News From Grace Cottage

Eating Healthy on a Budget: It’s Easy!

| Graceful Health

By Elizabeth Harrison, Grace Cottage Community Health Team Health Coach

Quite often, when I counsel my clients about nutrition, I find they have the mistaken idea that healthy food is more expensive. They believe they can’t afford to eat healthy. This just isn’t so.

The “Healthy Cooking on a Tight Budget” workshops that I have presenting along with two colleagues from the West Townshend Country Store is helping to dispel the myth that healthy food is high cost, and I would like to share here some of those insights we are presenting.

The first workshop, held in June, focused on soups. If you think about it, soup is one of the easiest ways to stretch a tight food budget.

Soup can be made out of any ingredients you have on hand, so it can save money by reducing wasted food that might otherwise be forgotten in the fridge and then end up being thrown away.

Speaking of food waste, what do you do with the ends when you cut up carrots, celery, onions and other vegetables? Do you throw them away? Next time, pop them into a pot of water, bring them to a boil, and simmer them for half an hour or so. You’ll have free and healthy broth that can be the start of your next soup. You can store this in the fridge for up to a week, or freeze it for use later.

You can also save money by growing your own vegetables. It doesn’t cost much to buy a package of vegetable seeds, and with a little bit of space at home, or at a community garden, and a little bit of effort, you can grow enough vegetables to make soup for months to come. Use some of it now, and put the extras in the freezer (blanch them first).

Add some leftover chicken, red meat, fish, or a can or two of low-cost beans, and a few vegetables (include some densely nutritious leafy greens), and you can feed a family for very little money, maybe a dollar or two per person. Much cheaper than “fast food,” and much healthier. Here’s a version of one of the soup recipes prepared during the June “Healthy Cooking” workshop:

  • Start with 8 cups of broth made from simmering vegetable ends, as described above. (You can also use an equal amount of canned vegetable broth.)
  • Chop up a variety of vegetables (onions, carrots, celery, parsnips, kale, turnip greens, tomatoes – whatever you have) and add them to the broth.
  • Add spices and herbs, for example, parsley, cilantro, garlic, a touch of salt, pepper, and whatever else you like.
  • Add a large can of beans (white, red, or black, your choice).
  • Simmer for half an hour or longer, and serve! Add some bread and it’s a meal. Quick, easy and healthy! And easily varied to whatever you have on hand.

I also have a go-to dinner that is extremely easy to make and inexpensive. I call it “Dinner in 20 Minutes.” It can also have endless variations. This will serve 2-4 people, but you can always add more of each ingredient for a bigger group. It goes like this:

  • Put a package of frozen vegetables in a pot, place a piece of chicken for each person on top, and add a moderate amount of oil and seasonings (I like to use Italian dressing).
  • Put on the lid, and cook on low heat for 20 minutes.
  • Cook some rice or quinoa on the side.
  • While you are doing laundry, checking your email, talking with your spouse and/or your kids, or taking a short walk, dinner is cooking, with little effort from you. You can also bake this in the oven, but if you do so, allow more time.

Eating real food is actually cheaper, as well as healthier than “junk,” and with a little preparation, it can be faster to create a real meal than to go out for “fast food.” For example, in half an hour once a week, you can chop many vegetables ahead of time, to make daily preparation easier. You can also bake a whole chicken or a pan full of pieces, and have the meat to use for a variety of meals throughout the week.

Remember, it’s not a matter of money. Eating healthy doesn’t have to be expensive. It does require a new way of thinking. I hope the information presented here will help you to make that shift.

For more ideas, you are welcome to join us for the upcoming “Healthy Cooking” series workshops to be held at the West Townshend Country Store on August 9, September 13, and October 11. Each class costs $5 and includes instruction, taste-testing, and take-home samples. Call 365-3766 to sign up (RSVP required). Information about quick and easy meals and food preservation will be provided.

Bio: Elizabeth Harrison is a board certified clinical nutritionist. She earned her B.S. in Psychology from Western College for Women (now Miami University of Ohio). Her board certification is through the International & American Associations of Clinical Nutritionists. As a member of the Grace Cottage Community Health Team, Harrison provides resources and skills to develop healthy habits, and runs monthly support groups. The services of the Grace Cottage Community Health Team are free for all Grace Cottage patients.

Healthy Food, Healthy Planet

| Graceful Health

By Danny Ballentine, Grace Cottage Emergency Department Physician Assistant

Food is medicine.

Chronic diseases are currently the leading cause of death in the developed world. A whole-foods, plant-based diet is excellent for decreasing the risk and treating chronic diseases such as diabetes, heart disease and even cancer, and is very effective for weight control. Plant-based diets are also anti-inflammatory diets, which have been shown to enhance athletic performance, decrease recovery time after a workout or competition, and foster a strong immune system. There are athletes of all sports, from ultra-running to body building, who have adopted completely plant-based, or vegan, diets and have seen improvement in performance.

Dr. Andrew Weil, a physician and advocate of integrative medicine, has developed a food pyramid that helps folks move towards healthy plant-based eating habits and is easily accessible and simple to follow (see While Dr. Weil is often a proponent of dietary supplements, if you follow his food pyramid and are not pregnant, breastfeeding, or at increased risk of osteoporosis, the only supplement you might seasonally need is vitamin D.  One exception: a completely vegan diet does require minimal supplementation of B vitamins, in particular B12 and seasonally Vitamin D during the winter when there is less sunlight (vitamin D is absorbed through the skin’s exposure to sunlight).

I have two young children. They eat what my wife and I eat; they’re active and healthy. Still, as I listen to the news on the way to work, I worry about their future. The way we are polluting our environment and the consequence of greenhouse gasses is frightening, and rolling back policies that protect the environment will only make it worse. Many scientific organizations, including the World Health Organization, are stating that as soon as 2030, climate change is expected to contribute to 250,000 additional deaths a year through various mechanisms.

Our national (and global) food industry is a major contributor to global warming. The foods that increase greenhouses gases are the same foods that contribute to global warming. The livestock industry produces more of these pollutants than all forms of global transportation and shipping combined, including cars, planes, trains and ships. Simply put, eating large quantities of meat is bad for the environment.

The U.S. is ranked second highest in meat consumption, at 270.7 pounds per person a year. Every calorie of animal protein (meat) produced requires 25 calories of fossil fuel, compared to only 2.2 calories for plant-based proteins.  Shifting to a meat-free diet or even significantly cutting back on meat consumption is the strongest way we can decrease global warming. It is also by far the least expensive.

Organic versus non-organic, or conventional, foods can be a contentious topic. There tends to be a significant cost difference between the two. Surprisingly this is not always the case and some organic foods have become more affordable.

From an individual perspective, there are increased health benefits from eating organic but these are marginal. The ecological impact should also be considered and mitigated. Organic foods shipped from farther away have more of an ecological impact than buying from local farmers. Likewise, conventional foods shipped from agribusinesses far away also have a large ecological footprint and support an industry which adversely affects farm workers by exposure to large quantities of chemicals.

The takeaway: support local farmers when you can. Even if they aren’t organic, they probably aren’t using the amount of pesticides and herbicides that you’ll find in large-scale farming. When deciding how to get the best bang for your buck, consider buying beans, nuts, fruits and vegetables and put a priority on buying locally over organic. If budget is a constraint, prioritize your organic purchases based on Dr. Weil’s “Dirty Dozen” list of fruits and vegetables that tend to have the highest pesticide levels. In addition, see his “Clean 15” list, which includes the safer fruits and veggies to buy conventional. Both lists can be found online.

Finally, and maybe most importantly, our eating habits are shaped by more than just having reliable information. Hopefully, I have already presented a compelling reason why a whole-food, plant-based diet is not only best for your physical health but also the environment.

Other factors at play stem primarily from our emotional relationship to food. Media outlets are a constant stream, determined to elicit emotional responses and tell us how we should feel about certain foods. The food industry invests millions of dollars in engineering foods using ingredients such as fat, sugar, and salt which, when combined, use the same neuropathways as opiates. Our familial eating habits and what we were raised eating as children largely shapes the way we eat as adults and what we consider comfort foods. When we are stressed, it is the natural tendency to seek out go-to comforts. Food is a big one and life is more stressful than maybe ever before.

Becoming mindful about our emotional ties to foods, what our food culture is, and our own stress habits can help change the narrative on how we eat and put us back in the driver’s seat.

“Let food be thy medicine and medicine be thy food.” -Hippocrates.

Danny Ballentine works in the Grace Cottage Hospital Emergency Department. He earned his B.S. in Wellness and Alternative Medicine from Johnson State College and his Master of Physician Assistant Studies from Franklin Pierce College. He joined Grace Cottage in 2012.

Prostate Cancer Screening? It Depends

| Graceful Health

By Dr. Moss Linder, Grace Cottage Family Health

Sometimes, a doctor can give medical advice that fits everyone, things like stop smoking, get regular exercise, and eat a healthy diet. Other times, a medical issue can’t be decided with a one-size-fits-all approach. Prostate cancer screening recommendations are one of those topics.

The prostate is a gland in a man’s body that surrounds the urethra, the tube through which urine flows. Prostate cancer is a disease that causes the gland to grow abnormally. Most prostate cancers have no symptoms at all, and the cancer grows so slowly that it does not cause any major problems. Some men may have urinary frequency or urgency or waking up at night to urinate.

The most common risk factors are age (more than 80% of prostate cancers are detected in men 65 or older, according to the American Society of Clinical Oncology); ethnicity (prostate cancer is more common in African-American men); and a family history of prostate cancer. There is research that a high fat diet may also contribute to the risk.

Prostate cancer is the most common solid organ cancer in men and, behind lung cancer, the second leading cause of cancer death.

There are two basic tests for prostate cancer screening. One is a prostate specific antigen (PSA) blood test that looks for a particular substance in the blood that may indicate the presence of prostate cancer. Other conditions aside from prostate cancer can also cause this test to be elevated. The other test is a rectal exam to see if the prostate is abnormal–uncomfortable, but useful for diagnosis. This test also can have drawbacks in that an abnormality can be missed or an abnormal exam may not be indicative of prostate cancer.

So, who gets screened for prostate cancer?

In the past, medical experts recommended that men over the age of 50 or 55 be screened for prostate cancer every year. Now, the advice is, it depends. As medical knowledge has evolved, the most recent research suggests that for most men, annual screenings may not be warranted.

The reason for this is that most men who develop prostate cancer will actually die for some other reason, such as heart disease or stroke. In fact, autopsy studies have shown that over 70% of men in their 70’s have evidence for prostate cancer. The side effects of treatment can have a profound effect on quality of life. They can include urinary incontinence, erectile dysfunction, bowel issues and osteoporosis, among others. Also the testing, PSA’s and rectal exams, can either over-diagnose or under-diagnose this condition.

On the other hand, since the introduction of PSA as a screening tool in 1986, the number of total prostate cancer deaths has decreased by approximately 30%. Early detection and treatment has decreased the number of patients suffering from possible consequences of advanced prostate cancer, such as severe bone pain and big tumors that obstruct the urinary tract.

To make matters even more confusing, there are differing and conflicting recommendations from major medical societies.

In summary, prostate cancer screening issues are nuanced. It is not an easy decision to make. A good approach to this issue is to discuss it with your provider at an annual wellness exam with thoughtful, shared decision making.

Dr. Moss Linder joined the Grace Cottage Hospital staff in 1997. He received his medical degree from the University of Vermont in 1991 and completed his Family Medicine residency at Oregon Health Services University. Prior to Grace Cottage, he worked as a family physician at the Acoma Cañoncito Laguna Hospital in New Mexico.

Tomatoes Wanted!

| Featured, News

Attention gardeners: we need tomatoes!

The “Ton of Tomatoes” project aims to bring local, nutritious food to area residents who are in need by collecting tomatoes during the growing season, processing and freezing them, then distributing them throughout the year via the food shelf. The collection goal is one ton of tomatoes!

This effort is being organized by Grace Cottage Family Health and Hospital, the Townshend Community Food Shelf, and the West River Project. These groups will collect and process the tomatoes.

Please help by designating one or more tomato plants in your garden and donating what those plants produce.

To participate in the program, contact Grace Cottage Community Health Team member Bill Monahan at or 365-3762.

Heading Out Into the Sun? Read This First!

| Graceful Health

By Natalie Harding, Grace Cottage Family Health PA-C

We waited so long for summer, and now it’s time to get outside and go biking, hiking, get work done on the house or garden, or spend time on the beach. Maybe you earn your living working outdoors. Did you pack the sunscreen?

“Only mad dogs and Englishmen go out in the midday sun,” says Rudyard Kipling in his poem “Gunga Din.” There’s wisdom in that. The welcome, warm light from the summer sun carries a risk — UVA and UVB radiation. The risk is there all year, but in the summer we tend to be outdoors longer, have more skin exposed, and the days are longer, extending the risk.

Ultimately, UVA and UVB can damage the skin and cause skin cancer. Here’s a mnemonic to help you remember the difference. UVA is responsible for Aging; it passes through window glass all year. UVB is responsible for Burning; it’s blocked by window glass. Clothing has varying degrees of protection, but of course, it doesn’t help the skin that’s exposed.

So, don’t forget to pack the sunscreen!

Skin damage can set in quickly and is compounded over years. In as little as 15 minutes you can start to burn, causing damage eventually. If you use tanning beds, you already are greatly increasing your risk of skin cancer, so adding outdoor exposure throughout the year can accelerate the risk of side effects from UVA/UVB radiation.

In order to make a good choice about what type of sunscreen to use and how to apply it, you need to know a little about “SPF” numbers and about sunscreen ingredients.

SPF stands for “sun protection factor.” The SPF number is used to label both clothing and sunscreens. SPF is figured by determining how long it takes skin protected with sunscreen to burn, compared to unprotected skin. It is important to know that SPF 30 sunscreen does NOT protect you twice as much as SPF 15. The American Academy of Dermatology does not suggest using any sunscreen lower than SPF 30, which blocks 97% of UVB rays. A higher SPF only blocks a slightly higher amount of UV.

Sunscreens still need to be reapplied every two hours, no matter what the number. Sunscreens labeled as “water-resistant” are supposed to remain effective for up to 40 minutes of swimming or sweating. After that, the sunscreen should be reapplied, especially after toweling off.

Another important tip about sunscreen: the ingredients of your sunscreen will affect how it feels on your skin. Some sunscreens use ingredients which absorb the UV rays and convert the rays to heat on your skin. These products can actually make you feel hotter.  Examples of these sunscreen ingredients include PABA, cinnamates, salicylates, and benzophenones.

Other sunscreens use ingredients like titanium dioxide or zinc oxide to reflect and scatter the UV rays. These ingredients are not absorbed by the skin, but instead set up a particle block. Zinc oxide was responsible for the classic lifeguard white nose. Today, this type of sunscreen is much more subtle and does not leave your skin white. It works well, and for people concerned about chemical risk from other sunscreens, it can be a less irritating and less worrisome option, so likely the safest if you are concerned about absorption.

Sunscreens come as creams, lotions, gels, sticks, and sprays. Creams and lotions can be soothing to dry skin; creams will be thicker than lotions. Gels may be easier to apply to areas of the body which have more hair.

Sprays are promoted as great for little children because they can be applied quickly, so the adult needs to spend less time wrangling a toddler into standing still while sunscreen is applied. However, there are two dangers to consider. First, it is more difficult to see how much you are applying. And second, sprays increase the risk of chemical inhalation, especially by children. Not ideal. If you do use spray sunscreen, use it around the face with special care.

Ultimately, it’s most important that you choose a type of sunscreen that you like, so you will actually use it! Don’t skimp when applying sunscreen.

Also use other methods of protecting yourself from midday sun, especially with children – things like umbrellas, cover-ups, hats, and beach tents, and sunglasses to protect your eyes.

So pack the sunscreen, and enjoy the summer!

P.S. Remember these tips when you ski in the winter, because they work well then, too!

Bio: Natalie Harding is a Physician Assistant practicing at Grace Cottage Family Health in Townshend, VT. Natalie earned her Master of Physician Assistant Studies from Franklin Pierce College in New Hampshire. She worked in Greenfield, MA, before joining Grace Cottage Hospital in 2014.

How Can I Sleep Better?

| Graceful Health

Tips from the Medical Providers of Grace Cottage Family Health

Do you have trouble falling asleep, or staying asleep throughout the night? If so, you are not alone. In Vermont, more than one-third of adults report that they get less than the recommended seven-plus hours of sleep per night.

If you are among that 30 percent, you might benefit from learning about sleep hygiene. No, that doesn’t mean brushing your teeth and washing your face at bedtime. The term “sleep hygiene” actually refers to various lifestyle habits and the environment in which you sleep.

No doubt, some of the principles of sleep hygiene are familiar to you, but it’s worthwhile to review them and to keep them in mind.

When the term “sleep hygiene” was first coined in the 1970s, researchers were just beginning to make connections between certain habits and insomnia. Today, as sleep research has continued, we have come to see that insomnia often has a deeper cause.

If you are having a recurring problem with sleep, it is a good idea to visit your medical provider. It may be that there is a physiological problem that needs to be addressed. For example, sleep apnea, which is a series of pauses in your breathing during sleep, is a common disruptor to the natural and necessary sleep cycles. Treatments to solve a medical problem may clear up the sleep issues. Those whose insomnia is brought on by anxiety may find that mental health counseling helps. Whatever is needed, your primary care provider can refer you to the best source.

Perhaps your sleep difficulties are only occasional. Whether the issue is chronic or sporadic, sleep hygiene habits can support other efforts to cure insomnia and to prevent relapses.

Hopefully, the following sleep tips that we often share with our patients will help you sleep better.

Eileen Arama, Licensed Clinical Social Worker: What helps me during an occasional sleepless night or two is to “relax and be OK with it.” I don’t fight it. I stay in bed, make myself comfortable, leave the lights off, and enjoy the dark and the quiet of the night. I breathe and tell myself that if I am resting both my brain and my body, I will manage my day just fine.

Dr. Ewa Arnold: The best sleep environment is a cool, dark room. Have a regular routine – try to go to bed at approximately the same time each night. And reserve the bedroom for two activities only—sex and sleeping.

Dr. Jesper Brickley: Sexual activity is one of the best ways to encourage sleep. It has so many physical and emotional benefits. When it’s time to sleep, keep the bedroom as dark as possible. If you can’t sleep, get out of bed and do something like reading to relax.

Jorda Daigneault, Family Nurse Practitioner: Avoid alcohol. Instead, I drink Sleepy Time tea. It has herbs that relax you and are good for your stomach. Reading in bed for a few minutes (a book, not on an electronic device) always puts me to sleep!

Dr. Maurice Geurts: Sleep in a dark, quiet bedroom (not much of a problem in Vermont!). Have a regular bedtime.

Natalie Harding, Physician Assistant: Do 30 minutes of yoga before bed. Meditation can also help.

Dr. Elizabeth Linder (Pediatrician): Kids benefit from a regular bedtime routine. Turning off the TV, the phone, and the computer an hour or two before bedtime helps. And the old tried-and-true method is still one of the most effective ones: read a bedtime story together.

Dr. Moss Linder: A regular exercise routine during the day will help you sleep better at night. Try to walk 30 minutes a day, walking outside as much as possible. Develop a regular practice of deep breathing. Dr. Andrew Weil has a method called the 4-7-8 technique that is remarkably effective. The basic idea is to inhale to a count of four, hold the breath in for a count of seven, and slowly exhale for a count of eight. You can look it up online.

Devan Lucier, Adult Gerontology Nurse Practitioner: Avoid taking naps during the day as much as possible. If you are napping on a regular basis, see your medical provider to find out why you are so tired all the time. And if you tend to lie in bed watching the clock, hide the clock!

Louise McDevitt, Family Nurse Practitioner: Chronic insomnia can lead to a host of other problems, including cardiovascular issues and hypertension. If insomnia lasts more than a couple of months, it’s important to see your medical provider and identify the cause. It could be related to anxiety, excess weight, sleep apnea, interactions with over-the-counter medications, genetics, or other reasons. Each cause needs to be addressed differently.

Dr. Timothy Shafer: Get some exercise daily. You will sleep better. Have a regular schedule of bedtime and rising. No caffeine after mid-day. Prolonged TV watching, reading in bed, or going on-line in bed leads to insomnia. Don’t go to bed until you are ready to sleep.

Benjamin Wright, Psychiatric Nurse Practitioner: Dr. Andrew Weil’s 4-7-8 breathing technique is very helpful for sleep and for stress. I use this with patients as a stress reduction practice. If you do it regularly, it becomes a habit that can kick in naturally to help you relax.

Bio: Grace Cottage Family Health is a federally-designated Rural Health Clinic that has been certified by the National Committee of Quality Assurance as a Level 3 Patient-Centered Medical Home, the highest level achievable. Grace Cottage’s primary care providers offer family practice, pediatrics, geriatrics, urology, and mental health services.

What is a Patient-Centered Medical Home?

| Graceful Health

By Elaine Swift, Grace Cottage Family Health Practice Director
as originally appeared in the Brattleboro Reformer’s Graceful Health series May 5, 2017

Sometimes the language used by government agencies obscures the goal. The term “Patient-Centered Medical Home” is like that. People ask me all the time, “What does it mean, and why is it important?” I’d like to explain some of the ways that being a Patient-Centered Medical Home (PCMH) helps Grace Cottage provide the best care for our patients.

First, it’s helpful to know that, while all of the various services offered at Grace Cottage are important, the PCMH designation applies specifically to primary care practices. It is Grace Cottage Family Health, the part of Grace Cottage where patients go for their regular checkups and other primary care needs, that has received the PCMH designation. In fact, Grace Cottage Family Health was recently awarded Level 3 PCMH recognition, the highest level possible.

What does that mean for our patients? The National Committee for Quality Assurance (NCQA) has established five crucial elements that are required in order for a medical practice to become a PCMH. These are:

  1. Patient-Centered Care
  2. Comprehensive Care
  3. Coordinated Care
  4. Accessible Services
  5. Quality and Safety

I’ll explain each of these one by one.

“Patient-centered care” means just what it says. At Grace Cottage, the main focus is always the patient. Countless testimonials have been received to prove that we are fulfilling our vision to be the standard for patient care, and Grace Cottage was recently ranked in the Top 20 in the nation for Patient Satisfaction among the 1,339 Critical Access Hospitals.

Beyond that, in the primary care setting, patient-centered also means partnering with patients and their families, making sure patients are fully informed about their care plans, and supporting patients’ choices about how to approach, manage, and organize their own care.

The easiest way to explain “comprehensive care” is to say that it is a team approach. PCMHs must offer a range of services, including medical and mental health care, prevention and wellness services, acute care, and chronic care. All of these are available at Grace Cottage.

Grace Cottage Family Health uses a team approach and offers a variety of services. Its family medicine, pediatric, geriatric, and mental health providers work together with each other and with the Grace Cottage Community Health Team, a group of professionals offering diabetes education; nutrition, exercise and stress-management coaching; crisis counseling; and care coordination (phone calls and visits with patients to make sure they have the medicines and equipment they need and that they understand their medical providers’ instructions). In addition, a resource advocate links patients to social services and support from other agencies.

“Coordinated care” means that PCMHs work to coordinate a patient’s care, whether it is provided at the PCMH or elsewhere. One way we do that is by helping with referrals and appointments with specialists. Another is by coordinating care among providers at Grace Cottage.

“Accessibility” is another key element for PCMHs. Grace Cottage patients benefit greatly by being able to access a wide range of services at one location.

To increase the accessibility of services, the Grace Cottage Family Health offers same-day appointments when available, for medical needs that are urgent but do not require an emergency department visit. The clinic is open for appointments Monday through Friday, 7:00 a.m. to 5:00 p.m., and until 6:00 p.m. on Tuesdays. When acute care is needed, Grace Cottage Hospital also has an always-open Emergency Department.

Another way that Grace Cottage offers increased access is through the Patient Portal. A patient who has signed up for an account through the Patient Portal can access his or her medical records anywhere there is internet access, so the records can easily be shared during a visit with a provider elsewhere. Grace Cottage’s Patient Portal also allows around-the-clock electronic messaging. Patients can email questions to their providers and be assured of a quick response. (This is not for medical emergencies; for those situations, you should still call 9-1-1.)

“Quality and safety” of patient care have always been of paramount importance at Grace Cottage. This is also required with the PCMH model. Quality initiatives and outreach are important aspects of the PCMH model, and we take these efforts very seriously.

All of this work leads to better coordination of care and better patient experiences and outcomes, while reducing medical care costs. Being a Level 3 PCMH proves we are not only doing the right thing, but doing it very well. We are always accepting new patients into our practice. Call 802-365-4331.

Bio: Elaine Swift, CHC, CPHRM, RHIT, is a Certified Healthcare Compliance Officer, a Certified Professional in Health Risk Management, and a Registered Health Information Technician. She joined the Grace Cottage staff 23 years ago and has served as Health Information and Billing Coordinator, Compliance Manager, and Director of Quality, Compliance, Risk Management, and Credentialing before becoming the Grace Cottage Family Health Practice Director in 2015.  

Alcohol and Your Health

| Graceful Health

By Louise McDevitt, Nurse Practitioner, Grace Cottage Family Health
as originally appeared in the April 21 Brattleboro Reformer Graceful Health column

Let’s start by looking at some common beliefs about alcohol. How would you answer the following questions, true or false? A moderate amount of alcohol each day is good for your health. The United Nations has established a standard portion size for alcoholic drinks that is honored in most countries worldwide. Drinking may decrease the risk of heart attack and strokes. Drinking decreases a woman’s risk for getting breast cancer. Women who are pregnant should not drink.  Wine is better for you than other alcoholic beverages. Your chances of having a car accident are doubled even if your blood alcohol limit is only half the legal limit.

You can find a variety of opinions out there. As a medical provider, I review the scientific evidence. One source that I rely on is, which offers detailed articles for medical providers, by subscription, and free articles for the general public. I recommend it.

First, is it healthy to drink a moderate amount of alcohol every day? It depends. Some people should abstain completely, especially those with liver disease, gastritis, esophagitis, pancreatitis, hepatitis C, patients taking sedating medications, and those who identify as alcoholics or who have a strong family tendency of alcoholism.

Second, there is no recommended daily dose of alcohol, nor is there any standard portion size worldwide. One study found that drinks served in the U.S. tend to have nearly twice as much alcohol than those served in Great Britain, most notably when people prepare their own “standard-size” drinks at home.

In the U.S., standard sizes served at restaurants and bars are a 12-ounce beer, a five-ounce glass of wine, or a 1.5-ounce shot of 80-proof liquor. Moderate drinking is defined as one to two drinks a day, or three to nine servings a week, using these standard sizes. Women and those of smaller stature should stick to the lower range.

Next, while it is true that some studies show that moderate amounts of alcohol consumption on a regular basis may lower one’s risk of heart attacks and the type of strokes caused by blockages, they also show that even a minimal amount of alcohol seems to increase the risk of other types of strokes.

Drinking several alcoholic beverages at once can increase the risk of atrial fibrillation (rapid and irregular heart rate), even among those who usually drink moderately. Also, those who regularly consume more than two drinks a day are twice as likely to have high blood pressure, excessive weight, high triglycerides, and high-risk behavior, compared to nondrinkers. Regular drinking above the recommended level cited above can also cause cardiomyopathy (enlarged heart), a serious condition affecting the heart’s ability to pump blood.

Men who drink regularly have an especially increased risk for certain types of cancer. In a large European study, the alcohol-related risk for men and women, respectively, was 44 and 25 percent for upper gastrointestinal cancer, 33 and 18 percent for hepatocellular cancer, and 17 and 4 percent for colorectal cancer. The increased risk was largely found in individuals who drank more than the recommended upper limit.

Regarding breast cancer, studies have consistently shown that it occurs more often in women who drink moderately or heavily. As little as one to two drinks a day appears to increase this risk, and the risk increases with the amount consumed.

Is it safe for a pregnant woman to drink alcohol? Alcohol consumption during pregnancy is common, which highlights the importance of educating women about the potential harms to the developing fetus. Heavy drinking can lead to fetal alcohol syndrome, causing developmental delay and other birth defects. The general consensus is that no amount of alcohol in pregnancy is recommended. My best advice is avoid it.

Wine versus beer? There is no conclusive evidence proving that wine is healthier for you than other alcohol. The so-called “French paradox,” based on the fact that death from chronic heart disease is lower than expected in France, considering the high rate of smoking and the amount of saturated fats in the diet, is often attributed to regular consumption of red wine. Other studies, however, do not support this conclusion, and researchers tend to conclude there is no difference.

How much can you safely drink before driving? Most states, including Vermont, have a legal blood alcohol concentration (BAC) limit of 0.08 percent. However, the risk of having an accident while driving doubles at half that amount, and driving ability is impaired with a BAC as low as 0.02 percent. So the correct answer is: do not drink and drive, fly a plane, operate a snowmobile, ride a bike, operate machinery, tweet, or go on a dating website!

One last idea: the best way to avoid abusing alcohol is by being involved with your community.

Two very significant behavioral studies were done using rats. In the first, a group of rats were separated into different cages, then offered two sources of liquid: regular water and water infused with cocaine. They had nothing else in their cages, no fellow rats, no mazes or toys for diversion. These rats invariably chose the cocaine water.

In the second study, the rats were caged as a community and were given exercise wheels and other engaging activities to do. They too had a choices of liquids, but they preferred the regular water and avoided the cocaine water. Social connections and pleasant activities made all the difference. Something to think about as we approach the issue of addiction.

Having a sense of community, mutual support, and purpose can help people overcome addictions and all kinds of unhealthy habits. Grace Cottage offers several health-related support groups and wellness activities. We’re here to help!

Bio: Louise McDevitt has been a certified Nurse Practitioner since 1989 and has practiced at Grace Cottage since 2003. She is triple certified as an Adult Nurse Practitioner, a Family Nurse Practitioner, and an Acute Care Nurse Practitioner, and is a Fellow in the American Academy of Nurse Practitioners. She is also a Senior Lecturer for Fitzgerald Health Education Associates, offering licensing preparation and continuing education for NPs, and she is an assistant clinical instructor at the UVM Medical School and its Graduate School of Nursing FNP Program.

Grace Cottage Hospital Ranks in Top 20 Nationally

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NRHA Top 20 Seal

Grace Cottage Hospital has been named a Top 20 Critical Access Hospital (CAH) for “Best Practice – Patient Satisfaction.” The National Rural Health Association (NRHA) has chosen Grace Cottage for this exclusive “Top 20” list out of all 1,339 CAH facilities throughout the U.S. It is the only CAH in the Northeast to receive this designation.

An awards ceremony marking this honor will be held during the NRHA’s CAH Conference this September in Kansas City, Mo.

The Top 20 Critical Access Hospitals “Best Practice—Patient Satisfaction” winners, including Grace Cottage, scored best among CAHs on iVantage Health Analytics’ Hospital Strength Index™. These Top 20 CAHs have achieved top percentile rank on independently collected patient surveys which measure “Overall Rating” and “Highly Recommend.”

“I am extremely proud that Grace Cottage Hospital has been ranked in the Top 20 in the nation for Patient Satisfaction. This is an extraordinary achievement,” said Grace Cottage CEO Roger Allbee. “This does not happen without the involvement and support of all staff in their interactions with patients and their families. These results help to prove what has always been true—that our community can count on us to deliver the services they need, now and into the future, in a compassionate and friendly way.”

The National Rural Health Association is a nonprofit organization working to improve the health and wellbeing of rural Americans and providing leadership on rural health issues through advocacy, communications, education and research. For more information, visit

iVantage Health Analytics, Inc.™ is a privately held healthcare business intelligence and technology company, and a leading provider of information products for the healthcare industry. For more information, visit

Complete List of All 2017 Top 20 Critical Access Hospitals

NRHA Top 20 Criteria

VT House of Reps Resolution 177 acknowledging this honor

Grace Cottage Family Health Earns National Recognition for Patient-Centered Care

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PCMH Award

Grace Cottage Family Health of Townshend, VT, has received Level 3 Patient-Centered Medical Home (PCMH) recognition from the National Committee for Quality Assurance (NCQA). This certifies that Grace Cottage’s Rural Health Clinic has achieved the highest level of evidence-based, patient-centered, coordinated care.

The NCQA PCMH model of primary care combines teamwork and information technology to improve access, communication and patient involvement, and to reduce costs. Medical homes use systematic, patient-centered, coordinated care to foster ongoing partnerships between patient and provider, rather than approaching medical care as a series of episodic office visits.

Research shows that medical homes can lead to higher quality and lower costs, and can improve patient and provider reported experiences of care.

In PCMHs, primary care providers oversee a team of professionals who can help with everything from patient and family education, to mental health care, to self-management support, to follow-up calls to answer questions and help ensure that necessary resources are in place. The primary care provider also oversees referrals to specialists and care by providers in multiple settings. This team approach helps to ensure that patients have better access to services across the health care system.

“At the core of each patient’s care is the provider-nurse team who together evaluate, educate and initiate any necessary treatment. As a Patient-Centered Medical Home, we can expand on that medical care and offer additional, coordinated services with other Grace Cottage professional staff,” says Grace Cottage Family Health Medical Director Dr. Timothy Shafer. “That might mean bringing in a health coach, a physical therapist, a mental health counselor, or a financial assistant. All members of a patient’s team have access to a confidential ‘Shared Care Plan,’ which allows primary care provider oversight, and coordinated efforts to help patients achieve optimum health.”

This NCQA Level 3 recognition is valid for three years. In order to receive it, Grace Cottage Family Health had to demonstrate the ability to meet the NCQA’s program standards, which are aligned with the joint principles of the PCMH established with the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association.

NCQA is a private, non-profit organization dedicated to improving healthcare quality. NCQA accredits and certifies a wide range of healthcare organizations. See the NCQA web site ( for more information.