Author: Larry Schwingel

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Osteoporosis: a ‘silent disease’ that leads to broken bones

Most people don’t care about statistics until they become one. But approximately 10 million Americans have osteoporosis, and another 44 million have low bone density that increases the risk. The importance of regular bone density testing cannot be underestimated, especially for adults over 50 years of age.

Eighty percent of older adults sustaining a broken bone never had a bone density test (BDT) and subsequently were never treated for osteoporosis. A BDT is the best diagnosis. If one’s T-score is –2.5 or lower, chances are that osteoporosis is present and a plan of treatment needs to be developed.

Osteoporosis is called the “silent disease” simply because it’s impossible to know when bones begin to deteriorate. Over time, they can become so brittle that a simple cough or bumping into furniture causes a break. Bone density tests are a vital part of one’s regular healthcare regime and should be repeated at least every two years.

Women are more susceptible to osteoporosis. One in two women will break a bone in their lifespan, and their incidence of breaking a bone is higher than their risk of a heart attack or a stroke — and it’s equal to the combined risk of getting breast, uterine, or ovarian cancer.

Not only is breaking a bone painful, it’s also very costly. The burden on the healthcare system is nearly $20 billion a year and specialists predict a gloomy future — expecting as many as 3 million fractures by 2025, costing patients, families, and the healthcare system as much as $25.3 billion.

Prevention

Bone tissue is constantly being broken down and replaced, and with age the process does not occur as frequently. Peak bone mass is usually achieved by the late 20s, but people can still build and maintain strong bones for the remainder of their lives. Osteoporosis occurs when creating new bone doesn’t keep up with the loss of old bone. Your physician can prescribe medications or other treatment options, but to gain full benefit it’s important to exercise regularly, and be sure to take the recommended amount of calcium and vitamin D obtained from foods and/or supplements.

Symptoms

There are typically no symptoms in the early stages of bone loss. When bones being to weaken, however, one can experience back pain, loss of height, a stooped posture, and bones that break more easily than expected. Women who have experienced early menopause or have taken corticosteroids for several months are highly susceptible to weaker bones. Low sex hormone levels will also weaken bones. A fall in estrogen levels in women at menopause is one of the strongest risk factors in developing osteoporosis. In addition, if a person has taken too much thyroid hormone medication to treat underactive or overactive thyroid conditions or adrenal glands, bone loss is a probability.

Diet

A lack of calcium, eating disorders, and gastrointestinal surgery are issues that can put people in the high-risk category for osteoporosis. A lack of calcium leads to lower bone density, early bone loss, and increases the risk of fractures. Surgery can limit the amount of surface area available to absorb nutrients because the size of the stomach has been reduced.

Medical Conditions

The risk of osteoporosis is higher in people with chronic medical problems. These include celiac disease, inflammatory bowel disease, kidney or liver disease, cancer, multiple myeloma, or rheumatoid arthritis.

May is National Osteoporosis Awareness Month. It’s an opportunity to be proactive about your health and a great time to make an appointment with a primary-care physician and undergo a painless bone density test. For more information, visit the Bone Health and Osteoporosis Foundation at www.bonehealthandosteoporosis.org.

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Run4Beigel: Memorial fund helps send at-risk children to summer camps

Scott J. Beigel was more than a geography teacher and cross-country coach at Marjory Stoneman Douglas High School (MSD). Among the 17 souls who lost their lives that fateful day in February 2018, he was a man that impacted lives. Ultimately, he was a man who saved lives by unlocking his classroom so students could find shelter.

To raise money for the Scott J. Beigel Memorial Fund, the annual Run4Beigel takes place April 10 at Pine Trails Park in Parkland. It’s where his team trained and, after their initial meeting, he told them he knew nothing about cross-country running. The team was impressed by his candor, and by his wit. When asked how they could improve, he would simply say, “Just run faster.” According to his mother, Linda Beigel Schulman, he told the team, “You teach me about cross country, and I’ll teach you about life.”

The Format

Beigel won the love and admiration of his team. To honor his memory, they took to social media and within six days of his death organized the first Run4Beigel event. It drew nearly 500 people. This year’s event features the traditional 5K Run-Walk and 1-mile Fun Run, and a 10-mile Two-Person Relay has been added that requires participants to run 5 miles each. Run4Beigel is also being done virtually and runners from around the world will be participating in his honor.

“We expanded to accommodate those who want a bigger challenge,” said Doug Eaton, race director. “The multiple events add a competitive component that never existed before, and we hope to draw friends, family, the philanthropic community, and competitive athletes from running clubs.”

Eaton says the events are a good way to get involved in a wonderful cause. “Scott was a great human being who cared so much about people,” he said. “Honoring him shows the Parkland spirit.” T-shirts will be given to all participants, and winners will receive trophies and cash prizes.

“It’s really a celebration of his life, and there’s a lot of energy because the community comes together as one in his memory,” said Beigel’s mother.

The memorial fund is rooted in Beigel’s love for summer camp. “It was something close to his heart and that’s why my husband Michael and I partnered with Summer Camp Opportunities Promote Education (SCOPE),” she said. “It’s an organization that funds ‘camperships’ for at-risk, low-income children affected by gun violence, and it helps youngsters become empowered and more self-confident.”

The Full SCOPE

The organization does not run the camps, but partners are vetted to meet high standards. “The camps help the emotional needs of kids affected by gun violence by offering an environment that is acceptive and responsive to their needs,” said Executive Director Molly Hott Gallagher.

Beigel’s parents found a partner in SCOPE that was experienced in working with underserved youth and had working relationships with accredited camps. “When Linda and I met, we hit it off immediately,” said HottGallagher. “This relationship has been incredible … because of the focus on providing greater financial access so kids can attend camps they could not otherwise afford.”

SCOPE partners with more than 50 nonprofit summer camps. Last year, it provided more than 700 children with a camp experience. “Helping at-risk kids affected by gun violence was very important to Scott,” said Eaton. “Our goal this year is to raise at least $300,000 and help send 200 kids to camp.”

According to Hott Gallagher, some of the organization’s partner camps are free for all children, and SCOPE subsidizes additional costs for meals, travel, programming, and staffing. Since its inception, SCOPE has funded more than 25,000 camperships.

Applicants must be between ages 7 and 16, be enrolled in a public school or public charter school, and qualify for the Free and Reduced Price School Meals program. They must commit to stay in school. Inner-city kids exist in a world where chaos and crime are routine, and they’re more prone to exposure to gun violence. “Summer camp is very therapeutic because it gives kids a chance to be themselves and have fun,” said HottGallagher. “It’s a break from their daily routine, and it’s proven to be psychologically beneficial.”

An Insight

Beigel grew up in Dix Hills on Long Island, NY. He was a self-taught guitarist, runner, teacher, coach, friend, advisor, and jokester. He found his dream job at MSD because it allowed him to teach geography his way, not always out of a book, but about life’s experiences.

Despite his biting wit, he was a humble man who lived by the golden rule of treating others as you would like to be treated. “Scott really never knew how much people loved him,” said his mother. “The first day he was at Douglas, he called to tell me he was the worst teacher in the world. Students who had doubts about him were the ones who loved him the most. Wherever Scott went, he impacted lives.”

Beigel loved to mentor kids and to be a champion for the underdog. He volunteered to teach in Cape Town, South Africa and returned home without any baggage. He told his mother that in America kids worry about what kind of athletic shoe to buy, but over there, kids were lucky to have shoes. “Mom, I left all my clothes for them, because I knew it was something they could really use,” he said. That was the essence of Scott Beigel.

Lingering Pain

“The scar tissue from what happened four years ago hasn’t gone away, but it’s made Parkland an even tighter-knit community,” said Eaton. “We still feel the pain of that day, and in Scott’s memory, we want to make things better. It’s a way in which our community can give each other a collective hug.” The 17 will always be remembered.

For Beigel’s legacy, this quote by Mahatma Gandhi is appropriate: “Life isn’t always about grand gestures, but when living by your values, you can make a difference.”

You can follow Run4Beigel on Instagram and Facebook. To sign up, go to www.run4beigel.com.

 

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Eczema and food allergies: what parents need to know

Eczema is a dry rash and skin condition in any stage of life, but it can be very common in infancy. Also known as atopic dermatitis, its root cause is unknown, but those with at least one first-degree relative with eczema, asthma, or hay fever are predisposed to having drier skin.

Wendy Sue Swanson, MD, MBE, FAAP, a pediatric specialist and chief medical officer at SpoonfulONE, says one in five children have dry skin classified as eczema. It can appear as small, dry flakes or develop into cracks in the skin that may lead to bleeding. Pediatricians call it the “itch that rashes,” and if unchecked, eczema can be persistent, recurring, and long-lasting.

When the skin breaks down, cracks and fissures form, causing the body to become an entry point that consumes everything in the environment. “The skin is the largest organ in the body and serves as protection from the outside world,” says Dr. Swanson. “What we know from data over the last 20 years is that when an infant is first introduced to food through the skin, the immune system reacts to it as an irritant, versus when the child begins to eat solid foods at the four-to-six-month mark.” By that time, the immune system is more comfortable and recognizes harmful substances, but due to cracks, rashes, and the intake of food through the skin during the early months of infancy, babies are prone to eczema.

Food Diversity

“A child with eczema is 600 times more likely to develop a lifelong food allergy,” says Swanson. “Studies show that the tummy is dominant to the skin, so that is why it is so important to introduce a diversity of foods as early and as often as possible to help develop the immune system.”

Swanson continues, “When solid foods are consumed through the stomach and not the skin, the immune system becomes more comfortable, normalizing intake rather than overreacting to it. The immune system is unique in that it needs to be ‘taught’ protection, and that only happens with food diversity.”

The skin provides security from outside elements, but through food diversity, the immune system “learns” how to react and protect. “How babies are fed early in life can be life-changing, so a diversity of foods is highly recommended,” Swanson commented. “Introducing new foods is not the risk, it’s the delay in introducing the foods that is the risk.”

According to Swanson, 8% of American children have a food allergy, which equals six million kids, or two in every classroom. A diverse diet in infancy protects against the development of allergies. “The more diverse a diet is at infancy through toddlerhood, the less likely he or she will develop food allergies,” says Swanson.

“Peanuts, eggs, and milk are the most common allergens in infancy, and parents need to understand they can help their child avoid a food allergy by getting proper foods and nutrients into the stomach to refortify the skin’s barrier.”

Establishing good food diversity is essential to a baby’s well-being. Formulas are not recommended after 12 months, but breastfeeding and/or formula can be sufficient up to the four-to-six-month period. Usually, from six to 12 months, a baby should become accustomed to a standard solid diet.

Breastfeeding

If a mother breastfeeds her baby exclusively during the first three months, the chances of the child getting a food allergy will not decrease, but breastfeeding does decrease the risk of eczema because the nutrients in a mother’s milk provide a baby’s skin with an extra level of protection. Developing a firm, protective skin barrier is important to deter eczema, and this can be done if parents recognize the importance of various food groups.

 

Solid Food Diet

The best way to get proteins and nutrients into a baby is through the stomach. “All the things Mommy consumes goes into her breast milk, but not all of it contains the necessary proteins needed to fortify a baby’s immune system,” Swanson commented. “Breastfeeding is great, and it can reduce the risk of eczema, but the USDA has made it clear that by four to six months, parents should be introducing allergens such as fish, shellfish, peanuts, wheat, eggs, and so forth into a baby’s diet.”

During pregnancy, a woman will eat many different types of foods, and the diversity of what she eats is what feeds her baby. A diverse diet of foods introduces more allergens and that is important in a baby’s early life — particularly if a child has eczema. The more proteins in the body, the more stabilized and healthier the baby will be.

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Growing up with vaccines: a parents’ guide

School doors open soon, and concerned parents should be aware of vaccinations required to protect their children. A vaccination schedule begins long before a child is ready for school — as early as the newborn stage of life. 

“Newborns do not have mature immune systems, and they’re particularly susceptible to certain infections under 3 months of age,” said Matthew Penson, M.D., a pediatrician at Children’s Medical Association in Coral Springs. “During this period, they receive partial immunoglobulin immunity via breast milk, yet it’s advisable not to take a newborn into a crowded environment.”

According to Dr. Penson, appropriate immunizations are a vital component of preventive care and one of the most rewarding aspects of being a pediatrician. “We lay the groundwork to protect a child’s health in the earliest stages, so once they do begin school they’re properly immunized against infections,” he said.

Getting Ready for School 

Learning and socializing enhance growth, but this can only be accomplished in a classroom free of illness. Parents need to check off all the boxes regarding their child’s health and schedule an appointment with a pediatrician to ensure that all required vaccinations have been received. 

Because influenza viruses constantly change, and the body’s immune system becomes weaker with age, flu vaccinations are a necessity. “As children prepare for kindergarten, booster shots are required between the ages of 4 and 5 to strengthen their immune response,” Penson said. “The flu remains a leading cause of pediatric morbidity and hospitalization, and it’s highly contagious in a day-care or school setting. We recommend starting at 6 months with yearly repeat vaccinations in the fall, no later than October.”

For older children, tetanus, meningococcal meningitis, and HPV vaccines are recommended beginning at the age of 11 and up. Parents should discuss all recommended vaccines with a pediatrician and understand their importance, risks, and benefits. Pediatricians at the Children’s Medical Association care for children and young adult patients up to the age of 21.

Importance of Vaccinations

Vaccinations provide immunity before a child is exposed to other diseases. The American Academy of Pediatrics and the Advisory Committee on Immunization Practices recommend a vaccination schedule as early as 2 months to guard against pertussis (whooping cough), pneumococcus (meningitis/bacteremia), polio, rotavirus, and Hemophilus influenza B (epiglottis, meningitis). 

“Several boosters are required to ‘train’ the immune system to recognize and combat those potentially serious illnesses,” said Penson. He says boosters are required at 4 and 6 months, and when children are a year old, the finishing boosters are given. 

The varicella vaccine guards against chickenpox, a contagious illness that can include blisters, fatigue, and fever. It can be even life-threatening, especially in babies and older adults who have weakened immune systems. To protect against this illness, the varicella vaccine is used (two doses, at 12 to 15 months and 4 to 5 years of age).

Measles, mumps, and rubella (MMR) are also highly contagious. Measles is caused by a virus forming in the mucus glands of the nose and throat. It may cause a high fever, rash, runny nose, and red eyes. In some cases, diarrhea and ear infections are also possible. Very severe cases may lead to pneumonia and even brain damage. Mumps is a virus that spreads via coughing and sneezing. Its warning signs include fever, headache, muscle ache, fatigue, and loss of appetite. The MMR vaccine is given at 12 to 15 months and 4 to 5 years. During the first year, the hepatitis B vaccination is given to provide lifelong immunity. 

The COVID Factor

A decrease in COVID-19 infections is heartening, but stressing the value of vaccinations to eligible ages continues to be important. “As children return to school, we expect to see a rise in both typical childhood illness and COVID-19 infections,” commented Penson. “Severe COVID cases among children are relatively rare (compared to the elderly), but it’s important that pediatricians remain vigilant.” 

According to Penson, parents should expect to see a rising number of upper-respiratory infections, influenza, and strep pharyngitis. Differentiating common illnesses from COVID is difficult, and if parents have questions, they are encouraged to call a pediatrician immediately.

Traveling

With the return of increased domestic and international travel, proper immunizations are vital. Most destinations do not require more vaccines than typically given by a pediatrician, but there are certain locations that have more complex requirements. The travel vaccinations can be accessed by going to the Center for Disease Control’s travel website, or you can inquire about them with your pediatrician. Infants 6 through 11 should have one dose of MMR prior to traveling abroad. Some locations recommend the hepatitis A vaccine, others require malaria medication (prophylaxis), and others recommend the meningococcal vaccine.

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The sad truth: Vision problems have no age boundaries

From young children to the elderly, no one is immune from vision problems. For some, it’s genetic; for others, it’s a part of the aging process. Four of the most common eye problems are cataracts, floaters, macular degeneration, and glaucoma. 

The National Eye Institute says that in the U.S., at least 24 million people over age 40 have cataracts, 11 million have age-related macular degeneration (AMD), and nearly 3 million have glaucoma. Eye floaters affect nearly 30% of the general population.

The sad truth: Vision problems have no age boundaries
Phoropter, ophthalmic testing device machine

Cataracts

“Routinely, people over 60 develop cataracts, but they can also occur among children,” says David Rand, M.D., a specialist at the Rand Eye Institute, a premier eye-care facility that for 35 years has treated thousands of people throughout South Florida and around the world. “Cataracts cloud the natural lens inside the eye and can be caused by sun exposure, trauma, a medical condition, genetics, and aging.” 

Warning signs include a need for more light, a lack of clarity, and glare from car lights or lampposts when driving at night. “Regardless of the degree, vision can be restored surgically,” Dr. Rand said. “There is more urgency among young children because their vision can be affected permanently.” Mild cataracts can be temporarily treated by changing the prescription of one’s glasses, but once visual quality becomes a problem, surgery is the definitive treatment.

Floaters

Millions experience eye floaters or “shadows” on the retina, and it’s a chronic problem that can impact the quality of life. Most are caused by age-related changes in the eye’s vitreous, a jelly-like substance that deteriorates over time. They occur primarily during middle age, or earlier, and develop due to an inflammatory condition. 

“As a physician, I’m concerned that a patient who has an acute increase in flashes or floaters may have a retina tear or detachment,” said Carl Danzig, M.D., a vitreoretinal specialist at Rand Eye Institute. “It’s very important to seek a diagnosis as early as possible.” 

Age-Related Macular Degeneration (AMD)

When new blood vessels grow under the eye’s retinal tissue, it’s referred to as “wet” AMD. When there is a thinning of the macula, a part of the retina responsible for clear vision in direct line of sight, it’s referred to as “dry” AMD. 

“If you have trouble reading a menu, small print, or have problems driving at night, dry AMD may be the cause,” said Dr. Danzig. Vitamins with the AREDS2 formula are used for both types, but they’re especially recommended for patients with intermediate-stage AMD or worse. “The standard treatment for wet AMD is intravitreal injections; surgery is not a first-line treatment.” 

The sad truth: Vision problems have no age boundaries

Glaucoma

When there is damage to the optic nerve due to high or fluctuating eye pressure, glaucoma can occur, and if untreated it can lead to vision loss. Although diabetes, high blood pressure, heart disease, and a history of trauma are contributing factors, a genetic predisposition is also common. “If a family member has glaucoma, it’s very important to be examined and monitored to be certain that glaucoma does not develop,” says Dr. Rand. “The important point common to all treatment options is to adequately lower and maintain the eye pressure to an acceptable level to prevent progression well before it becomes advanced enough to threaten the vision.”  

Glaucoma can be asymptomatic in its early stages, but gradual vision loss may still occur. “Sadly, many patients are unaware they have glaucoma until they lose their vision,” he said. According to the specialist, certain types produce painless vision loss, while other forms cause significant eye pain, pressure, and/or headaches. Among young children, it may lead to tearing or excessive eye rubbing.  

David Rand, M.D.

Dr. Rand completed his undergraduate education at the University of Miami and received his medical degree from the university’s Miller School of Medicine, Honors Program. He completed his postgraduate internship in internal medicine at the Staten Island University Hospital and completed his residency at the State University of New York, Downstate Medical Center. He has published scientific papers and presented before prestigious organizations, including the Association for Research in Vision and Ophthalmology and the Radiological Society of North America.  

Carl Danzig, M.D.

Dr. Danzig is a vitreoretinal disease specialist with experience treating a variety of complex eye disorders. He graduated cum laude from Tulane University and was accepted into the Phi Eta Sigma National Honor Society. After receiving his medical degree from Temple University, he completed an internship at Crozer-Chester Medical Center and residencies at Martin Luther King Jr. Hospital/Charles R. Drew University in Los Angeles and the State University of New York-Downstate, Brooklyn. He also enrolled in the University of Texas/Southwestern Medical Center’s vitreoretinal fellowship program.

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Honor with Action Coalition seeks community support on school safety

The Alyssa’s Legacy Youth in Schools Safety Alert Act, commonly called the “ALYSSA Act,” is legislation on school safety created in memory of 14-year-old Alyssa Alhadeff, one of 17 victims who perished during a mass shooting at Parkland’s Stoneman Douglas High School in 2018. The quiet city has now been added to a growing list of other memorable mass shooting sites that include Columbine, Sandy Hook, Blacksburg, Pittsburgh, Tucson, Aurora, Las Vegas, San Bernardino, Orlando, and El Paso.

Mass shootings, homicides, suicides, and accidental shootings accounted for 43,542 gun-related deaths in 2020, but gun sales remain at an all-time high. Every day, nearly 119 people die from gun violence in this country, according to Heather Chapman, a co-founder of the grassroots organization Honor with Action Coalition. The coalition was started when a group of Moms Demand Action volunteers branched off to start their own organization. “As Moms volunteers, we were limited to the legislation we could pursue, so we started Honor with Action and now have the dual focus of school safety and gun violence prevention,” said Chapman.

The group works with local organizations and also connects with leaders from larger ones to provide opportunities and resources. The coalition also connects volunteers with local and national groups and shares educational opportunities, updates, calls to action, training, and events.

The ALYSSA Act is a two-part legislative initiative that involves the installation of silent alarm systems in elementary and secondary schools and funding for school resource officers. The panic alert system can notify emergency services, staff, and students, and it provides two-way communications about specific information in a life-threatening emergency.

“Seconds save lives, and the ALYSSA Act does just that,” said Angela Weber, Honor with Action Coalition co-founder.

Alyssa’s Law was designated HB23/SB70 and passed in the 2020 legislative session. It was sponsored by Rep. Michael Gottlieb, Rep. Dan Daley, and Sen. Lauren Book. This bill is only for the state of Florida and requires mobile panic alert systems in public and charter schools. Beginning with the 2021-22 school year, school staff are required to activate the mobile panic alert system (Alyssa’s Alert) in the event of an emergency. Alyssa’s Law was signed into law in February 2019, and similar legislation is being debated in New York, Nebraska, and Arizona.

The Honor with Action Coalition was formed less than a year ago, yet it’s made excellent progress. State-level priorities for the coalition include a notification of a “threats in schools” bill, HB951/SB1284, proposed by Rep. Daley and Sen. Shevrin Jones, which provides requirements for reporting specified threats and incidents in schools. Another piece of legislature, HB7035 by Rep. Christine Hunschofsky and Rep. Chip LaMarca, is moving through the legislative session. Additional bills include SB836/HB455 by Sen. Jones and Rep. Omari Hardy to establish an urban core crime and violence task force, while HB167/SB428 sponsored by Rep. Hunschofsky and Sen. Tina Polsky focuses on safe gun storage. On the federal level, the coalition is working to help pass the ALYSSA Act for school safety alerts, Ethan’s Law for safe firearm storage, and HR8/HR1466 requiring background checks on all gun sales and a ban on assault weapons.

Chapman had a poignant message to lawmakers: “Our country has seen staggering numbers in death tolls due to a pandemic, yet I would like to remind Congress that we have an epidemic that is uniquely American — gun violence. After the attack on the Capitol in January, I would hope lawmakers now understand the fear our children face in schools across the country,” she said. “The problems of school safety and gun violence can be significantly reduced if they would pass federal legislation to turn the corner on the intolerable numbers of dead, injured, and traumatized citizens.”

U.S. Rep. Joshua Gottheimer of New Jersey will reintroduce the ALYSSA Act to a new Congress, with the co-sponsorship of Rep. Fred Upton, Rep. Elise Stefanik, and Rep. Carlos Jimenez. According to Chapman, New Jersey elected to install a hard-wired alert system but Florida decided that a mobile phone app alert system was more practical and cost-effective.

“The app is a good solution because if a student is in between classes, on a playground, or on a soccer field, he or she has access to both receiving and sending information,” said Chapman. “School districts have the option of choosing the system that works best for them and how it will be utilized.”

Formed less than a year ago, the Honor with Action Coalition has made excellent progress. Its steering committee meets regularly, and a campaign of public education and information on contacting representatives is ready to launch, but it remains on hold until the bill is formally reintroduced. “It takes a while for the process to unfold; we’re being patient but we are moving forward,” Weber emphasized. “We’ve made corrections to the text of the bill and know the committees it will be sent to. When it’s officially filed, we’ll be ready to go.”

The local coalition continues to seek the support of lawmakers in Washington, D.C., but communicating is difficult because many legislators work remotely. Where it was once possible to speak with a legislative aide or legislative director, messages are now forwarded to a voice mailbox. “This political limbo stalls the process, but it doesn’t stall our efforts,” Weber said. “Locally, the pandemic has limited the number of events we attend, but our Facebook page is updated frequently, making it easy for people to engage in our efforts and provide opportunities for calls to action.”

The Honor with Action Coalition has united with local and national groups to promote gun safety and school safety bills at both the state and federal levels. “The goal is a focus on legislative policies that promote safe firearm ownership, school safety, and support for victims of gun violence,” said Weber.

Follow the Honor with Action Coalition on Facebook and sign up for updates and calls to action at honorwithaction.com.

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Virtual care becomes new standard in era of COVID-19

The coronavirus pandemic has forced a reshaping of the landscape of healthcare, requiring the medical community to look for new, safer approaches to patient care.

To keep patients and team members safe, virtual visits are now conducted via remote communication technology, such as Telehealth and Telemedicine. This is the new normal of patient doctor interaction, and represents a new era of healthcare delivery, and one that will continue into the foreseeable future.

As the pandemic continues, frontline workers at doctors’ offices and hospitals have been put to the ultimate test. In response, new and better programs of communications via Internet technology were enhanced, and audio check-ins restructured. Through telehealth and telemedicine, doctors and nurses can now engage patients via digital devices to meet basic healthcare needs.

During the height of the pandemic, most elective procedures at hospitals and doctors’ clinics were cancelled. With new variants of the virus threatening the country, a new challenge has been created. With elective procedures canceled, questions arose on how to safely care for emergency and non-emergency patients in a safe environment.

The solution was a broadening of virtual care to interact with patients, maintain safe environments, and adhere to mandated social distancing guidelines. The Centers for Medicare & Medicaid Services (CMS) increased access to Medicare telehealth services so beneficiaries could receive a wider range of care from their doctors without them having to travel to a healthcare facility.

“To protect both staff and patients, some medical practices closed their doors to in-person visits because of concerns over the risk of transmission,” said Randall M. Taubman, M.D., CPE, regional medical director at ClareMedica Health Partners LLC, Miami Lakes. “We remained open; our staff wore personal protective equipment (PPE) and each patient was thoroughly screened. Anyone screened as a possible COVID candidate was seen remotely.”

According to Dr. Taubman, video-based visits are preferred and more effective. “The doctor and the patient can see each other and it’s a more natural interaction,” he said. “Plus, if there are any physical changes, doctors can analyze the problem, and that’s a big benefit over an audio virtual visit.” Differences also exist between the way medical codes are applied and how video-based visits are billed.

Scheduling a remote health visit
Telehealth visits can be Web-based or done through a phone call to the office, but prior to the online interaction, most practices require verification of identity and insurance information. “Patients must consent to this form of care, and when they ‘meet’ with their doctor, the visit is conducted in much the same way as an in-person visit,” said Dr. Taubman. “The one exception is that doctors may ask additional questions about a patient’s general health and well-being.”

Before opting for a telehealth or telemedicine visit, patients should make a list of questions. They should also be prepared to explain any symptoms and list medications, dosages, and times they are taken daily.

“The best way to prepare for a virtual health visit is to find a quiet, private room where there are no distractions,” Dr. Taubman said. “Patients need to download any applications needed for the two-way communications and decide beforehand if the visit will be done on a computer, tablet, or phone. The doctor’s office needs to be aware of the patient’s choice. When prescribing medications, doctors still use electronic prescribing to send the script to a pharmacy — a routine practice even before the start of the COVID-19 pandemic.”

A new revenue stream
Reaching out to patients and serving them remotely is now a necessity to sustain physician practices. It is even a benefit to hospitals where there has been a revenue decline in long-standing money-making units such as operating rooms, interventional radiology, and outpatient services. Virtual care is now a proven means of caring for patients safely while tapping into a revenue source that helps offset the decline of in-person visits.

Over the months, regulatory and reimbursement barriers that hindered the widespread use of telehealth were relaxed, allowing providers more freedom to use virtual care for their patients. The Centers for Disease Control (CDC) says that during the first quarter of 2020, the number of telehealth visits increased by 50 percent. This allowed providers to scale their technology, learn more about various platforms, and reshape strategies that would be the most benefit to patients.

The difference between Telehealth and Telemedicine
The words “telehealth” and “telemedicine” are sometimes used interchangeably, but they don’t mean the same thing. The Health Resources Services Administration (HRSA) says telehealth is the “use of electronic information and telecommunications technologies to support long-distance clinical health services, patient and professional health-related education, public health, and health administration.” These technologies include videoconferencing, the Internet, store-and-forward imaging, streaming media, and wireless communications. Telemedicine, however, refers to “specific remote clinical services.”

Both play a critical role in the new era of patient care. Virtual care allows doctors to communicate with patients at a variety of locations that include their residence, a nursing home, an emergency room, or specific divisions within hospitals such as wards, special care units, and even psychiatric units. In addition, access to remote care greatly reduces the potential of exposure to the virus and lowers demands on frontline workers.

Types of remote visits
The three basic types of access routinely used are: Medicare Telehealth (MTH) visits, Virtual Check-ins (VCI); and E-Visits (EV). MTH utilizes telecommunication systems between the provider and patient and may include office visits, out-patient visits, or consultations. The VCI is a brief phone check-in with a practitioner to discuss whether an in-office visit is required, or a remote evaluation can be conducted where a patient can submit images (as in the case of dermatology) to his or herdoctor for  evaluation. The EVs are a format to communicate between patient and provider via an online patient portal.

Telehealth popularity
According to the CDC, the number of telehealth visits in the U.S. increased by 50 percent during the first quarter of 2020 and providers reshaped their strategies to engage with patients. “The use of telehealth is a trend that I don’t foresee diminishing even if COVID improves,” commented Dr. Taubman. “It can help with physician shortage and travel issues in the medical industry, so I believe it’s here to stay.”

According to a Telehealth Impact Claims Analysis conducted by the COVID-19 Healthcare Coalition Telehealth Impact Study Work Group, the latest numbers on telehealth claims in Florida peaked at around 700,000 in April of 2020, and the primary diagnosis of circulatory issues exceeded 200,000. Claims nationwide for circulatory issues in the country exceeded five million in February of last year, and total claims exceeded 12 million.

New advances in digital health technology have transformed patient treatment models internationally. Greater access and more efficiency are the keys to serving patients in the era of COVID-19.

 

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Broward Health Coral Springs offers elite cardiac services

For many years Broward Health Coral Springs (BHCS) provided cardiac care services to the community, but one key component was missing—a cardiac catheterization lab for emergency catheterizations. Subsequently, patients were transported to other facilities, but that’s no longer the case.

Last June, a new state-of-the-art cath lab became operational at BHCS. “We now have the ability to care for specifi c patients with ST Elevation Myocardial Infarctions (STEMI),” said Mohamed Osman, M.D., director of the Cardiac Catheterization Laboratory and specialist in Interventional Cardiology at BHCS. “This is a unique opportunity to provide an even higher level of care through angioplasty procedures.”

Designated as a Level 1 Heart Program by the Agency for Healthcare Administration, the new cath lab was termed a “milestone” by hospital CEO Jared Smith, one that “increases our ability to provide a high level of care and uphold our recognition (per Our City Magazine) as the area’s best hospital and Emergency Department.”

Gary Lai, D.O., and chief of Emergency Medicine says the addition of the STEMI heart program makes it possible for EMS to pre-alert the ER and send electrocardiograms prior to a patient’s arrival. “We can prepare immediately to stabilize, medicate, and expedite patients to the in-house cath lab,” he said. “This saves lives and maximizes outcomes.”

The new catheterization lab allows BHCS specialists to perform invasive cardiac procedures and utilize advanced imaging for diagnoses by using contrast dye to determine the severity of the arterial blockage. Once identified, a balloon angioplasty is performed, or a stent is inserted to clear the artery and save as much of the heart muscle as possible. Pacemakers and defibrillator implant procedures are also performed.

Generally speaking, the last 20 years has seen a rapid transformation of new techniques focusing on minimally invasive procedures, rapid care, and shorter hospital stays, according to Dr. Osman. “Although open heart surgery is certainly an option, the major shift has been toward less invasive, less traumatic procedures that obtain excellent results.” People with severe heart valve problems always required open heart surgery. A significant number are now treated with stents to reduce the risk of a major heart event.

Surgical progress in cardiology can be defi ned by an alphabet soup of acronyms: SAVR (Surgical Aortic Valve Replacement); CABG (Coronary Artery Bypass Graft); BAG (Bilateral Arterial Grafting); PCI (Percutaneous Coronary Intervention); TAVR (Transcatheter Aortic Valve Replacement); EVAR (Endovascular Abdominal Aneurysm Repair): and ICD (Implantable Cardioverter Defi brillator). The term Electrophysiology refers to leadless pacemakers and remote monitoring devices. “Because of these techniques, patients spend less time in the hospital, recover faster, and there’s less trauma to the body,” said Dr. Osman. “An aortic valve replacement once required open heart surgery, but now the TAVR procedure accomplishes the same goal by inserting a transcatheter through a small incision in the groin.”

Surgical complications 

Any medical procedure has the potential for complications such as excessive bleeding, stroke, and even death, but the key is how often complications occur as a result of surgery. “Both minor and major complications are possible, but keep in mind that no patient is the same,” said Dr. Osman. “If a younger patient requires open heart surgery the only problem is the heart and nothing else, so the focus is isolated, but older patients—especially those with underlying conditions such as diabetes, kidney problems, or a previous stroke, are in a high- risk category for complications,” the specialist said.

To show that one size doesn’t fit all, Dr. Osman uses the example of two patients with the same high percentage of blockage that would be treated differently. “The one who is asymptomatic can be treated with medications and dietary changes, while the other who has difficulty breathing and may have underlying medical conditions is a prime candidate for a stent.” He reminds us that everyone is different, and each patient requires a different mode of treatment depending on general health and underlying conditions. “The key is a full evaluation to create a treatment plan with the best benefit.”

Dr. Osman refers to the doctor-patient relationship as “the art of medicine.” The unique relationship includes listening, evaluating, diagnosing, and treating. “At the end of the day when pieces of the ‘puzzle’ come together it’s the collaboration between the surgeon and interventional cardiologist that makes it happen,” he said. He recently saw a patient with a 90-percent blockage of the artery. CABG open heart surgery was performed, and the person is expected to make a full recovery. Choosing the right therapy is the goal.

The COVID consequence

When COVID’s first wave peaked in March 2020, it impacted cardiology services.

With a focus on caring for acute COVID patients, the shift was away from elective cardiac procedures. “Many patients feared coming to the hospital out of fear of COVID and that posed a huge problem,” said Dr. Osman. “In cardiology, time is a big factor and the longer treatment is delayed the worse a condition can become.” He cited a patient who suffered a heart attack yet remained at home for two days. They were able to save his life, but the heart muscle was significantly damaged and he’s now living with a very weak heart muscle. “Things like this are still happening but not to such a high degree. Remember that the margin of error is much less with age,” he said.

The medical facility keeps a log on how long it takes after arrival in the ER to when a clogged artery is opened in the cath lab. According to Dr. Osman the best time to date has been 23 minutes.

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Breast cancer statistics on the rise — among men

It was a normal day for Mike Weatherly– that was until he noticed that an abnormally long hair on his chest needed trimming. It was on the areola that surrounds the nipple, and when he began to trim, he noticed a dark spot the size of a pencil eraser.

But, like most men, the Parkland resident procrastinated, thinking it was a pimple that would go away in time. But after a few weeks, it remained and that’s when he sought the counsel of a neighbor who happened to be an emergency room doctor.

“He didn’t like what he saw and told me I should get it biopsied,” said Weatherly.

“In October, the results came back as a positive grade 3 tumor and I was told I had breast cancer.”

If 100 breast cancers are diagnosed, only one will be found in a man. This year, however, it’s estimated that approximately 2,600 new cases will be diagnosed.

The 71-year-old former pilot for American Airlines, who has always been physically fit, had suddenly become a statistic. Yet, he never asked why me? “As humans, there’s a certain amount of vulnerability and things are going to happen,” he said.

“I also have rheumatoid arthritis, which is rare among men, so I’ve learned how to cope and never allowed myself to become depressed.”

When a tumor is sent to a lab for analysis, its grade is based on aggressiveness and invasiveness. Weatherly’s came back as grade 3, but luckily his cancer was localized and did not spread to surrounding lymph nodes.

If cancer cells had spread to the lymph node, they could have already traveled to the lymph system and spread to other parts of the body.

Weatherly’s cancerous tissue—and his nipple—were removed by a general surgeon on an outpatient basis, and now his ongoing care is in the hands of an oncologist.

“My treatment plan began in December and for the foreseeable future I’ll be seeing the specialist every six months,” he said. “I’ve been told it was a hormone- responsive tumor so in all likelihood I won’t require chemotherapy.”

Weatherly, a self-described “health nut” has been retired for 12 years. He was a track athlete at Southwest Missouri State College, and even into his late 30s participated in triathlons.

He continues to eat nutritional foods, works out on a stationary bike, and lifts weights at home. “Running track pushes a person to the limits, both physically and mentally,” he said. “I guess that’s where I learned the discipline about keeping the going into surgery, the better shape you’ll be in coming out and the quicker you’ll recover.”

Most male breast cancers are discovered in men over 50, where there is a history of breast cancer in the family, and the BRAC1 and BRAC2 (breast cancer susceptibility genes) are present.

Plus, if a man has had previous chest radiation therapy, he could be prone. Estrogen, which is used to treat prostate cancer, also increases the chances of male breast cancer. Injured testicles, liver disease, and obesity are also contributing to underlying factors.

According to the Centers for Disease Control and Prevention, one of the most common types of breast cancer in men is invasive ductal carcinoma. This is where cells grow outside the ducts into other parts of the breast tissue with the possibility of spreading to other parts of the body.

Men who inherit abnormal mutated genes are in a high-risk category, as the mutation may lead to either breast cancer or prostate cancer.

In Weatherly’s case, there was no family history of breast cancer or cancer in general. “I have to admit it was a shock and I never thought something like this would happen to me,” he said. “Thank goodness it was caught early enough.”

Since his cancerous tissue was removed, he’s undergone precautionary follow-ups, including a CT scan and PET scan.

“Most men are not diagnosed until it’s too late, so I was very lucky,” he said. “Just think, if that long hair hadn’t needed trimming, I may be telling you a much different story.”

As a fighter pilot on aircraft carriers in the Navy during the Vietnam era,
Weatherly learned how to deal with all kinds of situations, and his advice to men is to always be aware of any changes in their bodies.

“We tend to focus on heart attacks, strokes or whatever, and male breast cancer is an afterthought,” he said. “It’s only an afterthought until it happens to you.”

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Autism: By the Numbers

When the Centers for Disease Control and Prevention (CDC) began tracking the prevalence of autism in American children, comprehensive data from 2000 and 2002 showed 1 in 150 kids were found to have autism. By last year, when the CDC released results from its most recent findings, autism rates had again jumped. Of the 8-year-olds from the study’s broad-based regional survey areas, 1 in 59 had been diagnosed with autism spectrum disorder (ASD).

In real numbers, here’s what that means: CDC tracking suggests that in 2000, roughly 26,700 kids across the U.S. were found to have ASD; the most recent data indicates that number grew to 72,375.

Autism rates, which increased steadily from 2000 to 2010, according to a 2018 report from Johns Hopkins University’s Bloomberg School of Public Health, had held steady, at 1 in 68, in the two sets of findings from 2010 to 2012.

Researchers and CDC officials pointed to myriad factors that appear to have a role in the increase in autism rates. One big takeaway from recent findings is the increase in autism prevalence among white children as compared to black children in previous reports.

“Although we continue to see disparities among racial and ethnic groups, the gap is closing,” Li-Ching Lee, a psychiatric epidemiologist at the Bloomberg School and one of the CDC survey’s principal investigators.

Lee and other experts say a primary factor in these increases and in the growing rate of ASD prevalence is that children are getting diagnosed at younger ages, often as early as 2 to 3 years old.

Autism, which appears as early as infancy, is a range of closely related disorders that share some core symptoms. ASD causes delays in basic developmental areas, such as learning to talk, play, and interact with others. Signs and symptoms of autism vary widely, just as some children with ASD suffer only mild impairment, while others may struggle with debilitating physical and cognitive challenges.

According to the CDC, children on the autism spectrum may vary in the severity of their impairment, but all struggle to some degree in three areas: verbal and non-verbal communication; relating to others and engaging in the world; and having flexibility in their thinking and behavior.

Opinions differ among doctors, parents and experts about autism’s causes — and about how to best treat it. But all agree, and research reinforces, that acting early and seeking intensive intervention for children showing early signs of autism is the best path toward the best outcomes. For more info, visit www.CDC.gov/ActEarly

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Project 1841 Brings Smiles to Foster Care Teens

The year was 2007, and Robin Miller sat in a living room watching TV. It was December, a time for family and friends, but the teenage girl sat in a chair isolated and alone, wondering what her life would be like without the safety net of foster care. The 18-year-old had aged out of the system, and admitted to being both “excited and scared.” The look of uncertainty on her face was captured by photographer Mike Stocker for a story written by Mike Mayo of the Sun-Sentinel. It was titled, “Her Independence Day.”

After reading the story, Weston high school freshman Alexandra “Alex” Rubin contacted ChildNet, Broward County’s foster care agency, to see how she could help. The answer was unexpected, but poignant. She was told teens aging out of foster care needed luggage or duffle bags so they could leave with dignity, and not resort to putting their belongings in trash bags.

She called three freshman friends, Ilana Wolpert, Alli Weiss, and Alexandra Kaplan. Each attended a different school, but all shared the same caring spirit. Out of their bond Project 1841 was created. The “18” was for 18 year-olds, “4” recognized the group’s four female members, and the “1” stood for one cause—to help foster teens transition into independence. As seniors, the founder received three Miami Herald Silver Knights Awards for community service.

After months of fundraising to buy essentials, members of 1841 delivered its first set of duffle bags to ChildNet in April 2008. Each was packed with a bed pillow and pillowcase, a towel, washcloth, toiletries, household items, snack bags, and a personalized birthday card wishing each teen a bright and successful future.

Kaydion Watson, the aftercare supervisor at ChildNet, called Project 1841 a “phenomenal source of support” and said the duffle bags tagged and delivered to the agency are extremely important. “It’s more than a goodwill gesture because it enhances their self-worth during a very difficult time of transition,” he said. “As trivial as a duffle bag may seem to some, it’s likely the first tangible, practical item they’ve ever owned.”

“We are a non-profit resource arm of ChildNet, and work in conjunction with the agency’s Independent Living Department,” said Dori Kaplan, mother of co-founder Alexandra, and program advisor. “I’m proud that in some small way we’ve been able to help, but I’m even prouder that 1841 is still going strong 10 year after it was founded.”

When members leave the group after four years, others wait in the wings. “This was such a great cause that when the original members left we didn’t want to see the program end,” Kaplan said. The torch was then passed to Kaplan’s daughter, Caroline and three of her friends formed the second generation of Project 1841. When it was their time, Kaplan’s niece, Amanda Richard and three of her friends ushered in the third generation. The fourth generation of Lexis Ofstein, Andrea Hengber, Sami Ofstein, and Julia Glacer are all students at Stoneman Douglas High School—the first time all four members have been from the same school.

Lexi, now a senior will have her spot filled by her younger sister. “I’m excited she’s getting involved because this is a terrific program,” Ofstein said. “It taught me to see the world with a different point of view, and not take the little things for granted.” She recently attended graduation ceremonies for many of the foster care teens she and her group had helped. “The smiles on their faces were genuine appreciation,” she said. “It really made me realize that small bags of basic necessities can make a huge difference in someone’s life.”

All the donated items are stored at the Kaplan home and once a month Project 1841 members gather to prepare the bags. The group is provided the first names of those that are to age out the following month. “We appreciate the generous donations that make these purchases possible,” Kaplan said. “Without the community’s support this program would not be what it is today.”

At any given time, about 600 youths between 18 and 23 will have exited foster care in Broward County, and another 120 are getting prepared to transition out on their own. Kaplan said that members of Project 1841 prepared more than 1,000 bags since the program began. “With the starter kits, there’s also a lot of hugs, words of encouragement, and best wishes for the next chapter of their lives,” Kaplan added. “We hope to inspire others from different counties or even other states to find out how they can help foster teens who age out in their communities.”

In a world of daily news cycles that are filled with anxiety, stories of good people doing great things are refreshing. Four generations of Project 1841 is a shining example.

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The Value of Volunteering

In Broward County, 324 schools provide an educational setting for 271,517 students. Comprising most of the enrollment is 96,000-plus students in grades K-5 and nearly 71,000 students in high schools. From a national perspective, 3.5 million teachers in 131,000 schools teach in excess of 55 million students. Large class sizes and overworked teachers are common, but parents that volunteer are valuable assets, especially when many schools face budget cuts, staff reductions, and diminished resources.

Most schools are beneficiaries of some form of parental contributions, and their involvement—not only at the school—but also in their child’s education is a huge advantage to both.

In most cases, high student standards and test scores gauge the success of a school. Studies show that involved parents help students achieve higher grades and they concentrate more on their future educational goals. With a balance of quality teachers and parental volunteers, many schools nationwide report fewer behavioral issues and better attendance.

“Parents are the main volunteers at Forest Glen Middle School, although we do have established educational partnerships,” said Robyne Friedland, mother of two sons educated at that school. “Parents volunteer mostly for electives selected by their child, such band, chorus, or drama. They are also very involved in sports, cheerleading, PTA/SAC, student government, and the honor society.”

According to Friedland, parents of middle school children are not usually in the classroom, but they do help with teacher-run clubs and electives. “From helping to transport instruments for a performance to fundraising, parents play a big role,” she said.

At Riverglades Elementary School in Parkland, where more than 600 students are enrolled in grades pre-K through 5, volunteers assist in classrooms when requested and also serve as room moms. “Our volunteers do whatever is needed to lighten the load on the teachers,” said Pamela Ofstein, former president of the school’s PTA. “They also volunteer for school parties, help chaperone on field trips, and assist the PTA with other special events.”

Volunteers at Riverglades have the flexibility of working remotely from home. “They help with donations with Partners in Education, email local businesses and when needed, visit businesses to help promote partnerships with the school,” Ofstein said. “Volunteering doesn’t always have to be in-house, and that’s a big benefit when it comes to flexibility.” High school students may also volunteer (with approval) at middle schools and receive community service hours for their efforts.

Many teachers pay as much as $500 of their own money to cover the expense of keeping their classrooms stocked with essentials. Volunteers run time-consuming errands to purchase paper, pens, pencils, highlighters, and other needed items. “Their willingness to pitch in is definitely a big help, whether it’s going for supplies, transporting instruments to a performance, or fundraising,” Friedland said.

The contributions of volunteers are extremely valuable in many areas, and their hard work doesn’t go unnoticed. “The teachers and administration truly appreciate the volunteers—as do the clubs and electives because a lot of time the effort they put in helps sustain those programs,” commented Friedland. “In appreciation of our volunteers—and the several thousand combined hours they put in—the PTA along with the administration, organizes an annual recognition breakfast.” At Riverglades, the PTA tracks volunteer hours for the year and recognizes those that have more than 200 or more hours of service.

All volunteer candidates must be approved by Broward County Public Schools. Candidates must sign up online at the Broward County School Board website and provide all information requested and agree to a criminal background check. Once administration approval is received, an ID photo badge is issued and volunteers must check in at the front office prior to receiving their assigned tasks.

Volunteering is an essential part of today’s educational environment and it can be done on a flexible schedule, regardless of task. The hours contributed benefit the school, the student, and the volunteer.

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