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Remember That People Work with You, Not for You

It’s been said that it’s lonely at the top. But it doesn’t have to be. Even the Lone Ranger wasn’t alone. He had Tonto. Alexander Graham Bell had Watson. And Thomas Edison had William Hammer. So why is it that so many executives today feel so alone and disengaged?
According to a recent Gallup Management Journal survey of U.S. workers, there are three types of employees: engaged, not engaged, and actively disengaged. The survey reported that 29% of the respondents are engaged, working with a passion and feeling a profound connection to their company. The not-engaged group, those who have mentally ‘checked out’ of their jobs, made up 56% of the respondents. The remaining 15% are actively disengaged, not only unhappy at work but acting out their unhappiness and undermining what their more engaged co-workers are trying to accomplish.
Maybe even more surprising, the study found that the actively disengaged group includes as much as 10% of executive-level employees. The Gallup study showed further that engaged employees are both more productive and more profitable. They tend to stay with their companies longer, are safer, and develop better relationships with the company’s customers. It follows, then, that actively disengaged employees are the ‘one bad apple’ effectively spoiling the whole bunch. And the effects are even more devastating if that bad apple is the person sitting in the executive suite.
What has happened here? Why are so many executives unhappy at work? Experience with unhappy people tells us that, very often, their unhappiness is a result of feeling as if something in their lives is out of control. While each individual case will vary, finding the part of your life that is not in control, not in balance, will help you to become more comfortable with your entire life.
Will Rogers once said that, “if you’re riding ahead of the herd, take a look back every now and then and make sure it’s still there.” Most top-level executives recognize that they didn’t get to the top by themselves. They’re like the turtle on the fencepost. He doesn’t know how he got there; he just knows he had help. Here are some tips to find a little more peace in the corner office.

• Recognize that no one works ‘for’ you. They may work for themselves, they may work for their family, or they may work for your customers, but they don’t work for you. They work with you. Developing a sense of team, shared responsibility for success, and shared accountability for non-success will go a long way toward making you a trusted part of the team again.

• Develop a culture of caring. Make friends at work. Find your ‘Tonto.’ The Gallup survey showed that fully 76% of engaged employees strongly agreed with the statement “I have a friend at work with whom I share new ideas.” It doesn’t matter what your position is in your company. People don’t care how much you know until they know how much you care. Ask them about themselves. Then shut up and listen to the answers.

• Create a controlled sense of urgency. Athletes understand this concept beautifully. Football players respond to the snap of the ball with a controlled sense of urgency. Basketball players, hockey players, and baseball players all understand the urgency that must accompany the missed shot, the face-off, or the crack of the bat. A controlled sense of urgency will energize both you and your team.

• Persist. In his book, Half Time — Changing Your Game Plan from Success to Significance, Bob Buford says that there is nothing in life less important than the score at halftime. No matter what your age, your position, your success, or lack thereof, you have the opportunity to do new and exciting things with your life in the second half. Re-evaluate, reinvent, reposition, and go for it.

• Have fun. Join the ‘Compliment of the Day Club.’ Find somebody doing something right, every day, and celebrate it publicly. It’s easy to find people doing things wrong. Change the lenses through which you view your company. Look for the good, not the bad. Change your perspective — and celebrate!

Bottom Line
For anyone who has been there, the top spot in a company can be a lonely place. Typically they have worked hard, made sacrifices, and dedicated themselves to their job and their company. Then they get there and wonder, is this all there is? Now what?
Both personally and professionally, senior-level executives need to repeatedly take stock of where they are. You must recognize and remember that you didn’t get there alone. You must re-engage yourself in your life, both at work and at home. You must remember that your purpose lies in your service to others, to your family, to your employees, and to your customers.
You must care. Do that, and it won’t be so lonely at the top.
Good luck.

James S. Bain, MBA, is an author, speaker, consultant, and coach. He is the founder of Focus on the 5, a division of Falcon Performance Institute, a consulting and corporate-training firm focused on productive performance; www.falconadv.com

Sections Supplements
Two Generations Build on Laplante Construction’s Solid Foundation
From left, Ray and Bill Laplante

From left, Ray and Bill Laplante say their family has built a strong reputation over five decades in business.

Ray Laplante says he’s always been more of a “hands-on guy.”
He told BusinessWest that he was following in his father’s footsteps by starting his own framing and carpentry company back in 1964, and that, while he would subcontract some work for his dad’s firm — called Albert Laplante Construction — his own namesake business went through the roof in the early 1970s.
“When he got out of the service, my older brother went to work for our father,” he remembered. “And when they hired a project manager, there wasn’t really room for me to be there all the time. Even though I was on my own, they did hire me a few times for sub jobs.”
It was a handful of spec houses that he put up 40 years ago, though, that paved the way for Laplante to find his niche in the home-construction market, and he went on to build many such properties in East Longmeadow, Longmeadow, and Wilbraham. “That’s when my business took off,” he said.
But even though his business, R.E. Laplante Construction Inc., started to develop a reputation for fine home craftsmanship that endures to this day, it was his desire to be out in the field that prompted one of his biggest decisions in the company’s almost-five-decade history.
His son, Bill, currently the company president, went to college to get an economics degree. “Basically, I started working here when I was 12 or 13,” Bill said. “I would come after school, during school vacations, and continued that throughout high school.
“During college,” he continued, “I was still in the field, framing or doing finish work, and continued that after I graduated. But in four or five years’ time, I made the transition into the office, doing a lot of the day-to-day functions, and then eventually sales.”
As Bill told the story, Ray smiled and added, “I’m a framer, a carpenter. I don’t have any kind of management education. Although the business was very successful, my plan always had been for him to come in, and bring the business up to that level.”
And that level, as the elder builder called it, was for his son to take over the behind-the-scenes (and front-of-house) operational aspect of Laplante Construction, while he himself builds on the foundation he created and nails down the strategy that continues to bring success to the family business.

Father Knows Best
As president, Bill said, his job is not just to make sure all the bills get paid — “all the day to day financials,” as he called it — but also to be the top-tier salesman for the company. Which is easy when his number-one selling tool happens to be the man who built the reputation he’s pitching.
With a history of building homes that he designed himself, Bill called his father’s expertise “invaluable.”
“He meets with the customer, listens to them, and has an incredible knack for design and for coming up with ideas,” Bill said. “He can take a look at something, especially in renovations, and come up with the ‘good idea’ for that specific project.”
Ray added that some 90% of his clients don’t in fact work with an outside architect. “So when people call us, they’re looking for ideas and for layouts,” he added. “And we have that capability here — we can put it on the computer and do layouts. My brother, Paul, does all the CAD drafting, which we do in-house. Which is great for our customers because we can take them from the design stage all the way through to completion.
“We’re not architects,” he clarified, “but both Paul and I are very knowledgeable with regard to framing, structural needs, and putting things where they need to be. When we run into situations where we need an engineer, we will hire one, but a lot of it we can do ourselves.
“And we do that design work for a fraction of what you would expect a professional architect or designer to do,” he added, emphatically.
As a result of the economic downturn, Bill did say that he’s noticed an overall shift in priority, from new construction back to renovations. “People are staying put, and putting money into their existing homes,” he explained.
But while other firms might have historically shied away from smaller-profile jobs, focusing on bigger budgets and entire houses, Laplante has always made it an unofficial policy to take on all work that met its criteria for a job well done, no matter the size.
“This has always been the case,” Bill said. “We never let go of renovation, remodeling, and new-addition projects.
“Through the years,” he went on, “you get a dip in the economy, or a recession, and renovations pick up. Some builders, when they get busy, might not want to have to deal with the $20,000 remodel job; we always did, no matter how busy we were — just for that reason, to keep the company diverse. And this has served us well.”
Just because a project might be termed a renovation, Ray noted, doesn’t necessarily mean it’s a small-scale project. “Some of these types of work can add up to $500,000 or $600,000.”
In addition, Bill said that a key facet to broadening the horizons for a building company is to always keep pace with developments in the industry. To that end, he has undertaken the necessary coursework through the National Assoc. of Home Builders to receive the designation as a certified green professional. What this means, he explained, is that his role as salesman for the firm now is fully compliant in all that a customer should and would want to know about available green technologies, processes, and products for their project.
“More and more people are looking for it these days,” he said. “But more than just using the word ‘green,’ I’d say that what they are after is energy efficiency. And they are looking for a payback on those investments.”
The key is to look at those technologies and discover what will give the payback that his clients expect, he said, whether that be spray-foam insulation, higher R-value windows, different construction techniques, or siting the house to take full advantage of the sun.
“There are a lot of ways to reduce the energy costs on a new home,” he added. “The nice thing is, we will give our customers that whole array of different products and technologies, and then help them make an informed decision, to decide if it works for them personally, or fits into their budget. That’s really why we tried to get out in front of the green-building process.”

The Family Way
“A lot of people that we work with aren’t price shopping,” Bill told BusinessWest. “They come to us through word-of-mouth referrals, and they trust that we’re going to give them a high-quality product at a fair price. We will bid against other contractors, but one thing we won’t do is compromise what goes into that house.
“I’d say that 75% of our business is just through word-of-mouth referral,” he continued. “That, and the reputation my father has built up over the years of being a high-quality and fair, responsible builder.”
To prosper in an industry that has suffered perhaps more than any other sector in this down economy, both men agreed that the best tack has been to proceed with business as usual. Provided, of course, that one has a track record like the Laplante company.
“It ultimately comes down to trust,” Bill stated. “In many cases this is the largest investment that someone will make in their lifetime. There are so many ways that builders can cut corners, to reduce price or increase their profit, and ultimately it comes down to being able to fully place your trust in the person you’re working with.”
To illustrate that point, Ray told of a recent meeting with a client, in this case someone with whom Laplante has worked in the past.
“We bid on this job; I think it was $80,000 or $90,000,” he said. “Now, they also had gotten a price of $20,000 less, and they wanted to know why. So they called me up and asked if I would go over the price bids. I put them both on the table. The other contractor hadn’t figured in painting, and hadn’t added a number of things — different materials. None of it was written into their contract. We try to be reasonable with our allowances, and because of that level of trust, we are doing that job now.”
Adding to their offerings as homebuilders, father and son have branched out both geographically and in their building envelope. Clients have asked them to build houses on Cape Cod, as well as light commercial structures.
But that doesn’t mean the pair are changing their direction at all. Rather, they’re just doing what their customers have asked of them. And when the conversation arrives at the next generation of Laplantes that might bring the company into the fourth generation of builders, the pair smiled. They aren’t ready to hang up their hammers yet.
Ray said he’d like to have the chance to play a bit more golf, but there’s plenty of time for that in the future.
“My main priority is to maintain the Laplante reputation,” he said. “That’s all I’m looking for.”
When the business of building homes can fall back on more than 40 years and multiple generations of service, that’s a pretty good sign this family is doing it the right way.

Sections Supplements
Gas Prices Shroud Summer Travel Season with Question Marks

Mary Kay Wydra, left, and Michele Goldberg

Mary Kay Wydra, left, and Michele Goldberg show off some of the advertising aimed at drawing people from the Boston area to Western Mass.

There are a number of traditions that are part and parcel to summer in this region — fireworks on the Fourth of July, family getaways to the lake, and stops for ice cream at roadside soft-serve stands, to name just a few.
Two more have been added in recent years: high gas prices, and seemingly endless speculation about the impact they will have on the local tourism industry. And those traditions will continue in 2011. Gas prices are already at $4 per gallon, and most analysts say they will go much higher. This has many restaurateurs and tourist-attraction managers understandably nervous, but there is also the sentiment that the fuel prices will keep people closer to home for their summer fun.
“For Americans, taking a summer vacation is a birthright,” said Mary Kay Wydra, director of the Greater Springfield Convention and Visitor’s Bureau. “People are going to travel, but they will probably make different choices. Based on the fact that it costs $60 to $80 to fill a gas tank, they may visit two attractions instead of three, and may eat at less-expensive restaurants.
“It’s very important this year that destinations show value to the customer,” she continued, hitting on a point that she and others would stress repeatedly as they assessed the approaching summer season.
And to that end, the bureau is teaming up with area venues to offer vacation packages that include hotel stays combined with discounts to hot spots such as the Naismith Memorial Basketball Hall of Fame in Springfield and Six Flags in Agawam.
This year, another of the bureau’s goals is to capture the interest of people in the eastern part of the state. “Our feeder markets are Boston, Connecticut, and New York, and we are targeting our marketing efforts in the Boston area this summer,” Wydra said.
A number of marketing initiatives will kick off in June, including digital billboards, online advertising, and a free coupon book that will be distributed at Exit 6 and Exit 15 on the Mass. Turnpike for a weekend, with signs posted before the exit to alert drivers to the giveaway who might otherwise breeze through the fast lane.
“We are cautiously optimistic about the summer. Our visitor numbers are never as high as major metropolitan areas like Boston, but they are also never as low,” Wydra said. “We are a drive-to destination, so it is important that we do everything possible to respond to rising gas prices. Destinations that get creative and show value to consumers are the ones that are going to be successful.”
For this issue and its focus on tourism, BusinessWest talked with a number of people in this sector about what they expect this summer, and what factors will determine the volume of travel — and spending.

Current Events
Wydra said the area is fortunate to have upcoming events designed to draw large crowds, such as the enshrinement at the Basketball Hall of Fame on Aug. 12, not to mention the Hoop City Jazz & Art Festival (July 8-10), Indian Day at the Museum of Springfield History (July 17), a Mini-Grand Prix car race in downtown Springfield (July 23-24), and the Six Flags concert series. “And if you go farther north, there are outdoor attractions which include zip lines,” she said.
Michele Goldberg, director of marketing for the Visitor’s Bureau, agrees. “There are two zip lines and three whitewater-rafting businesses in Charlemont. Plus there is the Quinnetukut Riverboat cruise in Northfield, the Lady Bea cruise at Brunelle’s in South Hadley, and boating, hiking and fishing,” she said.
Wydra touts the views from the rivers as attractions in themselves. “They are incredible, and the rivers are a magnet that attracts people of all ages,” she said.
Cliff Stevens is cautiously optimistic about the upcoming season. He owns Moxie Outdoor Adventures in Charlemont, which offers white-water rafting, family float trips, and related river activities. He says weather is always a major factor in the business.
“But last year we had a good season and held our own. We are expecting to do about the same this year,” he said.
The downturn in the economy has affected his bottom line, but Stevens hasn’t raised prices in about five years because he knows it’s important to keep excursions affordable.
“I think it will be a good season for local tourism,” he told BusinessWest. “We are no more than a tank of gas away for many people, so I’m optimistic that families will get out and relax. The trips we offer include lunch and have held up during the recession because they are a good value. There are five campgrounds in Charlemont, and people can stay at them, take a hike, go rafting, and have a nice getaway weekend, which has helped us.”
However, the soaring cost of gas has affected his employees, who typically have full-time jobs and work as river guides on weekends because they enjoy challenging situations as well as being on the water. “Some come from Boston, and the first question they’re asking is if I will give them money for gas,” Stevens said. “They are more hesitant to work for a day even though that has been their tradition.”
He is honoring their request because it is difficult to find professionals with enough expertise to navigate waterways that can quickly become treacherous.

Tanks for the Memories
Kevin Kennedy says the geographic area that stretches from the Berkshires to Springfield is home to more than 700,000 residents. “That’s a good-sized audience of people who don’t have to drive more than an hour to get to us,” said Kennedy, staff liaison of Museums10, a collaboration of seven campus museums and three independent facilities that have joined forces to attract visitors. The consortium is facilitated by Five Colleges Inc., which provides administrative support from its Amherst office.
“Each one has a different audience and different strengths, but there is also a lot of overlap,” Kennedy said. He views times such as these when gas prices soar and travel becomes more expensive as an opportunity to reach out to local audiences.
The group conducts an annual survey based on zip codes to gauge the economic impact their visitors have on the economy. Most guests drive from locations less than 90 minutes away, with many coming from Boston, Albany, New Haven, and Brattleboro.
“Because it’s an easy drive, people don’t have to wince too hard when they fill their gas tanks,” Kennedy said. “We’re also seeing folks from Hampshire County who have lived here for years and have been to some of the museums, but not all of them. People are looking for opportunities in their own backyards, and I think it’s good to have an increase in local visitors.”
The license-plate survey, which began in 2007, shows the most notable shift in attendance is the percentage of people from Massachusetts. In 2007, 37.9% of visitors came from the Bay State. That number rose to 47.3% the following year, held fairly steady at 45.6% in 2009, and climbed to 51.9 % last year.
Museums10 is looking to add value to its visits, and although six of the 10 museums don’t charge admission, they do feature gift shops, so the consortium is thinking about creating a card that would offer people reduced admissions and/or gift-shop discounts.

Soar Subject

Mike Desrosiers

Mike Desrosiers says he’s optimistic about the year ahead at the Basketball Hall of Fame.

Meanwhile, things seem to be on the upswing at the Naismith Memorial Basketball Hall of Fame. And Marketing and Media Representative Mike Desrosiers thinks this will be a good season.
“If the recent spring vacation was any indication of how the summer will play out, we are very hopeful,” he said, referring to April school-vacation week. “We had an attendance level that trumped what we’ve done in the past few years, and that is always encouraging.”
Officials at Yankee Candle Flagship in South Deerfield are also optimistic, but their confidence stems largely from measures they have taken to attract visitors.
“We typically see 1 million to 1.5  million people every year,” said Jim Ovitt, director of retail operations. Most guests are within a 2 ½-hour drive, and when gas prices rose in 2008, Yankee Candle Flagship saw more local traffic and fewer visitors from outlying areas.
Its strategy has been to implement a continuous stream of new offerings that keep the attraction fresh and provide more reasons for visits.
“Several years ago when gas prices rose, we looked at what we could do strategically around key events that would drive traffic to this location,” said Ovitt, adding that such efforts have kept the company’s numbers stable. “The fact that we have free admission and offerings for every age makes us very attractive to families of two or more.
“We try to change things to make newness part of the excitement,” he continued, “with events, entertainment, and attractions within the store such as our Wax Works, where people can create their own candles from wax beads with layers of fragrances. It has been so popular, we had to renovate the area twice to add more capacity.”
The candy shop is under renovation, and will reopen as Yankee Candy, while Santa’s Toy Shop is being expanded in line with its successful marketing strategy.
The New England Air Museum in Windsor Locks, Conn. has not experienced the same success. Although the facility is only about 20 minutes from downtown Springfield and a member of the Greater Springfield Convention and Visitor’s Bureau, the attraction has not been faring well, said Assistant Director Debbie Reed.
“The state line seems to scare people off,” she said. “It’s almost like a barrier, and we don’t know why.”
Museum officials hope to reverse this trend via a radio-advertising campaign aimed at the Springfield market. There is optimism, but administrators are adopting a wait-and-see attitude.
“January was terrible because of the weather; the last three months have been OK, but there is uncertainty because of the gas prices,” she said. “This season could be good, or it could be bad; we don’t know what to expect.”
However, a number of special events are also on their menu, including the annual Space Expo, which typically draws visitors from Rhode Island, Connecticut, Vermont, and parts of Western Mass.

The Bottom Line
Looking ahead to the summer season, the ever-optimistic but also realistic Wydra said there are a number of question marks hanging over the tourism sector — another tradition of sorts.
But while there is a good dose of concern about whether gas prices will temper visitation to area attractions and overall spending, there is widespread optimism that this sector will withstand that challenge and post solid numbers.
But as Wydra and others said many times, it all comes down to providing value.
“The term ‘new’ is so important, as new elements keep people coming back,” Wydra said. “And our attractions are always reinventing themselves.”

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Pediatric Dentists Stress Education, Prevention, and Fun

Drs. Laurie Brown and Vincent Trimboli Jr.

Drs. Laurie Brown and Vincent Trimboli Jr. say that, if decay is caught early enough in baby teeth, it can sometimes be healed with a combination of fluoride, proper hygiene, and new toothpaste and dental products.

Drs. Howard Kantor and Marie Tremblay have a brochure in their Northampton office titled, “If Only I’d Known,” and the pediatric dentists say educating parents about what they can do to prevent tooth decay is a critical component of their profession.
“It’s not necessary for tooth decay to be part of a child’s experience. Kids can go through their entire lives without having a cavity if their parents are proactive in terms of diet, brushing, and flossing,” said Kantor, adding that they have seen tooth decay in toddlers as young as 18 months.
Dr. Robert Matthews at the Kid’s Dentist in West Springfield agrees. “Baby teeth are building blocks for the future of a healthy mouth,” he said. “In the long run, it’s cheaper to treat children’s teeth early before they get extensive tooth decay.”
The American Dental Assoc. and the American Academy of Pediatric Dentistry recommend that children see a dentist on or before their first birthday. And, although many people might dispute the necessity of consulting with a professional when teeth are just starting to emerge, experts say a pediatric dentist is as important to a child’s health as a pediatrician.
“The idea is to establish a dental home. It’s not to fix teeth,” Tremblay said, adding that parents should start gently brushing their children’s teeth with a child-sized toothbrush as soon as they erupt, using water or children’s toothpaste to get rid of plaque.
During an initial visit to Pediatric Dental Associates of Greater Springfield in East Longmeadow, pediatric dentists Drs. Vincent Trimboli Jr. and Laurie Brown discuss nutrition, its effect on teeth, what to do if a child falls and injures a tooth, and even the importance of having children wear a helmet with a cage when they play sports such as soccer or teeball. They also explain the benefits and risks of fluoride and how baby teeth differ from adult teeth.
“The anatomy of a baby tooth is different. It has more nerve tissue and thinner enamel than an adult tooth,” Brown said. “So we are trained to treat these teeth differently.”
She added that dental decay is the number-one chronic disease in children. “But it is something that we can control with proper diet and hygiene habits.”
Clearly, dentists who work regularly with children educate their patients as much as they clean and repair teeth. But steering kids to a lifetime of good oral habits — and making the process fun for their often-anxious patients — is a rewarding challenge.

Knowledge Is Power
If teeth aren’t cared for, they can affect a child’s overall health. Baby teeth are present in the mouth during the years of growth and development. So if a child has a toothache, he or she may not get the proper nutrition to grow properly. Baby teeth also affect a child’s speech and hold a space for the adult teeth.
Pediatric dentists advise parents who fear dentists to let them do the talking and use their knowledge to make children comfortable. They are well-equipped to do this, they say, because they are required to complete two to three additional years of training in seven areas of specialty.
In addition to classes in child growth, development, and behavior management, Trimboli noted, they are trained in sedation techniques and must care for medically compromised children and adults before graduation.
The population ranges from individuals with seizure disorder to those with autism-spectrum disorders and cerebral palsy, so dentists must learn how to handle children with special needs. They’re also trained to deal with childhood fears, explain things in a way a child understands, and accomplish necessary dental procedures quickly.
“We are trained to know how our patients will behave and how to approach them as soon as see we them walking down the hall and talk to them and their parents,” Trimboli said, explaining that they pay attention to a child’s body language and how well they interact with people in the waiting room or their staff. “We engage them before we ever use any dental instruments because we want them to have a positive experience.”
Brown gives each child a toy to play with as soon as they are seated in pint-sized examination chairs.
In fact, pediatric dental offices are carefully designed to be inviting to the small set. Matthews’ office has child-sized chairs, and the equipment he uses is smaller than the adult version, which makes it easier for children to tolerate procedures. Computer screens are installed on the ceilings of his treatment rooms and continuously play Disney movies, while Disney posters add a cheerful ambience, and stuffed animals sit on counters for children to hold during treatment. Plus, they can choose a small toy to take home when they leave.
Tremblay and Kantor’s office is also filled with fun. “It’s almost like trick-or-treating when children come here,” Tremblay said. “We give them sunglasses to wear so the light doesn’t shine in their eyes, along with stickers, gifts from our treasure drawer, and a toothbrush and toothpaste. And they get a coupon for a free slice of pizza.”
Brown and Trimboli’s office is like a small village, with rooms for every age, from tots to teens. Each room has a theme, such as Disney or a jungle, and lightscapes on the ceilings feature glowing pictures of fish swimming in turquoise water. Trimboli loves the Beatles, so one of the teen spaces is filled with Beatles posters and a glass case holding a collection of guitars. The dental equipment is hidden beneath counters and pulled out right before use, so children don’t get frightened when they enter the exam rooms.
“What we do affects how the children act, so we try to make the office and our treatment as non-intimidating as possible,” Brown said, adding that she gives small children a stuffed animal to hold to take the focus off the dental procedure.
These extras — along with child-friendly terms pediatric dentists use, such as calling the suction device “Mr. Thirsty” — go a long way toward making a visit to the dentist enjoyable.

More Than Smiles
However, there is a lot more to pediatric dentistry than atmosphere and small treats. Dentists provide parents with valuable education and tell them what is normal, what to expect, and also to check to make sure a child’s bite is developing properly.
Kantor said babies who want a bottle at bedtime should be given water, as once they are asleep, saliva production is reduced, and the sugar in milk or juice remains on their teeth. This also happens when mothers breastfeed throughout the night. “The milk has natural sugars which bathe the teeth,” he said, adding that it can lead to decay.
Sippy cups can also lead to tooth decay if children carry them around all day. “Some children use sippy cups as a pacifier. The child’s teeth should be wiped off after they drink from one,” Matthews advised.
Parents should also brush and rebrush their children’s teeth, as the young ones’ limited dexterity makes it unlikely that they will do a good job. Kantor tells parents to stand or sit behind a child and have the child look up so they can see their entire mouth.
Dentists agree that it’s much easier for everyone if tooth decay is discovered early. “A cavity is a progressive disease and will continue to get worse if it is not taken care of. Cavities should be fixed while they are small,” Tremblay said.
Brown said that, if cavities are caught early enough, they can sometimes be healed or remineralized with a combination of fluoride, proper hygiene, and newer toothpaste and dental products.
He and Trimboli say it’s not uncommon to see 2-year-olds with 10 cavities. But the way a baby tooth is restored is different than procedures used on adults.
In cases where a cavity is deep or a child is very young, it may be necessary to use sedation or put him or her in the hospital to fill it so they can be put to sleep. And if the decay has progressed to the point where the tooth has to be pulled, space maintainers are necessary. If they are not installed, the baby teeth will shift, and the adult teeth may not come in properly.
If decay has reached the nerve and the child will have the tooth for a number of years, pediatric dentists may opt to do a pulpotomy, which is the equivalent of a partial root canal on a baby tooth. “We take out part of the nerve tissue and put in a little stainless-steel crown to protect the rest of the tooth,” Tremblay said. “We don’t want it to abscess, as there is a permanent tooth building beneath it.”
Early orthodontic intervention can also prevent problems. Matthews recently hired an orthodontist to address issues that can be seen as early as age 6. “We want to catch problems early, while the jaw is still developing,” he said.
Trimboli said X-rays and oral exams reveal problems such as extra teeth, missing teeth, double teeth, and cysts. The earlier they are identified, the easier it is to plan a course of action.
In short, there’s a lot more to pediatric dentistry than a small smile. “It’s the whole experience,” Trimboli said. “Most children don’t go to an internist, they go to a pediatrician, which is why they can benefit from a pediatric dentist.”

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Telemedicine Virtually Connects Patients with Doctors and Nurses

Mary Thomas

Mary Thomas shows off a computer monitor that displays the results of daily readings of vital signs taken by patients in their homes via a monitoring system, which transmits the data to a nurse.

It’s been called “the stethoscope of the future,” but the future is already here when it comes to telemedicine. This technology, which essentially refers to any kind of remote monitoring of patients, is used in a range of settings, from home health care agencies and visiting-nurse associations that track the vital signs of patients with chronic diseases to hospitals that use telemedicine in their emergency rooms to diagnose stroke victims. Proponents say the technology is helping people live longer, and more independently, while reducing the overall cost of health care.

Last summer Edna Ogulewicz had triple bypass surgery. When the 83-year-old returned home from the hospital, she didn’t know how to monitor her own recovery.
But thanks to the home-based telemonitoring system used by Mercy Home Care, a member of the Sisters of Providence Health System in Springfield, a nurse was able to see the octogenarian’s weight, blood pressure, and oxygen saturation every day via a computer screen without having to visit her home.
Ogulewicz was given a special blood-pressure cuff, a clip to attach to her finger to measure her oxygen, an oversized scale, and a small base unit which was plugged into the wall and into her home phone line.
Every morning between 6:30 and 7 a.m., she took her blood pressure, weighed herself, and used the oxygen monitor. That information was immediately transmitted to a central monitoring station and then to a secure Web site where a Mercy telehealth nurse could see the readings and determine whether there were any signs of trouble.
“It was very convenient. I am a very nervous person, but I found myself pretty calm doing this,” Ogulewicz said. “I am not a professional, so I didn’t know if the results were good, bad, or indifferent. It was something new, but I liked it, and it made me feel more secure.”
One day, when the scale showed she had gained a few pounds, the nurse called her and, after discussing what she had eaten the previous day, determined it was the result of consuming too much sodium. “It’s nice to have someone watching you,” Ogulewicz said, adding she found the system so beneficial that she told her doctor it would be great for all of his patients.
Ogulewicz is one of many people in the U.S. who are becoming more confident about caring for themselves and their chronic conditions as a result of telemedicine.
The technology is used locally in several settings. Many home health care agencies and visiting-nurse associations have deployed home telemonitoring systems to track the vital signs of their patients who have chronic diseases.
In addition, physicians at Baystate Franklin Medical Center and Baystate Mary Lane Hospital are using telemedicine in their emergency rooms with stroke victims.
“Telehealth is the stethoscope of the future that enables people to get information in a quick and efficient way,” said Mary Thomas, director of Homecare Operations for Baystate Health System’s Visiting Nurse Assoc.

Heart to Heart
In November 2009, the Journal of the American College of Cardiology published the results of the largest analysis ever conducted to measure the effectiveness of telehealth monitoring in patients with heart failure. They found that using the monitoring systems reduced mortality rates by 28% on average and reduced the rate of rehospitalizations for heart failure by 26% on average. That figure is significant, since people with congestive heart failure typically undergo multiple hospitalizations.
And this year, the government launched a new initiative focused on congestive heart failure through home telemonitoring to keep people with the disease out of the hospital. “Congestive heart failure is one of the biggest reasons for hospitalization and rehospitalization in patients over 65, which adds to the cost of health care,” said Sheryle Marceau, manager of clinical practice for Mercy Home Health.
“Patients often don’t understand why they ended up in the hospital or what they need to do to to prevent rehospitalization,” said Thomas.
But they learn quickly with telemonitoring, as a nurse visits their home several times a week to talk about what their daily readings mean. In addition, they are called by the telehealth nurse whenever their readings fall outside of the parameters their doctor has determined is acceptable for them.
“One of the great things is the feedback the patient gets immediately. It’s a real cause-and-effect type of learning and helps them stay out of the hospital. Plus, most patients love it because it gives them a sense of security knowing that someone is keeping an eye on them,” Marceau said.
“People who tend to be non-compliant often see the immediate effect,” she added. “If they eat Chinese food or pizza, they may see a four-pound weight gain the next day, which can put them in jeopardy, as it means they may be retaining fluids around their heart or lungs. Plus, they can call us any time to talk about their readings or ask questions.”
Sue Pickett agrees that the system works to prevent problems and educate patients. “We are trying to catch things before there is a full flareup, and telemonitoring can give us a sign that something may be wrong,” said the registered nurse and executive director of Mercy Home Health Care.
Most patients assigned to Mercy’s system use it for an average of 60 days. If there is a problem, the nurse calls and asks the person how they are feeling. In some instances, the patient is asked to take their blood pressure or other vital signs again, and at that point the nurse determines whether the situation warrants a home visit, a call to their doctor, or, in extreme cases, a trip to the emergency room. Telemedicine also benefits physicians, as they can access two months of daily monitoring results, Pickett said.
Many patients have more than one diagnosis, which can be overwhelming for them to understand. But monitoring makes a difference.
“If this can help them learn how to manage their conditions, it empowers them to have better control over their lives, which means a better quality of life with more time spent at home and less in the hospital,” Pickett said. She added that elderly patients using the system are asking more questions, and the knowledge they gain allows them to become more proactive about their own health.
It also has a ripple effect by reducing the cost of health care. “We know how to get people to live longer, but this results in chronic disease that needs to be managed better in order to not use up our health care resources,” Pickett said.
Baystate has plans to grow its home-monitoring program and include other diseases. “It’s very cost-effective,” Thomas said. “In this economic climate, we are very challenged to provide care that is cost-effective, efficient, and promotes a good outcome for the patient, and this provides us with a lot of opportunity. We have an aging nursing workforce, and telemedicine allows us to monitor people without having a nurse in their home. It doesn’t take the place of an actual visit, but is an addition at no cost to the patient.”
Right now, Baystate is using its system strictly for people with cardiac conditions while Mercy uses its telemonitoring units for patients with congestive heart failure, as well as emphysema or chronic obstructive pulmonary disease.
Mercy also has a patient using the equipment to monitor her blood pressure. “If it goes up, the doctor can adjust her medicine right away,” said Marceau. Additional equipment can be added to monitor low blood sugar or temperature, and even to allow people to do an EKG at home.

In the Hospital
Baystate Franklin Medical Center and Baystate Mary Lane Hospital are primary stroke centers. In order to earn that designation, a hospital must have a neurologist on staff around the clock. These community hospitals accomplish that through the use of telehealth technology at Baystate Medical Center.
If a person comes into the emergency room at one of the two community hospitals exhibiting stroke symptoms (which can include a sudden change in vision, garbled or slurred speech, numbness of the face, weak arms or legs, weakness on one side of the body, trouble walking, or dizziness or a headache that comes on without cause), and if the emergency-room physician thinks the person is having a stroke, they will be given a CT scan, and a neurologist can come on the scene if there is not one in house — remotely, through the use of telehealth technology.
“We have a special, giant TV screen similar to a large plasma TV which is interactive,” said Michelle Mortimer, nurse manager of the emergency room at Baystate Franklin. “The technology allows the neurologist to assess the patient by zooming in on them. They can see each other, and the neurologist works in conjunction with the emergency-room physician to do a full workup.”
This allows people who live far from major medical centers to access the options offered at one.
“Larger medical centers have more resources than community hospitals,” Mortimer said. “But telemedicine is an amazing advancement that allows community hospitals to provide services that would otherwise be out of reach. We use it to help us diagnose and treat patients, and we are able to collaborate and have an array of expanded services, which is always a benefit.”
Thomas concurred. “Technology of the future will enable people to get information in a quick and efficient way,” she said — no matter how far away they are.

Sections Supplements
Bay Path Women’s Leadership Conference Set for April 29

Women make many decisions throughout their lives that impact their present and future situations. Some are well-thought-out, while others are made quickly or without much deliberation.
But the attitude and the way women think about their choices can have a strong influence on how they feel, which is one of the reasons the theme for the 16th Annual Women’s Leadership Conference at Bay Path College is “The Power of Choice.”
The event will be held April 29 from 7:30 a.m. to 4:30 p.m. in the MassMutual Center in Springfield, and more than 1,000 women are expected to attend.
“Everyone takes something away at the end of the day they can use immediately because they are inspired by the speakers and the themes,” said Bay Path President Carol Leary, adding that past participants continue to tell her that the conference changed their lives.
“The day is a gift women give to themselves,” she told BusinessWest. “This conference will give people the opportunity to reflect on what the power of choice means to them and about the choices they are making in their personal and professional lives. By not making a choice, they may not have control over their own destiny.”
Critical life choices women make include whether they will seek higher education and, if so, in what field, as well as whether to have a family and stop their career to raise their children. “Women are at the center of families all their lives and make very critical choices about the paths people take, including their parents and in-laws,” said Leary. “So, at this conference, we have carefully selected speakers who made very important deicisions about how they were going to lead their lives.”
Victoria Kennedy is the keynote speaker for the afternoon. The accomplished attorney and wife of the late Sen. Edward Kennedy is a strong believer in women’s rights and has worked on issues ranging from domestic violence to education. Leary said Kennedy’s marriage was an active partnership, and she chose not to sit on the sidelines.
“When Ted Kennedy passed away, many people thought she would step into the race for the Senate,” Leary said, adding that she was disappointed Kennedy did not make that decision. “But I respected what she did. She made a very clear choice for herself.”
Leary noted that she served on the advisory board for the Western Mass. Women’s Fund with Kennedy, and was impressed that she traveled to the Pioneer Valley to attend the meetings. The goal of the fund is to empower women to reach their full potential through grants and strategic initiatives.
The morning keynote speaker is Wes Moore. He was a paratrooper and captain in the U.S. Army, serving a combat tour of duty in Afghanistan with the elite 1st Brigade of the 82nd Airborne Division in 2005-06. His career has been illustrious; he is recognized as an authority on the rise and ramifications of radical Islamism in the Western Hemisphere, served as a special assistant to Secretary of State Condoleezza Rice, is passionate about supporting U.S. veterans, and formed the organization STAND!, which works with Baltimore youth in the criminal-justice system.
He is also the author of The Other Wes Moore, which he wrote after discovering another man from his city by the same name who was two years older than him and was arrested for the murder of an off-duty Baltimore police officer during an armed robbery.
Moore wrote to him, visited him in prison, and discovered that, although they shared difficult childhoods in the same neighborhood, they had made very different decisions in their lives.
“I am intrigued by his extraordinary story,” Leary said, adding that Bay Path’s entire freshman class read Moore’s tome, and the conference will span generations as college students and professionals mingle together.
“This conference transforms lives,” she told BusinessWest. “This one day can really make a difference in a woman’s life.”
The third keynote speaker is Alison Levine. Despite the fact that she was born with a life-threatening heart condition so severe she was not even allowed to climb stairs until she had surgery at age 13, she was team captain of the first American Women’s Everest Expedition and skied across the Arctic Circle to the geographic North Pole.
In January 2008, Levine made history as the first American to complete a 600-mile traverse from West Antarctica to the South Pole on skis while hauling 150 pounds of her gear and supplies in a sled harnessed to her waist.
“She is a courageous woman who pushed herself. She could have let her childhood heart problem define her,” Leary said.
Conference participants can also choose a morning and afternoon breakout session. The topics are: “Women, Stress, and Fatigue: Best Solutions” by medical journalist Dr. Dolly Atkinson; “True Grit: Can Conscience Be Taught?” by Angela Duckworth; “The Seven Wealthy Habits of Successful Women” by author Deborah Owens; and “Meaning: How Remarkable Women Lead” by Catherine Tweedle.
The conference has a new offering this year. There will be a Career Center in the Exhibit Hall, and in addition to purchasing books and other materials, women will have the chance to meet with speed coaches, have mock job interviews, and receive tips from the coaches, Leary said. They will also be able to have their résumés reviewed.
“The purpose of the conference is not only to inspire and motivate people and provide opportunities for women to use what they learn, but also to help them advance in their careers,” Leary explained. “The coaches will be very honest. The economy is improving, but women may still need or want to find jobs or change careers, and this is an opportunity for them to leave with valuable information.”
There will also be time for networking. In addition, human-resources professionals and recruiters from a number of local firms will be available to talk to women about their careers. Bay Path is undergoing accreditation for a new Physician’s Assistant program expected to open in June 2012, and the director will be there to speak about it.
Students will volunteer during the conference, and Leary said their participation in the past has yielded laudable results. “After Mia Farrow spoke about atrocities in Africa, students started a campus organization to raise money to help women in Sudan,” she noted. “There will be time during this conference for women to think, network, and sit back and absorb everything. The conference hits a chord and meets a need in a lot of women who return to it every year.”
The cost of the conference is $300. For more information, visit baypath.com.