Bucks County Physician Winter 2015

Bucks County Medical Society

Letter From the Editor ......................................................................4

Board Profiles .................................................................................. 13

PAMED Updates

Surprise Medical Billing in Pennsylvania:What’s Being Done to Fix the Problem? .................................... 10

Combatting Pennsylvania’s Opioid Crisis:Tips For Patient Contracts ............................................................ 11

The Commonwealth Announces Efforts to Address Length of Credentialing Process for Medicaid Providers ....... 12

Health & Wellness

A Woman’s Place: Empowering Others to Thrive .................... 14

The ABCs of Vitamin DWhy Is It So Important & How Much Do You Really Need?................... 16

Health & Wellness Calendar {November 2015 – January 2016} .........25

Doylestown Hospital Stroke Care Earns Gold Plus Award ... 30

Planning Ahead

Spotlight On…Assisted Living /Residential Care .................... 20

Assessing a Home Health Care Agency ................................... 24

Contents WINTER 2015

F E A T U R E S

New Twist on “Educated Consumers”

Regenerative Treatment for Musculoskeletal Injuries

Dodging Diabetes

6

22

26

B C M S - PA .o r g

Letter From the Editor

With wintertime comes cooler weather and lower temperatures. Many will look to seek shelter indoors and stay out of the way of the cold. While the fallen leaves and glistening white snow catch our eye, that is not all that

needs our attention. It is also important that we take care of ourselves and focus on our physical health and wellbeing.

If you are an insured American in Pennsylvania and have received a ‘surprise’ medical bill—in which you receive a bill for a medical service that you believed was covered by insurance—there is an informative piece on what is being done to combat this issue. It is not good news for any patient, or any physician who wishes to provide the best care possible for his or her patient. Highlighted in this article are also several prominent issues that affect Pennsylvania physicians, such as narrow networks and balance billing.

Next you will find an article discussing Pennsylvania’s Opioid Crisis where Dr. Goldman outlines what he would recommend including in a patient contract. Turn-ing the tide on Pennsylvania’s Opioid Crisis will take a team effort, including the constant communication and collaboration from various members of the health care team—from physicians, to nurse practitioners, to pharmacists, but patients must also be willing to do their part.

EDITORSJ. Todd Alderfer, MD

Eric R. Gejer, DONancy Croll

EXECUTIVE DIRECTORJohn S. Detweiler

BOARD PRESIDENT, 2015Bindukumar C. Kansupada, MD

PAST PRESIDENTJ. Todd Alderfer, MD

VICE PRESIDENTSean P. Butler, DO

TREASURERIrwin J. Hollander, MD

SECRETARTYKieran D. Cody, MD

PUBLISHERHoffmann Publishing Group Inc.

2921 Windmill Road, Reading, PA 19608(610) 685-0914 x201 • HoffPubs.com

ADVERTIS ING CONTACTS

PRODUCTION ASSOCIATESara Radaoui

GRAPHIC DESIGNERBrittany Fry

Bucks County Medical Society200 Apple Street, Quakertown, PA 18951

(215) [email protected] • bcms-pa.org

The written and visual content of this magazine are protected by copyright. Reproduction of print or digital articles without written permission from Hoffmann Publishing Group, Inc., and/or the Bucks County Medical Society is forbidden. The placement of paid advertisement does not imply endorsements by Bucks County Medical Society.

J. Todd Alderfer, MD

Karen Zach(610) 685-0914 [email protected]

Sherry Mathias(610) 685-0914 x203

[email protected]

BUCKS COUNT Y PHYSICIAN

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One would be hard pressed to get through a television show with-out seeing an advertisement for

a prescription medication. The images are striking, the colors are soothing and the voice is convincing. Taking the medication will improve the quality of life.

Adolescents and adults are faced with these images on a daily basis. There is an expectation that, during an office visit, the consumer will leave with a prescription in hand, and that medication will lead to symptom relief. In an increasing number of such cases, though, this is the first step toward the downward spiral of addiction. The misuse of pain medication, or opiates, is an increasing issue. Time and time again, individuals seek substance use disorder treatment with the following scenario:

I had a minor surgery, or

accident, and was prescribed

a pain reliever. First, I used the

pills to relieve the pain, and

then I continued to use the

pills, even after the pain was

diminished. I became dependent

on that medication and used it

until it became too expensive.

When I could no longer get the

medication, or could no longer

afford it, I resorted to using

heroin. Heroin is less expensive

and extremely accessible.

In Bucks County, we are not immune to the national heroin epidemic. We sit adjacent to Philadelphia, arguably the home of the purest, and least expensive, heroin in the United States. According to residents who have been publicly funded for substance use disorder treatment, their primary drug of use is heroin. A heroin addiction that, most often, began with prescription medication misuse and abuse. We are in the midst of a perfect storm; increased misuse and abuse of prescription pain killers, along with low cost and high purity of heroin, which all too often is resulting in overdose death. This epidemic claims all lives—without regard to status, geography or willpower. We are seeking to stem the tide of a scourge that requires all hands on deck to reverse the alarming trend.


FEATURE

Diane W. Rosati, MAExecutive Director, Bucks County Drug & Alcohol Commission, Inc.

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Doctors, nurses, pharmacists, physician assistants, treatment providers and other allied healthcare professionals are vital part-ners in responding to the overdose epidemic. The key to that response is understanding the scope of the problem, along with iden-tifying potential signs of abuse, which may include patients who*:

O Claim multiple pain medication allergies;

O Visit multiple physicians for controlled prescriptions;

O Hoard medications;

O Make frequent calls to clinics;

O Use controlled substances for non-pain relief (e.g., to enhance mood, sleep);

O Make frequent unscheduled clinic visits for early refills;

O Display consistently disruptive behavior upon arrival to clinic;

O Obtain medications for family members;

O Pattern of lost or stolen prescriptions;

O Display anger or irritability when questioned closely about pain;

O Are unwilling to consider other medications or non-pharmacologic treatments;

O Request frequent dosage escalation after being told this is inappropriate;

O Inject oral formulations;

O Forge prescriptions;

O Are unwilling to sign a prescription agreement;

O Sell their medications;

O Maintain aliases;

O Refuse recommended lab tests;

O Demonstrate more concern about the medication, than the medical problem;

O Illicitly buying or obtaining medications;

O Targeting a specific provider; and

O Deterioration of function due to prescription medication

At the Bucks County Drug & Alcohol Commission, Inc. (BCDAC), it is our mission to promote healthy individuals, families and communities, eliminate the misuse, abuse and/or addiction to alcohol, tobacco and other drugs and support those in recovery from addiction. As the state and locally designated lead agency for alcohol, tobacco and other drugs, our agency will ensure the provision of a comprehensive and balanced continuum of quality prevention, intervention, treatment and recovery ser-vices for Bucks County. We stand ready to provide education, resources and support to the medical community as we address the overdose epidemic. Some of the opportu-nities include:

MEDICATION DISPOSAL There are 31 permanent medication

disposal sites located throughout Bucks County. Disposal is free and anonymous. In addition, twice each year a Medication Take Back is offered.

Opportunity: The “Got Drugs” flyer notes the locations of permanent boxes. Posting this flyer in the office, or providing a link on your website, would help to educate consumers.

RESOURCES FOR RESIDENTS One barrier for not seeking treatment

for substance use disorders is not knowing where to turn for help. The use of Methadone, Suboxone, Vivitrol, etc., when used in conjunction with licensed substance abuse treatment, can be effective. Various providers throughout Bucks County offer these medications within their facilities.

Opportunity: The “Where To Turn For Help With Drug And Alcohol Issues in Bucks County” flyer provides information on how to access private insurance, county funding, Medical Assistance, Veterans Benefits, etc. This flyer can be posted in the office, as well as on your website.

SCREENING, BRIEF INTERVENTION & REFERRAL TO TREATMENT (SBIRT)

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problem-atic use, abuse, and dependence on alcohol and illicit drugs. This brief sur-vey can be completed within minutes in the medical practice by healthcare professionals, and provides referral resources when indicated.

Opportunity: BCDAC, Inc. provides funding of SBIRT for Bucks County healthcare professionals. Training is available at your medical practice upon request, and is provided at no cost.

RECOVERY SUPPORTS Various services are available for

residents in recovery from substance use disorders.

Opportunity: Bucks County recovery resources include Recovery Housing, Peer Sup-port, Recovery Centers, Volunteerism, Advocacy and Mutual Aid Groups.


Continued on page 8

* Training for HealthCare Professionals, OverdoseFreePa, Physician Training


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PREVENTION CAMPAIGN PA Stop is designed to educate

Pennsylvanians about the risks of prescription painkiller and heroin use, the relationship between painkiller and heroin use, and how to get help. The goal is to prevent non-medical use of prescription painkillers and, in so doing, to break the connection between heroin and prescription painkillers. The website, and its content, will provide increased aware-ness, education and information on how to seek help.

Opportunity: Post flyers about PA Stop, and add the logo to your website, patient receipts, forms, waiting area materials, etc.

PRESCRIPTION DRUG MONITORING

A new database will be developed that will give Pennsylvania physicians access to a statewide controlled substances database, giving them better knowledge of prescriptions written for and filled by a patient.

Opportunity: Once launched, this database will increase quality of patient care by helping doctors better understand a patient's controlled substance prescription history, give patients thorough access to their own controlled substance prescription information, and assist regulatory and law enforcement agencies in their efforts to stem the surge of drug abuse and misuse in Pennsylvania.

We recognize that there is no single solution to the epidemic. Instead, we offer a multi-pronged approach that requires collaboration with all systems, including healthcare, law enforcement, education, clergy, community members, prevention and treatment providers, and people in recovery, to name a few. At the Bucks County Drug & Alcohol Commission, Inc., we stand ready to work with healthcare professionals to provide


education, support and resources so that, together, we may reduce the prescription medication and heroin epidemic. Please do not hesitate to contact our office, at (215) 444-2703, if you have any questions or would like to hear more about our services.

Bucks County Drug & Alcohol Commission, Inc.

600 Louis Dr., Suite 102A , Warminster, PA 18974

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Aldie Counseling Center11 Welden Dr., Doylestown, PA 18901(215) 345.8530 www.aldie.orgWalk-in hours: M–F 7:30am–2:00pm

*Evening assessments available on Mondays by appointment only.

Aldie Counseling Center2291 Cabot Blvd., West Langhorne, PA 19047(215) 642.3230 www.aldie.orgWalk-in hours: M–F 8:00am–2:00pm

TODAY, a Pyramid Company1990 Woodbourne Rd., Langhorne, PA 19047(215) 968.4713 www.todayinc.org

*Call for an appointment

DUI

For court ordered Driving Under the Influence (DUI) classes, assessment and treatment services.

Council of Southeast Pennsylvania, Inc. http://www.councilsepa.orgDUI Central & Upper Bucks County

Livengrin Foundation, Inc.http://www.livengrin.orgDUI Lower Bucks County

FAMILY SUPPORTS

Free Family Education Programs are available to help family members of individuals with an active addiction—call 1-800-221-6333 Mon-day-Friday 9am–5pm for locations and times.

RECOVERY CENTERS & INTENSIVE CASE MANAGEMENT SERVICES

For more information about Community Recov-ery Centers, Intensive Case Management and Recovery Coaches, go to the following website: www.proact.org or call 1-800-221-6333 Monday–Friday 9am–5pm. They can also give you information about local mutual aid support groups including AA and NA, Alanon, etc.

RECOVERY HOUSES

Recovery Houses are available throughout Bucks County. Recovery Houses provide a safe living environment for individuals seeking recovery and support. For more information, go to the following website: http://www.bucksrecoveryhouses.com

For more information about the full array of services available in Bucks County, go to the website: www.bucks.pa.networkofcare.org

If you have a complaint about assessment or treatment services you receive, please call:Bucks County Drug & Alcohol Commission, Inc.(215) [email protected]

Penn Foundation – The Recovery Center807 Lawn Ave., Sellersville, PA 18960(215) 257.9999 or 1.800.245.7366www.pennfoundation.orgWalk-in hours: M–F 8:30am–2:30pm

*Phone intake preferred prior to assessment

TODAY, a Pyramid Company1230 Veteran’s Hwy., Suite F-1,Bristol, PA 19007(215) 244.7607 www.todayinc.orgWalk-in hours: M–F 8:30am–3:00pm

Gaudenzia Lower Bucks501 Bath Rd., Bristol, PA 19007(on the grounds of Lower Bucks Hospital)(267) 405.6530 www.gaudenzia.org

*Walk-in and appointments available

WHERE TO TURN FOR HELP WITH DRUG & ALCOHOL ISSUES

In Bucks County

This informational sheet will help you or your family member access treatment for a drug and/or alcohol problem, as well as give some other resource information. The first step in accessing

treatment is for the individual to get a professional assessment to determine the extent of the problem and the type of treatment and recovery plan needed. Adult and adolescent services are available throughout Bucks County. For more information, please call our Approval of Care Depart-ment at (215) 773-9643.

To access treatment for those who have private health insurance, call the number on the back of the insurance card listed under Mental Health/Substance Abuse.

To access treatment for those with Medical Assistance, call Magellan Health Services at (877) 769-9784 and they will give information as to the nearest treatment agency for an assessment.

To access information regarding Veteran’s Benefits, call (877) 222-8387 to find out eligibility for services. Individuals who are Veterans are eligible for county funding.

For individuals with no insurance, there may be County funded treatment available as well as other supportive services. The individual must go to one of the assessment sites listed below, either as a walk in or calling for an appointment. The individual will need to bring certain documents to the assessment, including proof of Bucks County residency, and other documents to complete a Medical Assistance application. Due to limited funding, County funding for residential treatment is budgeted on a monthly basis, which limits the number of individuals who can be admitted into that level of care each month. However, other treatment alternatives, such as outpatient treatment, are available. Pregnant and/or injection drug users and those being referred by an emergency room following an overdose are given preference for funding.

The following is a listing of Assessment sites as well as other resources.

ASSESSMENT SITES

Compiled by Diane W. Rosati, MA


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Almost one third of privately insured Americans have received a “surprise” medical bill—in which they receive

a bill for a medical service they believed was covered by insurance—within the past two years. That’s according to a survey released by the Consumer Reports National Research Center. This occurs when, for example, a patient goes to the hospital for surgery, and though the hospital and surgeon are in-network, unbeknownst to the patient, the radiologist, anesthesiologist, and/or other specialists are not.

A public hearing, held in Harrisburg on Oct. 1 and led by Pennsylvania Insurance Commissioner Teresa Miller, addressed the growing concerns raised by patients and providers regarding the surprise medical bill. These bills can represent a significant financial burden to patients. One consumer group that testified at the hearing said that, in some extreme cases, they heard of bills being $6,000, $10,000, and even $35,000.

“Physicians are the last ones who would ever want to see harm come to a patient in any way, medically or financially,” said Brad Klein, MD, MBA, a Willow Grove neurologist, who testified at the hearing on behalf of the Pennsylvania Medical Society (PAMED).

Dr. Klein has firsthand experience with being an out-of-network provider. It’s not uncommon for him to accept an emergency call at 3 a.m. to help a patient in a time of need. Out-of-network billing is generally the result of a last resort or a situation outside of a physician’s control.

“We should not put the burden on the patient to decide if they will accept a

PAMED Updates

provider’s care at a time when they are suf-fering from mental or physical ailments and truly may not have a choice as that provider is the only one available in that community to assist that patient at that time,” he said.

Dr. Klein highlighted several issues that affect Pennsylvania physicians, including:

• Narrow Networks – Dr. Klein noted that, in this era of narrow networks, some solo practitioners are excluded from network participation. Narrow networks also may drive more patients to use out-of-network services.

• Health insurer consolidation leading to the exercise of market power by insurers in the purchasing of physician services – This is what is known as “monopsony,” the ability to reduce and maintain input prices below competitive levels. It can reduce the quality and quantity of health care below competitive levels and, in turn, harm consumers.

Physicians practicing in Pennsylvania are left with some hard choices, according to Dr. Klein. Should they leave the state to practice elsewhere, change careers, retire early, or seek employment by a larger system and hope for higher rates? PAMED is committed to helping physicians stay in Pennsylvania.

The hearing revealed the desire for collab-oration amongst the stakeholders involved. Other groups at the hearing included the Hospital and Healthsystem Association of Pennsylvania (HAP) and consumer advocacy groups like the Consumer’s Union, the policy division of Consumer Reports.

Balance billing is a complex problem affecting providers, patients, and insurers. The solution will require cooperation and coordination.

“PAMED stands ready to work with the Insurance Department and other stake-holders to find a solution that protects consumers and treats providers and insurers fairly,” said Dr. Klein.

“Physicians are the last ones who would ever want to see harm come to a patient in any way, medically or financially.”

This is not good news for patients who receive a surprise bill in their mailbox or for the physicians who want to provide the best care possible and maintain a good physician-patient relationship.

Surprise Medical Billing in Pennsylvania:What’s Being Done to Fix the Problem?

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Turning the tide on Pennsylvania’s opioid crisis will take a team effort. That includes constant communication and collaboration from various members of the health care

team—from physicians to nurse practitioners to pharmacists.

Patients also have to be willing to do their part.

One way for physicians to hold their patients accountable is through narcotic contracts, said numerous prescribers who par-ticipated in the online educational series Addressing Pennsylvania’s Opioid Crisis: What Health Care Teams Need to Know. You can learn more about this program at www.pamedsoc.org/opioidresources.

“This allows the patient to be equally as responsible,” said Cynthia Ferrari, PA-C, a physician assistant from outside Philadelphia. “I think as doctors, PAs, nurse practitioners, we’re trying to make it better so patients have a better quality life and can take care of themselves and live independently. But we know now, especially looking at studies, that there’s a limit to where we find (opioids) beneficial and beyond that it’s not really benefiting the patient. If anything, we’re harming the patient.”

Unfortunately, most patients do not realize the risks and limitations. They need education, and that’s another goal for any narcotic contract.

“It’s very important that you set limits with people and that you not make it easy for them to become addicted,” said John Goldman, MD, vice president of inpatient medicine at Pinnacle Health in

PAMED Updates

Combatting Pennsylvania’s Opioid Crisis:

Harrisburg. “You need to make sure you’re the only one giving them meds, so you know how much they’re being given.”

What should be included in patient contracts? Dr. Goldman recommends adding the following items:

Patients should only receive opioid medications from their primary care prescriber. That means they are for-bidden to seek refills from the emergency department or an urgent care center.

Patients agree to a regular but random urine drug screening. This ensures they take the proper doses of their medication, are not diverting or selling them, and aren’t taking other illegal substances.

Patients need to see their primary care provider on a reg-ular basis in order to get refills. They should not simply call to order refills.

Tools For PrescribersThe Pennsylvania Medical Society’s Opioid Prescription

Guidelines checklist is a tool designed to help physicians and other prescribers discuss pain management with their patients and educate them how to comply.

The Pennsylvania Medical Society, in collaboration with the Penn-sylvania Department of Health and other health care associations, is creating a multi-part online educational series for prescribers. Part 1 of Addressing Pennsylvania’s Opioid Crisis: What Health Care Teams Need to Know teaches prescribers how to effectively use the new voluntary state opioid prescribing guidelines, and is now available at www.pamedsoc.org/opioidresources.

“You need to make sure you’re the only one

giving them meds, so you know how much they’re being given.”

Tips For Patient Contracts


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The Pennsylvania Department of Human Services (DHS) announced

that it will impose additional require-ments in 2016 on its Physical Health Managed Care Organizations (PH-MCOs) related to credentialing timeframes.

The plans will be required to meet the following standards for timeliness of processing new provider applica-tions for credentialing:

• The PH-MCO must begin its creden-tialing process upon receipt of a provider’s application if the application contains all required information.

• The PH-MCO may not delay processing the application if the provider does not have DHS-issued Medical Assis-tance identification (MAID) number. However, the PH-MCO cannot com-plete its process until the provider has received its MAID from DHS.

• Provider applications submitted to the PH-MCO for credentialing must be completed within 60 days of receipt of the application packet if the infor-mation is complete.

DHS is interested in hearing from stakeholders who may have suggestions

The Commonwealth Announces Efforts to Address Length of Credentialing Process for Medicaid Providers

to streamline the process. Please feel free to forward your comments and suggestions to [email protected].

The Pennsylvania Medical Society (PAMED) continues to work to improve this process for Pennsylvania physi-cians. In addition to being actively engaged with DHS, PAMED is also supporting a bill that is expected to be introduced this fall that would streamline the physician credentialing process and make it more uniform across all insurers in Pennsylvania.

PAMED Updates

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BCMS Board Profiles

Joanne Brenneman Speigle, M.D.

Q: Favorite part of practicing medicine?

A: As a radiologist, I enjoy the challenge of exploring the history, signs and symptoms of a person’s health in conjunction with interpreting all imaging studies, in order to assist in their diagnosis and eventual care.

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

A: I practice radiology at Doylestown Hospital, the Pavilion and the Health and Wellness Center, all part of Doylestown Health Partners. I grew up in Doylestown, 2 miles from the current hospital. My father, Paul Brenneman, M.D., was a general practitioner in Doylestown. After 5 years in private practice in Richmond, Virginia I decided to return to my home town.

Q: Are you or any family members actively involved in any community, non-profit or professional organizations?

A: I have been actively involved with the Hospice Auction at the hospital for the past 14 years. My sister, Beth Styer, just retired as director of Child Home and Community in Doylestown for the past 20 years.

Q: Hobbies & interests when not working?A: In my spare time I enjoy reading, bicycling, water and snow skiing.

Q: What’s your vision for a better healthcare delivery system? A: I think everyone has a right to adequate healthcare,

however, the details of implementing that are clearly more difficult than we imagined! My hope is that we continue to work at making it affordable for all.

Karl W. Helmold, M.D.

Q: Favorite part of practicing medicine?

A: As an orthopaedic surgeon, I derive great satisfaction from being able to improve the quality of a patient’s life. Often this improvement can occur in a marked way over a short period of time.

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

A: I practice in lower Bucks County. Our family moved to Bucks County for the quality of life and educational opportunities for our children.

Q: Are you or any family members actively involved in any community, non-profit or professional organizations?

A: My son is a member of Alpha Phi Omega, a national service organization founded on the principles of Leadership, Friendship and Service. He has also been involved with the freshman orientation program at his university.

Q: Hobbies & interests when not working?A: In my spare time I enjoy working on automobiles,

home improvements and reading .

Q: What’s your vision for a better healthcare delivery system? A: I believe that a system that encourages personal

responsibility and informed decision making is optimal.

Meet Your Board!In each issue of Bucks County Physician we invite you to get to know a few of the members on the board of the Bucks County Medical Society.


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Traveling through scenic Bucks Coun-ty, with its plentiful farmlands and historic homes, it is easy to forget

that domestic violence can exist here as easily as anywhere else. Nationally, 1 in 3 women and 1 in 4 men are affected by domestic violence during their lifetimes. A Woman’s Place (AWP) is Bucks County’s only domestic violence service and preven-tion organization. Founded in 1976, AWP has helped countless victims of domestic violence and their children such as Jessica, whose personal experience reflects the diverse

Health & Wellness

ways that AWP is empowering people so they can flourish.

Jessica’s story starts out at what should have been a joyous and exciting time in her life. She was engaged, expecting a child, and working a steady job. On the outside, the pieces of her private and professional life seemed intact. In the course of one short week, however, her sense of security was shattered. Her fiancé spiraled into dangerous and unpredictable behavior that led her to end the relationship.

A Woman’s Place:

To donate, volunteer, or learn more about

AWP, please visit www.awomansplace.org.

The AWP Hotline (800.220.8116)

is available 24-hours a day for victims & community

members alike.

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Seek help. I know the feeling

of hopelessness and despair but there IS a light at the end of

the tunnel. It doesn’t happen overnight,

but fight for the life you deserve!

A Woman’s Place can help you.

Unfortunately for Jessica, the end of the relationship was just the beginning of a new nightmare. She found herself dealing with ongoing threatening phone calls, emails, and texts from her previous partner. “The [months] that followed were worse,” Jessica said. “His threats escalated to stalking. I found myself coming to terms that I was now a victim of domestic violence.”

Jessica’s ex-partner filed multiple petitions for custody. “I felt hopeless and desperate at the thought of not being able to protect my infant son from this man,” Jessica said. It was during her struggle to rebuild her home life and career—which both began to crumble beneath the controlling weight of her former partner’s abusive behavior—that she turned to AWP for guidance and support.

While Jessica’s ex was briefly incarcerated for unrelated charges, she diligently worked with legal advocates from AWP, stayed at the safe shelter, and formed healthy, supportive relationships with staff and volunteers. One of AWP’s strengths is its ability to coordi-nate a team of compassionate and qualified people with different areas of expertise to meet an individual client’s needs. Through AWP’s Safe Options Project counseling and advocacy services, clients like Jessica gain knowledge and skills that lead to safer and healthier living.

Jessica speaks gratefully about specific advocates and their ongoing dedication, remarking that “Since the stalker continues, to this day, to write letters from prison, AWP’s legal team members are still protect-ing me and working hard so that I can live a normal life again.”

AWP: Empowering Others to Thrive

AWP assists clients throughout the sepa-ration process and recognizes that recovery is ongoing. More importantly, AWP empha-sizes that recovery must come from within, and in order for clients to heal, they must feel empowered.

The Empowerment Project at AWP works to help clients and members of the local community develop and build self-confidence through various small group workshops. Each of the 12 focus areas within this project aims to instill skills, courage, and strength in those who attend, as well as provide a bridge back into the outside world for victims of domestic violence.

Looking toward the future, AWP also strives to break the cycle of domestic violence through its Prevention Project by helping individuals, families, and organizations understand the issue and how they can be part of the solution. Community knowledge is strengthened through events, workshops, and trainings. Old attitudes, beliefs, and behaviors that allow violence to continue are gradually replaced with ones that promote safety, justice, and equality instead.

As someone who knows firsthand how it feels to escape a violent relationship and struggle to return to a normal, fulfilling life, Jessica offers this advice: “For anyone reading who may be going through any form of domestic violence I’d like to give you a message. Seek help. I know the feeling of hopelessness and despair but there IS a light at the end of the tunnel. It doesn’t happen overnight, but fight for the life you deserve! A Woman’s Place can help you.”


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In 2012 alone there were more than 3,600 publications in PubMed on vitamin D. By the time this is in print, several other

articles will undoubtedly be published. (I just received one yesterday titled Cognitive Decline in Older Adults and Lower Levels of Vitamin D.) What do we know and what do we think we know about vitamin D?

Vitamin D is a fat-soluble vitamin. Or is it? It’s actually a steroid hormone precursor involved in multiple organs at all ages. It’s naturally present in some foods (beef liver, fatty fish, egg yolks, fortified milk, and cod liver oil) and available as a supplement. It’s produced in the body when ultraviolet rays from sunlight hit the skin and trigger vitamin D synthesis. In healthy, non-obese people wearing t-shirts and shorts, ten minutes of sunlight during hours of 10 a.m. and 3 p.m. will yield 3,000 International Units (IU) of vitamin D. Because exposure to sunlight is a risk for skin cancers, use a sunscreen after that initial 10 minutes and discuss sun exposure with your physician.

Vitamin D promotes calcium absorption in the gut and maintains adequate serum

calcium and phosphate concentrations to enable mineralization of bone. It’s needed for bone growth and remodeling. Many feel that vitamin D also helps with cell growth, neuromuscular and immune function, and reduction of inflammation, to name a few. We’ll look at some of the research data about this later. The issue is to find truly randomized controlled trials (RCTs), studies to demonstrate cause and effect with vitamin D. There are lots of associations of low vitamin D and medical problems, but is low vitamin D the cause or something that occurred from a disease or condition secondarily? We also must be mindful of what results we are looking at. Is it, for example, primarily mortality rates, less muscle aches, or risk for certain diseases? Some causes or associations of low vitamin D are felt to be:

O HIV drugs, anticonvulsants, ketoconazole, mineral oil, orlistat, cholestryramine, colestipol;

O Nephrotic syndrome;

The ABCs of Vitamin DWhy Is It So Important & How Much Do You Really Need?

Alan S. Peterson, MD

Health & Wellness

WINTER 2015

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Continued on page 18

O Granuloma-forming disorders, lymphomas, primary hyperparathyroidism;

O Bariatric surgery;

O Fat malabsorption syndromes, like celiac disease;

O Obesity;

O Inadequate exposure to sunlight, including dark skin

Let’s look at what the Mayo Clinic feels is strong evidence (Grade A), after tests in humans and other animals, of increased need for vitamin D. The list includes:

O Familial phosphate deficiency—A rare inherited condition;

O Kidney disease with low phosphate levels—Fanconi syndrome is an example;

O Osteomalacia (bone softening in adults)—Can be found in elderly with poor diets or with poor absorption without sun exposure, some gut surgery, chronic liver or renal disease, or aluminum intake;

O Psoriasis;

O Rickets (bone weakening in children)—Such as babies only fed milk without vitamin D supplementation;

O Thyroid conditions causing low calcium levels—Such as after parathyroid surgery or overactive parathyroid glands;

O Vitamin D deficiency—Associated with many conditions like bone loss, kidney disease, lung disorders, stomach and intestinal problems, and heart disease. Vitamin D supplementation has

been found to help prevent or treat vitamin D deficiency.

And those conditions that the Mayo Clinic feels there is strong evidence against (Grade F) vitamin D use are shown below. They point out further high quality research is needed for these:

O Atopic eczema;

O Cancer treatment (prostate);

O Heart disease—Although recognized for heart health, research isn’t consistent and some negative effects of vitamin D on heart health have also been found;

O High cholesterol—Results have been inconsistent.

The ABCs of Vitamin D


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What about the 49 other conditions in between Grade A and F in their list? They range between B (“Good” scientific evidence) and D (“Fair” evidence) against this use. Many of us fit into those areas.

SCREENINGWhat might we do? We can get a

25-hydroxyvitamin D (25-(OH)D) blood level drawn. The United States Preventative Health Task Force recently said there is insufficient evidence to assess the benefits and harms of screening for vitamin D deficiency in healthy individuals. Maybe future research will change that.

The answers to the questions of who needs screening for vitamin D deficiency and then treatment, and how much of the supplement they will need will have to await further RCTs. Generally, older and sicker adults are more likely to have inadequate vitamin D levels. An article in the Mayo Clinic Proceedings suggested the following groups might be tested:

O Dark skin, those with osteoporosis or previous fracture;

O Certain lab abnormalities (low urine calcium, low serum calcium, low serum phosphorus, elevated alkaline phosphatase, elevated parathyroid hormone);

O Chronic kidney disease, renal insufficiency or nephrotic syndrome;

O Chronic musculoskeletal pain or weakness;

O Malnutrition/poor oral intake;

O Malabsorption syndromes, celiac disease, inflammatory bowel disease;

O Liver disease, liver failure.

What are the harms of getting screened? Of course, expense is a big one. The test for a 25 (OH)D is over $100.00 and, of course, may prompt other tests. Then there is the

interpretation of the test level in that indi-vidual. As discussed previously, if one has a condition with few or no RCTs supporting supplementation, it is open to interpreta-tion between the health provider and the individual. Of course, that interpretation may change with the next RCT.

Luckily too much vitamin D is hard to get, but if you are someone with past kidney stones, vitamin D can potentially increase your risk. The Institute of Medicine (IOM) suggests excessive amounts of vitamin D might possibly also increase the risk for pancreatic or prostate cancer. These studies weren’t RCTs. One study in The Journal of the American Medical Association found women receiving a single dose of 500,000 IU once a year resulted in vitamin D levels over 40 ng/mL (100 nmol/L) and a higher risk of fractures.

True vitamin D toxicity in a healthy person usually occurs only if someone is on 40,000 IU daily for more than three months with blood levels over 150 ng/mL. Obviously significant levels in serum calcium can occur from being on too much vitamin D. Calcium can deposit in soft tissue such as the heart and lungs. (This toxicity is different from the calcium in arteries from coronary artery disease.) Confusion and disorientation, damage to kidneys, nausea, vomiting, constipation, poor appetite, weakness and weight loss can be found with the high blood calcium associated with very high levels of vitamin D.

BLOOD LEVELSThese are described either as nanograms

per milliliter (ng/mL) or nanomoles per liter (nmol/L), where 0.4 ng/mL = 1 nmol/L.

Health & Wellness

The IOM states we should keep 25 (OH) D levels below 50 ng/mL. Most feel that levels below 30 ng/mL are too low for maximum bone health and other organ functions. Optimum levels of serum 25 (OH) D, how-ever, are controversial. The IOM supports concentrations above 20 ng/mL (50 nmol/L) but not chronically exceeding 50 ng/mL (125 nmol/L) for skeletal health. I favor 30-40 ng/mL (75-100 nmol/L)—which is supported by The American Geriatrics Society, National Osteoporosis Foundation, Endocrine Society, and the International Osteoporosis Foundation—to decrease risk of falls and fractures.

There are no optimal levels of vitamin D established for conditions outside of the skeleton. Let’s look at some of the possible reasons for vitamin D supplementation for those conditions, keeping in mind that there are no prospective RCT studies to define recommended levels.

MUSCLE WEAKNESS — Some observational studies suggest an association with low vitamin D levels and muscle weakness. Causal relationships have not been proven.

FALLS — There are some meta-analyses showing a reduction in falls in the elderly following vitamin D supplements of 700 to 1000 units/day.

CANCER — There have not been enough studies to support large dose supplementation to prevent cancer or treat it.

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IMMUNITY — Although vitamin D has major effects on most immune systems, a link of low vitamin D and autoimmune diseases is unclear at this time.

CARDIOVASCULAR, INCLUDING HYPERTENSION— Most randomized studies have not shown a benefit.

DIABETES — Vitamin D levels are lower in the obese and in diabetics, but again, we don’t know if this is causal. Studies are underway.

NEUROPSYCHIATRIC — There have been few trials on these symptoms. Causal relationships between low vitamin D and brain dysfunction remain uncertain.

PREGNANCY — Once again randomized intervention trials in pregnancy have been few and data poor to prove protection in birth outcomes.

MORTALITY — Some studies, but not all, show those with low vitamin D levels have higher mortality, but RCTs with mortality as a primary end point are lacking.

As one can see, much more research to prove low vitamin D levels cause specific conditions or diseases is needed. Associations of low vitamin D could be a manifestation of general “poor” health due to many chronic problems. Rather than screen low risk patients, some medical groups weakly recommend an intake of 800 IU daily. This should be determined by you and your phy-sician. High risk patients should be screened and supplemented to adequate levels.

The ABCs of Vitamin D

Physicians generally prefer cholecalciferol (vitamin D3) over ergocalciferol (vitamin D2). Vitamin D3 is found in fish oil, eggs, animal fat, and cod liver oil, and is equivalent to the vitamin D3 formed in our skin from ultraviolet B rays. Vitamin D2 is from plants, and found in fortified foods and some supplements. This is felt to be less biologically active than vitamin D3. Also, at higher doses, vitamin D2 has greater potential for harm than D3 due to formation of toxic metabolites.

Three to four months after starting a vitamin D supplement, a 25 (OH) D blood level is suggested. As is the recom-mendation for most of us, try to maintain a healthy lifestyle by eating plenty of fruits, vegetables, and nuts; exercising regularly; and not smoking.


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Planning Ahead

Lisa Dombrowski (CLTC)

Spotlight on…Assisted Living / Residential Care

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When older individuals can no longer live independently but do not require 24-hour-a-day skilled

health care, the solution is often assisted living/residential care. Such a facility will fulfill the need for daily assistance with activities of daily life. These include bathing, dressing, eating, transferring, and toileting. The services provided, plus the security of living with others in a supervised setting, offer a viable alternative to in-home care for thousands of older Americans.

An assisted living residence is designed to meet personal needs, housing needs, and health care needs, when necessary. Accom-modations vary from single and double rooms to kitchen-equipped apartments. The residence may be part of a retirement community, nursing home, or elderly hous-ing facility, or it may be an independent building on its own campus.

Types of ServicesAssisted living/residential care services typically include the following:

• Prepared meals• Assistance with daily

living activities • Assistance with medications• Housekeeping• Laundry• Transportation• Shopping• Social activities

Choosing a Residence Each assisted living facility/residential

care facility offers its own unique services and atmosphere. If there are many choices in your area, visit several before making a choice. Ask the following questions:

What types of services are available? Do employees or independent contractors provide these services?

How much input do residents have in their daily schedules and care?

What range of accommoda-tions is offered?

What’s included in the cost? What extra services can be added?

Can residents bring furniture or other personal items from home?

What kinds of social and recre-ational activities are offered?

Does the facility provide other levels of care or would a move to another facility be required if additional care was later required?

The facility’s licensing status, safety, and environment is also critically important. Consider the following steps:

• Ask to see the most recent licensing inspection report from the state.

• Examine the physical aspects of the facility including cleanliness, lighting, accessibility, and mod-ifications, such as hand rails and grab bars.

• Ask about features or systems used for residents to get help quickly or in an emergency situation.

• Observe the staff. Are they respectful and friendly? Do they seem to enjoy their work and care about the residents? What are their qualifications?

• Talk with current residents about daily life at the facility.

Cost ConsiderationsThe yearly costs of assisted living/residen-

tial care facilities in the U.S. average $42,000 in 2015. However, cost can vary tremen-dously based on location, accommodations, and selected services. Some residents self-pay, using personal savings. Those who qualify for Medicaid may be eligible for financial assistance if the state has been approved for a home and community-based waiver.

With limited public assistance available, long-term care insurance has become a viable funding option. Many policies cover assisted living/residential care facilities, but it is important to review your policy to determine specific coverage. To learn more, visit the National Center for Assisted Living at www.ncal.org.

Assisted Living /Residential Care


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Platelet rich plasma (PRP) is an excit-ing new addition to conservative treatment for many musculoskeletal

maladies. The application of this treatment has been increasing and is most visible in the media for sports medicine. Many professional and non-professional athletes are using this treatment method to recover from various injuries. To obtain the PRP, a patient’s blood is taken in the office and separated via centrifuge into layers in order to extract a platelet concentrate. This concen-trate is then injected into the painful and/or pathological region of the musculoskeletal system. The entire office visit typically lasts about 30-45 minutes from the blood draw to the injection. It can take 1-3 injections to achieve the desired effect in most cases. PRP’s regenerative properties lie in its contents.

The proposed mechanism by which PRP works is via the activation of multiple growth factors contained in the platelet concentrate, as well as other molecules that allow for regeneration of bone, cartilage and tendon.1 There are many basic experimental studies that have determined its ability to regener-ate these tissues and there are an increasing amount of studies looking at its clinical utility. At this point, there have been enough clinical studies for certain ailments, such as lateral epicondylitis (tennis elbow)2 and knee osteoarthritis3, to formulate an opinion on its benefits for treatment, mainly for the pain of these conditions. PRP is now being used for many other similar acute and chronic painful conditions including shoulder, hip, neck and back pain. The aforementioned studies also show a good safety profile for this treatment.

Safety is always an issue when doctors and patients are considering a treatment plan. Balancing a treatment’s side effects with their potential benefits is often difficult and many of my patients want me to decide for them how to proceed; “You’re the doctor,” they often say. The decision is not always as simple as this, but given the paucity of reported side effects of PRP, this decision is much easier. Injection site discomfort is the most commonly reported adverse event reported. Since the platelets are derived from a patient’s own blood (autologous), there is no chance of rejection. In fact, there seem to be relatively few downsides, but it does require some “down-time.”

The period of relative rest following this procedure is usually between 2–4 weeks, followed by return to gentle stretching and strengthening and activity. Compared to surgery, however, this is a relatively short period of rest, and does not typically require pain medication after injection. Anti-inflammatories must be held during the 2–4 week rest period. After the first 4–8 weeks or so, the results of the PRP become more noticeable.

PRP is currently not covered by insur-ance companies, but as evidence for its use continues to grow, it will be hard for them to ignore its utility in treating mus-culoskeletal conditions. At Bucks County Orthopedic Specialists we are currently using PRP for many different problems including spine, tendon, muscle and cartilage (arthritis), and are seeing success in healing injuries that were previously unresponsive to other treatments.

Regenerative Treatmentfor Musculoskeletal Injuries

1. Platelet-Rich Plasma for Foot and Ankle Pathologies: A Systematic Review

F. Vannini, B. Di Matteo, G. Filardo, E. Kon, M. Marcacci, and S. Giannini

Foot and Ankle Surgery, 2014-03-01, Volume 20, Issue 1, Pages 2–9

2. The Effect of Platelet-Rich Plasma on Clinical Outcomes in Lateral Epicondylitis

Zafar Ahmad, Roger Brooks, Sertaz-Niel Kang, Holly Weaver, Ian Nunney, Graham Tytherleigh-Strong, and Neil Rushton

Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2013-11-01, Volume 29, Issue 11, Pages 1851–1862

3. Comparative Effectiveness of Platelet-Rich Plasma Injections for Treating Knee Joint Cartilage Degenerative Pathology: A Systematic Review and Meta-Analysis

Ke-Vin Chang, Chen-Yu Hung, Fanny Aliwarga, Tyng-Guey Wang, Der-Sheng Han, and Wen-Shiang Chen

Archives of Physical Medicine and Rehabilitation, 2014-03-01, Volume 95, Issue 3, Pages 562–575

FEATURE

Sean P. Butler, D.O.Regenerative Therapy Specialist, Interventional Spine, Electrodiagnosis, Sports MedicineBucks County Orthopedic Specialists


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Being cared for at home may be an ideal situation for many seniors who need assistance with the activities of

daily living (ADLs). To remain in a familiar environment, surrounded by the comforts of home, may provide psychological benefits that aid healing and promote longevity.

The demand for home health aides is growing dramatically as the population ages. Not surprisingly, so is the number of agencies supplying personnel. Now, more than ever, it is critical to compare the services of competing agencies, as well as evaluate the cost and quality of the care they provide.

Conduct a Smart Search

Here are a few ideas that can help you find the best fit when choosing a home health care agency:

Ask for an Evaluation. Many agencies will provide you with a

professional evaluation to help determine exactly what type of care is needed and for

how many hours a day or week. The best evaluations are conducted in person and at home, where the agency can evaluate the patient and his or her home environment, which is difficult to do over the phone.

Obtain a Written Plan. The evaluation should lead to a detailed

plan of action and job description. Use this document to compare agencies and assess the performance of the agency you select.

Look for Certification.The premier agencies hire only Certified

Home Health Aides who have had expe-rience working with older clients. The agency should also be able to verify that aides are up to date with vaccinations and are in good health, do not have criminal records, and comply with labor and immi-gration laws.

Insist on Case Managers.Look for agencies that employ case man-

agers to supervise their home health aides. These case managers coordinate care, make regular home visits, and maintain contact with you or another family member. They are essential to quality care delivery and open communication.

Identify Back-Up Plans.Find out what contingency plans

your agency has in place when a home health aide gets sick or goes on vacation. Ensure that care will always be available when you need it.

Inquire about “Matchmaking” Techniques.Learn what criteria the agency uses to

match a patient with a caregiver. Do they

consider compatible personalities and shared interests, in addition to scheduling and a patient’s physical and medical needs? Find out what steps they take when the match is wrong and a change of personnel is in order.

Research the Agency’s History and Reputation.

Make sure the agency is an established business that is licensed by the state. You may want to check its reputation with local hospitals, rehab centers, and visiting nurse associations. Ask the agency for at least three references, and be sure to verify each one.

Understand the Cost Structure.Ask for a comprehensive, written rate

schedule. Make sure you understand what expenses are covered, as well as the terms and schedule of payment.

Confirm that the Agency Is the Employer.First, confirm that home health aides are not independent contractors, but employees of the agency. Ensure that the agency pays them in accordance with overtime and minimum wage standards, deducts state and Federal taxes, and is responsible for Social Security and unemployment taxes, as well as workers compensation insurance. If the agency fails to do the above, the aide may be considered your employee, and you may be held responsible down the road.

Give Yourself Enough Time

If you think you or a loved one may need care sometime in the near future, start the search process now. Avoid waiting until the need is critical—when an accident happens or upon discharge from the hospital—before making your first phone calls. By planning ahead, you will have time to carefully con-sider all available options and make the best decision for your needs or those of a loved one.

Assessing aHome Health Care AgencyE. Dombrowski

Planning Ahead

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Health & Wellness

1– 30American Diabetes Month

1– 30COPD Awareness Month

1– 30Diabetic Eye Disease Month

1– 30Lung Cancer Awareness Month

1– 30National Alzheimer’s Disease Awareness Month

1– 30National Family Caregivers Month

1– 30National Stomach Cancer Awareness Month

22International Survivorsof Suicide Day

Health Awareness

NOVEMBER 2015 DECEMBER 2015 JANUARY 2016

DECEMBER 1

1– 31Cervical Health Awareness Month

1– 31National Birth Defects Prevention Month

1– 31National Glaucoma Awareness Month

1– 31Thyroid Awareness Month

1– 31National Folic Acid Awareness Month

JAN. 26 – FEB. 1National Drug Facts Week

7– 13National Influenza Vaccination Week


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Angela Oprendek, CMESProject Manager for Health Recovery & Disease Prevention at the Central Bucks Family YMCA

Diabetes. It’s a diagnosis no health care provider wants to deliver and certainly, no patient wants to

receive. It’s a diagnosis that means major changes in lifestyle to effectively manage. It also means the risk of major, possibly life threatening consequences for those who don’t make the necessary changes. It may mean daily medication for the rest of a patient’s life. Failure to adequately manage diabetes could result in escalating drug dosages, multiple medications and ultimately, the possibility of self-adminis-tered insulin injections. Diabetes can affect many parts of the body and is associated with serious complications, such as heart disease and stroke, blindness, kidney failure, and lower-limb amputation. Diabetes can complicate many other medical conditions, potentially reducing the patient’s quality of life or even shortening their lifespan.

DIABETES – The New Pandemic

Sadly, diabetes is rapidly becoming an epidemic in our society and is well on its way to becoming a world-wide pandemic. Obesity and inactivity are prominent risk factors for type 2 diabetes and both are rampant in our current culture.

According to the CDC’s National Diabetes Statistics Report 1 released in June 2014, based on data from 2012:

• 9.3% of the US population has

diabetes and 27% of those

are yet to be diagnosed

• 25.9% of seniors (age

65+) have diabetes

FEATURE

DODGING

The YMCA of the USA Diabetes Prevention Program at the Central Bucks Family YMCA helps participants avoid diabetes

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• Over 1.7 million people are

newly diagnosed every year

• Diabetes is the 7th leading cause of

death in the US (and that doesn’t

even begin to address the number

of complications and co-morbid

conditions associated with diabetes)

• On a cost basis, the US spent $245

BILLION on diabetes in 2012 ($176

billion for direct medical costs and

$69 billion in reduced productivity)

Diabetes is a terrible disease that affects more and more people every year. Wouldn’t it be great if we could PREVENT people from getting it?

Every health care professional knows that it can be done. A simple screening can be easily performed during a routine exam. In 2012, 86 million Americans age 20 and older were diagnosed with pre-diabetes (up from 79 million in 20102) and it can be reasonably projected that number has continued to increase in subsequent years.

After diagnosing an at-risk patient with pre-diabetes, health care providers know that simple lifestyle modifications to diet and activity level can often reverse the path to diabetes and place that patient on the road to improved quality of life, more energy, better body composition and, best of all, NO DIABETES!

It all sounds so easy, but the lifestyle change prescription is a tough one for most patients. The health care provider can screen, diagnose and recommend exactly what needs to be done, but he or she cannot control implementing the changes outside the examination room. The patient has to do the work and make the changes to reap the benefits.

That’s where the Y comes in. At the Y, we are experts in lifestyle change and in provid-ing the supportive environment to nurture those changes. We will welcome the pre-di-abetic patient to a diverse, non-threatening environment where they can feel comfortable just as they are. We will enroll them in a

one year, group-based program that meets them where they are, makes them part of a nurturing community and supports them as they work through making the changes to their eating and activity habits. We will include a four month membership to the Y so that they have a positive environment in which to exercise. We will also include their family in that membership so that increased activity can become a new family habit. They will become a part of the YMCA of the USA Diabetes Prevention Program at the Central Bucks Family YMCA. They will have all the support we can offer to help them avoid hearing the dreaded diagnosis of diabetes.

ABOUT THE PROGRAM

The YMCA of the USA Diabetes Pre-vention Program is part of the Centers for Disease Control and Prevention-led National Diabetes Program and is nationally support-ed by the Diabetes Prevention and Control Alliance and other national organizations committed to preventing chronic disease. Research by the National Institutes of Health has shown that programs like the YMCA of the USA Diabetes Prevention Program reduce the number of new cases of diabetes by 58% overall and by 71% in individuals over the age of 60.3

Continued on page 29

Dodging Diabetes


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YOU DO NOT HAVE TO DO IT ALONE!Participants gather in a relaxed classroom setting and work together in small groups to learn how to incorporate healthier eating and moderate physical activity into their daily lives.

THE YMCA’S DIABETES PREVENTION PROGRAM IS:

• Led by a trained Lifestyle Coach• A one-year program •16weeklysessions,then •3bi-weeklysessions,then •6monthlysessions

PROGRAM QUALIFICATIONS:• At least 18 years old,• Overweight (BMI ≥25)*, and• At risk for developing type 2 diabetes or• Diagnosed with pre-diabetes†

PROGRAM GOALS:• Reduce body weight by 7%• Increase physical activity to 150 minutes per week

A LOT Can Happen in a Year

You can reduce your risk for type 2 diabetes!

Small Steps,BIG Rewards

The YMCA of the USA’s Diabetes Prevention Program is a community-based lifestyle improvement program for adults with pre-diabetes. Its purpose is to empower adults with lasting lifestyle changes that will improve their overall health and reduce their chance of developing type 2 diabetes.

Currently, diabetes affects nearly 26 million people. Another 79 million have pre-diabetes and are at risk of developing diabetes, but only 11 percent are aware of it.

Research by the National Institutes of Health has shown that programs like the YMCA of the USA’s Diabetes Prevention Program reduce the number of new cases of diabetes by 58% overall and by 71% in individuals over age 60.

† Individuals who have already been diagnosed with either type 1 or type 2 diabetes do not qualify for this program.

*Asian individual(s) BMI ≥22

YMCA MEMBERSHIP NOT REQUIRED.

Toseeifyouqualifyorforinformationabouttheprogram,contact:

ANGELA OPRENDEK(215) 348-8131 x1184

[email protected]

CENTRAL BUCKS FAMILY YMCA,2500 Lower State RoadDoylestown, PA 18901

www.cbfymca.org

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Dodging Diabetes

In a classroom setting, a trained lifestyle coach will facilitate a small group of par-ticipants in learning about healthier eating, physical activity and other behavior changes over a 12 month period, beginning with 16 weekly one-hour sessions followed by 3 bi-weekly and 6 monthly maintenance sessions for added support to help them maintain their progress.

The program fee also includes a four month family membership to the Central Bucks Family YMCA. This provides an opportunity for participants to involve their families and nurture the support system that will help them include regular exercise in their lives.

To qualify, participants must be at least 18 years old, overweight (BMI > 25)* and at high risk for developing type 2 diabetes indicated by a confirmatory blood value†, a clinical diagnosis of Gestational Diabetes (GDM) during previous pregnancy, or a qualifying risk score.

PROGRAM GOALS INCLUDE:

O moderate physical activity

(gradually increasing to

150 minutes per week)

O moderate weight loss

(7% of total bodyweight)

Participants receive a binder where they accumulate the weekly worksheets and handouts from the sessions for future reference. They also maintain a daily food journal and track their activity minutes. This information is turned in and individually reviewed at each meeting.

With participant’s authorization to release information, we will provide the referring physician with periodic updates on their patient’s progress in the program.

The participant enrollment process is ongoing and patients can contact the Y for the most up-to-date schedule.

DOES IT WORK?

It absolutely does!

In the groups that have gone through the program at the Central Bucks Family YMCA alone;

• A majority of participants have

seen significantly reduced blood

sugar levels (Fasting Blood

Glucose or A1C) with some

returning to normal range.

• A majority of participants

have reduced their body

weight by over 7%.

• Over 80% of the participants

lost weight.

• Many have discovered and

continue to attend different

group exercise classes.

• Many participants have reported

that their new lifestyle choices

have inspired their family members

to pursue a healthier lifestyle. In

fact, one family member was

inspired to lose over 30 pounds

after seeing the participant’s

early success in the program.

Health care providers have long been champions of health education and chron-ic disease prevention. In our experience, people are more committed when their doctors recommend that they participate in a lifestyle change program. Now, there is a new, effective tool to use in the battle against pre-diabetes. The YMCA of the USA Diabetes Prevention Program can change the lives of properly motivated participants.

For more information about the YMCA of the USA Diabetes Prevention Program or to request screening and referral materials for your office, please contact Angela Oprendek at (215) 348-8131 x1184 or [email protected].

REFERENCES 1. Centers for Disease Control and Prevention.

National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014

2. Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014

3. Knowler W.C.1, Barrett-Connor E., Fowler S.E., Hamman R.F., Lachin J.M., Walker E.A., Nathan D.M.; Diabetes Prevention Program Research Group. (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine, 346(6):393-403. doi: 10.1056/NEJMoa012512


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Doylestown Hospital Stroke Care

Earn s G old Plu s Award

For the fourth year in a row, the Amer-ican Heart Association/American Stroke Association are recognizing

Doylestown Hospital with the Get With The Guidelines®–Stroke Gold Plus Achievement Award. Doylestown Hospital also qualifies for Target: StrokeSM Honor Roll Elite Plus.

The award signifies Doylestown Hospital’s commitment and success ensuring that stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

Close collaboration with local Emergency Medical Services (EMS) allows the stroke team at Doylestown Hospital to respond to suspected stroke more quickly than ever before.

To receive the Gold Plus Quality Achieve-ment Award, hospitals must achieve 85 percent or higher adherence to all Get With The Guidelines®–Stroke achievement indica-tors for two or more consecutive 12-month periods and achieved 75 percent or higher compliance with five of eight Get With The Guidelines®–Stroke Quality measures.

tissue. We know from almost 20 years of data that the faster we can assess and treat our stroke patients, the better the outcome they will have.

“Our work with EMS and the Emergency Department is an important reason we are receiving this award. It demonstrates our commitment to ensuring patients receive care based on nationally-respected clinical guidelines,” said Kearins. “Doylestown Hospital is dedicated to improving the qual-ity of stroke care and the American Heart Association/American Stroke Association’s Get With The Guidelines®–Stroke helps us achieve that goal.”

Doylestown Hospital has also met specific scientific guidelines as a Primary Stroke Center, featuring a comprehensive system for rapid diagnosis and treatment of stroke patients admitted to the emergency department. Close collaboration with local EMS results in a more efficient system to get suspected stroke patients the care they need more quickly than if the patient comes in on their own.

Health & Wellness

To qualify for the Target: Stroke Honor Roll Elite Plus, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. If given intravenously in the first 4.5 hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability. Doylestown Hospital earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period.

These quality measures are designed to help hospital teams provide the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients.

“We can not emphasize enough that ‘Time is Brain’.” said Brooke Kearins, MSN, CRNP, Director, Stroke Services at Doylestown Hospital. “Every minute counts when it comes to preserving functioning brain

Bucks County Physician Winter 2015

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