| Spring 2010 Newsletter |
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Check out the Spring 2010 newsletter from the NHSPA.
In this issue: Greeting from the new NHSPA President Save the Date! Clinical Corner Greetings from the Franklin Pierce Physician Assistant Program Capital Connection Membership Renewal Greetings from the NHSPA President  Since it’s time for our Spring Newsletter, I thought I would take the opportunity to let members know a little bit more about myself. As for my PA career, I am a graduate of MCPHS-Manchester, Class of 2006. I started working in Family Practice in Manchester in March of 2007. Since June of 2007, I have been working at Dartmouth-Hitchcock in Nashua as an Orthopaedic PA. I also moonlight doing some weekend call for the General Surgery practices at Southern NH Medical Center and also work Urgent Care for Dartmouth in Nashua. I was the Vice-president of the NHSPA last year and was elected as President for this year. In my previous career, I was an assistant professor at Rivier College and Plymouth State University teaching in the Health Sciences program. I received my Ph. D. in Exercise Physiology in 2000. Personally, my wife Nancy and I have lived in NH off and on since 1991, leaving the state temporarily for school in other states. We currently reside in Bow with our two children, two cats and dog. We have been there for just about 8 years now. When I am not using my PA education, I enjoy working around the house and working out. I previously held a certification as a Strength and Conditioning Coach and a Personal Trainer, although I haven’t been able to do much of that since I started PA school. My career goals are to eventually get back into teaching part-time in a PA program while continuing to learn and grow in my orthopaedic practice. This is an exciting time in the NHSPA with many opportunities for PA’s in NH to become active on any of our various committees and even by becoming a member of the Board of Directors. Please consider attending a BOD monthly meeting (schedule is posted on the NHSPA website – www.nhspa.org) to see what it is all about. READY FOR SOME FUN? The annual Primay Care Fall Conference is going to be held on October 22nd and 23rd at the Hilton Hotel in Portsmouth, NH. We’ve secured some excellent speakers and dozens of relative topics for this year and we are looking forward to seeing you there. In addition to our conference and silent auction, we are currently considering some fun evening activities for Friday night. Under consideration is a “Haunted Pubs of Portsmouth Walk” complete with a wine tasting and dinner. We’d love to hear your feedback if this is something you would enjoy. This e-mail address is being protected from spambots. You need JavaScript enabled to view it Clinical Corner
Men with BOO describe urinary hesitancy, a slow urinary stream, an intermittent stream and post void dribbling. Men with Lower Urinary Tract Symptoms (LUTS) describe urinary frequency, urinary urgency, nocturia along with the symptoms described for BOO. Men are more likely to be treated with alpha blockers i.e. Tamsulosin (Flomax), Alfuzosin (Uroxatral), Terazosin (Hytrin) or Doxazosin (Cardura) as first line treatment. But men with BOO/LUTS may also benefit from treatment with anticholinergics. A study published in the British Journal of Urology in 2004 showed that only 35% of men with BOO and OAB symptoms who were treated with Doxazosin (Cardura) alone had improvement in their symptoms while 65% still complained of urinary frequency and urgency. When Tolterodine (Detrol) was added to the Doxazosin, there was 73% improvement in symptoms. So, how to know what to do? History as with everything else will guide you almost 85% of the time. Certainly a Digital Rectal Exam needs to be performed, and laboratory work to include a urinalysis and PSA should be checked. You may find it helpful to utilize the American Urological Association’s International Prostate Symptom Score index (IPSS). It will give you a good sense of which symptoms your male patients are most bothered by and can guide initial treatment strategies. Click on www.usrf.org/questionnaires/AUA_SymptomScore.html. Only 28% of men with OAB are treated for this condition. Most of the time, we are hesitant to put male patients on anticholinergics for fear of causing urinary retention. The reality is that if male patients are describing urinary frequency and urinary urgency as the most bothersome symptoms as opposed to those related to the urinary stream, they may more likely have OAB. The bottom line is that men with OAB symptoms and BOO symptoms as well as men with OAB symptoms without BOO symptoms may benefit from combined treatment with alpha blockers first followed by the addition of anticholinergics. This condition can be treated in the primary care setting but when in doubt always consult your urology providers. Greetings from the Franklin Pierce Physician Assistant Program  Late November 2009 Franklin Pierce University in West Lebanon New Hampshire convened for classes for the first time. Our first class is 24 students strong and is filled with capable and enthusiastic people starting the 27 month process toward a Master of Physician Assistant Studies. We are currently awarded a provisional accreditation by ARC-PA, and are certain that in the spring of 2012 we will become New Hamphire’s second fully accredited Physician Assistant graduate program. Our program includes education of all of the physician assistant specialties but focuses on producing quality primary care PAs. While our clinical sites will likely include locations around the country, we are dedicated to primarily serving and learning in rural and underserved areas of New Hampshire and Vermont. We have been fortunate enough to have expert guest lecturers from across the region, adding greatly to our learning experiences. As with any new program we are adapting and building a framework that will prepare us to be confident and skilled PAs. As part of this process we are looking for more lecturers, mentors and preceptors. – Danny Balllentine, PA Student, Franklin PierceUniversity. If you would like more information about how you could help with the education of the future Physician Assistants of Vermont and New Hampshire please contact: Lisa Southwick by phone 1-603-298-6617 or by email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
The first issue is to amend the Federal Worker’s Compensation Program to include PAs in the language so that we can treat federal workers injured on the job. The second issue is to allow PAs to obtain a DEA waiver to prescribe and dispense Buprenorphine which is an FDA approved drug for the treatment of opioid addiction. It is a schedule III drug and we have prescriptive authority for schedule III drugs in NH. The last issue was to ask for support to enact health care reform legislation to include PAs in the Senate provision by approving a 15% carve out for PA education in Title VII Public Health Service’s Act’s Health Profession’s Cluster on Primary Care Medicine. In the House provision we are asking to have PAs included in language to allow us to order skilled nursing facility care and to provide hospice care for Medicare beneficiaries. Lastly, we are asking that both the Senate and House provisions integrate PAs into medical home and chronic care management models of care. I met with the legislative aides for Senators Gregg and Shaheen as well as the legislative aide for Representative Shea-Porter. I will follow up with them within the next few weeks. It is critical that we keep a dialogue going with both Senators and Representatives by contacting their NH offices to remind them about these key issues and to ask for their support in amending, sponsoring and enacting legislation to allow for the changes as I have outlined. You can visit the AAPA website at www.aapa.org and easily log on to the legislative action center under the tab “advocacy and practice resources”. It takes just a few moments to do this and can make a difference in PA practice in our state and nationally. Susan Finerty PA-C |
Overactive Bladder (OAB) is defined as urinary frequency, urinary urgency and nocturia with or without urinary incontinence in the absence of some other medical or neurological condition. OAB is equally present in men and women. As both age, the incidence of overactive bladder increases. OAB and Bladder Outlet Obstruction (BOO) often coexist. Interestingly enough, when BOO symptoms are treated, the OAB symptoms persist.
I attended Capital Connection with the AAPA in Washington, DC on February 22nd and 23rd. This was an event where PAs from each state met with their respective Senators and House of Representatives offices to ask for support on three key initiatives. We met Monday to review the legislative agenda, President Obama’s health care reform ideas and how PAs can and should be a part of the end result.