NLH Gastroenterology campaign gets National nod from American Hospital Assoc.

NLH Gastroenterology campaign gets National nod from American Hospital Assoc.

The American Hospital Association’s Matthew O’Connor reached out to Littauer after hearing about our gastroenterology campaign – his story is in the this months issue of the associations Health & Hospital Networks.


Using Humor to Address a Serious Health Care Concern

Nathan Littauer Hospital in upstate New York uses silly pint glasses, puzzles to help improve colon cancer mortality rates.

May 3, 2016
Unable to make a dent in colon cancer patients’ mortality rate through traditional means, a small hospital in upstate New York is adding a new ingredient to its approach: humor.The 74-bed Nathan Littauer Hospital found its home county of Fulton was near the national average for incidence, but had a higher than average mortality rate. Leaders there decided to look at their gastroenterology department, and specifically its colonoscopy procedure — or lack of procedures in this case. They staffed up from one gastroenterologist to three and opened a new endoscopy center, but something was still missing.

“Everyone knows that nobody wants a colonoscopy,” says Laurence Kelly, president and CEO of Nathan Littauer Hospital, in Gloversville, N.Y. “We said, ‘Let’s do something different and creative to get people’s attention,’ and it certainly has worked.”

That’s where their humorous colonoscopy initiative comes in. Patients who schedule a colonoscopy receive a notepad filled with quizzes, puzzles and a space to write “a haiku about #2” for their frequent trips to “the office.”

The real draw is that each patient who schedules a colonoscopy gets a pint glass with tick marks to help measure out his or her laxatives for the procedure. It also makes a great beer glass for later.

The program is only five months old, but many are optimistic it will help to bring the hospital’s colon cancer rates down, including Nathan Littauer gastroenterologist Kamini Ramani, M.D., who some patients call “Dr. Innerds” because of the logo on the pint glass. “I’m hopeful we will reach our goal and at least get near the national standard,” she says.

Hospitals don’t often employ humor to tackle such serious issues, but Kelly believes it has made all the difference. “Listen to ideas that are out of the box,” he says. “You think your usual efforts will work: this is science, this is medicine, it’s preventive and the right thing, so people would say, ‘Yes, sign me up’ — but it just doesn’t work that way.”




The Gazette features NLH Gastro campaign front page

Trying to bring a little humor to the process, anyone getting scoped at Nathan Littauer's endoscopy facility gets a complimentary pint glass scaled with markings o measure out their laxative. Afterward, it makes an ideal beer mug.

Trying to bring a little humor to the process, anyone getting scoped at Nathan Littauer’s endoscopy facility gets a complimentary pint glass scaled with markings o measure out their laxative. Afterward, it makes an ideal beer mug.

Bringing humor to a serious issue:

Fulton County aims to boost colonoscopy participation

By John Cropley March 30, 2016


FULTON COUNTY — Fulton County is in the odd position of having roughly the same incidence of colon cancer as the rest of the state but a much higher death rate.

A variety of factors may be at play, but health care administrators, regulators and providers agree the most likely cause is the low rate at which county residents are screened for cancer. So the local hospital has been taking steps to make it easier to get a colonoscopy, and taking steps to convince people to go ahead and get it done.

Nathan Littauer Hospital’s endoscopy office in Johnstown, which marks its first anniversary in April, is seeing 20 patients a day, more or less clearing the months-long backlog that existed when the only place to get a colonoscopy in Fulton County was at the hospital in Gloversville.

Colonoscopies can save lives, but they’re nobody’s idea of fun. The procedure requires the patient to skip several meals, drink a gallon of laxative, and then be sedated the next day and examined with a tiny camera mounted on a long slender tube that’s inserted in the rectum.

Some may find it embarrassing.

So Littauer is spiking its outreach campaign with a bit of humor. Anyone getting scoped at Littauer gets a complimentaryscaled with markings to measure out their laxative. (In happier times, it makes a spiffy beer glass, too.) And the procedure will be performed by the Innerds, “nerdy about your innards for nearly 100 years.” (The three doctors pictured on the beer glass are approaching a century in practice, in total.)

A pencil and a humorous little work pad to use while sitting in the bathroom round out the package.

Patrice McMahon, Littauer’s vice president of primary/specialty care services, was previously the administrator for a gastroenterology practice, so she had a lot of experience with hesitant patients.

“I knew the biggest way people would deflect their discomfort over it was through humor,” she said. This colored the hospital’s outreach.

Dr. Kamini Ramani, one of the  at the new Kingsboro GI Center, said she performs 1,600 to 1,800 colonoscopies a year and considers it a crucial tool to save lives.

“It is still probably not being done as much as I would like to see it done,” she said.

It’s a safe procedure for most patients, Ramani said, with physical damage resulting to the colon about once every 3,000 times under ideal conditions. The risk rises under less-than-ideal medical conditions, so in some cases non-invasive tests such as CT scans are substituted for colonoscopy.

Ramani said the CT scan is good for detecting larger and cancer, but not as accurate as a colonoscopy for identifying precancerous problems. Early diagnosis is key to successful treatment, she said, because colorectal cancer takes a long time to develop but once it does it is a tough opponent to fight.

“We do try to convince people that doing a colonoscopy is a good idea,” she said. “Many patients don’t know that they can have this done, and they should be having it done.”

From 2008 to 2012, an average 49.6 men and 38.1 women out of 100,000 were diagnosed with colorectal cancer statewide, according to the state Department of Health, compared with 48.5 men and 48.6 women in Fulton County. (The rates are adjusted in the case of Fulton County, which has fewer than 100,000 residents.)

In the same period, DOH statistics show 17.8 male and 12.8 female deaths from colorectal cancer statewide per 100,000 population, compared with 23.9 male and 16.5 female deaths in Fulton County.

“Our effort is in response to that,” McMahon said.

Littauer for years had a single gastroenterologist and two endoscopy rooms. The backlog for colonoscopies was six to 12 months, McMahon said, and many people in the hospital’s service area lacked money, transportation or motivation to travel elsewhere for quicker access to the procedure.

“When you’re not screened, you don’t have the opportunity to find that precancerous polyp,” McMahon said.

Littauer set out to recruit a second and third physician — Dr. Luz Alvarez and Dr. Hamid Azizur Rehman, both previously in Amsterdam — and outfitted a new site for them to work, a former Littauer ambulatory care center on South Kingsboro Avenue Extension in Johnstown.

In April 2015, the Kingsboro GI Center began operations three days a week. Two nurse practitioners work there with the three doctors, and they perform about 20 procedures a day. The endoscopy rooms at the hospital remain in full-time use, typically for patients unable to leave the hospital.

The co-payment at the Kingsboro GI Center ranges from $50 to $100, depending what insurance the patient has.

Ramani said the colonoscopy is part of a larger picture. Healthy diet and lifestyle on the part of the patient reduce the risk of colon cancer. Rectal exams and feces tests by the family physician during the annual checkup are important for early detection, as the colonoscopy is recommended only once ever 10 years starting at age 50 for the general population.

Nathan Littauer’s efforts are mirrored in the statewide public awareness campaign by the New York Department of Health to get more people to undergo colorectal cancer screening. A DOH spokesperson said the lower-than-average screening rate in Fulton County is a likely factor in the higher-than-average death rate.

In 2013-2014, the most recent years for which data are available, the colorectal cancer screening rate in Fulton County was 59.3 percent, compared with 68.7 percent statewide, according to DOH. Surrounding counties had higher screening rates and lower death rates, DOH noted.

The state goal is 80 percent screening statewide by 2018.

McMahon cited the previously limited colonoscopy options for Fulton County’s disparity with its neighbors.

“If you put up a barrier and people really have to pursue it, it’s going to fall by the wayside,” she said. “Those barriers were here and now they’re not.”


Littauer welcomes Dr. Luz Alvarez

“I am excited to join Littauer and I am happy to bring my practice here”

Nathan Littauer Hospital is proud to announce Luz F. Alvarez, M.D. has joined the Gastroenterology Specialists of Littauer. Alvarez is an established gastroenterologist with a dedicated practice in this region and nearly three decades of medical experience.

Dr. Alvarez will join the Nathan Littauer Gastroenterologist Specialty Team

Dr. Alvarez has joined the Nathan Littauer Gastroenterologist Specialty Team

“Dr. Alverez has a thriving practice and we were more than willing to help her migrate that practice to the new center we developed and customized to her clinical needs,” said Laurence E. Kelly, Littauer’s President and CEO. “As CEO, it is especially satisfying to know we will have thousands of new patients that will now be a part of Littauer Health Services.”

“I am excited to join Littauer and I am happy to bring my practice here,” claims Dr. Alvarez.

Dr. Alvarez is combining forces with Dr. Kamini Ramani who also has a firmly established and well respected medical practice, and Dr. Hamid Azizur Rehman, whom she has worked closely with for 25 years. The three Littauer doctors together create the region’s most highly respected force in gastroenterology, armed with the latest state-of-the-art technology and equipment.

“Joining Littauer was a very smooth transition for me and my practice,” said Alvarez. “I am able to work with a well-recognized team, and bring my services to the Littauer community.”

Dr. Alvarez was born in Colombia, and came to the United States when she was 14 years-old. She knew she wanted to be a doctor since childhood.

“I was told as a child to be a nurse – women are not meant to be doctors” said Dr. Alvarez. “Perhaps that is why I have always strived so hard to be the best at what I do.”

She completed her undergraduate education at SUNY New Paltz in three years then continued medical school at SUNY Upstate Medical University in Syracuse at where she fulfilled her childhood dream of becoming a doctor. She completed her residency and a GI fellowship at Albany Medical College and has been in private practice since 1990.

“What is most gratifying to me is working directly with my patients. I enjoy getting to know them,” said Alvarez.

You will find Dr. Alvarez’s offices at Littauer’s Gastroenterology Primary/Specialty Center, 135 County Highway 128, Johnstown, (also known as 434 So. Kingsboro Ave. Extension next to Cataract Care Center and Mohawk Valley Orthopedics).

“I am looking forward to working in the new and complete outpatient endoscopy center,” touted Dr. Alvarez. “My patients can now be seen, be pretested, and undergo their procedure all at the same site. With this new seamless process, there will be no delays, and in most cases no lines and no use for a different facility. I think it will create a much more comfortable process for patients.”

An entirely new gastroenterology suite was developed at Litttauer’s Johnstown Surgery Center on So. Kingsboro Ave. for Dr. Alvarez. The 1458 square foot suite houses three exam rooms, one procedure room, two offices, two restrooms, and a new reception area. The office is adjacent to the completely refurbished Endoscopy Center with a reception area, three operating rooms; sterilization equipment, a multiple patient bay recovery room, exam rooms, and the most complete state-of-the art technology and equipment for all procedures.

Dr. Alvarez notes the transition for her existing patients is going to be a very comfortable process, as she is happy to say her staff has joined her at Littauer.

“I am excited to bring to my new center many of the same people I have worked with for the past 25 years. People from the front desk, to nurses, and gastroenterology technicians have been with my practice. Patients will have a very easy transition with all the familiar faces they have gotten to know and trust over the years,” said Alvarez.

Alvarez went on to say; “In addition to the new center, I am thrilled to be working with such a brilliant team of gastroenterologists. I have worked in collaboration with Dr. Ramani and Dr. Rehman for the past 25 years. As a team we can offer wonderful, quality patient care with complete coverage and service to this area.”

Colorectal cancer – which can be detected and treated by gastroenterologists, is the third most common cancer diagnosed in both men and women in the United States. Regularly scheduled screenings are highly recommended. People with any type of digestive orders are encouraged to schedule a consultation or appointment with Dr. Alvarez by calling (518) 752-5275.