Treating breast cancer

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A Mammography Technologist assists a patient preparing for an exam.

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Treating breast cancer is never a simple fix. There are as many methods and strategies as there are people sick with the disease. Other than a dear friend of mine who had a double mastectomy a couple of years ago, the closest to home the words “breast cancer treatment” come for me is a memory from the mid-’80s when I was in nursing school. One of my patients was so ill from chemotherapy she could keep nothing down, and I watched her suffer horribly with constant nausea as she wasted away to a skeletal shape.

Although chemotherapy is still part of many people’s treatment these days, it is more often combined with other kinds of therapy in a multi-modal approach. A combination of radiation, surgery, and hormonal therapy and other medicines is tailored to each individual according to the results of the pathology report.

Knowledge is power. In an effort to inform patients of the options, Benedictine Hospital has scheduled a series of informative presentations. Thursday, Oct. 18, Dr. Richard McNally, director of pathology, outlined the various types of breast cancer for an audience of patients, supporters and others.

At the event, called “Reading Your Pathology Report and How it Influences Treatment Outcomes,” McNally presented large pastel-colored slides of enlarged cells. His in-depth lecture described the elements of the pathology report: clinical information, gross description, diagnosis and microscopic description. He explained how breast cancer can be in situ (non-spreading) or invasive, and how its location can be ductal (85 percent) or lobular (15 percent). He showed examples of cross-sections of ducts with invasive cancers, explained Nottingham grades and showed scary-looking dark opaque mitoses, cells that are dividing with a higher index, with aggressive behavior.

Afterwards, a panel answered audience questions. It included Dr. McNally and Zoë Weinstein, M.D., a breast surgeon; Alfonso Cutugno, M.D., a medical oncologist; and Camilo Torres, M.D., a radiation oncologist. Barbara Sarah, the founder of the hospital’s cancer support group, was on hand as well. The event was moderated by oncology social worker Ellen Marshall.

Home health care: where the jobs are

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While employment in much of the Ulster County economy remains generally flat, there’s at least one segment that continues to expand rapidly — jobs and services in home health care. Locally, it seems that not a week passes without an announcement of some kind involving job growth in that sector.

Two weeks ago Thursday, A&T Home Care moved a few blocks from a Hurley Avenue location in Kingston to larger offices on North Front Street. Founded in 1984 by nurse Tony Babington, the Rockland County-based home-care agency now has 800 employees in New York State (plus more in New Jersey), including, according to Babington, close to 200 in Ulster County, where it began operations just five years ago.

Babington sees the need in Ulster County for home care help for people in their homes as greater than the supply of such services. She said that A&T is particularly known for high-tech in-home services. Along with a wide variety of other services, A&T visiting staff provides in-home patients with wound care, diabetic teaching, ventilation care, infusion therapy and Coumadin (a blood thinner) testing. The agency maintains close contacts with a variety of insurance providers, the county Department of Social Services, the Northeast Center for Special Care and other community institutions.

Home Health Care & Companion Agency at 366 Albany Ave. in Kingston has offered medical services for home health care by nurses and nurses’ aides for 33 years. On Wednesday, Oct. 17, it held an opening celebration for AM/PM Home Care, which will occupy separate quarters and provide seniors with a great variety of non-medical services such as grocery shopping, transportation, live-in companions, organizing, homemaking, medication pickup, hospital sitting and respite care. The local agency managed by Bill Boone employs between 90 and 100 people.

Always There, a Town of Ulster-based agency that offers a variety of medical and non-medical services plus an adult day program, started at the Kingston Y 42 years ago and now has 280 employees. The non-profit agency inaugurated a day care program at the Clinton Alliance Church in Rhinebeck this Wednesday, according to communications director Jami Anson. “Our census is way up from two years ago,” reported Anson. “We’ve been growing. We hired eight more people this week.”

Keep it clean

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Wash your hands, damn it! But we don’t. Fewer of us in this country are washing our hands regularly even though it’s well established — and not only by our mothers and teachers — that there’s no better way to prevent transmission of a host of viruses and bacteria. A report from the Soap and Detergent Association (SDA) two years ago was so bad that the group felt it had to designate a September week as National Clean Hands Week.

A survey found that only 85 percent of respondents said they washed their hands after going to the bathroom, down from 92 percent in 2006.

Fifteen to 20 seconds of hand-washing with soap is recommended by the U.S. Centers for Disease Control and Prevention, CDC, and the SDA. What’s the right way to do it?

Turning on the water and exposing your fingers to it for a couple of seconds won’t do the job. Soap and warm water or an alcohol-based cleanser is necessary. When using soap and water your hands need to be involved with both for a good 20 seconds (the length of time it takes to sing Happy Birthday twice). Long enough to churn up a nice lather and scrub all surfaces, including under your rings.

Rinse well and dry your hands, preferably with a paper towel or air dryer. Then you can use the paper towel to turn off the faucet. You can even go a bit farther and use the paper towel to open the door.

Caveat emptor

There may be some truth to the old saw that patients should avoid doctors whose own office plants have died. But how should one choose well among health care providers?

We like simple formulae. An Internet search discloses that Dr. X has four stars next to his name on a list of local specialists and Dr. Y has only three. We probably will feel more comfortable with Dr. X, even though Dr. Y, perhaps a bit more brusque in his personal style, has a great reputation in the medical community and specializes in treating the ailment we are seeking a doctor for.

Don’t believe everything you read. What if Dr. Y hasn’t compared well with Dr. X in some hastily prepared magazine’s ranking system only because Y handles the most difficult cases in his expertise?

It’s not that we lack for health care ranking systems. There are at least 15 highly detailed ones, including compilers such as medical groups, magazines, government agencies and Consumer Reports. Heck, even Angie’s List offers a section for doctors, dentists and other practitioners. Angie also lists hospitals and insurance options.

Don’t doubt for a moment the importance of quality. When it comes to health care, quality and safety remain the paramount considerations for consumers. As a consequence, quality measurement is becoming steadily more sophisticated.

It follows, of course, that providers are not unwilling to publicize to consumers’ results that put them in a favorable light. Who wouldn’t? Attention to measurement has become key for health care institutions, especially those with aggressive competitors struggling with them for market share.

What’s little known to the consumer is how these lists are compiled. One wouldn’t want to rank an award that’s applied for in the mail equally against one that has to be measured and verified by a professional organization with an excellent reputation.

Though the average consumer may not want to become an expert in the habits and foibles of health care, a lively interest in taking responsibility is highly recommended. Until something better comes along, we’ll have to settle for a small dose of common sense as the most useful medicine for making health care choices.

The basis of commercial common law is the Latin phrase caveat emptor, let the buyer beware. Absent a warranty, services are provided on an as-is basis.

Here are five of my personal recommendations, based on my own experiences and unvetted by professional advice. If you are personally unable to follow these recommendations, I advise choosing a single proxy who will advocate for you:

• Cooperate. You are a member of the health care team attending to your health. Respect your fellow members.

• Ask lots of questions. You are entitled to explanations along every link of the healthcare chain. Be an intelligent consumer. Communication is vital.

• Look around. You can tell a lot about your provider’s attention to quality by the way you are treated. Your providers should be rigorously following systematic protocols, should be alert to your condition, and should be attentive to your needs.

• Anticipate teamwork. The best institutions are proud of what they do. They have developed an atmosphere of teamwork that includes everyone from the specialist on his daily rounds to the person who changes the bedsheets.

• Expect empowerment. Quality is a process as well as a result. The best institutions have created an atmosphere where everyone on the care team is constantly learning, expanding their opportunities, and sharing the successes they have achieved.

The beauty of bees

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Photo by Lauren Thomas

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Honey has been used for many millennia to delight the palette. The oldest sweetener known to man, it has also been used for centuries for medicinal purposes. Packed with antibacterial properties, enzymes and anti-oxidants, it is an ideal natural medicine.

If sealed properly, honey can last almost forever, as proven by the discovery of honey in King Tut’s Egyptian tomb. In its raw form, it can be used to help build the immune system against allergies, provide a slow-releasing energy boost throughout the day, prevent bacterial infections, serve as a cough suppressant and balm to a sore throat, and treat burns topically.

Carol Clement, co-owner of Heather Ridge Farms in Preston Hollow, has been a beekeeper for more than 30 hives. She has extensive knowledge on the various health benefits of raw honey. She sells three types of raw honey: clover, buckwheat and wildflower.

Like Gardiner-born honey farmer Todd Widmark, Clement believes that local raw wildflower honey is the best preventive medicine for sufferers from seasonal allergies. “The wildflower honey contains a mix of pollen from all different flowers,” said Clement. “So if you’re allergic to say ragweed or goldenrod, you want to start taking it long before the wildflower season to help strengthen your immune system.”

Widmark, originally of Widmark Farms and now running Honey Brook Farms in Pine Bush with his wife, concurred. Not only does wildflower honey taste great, he said, but it contains a great mix of wildflowers to which many people are allergic. “That’s why it’s important to buy raw, local honey because if contains small doses of the flowers blooming locally that you may be allergic to.”

Buckwheat honey can be used not only as a natural sweetener but also as a cough suppressant. “Buckwheat honey suppresses a cough better than any cough medicine you can find in a drug store,” claimed Widmark. “It’s better than antibiotics, and it also coats a sore throat like most honeys do.”