Substance Use Disorder

Judith Branche, MD

National Drug and Alcohol Facts Week is a health observance week for teens that aims to shatter the myths about drug and alcohol use. This year, we recognize this observance from Monday, January 23rd through Sunday, January 29th. Dr. Judith Branche, MD of Cornerstone Family Healthcare’s Center for Recovery is Board Certified in Addiction Medicine and has spent countless hours helping those who suffer from addiction in the Hudson Valley and beyond.

Substance use disorders (SUD’s) affect a significant portion of the population in New York State. Orange County is estimated to have at least 20,000 people who either qualify as having an SUD or whose drug use is categorized as ‘at risk’.

The country, as a whole, is in the midst of an opioid abuse epidemic and addressing this epidemic has become a priority with both federal and local officials. Part of the problem that exists in getting help to patients is the lack of sufficient treatment slots for the number of patients requiring treatment. Another significant problem is the lack of understanding of the problem for what it truly is.

Therefore, I would like to take this opportunity to explain what a substance use disorder really is. Addiction is a chronic disorder of the brain which affects brain chemistry in a significant way. This may be a new concept for many who believe that drug addiction is no more than a moral failing or a character defect that a person should be able to overcome if he or she puts their mind to it. Nothing could be further from the truth.

Science has discovered the facts of this disease and we have thus come into a new era of understanding and treatment of addiction. Drugs of abuse affect communication in the brain disrupting normal chemical pathways and levels of neurotransmitters. These changes, in addition to being profound are chronic.

The key neurotransmitter affected because of addiction is dopamine; this chemical affects the reward system. All drugs of abuse initially increase the levels of dopamine in the reward system; this is what drives the seemingly uncontrolled cravings that occur with use of the drug of choice. But over time these levels actually drop to a subnormal level and more and more of the drug is required to achieve the same effect. In time, an addict must use the drug just to feel ‘normal’.  This is referred to as a resetting of “hedonic tone”. It takes a great deal of time, cognitive and other therapies, often along with medication to reverse this process. A person with a SUD who does not seek treatment and tries to quit on his own is almost assuredly doomed to fail.

Often there is misconceptions that treatment does not work. This too is untrue. Treatment works and the rates of success are similar to rates for other common illnesses such as diabetes and asthma. The problem is that people often don’t know where to turn for help.

The Center for Recovery at Cornerstone Family Healthcare offers comprehensive substance abuse treatment for all drugs as well as alcohol. Anyone who is dealing with a drug problem or knows someone who is, is encouraged to call us at (845)220-2146 for an appointment. Help is available.

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Diabetic Friendly and Delicious Breakfast

Barbara Moschitta MPS, RD, CDN

Cornerstone’s registered dietitian, Barbara Moschitta regularly works with diabetics on their diet and how they can manage their condition. Here is one example of a meal Barbara recommends that you could try this year that is delicious and also healthy!

 

Low Carb Frittata

Ingredients:
2 tsp canola or olive oil
6 scallions/green onions
1 medium bell pepper
1 cup broccoli
8 eggs or may combine or use egg substitute or egg whites to cut back on fat and cholesterol
2 tbsp chopped parsley
1 tsp ground oregano
1/8 tsp tabasco sauce
1 pinch black pepper
1 pinch salt
½ cup shredded cheddar cheese
1 tbsp grated Parmesan cheese
(Recommended: low fat/part skim cheeses)

 
Instructions:
1. Cook the broccoli for 2 minutes in a pot of boiling water. Drain.
2. Heat the oil in a large nonstick skillet over medium heat. Add the scallions, bell pepper, and broccoli. Sauté for 2 minutes.
3. In a large bowl, whisk the eggs, parsley, oregano, and hot sauce until the whites are completely incorporated. Pour the eggs over the vegetables and season with salt and pepper.
4. Sprinkle the cheese on the surface and cover with a tight-fitting lid. Reduce the heat to low.
5. Cook without disturbing the egg mixture until the eggs are set, about 10 minutes. Cut into wedges and serve.

 

Cornerstone Family Healthcare provides a program called Living Well with Diabetes. The next series begins Thursday, January 19 from 2 p.m. – 4 p.m. until April 6. In this program, the health education team works with participants on creating a plan to manage their diabetes. Participants learn how to control their symptoms and live their lives in a healthier way. Those who attend all sessions and complete the program will receive a $15 gift card.

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Exercise as a New Year’s Resolution

Penelope Guccione, FNP, Cornerstone Family Healthcare

 

Many of us set New Year’s Resolutions that involve some level of restriction and include very strict rules. Rules are a huge factor when it comes to a lifestyle change, but may only last for a short period of time. After 28 days or maybe even 3 months, you are more likely to “fall off the wagon”.

So how do you keep your New Year’s Resolution of exercising?

  1. When setting a goal, make sure you set goals that are attainable and maintainable. Set rules that aren’t too stringent and that you will be able to maintain over the long term.
  2.  If you are starting from scratch with no prior exercise in your routine, start off slow. Start with exercising one day per week for 30 minutes, eventually increasing the number of days to three times per week. If you start the New Year by exercising 7 times per week; this plan is too much too fast and is not likely to be followed.
  3.  Make it enjoyable. Great types of exercise are running, swimming, biking, and weight lifting. If something feels less like work and more like fun, you will be more likely to stay consistent and committed.

Cornerstone Family Healthcare is holding Turbo Kick Live on Mondays, January 23rd & 30th from 5 – 6 p.m.  Maximize your workout with ab sculpting moves and fat burning cardio set to the hottest dance music. A $5 donation is requested but not required to participate. Since no experience is necessary, this would be a great way to start your resolution off and try a new workout.

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Flu Season – What You Need to Know

Yes, it’s that time again – flu season is here! Learn how you can prepare for the flu this season in the following article.

What is the flu?
The flu (or influenza) is an extremely contagious virus that is known for causing a respiratory illness. Typically the flu has a rapid onset and may cause symptoms, such as: fever, headache, muscle aches, and fatigue. The flu most commonly occurs during the winter months, but “flu season” is generally considered to extend from September to March. In most cases, the flu causes a self-limited infection; meaning it will make you sick and uncomfortable, but your body will destroy the virus. However, the younger and older populations, pregnant women, or any other individuals with weakened immune systems, are considered to be “at risk” or “susceptible” populations; meaning that these patients may require medical treatment or even hospitalization in order to successfully combat the virus.

How is the flu spread?
The flu is spread from person to person via droplets from a cough, sneeze or while someone is talking. These droplets then spread to nearby people’s mouths or noses, and ultimately to their lungs where the virus replicates.

How long am I contagious if I have the flu?
Most individuals are contagious as early as one day prior to the development of symptoms and up to five to seven days after becoming ill. Keep in mind that this means you are infectious both before and while you are sick.

How can I prevent myself from getting the flu?
Well first and foremost, you should receive the flu vaccine! The Centers for Disease Control and Prevention (CDC) recommends the vaccine as the most important way to prevent yourself from contracting the flu. Ideally, these vaccines should be administered before the onset of flu activity in a community (usually September to October). However, the vaccine can be given at any point during the flu season – it’s never too late! So if you haven’t already received one this season, then please come in for a flu shot today.

Additionally, take preventative precautions, such as: avoiding anyone who is sick, covering your mouth while sneezing/coughing, and washing your hands with soap and water.

Who should receive the flu vaccine?
Routine seasonal flu vaccine administration is recommended for all individuals aged > 6 months who do not have contraindications. Contraindications include: individuals who are allergic to eggs (anaphylaxis) and any individuals who had severe allergic reactions to previous flu vaccines.

The vaccine is available in a variety of different formulations, and the doses and strengths are dependent upon your age and health.

So if I’m allergic to eggs, I can’t receive the flu shot?
The typical flu vaccine (Fluarix, Fluzone) is prepared using a propagation of virus in embryonated eggs. So yes, that’s correct, if you are allergic to eggs, then you are not a candidate to receive the typical flu vaccine.

However, there is a brand new flu vaccine called Flubok that is produced with cell-based technology and does not contain any egg products. This vaccine is FDA approved for adults aged > 18 years and is suitable for anyone with a history of egg allergies.

I received my flu shot last year. Why do I need it this year?
The flu virus is constantly changing in order to adapt and survive. This process is called “drift,” and involves the virus mutating to form new strains of infectious particles. Each year, experts attempt to predict, which strains of the virus to include within vaccines. This process is executed by identifying the strains of the virus that were most prevalent from the previous year. It is a challenging process, but it generally provides strong coverage against the flu. And even if it isn’t a perfect match, it has been known to lessen the severity of symptoms associated with other flu strains.

Are there any antibiotics that I can take for the flu?
No, unfortunately antibiotics will not work for the flu because the flu is a virus and not a bacteria. However, there is an anti-viral called TamiFlu (Oseltamivir) that can be given within the first 48 hours of symptom onset. TamiFlu can decrease the duration of symptoms by one to two days. This medication can help reduce the severity of the flu, and could potentially prevent hospitalizations in those individuals who have pre-existing health conditions. So if you begin to develop flu-like symptoms, then be sure to see your medical provider for evaluation because treatment is available.

For more information about the flu, please visit the Center for Disease Control and Prevention at http://www.cdc.gov/. Schedule an appointment today at Cornerstone Family Healthcare, if you need a flu shot or are experiencing flu-like symptoms by calling (845) 563-8000.

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Healthy Holiday Tips

Brighten the holidays by making your health and safety a priority. The CDC offered 12 steps to keep you and your loved ones safe and healthy—and ready to enjoy the holidays.

  1. Wash hands often to help prevent the spread of germs. It’s flu season. Wash your hands with soap and clean running water for at least 20 seconds.
  2. Bundle up to stay dry and warm. Wear appropriate outdoor clothing: light, warm layers, gloves, hats, scarves, and waterproof boots.
  3. Manage stress. Give yourself a break if you feel stressed out, overwhelmed, and out of control. Some of the best ways to manage stress are to find support, connect socially, and get plenty of sleep.
  4. Don’t drink and drive or let others drink and drive. Whenever anyone drives drunk, they put everyone on the road in danger. Choose not to drink and drive and help others do the same.
  5. Be smoke-free. Avoid smoking and secondhand smoke. Smokers have greater health risks because of their tobacco use, but nonsmokers also are at risk when exposed to tobacco smoke.
  6. Fasten seat belts while driving or riding in a motor vehicle. Always buckle your children in the car using a child safety seat, booster seat, or seat belt according to their height, weight, and age. Buckle up every time, no matter how short the trip and encourage passengers to do the same.
  7. Get exams and screenings. Ask your health care provider what exams you need and when to get them. Update your personal and family history. Get insurance from the Health Insurance Marketplace if you are not insured.
  8. Get your vaccinations. Vaccinations help prevent diseases and save lives. Everyone 6 months and older should get a flu vaccine each year.
  9. Monitor children. Keep potentially dangerous toys, food, drinks, household items, and other objects out of children’s reach. Protect them from drowning, burns, falls, and other potential accidents.
  10. Practice fire safety. Most residential fires occur during the winter months, so don’t leave fireplaces, space heaters, food cooking on stoves, or candles unattended. Have an emergency plan and practice it regularly.
  11. Prepare food safely. Remember these simple steps: Wash hands and surfaces often, avoid cross-contamination, cook foods to proper temperatures and refrigerate foods promptly.
  12. Eat healthy, stay active. Eat fruits and vegetables which pack nutrients and help lower the risk for certain diseases. Limit your portion sizes and foods high in fat, salt, and sugar. Also, be active for at least 2½ hours a week and help kids and teens be active for at least 1 hour a day.

If you need assistance with health insurance visit Cornerstone’s Enabling Services department at 147 Lake Street Newburgh, NY or call (845) 563-8000.

Enjoy your holidays as much as possible by staying happy and staying healthy. Happy Holidays from Cornerstone Family Healthcare!

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Healthy Dental Habits for Children

Did you know that according the Centers for Disease Control and Prevention almost 20% of children between 2 and 19 have untreated cavities and that more that 50 million school hours are lost yearly due to dental pain?

Dental problems can contribute to poor eating habits due to pain, loss of sleep due to pain and loss of confidence due to the inability to talk or smile. This is why it is important to keep your teeth healthy and practice good eating habits.

When should I bring my child to see a dentist?

As soon as the first baby tooth appears so you can discuss proper brushing and the use of a smear of fluoridated toothpaste twice daily.

How can I keep my child’s teeth healthy?

Brushing for 2 minutes 2 times a day and visiting your dentist 2 times a year will make a huge difference in your child’s dental health.

Tips for keeping a healthy mouth?

The major enemy is SUGAR. The sugar in juice, formula and breast milk starts the cavities process in infancy.  For this reason, put babies to bed with a bottle of water only and limit the use of sippy cups with anything other than water at bedtime. Sugar is all around in children’s diets and giving teeth a bath in sugar is a sure way to get cavities.

Brush, brush, brush! Brush teeth for 2 minutes 2 times a day.

Go to the dentist twice a year.

Don’t let your young children brush their own teeth. Keeping your child’s teeth healthy is really a parent’s job until at least 10 years of age. Yes, they want to do it themselves at a pretty young age but really do not have the hand coordination to brush well until about 10 years of age. Parents have to check, at least nightly, and go over missed areas.

Every Tooth Counts; Drive for A Mobile Dental Van

Cornerstone Family Healthcare has three dental offices- two in Newburgh and one in Goshen. We are currently raising funds for a Mobile Dental Van to serve patients who struggle to access dental care. For more information, visit http://www.cornerstonefamilyhealthcare.org/how-to-help/giving-to-ghvfhc/ 

We can help you keep your children’s teeth healthy. To make an appointment, please call (845) 563-8000.

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Eating Raw Cookie Dough

Do you enjoying licking the spoon after mixing your cookie dough? Well, you could be eating raw eggs as part of that cookie dough mix or contaminated flour. Multiple ingredients within the dough could be contaminated by pathogens such as Salmonella and E. coli. There are a number of bacteria that would cause symptoms we consider food poisoning. But all of them cause nausea, vomiting, diarrhea and some combination thereof.

Instead, food safety authorities are most concerned about people eating anything uncooked that contains flour purchased off the shelf or delivered in 50-pound bags to pizzerias and bakeries.

According to the U.S. Food and Drug Administration (FDA), the risk of many of the more debilitating symptoms associated with food-borne illnesses increase for older adults, young children and infants, pregnant women, and people with compromised immune systems.

Store-bought dough is usually pasteurized so it’s not likely that the egg would make you sick.

However, other ingredients in the dough could potentially harbor pathogens as previously mentioned.

Experts say that a prime suspect in a 2009 E. coli outbreak linked to prepackaged cookie dough was actually the flour.

People debate whether egg or flour is the cause of illness from consuming raw cookie dough. Try to find safe snack options for you and your family to enjoy or just wait to eat the actual cookie!

There are also many recipes out there for edible raw cookie dough that is not likely to cause illness. Click the link below to try the recipe.

http://www.familyfreshmeals.com/2014/04/edible-cookie-dough-recipe-two.html

The good news is that you’re okay eating most commercial cookie dough products–certainly in cookie dough ice cream, where the product is intended to be eaten uncooked.

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World AIDS Day: Uniting in the prevention of HIV

An estimated 1.5 million people are living with HIV in this region, including 140,000 newly infected in 2014. The epidemic is driven primarily by injecting drug use, although heterosexual transmission also plays an important role.

World AIDS Day is an opportunity for people worldwide to unite in the fight against HIV, and show their support for people living with HIV and to commemorate people who have passed away.

On Thursday, December 1, 2016 World AIDS Day will be recognized at Cornerstone Family Healthcare with an educational event offering free testing for the community. The event will feature presentations from 12:30 p.m.-2 p.m. from Cornerstone’s Positive Choices Center about PrEP and HIV prevention, Hudson Valley Community Services will be helping attendees understand basic information about HIV and free HIV testing will be provided by Planned Parenthood from 2 p.m.-4:30 p.m. at the 147 Lake Street office in Newburgh.

Cornerstone’s Positive Choices Center was established to give people who are HIV positive and those that fear becoming HIV positive a place to feel safe. The staff at Positive Choices will hold the hand of patients who are scared and confused to guide them into treatment. Other services the center offers include assistance in telling loved ones about their diagnosis and constant education about living a normal life while keeping the illness under control.

“Through more than 25 years of serving clients with HIV, it has been learned that many clients drop out of care or forego care altogether out of fear of being ‘outted’ as an HIV/AIDS patient,” said Rocco Russo, MD a primary care provider at Cornerstone’s Highland Falls office. “As a result of this fear, clients often worry about being seen by friends, neighbors or family accessing care from the Positive Choices Center.”

Dr. Russo is highly involved with the Positive Choices Center and HIV prevention. Aside from being a primary care physician at the Highland Falls office, he also sees patients once a week at the Positive Choice Center to make sure their patients are still receiving primary care services. Overall health is crucial in controlling HIV. Dr. Russo regularly advocates for PrEP and its benefit to the community especially during the HIV/AIDS epidemic.

As an organization, Cornerstone strives to provide access to high-quality, comprehensive, primary and preventative health care services in an environment of caring, respect, and dignity regardless of one’s ability to pay. As an accessible point of HIV care providing PrEP, the funds now available to the organization will improve the quality of life for HIV exposed patients.

For more information about Cornerstone Family Healthcare or the Positive Choices Center visit www.cornerstonefamilyhealthcare.org

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Healthy Home. Healthy Diet. Healthy You.

Christine VanHoy, FNP

Good individual health begins with good community health and equal access to health promoting opportunities. As a leading provider of community-based primary and preventative healthcare, Cornerstone Family Healthcare reaches beyond the walls of conventional medicine and works with community stakeholders to address some of the factors that can lead to preventable disease states such as poor or inadequate nutrition, mental illness, homelessness and substance use and abuse.

Affordable and adequate housing is important to the well-being of families. Without the basics of shelter, food and clothing, the managing of day-to-day living becomes un-manageable. This leads to all kinds of difficulties including falling into poor health.

Having a place to call home provides several benefits to health including receiving consistent health care along with other supportive health care services. It affords the providers of health care and other support services a means of follow-up.

For those who are homeless or living in low-income, sub-standard housing, access to quality, fresh foods becomes a challenge. Challenged nutrition can lead to preventable disease states such as obesity, diabetes, hypertension and a lowered immune system to name a few.

Access to healthy foods is a nationally recognized challenge. A recent national study identified nearly eight percent of the total rural population in the United States as living in communities lacking access to healthy food and nearly 35 percent of those lacking access as also having low income.

In honor of National Hunger and Homelessness Awareness Week and addressing the correlation between the quality of our communities and health outcomes, Cornerstone Family Healthcare would like to highlight Harper Health, Cornerstone’s location offering care to individuals and families in transition.  This location exists for those that do not have a place to call home. It’s the place to go to where you can have your health care needs and  concerns taken care of. It’s a place that provides affordable medical services to all of those in need.

Harper Health, a place where care is provided in a safe, confidential, judgment-free environment.

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Smoking Cessation

Sneha Shrivastava, MD

If you’re a smoker, quitting can be the hardest, yet single most important step you take to protect your health and the health of your loved ones. Cornerstone Family Healthcare’s Sneha Shrivastava, MD from the Internal Medicine Department talked to us about some frequently asked questions regarding smoking cessation.

Can you explain the 5 d’s of smoking cessation? (distraction, discussion, drink water, deep breathing, delay the craving)

1)      Delay until the craving to smoke passes. Most urges come and go within thee to five minutes

2)      Distract yourself. Shift your attention away from thoughts of smoking — go for a walk around the block or call a friend.

3)      Drink water to beat cravings to smoke. This works very well.

4)      Deep breathing is a quick and effective way to reduce the stress that comes with early smoking cessation

5)      Discuss your feelings with someone close to you or with other ex-smokers

 

Can you explain what the typical cessation medications are and how they work?

  1. First-line drug therapies for smokers are combination nicotine replacement therapy (NRT) or the centrally acting medications varenicline or bupropion.
    1. NRT: Nicotine patch, gum, lozenge that will help decrease withdrawal symptoms that a patient might experience after quitting smoking.
    2. varenicline: nicotine receptor agonist that helps in decreasing craving for nicotine and therefore helps in quitting smoking.
    3. bupropion: believed to act by enhancing central nervous system noradrenergic and dopaminergic release that help in decreasing craving for nicotine and therefore help in quitting smoking.
    4. In addition, behavioral counseling also helps in smoking cessation. One of the best resources for patients in the United States is a free telephone quitline (1-800-QUIT-NOW) that will provide follow-up support and counseling to supplement the brief clinician intervention. Patients have also had some success with acupuncture and hypnosis.

Internally, how will you begin to feel once you quit smoking?

-          More energy

-          Breathing improves

-          Increased appetite

-          Positive mood

-          Increased cough which will improve in a few weeks.

 

What are important factors to consider when building a plan to quit smoking?

-          Personal health: smoking increases the risk for having heart attack and stroke. If they already have these medical conditions, quitting smoking would be beneficial to reduce further deterioration of health. If they don’t have these medical conditions, smoking cessation will help prevent these conditions.

-          Family’s health especially if patients have young children or aging patients.

-          Timeline: When exactly do they want to quit smoking.

-          Social situation: Does anyone smoke in their house? Spouse/children/parents. It would be helpful if they quit together. Situations that trigger the need for smoking and coming up with a plan to deal with those situations.

-          Personal motivation for quitting.

-          Resources: family support, access to health care.

 

Any other facts you find important to tell someone who is on the fence about quitting..

-          Talk to someone (family, PCP, friends) about smoking cessation

-          Ask yourself why is this important for yourself

-          Quitting smoking at anytime improves quality and quantity of life

-          Best to quit when patient is 100% ready

-          Offer support groups.

 

Cornerstone Family Healthcare, in partnership with the Orange County Department of Health’s Tobacco Use Prevention and Control Program, provides a four-part series Smoking Cessation program that runs year-round. The next series begins Monday, December 5 from 1 p.m. –  2p.m. In this program, the health education team works with participants on creating their plan to quit. It is a priority to meet them where they are at to determine their skills and look at their previous attempts to quit and build on them. The Smoking Cessation program provides the tools and support to successfully quit when the time is right.

 

Please call Cornerstone’s Health Education team at (845) 563-8043 or visit our website www.cornerstonefamilyhealthcare.org for more information.

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    Avi Silber, MD, FAAP
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    Adeola Ayodeji, MD, FAAP

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    Sneha Shrivastava, MD
    Penelope Guccione, FNP

    WOMEN’S HEALTH
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    Marian Seliquini, CM, LM, MS

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    Andrea Giovinazzo, FNP-C

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