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FALL 2026

Official Publication of The Lehigh County Medical Society

BEYOND MILESTONES Helping Children Reach the Skies

PLUS

BEYOND THE CHECKUP: WHY NATIONAL PRIMARY CARE WEEK MATTERS FOR LEHIGH COUNTY KNOWING BEFORE KNOWING: CLINICAL INTUITION AND THE ART OF MEDICINE LCMS NEW & REINSTATED MEMBERS

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IN THIS ISSUE

ou know fall is near when retailers begin filling inboxes with pumpkins. As in past editions, we hope you enjoy the articles we have gathered for you.

This fall’s edition features articles on primary care, clinical intuition in medicine, the importance of addressing prediabetes, cervical cancer screening, and more. National Primary Care Week takes place during the first full week of October, from October 6–10. In recognition of the occasion, we invite you to read “Beyond the Checkup,” an insightful article that explores why primary care is so essential. The piece also looks ahead to the future of the field, including the challenges posed by ongoing clinician shortages. You’ll also find “Knowing Before Knowing: Clinical Intuition and the Art of Medicine,” an article that explores the role of intuition in clinical practice. As medicine increasingly incorporates artificial intelligence, the piece reminds us that clinical judgment involves more than technology alone. Another compelling article traces the history of human papillomavirus and its connection to cervical cancer. As I read it, I was reminded of our piece on clinical intuition—making this another must-read. We also hope you will read the piece “Beyond Milestones,” an article authored by our past president on her thoughts on parenting over the years. We hope you enjoy the magazine and find it both educational and relevant to your interests. If you wish to see past issues, they can be found at https://lcmedsoc.org/ourpublication. Additionally, should you wish to write an article for an upcoming edition, please feel free to contact our office. As always, we hope you will enjoy reading our magazine! We will see you again in the next edition. FALL 2026 | Lehigh County Health & Medicine 3

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FALL 2026

LEHIGH COUNTY MEDICAL SOCIETY P.O. Box 8, East Texas, PA 18046

610-437-2288 | lcmedsoc.org

2026 LCMS BOARD OF DIRECTORS* Kimberly Fugok, DO President Alissa Romano, DO President-Elect Gregory Wheeler, DO Vice President Oscar A. Morffi, MD Treasurer Charles J. Scagliotti, MD, FACS Secretary Chaminie Wheeler, DO Immediate Past President *effective February 1, 2026 - for two-year terms

3 IN THIS ISSUE 6 BEYOND THE CHECKUP

CENSORS

Why National Primary Care Week Matters for Lehigh County By Radhika Chandramouli, MD, FAAFP, DipABOM, DipACLM

Laura Nicole Oswald, MD Mia Mattioli, MD

TRUSTEES

8 LCMS NEW & REINSTATED MEMBERS

Wayne E. Dubov, MD Kenneth J. Toff, DO Mary Stock, MD, MSCP

EDITOR

The opinions expressed in this publication are for general information only and are not intended to provide specific legal, medical or other advice or recommendations for any individuals. The placement of editorial opinions and paid advertising does not imply endorsement by the Lehigh County Medical Society.

14 THE HIDDEN EPIDEMIC

Why We Should Take Prediabetes Seriously and What You Can Do About It By Ayman Hajeer, MD

ON THE COVER 18 BEYOND MILESTONES Helping Children Reach the Skies By Chaminie Wheeler, DO

9 KNOWING BEFORE KNOWING

21 PENNSYLVANIA PASSES 2026-27 BUDGET

12 HUMAN PAPILLOMAVIRUS

22 THE PAMED HOUSE OF DELEGATES

Clinical Intuition and The Art of Medicine By Inna Conboy, MD

David Griffiths Executive Officer

Historical Underpinnings and Medical Practices By Jacqueline Blias, BA, BS, MS, and Patricia Maran, MD, FACOG

Hoffmann Publishing Group is the official publisher of the Lehigh County Medical Society’s Lehigh County Health & Medicine magazine. HoffmannPublishing.com | (610) 685.0914

FOR ADVERTISING OPPORTUNITIES CONTACT: Sales@HoffPubs.com, 610-685-0914 x715 FALL 2026 | Lehigh County Health & Medicine 5

FEATURE

E BEYOND THE

CHECKUP

Why National Primary Care Week Matters for Lehigh County RADHIKA CHANDRAMOULI, MD, FAAFP, DIPABOM, DIPACLM

As physician shortages deepen nationwide, the Lehigh County Medical Society (LCMS) marks National Primary Care Week by recognizing the specialty holding our healthcare system together.

very year, millions of patients walk into a familiar office: the same waiting room, the same friendly staff, the same physician who watched their children grow, tracked their blood pressure through a decade, and caught the early warning signs of illness before they became emergencies. This is the nature of primary care, and for patients and physicians across Lehigh County, National Primary Care Week offers an opportunity to recognize the role these clinicians play in the health of our community.

National Primary Care Week (NPCW), sponsored by the American Medical Student Association (AMSA), occurs every year during the first full week of October. This year it falls on October 6–10, 2026. The observance was created to spotlight the physicians, nurse practitioners, physician assistants, and care teams who serve as the front door to the healthcare system as well as to encourage the next generation of medical students to consider a career in family medicine, internal medicine, pediatrics, or geriatrics. WHY PRIMARY CARE DESERVES THE SPOTLIGHT Primary care clinicians are often the first, and sometimes the only, point of contact many patients have with the healthcare system. They manage chronic conditions, like diabetes and hypertension; coordinate specialist referrals; deliver preventive screenings; and build the longitudinal relationships that let them notice when something is truly wrong—not just physically, but emotionally and socially. Clinicians who choose primary care often describe a professional reward that is hard to replicate elsewhere in medicine: the chance to know patients and

6 Lehigh County Health & Medicine | FALL 2026

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families over years or decades, to see the downstream impact of early intervention, and to practice the kind of broad, wholeperson medicine that drew many of us to the field in the first place. Yet the specialty faces real headwinds. National workforce projections continue to point toward a shortage of primary care physicians over the next decade, driven by an aging population with increasingly complex needs, clinician burnout, and a steady decline in medical students choosing primary care residencies over other higher-compensated subspecialties. For a region like the Lehigh Valley, with its mix of urban centers, suburban communities, and more rural populations, this shortage is not an abstract statistic. It shows up in longer wait times for new patient appointments and in emergency departments absorbing visits that a primary care office could have handled. THE NUMBERS BEHIND THE SHORTAGE The workforce pressures facing primary care are already visible in Pennsylvania’s numbers. The Commonwealth is projected to face a shortfall of nearly 5,000 physicians as part of a broader nationwide gap that could reach 124,000 physicians in the coming years. 32 of Pennsylvania’s 67 counties are currently designated Health Professional Shortage Areas, meaning they lack enough primary care clinicians to meet basic population needs. The disparity is especially stark outside our metro corridors: some rural Pennsylvania counties report only one primary care physician for every 522 residents, compared to roughly one for every 222 residents in urban areas. Part of the challenge is structural. Pennsylvania has only about 350 primary care residency slots statewide each year, and of those graduates, an estimated 45% end up practicing outside the state entirely, which is a significant loss for the Commonwealth that trained them. Nationally, the Health Resources and Services Administration estimates that an additional 14,900 primary care clinicians are needed right now to meet current demand in designated shortage areas, with that gap projected to grow to more than 20,000 by the mid-2030s. These are not abstractions to those of us practicing in Lehigh County. They translate directly into primary care clinicians absorbing patient panels that have grown well beyond what many practices were designed to manage, limiting appointment capacity and placing greater clinical and administrative demands on already stretched care teams. Recognizing National Primary Care Week is, in part, an acknowledgment of just how much weight our primary care colleagues are already carrying, often quietly and without the staffing or reimbursement structures to match. GROWING THE NEXT GENERATION To address this shortage, much of the solution runs through medical education; specifically, through the experiences students have long before they choose a specialty. That makes the training

pipeline a critical part of the workforce response: the physicians Pennsylvania needs a decade from now are the students deciding today which specialties they will pursue. Research on Pennsylvania’s physician pipeline has repeatedly pointed to the same conclusion: students who receive substantive, well-supported exposure to primary care during their clinical training are far more likely to choose it as a career, while those who never rotate through a thoughtfully run family medicine or internal medicine clerkship rarely reconsider it later. This is where our region’s medical schools, teaching hospitals, and community-based preceptors play an important role. Thirdand fourth-year clerkships that place students in real primary care offices with structured teaching, feedback, and mentorship from practicing physicians (not just a checklist rotation) do more to shape career choice than almost any lecture or curriculum reform. The same is true of resident education: graduate medical education funding and support for resident well-being remain central to whether Pennsylvania can retain the physicians it trains. Locally, this work often happens without recognition: the preceptor who takes on a third-year student for six weeks; the program coordinator building out orientation materials and feedback tools for teaching faculty; or the physician who says yes to one more learner despite an already-full schedule. National Primary Care Week is a fitting moment to recognize that this kind of unglamorous, sustained investment in the next generation is itself a form of primary care. It is prevention, applied to the workforce itself. THE VIEW FROM LEHIGH COUNTY In Lehigh County, our primary care colleagues carry an outsized share of the region’s health burden. They are often the ones managing multiple chronic conditions in a single 20-minute visit; navigating language and transportation barriers for underserved patients; and serving as the connective tissue between hospital systems, specialists, and community resources. Their work rarely makes headlines, but it is the foundation for sustained improvements in population health, particularly through prevention, chronic disease management, and continuity of care. National Primary Care Week is an opportunity for the Lehigh County Medical Society to say thank you and to make that gratitude visible. HOW LCMS MEMBERS CAN TAKE PART • Recognize your primary care colleagues: A short note, a shoutout in a practice newsletter, or a mention at a staff meeting goes further than it seems.

• Mentor a student: Local medical students and pre-health undergraduates benefit enormously from shadowing opportunities or informal conversations about what a career in primary care looks like day to day. LCMS Health Career FALL 2026 | Lehigh County Health & Medicine 7

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Club, coordinated at local high schools, offers one existing avenue for members interested in this kind of engagement.

• Host or support a community health event: Blood pressure screenings, vaccine clinics, or health education sessions during NPCW week can extend primary care’s reach into the community. • Advocate: Support policy efforts locally and at the state level through PAMED that address primary care reimbursement, loan forgiveness for primary care residencies, and investment in graduate medical education. • Share your story: If you are a primary care clinician, consider submitting a reflection to a future issue of Lehigh County Health & Medicine about what drew you to the field, or what keeps you there. A WEEK WORTH MARKING ON THE CALENDAR National Primary Care Week will not generate the fanfare of a product launch or a medical breakthrough. But for the physicians who quietly hold together the health of this country, it is a chance for the rest of us in medicine to notice, and to say it out loud: thank you for being on the front line. To learn more about National Primary Care Week or AMSA’s advocacy efforts, visit amsa.org.

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LCMS NEW & REINSTATED MEMBERS Salman Ayaz, MD Resident - Hematology & Medical Oncology (Internal Medicine) Jessica Davis, DO Emergency Medicine Amy Marie Depuy, MD Obstetrics & Gynecology Nancy Luz Diaz-Pechar, MD Neurology Deborah Carolyn Fox, DO Family Medicine MacKenzie Rain Francis, DO Resident - Pediatrics

Heramba Vigneshwar Gopi, MD Student - Emergency Medicine Yuliya Goykhman, MD Resident - Psychiatry Christopher Groetsch, DO Student - Internal Medicine Sarah Louise Hewitt, DO Resident - Pediatrics Naif Hindosh, MD Internal Medicine Linda J. Hipps, MD Obstetrics & Gynecology

8 Lehigh County Health & Medicine | FALL 2026

Nnamdi Ezenwa Ihejirika, MD Resident - Emergency Medicine

Michael David Misbin, MD Anesthesiology

Jessica Lauren Shastay, DO Resident - Internal Medicine

Patricia Faye Kandle, MD Resident - Emergency Medicine

Aaron Karl Mory, MD Anesthesiology

Zaed Siddiqui Student

Bhumika Harshad Patel, DO Internal Medicine

Nancy Katiana SuarezTipton, MD Psychiatry/Neurology

Brian Douglas Kramer, DO Internal Medicine Sean Robert Lacey, MD Gastroenterology (Internal Medicine) Maikel Mansour Student

Kimberli Dejanea Reed, DO Resident - Emergency Medicine Christine Georgine Saad, MD Ophthalmology Vivan Shah, MD Physical Medicine And Rehabilitation

Samuel Umaru, MD Pediatric Critical Care Medicine (Pediatrics) Ashley Hyerin You, DO Resident - Pediatrics

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FEATURE

KNOWING BEFORE KNOWING

Clinical Intuition and The Art of Medicine INNA CONBOY, MD

This article includes a discussion of psychiatric emergency care and suicide. Reader discretion is advised. To protect patient privacy, names, identifying details, and some circumstances have been changed. In some instances, details from more than one patient encounter have been combined while preserving the clinical and emotional truth of the story. WHEN SOMETHING DOESN’T FIT It was a rather calm on-call day when Derek’s husband accompanied him to the psychiatric crisis center. He wasn’t sure whether bringing him was appropriate, but he didn’t know where else to go. He caringly relayed that Derek had been feeling rather sad ever since they moved from California, a state Derek had, until now, called home. His whole family was still there, and he desperately missed the abundant sunshine that now escaped him in moody Pennsylvania. As I always did, I spoke with Derek alone before inviting his husband back into the room with Derek’s permission. On paper, Derek wasn’t setting oﬀ any obvious alarms. In his 28 years of life, he had never taken any psychiatric medications, had never been in therapy, and denied thoughts of wanting to harm himself in any way. By every standard risk assessment, there wasn’t enough evidence to justify involuntary hospitalization, and I would have to make a very good case to Derek’s insurance company as to why even a voluntary hospitalization may be recommended. continued on next page > FALL 2026 | Lehigh County Health & Medicine 9

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And yet, something felt profoundly off. It wasn’t anything he said. It wasn’t a dramatic statement or other common warning signs. It was a deep gut feeling that made me worry about Derek, and I couldn’t shake it.

Derek didn’t want to be admitted to the hospital. His husband wondered if hospitalization might be excessive. Both of them just want some resources to help Derek cope with the move. Objectively, I understood why they felt that way. Other people who came through the crisis center with similar symptoms were often discharged with instructions to follow up with an outpatient clinic. Still, I found that I was unable to let Derek leave.

We talked. And talked some more. Nearly three hours passed as we discussed depression, treatment, and why I believed the safest decision was for him to admit himself voluntarily to the psychiatric hospital. I couldn’t fully explain my concern, only that I felt strongly enough to advocate for Derek’s immediate treatment. I attempted to lure him onto the inpatient unit with facts such as receiving care from a really great psychiatric team and being able to start treatment right away. Otherwise, it might take months for him to get in to see an outpatient therapist and psychiatrist. Eventually, Derek agreed and signed himself in. A few days later, he was discharged with a diagnosis of acute adjustment disorder and started on an antidepressant. As part of his discharge plan, Derek’s husband took him back to California for a visit so Derek could be surrounded by family, sunshine, and the familiar environment once again.

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About a week later, I received a phone call from Derek’s husband.

we understood electricity, germs, or gravity, people observed phenomena they could not explain. Curiosity and exploration propelled us toward scientific and medical discoveries. Today, clinicians continue to encounter phenomena we know to be real, yet do not fully understand. While the mechanisms of clinical intuition are being researched, much about it continues to be shrouded in mystery.

THE RESEARCH S c h r a d e r & Fi s c h e r defined clinical intuition as “The ability to experience the elements of a clinical situation as a whole, to solve a problem or reach a decision with limited concrete information.”

Derek had died by suicide. The news gut-punched me. He went on to say how utterly devastated he was and also that he had no regrets. He felt he had done everything In a study published by Oliva-Fanlo et al. he could to help Derek. He thanked me of 155 General Practitioners (GPs) and 1,487 for taking so much time with Derek and patients, it was found that GPs experienced persuading him to seek treatment. His “gut feelings” in 97% of consultations, with gratitude, oﬀered in the midst of tragedy, 75% sensing reassurance that the clinical has stayed with me since. picture is consistent and that everything fits, and 22% sensing alarm. This is one of the A FEELING WE CAN’T IGNORE many studies conducted that consistently show I still think about Derek. I wonder what intuition is a crucial aspect of clinical work. his life would have been like had he lived. I wonder how his husband is doing. I wonder Some researchers like Erik Stolper and his how my intuition recognized that Derek was colleagues go so far as to argue that intuition struggling so profoundly. I do not wonder, is a “third track” in diagnostic reasoning, with however, whether intuition exists. the first two traditional tracks being medical/ analytical decision-making and medical As physicians, we are often trained to rely problem solving that includes pattern on evidence, not intuition. We use structured recognition and hypothetico-deductive assessments, clinical interviews, and research- reasoning. In this third track, gut feelings backed guidelines to make clinical decisions. emerge from non-analytical processing Yet most clinicians encounter moments when of available patient information and are something doesn’t fit neatly into a checklist, filtered through the physician’s accumulated and a gut feeling takes over. knowledge and experience. These gut feelings continuously interact with the two traditional For as long as there have been healers, there tracks. have been moments like these. Long before

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WHAT WE KNOW WE DON’T KNOW When I think back to Derek, I am still not sure what activated my intuition and caused me to feel there were red flags.

Medicine has always been an artful balance between what we know about the human body and the enduring mystery of the human condition.

There are many theories about the origins of intuition and how it manifests. Some are grounded in current research on subconscious brain processing, neural and physiological synchronization, and right-to-right brain communication. Others venture into ideas such as quantum entanglement and unconscious precognition.

What seems increasingly diﬃcult to dismiss—as both research and everyday experience continue to suggest—is that nearly every one of us has experienced feelings, hunches, or moments of knowing that cannot be fully explained by conscious logic. These moments occur in both our personal lives and our clinical work. Medicine has always been an artful balance between what we know about the human body and the enduring mystery of the human condition. “TRUST, BUT VERIFY” While intuition is accessible to all of us, people vary considerably in how naturally it seems to arise. Some are the Mozarts of knowing the unknowable, while others move through life, as Forrest Gump famously said, as though it were “a box of chocolates. You never know what you’re gonna get.” However, even for those of us who seamlessly weave intuition into our clinical work, it is best when paired with rigorous science and analytical thinking. Sometimes intuition moves faster than conscious reasoning. It may be the quiet inner signal that tells us not to get too close to the patient who appears calm on the surface, but whose barely contained rage is only seconds away from erupting. At other times, as the Russian saying goes, we must “trust, but verify.” If time allows, we have to consider whether what we are sensing is indeed intuition rather than fear, bias, projection, or simple exhaustion. HONING CLINICAL INTUITION Clinical intuition works best when: • it is grounded in substantial clinical experience beyond formal training;

•

the clinical presentation is familiar;

•

intuitive impressions are tested against analytical thinking;

•

intuition serves as a guide rather than the final answer; and

•

cognitive biases are actively recognized and addressed.

MEDICINE: NEW FRONTIER Like any skill or talent, intuition is an instrument that can be tuned and cultivated over time. Mindfulness, deep listening, storytelling, emotional regulation, and thoughtful clinical supervision are just a few of the ways we can broaden our intuitive capacity while sharpening its accuracy. Gone are the days of bloodletting, lobotomies, and mercury treatments. We are living in the Information Age with more scientific knowledge at our fingertips than ever before. Yet the future of medicine will not be shaped by textbooks alone, or even artificial intelligence. It will also depend on our ability to connect deeply with ourselves, with our patients, and with the world around us. If we learn to listen carefully, we may discover that intuition is not the opposite of science, but one of its loyal companions—reflecting, resonating, and perhaps even synchronizing us in ways we are only beginning to understand. References Oliva-Fanlo, B., March, S., Gadea-Ruiz, C., Stolper, E., Esteva, M., & colleagues. (2022). Prospective observational study on the prevalence and diagnostic value of general practitioners’ gut feelings for cancer and serious diseases. Journal of General Internal Medicine, 37(15), 3823–3831. https://doi.org/ 10.1007/s11606-021-07352-w Schraeder, B. D., & Fischer, D. K. (1987). Using intuitive knowledge in the neonatal intensive care nursery. Holistic Nursing Practice, 1(3), 45–51. https://doi.org/10.1097/00004650-198705000-00009 Stolper, E., Van Royen, P., Van de Wiel, M., Van Bokhoven, M., Houben, P., Van der Weijden, T., Dinant, G.-J., & Van der Vleuten, C. (2011). Consensus on gut feelings in general practice. BMC Family Practice, 12, Article 11.

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FEATURE

HUMAN PAPILLOMAVIRUS Historical Underpinnings and Medical Practices

JACQUELINE BLIAS, BA, BS, MS, AND PATRICIA MARAN, MD, FACOG

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edicine is simultaneously steeped in tradition and moving forward at a breakneck pace. As doctors, we do things because that is “how we have always done it,” and yet the knowledge pushing us forward escalates at a dizzying speed. Nothing speaks to this juxtaposition between past and future as readily as the gynecologic recommendations for annual examinations. Long before the ease of electronic medical records, a very observant Italian physician in the 1840s realized that married women of Verona were dying of u t e r o - c e r v i c a l c a n c e r, but the Catholic nuns living in the surrounding countryside were not. So too, he was aware that the women working in the Italian brothels were the youngest and sickest to present with cancer. In this way, the epidemiologic underpinnings of cervical cancer arising from a sexually transmitted infection began to be elucidated.

milieu of the gynecologic reproductive tract, but he was able to codify the cellular changes that occurred in women’s vaginas before the development of cervical cancer. From the Italian countryside of Dr. Rigoni-Stern to the hands of a Greek surgeon turned pathologist in New York, it wasn’t until the early 1980s that scientists first isolated the specific sexually transmitted infection and strain that caused cervical cancer: human papillomavirus, dubbed HPV 16 and 18.

between the ages of 21 and 25; occur every three years; and if no high-risk HPV virus is found, the surveillance can extend to every five years. While all abnormal bleeding needs to be evaluated, and not all patients will be considered low risk, most patients may avoid the actual speculum exam. In fact, using scientific knowledge to its fullest, certain patients may even qualify for a screening test that can be collected in the privacy of their own home. Despite now knowing that the human papillomavirus can cause oral, anal, vaginal, vulvar, penile, and cervical cancers, we have yet to come to a consensus on how frequently or how to screen men and women. One thing is clear: we have both the knowledge and the science to eliminate these cancers before they even begin. An immunization series with the HPV vaccine can eliminate countless patients’ suffering. While originally marketed to girls and subsequently boys, we have now expanded the vaccine to include both men and women to the age of 45, knowing that preventing disease is always the most cost-effective, most humane way to practice medicine.

Despite now knowing that the human papillomavirus can cause oral, anal, vaginal, vulvar, penile, and cervical cancers, we have yet to come to a consensus on how frequently or how to screen men and women.

The history of cervical cancer screening and a doctor’s insistence on checking women every year for their annual “pap” smear dates to the Baby Boomer post-World War II era. Like everything in medicine, the scientific underpinnings of this practice date back decades to the early 1920s. Dr. Papanicolaou, a Greek surgeon, and his wife immigrated to the United States through Ellis Island. Like many southern European immigrants of that time, Dr. Papanicolaou found work in the rapidly developing New York metropolitan area. Unable to work as a surgeon, he eventually became a pathology technician at Cornell University Medical College. He is credited with first understanding and developing the histologic science behind examining cervical-vaginal cells under the microscope. Not only did he articulate the hormonal

When it comes to While tradition states that gynecologists the medical management of human get pap smears on patients every year, papillomavirus, it is our sincere hope that the scientific knowledge eclipses these the knowledge, wisdom, and experience recommendations. These days, we can we have gained become outdated. As a create DNA probes of the virus found in practicing gynecologist, I hope to one a woman’s vagina, amplify it, test for the day embody what historians have called high-risk strains, and risk stratify who “planned obsolescence.” If my junior doctors should be getting subsequent speculum and young residents never have to diagnose exams for histopathologic evaluation versus cervical cancer or get that horrible sinking who does not need to be tested for another feeling when a vulvar cancer mass erodes three to five years. We are looking for the into their vision, I feel I would have causative virus before any cellular changes accomplished a life’s teaching achievement. occur, thus making Dr. Papanicolaou’s “pap Until then, if something “down there” itches, smear” an outdated, scientific relic. burns, bleeds, or doesn’t smell “quite right,” it’s best to avoid the AI craze and come see Current gynecologic updates recommend your community doctor. that screening for cervical cancer can begin FALL 2026 | Lehigh County Health & Medicine 13

FEATURE

THE HIDDEN EPIDEMIC Why We Should Take Prediabetes Seriously and What You Can Do About It AYMAN HAJEER, MD

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pproximately one in three American adults has prediabetes—and most don’t know they have it.¹ For many people, a routine blood test showing a mildly elevated blood sugar may seem like a minor issue. A clinician may say, “You have prediabetes,” and the patient may leave the office thinking, “At least I don’t have diabetes.”

That reaction is understandable—but prediabetes deserves more attention than it often receives. Prediabetes is not simply a label or a distant warning that diabetes might develop someday. It is a clinically important state that signals increased metabolic risk and, importantly, provides an opportunity to intervene before type 2 diabetes develops. Because prediabetes often causes no symptoms, it can remain undiagnosed for years. The good news is that prediabetes is also a window of opportunity. Early recognition, followed by evidence-based lifestyle changes and appropriate medical care, can substantially reduce the risk of progressing to type 2 diabetes.² WHAT EXACTLY IS PREDIABETES? Prediabetes occurs when blood glucose levels are higher than normal but not yet in the range used to diagnose diabetes. It may be identified using a fasting plasma glucose test, hemoglobin A1C, or an oral glucose tolerance test.² Prediabetes reflects a complex metabolic process. In many individuals, the body’s tissues become less responsive to insulin, a hormone that helps glucose move from the bloodstream into cells. The pancreas initially compensates by producing more insulin, allowing blood glucose to remain relatively controlled. Over time, however, the body’s ability to compensate may decline, and blood glucose levels begin to rise.

PREDIABETES AT A GLANCE WHAT IS PREDIABETES? Blood glucose levels are higher than normal but below the diagnostic threshold for diabetes. DOES PREDIABETES MEAN I WILL DEVELOP DIABETES? No. Progression is not inevitable. Evidence-based lifestyle interventions can significantly reduce the risk of developing type 2 diabetes.² WHAT CAN I DO? • Focus on regular physical activity, such as 150-minutes/week of moderateintensity physical activity such as brisk walking, cycling, swimming, or other activities that increase the heart rate.² • Focus on a sustainable overall pattern of eating. This may include: - Increasing vegetables, fruits, whole grains, and other high-fiber foods - Choosing lean sources of protein - Incorporating unsaturated fats from foods such as nuts, seeds, fish, and olive oil - Limiting sugar-sweetened beverages - Reducing highly processed foods and refined carbohydrates - Paying attention to portion sizes

- Choosing water or unsweetened beverages more often • Fo c u s o n a p p r o p r i a t e w e i g h t management and overall metabolic health, including a consistent sleep schedule and stress management. SHOULD I BE MONITORED? Yes. People with prediabetes should generally have their glucose status monitored at least annually, with testing frequency individualized according to risk.² • Understand your blood glucose and A1C results. • Discuss your blood pressure and cholesterol. • Assess your overall cardiovascular risk. SMALL CHANGES CAN HAVE A BIG IMPACT. Preventing diabetes is rarely about making one perfect decision. It is about making healthier decisions repeatedly. • Taking a walk after dinner • Replacing a sugary drink with water • Adding vegetables to a meal • Choosing a whole-grain alternative • Going to bed a little earlier • Finding an activity you genuinely enjoy

This process can occur gradually and silently. Many people with prediabetes feel completely well. That is one reason it is so easy to overlook. continued on next page > FALL 2026 | Lehigh County Health & Medicine 15

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WHY SHOULD WE TAKE PREDIABETES SERIOUSLY? The most obvious concern is progression to type 2 diabetes. But the significance of prediabetes extends beyond the possibility of eventually meeting the diagnostic criteria for diabetes. Prediabetes frequently occurs in the setting of other cardiometabolic risk factors, including excess weight, hypertension, and abnormal lipid levels. These factors often cluster together and can contribute to an increased risk of cardiovascular disease and other chronic health conditions.² For this reason, identifying prediabetes should prompt more than simply asking, “Will I develop diabetes?” It should also prompt questions such as:

One of the most effective interventions is also one of the simplest: regular physical activity. Exercise improves insulin sensitivity and helps the body use glucose more effectively. You do not need to become an athlete to benefit. For many people, starting

most intense one. It is the one you can sustain. FOOD MATTERS—BUT PERFECTION IS NOT REQUIRED A diagnosis of prediabetes can sometimes lead people toward overly restrictive diets. So m e m a y b e l i e ve they need to eliminate all carbohydrates or completely overhaul their eating habits overnight. In reality, healthy eating does not require perfection—or an extreme diet. The goal is not to follow a diet perfectly for two weeks. The goal is to develop an eating pattern that supports health for years to come.

One of the most effective interventions is also one of the simplest: regular physical activity. Exercise improves insulin sensitivity and helps the body use glucose more effectively.

• What is my overall cardiovascular risk? • Is my blood pressure under control? • Are my cholesterol levels appropriate? • Am I physically active? • Is my diet supporting my health? • Am I getting adequate sleep? • What changes can I realistically make now? The diagnosis of prediabetes should be viewed as an opportunity to address health more broadly—not simply as a precursor to diabetes. THE GOOD NEWS: YOU CAN DO SOMETHING ABOUT IT A diagnosis of prediabetes does not mean that diabetes is inevitable.

16 Lehigh County Health & Medicine | FALL 2026

with a daily walk, gradually increasing activity, and finding a form of exercise that is enjoyable and sustainable can make a meaningful difference. The landmark Diabetes Prevention Program, a large clinical trial involving people at high risk for type 2 diabetes, demonstrated the power of lifestyle intervention. Participants assigned to an intensive lifestyle program focused on achieving modest weight loss and at least 150 minutes of physical activity per week experienced a 58% reduction in the incidence of type 2 diabetes compared with those receiving placebo over approximately three years.³ Strength training can also be valuable. Maintaining and building muscle supports physical function and can contribute to improved metabolic health. Importantly, the intervention did not require perfection. It required consistency. The best exercise program is often not the

WEIGHT MANAGEMENT CAN MAKE A DIFFERENCE For individuals who are overweight or have obesity, even modest weight loss can improve insulin sensitivity and glucose metabolism. In the Diabetes Prevention Program, the lifestyle intervention targeted approximately 7% weight loss.³ The CDC’s National Diabetes Prevention Program similarly emphasizes modest weight loss and increased physical activity as key components of diabetes prevention.⁴ This does not mean that a person’s health or worth is defined by a number on a scale. Weight is influenced by a complex combination of genetics, biology, medications, sleep, stress, environment, access to healthy food, and physical activity, and many other factors. It does mean, however, that for some individuals, addressing excess weight can be an important part of reducing metabolic risk.

Today, clinicians have more tools available to help patients manage obesity and metabolic disease than ever before. Depending on an individual’s health, risk factors, and preferences, treatment may include nutrition and physical activity

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counseling, structured lifestyle programs, anti-obesity medications, and, for selected patients, metabolic or bariatric surgery. These decisions should be individualized and discussed with a healthcare professional. DON’T FORGET SLEEP AND STRESS Metabolic health is not only about food and exercise. Sleep and stress also matter. Insufficient or disrupted sleep may affect appetite regulation, energy balance, and metabolic health. Chronic stress can similarly influence behaviors, sleep, and other factors relevant to cardiometabolic health.²,⁵

An opportunity to address risk factors before complications develop. And an opportunity to work with your healthcare team to change the trajectory of your health. The earlier we recognize prediabetes, the earlier we can act.

Supplement_1/S50/162204/3-Preventionor-Delay-of-Diabetes-and-Associated?utm_ source=chatgpt.com) 3. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393403. doi:10.1056/ NEJMoa012512. [Diabetes Prevention Program—NEJM] (https://www.nejm. org/doi/full/10.1056/ NEJMoa012512 ?utm_source=chatgpt. com)

In reality, healthy eating does not require perfection—or an extreme diet. The goal is not to follow a diet perfectly for two weeks. The goal is to develop an eating pattern that supports health for years to come.

Life does not always allow for perfect sleep or stress-free days. However, small changes can still be meaningful. Maintaining a consistent sleep schedule, reducing unnecessary late-night screen exposure, making time for physical activity, and developing healthy strategies for managing stress can all contribute to overall well-being.

These steps may not replace other interventions, but they can be important pieces of a broader approach to health. KNOW YOUR NUMBERS Because prediabetes often causes no symptoms, understanding your risk and obtaining appropriate screening are important. Your healthcare professional can help determine whether you should be tested based on factors such as age, body weight, family history, blood pressure, cholesterol levels, history of gestational diabetes, and other medical conditions.² If you are diagnosed with prediabetes, do not view it as a reason to panic. Instead, view it as information—and an opportunity. An opportunity to learn about your health.

And sometimes, the most important step toward preventing diabetes is simply recognizing that there is still time to change the course.

4. Centers for Disease Control and Prevention. National Diabetes Prevention Pro g ra m . [ C D C National Diabetes Prevention Program] (https://www.cdc.gov/ diabetes-prevention/ php/about/index.html?utm_source=chatgpt. com)

References 1. Centers for Disease Control and Prevention. National Diabetes Prevention Program: Prediabetes—Your Chance to Prevent Type 2 Diabetes. Updated December 26, 2024. [CDC National Diabetes Prevention Program](https://www.cdc. gov/diabetes-prevention/php/about/index. html?utm_source=chatgpt.com)

5. American Diabetes Association Professional Practice Committee for Diabetes. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S89-S131. [ADA Standards of Care—Health Behaviors and Well-being](https://diabetesjournals. org/care/ar ticle/49/Supplement_1/ S89/162206/5-Facilitating-Positive-HealthBehaviors-and?utm_source=chatgpt.com)

2. American Diabetes Association Professional Practice Committee for Diabetes. 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S50-S60. doi:10.2337/dc26-S003. [ADA Standards of Care in Diabetes—2026](https:// diabetesjournals.org/care/article/49/

About the author: Ayman Hajeer, MD, is an Internal Medicine resident physician at St. Luke’s University Hospital Anderson Campus, with clinical interests in endocrinology, metabolic health, and preventive medicine. Dr. Hajeer is passionate about helping patients understand their health and empowering them to take meaningful steps toward disease prevention. FALL 2026 | Lehigh County Health & Medicine 17

FEATURE

BEYOND MILESTONES HELPING CHILDREN REACH THE SKIES

A Pediatrician’s Reflection at the Start of a New School Year CHAMINIE WHEELER, DO 18 Lehigh County Health & Medicine | FALL 2026

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“Our job as parents isn’t to keep our children from falling. It’s to make sure they know they can get back up.”

s I sit down to write this letter, my eyes are filled with tears—tears of gratitude, joy, and just a little bit of disbelief. In just a few weeks, my youngest son will begin his senior year of high school. Like so many parents, I’m wondering how the years passed so quickly. It seems like yesterday I was walking him into kindergarten, cheering at Little League games, helping with homework, and tucking him into bed. Now I’m watching him prepare for the next chapter of his life. This season has reminded me that the goal of parenting was never to keep my children little. It has always been to prepare them to launch. As both a mother and a pediatrician, I’ve come to realize that these two callings are beautifully intertwined. Every day in my office, I have the privilege of monitoring children’s growth and celebrating developmental milestones. Every day at home, I have the privilege of watching my own children grow into the unique people they were designed to be. Whether I am caring for my patients or loving my own children, my mission is ultimately the same: to help prepare them

to become the men and women they were created to be. That preparation is about so much more than report cards, test scores, athletic achievements, or developmental checklists. It’s about building character, resilience, faith, compassion, and the confidence to step into adulthood knowing they are deeply loved and capable of overcoming life’s challenges. Every August, something changes in my exam room. Parents begin asking different questions. They wonder if their child is ready for kindergarten, whether they’re reading at grade level, making friends, or keeping up with classmates. Whether children attend public school, private school, or learn at home, the concerns are remarkably similar. We all want reassurance that our children are on the right path. Those questions come from a place of deep love. As parents, we celebrate every first smile, first step, first word, and every milestone that follows. Developmental milestones matter. They help us recognize when children are growing as expected and when they may benefit from additional support or early intervention. As pediatricians, we celebrate those milestones because they are important guideposts along a child’s journey. But after years of walking alongside families, I’ve come to believe there is an even more important question than, “Is my child on track?”

a modern intelligence test. Yet history doesn’t remember him because of a number. It remembers him because of his curiosity, creativity, perseverance, imagination, and courage to ask questions that changed the world. The same is true for our children. Some will excel academically. Others will shine through compassion, leadership, creativity, craftsmanship, or service. Some discover their gifts early, while others reveal them slowly over years of growing and overcoming challenges. Milestones, report cards, and test scores tell us something important about where a child is today, but they can never fully tell us who that child will become. Children are not problems to solve… They are people to develop. Perhaps no childhood experience illustrates healthy development better than learning to ride a bicycle. Every parent knows what’s coming. At some point your child is going to fall. There will be scraped knees, tears, and maybe even the declaration, “I don’t want to do this anymore.” Yet we encourage them to climb back on because we understand something deeper. Confidence isn’t built by preventing every fall. It’s built by discovering that you can get back up. Parenting is much the same way.

That question shifts our focus from comparison to purpose, from achievement to character, and from simply measuring progress to intentionally nurturing potential. Childhood is not merely a race from one milestone to the next. It is a journey of becoming.

Our instinct is often to protect our children from disappointment, failure, and heartache. But healthy growth happens when children experience ageappropriate challenges within the safety of loving relationships. Our job isn’t to remove every obstacle from their path. Our job is to walk beside them long enough that they discover they can move forward on their own.

One of the most common questions people ask about Albert Einstein is, “What was his IQ?” The truth is, we don’t actually know. Einstein never took

One of my favorite illustrations of this comes from an unlikely place—a playground. continued on next page >

Is my child becoming the person they were created to be?

FALL 2026 | Lehigh County Health & Medicine 19

FEATURE

None of it was simply preparing him for his senior year—it was preparing him for life. Researchers have observed that children actually play more freely inside a thoughtfully fenced playground than they do in a wide-open field. At first glance, the fence appears restrictive. In reality, it creates security. Because children know where it is safe to explore, they climb higher, run farther, imagine more creatively, and confidently discover the world around them. Families work the same way. Children flourish within loving boundaries that provide consistency, security, grace, and unconditional love. Predictable routines, clear expectations, meaningful responsibilities, forgiveness when they fail, and encouragement when they struggle don’t limit a child’s freedom—they create the foundation from which true independence grows. Those boundaries aren’t walls that hold our children back. They are launch pads preparing them for life. As I write these words, my youngest is getting ready for his senior year. His backpack will soon be replaced with college applications, decisions, and dreams that are becoming his own. If I’m honest, there are moments when I wish I could slow time just a little longer. But then I remember that this has always been the goal. Every bedtime story. Every scraped knee. Every parent-teacher conference. Every family dinner. 20 Lehigh County Health & Medicine | FALL 2026

Every prayer whispered over a sleeping child. Every boundary we lovingly held. Every difficult conversation. Every opportunity to let him fail, try again, and discover he was stronger than he realized. None of it was simply preparing him for his senior year—it was preparing him for life. Isaiah 40:31 reminds us that “those who hope in the Lord will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not faint.” That verse has taken on a new meaning for me this year. Eagles aren’t meant to stay in the nest forever. Loving parents were never called to keep their children in the nest. We are called to strengthen their wings, nurture their faith, and prepare them to soar—“to infinity and beyond.” So, this August, celebrate every milestone. They matter. They tell us our children are growing, learning, and developing. But don’t stop there. Celebrate their kindness. Their curiosity. Their courage. Their perseverance. Their faith. Celebrate the people they are becoming. Because long after the report cards are forgotten, and the trophies gather dust, those are the qualities that will carry them through life. And if you’re anything like me, you’ll probably watch them spread their wings through tears of joy—grateful that God

entrusted them to you for a season and even more grateful that He has a beautiful purpose prepared for the journey ahead. References 1. Lipkin PH, Macias MM; Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics. 2020;145(1):e20193449. doi:10.1542/peds.2019-3449

2. Masten AS. Ordinary Magic: Resilience in Development. New York, NY: Guilford Press; 2014. 3. Center on the Developing Child at Harvard University. From Best Practices to Breakthrough Impacts: A ScienceBased Approach to Building a More Promising Future for Young Children and Families. Harvard University; 2016. 4. Bethell CD, Jones J, Gombojav N, Linkenbach J, Sege R. Positive childhood experiences and adult mental and relational health in a statewide sample: Associations across adverse childhood experiences levels. JAMA Pediatrics.2019;173(11):e193007. doi:10.1001/jamapediatrics.2019.3007 5. The Holy Bible, New International Version. Isaiah 40:31. Grand Rapids, MI: Zondervan; 2011.

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PENNSYLVANIA PASSES 2026-27 BUDGET F

ollowing a 12-day impasse, Governor Josh Shapiro signed a bipartisan compromise $50.85 billion state budget for FY 2026-27. The spending plan, passed by the Pennsylvania General Assembly and signed into law on Sunday, July 12, increases overall spending by about 3.7% without taking any of the state’s $8 billion Rainy Day Fund and avoiding any new or increased broad-based taxes. To balance the budget without new sources of revenue or transferring Rainy Day Funds, lawmakers shifted $500 million from offbudget special funds and deferred $1.3 billion in recurring Medicaid managed care costs into the next fiscal year. One element of significance to PAMED is the Primary Health Care Practitioner line-item administered by the Department of Health. This line-item provides the funding for the physician loan repayment program and the state-funded residency program, and this budget continues the increased level of funding achieved over the past several budget cycles. Some additional significant elements include: Health and Human Services – Mental health services see an increase of $41 million, including $10 million for the 988 network and $5 million for walk-in crisis stabilization clinics. Rape crisis centers receive a $12 million increase over last year. Education – Education receives $678 million in new funding, including $565

million for underfunded schools, $58 million for basic education, and $55 million for special education. Infrastructure – A new Rapid Bridge and Road Deployment Program receives $775 million to fast-track shovel-ready transit projects. Taxpayer Relief – Provides $216.7 million for low- and middle-income workers via The Working Pennsylvanians Tax Credit. Corporate Tax Reductions – Maintains the scheduled phase-down of the Corporate Net Income Tax leading to a target of 4.99% by 2031. Biotechnology and Innovation – Establishes the “Innovate in PA 2.0” initiative, providing $125 million in capital to support biotechnology startups and fund clinical trials for the life sciences. Childcare Support – Provides $30 million for childcare worker retention and recruitment bonuses. You may recall that in 2017, the General Assembly passed legislation requiring the Joint Underwriting Authority (JUA) to transfer $200 million in surplus funds to the General Fund. The JUA is Pennsylvania’s legislatively established malpractice insurer of last resort and provides a way for physicians to buy

malpractice insurance who are unable to do so through regular insurance providers. The JUA filed litigation opposing this legislation, with PAMED and the AMA submitting briefs in support. After years of litigation, the U.S. Third Circuit Court of Appeals ruled that the JUA is a public entity, and the Commonwealth has broad authority to oversee the JUA and transfer funds as it deems appropriate. After the U.S. Supreme Court denied review, in August 2025, the Commonwealth of Pennsylvania transferred the $200 million from JUA to the General Fund. With that legal question settled, in November 2025, as part of the 2025-26 PA Budget’s Fiscal Code legislation, the General Assembly transferred another $100 million from the JUA to the General Fund to help close the funding gap for medical assistance payments. As part of that legislation, the JUA was also restructured, and now each June the Commissioner of the Department of Insurance is required to report to the General Assembly on the amount of funds in excess of the minimum operational reserves needed for that year. That amount is then available to be transferred to the General Fund. In June, the Commissioner reported that the JUA had $14.3 million available to transfer to the General Fund. As part of the 2026-27 PA Budget enacted on July 12th, the Fiscal Code bill, SB 146, included a transfer of $14.3 million from the JUA to the General Fund. PAMED has in the past and continues to oppose any transfers of funds from the JUA. However, it is important to note that the only funds the JUA has come from premiums paid by physicians using the JUA and from earnings on investments made by the JUA. No MCARE Fund monies are involved. FALL 2026 | Lehigh County Health & Medicine 21

FEATURE

THE PAMED HOUSE OF DELEGATES

n April 11, 1848, 61 physicians gathered at the First Methodist Episcopal Church in Lancaster, Pennsylvania, to establish a unified state medical body. This founding group was originally known as the Medical Society of the State of Pennsylvania—making it the 16th state medical society in the nation. That early gathering became today’s Pennsylvania Medical Society (PAMED), whose House of Delegates (HOD) now serves as the organization’s primary annual policy-making assembly. THE CORE PURPOSE OF THE HOD

The House of Delegates functions as PAMED’s annual business meeting, acting as the democratic core of the organization. Rather than operating top-down, PAMED’s direction is set by physician delegates selected to represent a wide spectrum of the state’s medical community. These representatives hail from county medical societies, specialty organizations, and special interest sections—including medical students, resident and fellow physicians, early-career doctors, international medical graduates, and women physicians. During the annual assembly, delegates vote on policies that determine PAMED’s strategic initiatives and shape its legislative advocacy at the State Capitol in Harrisburg. By bringing together rural practitioners, urban specialists, academic researchers, and independent doctors, the HOD ensures that the collective voice of Pennsylvania medicine reflects the needs of both physicians and their patients. THE RESOLUTION REVIEW PROCESS

At the center of the HOD’s deliberative body is the resolution review process. Any PAMED member may author a resolution proposing new policy, advocating for state legislative changes, or directing PAMED’s operational priorities, with resolutions moving through the HOD process according to PAMED’s bylaws and delegate procedures. To manage these proposals systematically, resolutions are organized for review by topic area, such as: • Bylaws and Governance: Examines the structural framework, internal rules, and official operational guidelines of PAMED. • Education, Science, Public Health, and Managed Care: Focuses on continuing medical education, clinical practice 22 Lehigh County Health & Medicine | FALL 2026

guidelines, public health initiatives, and third-party reimbursement challenges. • Medicare Fund, Tort Reform, and Legislative Regulations: Addresses state and federal regulatory frameworks, medical liability reform, healthcare funding, and scope-of-practice laws. • Membership, Leadership, and Subsidiaries: Evaluates physician engagement, leadership development pipelines, and organizational subsidiary operations. In these reference committees, delegates review written testimony, debate the merits of each resolution, and draft recommendations. The full assembly then votes to adopt, amend, or reject each resolution, or refer it to the Board of Trustees for further study. A HISTORY OF EVOLUTION AND ADVOCACY

When the 61 founding physicians met in 1848, medicine looked vastly different than it does today. Their initial mandate was straightforward: foster the advancement of medical knowledge, relieve human suffering, and elevate community health standards. As healthcare grew more complex over the 19th and 20th centuries, the HOD’s mandate expanded. The body shifted from discussing basic clinical observations to tackling intricate public health challenges, medical licensing standards, and ethical frameworks. In the modern era, the HOD addresses contemporary medical hurdles, such as prior authorization burdens, scope-of-practice debates, administrative overhead, medical liability, and public health equity. What has remained constant across nearly two centuries is the core mechanism: physicians gathering to debate, deliberate, and decide how best to protect the practice of medicine and patient care. LOOKING AHEAD TO OCTOBER 23–25

Continuing a tradition that dates back to 1848, the assembly remains the official voice of Pennsylvania physicians. This year’s assembly will take place October 23–25. Delegates from every corner of the Commonwealth will convene to evaluate new resolutions, deliberate on pressing healthcare issues, and set PAMED’s legislative trajectory for the coming year.

WE’RE MORE THAN BONES & JOINTS

We’re Berks County’s Best Choice for Comprehensive Orthopedics and Sports Medicine!

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Patients, community members, and physicians alike trust us for their comprehensive orthopedic and sports medicine care. DISCOVER WHY

Better heart care starts with a better choice.

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Recognized 8 times as a 50 Top Heart Hospital. Heart care that’s just better. Better Innovation with the most advanced treatments. Better Collaboration with seamless care from diagnosis to recovery. Better Outcomes recognized nationally for quality heart care, all at the nation’s top-performing health system for quality. Now, with a hospital dedicated entirely to heart care, St. Luke’s is advancing heart and vascular care like never before.

Lehigh County Health and Medicine Fall 2026