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2 pages. Excerpt: “Information about HRA coverage must be submitted by Responsible Reporting Entities . . . starting in the fourth quarter of 2010.” (Buck Consultants)
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Excerpt: “On the face of it, lifting the retirement age [for Social Security and Medicare] makes sense. Americans are living longer, so they could retire later and still enjoy their golden years. Except??’only some of us are living longer.” (The Century Foundation)
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Excerpt: “Among the issues addressed in the updated guide are references to changes in reporting for Health Reimbursement Arrangements (HRAs). CMS has removed all references from the updated guide that previously referred to reporting only for ‘free-standing’ HRAs.” (Fisher & Phillips LLP)
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Excerpt: “According to the reports, the date of insolvency for Medicare’s hospital fund was pushed back, from 2017 to 2029, because of cost-saving measures in health reform. As for Social Security, without any changes, it will be able to pay full benefits until 2037 and partial benefits after that, the same estimate as in last year’s report, despite temporary setbacks from the recession.” (The New York Times; free registration required)
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Excerpt: “The theory is that the health law will help the financial viability of Social Security because employers will shift money they now spend on health insurance into higher wages. That, in turn, will mean more taxes collected on fatter payrolls to support Social Security and Medicare.” (National Public Radio)
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Excerpt: “The Social Security law allows people to postpone enrollment in [Medicare] Part B without penalty only if, and for so long as, they have group health insurance coverage that is provided by an employer for whom they (or their spouses) are still working.” (Ford & Harrison LLP)
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Fall River received designation as a “Heart Safe Community” at a ceremony at City Hall. Pictured from left are Anne Ferreira, President of Southeast Board of American Heart Association; Keith A. Hovan, President & CEO of Southcoast Hospitals Group; Donna Querim, RN, Cardiac Prevention Coordinator at Southcoast Hospitals Group; Henry Vaillancourt, MD, Director of Health & Human Services for the City of Fall River; Fall River Mayor William A. Flanagan; Acting Fall River Police Chief Daniel Racine; Fred Fowler, Director of the Region 5 Emergency Medical Services Office; Fall River Fire Chief Paul Ford; Margaret Ferrell, MD, Medical Director of Cardiac Interventional Services at Charlton Memorial Hospital; Andrew Old, MD, FACEP, Associate Director of Emergency Medicine at Saint Anne’s Hospital, and Kerry Mello, Marketing & Community Relations Coordinator for Southcoast Hospitals Group.

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FALL RIVER, Mass. — The Region 5 EMS Council, along with the American Heart Association, announced that Fall River has been designated a “Heart Safe Community” during a ceremony today at City Hall. The designation recognizes that Fall River exceeds the requirement for the Heart Safe designation by creating a strong network of heart care that greatly improves residents’ chances of surviving a sudden cardiac problem.

Mayor William A. Flanagan, along with representatives from the city’s health, police, EMS departments, Southcoast Hospitals Group and Saint Anne’s Hospital, accepted the distinction from Fred Fowler, Director of the Region 5 Emergency Medical Services Office, a branch of the Massachusetts Department of Public Health.

“The Southeastern Massachusetts Emergency Medical Services Council applauds the City of Fall River’s past efforts to improve emergency cardiac care for their residents and visitors and its commitment to continuously improving that care,” Fowler said.

Mayor Flanagan said: “This designation will allow our City the opportunity to continue the important task of raising awareness regarding heart health and to promote the accomplishments we have made to date. I wish to extend my sincerest thanks to all who have worked so hard to make this designation possible.”

Fowler presented Mayor Flanagan with a sample of Fall River’s new Heart Safe Community signs, which will be posted around the city to promote community awareness.

The effort to become a Heart Safe Community was lead by several community organizations, including Fall River Health & Human Services department, Fall River Police, the Emergency Medical Services division of the Fall River Fire Department, Southcoast Hospitals Group, Saint Anne’s Hospital, the American Heart Association and the American Red Cross.

“Fall River is in the forefront of providing heart care to our community — from our emergency medical services and first responders to our hospitals,” said John Duclos, Deputy Director of Emergency Medical Services for the Fall River Fire Department. “We all work closely together to constantly improve the chain of survival for heart disease victims.”

Daniel S. Racine, Chief of Police for Fall River, said: “The Fall River Police Department is very proud to be a part of the Fall River Heart Safe Community. We take great pride in the fact that our training and equipment is of the highest standards.”

“Heart disease is the No. 1 health problem in our region and, at Southcoast Hospitals, one of our major missions has been to build advanced heart care right here where it’s needed most — in our communities,” said Keith A. Hovan, President & CEO of Southcoast Hospitals Group, which includes Charlton Memorial Hospital in Fall River. “The fight against heart disease requires strong teamwork, both at our local hospitals and in our community. The Heart Safe designation is evidence that this teamwork is saving lives in Fall River every single day.”

Margaret Ferrell, MD, Medical Director of Cardiac Interventional Services at Charlton Memorial Hospital, said advances in cardiac care at Charlton, such as immediate angioplasty and the availability of open heart surgery, mean that more local residents are receiving the critical care they need to survive heart attacks and cardiac arrest.

“The outstanding cardiac services provided cannot be of value without the outstanding pre-hospital care we have in our community,” Dr. Ferrell said. “We work closely with the local police, EMS and other first responders so that we all share the same expertise.”

Most importantly, all of these cardiac services are available right in Greater Fall River.

“As a community hospital, Saint Anne’s Hospital assists with rapid triage and facilitates transfer of patients for coronary intervention in our community,” said Andrew Old, MD, FACEP, Associate Director of Emergency Medicine at Saint Anne’s. “We are committed to providing outstanding cardiac care and helping to ensure this care reaches all segments of our community.”

Heart Safe Communities is a campaign spearheaded by the American Heart Association to increase survival rates for victims of sudden cardiac arrest by strengthening the “chain of survival” system in communities. The program and the requirements for becoming a Heart Safe Community include insuring the availability of four key resources — early access to emergency care, cardiopulmonary resuscitation, automated emergency defibrillators (also known as AEDs) and the availability of advanced pre-hospital emergency care, such as paramedics. These key resources dramatically increase survival in cases of a sudden cardiac event or cardiac arrest.

Across the U.S., sudden cardiac arrest claims 250,000 lives each year — up to 1,000 daily — of which an estimated 40,000 could be saved by proper implementation of these four resources. In Fall River, the death rate from heart disease is higher than the state average.
“Recognition as a Heart Safe Community means Falls River has taken steps to ensure widespread access to life-saving support for sudden heart attack victims,” said Henry Vaillancourt, MD, Director of Health & Human Services for the City of Fall River.

Fall River has a network of regular CPR training, including monthly American Red Cross courses, instruction in public schools and youth sports organizations and training of not only police officers but also their families. There are also scores of documented AEDs in locations from City Hall to elementary schools, Bristol Community College and a number of local businesses.

While access to AEDs is important, training is still needed to operate the devices and is available through several agencies, including the American Red Cross, Southcoast Hospitals Group and Saint Anne’s Hospital.

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DARTMOUTH, Mass. — Southcoast Sports Performance & Orthopedic Rehabilitation Team (SPORT) is offering a free lecture on how to safely prevent and identify concussions in young athletes. The lecture will be held on Wednesday, August 18, from 6:30 to 7:30 p.m. at Southcoast SPORT at Dartmouth Place, 49 State Road, Mashpee Building, Dartmouth, Mass.

“Whether your child is playing football, soccer or riding a bike, a head injury can be alarming,” said Kathy Thornton, Certified Athletic Trainer at Southcoast SPORT. “We encourage anyone who is involved with youth activities to attend. Our experts will share important information on how to prevent injuries and identify a potential concussion in the event of an injury.”

Topics covered during the presentation include:

How to know if my child has a concussion?
What should I do if I think my child has a concussion?
Do children always recover faster from injury?
Who is at risk for a concussion? (The answer may surprise you.)
How can I minimize my child’s risk of concussion?
Can a poorly fitted helmet contribute to increased risk of concussion?
What can happen if my child returns to play and still has symptoms?

Free and open to the public, coaches of all age groups, parents and youth of all ages are encouraged to attend the lecture. Participants can bring their own helmet for a free professional fit test. To register call Kathy Thornton at 508-910-3443 by Thursday, August 5.

Southcoast Hospitals has the largest hospital-based sports medicine program in New England with more than 14 athletic trainers serving 11 area high schools and colleges.

Southcoast SPORT’s Certified Athletic Trainers are experts in athletic health care and the rehabilitation of athletic injuries. They work in cooperation with physicians, physical therapists and other health professionals to help prevent and treat athletic injuries for athletes from recreational to professional.

For more information on Southcoast’s sport medicine program or to receive a free “Play On” brochure visit www.southcoast.org/sports/.

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WAREHAM, Mass. — Southcoast Hospitals, in association with the Town of Wareham’s Safe Summer project, will be sponsoring a “Sun Safety Day” on Thursday, August 5, at Onset Beach.

The Southcoast Health Van will be at the Onset Pier from 10 a.m. to 3 p.m.

Southcoast staff, representatives of the Barnstable County Health Department and lifeguards for the Town of Wareham will distribute sunscreen and information about the dangers of sun exposure related to skin cancer.

“Skin cancer is a growing problem, particularly among young people, who may feel that they are somehow immune from this disease,” said Catherine Nwosu, MPH, Cancer Education Program Coordinator for the Southcoast Centers for Cancer Care. “It’s important that everyone use safe sun practices such as using sunscreen and minimizing exposure.”

There will be free screenings on the van with a special machine that shows skin damage by using ultraviolet lighting. Those taking part in the program will receive free beach balls and other giveaways and will be eligible for a free raffle drawing.

The Sun Safety Day is part of a summer-long promotion from the Barnstable County Department of Health to educate young beach-goers about sun safety. The initiative will deliver five educational messages:

Understand health risks associated with sun exposure.
Take sun protective measures: wear sunscreen, hats, sunglasses and cover-up.
Avoid sun exposure during mid-day hours.
Understand the UV index.
Discourage teen use of tanning facilities; emphasize increased rates of skin cancers, including melanoma, in young adults due to the use of tanning beds.

For more information about summer safety, visit www.southcoast.org/summer/.

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By Christian S. Pope, DO, FACOG
Diplomate, American Board of Obstetrics and Gynecology
HealthCare for Women Inc., New Bedford and Mattapoisett

Dr. Pope practices at St. Luke’s Hospital, the New Bedford site of Southcoast Hospitals Group. He can be reached at 508-999-6245.

Dr. Pope is a featured columnist for The Standard-Times on women’s health topics. Check out Dr. Pope’s column the first Tuesday of every month at www.southcoasttoday.com.

A woman in her early twenties presents with worsening menstrual cramps, pain of recent onset in her lower left abdomen, and painful relations. She has regular menstrual cycles. What may be her diagnosis?

What you should know about endometriosis

Endometriosis is a major contributor to pelvic pain and subfertility/infertility, and is characterized by endometrial (uterine lining)-like tissue growing outside the uterus. It primarily occurs on the pelvic organs such as the lining of the pelvic cavity, ovaries, between the bladder and uterus, behind the uterus at the top of the vagina, and around the rectum. Endometriosis affects about 8 percent of reproductive-aged women, and more than half of teenagers with pelvic pain and those affected with infertility. It is a major cause of disability and compromised life quality in both women and teenagers. In the U.S., the costs of diagnosing endometriosis and treating its associated symptoms and infertility totaled over $20 billion.

What causes endometriosis?

Not sure! It is multifactorially derived both genetically and hormonally influenced. One theory is “retrograde menstrual flow,” where some menstrual tissue shed during the period flows into the pelvis and establishes growth there. Endometriosis is fed by the hormone estrogen, made primarily in the ovaries.

How Do You Know if You May Have Endometriosis?
A complete medical history, surgical, and family history should be obtained by your gynecologist if you have chronic pelvic pain, painful menstrual cycles and painful intercourse. All patients should undergo a physical exam including a pelvic examination, when age-appropriate. Focal pain or tenderness on examination is associated with pelvic endometriosis in 60 to 97 percent of patients. A pelvic mass, immobile pelvic organs, and nodules felt on vaginal examination are suggestive of endometriosis to the gynecologist.

Typical symptoms are as following: chronic, lasting for more than six months, associated with painful menstrual cycles, painful intercourse, deep pelvic pain, and lower abdominal pain with or without low back pain.

Such symptoms, unfortunately may overlap with other diagnosis and confuse the picture such as pelvic inflammatory disease, pelvic adhesions, ovarian cysts, uterine fibroids, adenomyosis as well as other non-gynecologic conditions such as irritable bowel syndrome, insterstitial cystitis, myofascial pain, depression, and a history of sexual abuse. This vast array of shared symptoms may make the diagnosis challenging in some patients.

How is endometriosis diagnosed?

Currently, the only true way to diagnosis endometriosis is by surgery, a procedure called, laparoscopy. This is when your gynecologic surgeon looks into the abdomen and pelvis through a small bell-button incision and camera. This is the “gold-standard” method to surely diagnose endometriosis. With that said, many physicians will forego surgery at first, and when endometriosis is highly suspected, will start treatment just based on symptoms. At times, endometriosis may appear on imaging such as ultrasounds and MRI, although this is not the typical method used for diagnosis.

What treatments are available?

There is no cure for endometriosis; however there are several successful treatment options as well as methods to control the painful symptoms. Medications used include nonsteroidal antiflammatory drugs (NSAIDS) commonly used to relieve dysmenorrheal (or painful periods). An older NSAID which works well is Ponstel. Your doctor can better evaluate which NSAID is right for you.

Oral contraceptives are also beneficial either used cyclically or continuously for endometriosis-related pain, combined with NSAIDs. This approach is actually the first line of treatment for suspected endometriosis-related discomfort. Additionally, the progesterone-releasing intrauterine device (Mirena IUD) has been proven to reduce painful periods as well as diminish heavy menstrual flow. Furthermore, your gynecologist may prescribe Lupron Therapy, a monthly injection which temporally puts the ovaries to sleep and stops estrogen secretion, thus alleviating and sometimes abolishing endometriosis and its related pain symptoms. You’ve heard of danazol? Well, it’s not really used any longer.

Surgical approaches to relieve endometriosis may be used as first-line therapy or initiated after failed medical therapy, or may be used together with medical therapy. Minimally –invasive laparoscopic surgical techniques are now available and have proven a 65 percent effectiveness in reduction of endometriosis related pain. Unfortunately, recurrence is common which may require repeated treatments in up to 60 percent of patients.

What if you want to become pregnant?

Having endometriosis may make it difficult to become pregnant; however success rates are very good, depending on the severity of the endometriosis. In this case, treatment decisions may become more complex, depending on your age, symptoms, and other health factors. Endometriosis-related infertility is often successfully treated with hormones and laparoscopy, and other advanced fertility treatments, such as in vitro fertilization, may improve pregnancy success.

Conclusions & Recommendations

The young patient in her 20s described in the beginning of this article, has symptoms of pain that are suggestive, and typical of endometriosis. Not all patients have the “typical” presentation. After a complete history and physical examination are performed, an ultrasound should be considered in the evaluation of such patients. In patients such as this, NSAIDS and cyclical oral contraceptives are recommended as first line therapy. If pain persists, a switch to continuous oral contraceptives is indicated for six months or consideration for a Mirena IUD. If these therapies are ineffective, Lupron (monthly injection therapy) is appropriate. Laparoscopic surgery may be indicated at any time in this diagnosis and treatment course as the discretion of the physician and patient.

All women should be counseled about the association of endometriosis and infertility, but women should be REASURRED that they may not have a problem conceiving and that treatment for endometriosis-associated infertility is often very effective.

Where can I get more information?

American Congress of Obstetrics and Gynecology
National Institutes of Health

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