs.
According to a study of online physician reviews published in Becker’s Hospital Review, consumers report the highest satisfaction levels with neuromuscular specialists, thoracic surgeons, podiatrists, plastic surgeons and colorectal surgeons. The lowest ranking were with psychiatrists, preventive medicine specialists, pain specialists, emergency physicians and neurologists.
Physicians refusing care
A debate over how much autonomy a physician should have when he/she has a conscientious objection to providing a service like abortion, birth control, unnecessary testing and assisted suicide is published in the Journal of Bioethics. Those who argue a physician does not have the right to refuse care feel access to care, especially when there are few if any alternatives, must override a physician’s personal beliefs. Those who argue a physician does have the right to refuse care argue they are entitled to have values like everyone else. Sweden and France bar physicians from refusing any legal service and can suspend or revoke a practi-
November 2016 •
tioner’s license. The US, Canada and the UK have historically allowed the refusal of services based on conscientious objection. Most physicians who will not provide certain services due to moral objections will be happy to refer their patients to another provider without disrupting the overall relationship between them.
Watch your scale
The good news, according to a study by a Cornell professor published in the New England Journal of Medicine, is your weight might be at an annual low right now. The bad news is that, thanks to the upcoming holidays, you will gain weight and a lot of the gain will be permanent, if you don’t pay attention. Weight gain typically starts 10 days before the holiday season and peaks around New Year. Because the study participants were aware they were in a weight study, the professor believes the weight gains were probably artificially low to moderate and that weight gain in the general public is worse. Other studies have found that after 30, most of us gain two pounds of permanent weight every holiday season. George W. Chapman is a healthcare consultant who works with hospitals and medical groups. He operates GW Chapman Consulting based in Syracuse. Email him at gwc@ gwchapmanconsulting. com.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
Steep Rise in Price of Older Cancer Drugs
any older cancer drugs took a bigger bite out of Medicare and older Americans’ wallets last year than five years earlier, a new analysis finds. After adjusting for inflation, nearly two-thirds of 86 cancer medicines in the study had price increases between 2010 and 2015, researchers reported. Eleven drugs more than doubled in price, and older drugs increased more than newer drugs, the study found. The study included oral and intravenous chemotherapy drugs covered by Medicare Part B. Medicare is the federal health insurance plan for people 65 or older. “Higher costs lead to higher copays,” said study co-author, physician Sham Mailankody. He’s a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City. “And empiric research suggests higher copays lead to treatment delays or discontinuation,” he added. Patients with Medicare Part B coverage are responsible for up to 20 percent of the cost of these medicines. Stacie Dusetzina, assistant professor of pharmacy and public health at the University of North Carolina at Chapel Hill, finds the price increases concerning. “Patients who don’t have a supplemental health insurance plan to help them with out-ofpocket costs will pay more as the price goes up,” she said. About 19 percent of Medicare enrollees lack that coverage, noted Dusetzina, who was not involved with the study. When researchers split cancer drugs into two groups by their date of approval, older medicines jumped nearly 23 percent in price. That compared with a 6 percent bump for newer treatments. “Raising the price of older drugs seems particularly objectionable when one considers that the outlay for research and development occurred long ago, and has almost certainly already been recouped,” the study authors wrote. Moreover, drug prices were unrelated to the drugs’ benefits, they said. The findings were published online Oct. 6 in JAMA Oncology. Public scrutiny of older drug prices has intensified in the wake of recent dramatic price hikes. Former Turing Pharmaceuticals CEO Martin Shkreli faced price-gouging accusations after bumping the price of Daraprim (pyrimethamine), an HIV and cancer drug, by more than 5,000 percent — from $13.50 to $750 a pill. More recently, the price of a two-pack EpiPen, a standby treatment for life-threatening allergic reactions, increased from $100 to $600.
By Chris Motola
Tom Mahl, MD Chief of gastroenterology at VA discusses liver diseases and the fact that most of those who have hepatitis don’t know they have the disease Q: Give us an overview of your specialty. A: I am a board-certified gastroenterologist and also a boardcertified internist. I’ve been here at the Buffalo VA for 26 years and on the faculty of the University of Buffalo for as many years. I’m currently a clinical professor of medicine at UB. Q: I understand you’ve been particularly involved with treating liver disease. A: My academic interest has been liver disease. So hepatitis, cirrhosis, fatty liver, other disorders of the liver. But I do also take care of Crohn’s, celiac disease, ulcers, heart burn, what we call ‘luminal disorders.” Q: The liver has the reputation of being one of the body’s most resilient organs, what has to go wrong for it to fail? A: That’s a very good question. There are two important topics in liver disease right now. One is discovering people who have hepatitis C who don’t know they have it. Many people aren’t receiving regular health care, who only get treated when there’s a crisis: many are not being treated for hepatitis C. About one-third to one-half of all people with the disease don’t know they have it. The reason that’s important is that we can cure upwards of 95 percent of patients with hepatitis C. In the past, it didn’t matter as much because we didn’t have too much to offer them. But in the last two years, things have changed dramatically. We can actually eradicate the virus, but it’s really best that we do it before it’s too late and they’ve already developed long-term complications. And though the liver is a resilient organ that can repair itself, it can develop scar tissue if it’s pushed too far. If you have a lot of it, we call that cirrhosis. Many people think that if you have cirrhosis that means it’s alcohol-related. It can actually be caused by a number of things, including viruses.
Q: I know I have a hard time keeping track of which hepatitis is which. Can you remind us? A: Most laypeople think of it as a viral disease, but to a liver doctor, hepatitis means irritation of the liver. It can be from anything from viruses, to alcohol, to autoimmune diseases, to toxins. But within viral hepatitis, there are three major, completely different viruses. Hepatitis A, or “infectious hepatitis,” is transmitted through the fecal-oral route, so it’s transmitted by the ingestion of fecal matter. That’s why you see signs in restaurants that employees must wash their hands before returning to work. It’s very common in the third world. About 99 percent of people get over it and are immune for the rest of their life. It’s most dangerous to elderly people who weren’t exposed to it at an early age, but even that is a little unusual. Hepatitis B, or “serum hepatitis,” is transmitted by blood and body fluids. It used to be a problem with transfusions. We’ve been screening it out for the past 30 years, and it’s almost never transmitted that way anymore. So it’s more often spread by sexual transmission. But we do have a wonderful vaccine for that, so the incidences are plummeting. The biggest risk groups we’ve noticed are immigrants from Asia and men who have sex with men. We have drugs that can suppress it, but not eradicate it. So you’ll have to be on medication the rest of your life, but it’s pretty much just taking a pill a day. Until 25 years ago, we weren’t exactly sure what hepatitis C was. Before that, we would test hepatitis patients for A and B, and if they were negative, we’d call it “non-A, non-B.” It’s transmitted mostly by blood and less so by sexual transmission. So if you had a transfusion a long time ago or you’ve been sharing needles, then you’re more at risk. So we’re looking to screen baby boomers in particular, as well as anyone with anyone with signs of liver
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • November 2016
irritation, especially since we can completely cure it in nearly all patients. Q: How about the other important topic in liver disease right now? A: The other topic is what we call non-alcoholic fatty liver disease. It looks just like alcoholic fatty liver disease in a biopsy. It consists of fat deposited in the liver. In some people, that fat can promote inflammation and scar tissue. I probably put my kids through college on the number of patients I’ve seen with alcohol-related fatty liver disease, but this is unrelated. It’s related to insulin resistance. It’s a very common problem that tons of people don’t know they have. It typically occurs in overweight people. What’s happening is the body isn’t responding as well to insulin, which lowers blood sugar. But insulin does a lot of other things too. If you’re not responding to it, you see high blood pressure, lipids in the blood, a predisposition to atherosclerosis and fatty liver disease. You can actually see a globule of fat within the liver cell. Many people tolerate that well, but a percentage will go on to get more progressive liver disease, including cirrhosis. With obesity as common as it is, as much as 25 percent of the population may have fatty liver. Many will do fine with regard to their liver, but if even 10 or 20 percent of them get cirrhosis, we’re talking about millions of people with cirrhosis. Q: Are there warning signs that you can notice, outside of testing? A: You really have no nerve endings in the liver, and you won’t see jaundice until you have significant cirrhosis. If you’re seeing your doctor regularly, normal blood tests can usually detect general liver abnormalities, which then can let us know that you need further, more specific testing. Q: And I take it alcohol can make all these situations worse. How much is too much? A: We know there’s a bit of a double-whammy with hepatitis C. By itself, the virus isn’t necessarily a death sentence — maybe 20 percent or less — but you add alcohol and the combo-platter has at least an additive and possibly a multiplicative effect on liver disease. You’d be surprised how many people drink a case of beer a day. I saw a 20-year-old who drank a liter of vodka a day. The threshold for alcohol-related liver problems seems to be around six drinks a day.
Lifelines Name: Thomas C. Mahl, M.D. Position: Chief of Gastroenterology at VA Western New York Healthcare System; Clinical Professor and Interim Chief of Gastroenterology, Hepatology and Nutrition at University of Buffalo Hometown: Tonawanda, NY Education: Fellowship-Yale; ResidencyUniversity of Connecticut; MDUniversity of Buffalo; BS-SUNY Oswego Affiliations: Veterans Health Administration (local and telemedicine); Buffalo General; Erie County Medical Center Family: Two sons Hobbies: Kayaking, biking
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The Paradox of ADHD Hyperfocus By Deborah Jeanne Sergeant
ttention Deficit Hyperactivity Disorder (ADHD) has long been recognized as lifelong, not only a problem for struggling schoolchildren. As students mature into adults, their career choice may aid them in coping with ADHD and, in the case of those who experience hyperfocus, actually complement their career. Hyperfocus is a phenomenon in which people with ADHD hone in on a particular activity, issue or topic to the neglect of all else. For a child, it may be a threemonth obsession with dinosaurs. Then, abruptly, the dino-fixation disappears and it’s on to rocket ships or trains or race cars while completely ignoring other themes. For adults, the individual’s hobbies often shift, even after significant investment and intense interest. How this translates to careers depends upon many factors. Christopher J. Pino, licensed psychologist in practice in Buffalo, said that making sure that it’s really ADHD is the first step. But after confirming a diagnosis, some people find that medication can help them focus on what’s important. “Some studies show meditation can be helpful, as is mindfulness,” Pino said. Some people with ADHD find it difficult to settle on one career,
despite extensive talent and a great work ethic. Selecting the right career helped Maria C. Jones, licensed mental health counselor in Williamsville, build a more stable life. As a young adult, she attended seven different colleges and held several jobs before she began teaching and ultimately school counseling, her first long-term employment. “It certainly did meet my needs,” Jones said. “I didn’t sit still a lot. It had a lot of variety.” Years before, staying in one place on an assembly line had proved very difficult. By contrast, when she’s hyperfocused, she can sit for hours doing one activity. The difference is that when she’s
doing something engaging to her, she can easily lose track of time. “Know what your interest is,” Jones advises other adults with ADHD. “If you have an interest in something, you can stay focused with it for a longer period of time. Avoid a job where you’re doing the same thing repetitively for eight hours. You need more short-term gratification.” While she doesn’t completely object to medication for people with ADHD, she encourages learning coping mechanisms to reduce dependence on prescriptions. “I don’t think it’s one of those things that you’re paralyzed for life,” she said. When it comes to relationships, people with ADHD can hyperfocus on a new love interest so intensely that when they lose interest and move on to someone else in mere months, the people they leave behind can feel deeply hurt. Corrin Matthews-Rutkowski, certified hynotherapist with Extraordinary Change Hypnosis in Buffalo, said that people with ADHD can easily make new
November 2016 •
friends, but often lack the followthrough to maintain long-term relationships. Since people enter marriage relationships with the expectation of staying together, the attention defection can cause serious problems. The person with ADHD must mature enough to commit long-term and seek novelty in other areas instead of a new spouse. Matthews-Rutkowski said that both partners can find it helpful to visit a marriage counselor who is also trained in treating clients with ADHD. “The most important thing to do is to help them realize they can take control of how they behave and think,” she said. “It’s about resetting patterns and habits. “It doesn’t has to be a disability, but you have to understand the mind of the person you’re married to. One thing you can do is have appropriate boundaries where you don’t have people feel sad about others but realize it’s a two-person commitment.” The non-ADHD spouse must realize that it’s not spite that drives the ADHD spouse to leave cupboard doors open, forget tasks or spend numerous hours and dollars on a hobby only to walk away from it after a few weeks. The spouse must learn to “be tolerant, not enabling,” MatthewsRutkowski said. “Have balance. Understand what the issue is and create your life around that understanding so no one feels inferior or judged or rejected.”
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
Live Alone & Thrive
By Gwenn Voelckers
Practical tips, advice and hope for those who live alone
Are You Facing Thanksgiving Alone? If you are facing Thanksgiving alone for the first time, you may be anticipating a lonely and depressing fourth Thursday of November. But it doesn’t have to be so. Whether you’re divorced, widowed or just can’t make it home for Thanksgiving, this family-centered holiday can be an opportunity for personal growth and expression. Below are some tips and creative ways to manage and embrace what can be a challenging day in the life of those alone this time of year: Be thankful. And why not start with yourself? Consider making a list of all the things you are thankful for this year: Your health? Your children? Those good friends who have stood by you through thick and thin? A career or volunteer job you love? A beloved pet? Or perhaps even this opportunity in your life to learn and grow? Take the long view. While you may be alone this year, it doesn’t mean you’ll be dining solo on leftover stuffing the rest of your life. This one day doesn’t dictate your destiny. Who knows what the future holds? Over the next year, you may meet someone special or
achieve a measure of inner peace and confidence that enables you to enjoy a holiday on your own or with a “family of friends.” Do good. Helping others this time of year can take your mind off being alone and give you something worthwhile to do. Shelters and food kitchens often welcome volunteers, but — truth is — many of these agencies fill up fast with regular volunteers. You may need to plan ahead and be creative. As an alternative, many local YMCAs host “turkey trot” races and need volunteers to register and cheer on runners of all ages. Instead of serving stuffing at the shelter, you could be serving up smiles at the finish line. Throw your own little holiday dinner for fellow “strays” or “disconnected” persons. Have some fun! It doesn’t have to be elaborate or even planned far in advance. Sometimes lastminute dinner invitations can turn into the best, most memorable gettogethers. Chances are you know others who may be alone this Thanksgiving. Extend a warm invitation and ask people to bring a holiday side dish to pass. This gives everyone a chance to
KIDS Corner U.S. Children Are Less Fit Than Others Around The World Aerobic fitness levels of children and youth across 50 countries; U.S. ranked 47 of 50
n international research team co-led from the University of North Dakota and the Children’s Hospital of Eastern Ontario (CHEO) studied the aerobic fitness levels of children and youth across 50 countries. The results were recently published in the British Journal of Sports Medicine. “If all the kids in the world were to line up for a race, the average American child would finish at the back of the pack,” said Grant Tomkinson, associate professor of kinesiology in the UND College of Education & Human Development and senior author of the study.
“Canada, on the other hand, fared moderately well placing just above middle of the pack. This study is the largest of its kind so it’s exciting to have this evidence at hand.” “Kids who are aerobically fit tend to be healthy; and kids who are healthy are apt to be healthy adults. So studying aerobic fitness in the early years is very insightful to overall population health,” said Justin Lang, the report’s lead author. Ranking highlights: • Top 5 fittest countries: Tanzania, Iceland, Estonia, Norway, Japan • Canada placed 19 out of 50 • America placed 47 out of 50
make a meaningful (and delicious!) contribution. Beware of “euphoric recall.” When you are feeling lonely, it can be easy to glorify the past. Did last year’s Thanksgiving live up to the Norman Rockwell ideal? Or did all the bickering, bad blood, and woozy, overstuffed relatives make you want to run for the hills? Maybe, just maybe, being with your own good company is a blessing. Rent a movie and indulge in a tasty guilty pleasure. Oh, why not? Rent a favorite “feel good” film and make a night of it. You might check out “Tootsie” or “On Golden Pond,” two of my favorite oldies, which never fail to warm my heart. Or find a new movie you haven’t seen and enjoy the novelty of seeing something for the first time. Top it off with a favorite treat. I love pumpkin pie ice cream this time of year! Pick up the phone. I’ve adaped one of Abe Lincoln’s famous lines for my own purposes: Most folks are as lonely as they make up their minds to be. The difference between isolation and engagement can be as simple as dialing a seven-digit phone number. My experience happily tells me that most folks welcome a call on Thanksgiving. An invitation to go for a walk or see a matinee while the turkey is in the oven is often seen as a nice diversion and chance to get out of the house. Others just love opening their homes, inviting friends in, and expanding the celebration. It can be a beautiful thing for everyone. Decorate your home inside and out. Do it for you. It may help put you in the spirit of the holiday. This past weekend, I recreated my annual stacked-pumpkin display for my front porch. It gives me a warm feeling every time I pull up to the
house. Create harvest accents for your home and feel the essence of Thanksgiving in your heart. Nurture yourself. On your own, Thanksgiving can be a great day to do whatever you enjoy doing. Treat yourself to well-deserved time to yourself to read, luxuriate in a warm bath, nap or take a nice walk to enjoy nature. Pamper yourself for at least 30 minutes and take a mini-vacation from your worries, doubts, and fears. Write “thank you” notes. Now here’s an idea that’s so obvious it often gets overlooked on Thanksgiving. “Build bridges the rest of the year, and cross them during the holidays,” said Craig Ellison, PhD, author of “Saying Goodbye to Loneliness and Finding Intimacy.” If you can’t be with friends or family this holiday, pick up a pen and thank them for their support and friendship. Who wouldn’t love to receive a card on the day after Thanksgiving that begins, “I’m sitting here on Thanksgiving morning thinking of you. On this day of thanks, I can’t help but be thankful for our (fill in the blank).” In preparation for this kind gesture, purchase cards and stamps in advance. So there you have it: Survival tips for a single-serving Turkey Day. The good news? It will be Friday before you know it and you can be thankful you got out of bed, rose to the occasion, and enjoyed your Thanksgiving. Gwenn Voelckers is the founder and facilitator of Live Alone and Thrive, empowerment workshops for women held throughout the year in Mendon, New York. For information about her workshops or to invite her to speak, call 585-624-7887, or email email@example.com.
One in 5 U.S. Young Adults smokes a Hookah
ookah use has taken off among Americans in recent years, with almost one in five young adults using the water pipes, a new study says. New York University investigators analyzed U.S. government data on tobacco use and found 12 percent of Americans had used a hookah during their lifetime. They also found that the rate of current hookah use among adults aged 18 to 24 is nearly 20 percent — similar to their rate of current cigarette use. “Hookah is addictive, causes similar health effects as cigarettes, and results in substantially higher inhalation of smoke than cigarette smoking, yet misperceptions persist that its use is safer than cigarette smoking,” say researchers led by physician Michael Weitzman. He is a professor in the departments of pediatrics and environmental medicine at NYU. Increases in hookah smoking are highest among single, adult males, and those with higher education and income. In contrast, cigarette smoking is more common among those who are poorer and have low levels of education, the researchers noted.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • November 2016
Reduce or Eli
You rN eed
By Angie R. Lucarini
hortly after the birth of my daughter, I recall feeling pure exhaustion. It was like none that I have felt before. My body was aching and burning with pain, with no apparent reason. I felt as though my nerves were on fire.
Before long, I was turning down family outings, due to my being too tired and riddled with pain to push past. What’s more, I was dealing with restless leg syndrome. At first, I thought I might be experiencing postpartum depression for the first time, and I was treated as such. However, I didn’t improve. I was pleading with my husband and my doctors for help; needing them to understand exactly what I was going through. I then sought help from my OB-GYN Donna Feldman of Women’s Medicine of Niagara. Upon a thorough examination and review of my symptoms, Feldman concluded that I had fibromyalgia. I had never heard the name before. Not wanting to overstep my family doctor, she recommended that I share her findings with my family doctor who could do his own exam to confirm the diagnosis or offer an alternative. Physician Todd Orszulak Jr. with TMO Medical in Niagara Falls, quickly concurred with Feldman, immediately following his own check up. He gave me a booklet to read, providing all of the symptoms of fibromyalgia, and informed me that it is treatable. I skimmed through the pamphlet, which listed every ailment I was suffering from. I practically fell into his arms. At last, I was being heard, my cry for help, validated. Fibromyalgia is an illness with chronic pain all over your body. It affects the nervous system, causing pain and tenderness to several points of the body. This autoimmune disease induces muscle tension, stress, limited activity, fatigue, sometimes depression, muscle stiffness, restless leg syndrome, and widespread pain. There was a name for my symptoms. I was instantly put on medication, which helped to relieve many of my symptoms. Among other things, exercise, supplements and massages have been found to
reduce, or alleviate symptoms. Fortunately, I have good doctors who were schooled on fibromyalgia, both in recognizing it, and in how to treat it. The top misconception about the disease, is that it isn’t a real medical problem — or “it’s all in your head.” It’s not. People who have this condition, have their brains and spinal cords processing pain signals differently. This produces very real physiological and neurochemical problems, according to a Mayo Clinic expert. In 2015, physician Ginevra Liptan announced, “fibromyalgia will finally be recognized as an official diagnosis in the new ICD-10 list of codes being adopted across the U.S.” In other words, it is finally being accepted as a real disease, being legitimized, and more prone to be studied, and advancing in the medical field. I overheard a woman at the beauty shop the other day. She spoke of how she continues telling her doctor all of her symptoms (describing fibromyalgia to a tee), still her physician kept telling her it was “all in her head.” I felt for her, and suggested she switch doctors, giving her the name of mine. Although some progress has been made in diagnosing, understanding and treating this disorder, all physicians should attend workshops, in order that they hear and answer those patients who are crying for help as I was. As the medical community continues to study myalgia (another name used to refer to fibromyalgia), we who have this disease, are given more hope. According to the National Fibromyalgia & Chronic Pain Association, there are an estimated 10 million people in the U.S. affected by the disorder, and an estimated 3 to 6 percent of the world population. It is my wish, that as we learn more about it. We can be more resourceful in fighting fibromyalgia, and perhaps even find a cure. Angie Lucarini resides in Niagara Falls, N.Y. with her husband and 5 children. She is an author of two books, which are available on Amazon.com.
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
SmartBites The skinny on healthy eating
Nutritious Nut Butters Boast Healthy Fats
ovember is National Peanut Butter Lovers’ Month! What better time to celebrate all that’s wonderful about this healthy plant-based protein? Some things just go together: Tarzan and Jane, socks and shoes, peanut butter and jelly. Here’s one more: nut butters and good nutrition. Surprised? Some people are. But according to dietitians, nutritionists and people in the know, nut butters are a convenient, low-cost, nutritious addition to most diets. Although “peanut butter” comes to mind first when considering nut butters, there are many alternatives, each with their own unique health benefits. For the most part, however, all nut butters — from peanut to pistachio, almond to walnut — deliver about 200 calories, 7 to 8 grams of protein and 16 grams of fat per 2-tablespoon serving. The calories and fat are what deter some from consuming this particular food; and, indeed, if you are closely monitoring either, then nut butters might not be right for you. But for many, nut butters, when eaten in moderation — say, a couple
of tablespoons a day — are a healthy choice. Not so surprisingly, highquality nut butters without added sweeteners, salt or preservatives have nutrient profiles similar to the nuts from which they are made. My go-to nut butter is the one with the most calcium: almond butter. My husband, on the other hand, reaches for walnut butter, a nut butter that’s loaded with heart-healthy omega-3 fatty acids. Both my budget-conscious adult kids, however, stock their pantries
When and How Much to Take Though supplements can help people attain their fitness goals, they need to be taken in conjunction with a good diet, say trainers By Tim Fenster
hese days, supplements are synonymous with bulking up, getting into shape and even losing weight. But with entire GNC and Vitamin World stores stocked with dozens of varying products, figuring out which supplements to take — and when — can seem as daunting as establishing a dietary and workout regimen. Dwayne Brinson, a personal trainer who runs Fit Nation in Clarence, says that regardless of a person’s body type or goals, it’s Page 10
with peanut butter, a childhood favorite that has a tad more protein, manganese and niacin than most. Many wonder how nut butters, with their high fat content, can be considered a healthy food. Just like olive oil, nut butters tend to be richer in the types of fat that benefit heart health — monounsaturated and polyunsaturated fat — and not so rich in saturated fat. In fact, a 2-tablespoon serving of peanut butter has the same ratio of unsaturated fat to saturated fat as olive oil. Another good reason to go crazy for nut butters: According to the Harvard School of Public Health, numerous studies have shown that people who regularly include nuts or nut butters in their diets are less likely to develop heart disease or Type 2 diabetes than those who rarely eat nuts. Last but not least? November is National Peanut Butter Lovers’ Month! What better time to celebrate all that’s wonderful about this healthy plant-based protein?
important to consume carbohydrates and protein shortly after a workout. Whey protein supplements work well because they can replenish your body much faster than food. “You have a 30- to 45-minute window to get those nutrients back into the body,” Brinson said. “If you do solid food at that time, it’s going to be too late. Why? Because solid food has to break down, so it takes a few hours. By that time you’ve already set your body into a catatonic state.”
Unlike some of the other nut butters, there’s tremendous variation in the quality of peanut butters sold. Scour the labels carefully (nutrition facts and ingredients list) and opt for peanut butters that are lower in sugar and salt and that do not contain added oils, especially “partially hydrogenated oil,” which is a source of trans fat. Steer clear of reducedfat peanut butters, which replace the “healthy fats” with add-ins and starchy fillers that boost the spread’s sugar content. Choose natural and/ or organic peanut butters that contain peanuts and salt (if you prefer a little salt) and nothing more. Brinson recommends purchasing a whey protein isolate, which is typically more expensive but contains less cholesterol, fat and sugars, according to him, and mixing it with water or skim milk. The amount one takes depends on that person’s body type, lifestyle and goals. Mobile apps such as MyFitnessPal can help people figure out how many calories they should consume both post-workout and on a daily basis. “It all depends on what that person is trying to do. Is that person trying to gain weight or is that person trying to lose weigh?” Brinson said. That can be found in a basic app tracking nutrients for a person to find out what exactly they would need for their body type.” Protein can also be taken before a workout, but it should not replace the post-workout protein. Consuming protein before a workout can help provide an extra boost of energy, but the same can be achieved by eating an hour or two before a workout. For the same reason, some people take pre-workout supplements, but these give you a boost because they are loaded with caffeine. Brinson says pre-workout supplements can aggravate heart conditions, and recommends instead making lifestyle changes — sleeping a full eight hours, drinking water, eating frequently — to improve one’s energy for working out. Brinson has a similar view on creatine supplements, saying that
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • November 2016
Peanut Butter Pumpkin Soup Serves 4 to 6
2 tablespoons olive oil ½ medium onion, chopped 2 garlic cloves, minced 1 (15 oz.) can 100 percent pure pumpkin 1 cooked sweet potato or yam (baked or microwaved) ½ cup smooth peanut butter (or, nut butter of choice) 3 ½ cups sodium-reduced stock of choice (or, water) ½ teaspoon coarse black pepper 1 teaspoon salt (or, less) 1 teaspoon curry powder ½ teaspoon dried coriander ¼ teaspoon cayenne pepper (optional) snipped fresh chives, for garnish In medium soup pot, sauté onions over medium heat until soft, about 5 minutes. Add garlic and cook 1 minute more. Stir in the pumpkin, sweet potato and peanut butter. Add the stock and spices and stir well. Bring to a boil and then reduce the heat to a simmer and cook for 20 minutes, covered. Puree with a handheld blender. If soup seems too thick, add more water. Garnish with chopped chives. Anne Palumbo is a lifestyle columnist, 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 firstname.lastname@example.org. while they can help one gain muscle mass, they can also cause digestive problems, and aggravate conditions such as kidney disease, hypertension and liver disease. “Everybody wants a quick fix instead of putting in the effort,” Brinson said. Though supplements can help people attain their fitness goals, they need to be taken in conjunction with a good diet. That does not mean simply consuming as many (or as few) calories as possible, but rather consuming a well-balanced diet that is rich in vitamins and minerals, whole grains and a variety of sources for protein. Brinson notes that men who are trying to gain mass often have an outdated dietary mindset and limit themselves to basics like chicken and rice, or steak and potatoes. They also end up limiting their progress, because they aren’t getting as many nutrients and complete proteins (characterized by the presence of all nine essential amino acids) as someone with a well-balanced diet. “You’ve got to step out and get those other things. If not, it’s going to be a lot harder on your body, because you’re only getting fats and carbohydrates and protein from one direction versus blending it and getting a variety of sources,” he said. In addition to a healthy diet, Brinson recommends a daily multivitamin, fish oil supplements and glutamine — an amino acid that helps protein synthesis — for those trying to bulk up.
Nutritionists Vs. Dietitians
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Just what is the difference between the two? By Tim Fenster
f you have never sought consultation from one of either before, chances are that you have never put much thought to the question — what’s the difference between a nutritionist and a dietitian? But while the titles might seem like two words for the same thing, patients should be mindful that there is an important difference. Nicole Klem, director of the nutrition and dietetics program at Trocaire College, warns that the term nutritionist is a non-accredited title, unlike the accredited “dietitian.” She said that some “nutritionists” have simply given themselves their title. “The term nutritionist is not protected by law in almost all countries so people with different levels of knowledge can call themselves a ‘nutritionist,’” Klem said. She added that while some nutritionists do in fact have degrees in areas such as food science, human nutrition or food technology, they do not have any professionally supervised practical training. “[They] should not be involved in the diagnosis and dietary treatment of conditions,” she said. Meanwhile, the titles of dietitian and dietetic technician are protected by law in the U.S. and Canada. Here in the U.S., Registered Dietitian Nutritionists and Nutrition and Dietetics Technicians, Registered (sic) must meet the educational, experiential and examination standards laid out by the Commission on Dietetic Registration, the credentialing agency of the Academy of Nutrition and Dietetics, the largest organization of food and nutrition professionals in the U.S. This means that to use the dietitian title, prospective professionals must go through programs such as those offered at Buffalo State College and Trocaire. At Trocaire, students must complete a two-year Associate of Applied Science degree that includes three mandatory supervised field experience courses at health care facilities and community sites in the area. “The program is designed to educate students in the areas of medical nutrition therapy and dietetics with a focus on the role of human nutrition in health and wellness,” Klem said. Upon graduation, students are eligible to take the CDR’s registration examination for dietitians. Many
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Nicole Klem is director of the nutrition and dietetics program at Trocaire College. She warns that the term nutritionist is a non-accredited title, unlike the accredited “dietitian.” move on to receive baccalaureate and master’s degrees in specific dietetic program concentrations, such as clinical nutrition, dietetics management and communication, public health nutrition and school nutrition (among others), while others look for work with their AAS degree. Given the differences in training and certification requirements, Klem says nutritionists should not be relied upon unless it’s for basic culinary and nutritional advice, such as healthy recipes. Those with more serious ailments should see an RDN (registered dietitian nutritionist) or or NDTR (nutrition and dietetics technician, registered). “I am very, very concerned that individuals without a broad and in-depth scientific understanding of human biology and food science are providing diagnoses with associated nutrition therapy to individuals who are seeking an answer to their distress,” Klem said. “Chronic conditions such as heart disease, diabetes and obesity can have multifaceted and complicated effects on the body, and (treatment) may not be as simple as a diet plan or supplement.” Many insurance companies seem to agree, and require that medical nutrition therapy providers be RDNs or medical doctors.
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November 2016 •
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
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(Almost) Dead Last Study: Buffalo an undesirable location for disabled community
By Lou Sorendo
uffalo is among the worst cities in the nation for people with disabilities. So claims WalletHub.com, a personal finance website, which did an analysis recently in light of a trend that sees the unemployment rate for persons with a disability rising and 2015 disability benefits not adequate enough to keep a beneficiary above 2014 poverty levels. At the beginning of 2015, Social Security paid an average monthly disability benefit of $1,165. “That is barely enough to keep a beneficiary above the 2014 poverty level ($11,670 annually),” according to WalletHub. com. The analysis is called “2016’s Best & Worst Cities for People with Disabilities.” With a mission to expedite the process of finding the best place to live while managing a disability, WalletHub’s analysts compared the 150 most populated cities across three key dimensions: economy, quality of life and health care. Buffalo is 146th after being ranked 134th in economy, 66th in quality of life and 144th in health care. Rochester is one slot behind. It is positioned 147th after being ranked 146th in economy, 60th in qualify of life and 143rd in health care. According to the report, Rochester has the highest percentage of people with disabilities living below poverty level — 44.1 percent. Buffalo is next to last on the list in that same category. WalletHub evaluated the study’s three categories using 25 metrics. Some factors under economy include housing affordability and cost of living. Metrics under quality of life include percentage of persons with disabilities living in the area and
number of special-education teachers per 1,000 residents. Metrics in the health care area include cost of a doctor visit and average per-person health insurance premium.
Not so fast
Frank Cammarata is the executive director of the Erie County Office for the Disabled in Buffalo, and has issues with the study. While Cammarata said he could not gauge the credibility of WalletHub.com, he did say the media source is focused on financial issues and not disability services or topics. For statistical information, he generally refers to the American Community Survey produced through the U.S. Census Bureau, ARC’s annual survey, the Cornell University School of Industrial and Labor Relations, or the Kessler Foundation. “These surveyors have a more educational and informational basis,” he said. Cammarata said the metrics
within the study only take into account the “city proper.” “Buffalo has a newer renaissance occurring which is improving the cost of living for many, but Buffalo should include all of our surrounding communities for a proper survey,” he said. Cammarata said Buffalo ended up with poor rankings because the whole area was not considered. “There is a lot going on in our area and improvements are being made in many communities to make them accessible to all, but we still have work to do,” he said. Cammarata also questioned the reach of the website’s study. “I find it interesting that the disabled community has not reached out to me regarding this survey, nor have I seen it on any media outlets locally,” he said. “I think people with disabilities feel we have a good community that is on an upswing and that this survey does not truly reflect that.” “It is never good to see your area at the bottom of a survey especially when you see the good work being done by the various terrific agencies in our area,” he added. Cammarata has worked in the human services field for 23 years, 19 of which were dedicated to people with developmental disabilities specifically. He noted Erie County is fortunate to have an Office for People with Disabilities, only one of five across New York state. “Depending on funding from state agencies, there are good times and not so good times,” he said. “I have seen both sides. At this time, there are challenges for families and for the person with the disability.” The challenges focus on transportation, housing and job opportunities, he said.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • November 2016
Transportation key issue
“We are fortunate to see the unemployment rate in our area dropping, which helps provide more opportunities,” he said. The unemployment rate in the Buffalo-Niagara Falls area dropped from 5.3 percent in March to 4.7 percent in August, according to the Bureau
of Labor Statistics. Cammarata said Erie County and surrounding areas feature many well-qualified and highly educated people who have a disability and are working and many who are seeking employment. “There are jobs, but public transportation is a major issue that needs to be addressed,” he said. Fixed routes have been reduced, resulting in less paratransit routes. “People with mobility disabilities in many cases rely upon our public transportation system for daily living activities,” he said. Among Erie County’s disabled population, 42 percent experience mobility issues, 27 percent face cognitive challenges, 20 percent have hearing problems and another 11 percent are vision impaired. Cammarata said he participates in community meetings regarding transportation and expresses the increasing needs for greater transportation opportunities. Cammarata said Buffalo is working on a “green code” to make it more accessible to everyone. The Buffalo Green Code is a land use plan that concentrates on “fixing the basics, building on assets, implementing smart growth and embracing sustainability,” according to the Buffalo mayor’s office. “That is a good step. The entire community needs to have discussions with developers of new housing, public transportation providers and major employers to discuss the needs of people with disabilities,” Cammarata said. He said some of these conversations are happening. “I have spoken to many large employers about the benefits of hiring a person with a disability and hold career fairs to provide greater opportunities,” he said. He said the Buffalo area needs financial resources for its transportation infrastructure to improve. “With good transportation comes opportunities,” he said. WalletHub.com used a host of sources for its study, including data from the U.S. Census Bureau, Bureau of Labor Statistics and Department of Housing and Urban Development. To view the full report, visit https://wallethub.com/edu/ best-worst-cities-for-people-withdisabilities/7164/.
Hire Your Own Private Doctor
Some doctors in the area can provide you with home visits and 24/7 availability — and it’s less expensive than you think By Deborah Jeanne Sergeant
ant a doctor who really knows you and offers 24/7 availability or even house calls? These options have become reality as physicians reinvent how they provide care. A few doctors in the area have begun offering alternative ways to deliver care, and not just because they want to enhance their patients' experience. As margins grow thinner and thinner in the healthcare industry, many providers take on additional patients to receive adequate reimbursement from insurers. Since they can't add more hours to the day, this means that each patient receives less time during visits. Physicians in general also have little opportunity to develop a close patient/doctor relationship. If they increase the number of visits they schedule, they must work longer hours, which affects their quality of life. All of these factors add up to less satisfaction for doctors and patients. Some have turned to offering retainer-based care, sometimes called concierge medical care. Nora E. Meaney-Elman, a primary care physician who owns and operates a self-named practice in Williamsville, believes that affiliation with MDVIP (www.mdvip. com) for the past year has helped her solve the
Nora E. Meaney-Elman
Some doctors in the area can provide you with home visits and 24/7 availability — and it’s less expensive than you think problem. MDVIP, a patient-centered wellness program headquartered in Boca Raton, Fla., provides physicians with more direct access to providers for an annual fee. The program focuses on wellness and prevention as keys to good health. Meaney-Elman offers an out-ofpocket wellness program that centers around an "executive physical" which lasts an hour, instead of the usual half hour with just 15 minutes provided by a physician. The physical includes onsite testing for audiology, pulmonary, vision and cardiology health needs. Lab tests and other screenings help assess patient health and benchmark vital numbers. "I was drawn to this for this for a variety of reasons," MeaneyElman said. "I always had a patientcentered practice, but the mandates from government and insurance companies with electronic records depersonalized
our relationship. It fragmented offices more and more. Ultimately, this is the most sensible plan I've seen." Through her affiliation with MDVIP, she can link to top specialists nationwide to consult on tougher cases. She participates with insurance and bills them for services delivered on-site. "Most of the insurance companies find there's a lot of value in these programs because we keep people out of the hospital," MeaneyElman said. "We know the patient really well. In general, they and the government have recognized the role these plans play." Her VIP patients don't have to wait for care, and she feels that she can empower patients to take charge of their health since she spends more time with them to help them make informed health decisions. "It's a joint venture in the patient's command of the health system and that's very gratifying," she said. She employs two RNs and a medical technician but she is the only person who sees patients. When she's out of town, she refers patients to another physician.
November 2016 •
Leonard Kaplan, osteopath who specializes in spine, sports and wellness, operates Osteopathic Wellness Medicine in Buffalo. Since many patients require a number of visits, he provides package deals with multiple modalities. Kaplan had worked as a managing partner at a large sports medicine group for 12 years, but as insurance reimbursements tightened, he felt squeezed as overhead went up. "What ends up happening is physicians across the country reduce the time they spend with patients and they start to employ nurse practitioners and physician assistants," Kaplan said. His patients have told him that at other practices, they never saw their doctors, even at their initial visits. Kaplan felt the quality of care declined and became impersonal. Two years ago, he decided to go back to "old-style medicine," he said. "It removes the middle man between you and the patient — you don't have high prices. You can charge less than you would charge the insurance companies." He said that many physicians must inflate their prices to insurance companies to receive enough reimbursement to cover their expenses, "a ridiculous game," Kaplan said. He began his high-value, lowvolume practice so he could spend an hour with each patient. He now knows his patients by first name. To keep his overhead low and charge patients fees they can afford, he employs only a receptionist and accepts cash payments from patients. "There's never any waiting," Kaplan said. "I have four chairs in my waiting area and they're almost always empty. That's what it's all about: relationship-based medicine. You know the patient. You understand them and what they need." He integrates wellness aspects by working with a nutritionist, yoga instructor and mindfulness counselor, among others. "Everything I have, my team, is all available on first-service basis," Kaplan said. "What I do that's unique is I integrate all those services. I'm like a conductor." Membership is $2,000 annually, which includes multiple visits with Kaplan, and blood work. Any procedures incur additional fees. "It's like a membership in a gym and I make recommendations," Kaplan said. "I can give them a total cost." He does not bill insurers, though he will provide a bill if patients wish to bill their company. "The job satisfaction is unbelievable," Kaplan said. "I'm extremely happy and I love what I do. There's no burnout. All those feelings like I'm getting squeezed are gone. Now I can take my time." He admits that his care is "not affordable for everyone" but added, "it's the reality of medicine. It does require for a person to have some means, but the prices aren't outrageous. The majority of my patients are not wealthy." To comply with the Affordable Care Act, patients must also take part in a qualified health insurance plan.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
Golden Years Cataract Surgery Has Come a Long Way
Surgeries are quicker, more precise and allow many patients to discard their reading glasses By Deborah Jeanne Sergeant
ataract surgery has become commonplace, but the techniques involved and results possible have improved over the past several years. Some patients may reduce their astigmatism and need for reading glasses, among other advances. Largely associated with aging, cataracts affect many older people with yellow tinted vision, limited night vision, glare in bright light, cloudy vision and double vision. Mostly a routine surgery widely performed at out-patient centers and hospitals, cataract surgery has developed much in recent years. “There are constant modifications and improvements to the intraocular manmade lenses that are inserted into the eye during cataract surgery,” said ophthalmologist Sandra Fernando Sieminski, director,
glaucoma services in the department of ophthalmology, Jacobs School of Medicine and Biomedical Sciences at UB and an ophthalmologist with UBMD Ophthalmology/Ross Eye Institute. “One of the big areas of development is the creation of a lens to help patients see at all distances — near, intermediate, and far. These lenses, called multifocal lenses, already exist, but they are continuously being improved.” Instead of anticipating weeks of thrice a day drops, some surgeons offer no-drop surgery. While this may seem a minor advantage, it’s a big deal when a widow who lives alone delays surgery — and her chance for clear vision — because she feels uncertain about administering the eye drops afterwards. Plus, patients won’t have to pay for the drops,
Cochlear Implant Not Just for People Who Are Deaf
Technology has come a long way and some with hearing impairment are opting for the device instead of regular hearing aids By Deborah Jeanne Sergeant
ust as hearing aids have advanced dramatically in the past few years, cochlear implants have improved vastly as well. “In 25 years of doing this, I’ve never been as excited at the advances with cochlear implants,” said David Nelson, doctor of audiology with Audiology Service Associates in Williamsville. “It’s amazing the benefits and connections being made to the world around us. “They were never super hazardous but they’ve become more safe. They can help more losses than before.” The device’s ability to process sound has improved by employing multiple microphone technology similar to that of the current, advanced hearing aids. Some sound processors in cochlear devices use wireless or Bluetooth technology so users can wirelessly connect to the output of a smart TV, smartphones and portable devices. Implants have become thinner and easier to insert. This improvement decreases the chances of damaging the person’s remaining hearing. That’s one reason why cochlear implants are no longer just for people who are profoundly deaf. Now, both children and adults Page 14
can receive cochlear implants. Although people who are deaf can benefit dramatically from cochlear implants regardless of age, the very young and the very old receive unique benefits. For young children, it’s about acquiring language; for the elderly, it’s about staying connected to their community to stay vibrant. “Because our brain develops through the senses, sensory stimulation is important to keep our brains healthy,” Nelson said. “How are you going to keep your brain molding and changing? If you have lack of stimulation, it won’t come back. If you have an arm left in a cast an extended time, you don’t get the full sensation and use back you had before.” Early exposure helps people communicate better, whether verbally or through sign language. Using verbal language helps people communicate easier with more people. Donna Sorkin, executive director of The American Cochlear Implant Alliance, said that people who receive cochlear implants do better when they have experienced a shorter period of deafness and they have more residual hearing while still fitting with the FDA candidacy
which can spare them three copays. For dropless surgery, “typically, an antiinflammatory and antibiotic medication are injected into the eye,” Fernando Sieminski said. “This procedure is still not universally utilized, but may become a standard in the future.” Laser cataract surgery has increased the surgeon’s precision in making incisions and breaking up the natural lens. “This method of cataract surgery, in some cases, can help improve visual acuity outcomes, and help to remove difficult, dense cataracts,” Fernando Sieminski said. “Typically, the lens that is implanted to replace the cataract corrects patients’ distance vision, but they will need readers or ‘cheaters’ for reading vision. There are specialty lenses that can correct astigmatism — toric lenses — and others that can help correct near, intermediate, and distance vision all in one lens: accommodative or multifocal lenses.” guideline. “That’s because of all the issues with brain plasticity,” Sorkin said. “At some point, even though hearing aids have gotten dramatically better with digital technology, the hair cells in the cochlear are absent in sufficient numbers to provide meaningful information. High frequently sounds like ‘s’ and ‘t’, and higher frequency sounds may be totally missing.” Those individuals “miss important sound information,” Sorkin added. Helping children hear before 18 months makes a big difference in helping them acquire language, according to Sorkin. Given the FDA guideline, most insurers won’t cover a cochlear implant for a child until 12 months. The evaluation process takes time, which is why Sorkin urges parents of children born deaf to get the ball rolling right away. “I would have the child fit with hearing aids, as there’s usually some residual hearing,” she said. “I would teach the parents to be providing the best possible auditory environment, talking all the time. Give exposure to language. On their first birthday, once insurance will kick in, they have cochlear implant surgery.” Sorkin has observed many children who have taken this route entering first grade with typical language skills. Older people can benefit as well. Sorkin said that people in their 90s can have the surgery as long as they’re generally healthy. “If you miss most of what people say even wearing wellfitted hearing aids, you can’t really communicate with your family or others,” Sorkin said. “Many older
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • November 2016
Though it’s not suitable for all patients, candidates can improve their near vision and astigmatism. “Depending upon your needs and how bad your astigmatism is, these could be options for you,” said Kathleen Otto, representing Fichte Endl & Elmer Eyecare in Amherst and Niagara Falls and the new Ambulatory Surgery Center of Niagara. Previously, people with small pupils challenged surgeons; however, a new advance has made treating them easier. “The new pupil expander device, the iRing, assists the surgeon in small pupil cases,” said Ken Lindahl, ophthalmologist at Rochester Eye and Laser Center. “Small pupils are a known risk factor for complications during the cataract procedure.” people miss out of the benefits of hearing with cochlear implants. Medicare does cover this.” She referenced the connection between loss of hearing and its effect on isolation. Many seniors who cannot hear well don’t socialize as often and miss the stimulation that helps keep their brains active. Hybrid devices that combine acoustic and electronic hearing assistance use cochlear implants for mid- and higher-range frequency and hearing aids for low-range frequencies. “People don’t want to lose what they have at low frequency,” Sorkin said. “It’s a major advantage.” An implanted device that accesses the brain stem has also shown helpful for those without a working auditory nerve. The FDA has approved its use in adults and trials are underway for its use in children.
By Jim Miller
Planning a Funeral? Expect to Pay $11,000 or More Dear Savvy Senior,
How much does an average funeral and body burial cost? I need to make funeral arrangements for my aunt, who’s terminally ill, and would like to have a cost idea going in so I can plan and budget appropriately.
It definitely pays to know what charges to expect when pre-planning a funeral. Most people don’t have a clue, and can often be upsold thousands of dollars worth of extra services you may not want or need. Here’s a breakdown of what you can expect
The first thing you need to be aware of is that funeral costs will vary considerably depending on your geographic location, the funeral home you choose and the funeral choices you make. With that said, here’s a breakdown of what an average funeral costs, nationwide, according to recent data from the National Funeral Directors Association. • Professional services fee: This is a basic non-declinable fee that covers the funeral provider’s time, expertise and overhead. $2,000 • Transfer of the remains: This is for picking up the body and taking it to the funeral home. $310 • Embalming and body preparation: Embalming is usually mandatory for open-casket viewing, otherwise it’s not required unless the body is going to be transported across state lines. Embalming costs $695. Other body preparations, which includes hairdressing and cosmetics runs $250. • Funeral viewing and ceremony: If the viewing and funeral ceremony is at the funeral home, you’ll be charged for use of the chapel and any necessary staff. Costs: $420 for viewing, and $495 for funeral ceremony. • Metal casket: This is a big money maker for funeral homes, with markups of up to 300 percent over the wholesale price. $2,395. • Funeral transportation: Use of hearse and driver $318 to transport the body to the cemetery. Use of a
service car/van $143. • Memorial printed package: This includes printed programs and memorial guest book. $155. In addition to these costs, there are a number of other related expenses such as flowers for the funeral (around $200 to $400), the newspaper obituary fee ($100 to $600 or more), the clergy honorarium ($200 to $300) and extra copies of the death certificate ($5 to $35 per copy depending on the state). And, a number of large cemetery costs like the plot or mausoleum fee, the vault or grave liner that’s required by most cemeteries, and the opening and closing of the grave, all of which average between $2,000 and $4,000; and the gravestone, which typically costs between $1,000 and $3,000. All told, the average cost of a total funeral today is around $11,000 or more.
Ways to Save
If your aunt’s estate can’t afford this, there are ways to save. For starters, you should know that prices can vary significantly by funeral provider, so it’s wise to shop around. If you need some help finding an affordable provider, your area funeral consumers alliance program may be able to refer you. See Funerals. org/local-fca or call 802-865-8300 for contact information. There are also free websites you can turn to, like Parting.com that lets you compare prices, and FuneralDecisions.com that will provide estimates from local funeral homes based on what you want. When evaluating funeral providers, be sure you get an itemized price list of services and products so you can accurately compare and choose what you want. But the most significant way to save on a funeral is to request a “direct burial” or “direct cremation.” With these options your aunt would be buried or cremated shortly after death, which skips the embalming and viewing. If she wants a memorial service you can have it at the graveside or at her place of worship without the body. These services usually run between $600 and $2,000, not counting cemetery charges.
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IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
Navigating the Hospice Learning Curve
‘Where I once associated hospice with death, I now regard hospice as representing the essence of life itself’ By Phil Rice
bout 20 years ago a group of friends and I visited an acquaintance who was in a special hospice wing of a local hospital. We were told he had been taken there to die. We visited, and the next day he died. For several years after this experience, my immediate association with the word “hospice” was a one-dimensional scenario of hopelessness personified. But my impression would change. In 2005, my mother, who was suffering from non-Hodgins lymphoma and various other ailments, moved in with my 11-yearold son Paul and me. Mom was still ambulatory, but osteoporosis, arthritis and phlebitis were making movement increasingly difficult. During the first year of this arrangement she acquired vascular dementia brought on by a series of mini-strokes. My son Paul and I spent several months caring for her at our home but we were woefully unprepared for the task. When her falls became more frequent and she clearly needed fulltime attention, I reluctantly agreed to let her be taken to a hospital. Five days later she was in a nursing home, and four months after that she was in an assisted living facility. After three difficult years of such care, my cousin Starr asked me if I had considered hospice. My response was to assure her that although mom was in deep dementia and completely dependent upon physical assistance for even the simplest of tasks, there was no indication that her passing was imminent. Nevertheless, Starr urged me to look into hospice. I finally took her advice, and thus began a profound learning experience.
How it Worked for Me
A hospice evaluation soon confirmed that mom indeed qualified — and that her insurance would cover the services. This was an amazing revelation. From that day forward a hospice caregiver would come by three times a week and make sure Mom was properly bathed and generally being treated well. A registered nurse visited at least once a week to monitor any medications and health concerns, keeping me fully informed along the way. If there was a specific concern, the nurse visited more frequently. A chaplain and social worker each made regular visits as well. Having hospice involved was a huge benefit toward ensuring that mom was comfortable and safe, which in turn eased my own stress. This became even more important Page 16
a couple of years later when my fiancée Janice had emergency brain surgery to remove a malignant brain tumor. Unable to visit with my usual frequency, hospice became my lifeline to Mom during those weeks. When it became apparent that Janice was not going to win her battle, hospice again stepped to the front.
What Hospice Taught Me
After two months in the hospital we were able to bring Janice home. Hospice provided all of the necessary equipment and supplies for us to properly care for her needs. The caregiver showed me how to bathe Janice and change her clothing and sheets with the least amount of discomfort. The RN made sure I understood how to use the feeding tube and how to gauge her need for medication. I spent many hours a day alone with Janice, but I never felt alone. There was a team involved.
How Hospice Changes Lives
I have accrued years of experience in dealing with healthcare professionals and caregivers, from the top hospitals to the bare-boned assisted living facilities and nursing homes. Some were exceptionally dedicated and skilled, and most were genuinely compassionate and competent. But some were less than competent. Hospice workers are different. I’ve never encountered a hospice worker who was anything less than fully and passionately engaged with the difficult task at hand. Where I once associated hospice with death, I now regard hospice as representing the essence of life itself. Because of hospice Janice and I were able to experience life to the fullest in her final weeks, and I was able to share in her journey as much as humanly possible. As a society we ascribe deep significance to the beginning of life; for many, birth is the moment where the physical is most connected with the spiritual. Hospice provides an opportunity to embrace the end of life just as profoundly and lovingly. Easing the transition of a loved one and sharing the moment of passing are among the finest gifts we can hope to give and receive in this life. I consistently seek new ways to express my gratitude to hospice for my gaining this awareness.
Phil Rice is a native Tennessean and author of “Winter Sun: A Memoir of Love and Hospice.”
The Social Ask Security Office
From the Social Security District Office
Supporting Our Wounded Warriors
very Veterans Day, the nation honors the brave men and women who risk their lives to protect our country and the freedoms we cherish. Social Security honors veterans and active duty members of the military every day by giving them the support they deserve. A vital part of that is administering the Social Security disability program. For those who return home with injuries, Social Security is a resource they can turn to for disability benefits. Social Security’s Wounded Warriors website is at www. socialsecurity.gov/woundedwarriors. The Wounded Warriors website has answers to many commonly asked questions, and shares other useful information about disability benefits, including how veterans can receive expedited processing of disability claims. Benefits available through Social Security are different from those available from the Department of Veterans Affairs and require a separate application. The expedited process is available to military service members
who become disabled while on active military service on or after Oct. 1, 2001, regardless of where the disability occurs. Even active duty military who continue to receive pay while in a hospital or on medical leave should consider applying for disability benefits if they’re unable to work due to a disabling condition. Active duty status and receipt of military pay doesn’t necessarily prevent payment of Social Security disability benefits. Although a person can’t receive Social Security disability benefits while engaging in substantial work for pay or profit, receipt of military payments should never stop someone from applying for disability benefits from Social Security. Learn more by visiting www.socialsecurity.gov/ woundedwarriors. With over 80 years of experience and compassionate service, Social Security is proud to support our veterans and active duty members of the military. Let these heroes know they can count on us when they need to take advantage of their earned benefits, today and tomorrow.
Q: How do I earn Social Security credits, and how many do I need to qualify for benefits? A: We use your total yearly earnings to figure your Social Security credits. The amount needed for a credit in 2016 is $1,260. You can earn a maximum of four credits for any year. The amount needed to earn one credit increases automatically each year when average wages increase. You must earn a certain number of credits to qualify for Social Security benefits. The number of credits you need depends on your age when you apply and the type of benefit application. No one needs more than 40 credits for any Social Security benefit. For more information, visit our website at www.socialsecurity.gov.
benefits if you currently receive them; and • Manage your benefits: – Change your address or telephone number; – Start or change your direct deposit; – Get a replacement Medicare card; and – Get a replacement SSA-1099 or SSA-1042S for tax season.
Q: Why should I sign up for a my Social Security online account? A: my Social Security gives you a personal online account you can securely use to check your Social Security information and do business with us. With a my Social Security account you can: • Keep track of your earnings and verify them every year; • Get an estimate of your future benefits if you are still working; • Get a replacement Social Security card if you meet certain criteria and reside in these locations; • Get a letter with proof of your
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • November 2016
Q: My spouse died recently and my neighbor said my children and I might be eligible for survivors benefits. Don’t I have to be retirement age to receive benefits? A: No. As a survivor, you can receive benefits at any age if you are caring for a child who is receiving Social Security benefits and who is under age 16. Your children are eligible for survivors benefits through Social Security up to age 19 if they are unmarried and attending elementary or secondary school full time. Keep in mind that you are still subject to the annual earnings limit if you are working. If you are not caring for minor children, you would need to wait until age 60 (age 50 if disabled) to collect survivors benefits. For more information about survivors benefits, read our publication Survivors Benefits at www.socialsecurity.gov/pubs. To find all of the services available and set up an account, go to www.socialsecurity.gov/myaccount.
108 Years of Age
Family and friends of East Aurora native gathered for big birthday celebration. Key to longevity? Stay calm By Daniel Meyer
iriam Rosen Minsker thinks her simple approach to life is the reason why she was recently able to celebrate her 108th birthday. The soft-spoken but quick-witted woman believes her philosophy of taking life “one day at a time” is something that others should take note of if they have aspirations to living anywhere close to as long as she has. “So many people fuss and make a racket but it really shouldn’t be that hard,” says Minsker, who spoke after being lauded by family members, friends and elected officials at a recent party at Beechwood Homes in Getzville. “You just have to do it one day at a time and that means staying healthy and staying calm.” Minsker was born in East Aurora in 1908, a time when the average life expectancy was 47 years old. The median annual salary then was $300,
Things You Need to Do If You’re an Older Adult
Have a conversation with your doctor about your condition and treatment. Often, people don’t think about what kind of intervention they want when it comes to their end-of-life treatment. Most people don’t even want to discuss the issue whether that’s because of fear, discomfort with the topic or sheer misinformation about the need to put things in order before death. However, having even a brief talk with your physician is vital so it’s clear the kind of life-saving or non-life-saving treatment you desire. “Patients don’t understand the scope of overall options they have available for their care,” said Clemency, a double board-certified physician in emergency medicine and emergency medical services. “It’s important to understand what your current medical conditions are and what type of invention you want. Do you want CPR administered if your
heart stops? Do you want to be intubated? Do you want longterm health care if you are in a coma? Those issues can’t just be thought about for the first time when you come into the emergency room.”
Sharing the information with your family. After the long discussion with your physician to create an end-of-life plan, the next step must be letting your family know about your plans. Medical officials believe they often are the last to know about their own family member’s wishes. Family members may have the best of intentions to advocate for a certain treatment that may be contradictory to what the patients wants. Early discussion can eliminate those issues. “Sometimes, there is confusion and stress when end-of-life is coming. The patient may not be able to make decisions on their own and family members don’t know what they want to do either,” said Clemency. “But if you have a plan in place and you have already discussed it with your family, then you already know what they would want and there is a clear viewpoint. The last thing you want is for important decisions to be undecided and family members to be fighting about which treatments to do during the most critical times. It just adds stress to an already stressful situation.”
health and can stay calm and not get too upset, you can live a long and happy life just like me.”
Clemency said one of the biggest issues is conflicting information. There are patients that say they don’t want any additional measures to keep them alive, but on that same form they write down yes to questions that would force a doctor to do extra measures to keep them alive. “When a physician sees that, it can be confusing as to what the patient actually wants,” Clemency added. “You have to treat the form like a complete puzzle that must be put together thoroughly with each piece making sense.”
By Ernst Lamothe Jr.
hysician Brian Clemency has been involved in prehospital care for nearly 20 years, beginning his career as a firefighter and emergency medical technician. He discusses five things people should think about before their end-of-life care. He is the clinical assistant professor of emergency medicine at the University of Buffalo as well as the associate medical director of the Rural/Metro Medical Services of Western New York.
the cost of one dozen eggs was 14 cents and the president of the United States was Theodore Roosevelt, a man Minsker describes as “a great leader for our nation.” She turned 108 Aug. 16. Minsker’s family had deep roots in East Aurora, as her father, Cy Rosen, served as superintendent of printing on the historic Roycroft campus. Her father worked for Elbert Hubbard Sr., the man who founded Roycroft in the late 1890s. The family lived in a home based on the Roycroft property on Main Street in East Aurora. Minsker herself later worked at Roycroft, first as an employee in the pamphlet bindery while attending college then later as a secretary and bookkeeper. Her memories of being employed by the Hubbard family include happy stories that recall her family’s pride in working for a locallyowned and operated company
that employed other East Aurora residents, which helped churn early economic development in the village and surrounding communities. “They were kind people to work for and be around,” recalls Minsker. “They were good to my father and our family. They took care of us.” Minsker attended Syracuse University for two years before transferring to the University of Pittsburgh, where she received a degree in business administration, an impressive accomplishment during an era when it was not very common for a woman to pursue a secondary education. “I wanted to learn, I loved to learn,” says Minsker. “It was very important to me and my family for me to get that schooling. I am glad that I did it.” Minsker and her husband, the late John Minsker, had three children, eight grandchildren and 14 great grandchildren. They were among the first residents to move into the Asbury Pointe Retirement Community when it opened in 2000. Minsker has many fond memories of over a dozen years living at that facility and also praises the employees of Beechwood Homes, where she has lived since 2013. “I stay healthy and stay calm because my meals are made for me, they help keep my room clean and let me spend time with my friends,” says Minsker. “If you have your
Filling out your medical order for life-sustaining treatment completely A medical order for life-sustaining treatment form — or MOLST — is designed to improve the quality of care patients receive at the end of life by translating patient goals for care and preferences into medical orders. MOLST is based on communication between the patient, his or her health care agent or other designated surrogate decision-maker, and health care professionals that ensures shared, informed medical decision-making. “Patients must understand if they don’t list any limitations of treatment or don’t have a MOLST form then the emergency departments will perform the most aggressive treatment possible to bring them back to life and sustain them,” said Clemency. “If you leave anything open to interpretation, then physician must make that assumption for you even if you wouldn’t want the most aggressive treatment. You have to fill out the form completely and make sure no detail is left to interpretation.”
November 2016 •
Discuss the difference between quality of life and duration of life Because of modern healthcare technology, there are more ways to keep a patient alive longer than ever before. However, just because that is an option doesn’t mean every patient wants it. “When thinking about certain interventions, it is critical to know the difference,” said Clemency. “Do you want your care to focus on keeping you alive as long as you want? If so there are a list of treatments that could make that possible. Modern medicine allows us to do that, but some invention can also cause more issues.
Make sure the form is with you Clemency believes while this last step might seem to be the simplest, it often is overlooked. “If the patient is moving from one nursing home to another, they have to make sure their form is with them,” he said. “Unfortunately the MOLST form is not in electronic form so you have to make sure that paper is with you when you travel or if you move. You need to make sure the form follows you wherever you go.”
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper
Health News Local Kaleida Health hospitals have new CEO Kaleida Health has named Darcy Craven president of Millard Fillmore Suburban and DeGraff Memorial Hospitals. Craven was recruited from the Carolinas Hospital System where he has served as chief executive officer since 2012. Carolinas Hospital System is a 420-bed tertiary care Craven facility located in Florence, S. C.. Comprised of two campuses, it is the third largest employer in Florence County with annual operating budget of $250 Million. “We are thrilled to have Darcy join the Kaleida Health family,” said Jody Lomeo, president and CEO of Kaleida Health. “As you can imagine, there were a number of great candidates who were interested in the position, but his 20 years of success in operations, putting the patient first and leading
from the bedside really stood out to us. He will be a great fit for Millard Suburban and DeGraff Memorial Hospitals.” Craven assumes the post previously held by Chris Lane, who was appointed president of Buffalo General Medical Center/Gates Vascular Institute in May. Craven said, “I couldn’t be more excited to join Kaleida Health. The organization has a clear commitment to providing great care and it will be my goal to support the physicians and staff at Suburban and DeGraff in advancing that mission. After recently visiting as a family, my wife and I are delighted to be able to call Buffalo home and are eager to become active members of the community.” Craven joined the Carolinas Hospital System in 2010 as its chief operating officer, before being promoted to the CEO position in 2012. Prior to this, Craven held executive leadership positions with two Carolinas Hospital System affiliates: interim CEO of Cherokee Medical Center in Centre, Ala., and the assistant CEO of DeKalb Regional Medical Center in Fort Payne, Ala. Craven has a master’s degree in business administration from
Questions to Kenneth Houseknecht
Mental Health Association director working to protect those challenged by mental illness By Michael J. Billoni
enneth Houseknecht, who has more than 30 years experience in public and investor relations work, has been the executive director of the Mental Health Association of Erie County for the past four years. As a volunteer of MHA for nearly 30 years, he has found his passion in this position. “I work with
incredibly talented and passionate people who are doing work that truly makes a difference in people’s lives. I am so blessed to be here.”
1 Explain what is the mission of 1. the Mental Health Association of Erie County?
A. We promote mental health and wellness in our community and support individuals and families who are challenged by mental illness. Since 1962, the Mental Health Association of Erie County, Inc. has provided essential programs and services to seniors, adults, families and children in Erie County. Over the years, the Mental Health Association has positioned itself to know what the most pressing and current mental health needs are in our community and to deliver the best possible programming and services to meet those needs.
Gardner-Webb University and a bachelor’s degree from the University of Manitoba (Canada). He began his new role with the hospitals and Kaleida Health in October.
Compeer gets $25K from Community Foundation Compeer of Greater Buffalo, the only organization in Western New York dedicated to recovery through the healing power of friendship, recently announced that the organization, through a collaboration with Say Yes Buffalo, received a $25,000 grant from The Community Foundation for Greater Buffalo to conduct a unique mentoring program with low income high school seniors currently enrolled in a city of Buffalo public or charter school. “Our team will utilize these grant funds to match 50 students with volunteer, working professional, mentors,” said Timothy Boling, executive director, Compeer Inc. “Many of these identified students could be the first members of their families to attend college and now, because of the generous support of the Community Foundation, we
2 Explain the Court Appointed 2.
Special Advocates (C.A.S.A.) program and the challenges many of our children face?
A. The mission of Erie County CASA is to speak for the best interests of abused and neglected children in the courts. CASA promotes and supports quality volunteer representation for children, with volunteers advocating to provide each child a safe, permanent, nurturing home, as quickly as possible. CASA believes every child deserves to have the opportunity to thrive and reach their potential. Based on 2009 statistics, each year, nearly 24,605 New York state children were in foster care. Furthermore, authorities typically investigate between 40,000 and 50,000 new reports of indicated child abuse or neglect each year. In 2009, CASA volunteers were involved in 3,236 cases. Every day, these children enter the child welfare system, which works with families, foster parents and treatment providers to ensure their safety. But these children are often scared and reluctant to trust in the system. How their cases are handled can mean the difference between their growing up as contributing adults or as reminders of how we, as a society, have failed them. A child at risk, who finds himself caught up in the foster care system, faces a confusing and often intimidating court system and child welfare bureaucracy. CASA — Court Appointed Special Advocates — works with family courts to make sure that each child’s voice is heard.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • November 2016
will now be able to ensure they are equipped with the tools to apply to colleges, apply for financial aid, select a college to attend and prepare for the transition from high school to college.” A key component to the program will be recruiting working professionals to become volunteer mentors to the students. Compeer and Say Yes staff will recruit, properly vet, train and orient volunteers. Based on the backgrounds, life experiences, interests, and desires of both the scholars and volunteers, matches will then take place. Once matched, the students and volunteers will continue to receive support, resources, and guidance from Compeer and Say Yes staff. Both mentors and mentees will be required to make a minimum of an 18-month time commitment.
Plans by Independent Health among the best Independent Health is again one of the highest-rated health insurance plans in the nation, according to the 2016-2017 Health Insurance Plan Ratings by The National Committee for Quality Assurance (NCQA),
3 What is the Superhero Race and 3.
Wellness Walk and when will it be held in 2017?
A. The Superhero Race & Wellness Walk is an annual event that highlights the strength and diversity of the mental health community of Western New York. Our race supports youth who live with mental health challenges, are receiving mentoring and advocacy services, and may be in foster care. The Superhero Race benefits two Western New York programs supporting the mental health community. The funding is distributed evenly to a mentoring program for individuals with a mental health challenge facilitated and managed by Compeer of Greater Buffalo and the Court Appointed Special Advocates (CASA) program facilitated and managed by the Mental Health Association of Erie County, Inc. The Superhero Race and Wellness Walk is designed for runners and walkers of all ages and fitness levels. We celebrate a sense of community and encourage groups to come together as teams for friendly competition. The race will be held Friday, June 2, 2017. For more information, visit buffalosuperherorace.com.
For more information or to learn about volunteer opportunities about MHA of Erie County visit eriemha.org or for Compeer of Greater Buffalo, visit compeerbuffalo.org.
Health News a private, leading organization dedicated to improving health care quality. “We’re very proud that Independent Health is again being recognized as one of the highestrated health plans in the U.S. This recognition from NCQA is the latest in a long line of national honors we’ve received for quality and service,” said physician Michael Cropp, president & CEO, Independent Health. “As a widely recognized symbol of quality in health care, NCQA’s rating for 2016-2017 reaffirms Independent Health’s commitment and ability to consistently provide the highest level of service for our members to get the care they need.” Independent Health’s HMO/ POS (commercial/private) products are rated 4.5 out of 5 in NCQA’s 2016-2017 Health Insurance Plan Ratings. In addition, Independent Health rated 4 out of 5 for both its Medicare HMO and PPO products and 3.5 out of 5 for its Medicaid HMO product. These ratings are based on clinical quality, member satisfaction and NCQA accreditation standards. Independent Health has
consistently been rated among the top health plans in the country for customer service and member satisfaction, according to a company news release. Earlier this year, Independent Health was recognized as the highest ranked health insurance plan for member satisfaction among commercial health plans in the New York/New Jersey region by J.D. Power’s 2016 U.S. Member Health Plan Study. Additionally, Independent Health earned 4.5 out of 5 stars by Medicare in its 2015 rating of Medicare Advantage plans based on quality, value and performance. For the 2016-2017 Health Insurance Plan Ratings, NCQA reviewed 1,500 health plans and rated more than 1,000 private, Medicare and Medicaid health insurance plans based on their combined Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and NCQA Accreditation scores. NCQA uses a ratings methodology that classifies plans into scores from 0-5 in 0.5 increments – a system similar to CMS’ Five-Start Quality Rating System.
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Millard Fillmore Suburban staff. Front row, left, Tricia Fusillo. Back, from left, are physician Dennis Weppner, Chris Lufkin, Renee Davis, Michelle Schafer and Diane Lobdell.
Millard Fillmore Suburban Hospital’s NICU Celebrates 1-Year Anniversary Physicians and staff gathered Oct. 13 to celebrate the one-year anniversary of the opening of Millard Fillmore Suburban Hospital’s neonatal intensive care unit. A neonatal intensive care unit (NICU) specializes in the care of ill or premature newborn infants. The NICU at Millard Suburban, built as a brand new fourth floor, one floor above the labor and delivery program opened last fall. The first exclusively single-room NICU in Western New York reduces the need for at-risk newborns to be transported to a separate facility and risk further medical complications while keeping moms and infants together. The 10 bed NICU team has treated approximately 170 babies since opening. “Adding this critical care unit allows us to better serve our moms and newborns,” said Diane
Lobdell, chief nursing officer of Millard Fillmore Suburban and DeGraff Memorial Hospitals. “The beautiful single rooms allow parents to comfortably remain at their newborn’s bedside while they receive the medical care they need right here at Suburban.” The Millard Fillmore Suburban Hospital NICU is a partnership with the WNY regional perinatal center, Women & Children’s Hospital of Buffalo (WCHOB). “I am proud to be part of the expert interdisciplinary NICU team providing the northtowns with high quality neonatal care,” said physician Deepali Handa, the NICU’s medical director. “The new modern accommodations create a very calm and nurturing environment for our critically ill babies to grow and develop. We continuously receive high praise from families regarding the care and comfort in the NICU.”
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Winter is Coming.
Time to Get Moving
Cross-country skiing and snowshoeing are some of the great ways to stay in shape this coming season By Tim Fenster
or those who live in regions as cold and snowy as the Buffalo area, the very concept of winter recreation may seem like an oxymoron. Winter is our time to hibernate, and hibernate we do — recent studies show that Americans tend to gain weight in early winter, then join gyms at accelerated rates from January to March to shed it off. But perhaps both these trends — the holiday weight-gain and post-New Year’s gym rush — could be avoided if we spent more time enjoying the winter wilderness in all its blindingly white glory. This is best done — as was the case millennia ago — with the aid of either cross-country skis or snowshoes. If you’ve never tried either, a good place to start may be Reinstein Woods Nature Preserve in Cheektowaga. The preserve offers about three miles of trails on some nearly 300 acres, and provides rentals of both snowshoes and skis at affordable rates ($3 for snowshoes and $5 for skis for members of Friends of Reinstein Woods; $5 and $8 for nonmembers, respectively). “It’s a good place to learn how to snowshoe or cross-country ski,” said Meaghan Boice-Green, director of Reinstein Woods Environmental
Education Center. “It’s certainly a great way to experience winter, and it’s a great workout.” But Reinstein Woods isn’t alone. There are many parks and sporting goods stores across the area where one can rent a pair of snowshoes or cross-country skis. Sarah Beckwith, co-owner of one such store, Gear For Adventure, 305 Buffalo St. in Hamburg, says snowshoeing novices should be sure to tailor the snowshoe to their weight and the difficulty of the trek. Most basic snowshoes have a single crampon — a claw that helps grip the snow. Those who plan to head up steeper terrain should use a mountaineer snowshoe. These have additional crampons and a televator — a small metal loop that raised the heel of the foot and allows for better grip. For local terrain, Beckwith recommends a lightweight snowshoe made by MSR; it has extra crampons along the side that prevent the region’s wet, lake-effect snow from balling up under the shoe. Once outfitted with the proper shoes, you can hit either the trails or just about anywhere you please. “If you have the right gear, the packed snow [of a well-used trail] is definitely going to be easier, because
Group of people snowshoeing at Reinstein Woods Nature Preserve in Cheektowaga. Page 20
you’re not going to slip and slide, and there’s no resistance,” Beckwith said. “But if you want a really good workout, step to the side and use the powder.” To increase both your workout and your balance, bring along a pair of hiking poles. Beckwith says about half their customers take poles with them. “It will give you a better cardio workout because you’re moving your arms now,” she said. “The second reason is for stability, especially in deeper snow.” Beckwith says snowshoeing has grown steadily popular with each year while cross-country skiing, not so much. But skis do offer much of the stability and buoyancy that snowshoes do. Just make sure to use the proper gear. Unlike downhill skis, cross-country skis are thin, much longer than the rider is tall, slightly pliable and attach only at the toe, leaving the rider with a free heel. “Certainly with fresh snow,
the advantage is they spread your weight out so you don’t sink into the snow as much,” Boice-Green said. Boice-Green urged those who enjoy hiking to give snowshoeing or cross-country skiing a shot, adding that Reinstein Woods’ small size makes it ideal for families with young children. (Beckwith suggests Taylor Road Family Recreation Facility in Hamburg for those with kids, much for the same reason.) “People who get outside regularly are happier and healthier. Getting out when most people hibernate can have great benefits for their health,” Boice-Green said. Reinstein Woods is open from 9 a.m. to 4:30 p.m. Monday through Friday, and 1 to 4:30 p.m. Saturdays. For more information, visit www. reinsteinwoods.org or follow the group’s page on Facebook.
People learning how to ski at Reinstein Woods Nature Preserve in Cheektowaga.
IN GOOD HEALTH – Buffalo & WNY’s Healthcare Newspaper • November 2016