Family nurse starts new practice

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CLINTON — A native of Camden and current resident of Deansboro, Family Nurse Practitioner Annie Wafer has started a new family practice, with an emphasis on chronic pain management, hormone therapy and addiction recovery, at 3 Kirkland Ave., Suite 101.

Wafer’s children attend school at Clinton middle and high schools. The family previously lived in Canastota, to be close to the FNP’s jobs at Oneida Hospital, and later, Oneida OB/GYN. But Wafer said she would decide to make the move to an area that could better serve her son’s needs.

“My oldest son has Asperger’s Syndrome and was having some behavior problems without the appropriate support. Long story short, I decided that we needed to move to a school district that had the ability to help my son become as high functioning as possible,” Wafer said. “So we moved to Clinton school district, but still out by the farmland like where I grew up in Camden.”

While completing most her schooling through Camden Central School, Wafer also attended Rome Catholic Junior-Senior High School from 6-11 grades — 1994-99. She ended up graduating from Camden High School as an honor student and academic athlete, competing in soccer, basketball and softball.

Wafer entered college early during the summer of 2000 at Syracuse University, majoring in pre-med and minoring in physics. But she would soon realize, through some volunteer work at a local hospital, that she could “help people more” as a nurse, rather than physician.

“It suited my personality. I like to make people feel like they are being heard and never judged,” said Wafer. “To this day, that is how I practice.”

So Wafer would change her course of direction and entered Mohawk Valley Community College in the spring of 2001, graduating with her associate’s degree in science, nursing, ASN, and passed her Registered Nurse boards a week after graduation.

“I also acted as the volunteer treasurer for our student nurses association,” she recalled of her college days. “After graduation, I worked in many areas such as the NICU at Albany Medical Center, Maternity Unit at Rome Memorial Hospital as well as Crouse, and then I worked as a pediatric nurse/float nurse at Oneida Hospital. There I worked in maternity, the obstetric operating room, medical/surgical unit, ICU and ER. I fell in love with taking care of patients of all ages and with all conditions. I felt that becoming a Nurse Practitioner was how I could help on a greater scale.”

After her associate’s degree, Wafer would go on to earn her bachelor’s of science degree in nursing from Keuka College in 2008, and then decided to become a Family Nurse Practitioner in 2010. She would earn her master’s of science degree, FNP, from the University of Cincinnati in 2012.

“I then worked in private practice OB/GYN for Dr. Cooley at Oneida OB/GYN and found my niche there with women who needed lots of teaching and TLC,” said Wafer. “I had one patient who was pregnant who quit heroin. I learned a lot from her about addiction/recovery services in our area, or more like the lack of.”

When Wafer left the practice, she decided to complete an internship with a nurse practitioner friend who was a previous professor in her bachelor’s program at Keuka College who had her own practice performing integrative medicine.

“I was planning on seeing GYN patients with her for hormone replacement initially,” she explained. “The practice didn’t accept insurance, and not many patients were coming to see me. The patients that saw the other provider suffered from chronic fatigue, chronic pain, Lyme disease, autoimmune disorders, and other things that were not improving with traditional care. I spent three months learning everything I possibly could about integrative medicine, which is in simple terms, Eastern Medicine meets Western Medicine.”

Wafer said, “The experience changed my outlook on medicine. Environment, nutrition, past traumas, stress at work or with family, and many other things, contribute to chronic disease. Mental health is really at the top of the list too. Teaching patients how to manage symptoms, treat causes of disease states and prevent relapses were what we did. The most important thing I learned is that inflammation is the cause of most disease, so even if you can’t pinpoint what is going on with a patient, if you can decrease their inflammation, then they always got better.”

Feeling like she wasn’t seeing her share of patients and had more to give to the community, Wafer said she then took a position at Rome Hospital at its OB/Pre-Natal Care Services clinic. The clinic served high-risk pregnant women in the area, with most not having a primary care provider. Some of her patients had diabetes, high blood pressure, hepatitis, untreated drug addiction and several other ailments, she said.

“I was there for five years and along with being the sole provider, I was also the manager and director of the clinic. I learned so much about management, budgeting and so on,” Wafer said. “A few years into this position, I realized that there was a huge need for addiction treatment and care for these women, and the whole community. Rome Hospital had recently started a MAT (Medication Assisted Treatment) program at their outpatient drug and alcohol treatment center...I felt as though I had to help and decided to work one day a week at the Community Recovery Center, providing addiction treatment services.”

“Many of the women I had at the OB clinic who were in treatment saw me at CRC as well,” the FNP continued. “We were able to provide an amazing service to these patients. I took it upon myself to provide educational speaking engagements for hospital staff regarding the basics of addiction, treatment and outcomes.”

At the same time, the FNP said she decided to take the medical marijuana course, as it’s known to help with chronic pain. The course would give her a “huge” amount of information and knowledge about chronic pain, neurologic conditions, Post-traumatic Stress Disorder (PTSD), epilepsy and other diseases.

“I was very excited to be able to provide this service to the community as an alternative to opioids,” Wafer said. “Unfortunately, I couldn’t do so while working for the hospital. This was disappointing to me, but I understood as medical marijuana is still illegal federally, although considered medication in New York. Any facility that accepts federal funding or takes government insurance can’t certify patients.”

She said, “During this time, I was asked to speak at multiple engagements regarding my new specialty, management of opioid use disorder in pregnancy. I was also a guest panelist for Crouse Hospital, speaking on this topic, after a screening of a documentary regarding opioid addiction in Chenango County. The audience consisted of nurses and all medical providers. There were so many questions, and I was so happy to share my knowledge. It was one of the most fulfilling moments of my career to be acknowledged by the High-Risk Perinatal Center as the one who could provide the most education and information to the audience, and the community.”

At that time, Wafer was still working at the OB Clinic four days a week and performing management duties as well, when she received an offer from the Beacon Center to work for them full-time, performing addiction treatment services. But then the pandemic would strike.

“I started at the Beacon Center three months before COVID hit, but on March 18, I was told I was not an essential worker,” Wafer explained. “I was quite upset — I wanted to continue to provide services via telemedicine to the patients as this was a highly stressful time when many were at high risk to relapse. I investigated other employment options, including volunteering in New York City when the pandemic hit. But as a single mother of two children, I couldn’t take the risk of doing that. I investigated working for other facilities doing telemedicine, but they were mostly out-of-state and required a physician to be a collaborator, which in New York is not necessarily due to my years of experience.”

As she began to toss around ideas about possible employment opportunities, and after a month of staying home during the pandemic, the FNP said she decided she needed to make her own practice a reality. The process started in April, and she leased her new space in Clinton in July.

Seeing her new space was the former home of the Soul Bowl cafe, it wasn’t yet ready to become a medical office. Wafer said she and a friend worked non-stop through the month of July to get the space ready, deep cleaning and decorating to a stylish decor and also meeting with planning boards regarding signage on the historic building.

“I opened the practice to patients on Aug. 3, my 38th birthday,” she said. “It was the best gift I have ever given myself. I can practice in the way that I feel is best for the patient. I do not accept insurance as I feel they dictate care and I wanted to be able to give the patient what they truly needed, in regards to the amount of time spent speaking with them and discussing their plan of care, but also in the tests I ordered and the services I provide.”

Wafer also provides medical marijuana certification for those who are eligible and are state residents. She also provides medication management for addiction treatment, using medications like suboxone, Subutex, naltrexone and vivitrol.

“The patients I have seen so far have alcohol-use disorder and opioid use disorder,” the FNP explained. “There are no medication management protocols for some other drugs being abused in our community though. Ketamine is a drug that is widely abused in our community and can cause detrimental damage throughout the body. Most providers don’t screen for this and if a patient admits this, many don’t realize the devastation it causes to the body.”

“Another is stimulant use disorder, including cocaine and medications like Adderall and Ritalin, as well as methamphetamines,” she continued. “Again, there is no medication treatment protocol for this either. I have decided to write a metanalysis on Ketamine Addiction in attempts to develop my own treatment protocol, or to possibly develop my own research study to fill in the gaps of knowledge. The same goes for stimulant use disorder.”

In addition to providing the addiction treatment medication, Wafer also treats for hepatitis C. Patients find it convenient to be able to have their MAT and hepatitis C treatment at the same place, especially with a provider who doesn’t judge them, she said.

“I provide hormone evaluations and treatment with bioidental hormones at my office. Most people who have used opioids, prescribed or not, over the course of even two years can develop severe androgen deficiency,” said Wafer. “This leads to depression, anxiety, social isolation and sexual dysfunction...Even one patient, with the use of medical marijuana and replacement of testosterone, was able to wean completely. He said he felt the best he had in years. Hormone imbalances can cause many health problems that sometimes aren’t addressed by someone’s primary care provider.”

Wafer is also in the process of finishing her certification in transgender hormone therapy and transgender care.

“I am excited to be able to provide this service to members of our community who maybe had to travel quite a way to get to a provider comfortable with transgender hormone treatments,” she said.

She is also providing chronic disease consultations like when she worked in integrative medicine.

“Many of these patients I have seen requested I become their primary care provider, which I have done for some,” said Wafer. “They usually have quite a complicated history, many involving chronic pain and inability to relieve it, but the patient doesn’t want to take opiates. Others have undiagnosed autoimmune disorders, or undiagnosed and treated Lyme disease. Unfortunately, I am one of those people who found out I had Lyme disease and was never treated myself.”

She said, “Most all the patients need someone to listen to them, their history, their concerns and their preferences. Together we come up with a plan of care after a full work up and a significant amount of education regarding treatment options.”

What greatly excites Wafer, is that she will soon provide regenerative medicine to the community.

“Regenerative medicine is the process of replacing/regenerating cells and tissue in the body to help return the body to normal function,” the FNP explained. “There are many options for these treatments, including stem cell treatment. Many times, those with chronic pain need one injection and are pain free for the rest of their life. The stem cells go to injured tissues and help them heal the way they are supposed to and then regenerate themselves. I find this very promising in the world of chronic pain.”

Being able to provide much-needed services to the community she lives in has been quite fulfilling so far, Wafer said.

“I realize that it is hard having to pay for visits out of pocket, but labs some medications (besides stem cells and the regenerative medicine) are covered by insurance. Most people with high deductible plans won’t even spend close to what their deductible is,” Wafer said. “Also, many insurance companies will accept the request for reimbursement for an out-of-network provider, and you can also take the funds out of a Health Savings Account. In my opinion, and in the opinion of my patients, not letting insurance dictate how long I have with each patient and letting them dictate the plan of care is truly priceless.”

She said, “I have lost many, many friends to drug addiction and have friends and family struggle daily. I have a personal relationship with addiction treatment due to this and I try to help prevent or treat this in any way I can — addiction medication, hormone replacement, medical marijuana, holistic primary care, and soon, stem cell therapy for chronic pain.”

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