Hospital at Home option; a Lyme disease patient and advocate; mammogram preparation; cellphone 'addiction': Upstate Medical University's HealthLink on Air for Sunday, July 24, 2022
Nurse administrator Diane Nanno describes the Hospital at Home program, where patients recover at home. Anne Messenger tells about her experience with Lyme disease and the formation of the Central New York Lyme and Tick-Borne Disease Alliance. Program manager Wendy Hunt, from Upstate's mobile health unit with mammography, the "mammo van," tells how to prepare for a mammogram. Psychiatrist Christopher Lucas, MD, advises on how to limit one's cellphone use.
Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a new program allows some patients to receive hospital care in their homes.
Diane Nanno: ... And I can't stress enough the importance of a collaboration between the nurses and the physicians, our own pharmacy, the infusion company, the durable medical equipment company -- it's really, at this point, a well-oiled machine. ...
Host Amber Smith: A woman who developed Lyme disease shares her story about trying to educate others.
Anne Messenger: ... While the doctors are treating, and while the researchers are doing their fabulous research to fix this thing, we need to teach people. ...
Host Amber Smith: And what's important to know about mammograms.
Wendy Hunt: ... We suggest no deodorant, lotions, powders in the breast area before you come for your mammogram, because there's metallic particles in these items that can interfere with the imaging. ...
Host Amber Smith: All that, along with a visit from The Healing Muse, coming up after the news.
This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith. On this week's show, a Lyme disease group started by a woman who had the disease works to spread education. Then, find out when the mammography van will be in your neighborhood. But first, certain patients can now receive hospital care in their homes.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
A special care program that allows certain admitted hospital patients to continue their recovery in their homes is now offered at Upstate University Hospital. And today I'm talking about this Hospital at Home program with one of the people who helped establish it. Diane Nanno is a nurse who is the director of nursing for Upstate's Transitional Care Services.
Welcome to "HealthLink on Air," Ms. Nanno.
Diane Nanno: Thank you. Thank you for having me.
Host Amber Smith: I understand that this is not a program that everyone is going to qualify for, and I'm going to have you go over the specific criteria for patients who could consider participating.
But first, could you please explain what Hospital at Home is?
Diane Nanno: Absolutely. Back during the real surges of the pandemic, there were concerns about, and are still concerns about, hospital capacity and our ability to meet the needs of the community. So, CMS, which is the Center for Medicare and Medicaid Services, which is federal, came out with a waiver that was made available for applications for hospitals to be able to start a Hospital at Home program. There were a few hospitals throughout the country who were doing this program, but it was made more available to other hospitals, especially given our capacity issues and with the COVID pandemic. So we applied for the waiver, and we were accepted for the waiver. And the waiver is meant to serve Medicare patients, so they're Medicare fee-for-service patients, or straight Medicare is what it's normally called, and there are some managed Medicare plans also that are on board with us for Hospital at Home.
Host Amber Smith: So there's some experience, a track record in other cities or states. Other hospitals have had this underway for a little while.
Diane Nanno: Absolutely, and those hospitals that have had it underway for a while found that 30-day readmissions were reduced for patients who used Hospital at Home, as well as emergency department utilization. And patient experience was very high (good) with these patients, so yes, there is a track record. We know that certain patients can be taken care of at home, so we decided to start it in our own community.
Host Amber Smith: So does it overall save the hospital money?
Diane Nanno: Not really, because patients are still inpatients, and the costs that are associated with an inpatient stay remain. But what it does is it gives us the ability to increase capacity for our hospitals, so we can take more patients who cannot be taken care of at home.
Host Amber Smith: Now, Ms. Nanno, you're director of nursing for Upstate's Transitional Care Services, and people may not understand what that is.
Can you give us a quick explanation?
Diane Nanno: Sure. Absolutely. The definition of transitional care is actually the way people move across the health care continuum. So they might go from home to their physician's office to the hospital and places in between. So it really means how patients transition throughout the continuum of care. Transitional care at Upstate really looks at patients as they enter our system, navigate through our system, leave our system, if they do, or if they're navigating through, making sure those navigations are as smooth as possible, because if they're not, it puts patients at risk of ending up in the emergency room or hospitalized.
Host Amber Smith: It seems like it makes a lot of sense for you to be involved in the Hospital at Home, even though it's not exactly transitional. I mean, I guess it is, sort of.
Diane Nanno: That's right. And the reason that it makes most sense to be under transitional care is it very much is about, and depends on, our relationships with post-acute partners in the community.
For instance, the nursing piece of Hospital at Home is done by Nascentia Health, which is a home care agency in the area. So transitional care just by definition has relationships with organizations within the community.
Host Amber Smith: Well, let's talk about which patients might be considered candidates for Hospital at Home. Are there medical criteria that the doctors and nurses consider before anyone can be recommended?
Diane Nanno: So these are patients who need to be stable. We would never send a patient who we're really worried about having an adverse outcome, we would never send those patients home, so they have to be stable, but they're still acute care, so they still meet criteria for hospitalization. They've got to have a home. They've got to have a safe home. They've got to have some sort of support at home, whether it's informal family support or some sort of formal support. Obviously, patients opt out or opt in, so we would never make someone do Hospital at Home, so that's a piece of it, too, and comfort level at being home, as well. It's a new program. So these are the patients that we're looking at. So they're not that sick, but they're sick enough to be in the hospital. They've got the support, and we can provide those services at home.
The other thing that we need to be sure of with patients we send home with Hospital at Home is that they're not necessarily needing very complex testing, because there's a lot of testing we can do at home, but things like CT scans, MRIs, things like that, we cannot, so we don't want to have to send them back in.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Diane Nanno. She's a nurse who directs Transitional Care Services at Upstate. And she's telling us about a new program called Hospital at Home.
Now, is it evident from the time of admission if someone might be a candidate for this, or would potentially a patient's condition changed during their hospitalization so that they would qualify.
Diane Nanno: Absolutely. So what happens is there's an automatic list generated for us in our electronic health record for patients who meet criteria for Hospital at Home. And then we're looking at every one of those patients throughout their hospitalization. Some patients may be appropriate for Hospital at Home when they're still in the emergency room, so they never actually make it up to an inpatient bed. So for those patients, we're avoiding the entire inpatient hospital stay in the brick-and-mortar building and sending them home. Some patients, what we're doing is identifying them on the (inpatient) unit, either because they needed some testing, (or) they needed some assessment, and then we decide that this would be a good or appropriate patient for Hospital at Home. And we're transferring them home from there, and that decreases the length of stay in the brick-and-mortar hospital.
Host Amber Smith: Now what if a patient requires some hospital equipment? Are there things that would go home with them on loan?
Diane Nanno: Yes. We have community partners that are working with us at Hospital at Home. We have a DME provider, so durable medical equipment provider, that is our preferred provider, that delivers whatever equipment is needed. So we have delivered things like hospital beds, commodes, rockers, canes, oxygen, things like that, in addition to the medications that are needed, so we can do intravenous and really have with pretty much all of our patients, intravenous medications at home, typically antibiotics, but they could be other things. So there's another vendor that we use for that piece of it.
Host Amber Smith: So how does the patient stay in contact with their doctor or their nurses from Upstate? Is there any interaction?
Diane Nanno: There's a lot of interaction. So, patients get an in-person nursing visit twice a day, typically in the morning, and then later in the day. Each patient has an iPad with a call button, essentially. So if there's an issue, a question, really anything that the patient wants to communicate, they're pushing that button. That communication then goes to nursing, and then if it needs to, it's then escalated to our physician. The physician, or advanced practitioner, is connecting with the patient and or family once a day, at least once a day, either in person or virtually.
Host Amber Smith: What happens if someone who is doing Hospital at Home starts deteriorating? Do they return to the hospital itself?
Diane Nanno: Absolutely. So we haven't run into that yet, knock on wood, but yes, that is considered, in CMS terms, an escalation. So, say a patient becomes more short of breath at home, and we're concerned about their status. We would bring them back in to the hospital. It's not a readmission because they're already admitted.
We have a workflow, so patients don't have to go through the emergency room if that were to happen. And then that patient could be cared for in the brick-and-mortar hospital and sent home again, if that's appropriate. If not, we would just continue their hospitalization.
Host Amber Smith: Well, I know this is a relatively new program. How have the doctors and nurses responded to this concept in general?
Diane Nanno: Very favorably. What we have found is, I'm going to be honest, there was some concern, in the beginning, this is not something we've ever done, taking care of hospitalized patients in their own homes.
I would say we have reached that comfort level now. We understand that the patients that we're sending home are stable, that they're able to reach us if they need to. There's lots and lots of oversight, and so the physicians and nurses and NPs (nurse practitioners) that are working with this program really like it.
Host Amber Smith: What sort of patient feedback have you received?
Diane Nanno: Very, very positive feedback.Patients are very happy to be home. They're happy to be comfortable in their own beds. They are happy with the oversight and comfort level of those that are taking care of them. And I can't stress enough the importance of a collaboration between the nurses and the physicians, our own pharmacy, the infusion company, the durable medical equipment company -- it's really, at this point, a well-oiled machine, and there's much patient satisfaction.
Host Amber Smith: I'm wondering, do you think the concept of Hospital at Home is pointing us toward the future of hospital care? Do you think there'll be more things like this as we go forward?
Diane Nanno: I do. Really by virtue of what we do in transitional care, we see the importance of community-based organizations and really taking care of patients, meeting them where they are. So if we can look at care individualized like this, as we were saying, this program is not for everyone, but it's for a lot of patients.
So I definitely see us increasing, doing care outside the hospital.
Host Amber Smith: So if a patient is admitted and is interested in this, is it something they could just bring up with their provider to find out whether it might be something they qualify for?
Diane Nanno: Absolutely, so they could bring it up with their provider, they can bring it up with their case manager. Every patient has a case manager, which is a nurse who helps with discharge planning. They can bring it up with their bedside nurses. And then we would just go up and talk to the patient and family, talk about whether it's appropriate, if they're eligible, and then work to get these patients.
Host Amber Smith: Well, Ms. Nanno, I appreciate you making time to tell us about this.
Diane Nanno: Thank you for having me.
Host Amber Smith: My guest has been Diane Nanno. She's a nurse who is director of nursing for Upstate's Transitional Care Services. And she's one of the people who helped establish the Hospital at Home program at Upstate University Hospital. I'm Amber Smith for Upstate's "HealthLink on Air."
Personal experience with Lyme leads to creation of an Alliance -- Next, on Upstate's "HealthLink on Air."
From Upstate Medical University in Syracuse, New York. I'm Amber Smith. This is "HealthLink on Air." Ticks are a huge and growing concern in Central New York, primarily because of the diseases they can transmit to humans. Here with me to talk about ticks and Lyme disease is Anne Messenger. She leads the board of the Central New York Lyme and Tick-borne Disease Alliance, and she has personal experience with Lyme disease. Welcome to "HealthLink on Air," Ms. Messenger.
Anne Messenger: Oh, Amber, thanks. And it's Anne.
Host Amber Smith: OK, Anne. I'd like to start by having you tell us how you discovered you had Lyme disease.
Anne Messenger: I certainly can do that. I want to say upfront, Amber, I am the chair of that Lyme Alliance board, but I am not a doctor. I'm not a nurse. I'm just a regular human being. So you're talking to a patient who's been on a steep learning curve, not a clinician, a steep learning curve over the last four years. I was first diagnosed four years ago-ish.
Host Amber Smith: So, in 2018-ish?
Anne Messenger: Yes.
Host Amber Smith: So what symptoms brought you to a doctor's office?
Anne Messenger: The symptoms didn't do that. My annual physical did.
I was just in for my yearly physical, and I was so tired. I would get up in the morning. I go downstairs to feed the cats and thinking I got to go back to bed. Something was weird. So I go for my annual physical. I must have yawned in my doctor's face -- he's known me forever -- I must've yawned in his face 20 times. He said, "What is the matter with you? I think you have sleep apnea." He sent me off to a sleep clinic. I did not have sleep apnea.
I saw another doctor for a whole different reason. She, unbeknownst to me, tested me for Lyme, hearing that I had this extreme fatigue. She has a whole personal background in Lyme and had gotten smart in that field. She gave me a test for Lyme, called me a week later and said, "I know why you're so tired. You have Lyme." When I think about it now, and I think back to that time, for years I was exhibiting other symptoms that are pretty standard. I realized that I thought were just day-to-day things. Brain fog, fuzziness in my brain. That was the worst. I had a stiff neck. I had this free- floating pain, especially weirdly at the top of my left foot. I had something called trigger finger, so when I bent my thumb, it would just kind of stick there until I popped it back open. It kind of was stuck. But I had just passed those off as day-to-day aches and pains, until I got smarter about this whole thing.
And you probably know, Lyme is called, the nickname for Lyme, is The Great Imitator because its symptoms mimic many other diseases -- MS, Alzheimer's, fibromyalgia, arthritis, just a host of other things.
Host Amber Smith: So the doctor that tested you for Lyme, was that just through she was doing blood work and she was able to just add that to the list of things to test for?
Anne Messenger: Exactly. Which in my mind should be standard operating procedure for anybody who walks into a doctor's office going "something weird is going on." Put a Lyme test in there, even though the Lyme tests today are sketchy, and many times will come back with a negative that is a false negative. So frequently people have to be tested again, and sometimes again and again. But she did it once, and it came back, oh yeah, you got it. Very positive.
Host Amber Smith: So when you heard the word Lyme disease, at that point, did you know anything about it? Did you know that it was tick-borne when she said Lyme disease? What did you know about Lyme disease?
Anne Messenger: So little. I was so vague. I knew it was a thing, and it caused big-time physical distress. I didn't know. I feel as if I've been in med school for the past four years. I knew very little about it. What I did know was, I had to get it addressed right away.
Host Amber Smith: So what did you do?
Anne Messenger: I got it addressed right away. That doctor put me on a very aggressive doxycycline treatment -- two months. That's very aggressive.
Host Amber Smith: So the doxycycline, that's an antibiotic, and so you were on that for two months?
Anne Messenger: Yes.
Host Amber Smith: How long until you started feeling better?
Anne Messenger: I suspected you were going to ask that question. I'm trying to think how long. It probably, at the end of those two months, those immediately very troublesome symptoms. The two were the extreme fatigue and the brain fog, started to subside within those two months. I could tell. Definitely. And that whole doxycycline thing, that can be problematic for some people, especially over that length of time. My body accommodated it. I was cool with it, thank goodness.
Host Amber Smith: Once you've had Lyme disease, can you get it again?
Anne Messenger: Absolutely. You can get it again. Why? Because it's a gorgeous day, and you want to go out in the backyard and do your gardening, and the ticks are waiting for you. They're waiting to get your blood. So absolutely you can get it again. I was one of the lucky ones, four years ago. I was just exhausted and brain foggy. I was not confined to my bed with extreme pain. I had pain, but not extreme pain that kept me there for two weeks or two months. I was not suicidal. I didn't die. All of those things happen to people. Fast forward to today. I don't know if I still have Lyme disease. I'm testing negative for it. But I've got these weird things going on in my body. I still have symptoms, but I'll tell you that I'm day 38 post-COVID. I'm standing up, but I'm still tired. My couch and I are best friends for nap time. And I have this brain fogginess.
Host Amber Smith: Are there any lessons from your experience as a patient that you find yourself sharing with people, or something that you're glad you did or something you would've done differently?
Anne Messenger: My lessons learned are a roll-up over the past four years. So, I'm not sure they would be necessarily in this order, but absolutely No. 1 is prevention is absolutely the best, is the biggest lesson. I've made it a habit. So I have bug spray on my patio. I have bug spray in my car. It's a loaded with picaridin. That's a chemical that should be in a bug spray. DEET works, too. If you've got a concentration between 20 and 30% of DEET, that's a good thing. There's another chemical called permethrin that I've sprayed my clothes with. I put my cats inside because permethrin is deadly toxic for cats. The cats are inside. I put my shoes and my clothes, I lay them out. This is at the beginning of the season. I put them out in my driveway, spray them with permethrin, hang them up in the garage to dry for a day or two, and the cats can go out, and then I'm good to go. I put those on when I go outside.
Other prevention things: dress properly, wear long sleeves, wear long pants, pull your socks up over your pants. When you come back in, after you're out in the garden or just walking around in the grass, take your clothes off. Put them right in the dryer. Run that dryer for 15, 20 minutes. Ticks do not like -- they die; when it comes to dry heat, they die. I actually put them in the wash first, especially when I'm grubby from the garden. But the dryer is the big thing. Do a tick check. Take a shower, a scrubby shower is what I tell our camp kids.That prevention is the first thing.
Find support. Find a doctor who actually listens, No. 1, and No. 2, if you can, knows tick-borne diseases. Find support family. The Lyme Alliance is a great support. If you get a diagnosis, and those symptoms persist, keep pushing back. "Now I want another test."
Huge lesson learned: If you find a tick -- and I have to steel myself to do this, sometimes if I find a tick -- do not panic. We have this fabulous resource in Syracuse, for free tick testing. It's at NYticks.org. You pull a tick off yourself, pop it into a little plastic baggie, along with a bit of a damp paper towel. Put it in a plastic baggy. Go on to NYticks.org. They will tell you how to send it in for free tick testing. Send it in, and you'll get results back -- negative, that tick was negative. A big percentage, though, of ticks will show up as positive. And then you can take that to your doctor. That site that I mentioned -- NYticks.org -- is not a diagnostic site, but you can take those results to your doc and say, "Hey, I'm presenting with symptoms. And that tick that bit me is showing positive for this pathogen, this pathogen, whatever. I need some help."
Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Anne Messenger. She leads the board of the Central New York Lyme and Tick-borne Disease Alliance, and she's had Lyme disease.
Now, after your own ordeal, you helped found the Central New York Lyme and Tick-borne Disease Alliance. Why did you think there was a need for an organization like this?
Anne Messenger: Because my tick doctor -- bless him, Kris Paolino at Upstate -- took me to a Lyme summit three years ago at Cornell (University.) And, the room was filled with doctors and researchers and educators. I tell people I was the only normal person in the room. What did I know about this stuff? But it became very clear to me at the end of the morning. And we've spent a day together. They're presenting their papers and talking very high-level things that I had no idea about. But it did become clear to me that a lot of those folks who were doing fabulous work, world-class work, weren't talking with each other. So a researcher, for instance, would stand up and say, I've got this money. I'm doing this research on whatever it had to do with ticks, and I've had these outcomes, but my biggest challenge is I don't have patients. And a doctor would turn around and say, wait a minute, I need, what do I need to learn what you're finding out. I can help you. I have the patients. I will send you their serum. Well, come on, we need to be talking. So I sat down with Kris Paolino, my Lyme doctor, sat down with him and some others and said, we need to do something about this to connect these dots. I hosted a meeting with nine players in Central New York -- doctors, scientists, a couple of foundation people, people like that, businesspeople. I scheduled that meeting for two hours. I could not get them out of the room after two hours. It was, it was great. So, fast-forward, now we're in our third year. We have a board of doctors, nurses, scientists and community members, 19 members of that board, and a growing core of volunteers who are tackling this issue, in a connecting-the-dots kind of way that we have to be tackling this.
Host Amber Smith: So what would you say the organization's mission is? It sounds like you've brought a lot of people together that really need to be communicating.
Anne Messenger: We're a collaborative to support research, drive education, and promote awareness to combat tick-borne diseases. That's official. That's on our website. That's at the top of every agenda. In a nutshell, though, Amber, we're all about education. We have clinicians on our board, but we don't do treatments. We have research scientists on our board, but we don't do research. We bring their things together on our website, our social media platforms and so on and talk about it to bring up the level of awareness and education in Central New York. Educate, educate, educate. While the doctors are treating, and while the researchers are doing their fabulous research to fix this thing, we need to teach people.
Host Amber Smith: Does the Alliance take a stand about how best to treat Lyme disease? Because I know there's some controversy among the experts.
Anne Messenger: Controversy is a light word for it. There are different approaches, and sometimes they are bitterly combative. It's a touchy area because there are different schools of thought who are passionately aligned with their training and their experience, both of which I respect. What we are all about, I should say, is education, so I'm going to have to wade carefully here in how I address this question.
One of our biggest pain points in Central New York is access to doctors who know about Lyme or tick-borne diseases, know about it and can treat it. By access I mean just getting in the door. Our executive director and I, and our board members every single day get phone calls, emails, texts, "I've got Lyme disease. I'm terrified. What do I do?" All of those people are trying to line up. So what we're doing is hosting in this fall, hosting a summit. It's going to be by invitation only, probably 30 practitioners, invitation only. We're developing a list, a targeted list, family practices, nurse leaders, emergency department docs, and so on, to teach them about ... they will leave that day and a half's worth of training -- for which they'll get CME (continuing medical education) credit -- they will leave that day and a half with a basic understanding of Lyme disease. They don't have that right now. Many, many doctors do not know about the signs, the real basics of Lyme disease or how to treat it. They will leave that session knowing about it.
And then we can address the other, maybe do a deeper dive into the different approaches. But right now there are basics which every doctor I'm sure would subscribe to.
Host Amber Smith: Well, Anne, thank you so much for making time for this interview and sharing with us your personal experience. I appreciate it.
Anne Messenger: Such a pleasure, Amber. Thank you for helping get the word out about these dreadful diseases, which can be easily prevented. I really appreciate it. Thanks.
Host Amber Smith: My guest has been Anne Messenger. She leads the board of the Central New York Lyme and Tick-borne Disease Alliance, and she's also had Lyme disease herself. I'm Amber Smith for Upstate's "HealthLink on Air."
Next on Upstate's "HealthLink on Air," how to prepare for your mammogram.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air." As a screening tool to detect breast cancer early, mammograms are part of routine health care for many women, but life sometimes gets in the way, making it difficult to find time to get an appointment at an imaging center. To help with that, Upstate offers a mobile health clinic with mammography throughout the greater Central New York region. Here to talk about what is known as the "mammo van" is program manager Wendy Hunt. Welcome to "HealthLink on Air," Ms. Hunt.
Wendy Hunt: Thanks for having me.
Host Amber Smith: I've seen the mammo van in person, and it's way bigger than a typical van. It's the size of an RV. What all is inside the van?
Wendy Hunt: The looks are deceiving because inside, it seems small. There's a waiting area, there's a check-in area, there's an exam room, which is actually the front part of the van, where the driver sits. So it's all windows, but we have blinds that block everything out that are pulled down when it's time for a patient to go in -- that's where the nurse does her exams. There's the mammo room in the back, with all the equipment in it, where the mammograms occur. And then there's two dressing areas, there's a work area/kitchen over behind the mammography area so that the tech has a space to work. And then they have a place to heat up lunch when they're working and that kind of stuff. And there's a restroom on there, but we don't encourage the use of that.
Host Amber Smith: So it sounds like, a big office on wheels that you can move around from location to location.
Wendy Hunt: Yeah.
Host Amber Smith: Where all do you go? Where does the mammo van travel?
Wendy Hunt: So when we started, we were under a grant from the state Department of Health, and they prescribed our region to include Onondaga County, Oswego, Jefferson, Lewis, St. Lawrence, Oneida, Herkimer and Madison counties. So we've been traveling within those eight counties. We will continue with some of those counties, but now that the grant has ended, we can go anywhere we want. So we ventured a little bit into Cayuga and Cortland counties and hope to do more of that as we go.
Host Amber Smith: Is the van on the road year-round?
Wendy Hunt: Yeah, we are year-round. It just depends on the weather in the winter. We don't go as far north.
Host Amber Smith: OK. What about handicap accessibility?
Wendy Hunt: We have a lift that goes right into the mammography room, and the patient is then assisted with whatever they need help with in terms of getting ready for the mammogram.
Host Amber Smith: Now, do people need to have appointments ahead of time?
Wendy Hunt: Yes, right now, that is how we're doing things. That will change, hopefully, in the near future -- we could take walk-ons. However, on a day when we're not super busy, if someone shows up to the van and has an order with them and is due for a mammogram at that point, if we can fit her into the schedule, we do it if we can.
Host Amber Smith: So they would need to have a prescription from their doctor to get this. You can't just walk in and say, I'd like one.
Wendy Hunt: Correct, yes.
Host Amber Smith: How would someone know, or be able to predict, when the mammo van is going to be near where they live or work?
Wendy Hunt: We try to keep somewhat of an annual schedule of places. So if we're in, say, Oswego in October, then we try to go back there annually so that we're there, but we also have a website through Upstate that we list all of our dates on. We post up on our social media, and then the hosts that we work with, they quite often will be able to promote and post things as well, to help people know what's going on, when we're going to be there.
Host Amber Smith: And we ought to tell people that website, upstate.edu/mobile-mammography.
Wendy Hunt: Either that or upstate.edu/noexcuses. Either one of those would work.
Host Amber Smith: All right. Well, let me ask you some basic questions. Can you please explain what a mammogram is for?
Wendy Hunt: Mammography is a cancer screening to find cancer early. And, the earlier it is found, the better treatment options are for people. So that is why it's encouraged on a yearly basis.
Host Amber Smith: How has it done?
Wendy Hunt: It's done with the machine. It compresses the breast and takes pictures. And right now we're using what's known as 3-D imaging, which allows the machine to take what -- it's been described to me as slices of pictures, so that there's multiple pictures taken and they're all put together and create one 3-D image of the breast, which allows the doctors to see more than the traditional 2- D imaging has been, because.there's more images to look at. It's looked at different areas of the breast.
Host Amber Smith: Do you know who is recommended to have a mammogram and how often?
Wendy Hunt: Yes. Women who are 40 and older, average risk, should probably be going on a yearly basis.
Women who maybe have an increased risk, if they have a genetic mutation or they have a family history, that's something that they would want to talk with their doctor about and make a decision with the doctor as to how often they should be screened.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Wendy Hunt, the program manager for Upstate's mobile mammography van.
Now let's talk about how someone goes about qualifying to make an appointment.
Wendy Hunt: We do screening mammography only on the van at this time. Women who have breast issues, maybe they're feeling some pain, they felt a lump, they have some skin dimpling. Those are all things that we couldn't see them on the van at that point. They would really need to go to one of our fixed sites, have a mammogram there, because then if there is something that needs to be looked at more closely, they can do that right then and there instead of us having tobring the patient back.
So yes, it would be women who, again, average risk, aren't having any problems with their breasts at this point, women who are 40 and older, women who haven't had a mammogram in 365 days, because most insurances require you to wait 365 days in between mammograms in order for them to cover that service for you. Well, I think that's about it.
Host Amber Smith: Do women need to have health insurance in order to come to the mammo van?
Wendy Hunt: No, there is a program, called the Cancer Services Program, that is through the state Department of Health, but there's one in each county in New York state. They provide screening mammograms for women who don't have health insurance or maybe are under-insured.
They will also provide follow-up for those women, and then they have a specialized Medicaid program, so if a woman is diagnosed with cancer and needs treatment, they would help get her enrolled in that program too, if she's eligible. So no, insurance is not required.
We do bill insurance. It's technically not a free service. I've heard people say that they consider it to be free service. It's free to the patient for the most part because insurances don't charge a copay for a mammogram. And like I said, if the patient is uninsured, then we can work with the Cancer Services Program to get them covered.
Host Amber Smith: So if a woman has a prescription for a mammogram from their doctor and they make an appointment to come to the mammo van at a certain time and location, beyond that, how do you recommend that women prepare for their mammography appointments?
Wendy Hunt: There's just a few things women should keep in mind when they're scheduling their appointments. There's a couple of weeks out of the month, if women are still menstruating, that their breasts will be more tender, usually the week before their period and the week during. So if you're able to schedule that at maybe the week after, when you're done menstruating, your breasts will be less tender. That's one of the things to take into consideration.
Another thing is COVID vaccinations and booster shots. We're all going through this right now. Those vaccines, you need to wait four to six weeks after your vaccine or booster. They're given in the upper arm, which is close to the armpit and is known to have shown up as enlarged lymph nodes on a mammogram.
If that happens, then, we bring you back for further imaging, and that can cause anxiety for people. So in order to avoid that, we ask you to wait four to six weeks after any COVID vaccination or booster.
Like you mentioned, Amber, the order, if the patient does not have an order, we can help them obtain that order. We will work with their physician to get that. If the patient doesn't have a physician, we can also work with them to get that mammogram ordered through one of our doctors here at Upstate.
Prior images, that's something that's very important because the radiologist will want to review prior images from previous mammograms and compare them to the current mammogram. And so we ask that people know where they went previously for that imaging and when they went, because we will request them. And that's not a problem; it's what we do, but we just need to know where you went and when, because otherwise it's kind of hard. Sometimes it can be a lot of detective work.
And then the final thing, the day of, we suggest no deodorant, lotions, powders in the breast area before you come for your mammogram, because there's metallic particles in these items that can interfere with the imaging.
Host Amber Smith: About how long do the appointments last?
Wendy Hunt: The mammogram itself, for a woman who doesn't need to see our nurse, is about 15 minutes. There'll be a few minutes prior to that doing paperwork, getting changed, so for someone just coming for a mammogram, I would plan for about a half an hour at the most.
Like I mentioned earlier, for some women who maybe don't have a medical provider, there's a provider at Upstate that provides an order for patients, and in that situation, they will see our nurse before their mammogram, and she'll do a clinical breast exam, which is the hands-on manual breast exam. And along with that, just some breast health education with the patient. And once that's done, the doctor will provide an order, and then the patient can get the mammogram, but the doctor will only do that once. We can't have people coming back every year. The goal is to have them find a doctor that they can establish with. And we do give them information about that and can help facilitate that for them if they want to.
Host Amber Smith: Now, once the mammogram is done, who goes over the images?
Wendy Hunt: The radiologist will read the images. She'll look at the priors (previous mammograms). Like I said, we request those priors. That's very important. For people who have had previous mammography, she needs to see those to make sure that if there is something on this current mammogram that maybe it was something that's been there before, and it's unchanged, so it's not a problem. Or maybe it's something new, and we've never seen it before. So the radiologist will review them. They are required by law to do that within 30 days after the mammogram, and then a letter goes out to the patient within that 30 day time frame, letting them know what the results are.
For patients that have MyChart (an online medical record), once that report is done, it goes right into MyChart, and the patient can access it.
Host Amber Smith: What happens if something unusual is discovered?
Wendy Hunt: If that's the case, we have a nurse on staff that will help patients facilitate additional imaging if they need it, but she will generally contact the patient's provider first, whoever referred the patient, to make sure that the provider's aware that they've received the report and they know what's going on. And if the provider wants to make those arrangements, the provider will reach out to the patient and do that. But if they want our nurse to do it, she does that, too. And for those patients thatget an order from our Upstate provider, the nurse takes care of that with them and gets them set up.
Host Amber Smith: Now, you mentioned MyChart. Can the nurse help someone enroll in MyChart ? That's an online medical records thing, right?
Wendy Hunt: Yes, I'm sorry. Correct. It's the patient portal. I believe any one of our staff would be able to help with the information on how to do that. They can get the patients the information, and we do give them, a brochure or pamphlet regarding MyChart and how to use MyChart, so they do get that information, but contact any one of us for help with that.
Host Amber Smith: Before we wrap up, let's make sure people know, once again, how to make an appointment and how to find information on where the mammo van is going to be. The website: upstate.edu/mobile-mammography.
Wendy Hunt: Uh-huh.
Host Amber Smith: And is there a phone number?
Wendy Hunt: Yes. They can actually request an appointment through the website, so there's a page on there that allows them to do that, but they can also call 315-464-2588 and schedule their appointment through that phone number.
Host Amber Smith: Thank you so much for this information.
Wendy Hunt: Yes, you're very welcome. Thanks for having me.
Host Amber Smith: My guest has been Wendy Hunt. She's the program manager for Upstate's mobile mammography van. I'm Amber Smith for Upstate's "HealthLink on Air."
Here's some expert advice from psychiatrist Dr. Christopher Lucas from Upstate Medical University. How can someone avoid becoming addicted to their cellphone?
Christopher Lucas, MD: Well, the most basic step is to try and limit the use so that, maybe set an alarm or a schedule for how often you will check your phone. Sometimes people are already checking it every few minutes. Then say, OK, I'm going to check it every 15 minutes. And then you could move to unchecking it every half hour, then every hour. And then once you set an alarm, then you could spend that time looking through any emails or notifications and then reset your timer. Now people will get anxious about not responding quickly enough, so you could head that off by letting friends or family know that you might not respond to their messages as quickly as you used to.
The phones have been manufactured to do things called push notifications, where you get a little chirp or pop-up screen when something happens. You don't need to be interrupted by every "like" that your Instagram picture gets or that someone has just released a new episode of your favorite podcast. And so turn off push notifications for as many apps as you can, and really leave the notifications only for the ones that you absolutely need, such as an email or a calendar reminder. And then for other things, only have the notifications for when you're using the app themselves.
People tend to use phones in a sort of distracted way. So they go from one thing to another, to another, and they never really planned to go and check the weather, but they see the app for it. So take distracting apps off your home screen. Put them on a secondary screen or within a folder. Someone also had a suggestion of turning the icon from colorful and engaging to boring and gray, and there are options within the accessibility functions on your phone that would allow you to do that. You might actually want to delete certain apps that are particularly time-wasters or ones that seem to affect you negatively in terms of your mood or yourself esteem.
I think one of the most pernicious components of using cellphones is using them late at night whilst you're in bed just before trying to get to sleep. Although there have been some efforts to try and reduce the light emissions and the spectrum of the light that doesn't affect sleep, just using the phone prior to sleep is likely to make it harder to sleep. Phones and bedtime are definitely a danger area. So don't have the phone be the first thing that you check in the morning or the last thing you look at at night. Just use the regular alarm clock. Charge your phone outside of your reach. And you then won't, potentially, get tempted to use your phone first thing and get stuck in a whole bunch of messages.
If you have a smart speaker, such as an Amazon Echo or a Google Home, you might want to use that. You can ask the questions about what's the weather, or what's the traffic rather than having to go and interact with your phone.
And finally, as in anything where you're trying to monitor or change your pattern of use, you need to keep an eye on how much you're actually doing that. So there are a bunch of apps, like Quality Time or Moment, that can track your smartphone habits. What are you using? How are you spending your time? And then you can set specific goals and then see how well you are sticking to it.
It's obviously a difficult thing to do, and I struggle myself sometimes to put the phone down when I should be doing other things. But it's always a tricky process because all of these phones and all of this software and all of this social media is engineered to try and get you addicted, to keep using so that you'll buy more phones, you'll upgrade your phone and you'll provide more advertising dollars to the various sites that you look at.
Host Amber Smith: You've been listening to psychiatrist, Dr. Christopher Lucas from Upstate Medical University.
And now, Deirdre Neilen, editor of Upstate's literary and visual arts journal, The Healing Muse, with this week's selection.
Deirdre Neilen, PhD: Rob Jacques lives and writes on a rural island in Washington state's Puget Sound. He takes us through a man's determined struggle to stay clear in his poem "It's Not Dementia."
He begins with some lines from Robert Frost:
-- One can see what will trouble
This sleep of mine, whatever sleep it is.
Were he not gone,
The woodchuck could say whether it's like his
Long sleep, as I described its coming on,
Or just some human sleep.
For the life of me, I can't get used to seeing old friends
gone for years visiting me at odd moments, their being
dead no barrier at all to their attentive listening to me,
then disappearing as if they were never here beside me,
their smiles as warm as ever, their bodies as healthy
as they were long ago when we were young humanity.
The walk may be asphalt to you, but to me, I walk on
a soft woodsy duff as I reach out, not for that steel pole,
but for a black birch that grew old beside my school,
that grows there still in my timeless, faultless mind,
and even now its bold, lenticillated bark feels cool
to my hand though you see metal from where you stand.
My birdfeeders, where are they? Where did I put seed?
Here in my room, I search for small things that stray
and are lost to you, but not to me, and I need their feel
between my fingers: rings, coins, photographs, and such
that trigger scenes that seem to be current still and I'm
in them as I was back then: young, robust with a will.
Strings of long-ago conversations yet come to mind.
I try to carry them on even though I know I'm alone
and who knows who's listening? Things I wished
I'd said I say now hoping those who aren't here
still can hear, those who mattered once can know
I haven't forgotten them though time has shattered.
The past is a better place than here, and I dust off
memories to be back bright again in my world of yore
where I was whole and strong and still am in my
mind's eye where there are no stone strangers,
no corridors that lead nowhere I want to go, and I
live inside a blown reverie of what was until I die.
Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York.
Next week on "HealthLink on Air": Is melatonin safe for children?
If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org. Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Stephen Shaw. This is your host, Amber Smith, thanking you for listening.