Debunking the “July Effect”

For decades, doctors have all shared one piece of common advice, “Don’t get sick on the first of July.”

This timeline, known as the July Effect, is an infamous phenomenon in the medical world. Recent medical school graduates step foot in teaching hospitals as residents for the first time, as the class above them takes on new duties.

It’s at this time of the year that patients in even the nation’s best teaching hospitals notice budding physicians being replaced with a new class of diffident, albeit eager, students. With their white coats neatly pressed, brand new stethoscopes around their necks and pockets full of smart devices, offering a world’s worth of information at their fingertips, it’s not difficult to distinguish this new crop of aspiring doctors from their much more experienced counterparts.

Throughout the medical world, there’s the understanding that even the smallest of errors, committed by inexperienced interns, can have catastrophic consequences for patient care.

While this concern of overenthusiastic residents, perhaps enjoying more independence than they really should have in teaching hospitals of the past, may have very well have once been warranted, Arnot Health chooses to look more closely at the future of our teaching programs to cultivate the true potential of our incoming residents as aspiring medical professionals and valuable assets to our caregiving team.

In fact, we believe that the introduction of these eager residents and interns is an added dynamic to our hospital’s total patient care opportunities, and most importantly, the patient experience.

Long story short…things have changed. The July Effect is just a myth, now more than ever. Our residents are just as much an integral part of our team as anyone else.

They learn from our doctors and listen to our nurses, and are always closely supervised. As a result, the kind of care that our residents can provide for our patients is better now than ever before.

Arnot Health is in its third year as a teaching hospital. In those three short years, we’ve made it our mission to transform the way our residents gain hands-on experience, in a world class educational setting.

Before being given any kind of independent authority, aspiring doctors go through a kind of “resident bootcamp,” if you will. For months, residents are drilled on the basics: where specific medical materials are located, who to talk to depending on any given situation, the importance of listening to a nurse’s recommendations and so on. There’s so much supervision, it wouldn’t be uncommon for a resident not to take a call on their own for the first six months of their residency.

We watch our residents like hawks. We take the job of teaching these students incredibly seriously.

And, there’s something important to remember: We are absolutely responsible for the patients that these residents are working with. We make very certain that they continue to receive the proper care no matter what, and from whomever may be providing it.

Ultimately, with so much supervision and attention to detail paid to our residents’ roles and responsibilities, Arnot Health is ensuring that they become a truly necessary, effective branch of our caregiving team. As a result, the hospital has more eyes on its patients, and more skilled boots on the ground providing the kind of total care that wasn’t possible before the insertion of medical students into the hospital’s various departments and programs.

What may have once been a legitimate concern to both doctors and their patients is no more, at least when it comes to the kind of care that Arnot Health prides itself on offering.

Rather than succumb to the myth of the July Effect, aspiring physicians and their supervisors hunker in for the long haul. We work off of one-another’s strengths and expertise and provide the best possible and complete care to anyone who steps foot in an Arnot Health facility.

Dr. Beth Dollinger, orthopedic surgeon for Arnot Health, writes a blog series to help answer frequently-asked questions, offer perspective on newsworthy events, and essentially give patients a hand in their own healthcare. If you’d like more information, or to schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Arnot Health Leads the Way in Creating Healthy Places

From promoting community gardens and installing better lighting in public parks, to working with local restaurants to offer healthier food options, an Arnot Health-led community collaboration is making a major impact on population health in Chemung County.

Chemung County received a “Creating Healthy Places to Live, Work, and Play” grant from the New York State Department of Health in 2010. The program is designed to promote healthy lifestyles and prevent obesity and type 2 diabetes. Arnot Health applied for the grant as the lead agency for the County, and won an award of $850,000, which was implemented over five years. With the support of more than thirty community groups and partner agencies, the program has demonstrated impressive, impactful results and has laid the groundwork for long-term sustainability.

“From a population health perspective, this program helps prevent chronic disease, and has tied in very well with Arnot Health’s overall vision of improving the health of the community,” says Rosemary Anthony, BSN,MSE,RN, Arnot Health’s Senior Director of Population Health. “It has also been instrumental in helping us to build a collaborative partnership with the local community. The future of medicine is geared toward getting outside the walls of the hospital and building a health infrastructure within the larger community. It is a real paradigm shift.”

Arnot Health has devoted significant resources to this program, including hiring Constance Scudder as its first-ever Creating Healthy Places Grant Facilitator.

According to Ms. Scudder, “We had a set of goals to achieve. Our work plan and budget were met by what we agreed upon with our community partners and according to the requirements of the grant. We are proud to have worked with over 30 community partners on this grant— from the non-profit, education, private industry, public health, political, transportation and local government sectors. What is unique about this partnership is its diversity and the focus on policy, systems, and environmental changes.”

The mission of Creating Healthy Places to Live, Work, and Play is based upon four prongs: improving local parks and playgrounds, enabling easier and safer access, creating community gardens, and working with restaurants to offer healthier eating choices.

United Way Day of Action - Arnot Health

Volunteers paint a hopscotch court as part of the United Way Day of Action in 2015.

The goal of easier and safer access to parks and recreation areas was tackled through such initiatives as: a new crosswalk on Lake Street in Elmira to provide greater accessibility to McKinnon Park, six new crosswalks and tactile ramps at Grove Park, and new universal playground signs for all nine parks that received improvements. Also, through collaboration with the City of Elmira, bike racks were installed on all City busses, allowing children and adults greater door-to-door access to healthy, active recreational options throughout the City.

Another success story has been the creation and support of community gardens throughout the County.

Community gardens were established using mini grants at Quatrano Park, the Town of Erin Community Garden, Woodlawn Community Garden (shared with Tanglewood Nature Center and Frontline Ministries),  and the Near Westside Neighborhood Association. Additionally, a MEWU (Mobile, Edible Wall Unit) was purchased for Diven Elementary School but was moved to Hendy Elementary under the district reorganization plan. Two MUGS (Mobile Upright Gardens) were purchased for use at the Southside Community Center and another is currently in use at the Economic Opportunity Program of Chemung and Schuyler Counties.

Five “pizza gardens” were purchased with a grant from Pizza Hut through their “Raising Dough for Kids Program” for use at Head Start and at the Chemung County YWCA and YMCA. In addition, funding was provided to existing community gardens to refurbish them with additional amenities at the Equal Opportunity Program, Katy Leary Park, and at Pirozzolo Park.

The gardens have been immensely popular— the Southside Community Center garden can see up to four hundred students passing through each week. And whole neighborhoods have jumped in with enthusiasm. At the Quatrano Park community garden, which is overseen by ARC of Chemung, residents, ARC staff, and neighbors collaborated in the garden’s first year to donate 140 pounds of produce to the Food Bank of the Southern Tier.

Arnot Health also worked with five local restaurants to encourage their patrons to choose healthier dining choices by using a salt substitute, offering salad dressings served on the side, providing doggie bags earlier in the meal to encourage portion control, and promoting non-sweetened beverages rather than sugary soft drinks. The local Elmira-area restaurant partners are Classic Café, Hill Top Inn, the Starlite Room, Turtle Leaf Café, and Charlie’s Café.

Creating Healthy Places to Live, Work, and Play has already made a statistical impact on population health in the local area. Chemung County, long mired near the bottom of the list of 62 counties in New York State in terms of overall health, rose one place to 59th in the most recent state rankings. Although factors like unemployment and poverty still plague the region, Chemung County showed a strong improvement in the area of “access to physical activity” from 2014 to 2015. There was a statistically significant improvement in this health indicator due to the work of the Creating Healthy Places initiative. 

The program has received numerous awards and accolades, including the inaugural Age-Friendly Community Award in May 2015 from the Chemung County Department of Aging and Long-term Care. Creating Healthy Places has also garnered recognition as a best practice from the New York State Division of Chronic Disease and Injury Prevention, and Arnot Health’s efforts were named an Outstanding Community Outreach Program by the New York Association of Rural Health.

Although the Creating Healthy Places grant expires this year, the success of the program has spurred Arnot Health to apply for a new five-year grant application through the New York State Department of Health. The $1.25 million “Creating Healthy Schools and Communities” grant was submitted by The Student Support Services Center of the Genesee Valley Educational Partnership as the lead agency with Arnot Health as a co-collaborator.

But perhaps the best reward is in seeing the direct impact that Creating Healthy Places is having on health in our community.

“I am very, very proud that it has really provided a successful example of what can be done when people work together through a shared mission,” says Rosemary Anthony. “We are one of the few hospitals that has a Population Health Department and dedicated staff to work on community health initiatives. This program has widened the vision of what can be done outside of a hospital, to help people make the right decisions and enjoy better health for the rest of their lives.”

Blandford Park Elmira - Ribbon Cutting

A ribbon-cutting ceremony marks the opening of the playground at Blandford Park in Elmira.

Nicer Weather May Cause More Injuries

The nice weather is upon us and the urge to push the kids outdoors for some quality fresh air and playtime is overwhelming. This time of year is full of possibilities, including the possibility of injuries. For a variety of reasons, emergency room visits increase as much as 15-20% for children and young adults in the spring and summer. Let’s take a look at some of those injuries and common causes and see if we can’t put a little more focus on safety.

Spring & Summertime Injuries:

With a sudden increase in outdoor activities, emergency room visits for this age group also increase. Typical injuries include:

  • Wrist Fractures
  • Ankle Fractures
  • Repetitive Motion Injuries
  • Sprains
  • Stress Fractures

Children and young adults are growing. Where the bones are actively lengthening (a.k.a. wrists, ankles, etc.) the structure can be weakened and fracture easily.

What You Can Do Throughout The Year:

Being dormant and inactive throughout the long winter months is of particular concern not only for your overall health, but can be a large contributor to injury numbers. Muscles are cold and weakened, tendons are tight, and for growing children, still adjusting to their new size. One of the most important things you can do to prevent injury is to stay active, and keep your children active, throughout the year. Make sure they are moving and stretching indoors throughout the long winters. Make sure to switch it up, working in strength, cardio, and aerobic exercise year-round.

Once the Nice Weather is Upon You:

When the days get longer and the temperature finally reaches acceptable levels, take it slow. Try to gradually ease your kids back into the full swing of strenuous activities. Too much too fast is taxing on the body. A 30 mile bike ride or a marathon session of pitch and catch may sound like a perfect way to spend the first nice day of the year but doing too much too fast can be, simply put, too much. In addition to taking it slow to start, you can also make sure you take the usual precautions associated with outdoor safety such as:

  • Bike Helmets
  • Wrist Guards
  • Knee Pads
  • Shin Guards

A quick note about safety equipment: Please don’t merely dust it off and send it out with the kids. Make sure the equipment fits properly and is in good condition; kids can grow a lot in just a few months, so last year’s sizes may be too small this year.

Trampolines:

In addition to all the things listed above, some outdoor activities are just not a good idea. Backyard trampolines are the cause of a surprising number of injuries and should probably, for peace of mind alone, be avoided. Ankle Injuries, wrist injuries, back injuries, and neck injuries abound, and those are just the most common. There are plenty of other fun things to do outside, the risk may not be worth the bounce.

For more information, or to talk or schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Tanner’s PAWS and Arnot Health – Combination of Care

In our recent ad campaign for Orthopedic Care, we’re featuring two representatives of a local animal rescue organization called Tanner’s PAWS. Sue Allen is a substitute school teacher and a volunteer for Tanner’s PAWS; Cotton is a beautiful lab mix who successfully made it through the organization to find his new family. Check out the two in action together:

Tanner’s PAWS is a grassroots organization that began in 2012 to help rehabilitate lost and unwanted dogs by fostering them instead of using a shelter. Through a website and social media presence, volunteers try to locate the families of these lost dogs or find a permanent place for them to live. Although they have a small shelter in Corning for emergency situations, foster families throughout the region are responsible for providing temporary care and connecting the pets with a “forever home.”

Sue Preset is the Board Treasurer for Tanner’s PAWS and has been with the organization since its inception. She said there was a need for this in our region because shelters can sometimes misrepresent the true character of a dog. According to Sue, “sometimes it’s the shelter environment itself that can have a negative impact because confined spaces and incessant barking can be stressful.” She said that by providing foster care for the animals, their true colors shine through.

Cotton was an unwanted dog who was originally kept in a very small kennel with limited access to the outdoors and exercise. During the search for a better home, Cotton acted in our commercial for Orthopedic Care. The organization has since reported that he is living with a family that has two small children and is enjoying all the care and exercise he can handle.

Our other actress, Sue Allen, was a candidate for double-knee replacement surgery at the time of filming. In the hands of our Orthopedic team at Arnot Health, Sue underwent an operation in September 2014 on both knees simultaneously. By working with our physical therapists, she is now back to work as a substitute teacher, able to walk her own dogs, and attending her grandkids’ ball games.

Anyone looking to volunteer, adopt a pet, or provide a foster home for the dogs at Tanner’s PAWS may fill out an application on the Tanner’s PAWS website. Donations may also be made through the site in the form of money or any of the items on the organization’s wish list. “You’ll get tired,” said Sue Preset, “but you know if you can save just one dog, it’s all worth it.”

Visit our landing page for more information about Orthopedic Care at Arnot Health.

Flat Feet May Develop Over Time

Over time, the physical stress of our everyday lives can begin to take a toll on our feet. When you begin to notice a change in the shape of your foot, your shoes not fitting properly or striking the ground on the sole, or your arch in getting increasingly closer to the ground when standing, you might be on your way to developing flat feet. This condition, referred to as adult acquired flat feet, is a condition that can cause pain in your feet, pain and swelling of the ankles and/or knees, and generally make normal mobility a painful activity. In addition, standing on your ‘tippy-toes’ can become difficult or nearly impossible and you may develop signs of arthritis.

What’s Happening in There?
When developing flat feet, you can certainly notice the outward signs of a lowered arch, shoe issues, and the physical pain. What is actually happening inside your body is that your tendons are beginning to stretch out, leading to strain and collapse. After this occurs, your ligaments become overworked and can follow in the same downward progression, furthering the condition and weakening the structure of the entire foot.

Possible Causes:
There is no specific set of circumstances that will absolutely lead you to developing flat feet in your adult life, however, there are a few conditions that may increase your risk:

  • Decreased or low activity level
  • Overweight
  • Previous injury
  • Genetic pre-disposition

In my practice, I am noticing a higher ratio of women to men presenting with this condition and typically seeing patients in their 40’s through 60’s.

Diagnosis and Treatment:
When a patient presents with the signs and symptoms of adult acquired flat feet, the first step is diagnosis and identifying how severe the condition is. This can be done with a thorough physical exam, which then may be followed by an x-ray, MRI, and/or CAT scan. If the condition is identified early, treatment may include physical therapy, orthotic inserts or shoes. They may also advise you to wear a brace which can range from soft to ridged or hard depending on the level of support needed.

If the condition has progressed, more aggressive treatment may be necessary, including surgery. Surgery can also vary in severity and may include cleaning up tendons, transferring a tendon, and/or breaking and fusing bones to return your foot to it’s proper structural state.

Recovery:
If the condition is identified early or the damage is not severe, with the proper orthotics and dedication to physical therapy, you may see improvement within a few weeks. Once surgery is involved, the recovery time becomes much more drawn out including up to eight weeks in a cast or a boot followed by months of physical therapy.

Adult acquired flat feet can threaten the ease and comfort of staying active. Mobility and physical activity are key components to a healthy lifestyle, and we want to help you stay active. If you notice any of the symptoms or you aren’t feeling as comfortable on your feet as you once were, don’t hesitate to call us, and together we’ll get that spring back in your step!

Dr. Beth Dollinger, orthopedic surgeon for Arnot Health, writes a blog series to help answer frequently-asked questions, offer perspective on newsworthy events, and essentially give patients a hand in their own healthcare. If you’d like more information, or to schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.

Walking Program Participants “Step It Up” at the Arnot Mall

Last night, members of the Arnot Health “Step It Up” walking program met at the Arnot Mall for a mid-point check in. “Step It Up,” which began with a kick-off event on April 7, is a free 6-week community walking program designed to improve overall health through a focus on improved nutrition and increased activity.

More than 20 participants showed up for the mid-program event, which began with a stretch and warm-up routine in the community room at the mall. The group then dispersed in several directions so that each member walked a full lap around the interior of the mall; the estimated distance was over a half mile.

Once they returned, Nykole Parks, Community Health Services Coordinator for Arnot Health, asked about their progress so far and gave some tips to keep participants motivated during the second half of the “Step It Up!” program.

On May 19, a program End Event will celebrate the overall progress of each member. Health screenings that were initiated in the opening event will be performed again to track participant progress.

“Step It Up!” is sponsored by Arnot Health, Chemung County Health Department, Elmira-Chemung Transportation Council, and Creating Health Places to Live, Work and Play. For more information, or to find out how you can be a part of this program next time it’s offered, visit www.arnothealth.org/weight-loss-and-healthy-habits-step-it-up-program.

DSC_0585 DSC_0584 DSC_0576 DSC_0568 Arnot Health Step It Up Walking Program at the Arnot Mall

Is Your Clothing Bad For Your Health?

For most of us, picking an outfit for the day is driven by a few factors including where we plan on going (work, the grocery store, hiking, etc.), what is seasonably appropriate, and to a varying degree, what looks good. When we are getting dressed or picking out clothes at the store, we are typically thinking thinks like, “Is this flattering? Is it appropriate for work/school/etc.? Does it match my new shoes? Does it match anything I have in my closet?” One question that isn’t typically top of mind (but might be the most important) is, “Is this bad for my health?” If that question wouldn’t even occur to you to ask, than the rest of this article may just be great information for you …

How Can Your Clothes be Bad for You?

In general, wearing cloths isn’t particularly bad for you. In fact, I would venture that wearing them on a daily basis probably keeps you out of trouble. However, there are a few things we should be cognizant of when we’re picking out our attire. Here are just a few examples:

Bowties, Neckties, and Shirt Collars:
Make sure you are measuring correctly for your shirt collar size and wearing your ties loose enough to feel comfortable. If they are too small or tight, you may be causing a decrease in blood flow to your head, causing tingling and numbness, in addition to, well, less blood flowing to the brain. According to the British Journal of Ophthalmology, wearing your shirt collar too tight can even increase intraocular pressure, possibly leading to glaucoma. How many men could possibly be walking around with their collars and ties to tight? According to some studies, it’s as high as 70%!

Skinny Jeans:
We’ve all seen them, and a vast majority of us may even have a pair or two. However, if you do have them, check for these signs that they are a little too tight: tingling in the thigh, numbness, or the feeling that your foot is no longer under you. If you have any of these symptoms when you’re sporting your trendy trousers, it may be time to take them off and opt for a looser-fitting style.

Tight Belts & Tight-Waisted Pants:
Belts and the waistband of your pants are designed to keep your britches on, not change your shape. Wearing your belt cinched too tight a waistband a few sizes to snug can cause a myriad of problems including acid reflux, indigestion, bowl discomfort, and can even cause temporary nerve damage.

Compression Wear/Shape Wear:
Shape wear (Spanx, etc.) are designed to smooth you out, not shrink you down. Wearing a garment of this nature is not inherently bad, you just have to make sure it’s the right size. Much like a tight belt, shape wear can cause increased acid reflux and indigestion. In addition, wearing restrictive clothing can limit your lung capacity and ability to breathe. If you are uncomfortable, lightheaded, or you’re experiencing trouble breathing, it’s too tight.

Finding clothes that fit could be better for your health

So the next time you open those closet doors and decide on an outfit, make sure you add one additional question to your list … “Is this a healthy choice?” Wearing clothes should be a comfortable experience. If something doesn’t feel right, choose another option. Don’t sacrifice your health for fashion.

If you’d like more information, or to schedule an appointment with Dr. Beth Dollinger, click here to find her contact information listed in our provider directory.