This Penn heart patient is a 9-year-old boxer dog named Sophie

Cardiology resident Alexandra Crooks and cardiologist Anna Gelzer of Penn Vet headed up care for 9-year-old Sophie, the beloved pet of Karen Cortellino, pictured here with her son Alex Peña. Not long after the ablation procedure, Cortellino says the boxer was “back to her perky self.”

For Karen Cortellino, her 9-year-old dog Sophie is more than just a companion.

“There’s this bumper sticker that says, ‘Rescue dogs: Who rescued who?’” says Cortellino, a physician from New Jersey. “That’s exactly how I feel.” Eight years ago, she adopted Sophie, a boxer, two weeks after the death of the family’s first boxer, and “she’s been Mommy’s baby ever since.”

A few months ago, however, Sophie’s star rose even higher: She became the first dog with a particular type of heart disease—arrhythmogenic right ventricle cardiomyopathy (ARVC)—to be treated with cardiac ablation.

Anna Gelzer

, a cardiologist in Penn’s

School of Veterinary Medicine

, led Sophie through the procedure, together with cardiology resident Alexandra Crooks. But the equipment and expertise to perform an ablation, in which a high energy catheter tip burns tiny portions of damaged heart tissue to restore normal rhythms, wouldn’t have been possible without collaborators from just down the street. At the

Perelman School of Medicine

’s

Translational Cardiac Electrophysiology Laboratory

, Director

Cory Tschabrunn

and members of his team worked hand-in-hand with their veterinary colleagues to plan out and provide Sophie a procedure that mirrors the best that human medicine has to offer.

“This collaboration and this close distance between our hospitals allows us to be able to utilize the tremendous access to all this knowledge,” says Gelzer. “And from our experience with Sophie and other dogs to come, we may able to glean information that will be valuable to human medicine. It’s the best of both worlds.”

For Gelzer and Crooks, Sophie is a pilot case for a study now backed by two grants that will support cardiac mapping and ablation procedures for six additional dogs. Currently, cardiac ablation is only available for pet dogs in two other sites in the world, one in Italy and one in Ohio. Sophie’s case puts Penn Vet on the map. While the equipment necessary to perform ablations is costly, access to Penn Medicine’s translational electrophysiology lab has opened the possibility that Penn Vet may one day be able to provide committed dog owners a more durable alternative to medication for treating their pets’ arrhythmias.

A scary spell

ARVC is not an uncommon diagnosis in boxers. Some studies estimate as much as a quarter of the breed may have the inherited disease, which is also prevalent in American bulldogs. But Sophie’s heart was not top of mind in early July, when she had surgery to repair a torn ligament in her left knee. Two weeks later, Cortellino took her for a follow-up visit at their local veterinary hospital to have her stitches removed.

Sophie’s diagnosis of ARVC meant she could suffer a life-threatening arrhythmia, despite starting medications to reduce that risk.

“Everything was great and literally we were just about walking out the door when Sophie collapsed,” Cortellino says.

Sophie received emergency care, was transferred to another veterinary facility with a cardiac department, and was soon diagnosed with ARVC. A strikingly similar condition affects roughly 1 in 1,000 humans. In both dogs and humans, the disease, which doesn’t manifest until adulthood, causes a deterioration of the tissues in the heart muscle, leading to occasional episodes when the heart beats very fast.

The condition increases the risk of sudden death. While drugs like beta blockers and sodium channel blockers can mitigate this risk, arrhythmias can sometimes break through these medications.

“It was kind of a somber picture when she was diagnosed,” Cortellino says. “She could have a fatal arrhythmia at any time: today, next month, next year, three years from now.”

Cortellino, capitalizing on her medical training, began researching alternative treatment options. In humans with a diagnosis similar to Sophie’s, the treatment of choice is an implantable cardiac defibrillator (ICD). But, as Gelzer explained to Cortellino when she reached out about this possibility, that option is not yet tenable for dogs.

“ICDs are designed to recognize human arrhythmias,” Gelzer says. “But they’re not able to distinguish the normal variation in heart rate that a dog is capable of from a life-threatening arrhythmia.”

An affectionate dog awaiting its owners’ return home for work, for example, might get so excited upon hearing a key turn in the door that its heart rate could jump from 40 to 200 beats per minute within the space of a few heartbeats. If that dog was outfitted with an ICD, the device might interpret the rate change as an arrhythmia and misfire, triggering a painful and possibly traumatic shock.

But Gelzer did have an alternative proposal for Cortellino, one that could address the underlying cause of Sophie’s heart condition. The only catch was that it had never been done in a dog with ARVC before.

Ideal expertise

When Cortellino emailed Gelzer, the timing was good. Gelzer had been thinking about options for curing cases like Sophie’s for many years. And she had the right kind of expertise to be considering that possibility.

In 2000, when Gelzer was a junior faculty member at Penn Vet, she worked with

David Callans

, an expert on cardiac electrophysiology at the School of Medicine. At the time, they collaborated on basic cardiac research, using pig models. Gelzer remembers wishing they could apply the technique of ablations to dogs, which develop heart conditions similar to humans.

Fast forward 15 years, after time away from Penn Vet in positions at Cornell and University of Liverpool, Gelzer returned and reconnected with Callans. His old basic research lab was no longer operating, but Gelzer continued to reach out to him for consultations from time to time, or attended rounds for human patients in his group.

Roughly a year ago, when discussing one of Gelzer’s cases, Callans connected her with Tschabrunn, who had recently set up his lab in Penn Medicine’s

Smilow Center for Translational Research

as part of the recently established Electrophysiology Translational Center of Excellence (EP-TCE) initiative, led by

Francis Marchlinski

, director of cardiac electrophysiology for Penn Medicine. Marchlinski and the Penn EP team have been pioneers in the evaluation and treatment of patients with inherited arrhythmia disorders like ARVC.

Tschabrunn’s primary research interests focus on the development of clinically relevant translational research models to elucidate the underlying pathophysiology and mechanisms of complex arrhythmias and the creation of new diagnostic and therapeutic technologies for treating cardiovascular diseases. He also performs, in close collaboration with Marchlinski and with support from the Winkelman Family Fund in Cardiovascular Innovation, clinical research in human patients with ARVC.

As such, Tschabrunn responded with enthusiasm upon hearing of Gelzer’s interest in pursuing ablations in dogs, particularly those with ARVC. The two struck up a collaboration that brought together the latest in technique and technology in cardiac electrophysiology with deep knowledge in veterinary cardiology.

“This was an exciting opportunity not only in terms of a research collaboration,” says Tschabrunn, “but we also had the chance to help a patient by combining our expertise and resources that are really only available at just a few institutions in the world.”

Not a bandage

Ablations are “routine care” for many cases of arrhythmias in people. “You approach the heart through the blood vessel, get in the right spot, and—with all the expertise and knowledge of the practitioner—you can find the damaged area and burn it,” says Gelzer. “And then maybe the patient doesn’t need to be on medications that can have side effects and are in some cases not that effective.”

Gelzer saw Sophie, a healthy dog aside from her heart condition, as an excellent candidate for an ablation. Cortellino, while a bit nervous about putting her beloved dog into uncharted medical territory, was comforted by Gelzer’s and Crooks’s clear expertise, their warm manner with Sophie, and their openness and honesty about the procedure’s upsides—and possible risks.

“I was a little nervous—a lot nervous—but we thought to ourselves, really, what’s our alternative?” Cortellino says. “As my son said, ‘Look Mom, at the very least, Sophie is contributing to the possible welfare of other dogs.’ So there was a small element of altruism in putting Sophie through this, in addition to hoping for a more definitive treatment for her condition.”

Before the surgery, the veterinarians gathered data on the patterns of Sophie’s arrhythmias using a device called a Reveal LINQ, implanted just beneath her skin. The LINQ—which is also used in humans—records a continuous electrocardiogram (ECG) as a loop recorder, storing abnormal rhythm strips for up to three years, giving clinicians a more complete picture of abnormal heart activity than a quick office visit ECG. That information was used during the procedure to zero in on the correct area of the heart to target with the ablation.

Performing the mapping of Sophie’s heart and the ablation procedure was a team effort, involving experts from both Penn Vet and the Perelman School of Medicine. “I think the openness and enthusiasm for this type of multidisciplinary collaboration is a major strength of this University,” says Cory Tschabrunn (to right of Sophie, with black glasses around neck), who directs the translational electrophysiology lab where it happened.

The morning of the procedure, Gelzer used her own car to drive Sophie the short distance from Penn Vet’s

Ryan Hospital

to the Smilow Center. When she brought the dog up to the lab, a full complement of experts awaited her: not only Crooks, Tschabrunn and his team, and

Giacomo Gianotti

, head of anesthesia at Ryan, but also two anesthesia residents, Penn Vet’s two other cardiology faculty, Marc Kraus and Mark Oyama, two other cardiology residents, a cardiology research intern, experts on the machines that were used in the procedure, veterinary nurses, and interested observers.

“The number of people we had in one room for one patient, it blows my mind,” says Gianotti. “Everyone had a specific role, and it took a lot of training and cooperation to get there.”

The procedure was long and complex, taking place in different stages. First, to locate the areas of unhealthy heart tissue that had been indicated by the ECG, the clinicians used an advanced mapping system based on GPS technology called CARTO.

“You put a patch on the bottom and top of the dog,” Gelzer says. “You then use those as your points of orientation as you advance the catheter and create a map of the inside of the heart. It’s great because you don’t have to use fluoroscopy, so nobody is exposed to X-rays.”

The technology Tschabrunn and Gelzer and colleagues used during the procedure mirrors that employed during a human intervention. At right, a map of Sophie’s heart guided the clinicians in making tiny burns to eliminate damaged heart tissue.

The CARTO system maps the voltage of the heart tissue, a technique pioneered by Marchlinski and Callans nearly two decades ago and a continued area of Tschabrunn\’s research focus today in both the translational and clinical PE laboratories. Decreased voltage corresponds with diseased tissue. They confirmed these areas by artificially introducing extra heart beats into Sophie’s normal rhythm. But Sophie’s heart resisted these challenges, a sign that her disease was being kept in check by her medications.

The heart mapping and challenges did, however, allow the clinicians to reproduce the abnormal beats that they had seen on the ECG, giving them more evidence that they were targeting the right areas for ablation. Guided by that information, Tschabrunn used precisely directed radiofrequency to burn millimeter-sized portions of the tissue inside Sophie’s right ventricle, one of the lower chambers of the heart.

Throughout the several-hours-long procedure, Gelzer and Crooks sent texts with updates to Cortellino. “While it was nerve-wracking, I really felt that Sophie was in good hands,” she says.

And all went smoothly. “Sophie did amazing,” Gelzer says. “After we were done, we pulled the catheter out, she rested, and then went home the next day.”

Paving the way

Gelzer and Tschabrunn recently performed another ablation on a canine patient, and they are hopeful that the outcomes from the study will lay the groundwork for ablation to become a more routine option for dogs and their owners.

“My long-term hope for Penn Vet is that any arrhythmia that is potentially ablatable, we will be able to offer ablation therapy,” she says. “It’s not going to be the right option for every owner or dog, but with the right case, the right circumstance, it’s a very promising and rewarding treatment to be able to provide.”

Members of the team on both the veterinary and medical sides share enthusiasm about the information that canine patients will be able to lend to human medicine as well. “There is a lot we can learn about cardiac disease pathology from veterinary patients like Sophie,” says Tschabrunn. “It is extremely difficult or nearly impossible to model human-like inherited cardiac diseases and complex arrhythmias in the laboratory, but similar diseases can occur naturally in dogs. This provides us a unique opportunity to improve our understanding of these diseases and develop new treatments for human and veterinarian patients alike.”

From Sophie’s case and others that follow, researchers hope to glean information that could benefit both human and veterinary patients in the future.

This type of mutually beneficial exchange highlights the value of a One Health approach to medicine, one that takes advantage of the remarkable similarities between humans and our companion animals, says

Oliver Garden

, who heads the

Department of Clinical Sciences and Advanced Medicine

at Penn Vet.

“If ever there was a thrilling example of One Health in action, this is it,” says Garden. “Sophie’s case brings new heights to our department’s ethos of advanced medicine. And the work of such a transdisciplinary team, in this case involving members of our own esteemed faculty collaborating with experts at the Perelman School of Medicine, is nothing short of breathtaking.”

Tschabrunn concurs. “I think the openness and enthusiasm for this type of multi-disciplinary collaboration is a major strength of this University,” he says. “It is only possible in places like Penn, which brings together the expertise from faculty across so many diverse schools coupled with extraordinary facilities and resources all on a single campus. There’s always something incredible going on that you can be a part of.”

And Cortellino and her family are reaping the benefits: “Sophie is back to her perky self.”

Anna Gelzer is professor of cardiology at the University of Pennsylvania School of Veterinary Medicine.

Alexandra Crooks is a resident in cardiology at the University of Pennsylvania School of Veterinary Medicine.

Giacomo Gianotti is associate professor of clinical anesthesiology at the University of Pennsylvania School of Veterinary Medicine.

Oliver Garden is the Henry and Corinne R. Bower Professor of Medicine and chair of the Department of Clinical Sciences and Advanced Medicine at the University of Pennsylvania School of Veterinary Medicine.

Cory Tschabrunn is an instructor of medicine and director of the Translational Cardiac Electrophysiology Laboratory at the University of Pennsylvania Perelman School of Medicine.

David Callans is professor of medicine at the University of Pennsylvania Perelman School of Medicine.

Francis Marchlinksi is the Richard T. and Angela Clark President’s Distinguished Professor in the Department of Medicine at the University of Pennsylvania Perelman School of Medicine.

source https://www.vet.upenn.edu/

Reaching youth where they’re at

Written by Peter G. Sánchez/

The Diocese of Camden

As Camden Catholic’s Christian Leadership students gathered in class last month, all eyes were on Father Edward Kennedy.

The part-time Director of Catholic Identity, critiquing students’ recent promotions of their upcoming school retreats (Kairos, a Women’s Retreat, Catholic Performers, and a Catholic Athletes for Christ), explained how one retreat group could have done even better.

“Promise them donuts,” and students will come out, he said half-jokingly, as students laughed and nodded their heads.

“Come for the donuts, stay for the faith” doesn’t sound like too bad a marketing plan for attracting busy high-schoolers to events. And with the endgame being that students are drawn more closely to Jesus and further develop their spiritual life, it’s an idea suited to the work of Directors of Catholic Identity.

Established six years ago by Bishop Dennis Sullivan, the position of Director of Catholic Identity brings “pastors” into the classrooms and sporting arenas of the Diocese of Camden’s Catholic high schools. They teach the faith, lead school liturgies, encourage vocations and serve as a spiritual resource for students, faculty and staff.

Father Ramos, Director of Catholic Identity at Gloucester Catholic takes a selfie.

This school year, Camden’s priests are serving in five high schools: Father Kennedy at Camden Catholic; Father Dexter J. Nebrida at Paul VI, Haddonfield; Father Josh Nevitt at Holy Spirit, Absecon; Father Steven Pinzon at Wildwood Catholic; and Father J. Philip Ramos at Gloucester Catholic.

“Father Kennedy’s presence here helps us,” said Father Joseph P. Capella, he himself a former Director of Catholic Identity at Camden Catholic, and now serving as the school’s rector. He is also the teacher of the Christian Leadership class which Father Kennedy assisted with.

“His youth, his personality — the students relate to him. He’s a presence in the community, celebrating sacraments with the school and promoting the school’s values,” Father Capella continued.

Their ‘parishioners’ are in the classrooms, hallways and cafeteria

As a part-time Director, Father Kennedy juggles his time between Camden Catholic and his parish assignment at Saint Rose of Lima in nearby Haddon Heights. On Wednesdays and Fridays, he can be found in the school’s green and white hallways, celebrating morning Mass in the chapel for students and faculty, mentoring students in Father Capella’s class, or chatting with students in the Campus Ministry office he shares with Jennifer LaRosa, the school campus minister.

“Father Kennedy is joyful,” LaRosa said. “He’s great with the students, making sure they know he is there for them” in any conflicts they have, be it school-related or personal struggles.

Father Kennedy with Jennifer LaRosa, campus minister at Camden Catholic High School, Cherry Hill. Photo by Peter G. Sánchez

Father Kennedy, in his first year as Director, acknowledges that the students have played a huge part in making him feel welcome and part of the community.

“I’m blown away by their maturity and hunger for the faith,” he says. “These students want to know and find the truth.”

At Wildwood Catholic, Father Pinzon, Director of Catholic Identity for the past two years, sees the importance of “planting the seeds” of spirituality in his students’ lives.

“I’m a visible presence, offering them confession, attending their sports contests, plays and socials,” he says. “Presence is so important, just to be with them, and meet them where they are at.”

He also has a parish assignment at Notre Dame de la Mer, Wildwood, as parochial vicar.

“We have good kids and a good staff” at Wildwood Catholic High School, he says.

Before coming to the Diocese of Camden from the Philippines two years ago, Father J. Philip Ramos, A.M., spent every week teaching the Catholic faith in public schools. Now, the Disciple of Mary is almost finished with his first semester at Gloucester Catholic.

“I’m happy here, being present at the school three days a week,” he says of the time he is not fulfilling his responsibilities as parochial vicar at Saint Simon Stock Parish in Berlin.

During October, the month of the rosary, he invited students to pray with him in the school chapel, and he taught them about the rosary’s origins and connections to the Blessed Mother.

He makes it a point “to involve myself in the school community as much as possible,” be it attending a Friday night football game or visiting a student’s loved one in the hospital.

Over these past three months, he has come to know and love the school community.

“It’s a family,” he emphasizes.

He believes that as much as he brings himself and his work to any interaction with students — be it on the field, classroom or lunchroom — he is learning just as much as they are.

“I learn something new from them every day, and hope they can learn something from me,” he says.

Seniors in Pain find Relief with Cannabis

Stephanie O\’Neill:

September 18, 2018

Megan Baker (left) of Papa & Barkley Co., a cannabis company based in Eureka, Calif., shows Shirley Avedon different products intended to help with pain relief. (Stephanie O’Neill for KHN)

Shirley Avedon, 90, had never been a cannabis user. But carpal tunnel syndrome that sends shooting pains into both of her hands and an aversion to conventional steroid and surgical treatments is prompting her to consider some new options.

“It’s very painful, sometimes I can’t even open my hand,” Avedon said

So for the second time in two months, she’s climbed on board a bus that provides seniors at the Laguna Woods Village retirement community in Orange County, Calif., with a free shuttle to a nearby marijuana dispensary.

The retired manager of an oncology office says she’s seeking the same relief she saw cancer patients get from smoking marijuana 25 years ago.

“At that time [marijuana] wasn’t legal, so they used to get it off their children,” she said with a laugh. “It was fantastic what it did for them.”

Avedon, who doesn’t want to get high from anything she uses, picked up a topical cream on her first trip that was sold as a pain reliever. It contained cannabidiol, or CBD, but was formulated without THC, or tetrahydrocannabinol, marijuana’s psychoactive ingredient.

“It helped a little,” she said. “Now I’m going back for the second time hoping they have something better.”

As more states legalize marijuana for medical or recreational use — 30 states plus the District of Columbia to date — the cannabis industry is booming. Among

the fastest growing group

of users: people over 50, with especially steep increases among those 65 and older. And some dispensaries are tailoring their pitches to seniors like Avedon who are seeking alternative treatments for their aches, pains and other medical conditions

On this particular morning, about 35 seniors climb on board the free shuttle — paid for by Bud and Bloom, a licensed cannabis dispensary in Santa Ana. After about a half-hour drive, the large white bus pulls up to the parking lot of the dispensary.

About half of the seniors on board today are repeat customers; the other half are cannabis newbies who’ve never tried it before, said Kandice Hawes, director of community outreach for Bud and Bloom.

Residents of Laguna Woods Village, a retirement community in Orange County, Calif., ride a free shuttle to a marijuana dispensary in August.

(Stephanie O’Neill for KHN)

“Not everybody is coming to be a customer,” Hawes said. “A lot are just coming to be educated.”

Among them, Layla Sabet, 72, a first-timer seeking relief from back pain that keeps her awake at night, she said.

“I’m taking so much medication to sleep and still I can’t sleep,” she said. “So I’m trying it for the back pain and the sleep

.”

Hawes invited the seniors into a large room with chairs and a table set up with free sandwiches and drinks. As they ate, she gave a presentation focused on the potential benefits of cannabis as a reliever of anxiety, insomnia and chronic pain and the various ways people can consume it.

Several vendors on site took turns speaking to the group about the goods they sell. Then, the seniors entered the dispensary for the chance to buy everything from old-school rolled joints and high-tech vaporizer pens to liquid sublingual tinctures, topical creams and an assortment of sweet, cannabis-infused edibles.

Jim Lebowitz, 75, is a return customer who suffers pain from back surgery two years ago.

He prefers to eat his cannabis, he said.

“I got chocolate and I got gummies,” he told a visitor. “Never had the chocolate before, but I’ve had the gummies and they worked pretty good.”

“Gummies” are cannabis-infused chewy candies. His contain both the CBD and THC, two active ingredients in marijuana.

Derek Tauchman rings up sales at one of several Bud and Bloom registers in the dispensary. Fear of getting high is the biggest concern expressed by senior consumers, who make up the bulk of the dispensary’s new business, he said.

“What they don’t realize is there’s so many different ways to medicate now that you don’t have to actually get high to relieve all your aches and pains,” he said.

But despite such enthusiasm, marijuana isn’t well researched, said Dr. David Reuben, the Archstone Foundation professor of medicine and geriatrics at UCLA’s David Geffen School of Medicine.

While cannabis is legal both medically and recreationally in California, it remains a Schedule 1 substance — meaning it’s illegal under federal law. And that makes it harder to study.

The limited research that exists suggests that marijuana may be helpful in treating pain and nausea, according to a

research overview

published last year by the National Academies of Sciences, Engineering and Medicine. Less conclusive research points to it helping with sleep problems and anxiety.

Reuben said he sees a growing number of patients interested in using it for things like anxiety, chronic pain and depression.

“I am, in general, fairly supportive of this because these are conditions [for which] there aren’t good alternatives,” he said.

But Reuben cautions his patients that products bought at marijuana dispensaries aren’t FDA-regulated, as are prescription drugs. That means dose and consistency can vary.

“There’s still so much left to learn about how to package, how to ensure quality and standards,” he said. “So the question is how to make sure the people are getting high-quality product and then testing its effectiveness.”

And there are risks associated with cannabis use too, said

Dr. Elinore McCance-Katz,

who directs the Substance Abuse and Mental Health Services Administration.

“When you have an industry that does nothing but blanket our society with messages about the medicinal value of marijuana, people get the idea this is a safe substance to use. And that’s not true,” she said.

Side effects can include increased heart rate, nausea and vomiting, and with long-term use, there’s a potential for addiction, some studies say.

Research suggests

that between 9 and 30 percent of those who use marijuana may develop some degree of marijuana use disorder.

Still, Reuben said, if it gets patients off more addictive and potentially dangerous prescription drugs — like opioids — all the better.

Jim Levy, 71, suffers a pinched nerve that shoots pain down both his legs. He uses a topical cream and ingests cannabis gelatin capsules and lozenges.

“I have no way to measure, but I’d say it gets rid of 90 percent of the pain,” said Levy, who — like other seniors here — pays for these products out-of-pocket, as Medicare doesn’t cover cannabis.

“I got something they say is wonderful and I hope it works,” said Shirley Avedon. “It’s a cream.”

The price tag: $90. Avedon said if it helps ease the carpal tunnel pain she suffers, it’ll be worth it.

“It’s better than having surgery,” she said.

Precautions To Keep In Mind

Though marijuana use remains illegal under federal law, it’s legal in some form in 30 states and the District of Columbia. And a growing number of Americans are considering trying it for health reasons. For people who are, doctors advise the following cautions.

Talk to your doctor.

Tell your doctor you’re thinking about trying medical marijuana. Although he or she may have some concerns, most doctors won’t judge you for seeking out alternative treatments.

Make sure your prescriber is aware of all the medications you take. Marijuana might have dangerous interactions with prescription medications, particularly medicines that can be sedating, said Dr. Benjamin Han, a geriatrician at New York University School of Medicine who studies marijuana use in the elderly.

Watch out for dosing.

Older adults metabolize drugs differently than young people. If your doctor gives you the go-ahead, try the lowest possible dose first to avoid feeling intoxicated. And be especially careful with edibles. They can have very concentrated doses that don’t take effect right away.

Elderly people are also more sensitive to side effects. If you start to feel unwell, talk to your doctor right away. “When you’re older, you’re more vulnerable to the side effects of everything,” Han said. “I’m cautious about everything.”

Look for licensed providers.

In some states like California, licensed dispensaries must test for contaminants. Be especially careful with marijuana bought illegally. “If you’re just buying marijuana down the street … you don’t really know what’s in that,” said Dr. Joshua Briscoe, a palliative care doctor at Duke University School of Medicine who has studied the use of marijuana for pain and nausea in older patients. “Buyer, beware.”

Bottom line:

The research on medical marijuana is limited. There’s even less we know about marijuana use in older people. Proceed with caution.

Jenny Gold and Mara Gordon contributed to this report.

This story is part of a partnership that includes

NPR

and Kaiser Health News.

KHN’s coverage of these topics is supported by

John A. Hartford Foundation

and

The SCAN Foundation

SUNDAY HUNTING BILL SIGNED INTO LAW

HARRISBURG, PA

– It’s official: expanded Sunday hunting is coming to Pennsylvania in 2020.

Gov. Tom Wolf today signed into law Senate Bill 147, which permits additional hunting on three Sundays per calendar year – one within the archery deer season, one within the firearms deer season and one selected by the Pennsylvania Game Commission.

The law will take effect Feb. 25, 2020, and the first new Sunday hunting opportunities will be identified by the Game Commission thereafter.

In Pennsylvania, Sunday hunting generally is limited to the hunting of foxes, coyotes, crows and feral hogs during open seasons.

Introduced by state Sen. Dan Laughlin, R-Erie, Senate Bill 147 passed the state House of Representatives by a 144-54 vote Oct. 29, then passed the state Senate by a 38-11 vote Nov. 18.

Game Commission Executive Director Bryan Burhans said today’s signing of Senate Bill 147 by Gov. Wolf is a win for Pennsylvania’s hunters.

“People today tend to lead busy lives, and hunters are no exception,” Burhans said. “No matter how badly a hunter might want to get out and enjoy the outdoors during hunting season, other responsibilities might take priority and make it difficult.

“Providing opportunity to experience hunting on previously closed Sundays has game-changing potential for hunters with tight schedules and, in many cases, will make a difference by enabling those hunters to hunt alongside their children, setting them on a path they’ll follow the rest of their lives,” Burhans said. “To Sen. Dan Laughlin and to all of those who supported the bill and helped to make it a reality, please accept a heartfelt thank you on behalf of the Game Commission and hunters statewide.”

Laughlin, Chair of the Senate Game and Fisheries Committee, said the new law will create opportunities for tens of thousands of working families across Pennsylvania.

“I believe this has been a long time in coming and is truly a tribute to the thousands of hunters and the many organizations who have supported this effort,” he said. “Weekends are essentially the only time that most working men and women can get out into the woods. The same could be said for many young people, the ones who represent the future of the sport. Lifting the ban will give them increased opportunities to pursue the activity that they love.”

Sen. Jim Brewster, D-McKeesport, who serves on the Senate Game and Fisheries Committee as Minority Chair, sees the new law as an important tool in helping to recruit new hunters and keep them active.

“Sunday hunting will boost interest in the sport and open up new opportunities for hunters who are unable to get into the woods on other days of the week,” Brewster said. “I have been a longtime supporter of adding days when hunters are able to be in the field.

“This law will create access yet provide reasonable protections for farmers and landowners,” he said. “Sunday hunting will allow us to usher in new generations of sportsmen and women to enjoy our woodlands.”

State Rep. Bill Kortz, D-Dravosburg, the Democratic Chair of the House Game and Fisheries Committee, said Sunday hunting provides for hunters who otherwise have little time to hunt.

“It opens up opportunities for hunters who work six days a week, for students in college, and for junior hunters who can spend an extra day being introduced to our sport,” Kortz said. “It’s a big win for hunters, while respecting the concerns of all who enjoy our state’s outdoor traditions.”

Prior to passing the House of Representatives, Senate Bill 147 was amended to require all hunters on private land on the selected Sundays to carry written permission from the landowner. This requirement does not apply on Sundays when only foxes, coyotes, crows and feral hogs may be hunted.

The bill also gives Game Commission officers the authority to investigate private-land trespassing complaints and enforce trespassing violations as a primary offense. Previously, trespassing violations were referred to police unless a Game & Wildlife Code violation also was alleged. Once the new law takes effect, hunting-related private-land trespassing violations will be enforced year-round by the Game Commission.

MEDIA CONTACT:

Travis Lau – 717-705-6541

# # #

Pennsylvania Lawmakers to Raise Minimum Wage

By Todd DeFeo |

The Center Square

The state Senate has

passed legislation

to raise the minimum wage in Pennsylvania from $7.25 per hour to $9.50 per hour by 2022, but the move, which now heads to the state House for consideration, does not have universal support.

Raising the minimum wage “will cut off access to work experience for those trying to enter or re-enter the workforce, such as teenagers and former inmates, halting economic progress in its tracks for many Pennsylvanians,” Commonwealth Foundation Vice President & COO Nathan Benefield charged in a statement.

“Instead of pushing counterproductive wage mandates, policymakers should focus on proven ways to boost economic opportunity for all, including enacting commonsense spending limits to prevent tax hikes, lowering Pennsylvania’s extreme corporate tax rate to promote job growth, and cutting licensing requirements so low-income earners can start their own businesses and control their own futures,” Benefield added.

The Keystone State is one of 21 states where the minimum wage is set to the federal rate, “while half of the states have authorized an automatic future wage increase of some sort,” Senate Majority Leader Jake Corman, R-Benner Township, said

in a tweet

. “Senate Bill 79 is a responsible approach to increase the minimum wage rate incrementally.”

“Pennsylvania residents – especially those in my community – have indicated that they support raising the minimum wage in a way that is not disruptive for small employers,” Corman said in a news release. “Compromise is not a four-letter word. You know what is? Zero. Zero is what you get when you don’t compromise. This bill reflects a compromise that will help low-wage earners and reflect the economic realities … small employers face.”

A 2018 Independent Fiscal Office (IFO) analysis found there were 23,000 people out of 101 million working full time and earning between $7.25 and $8 per hour, according to Corman. Another 89,000 people worked part-time and fell within that hourly wage rate range.

“I’ve heard from those who wanted more that it’s not enough,” House Majority Leader Bryan Cutler, R-Lancaster, said on the

Pennsylvania Newsmakers program

. \”I’ve heard from some that it’s too much, and I think that we just need to dig into the issues and see what reforms can come with it.\”

Pennsylvania Gov. Tom Wolf has called for an increase in the minimum wage. A previous proposal would have increased the minimum wage to $12 per hour on July 1 and $15 per hour by 2025.

“We know that over 30 percent of college students go hungry because they can’t afford proper nutrition,” first lady Frances Wolf said in a release after touring Penn State’s student-run food pantry. “We also know that many of these students carry jobs in addition to their studies. Raising the commonwealth’s minimum wage would help these struggling students meet their basic needs so they can succeed in school and get the skills they need to attain jobs after graduation.”

published here with permission

Wreaths of Remembrance Dec. 7

(Monroe Township, NJ) On Saturday, Dec. 7, residents are invited to gather at the Gloucester County Veterans Memorial Cemetery to help remember those men and women who defended our country\’s freedom during the annual Wreaths of Remembrance Ceremony.

Freeholder Director Robert M. Damminger said, \”By placing these wreaths annually, we continue to show our thanks to those who gave their lives and show that we remember them and will continue to do so for years to come.\”

The Wreaths of Remembrance Ceremony is open to the public and will begin at 10 a.m. sharp.

Freeholder Dan Christy, liaison to the Department of Veterans Affairs, said, \”For some families, this is a way to include their relatives in their holiday festivities and keep them in their hearts, for others, it is a way to honor a veteran for their service and sacrifice.\”

The Ceremony will include a moment of silence for those who served, followed by opening remarks and the announcing of those laying the wreaths. Immediately following the ceremony, volunteers will assist to lay a wreath on each of the individual 2,800 graves.

The Gloucester County Veterans Memorial Cemetery is located at 240 N. Tuckahoe Road in Monroe Township.

Wreaths of Remembrance Parking is at Williamstown High School. Bus service will be provided to and from the cemetery. Vehicles should not park on the roadway.

PRELIMINARY THREE-DAY BEAR HARVEST RESULTS

HARRISBURG, PA

– Through three days of Pennsylvania’s general bear season, hunters have harvested 1,498 bears, with bears taken in 52 counties.

That compares to a three-day 1,833 in the 2018 general season. However, the 2019 general season harvest is complemented by a large bear harvest during new and expanded early bear seasons for muzzleloader, firearms and archery hunters. Factoring in the early season harvest, 3,373 bears have been taken through Tuesday. That already tops the 2018 total bear harvest of 3,153, with plenty more bear hunting still to go.

After the season’s third day, two bears of more than 600 pounds have been added to the list.

A 743-pound bear taken Tuesday morning with a rifle in Greene Township, Pike County, by Matthew J. Erdie Jr., of Nazareth, ranks as the third-heaviest bear taken across all 2019 bear seasons.

Meanwhile, a 661-pounder taken Monday morning with a rifle in Lake Township, Wayne County, by Michael A. Biduck II, of West Abington, now ranks as the fifth-heaviest bear in 2019.

The largest bear through all 2019 seasons continues to be the 813-pound male taken with a rifle on the opening day of the general season in Smithfield Township, Monroe County, by Victor M. Vassalluzzo, of Kintnersville.

The heaviest bear ever taken in Pennsylvania was an 875-pounder harvested in 2010 in Middle Smithfield Township, Pike County. Since 1992, seven black bears weighing at least 800 pounds have been lawfully harvested in Pennsylvania hunting seasons.

Other large bears taken in the 2019 general season’s first three days – all taken with a rifle – include: a 747-pound male taken in Wright Township, Luzerne County, by J. Kripp Jr., of Mountaintop; a 696-pound male taken in Penn Forest Township, Carbon County, by Brian J. Borosh, of Jim Thorpe; a 657-pound male taken in Franklin Township, Columbia County, by Nicholas A. Podgurski, of Elysburg; a 656-pound male taken in Hanover Township, Luzerne County, by Dale J. Kobal, of Hunlock Creek; a 623-pound male taken in Beech Creek Township, Clinton County, by Mikael J. Catanese, of Sewickley; a 620-pound male taken in Miles Township, Centre County, by Reuben Kennel, of Turbotville; and a 604-pound male taken in Gallagher Township, Clinton County, by Steven Z. Rohrbach, of Lock Haven.

The top bear-hunting county in the state over the general season’s first three days was Lycoming County with 113 bears. It was followed by Tioga County with 107 bears.

Three-day preliminary harvests by county and region are:

The preliminary three-day bear harvest by Wildlife Management Unit was as follows:

WMU 1A

, 11 (17 in 2018);

WMU 1B

, 44 (100);

WMU 2A

, 3 (5);

WMU 2C

, 69 (115);

WMU 2D

, 92 (114);

WMU 2E

, 38 (56);

WMU 2F

, 170 (198);

WMU 2G

, 309 (344);

WMU 2H

, 49 (59);

WMU 3A

, 85 (99);

WMU 3B

, 138 (117);

WMU 3C

, 56 (45);

WMU 3D

, 161 (141);

WMU 4A

, 76 (123);

WMU 4B

, 32 (53);

WMU 4C

, 50 (83);

WMU 4D

, 92 (112);

WMU 4E

, 21 (48);

WMU 5A

, 1 (4);

WMU 5C

, 1 (0).

Three-day harvests by county and region are:

Northwest (221)

: Warren, 61 (52); Clarion, 35 (37); Venango, 30 (68); Forest, 26 (52); Jefferson, 25 (64); Butler, 20 (17); Crawford, 19 (49); Mercer, 4 (12); and Erie, 1 (15).

Southwest (114)

: Somerset, 34 (57); Armstrong, 30 (25); Indiana, 24 (30); Fayette, 14 (32); Cambria, 7 (13); Westmoreland, 4 (11); and Greene, 1 (0).

Northcentral (626)

: Lycoming, 113 (103); Tioga, 107 (86); Clinton, 87 (119); Potter, 76 (54); McKean, 59 (43); Clearfield, 53 (72); Elk, 51 (46); Centre, 35 (46); Cameron, 30 (61); and Union, 15 (13).

Southcentral (154)

: Huntingdon, 49 (76); Bedford, 34 (51); Fulton, 17 (33); Perry, 16 (14); Blair, 15 (21); Juniata, 8 (15); Mifflin, 6 (10); Franklin, 5 (14); Cumberland, 3 (4); and Adams, 1 (4).

Northeast (349)

: Pike, 66 (46); Monroe, 44 (46); Luzerne, 39 (50); Bradford, 36 (46); Wayne, 35 (29); Sullivan, 30 (30); Susquehanna, 29 (10); Wyoming, 19 (24); Lackawanna, 18 (15); Carbon, 16 (25); Columbia, 12 (17); and Northumberland, 5 (17).

Southeast (34)

: Dauphin, 14 (25); Schuylkill, 13 (17); Berks 6 (1); and Lebanon, 1 (7).

Bergen County Doctor Pleads Guilty to Submitting More than $32,000 in False Claims

Faces Five-Year Prison Sentence for Health Care Claims Fraud

TRENTON

– Attorney General Gurbir S. Grewal and the Office of the Insurance Fraud Prosecutor (“OIFP”) announced today that a Bergen County family practitioner is facing five years in prison for submitting more than $32,000 in false claims to an insurance company for health care services he never rendered.

Dr. Robert Delagente, 45, of Oakland, who practiced at North Jersey Family Medicine, pleaded guilty to a one-count accusation charging him with second-degree health care claims fraud. Under the terms of the plea agreement, the State will recommend that Delagente be sentenced to five years in prison. Delagente is scheduled to be sentenced on January 10, 2020.

In pleading guilty before Superior Court Judge James X. Sattely in Bergen County on Nov. 21, 2019, Delagente admitted that between May and December of 2016 he submitted seven fraudulent claims to Blue Cross/Blue Shield of New Jersey totaling $32,006.

The fraudulent claims billed the insurance company for allergy testing and immunotherapy services that Delagente did not provide to patients.

“When doctors cheat the insurance system, they’re committing a crime that drives up the cost of healthcare for everyone, including the patients they took an oath to serve,” said Attorney General Grewal. “The five-year prison sentence this doctor faces sends a message that New Jersey will not tolerate medical providers who abuse their professional authority for illegal gain.”

“Insurance fraud costs insurance companies billions of dollars every year nationwide and those losses are passed on to all of us through higher insurance premiums and increased costs for goods and services,” said Acting Insurance Fraud Prosecutor Tracy M. Thompson. “To protect New Jersey residents from being victimized by insurance cheats we will continue to pursue harsh punishments like the one announced today to send a strong message of deterrence.”

Deputy Attorney General Crystal Callahan represented the State during the plea hearing.

Delagente was charged following a joint investigation of his practice by OIFP and the FBI. The investigation was coordinated by OIFP Detectives Suzanna Lopez and Janet Thai, and special agents with the FBI Health Care Fraud Unit.

Delagente also faces criminal charges in federal court stemming from this investigation.

On May 13, 2019, the

U.S. Attorney’s Office of the District of New Jersey charged Delagente

with one count of distribution of controlled dangerous substances for allegedly prescribing opioid pain medications and other controlled substances outside the ordinary course of professional practice, and one count of obstruction of justice for allegedly falsifying medical records to cover it up.

In the wake of the federal charges against him, Delagente entered an

Interim Consent Order

with the State Board of Medical Examiners in which he agreed to the temporary suspension of his license pending the outcome of those charges and pending further action by the Board.

Acting Insurance Fraud Prosecutor Thompson noted that some important cases have started with anonymous tips. People who are concerned about insurance cheating and have information about a fraud can report it anonymously by calling the toll-free hotline at

1-877-55-FRAUD

, or visiting the Web site at

www.njinsurancefraud.org

. State regulations permit a reward to be paid to an eligible person who provides information that leads to a conviction for insurance fraud.

Mental Health board member recognized for 20 years of service

(West Deptford, NJ) Gloucester County Freeholder Jim Jefferson recognized Elaine Vets for her 20 years of service to the Gloucester County Mental Health Board.

Elaine has made it a priority to learn about the community mental health services, promote education and advocate for individuals experiencing mental illness. She has been an appointed member on the Mental Health Board for 20 years, 15 of which she has served as chairperson.

Freeholder Director Robert M. Damminger said, \”The Mental Health Board promotes understanding and education towards those experiencing and those affected by mental illness. Gloucester County is fortunate to have Elaine on their team.\”

Freeholder Jefferson, liaison to the Mental Health Board said, “Elaine works hard to provide our community with the tools necessary to effectively deal with and advocate for their loved ones who are living with mental health conditions. Her abilities and contributions are an important key to the success of the Mental Health Board.”

For resources and contact numbers for those suffering from mental health issues or those who know someone who may be suffering, visit

http://www.gloucestercountynj.gov/depts/h/hserv/mhs/resources.asp.

North Jersey Oral Surgeon License Revoked

Final Decision

Initial Decision

NEWARK

– Attorney General Gurbir S. Grewal and the Division of Consumer Affairs today announced that the State Board of Dentistry (“the Board”) revoked the license of a North Jersey oral and maxillofacial surgeon and ordered him to pay more than $500,000 in penalties, costs, and restitution to patients for engaging in “hit and run dentistry” that left a swath of harmful consequences for patients in four counties.

Dr. Andrew Maron, who owned a string of dental practices in Monmouth, Passaic, Hudson, and Union counties, and also practiced as an itinerant oral surgeon in those counties, has been prohibited from practicing in New Jersey since the State filed multiple allegations of negligence, gross negligence and professional misconduct against him in 2015.

In a final decision that brings closure to the State’s case, the Board revoked the license of the 58-year-old Maron, finding that his treatment of patients – many of whom were low-income, elderly, or disabled – amounted to “hit and run dentistry” that reflected a “cavalier indifference to his patients’ well-being” and a “pattern of substantial deviations from the standard of care that existed unabated for years.”

“Most dental practitioners are dedicated to the health and safety of their patients,” said Attorney General Grewal. “But revolving-door dentistry that puts practitioners’ financial gain ahead of patient health and safety erodes public trust and undermines the integrity of the entire profession. That’s why it’s important for the Board to take decisive action in cases like this one, and we are pleased that the Board did so.”

According to findings in the case, Maron committed multiple acts of negligence and gross negligence and professional misconduct in his treatment of 17 patients between 2010 and 2015. Such conduct included:

Pulling natural teeth and replacing them with dental implants with little or no regard to the restorability of the natural tooth;

Placing numerous implants that failed, some dangerously so by migrating into the sinus, or by patients swallowing them;

Performing, planning and undertaking treatment without regard to a patient’s ability to pay for the treatment;

Discussing treatment with patients who were already in the chair receiving anesthesia;

Pressuring elderly patients into having implants placed without pre-operative diagnosis, review, or informed consent;

Pressuring Medicaid patients into taking CareCredit loans which exceeded their ability to repay;

Ignoring or failing to take patients’ medical histories;

Submitting inaccurate and inflated billing for treatment; and

Failing to ensure that the dentists in his employ practiced with patients\’ health, safety, and welfare in mind.

“Dr. Maron placed patients at risk through egregious conduct that violated the most basic tenets of professionalism,” said Paul R. Rodríguez, Acting Director of the Division of Consumer Affairs. “His disregard for the well-being of his patients makes a mockery of the standards adhered to by those who are privileged to hold a license to practice dentistry. The revocation of his license not only protects the public from the threat posed by Dr. Maron, it removes a stain on New Jersey’s esteemed dental profession.”

The Board\’s decision to revoke Maron’s license largely upholds the findings of an Administrative Law Judge who heard the case in a series of hearings that concluded in January 2019.

In an Initial Decision rendered in May 2019, Administrative Law Judge Susan M. Scarola concluded that Maron’s practice was “so overextended it was almost impossible for him to provide quality care.”

“Respondent’s repeated acts of negligence and gross negligence, his professional misconduct, his dishonesty and deception, and his lack of providing appropriate and determined care for his patients warrant the severest possible sanction, namely, revocation of his license,” Judge Scarola concluded.

Judge Scarola also agreed with the State’s argument that Maron should be ordered to pay a substantial penalty for each unlawful act he committed, and that he be ordered to reimburse patients for deficient treatment, and reimburse the State for fees and costs associated with investigating and prosecuting the case.

Following a hearing on July 24, 2019, the Board adopted Judge Scarola’s findings and conclusions with limited modifications. Those modifications lowered the amount of restitution to one patient, and removed restitution to another patient who already received payment through civil litigation.

The Board ordered Maron to pay civil penalties totaling $138,500; restitution totaling $75,041.22 to 15 patients; and aggregate costs and attorneys\’ fees of $303,856.22. The Board filed its written decision on Nov. 1, 2019.

This investigation was conducted by the Enforcement Bureau of the Division of Consumer Affairs.

Senior Deputy Attorney General Joan D. Gelber, from the Division of Law represented the State in this matter.

Patients who believe that they have been treated by a licensed health care professional in an inappropriate manner can file an online complaint with the State Division of Consumer Affairs by visiting its

website

or by calling

1-800-242-5846

(toll free within New Jersey) or

973-504- 6200