The Entering Class at Baystate Has a Decidedly Regional Feel

Dr. Margo Rockwell says she recently came across a journal she kept while winding her way through the eighth grade.
She said she just happened to open the book to an entry that today seems loaded with prescience — and irony.
“I hurt my ankle playing soccer, and so I came to the hospital,” she said, paraphrasing what she put down on paper 17 years ago. “I talked about going up to the NICU [neonatal intensive-care unit, where her father, Gary, worked as a neonatologist], where my dad showed me around, and I saw all the babies. And I wrote, ‘maybe someday I’ll be able to work at the NICU — I think that would be fun.’”
Well, that day is here. Sort of.
Rockwell is now a pediatric resident at Baystate Medical Center, and will undertake a rotation in the NICU sometime within the next year. She’s also one of an unusually large number of people who grew up in this region who are part of the new class of residents at Baystate and started work just about a month ago.
Indeed, Rockwell said she found her journal after “moving back home,” a phrase that many at Baystate are using this summer. In some cases, it means back to the house they grew up in, while for others it simply means Western Mass.
BusinessWest talked recently with four of these local residents — a phrase that certainly has a double meaning — three of whom are in the same field, pediatrics, or ‘peds,’ as it’s called. Their stories vary in some respects, but the common denominator is that on March 15, ‘Match Day’ for thousands of medical students across the country, they were thrilled to get the news that they would be coming back to this region.
“I was born here, and my mother was an RN here,” said Dr. Adam Kasper, a 2005 graduate of East Longmeadow High School. He would go on to Lehigh University and then Temple University Medical School, which still distributes old-fashioned letters in envelopes to let students know where they’ll be going for their residency.
As Kasper opened his, he was confident he’d be staying in this time zone — eight of the 12 teaching hospitals he interviewed with are in the Northeast — but was pleasantly surprised to read simply ‘Baystate Medical Center.’
“I’ve got my old bedroom back,” he said, describing his parents’ home as an intermediate-term living plan. “I plan on moving out in the fall, but it’s very nice to be at home; it made the transition from medical school to residency so much less stressful.”
Dr. Elizabeth Langmore-Avila won’t be moving back to her childhood home, but she will be returning to the area where she grew up — she was born in Blandford — and has already worked professionally in the behavioral-health field.
She’s called many other places home along the way, though. She went to college at Vassar in New York, then lived in Mexico for a number of years, where she went to drama school and did community work with children. She returned to this country to pursue a master’s degree at Antioch College in Keene, N.H., and then returned to this region to work, settling in Amherst for awhile before heading off to medical school at A.T. Still University in Mesa, Ariz., where she would focus on psychology (more on that later).
Revisiting Match Day, she said she had interviewed at hospitals on both coasts, but Western Mass. was her preferred landing spot.
“I realized that it has a lot to offer in terms of what I’m looking for,” she said, listing both professional opportunities and quality of life. “And I decided I wanted to come back.”
That goal became reality when she woke up after a long night’s work in an emergency room to see a message on her phone left by someone with the prefix 413. It was the director of Baystate’s Psychiatry program offering her a welcome.
For this issue, BusinessWest revisits four such message deliveries and what they meant to those who received them, but also looks ahead with those individuals at where their current experiences in the place they call home might take them.

Meeting Their Match
As Dr. Laura Koenigs, director of the Pediatric Residency Program at Baystate, talked about Match Day, she referenced what she called the “computer in the sky.”
Others we spoke with used similar language, calling it simply “a computer” or “the computer,” or “a very complicated logarithm.” What it is, where it is, and what it’s called, no one seemed to know.
What they did know is that the software program in this computer would somehow determine their fate — for the next four years and possibly for the duration of their careers in medicine.
It’s called Match Day, because that’s when thousands of matches are announced, said Koenigs, adding that both medical students and teaching hospitals that interview them send their preferences for various specialties to that aforementioned computer, which ultimately analyzes a host of factors and determines where each medical-school graduate will go next.
“You rank programs, and the programs rank you, and you get matches — that’s what the computer does,” said Langmore-Avila, adding that med school students first learn if they’ve been matched (and more than 80% are), then must wait five agonizing days to find out which hospital they’ve been matched with.
Teaching hospitals like Baystate will weigh everything from academic performance to Springfield’s climate — “the cold and the dark can really impact some people,” said Koenigs, referring to the region’s long winters — when they submit their preferences. Meanwhile, medical-school students, some of whom will apply to a few dozen hospitals, will have their own criteria and priorities.
This year, the pediatric program took on 12 new residents, with half of them calling Massachusetts home, and four from the Pioneer Valley.
Dr. Shannon Rindone is among them.

She received her diploma from East Longmeadow High School four years before Kasper (“he graduated with my little brother”), and by then had a pretty good idea that she wanted to follow her parents into the healthcare field — her mother is a nurse at Mercy Medical Center, and her stepfather does the same at Cooley Dickinson Hospital.
“I’ve always been surrounded by it,” she said, referring to the world of medicine. “My mother always said I could be whatever I wanted, and when she would bring me to work, I just loved it — I enjoyed talking to the doctors, the nurses, and the patients, and then I wound up working at Mercy myself as a patient-care technician.”
She said she was first drawn to pediatrics, or what she called “the little people,” while working at Cambridge University Hospital in England as a midwife care assistant. (She went overseas to be with her then-fiance as he worked toward his MBA at Cambridge.) She would go on to attend medical school at Nova Southeastern in Fort Lauderdale, Fla., and is now a DO, or doctor of osteopathic medicine.
On Match Day, she remembers being nervous and also somewhat jealous when a friend attending another medical school received her news a full half-hour before she did. When the e-mail finally arrived, she saw several words, including her name, but the only one she read, or cared about at that moment, was ‘Baystate.’
“The real preference was to come back home, and this is home,” she said, noting that she interviewed at many institutions, including a few in Florida.
She doesn’t, and couldn’t, know what tackling the rigors of a residency 1,000 miles from home, family, and friends would be like, but she acknowleged that having a support system close by (her mother and Mercy Medical Center are a half-mile away) is comforting.
“But at the same time, after a 16-hour day, sometimes you just want to put your head on a pillow, and your sister may want you to come over for dinner,” she noted. “And that can sometimes be difficult, because it’s hard for everyone to understand that you’re exhausted; you’re home, and they want to see you.”
She told BusinessWest that her career could take one of a number of paths, but she has developed a passion for pediatrics, and has shifted her focus there from her original pursuit, the ob/gyn field.
“I realized that the reason I liked obstetrics and gynecology was because of the family interaction and the baby, the product, at the end,” she explained. “And I really fell in love with just dealing with kids of all ages.”
Currently on the rotation known simply as ‘the wards,’ or the ‘floors,’ Rindone said this involves seeing and treating patients in the Children’s Hospital, and represents a steep learning curve.
On the wards, she encounters children suffering from everything from meningitis to seizure disorders to fever. “It’s hard to see them when they’re like that, but it’s wonderful to know you’re helping them and easing the parents’ anxiety.
“Working with kids makes me smile every day,” she went on, “and you can’t complain about a job that makes you smile.”

Close Calls
Kasper can relate.
He said he was drawn to pediatrics while moving through the core clerkships during his third year of medical school at Temple. These also included internal medicine, surgery, family medicine, ob/gyn, and others, with pediatrics somewhere in the middle.
“I just found that I was more interested in the material,” he said of his chosen specialty. “I actually didn’t mind going home and reading about the topics as much as I did some of the other rotations. I just found that I enjoyed going to the hospital a little more each day — I knew this was where I was supposed to be.”
Elaborating, he said he liked the “patient population,” found his personality is better suited for that field than others, and, overall, considered it both more challenging and more rewarding than other areas of practice.
“The potential impact that you have,” he explained, “is much greater than when you’re treating a 70-year-old who’s been smoking for the past 50 years and has no intention of changing anything he does no matter what you say.”
Currently on the genetics rotation, Kasper said behavioral development is next, and as he looks ahead, he’s eyeing each of the segments with equal amounts of anxious anticipation and “dread about how well I’ll perform in them, because I’m still getting my feet under me and getting used to working at this hospital.
“They’re equally exciting to me right now because I’m entering residency the same way I while I was in medical school,” he continued. “I don’t know exactly where I want to go in pediatrics, so each thing is a possibility.”
Rockwell said she’s in a similar state, one where the options are many and most have yet to be explored in depth.
She segued into medicine while majoring in geology and comparative literature at Hamilton College in New York. “You could write about rocks, I guess,” she said with a laugh when asked what one could do with those degrees, adding quickly that she always had medicine in the back of her mind, did pre-med work at Hamilton, and was an EMT on campus.
She enrolled at the University of New England Medical School in Maine, where, like Kasper, she zeroed in on pediatrics rather late in the game — it was her last rotation, and she found she enjoyed working with children and families.
On Match Day, she was in surgery at a hospital in New York City when the clock struck noon and the results are posted. “The surgeon let me scrub out,” she recalled. “I opened my phone, and it was there in an e-mail: ‘Margo Rockwell; Baystate Medical Center; Pediatrics.’
“You were waiting all year for that e-mail, so it was pretty exciting,” Rockwell went on, adding that pediatric endocrinology was her first rotation, and that two months in the NICU, November and May, lie ahead.
She said she might get to work with her father, although they will likely be on different teams. And in the meantime, he’s been a great resource. “I certainly ask him a lot of questions.”
Meanwhile, Langmore-Avila is working with much older patients in Baystate’s Adult Psychiatric Treatment Unit, the adult inpatient facility at the hospital, one of many rotations she’ll experience this year.
Many of those she sees each day as part of a team of professionals have substance-abuse issues, she said, adding that it was work in this realm several years ago at the Riverbend Medical Group that inspired her to go to medical school and pursue work in that field.
“We admit patients, evaluate them, treat them as necessary, and monitor their progress,” she explained, adding that such individuals are then released either into the community or to a treatment facility.
This is work she finds rewarding on a number of levels, especially when she and other members of a team can change the course of someone’s life.
“I did a lot of substance-abuse treatment before medical school, and found it’s a field that I really like,” she said of her chosen path in healthcare. “It’s very much on the front lines, and it’s an opportunity to help someone who may have hit rock bottom. That’s a tragic state of being for a person, and if I can be there in the moment and try to help someone come out of that, get through that … that’s very important to me; it’s very meaningful.”

Local Flavor
As she walked with BusinessWest to the NICU for a few photos, Rockwell pointed to a small courtyard area where staffers can enjoy a meal or a quiet moment.
“That’s where I used to bring pizza for my dad,” she said, adding that she would often deliver him snacks when he was on call for stints that could last 24 hours or more.
Soon, the two might be sharing lunch or dinner there again, only this time they’ll both be wearing white coats and badges identifying them as doctors.
That journal entry logged all those years ago hasn’t officially come to fruition yet, but the younger Rockwell is a giant step closer to making it all reality.
For now, though, she’s another of Baystate’s local residents, and one of many happy to be back home.

George O’Brien can be reached at [email protected]

Sleeve Gastrectomy Is the Hot Option in Weight-loss Surgery

Surgically shrinking the stomach to combat obesity is nothing new in the medical world.
But the options for doing so are looking better all the time.
Specifically, sleeve gastrectomy has begun to overtake gastric-bypass surgery and gastric-banding procedures as the surgical weapon of choice, boasting comparative effectiveness with far fewer side effects.
“This operation is elegant in its simplicity,” said Dr. John Romanelli, medical director of the Weight Loss Surgery Program at Baystate Medical Center. “Anyone in the public can get this. We make the stomach smaller, and the way we do that is, we take out everything but the lesser curvature side of the stomach. In other words, we make a sleeve or a tube of the stomach the width of the esophagus, which comes down until it gets to the bottom of the stomach.”
Unlike gastric bypass, which moves a portion of the small intestine, sleeve gastrectomy is performed only on the stomach itself, he noted, so the digestive process is unaffected. “The intestine is left undisturbed, so it’s closer to gastric banding in terms of digestion, and closer to gastric bypass in terms of performance.”
The procedure, which is irreversible, reduces the stomach to about 25% its original size, thereby suppressing appetite in the same way gastric bypass or gastric banding do, said Dr. Andrew Lederman, director of the Berkshire Medical Center Weight Loss Surgery program.
Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric-bypass operation on extremely obese patients for whom the risk of performing gastric-bypass surgery was deemed too large, he noted. The initial weight loss in these patients was so successful, it began to be investigated as a standalone procedure. Today, it’s the fastest-growing surgical option for weight loss in North America.
The reduced impact on digestion is only one reason why sleeve gastrectomy is attractive to patients and surgeons, Romanelli said.
“From my end of things, very simply, the complications are so much lower than bypass or banding. As one of my colleagues said, ‘it’s like bariatric surgery, except you get to sleep at night.’ That’s key; most surgeons report complication rates of 20% to 30% with gastric bypass.”
He explained that there might be 10 or so little things that could go wrong with bypass, and while each may happen only 2% to 3% of the time, combined, the odds add up. With banding, complication rates are 5% per year, and it’s not uncommon for patients to have to undergo repeat procedures.
“It’s easy for patients to understand, easy to perform, with a minimum of complications,” Romanelli told BusinessWest. “In a lot of respects, it’s the holy grail of operations.”

Who Qualifies?
Sleeve gastrectomy uses a stapling device to create a thin, vertical sleeve of stomach, with most of the original organ then removed. It differs in many ways from both gastric bypass, which divides the stomach into a small upper pouch and a much larger ‘remnant’ pouch and then rearranges the small intestine to connect to both; and gastric banding, which incorporates an inflatable band around the upper part of the stomach to create a smaller pouch. But all three procedures have the same goal: to limit food intake while creating a sated feeling.
Romanelli performed his first sleeve gastrectomy in 2006, and it became more common in 2008 and 2009 as more insurers began covering it. “Success bred success,” he said, “and more patients started asking for it.” By 2010 and 2011, the procedure had gained wide approval, and virtually all payers were on board.
Lederman said people considering weight-loss surgery must have a body-mass index greater than 40, between 35 and 40 with two weight-related health risks, such as diabetes, high blood pressure, high cholesterol, cardiac disease, obstructive sleep apnea, arthritis and joint pain, and incontinence, among others. Typically, candidates are 100 pounds or more overweight, and have already tried other options to lose weight.
He added that, when surgical patients begin losing weight, those obesity-related medical problems often disappear; in fact, 86% of diabetics improve with bariatric surgery, while 74% of type II diabetics are effectively cured of their diabetes.
Romanelli said Baystate’s standards are similar, and he’s particularly intrigued by candidates who present with those ancillary medical issues.
“Those are the people I’m more interested in because we can make those diseases go away and add 10 years to their life,” he said. “I don’t care what dress size they wear; I want them to throw the pillbox in the garbage. They desperately need that.”
As for the age range, typically Romanelli performs sleeve gastrectomy on those between 18 and 65. He said 18- to 21-year-olds are often an underserved population in healthcare in general because they’re transitioning from a pediatrician to an adult doctor and often don’t have a primary-care physician. But it’s important to establish a surgical track record with that group to determine whether even younger patients would be good candidates for the procedure.
When talking about 16- and 17-year-olds, he continued, “the problem is the psychological component; kids aren’t at maturity, so you’ve really got to be careful. A lot of adolescents have serious emotional problems and are probably not suitable candidates.”
In addition, he added, “we’re sifting through much more variable family dynamics.” For instance, if a teenager lives in a house with two morbidly obese parents who do not plan to change their lifestyles, that’s not an ideal environment for gastric surgery.
The upper age limit isn’t set in stone, either, Romanelli said. “It’s not like, on their 66th birthday, they no longer qualify. But a fair amount of data shows that cardiac diseases don’t go away as easily when they turn 65. They’ve already got hardened arteries; the damage is already done.” Meanwhile, complication rates rise in older patients as well.
“But someone who is, say, 67 and in reasonable health, if they want weight-loss surgery, we wouldn’t turn them away. Age 70 has been my limit, but others have gone up to age 80, which I think is a bit excessive.”
That said, Romanelli told BusinessWest, “I’ve done more surgeries on 65- to 70-year-olds in the past year than ever before. There are a fair number who are healthy. But we do take a closer look at them. I have medical colleagues who work with us to give them a once-over before we put them through this elective operation.”

Risk and Reward
All surgery involves risk, Lederman stressed, and even with the reduced odds of complications in sleeve gastrectomy, patients still undergo a medical and psychological evaluation to determine if they are healthy enough to undergo the procedure. Meanwhile, all types of gastric surgery require serious lifestyle adjustment.
“Weight-loss surgery was not an easy way out,” said Tracy DiGrigoli, one of Berkshire Medical Center’s gastric-surgery patients. “I have to make an effort every day to make the right choices in what to eat and to exercise.”
Added patient Michelle Simon Grady, “there are days I get down, but I keep a picture of myself 100 pounds heavier, and people will see me and say, ‘you look wonderful. How do you do it?’ Well, it’s not easy. I eat in moderation, not binging the way I did before.”
Meanwhile, even sleeve gastrectomy carries some drawbacks, Romanelli said. Nausea is common during the first six weeks following the surgery; for some patients it’s profound, while others have a relatively easy time.
But, buoyed by their own research and desire to lose triple-digit weight, patients are increasingly clamoring for this relatively new option.
“I would say 50% who come in are already asking for this operation,” Romanelli said. “The bottom line is, if you’re going to have an operation, the results are about as good as bypass, but it’s a lot safer.”
He went so far as to predict that gastric banding will become relatively rare within three to five years. “I do think diabetics do better with gastric bypass, but everyone else will get sleeves. I think that’s where we’re heading. I’d like to tell you that one operation fits all, but I’m not convinced; it’s not that good, to where we’d do that and nothing else. Patients should have a choice.”
Indeed, “I don’t go out of my way to encourage banding, but if a patient wants it and it’s reasonable, I’ll do it,” Romanelli said, noting, for example, women who want to get pregnant at some point in the future; they can have the band deflated during the pregnancy and tightened afterward. “So there’s an adjustability factor for women of childbrearing age. And bypass is good for people with metabolic disease. But for most people, sleeve gastrectomy is becoming the most popular.”
“Between its effectiveness and relative safety, it’s really the best of both worlds,” he told BusinessWest. “I know that makes it sound too good to be true, and maybe five, 10, 15 years from now, like all things in the media, people will be saying, ‘yeah, that’s too good to be true.’ But the results have been great, and patients are happy. They come in and say, ‘I can’t believe how easy this is!’ I never hear that with gastric bypass. I never hear that with banding patients. But I always hear it with sleeve patients.
“They can eat what they want, just less,” Romanelli concluded. “So they keep the same quality of food and lose weight every week. Who wouldn’t want that?”

With STDs, Information Is Often the Key to Prevention

By DR. PATRICIA BAILEY-SARNELLI

Did you know that nearly 20 million new sexually transmitted diseases — some of the most common being chlamydia, herpes, and gonorrhea — occur in the U.S. each year?
Or that a new Centers for Disease Control and Prevention (CDC) analysis released in March — which included eight common STDs: chlamydia, gonorrhea, hepatitis B virus (HBV), herpes simplex virus type 2 (HSV-2), human immunodeficiency virus (HIV), human papilloma virus (HPV), syphilis, and trichomoniasis — noted that about half of all new infections each year occur among young people ages 15 to 24?
Those numbers, especially among our youth, highlight the critical need for prevention. I see many adolescent girls in my practice, and a part of the problem has to do with their normal adolescent psychological development.
Adolescents go through a phase of magical thinking where they have a sense of invulnerability, that nothing can hurt them. For that reason, they tend to be less consistent about condom use, and that puts them at greater risk. The other part of the problem is their lack of knowledge and general understanding of the risks of STDs. In one study, for example, 25% of urban adolescent females developed an STI (sexually transmitted infection) within one year of first intercourse.
While the terms STD and STI are often used interchangeably, there is a difference, and STI is now being used more often in the public-health sector. The difference can be found in the terminology used to refer to an infection versus disease. You can have an infection spread through sexual contact that may or may not lead to symptoms and a future medical problem, but when it does, the result is a disease. In other words, STDs are preceded by STIs, but not all STIs result in the development of an STD. There is also a belief among some that referring to an infection, rather than a disease, has less of a stigma attached to it and is therefore less embarrassing to talk about.
Also, the CDC cites stigma, inconsistent or incorrect condom use, limited access to healthcare, and a combination of other factors as contributing to higher rates of STDs among teens and young adults.
Despite the challenges remaining, parents and schools are doing a better job about informing young people about sex and its consequences, including discussions about abstinence, reducing their number of sexual partners, and how to correctly use a condom.
The girls that I am seeing now are somewhat better-informed, and most talk about learning about sex in their health class at school. It’s also very important for parents to have a frank discussion with their children about sex and its risks. Literature shows that the results cut across all socioeconomic and racial boundaries, that kids whose parents have spoken with them about sex tend to make better decisions.
When it comes to talking to my young patients about STDs, I tell them that we are all sexual beings, and that the most important part of that is being a responsible sexual being — responsible to themselves, their partners, their family, and their community — and part of that includes using protection against sexually transmitted diseases.
The concern among clinicians is that, while most of these infections are treatable — many are curable — some can result in serious health consequences if left undiagnosed and not treated early. Also, the CDC’s March analysis noted that, while the consequences of untreated STDs are often worse for young women, the annual number of new infections is about the same between women and men.
According to the CDC, four of the STDs included in the analysis are easily treated and cured if diagnosed early: chlamydia, gonorrhea, syphilis, and trichomoniasis.
Because they often have no symptoms, many of these infections go undetected. However, even STDs with no symptoms can seriously affect one’s health. Undiagnosed and untreated chlamydia or gonorrhea can put a woman at increased risk of chronic pelvic pain and life-threatening ectopic pregnancy, and can also increase a woman’s chance of infertility.
But while gonorrhea and chlamydia can be treated with antibiotics and cured, other STDs are lifelong, affecting both the physical and social health of an individual.
HSV-2, HBV, and HIV are lifelong infections that together account for nearly one-quarter of all prevalent infections. HSV-2 can lead to painful chronic infection, miscarriage or premature birth, and fatal infections in newborns. HBV can lead to cirrhosis, a life-threatening liver disease. And HIV damages a person’s immune system over time, increasing an infected person’s susceptibility to a number of diseases. Additionally, nearly 18,000 people in the U.S. die of AIDS each year.
Herpes, which will affect you for the rest of your life, is a very individual disease process. Some will experience a single outbreak, then may go for years without another. Others will have an outbreak every month. As for the psychological and social repercussions, those with herpes must make the responsible decision to tell a new partner and face the consequences of how they will react to the news. This can have enormous consequences and seriously affect one’s ability to connect with others throughout their life.
Also, when you think about sexually transmitted diseases, most people don’t always think of human papillomavirus (HPV), which can cause cervical cancer. HPV, for which there is no treatment, is the second-leading cause of cancer deaths among women worldwide. The virus accounts for the majority of prevalent STDs in the U.S. today, and more than half of sexually active men and women will become infected at some time in their lives.
While there is no cure for HPV infection, there is a vaccine that parents can have administered to their sons and daughters to protect them from certain HPV-related diseases. In fact, the CDC recommends routine vaccinations with Gardasil for boys and girls ages 11 or 12. Gardasil is given as three injections over a six-month period.
Based on information from the gardasil.com website, the vaccine helps protect against four types of HPV. In girls and young women ages 9 to 26, Gardasil helps protect against two types of HPV that cause about 75% of cervical cancer cases, and two more types that cause about 90% of genital warts cases. In boys and young men ages 9 to 26, Gardasil helps protect against approximately 90% of genital warts cases. Gardasil also helps protect girls and young women ages 9 to 26 against approximately 70% of vaginal cancer cases and up to 50% of vulvar cancer cases.
As importantly noted on the website, “Gardasil may not fully protect everyone, nor will it protect against diseases caused by other HPV types or against diseases not caused by HPV. Gardasil does not prevent all types of cervical cancer, so it’s important for women to continue routine cervical cancer screenings.”
In addition to the severe human burden STDs place on individuals, STDs also cost an already-stressed American healthcare system nearly $16 billion in direct medical costs alone, according to CDC figures.
Baystate Medical Center’s two community health clinics — Baystate Brightwood Health Center and Baystate Mason Square Neighborhood Health Center — offer both free testing and treatment of sexually transmitted diseases. STD testing is available Monday through Friday from 8 a.m. to 4 p.m., including rapid HIV testing, as well as testing for gonorrhea, chlamydia, syphilis, and hepatitis C. Nurse practitioner Rebecca Reed also provides exams and treatment at Brightwood Health Center on Tuesday and Mason Square Neighborhood Health Center on Wednesday from 8 a.m. to 4:30 p.m. She is also at Brightwood on Friday from 8 a.m. to noon and at Mason Square from 1 to 4:30 p.m.

Dr. Patricia Bailey-Sarnelli is director of Pediatric and Adolescent Gynecologic Services at Baystate Medical Center.

Studies Show Acupuncture Helps Treat a Broad Range of Conditions

Emily Angotti had never heard of the Chinese method of healing known as acupuncture until her daughter came home from medical school and told her about it.

But it has made a remarkable difference in her life and is a modality she has turned to repeatedly for pain and other problems.

“I would probably be in a wheelchair without acupuncture; I was looking for anything that would help me when I found it,” she said, adding that she has rheumatoid arthritis, fibromyalgia, lung cancer, and severe allergies. “I don’t know how it works, but for me it has been a miracle.”

Angotti said her family doctor sent her for treatments when physical therapy failed to relieve the pain she was suffering as a result of from fibromyalgia. “It was so bad that I couldn’t walk,” she told BusinessWest. Acupuncture has also helped with stabbing pain that occurred after she had a portion of a lung removed and medication made her so nauseous she couldn’t continue taking it. “It helped me breathe better and has also helped my allergies.”

Marianne Mahoney and her family have also benefited from acupuncture.

“I began getting it for my daughter when she was 7 years old,” she said, explaining that she was uncomfortable with the idea of putting the girl on steroids for a long period of time for an autoimmune disease. “I did a lot of research and was concerned about the side effects of the drug. And I have no doubt that Chinese medicine was one of the factors in her slow, but profound, recovery.”

She also utilized acupuncture herself after a variety of surgeries that resulted in pain and complications. “It works on all aspects of your health and well-being. Every time I have acupuncture, I get a deep sense of immediate relaxation, and it has provided me with enormous relief over a period of time,” she said.

Angotti and Mahoney are among millions of people who have turned to acupuncture for help in relieving pain and curing conditions that range from insomnia to infertility, headaches, asthma, depression, anxiety, and more.

The treatment, as defined by the National Center for Complementary and Alternative Medicine, is a procedure that stimulates points on the body through a variety of techniques. The one most often scientifically studied involves penetrating the skin with thin, solid, metallic needles that are manipulated by the acupuncturist or by electrical stimulation.

“It’s a great treatment for a variety of conditions and has been used for more than 5,000 years,” said licensed acupuncturist and nationally certified herbalist Susana Byers, who has offices in Easthampton and Amherst. “The great strength of Chinese medicine is that it is truly holistic, since it treats the connection of body, mind, and spirit as one. In fact the World Health Organization recognizes acupuncture as effective for treating allergies, depression, dysmenorrhea, headache, knee pain, low back pain, adverse reactions to radiation and chemotherapy, as well as a host of other conditions.”

Dr. Shewee-Tian Chou, of the Acupuncture and General Medicine Center in Springfield, is a licensed physician in China as well as the U.S. He practices Eastern and Western medicine, incorporating Chinese herbs and other modalities into the treatment plan as needed.

He began studying acupuncture in China 57 years ago under his father’s tutelage. “When I was 7 years old, I saw my father help people in wheelchairs and thought he had magical powers,” he told BusinessWest, adding that he spent years studying Chinese medicine, became a physician in the Republic of China, then went on to study Western medicine to gain modern scientific knowledge, and finally became a board-registered physician in Massachusetts.

“In Oriental medicine, a disease is viewed as the result of an imbalance in the body,” Chou said; practitioners of acupuncture aim to correct that imbalance.

The needles used in the treatment are usually about the size of a cat’s whisker, so there is little if any pain and no bruising. They typically remain in place for 15 to 30 minutes. In ancient times, they were manipulated by hand, but today, battery-operated electrical stimulation is used, which is consistent and comfortable.

“But the needles must pierce the skin to a certain depth and in a certain direction,” Chou explained. “It is not a simple procedure that someone educated in Western medicine can learn in a short period of time.”

And success depends on the severity of the problem. “The longer someone waits, the longer it will take to fix,” he said.

 

Inner Workings

Although many people turn to acupuncture to resolve a specific issue, others use it to maintain their health and well-being.

“There are many diseases and physiological dysfunctions that do not yet amount to a disease that can be cured by acupuncture,” said Chou, explaining that sometimes people go to their doctor with vague symptoms and leave without a diagnosis, but still don’t feel right.

Byers concurs. “Acupuncturists are interested in your diet, your lifestyle, and all aspects of your life as it impacts your health,” she said. “A lot of people feel there is something wrong with them, yet nothing shows up in tests, so their doctors send them home. But they still don’t feel right. And acupuncture is really good at putting the body back in balance by improving the immune system.”

The cost of private sessions typically range from $60 to $125, although there are low-cost clinics at which treatments cost $20 to $40. And some acupuncturists use a sliding scale.

“People generally feel somewhat better after one treatment, but to fully resolve a problem may take a number of treatments,” Byers said.

Chou said his working definition of acupuncture is that it “works to normalize physiological functions by balancing the chemicals in the body.”

Chinese medicine says energy comes from chemicals, and energy runs through meridians in the body. “Even water has a chemical formula,” he said, adding that chemicals are used in every bodily function, including digestion.

Chou was the director of a hospital in China that employed both types of medicine, and he treated people from all over the world, including a doctor from Florida who wanted to learn acupuncture. He also trained many practitioners in the discipline.

He said the modality was first discovered about 5,000 years ago when a cave dweller’s illness was cured due to pressure from pointed objects on certain parts of the body. “And experience taught man to apply pointed bamboo, wooden sticks, or rocks to certain locations on the body to treat illnesses. Gradually, Chinese physicians discovered the nerve centers strategically located at certain vital points of the body, Chou noted.

But although acupuncture is an ancient form of medicine, it did not become popular in the U.S. until 1972, when President Nixon’s secretary of State, Henry Kissinger, traveled to China accompanied by a journalist for the New York Times. The journalist had an emergency appendectomy in a Chinese hospital, and doctors there used acupuncture to relieve his pain.

However, Byers says many misconceptions exist about the treatment. “Some people think it’s nothing more than a placebo. It’s very hard to prove how it works in a way that Western medicine accepts. But there are many scientific studies that show that it is effective,” she said.

Byers offered more insight in how acupuncture works. She explained that, when life energy, known in Chinese medicine as ‘qi’ (pronounced ‘chee’), doesn’t move smoothly through the body, it is due to a blockage in the meridian. For example, when a person has neck or shoulder pain and feels a knot or hard spot, it is the result of the blockage of energy.

Chou said treatments enhance the immune system by causing the brain to release positive chemicals. “Acupuncture stimulates the skin, and the nerve endings transmit the sensation through the spine to the brain. Then the brain discharges chemicals, including endorphins, hormones, and others which the body needs to fight the disease and increase the immune system. The brain produces chemicals instead of the person having to take medication.”

The goal is holistic treatment of the entire person, since a blockage can result in a variety of symptoms or conditions that can affect people in different ways.

“We treat the person, not the disease. For example, if someone is suffering from insomnia, it may be due to a variety of reasons,” said Byers, adding that causes could range from constipation to worry or anxiety.

“There is not one treatment strategy for any Western disease,” she told BusinessWest. “But acupuncture is very good at helping people minimize sickness, such as the effects of colds and allergies. We can help to build their immune system or treat their fever and sore throat. And if they have a cold, they may also have neck or shoulder pain or a runny nose, and we can treat that, too.”

Chou said acupuncture is effective in treating many problems at once, as some are secondary. It works because “we are trying to normalize physiological functions. And different combinations lead the brain to produce different chemicals.”

Scientific studies show acupuncture relieves pain in the body by releasing natural painkillers or opiates, Byers said. But depression often occurs in conjunction with chronic pain.

Mahoney agrees. “When you are ill or injured and have a bad outcome, you get depressed,” she said. “And our bodies can’t be well if we are emotionally stressed. But acupuncture doesn’t separate the two. Acupuncturists look at your whole system, and the way it works is amazing.”

Both Chou and Byers cited cases of people with a wide range of conditions they have helped. Byers recalled, from her early training, conducting an externship at a Veterans’ Administration hospital where acupuncture was used to treat patients who could no longer take pain medication due to damage to their kidneys. “It provided them with the only pain relief they could get,” she said. “And there is a cumulative effect with treatments. The more you have, the longer the relief lasts.”

 

Health Maintenance

Byers often combines acupuncture with Chinese herbal medicine, which she says is quite safe as long as the herbs are obtained from a licensed, certified practitioner.

“Many people use acupuncture as a last resort,” she said. “But it is more effective if people seek treatment earlier. It is very valuable and is a complementary form of treatment that can be used in combination with Western medicine.”

Mahoney agrees. “Acupuncture is phenomenal,” she said. “I have a smile on my face after a treatment. And we are lucky to have many skilled acupuncturists in Western Mass.”

Therapy Dogs Make a Difference in the Lives of Children and Adults

Jesse Hagerman says magical things happen when therapy dogs visit Shriners Hospital for Children in Springfield and interact with the patients.
“They light up; it helps them forget why they are here,” said the hospital’s child life supervisor. “These dogs can evoke wonderful responses, and I have seen children really open up around them. “It decreases the anxiety and stress of being hospitalized and enhances self-esteem because the dogs offer non-judgmental, non-threatening attention and give the children unconditional love.”
The canines and trainers that visit the hospital come from K-9 for Kids Pediatric Therapy Unit, a volunteer, nonprofit organization that serves children in Western Mass. and Connecticut. It was established by president/director Melissa Kielbasa of Sandy Hills Farms in Westfield in 1999 at the request of the Melha Shrine Unit, and has expanded to serve other pediatric medical facilities, camp and library programs, school systems, and a youth detention facility.
“The visits are designed to offer emotional support,” Kielbasa said, adding that some handler/dog teams also work with adults in nursing homes and hospitals.
The K-9 program includes dogs who like to cuddle as well as a number who have been trained to do unusual tricks and entertain children. “One dog will hide on command, and the kids think it’s hysterical,” Kielbasa said. Another rolls over on her back and drinks out of a baby bottle which it holds with its front paws. “My dog sneezes on cue. We have dogs that dance, and we have a talking pug that does a yodel that sounds like ‘I love you.’
“And they all love to be petted,” she continued. “Other species might not tolerate it, but dogs are looking for relationships and just want to please people.”
Research shows the interaction between therapy pets and patients is indeed pleasant. The specially trained dogs offer valuable benefits to children as well as adults in settings that include hospitals, hospice units, nursing homes, assisted-living centers, and rehabilitation facilities, to name a few.
Diane Mintz, executive vice president of Spectrum Home Health and Hospice Care, a program of Jewish Geriatric Services in Longmeadow, says its hospice patients and the families it serves find pet therapy extremely beneficial.
The organization works with Bright Spot Therapy Dogs Inc., another all-volunteer, nonprofit group founded by Cynthia Hinckley of Westhampton.
“The dogs are very sensitive to how the person is feeling and are very gentle. When they visit, it makes people smile and brings joy into their day,” Mintz said. “It’s a bright spot for them. Sometimes, when a patient is in a declining state and we gently introduce the dog, they say endearing things to it. It’s comforting for them to have a dog there.”
She noted that the pets are content to simply relax by a person’s side.
Hinckley says dogs from Bright Spot visit hospitals, public and private day and residential schools, psychiatric facilities, senior centers, rehabilitation facilities, and schools with reading programs for children. “Whenever I leave a visit, I know I have made at least one person happier, more comfortable, and less lonely,” she said.
Studies have shown that therapy dogs provide comfort and facilitate learning, and researchers continue to seek empirical evidence to support the theory. The University of California Irvine has begun a four-year, $2.2 million study to learn whether pet therapy can help children with attention deficit hyperactivity disorder improve their social skills and control their symptoms. Meanwhile, other studies in recent years have focused on therapy dogs and people with Alzheimer’s disease.
In addition, last year, a Wall Street Journal article chronicled research that proves a few minutes of stroking a dog reduces the stress hormone cortisol, while a study done at Monmouth Medical Center in New Jersey showed patients waiting to have magnetic resonance imaging (an MRI) found interacting with a therapy dog soothing.

Intense Training
Bright Spot has 90 dogs and 80 volunteers in its program. There is no fee for its services, but the dogs and their handlers must undergo specialized training before the animals are certified to work in therapeutic settings.
Hinckley has been engaged in pet therapy for 20 years, and founded her program in 2004. She became passionate about the mission when she went into a psychiatric facility with one of her dogs and a patient who hadn’t spoken in 20 years began to talk.
“It changed my life,” she said, adding that she runs classes and certifies dogs and their trainers, and has evaluated and mentored hundreds of therapy-dog teams in Western Mass. and Connecticut.
The first step is a phone interview. “The most important thing is their temperament,” Hinckley said, adding that she asks a series of questions to determine if the dog has ever shown any aggression. She also advises owners to take their dogs everywhere they go because the animals must remain calm in a variety of settings.
During training sessions, they work on obedience and control. Dogs must obey commands at all times, never jump on people, and not bark incessantly for any reason. Surprisingly, although some dogs do well during training, they don’t do well when they encounter unusual situations.
Hinckley said one dog panicked at a nursing home when it saw someone approach who was using a walker. “Therapy dogs have to be able to deal with loud, piercing noises and equipment such as hospital carts, food trays, medical devices, and machinery, Hinckley explained. “And if they are visiting children, they have to be able to deal with the unexpected. Some dogs are better with children, while others are more suited to adults or the elderly.”
When she certifies a dog, she makes a recommendation about the type of facility and population it is suited to work with. However, the owner must also be comfortable with the setting. “I recently evaluated a dog that would be fabulous for hospice work, but the owner said she couldn’t do that,” she told BusinessWest.
Cooley Dickinson Hospital in Northampton and Bright Spot formed a working partnership in 2005. “They do a wonderful job and have dogs that are uniquely suited to a hospital environment,” said Robin Kline, the hospital’s director of volunteer services, adding that CDH is grateful to Hinckley because she worked closely with them for several years to get the program off the ground.
However, before dogs and trainers are allowed into the hospital, Kline conducts an additional screening that includes immunization records and a criminal record check on the handler.
Once that is complete, remarkable things can occur.
Kline says the dogs help patients cope with depression, loneliness, and feelings of isolation, and also stimulate social interaction. She explained that, when the handler introduces himself or herself and the dog, it often sparks conversations about a pet the patient had as a child or a dog they have at home.
“It’s part of the magic that occurs with therapy dogs,” she said. “There are really wonderful moments because the handlers are skilled at creating connections and can help patients who haven’t responded or communicated much. And the dogs have a calming effect on patients. Their presence makes the hospital environment more homelike and brings some relief to the stress of being ill.”
If the dog is small and the patient doesn’t have health issues that prevent it from getting in their bed, they often end up cuddling with the animals. “We have had some beautiful little dogs on beds, and the patients love it; it really cheers them up,” Kline said.
The program operates on the North 3 ward and in the psychiatric unit of the hospital, where the dogs are introduced in a group setting. And if people are having a difficult day, that can change when they interact with the gentle canines.
“A dog can really improve someone’s mood. When patients pet a dog and say, ‘I love animals’ or ‘this is such a good dog,’ they are clearly having a positive experience,” Kline said, adding that staff members really appreciate the volunteers who bring their pets to the hospital.

Creating Relationships
Kielbasa also trains therapy dogs at Sandy Meadow Farms. In addition to a general course, she runs an approved, seven-week pediatric therapy dog unit training class.
But taking the class and passing the certification exam are not enough to qualify for her K-9 program. The dogs and handlers must also pass the K-9s for Kids Performance and Evaluation Test and the American Kennel Club Canine Good Citizen Test. In addition, their handlers undergo background checks.
K-9 teams are used in the Read to Rover program at Franklin Avenue School in Westfield, which was designed to help children who have difficulty with reading.
When the dogs arrive in the classroom, all the students are allowed to pet them before they are sent off with the children in the program.
“It helps with their self-esteem because their classmates think it’s pretty cool. Plus, it provides an opportunity for them to sit and read to a very attentive and loving audience,” said teacher Carly Bannish, explaining that the child sits on a beanbag, the dog sits on a little carpet, and the trainer sits nearby on a chair and is available if the child needs help with a word.
The program has resulted in an increase in reading fluency and comprehension. “The dogs are a non-judgmental audience, so it is a very safe environment for the children to practice something that may be difficult. The dogs give unconditional love, whereas adults correct children or try to help when they make a mistake, which can get pretty frustrating,” Bannish said.
Kielbasa concurs. “The dog doesn’t care if the child reads correctly or mispronounces a word, which can be embarrassing if they are reading aloud in their classroom,” she said.
Children who are hospitalized can suffer from anxiety and stress, and Hagerman said the K-9 dogs also improve life at Shriners. “The environment here can be intimidating as there are so many things that are new to children. The dogs make them feel more at home, and if a child is having a down day, the dogs can really lift their spirits.”
Visits take place in the hospital auditorium because animals are not allowed in the direct-care areas due to stringent infection-control policies, which include a handwashing protocol. However, all children who are medically able to attend are invited.
Peyton Malloy entered Shriners Jan. 9 and was there until the end of the third week in March. “It was so exciting for him every time the dogs came to visit. He looked forward to it,” said his mother, Anne Malloy.
The 6-year-old would hold the small dogs on his lap and pet them and play fetch with the larger breeds and try to make them do tricks. “He would stay for the entire hour. He absolutely loved them, and it made a real difference,” Anne said. “It was something he looked forward to. He would peek out of the door to see if they were coming. And when the talking pug said, ‘I love you,’ he would say it back to the dog.”
Hagerman said the opportunity to play or cuddle with a dog has inspired children to leave their rooms, which can improve mobility and help with their mood. “It provides a diversion from the normal hospital routine, helps them pass the time, and is something to remember that is positive,” she said, adding that staff members take pictures of the children with the dogs, which they are given to bring home.
Kielbasa agrees. “It takes their mind off of things, especially if they are facing surgery or doctor’s appointments. And we do just as much with the parents as the children, as they are also nervous. It doesn’t solve anything, but it helps with what they have to deal with that day,” she said.
Playing with the dogs can also aid in physical therapy, as the interaction involves movement that is fun, rather than repetitive. And in some cases, children who have been hospitalized for months have developed strong bonds with the canines.
That also happens in the hospice setting. Mintz says it’s not unusual for a dog to cuddle in bed with a hospice patient. “It is very therapeutic because relaxation takes place when that occurs. And when our patients pet the dogs or talk to them, it distracts them from their symptoms. It is also a way to help them feel connected. Sometimes there is an opportunity for a patient to be involved with a dog for a few weeks or months, so a relationship develops.”
Kielbasa has also seen dramatic changes during visits a team makes to a youth-detention facility. “When we first started going there, the girls were tough and cold. But after a couple of months, they turned into marshmallows when they saw the dogs walk in. They got excited, wanted them to do tricks, and giggled and talked to each other,” she said.

Healing Touch
Laura Coon is a nurse manager at the Linda Manor Extended Care Facility in Leeds, and says Hinckley and her dogs are a welcome sight. “The residents light up when she arrives. So many people had a dog when they were at home, and the visits are calming for them because the animals love unconditionally and people warm up to their warmth. It’s lovely to see.”
It’s also a lovely and love-filled experience for all who take part in these programs.